Clinical referents for nursing diagnoses.

Validation of nursing diagnoses is an essential step in developing knowledge for nursing practice and should be a major goal of the discipline. Nursing diagnoses must have clinical referents, that is, defining characteristics which appear in patient populations exhibiting specific nursing diagnoses. Selecting nursing diagnoses for patient populations, developing a list of defining characteristics and operational definitions for a nursing diagnosis, selecting a standard to discriminate among subjects and constructing an instrument to document the occurrence of defining characteristics in selected patient populations are preliminary steps in identifying clinical referents. Methodological concerns addressed in establishing clinical referents for nursing diagnoses included controlling confounding factors, determining sample size, conducting a pilot study, determining interrater reliability, selecting appropriate statistical tests, and identifying critical defining characteristics for a nursing diagnosis.