bluuebunny/crossref_metadata_2025 huggingface dataset:
Acetylcholinesterase from the invertebrate Ciona intestinalis is capable of assembling into asymmetric forms when co‐expressed with vertebrate collagenic tail peptide
Authors: Frederick Adam , Tsigelny Igor , Cohenour Frances , Spiker Christopher , Krejci Eric , Chatonnet Arnaud , Bourgoin Stefan , Richards Greg , Allen Tessa , Whitlock Mary H. , Pezzementi Leo
Published: February 2008

To learn more about the evolution of the cholinesterases (ChEs), acetylcholinesterase (AChE) and butyrylcholinesterase in the vertebrates, we investigated the AChE activity of a deuterostome invertebrate, the urochordate Ciona intestinalis, by expressing in vitro a synthetic recombinant cDNA for the enzyme in COS‐7 cells. Evidence from kinetics, pharmacology, molecular biology, and molecular modeling confirms that the enzyme is AChE. Sequence analysis and molecular modeling also indicate that the cDNA codes for the AChET subunit, which should be able to produce all three globular forms of AChE: monomers (G1), dimers (G2), and tetramers (G4), and assemble into asymmetric forms in association with the collagenic subunit collagen Q. Using velocity sedimentation on sucrose gradients, we found that all three of the globular forms are either expressed in cells or secreted into the medium. In cell extracts, amphiphilic monomers (G1a) and non‐amphiphilic tetramers (G4na) are found. Amphiphilic dimers (G2a) and non‐amphiphilic tetramers (G4na) are secreted into the medium. Co‐expression of the catalytic subunit with Rattus norvegicus collagen Q produces the asymmetric A12 form of the enzyme. Collagenase digestion of the A12 AChE produces a lytic G4 form. Notably, only globular forms are present in vivo. This is the first demonstration that an invertebrate AChE is capable of assembling into asymmetric forms. We also performed a phylogenetic analysis of the sequence. We discuss the relevance of our results with respect to the evolution of the ChEs in general, in deuterostome invertebrates, and in chordates including vertebrates.
The elusive intermediate on the folding pathway of the prion protein
Authors: Jenkins David C. , Sylvester Ian D. , Pinheiro Teresa J. T.
Published: February 2008

A key molecular event in prion diseases is the conversion of the cellular conformation of the prion protein (PrPC) to an altered disease‐associated form, generally denoted as scrapie isoform (PrPSc). The molecular details of this conformational transition are not fully understood, but it has been suggested that an intermediate on the folding pathway of PrPC may be recruited to form PrPSc. In order to investigate the folding pathway of PrP we designed and expressed two mutants, each possessing a single strategically located tryptophan residue. The secondary structure and folding properties of the mutants were examined. Using conventional analyses of folding transition data determined by fluorescence and CD, and novel phase‐diagram analyses, we present compelling evidence for the presence of an intermediate species on the folding pathway of PrP. The potential role of this intermediate in prion conversion is discussed.
Accuracy of Nursing Diagnoses: Concept Development
Authors: Lunney Margaret
Published: February 2008

The concept of accuracy of nursing diagnoses was developed by the author as a first step of theory development related to nursing diagnosis. Accuracy is conceptually redefined as a continuous variable and as such contrasts with the prevailing view of accuracy that diagnoses are either accurate or inaccurate. The conceptual definition of accuracy of a nursing diagnosis and a delineation of the characteristics of accuracy emphasize the relativistic nature of the concept.
A Pilot Study of the Diagnosis and Treatment of Impaired Skin Integrity: Dry Skin in Older Persons
Authors: Hardy Mary Anderson
Published: February 2008

A pilot study was conducted to isolate the clinical indicators of dry skin in the elderly, test an instrument used to measure dry skin, analyze the importance of factors thought to contribute to dry skin, test the effectiveness of an intervention for treating dry skin, and determine the feasibility of clinical implementation of the protocol. The sample included 15 elderly long‐term care residents with a nursing and medical diagnosis of dry skin. Although the small sample size limits interpretation of findings, there is some evidence that scaling and flaking may be indicators of skin dryness. Subjects received the bathing intervention for 6 weeks and were assessed every 2 weeks during the 6‐week periods before, during, and after intervention (nine data collection points). Analysis of the nine repeated measures of skin dryness indicated significantly reduced total dryness (p= 031), redness (p=.001), scaling (p=.007), and flaking (p=.002) over time. Post hoc comparisons, interrater agreement on the Skin Condition Data Form, and categorical variables were analyzed. Findings from this study will be used to generate further hypotheses.
Research on Diagnostic Reasoning in Nursing
Authors: Radwin Laurel E.
Published: February 2008

NANDA has traditionally complemented its work on the development and clinical testing of nursing diagnoses with concurrent interest in nurses' diagnostic reasoning processes. This literature review describes studies in diagnostic reasoning, including research based on the information processing model, research examining the role of intuition, and research using grounded theory to study the diagnosis of specific patient conditions. The review presents a synthesis of the research to date, and common themes in these diverse studies are identified. This review emphasizes research in nursing, although pertinent findings from cognitive psychology and medicine are included. Suggestions for future work in diagnostic reasoning are offered.
Concept Analysis of Feeling: A Human Response Pattern
Authors: Beyea Suzanne Cushman
Published: February 2008

This article explores the concept of feeling, its historical foundations, and the use of this construct by other disciplines, e.g., philosophy and psychology. Feelings are well known and accepted as integral to human sensations and emotional experiences. One of the basic assumptions within nursing science is the notion that clients and nurses are emotional beings continually responding to the environment in a dynamic mind‐body‐spirit interaction. Phenomena classified within the taxonomic category of Feeling relate to a human response pattern involving the subjective awareness of information (NANDA. 1989). However, feeling as a human response has remained an underdeveloped and unrefined concept within nursing science. An operational definition is proposed in an effort to facilitate the classification of nursing diagnoses in regard to the holistic nature of persons.
Conceptual Basis for the Organization and Advancement of Nursing Knowledge: Nursing Diagnosis/Taxonomy
Authors: Fitzpatrick Joyce J.
Published: February 2008

An analysis of the conceptualization embedded within the development of nursing diagnoses, including the historical perspective on this process, is presented. Although there are conceptual issues still to be resolved, nursing diagnosis can be considered as a conceptual approach to developing disciplinary knowledge.
Auditory Sensory/Perceptual Alteration: Suggested Revision of Defining Characteristics
Authors: Janken Janice K. , Cullinan Carol Lewis
Published: February 2008

This correlational study of acutely ill geriatric patients examined (1) if psychosocial dysfunctioning is associated with hearing impairment, as popularly believed; (2) the utility of using psychosocial changes as cues for making the nursing diagnosis sensory/perceptual alterations: auditory; and (3) an alternative model of defining characteristics for predicting auditory perception using variables that have been reported in the literature as being associated with hearing loss but, to date, are not part of the approved diagnostic category. A random sample (n = 226) was drawn from daily admission lists of English‐speaking patients 65 years of age or older, admitted to nonintensive care units of a medical center hospital. The major defining characteristics for sensory/perceptual alterations were operationalized as seven variables: depression, cognitive function, social contact with children, social contact with other relatives, social contact with friends, subject‐reported hearing ability, and subject‐reported overall health status. Auditory sensory perception was operationalized as number of tones heard on audiometric examination. Findings indicate that assessing psychosocial functions does not provide nurses with helpful cues for making the auditory alteration diagnosis. Rather results suggest that nurses can make a more accurate diagnosis merely by knowing the patient's age, self‐rating of hearing, and checking ear canals for impacted cerumen.
The Development of NANDA's Nursing Diagnosis Taxonomy
Authors: Warren Judith J. , Hoskins Lois M.
Published: February 2008

In the early 1970s the need for a precise and computerizable language of nursing phenomena was identified. This need stimulated the formation of the National Conference Group for the Classification of Nursing Diagnoses The group began the work of identifying nursing diagnoses and developing a taxonomic structure for their classification. Based on the initial success with the development of nursing diagnoses, the conference group became the North American Nursing Diagnosis Association (NANDA). There are two benefits of taxonomic development within nursing: one is scientific in nature, while the other is applied or practical. The development of this taxonomy has occurred over a span of 17 years including nine national conferences. Details of this development have been abstracted from the proceedings of the nine conferences and the minutes of the Taxonomy Committee in order to explicate the taxonomic structure. The rules for the classification, developed by the committee, are presented. Future directions for taxonomic development and collaboration with other health care professions are proposed.
Wellness Nursing Diagnoses: To Be or Not To Be?
Authors: Popkess–Vawter Sue
Published: February 2008

Problem orientation has dominated the nursing diagnosis movement since the early 1970s. The purpose of this article is to discuss how the new nursing diagnosis definition provides opportunity for a wellness perspective to be incorporated into the movement. Wellness is differentiated from illness and health, and a conceptual model is offered to clarify these concepts. Work is reviewed from the growing number of authors who have supported wellness nursing diagnoses and advocated their incorporation into the current taxonomic listing. Cases of ill–well and well–ill clients and examples of wellness nursing diagnoses are included lo emphasize the need for wellness diagnoses across the wide scope of nursing practice. Nurses are challenged lo generate, research, and use wellness diagnoses in their practices.
Exploring NANDA's Definition of Nursing Diagnosis: Linking Diagnostic Judgments with the Selection of Outcomes and Interventions
Authors: Pinkley Connie L.
Published: February 2008

Nursing diagnoses are described by definition as the basis for selection of interventions to achieve health outcomes. Processes used to link diagnostic judgments with desired outcomes and interventions can be holistic or reductionistic. A model of clinical inference is presented to illustrate the interrelated nature of judgments about diagnoses, desired outcomes, and interventions. Implications for development of diagnostic and taxonomic tools to guide holistic judgments are explored.
Classification of Nursing Interventions for Care of the Integument
Authors: Titler Marita G. , Pettit Debra , Bulechek Gloria M. , McCloskey Joanne C. , Craft Martha J. , Cohen Marlene Z. , Crossley John D. , Denehy Janice A. , Glick Orpha J. , Kruckeberg Thomas W. , Maas Meridean L. , Prophet Colleen M. , Tripp–Reimer Toni
Published: February 2008

The Classification of Nursing Interventions research team at The University of Iowa, College of Nursing is building a taxonomy of nursing interventions that will include all of the direct care treatment activities that nurses perform on behalf of patients. This report describes the study in which 12 nursing interventions and their associated activities for care of the integument were extracted from a large database and validated through a two‐round Delphi survey. Using an adaptation of Fehring's model for determining diagnostic content validity of nursing diagnoses, a definition, critical activities, and supporting activities were developed for each of the following interventions: Bathing, Bedrest Care, Hair Care, Nail Care, Oral Health Maintenance, Oral Health Promotion, Oral Health Restoration, Positioning, Pressure Management, Skin Care–Topical Treatments, Skin Surveillance, and Wound Care. Further research is needed to validate supporting activities and to continue classifying interventions and activities that nurses use in treating impaired skin integrity (potential and actual) and altered oral mucous membrane integrity (potential and actual).
Multinational Validation of Anxiety, Hopelessness, and Ineffective Airway Clearance
Authors: Fehring Richard J. , Fadden Teresa , Wake Madeline Musante
Published: February 2008

The effective use of nursing diagnosis internationally depends in part on incorporating language and cultural difference into the common language of nursing. International validation studies can provide a basis for this effort. This study tested three diagnoses—anxiety, hopelessness. and ineffective airway clearance— through multinational validation. The Diagnostic Content Validity (DCV) model was used to collect data from critical care nurses in six countries. Defining characteristics rated as critical (> 80) by the total sample were dyspnea for ineffective airway clearance and panic and nervousness for anxiety. No critical defining characteristics for hopelessness were identified. DCV ratios for all defining characteristics are compared by country.
Development and Content Validity Testing of a Comprehensive Classification of Diagnoses for Pediatric Nurse Practitioners
Authors: Burns Catherine
Published: February 2008

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 l=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.
Examination of Nursing Diagnoses for Adults Hospitalized with Acquired Immunodeficiency Syndrome, 1982–1990
Authors: Smith Amy Rex
Published: February 2008

The literature on nursing care of the hospitalized adult with acquired immunodeficiency syndrome (AIDS) from 1982 to the present was examined, and 16 formal care plans were extracted. The nursing care plans were examined for commonalities of identified nursing diagnoses, which were then tabulated according to frequency. Analysis of the types of problems addressed shows that five of the nine highest‐frequency problems were physiologic (altered nutrition: less than body requirements, respiratory problems, impaired skin integrity, diarrhea, potential for infection). The other four problems were cognitive (altered thought processes), safety (potential for injury), social (social isolation), and a combination of physiologic and cognitive (pain). Validation of nursing diagnoses is needed as a solid foundation for nursing intervention research in the care of patients with AIDS.
Nursing Diagnoses and Functional Health Patterns in Patients Receiving External Radiation Therapy: Cancer of the Head and Neck
Authors: Woodtli M. Anne , Ort Suzanne Van
Published: February 2008

A descriptive study using clinical methods was conducted to identify and describe core and site‐specific symptoms reported by 15 patients with canter of the head or neck who received external radiation therapy. A 45‐item Radiation Symptom Scale (RSS) was designed by the investigators for this study. Symptoms identified by patients with a mean occurrence of at least “sometimes” were considered potential defining characteristics and were submitted to a panel of experts for identification of nursing diagnoses. Eighteen nursing diagnoses with their associated defining characteristics were identified and classified within eight Functional Health Patterns. Half of the nursing diagnoses were formulated within the Nutritional‐Metabolic and Activity‐Exercise health patterns. Four of the health patterns were primarily physiologic; four were primarily psychologic‐behavioral. Results of the study describe the nursing needs of patients who receive radiotherapy to the head and neck and are formulated within a nursing diagnosis/Functional Health Pattern framework. These findings have implications for nursing assessment, nursing interventions, and evaluation of patient outcomes, and findings provide a beginning empiric basis for identifying nursing diagnoses and their associated defining characteristics for cancer patients who receive external radiation therapy.
Staff Nurse Identification of Nursing Diagnosis from a Written Case Study
Authors: Etheridge Sharon , Bos Sara , Bos Nathan
Published: February 2008

A descriptive study was conducted to determine whether staff nurses identified the same nursing diagnoses and defining characteristics from a written case study. A convenience sample of 83 staff nurses from four acute care institutions participated in the study. Of the total diagnostic statements made, 43% were the same as those identified by an expert panel. Only three nurses (3.6%) correctly identified all five nursing diagnoses. An additional seven (8.4%) nurses correctly identified four of the five nursing diagnoses. The demographic characteristics of these nurses were varied. There was no statistical relationship between any of the demographic variables and the ability to correctly identify the nursing diagnoses.
Inadvertent Hypothermia: Clinical Validation in Postanesthesia Patients
Authors: Summers Sharon
Published: February 2008

The nursing diagnosis of hypothermia contains a variety of defining characteristics and an inconsistency in an exact temperature measurement for this diagnosis. A review of the literature from surgery, anesthesiology, and physiology identified criteria for three types of hypothermia: inadvertent, accidental, and intentional. In addition to the three types, three different core temperatures were given to facilitate medical diagnosis of these types. This study examines inadvertent hypothermia in postanesthesia patients. The findings indicated that inadvertent hypothermia characteristics are distinctly different from the global nursing diagnosis of hypothermia. Future studies are recommended to confirm the findings from this study and to validate accidental and intentional types of hypothermia.
Decreased Cardiac Output in the Critical Care Setting
Authors: Kern Leslie , Omery Anna
Published: February 2008

The specific aim of this exploratory, descriptive study was to demonstrate that the nursing diagnosis, decreased cardiac output, contains at least seven separate and specific components. Forty critical care nurses completed a questionnaire about seven different case studies, or vignettes. Each vignette reflected one of the following: myocardial injury, arrhythmias, decreased preload, myocardial ischemia, increased afterload, drug effects, and cardiac surgery alterations. Mean scores were used to validate the specific subcategories. Analyses of variance were used to demonstrate statistically significant differences among them. Six of the labels were supported, providing preliminary evidence for the validity of these components of decreased cardiac output.
Axes: Focus of Taxonomy II
Authors: Hoskins Lois M. , Kerr Mary E. , Fitzpatrick Joyce J. , Warren Judith J. , Avant Kay , Carpenito Lynda Juall , Hurley Mary E. , Jakob Dorothea , Lunney Margaret , Mills Winnifred C. , Rottkamp Barbara C.
Published: February 2008

A number of persistent issues in the nursing diagnosis community have challenged the ability of one nursing diagnosis taxonomy to account for nursing's practice. The North American Nursing Diagnosis Association (NANDA) Taxonomy Committee, charged with the preparation of one taxonomy for all, has struggled with some of these issues and has initiated dcvelopment of axes. The issues, figuratively speaking, become the axes. The axes are intended to describe the dimensions of the human condition. This article, third in a series of four, describes the process and development of the proposed axes.
Toward Further Understanding of Nursing Diagnosis: An Interpretation
Authors: Briody Margaret E. , Carpenito Lynda J. , Jones Dorothy A. , Fitzpatrick Joyce J.
Published: February 2008

Editor's Note: The position article that follows was prepared for presentation to the NANDA Board of Directors and represents the opinions of the individual authors. It is not the official view of the NANDA Board of Directors as a group. The article is presented to stimulate discussion of this important topic. Papers discussing alternate views are welcome.
Nursing Diagnoses and Functional Health Patterns in Patients Receiving External Radiation Therapy: Cancer of the Digestive Organs
Authors: Woodtli M. Anne , Ort Suzanne Van
Published: February 2008

A descriptive study using clinical methodology was conducted to identify and describe core and site‐specific symptoms reported by 15 patients with cancer of the digestive organs who received external radiation therapy. A 47‐item Radiation Symptom Scale was designed by the investigators for this study. Symptoms identified by patients with a mean occurrence of at least “sometimes” were considered potential defining characteristics and were submitted to a panel of experts for identification of nursing diagnoses. Seventeen nursing diagnoses, with their associated defining characteristics, were identified and classified within eight Functional Health Patterns (FHP). Half of the nursing diagnoses were formulated within the Nutritional‐Metabolic and Elimination patterns. Four of the FHPs were related to primarily functional patterns; four were primarily psychological‐behavioral. Results of the study describe the nursing needs of patients who receive radiotherapy to the digestive organs.
Validation of Social Isolation Related to Maturational Age: Elderly
Authors: Lien‐Gieschen Teresa
Published: February 2008

The purpose of this study was to obtain expert validation of the defining characteristics used when diagnosing social isolation in the elderly and to compare these characteristics with those identified in the NANDA Taxonomy I Revised (1990) and the characteristics identified by the investigator through a literature review. A descriptive survey design using Fehring's Diagnostic Content Validity Model and a Q‐Sort methodology was used. The sample consisted of 300 registered nurses (68% response rate) selected randomly from the ANA's Council of Gerontology and Community Health. Findings suggest the need for clinical validation of this diagnosis and the possible need for the addition of developmental age categories to the defining characteristics of social isolation.
Nursing Diagnosis: The Central Theme in Nursing Knowledge
Authors: Wooldridge Judith B. , Brown Opal F. , Herman JoAnne
Published: February 2008

The author's purpose is to argue that theory development involving nursing diagnoses is a central element in the development of nursing knowledge. Nursing diagnosis is viewed as a way of conceptualizing the domain of nursing when human responses are viewed as a nursing focus. Differing views from the literature on what should be the central focus of nursing are presented. These authors conclude that nursing's growth as a science can be facilitated by taxonomy development as nursing diagnoses delineate nursing's unique domain. The importance of theory development surrounding nursing diagnoses is explored and ideas on how theory development might proceed are presented. Ultimately, theory supporting nursing diagnoses must account for description, explanation, prediction, and control of phenomena that nurses autonomously treat. Theory development associated with nursing diagnoses will help develop the unique knowledge base of the discipline of nursing.
Validation of the Defining Characteristics of Altered Sexuality Patterns
Authors: LeMone Priscilla
Published: February 2008

Human sexuality is a complex and multifaceted phenomenon that encompasses physical, psychological, and social components. The nursing diagnosis altered sexuality patterns labels the human response to alterations in sexuality that occur as the result of various health problems. This validation of the defining characteristics of the diagnosis was based on a substantive theory derived from a qualitative grounded theory study. In the original study, data from 11 adult insulin‐dependent diabetics living in a rural area of the Midwest were analyzed and relevant experiences conceptualized through the core concept of transforming and the supporting concepts of valuing self and meeting intimacy needs. The theory was then used as a framework to formulate specific defining characteristics for the nursing diagnosis. A single diagnosis of altered sexuality has emerged that encompasses the perception of change in sexuality as well as the change itself.
New Diagnosis: Interrupted Breastfeeding
Authors: Henrikson Mary L. , Wall Ginna A. , McClurg Vicki E. , Lethbridge Donna
Published: February 2008

Interrupted breastfeeding was approved by the membership to be added to the NANDA taxonomy in 1992. The diagnosis was developed to name the response that occurs when a breastfed baby cannot be put to breast for some or all of the feedings. Two examples of life processes/events, premature or sick infant and maternal employment, illustrate the application and use of the diagnosis. Nursing interventions for each situation are discussed. A comparison describing the differences between interrupted breastfeeding and ineffective breastfeeding is included to address the controversy of whether or not the diagnoses are the same. A sample diagnosis/care plan is added to demonstrate use of the diagnoses in clinical practice.
The Relationships Among Nursing Diagnoses in Discharge Planning for Patients With Lung Cancer
Authors: Sheppard Kathleen C.
Published: February 2008

An explanatory study was designed to investigate whether nursing diagnoses present at discharge from the hospital accurately describe the complexity of care required in the community. A sample of 196 patients with lung cancer referred to community agencies at discharge was described by types of nursing diagnoses; types of agencies needed and services required; and by age, gender, race, economic status, and hospital length of stay. Using multiple logistic regression, a model for home care referral resulted in four significant predictor diagnoses: altered nutrition: less than body requirements, bathing/hygiene self‐care deficit, high risk for infection, and high risk for injury. The model for hospice referral resulted in four significant predictor diagnoses: anticipatory grieving, impaired skin integrity, high risk for impaired skin integrity, and pain. The data suggest that the nursing diagnoses described the discharge planning needs, which predicted the type of agency referral needed.
Expert Validation and Differentiation of the Nursing Diagnoses Anxiety and Fear
Authors: Whitley Georgia Griffith
Published: February 2008

In this study, the author (a) identifies and validates critical and supportive characteristics of the nursing diagnosis anxiety, and (b) differentiates the defining characteristics of the nursing diagnosis anxiety from the nursing diagnosis fear. The sample consisted of 233 nurses with a master's degree in psychiatric‐mental health nursing or medical‐surgical nursing. The study design followed the nurse validation model of Gordon and Sweeney (1979) as expanded by Fehring (1986, 1987). Following concept analyses of anxiety and fear, the author developed three instruments for rating characteristics as to how representative they were of fear or anxiety. Three critical defining characteristics were identified for anxiety and six critical defining characteristics were identified for fear. Nurses differentiated between the two diagnoses but also suggested the presence of a fear‐anxiety syndrome in some clients.
Predicting Violence: Nursing Diagnosis Versus Psychiatric Diagnosis
Authors: Lanza Marilyn Lewis , Kayne Herbert L. , Pattison Ivor , Hicks Carol , Islam Shaheen
Published: February 2008

Predicting violent behavior is a major concern for nurses as well as other mental health professionals. Two diagnostic assessment systems (Nursing Diagnosis‐NANDA and Psychiatric Diagnosis‐DSM III‐R) were compared in their ability to predict assaultive behavior. The nursing diagnosis potential for violence suggested a difference (p= .07) between the assaultive and control subjects. No differences were found between assaultive and control subjects on psychiatric diagnoses. Nursing diagnosis is based upon measurable behaviors and is time specific. Clinical implications and further research endeavors in this area are suggested.
Altered Thought Processes and Sensory / Perceptual Alterations: A Critique
Authors: Hancock Catherine Kedy , Munjas Barbara , Berry Katherine , Jones Jacquelyn
Published: February 2008

Concerns about the clinical usefulness of altered thought processes and sensory/perceptual alterations— and the resulting avoidance of these two diagnoses—led to a study to determine how expert nurses differentiate between the diagnoses and how the diagnoses are used in practice. The authors developed a questionnaire and mailed it to 128 members of NANDA who had identified themselves as experts in the diagnoses; sixty‐six (52%) responded. Conclusions were that the defining characteristics for altered thought processes were cognitively oriented and those for sensory/perceptual alterations were perceptually oriented. The overlap of defining characteristics, such as change in problem‐solving ability, makes differential diagnosis a difficult task.
Using Metacognitive Skills: The Quality Audit Tool
Authors: Herman JoAnne , Pesut Daniel J. , Conard Laura P.
Published: February 2008

The authors describe a strategy used to teach clinical reasoning skills to novice diagnosticians. The strategy proposed is the Quality Audit Tool, an instrument designed to help novices use metacognitive skills to critique diagnostic statements and care plans. The Quality Audit Tool has eight frames (Diagnostic Statement, Diagnostic Cues, Functional Relationship, Outcome, Etiology, Nursing Orders, Evaluation, and Clinical Judgment); each frame has a content and process focus. Conducting a Quality Audit enables the novice diagnostician to understand relationships among the parts of a nursing diagnosis, recognize the metacognitive skills used in clinical reasoning, and evaluate knowledge and clinical reasoning against a set of standards.
Functional Health Patterns: A Curricular Course Model for Adult Acute Care
Authors: Vincenz Mary C. , Siskind Michele M.
Published: February 2008

The Functional Health Pattern (FHP) model is a categorization of 11 areas that assist in diagnosing human responses to illness and identifying risk factors for dysfunctional health. The incorporation of this model as a content organizer in a beginning medical‐surgical course in a baccalaureate curriculum is presented as an effective method of familiarizing students with the application of the nursing process. This model permits the student nurse to identify FHPs (client strengths) and dysfunctional patterns (nursing diagnoses).
Nurse Practitioners' Use of Nursing Diagnosis
Authors: Martin Kathleen
Published: February 2008

The role of the nurse practitioner (NP) represents a unique blend of nursing and medical functions. Few studies exist that address the nursing component of the NP role and no literature is available to document the extent to which nurse practitioners utilize nursing diagnoses in their clinical practice. Thus, the author reports findings of a study that sought to describe the use of nursing diagnosis in current NP practice and to identify advantages and barriers to the use of nursing diagnoses by NPs. Fifteen percent of nurses surveyed used nursing diagnoses in their practice. The diagnoses most commonly used reflected attention to clients' lifestyles and daily living problems.
Mixed Incontinence: A New Nursing Diagnosis?
Authors: Woodtli Anne
Published: February 2008

Consistent efforts to identify and clinically validate new nursing diagnosis within recognized categories are essential to taxonomy development. Mixed incontinence is a clinical condition resulting in leakage of urine associated with increased intra‐abdominal pressure (stress) and inability to delay voiding (urge). The presence of mixed incontinence was clinically validated in two populations (n = 9, n = 40) of community‐dwelling women and initial defining characteristics were identified. Research findings from both studies support the addition of a proposed sixth nursing diagnosis, mixed incontinence, to the diagnostic category, alteration in urinary elimination.
Validation of the Defining Characteristics of the Nursing Diagnosis Ineffective Airway Clearance
Authors: Brukwitzki Genee , Holmgren Cynthia , Maibusch Regina Marie
Published: February 2008

The investigators designed this validation study to determine the defining characteristics of the nursing diagnosis ineffective airway clearance. Using Fehring's Diagnostic Content Validity Model, 546 nurses who care for respiratory clients validated one major and 19 minor defining characteristics. Nine characteristics previously described in the literature were eliminated. Clarification of the defining characteristics of this diagnosis improves communication in practice, education and research.
Validation Study for Impaired Personal Boundaries, Proposed Nursing Diagnosis
Authors: Hoover Sister Dorothy , Norris Joan
Published: February 2008

The authors propose a new nursing diagnosis of impaired personal boundaries based on their experience in psychiatric nursing, a concept analysis of the literature and diagnostic content validation by a panel of experts. Impaired personal boundaries are common in a number of mental disorders including, schizophrenia, borderline personality, substance abuse and enabling. Recognition of this patient problem has implications for further research and nursing interventions.
Reconceptualization of the Nursing Diagnosis Decreased Cardiac Output
Authors: Dougherty Cynthia M.
Published: February 2008

TOPIC. The parameters of the diagnoses decreased cardiac output.

PURPOSE. To propose an alternative conceptual structure for cardiac output that links conceptual parameters with clinical and hemodynamic data.

SOURCE. Past discussions and research investigations

CONCLUSION. Careful analysis illustrates several diagnoses are contained within cardiac output at differing levels of abstraction. Testing of the model, including linking diagnoses with nursing interventions and outcomes, is suggested.
Use of Nursing Diagnosis in China—Measures and Thoughts on Education of Nursing
Authors: Zhu Feng‐Rong , Zhang Xiao‐Hong , Lu Mei‐Na , Ma Wen‐Ling
Published: February 2008

“Where Are We Now?” is an occasional feature in Nursing Diagnosis. The column focuses on current issues and trends related to nursing diagnosis development, implementation, and evaluation. The writing in this issue describes use of nursing diagnosis in China, and provides a perspective on the international use of the taxonomy. The authors describe introduction of nursing diagnoses content in their school of nursing.
Impaired Verbal Communication During Short‐Term Oral Intubation
Authors: Fowler Susan B.
Published: February 2008

PURPOSE.
To describe the experience of impaired verbal communication during short‐term oral intubation in surgical critical care patients.

METHODS.
Semi‐structured interviews(N=10)

FINDINGS.
Patients identified feelings related to discomfort, fear, and frustration. Patients desired to communicate messages regarding pain and discomfort, difficulty breathing, length of intubation, use of restraints, family, physical status, and suctioning.

CONCLUSION.
Findings can be used to educate patients and families and develop patient‐driven communication tools.
Cognitive Development, Clinical Knowledge, and Clinical Experience Related to Diagnostic Ability
Authors: Aquilino Mary Lober
Published: February 2008

PURPOSE.
To examine the relationship among cognitive development, clinical knowledge, and clinical experience in nursing students.

METHODS.
A survey of junior and senior baccalaureate nursing students from three Midwestern colleges (N = 55).

FINDINGS.
Students' diagnostic ability increased as they gained clinical experience and clinical knowledge. However, students failed to identify many nursing diagnoses and demonstrated only moderate levels of cognitive development.

CONCLUSIONS.
Nurse educators and nursing students need to change their approaches to teaching and learning to enhance students' diagnostic ability and cognitive development.
Predictive Power of Clinical Indicators for Self‐Care Deficit
Authors: Chang Betty L. , Uman Gwen C. , Hirsch Maureen
Published: February 2008

PURPOSE. To describe the predictive power of a set of the best clinical indicators for the nursing diagnostic labels self‐care deficit (SCD) and impaired physical mobility.

METHODS. Patient assessment data (physical examination and interview) were obtained from 414 hospitalized patients.

FINDINGS. Patients with the diagnostic label of self‐care deficit were significantly older in age, had a greater number of nursing diagnoses, required greater assistance in activities of daily living, and were less mobile than those without the diagnostic label. While 18 of 32 clinical indicators were positively related to self‐care deficit, five clinical indicators were sufficient to diagnose SCD.

CONCLUSIONS. Further development of the method may be useful in improving diagnostic accuracy and efficiency of nursing diagnoses.
The Influence of Nursing Diagnosis on Information Processing by Undergraduate Students
Authors: Cruz Diná de Almeida Lopes Monteiro da , Arcuri Edna Apparecida Moura
Published: February 2008

PURPOSE. To examine the influence of a nursing diagnosis course on the information processing by undergraduate students.

METHODS. A quasi‐experimental study conducted with two groups (experimental, n = 15; control, n = 22) of undergraduate nursing students, subjecting only one to a nursing diagnosis course. The students' ability to identify, cluster, and name clusters of relevant data were compared between and within groups.

FINDINGS. After the course, the experimental group performed better than the control group in the three activities studied.

CONCLUSIONS. The results of this study suggest that the nursing diagnosis content in teaching favors clinical reasoning to determine the patient's nursing care.
Nursing Diagnoses and Interventions for Post‐Acute‐Phase Battered Women
Authors: Carlson‐Catalano Judy
Published: February 2008

PURPOSE.To identify nursing diagnoses and interventions applicable for post‐acute‐phase battered women.

METHODS.Eight battered women were interviewed twice for 2 hours. Gordon's functional health patterns provided the framework for data collection.

FINDINGS.Fifty‐three nursing diagnoses and 52 nursing interventions were indicated in the data; 24 nursing diagnoses and 26 nursing interventions were present in all participants' data.

CONCLUSIONS.With the use of comprehensive interventions, nurses can make a major contribution to society by enabling battered women to move to a more protected lifestyle.
Nursing Diagnosis in the International Classification for Nursing Practice (ICNP)
Authors: Wake Madeline , Coenen Amy
Published: February 2008

TOPIC.International Classification for Nursing Practice (ICNP) Classification of Nursing Phenomena.

PURPOSE.Provide a historical review of nursing diagnosis in the developing ICNP.

SOURCES.Literature, meeting notes, and experience.

CONCLUSION.The development of the ICNP has benefited from contributions of many. Continued refinement depends on participation of nurses globally.
Moving Beyond Content Validation of Nursing Diagnoses
Authors: Parker Laurence , Lunney Margaret
Published: February 2008

TOPIC.Studies to establish construct and criterion‐related validity of nursing diagnoses.

PURPOSE.The overwhelming majority of previous studies addressed content validation by nurse experts. This paper describes strategies to move beyond content validation research to construct and criterion‐related validation.

SOURCES.The range of studies that should be conducted for development of nursing diagnoses are reviewed with examples drawn from the field of psychology. Existing studies on the diagnoses of ineffective breathing pattern, ineffective airway clearance and impaired gas exchange are used as examples.

CONCLUSIONS.Many types of studies are needed for each nursing diagnosis. Increased funding and support for nursing diagnosis research will be facilitated by attention to the accuracy of nurses' diagnoses and outcomes of the diagnostic process.
Marketing Nursing in a Nurse Practitioner Practice
Authors: Carlson‐Catalano Judy , Judge M. Kay M.
Published: February 2008

This issue of our journal contains the inaugural column of a new feature. When the Editorial Board of the journal met in St. Louis at NANDA's 25th year anniversary celebration, we discussed strategies to further spread the word that nursing diagnosis is alive, well, and at work daily in clinical settings. The idea for this column was born, and it will appear regularly from now on.

I can think of no better beginning than the one Dr. Judy Carlson‐Catalano has given us. Dr. Catalano not only uses nursing diagnosis in her private nursing practice; she uses nursing diagnosis to advertise her work. I invite you to read and enjoy the first column of Nursing Diagnosis at Work. MKMJ.
Concept Analysis of Relating: A Human Response Pattern
Authors: Lamb Margaret Anne
Published: February 2008

TOPIC.
An investigation of relating, one of the nine human response patterns, used as the conceptual basis for the classification of nursing diagnoses.

PURPOSE.
A formal linguistic analysis of each of the nine human response patterns is warranted in order to allow a continuation of the exploration, definition, and development of research‐based practice based on the NANDA framework.

SOURCE.
“Human Response Patterns” developed by NANDA, historical foundations of the concept of relating, the use of this construct by nursing and other disciplines.

CONCLUSIONS.
Concept analysis of relating resulted in conceptual and operational definitions. The efficacy of further developing nursing's taxonomic tree on the nine human response patterns has been advanced.
Validation of the Defining Characteristics of Body Image Disturbance in Japan
Authors: Ogasawara Chie , Matsuki Mitsuko , Egawa Takako , Ohno Yuko , Masutani Eiko , Yamamoto Yuko , Kume Yasuko
Published: February 2008

PURPOSE.
To examine the validity of the nursing diagnosis body image disturbance and to specify its major and minor defining characteristics in Japanese culture.

METHODS.
A qualified sample of 149 RNs with an average of 10 years of clinical experience and knowledge of nursing diagnosis was given a questionnaire consisting of 21 defining characteristics from NANDA, 8 additional items from the literature, and 2 distracting characteristics.

FINDINGS.
Four major diagnostic content validation (DCV) scores of 0.75 and higher and 15 minor defining characteristics with DCV scores from 0.60 to 0.74 were identified.

CONCLUSIONS.
This study provides a foundation for further study of culturally appropriate defining characteristics for use in Japan.
Notes on NDEC: Nursing Diagnosis Extension and Classification (NDEC) Report
Authors: Craft‐Rosenberg Column Editor: Martha , Craft‐Rosenberg Martha , Delaney Connie , Denehy Janice
Published: February 2008

This marks the beginning of a new column, Notes on NDEC. This column will appear in each issue to describe the work of the Nursing Diagnosis Extension and Classification (NDEC) research team. We hope you will read it carefully and send your responses to the principal investigator of NDEC, Martha Craft‐Rosenberg, at the University of Iowa College of Nursing (martha-craft-rosm-berguicmn.edu) or to the Editor (jsimon6721aol.com). Your responses will facilitate an open dialogue on conceptual and methodological issues in nursing diagnosis.

This first column reports on the work completed by Spring 1998, the work in progress, and the work planned for the future. We are pleased to provide these Notes on NDEC. MCR.
A Review of the Use of Nursing Diagnosis in U.S. Nurse Practice Acts
Authors: Lavin Mary Ann , Meyer Geralyn , Carlson Judith H.
Published: February 2008

PURPOSE.
To determine how many state nurse practice acts include the term or concept of “nursing diagnosis” and describe their similarities and differences.

METHODS.
Investigators independently divided the practice acts of the 50 states and the District of Columbia into those that did or did not include the term “nursing diagnosis” or the word “diagnosis” within a nursing context. To describe other differences, the investigators operationally defined and independently categorized each act as trendsetting, contemporary, or traditional.

FINDINGS.
Thirty‐three of the 51 practice acts used the term “diagnosis” within nursing context. Of these 33, 13 were identified as trendsetters and 20 as contemporary. Seven trendsetting and 5 contemporary practice acts used the NANDA‐based language or “response” when describing the “what” of nursing diagnosis. None of the trendsetting practice acts, but 8 of the contemporary acts, used the NANDA‐based “individual, family or community” when describing the “who” of nursing diagnosis.

CONCLUSIONS.
The language of nursing is changing. The majority of practice acts now define the practice of professional nursing as including the diagnostic act, although the manner in which they use the term varies.