Clinical validation of nursing diagnosis Fragile Elderly Syndrome

a methodological study, guided by the STROBE instrument, composed of 40 elderly people admitted to a teaching hospital in Paraíba, Brazil. The last phase of Hoskins’ Nursing Diagnostic Validation Model: clinical validation was adopted. Data collection took place from August to December 2018. The data were analyzed using univariate descriptive statistics. It was approved by the hospital’s ethics and research committee.

Results:

nine defining characteristics were validated; seven risk factors; six populations at risk and two associated conditions.

Conclusion:

the validation of the nursing diagnosis of the Frail Elderly Syndrome in our socio-cultural context was considered appropriate, being an important step for critical thinking that underlies the decision-making of nurses in the care of the frail elderly, as well as professional practice.

Descriptors:
Nursing; Validation Studies; Nursing Diagnosis; Frail Elderly; Syndrome

Defining characteristics	n (D1^* * D1 = Diagnostician 1; D2 = Diagnostician 2; IC = Reliability Index. )	% (D1^* * D1 = Diagnostician 1; D2 = Diagnostician 2; IC = Reliability Index. )	n (D2**)	% (D2**)	Kappa	IC***
Impaired walking	38	95	38	95	1.00	0.95
Impaired physical mobility	34	85	32	80	0.83	0.80
Fatigue	32	80	31	77.5	0.75	0.80
Activity intolerance	33	82.5	30	75	0.78	0.74
Dressing self-care deficit	26	65	25	62.5	0.84	0.62
Bathing self-care deficit	24	60	24	60	1.00	0.60
Imbalanced nutrition: less than body requirements	26	65	24	60	0.89	0.60
Toileting self-care deficit	23	57.5	23	57.5	1.00	0.57
Decreased cardiac output	22	55	21	52.5	0.95	0.52
Deficit in self-care: eating	18	45	18	45	1.00	0.45
Social isolation	18	45	16	40	0.89	0.45
Hopelessness	15	37.5	15	37.5	1.00	0.42
Impaired memory	11	27.5	12	30	0.94	0.28

Related factors	n (D1^* * D1 = Diagnostician 1; D2 = Diagnostician 2; IC = Reliability Index. )	% (D1^* * D1 = Diagnostician 1; D2 = Diagnostician 2; IC = Reliability Index. )	n (D2**)	% (D2**)	Kappa	IC***
Fear of falling	32	80	34	85	0.83	0.80
Average daily physical activity is less than recommended for gender and age	36	90	31	77.5	0.20	0.77
Impaired physical mobility	30	75	33	82.5	0.63	0.74
Muscle weakness	32	80	29	72.5	0.52	0.72
Decrease in muscle strength	32	80	26	65	0.63	0.65
Activity intolerance	25	62.5	26	65	0.30	0.62
Impaired balance	21	52.5	22	55	0.55	0.51
Sedentary lifestyle	31	77.5	18	45	0.38	0.48
Sadness	18	45	19	47.5	0.85	0.45
Anxiety	20	50	17	42.5	0.75	0.42
Decrease in energy	17	42.5	15	37.5	0.48	0.37
Obesity	3	7.5	2	5	0.79	0.28
Immobility	8	20	10	25	0.86	0.20
Depression	7	17.5	7	17.5	0.83	0.17
Social isolation	9	22.5	2	5	-0.09	0.12
Exhaustion	12	30	2	5	0.22	0.10
Malnutrition	3	7.5	4	10	0.84	0.07
Insufficient social support	2	5	1	2.5	0.66	0.01
Insufficient knowledge of modifiable risk factors	1	2.5	0	0	0.00	0.00

Population at risk	n (D1^* * D1 = Diagnostician 1; D2 = Diagnostician 2; IC = Reliability Index. )	% (D1^* * D1 = Diagnostician 1; D2 = Diagnostician 2; IC = Reliability Index. )	n (D2**)	% (D2**)	Kappa	IC***
Female gender	28	70	28	70	1.00	0.70
Age> 70 years	26	65	26	65	0.95	0.65
Low educational level	24	60	26	65	0.89	0.60
Prolonged hospitalization	24	60	25	62.5	0.84	0.60
Economically disadvantaged	20	50	21	52.5	0.45	0.50
History of falls	20	50	22	55	0.90	0.50
Living alone	3	7.5	3	7.5	1.00	0.07
Social vulnerability	2	5	6	15	0.19	0.06
Ethnicity other than Caucasian	7	17.5	1	2.5	0.22	0.05

Associated conditions	n (D1^* * D1 = Diagnostician 1; D2 = Diagnostician 2; IC = Reliability Index. )	% (D1^* * D1 = Diagnostician 1; D2 = Diagnostician 2; IC = Reliability Index. )	n (D2**)	% (D2**)	Kappa	IC***
Chronic disease	40	100	39	97.5	0.00	0.96
Walking 4 meters requires >5 seconds	32	80	36	90	0.62	0.80
Unintentional loss of >4,5kg of body weight in one year	22	55	19	47.5	0.85	0.47
Endocrine regulatory dysfunction	14	35	13	32.5	0.94	0.32
Alteration in cognitive functioning	8	20	6	15	0.83	0.15
Unintentional loss of 20% of body weight over one year	15	37.5	5	12.5	0.39	0.15
Sensory deficit	7	17.5	5	12.5	0.61	0.12
Sarcopenic obesity	5	12.5	2	5	0.54	0.06
Sarcopenia	2	5	2	5	1.00	0.05
Altered coagulation	1	2.5	1	2.5	1.00	0.02
Decrease in serum 25-hydroxyvitamin D concentration	1	2.5	1	2.5	1.00	0.02
Suppressed inflammatory response	2	5	0	0	0.00	0.01

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[1] Corresponding author: Fabiana Maria Rodrigues Lopes de Oliveira fabianarodriguesenf@yahoo.com.br