“Spiritual distress (00066)” in patients under fertility treatment: Clinical validation study

Abstract

Purpose

This study aimed to clinically validate the NANDA-I nursing diagnosis of “Spiritual distress (00066)” in people under assisted reproductive technologies, and to determine the sensitivity, specificity, and predictive value of the defining characteristics.

Methods

Cross-sectional study that was conducted between September 2019 and June 2020. Recruitment happened by invitation posted in fertility-related websites. Those who accepted to participate were asked to fill the consent form and the online questionnaire. Statistical analysis was based on Rasch's model. The study was approved by the Ethics Committee.

Findings

The sample comprised 104 Portuguese individuals undergoing assisted reproductive techniques. The “Spiritual distress (00066)” was validated and 22 defining characteristics were confirmed as representative. No item showed differential item functioning. “Perceived suffering” was the most sensitive defining characteristic and had the highest negative predictive value. “Insufficient courage” had the highest positive predictive value, and “Anger toward power greater than self” was the most specific.

Conclusions

Results validated the presence of the NANDA-I nursing diagnosis of “Spiritual distress (00066)” in a sample going through assisted reproductive technologies, improving accuracy of this nursing diagnosis in such population.

Implications for nursing practice

This is a crucial step to raise the level of evidence of such nursing diagnosis and to increase the level of evidence on NANDA-I terminology. Furthermore, this study has contributed to raising the quality of nurse's critical judgement and clinical reasoning and allow an early spiritual and a more holistic and personalized patient-centered intervention in the reproductive field.

Objetivo

O presente estudo teve como objetivo analisar a validade clínica do diagnóstico de “angústia espiritual (00066)” em pessoas a realizar técnicas de reprodução assistida e determinar a sensibilidade, especificidade e valor preditivo das características definidoras.

Métodos

Este é um estudo transversal que decorreu entre Setembro de 2019 e Junho de 2020. O recrutamento ocorreu por meio de convite lançado em sítios afetos ao tema da fertilidade. As pessoas interessadas em participar preencheram um formulário de consentimento informado e um questionário online. A análise estatística primou pelo emprego do modelo Rasch. O estudo foi aprovado pela Comissão de Ética.

Resultados

A amostra final incluiu 104 portugueses submetidos a técnicas de reprodução medicamente assistida. O diagnóstico de “angústia espiritual (00066)” foi validado e 22 características definidoras foram confirmadas pelos dados. “Sofrimento percebido” foi a característica definidora mais sensível e com o maior valor negativo preditivo. “Coragem insuficiente” destacou-se no valor positivo preditivo, e “Raiva relativa a Poder Maior do que o próprio” foi a mais específica.

Conclusões

Os resultados obtidos validaram a presença do diagnóstico de “angústia espiritual (00066)” em pessoas a realizar técnicas de reprodução assistida, contribuindo, desta forma para melhorar a acurácia deste diagnóstico de enfermagem nesta população.

Implicações para a prática

Este é um passo crucial para elevar o nível de evidência deste diagnóstico de enfermagem e aumentar o corpo do conhecimento da terminologia NANDA-I. O seu contributo passa também por elevar a qualidade do julgamento crítico dos enfermeiros e o seu poder de decisão clínica permitindo uma intervenção precoce mais holística, centrada na espiritualidade e no paciente em contexto reprodutivo.

Keywords

Assisted reproductive techniques infertility nursing diagnosis spirituality validation studies

Get full access to this article

View all access options for this article.

References

Allot

Payne

Dann

(2013). Midwifery and assisted reproductive technologies. New Zealand College of Midwives, 47, 10–13.

Batool

S. S.

Visser

R. O.

(2016). Experiences of infertility in British and Pakistani Women: A cross-cultural qualitative analysis. Health Care for Women International, 37, 180–196. https://doi.org/10.1080/07399332.2014.980890

Behboodi-Moghadam

Salsali

Eftekhar-Ardabily

Vaismoradi

Ramezanzadeh

(2013). Experiences of infertility through the lens of Iranian infertile women: A qualitative study. Japan Journal of Nursing Science, 10, 41–46. https://doi.org/10.1111/j.1742-7924.2012.00208.x

Berger

Paul

Henshaw

(2013). Women's experience of infertility: A multi-systemic perspective. Journal of International Women's Studies, 14(1), 54–68.

Cabral

H. B. O.

Bucher-Maluschke

J. S. N. F.

(2016). Desenvolvimento dos fatores de resiliência no contexto da infertilidade: Revisão. Psicologia, Saúde & Doença, 17(3), . https://doi.org/10.15309/16psd170315

Caldeira

Timmins

deCarvalho

E. C.

Vieira

(2015). Clinical validation of the nursing diagnosis spiritual distress in cancer patients undergoing chemotherapy. International Journal of Nursing Knowledge, 28(1), 44–52. https://doi.org/10.1111/2047-3095.12105

Caldeira

Timmins

deCarvalho

E. C.

Vieira

(2016). Nursing diagnosis of «spiritual distress» in women with breast cancer: Prevalence and major defining characteristics. Cancer Nursing, 39(4), 321–327. https://doi.org/10.1097/NCC.0000000000000310

Carvalho

J. L. S.

Santos

(2009). Estudo Afrodite, Caracterização da Infertilidade em Portugal (p. 74). Faculdade de Medicina da Universidade do Porto, Sociedade Portuguesa de Medicina da Reprodução, KeyPoint. http://static.publico.pt/docs/sociedade/AfroditeInfertilidade.pdf

Cassel

E. J.

(1982). The nature of suffering and the goals of medicine. The New England Journal of Medicine, 306(11), 639–645. https://doi.org/10.1056/NEJM198203183061104

10.

CNPMA . (2013). Relatório de Atividades desenvolvida pelos Centros de PMA em 2011 (p. 27). Conselho Nacional de Procriação Medicamente Assistida. http://www.spmr.pt/files/pma_nacional_2011.pdf

11.

Daibes

M. A.

Safadi

R. R.

Athamneh

Anees

I. F.

Constantino

R. E.

(2018). Half a woman, half a man; that is how they make me feel: A qualitative study of rural Jordanian women's experience of infertility. Culture, Health & Sexuality, 20(5), 516–530. https://doi.org/10.1080/13691058.2017.1359672

12.

Decreto-Lei no319/86, 25 Setembro , Pub. L. No. I Série, no221, 2726 (1986).

13.

deSouza Oliveira-Kumakura

A. R.

Caldeira

Prado Simão

Camargo-Figuera

F. A.

deAlmeida Lopes Monteiro da Cruz

Campos de Carvalho

(2018). The contribution of the Rasch model to the clinical validation of nursing diagnoses: Integrative literature review. International Journal of Nursing Knowledge, 29(2), 89–96. https://doi.org/10.1111/2047-3095.12162

14.

Dierickx

Rahbari

Longman

Jaiteh

Coene

(2018). ‘I am always crying on the inside’: A qualitative study on the implications of infertility on women's lives in urban Gambia. Reproductive Health, 15(1), 151. https://doi.org/10.1186/s12978-018-0596-2

15.

Dyer

S. J.

Abrahams

Hoffman

van derSpuy

Z. M.

(2002). Men leave me as I cannot have children: Women's experiences with involuntary childlessness. Human Reproduction (Oxford, England), 17(6), 1663–1668.

16.

Fisher

(2010). Development and application of a spiritual well-being questionnaire called SHALOM. Religions, 1(1), 105–121. https://doi.org/10.3390/rel1010105

17.

Frankl

V. E.

(2013). Em busca de sentido: Um psicólogo no campo de concentração. Editora Sinodal.

18.

Gameiro

Van Den Belt-Dusebout

A. W.

Smeenk

J. M. J.

Braat

D. D. M.

Van Leeuwen

F. E.

Verhaak

C. M.

(2016). Women's adjustment trajectories during IVF and impact on mental health 11–17 years later. Human Reproduction, 31(8), . https://doi.org/10.1093/humrep/dew131

19.

Gengo e Silva

R. de C.

Guedes

E. de S.

daCruz

D. d. A. L. M.

(2014). Ineffective peripheral tissue perfusion: construct validation using Rasch analysis [Poster presentation]. 25th International Nursing Research Congress, Hong Kong. https://sigma.nursingrepository.org/handle/10755/335255

20.

Gómez

E. P.

Orozco

Camargo

Berrío

J. A.

Moreno

L. X. M.

(2012). Bullying en adolescentes escolarizados: Validacion del diagnostico de enfermeria «riesgo de violencia dirigida a otros». Hacia la Promoción de la Salud, 17(1), 45–58.

21.

Gómez

E. P.

Orozco

V. L. C.

Camargo

F. F. A.

Alfonso

H. E. P.

Peña

V, E. R.

Villabona

A. L. N.

Acevedo

G. Y.

(2011). Lactancia materna ineficaz: Prevalencia y factores asociados. Revista de la Universidad Industrial de Santander. Salud, 43(3), 271–279.

22.

Gomez

Fisher

J. W.

(2003). Domains of spiritual well-being and development and validation of the spiritual well-being questionnaire. Personality and Individual Differences, 35, 1975–1991. https://doi.org/10.1016/S0191-8869(03)00045-X

23.

Gomez

Fisher

J. W.

(2005). The spiritual well-being questionnaire: Testing for model applicability, measurement and structural equivalencies, and latent mean differences across gender. Personality and Individual Differences, 39(8), 1383–1393. https://doi.org/10.1016/j.paid.2005.03.023

24.

Gouveia

M. J.

Marques

Ribeiro

J. L. P.

(2009). Versão portuguesa do questionário de bem-estar espiritual (SWBQ): Análise confirmatória da sua estrutura factorial. Psicologia, Saúde & Doenças, 10(2), 285–293.

25.

Greil

A. L.

Slauson-Blevins

McQuillan

(2010). The experience of infertility: A review of recent literature. Sociology of Health and Illness, 32(1), 140–162. https://doi.org/10.1111/j.1467-9566.2009.01213.x

26.

Hagquist

Bruce

Gustavsson

J. P.

(2009). Using the Rasch model in nursing research: An introduction and illustrative example. International Journal of Nursing Studies, 46, 380–393.

27.

Hendriks

Peeraer

Bos

Repping

Dancet

E. a. F.

(2017). The importance of genetic parenthood for infertile men and women. Human Reproduction (Oxford, England), 32(10), 2076–2087. https://doi.org/10.1093/humrep/dex256

28.

Herdman

H. T.

Kamitsuru

(2018). Nursing diagnoses: Definitions & classification 2018–2020. Thieme.

29.

Herdman

H. T.

Kamitsuru

Lopes

camila.

(2021). NANDA-I Nursing diagnoses: Definitions and classification 2021–2023 (12th edition). Thieme Medical Publishers.

30.

Kahn

D. L.

Steeves

R. H.

(1986). The experience of suffering: Conceptual clarification and theoretical definition. Journal of Advanced Nursing, 11(6), 623–631. https://doi.org/10.1111/j.1365-2648.1986.tb03379.x

31.

Kraus

(2014). Sentido de vida da pessoa com dor crónica [Tese Doutoramento, Universidade Católica Portuguesa, Instituto de Ciências da Saúde]. Veritati – Repositório Institucional da Universidade Católica Portuguesa. https://repositorio.ucp.pt/handle/10400.14/16164

32.

Kraus

(2021). Tradução, adaptação cultural e validação do meaning in suffering test para português Europeu. Revista de Enfermagem Referência, 5, e20069. https://doi.org/10.12707/RV20069

33.

Lalos

Jacobsson

vonSchoultz

(1985). Psychological reactions to the medical investigation and surgical treatment of infertility. Gynecologic and Obstetric Investigation, 20(4), 209–217.

34.

Levett-Jones

Hoffman

Dempsey

Jeong

S. Y.-S.

Noble

Norton

C. A.

Roche

Hickey

(2010). The «five rights» of clinical reasoning: An educational model to enhance nursing students’ ability to identify and manage clinically «at risk» patients. Nurse Education Today, 30(6), 515–520. https://doi.org/10.1016/j.nedt.2009.10.020

35.

Linacre

J. M.

(1994). Sample size and item calibration or person measure stability. Rasch Measurement Transactions, 7, 328.

36.

Linacre

J. M.

(2011). Table 23.1, 23.11, … Principal components/contrast plots of item loadings. Winsteps. https://www.winsteps.com/winman/table23_1.htm

37.

Linacre

J. M.

(2021a). Table 23.0 Variance components for items. Winsteps. https://www.winsteps.com/winman/table23_0.htm

38.

Linacre

J. M.

(2021b). WINSTEPS – Multiple-choice, rating scale and partial credit Rasch analysis (4.8.0) [Computer software]. https://www.winsteps.com/winsteps.htm

39.

Lopes

M. V.

Silva da

V. M.

deAraujo

T. L.

(2013). Validação de diagnósticos de enfermagem: Desafios e alternativas. Revista Brasileira de Enfermagem, 66, 649–655. https://doi.org/10.1590/S0034-71672013000500002

40.

Machado

M. H.

(1999). Controvérsias éticas e jurídicas na reprodução medicamente assistida [Dissertação apresentada ao Curso de Pós-Graduação em Direito da Universidade Federal de Santa Catarina» como requisito à obtenção do titulo de Mestre em Ciências Humanas – Especialidade em Direito.]. Universidade Federal de Santa Catarina.

41.

Mascarenhas

M. N.

Flaxman

S. R.

Boerma

Vanderpoel

Stevens

G. A.

(2012). National, regional, and global trends in infertility prevalence since 1990: A systematic analysis of 277 health surveys. PLOS Medicine, 9(12), 1–12.

42.

McCreary

L. L.

Conrad

K. M.

Conrad

K. J.

Scott

C. K.

Funk

R. R.

Dennis

M. L.

(2013). Using the Rasch measurement model in psychometric analysis of the family effectiveness measure. Nursing Research, 62(3), 149–159. https://doi.org/10.1097/NNR.0b013e31828eafe6

43.

McQuillan

Stone

R. A. T.

Greil

A. L.

(2007). Infertility and life satisfaction among women. Journal of Family Issues, 28(7), 955–981.

44.

Miguel

Romeiro

Martins

Casaleiro

Herdman

T. H.

(2018). “Call for the use of axial terms”: Toward completeness of NANDA-I nursing diagnoses Labels. International Journal of Nursing Knowledge, 30(3), 131–136. https://doi.org/10.1111/2047-3095.12228

45.

Moreira

S. M.

(2011). Espiritualidade, bem-estar e qualidade de vida de pessoas idosas que vivem sós no domicílio habitual [Tese Mestrado em Enfermagem de Saúde Mental e Psiquiatria, Escola Superior de Enfermagem do Porto]. https://comum.rcaap.pt/handle/10400.26/9214

46.

Nunnally

J. C.

Bernstein

I. H.

(1994). The assessment of reliability. Em Psychometric theory (Vol. 3, pp. 248–292). McGraw-Hill.

47.

Oddens

B. J.

Tonkelaar den

Nieuwenhuyse

(1999). Psychosocial experiences in women facing fertility problems—A comparative survey. Human Reproduction, 14(1), 255–261.

48.

Orozco-Vargas

L. C.

Villamizar-Carvajal

Vargas-Porras

(2015a). Impaired parenting (00056) in primiparous mothers: Clinical validation through Rasch analysis. Aquichan, 15(2), 176–187. https://doi.org/10.5294/aqui.2015.15.2.2

49.

Pedro

Sobral

M. P.

Mesquita-Guimarães

Leal

Costa

M. E.

Martins

M. V.

(2017). Couples’ discontinuation of fertility treatments: A longitudinal study on demographic, biomedical, and psychosocial risk factors. Journal of Assisted Reproduction and Genetics, 34(2), . https://doi.org/10.1007/s10815-016-0844-8

50.

Practice Committee of American Society for Reproductive Medicine . (2012). Definitions of infertility and recurrent pregnancy loss: A committee opinion. Fertility and Sterility, 99(1), 63. https://doi.org/10.1016/j.fertnstert.2012.09.023

51.

Rayner

J.-A.

McLachlan

H. L.

Forster

D. A.

Cramer

(2009). Australian women's use of complementary and alternative medicines to enhance fertility: Exploring the experiences of women and practitioners. BMC Complementary and Alternative Medicine, 9(52), 1–10. https://doi.org/10.1186/1472-6882-9-52

52.

Romeiro

Caldeira

(2018a). A synthesis of Portuguese studies regarding infertile patients. BMC Health Services Research, 18(Suppl 2), 684, 1–183. https://doi.org/10.1186/s12913-018-3444-8

53.

Romeiro

Caldeira

(2018b). The human responses and nursing diagnoses of those living with infertility: A qualitative systematic review. International Journal of Nursing Knowledge, . https://doi.org/10.1111/2047-3095.12223

54.

Romeiro

Caldeira

Brady

Hall

Timmins

(2017). The spiritual journey of infertile couples: Discussing the opportunity for spiritual care. Religions, 8(4), 76. https://doi.org/10.3390/rel8040076

55.

Romeiro

Caldeira

Brady

Timmins

Hall

(2017). Spiritual aspects of living with infertility: A synthesis of qualitative studies. Journal of Clinical Nursing, 26, 3917–3935. https://doi.org/10.1111/jocn.13813

56.

Romeiro

Nogueira

P. J.

Fisher

Caldeira

(2022). Portuguese version of the spiritual well-being questionnaire: Validation study in people under assisted reproductive techniques. Religions, 13(5), 400. https://doi.org/10.3390/rel13050400

57.

Roudsari

R. L.

Allan

H. T.

Smith

P. A.

(2007). Looking at infertility through the lens of religion and spirituality: A review of the literature. Human Fertility, 10(3), 141–149.

58.

Silva

I. R. V.

Ferreira

A. M. N. dos S.

Brito

M. A. F.

Dias

N. M. B.

Henriques

C. M. G.

(2012). As vivências da mulher infértil. Revista de Enfermagem Referência, III(8), 181–189.

59.

Sormunen

Karlgren

Aanesen

Fossum

Westerbotn

(2020). The role of social media for persons affected by infertility. BMC Women's Health, 20(1), 112. https://doi.org/10.1186/s12905-020-00964-0

60.

Tabachnick

B. G.

Fidell

L. S.

(2007). Using multivariate statistics. (5th ed.). Allyn & Bacon/Pearson Education.

61.

Van Den Broeck

Holvoet

Enzlin

Bakelants

Demyttenaere

D'Hooghe

(2009). Reasons for dropout in infertility treatment. Gynecologic and Obstetric Investigation, 68(1), . https://doi.org/10.1159/000214839

62.

Weathers

McCarthy

Coffey

(2016). Concept analysis of spirituality: An evolutionary approach. Nursing Forum, 51(2), 79–96. https://doi.org/10.1111/nuf.12128

63.

Wright

B. D.

Linacre

J. M.

(1994). Reasonable mean-square fit values. Rasch Measurement Transactions, 8, 370–371.

64.

Zegers-Hochschild

Adamson

G. D.

Dyer

Racowsky

deMouzon

Sokol

Rienzi

Sunde

Schmidt

Cooke

I. D.

Simpson

J. L.

van derPoel

(2017). The international glossary on infertility and fertility care, 2017. Fertility and Sterility, 108(3), . https://doi.org/10.1016/j.fertnstert.2017.06.005