Content analysis of nursing diagnoses related to urinary incontinence

Methodological study conducted with judges who were experts in urinary dysfunctions and nursing diagnosis. The analysis included diagnoses of Stress Urinary Incontinence, Urgency Urinary Incontinence, Functional Urinary Incontinence, Urinary Incontinence due to Neurogenic Detrusor Overactivity (previously denominated Reflex Urinary Incontinence in NANDA International’s taxonomy), Mixed Urinary Incontinence, and Transient Urinary Incontinence. Wilcoxon test was applied and Content Validity Index ≥ 0.85 was considered appropriate.

Results

Fifty-one judges participated in this study. The judges recommended modifications in elements of all diagnoses (inclusion, exclusion or change of previous element type).

Conclusion

The four diagnoses analyzed in NANDA International’s taxonomy are recommended to be maintained with modifications; inclusion of nursing diagnoses Mixed and Transient Urinary Incontinence is also recommended.

Urinary Incontinence; Nursing Diagnosis; Classification; Terminology; Validation Studies

Item	CVI	CI 95%	Wilcoxon Test
Item	CVI	CI 95%	V	p-value
Stress Urinary Incontinence
DC: Urine loss with effort (exclusively or predominantly)	1.000	1.000-1.000	4095	1.000
DC: Absent or small residue after urination	0.500	0.500-0.625	253	<0.001
DC: Urine loss with no symptoms of bladder storage	0.750	0.625-0.750	666	<0.001
DC: Loss of small amounts of urine	0.750	0.625-0.750	741	<0.001
RF: Pelvic floor muscle weakness or less effective pelvic floor muscle contraction	1.000	1.000-1.000	3741	0.998
RF: Any factor leading to higher intra-abdominal pressure associated to some physiological abnormality (muscle or nerves)	0.875	0.875-1.000	2556	0.141
RF: Muscle trauma or lesion due to denervation	0.875	0.875-0.875	2080	0.005
RF: Medication side-effects	0.750	0.750-0.750	406	<0.001
AC: Weakness or damage in muscles and connective tissue of the pelvic floor	1.000	1.000-1.000	4095	1.000
AC: Non-neurogenic causes of pelvic floor or urethral sphincter lesion	0.875	0.875-0.875	2016	0.003
AC: Urethral sphincter weakness or relaxation due to lesion or neurologic disease	0.875	0.875-0.875	1830	<0.001
AC: Vaginal or vulvar atrophy	0.750	0.750-0.750	703	<0.001
RP: Men ≥ 60 years-old	1.000	1.000-1.000	4465	1.000
RP: Women who had vaginal birth	0.875	0.750-0.875	1596	<0.001
RP: Multiparous	0.875	0.875-0.875	1953	0.001
RP: Men after prostatectomy	1.000	0.875-1.000	2926	0.549
RP: People with excess body weight	0.875	0.750-0.875	1035	<0.001
RP: White women	0.500	0.500-0.625	171	<0.001
RP: Men with abdominal obesity	0.750	0.625-0.750	435	<0.001
RP: People with a history of previous pelvic surgery	0.750	0.750-0.750	703	<0.001

Item	CVI	CI 95%	Wilcoxon Test
Item	CVI	CI 95%	V	p-value
Urgency Urinary Incontinence
DC: Urgency	1.000	1.000-1.000	4656	1.000
DC: Urine loss between varied amounts of urination, associated with urgency	0.875	0.750-0.875	1540	<0.001
DC: Increased Urinary frequency	0.875	0.750-0.875	1431	<0.001
DC: Nocturia	0.750	0.750-0.875	946	<0.001
DC: Decreased bladder capacity	0.875	0.750-0.875	1326	<0.001
DC: Small or absent residual after urination	0.625	0.500-0.625	231	<0.001
DC: Presents adaptive behavior due to urgency	0.750	0.750-0.750	595	<0.001
DC: Urgency sensation triggered by stimuli	0.875	0.875-0.875	1830	<0.001
RF: Pelvic floor weakness	0.875	0.875-0.875	2145	0.009
RF: Tobacco usage	0.625	0.500-0.625	210	<0.001
RF: Restricted/impaired mobility	0.750	0.625-0.750	561	<0.001
RF: Adverse effects from medication (polyuria): diuretics, especially rapid action agents	0.875	0.750-0.875	903	<0.001
RF: Chronic constipation	0.750	0.625-0.750	300	<0.001
RF: Pelvic organs prolapse	0.875	0.875-0.875	1378	<0.001
RF: Bladder overactivity syndrome	1.000	1.000-1.000	3828	0.999
RF: Excessive ingestion of liquids	0.750	0.625-0.750	630	<0.001
RF: Consumption of alcohol, caffeine, and carbonated beverages	0.750	0.750-0.875	903	<0.001
RF: Constraints on ingestion of liquids	0.500	0.375-0.500	210	<0.001
AC: Diminished capability to deal with afferent signals in the brain and abnormal increased afferent signals from bladder and/or urethra	0.875	0.875-0.875	2145	0.009
AC: Bladder abnormality or inflammation (such as tumors, calculi, interstitial cystitis, painful bladder syndrome, infections or after radiotherapy)	1.000	0.875-1.000	3081	0.736
AC: Vascular insufficiency and cardiac disease (congestive cardiac insufficiency)	0.625	0.625-0.750	171	<0.001
AC: Estrogen deficiency with vaginal or vulvar atrophy	0.750	0.750-0.750	351	<0.001
AC: Altered mental health (anxiety, depression, postpartum depression, sexual, physical, and emotional abuse)	0.750	0.750-0.875	820	<0.001
AC: Diabetes	0.875	0.750-0.875	1225	<0.001
AC: Infravesical obstruction	0.750	0.750-0.875	1081	<0.001
AC: Medication side-effects: Cholinesterase inhibitors	0.875	0.750-0.875	903	<0.001
AC: Impaired bladder emptying	0.875	0.750-0.875	1128	<0.001
AC: Sleep disorders (sleep apnea, periodic leg movements)	0.500	0.500-0.625	120	<0.001
RP: Elderly individuals and increased age	1.000	0.875-1.000	2926	0.549
RP: Race/ethnicity	0.625	0.500-0.625	276	<0.001
RP: Female gender: reproductive factors	0.875	0.875-0.875	1485	<0.001
RP: Obese people	0.750	0.750-0.875	820	<0.001

Item	CVI	CI 95%	Wilcoxon Test
Item	CVI	CI 95%	V	p-value
Urinary Incontinence Due to Neurogenic Detrusor Overactivity
DC: Reflex Urination	1.000	0.875-1.000	2926	0.549
DC: Prophylactic Urination	0.750	0.625-0.750	666	<0.001
DC: Looking for a toilet immediately when arriving at a new place	0.625	0.500-0.625	351	<0.001
DC: Drinking less liquid due to bladder control problems	0.750	0.750-0.750	1035	<0.001
DC: Choosing clothes that do not show urine loss	0.625	0.500-0.625	231	<0.001
DC: Avoiding sexual intimacy	0.625	0.625-0.750	231	<0.001
DC: Urination induced by electrical stimulation of sacral roots or catheterization	0.875	0.750-0.875	2145	0.009
DC: Frequent loss of small amounts of urine	0.875	0.875-0.875	2145	0.009
RF: Neurogenic Detrusor Overactivity	1.000	1.000-1.000	4656	1.000
RF: Detrusor Sphincter Dyssynergia	1.000	0.875-1.000	3403	0.955
RF: Bladder hypersensitivity	0.875	0.875-1.000	2628	0.199
RF: Decreased bladder compliance	0.875	0.875-1.000	2701	0.272
RF: Consumption of alcohol, caffeine, and carbonated beverages	0.750	0.625-0.750	561	<0.001
RF: Excessive ingestion of liquids	0.625	0.500-0.625	435	<0.001
RF: Constraints on ingestion of liquids	0.500	0.500-0.625	300	<0.001
RF: Chronic constipation	0.625	0.500-0.625	300	<0.001
RF: Obesity	0.625	0.500-0.625	253	<0.001
RF: Vitamin C, calcium	0.500	0.375-0.500	10	<0.001
RF: Tobacco dependence	0.625	0.500-0.625	45	<0.001
AC: Suprapontine lesions	1.000	0.875-1.000	3003	0.646
AC: Pontine lesions	0.875	0.875-1.000	2850	0.450
AC: Supra-sacral medullary lesions	1.000	0.875-1.000	3240	0.876
AC: Urological complications: Recurrent urinary tract infection, Kidney and/or vesical calculi, Vesicoureteral reflux, Hydronephrosis, Kidney insufficiency	0.875	0.750-0.875	1653	<0.001
RP: Obese women	0.625	0.500-0.625	190	<0.001
RP: Elderly	0.750	0.750-0.875	1225	<0.001

Item	CVI	CI 95%	Wilcoxon Test
Item	CVI	CI 95%	V	p-value
Disability Associated Urinary Incontinence
DC: Restricted/impaired mobility	0.875	0.875-1.000	2701	0.272
DC: Lack of preoccupation with going to the toilet or incontinence itself	0.750	0.625-0.750	741	<0.001
DC: Not knowing how to find the toilet	0.750	0.750-0.875	1275	<0.001
DC: Postponing urination	0.875	0.750-0.875	1540	<0.001
DC: Reduced urinary frequency	0.625	0.625-0.750	741	<0.001
DC: Urinary urgency	0.750	0.750-0.875	903	<0.001
DC: Employing strategies for urine contention	0.875	0.750-0.875	1275	<0.001
DC: Restriction on liquids	0.625	0.500-0.750	351	<0.001
DF: Adaptive behavior to avoid urine loss	0.750	0.750-0.875	1275	<0.001
RF: Avoids anti-hygienic toilets	0.750	0.750-0.875	1540	<0.001
RF: Avoids going to the toilet in social situations due to embarrassment	0.875	0.750-0.875	1830	<0.001
RF: Oppositional and provocative behavior	0.750	0.625-0.750	630	<0.001
RF: Pleasant sensations associated to excessively distended bladder or rectum	0.625	0.500-0.625	351	<0.001
RF: Getting used to the habit of postponing urination	0.875	0.875-0.875	1891	0.001
RF: Constipation or fecal impaction	0.750	0.625-0.750	595	<0.001
RF: Problems due to vesical training or psychological difficulty	0.875	0.875-0.875	2016	0.003
RF: Environmental factors that interfere with continence	0.875	0.875-1.000	2556	0.141
RF: Increased liquid consumption	0.875	0.750-0.875	1035	<0.001
RF: Liquid retention	0.625	0.625-0.750	435	<0.001
RF: Use of diuretics	0.875	0.875-0.875	1953	0.001
AC: Cognitive impairment	1.000	1.000-1.000	3916	1.000
AC: Motivational issues	0.875	0.875-1.000	2485	0.097
AC: Overall intellectual disability	1.000	0.875-1.000	3240	0.876
AC: Use of medication that alters urinary tract function or cause sedation or confusion	0.875	0.875-0.875	1770	<0.001
AC: Compromised mobility/coordination/hand dexterity	1.000	1.000-1.000	3741	0.998
AC: Health clinical conditions (osteoarticular, cardiac and urinary tract diseases)	0.875	0.750-0.875	2016	0.003
RP: Female children	0.625	0.625-0.750	595	<0.001
RP: Fragile elderly women	0.875	0.875-1.000	2775	0.356
RP: Fragile elderly	1.000	0.875-1.000	2926	0.549
RP: Children	0.750	0.750-0.875	1035	<0.001

Item	CVI	CI 95%	Wilcoxon Test
Item	CVI	CI 95%	V	p-value
Mixed Urinary Incontinence
DC: Urgency	1.000	1.000-1.000	3741	0.998
DC: Urine loss preceded by urgency sensation	1.000	1.000-1.000	3570	0.988
DC: Urine loss with effort, cough, sneeze, or laughter	1.000	1.000-1.000	3741	0.998
DC: Nocturia	0.750	0.750-0.875	1225	<0.001
DC: Sensation of incomplete bladder emptying	0.750	0.750-0.875	1378	<0.001
RF: Flaccid/weak anterior vaginal wall and/or atrophy of striated muscles	1.000	1.000-1.000	3486	0.976
RF: Urethral sphincter and bladder neck incompetence	1.000	1.000-1.000	3570	0.988
AC: Estrogen deficiency	0.875	0.875-0.875	1711	<0.001
AC: Menopause	0.875	0.875-0.875	2278	0.025
AC: Obesity	0.875	0.750-0.875	1770	<0.001
AC: Pelvic organ prolapse	0.875	0.875-1.000	2775	0.356
AC: Diabetes	0.875	0.750-0.875	1891	0.001
AC: Chronic cough or tobacco use	0.875	0.875-0.875	1891	0.001
RP: People who already have one type of urinary incontinence	0.875	0.875-1.000	2775	0.356
RP: People with functional mobility difficulties	0.875	0.750-0.875	1596	<0.001
RP: People with advanced age	0.875	0.875-0.875	2278	0.025
RP: Race	0.625	0.500-0.625	153	<0.001
RP: Multiparous	0.875	0.750-0.875	1275	<0.001
RP: People with long-lasting presence of one type of urinary incontinence	0.875	0.875-0.875	1953	0.001
RP: Trauma in urethral muscles or pelvic floor	1.000	1.000-1.000	3570	0.988
Transient Urinary Incontinence
DC: Loss of urine caused by reversible or transient factors	1.000	0.875-1.000	3321	0.923
DC: Sudden urine loss	1.000	0.875-1.000	2926	0.549
DC: Signs and symptoms of urine loss persist for less than six months	1.000	0.875-1.000	3403	0.955
RF: Delirium	0.750	0.750-0.875	990	<0.001
RF: Infection/urinary tract infection	0.875	0.875-1.000	2775	0.356
RF: Atrophic vaginitis	0.875	0.750-0.875	903	<0.001
RF: Use of medications that alter normal neurotransmitter levels in the lower urinary tract	0.875	0.875-1.000	2485	0.096
RF: Psychological condition (anxiety, depression, postpartum depression, sexual, physical, and emotional abuse)	1.000	0.875-1.000	2926	0.549
RF: Excess urine production	0.750	0.750-0.875	903	<0.001
RF: Restricted/impaired mobility	0.875	0.875-0.875	1953	0.001
RF: Fecal impaction/intestinal constipation	0.750	0.750-0.875	1035	<0.001
RF: Dehydration	0.625	0.500-0.625	253	<0.001
RF: Consumption of dietary irritants	0.750	0.750-0.875	820	<0.001
AC: Age-related urinary tract changes	0.750	0.625-0.875	1035	<0.001
AC: Conditions that alter the position or innervation of bladder and sphincter	0.875	0.750-0.875	2016	0.003
AC: Conditions that result in the reduction of vesical compliance	0.875	0.875-1.000	2346	0.040
AC: Infravesical obstruction	0.875	0.875-0.875	2211	0.015
AC: Pregnancy and postpartum	0.875	0.875-1.000	2775	0.356
RP: Elderly	0.875	0.750-0.875	1711	<0.001
RP: People with some acute disease which may influence continence or urine production	1.000	0.875-1.000	3403	0.955

Universidade de São Paulo, Escola de Enfermagem Av. Dr. Enéas de Carvalho Aguiar, 419 , 05403-000 São Paulo - SP/ Brasil, Tel./Fax: (55 11) 3061-7553, - São Paulo - SP - Brazil
E-mail: reeusp@usp.br

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[1] Corresponding author: Juliana Neves da Costa Cidade Universitária – Distrito de Barão Geraldo Rua Tessália Vieira de Camargo, 126 CEP 13081-970 – Campinas, SP, Brazil julianancosta@yahoo.com.br

Brasil

Brasil

Content analysis of nursing diagnoses related to urinary incontinence* * Extracted from the thesis: “Análise de conteúdo dos diagnósticos de enfermagem relacionados à incontinência urinária”, Universidade Estadual de Campinas, Faculdade de Enfermagem, 2019.

ABSTRACT

Objective

Method

Results

Conclusion

Content analysis of nursing diagnoses related to urinary incontinence^* * Extracted from the thesis: “Análise de conteúdo dos diagnósticos de enfermagem relacionados à incontinência urinária”, Universidade Estadual de Campinas, Faculdade de Enfermagem, 2019.