Nursing Process in Human Milk Banks: technology development and validity

Saldanha, Camila Trevisan; Zanotelli, Silvana dos Santos; Argenta, Carla; Adamy, Edlamar Kátia; Fontes, Cassiana Mendes Bertoncello

doi:10.1590/0034-7167-2025-0206

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ORIGINAL ARTICLE • Rev. Bras. Enferm. 79 • 2026 • https://doi.org/10.1590/0034-7167-2025-0206 linkcopy

Nursing Process in Human Milk Banks: technology development and validity

Proceso de Enfermería en Bancos de Leche Humana: desarrollo y validación de tecnología

Authorship SCIMAGO INSTITUTIONS RANKINGS

Objectives: to construct and validate a nursing assessment instrument and care matrix for implementing the Nursing Process in a Human Milk Bank.

Methods: methodological research, carried out in two stages: evidence-based instrument construction using an integrative review, the Theory of Basic Human Needs, and the NANDA International, Nursing Outcomes Classification, and Nursing Interventions Classification taxonomies; and content validity by 12 experts using an electronic form. Data analysis was performed using the Content Validity Index and the Kappa Index.

Results: the instrument consists of two parts: initial assessment; and a matrix with nursing diagnoses, outcomes, and interventions. The first part had a Content Validity Index and Kappa Index of 0.84 and 0.74, respectively. The second part had a Content Validity Index of 0.96 and a Kappa Index of 0.86.

Conclusions: the technology proved valid in terms of content, with the potential to standardize and guide nursing practices.

Descriptors:
Nursing Process; Technology; Nursing; Milk Banks; Breast Feeding.

Items	I	PA	A	TA	CVI	Kappa
Sociodemographic data	0	3	5	4	0.75	0.62
Obstetric history	0	2	6	4	0.83	0.71
Examination results	0	2	6	4	0.83	0.71
Current breastfeeding status	0	3	6	3	0.75	0.60
Breast examination	0	2	6	4	0.83	0.71
Vital signs record	1	1	7	3	0.83	0.75
Psychobiological needs (chunk 1)	0	2	8	2	0.83	0.71
Psychobiological needs (chunk 2)	0	1	9	2	0.91	0.86
Psychobiological needs (chunk 3)	0	1	9	2	0.91	0.86
Psychosocial needs (chunk 1)	0	2	8	2	0.83	0.75
Psychosocial needs (chunk 2)	0	2	8	2	0.83	0.71
Psychospiritual needs (chunk 3)	0	1	9	2	0.91	0.85
TOTAL Content Validity Index/Kappa					0.84	0.74

N°	Suggestion	Action
Sociodemographic data
E3	What would be the reason for sharing information about WhatsApp scams in relation to surveys?	Accepted, withdrawn.
E3	Will there be any data to identify the patient, such as a taxpayer identification number, national identity card number, or mother’s name?	Not accepted. This data was not included because it is admission data already included in the service user’s registration. Nursing assessment data was considered in this stage.
E8	Home collection would be for donors. So, perhaps the question should be asked if a patient is a donor/potential donor, because who would these processes be for? Any patient who is served by the Human Milk Bank or only donors?	Accepted, donor identification item included.
E10	A question could be included to address difficulties or ease of accessing the milk bank, accessibility, or reduced mobility.	If not addressed, mobility issues are covered under the category of psychobiological needs.
Current breastfeeding conditions
E3	Include information about laser therapy (performs laser therapy).	Accepted. Information regarding laser therapy added.
E3	“Normal” is also a bad term to use. Normal for whom? What is normal production?	Accepted. Appropriate terminology was used to reflect clinical expectations.
E10	Identify any breastfeeding difficulties and specify those that are currently supported by scientific evidence in the literature, using closed-ended questions (as proposed in this questionnaire).	Accepted, with added items such as pain while breastfeeding, difficulty latching, difficulty positioning, interference from nipples/bottles/pacifiers, decreased milk flow, and increased milk flow.
E11	In the sentence “is breastfeeding”, add “breastfeeding supplemented”.	Included item: “Breastfeeding supplemented with: artificial formula; other types of milk; food”.

Connection number - nursing diagnosis	I	PA	A	TA	CVI	Kappa
1 - Ineffective breastfeeding	0	1	9	2	0.92	0.84
2 - Interrupted breastfeeding	0	1	9	2	0.92	0.84
3 - Readiness for Enhanced breastfeeding	0	0	10	2	1	0.89
4 - Insufficient breast milk production	0	1	9	2	0.92	0.84
5 - Risk for nipple-areolar complex injury	0	1	9	2	0.92	0.84
6 - Impaired tissue integrity	0	0	10	2	1	0.89
7 - Imbalanced nutrition less than body requirements	0	0	10	2	1	0.89
8 - Risk for imbalanced fluid volume	0	0	10	2	1	0.89
9 - Risk for constipation	0	3	7	2	0.75	0.63
10 - Disturbed sleep pattern	0	1	9	2	0.92	0.84
11 - Risk for infection	0	0	10	2	1	0.89
12 - Ineffective childbearing process	0	0	10	2	1	0.89
13 - Acute pain	0	0	10	2	1	0.89
14 - Situational low self-esteem	0	0	10	2	1	0.89
15 - Readiness for enhanced parenting	0	0	10	2	1	0.89
16 - Interrupted family processes	0	0	10	2	1	0.89
17 - Anxiety	0	0	10	2	1	0.89
18 - Fear	0	0	10	2	1	0.89
19 - Risk for caregiver role strain	0	1	10	1	0.92	0.84
20 - Risk for impaired attachment	0	0	10	2	1	0.89
21 - Impaired comfort	0	1	9	2	0.92	0.84
22 - Disturbed body image	0	0	10	2	1	0.89
23 - Readiness for enhanced spiritual well-being	0	1	9	2	0.92	0.84
24 - Spiritual distress	0	1	9	2	0.92	0.89
Total Content Validity Index					0.96	0.86

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