Clinical validation of the nursing diagnosis “Risk for delayed child development”

Melo, Nádia Proença de; Souza, Juliana Martins de; Cordeiro, Samara Macedo; Veríssimo, Maria de La Ó Ramallo

doi:10.1590/1980-220X-REEUSP-2022-0229en

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ORIGINAL ARTICLE • Rev. esc. enferm. USP 56 • 2022 • https://doi.org/10.1590/1980-220X-REEUSP-2022-0229en copy

Clinical validation of the nursing diagnosis “Risk for delayed child development”^* * Extracted from the dissertation: “Validação clínica do diagnóstico de enfermagem ‘Risco de atraso no desenvolvimento infantil’ proposto para a taxonomia NANDA-I ”, Universidade de São Paulo, Escola de Enfermagem, 2018.

Validación clínica del diagnóstico de enfermería “Riesgo de retraso en el desarrollo infantil”

Authorship SCIMAGO INSTITUTIONS RANKINGS

ABSTRACT

Objective:

To validate clinically the risk factors of the nursing diagnosis “Risk for delayed child development”.

Method:

Cross-sectional quantitative study carried out in a specialty outpatient clinic and in family health units with 124 children. The data was collected through interviews with the children’s guardians to investigate the risk factors for delay in child development.

Results:

The tested risk factors affected 108 of the evaluated children (87.1%). In the accuracy tests, most specificity values were above 80% and sensitivity values were lower than 30%. Most risk factors had odds ratio >1, three of which were noteworthy: genetic disorder (OR = 38, p < 0.05) and congenital disorder (OR = 4.4, p < 0.05), among child-related aspects, and impaired cognitive development in parents (OR = 27, p < 0.05), among caregiver-related aspects.

Conclusion:

The study contributed to a refined diagnostic accuracy, identifying potential associated factors of the evaluated diagnosis.

DESCRIPTORS
Child Developmen; Validation Stud; Pediatric nursin; Nursing Diagnosi; Terminology

Risk factors	Present N (%)	Absent N (%)
Chronic diseases	15 (12.1)	109 (87.9)
Acute diseases	25 (20.2)	99 (79.8)
Genetic disorders	8 (6.5)	116 (93.5)
Congenital disorders	29 (23.4)	95 (76.6)
Sensory disorders	2 (1.6)	122 (98.4)
Inadequate growth	28 (22.5)	96 (77.5)
Prematurity and/or low birth weight	24 (19.4)	100 (80.6)
Use of medications during pregnancy	1 (0.8)	123 (99.2)
Tobacco use during pregnancy	12 (9.7)	112 (90.3)
Use of alcohol and drugs during pregnancy	11 (8.9)	113 (91.1)
Exposure to environmental pollutants	1 (0.8)	123 (99.2)
Altered maternal mental health during pregnancy	9 (7.3)	115 (92.7)
Maternal disease	6 (4.8)	118 (95.2)
Insufficient prenatal follow-up	6 (4.8)	118 (95.2)
Bond with the impaired caregiver	1 (0.8)	123 (99.2)
Exposure to domestic violence	9 (7.3)	115 (92.7)
Impaired cognitive development of parents	3 (2.4)	121 (97.6)
Lack of support from the health professional	11 (8.9)	113 (91.1)
Institutionalization	3 (2.4)	121 (97.6)
Lack of child stimulation	2 (1.6)	122 (98.4)
Unfavorable social conditions	41 (33.1)	83 (66.9)
Unfavorable economic conditions	34 (27.4)	90 (72.6)

Risk factors	Children with developmental milestones N (%)	Children with missing developmental milestones N (%)
Chronic diseases	11 (73.3)	4 (26.7)
Acute disease	21 (84.0)	4 (16.0)
Genetic disorders	1 (12.5)	7 (87.5)
Congenital disorders	17 (58.6)	12 (41.3)
Sensory disorders	1 (50.0)	1 (50.0)
Inadequate growth	24 (85.5)	4 (14.2)
Prematurity and/or low birth weight	16 (66.6)	8 (33.3)
Use of medications during pregnancy	1 (100)	0 (0.0)
Tobacco use during pregnancy	8 (66.6)	4 (33.3)
Use of alcohol and drugs during pregnancy	9 (81.8)	2 (18.2)
Exposure to environmental pollutants	1 (100)	0 (0.0)
Altered maternal mental health during pregnancy	5 (55.5)	4 (44.4)
Maternal disease	6 (100)	0 (0.0)
Insufficient prenatal follow-up	4 (66.6)	2 (33.3)
Exposure to domestic violence	9 (100)	0 (0.0)
Impaired cognitive development of parents	0 (0.0)	3 (100)
Lack of support from the health professional	10 (90.9)	1 (11.1)
Institutionalization	2 (66.6)	1 (33.3)
Lack of child stimulation	1 (50.0)	1 (50.0)
Unfavorable social conditions	32 (78.0)	9 (21.9)
Unfavorable economic conditions	31 (91.2)	3 (8.8)

Risk factors	Specificity (%)	Sensitivity (%)	Positive predictive value (%)	Negative predictive value (%)
Chronic diseases (n = 15)	88.9	16.0	26.7	80.7
Acute disease (n = 25)	78.8	16.0	16.0	78.8
Genetic disorders (n = 8)	99.0	28.0	87.5	84.5
Congenital disorders (n = 29)	82.8	48.0	41.4	86.3
Sensory disorders (n = 2)	99.0	4.0	50.0	80.3
Inadequate growth (n = 28)	75.8	16.0	14.3	78.1
Prematurity and/or low birth weight (n = 24)	83.8	32.0	33.3	83.0
Use of medications during pregnancy (n = 1)	99.0	0.0	0.0	79.7
Tobacco use during pregnancy (n = 12)	91.9	16.0	33.3	81.3
Use of alcohol and drugs during pregnancy (n = 11)	90.9	8.0	18.2	79.6
Exposure to environmental pollutants (n = 1)	99.0	0.0	0.0	79.7
Altered maternal mental health during pregnancy (n = 9)	94.9	16.0	44.4	81.7
Maternal disease (n = 11)	93.9	0.0	0.0	78.8
Insufficient prenatal follow-up (n = 6)	96.0	8.0	33.3	80.5
Exposure to domestic violence (n = 9)	90.9	0.0	0.0	78.3
Impaired cognitive development of parents (n = 3)	100.0	12.0	100.0	81.8
Lack of support from the health professional (n = 11)	89.8	4.0	10.1	90.9
Institutionalization (n = 3)	98.0	4.0	33.3	80.2
Lack of child stimulation (n = 2)	99.0	4.0	50.0	80.3
Unfavorable social conditions (n = 41)	67.7	36.0	22.0	80.7
Unfavorable economic conditions (n = 34)	68.7	12.0	8.8	75.6

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: Nádia Proença de Melo Avenida Jabaquara, 144, Mirandópolis 04046-000 – São Paulo, SP, Brazil nadiaprmelo@gmail.com