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ORIGINAL ARTICLE • Rev. Bras. Enferm. 77 (3) • 2024 • https://doi.org/10.1590/0034-7167-2023-0464 copy

Disrupted mother-fetus dyad risk in high-risk pregnancies: a Middle-Range Theory

Riesgo de disrupción del binomio madre-feto en embarazos de alto riesgo: Una Teoría de Alcance Intermedio

Authorship SCIMAGO INSTITUTIONS RANKINGS

ABSTRACT

Objectives:

to develop and evaluate a Middle-Range Theory for the nursing diagnosis “Disrupted Mother-Fetus Dyad Risk” in high-risk pregnancies.

Methods:

this methodological study was conducted in two stages: theory development and evaluation. Dorothea Orem’s General Nursing Model was used as the theoretical-conceptual foundation. Evaluation was conducted using the Delphi method with seven judges, and consensus was achieved when the Content Validity Index of the evaluated items was ≥ 0.80.

Results:

the theory identified 20 elements of the nursing diagnosis “Disrupted Mother-Fetus Dyad Risk” (10 risk factors, 4 at-risk populations, and 6 associated conditions), 14 propositions, and 1 pictogram. After two rounds of evaluation, the theory was considered consistent, with consensus reached for all items, each achieving a Content Validity Index ≥ 0.80.

Conclusions:

the Middle-Range Theory included biopsychosocial factors explaining the nursing phenomenon “Disrupted Mother-Fetus Dyad Risk,” which aids in nurses’ diagnostic reasoning.

Descriptors:
Nursing Diagnosis; Pregnancy; High-Risk; Nursing Process; Maternal-Fetal Relations; Nursing Theory

Defining Attributes
Symbiotic maternal-fetal relationship; Bond between mother and fetus
Risk Factors
Smoking; Inadequate/absent prenatal care; Illicit drug use; Alcohol abuse; Obesity; Unsatisfactory gestational weight gain; Smoking; Violence; Insufficient/absent partner support; Insufficient/absent social support.
Risk Factors
Pregnant women with low educational levels; Economically disadvantaged pregnant women; Extreme maternal age; Previous pregnancy with pre-eclampsia.
Associated Conditions
Gestational complications; Altered glucose metabolism; Compromised oxygen transfer to the fetus; Maternal diseases; Treatment regimen; Maternal conditions.

Intrinsic Conditioning Factors

Extrinsic Conditioning Factors

• Predispositional:
Extreme maternal age; Alcohol abuse^* * Caused by a deficit in universal self-care requisites; ; Illicit drug use^* * Caused by a deficit in universal self-care requisites; ; Smoking^* * Caused by a deficit in universal self-care requisites; .
• Reinforcing:
Unsatisfactory gestational weight gain^** ** Caused by a deficit in developmental self-care requisites; ; Overweight^* * Caused by a deficit in universal self-care requisites; ; Obesity^* * Caused by a deficit in universal self-care requisites; ; Previous pregnancy with pre-eclampsia^*** *** Caused by a deficit in health-deviation self-care requisites; +Corresponds to the absence/insufficiency of the nursing support-education system. ; Maternal conditions^*** *** Caused by a deficit in health-deviation self-care requisites; +Corresponds to the absence/insufficiency of the nursing support-education system. .
• Precipitating:
Gestational complications^*** *** Caused by a deficit in health-deviation self-care requisites; +Corresponds to the absence/insufficiency of the nursing support-education system. ; Altered glucose metabolism^*** *** Caused by a deficit in health-deviation self-care requisites; +Corresponds to the absence/insufficiency of the nursing support-education system. ; Compromised oxygen transfer to the fetus^*** *** Caused by a deficit in health-deviation self-care requisites; +Corresponds to the absence/insufficiency of the nursing support-education system. ; Maternal diseases^*** *** Caused by a deficit in health-deviation self-care requisites; +Corresponds to the absence/insufficiency of the nursing support-education system. .

• Predispositional:
Violence^* * Caused by a deficit in universal self-care requisites; ; Treatment regimen^*** *** Caused by a deficit in health-deviation self-care requisites; +Corresponds to the absence/insufficiency of the nursing support-education system. .
• Incapacitating:
Inadequate/absent prenatal care+^** ** Caused by a deficit in developmental self-care requisites; ; Insufficient/absent partner support^* * Caused by a deficit in universal self-care requisites; ; Insufficient/absent social support^* * Caused by a deficit in universal self-care requisites; ; Pregnant woman with a low educational level; Economically disadvantaged pregnant woman.

• Metaparadigmatic Concepts: person, health, environment, and nursing.

Items	Shapiro-Wilk Test		Content Validity Index
Items	W	p value	Weighted Mean or Median	95% CI
The theory's purpose (predictive) is described	0.869	0.182	0.85^‖ ‖ Weighted mean;	0.787; 0.923
It is a MRT	0.537	<0.001	0.96^‖ ‖ Weighted mean;	0.921; 0.998
The theory's origin is described	0.989	0.991	0.93^‖ ‖ Weighted mean;	0.884; 0.975
The main concepts are described	0.537	<0.001	0.96^† † Weighted median;	0.902; 1.00
The main theoretical propositions are described	0.908	0.383	0.92^‖ ‖ Weighted mean;	0.849; 0.990
The context for use is described	0.989	0.991	0.94^‖ ‖ Weighted mean;	0.895; 0.984
The concepts are theoretically and operationally defined	0.537	<0.001	0.94^† † Weighted median;	0.871; 1.00
The relationships are explicit	0.980	0.959	0.81^‖ ‖ Weighted mean;	0.732; 0.887
The theory is organized logically	0.908	0.383	0.92^‖ ‖ Weighted mean;	0.849; 0.990
A model/diagram exists	^* * Values with no variability.	^* * Values with no variability.	1.0^‖ ‖ Weighted mean;	^* * Values with no variability.
The model/diagram contributes to clarifying the theory	0.537	<0.001	0.97^† † Weighted median;	0.935; 1.00
The concepts are well-founded	0.981	0.964	0.92^‖ ‖ Weighted mean;	0.872; 0.967
Results or consequences are predicted	0.887	0.260	0.73^‖ ‖ Weighted mean;	0.619; 0.619
The theory is congruent with current nursing standards	0.537	<0.001	0.98^† † Weighted median;	0.951; 1.00
It is supported by the literature	0.537	<0.001	0.98^† † Weighted median;	0.951; 1.00
The theory is socially relevant	0.537	<0.001	0.97^† † Weighted median;	0.935; 1.00
The theory has cross-cultural relevance	0.908	0.383	0.93^‖ ‖ Weighted mean;	0.867; 0.992
The theory contributes to the discipline of nursing	^* * Values with no variability.	^* * Values with no variability.	1.0^‖ ‖ Weighted mean;	^* * Values with no variability.

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