CLINICAL VALIDATION OF THE NANDA-I "CAREGIVER ROLE STRAIN" NURSING DIAGNOSIS IN THE CONTEXT OF PALLIATIVE CARE

Lourenço, Tânia Marlene Gonçalves; Abreu-Figueiredo, Rita Maria de Sousa; Sá, Luís Octávio

doi:10.1590/1980-265X-TCE-2020-0549

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Original Article • Texto contexto - enferm. 30 • 2021 • https://doi.org/10.1590/1980-265X-TCE-2020-0549 copy

CLINICAL VALIDATION OF THE NANDA-I "CAREGIVER ROLE STRAIN" NURSING DIAGNOSIS IN THE CONTEXT OF PALLIATIVE CARE

VALIDACIÓN CLÍNICA DEL DIAGNÓSTICO DE ENFERMERÍA NANDA-I "CANSANCIO DEL ROL DE CUIDADOR" EN EL CONTEXTO DE LOS CUIDADOS PALIATIVOS

Authorship SCIMAGO INSTITUTIONS RANKINGS

ABSTRACT

Objective:

to clinically validate the defining characteristics of the “Caregiver Role Strain” Nursing diagnosis for caregivers of people in a palliative care situation.

Method:

a cross-sectional, quantitative, descriptive and analytical study. It was developed based on Fehring's Clinical Validation Model and on the diagnostic accuracy measures (sensitivity, specificity, predictive values and Receiver Operating Characteristic curve). The data collection instrument used was a form, applied in 2017 by two nurses to a sample of 111 caregivers of people in a palliative care situation, in Portugal. The caregivers were divided into two groups (with and without the diagnosis), being identified by the simultaneity of three criteria, namely: Zarit Burden Interview values greater than 56; agreement of two nurses about the diagnosis; and caregiver's perception of the presence of signs and symptoms. The defining characteristics were classified as major, secondary and irrelevant, according to the models used.

Results:

the prevalence of diagnosis was 42.3%. Of the 29 characteristics subjected to the validation process, 9 were considered major, 13 secondary and 7 irrelevant. Ineffective coping, depressive mood, frustration, worsening of previous diseases, stress and fatigue were the characteristics which proved to be more associated with the diagnosis in both analyses. The overall score of the diagnosis was 0.68.

Conclusion:

the study results contribute to the improvement of the diagnosis, making it more accurate. In addition, they enable better clinical decision in Nursing, allowing nurses to make a diagnostic judgment supported by scientific evidence.

DESCRIPTORS:
Caregivers; Palliative care; Psychological stress; Nursing diagnosis; Validation studies

Defining characteristic	With diagnosis (n=47)		Without diagnosis (n=64)		p*	Fehring's Score
Defining characteristic	n	%	n	%	p*	Fehring's Score
Lack of time to meet personal needs	42	89.4	40	62.5	0.001^*	0.8
Reports difficulty watching care receiver go through the illness	43	91.5	54	84.4	0.265	0.8
Apprehension about the future regarding care receiver´s health	43	91.5	53	82.8	0.186	0.8
Preoccupation with care routine	41	87.2	45	70.3	0.035*	0.8
Changes in social life and leisure activities	40	85.1	39	60.9	0.005^*	0.8
Emotional lability	39	83.0	38	59.4	0.008^*	0.8
Fatigue	42	89.4	31	48.4	≤0.001*	0.7
Feeling of role captivity	38	80.9	33	51.6	0.001^*	0.7
Stress	37	78.7	37	42.2	≤0.001^*	0.7
Alteration in sleep pattern	37	78.7	38	59.4	0.031^*	0.7
Financial difficulties	33	70.2	25	39.1	0.002^*	0.7
Depressive mood	41	87.2	28	43.8	≤0.001^*	0.6
Ineffective coping	33	70.2	14	21.9	≤0.001^*	0.6
Impatience	33	70.2	26	40.6	0.002^*	0.6
Difficulty performing required tasks	32	68.1	29	45.3	0.017^*	0.5
Frustration	31	66.0	19	29.7	≤0.001*	0.5
Apprehensiveness about future ability to provide care	30	63.8	33	51.6	0.197	0.5
Somatization	30	63.8	33	51.6	0.197	0.5
Worsening of previous diseases	27	57.4	13	20.3	≤0.001^*	0.5
Anger	23	48.9	29	45.3	0.705	0.5
Changes in work/academic activity	28	59.6	21	32.8	0.005*	0.4
Lack of privacy	22	46.8	12	18.8	0.002*	0.4
Guilt	19	40.4	19	29.7	0.239	0.4
Low self-esteem	17	36.2	10	15.6	0.013^*	0.3
Deterioration of family relationships	17	36.2	18	28.1	0.367	0.3
Perception of change in quality of care provided	19	40.4	13	20.3	0.021^*	0.2
Feelings of manipulation by care receiver	13	27.7	13	20.3	0.366	0.2
Shame of care receiver	7	14.9	11	17.2	0.746	0.1
Uncertainty and grieving about changes in relationship with care receiver	5	10.6	6	9.4	0.826	0.1

Fehring	Defining characteristic	Se^† (%)	Sp^‡ (%)	PPV^§ (%)	NPV^\|\| (%)	AUC^¶	P*
Major	Reports difficulty watching care receiver go through the illness	91.5	15.6	44.3	71.4	0.5	0.523
	Apprehension about the future regarding care receiver´s health	91.5	17.2	44.8	73.3	0.5	0.436
	Lack of time to meet personal needs	89.4	37.5	51.2	82.8	0.6	0.016^*
	Preoccupation with care routine	87.2	29.7	47.7	76	0.6	0.129
	Changes in social life and leisure activities	85.1	39.1	50.6	78.1	0.6	0.030^*
	Fatigue	89.4	51.6	57.5	86.8	0.7	≤0.001^*
	Emotional lability	83.0	40.6	50.6	76.5	0.6	0.034*
Secondary	Depressive mood	87.2	56.3	59.4	85.7	0.7	≤0.001^*
	Feeling of role captivity	80.9	48.4	53.5	77.5	0.7	0.009^*
	Stress	78.7	57.8	57.8	78.7	0.7	0.001^*
	Alteration in sleep pattern	78.7	40.6	49.3	72.2	0.6	0.082
	Ineffective coping	70.2	78.1	70.2	78.1	0.7	≤0.001^*
	Impatience	70.2	59.4	55.9	73.1	0.7	0.008^*
	Financial difficulties	70.2	60.9	56.9	73.6	0.7	0.005^*
	Difficulty performing required tasks	68.1	54.7	52.5	70	0.6	0.041^*
	Frustration	66.0	70.3	62.0	73.8	0.7	0.001^*
	Apprehensiveness about future ability to provide care	63.8	48.4	47.6	64.6	0.6	0.271
	Somatization	63.8	48.4	47.6	64.6	0.6	0.271
	Changes in work/academic activity	59.6	67.2	57.1	69.4	0.6	0.016^*
	Worsening of previous diseases	57.4	79.7	67.5	71.8	0.7	0.001^*
	Anger	48.9	54.7	44.2	59.3	0.5	0.745
Irrelevant	Lack of privacy	46.8	81.3	64.7	67.5	0.6	0.012^*
	Perception of change in quality of care provided	40.4	79.7	59.4	64.6	0.6	0.071
	Guilt	40.4	70.3	50	61.6	0.6	0.335
	Low self-esteem	36.2	84.4	63	64.3	0.6	0.065
	Deterioration of family relationships	36.2	71.9	48.6	60.5	0.5	0.470
	Feelings of manipulation by care receiver	27.7	79.7	50.0	60.0	0.5	0.510
	Shame of care receiver	14.9	82.8	38.9	57.0	0.5	0.837
	Uncertainty and grieving about changes in relationship with care receiver	10.6	90.6	45.5	58.0	0.5	0.910

Major	Secondary	Irrelevant
Apprehension about the future regarding care receiver´s health Preoccupation with care routine Lack of time to meet personal needs Emotional lability Depressive mood Fatigue Changes in social life and leisure activities Reports difficulty watching care receiver go through the illness Feeling of role captivity	Apprehensiveness about future ability to provide care Difficulty performing required tasks Stress Ineffective coping Frustration Impatience Alteration in sleep pattern Anger Somatization Worsening of previous diseases Changes in work/academic activity Lack of privacy Financial difficulties	Perception of change in quality of care provided Guilt Low self-esteem Uncertainty and grieving about changes in relationship with care receiver Deterioration of family relationships Feelings of manipulation by care receiver Shame of care receiver

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E-mail: textoecontexto@contato.ufsc.br

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[1] CORRESPONDING AUTHOR
Tânia Marlene Gonçalves Lourenço tmlourenco@esesjcluny.pt