Federal University of Rio Grande do Norte Natal, Rio Grande do Norte, Brazil.
Department of Nursing, Federal University of Pernambuco, Recife, Pernambuco, Brazil.
J Clin Nurs. 2018 Jan;27(1-2):e195-e202. doi: 10.1111/jocn.13915. Epub 2017 Aug 3.
To evaluate the clinical validity of indicators of the nursing diagnosis of "ineffective protection" in haemodialysis patients.
Haemodialysis patients have reduced protection. Studies on the nursing diagnosis of "ineffective protection" are scarce in the literature. The use of indicators to diagnose "ineffective protection" could improve the care of haemodialysis patients. The clinical usefulness of the indicators requires clinical validation.
This was a diagnostic accuracy study.
This study assessed a sample of 200 patients undergoing haemodialysis in a reference clinic for nephrology during the first half of 2015. Operational definitions were created for each clinical indicator based on concept analysis and content validation by experts for these indicators. Diagnostic accuracy measurement was performed with latent class analysis with randomised effects.
The clinical indicator of "fatigue" had high sensitivity (p = .999) and specificity (p = 1.000) for the identification of "ineffective protection." Additionally, "maladaptive response to stress" (p = .711) and "coagulation change" (p = .653) were sensitive indicators. The main indicators that showed high specificity were "fever" (p = .987), "increased number of hospitalisations" (p = .911), "weakness" (p = .937), "infected vascular access" (p = .962) and "vascular access dysfunction" (p = .722).
A set of nine clinical indicators of "ineffective protection" were accurate and statistically significant for haemodialysis patients. Three clinical indicators showed sensitivity, and six indicators showed specificity.
Accurate measures for nursing diagnoses can help nurses confirm or rule out the probability of the occurrence of "ineffective protection" in patients undergoing haemodialysis.
评估血液透析患者“无效保护”护理诊断指标的临床有效性。
血液透析患者的保护作用降低。文献中对“无效保护”护理诊断的研究较少。使用指标来诊断“无效保护”可以改善血液透析患者的护理。这些指标的临床实用性需要临床验证。
这是一项诊断准确性研究。
本研究评估了 2015 年上半年在肾病学参考诊所接受血液透析的 200 名患者的样本。根据概念分析和专家对这些指标的内容验证，为每个临床指标创建了操作定义。使用具有随机效应的潜在类别分析进行诊断准确性测量。
“疲劳”的临床指标对识别“无效保护”具有高灵敏度（p =.999）和特异性（p = 1.000）。此外，“对压力的适应性反应不良”（p =.711）和“凝血变化”（p =.653）是敏感指标。特异性较高的主要指标为“发热”（p =.987）、“住院次数增加”（p =.911）、“虚弱”（p =.937）、“感染的血管通路”（p =.962）和“血管通路功能障碍”（p =.722）。
一套九个用于血液透析患者的“无效保护”临床指标具有准确性和统计学意义。三个临床指标显示出敏感性，六个指标显示出特异性。
准确的护理诊断措施可以帮助护士确认或排除血液透析患者“无效保护”发生的可能性。
