Review of nursing diagnosis validation studies: caregiver role strain

Integrative literature review. Research of studies carried out between 2000 and 2018 with the descriptors: caregivers, nursing diagnosis and validation study in the following databases: Web of Science, EBESCOhost, Scielo Brasil and Portugal, LILACS, RCAAP, CAPES, NANDA-I website, and in the bibliographic references of the articles. Articles in Portuguese, English or Spanish were included.

Results:

The sample consisted of seven validation studies, with heterogeneity in the methodologies used. The populations where the diagnosis was clinically validated focused on caregivers for the elderly and people with chronic illness. The most prevalent defining characteristics were Stress and Apprehension related to the future.

Conclusions:

This diagnosis requires further validation studies among different populations in search of greater accuracy and a reduction in the number of defining characteristics, facilitating the use of taxonomy.

Keywords:
Nursing diagnosis; Caregivers; Validation study

No.	Title	Date	Country	Authors	Training Area
1	Caregiver role strain: bi-national study of content validation(30)30. Diaz LJ, Cruz DL, Silva RG. Caregiver role strain: bi-national study of content validation. Invest Educ Enferm. 2016; 34(2):280-7. doi: https://doi.org/10.17533/udea.iee.v34n2a07 https://doi.org/https://doi.org/10.17533...	2016	Columbia and Brasil	Rueda Diaz, Monteiro da Cruz & Gengo	Nursing
2	Validação do diagnóstico de enfermagem: tensão do papel de cuidador em familiares de idosos(29)29. Loureiro LN. Validation of the nursing diagnosis "Caregiver role strain" in relatives of elderly [tese]. João Pessoa (PB): Universidade Federal da Paraíba; 2015 [cited 2019 Aug 25]. p. 196. Available from: Available from: http://tede.biblioteca.ufpb.br/handle/tede/8177#preview-link0:193- http://tede.biblioteca.ufpb.br/handle/te...	2015	Brazil	Loureiro	Nursing
3	Clinical Validation of the Nursing Diagnosis Caregiver Role Strain in the Czech Republic(31)31. Zeleníková R, Kozáková R, Jarošová D. Clinical validation of the Nursing Diagnosis Caregiver Role Strain in the Czech Republic. Int J Nurs Knowl. 2014;25(2):80-4. doi: https://doi.org/10.1111/2047-3095.12020 https://doi.org/https://doi.org/10.1111/...	2014	Czech Republic	Zeleníková, Kozáková & Jarošová	Nursing
4	Clinical indicators of 'caregiver role strain' in caregivers of stroke patients(32)32. Oliveira ARS, Cordeiro RR, Carvalho VE, Costa AG, Lopes MV, Araujo TL. Clinical indicators of 'caregiver role strain' in caregivers of stroke patients. Contemp Nurse. 2013;44(2):215-24. doi: https://doi.org/110.5172/conu.2013.44.2.215 https://doi.org/https://doi.org/110.5172...	2013	Brazil	Oliveira et al	Nursing
5	Validación de las características definitorias del diagnóstico cansancio en el desempeño del rol de cuidador en atención primaria(33)33. Embarba BA, Pintado AQ, Carrasco PR. Definitory characteristics validation of the Caregiver Role Fatigue Diagnosis in primary care. Nure Investigación. 2012 Jan/Feb [cited Aug 25, 2019];9(56):1-8. Available from: Available from: http://www.nureinvestigacion.es/OJS/index.php/nure/article/view/562/551 http://www.nureinvestigacion.es/OJS/inde...	2012	Spain	Embarba, Pintado & Carrasco	Nursing
6	Cansancio del Rol de Cuidador: Validación Clínica Mediante Análisis Rasch(27)27. Rueda LMA, Pérez CPB, Marcela D, Chávez G, Méjia MJS, Figueira FAC, et al. Caregiver Role Strain: Clinical Validation by Rasch Analysis. In: Proceedings of NANDA-I Latin American Symposium; 2011 Jun 3-4; São Paulo, Brasil. p. 125-67.	2011	Columbia	Rueda et al	Nursing and Medicine
7	Aportación para el diagnóstico de cansancio en el desempeño del rol de cuidador(28)28. Vázquez Sánchez MA, Casals SJL, Aguilar TP, Aparicio Benito BP, Estébanez CF, Luque EA, et al. Contribution to the diagnosis of caregiver role strain. Enfermeria Clinica. 2005;15(2):63-70. doi: https://doi.org/10.1016/S1130-8621(05)71085-8 https://doi.org/https://doi.org/10.1016/...	2005	Spain	Sánchez et al	Nursing and Medicine

No.	Type of Validation	Population	Main Results
1	Fehring Content Validation	6 Colombian nurses and 9 Brazilian nurses. 60.0% doctor and 40.0% master	Of the NANDA-I DCs, 22 defining characteristics were identified as major, 13 as secondary and one irrelevant. The total score of the diagnosis was 0.79.
2	Hoskins content and clinical validation	30 nurses. 50% doctors, 30% masters and 20 with a post-doctorate 40 family caregivers of dependent elderly persons Mean age = 51.4 (+/- 13.7) years old Gender = 87.5% Female Relationship = 42.5% Child 67.5% are not employed	The content validation resulted in a new definition, new DCs and new related factors. From the specialists came 48 DC and 50 RF, from the clinic came 29 DC (11 are not in NANDA-I) and 28 RF (seven are not in NANDA-I). Total score of diagnosis by specialists 0.72, and 0.69 in clinical validation.
3	Fehring's Clinical Validation	225 caregivers of dependent persons in home setting Mean age = 52.3 (+/- 13.3) years old Gender = 80.4% Female	Two DCs were considered major, 20 were considered minor, and 14 were irrelevant
4	Measures of diagnostic accuracy (sensitivity, specificity and predictive values)	42 caregivers of a person with stroke sequelae Mean age = 46.4 (+/- 15.6) years old Gender = 90.5% Female Relationship = 45.2% Child 83.3% are not employed	27 DCs were found in the sample, nine had p ≤0.05, and only four of that total had high values in the diagnostic accuracy measures. Ten NANDA-I DCs were not identified.
5	Cross-sectional descriptive study with univariate and multivariate analysis	47 caregivers of dependent persons Mean age = 65.2 years old Gender = 71.0% Female Relationship = 43.3% Child	11 DCs did not obtain statistical significance, 16 DCs were related to the diagnosis, where four obtained greater statistical significance. They used the Zarit Scale as a DC
6	Rasch Analysis	200 caregivers of dependent persons with chronic illness Mean age = 45 years old Gender = 80.0% Female Relationship = 51.5% Child	The Zarit scale adjusted most items.
7	Cross-section analytical study	49 caregivers of dependent persons Mean age = 58 years old Gender = 91.8% Female Relationship = 64.3% Child 85.8% are not employed	Association between the diagnosis and 4 DC and 5 RF of NANDA-I.

Defining Characteristic	Major		Minor		Irrelevant
Defining Characteristic	CT*	CL^†	CT*	CL^†	CT*	CL^†
Apprehension about the future regarding the caregiver's ability to provide care	(29-30)	(31)		(29,33)		(32)
Apprehension about the future regarding care receiver´s health	(29-30)	(31)		(29,33)		(32)
Apprehension about the possible institutionalization of the care receiver	(30)		(29)	(31,33)		(29,32)
Apprehension about the care that the recipient should have if the caregiver is unable to offer it	(30)		(29)	(29,31,33)		(32)
Difficulties completing required tasks			(30)	(31,33)	(29)	(32)
Difficulty performing required tasks				(31-33)		(29)
Dysfunctional changes in caregiving activities			(30)	(31,33)	(29)	(32)
Preoccupation with care routine		(33)	(29-30)	(29,31)		(32)
Ineffective coping	(30)			(33)	(29)	(31-32)
Stress	(29-30)	(28-29)		(31-33)
Lack of time to meet personal needs	(30)	(28,33)		(31)	(29)
Frustration	(30)		(29)			(29,31-33)
Impatience	(30)		(29)	(33)		(29,31-32)
Increased emotional lability	(29-30)	(32)		(29,31,33)
Increased nervousness	(30)		(29)	(29,31-33)
Disturbed sleep pattern	(30)	(33)	(29)	(29,31-32)
Sleep deprivation	(29-30)			(29,31,33)		(32)
Anger			(29-30)	(33)		(29,31-32)
Reports feeling depressed	(30)	(28)	(29)	(29,31,33)		(32)
Somatization	(30)		(29)	(29)		(31-33)
Headaches			(29-30)	(29)		(31-33)
Diabetes				(33)	(29)	(29,31-32)
Cardiovascular disease			(30)		(29)	(29,31-32)
Rash					(29-30)	(29-33)
Fatigue	(29-30)	(29)		(31)		(32-33)
Hypertension			(29-30)	(33)		(29,31-32)
Weight change			(29-30)	(29)		(31-33)
Gastrointestinal upset			(29-30)			(29,31-33)
Withdraws from social life	(29)	(29,32)		(31)		(33)
Low work productivity			(29-30)	(29)		(31-33)
Changes in leisure activities	(30)	(29,32)	(29)	(31,33)
Refusals of career advancement			(30)		(29)	(29,31-33)
Reports uncertainty regarding changed relationship with care receiver			(30)	(31,33)	(29)	(29,32)
Reports difficulty watching care receiver go through the illness	(30)		(29)	(29,31,33)		(32)
Reports grief regarding the changed relationship with care receiver	(30)	(28)	(29)	(31,33)		(29,32)
Family conflict	(30)		(29)	(29,31)		(32-33)
Reports concerns about family members	(30)		(29)	(31-33)		(29)

Universidade Federal do Rio Grande do Sul. Escola de Enfermagem Rua São Manoel, 963 -Campus da Saúde , 90.620-110 - Porto Alegre - RS - Brasil, Fone: (55 51) 3308-5242 / Fax: (55 51) 3308-5436 - Porto Alegre - RS - Brazil
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[1] Corresponding author:
Tânia Marlene Gonçalves Lourenço E-mail: tmlourenco@esesjcluny.pt