Nursing diagnoses of impaired memory and chronic confusion for older adults: diagnostic content validation

Souza, Priscilla Alfradique de; Avant, Kay Coalson; Berndt, Andrea E.

doi:10.1590/0034-7167-2020-0370

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ORIGINAL ARTICLE • Rev. Bras. Enferm. 74 (suppl 2) • 2021 • https://doi.org/10.1590/0034-7167-2020-0370 copy

Nursing diagnoses of impaired memory and chronic confusion for older adults: diagnostic content validation

Diagnósticos de enfermagem memória prejudicada e confusão crônica para idosos: validação de conteúdo diagnóstico

Diagnósticos de enfermería memoria deteriorada y confusión crónica en adultos mayores: validación del contenido diagnóstico

Authorship SCIMAGO INSTITUTIONS RANKINGS

ABSTRACT

Objective:

To validate the defining characteristics of the nursing diagnoses, impaired memory and chronic confusion for older adults, by testing diagnostic concept definitions among expert nurses.

Methods:

We used a Diagnostic content validation using an online survey of expert clinical nurses.

Results:

195 expert nurses performed the diagnostic validations. Findings provided validity of impaired memory with 11 major defining characteristics and chronic confusion, with 11 major and one minor defining characteristics. In both diagnoses, content validity index was 0.85. Factor analysis provided four and five supported factors for impaired memory and chronic confusion, respectively.

Conclusion:

The study provided evidence of validity of the two diagnoses and made them clearer. Using these updated nursing diagnoses, nurses have the potential to improve accuracy and quality of care for elderly patients, contributing to more accurate nursing gerontological care.

Descriptors:
Nursing Diagnosis; Memory Disorders; Confusion; Geriatric Nursing; Validation Study

Defining Characteristics of Impaired Memory	R -CVI	C -CVI	I -CVI	T -CVI
Persistent forgetfulness	0.89	0.85	0.88	0.87
Consistently forgets to perform a behavior at the scheduled time	0.87	0.85	0.86	0.86
Persistent inability to recall if a behavior was performed	0.89	0.86	0.88	0.88
Persistent inability to recall familiar names, words, or objects	0.89	0.84	0.87	0.87
Persistent inability to recall factual information or events	0.88	0.84	0.87	0.86
Persistent inability to perform a previously learned skill	0.89	0.88	0.89	0.89
Persistent inability to learn a new skill	0.82	0.83	0.79	0.81
Persistent inability to learn new information	0.83	0.85	0.82	0.83
Persistent inability to retain a new skill	0.81	0.83	0.79	0.81
Persistent inability to retain new information	0.86	0.86	0.83	0.85
Preserved capacity to perform daily activities independently^* * Activities of Daily Living & Instrumental Activities of Daily Living. (CVI represents the proportion of raters in agreement about a given rating. CVI of 0.80 or greater is considered critical evidence.).	0.86	0.87	0.85	0.86
MEAN SCORE	0.86	0.86	0.84	0.85

Defining Characteristics of Chronic Confusion	R -CVI	C -CVI	I -CVI	T -CVI
Progressive impairment in cognitive functioning	0. 92	0. 88	0. 92	0. 91
Insidious and irreversible onset in cognitive impairment	0. 90	0. 85	0. 90	0. 88
Long -term cognitive impairment	0. 90	0. 86	0. 90	0. 89
Alteration in short-term memory	0. 86	0. 86	0.86	0. 86
Alteration in long-term memory	0. 89	0. 86	0. 87	0. 87
Alteration in at least one cognitive function other than memory	0. 87	0. 84	0. 86	0. 86
Alteration in personality	0. 84	0. 80	0. 83	0. 82
Alteration in behavior	0. 84	0. 83	0. 82	0. 83
Alteration in social functioning	0. 86	0. 86	0. 84	0. 85
Adequate alertness to surroundings	0. 81	0. 80	0. 79	0. 80
No changes on level of alertness	0. 73	0. 73	0. 73	0. 73
Inability to perform at least one daily activity*	0. 88	0. 89	0. 88	0. 88
MEAN SCORE	0. 86	0. 84	0. 86	0. 85

Defining Characteristics	Factor Loadings				C
Defining Characteristics	1	2	3	4	C
Persistent forgetfulness: R			0.75		0.64
Persistent forgetfulness: I			0.74		0.63
Consistently forgets to perform a behavior at the scheduled time: R			0.92		0.81
Consistently forgets to perform a behavior at the scheduled time: I			0.84		0.76
Persistent inability to recall if a behavior was performed: R		0.52			0.72
Persistent inability to recall if a behavior was performed: I		0.50			0.72
Persistent inability to recall familiar names, words, or objects: R		0.84			0.71
Persistent inability to recall familiar names, words, or objects: I		0.92			0.74
Persistent inability to recall factual information or events: R		0.59			0.65
Persistent inability to recall factual information or events: I		0.72			0.64
Persistent inability to perform a previously learned skill: R		0.77			0.71
Persistent inability to perform a previously learned skill: I		0.79			0.73
Persistent inability to learn a new skill: R	0.84				0.76
Persistent inability to learn a new skill: I	0.86				0.79
Persistent inability to learn new information: R	0.85				0.80
Persistent inability to learn new information: I	0.86				0.80
Persistent inability to retain a new skill: R	0.90				0.81
Persistent inability to retain a new skill: I	0.89				0.77
Persistent inability to retain new information: R	0.84				0.80
Persistent inability to retain new information: I	0.81				0.77
Preserved capacity to perform daily activities independently: R				0.93	0.87
Preserved capacity to perform daily activities independently: I				0.96	0.93
Rotation Sums of Squared Loadings in Pattern Matrix	9.38	9.03	7.28	4.92

Defining Characteristics	Factor Loadings					C
Defining Characteristics	1	2	3	4	5
Progressive impairment in cognitive functioning: R		0.84				0.72
Progressive impairment in cognitive functioning: I		0.85				0.71
Insidious and irreversible onset in cognitive impairment: R		0.91				0.77
Insidious and irreversible onset in cognitive impairment: I		0.95				0.78
Long-term cognitive impairment: R			0.42		0.43	0.71
Long-term cognitive impairment: I			0.47		0.53	0.72
Alteration in short-term memory: C			0.74			0.67
Alteration in short-term memory: I			0.84			0.75
Alteration in long-term memory: R			0.80			0.77
Alteration in long-term memory: I			0.81			0.70
Alteration in at least one CF other than memory: R		0.59				0.64
Alteration in at least one CF other than memory: I		0.52				0.61
Alteration in personality: R	0.79					0.81
Alteration in personality: I	0.77					0.78
Alteration in behavior: R	0.78					0.77
Alteration in behavior: I	0.82					0.80
Alteration in social functioning: R	0.75					0.80
Alteration in social functioning: I	0.71					0.78
Adequate alertness to surroundings: R				0.76		0.76
Adequate alertness to surroundings: I				0.76		0.78
No changes on level of alertness: R				0.88		0.80
No changes on level of alertness: I				0.92		0.81
Inability to perform at least one daily activity: R					0.89	0.81
Inability to perform at least one daily activity: I					0.96	0.83
Rotation Sums of Squared Loadings in Pattern Matrix	7.84	7.18	7.32	6.43	6.26

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[1] Corresponding author: Priscilla Alfradique de Souza. E-mail: priscillalfradique@gmail.com