bluuebunny/crossref_metadata_2025 huggingface dataset:
Enamel Microabrasion for Removal of Superficial Discoloration
Authors: Croll Theodore P.
Published: February 2008

The author reports on microabrasion for the removal of superficial enamel discoloration using a new enamel microabrasion compound and rotary application. After discussing the concept of enamel microabrasion, he describes the step‐by‐step procedures to follow in performing this technique.
Clinical Evaluation of Etched Porcelain Veneers Over a Period of 18 to 42 Months
Authors: Strassler Howard E. , Nathanson Dan
Published: February 2008

The clinical evaluation of an etched porcelain veneer system for its efficacy and durability is reported. The study, which covers a period of 18 to 42 months, concludes that, based on the data presented, one can consider the esthetic restoration of anterior and posterior teeth on the facial surfaces with etched porcelain veneers as an excellent alternative where the clinical situation indicates a bonded restoration.
Clinical Evaluation of Dentacolor as a Posterior Veneering Agent
Authors: O'Neal Sandra J. , Leinfelder Karl F. , Barrett Charles E.
Published: February 2008

A growing number of clinicians have been using laboratory light‐cured resins as a substitute for porcelain veneers. These new systems offer a number of advantages over porcelain. In addition to possessing the ability of being repaired or modified directly in the oral cavity, they can be used with virtually any alloy. This two‐year study dealt with the clinical evaluation of Dentacolor as a veneering agent on posterior crowns. Forty restorations were inserted into a series of patients and evaluated for the following characteristics: color matching ability, wear or loss of anatomic form, surface texture and microleakage at the veneer‐metal interface. At the end of the two years the average wear was only 22 μm. Furthermore, the wear rate was linear. The surfaces were free from pitting, retained a high luster, and exhibited excellent color matching ability.
The Use of an Argon Laser For Polymerization of Composite Resin
Authors: Powell G. Lynn , Kelsey W. Patrick , Blankenau Richard J. , Barkmeier Wayne W.
Published: February 2008

A pilot study conducted to evaluate the initial application of laser technology to composite resin restorative dentistry is reported. Examination was carried out on the effects of enamel and dentin bond strengths and on the physical and mechanical properties of photo‐activated composite resin that has been laser polymerized.
Modulation of the enzymatic efficiency of ferredoxin‐NADP(H) reductase by the amino acid volume around the catalytic site
Authors: Musumeci Matías A. , Arakaki Adrián K. , Rial Daniela V. , Catalano‐Dupuy Daniela L. , Ceccarelli Eduardo A.
Published: February 2008

Ferredoxin (flavodoxin)‐NADP(H) reductases (FNRs) are ubiquitous flavoenzymes that deliver NADPH or low‐potential one‐electron donors (ferredoxin, flavodoxin, adrenodoxin) to redox‐based metabolic reactions in plastids, mitochondria and bacteria. Plastidic FNRs are quite efficient reductases. In contrast, FNRs from organisms possessing a heterotrophic metabolism or anoxygenic photosynthesis display turnover numbers 20‐ to 100‐fold lower than those of their plastidic and cyanobacterial counterparts. Several structural features of these enzymes have yet to be explained. The residue Y308 in pea FNR is stacked nearly parallel to the re‐face of the flavin and is highly conserved amongst members of the family. By computing the relative free energy for the lumiflavin–phenol pair at different angles with the relative position found for Y308 in pea FNR, it can be concluded that this amino acid is constrained against the isoalloxazine. This effect is probably caused by amino acids C266 and L268, which face the other side of this tyrosine. Simple and double FNR mutants of these amino acids were obtained and characterized. It was observed that a decrease or increase in the amino acid volume resulted in a decrease in the catalytic efficiency of the enzyme without altering the protein structure. Our results provide experimental evidence that the volume of these amino acids participates in the fine‐tuning of the catalytic efficiency of the enzyme.
Toward Theory‐Based Diagnostic Categories
Authors: Gordon Marjory
Published: February 2008

As a social institution, nursing has a responsibility to society for the development of knowledge in the areas described by nursing diagnoses. This article focuses on the need for developing the theoretical basis of each diagnostic category. Diagnoses are viewed as summarizations of underlying conceptual models for interpreting observations, and as such, they provide a perspective for understanding and thinking about a set of clinical observations. At present many diagnostic concepts do not meet this standard and suggest primitive, pretheoretical ideas with a minimal knowledge base. The importance of having valid and reliable diagnostic categories for use in making clinical judgments and as a focus for care planning is discussed. A cycle of development is outlined in three phases: diagnostic concept identification, concept analysis‐model development, and construction/reconstruction of diagnostic categories. It is suggested that a useful category captures the conceptual understanding and state of knowledge development about a phenomena in its (a) name, (b) definition, and (c) cluster of defining characteristics.
An Evaluation Guide to Assist with Implementation of Nursing Diagnosis
Authors: Bulechek Gloria M. , Kraus Vicki L. , Wakefield Bonnie , Kowalski Doris K.
Published: February 2008

Nursing diagnosis is increasingly recognized as an integral component of professional nursing practice. Implementation of nursing diagnosis impacts on all elements of professional practice: the philosophy, purpose, and objectives of an organization; care planning; quality assurance; staff education; performance standards; the nursing care delivery system; documentation; and patient classification. A guide organized around these elements has been developed to assist with the implementation of nursing diagnosis. This guide can be used to gather information to plan for the implementation of nursing diagnosis or as a post‐test to judge the success of the implementation process.
Some Methodologic Considerations in Nursing Diagnosis Research
Authors: PhD Meridean L. Maas , Hardy Mary A. , Craft Martha
Published: February 2008

The validation of nursing diagnostic concepts, interventions, and desired outcomes is necessary for the development of nursing science. The purpose of this article is to contribute to the development of more rigorous methods for research of nursing diagnoses. Methodologic problems and issues are discussed and illustrated in the context of a descriptive study of the nursing diagnoses of patients at a large long‐term care facility. Issues surrounding the selection of setting and samples, the source and presentation of data collected, and methods used for data analysis and interpretation are described. The need for consistency among research questions, setting and sample, data collection methods, and data analysis and interpretation are emphasized. Researchers are encouraged to explicate the issues and decisions in nursing diagnosis research to encourage scholarly criticism and refinement by clinicians and scientists.
Self‐Care Deficit with Etiologies: Reliability of Measurement
Authors: Chang Betty L. , Hirsch Maureen , Brazal‐Villanueva Eleanor , Iverson Donna W. Ray
Published: February 2008

The purpose of the present study is to examine the reliability of items in an assessment guide for a specific diagnostic label, self‐care deficit, and its etiologies/contributing factors. Subjects assessed were 30 patients from an acute orthopedic unit in a large medical center. First, an estimate of internal consistency as a measure of reliability was obtained for items measuring self‐care deficit (Cronbach's alpha. 0.83). Second, inter‐rater reliability was obtained for the formulation of complete diagnostic statements; that is, selfcare deficit with etiologies. An 88% agreement was found with respect to the diagnosis self‐care deficit, bathing related to immobility. Overall, agreement on the five most commonly found nursing diagnoses with their etiologies was 69%. The use of an assessment instrument that has reliability and validity may contribute to more accurate diagnostic decisions and impact on appropriate and effective nursing interventions. Further work on assessment parameters for both the diagnostic labels and their etiologies/contributing factors, and the linking of diagnoses to interventions is recommended.
Deriving a New Nursing Diagnosis Through Qualitative Research: Dysfunctional Ventilatory Weaning Response
Authors: Logan Jo , Jenny Jean
Published: February 2008

A secondary analysis was conducted on data originally collected using grounded theory methodology, to study nurses' perceptions of how they wean adult patients from mechanical ventilation. From this secondary analysis, a new nursing diagnosis was derived: dysfunctional ventilatory weaning response. This article discusses the rationale for the diagnostic label and describes salient characteristics and interventions related to the diagnosis.
Using Magnitude Estimation Scaling to Examine the Validity of Nursing Diagnoses
Authors: Grant Joan S. , Kinney Marguerite , Guzzetta Cathie E.
Published: February 2008

This paper describes the use of magnitude estimation scaling in the validation of the critical defining characteristics of nursing diagnoses. Magnitude estimation is a sensitive and accurate technique producing ratio level scales that offer advantages over ordinal level scales frequently used in validating nursing diagnoses. Magnitude estimation responses permit a consensus pattern to be achieved by producing stable and repeatable judgments to validate the importance of each sign and symptom investigated. Thus, magnitude estimation shows promise as a methodologic strategy for validating the critical defining characteristics of nursing diagnoses, thereby expanding the effort to identify and classify nursing phenomena.
Implementing Nursing Diagnoses Within the Context of King's Conceptual Framework
Authors: Byrne‐Coker Esther , Fradley Thelma , Harris Janet , Tomarchio Dianne , Chan Vivian , Caron Charmaine
Published: February 2008

The use of nursing conceptual frameworks and nursing diagnoses is generally acknowledged to hold immense promise for the further development of nursing's scientific base. The nursing profession to date has failed to link the two, thus diminishing their impact. A large community hospital in Canada adopted King's Conceptual Framework for Nursing Practice and advocated the use of NANDA's nursing diagnostic statements as the manner by which patient needs or problems would be identified. Nurses, however, required assistance in identifying more clearly the connection between the theoretical base and nursing diagnoses. During stage one of this project a tool was designed that categorized NANDA's nursing diagnoses according to the concepts and systems of King's conceptual framework. The difficulties encountered in categorizing the nursing diagnoses are discussed and the categorization system is outlined. The utility of the tool was tested during stage two. A total of 25 nurses were asked to describe how they arrived at a particular nursing diagnosis before and after using the categorization tool. Criteria were used to indicate whether a connection had been made between the formulation of the nursing diagnosis and King's conceptual framework throughout the nurse's thought processes. The results indicated that nurses could make a connection between NANDA's nursing diagnoses and King's framework with the assistance of the categorization tool.
Development of Alterations in Learning: Situational Learning Disabilities
Authors: Rakel Barbara A. , Bulechek Gloria M.
Published: February 2008

Until now the nursing diagnosisknowledge deficithas served as a label for all teaching/learning situations. This is inadequate and does not effectively give direction to correct intervention(s). The purpose of this article is to present the diagnostic concept,situational learning disability(SLD), a component of Alterations in Learning, which has been identified as an area to be devel‐oped in the Knowing pattern of the NANDA taxonomy. A thorough review of the literature and empirical support involving 20 cardiology patients on a 27‐bed telemetry step‐down unit is provided. The data support the development of two nursing diagnoses: (1)situational learning disability: impaired ability to learn; and (2) situational learning disability: lack of motivation to learn.The proper identification of these diagnoses can assist nurses in discriminating between patients who can learn, those who cannot learn, and those who need adjustments made in order to facilitate their learning. With this information nurses will be able to make decisions concerning the timing and type of intervention that is most appropriate.
Bathing / Hygiene Self‐Care Deficit: Defining Characteristics and Related Factors Across Age Groups and Diagnosis‐Related Groups in an Acute Care Setting
Authors: McKeighen Rosemary J. , Mehmert Peg A. , Dickel Carol A.
Published: February 2008

The purpose of this descriptive study was to validate the nursing diagnosis, bathing/hygine self‐care deficit. Defining characteristics and related factors were abstracted retrospectively from a computerized patient care planning database. Data were treated to descriptive statistics and chi‐square analysis to determine frequencies and percentages. Major support was found for the defining characteristic “inability to wash body or body parts” (84%) and minor support was garnered for “inability to obtain/access water source” (77%). Related factors associated with the diagnosis were also examined for this acute‐care patient population. The percentages of occurrence were decreased activity tolerance (40%); mobility impairment (24%). pain (19%), musculoskeletal impairment (19%), neuromuscular impairment (9%), and perceptual or cognitive impairment (4%). The diagnosis was found among 80 DRCs and across all age groups (range, 9–92 years).
Respiratory Nursing Diagnoses: Practicing Nurses' Selection of Defining Characteristics
Authors: Capuano Terry Ann , Hitchings Kim S. , Johnson Sharon
Published: February 2008

One‐hundred medical/surgical nurses from two hospitals participated in a study designed to determine which defining characteristics professional nurses working in acute‐care settings associated with each of the three respiratory nursing diagnoses identified by the North American Nursing Diagnosis Association (NANDA). All NANDA defining characteristics for impaired gas exchange and ineffective airway clearance were selected by at least 63% and 67% of the study participants, respectively. Thirteen of the 15 NANDA defining characteristics for ineffective breathing pattern were selected by at least 68% of the study participants. Two characteristics of ineffective breathing pattern identified by NANDA, cough and fremitus, were selected by only 47% and 45% of respondents. This study was the first in a series of studies intended to validate the respiratory nursing diagnoses.
Nursing Diagnosis: The Importance of a Definition
Authors: Mills Winnifred C.
Published: February 2008

Nursing as an evolving science entertains the usage of terminology that lacks clarity and the singular application of terms. The resulting semantic confusion leads to difficulty in operationalizing definitions for use in taxonomic efforts and in research. Examples of this confusion exist where the term nursing diagnosis is used as concept, category, process, and product. Four suggestions are made to alleviate these difficulties.
NANDA's Definition of Nursing Diagnosis: A Plea for Conceptual Clarity
Authors: Miers Linda J.
Published: February 2008

A working definition of nursing diagnosis was adopted by the North American Nursing Diagnosis Association (NANDA) Biennial Business Meeting in March 1990. Because of the working nature of the definition, members and nonmembers of the Association were invited to judge the merits and faults of the definition and to recommend areas needing further debate, analysis, or modification. The purpose of this article is to apply principles and rules of definition to an analysis of the working definition of nursing diagnosis as adopted by the NANDA General Assembly. In presenting this analysis, concerns and questions regarding the conceptual, logical, and grammatical clarity of essential elements (e.g., clinical judgment; individual, family, or community responses; actual or potential health problems; and actual or potential life processes) in the definition are posed; and, where appropriate, suggestions for clarification are offered. Further debate, research, and clinical testing is requested in an attempt to improve NANDA's very important contribution to the development of nursing practice theory.
Nursing Diagnosis and the Effectiveness Initiative
Authors: Lancour Jane
Published: February 2008

Through the Omnibus Budget Reconciliation Act of 1989 the Agency for Health Care Policy and Research (AHCPR) was established as the successor to the National Center for Health Services Research and Health Care Technology Assessment (NCHSR). Under the auspices of the Office of the Forum for Quality and Effectiveness in Health Care, AHCPR is responsible for developing and updating guidelines to be used in the management of clinical conditions. This is being accomplished through AHCPR's Medical Treatment Effectiveness Program (MEDTEP). MEDTEP's purpose is to improve the effectiveness and appropriateness of health care services by determining the effects of health care practices, including nursing practices on patient outcomes. MEDTEP is focusing on four sets of activities: guideline development, dissemination of research findings, data base development, and effectiveness and outcomes research.
Dyspnea: A Case for Nursing Diagnosis Status
Authors: Gift Audrey G. , Nield Margaret
Published: February 2008

Dyspnea, the unpleasant subjective sensation of difficult breathing, is one of the most common symptoms experienced by patients with pulmonary and cardiac disorders. This article reviews the research concerning dyspnea and proposes it for consideration as a nursing diagnosis. The etiologies are categorized according to the neurosensory, neurochemical, cognitive, and affective mechanisms. The defining characteristics include the subjective words describing dyspnea, such as shortness of breath, suffocation, and tightness. The most supported objective sign of dyspnea in the literature is an increased use of accessory muscles of respiration. Nursing interventions for dyspnea relief are geared toward reducing the afferent activity from receptors in the respiratory muscles and dealing with the affective component of dyspnea. These interventions include pacing activities, breathing techniques, and inducing the relaxation response. Because most research for interventions to reduce dyspnea have focused on patients with obstructive lung disorders who have chronic dyspnea, recommendations for further research include using acutely ill patients and those with a variety of medical conditions.
Clinical Nurses' Characterizations of Patient Coping Problems
Authors: Becket Nola
Published: February 2008

The author reports the findings from a qualitative study of diagnostic data obtained and interpreted by hospital nurses on the coping of adult patients and their families. Clinical data taken from taped interviews were transcribed and analyzed using grounded theory and analytic induction techniques. The data were then compared with diagnoses accepted for testing by NANDA. The phenomena described by the research did not match the NANDA constructs for individual and family coping problems. Nurses' assessments of coping responses, however, fit within transactional theory. The use of the term “ineffective” to qualify coping was generally avoided. Ineffective coping, suggesting an outcome or product of coping, was not often considered applicable to the coping responses nurses found appropriate at specific times in specific situations.
Paths to Concept Development in Nursing Diagnosis
Authors: Avant Kay C.
Published: February 2008

Three pathways to diagnostic concept development are proposed. Principles and methods that operate on each path are presented. Careful concept development contributes to precise diagnostic labels and to the advancement of nursing science.
Analysis of a Human Phenomenon: Self‐Concept
Authors: LeMone Priscilla
Published: February 2008

This analysis of self‐concept includes an examination of definitions, historical perspectives, theoretical basis, and closely related terms. Antecedents, consequences, defining attributes, and a definition were formulated based on the analysis. The purpose of the analysis was to provide support for the use of the label “self‐concept”as a broad category that encompasses the self‐esteem, identity, and body‐image nursing diagnoses within Taxonomy I. This classification could allow the use of a broad diagnostic label to better describe conditions that necessitate nursing care. It may also further explain the relationships between and among those diagnoses that describe human responses to disturbance of any component of the self‐concept.
Validating Impaired Physical Mobility
Authors: Mehmert Peg A. , Delaney W.
Published: February 2008

The clinical presence of impaired physical mobility documented for acute‐care patients was studied. The frequency, individual, and group sensitivity levels of the defining characteristics documented as empirical referents for the diagnosis were examined. The frequency of the related factors associated with the diagnosis, patient demographics, length of stay (LOS), discharge destination, and diagnostic‐related groups (DRGs) were also examined. Data were obtained from electronic tapes of patient information. Support was found for impaired mobility, as a high‐frequency diagnosis, in heterogeneous acute‐care patients. No support was found for any major defining characteristics across the heterogeneous sample. A cluster of three defining characteristics: (a) inability to purposefully move within the environment; (b) decreased muscle strength, control, or mass; and (c) imposed restrictions of movement was supported by group sensitivity measures. Major defining characteristics were supported in two DRG subsets. Clusters of defining characteristics varied among four DRGs. The NANDA‐preidentified related factors were associated with the diagnosis. Electronic storage and retrieval of computerized nursing data, including the elements of the Nursing Minimum Data Set (NMDS), was an effective, efficient method for data collection and analysis.
Nursing Effort and the Exchanging Human Response Pattern
Authors: Happ Mary Beth , Kerr Mary E.
Published: February 2008

This descriptive, comparative study was done to determine the nursing effort required to treat actual and potential nursing diagnoses from the Exchanging Human Response Pattern in two patient care specialties: acute medical–surgical and postpartum. Patterns of diagnosis identification are described for the two groups, and differences in allocation of nursing resources (nursing effort) are examined. The sample included 200 observations (hospital days) for 50 patients: 33 postpartum patients, and 17 medical–surgical patients. Data were collected daily during the study period by nurses who provided direct care to the selected patients using an investigator‐developed version of the Nurse–Patient Summary (NPS) nursing information and patient classification tool (Halloran. 1985). Potential nursing diagnoses received most of the nursing effort in the postpartum area (mean effort = 5.28), whereas actual nursing diagnoses in the Exchanging Human Response Pattern received a higher priority in the medical–surgical area (mean effort = 12.03). Statistically significant differences existed between groups in total nursing effort (t = ‐4.73, p < .0001) and in nursing effort required to treat actual (t = ‐7.42, p < .0001) and potential diagnoses (t = 3.99, p < .0001) in the Exchanging Human Response Pattern. This study provides unique information about how nurses allocate their lime to patients for the treatment of actual and potential nursing diagnoses, and outlines areas for further development in diagnosis‐based patient classification.
Patients' Perceptions of Health, Chronic Illness, and Nursing Diagnoses
Authors: Loomis Maxine E. , Conco Diana
Published: February 2008

This descriptive, exploratory study sought to determine how persons with chronic health problems define their experiences of health and illness and to collect information from these subjects regarding their ability to identify their health problems on the list of NANDA‐approved nursing diagnoses. A convenience sample of 19 subjects was interviewed using qualitative triangu‐lation methods. Subjects defined experiences of health in terms of their abilities to perform functions independently. Illness was defined primarily in terms of physical symptoms. Thirteen subjects identified self‐initiated activities oriented toward alleviation of physical symptoms as strategies for helping themselves get better or feel better when “sick.”

Subjects were able to use nursing diagnoses to identify their health problems, selecting 61 of the 106 NANDA‐approved diagnoses. Data related to subject‐selected diagnoses are compared with available NANDA diagnoses by taxonomy category and nurse‐interviewer diagnoses. Moving, Perceiving, and Valuing were the taxonomy categories that were most frequently identified by this sample. A new nursing diagnosis of altered nutrition: regimentation (in timing, amounts, and types of food), as well as the need for additional diagnostic development in the areas of urinary frequency, disrupted relationships, and medications were identified by the subjects. Finally, the researchers propose the development of nursing diagnoses that foster health promotion and illness prevention based on the health orientation of this sample, despite their chronic health problems.
The Need for Operational Definitions for Defining Characteristics
Authors: Grant Joan S. , Kinney Marguerite R.
Published: February 2008

Although much attention has focused on the validation of denning characteristics for nursing diagnoses, equal attention has not been devoted to the development of operational definitions for defining characteristics. Operational definitions, however, provide a reference for determining whether defining characteristics are present in patients who participate in clinical validation studies. Validation of nursing diagnoses emerges from occurrence of the diagnostic label in clinical practice. Operational definitions provide the bridge between incidental observation and scientific validation of nursing diagnoses.
Alice in NANDAIand
Authors: Grace Jeanne T.
Published: February 2008

This entertainment was created for the 1991 student–faculty banquet at the University of Rochester School of Nursing, which honored the graduating seniors. Traditionally, groups of juniors, seniors, and faculty present a skit at this event that recalls some aspect of the year's activities. Because nursing diagnosis received more emphasis in junior coursework this year than in previous years, the faculty agreed to use this theme for their presentation. The author volunteered because she enjoys writing parody and has a fondness for the works of Lewis Carroll. The cast, which included one member of the NANDA Board of Directors, consisted of undergraduate faculty from all clinical areas.
Hypothermia: One Nursing Diagnosis or Three?
Authors: Summers Sharon
Published: February 2008

The nursing diagnosis of hypothermia has been described by various authors as having multiple defining characteristics. A major problem identified was a lack of consistency on an exact temperature value for this nursing diagnosis. A review of the literature on hypothermia showed three distinct types of hypothermia: inadvertent, accidental, and intentional. Each of these types were distinguished by etiologies and defining characteristics and are presented using the hypothetic model case approach.
Using the Delphi Technique to Examine the Content Validity of Nursing Diagnoses
Authors: Grant Joan S. , Kinney Marguerite R.
Published: February 2008

Official labeling of phenomena that nurses diagnose and treat requires that researchers validate the existence of proposed diagnoses. One part of the validation process is the examination of content validity. The Delphi technique is a useful methodologic technique for such an examination. This article describes the characteristics, background, advantages, and disadvantages of the Delphi technique, as well as suggested strategies for using it to validate nursing diagnoses. In discussing strategies for using the Delphi technique to validate nursing diagnoses, the format, essential components, and steps of each round of the traditional and modified Delphi procedure are addressed. Round I of the traditional Delphi technique involves selection of a panel of content experts, developing and mailing questionnaires and content analysis, and generating a list of defining characteristics and operational definitions for a nursing diagnosis. Round II involves developing and mailing questionnaires, determining percentage of agreement, and providing statistical analysis. Round III includes developing and mailing questionnaires and providing statistical analysis of data. Round IV consists of developing and mailing the final report, which includes a statistical summary of individual and grouped responses in round III, as well as a minority report. The format and statistical analysis of the modified Delphi procedure is similar to rounds II, III, and IV of the traditional Delphi technique, except the modified technique usually will require only three rounds.
Development of Written Case Studies as Simulations of Diagnosis in Nursing
Authors: Lunney Margaret
Published: February 2008

Written case studies, as simulations of diagnosis in nursing, are valuable tools for research, education, and practice. This article presents guidelines and methods for systematic development of valid and reliable case studies. Examples of purposes, objectives, and methods are given. A content validity form and directions also are provided.
Identification of a Cluster of Nursing Diagnoses for a Caregiver Support Group
Authors: Pierson Margaret A. , Irons Kathy
Published: February 2008

Caregivers providing home care for the elderly are an “at‐risk” population because of the multitude of demands placed on them. A cluster of nursing diagnoses, thought to be representative of problems and needs encountered by the community of caregivers, is identified. The diagnoses were developed from the perspective of a community (the support group), yet with recognition of the uniqueness of each caregiving relationship within the group. This cluster of diagnoses has provided the focus for program planning for the support group. Group facilitators became more aware of the range of diffi‐culties encountered by the caregivers and gained insight that helped in selecting topics of interest for the informational suggeslions provided at the monthly group meetings. Heightened awareness of this cluster of diagnoses can enable healthcare providers to belter assist caregivers in assuming or continuing in that role. Accurate diagnosis and appropriate intervention relative to the needs of this group may enhance their quality of life and enable them to better fulfill their caregiving responsibilities.
Nursing Intervention for Self‐Esteem Disturbances
Authors: Norris Joan
Published: February 2008

In 1988, ihe broad diagnosis of self‐esteem disturbance was refined into three distinct problems: defensive coping, situational low self‐esteem, and chronic low self‐esteem. The rationale for this refinement is discussed, and distinct nursing interventions are proposed that differ by type of self‐esteem problem and nursing expertise.
Development of Definitions for Taxonomy II
Authors: Kerr Mary E. , Hoskins Lois M. , Fitzpatrick Joyce J. , Warren Judith J. , Avant Kay C. , Carpenito Lynda Juall , Hurley Mary E. , Jakob Dorothea , Lunney Margaret , Mills Winnifred C. , Rottkamp Barbara C.
Published: February 2008

In the process of placing diagnoses into Taxonomy I. certain inconsistencies became apparent. Inadequate definition of both diagnoses and human response patterns, lack of defining characteristics, and inconsistency in the levels of abstraction within the taxonomic hierarchy made the task of assigning a diagnosis to a taxonomic pattern difficult. Ambiguity in the definitions of the nine patterns resulted in ambiguity in the basic foundation, which affected the entire structure. The Taxonomy Committee, before evaluating the current structure, had to make the following decisions regarding the current human response patterns: (1) Should the nine human response patterns be retained for further taxonomic work? and (2) If they are retained. what should be the first step in examining Taxonomy I‐Revised? This second article in a series of four will familiarize the readers with the process and decisions by which Taxonomy II of the North American Nursing Diagnosis Association (NANDA) is evolving through the work of the Taxonomy Committee. This article also will identify the specific problems encountered in the development of Taxonomy I and Taxonomy I‐Revised. and describe the steps establishing the validity of the process of formation of the nine human response patterns.
Mental Status and Functional Abilities: Change in Institutionalized Elderly Women
Authors: Hamilton Linda W. , Creason Nancy S.
Published: February 2008

A study of 40 institutionalized elderly women was undertaken to determine if changes occurred in mental status and functional abilities over the course of 1 year. Although a number of studies examine factors that impact on successful adaptation in persons admitted to long‐term care facilities, the longitudinal changes on functional abilities and mental status have not been addressed. These variables were examined in relation to the concept of selfcare, which has been applied to the elderly only recently. Findings indicate a decline in mental status and an increase in functional dependency. Nursing implications and questions that merit further study in the area of self‐care are presented.
Taxonomic Validation: An Overview
Authors: Kerr Mary , Hoskins Lois M. , Fitzpatrick Joyce J. , Warren Judith J. , Avant Kay C. , Hurley Mary , Lunney Margaret , Mills Winnifred C. , Rottkamp Barbara C.
Published: February 2008

A valid taxonomy legitimizes the elements that make up the taxonomy and increases trust in its generalizability and predictability. There is a concern that the NANDA Taxonomy is not a valid taxanomic structure. Despite on‐going work to validate individual nursing diagnoses, there is little research that focuses on validation of groups of diagnoses (taxons) within the NANDA taxonomy. This last article in a series of four will familiarize the readers with why, what, and how a taxonomy of nursing diagnoses can be validated. This article highlights assessment of the validity and reliability of a taxonomy, compares the process of taxonomic validation to the research process, and explores examples of validation design
Nursing Diagnosis by Computers: An Application of Neural Networks
Authors: Harvey Rose M.
Published: February 2008

In a pilot‐test application of the neural network, test case diagnoses made by the ART‐2 neural network agreed with those made independently by nurses. The main conclusion is that the ART‐2 neural network is promising as a decision‐making aid. It can handle probabilistic and ill‐defined data through a process of pattern recognition without programming rules. A disadvantage is that the ART‐2 neural network requires “training” by the nurse using at least one example to define a diagnosis. In practice, however, this requirement does not affect its usefulness. Moreover, providing the ART‐2 neural network with several training examples enables it to identify new patterns that are “close” to the textbook case but vary in one or more characteristics.
An Axial Representation of Community Mental Health Nursing Diagnoses of a Country at War: El Salvador
Authors: Coler Marga Simon
Published: February 2008

This paper explores the impact of a workshop on the formulation of community mental health diagnoses in El Salvador. The author taught the process of diagnosis from the NANDA framework and explored diagnostic decision making through Caplan's Crisis Model. An epidemiologic framework was also incorporated in the diagnostic process so that host, agent, and environment could be scrutinized. The workshop resulted in the formulation of three universal community mental health diagnoses for this (then) war‐torn country: depression, aggression, and anxiety; the development of a proposal for the implementation of mental health services; and an invitation to explore implementation of community mental health care services in five rural communities in El Salvador. Although the politics of El Salvador have changed, this example is typical of many Third‐World and war‐torn countries.
New Diagnosis: Caregiver Role Strain
Authors: Burns Catherine , Archbold Patricia , Stewart Barbara , Shelton Kathleen
Published: February 2008

Caregiver role strain is a new diagnosis accepted by NANDA in 1992. The diagnosis is a well‐described family phenomenon that can be measured and predicted. Sources of variance for the various defining characteristics have been identified. The diagnosis is also important to society. Nurses can play a significant part in reducing the role strain caregivers feel or preventing its occurrence.

Summary

Caregiver role strain is an important diagnosis to add to the nursing taxonomy. It is a phenomenon that has been well‐described and studied from many perspectives. It can be measured and identified by nurses. It can be predicted, and interventions can be instituted to diminish its effects or decrease the likelihood of its onset. It is a diagnosis that has boundaries and can be distinguished from other kinds of family problems related to health and illness of family members. It is also a significant issue in society that needs to be addressed by nurses working in many settings and roles.
Noncompliance Revisited: A Disciplinary Perspective of a Nursing Diagnosis
Authors: Keeling Arlene , Utz Sharon Williams , Shuster George F. , Boyle Ann
Published: February 2008

One of the nursing diagnoses accepted by NANDA is noncompliance. However, this diagnosis has been criticized because it implies coercion and dominance by health professionals, and because of the negative stereotyping the term promotes. The authors argue that noncompliance should not be used as a nursing diagnosis because of incongruence with nursing history, philosophy, ethics, theory, and the need for clinical utility of diagnoses. Alternative diagnoses are proposed.
Guided Visual Metaphor: A Creative Strategy for Teaching Nursing Diagnosis
Authors: Jeffreys Marianne R.
Published: February 2008

Guided Visual Metaphor (GVM) is a six‐step, learner‐centered, creative strategy for teaching nursing diagnosis that combines multidimensional visual and verbal techniques. Learner‐participative components include drawing and labeling, reflection, strength and problem identification, nursing diagnosis selection, prioritization, and discussion. The GVM was implemented over a four‐week period with 19 associate degree students enrolled in their first nursing course. Positive student evaluations for the GVM, as well as positive learner outcomes, support its continued use. Teacher evaluation of the product (nursing diagnostic statement) was based on three levels of diagnostic skills criteria. Following week four, all students met all Level 1 and Level 2 skills criteria for each nursing diagnosis. Seventy‐four percent met at least one Level 3 (highest level) criterion for one or more nursing diagnosis. Fifty‐eight percent met at least one Level 3 criterion for two or more nursing diagnoses. Students also required less teacher guidance with each subsequent use of the GVM.
The Nature and Use of Nursing Diagnosis in Hospitals
Authors: Lutjens Louette R. Johnson
Published: February 2008

This descriptive study examined the frequency of types of diagnoses formulated by RNs. Ten patient charts were randomly selected from each of 10 frequently occurring diagnosis‐related groups (DRGs) (N = 100). Findings indicated the majority of diagnoses (N = 1,504) were made in the Exchanging (55.33%) Human Response Pattern by two groups of nurse raters—RN caregivers and CNSs. Differences in number of diagnoses made by the nurse groups were statistically significant for all Human Response Patterns. Overall, the CNSs made more diagnoses than the caregivers (944 vs. 560), and their diagnoses were of a broader nature.
The Spiritual Dimension of Individuals: Conceptual Development
Authors: Mansen Thom J.
Published: February 2008

The concept of spirituality (the spiritual dimension of an individual) is discussed related to concept development using the Path Associated with Differences. Spirituality is discussed as being different from religion and the psychosocial dimension of individuals. Methods for concept development—e.g., concept derivation, intuition, and qualitative analysis—are explored.
Validation of the Defining Characteristics of Potential for Violence
Authors: Smith Janet E. , Czicman Sharon P. , Early Jane A. , Green Patricia T. , Lauck Donna L. , Lindsay Kathryn , Oblaczynski Catherine , Smochek Mary Rose , Wright Gertrude
Published: February 2008

A high incidence of violence occurs in contemporary society, which is reflected in the violence exhibited by psychiatric patients. To validate the defining characteristics of potential for violence, 125 registered nurses were asked to rate the relevance of defining characteristics of the diagnosis. A diagnostic content validity index was used to ascertain which defining characteristics the nurses believed to be the most critical in the identification of violence potential. Nine major and 20 minor characteristics were identified by these nurses.
Use of Nursing Diagnosis With Population Groups
Authors: Neufeld Anne , Harrison Margaret J.
Published: February 2008

The authors report findings of a study done to examine the use of nursing diagnosis by community health nurses (n= 15) and students (n= 20) who worked with population groups. Results of the analysis of the open‐ended questionnaires and student assignments indicate that many of the diagnoses, both wellness and deficit, could be classified in relation to the concepts present in published classification systems. Issues raised by the study about the use of nursing diagnosis with population groups include: incorporating wellness diagnoses in the NANDA Taxonomy, identifying when a group diagnosis is appropriate, determining whether to give priority to a behavioral or an environmental focus, and selecting the level of abstraction.
Nursing Diagnosis Research: Computer‐Aided Research in Nursing
Authors: Chang Betty L. , Hirsch Maureen
Published: February 2008

The authors describe the development of a research tool for studies on nursing diagnosis by the Computer‐Aided Research in Nursing (CARIN) project. The tool, a computerized assessment guide, has reliable and valid items for the identification of patient problem areas. The patient information in the assessment guide, nursing diagnoses identified by the clinical nurse specialist, and a statistical interface are linked in a customized computer program for the CARIN project, providing a system capable of analyzing patient problems from several perspectives. The system provides an accurate assessment and subsequent analysis of patient problems, as well as large data sets. Implications for the future of nursing diagnosis research are discussed.
Concept Analysis of Pain: Implications Related to Nursing Diagnoses
Authors: Mahon Suzanne M.
Published: February 2008

Pain is a phenomenon that has an impact on clients in a variety of settings. Nurses have many responsibilities related to assessment, diagnosis, intervention, and evaluation when caring for the person experiencing pain. The phenomenon of pain is described through a concept analysis, which is guided by the research tradition of phenomenology. A review of both medical and nonmedical literature provides a broad base of definitions from which the attributes, antecedents, and consequences are derived. The analysis includes the construction of various cases and identification of empirical referents in the phenomenologic tradition. Suggestions for future development and implementation of the concept into clinical nursing practice and clinical nursing research are included.
Modification of the Diagnostic Content Validity Model
Authors: Sparks Sheila M. , Lien‐Gieschen Teresa
Published: February 2008

Diagnostic content validation of nursing diagnoses is a recommended means to confirm the defining characteristics necessary to establish a specific nursing diagnosis. The diagnostic content validity model has been used in numerous studies to develop lists of major and minor defining characteristics recommended by experts as being present in patients with specific diagnoses. The authors provide an overview of the diagnostic content validity model, review the meaning and purposes of content validity, discuss problems with information processing, and suggest revisions to the diagnostic content validity model. Incorporation of these changes may improve the usability of nursing diagnoses in clinical practice, education, and research.
Content Validation of Impaired Skin Integrity and Urinary Incontinence in the Home Health Setting
Authors: Lewis‐Abney Kay , Rosenkranz Carol F.
Published: February 2008

The purpose of this study was to examine content validity of two nursing diagnoses in the home health setting: impaired skin integrity and altered urinary elimination: total incontinence. Eighty‐two home health nurses rated the importance of each of the defining characteristics for the two nursing diagnoses. Diagnostic content validity scores (DCV) were calculated for each defining characteristic for both diagnoses using the method described by Fehring (1986). Four characteristics for each diagnosis had DCV scores greater than .75, indicating characteristics were critical indicators for the diagnosis. Erythema, denuded skin, disruptions of dermal and epidermal tissue, and lesions were critical indicators for impaired skin integrity. Lack of awareness of incontinence, constant flow of urine, lack of awareness of bladder cues to void, and incontinence refractory to other treatments were critical indicators for alteration in urinary elimination: total incontinence.
The Alcoholic Family: A Nursing Diagnosis Validation Study
Authors: Lindeman Marlene , Hawks Jane Hokanson , Bartek Jean Krajicek
Published: February 2008

This study was designed to develop and validate a new nursing diagnosis, altered family processes: alcoholism. The Delphi technique was used to obtain nurse experts' (N = 201) ratings of terms for the definition, related factors, and defining characteristics. Degree of consensus was determined by analyzing the mean, frequencies, and Fehring's (1987) Diagnostic Content Validity Index for items. Findings supported a proposed definition and related factors including family history of alcoholism and lack of problem‐solving skills. Defining characteristics were grouped into three categories: feelings (e.g. mistrust, insecurity, powerlessness, unhappiness), roles, and relationships (e.g. disturbed family dynamics, inconsistent parenting, marital problems), and behaviors (e.g. impaired communication, dependency, denial). Future research includes the proposal and testing of nursing interventions for alcoholic families.