Construction and Validation of an Instrument for Assessment of the Nursing Diagnosis,Risk for Infection,in Patients Following Cardiac Surgery

Abstract

Purpose

To construct and validate a data collection instrument (DCI), and a corresponding instructional guide, for assessment of the nursing diagnosis, risk for infection, in patients following cardiac surgery.

Methods

Construction of conceptual and operational definitions for risk factors based on literature, content validation by experts, and clinical validation by clinical nurses.

Findings

There were significant internal consistency and reproducibility in the content validation. In the clinical validation, agreement among nurses was higher than 70% for all risk factors.

Conclusions

The DCI was constructed and validated.

Implications for Nursing Practice

This DCI could be used for assessment of adult patients after cardiac surgeries worldwide because of its detailed cues for risk factors, which facilitate clinical reasoning and diagnostic judgment.

Objetivo

Construir e validar um instrumento de coleta de dados (ICD) e seu roteiro instrucional (RI) para avaliação do diagnóstico de enfermagem Risco de infecção em pacientes pós-cirurgia cardíaca.

Métodos

Construção de definições conceituais e operacionais dos fatores de risco baseada na literatura, validação de conteúdo por experts e validação clínica por enfermeiras assistenciais.

Resultados

Consistência interna e reprodutibilidade significativas na validação de conteúdo. Na validação clínica, a concordância foi maior que 70% para todos os fatores de risco.

Conclusões

O ICD foi construído e validado.

Implicações Para Prática De Enfermagem

O ICD poderia ser utilizado para avaliação de adultos pós-cirurgia cardíaca internacionalmente devido às suas pistas detalhadas sobre os fatores de risco, que facilitam o raciocínio clínico julgamento diagnóstico.

Keywords

Infection nursing diagnosis validation studies

Get full access to this article

View all access options for this article.

References

Abbas

A. K.

Lichtman

A. H.

Pillai

(2012). Cellular and molecular immunology. Philadelphia: Elsevier.

Abboud

C. S.

Wey

S. B.

Baltar

V. T.

(2004). Risk factors for mediastinitis after cardiac surgery. Annals of Thoracic Surgery, 77(2), 676–683.

Afilalo

Eisenberg

M. J.

Morin

J.-F.

(2010). Gait speed as an incremental predictor of mortality and major morbidity in elderly patients undergoing cardiac surgery. Journal of the American College of Cardiology, 56, 1668–1676.

Ambrosino

Gabbrielli

(2010). Physiotherapy in the perioperative period. Best Practice & Research. Clinical Anaesthesiology, 24(2), 283–289.

Berdajs

D. A.

Trampuz

Ferrari

Ruchat

Hurni

vonSegesser

L. K.

(2011). Delayed primary versus late secondary wound closure in the treatment of postsurgical sternum osteomyelitis. Interactive Cardiovascular and Thoracic Surgery, 12(6), 914–918.

Biglioli

Cannata

Alamanni

Naliato

Porqueddu

Zanobini

, … Parolari

(2003). Biological effects of off-pump vs. on-pump coronary artery surgery: Focus on inflammation, hemostasis and oxidative stress. European Journal of Cardio-thoracic Surgery, 24, 260–269.

Bouza

Hortal

Munoz

Pascau

Perez

M. J.

Hiesmayr

(2006). Postoperative infections after major heart surgery and prevention of ventilator-associated pneumonia: A one-day European prevalence study. Journal of Hospital Infection, 64, 224–230.

Carvalho

E. C.

Mello

A. S.

Napoleão

A. A.

Bachion

M. M.

Dalri

M. C. B.

Canini

S. R. M. S.

(2008). [Nursing diagnosis validation: Reflection on difficulties faced by researchers]. Revista Eletrônica de Enfermagem, 10(1), 235–240. (Portuguese).

Carvalho

E. C.

Tonani

Barbosa

J. S.

(2005). [Nursing actions to combat cancer developed in basic health units in a city in the state of São Paulo]. Revista Brasileira de Cancerologia, 51(4), 297–303. (Portuguese).

10.

Cavalcanti

A. B.

Avezum

Sousa

A. G.

Rassi Júnior

Coutinho

Mesquita

E. T.

(2001). [Medical semiology: Contribution of evidence-based cardiology]. Revista da Sociedade de Cardiologia do Estado de São Paulo, 11, 176–188. (Portuguese).

11.

Centers for Disease Control and Prevention . (2009). The National Healthcare Safety Network (NHSN) patient safety component protocol . Retrieved from http://www.cdc.gov/nhsn/PDFs/pscManual/pscManual_current.pdf

12.

Dallé

Lucena

A. F.

(2012). Nursing diagnoses identified in hospitalized patients during hemodialysis. Acta Paulista de Enfermagem, 25(4), 504–510.

13.

Eom

C.-S.

Jeon

C. Y.

Lim

J.-W.

Cho

E. G.

Park

S. M.

Lee

K. S.

(2011). Use of acid-suppressive drugs and risk of pneumonia: A systematic review and meta-analysis. Canadian Medical Association Journal, 183(3), 310–319.

14.

Fehring

(1987). Methods to validate nursing diagnosis. Heart & Lung, 16(6), 625–629.

15.

Fernandes

A. T.

Ribeiro Filho

Barroso

E. A. R.

(2000). [Concept, epidemiological chain of nosocomial infections and cost-benefit assessment of control measures]. In Fernandes

A. T.

(Ed.), Infecção Hospitalar e suas Interfaces na Área da Saúde (pp. 479–502). São Paulo: Atheneu. (Portuguese).

16.

Filsoufi

Castillo

J. G.

Rahmanian

P. B.

Broumand

S. R.

Silvay

Carpentier

Adams

D. H.

(2009). Epidemiology of deep sternal wound infection in cardiac surgery. Journal of Cardiothoracic and Vascular Anesthesia, 23(4), 488–494.

17.

Galdeano

Rossi

L. A.

(2002). [Construction and validation of a data collection instrument for the perioperative period of cardiac surgery]. Revista Latino-Americana de Enfermagem, 10(6), 800–804. (Portuguese).

18.

Galdeano

L. E.

Rossi

L. A.

Nobre

L. F.

Ignacio

D. S.

(2003). [Nursing diagnosis in patients in the intraoperative period of cardiac surgery]. Revista Latino-Americana de Enfermagem, 11(2), 199–206. (Portuguese).

19.

Galdeano

L. E.

Rossi

L. A.

Santos

C. B.

Dantas

R. A. S.

(2006). [Nursing diagnosis in the perioperative of cardiac surgery]. Revista da Escola de Enfermagem da USP, 40(1), 26–33. (Portuguese).

20.

Glashan

R. Q.

Fera

(2002). [Abdominal examination: Urinary tract]. In Barros

A. L. B. L.

(Ed.), Anamnese e Exame Físico. Avaliação diagnóstica de enfermagem no adulto (pp. 174–178). Porto Alegre, Brazil: Artmed. (Portuguese).

21.

Gowardman

J. R.

Robertson

I. K.

Parkes

Rickard

C. M.

(2008). Influence of insertion site on central venous catheter colonization and bloodstream infection rates. Intensive Care Medicine, 34(6), 1038–1045.

22.

Guaragna

J. C.

Facchi

L. M.

Baião

C. G.

daCruz

I. B. M.

Bodanese

L. C.

Albuquerque

, … Goldani

M. A.

(2004). [Predictors of mediastinitis in cardiac surgery]. Revista Brasileira de Cirurgia Cardiovascular, 19(2), 165–170. (Portuguese).

23.

Guedes

H. M.

Santos

W. L.

Nakatani

A. Y. K.

Chianca

T. C. M.

(2011). [Nursing diagnosis in hospital admission and discharge of the elderly]. Revista de Enfermagem da UERJ, 19(4), 564–570. (Portuguese).

24.

Guerriero

A. L. S.

Guimaräes

H. C. Q. C. P.

Maria

V. L. R.

(2000). [Nursing diagnoses of the adult patient in the first postoperatory of cardiac surgery]. Acta Paulista de Enfermagem, 13(2), 59–67. (Portuguese).

25.

Henry

J. F.

(2011). The ASA classification and peri-operative risk. Annals of the Royal College of Surgeons of England, 93(3), 185–187.

26.

Herdman

T. H.

(Ed.). (2012). NANDA International nursing diagnoses: Definitions and classification, 2012–2014. Oxford, UK: Wiley-Blackwell.

27.

Hortal

Giannella

Pérez

M. J.

Barrio

J. M.

Desco

Bouza

Muñoz

(2009). Incidence and risk factors for ventilator-associated pneumonia after major heart surgery. Intensive Care Medicine, 35(9), 1518–1525.

28.

Klein

D. J.

Briet

Nisenbaum

Romaschin

A. D.

Mazer

C. D.

(2011). Endotoxemia related to cardiopulmonary bypass is associated with increased risk of infection after cardiac surgery: A prospective observational study. Critical Care, 15, R69–R74.

29.

Laizo

Delgado

F. E. F.

Rocha

G. M.

(2010). Complications that increase the time of hospitalization at ICU of patients submitted to cardiac surgery. Revista Brasileira de Cirurgia Cardiovascular, 25(2), 166–171.

30.

Miliani

L'Hériteau

Astagneau

, on behalf of the INCISO Network Study Group . (2009). Non-compliance with recommendations for the practice of antibiotic prophylaxis and risk of surgical site infection: Results of a multilevel analysis from the INCISO Surveillance Network. Journal of Antimicrobial Chemotherapy, 64, 1307–1315.

31.

Murphy

G. J.

Reeves

B. C.

Rogers

C. A.

Rizvi

S. I.

Culliford

Angelini

G. D.

(2007). Increased mortality, postoperative morbidity, and cost after red blood cell transfusion in patients having cardiac surgery. Circulation, 116(22), 2544–2552.

32.

NANDA International . (2007). NANDA nursing diagnoses: Definitions and classification (2007–2008). Porto Alegre: Artmed.

33.

Phillips

L. D.

(2001). [Manual of intravenous therapy]. Porto Alegre, Brazil: Artmed. (Portuguese).

34.

Polit

D. F.

Beck

C. T.

(Eds.). (2013). Essentials of nursing research: Appraising evidence for nursing practice (8th ed.). Philadelphia: Lippincott Williams & Wilkins.

35.

Rocha

L. A.

Maia

T. F.

Silva

L. F.

(2006). [Nursing diagnoses in patients undergoing cardiac surgery]. Revista Brasileira de Enfermagem, 59(3), 321–326. (Portuguese).

36.

Rogers

M. A.

Blumberg

Saint

Langa

K. M.

Nallamothu

B. K.

(2009). Hospital variation in transfusion and infection after cardiac surgery. BMC Medicine, 7, 37–45.

37.

Roitt

I. M.

Delves

P. J.

(2004). [Inate immunity]. Rio de Janeiro: Guanabara Koogan. (Portuguese).

38.

Saad

I. A. B.

Zambom

(2001). [Clinical variables of preoperative risk]. Revista da Associação Médica Brasileira, 47(2), 117–124. (Portuguese).

39.

Safdaremail

O'Horo

J. C.

Maki

D. G.

(2013). Arterial catheter-related bloodstream infection: Incidence, pathogenesis, risk factors and prevention. Journal of Hospital Infection, 85(3), 189–195.

40.

Schimmer

Reents

Berneder

Eigel

Sezer

Scheld

, … Leyh

(2008). Prevention of sternal dehiscence and infection in high-risk patients: A prospective randomized multicenter trial. Annals of Thoracic Surgery, 86(6), 1897–1904.

41.

Snyder-Ramos

S. A.

Möhnle

Weng

Y. S.

Böttiger

B. W.

Kulier

Levin

Mangano

D. T.

; Investigators of the Multicenter Study of Perioperative Ischemia; MCSPI Research Group . (2008). The ongoing variability in blood transfusion practices in cardiac surgery. Transfusion, 48(7), 1284–1299.

42.

Speksnijder

H. T.

Mank

A. P.

vanAchterberg

(2011). Nursing diagnoses (NANDA-I) in hematology-oncology: A Delphi study. International Journal of Nursing Terminologies and Classifications, 22(2), 77–91.

43.

Steinberg

J. P.

Braun

B. I.

Hellinger

W. C.

Kusek

Bozikis

M. R.

Bush

A. J.

, … Kritchevsky

S. B.

(2009). Timing of antimicrobial prophylaxis and the risk of surgical site infections: Results from the trial to reduce antimicrobial prophylaxis errors. Annals of Surgery, 250(1), 10–16.

44.

Tanner

Woodings

Moncaster

(2006). Preoperative hair removal to reduce surgical site infection. Cochrane Database of Systematic Reviews, 19(2), CD004122. Retrieved from http://dx.doi.org/10.1002/14651858

45.

Taylor

Lilles

Lê Mone

(2007). [Nursing fundamentals. The art and science of nursing care]. Porto Alegre, Brazil: Artmed. (Portuguese).

46.

Vanhuyse

Maureira

Portocarrero

Laurent

Lekehal

Carteaux

J.-P.

Villemot

J.-P.

(2012). Cardiac surgery in cirrhotic patients: Results and evaluation of risk factors. European Journal of Cardio-Thoracic Surgery, 42(2), 293–299.

47.

Wald

H. L.

Bratzler

D. H.

Kramer

A. M.

(2008). Indwelling urinary catheter use in the postoperative period analysis of the national surgical infection prevention project data. Archives of Surgery, 143(6), 551–557.

48.

Yamauti

A. K.

Ochiai

M. E.

Bifulco

P. S.

Moab

A. A.

Alonso

R. R.

Ribeiro

R. H. C.

Pereira-Barretto

A. C.

(2006). [Subjective global nutritional assessment in cardiac patients]. Arquivos Brasileiros de Cardiologia, 87(6), 772–777. (Portuguese).