Validação clínica do diagnóstico de enfermagem autoeficácia em saúde inadequada em pessoas com diabetes mellitus

Abstract

The concept of self-efficacy developed by Bandura is defined as the belief that an individual has in himself that he can successfully perform an action to produce expected results. That said, the identification of inadequate self-efficacy in patients during therapeutic treatment becomes a human response that needs to be correctly identified. Thus, the most recent nursing diagnosis Inadequate Health Self-Efficacy stands out, as this is a relevant diagnosis in patient care, especially for patients with chronic diseases. In addition, it is worth noting that Diabetes Mellitus is a chronic disease with a high mortality rate in Brazil, so that the main cause of death has been the complications of DM that occur mainly due to impaired health self-management. The study aimed to verify the evidence of clinical validity of the nursing diagnosis inadequate health self-efficacy in patients with type 2 diabetes mellitus. A cross-sectional study developed with adults aged 18 years and older with a diagnosis of type 2 diabetes mellitus who were followed in primary health care. The data collection instrument developed for the validation of the nursing diagnosis Inadequate health self-efficacy was used, divided into two sections, the first being an interview, in order to identify the patient's sociodemographic data and clinical information and evaluate five etiological factors and three clinical indicators of the diagnosis, and the second part a self-administered questionnaire that was given to the patient in which 13 etiological factors and 10 clinical indicators were evaluated. A total of 219 people with type 2 diabetes mellitus participated in the study. Descriptive analysis of the data was performed by calculating absolute frequencies, percentages, measures of central tendency and dispersion. For the proportions of categorical variables, 95% confidence intervals were calculated. The Lilliefors test was applied to verify adherence to the normal distribution of quantitative variables. The diagnostic accuracy measures of each clinical indicator were obtained from the latent class analysis method. A logistic regression model was adjusted to estimate the magnitude of the effect of the etiological factors from Odds Ratio values. The study was submitted to the Ethics Committee for evaluation, obtaining opinion No. 6,817,480. The prevalence of the diagnosis was 41.5%. The indicator “Failures in action to prevent health problems” showed a high sensitivity value (99.9%). The indicators “Denial of change in health status” and “Riskprone health behavior” demonstrated higher specificity values (98.3% and 95.9%, respectively). The etiological factors related to Inadequate Health Self-Efficacy in patients with type 2 diabetes mellitus were “Experience of failure” and “Beliefs in compensatory health behaviors”. Therefore, the elements identified as relevant configure a new organization for the nursing diagnosis Inadequate Health Self-Efficacy in patients with type 2 diabetes mellitus. Furthermore, accurate identification of the ND in this population will contribute to healthcare practice in the elaboration of a care plan directed to the specific needs of each patient.