Content validation of the nursing diagnosis “Insufficient breast milk production (00216)”

Abstract

Purpose

To review and validate the elements of the nursing diagnosis (ND) “Insufficient breast milk production” (00216) based on the literature and expert consensus, and to construct operational definitions (ODs) for its defining characteristics (DCs).

Methods

It is a methodological study carried out in two phases. In the first phase, a scoping review was conducted, and in the second, a committee of experts reviewed the elements’ content. Items with a Content Validity Index ≥0.8 were validated for relevance, clarity, and precision. Discussions were conducted until a consensus was reached on all items and criteria evaluated. The Ethics Committee approved the study.

Findings

The final scoping review sample consisted of 61 articles, and 19 experts evaluated the content of the ND. All DCs were revised. Three at-risk populations, three associated conditions, and one related factor were added. Three elements had their category changed, and an element was deleted. Experts also validated ODs developed for all DCs.

Conclusion

“Insufficient breast milk production (00216)” was validated by experts. This study improved the ND through literature and expert consensus. New elements were added, and existing ones were revised.

Implications for nursing practice

This study improves this ND based on scientific evidence and clinical expertise and potentially improves nurses’ diagnostic accuracy through ODs.

Objetivo

Revisar e validar os elementos do Diagnóstico de Enfermagem “Produção insuficiente de leite materno (00216)”, com base na literatura e no consenso de especialistas, e construir definições operacionais para suas características definidoras.

Método

Estudo metodológico realizado em duas fases. Na primeira fase foi realizada uma revisão da literatura e na segunda um comitê de especialistas revisou o conteúdo dos elementos. Os itens com Índice de Validade de Conteúdo ≥ 0,8 foram validados quanto à relevância, clareza e precisão. As discussões foram conduzidas até que se chegasse a um consenso sobre todos os itens e critérios avaliados. O estudo foi aprovado por Comitê de Ética em Pesquisa.

Resultados

A amostra final da revisão foi composta por 61 artigos e 19 especialistas avaliaram o conteúdo do diagnóstico de enfermagem. Todas as características definidoras foram revisadas. Foram acrescentadas três populações de risco, três condições associadas e um fator relacionado. Três elementos tiveram sua categoria alterada e um elemento foi excluído. Os especialistas também validaram as definições operacionais desenvolvidas para todas as características definidoras.

Conclusão

“Produção insuficiente de leite materno (00216)” foi validado por especialistas. Este estudo melhorou o diagnóstico de enfermagem por meio da literatura e do consenso de especialistas. Novos elementos foram adicionados e os existentes foram revisados.

Implicações para a prática de enfermagem

Este estudo melhora o diagnóstico de enfermagem estudado com base em evidências científicas e experiência clínica, assim como tem potencial para melhorar a precisão diagnóstica dos enfermeiros por meio do desenvolvimento de definições operacionais.

Keywords

breastfeeding standardized nursing terminologies validation studies

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References

Ames

E. G.

Burrows

H. L.

(2019). Differing experiences with breastfeeding in residency between mothers and coresidents. Breastfeeding Medicine, 14(8), 575–579. https://doi.org/10.1089/bfm.2019.0001

Azulay Chertok

I. R.

Wolf

J. H.

Beigelman

Warner

(2020). Infant feeding among women with a history of breast cancer. Journal of Cancer Survivorship: Research and Practice, 14(3), 356–362. https://doi.org/10.1007/s11764-019-00852-z

Backes

D. S. C.

Erdmann

J. S.

Lunardi

R. H.

Lerch

(2011). Grupo focal como técnica de coleta e análise de dados em pesquisas qualitativas. Mundo Saúde, 35(4), 438–442.

Barbosa

G. E. F.

Silva

V. B.

Pereira

J. M.

Soares

M. S.

Medeiros Filho

R. A.

Pereira

L. B.

Pinho

Caldeira

A. P.

(2017). Dificuldades iniciais com a técnica da amamentação e fatores associados a problemas com a mama em puérperas. Revista Paulista de Pediatria, 35(3), 265–272.

Bertini

Elia

Lori

Dani

(2019). Abnormal neurological soft signs in babies born to smoking mothers were associated with lower breastfeeding for first three months. Acta Paediatrica, 108(7), 1256–1261. https://doi.org/10.1111/apa.14762

Brown

Stuart-Butler

Leane

Glover

Mitchell

Deverix

Francis

Ah Kit

Weetra

Gartland

Yelland

(2019). Initiation and duration of breastfeeding of Aboriginal infants in South Australia. Women and Birth, 32(3), e315–e322. https://doi.org/10.1016/j.wombi.2018.07.009

Campos

P. M.

Gouveia

H. G.

Strada

J. K. R.

Moraes

B. A.

(2020). Skin-to-skin contact and breastfeeding of newborns in a university hospital. Revista Gaucha de Enfermagem, 41, e20190154. https://doi.org/10.1590/1983-1447.2020.20190154

Carvalho

M. R.

Gomes

C. F.

(2019). Amamentação: Bases científicas. Guanabara Koogan.

Cohen

S. S.

Alexander

D. D.

Krebs

N. F.

Young

B. E.

Cabana

M. D.

Erdmann

Hays

N. P.

Bezold

C. P.

Levin-Sparenberg

Turini

Saavedra

J. M.

(2018). Factors associated with breastfeeding initiation and continuation: A meta-analysis. The Journal of Pediatrics, 203, 190.e21–196.e21. https://doi.org/10.1016/j.jpeds.2018.08.008

10.

Colombo

Crippa

B. L.

Consonni

Bettinelli

M. E.

Agosti

Mangino

Bezze

E. N.

Mauri

P. A.

Zanotta

Roggero

Plevani

Bertoli

Giannì

M. L.

Mosca

(2018). Breastfeeding determinants in healthy term newborns. Nutrients, 10(1), 48. https://doi.org/10.3390/nu10010048

11.

Correia

M. D. L.

Duran

E. C. M.

(2017). Conceptual and operational definitions of the components of the nursing diagnosis Acute Pain (00132). Revista Latino-Americana de Enfermagem, 25, e2973. https://doi.org/10.1590/1518-8345.2330.2973

12.

Cortés-Rúa

Díaz-Grávalos

G. J.

(2019). Early interruption of breastfeeding: A qualitative study. Enfermería Clinica, 29, 207–215. https://doi.org/10.1016/j.enfcli.2018.11.003

13.

Costa

J. N. D.

Botelho

M. L.

Duran

E. C. M.

Carmona

E. V.

Oliveira-Kumakura

A. R. S.

Lopes

M. H. B. M.

(2019). Conceptual and operational definitions for the nursing diagnosis “Urinary Retention”. International Journal of Nursing Knowledge, 30(1), 49–54. https://doi.org/10.1111/2047-3095.12196

14.

DeVane-Johnson

Woods-Giscombé

Thoyre

Fogel

Williams

(2017). Integrative literature review of factors related to breastfeeding in African American women: Evidence for a potential paradigm shift. Journal of Human Lactation, 33(2), 435–447. https://doi.org/10.1177/0890334417693209

15.

Emidio

S. C. D.

deDias

F. S. B.

Moorhead

Deberg

deOliveira-Kumakura

A. R. S.

Carmona

E. V.

(2020). Conceptual and operational definition of nursing outcomes regarding the breastfeeding establishment. Revista Latino-Americana de Enfermagem, 28, e3259. https://doi.org/10.1590/1518-8345.3007.3259

16.

Feenstra

M. M.

Jørgine Kirkeby

Thygesen

Danbjørg

D. B.

Kronborg

(2018). Early breastfeeding problems: A mixed method study of mothers' experiences. Sexual & Reproductive Healthcare, 16, 167–174. https://doi.org/10.1016/j.srhc.2018.04.003

17.

Feldman-Winter

Kellams

Peter-Wohl

Taylor

J. S.

Lee

K. G.

Terrell

M. J.

Noble

Maynor

A. R.

Meek

J. Y.

Stuebe

A. M.

(2020). Evidence-based updates on the first week of exclusive breastfeeding among infants ≥35 weeks. Pediatrics, 145(4), e20183696. https://doi.org/10.1542/peds.2018-3696

18.

Gasparin

V. A.

Broch

Betti

Riquinho

D. L.

Santo

L. C. E.

(2018). Nursing diagnoses related to breastfeeding: An integrating review. Revista de Enfermagem Atenção Saúde, 7(1), 234–246.

19.

Gianni

M. L.

Bettinelli

M. E.

Manfra

Sorrentino

Bezze

Plevani

Cavallaro

Raffaeli

Crippa

B. L.

Colombo

Morniroli

Liotto

Roggero

Villamor

Marchisio

Mosca

(2019). Breastfeeding difficulties and risk for early breastfeeding cessation. Nutrients, 11(10), 2266. https://doi.org/10.3390/nu11102266

20.

Giannì

M. L.

Lanzani

Consales

Bestetti

Colombo

Bettinelli

M. E.

Plevani

Morniroli

Sorrentino

Bezze

Zanotta

Sannino

Cavallaro

Villamor

Marchisio

Mosca

(2020). Exploring the emotional breastfeeding experience of first-time mothers: Implications for healthcare support. Frontiers in Pediatrics, 8, 199. https://doi.org/10.3389/fped.2020.00199

21.

Hasselberg

Huus

Golsäter

(2016). Breastfeeding preterm infants at a neonatal care unit in rural Tanzania. Journal of Obstetric, Gynecologic, and Neonatal Nursing, 45(6), 825–835. https://doi.org/10.1016/j.jogn.2016.07.010

22.

Herdman

T. H.

Kamitsuru

Lopes

C. T.

(2021). Diagnósticos de enfermagem da NANDA-I: Definições e classificação 2021- 2023 (12th ed.). Artmed.

23.

Hossain

Mihrshahi

(2022). Exclusive breastfeeding and childhood morbidity: A narrative review. International Journal of Environmental Research and Public Health, 19(22), 14804. https://doi.org/10.3390/ijerph192214804

24.

Kair

L. R.

Colaizy

T. T.

(2016a). When breast milk alone is not enough: Barriers to breastfeeding continuation among overweight and obese mothers. Journal of Human Lactation, 32(2), 250–257. https://doi.org/10.1177/0890334415605303

25.

Kair

L. R.

Colaizy

T. T.

(2016b). Breastfeeding continuation among late preterm infants: Barriers, facilitators, and any association with NICU admission? Hospital Pediatrics, 6(5), 261–268. https://doi.org/10.1542/hpeds.2015-0172

26.

Karaçam

Sağlık

(2018). Breastfeeding problems and interventions performed on problems: Systematic review based on studies made in Turkey. Turk Pediatri Arsivi, 53(3), 134–148. https://doi.org/10.5152/TurkPediatriArs.2018.6350

27.

Karimi

F. Z.

Miri

H. H.

Khadivzadeh

Maleki-Saghooni

(2020). The effect of mother-infant skin-to-skin contact immediately after birth on exclusive breastfeeding: A systematic review and meta-analysis. Journal of the Turkish German Gynecological Association, 21(1), 46–56. https://doi.org/10.4274/jtgga.galenos.2019.2018.0138

28.

Kaur

Sodhi

M. K.

Mahajan

Singh

Kumar

Kaur

Goyal

Kapoor

(2020). Evaluation of utility of various interventions related to relactation and assessment of outcomes of relactation practice in mothers with infants up to 6 months of age. Perinatology, 21(3), 105–111.

29.

Kent

J. C.

Ashton

Hardwick

C. M.

Rea

Murray

Geddes

D. T.

(2021). Causes of perception of insufficient milk supply in Western Australian mothers. Maternal & Child Nutrition, 17(1), e13080. https://doi.org/10.1111/mcn.13080

30.

Manipon

(2016). Ankyloglossia and the breastfeeding infant: Assessment and intervention. Advances in Neonatal Care, 16(2), 108–113. https://doi.org/10.1097/ANC.0000000000000252

31.

Manzoli

J. P. B.

Correia

M. D. L.

Duran

E. C. M.

(2018). Conceptual and operational definitions of the defining characteristics of the nursing diagnosis Disturbed Sleep Pattern. Revista Latino-Americana de Enfermagem, 26, e3105. https://doi.org/10.1590/1518-8345.2582.3105

32.

Matare

C. R.

Craig

H. C.

Martin

S. L.

Kayanda

R. A.

Chapleau

G. M.

Kerr

R. B.

Dearden

K. A.

Nnally

L. P.

Dickin

K. L.

(2019). Barriers and opportunities for improved exclusive breast-feeding practices in Tanzania: Household trials with mothers and fathers. Food and Nutrition Bulletin, 40(3), 308–325. https://doi.org/10.1177/0379572119841961

33.

Melo

D. S.

deOliveira

M. H.

dos Pereira

D. S.

(2021). Brazil's progress in protecting, promoting and supporting breastfeeding from the perspective of the global breastfeeding collective. Revista Paulista de Pediatria, 39, e2019296. https://doi.org/10.1590/1984-0462/2021/39/2019296

34.

Mosca

Roggero

Garbarino

Morniroli

Bracco

Morlacchi

Mallardi

Gianni

M. L.

Consonni

(2018). Determinants of breastfeeding discontinuation in an Italian cohort of mother-infant dyads in the first six months of life: A randomized controlled trial. Italian Journal of Pediatrics, 44(1), 134. https://doi.org/10.1186/s13052-018-0572-z

35.

Moss

K. M.

Dobson

A. J.

Tooth

Mishra

G. D.

(2021). Which Australian women do not exclusively breastfeed to 6 months, and why? Journal of Human Lactation, 37(2), 390–402. https://doi.org/10.1177/0890334420929993

36.

Munn

A. C.

Newman

S. D.

Phillips

S. M.

Mueller

Taylor

S. N.

(2018). Factors influencing Southeastern U.S. mothers' participation in baby-friendly practices: A mixed-methods study. Journal of Human Lactation, 34(4), 821–834. https://doi.org/10.1177/0890334417750143

37.

Nuampa

Tilokskulchai

Patil

C. L.

Sinsuksai

Phahuwatanakorn

(2019). Factors related to exclusive breastfeeding in Thai adolescent mothers: Concept mapping approach. Maternal & Child Nutrition, 15(2), e12714. https://doi.org/10.1111/mcn.12714

38.

Parker

L. A.

Krueger

Sullivan

Mueller

(2021). Demographic, social, and personal factors associated with lactation cessation by 6 weeks in mothers of very low birth weight infants. Journal of Human Lactation, 37(3), 511–520. https://doi.org/10.1177/0890334420940239

39.

Pasquali

(2003). Psicometria: Teoria dos testes na psicologia e na educação (2nd ed.). Editora Vozes.

40.

Peacock-Chambers

Dicks

Sarathy

Brown

A. A.

Boynton-Jarrett

(2017). Perceived maternal behavioral control, infant behavior, and milk supply: A qualitative study. Journal of Developmental and Behavioral Pediatrics, 38(6), 401–408. https://doi.org/10.1097/DBP.0000000000000455

41.

Peters

Godfrey

McInerney

Munn

Tricco

Khalil

(2020). Chapter 11: Scoping reviews. In Aromataris

Munn

(Eds.), Joanna Briggs Institute reviewer's manual (pp. 406–451). University of Adelaide.

42.

Prentice

A. M.

(2022). Breastfeeding in the modern world. Annals of Nutrition & Metabolism, 78(Suppl 2), 29–38. https://doi.org/10.1159/000524354

43.

Polit

D. F.

Beck

C. T.

Owen

S. V.

(2007). Is the CVI an acceptable indicator of content validity? Appraisal and recommendations. Research in Nursing & Health, 30(4), 459–467. https://doi.org/10.1002/nur.20199

44.

Prieto-Gómez

Saavedra-Sepúlveda

Alvear-Aguirre

Lazo-Millar

Soto-Acuña

(2019). Lactancia materna no exitosa, percepción de los profesionales de la salud: Estudio de casos, Ix Región, Chile. Revista Colombiana de Obstetricia y Ginecología, 70(4), 219–227. https://doi.org/10.18597/rcog.3225

45.

Riddle

S. W.

Nommsen-Rivers

L. A.

(2017). Low milk supply and the pediatrician. Current Opinion in Pediatrics, 29(2), 249–256. https://doi.org/10.1097/MOP.0000000000000468

46.

Rodrigo

Liyanage

Hatahagoda

Hewavitharana

(2019). Maternal perception of adequacy of mother's milk among mothers giving birth at a teaching hospital in Sri Lanka. Journal of Human Lactation, 35(1), 171–180. https://doi.org/10.1177/0890334418773304

47.

Rosinger

A. Y.

(2020). Biobehavioral variation in human water needs: How adaptations, early life environments, and the life course affect body water homeostasis. American Journal of Human Biology, 32(1), e23338. https://doi.org/10.1002/ajhb.23338

48.

Sandhi

Lee

G. T.

Chipojola

Huda

M. H.

Kuo

S. Y.

(2020). The relationship between perceived milk supply and exclusive breastfeeding during the first six months postpartum: A cross-sectional study. International Breastfeeding Journal, 15(1), 65. https://doi.org/10.1186/s13006-020-00310-y

49.

Schliep

K. C.

Denhalter

Gren

L. H.

Panushka

K. A.

Singh

T. P.

Varner

M. W.

(2019). Factors in the hospital experience associated with postpartum breastfeeding success. Breastfeeding Medicine, 14(5), 334–341. https://doi.org/10.1089/bfm.2018.0039

50.

Tricco

A. C.

Lillie

Zarin

O'Brien

K. K.

Colquhoun

Levac

Moher

Peters

M. D. J.

Horsley

Weeks

Hempel

Akl

E. A.

Chang

McGowan

Stewart

Hartling

Aldcroft

Wilson

M. G.

Garritty

, … Straus

S. E.

(2018). PRISMA extension for scoping reviews (PRISMA-ScR): Checklist and explanation. Annals of Internal Medicine, 169(7), 467–473. https://doi.org/10.7326/M18-0850

51.

Wambach

Domian

E. W.

Page-Goertz

Wurtz

Hoffman

(2016). Exclusive breastfeeding experiences among Mexican American women. Journal of Human Lactation, 32(1), 103–111. https://doi.org/10.1177/0890334415599400

52.

Wang

Briere

C. E.

Cong

(2019). Factors affecting breastfeeding outcomes at six months in preterm infants. Journal of Human Lactation, 35(1), 80–89. https://doi.org/10.1177/0890334418771307

53.

Xiao

Loke

A. Y.

Zhu

S. N.

Gong

Shi

H. M.

Ngai

F. W.

(2020). “The sweet and the bitter”: Mothers' experiences of breastfeeding in the early postpartum period: A qualitative exploratory study in China. International Breastfeeding Journal, 15(1), 12. https://doi.org/10.1186/s13006-020-00256-1

54.

Yonke

Jimenez

E. Y.

Leeman

Leyva

Ortega

Bakhireva

L. N.

(2020). Breastfeeding motivators and barriers in women receiving medications for opioid use disorder. Breastfeeding Medicine, 15(1), 17–23. https://doi.org/10.1089/bfm.2019.0122

55.

Lin

Luan

(2019). Association between delayed lactogenesis II and early milk volume among mothers of preterm infants. Asian Nursing Research, 13(2), 93–98. https://doi.org/10.1016/j.anr.2019.02.001

56.

Zhang

Xia

Shen

Qin

(2016). Are prolactin levels linked to suction pressure? Breastfeeding Medicine, 11, 461–468. https://doi.org/10.1089/bfm.2015.0083

57.

Zielinska

M. A.

Hamulka

(2018). Reasons for non-exclusive breast-feeding in the first 6 months. Pediatrics International, 60(3), 276–281. https://doi.org/10.1111/ped.13480

58.

Zimmerman

Rodgers

R. F.

O'Flynn

Bourdeau

(2019). Weight-related concerns as barriers to exclusive breastfeeding at 6 months. Journal of Human Lactation, 35(2), 284–291. https://doi.org/10.1177/0890334418797312