Nursing contribution to ineffective protection in hemodialysis patients

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The aim of this study was to evaluate the clinical validity of indicators of the nursing diagnosis of “ineffective protection” in hemodialysis patients” de Sá Tinôco et al (2017).

Abstract:

AIMS AND OBJECTIVES: The aim of this study was to evaluate the clinical validity of indicators of the nursing diagnosis of “ineffective protection” in hemodialysis patients.

BACKGROUND: Hemodialysis patients have reduced protection. Studies on the nursing diagnosis of “ineffective protection” are scarce in the literature. The use of indicators to diagnose “ineffective protection” could improve the care of hemodialysis patients. The clinical usefulness of the indicators requires clinical validation.

DESIGN: This was a diagnostic accuracy study.

METHOD: This study assessed a sample of 200 patients undergoing hemodialysis in a reference clinic for nephrology during the first half of 2015. Operational definitions were created for each clinical indicator based on concept analysis and content validation by experts for these indicators. Diagnostic accuracy measurement was performed with latent class analysis with randomized effects.

RESULTS: The clinical indicator of “fatigue” had high sensitivity (p = 0.999) and specificity (p = 1.000) for the identification of “ineffective protection”. Additionally, “maladaptive response to stress” (p = 0.711) and “coagulation change” (p = 0.653) were sensitive indicators. The main indicators that showed high specificity were “fever” (p = 0.987), “increased number of hospitalizations” (p = 0.911), “weakness” (p = 0.937), “infected vascular access” (p = 0.962) and “vascular access dysfunction” (p = 0.722).

CONCLUSION: A set of nine clinical indicators of “ineffective protection” were accurate and statistically significant for hemodialysis patients. Three clinical indicators showed sensitivity, and six indicators showed specificity.

RELEVANCE TO CLINICAL PRACTICE: Accurate measures for nursing diagnoses can help nurses confirm or rule out the probability of the occurrence of “ineffective protection” in patients undergoing hemodialysis

Reference:

de Sá Tinôco, J.D., de Paiva, M.D.G.M.N., de Queiroz Frazão, C.M.F., Lucio, K.D.B., da Conceição Dias Fernandes, M.I., de Oliveira Lopes, M.V. and de Carvalho Lira, A.L.B. (2017) Clinical validation of the nursing diagnosis of ineffective protection in hemodialysis patients. Journal of Clinical Nursing. June 15th. [Epub ahead of print].

doi: 10.1111/jocn.13915.

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