Content validation of the defining characteristics of the nursing diagnosis “impaired swallowing” using the Delphi technique: A study with dysphagia nursing experts in Japan

Abstract

Purpose

Nurses’ clinical reasoning skills regarding impaired swallowing can help prevent patient complications and maintain quality of life. Clinical reasoning skills need content-validated defining characteristics (DCs). We aimed to validate the content of these DCs for nursing diagnosis “impaired swallowing.”

Methods

Content validation of the DCs was performed by 275 dysphagia nursing experts in Japan, using 3 rounds of the Delphi technique and Fehring's Diagnostic Content Validation (DCV) model. Three rounds of questionnaires on 84 DCs were completed via printed mail.

Findings

The valid response rates for each round were as follows: round 1, 90.2%; round 2, 77.8%; and round 3, 71.3%. Of the 84 DCs, 77 that met the consensus criteria were categorized as major (n = 18), minor (n = 45), and excluded (n = 14). There were four minor DCs other than the oral, pharyngeal, and esophageal phases. DCs listed from outside NANDA-I included 12 major, 16 minor, and 3 excluded characteristics. Of the NANDA-I DCs, 5 were no consensus and 11 were excluded. The total DCV score for the 63 major and minor DCs was 0.8.

Conclusions

Our results recommend the addition of 28 DCs and the exclusion of 11 for the NANDA-I nursing diagnosis “impaired swallowing” (00103). Major DCs were prominent indicators of impaired swallowing and signs of aspiration or pharyngeal residuals. Minor DCs included not only the three phases but also other signs necessary for a comprehensive understanding of impaired swallowing.

Implications for nursing practice

This validation study strengthens the clinical usefulness of the DCs for impaired swallowing, which can improve nurses’ clinical reasoning skills. Major and minor DCs can increase the awareness of impaired swallowing and enable accurate intervention, thereby preventing patient complications and maintaining quality of life.

目的::

看護師の嚥下障害に関する臨床推論能力は, 患者の合併症を予防し, QOLを維持するのに役立つ.臨床推論には, 内容妥当性が検証された診断指標が必要である.我々は, 看護診断「嚥下障害」の診断指標の内容妥当性検証をすることを目的とした.

方法::

嚥下障害看護の専門家275名を対象に, デルファイ法およびFehringのDiagnostic Content Validationモデルを用いて, 診断指標の内容妥当性検証を行った.３回の診断指標84項目に関する質問紙調査が郵送法で実施された.

結果::

各roundの有効回答率は, 第1 round 90.2％, 第2 round 77.8％, 第3 round 71.3％であった.診断指標84項目のうち, コンセンサス基準を満たした77項目は, major (n = 18), minor (n = 45), 除外 (n = 14) に分類された.口腔相, 咽頭相, 食道相以外のminorの診断指標は4項目あった.NANDA-I以外の診断指標は, major 12項目, minor 16項目, 除外3項目であった.NANDA-Iの診断指標のうち, 5項目はコンセンサスに至らず, 11項目は除外となった.Majorとminorを合わせた診断指標63項目のtotal Diagnostic Content Validationスコアは0.8であった.

結論::

この結果から, NANDA-Iの看護診断「嚥下障害」(00103)の診断指標には, 28項目を追加し, 11項目を除外することが提案された.Majorの診断指標は, 嚥下障害を顕著に示す指標や, 誤嚥または咽頭残留を示す徴候であった.Minorの診断指標には, 3つの相だけでなく, 嚥下障害を包括的に理解するために必要となる「その他」の徴候も含まれた.

看護実践への示唆:

この研究は, 嚥下障害の診断指標の臨床的有用性を強化し, 看護師の臨床推論能力を向上させることができる.Majorとminorの診断指標は, 嚥下障害に対する気づきを促し, 正確な介入を可能にし, 患者の合併症を予防してQOLを維持することができる

Keywords

content validation defining characteristics Delphi technique impaired swallowing nursing diagnosis

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