Carlson-Catalano J, Lunney M, Paradiso C, Bruno J, Luise B K, Martin T, Massoni M, Pachter S
Radford University, School of Nursing, VA 24142, USA.
Image J Nurs Sch. 1998;30(3):243-8. doi: 10.1111/j.1547-5069.1998.tb01299.x.
To describe the clinical validation of symptoms or defining characteristics of three respiratory diagnoses. The contributing factors or etiologies of the diagnoses were identified and the degree of importance of 30 nursing interventions, 15 direct care and 15 teaching, was rated for each diagnosis and each patient. Three nursing diagnoses--ineffective breathing pattern (IBP), ineffective airway clearance (IAC), and impaired gas exchange (IGE)--were among the most frequently used, yet no reported clinical studies validated the defining characteristics of these diagnoses. This study answers the research questions: What are the defining characteristics of IBP, IAC, and IGE? What are the etiologies of IBP, IAC, AND IGE? What are the most important interventions for IBP, IAC, and IGE?
Standardized clinical validation using a convenience sample of 76 people hospitalized with medical and surgical diagnoses, in one U.S. city, and identified as having one of the three diagnoses. Data were collected in 1992-1993.
A literature-based concept analysis generated 37 possible defining characteristics for the three diagnoses which were included in the instrument. The nurse experts conducted a health history and physical examination of each patients and decided (a) whether the 37 defining characteristics were present or absent, (b) the degree of importance of each possible defining characteristic for making one or more of the diagnoses, (c) the etiologies, and (d) which of the 30 nursing interventions were important for each diagnosis and patient.
For each diagnosis, many of the 37 possible defining characteristics were judged as present but few reached the criterion of .50 as important for making one of the diagnoses. Two of the possible defining characteristics reached this criterion for IBP, seven for IAC, and two for IGE. In contrast to the defining characteristics approved by NANDA, the subjective cues of "expresses fatigue" and "expresses anxiety" were judged as important for making one or more of the diagnoses.
Clinical validation methods allow discriminating among defining characteristics. Data that are present are not necessarily characteristic of a diagnosis, and the subjective cues of expresses fatigue or anxiety may be important for making these diagnoses.
描述三种呼吸诊断的症状或定义特征的临床验证。确定诊断的促成因素或病因，并对30项护理干预措施（15项直接护理和15项教学干预）对每种诊断和每位患者的重要程度进行评分。三种护理诊断——无效呼吸模式（IBP）、无效气道清除（IAC）和气体交换受损（IGE）——是最常用的诊断，但尚无临床研究验证这些诊断的定义特征。本研究回答了以下研究问题：IBP、IAC和IGE的定义特征是什么？IBP、IAC和IGE的病因是什么？针对IBP、IAC和IGE最重要的干预措施是什么？
采用标准化临床验证方法，在美国一个城市选取76名因内科和外科诊断住院且被确定患有三种诊断之一的患者作为便利样本。数据于1992年至1993年收集。
基于文献的概念分析为三种诊断生成了37个可能的定义特征，并纳入研究工具。护士专家对每位患者进行健康史询问和体格检查，然后确定：（a）37个定义特征是否存在；（b）每个可能的定义特征对做出一种或多种诊断的重要程度；（c）病因；（d）30项护理干预措施中哪些对每种诊断和患者重要。
对于每种诊断，37个可能的定义特征中有许多被判定为存在，但很少有特征达到对做出一种诊断重要性为0.50的标准。对于IBP，有两个可能的定义特征达到该标准；对于IAC，有七个；对于IGE，有两个。与北美护理诊断协会（NANDA）认可的定义特征不同，“表达疲劳”和“表达焦虑”这些主观线索被判定为对做出一种或多种诊断很重要。
临床验证方法能够区分定义特征。存在的数据不一定是诊断的特征，而表达疲劳或焦虑的主观线索可能对做出这些诊断很重要。
