<b>Terminology subset for the International Classification of Nursing Practice in Diabetes Mellitus</b>

Chaves, Fernanda Azeredo; Torres, Heloisa de Carvalho; Chianca, Tânia Couto Machado

doi:10.1590/1518-8345.7018.4188

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Revista Latino-Americana de Enfermagem

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Original Article • Rev. Latino-Am. Enfermagem 32 • 2024 • https://doi.org/10.1590/1518-8345.7018.4188 copy

Terminology subset for the International Classification of Nursing Practice in Diabetes Mellitus ^* * Paper extracted from doctoral dissertation “Construction, validation and application of the icnp® catalog for people with type 2 diabetes mellitus in primary health care”, presented to Universidade Federal de Minas Gerais, Escola de Enfermagem, Belo Horizonte, MG, Brazil.

Authorship SCIMAGO INSTITUTIONS RANKINGS

Objective:

to describe the process of developing a terminological subset for the International Classification of Nursing Practice in Diabetes Mellitus, based on Horta’s Basic Human Needs Theory and Bandura’s Social Cognitive Theory.

Method:

a methodological study based on the identification in the literature of 313 statements of nursing diagnoses pertinent to diabetes care, selected and validated by a consensus of nurses from different states of Brazil, specialists in diabetes, using the nominal group technique.

Results:

156 nursing diagnosis/result statements were selected, of which 111 (71.15%) related to psychobiological needs, 42 (26.92%) to psychosocial needs and three (1.92%) to psychospiritual needs. A total of 433 nursing interventions were developed. The diagnostic statements were validated on the basis of a consensus among the experts, with an average content validity index of 0.89: 0.87 for psychobiological needs, 0.93 for psychosocial needs, and 0.77 for psychospiritual needs.

Conclusion:

the study validated the terminological subset for the International Classification of Nursing Practice in Diabetes, favoring clinical reasoning, the qualification of the Nursing Process, and the improvement of self-care practices in diabetes. It has made it possible to use nursing’s own language based on a globally recognized classification.

Descriptors:
Nursing Diagnosis; Diabetes Mellitus Type 2 ; Nursing Process; Primary Health Care; Standardized Nursing Terminology; Nursing Care

Highlights:

(1) Provision of the guiding document for nursing practice in diabetes.

(2) Methodological innovation in the development of ICNP® subsets.

(3) Advances in knowledge of the basic human needs of people with diabetes.

(4) The potential of standardized language for coding and monitoring data.

(5) Improving clinical reasoning during nursing consultations.

Listing (L1)	Analysis of constancy in ICNP ® version (2019-2020)	Degree of equivalence	Listing (L2) statements contained in ICNP ® *^ * ICNP® = International Classification for Nursing Practice version (2019-2020)**
Adequate knowledge of the disease	not constant	2	Knowledge about the disease (10023826)
Adequate knowledge of medication	not constant	2	Knowledge about medication (10025968)
Adequate knowledge of exercise	not constant	2	Knowledge of physical exercise (10023786)
Inadequate knowledge of medication	not constant	2	Lack of knowledge about medication (10025975)
Inadequate knowledge about exercise	not constant	2	Lack of knowledge about physical exercise (10022585)
Inadequate knowledge about Diabetes Mellitus	not constant	2	Lack of knowledge about the disease (10021994)
Deficit in self-care for eating	not constant	4	Lack of self-care (10023410)
Total self-care deficit for bathing, dressing, hygiene	not constant	4	Lack of self-care (10023410)
Unfamiliarity with the disease	not constant	2	Lack of knowledge about the disease (10021994)
Unfamiliarity with the medication regimen	not constant	2	Lack of knowledge about medication (10025975)
Lack of adherence to the therapeutic regimen	not constant	2	Non-adherence to therapeutic regimen (10022155)
Preserved skin integrity	not constant	2	Skin integrity, effective (10028501)
Impaired orientation in time and space	not constant	2	Disorientation (10001235)
Orientation in time and space preserved	not constant	2	Orientation, improved (or increased) (10028586)
Adequate body weight	not constant	2	Weight, within normal limits (10027392)
Risk of diabetic foot	not constant	2	Risk of diabetic foot ulcer (10042666)
Impaired sleep and rest	not constant	2	Sleep, impaired (10027226)
Preserved sleep	not constant	2	Sleep, adequate (10024930)

State/country of residence	N ^* * N = Absolute number of nurse judges;	(%)
Minas Gerais (BR ^† † BR = Brazil; )	27	72.97
São Paulo (BR ^† † BR = Brazil; )	5	13.51
Bahia (BR ^† † BR = Brazil; )	1	2.70
Ceará (BR ^† † BR = Brazil; )	1	2.70
Paraná (BR ^† † BR = Brazil; )	1	2.70
Sergipe (BR ^† † BR = Brazil; )	1	2.70
Florida (USA ^‡ ‡ USA = United States of America )	1	2.70
Total	37	100

Wanda Horta BHN ^‡ ‡ BHN = Basic Human Needs;	Psychobiologica	ND/NR ^* * ND/NR = Nursing Diagnosis/Nursing Results;	CVI ^§ § CVI = Content Validity Index	NI ^† † NI = Nursing Interventions;
Hormone regulation	Psychobiological	3 (1.9%)	0.99	32 (7.4%)
Physical integrity	Psychobiological	6 (3.8%)	0.96	53 (12.2%)
Therapeutic	Psychobiological	18 (11.5%)	0.94	33 (7.6%)
Sleep and rest	Psychobiological	6 (3.8%)	0.90	13 (3.0%)
Physical activity	Psychobiological	5 (3.2%)	0.90	23 (5.3%)
Hydration	Psychobiological	4 (2.6%)	0.89	14 (3.2%)
Elimination	Psychobiological	12 (7.7%)	0.89	43 (9.9%)
Perception of the sense organs	Psychobiological	10 (6.4%)	0.88	24 (5.5%)
Vascular regulation	Psychobiological	8 (5.1%)	0.88	23 (5.3%)
Physical safety and the environment	Psychobiological	15 (9.6%)	0.86	18 (4.2%)
Nutrition	Psychobiological	8 (5.1%)	0.85	29 (6.7%)
Immune regulation	Psychobiological	2 (1.3%)	0.84	6 (1.4%)
Sexuality and reproduction	Psychobiological	2 (1.3%)	0,82	9 (2.1%)
Neurological regulation	Psychobiological	9 (5.8%)	0.80	22 (5.1%)
Oxygenation	Psychobiological	3 (1.9%)	0.72	11 (2.5%)
Recreation and leisure	Psychosocial	2 (1.3%)	0.97	4 (0.9%)
Health education/learning	Psychosocial	19 (12.2%)	0.94	21 (4.8%)
Gregariousness	Psychosocial	4 (2.6%)	0.93	6 (1.4%)
Self-esteem, self-confidence, self-respect	Psychosocial	15 (9.6%)	0.92	27 (6.2%)
Communication	Psychosocial	2 (1.3%)	0.89	14 (3.2%)
Spirituality	Psychospiritual	3 (1.9%)	0.77	8 (1.8%)
Total		156 (100%)	0.89	433 (100%)

Psychobiological BHN ^* * BHN = Basic Human Needs; : hormonal regulation
ND/NR ^† † ND/NR = Nursing Diagnosis/Nursing Result;	Blood glucose level, within normal limits (ICNP code ^‡ ‡ ICNP® = International Classification for Nursing Practice; 10033685)
ND/NR ^† † ND/NR = Nursing Diagnosis/Nursing Result;	Blood glucose level, within normal limits (ICNP code ^‡ ‡ ICNP® = International Classification for Nursing Practice; 10033685)
NI ^§ § IE = Nursing Interventions	1- Analyze the glucose monitoring data. 2- Guide the correct use of the glucose monitor, according to the manufacturer’s instructions; 3- Reinforce the glycemic targets, according to age group (pre-, postprandial, and at bedtime); 4- Guide glycemic monitoring at home or in PHC, according to the treatment objective; 5- Guide the signs and symptoms of hypoglycemia and hyperglycemia; 6- Carry out continuing diabetes education; 7- Encourage self-care behaviors.
ND/NR ^† † ND/NR = Nursing Diagnosis/Nursing Result;	Hyperglycemia (ICNP code ^‡ ‡ ICNP® = International Classification for Nursing Practice; 10027550)
ND/NR ^† † ND/NR = Nursing Diagnosis/Nursing Result;	Blood glucose level, within normal limits (ICNP code ^‡ ‡ ICNP® = International Classification for Nursing Practice; 10033685)
ND/NR ^§ § IE = Nursing Interventions	Acute hyperglycemia: 1- Check for signs/symptoms of hyperglycemia; 2- Monitor capillary glycemia; 3- Stimulate hydration; 4- Administer insulin, according to the prescribed therapeutic adjustment; 5- Refer to the emergency network, if necessary. Recurrent hyperglycemia: 1- Analyze blood glucose monitoring data; 2- Guide the correct use of the glucose monitor, according to the manufacturer’s instructions; 3- Obtain information on adherence to the therapeutic regimen; 4- Provide guidance on glycemic targets according to age group; 5- Guide capillary blood glucose monitoring at home or in PHC, as indicated; 6- Identify the causes of hyperglycemia in order to prevent new episodes; 7- Screen for chronic complications; 8- Refer to the support team, if necessary.
ND/NR ^† † ND/NR = Nursing Diagnosis/Nursing Result;	Hypoglycemia (ICNP code ^‡ ‡ ICNP® = International Classification for Nursing Practice; 10027566)
ND/NR ^† † ND/NR = Nursing Diagnosis/Nursing Result;	Blood glucose level, within normal limits (ICNP code ^‡ ‡ ICNP® = International Classification for Nursing Practice; 10033685)
NI ^§ § IE = Nursing Interventions	Acute hypoglycemia: 1- Check for signs/symptoms of hypoglycemia; 2- Monitor capillary blood glucose; 3- Treat hypoglycemia according to institutional protocols; 4- Refer to the emergency network if necessary. Recurrent hypoglycemia: 1- Analyze the blood glucose monitoring data; 2- Guide the correct use of the glucose monitor, according to the manufacturer’s instructions; 3- Obtain information on adherence to the therapeutic regimen; 4- Guide the signs and symptoms of hypoglycemia and correction; 5- Guiding the family member/caregiver to call the emergency service in cases of severe hypoglycemia and no response to initial care; 6- Guiding capillary blood glucose monitoring at home or in PHC, as indicated; 7- Identifying the causes of hypoglycemia in order to prevent further episodes; 8- Referring to the support team, if necessary.

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[1] Corresponding author: Fernanda Azeredo Chaves E-mail: fechaves1000@gmail.com https://orcid.org/0000-0003-3093-7905