Burns C
Nurs Diagn. 1991 Jul-Sep;2(3):93-104. doi: 10.1111/j.1744-618x.1991.tb00343.x.
Pediatric nurse practitioners (PNPs) need an integrated, comprehensive classification that includes nursing, disease, and developmental diagnoses to effectively describe their practice. No such classification exists. Further, methodologic studies to help evaluate the content validity of any nursing taxonomy are unavailable. A conceptual framework was derived. Then 178 diagnoses from the North American Nursing Diagnosis Association (NANDA) 1986 list, selected diagnoses from the International Classification of Diseases, the Diagnostic and Statistical Manual, Third Revision, and others were selected. This framework identified and listed, with definitions, three domains of diagnoses: Developmental Problems, Diseases, and Daily Living Problems. The diagnoses were ranked using a 4-point scale (4 = highly related to 1 = not related) and were placed into the three domains. The rating scale was assigned by a panel of eight expert pediatric nurses. Diagnoses that were assigned to the Daily Living Problems domain were then sorted into the 11 Functional Health patterns described by Gordon (1987). Reliability was measured using proportions of agreement and Kappas. Content validity of the groups created was measured using indices of content validity and average congruency percentages. The experts used a new method to sort the diagnoses in a new way that decreased overlaps among the domains. The Developmental and Disease domains were judged reliable and valid. The Daily Living domain of nursing diagnoses showed marginally acceptable validity with acceptable reliability. Six Functional Health Patterns were judged reliable and valid, mixed results were determined for four categories, and the Coping/Stress Tolerance category was judged reliable but not valid using either test. There were considerable differences between the panel's, Gordon's (1987), and NANDA's clustering of NANDA diagnoses. This study defines the diagnostic practice of nurses from a holistic, patient-centered perspective. It is the first study to use quantitative methods to test a diagnostic classification system for nursing. The classification model could also be adapted for other nurse specialties.
儿科执业护士（PNP）需要一个综合、全面的分类系统，该系统应涵盖护理、疾病和发育诊断，以便有效地描述他们的执业范围。但目前尚无此类分类系统。此外，也没有用于帮助评估任何护理分类法内容效度的方法学研究。于是得出了一个概念框架。然后从北美护理诊断协会（NANDA）1986年的列表中选取了178个诊断，还选取了国际疾病分类、《诊断与统计手册》第三版及其他中的特定诊断。该框架确定并列出了三个诊断领域及其定义：发育问题、疾病和日常生活问题。这些诊断使用4分制量表进行排序（4 = 高度相关至1 = 不相关），并归入这三个领域。评分量表由八名儿科专家护士组成的小组进行评定。然后将归入日常生活问题领域的诊断按照戈登（1987年）描述的11种功能健康模式进行分类。使用一致性比例和卡帕值来衡量可靠性。通过内容效度指数和平均一致性百分比来衡量所创建分组的内容效度。专家们采用一种新方法以新方式对诊断进行分类，减少了各领域之间的重叠。发育和疾病领域被判定具有可靠性和效度。护理诊断的日常生活领域显示出效度勉强可接受且可靠性可接受。六种功能健康模式被判定具有可靠性和效度，四个类别得出混合结果，应对/压力耐受类别使用任何一种测试判定为可靠但无效。该小组、戈登（1987年）以及NANDA对NANDA诊断的聚类之间存在相当大的差异。本研究从整体、以患者为中心的角度定义了护士的诊断实践。这是第一项使用定量方法测试护理诊断分类系统的研究。该分类模型也可适用于其他护士专业。
