Accuracy of the defining characteristics of respiratory nursing diagnoses in patients with COVID-19

Abstract

Objective

To analyze the accuracy of the defining characteristics of four respiratory nursing diagnoses (ND) in patients with COVID-19 and on oxygen therapy.

Methods

This is a cross-sectional study conducted in four Brazilian public hospitals in two regions of the country. A total of 474 patients with COVID-19 receiving oxygen therapy were assessed. Latent-adjusted class analysis with random effects was used to establish the sensitivity (Se) and specificity (Sp) of the defining characteristics evaluated for each ND.

Results

Among the ND that constituted the study (impaired spontaneous ventilatory, impaired gas exchange, ineffective airway clearance, and dysfunctional ventilatory weaning response), the following defining characteristics had the highest simultaneous Se and Sp (>0.8): decrease in tidal volume, confusion, irritability, dyspnea, decreased breath sounds, orthopnea, impaired ability to cooperate and respond to coaching, and decrease in the level of consciousness.

Conclusions

Recognizing the clinical signs that predict respiratory ND in patients affected by COVID-19 can contribute to the nurse's accurate diagnostic inference and designate the appropriate nursing interventions to achieve the desired results and avoid complications.

Objetivo

Analisar a acurácia das características definidoras de quatro Diagnósticos de Enfermagem (DE) respiratórios em pacientes com COVID-19 e em uso de oxigenoterapia.

Métodos

Estudo transversal, realizado em quatro hospitais públicos brasileiros de duas regiões do país. Foram avaliados 474 pacientes diagnosticados com COVID-19 e em uso de oxigenoterapia. A análise de classe latente ajustada com efeitos randômicos foi utilizada para estabelecer a sensibilidade (Se) e especificidade (Sp) das características definidoras avaliadas para cada DE.

Resultados

As características definidoras volume corrente diminuído, confusão, irritabilidade, dispneia, sons respiratórios diminuídos, ortopneia, capacidade prejudicada para cooperar e responder orientações, e nível de consciência diminuído foram as que obtiveram maior sensibilidade e especificidade simultaneamente (> 0.8) dentre os diagnósticos de enfermagem compuseram o estudo: Ventilação espontânea prejudicada, Resposta disfuncional ao desmame, Desobstrução ineficaz das vias aéreas e Troca de gases prejudicada.

Conclusões

Conhecer os sinais clínicos preditores dos diagnósticos de enfermagem respiratórios em pacientes acometidos por COVID-19 pode contribuir para a inferência diagnóstica acurada do enfermeiro e designar as intervenções de enfermagem apropriadas para atingir os resultados desejados e evitar complicações.

Keywords

COVID-19 cross-sectional studies nursing diagnosis respiratory system standardized nursing terminology

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References

Adams

C. D.

Altshuler

Barlow

B. L.

Dixit

Droege

C. A.

Effendi

M. K.

Heavner

M. S.

Johnston

J. P.

Kiskaddon

A. L.

Lemieux

D. G.

Lemieux

S. M.

Littlefield

A. J.

Owusu

K. A.

Rouse

G. E.

Thompson Bastin

M. L.

Berger

(2020). Analgesia and sedation strategies in mechanically ventilated adults with COVID-19. Pharmacotherapy, 40(12), 1180–1191. https://doi.org/10.1002/phar.2471

Al-Azzam

Khassawneh

Al-Azzam

Karasneh

R. A.

Aldeyab

M. A.

(2023). Acid-base imbalance as a risk factor for mortality among COVID-19 hospitalized patients. Bioscience Reports, 43(3), BSR20222362. https://doi.org/10.1042/BSR20222362

Albuquerque

E. G.

Araújo

J. N. M.

Silva

A. B.

Alves

D. L. B. S.

Borges

B. E. C.

Vitor

A. F.

(2023). Concept analysis of the nursing diagnosis of impaired spontaneous ventilation in critical patients. Aquichán, 23(3):e2337. https://doi.org/10.5294/aqui.2023.23.3.7

Alfaro-LeFevre

(2022). Critical thinking, clinical reasoning, and clinical judgment for nursing (7. ed.). Elsevier.

Barbas

C. S. V.

Ísola

A. M.

Farias

A. M. D. C.

Cavalcanti

A. B.

Gama

A. M. C.

Duarte

A. C. M.

Vianna

Serpa Neto

Bravim

B. D. A.

Pinheiro

B. D. V.

Mazza

B. F.

deCarvalho

C. R. R.

Toufen

David

C. M. N.

Taniguchi

daSilveira Mazza

D. D.

Dragosavac

Toledo

D. O.

Costa

E. L.

, …, Amado

V. M.

(2013). Brazilian recommendations of mechanical ventilation 2013. Part I. Revista Brasileira de Terapia Intensiva, 26, 89–121. https://doi.org/10.5935/0103-507X.20140017

Barioni

E. M. S.

Nascimento

C. S.

Amaral

T. L. M.

Neto

J. M. R.

Prado

P. R.

(2022). Clinical indicators, nursing diagnoses, and mortality risk in critically ill patients with COVID-19: A retrospective cohort. Revista da Escola de Enfermagem da USP, 56, e20210568. https://doi.org/10.1590/1980-220X-REEUSP-2021-0568en

Barros

A. L. B. L.

Silva

V. M.

Santana

R. F.

Cavalcante

A. M. R. Z.

Vitor

A. F.

Lucena

A. F.

Napoleão

A. A.

Lopes

C. T.

Primo

C. C.

Carmona

E. V.

Duran

E. C. M.

Butcher

H. K.

deLima Lopes

Díaz

L. J. R.

Cubas

M. R.

Brandão

M. A. G.

deOliveira Lopes

M. V.

daNóbrega

M. M. L.

deAbreu Almeida

, … Santos

V. B.

(2020). Brazilian nursing process research network contributions for assistance in the COVID-19 pandemic. Revista Brasileira de Enfermagem, 73(2):e20200798. http://doi.org/10.1590/0034-7167-2020-0798

Boniatti

V. M. C.

Pereira

C. R.

Costa

G. M.

Teixeira

M. C.

Werlang

A. P.

Martins

F. T. M.

Marques

L. D. S.

Nedel

W. L.

Boniatti

M. M.

(2023). Failure of extubation and use of noninvasive ventilation during the weaning process in critically ill COVID-19 patients. Critical Care Science, 35(2), 163–167. https://doi.org/10.5935/2965-2774.20230009-pt

Bossuyt

P. M.

Reitsma

J. B.

Bruns

D. E.

Gatsonis

C. A.

Glasziou

P. P.

Irwig

Lijmer

J. G.

Moher

Rennie

deVet

H. C. W.

Kressel

H. Y.

Rifai

Golub

R. M.

Altman

D. G.

Hooft

Korevaar

D. A.

Cohen

J. F.

(2015). STARD 2015: An updated list of essential items for reporting diagnostic accuracy studies. BMJ, 28(351), h5527. https://doi.org/10.1136/bmj.h5527

10.

Carsana

Sonzogni

Nasr

Rossi

R. S.

Pellegrinelli

Zerbi

Rech

Colombo

Antinori

Corbellino

Galli

Catena

Tosoni

Gianatti

Nebuloni

(2020). Pulmonary post-mortem findings in a series of COVID-19 cases from Northern Italy: A two-centre descriptive study. The Lancet Infectious Diseases, 20(10), 1135–1140. https://doi.org/10.1016/S1473-3099(20)30434-5

11.

Cucinotta

Vanelli

(2020). WHO Declares COVID-19 a Pandemic. Acta Biomedica, 91(1), 157–160. http://doi.org/10.23750/abm.v91i1.9397

12.

Damanti

Cristel

Ramirez

G. A.

Bozzolo

E. P.

Da Prat

Gobbi

Centurioni

Di Gaeta

Del Prete

Calabrò

M. G.

Calvi

M. R.

Borghi

Zangrillo

De Cobelli

Landoni

Tresoldi

(2022). Influence of reduced muscle mass and quality on ventilator weaning and complications during intensive care unit stay in COVID-19 patients. Clinical Nutrition, 41(12), 2965–2972. https://doi.org/10.1016/j.clnu.2021.08.004

13.

Dantas

J. R.

Almeida

A. T. D.

Matias

K. C.

Fernandes

M. I. C. D.

Tinôco

J. D. S.

Lopes

M. V. O.

deCarvalho Lira

A. L. B.

(2023). Accuracy of the nursing diagnosis of ineffective airway clearance in intensive care unit patients. Revista Brasileira de Enfermagem, 76(1), e20220174. https://doi.org/10.1590/0034-7167-2022-0174

14.

daSilva

L. C. R.

Tonelli

I. S.

Oliveira

R. C. C.

Lemos

P. L.

Matos

S. S.

Chianca

T. C. M.

(2020). Clinical study of the dysfunctional response to ventilatory weaning in critically ill patients. Revista Latino-Americana de Enfermagem, 28, e3334. https://www.scielo.br/j/rlae/a/jckqKzgFQ99VGpsP5CJHq8G/?lang=pt

15.

Guyton

A. C.

Hall

J. E.

(2012). Texbook of medical physiology (12th ed.). Elsevier.

16.

Herdman

T. H.

Kamitsuru

Lopes

C. T.

(2018). NANDA international nursing diagnoses: Definitions and classification: 2018–2020 (11th ed.). Thieme.

17.

Hidayati

Hadi

Maghfiroh

I. L.

Andarini

Setiawan

Sandi

Y. D. L.

(2022). Nursing diagnoses in hospitalized patients with COVID-19 in Indonesia. Belitung Nursing Journal, 8(1), 44–52. http://doi.org/10.33546/bnj.1828

18.

Hirzallah

F. M.

Alkaissi

Do Céu Barbieri-Figueiredo

(2019). A systematic review of nurse-led weaning protocol for mechanically ventilated adult patients. Nursing in Critical Care, 24(2), 89–96. https://doi.org/10.1111/nicc.12404

19.

Hughes

T. D.

Subramanian

Chakraborty

Algodão

S. A.

Herrera

M. D. P. G.

Huang

Lambert

Pinto

M. D.

Rahmani

A. M.

Sierra

C. J.

Downs

C. A.

(2023). The effect of SARS-CoV-2 variant on respiratory features and mortality. Scientific Reports, 13, 4503. https://doi.org/10.1038/s41598-023-31761-y

20.

Kallet

R. H.

Branson

R. D.

Lipnick

M. S.

(2022). Respiratory drive, dyspnea, and silent hypoxemia: A physiological review in the context of covid-19. Respiratory Care, 67(10), 1343–1360. https://doi.org/10.4187/respcare.10075

21.

Kato

Asakura

Edwards

C. E.

Dang

Mikami

Okuda

Chen

Sun

Gilmore

R. C.

Hawkins

De la Cruz

Cooley

M. R.

Bailey

A. B.

Hewitt

S. M.

Chertow

D. S.

Borczuk

A. C.

Salvatore

Martinez

F. J.

Thorne

L. B.

, …, Boucher

R. C.

(2022). Prevalence and mechanisms of mucus accumulation in COVID-19 lung disease. American Journal of Respiratory and Critical Care Medicine, 206(11), 1336–1352. https://doi.org/10.1164/rccm.202111-2606OC

22.

Yuan

Zhang

Guan

Gao

Dong

(2021). Meta-analysis investigating the relationship between clinical features, outcomes, and severity of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pneumonia. American Journal of Infection Control, 49(1), 82–89. https://doi.org/10.1016/j.asik.2020.06.008

23.

Lopes

M. V. O.

Silva

V. M.

Araujo

T. L.

(2012). Methods for establishing the accuracy of clinical indicators in predicting nursing diagnoses. International Journal of Nursing Knowledge, 23(3), 134–139. https://doi.org/10.1111/j.2047-3095.2012.01213.x

24.

Manickavel

(2021). Pathophysiology of respiratory failure and physiology of gas exchange during ECMO. Indian Journal of Thoracic and Cardiovascular Surgery, 37(2), 203–209. https://doi.org/10.1007/s12055-020-01042-8

25.

Merchán-Tahvanainen

M. E.

Romero-Belmonte

Cundín-Laguna

Basterra-Brun

San Miguel-Aguirre

Regaira-Martínez

(2017). Patients’ experience during weaning of invasive mechanical ventilation: A review of the literature. Enfermería Intensiva, 28(2), 64–79. https://doi.org/10.1016/j.enfie.2016.11.001

26.

Morton

P. G.

Fontaine

D. K.

(2019). Critical care nursing: A holistic approach (11. ed.). Guanabara Koogan.

27.

Msemburi

Karlinsky

Knutson

Aleshin-Guendel

Chatterji

Wakefield

(2023). The WHO estimates of excess mortality associated with the COVID-19 pandemic. Nature, 613, 130–137. https://doi.org/10.1038/s41586-022-05522-2

28.

Musumeci

M. M.

Pinheiro

B. V.

Chiavegato

L. D.

Phillip

D. S. A.

Machado

F. R.

Freires

Beppu

O. S.

Arakaki

J. S. O.

Ramos

R. P.

(2023). Predictors of prolonged ventilator weaning and mortality in critically ill patients with COVID-19. Jornal Brasileiro de Pneumologia, 49(4), e20230131. https://doi.org/10.36416/1806-3756/e20230131

29.

Nursing Process Research Network (RePPE) . (2020). Nursing diagnoses, outcomes, and interventions for the care of critically ill COVID-19 patients during the pandemic COVID-19. RePPE. https://repperede.org/wp-content/uploads/2020/05/Paciente-cr%C3%ADtico_RePPE_vers%C3%A3o-2-1.pdf

30.

Otifi

H. M.

Adiga

B. K.

(2022). Endothelial dysfunction in Covid-19 infection. The American Journal of the Medical Sciences, 363(4), 281–287. https://doi.org/10.1016/j.amjms.2021.12.010

31.

Pascoal

L. M.

Lopes

M. V. O.

Silva

V. M.

Diniz

C. M.

Nunes

M. M.

Freire

V. E. C. S.

Amorim

B. B.

(2021). Content analysis of clinical indicators for impaired gas exchange. Revista Gaúcha de Enfermagem, 42, e20200099. https://doi.org/10.1590/1983-1447.2021.20200099

32.

Pascoal

L. M.

Lopes

M. V. D. O.

Diniz

C. M.

Nunes

M. M.

Silva

V. M. D.

Guedes

N. G.

Menezes

A. P. D.

Santos

(2022). Content validity of clinical indicators of ineffective airway clearance. Acta Paulista de Enfermagem, 35, eAPE039007434. https://doi.org/10.37689/acta-ape/2022AO007434

33.

Rabaan

A. A.

Smajlović

Tombuloglu

Ćordić

Hajdarević

Kudić

(2023). SARS-CoV-2 infection and multi-organ system damage: A review. Biomolecules and Biomedicine, 23(1), 37–52. https://doi.org/10.17305/bjbms.2022.7762

34.

Sá

E. S.

Maurício

A. B.

Bruni

L. G.

Vieira

L. G. D.

Santos

V. B.

Cavalcante

A. M. R. Z.

deBarros

A. L. B. L.

daSilva

V. M.

(2024). Content analysis of NOC outcomes related to mechanical ventilation in people with COVID-19. Revista da Escola de Enfermagem da USP, 58, e20230343. https://doi.org/10.1590/1980-220X-REEUSP-2023-0343en

35.

Seganfredo

D. H.

Beltrão

B. A.

Silva

V. M.

Lopes

M. V. O.

Castro

S. M. J.

Almeida

M. A.

(2017). Analysis of ineffective breathing pattern and impaired spontaneous ventilation of adults in ICU with oxygen therapy. Revista Latino-Americana de Enfermagem, 25, e2954. http://doi.org/10.1590/1518-8345.1950.2954

36.

Shah

M. D.

Sumeh

A. S.

Sheraz

Kavitha

M. S.

Maran

B. A. V.

Rodrigues

K. F.

(2021). A mini-review on the impact of COVID 19 on vital organs. Biomedicine & Pharmacotherapy, 143, 112158. https://doi.org/10.1016/j.biopha.2021.112158

37.

Shi

Wang

Duan

Yang

(2020). Dyspnea rather than fever is a risk factor for predicting mortality in patients with COVID-19. Journal of Infection, 81(4), 647–679. https://doi.org/10.1016/j.jinf.2020.05.013

38.

Swanson

S. A.

Lindenberg

Bauer

Crosby

R. D.

(2012). A Monte Carlo investigation of factors influencing latent class analysis: An application to eating disorder research. International Journal of Eating Disorders, 45(5), 677–684. https://doi.org/10.1002/eat.20958

39.

Swanson

Mantovani

V. M.

Wagner

Moorhead

Lopez

K. D.

Macieira

T. G. R.

Abe

(2021). NANDA-I, NOC, and NIC linkages to SARS-CoV-2 (COVID-19): Part 2. Individual response. International Journal of Nursing Knowledge, 32(1), 68–83. Portico. https://doi.org/10.1111/2047-3095.12307

40.

Swelum

A. A.

Shafi

M. E.

Albaqami

N. M.

El-Saadony

M. T.

Elsify

Abdo

Taha

A. E.

Abdel-Moneim

A.-M. E.

Al-Gabri

N. A.

Almaiman

A. A.

Al-Wajeeh

A. S.

Tufarelli

Staffa

V. N.

Abd El-Hack

M. E.

(2020). COVID-19 in human, animal, and environment: A review. Frontiers in Veterinary Science, 4(7), 578. https://doi.org/10.3389/fvets.2020.00578

41.

Talukder

Razu

S. R.

Alif

S. M.

Aziz Rahman

Islam

S. M. S.

(2022). Association between symptoms and severity of disease in hospitalized novel coronavirus (COVID-19) patients: A systematic review and meta-analysis. Journal of Multidisciplinary Healthcare, 15, 1101–1110. https://doi.org/10.2147/JMDH.S357867

42.

Trudzinski

F. C.

Neetz

Bornitz

Müller

Weis

Kronsteiner

Herth

F. J. F.

Sturm

Gassmann

Frerk

Neurohr

Ghiani

Joves

Schneider

Szecsenyi

Von Schumann

Meis

(2022). Risk factors for prolonged mechanical ventilation and weaning failure: A systematic review. Respiration, 101(10), 959–969. https://doi.org/10.1159/000525604

43.

Wang

Zhang

Zhong

(2021). Association between respiratory alkalosis and the prognosis of COVID-19 patients. Frontiers in Medicine (Lausanne), 26(8), 564635. https://doi.org/10.3389/fmed.2021.564635

44.

Yaroshetskiy

A. I.

Merzhoeva

Z. M.

Tsareva

N. A.

Trushenko

N. V.

Nuralieva

G. S.

Konanykhin

V. D.

Krasnoshchekova

A. P.

Avdeev

S. N.

(2022). Breathing pattern, accessory respiratory muscles work, and gas exchange evaluation for prediction of NIV failure in moderate-to-severe COVID-19-associated ARDS after deterioration of respiratory failure outside ICU: The COVID-NIV observational study. BMC Anesthesiology, 22(1), 307. https://doi.org/10.1186/s12871-022-01847-7

45.

Zhu

Pang

Zhong

Zhang

Zhao

(2020). Clinical characteristics of 3062 COVID-19 patients: A meta-analysis. Journal of Medical Virology, 92(10), 1902–1914. https://doi.org/10.1002/jmv.25884

46.

Zhu

Zhang

Wang

Yang

Song

Zhao

Huang

Shi

Niu

Zhan

Wang

Gao

G. F.

Tan

(2020). A novel coronavirus from patients with pneumonia in China, 2019. The New England Journal of Medicine, 382(8), 727–733. https://doi.org/10.1056/NEJMoa2001017

47.

Zorrilla-Riveiro

J. G.

Bartés

A. A.

Pérez

G. D.

Sellarés

R. R.

Serra

A. M.

Fernández

R. F.

(2015). Nasal flaring as a predictor of mortality in patients with severe dyspnea. Emergencias, 27(1), 27–33.

48.

Zorrilla-Riveiro

J. G.

Bartés

A. A.

Pérez

G. D.

Sellarés

R. R.

Serra

A. M.

Fernández

R. F.

(2017). Nasal flaring as a clinical sign of respiratory acidosis in patients with dyspnea. American Journal of Emergency Medicine, 35(4), 548–553. https://doi.org/10.1016/j.ajem.2016.12.008