To evaluate the clinical validity of the defining characteristics and the aetiological factors of the nursing diagnosis Disrupted thought process (00493) among institutionalized elderly people.
Methods
Cross-sectional analytical study. Data were collected between 2021 and 2022, in 7 nursing homes in Spain. Beyond sociodemographic profiling, the accuracy of the diagnosis's defining characteristics was analyzed with diagnostic test validity tests (sensitivity and specificity). Prevalence of the nursing diagnosis was estimated through Latent Variable Modeling.
Results
In a sample of 252 residents (59.8% female), nine of the 14 defining characteristics showed a frequency above 20%. Latent Class Analysis revealed a 31.7% prevalence rate for the nursing diagnosis Disrupted Thought Process. Accuracy measures identified 6 defining characteristics with high specificity and sensitivity values.
Conclusions
These results contribute to establish the clinical validity of the diagnosis among institutionalized elderly people. The results suggest the inclusion of new diagnostic elements for this nursing diagnosis. This study enables nurses in the development of targeted, individualized care plans to respond to the needs of individual with impairment of cognitive function.
AmuntsJ.CamilleriJ. A.EickhoffS. B.PatilK. R.HeimS.von PolierG. G.WeisS. (2021). Comprehensive verbal fluency features predict executive function performance. Scientific Reports, 11(1), 6929. https://doi.org/10.1038/s41598-021-85981-1
2.
BertocchiL.PetrucciC.MasottaV.MarcotullioA.JonesD.LanciaL.DanteA. (2025). Standardized nursing terminologies and electronic health records: A secondary analysis of a systematic review. Healthcare, 13(16), 1952. https://doi.org/10.3390/healthcare13161952
3.
BragaP. L. G.HenriqueJ. S.AlmeidaS. S.AridaR. M.Gomes da SilvaS. (2022). Factors affecting executive function performance of Brazilian elderly in the stroop test. Brazilian Journal of Medical and Biological Research, 27(55), e11917. https://doi.org/10.1590/1414-431X2022e11917
4.
CardonaM.AndrésP. (2023). Are social isolation and loneliness associated with cognitive decline in ageing?Frontiers in Aging Neuroscience, 15, 1075563. https://doi.org/10.3389/fnagi.2023.1075563
5.
ChenP.CaiH.BaiW.SuZ.TangY.-L.UngvariG. S.NgC. H.ZhangQ.XiangY.-T. (2023). Global prevalence of mild cognitive impairment among older adults living in nursing homes: A meta-analysis and systematic review of epidemiological surveys. Translational Psychiatry, 13(1), 1–11. https://doi.org/10.1038/s41398-023-02361-1
6.
Cortés-ÁlvarezN. Y.Vuelvas-OlmosC. R.Marmolejo-MurilloL. G.Sánchez-DuarteE.Lara-MoralesA. (2025). Cognitive stimulation and its effects on well-being, executive functions, and brain-derived neurotrophic factor in older adults from a Mexican geriatric center: A quasi-experimental study. Nursing Reports, 15(5), 151. https://doi.org/10.3390/nursrep15050151
7.
De Lima NetoA. V.De Araújo NunesV. M.Andrade De OliveiraK. S.De AzevedoL. M.Barbalho MesquitaG. X. (2017). Estimulação em idosos institucionalizados: Efeitos da prática de atividades cognitivas [stimulation in institutionalized elderly people: Effects of cognitive activity practice]. Revista de Pesquisa Cuidado é Fundamental Online, 9(3), 753–759. https://doi.org/10.9789/2175-5361.2017.v9i3.753-759
8.
de OliveiraL. F. S.WanderleyR. L.de MedeirosM. M. D.de FigueredoO. M. C.PinheiroM. A.Rodrigues GarciaR. C. M.AlmeidaL. d. F. D. d.CavalcantiY. W. (2021). Health-related quality of life of institutionalized older adults: Influence of physical, nutritional and self-perceived health status. Archives of Gerontology and Geriatrics, 92, 104278. https://doi.org/10.1016/j.archger.2020.104278
9.
de Oliveira LopesM. V.da SilvaV. M.de AraujoT. 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
10.
de Oliveira LopesM. V.Martins da SilvaV. (2016). Capítulo 6. Aplicación de la metodología cuantitativa a la investigación en lenguajes enfermeros estandarizados. In Echevarría PérezP.Giménez FernándezM.Giró FormatgerM. D. (Eds.), Investigación en metodología y lenguajes enfermeros (pp. 65–76). Elsevier; AETNDE.
11.
de Oliveira LopesM. V.Martins da SilvaV.AraujoT. L. D. (2013). Validação de diagnósticos de enfermagem: Desafios e alternativas. Revista Brasileira de Enfermagem, 66(5), 649–655. https://doi.org/10.1590/S0034-71672013000500002
12.
de Oliveira LopesM. V.Martins da SivlaV.de Almeida Lopes Monteiro da CruzD. (2024). Revised level of evidence criteria for diagnosis submission. In HerdmanT. H.KamitsuruS.Takao LopesC. (Eds.), Nursing diagnosis: Definitions and classification 2024-2026 ((13th edn, pp. 182–202). Thieme.
13.
DrigasA.KaryotakiM. (2019). Executive functioning and problem solving: A bidirectional relation. International Journal of Engineering Pedagogy (iJEP), 9(3), 76–98. https://doi.org/10.3991/ijep.v9i3.10186
14.
Escalada-HernándezP.Marín-FernándezB. (2018). The nursing diagnosis disturbed thought processes: An integrative review. International Journal of Nursing Knowledge, 29(4), 253–262. https://doi.org/10.1111/2047-3095.12186
15.
Escalada-HernándezP.Marín-FernándezB. (2021). Conceptual development and validation of the nursing diagnosis “disturbed thought process”. International Journal of Nursing Knowledge, 32(4), 262–273. https://doi.org/10.1111/2047-3095.12318
16.
FagundesD. F.CostaM. T.AlvesB. B. d. S.BenícioM. M. S.VieiraL. P.CarneiroL. S. F.NascimentoO. J. M.Monteiro JuniorR. S. (2021). Prevalence of dementia in long-term care institutions: A meta-analysis. Jornal Brasileiro de Psiquiatria, 70, 59–67. https://doi.org/10.1590/0047-2085000000298
17.
FengZ.ChenQ.LiY.XueZ.HaoX. (2023). The association between falls and depressive symptoms among older adults: Evidence from the China Health and Retirement Longitudinal Study. Frontiers in Public Health, 30(11), 1248551. https://doi.org/10.3389/fpubh.2023.1248551
18.
FolsteinM. F.FolsteinS. E.McHughP. R. (1975). Mini-mental state”: A practical method for grading the cognitive state of patients for the clinician. Journal of Psychiatric Research, 12(3), 189–198. https://doi.org/10.1016/0022-3956(75)90026-6
19.
FurtadoG. E.CaldoA.Vieira-PedrosaA.LetieriR. V.HogervorstE.TeixeiraA. M.FerreiraJ. P. (2020). Emotional well-being and cognitive function have robust relationship with physical frailty in institutionalized older women. Frontiers in Psychology, 16(11), 1568. https://doi.org/10.3389/fpsyg.2020.01568
20.
HeawY. C.SinghD. K. A.TanM. P.KumarS. (2022). Bidirectional association between executive and physical functions among older adults: A systematic review. Australasian Journal on Ageing, 41(1), 20–41. https://doi.org/10.1111/ajag.13008
21.
HerdmanT. H.KamitsuruS.LopesC. T. (2024). NANDA international nursing diagnoses: definitions and classification, 2024-2026 (13th edn). Thieme.
22.
HerdmanT. H.KamitsuruS.Takáo LopesC. (eds) (2021). NANDA international nursing diagnoses. Definitions and clasification 2021-2023. Thieme.
23.
LogueS. F.GouldT. J. (2014). The neural and genetic basis of executive function: Attention, cognitive flexibility, and response inhibition. Pharmacology, Biochemistry, and Behavior, 123, 45–54. https://doi.org/10.1016/j.pbb.2013.08.007
24.
MahoneyF.BarthelD. (1965). Functional evaluation: The barthel index. Maryland State Medical Journal, 14(61), 5–5.
25.
Malloy-DinizL. F.MirandaD. M.Grassi-OliveiraR. (2017). Editorial: Executive functions in psychiatric disorders. Frontiers in Psychology, 8, 1461. https://doi.org/10.3389/fpsyg.2017.01461
PangS.ChenN. Y. C.DongY. (2025). Should cognition be the fifth vital sign in nursing?International Journal of Nursing Studies, 170, 105101. https://doi.org/10.1016/j.ijnurstu.2025.105101
28.
PeerM.LyonR.ArzyS. (2014). Orientation and disorientation: Lessons from patients with epilepsy. Epilepsy & Behavior, 41, 149–157. https://doi.org/10.1016/j.yebeh.2014.09.055
29.
RaimoS.MaggiG.IlardiC. R.CavalloN. D.TorchiaV.PilgromM. A.CropanoM.Roldán-TapiaM. D.SantangeloG. (2024). The relation between cognitive functioning and activities of daily living in normal aging, mild cognitive impairment, and dementia: A meta-analysis. Neurological Sciences, 45(6), 2427–2443. https://doi.org/10.1007/s10072-024-07366-2
30.
ReisbergB.FerrisS. H.de LeonM. J.CrookT. (1982). The global deterioration scale for assessment of primary degenerative dementia. The American Journal of Psychiatry, 139, 1136–1139. https://doi.org/10.1176/ajp.139.9.1136
31.
Silva e FariasI. P.MontenegroL. D. A. S.WanderleyR. L.De PontesJ. C. X.PereiraA. C.De AlmeidaL. D. F. D.CavalcantiY. W. (2020). Physical and psychological states interfere with health-related quality of life of institutionalized elderly: A cross-sectional study. BMC Geriatrics, 20(1), 386. https://doi.org/10.1186/s12877-020-01791-6
32.
TateK.BaileyS.DeschenesS.GrabusicC.CummingsG. G. (2023). Factors influencing older persons’ transitions to facility-based care settings: A scoping review. The Gerontologist, 63(7), 1211–1227. https://doi.org/10.1093/geront/gnac091
33.
von ElmE.AltmanD. G.EggerM.PocockS. J.GøtzscheP. C.VandenbrouckeJ. P. (2007). The strengthening the reporting of observational studies in epidemiology (STROBE) statement: Guidelines for reporting observational studies. Lancet (London, England), 370(9596), 1453–1457. https://doi.org/10.1016/S0140-6736(07)61602-X
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