Clinical validation of nursing diagnosis “00085 Impaired Physical Mobility” in multiple traumas victims

Ferreira, Raisa Camilo; Duran, Erika Christiane Marocco

doi:10.1590/1518-8345.2859.3190

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Revista Latino-Americana de Enfermagem

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Original Article • Rev. Latino-Am. Enfermagem 27 • 2019 • https://doi.org/10.1590/1518-8345.2859.3190 copy

Clinical validation of nursing diagnosis “00085 Impaired Physical Mobility” in multiple traumas victims^* * Paper extracted from master’s thesis “Clinical validation of nursing diagnosis ‘Impaired physical mobility’ in multiple trauma victims”, presented to Universidade Estadual de Campinas, Faculdade de Enfermagem, Campinas, SP, Brazil.

Authorship SCIMAGO INSTITUTIONS RANKINGS

Objective:

to clinically validate the nursing diagnosis “Impaired Physical Mobility”, identifying its prevalence, defining characteristics, related factors, and associated conditions with the calculation of accuracy measures and generation of Decision Trees, as well as clinically and etiologically characterize the multiple traumas victims.

Method:

methodological, cross-sectional study of clinical validation type, using diagnostic accuracy measures and generating decision tree.

Results:

the sample consisted of 126 patients, 73% male, with a mean age of 38.29 years. The frequency of the nursing diagnosis studied was 88.10%; the defining characteristic with the highest prevalence was “Difficulty turning” (58.73%), with a predictive power of 98.6%; the associated condition “Alteration in bone structure integrity” stood out with 72.22%. The accuracy measures also indicated their predictive power.

Conclusion:

the components aforementioned were considered predictors of this diagnosis. This study contributed to improve the identification of clinical indicators associated with advanced methods of diagnostic validation, directing care and reducing the variability present in clinical situations.

Descriptors:
Nursing Diagnosis; Validation Studies; Multiple Trauma; Patient Care Planning; Nursing Process; Decision Trees

Variables	Mean	SD^* * SD – standard deviation;	Median	Minimum	Maximum
Body Mass Index	27.50	4.94	26.8	20.00	45.70
Systolic Blood Pressure^† † Systolic and Diastolic blood pressure values, Heart rate and Respiratory rate – were measured by the multiparameter monitors (pressure values marked as zero refer to cases in which they were not quantified by the monitor, i.e., the values were below 30 mmHg)	119.66	25.30	120.00	0.00	180.00
Diastolic Blood Pressure^† † Systolic and Diastolic blood pressure values, Heart rate and Respiratory rate – were measured by the multiparameter monitors (pressure values marked as zero refer to cases in which they were not quantified by the monitor, i.e., the values were below 30 mmHg)	72.03	15.99	73.50	0.00	110.00
Noninvasive Mean Arterial Pressure	87.91	18.12	90.00	0.00	125.33
Heart Rate^† † Systolic and Diastolic blood pressure values, Heart rate and Respiratory rate – were measured by the multiparameter monitors (pressure values marked as zero refer to cases in which they were not quantified by the monitor, i.e., the values were below 30 mmHg)	88.29	19.96	86.00	55.00	150.00
Respiratory Rate^† † Systolic and Diastolic blood pressure values, Heart rate and Respiratory rate – were measured by the multiparameter monitors (pressure values marked as zero refer to cases in which they were not quantified by the monitor, i.e., the values were below 30 mmHg)	18.01	3.83	18.00	2.00	30.00
Glasgow Coma Scale	12.09	3.79	15.00	3.00	15.00

Variables	Presence		Absence
	n^* * n = absolute value;	%^† † % = percentage value	n^* * n = absolute value;	%^† † % = percentage value
Defining characteristics
Difficulty turning	74	58.73	52	41.27
Discomfort	55	43.65	71	56.35
Decrease in gross motor skills	22	17.46	104	82.54
Decrease in range of motion	13	10.32	113	89.68
Alteration in gait	12	9.52	114	90.48
Exertion dyspnea	8	6.35	118	93.65
Decrease in fine motor skills	8	6.35	118	93.65
Slowed movement	7	5.56	119	94.44
Postural instability	2	1.59	124	98.41
Uncoordinated movement	2	1.59	124	98.41
Decrease in reaction time	2	1.59	124	98.41
Related factors
Pain	7	5.56	119	94.44
Decrease in muscle control	3	2.38	123	97.62
Disuse	1	0.79	125	99.21
Activity intolerance	1	0.79	125	99.21
Decrease in muscle mass	1	0.79	125	99.21
Reluctance to initiate movement	1	0.79	125	99.21

Variable	Se^* * Se = sensitivity;	Sp^† † SP = specificity;	PPV^‡ ‡ PPV = positive predictive value;	NPV^§ § NPV = negative predictive value;	Prevalence	p-value
Defining characteristic
Difficulty turning	0.6577	0.9333	0.9865	0.2692	65.72	< 0.0001^‖ ‖ p-value – obtained by Chi-square test;
Discomfort	0.4685	0.8000	0.9455	0.1690	46.85	0.0491^‖ ‖ p-value – obtained by Chi-square test;
Decrease in gross motor skills	0.1982	1.0000	1.0000	0.1442	19.82	0.0713^¶ ¶ p-value – obtained by Fisher’s exact test;
Decrease in the range of motion	0.1171	1.0000	1.0000	0.1327	11.71	0.3625^¶ ¶ p-value – obtained by Fisher’s exact test;
Alteration in gait	0.1081	1.0000	1.0000	0.1316	10.81	0.3575^¶ ¶ p-value – obtained by Fisher’s exact test;
Related factors
Pain	0.0360	0.8000	0.5717	0.1008	3.60	^ It was not possible to define the p-value for RF because the number of observations was small
Decrease in muscular control	0.0270	1.0000	1.0000	0.1220	2.70	^ It was not possible to define the p-value for RF because the number of observations was small
Disuse	0.0090	1.0000	1.0000	0.1200	0.09	^ It was not possible to define the p-value for RF because the number of observations was small
Activity intolerance	0.0090	1.0000	1.0000	0.1200	0.09	^ It was not possible to define the p-value for RF because the number of observations was small
Decrease in muscle mass	0.0090	1.0000	1.0000	0.1200	0.09	^ It was not possible to define the p-value for RF because the number of observations was small
Reluctance to initiate movement	0.0090	1.0000	1.0000	0.1200	0.09	^ It was not possible to define the p-value for RF because the number of observations was small

Variable	Se^* * Se = Sensitivity;	Sp^† † Sp = Specificity;	PPV^‡ ‡ PPV = positive predictive value;	NPV^§ § NPV = negative predictive value;	Prevalence	p-value^‖ ‖ p-value obtained by Fisher’s exact test
Associated conditions
Alteration in bone structure integrity	0.7477	0.4667	0.9121	0.2000	74.77	0.1212
Pharmaceutical agent	0.1802	1.0000	1.0000	0.1415	18.02	0.1260
Prescribed movement restrictions	0.1532	0.9333	0.9444	0.1296	15.32	0.6938
Alteration in cognitive functioning	0.0991	1.0000	1.0000	0.1304	9.91	0.3583

Escola de Enfermagem de Ribeirão Preto / Universidade de São Paulo Av. Bandeirantes, 3900, 14040-902 Ribeirão Preto SP Brazil, Tel.: +55 (16) 3315-3451 / 3315-4407 - Ribeirão Preto - SP - Brazil
E-mail: rlae@eerp.usp.br

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[1] Corresponding author: Raisa Camilo Ferreira. E-mail: raisacf@hotmail.com