Validação do conteúdo do diagnóstico de enfermagem intolerância à atividade em pacientes com insuficiência cardíaca

Abstract

This study aims to validate the nursing diagnosis Intolerance to the activity belonging to the taxonomy of NANDA International (NANDA-I) in patients with heart failure. It was developed in two parts: development of a Medium-Sized Theory (TMA) for the diagnosis of Intolerance to Activity (AI) and validation of content by judges. The development of TMA was based on five stages: definition of conceptual models to be analyzed, definition of the main concepts (key concepts), construction of a pictogram, construction of propositions and, finally, establishment of causal relations and evidence for practice. A literature review was used for the first stage of TMA preparation. The studies were identified in the databases Web of Science, PubMed, Scopus, CINAHL and Cochcrane, using descriptors heart failure, motor activity and activity intolerance, obtaining the final sample of 16 articles. In the second stage, the conceptual and operational definitions were constructed. A pictogram was elaborated in the third stage to understand the causal relationships of the elements that make up the AI diagnosis. Finally, we defined the propositions, causal relations and the evidences for the practice. In the second part of the study, the validation of content by judges was performed to identify the clarity, relevance and precision of the conceptual and operational definitions of the elements of the diagnosis of AI identified from the TMA. For this, the predictive diversity theorem and the collective wisdom effect were used. It was carried out from the formation of a group of judges formed by nurses who participate in research groups who develop studies on nursing diagnoses. The present study was sent to the Research Ethics Committee of the Federal University of Ceará - COMEPE, obtaining opinion No. 2,439,025. It is still important to note that all the recommendations of resolution 466/2012 regarding human research were obeyed. In the results we obtained a sample of 23 judges, most of whom had masters level (56.5%) and professional training time of 8.1 years (SD = 7.57). In relation to professional performance, the majority (34.8%) developed activities in hospital institutions. The experience with nursing diagnosis was identified in the total sample and 95% participated in projects that carry out researches related to Nursing Diagnostics with a mean of 6.81 years for participation time. Regarding the level of expertise, the sample counted mostly with judges at the Advanced Beginner level. All the proposed indicators were considered relevant for the identification of the diagnosis of Intolerance to the activity. For the indicator dyspnea on exertion was considered a change in its clarity and operational precision. Already in the analysis of the indicators Abnormal response of blood pressure to activity and Abnormal response of heart rate to activity, the judges suggested a revision regarding their conceptual and operational definitions. The etiological factors Age and rest in the bed were not considered relevant by the judges for the diagnosis under study (p <0.001). It is hoped that the data obtained in this study may contribute to a better understanding of the SD intolerance to the activity as well as the refinement of this taxonomy.