Validation of definitions of the indicators for Nursing Outcomes Classification outcomes: Self-management cardiac disease

Cavalcante, Agueda Maria Ruiz Zimmer; Lopes, Camila Takao; Swanson, Elizabeth; Moorhead, Sue Ann; Bachion, Maria Márcia; Barros, Alba Lucia Bottura Leite de

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Acta Paulista de Enfermagem

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Original Article • Acta Paul Enferm 33 • 2020 • https://doi.org/10.37689/acta-ape/2020AO0265 copy

Validation of definitions of the indicators for Nursing Outcomes Classification outcomes: Self-management cardiac disease

Authorship SCIMAGO INSTITUTIONS RANKINGS

Abstract

Objective

To validate conceptual and operational definitions of the indicators for NOC outcomes: cardiac disease self-management.

Methods

This consensus-validation study was developed in three steps: integrative literature review, development of conceptual and operational definitions of the indicators for NOC outcome: cardiac disease self-management, and consensus-validation of definitions by 20 nursing specialists. A binomial test was conducted to analyze the proportion of nursing specialists who agreed on the relevance and clarity of definitions. P-values lower than 0.05 indicated a significant difference of the opinion among nursing specialits concerning the relevance and clarity of definitions.

Results

After the reviewing by nursing specialits, the conceptual definitions of 43 indicators for clarity and 43 for relevance had a p >0.05. Operational definitions of 36 indicators presented for clarity and 43 for relevance had a p-value >0.05. Indicators showing p <0.05 were adjusted accordingly to reflect the opinion of nursing specialists.

Conclusion

To establish conceptual and operational definitions for NOC indicators turn the assessment process more, and guide the clinical practice towards better results. Once validated, these indicators may provide higher precision and increase effectiveness in clinical practice.

Heart failure; Patient outcome assessment; Nursing assessment; Validation studies

Self-management: Cardiac disease	Conceptual definition P-value* (%**)		Operational definition P-value* (%**)
Indicators	Relevance	Clarity	Relevance	Clarity
161701 – Accepts diagnosis	0.82(90.0)	0.17(75.0)	0.60(85.0)	0.02(65.0)
161702 – Seeks information about methods to maintain cardiovascular health	0.96(95.0)	0.60(85.0)	1.00(100.0)	0.82(90.0)
161703 – Participates in health care decisions	1.00(100.0)	0.60(85.0)	0.96(95.0)	0.60(85.0)
161704 – Participates in prescribed cardiac rehabilitation	1.00(100.0)	0.96(95%)	0.35(80.0)	0.00(50%)
161705 – Performs treatment regimen as prescribed	0.96(95.0)	0.60(85%)	0.35(80.0)	0.01(60%)
161706 – Monitors symptom onset	0.96(95.0)	0.82(90%)	0.82(90.0)	0.17(75.0)
161707 – Monitors symptom persistence	0.82(90.0)	0.82(90%)	0.96(95.0)	0.01(60.0)
161708 – Monitors symptom severity	1.00(100.0)	0.82(90.0)	0.96(95.0)	0.02(65.0)
161709 – Monitors symptom frequency	0.96(95.0)	0.96(95.0)	0.82(90.0)	0.35(82.0)
161710 – Reports symptoms of worsening disease	0.82(90.0)	0.82(90.0)	0.82(90.0)	0.17(75.0)
161711 – Reports signs and symptoms of depression	0.35(80.0)	0.60(85.0)	0.07(70.0)	0.00(55.0)
161712 – Uses diary to monitor symptoms over time	0.17(75.0)	0.35(80.0)	0.17(75.0)	0.07(70.0)
161713 – Uses preventive measures to reduce risk of complications	0.82(90.0)	0.60(85.0)	0.96(95.0)	0.96(95.0)
161714 – Uses symptom relief methods	1.00(100.0)	1.00(100.0)	0.82(90.0)	0.35(80.0)
161744 – Obtains health care when warning signs occur	0.82(90.0)	0.35(80.0)	0.82(90.0)	0.60(85.0)
161716 – Monitors pulse rate and rhythm	0.35(80.0)	0.02(65.0)	0.35(80.0)	0.00(50.0)
161717 – Monitors blood pressure	0.96(95.0)	0.35(80.0)	0.82(90.0)	0.07(70.0)
161718 – Limits sodium intake	0.96(95.0)	0.60(85.0)	0.82(90.0)	0.60(85.0)
161719 – Limits fat and cholesterol intake	0.96(95.0)	0.96(95.0)	0.60(85.0)	0.17(75.0)
161720 – Follows recommended diet	1.00(100.0)	0.35(80.0)	0.96(95.0)	0.60(75.0)
161721 – Follows fluid restrictions	0.96(95.0)	0.82(90.0)	0.60(85.0)	0.07(70.0)
161722 – Monitors effects of stimulants	0.60(85.0)	0.07(70.0)	0.96(95.0)	0.35(80.0)
161723 – Monitors body weight	0.96(95.0)	0.82(90.0)	0.82(90.0)	0.82(90.0)
161724 – Uses effective weight control strategies	0.96(95.0)	0.35(80.0)	0.96(95.0)	0.82(90.0)
161725 – Maintains optimum weight	0.96(95.0)	0.96(95.0)	0.82(90.0)	0.35(80.0)
161726 – Follows recommendations for alcohol use	0.96(95.0)	0.07(70.0)	0.82(90.0)	0.60(85.0)
161727 – Participates in smoking cessation regimen	1.00(100.0)	0.96(95.0)	0.96(95.0)	0.35(80.0)
161728 – Participates in recommended exercise	0.96(95.0)	0.82(90.0)	0.96(95.0)	0.60(85.0)
161729 – Uses energy conservation techniques	0.02(65.0)	0.60(85.0)	0.02(65.0)	0.01(60.0)
161730 – Balances activity and rest	0.60(85.0)	0.60(85.0)	0.60(85.0)	0.17(75.0)
161731 – Performs usual life routine	1.00(100.0)	1.00(100.0)	0.96(95.0)	1.00(100.0)
161732 – Follows recommendations for sexual activity	0.60(85.0)	0.82(90.0)	0.35(80.0)	0.17(75.0)
161733 – Obtains required medication	0.96(95.0)	0.96(95.0)	0.96(95.0)	0.96(95.0)
161734 – Uses medication as prescribed	1.00(100.0)	0.96(95.0)	1.00(100.0)	1.00(100.0)
161735 – Monitors prescribed medication therapeutic effects	1.00(100.0)	0.60(85.0)	1.00(100.0)	0.35(80.0)
161736 – Uses only non-prescription medication approved by health professional	0.96(95.0)	0.07(70.0)	0.82(90.0)	0.82(90.0)
161737 – Uses stress management strategies	0.96(95.0)	0.96(95.0)	0.82(90.0)	0.35(80.0)
161738 – Obtains influenza and pneumonia vaccine	0.82(90.0)	1.00(100.0)	0.60(85.0)	0.60(85.0)
161739 – Uses health care services congruent with needs	0.96(95.0)	0.96(95.0)	0.96(95.0)	0.96(95.0)
161740 – Participates in screening for cholesterol	0.60(85.0)	0.35(80.0)	0.60(85.0)	0.60(85.0)
161741 – Reports need for financial assistance	0.82(90.0)	1.00(100.0)	0.82(90.0)	0.96(95.0)
161742 – Keeps appointments with health professional	1.00(100.0)	1.00(100.0)	1.00(100.0)	0.96(95.0)
161743 – Maintains plan for medical emergencies	1.00(100.0)	0.96(95.0)	0.96(95.0)	0.82(90.0)
161745 – Adjusts life routine for optimal health	0.82(90.0)	0.60(85.0)	0.82(90.0)	0.96(95.0)

161720 Follows recommended diet	Operational definition for individual ratings in the Likert-type scale		Percent agreement
Conceptual definition of Indicator Takes actions that correspond to orientations for obtaining a healthy diet. Operational definition Ask the patient if he or she follows the recommendations bellow: choses lean meat and vegetables; selects fat-free food and low-fat dairy products (skimmed); minimizes the intake of partially hydrogenated fats; reduces the volume of the diet and increases the fractionation (6 to 8 meals / day); consumes 50-60% of the energy value of the diet; consumes 20-30g of fiber and 150 calorie / gram of protein; does not exceed 30% of the energy value of the diet.	1. Does not execute any of the recommendations for a healthy diet intake.		R	100.0
			C	95.0
	2. Avoids inadequate food in the presence of decompensation or exacerbation of the symptoms of the disease.		R	95.0
			C	90.0
	3. Performs some actions only on the main meal and during the weekdays.		R	100.0
			C	85.0
	4. Runs up to 3 actions, up to 4x / week.		R	100.0
	4. Runs up to 3 actions, up to 4x / week.		C	95.0
	5. Performs all recommendations for a healthy diet.		R	100.0
	5. Performs all recommendations for a healthy diet.		C	90.0

REVISED VERSION

Conceptual definition of Indicator Takes actions to obtain a diet according to the health professional’s orientations. Operational definition Ask the patient if he or she follows the recommendations bellow: chooses lean meats and vegetables; selects fat-free food and low-fat dairy products (skimmed); minimizes the intake of partially hydrogenated fats; reduces the volume of the diet and increases the fractionation (6 to 8 meals / day); consumes 50-60% of the energetic value of the diet in the form of carbohydrates; consumes 20-30g of fiber; consumes 150 calories / gram of protein and 150 calories / gram of protein; does not exceed 30% of the energetic value of the diet in the form of fat; does not exceed the recommended daily amount of sodium.		1. Does not implement any of the recommendations for a healthy diet intake.
		2. Implements actions avoiding inadequate food in the presence of decompensation or exacerbation of symptoms of the disease.
		3. Implements some actions only in the main meal.
		4. Implements some actions only during the weekdays, but not during the weekends.
		5. Implements all recommendations for a healthy diet daily.

161716 Monitors pulse rate and rhythm	Operational definition for individual ratings in the Likert-type scale	Percent agreement
Conceptual definition of Indicator Control pulse rate as well as heart rate. Operational definition Check if the patient knows: what the heart rate (HR) should be at rest; how to check the HR; the importance of medication even with normal HR; changes in HR and pulse rate are recognized; controls the HR between 60 and 90 bpm at rest; seeks to maintain sinus rhythm; seeks the health service when changes are identified.	1. Does not follow any orientation, does not know the rhythm and HR changes.	R	80.0
		C	65.0
	2. Monitors only heart rate.	R	70.0
	2. Monitors only heart rate.	C	70.0
	3. Monitors heart rate and rhythm when symptoms exacerbate.	R	80.0
	3. Monitors heart rate and rhythm when symptoms exacerbate.	C	75.0
	4. Monitors heart rate and rhythm when remembered (1x / week).	R	75.0
		C	70.0
	5. Follows all the guidelines and knows the changes in rhythm and HR.	R	85.0
		C	80.0

REVISED VERSION

Conceptual definition of Indicator Measures and recognizes changes in heart rate and heart rate. Operational definition Check if the patient knows: what the heart rate (HR) should be at rest; how to check heart rate; how to recognize changes in pulse rate and heart rate; how to control the HR between 60 and 90 bpm at	1. Does not measure or recognize changes in HR and rhythm.
	2. Recognizes palpitations, but does not recognize or measure HR and rhythm.
	3. Recognizes changes in HR and rhythm when feeling “palpitations” but not measure them.
	4. Recognizes changes in HR and rhythm heart when feels “palpitations” and perform measurement.
	5. Measures and recognizes changes in HR and rhythm.

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[1] Corresponding author. Agueda Maria Ruiz Zimmer Cavalcante E-mail: aguedamrzc@gmail.com https://orcid.org/0000-0003-3910-2162