VALIDITY OF NURSING OUTCOME INDICATOR DEFINITIONS FOR THE RISK FOR INFECTION DIAGNOSISABSTRACT
Objective: to construct and validate the content of constitutive and operational definitions and operational magnitude of selected indicators in an Intensive Care Unit for the “Risk for infection” nursing diagnosis.
Method: methodological research carried out between May and June 2021 with eight experts who assessed the definitions in terms of content and agreement.
Results: the definitions of indicators for “Infection severity” and “Risk control: infectious process” outcomes obtained a scale-level content validity index based on the average method of 1.00 and 0.96, respectively. In the operational definitions, the indicators “Identifies risk factors for infection” and “Uses universal precautions presented”, respectively, an item-level content validity index of 0.98, demonstrating almost perfect agreement, and 1.00, perfect agreement. Regarding the operational magnitude, the definitions of indicators for the “Risk control: infectious process” outcome were reviewed, although the Scale-level content validity index based on the average method demonstrated almost perfect agreement of 0.96 for each criterion. As for the definitions of operational magnitudes, the “Fever” indicator was reviewed, even though it presented an Item-level content validity index of 1.00 for all the criteria assessed.
Conclusion: it was demonstrated that the constitutive, operational, and operational magnitude definitions constructed have content validity, constituting a scientific construct capable of being reproduced in different health environments.
DESCRIPTORS:
Standardized nursing terminology; Intensive care units; Nursing process; Validation study; Nursing diagnosis
RESUMO
Objetivo: construir e validar o conteúdo das definições constitutivas, operacionais, e a magnitude operacional de indicadores selecionados em uma Unidade de Terapia Intensiva para o diagnóstico de enfermagem Risco de infecção.
Método: pesquisa metodológica realizada entre maio a junho de 2021, com oito especialistas que avaliaram as definições quanto ao conteúdo e concordância.
Resultados: as definições constitutivas dos indicadores dos resultados Gravidade da infecção e Controle de riscos: processo infeccioso, obtiveram Scale-level content validity index based on the average method de 1,00 e 0,96 respectivamente. Nas definições operacionais, os indicadores “Identifica fatores de risco para infecção e utiliza precauções universais” apresentaram, respectivamente, Item-level content validity index de 0,98 demonstrando concordância quase perfeita e 1,00, concordância perfeita. Referente à magnitude operacional, foram revisadas as definições dos indicadores do resultado controle de riscos: processo infeccioso, embora o Scale-level content validity index based on the average method tenha demonstrado concordância quase perfeita de 0,96 para cada critério. Sobre as definições das magnitudes operacionais, revisou-se o indicador Febre, mesmo apresentando Item-level content validity index de 1,00 para todos os critérios avaliados.
Conclusão: demonstrou-se que as definições constitutivas, operacionais, e de magnitude operacional construídas possuem validade de conteúdo, constituindo-se em um constructo científico capaz de ser reproduzido nos diversos ambientes de saúde.
DESCRITORES:
Terminologia padronizada em enfermagem; Unidade de Terapia intensiva; Processo de enfermagem; Estudos de validação; Diagnóstico de enfermagem
RESUMEN
Objetivo: construir y validar el contenido de las definiciones constitutivas y operativas y la magnitud operativa de indicadores seleccionados en una Unidad de Cuidados Intensivos para el diagnóstico de enfermería “Riesgo de infección”.
Método: investigación metodológica realizada entre mayo y junio de 2021 con ocho expertos que evaluaron las definiciones en términos de contenido y concordancia.
Resultados: las definiciones constitutivas de los indicadores de resultado “Gravedad de la infección” y “Control de riesgos: proceso infeccioso” obtuvieron un scale-level content validity index based on the average method de 1,00 y 0,96, respectivamente. En las definiciones operativas, los indicadores “Identifica factores de riesgo de infección” y “Utiliza precauciones universales” presentaron, respectivamente, un item-level content validity index de 0,98, demostrando una concordancia casi perfecta, y de 1,00, con una concordancia perfecta. En cuanto a la magnitud operativa, se revisaron las definiciones de los indicadores de resultado “Control de riesgo: proceso infeccioso”, aunque el scale-level content validity index based on the average method demostró una concordancia casi perfecta de 0,96 para cada criterio. En cuanto a las definiciones de magnitudes operativas, se revisó el indicador “Fiebre”, aunque presentó un item-level content validity index de 1,00 para todos los criterios evaluados.
Conclusión: se demostró que las definiciones constitutiva, operacional y de magnitud operacional construidas tienen validez de contenido, constituyendo un constructo científico capaz de ser reproducido en diferentes ambientes de salud.
DESCRIPTORES:
Terminología normalizada de enfermería; Unidades de cuidados intensivos; Proceso de enfermería; Estudio de validación; Diagnóstico de enfermería
INTRODUCTION
The “Risk for infection” Nursing Diagnosis (ND) from the NANDA International (NANDA-I) taxonomy is defined as “Susceptible to invasion and multiplication of pathogenic organisms, which may compromise health”. The associated conditions of this ND includes the “Invasive procedure” item. Thus, any patient who undergoes an invasive procedure has an increased risk of developing an infection, which in this case would be a healthcare-associated infection (HAI), defined as any infection that manifests itself in a specific site after a patient is admitted to the healthcare service, or one that begins after the third day (72h) of hospitalization1.
Additionally, to meet the diagnostic criteria for an HAI, it is necessary to define what is known as the infection window period, characterized by a period of seven days during which signs, symptoms, and test results are identified. Thus, three days before and three days after the collection of the first laboratory test with a positive result or the first imaging test with an altered result must be considered. In the absence of tests, the date of the first specific sign or symptom for that particular HAI must be considered. Therefore, in the epidemiological context, it will not be considered a HAI if the signs or symptoms defined for a specific infection are outside the infection window period2.
The diagnostic criteria for HAIs that are subject to mandatory national reporting, such as those that occur most commonly in ICUs, such as central catheter-associated bloodstream infection (BSI), ventilator-associated pneumonia (VAP), and urinary tract infection (UTI) associated with indwelling urinary catheters, and surgical site infections have their own specificities. In these situations, among other particularities considered, the date of infection is well defined, being characterized as the day of installation of the respective device or surgical procedure2.
Through a preliminary survey carried out by the authors of the study in question, including the collection of information from electronic medical records covering all patients admitted in 2020 to a reference general adult Intensive Care Unit (ICU) located in the state of Santa Catarina, it was found that 91.1% of medical records analyzed had the “Risk for infection” diagnosis. The associated condition named “Invasive procedure” was present in 90.2% of the total analyzed. The outcomes “Infection severity”, with the indicators “Temperature instability”, “Fever”, “Purulent sputum”, “Pain”, and “Risk control: infectious process”, with the indicators “Identifies risk factors for infection”, “Uses universal precautions” and “Identifies signs and symptoms of infection”, were the most prevalent.
Supporting the evidence presented above, in ICUs, patients undergo numerous invasive procedures, predicting the selection of the “Risk for infection” ND3. Thus, for care planning, using the Nursing Outcomes Classification (NOC), outcomes and their respective indicators must be selected to guide the choice of interventions, consistent with patients’ health needs. However, it is difficult to choose the index that best represents the operational magnitude of the indicator, as there are no definitions that characterize them, especially in the intermediate magnitudes represented by indices “2”, “3”, and “4”, since the extremes “1” and “5” have, respectively, the “worst” and “best” clinical condition4. In this regard, it is argued that accuracy regarding using the NOC involves the need to construct constitutive, operational, and operational magnitude definitions for outcome indicators that are applicable to clinical practice5.
Constitutive definitions can be understood as a synthesis of knowledge, defined according to the unrefined meaning of the word. Operational definitions attribute meaning to a given word, specifying how such a concept should be measured. Finally, operational magnitude definitions represent the detailed description of each index of the Likert-type assessment scale6.
Considering the relevance of using the “Risk for infection” ND in ICUs and positive selections of results and interventions, it is believed that the construction and validity of definitions for the outcome indicators contributes to improving knowledge and using the NOC in clinical practice, as indicators describe the state of a given sign/symptom and direct nursing activities5.
The aim, therefore, was to construct and validate the content of constitutive and operational definitions and operational magnitude of indicators of “Infection severity” and “Risk control: infectious process” outcomes evidenced in an ICU.
METHOD
This is a methodological study based on the construction and validity of instruments6. To select the experts, the model proposed for nursing study validity was adopted7.
Professors who were experts on the subject were included and obtained a score equal to or higher than six, by meeting the following criteria: experience of at least two years in teaching nursing classifications (four points); experience in research, with articles published on nursing classifications in reference journals (two points); participation of at least one year in a research or extension group in the area of nursing classifications (two points); doctoral degree in nursing, with a thesis related to nursing classifications (two points); master’s degree in nursing, with a dissertation related to nursing classifications (two points); nursing residency, with a final project related to nursing classifications (two points). For every two years of clinical or teaching experience, one point was added7. The exclusion criterion included failure to complete the validity form.
Nine experts were invited and eight agreed to participate. Expert selection deemed potentially eligible occurred through the analysis of resumes, covering three higher education institutions in western Santa Catarina, which offer undergraduate nursing courses. This selection took into account the existence of a study center on the Nursing Process (NP) in the region and the use of NANDA-I, NOC, and NIC taxonomies, with the involvement of the respective educational institutions.
Data collection took place in May and June 2021, using an electronic form on Google Forms®, containing the research acceptance term, sociodemographic data, and the definitions to be validated. An invitation with the link to access the form was sent by email, enabling assessing the constitutive and operational definitions through three options: “definition is appropriate for the indicator”; “definition is somewhat appropriate for the indicator, but with a suggestion”; “definition is not appropriate for the indicator”.
In turn, for each of the five indexes of the operational magnitude scale, adequacy was assessed using the simplicity, clarity, and accuracy criteria. The simplicity criterion sought to assess whether the definition was able to express a single idea; the clarity criterion sought to assess whether it was intelligible; and the accuracy criterion sought to assess whether the definition had a defined position, distinguishing it from the others. For each of these criteria, experts were given three options: “the criterion is met”; “indecision as to whether the criterion is met”; and “the criterion is not met” 6.
To assess the measures of agreement among experts, the item-level content validity index (I-CVI) was used. For the general analysis of constructed definitions, the scale-level content validity index based on the average method (S-CVI/Ave) was used, enabling the analysis of the mean of I-CVI scores for all construct items8. In this study, a minimum agreement of 0.83 was considered for both I-CVI and S-CVI/Ave9.
Additionally, the Inter-Rater Agreement (IrA) for each definition and for the set of definitions, separated according to the respective nursing outcomes, are presented in terms of percentage. For this measurement, the minimum index of 75% was considered for validity by expert agreement10. The study met the requirements of Resolution 466/2012.
RESULTS
The eight participating experts had doctoral degrees, and one of them had a post-doctoral degree. The effective participation of most experts in research groups in the area ranged from one to five years. The average time of teaching experience, related to NANDA-I, NOC, and NIC, was 9.5 years. All had at least one publication in the area. The score achieved in the eligibility criteria ranged from eight to 17 points, with an average of 11.87.
In this study, the constitutive, operational, and operational magnitude definitions of seven indicators were constructed, summarized in Charts 1 and 2. The adjustments, as suggested by experts, are highlighted in bold.
Most of constitutive definitions were considered “adequate to the indicator”, with S-CVI/Ave 1.00 for the definitions of the “Infection severity” outcome indicator and 0.96 for the definitions of the “Risk control: infectious process” outcome indicator. However, even with perfect and almost perfect agreement, respectively, there were pertinent suggestions from experts for the definitions of “Fever”, “Temperature instability” and “Uses universal precautions”, aiming to qualify the constructed concepts.
Concerning the “Fever” indicator, when defining the values of normothermia (between 36º and 37ºC), subfebrile state (between 37.1º and 37.7ºC) and fever (equal to or greater than 37.8ºC) in the revised version of the scientific construct, the operational magnitude definitions were adapted regarding the temperature ranges for each of the indexes of the assessment scale. Thus, index “5” represents the absence of fever and index “4” establishes the margin of increase of up to 1ºC above the upper limit of normothermia (which is 37ºC). From this point on, the cumulative increase of 0.5ºC was considered for the remaining indexes, taking care to present temperature ranges for each index, as a way of facilitating the selection of the most appropriate index by nurses.
It was also observed that only the constitutive definition of the “Uses universal precautions” indicator, belonging to the “Risk control: infectious process” outcome, presented an I-CVI of 0.88. In this case, the evaluators suggested adjustments that are better outlined in the discussion.
As for operational definitions, only the definitions of the “Identifies risk factors for infection”, “Uses universal precautions” and “Identifies signs and symptoms of infection” indicators, all belonging to the “Risk control: infectious process” outcome, presented S-CVI/Ave lower than 1.00 (0.99) and mean IrA lower than 100% (93%). Even presenting almost perfect agreements, after analyzing experts’ suggestions, it was decided to make adjustments to the three indicators. Table 1 presents results of I-CVI, S-CVI/Ave and IrA.
In relation to the definitions of operational magnitudes of indicators, the wording of magnitude “5” of each of the indicators of the “Risk control: infectious process” outcome was reviewed for simplicity, clarity, and accuracy, although the mean IrA was shown to be high (between 89.3 and 93.5%), and the S-CVI/Ave of the three criteria demonstrated almost perfect agreement (0.96 for each criterion) (Table 2).
DISCUSSION
Following the criteria for selecting experts, 100% of those selected were classified as masters, which demonstrates adequate qualifications due mainly to clinical practice and teaching of NANDA-I, NOC, and NIC. Junior experts must present a minimum score of five; masters, a score between six and 20; and seniors, a score above 20 points7.
Concerning the validated definitions, it is considered that for the constituents of the “Fever” and “Temperature instability” indicators associated with the “Infection severity” outcome, even though a high level of agreement was obtained among experts, it was decided to adapt them based on the suggestions presented. The definition of a cut-off point for fever is still a subject of discussion in many research groups, mainly due to the existence of numerous variables and uncertainties that affect both the definition and the determination of normal and elevated temperatures11.
Thus, the initial proposal for this study was based on the concept of ideal body temperature, whose range varies between 36º and 36.7ºC12. However, following experts’ recommendations, the concept of normothermia13 was adopted, with a range between 36º and 37ºC, as the initial parameter for establishing temperature ranges, both for the “Fever” indicator and for the “Temperature instability” indicator.
The manifestation of an axillary temperature equal to or greater than 37.8ºC is considered fever, and temperature interval between the upper limit value of normothermia (37ºC) and that considered fever (37.8ºC) can be called a subfebrile state14. Given the various possibilities of values, temperature intervals, and nomenclatures highlighted, we also considered the parameter adopted by the local hospital of the study, which considers fever to be an axillary temperature equal to or greater than 37.8ºC.
In relation the “Temperature instability” indicator, the difficulty in finding theoretical support in the literature, both in books and articles, with an approach to this topic, is problematic. It was observed that most studies related to body temperature instability refer to the context of patient in the perioperative period, i.e., addressing temperature regulatory responses through oscillation between hypothermia, normothermia, and hyperthermia.
As a way of assisting nurses in selecting more accurate indicators, given the manifestation of oscillations in patients’ body temperature, the definitions of operational magnitude indexes seek to establish a cut-off point for the “Temperature instability” indicator, with the observation of at least three episodes of temperature oscillation below and/or above the limiting values of normothermia in a period of 24 hours.
Checking body temperature in ICUs is essential for managing critically ill patients and, currently, it is known that this monitoring can be performed invasively or non-invasively, reflecting central or peripheral body temperature. Invasive methods are among the most reliable for measuring temperature, although they present a higher risk of complications and/or infections15. The pulmonary artery stands out among the methods of measuring core temperature, measured through the pulmonary artery catheter, and is considered the gold standard among measurement methods. Bladder temperature, measured through a urinary catheter with a thermal sensor, has been a method supported in several studies as it has been shown to be reliable and accurate in terms of measuring core temperature16.
Esophageal temperature, measured using a dedicated probe or a probe with a stethoscope, is also a widely used method for monitoring the temperature of critically ill patients. This assesses patient’s core temperature by placing the thermal probe in the lower third of the esophagus and has been widely referred to as an accurate method compared with the pulmonary artery catheter17.
Among the most commonly used non-invasive techniques are axillary temperature, temporal artery temperature, oral temperature, and tympanic membrane temperature. Non-invasive thermometry methods do not have well-established reliability, especially in patients requiring critical care. However, as observed in the ICU participating in this study, due to its practicality and low cost, axillary temperature continues to be used in different ICUs as a reference parameter for therapeutic interventions15.
Regarding the “Purulent sputum” indicator, which also belongs to the “Infection severity” outcome, the construction of definitions of operational magnitude indexes was also hampered by the scarcity of studies addressing, among other conditions, the characteristics of sputum that would encourage its classification. Therefore, no classifications were found in the widely researched literature that, for instance, referred to severity according to the characteristics observed in secretions of respiratory origin.
In this context, from the elaboration of definitions of operational magnitude for the “Purulent sputum” indicator, severity classifications, according to aspects observed in sputum, were outlined based on the most frequent findings in lung diseases. From the careful analysis of the main diseases of lung origin18, it was possible to classify the indexes of the operational magnitude of this indicator, with emphasis on color, consistency, odor, and quantity on a scale in which index “5” is characterized by the absence of sputum and index “1” by the worst possible presentation, such as “Purulent sputum, yellow, green, brown, pink, blackish, rusty or bloody, mucoid, foamy or thick, with a slight or foul odor, in abundant quantity, obtained through copious expectorations”.
Concerning the “Pain” indicator, the last one selected for the “Infection severity” outcome, the construction of operational definitions sought to address one of the main challenges observed in clinical practice, which is pain assessment in non-responsive individuals, a health condition frequently observed in ICUs. It is important to highlight that care protocols have strongly recommended pain assessment during the exercise of care19.
It is also problematic that, for individuals with preserved cognition, pain measurement is more easily performed through patient’s own report and the use of visual scales. However, for critically ill patients, who are often unable to verbalize due to changes in their level of consciousness, the use of observational scales has been recommended, which are based on physiological parameters and body expressions19.
Hence, in pain assessment in unresponsive patients, the operational definition constructed sought to equip nurses with the necessary tools through “triggers”, suggesting the observation of facial expressions, body movements, and patient’s non-verbal behavior. Another important piece of information addressed in this definition refers to sudden changes in vital signs, especially during the performance of procedures that may cause discomfort, which may be signs suggestive of pain.
It is important to highlight that the use of only physiological data to measure pain is debatable, since several factors such as fear, concern, and anxiety can directly influence this assessment. Furthermore, the absence of changes in vital signs does not necessarily indicate the absence of pain19. Considering this important evidence, the construction of definitions of operational magnitude indexes was based on two possibilities, i.e., the measurement of the magnitude for responsive and non-responsive patients.
Thus, for verbalizing patients, the index definitions adopt the use of information from the visual analogue scale (VAS) which, according to the Brazilian Society for the Study of Pain (SBED - Sociedade Brasileira para o Estudo da Dor)20, comprises a numerical scale from 0 to 10 and, in the case of this study, was associated with a verbal scale with five descriptors. The descriptors will be presented to patients so that they can choose the one that represents pain intensity or relief at the time of assessment. For each of the five indexes of the Likert scale, there is a numerical range corresponding to pain intensity and the use of descriptors (No pain; Mild/weak pain; Moderate pain; Strong/intense pain; and Unbearable pain/worst possible pain).
For patients who are unable to verbalize and/or have an altered level of consciousness, the definitions of operational magnitude indexes present an adaptation of the Nociception Coma Scale (NCS). The NCS was developed based on observations that suggest painful behaviors based on four items, such as motor, verbal, visual, and facial expression responses, with a score where zero means no pain in response to the painful stimulus and 12 points would be the maximum response to the stimulus21. However, when using the VAS to measure pain intensity, we suppressed the scores suggested by the NCS, adapting them to the five indexes of the Likert scale.
Considering that pain control and relief of suffering are the responsibility of healthcare professionals and, given reports in specialized literature that pain is often undertreated, attesting to it as a recurring symptom in the hospital environment20, the widespread use of this indicator reinforces the importance given by nurses to patients’ physical and emotional well-being.
The indicators related to the “Risk control: infectious process” outcome, because they are classified as “performance results”, which begin with the terms “knowledge”, “behavior”, “beliefs”, “control”, “self-control”, and “self-care”, are considered as results directed at the personal actions of patients4. Therefore, the constitutive definitions constructed for the “Identifies risk factors for infection”, “Uses universal precautions” and “Identifies signs and symptoms of infection” indicators begin with the words “patient knows...” or “patient identifies...”, thus reinforcing the subject of action in relation to these indicators. It is imperative to highlight that “personal actions” refer to the care that patients must take to prevent infections, i.e., the indicators for this result should not be selected with a focus on the care provided by healthcare professionals.
For the operational definitions of these “performance results” indicators, a more detailed description was chosen rather than objective information as a way of providing nurses with scientific knowledge and encouraging the development of clinical reasoning. Therefore, in the instructions for the content validity process, care was taken to include this information for experts.
There were few suggestions for adjustments to both the constitutive and operational definitions, dealing with issues of grammatical order or verbal agreement. One example of this was the deletion of item 7 of the operational definition of the “Identifies risk factors for infection” indicator, whose approach regarding leukopenia was already covered in item 6. The most important adjustment was directed to the “Uses universal precautions” indicator, where experts suggested, for the constitutive definition and, consequently, for definitions of operational magnitude indexes, replacing the term “universal precautions” with “standard precautions”. Although the title of the indicator, as set out by NOC4, contains the term “universal precautions”, it was decided to replace it in the definitions constructed as a way of adopting a common and updated terminology.
Therefore, infection prevention and control measures must be implemented by professionals working in healthcare services with the aim of avoiding or at least minimizing the transmission of microorganisms during any and all healthcare provided. It is also believed that the organizational culture, the work management model, and the appreciation of nursing professionals contribute to greater adherence to and management of standard precautions.
CONCLUSION
It is argued that the process of validity by experts of definitions of NOC outcome indicators favors the construction of scientifically based knowledge and, consequently, the strengthening of the profession. Studies that address the use of NOC are still very incipient and, in view of this finding, it is observed that most indicators do not present details in the literature. Thus, critical analysis of experts was fundamental for improving the scientific construct.
Furthermore, the use of NOC indicators in clinical practice, with detailed definitions, contributes to developing clinical reasoning, greater accuracy in the selection of results consistent with patients’ real health needs and for nurses’ decision-making in the context of the NP.
It is suggested that clinical validity of constructed definitions be carried out, aiming at greater reliability and less subjectivity in NOC applicability. Moreover, one of the main implications of this study is the contribution to the current process of implementing the NP in the participating hospital institution.
REFERENCES
-
1. Centers for Disease Control and Prevention. National Healthcare Safety Network (NHSN). Patient Safety Component Manual [Internet]. 2020 [cited 2024 Jul 04]. Available from: https://www.cdc.gov/nhsn
» https://www.cdc.gov/nhsn -
2. Agência Nacional de Vigilância Sanitária. Nota Técnica GVIMS/GGTES/DIRE3/ANVISA nº 03 / 2024. Critérios Diagnósticos das Infecções Relacionadas à Assistência à Saúde de Notificação Nacional Obrigatória [Internet]. 2024 [cited 2024 Aug 26]. Available from: https://www.gov.br/anvisa/pt-br/centraisdeconteudo/publicacoes/servicosdesaude/notas-tecnicas/notas-tecnicas-vigentes/nota-tecnica-no-03-2024-criterios-diagnosticos-de-iras/view
» https://www.gov.br/anvisa/pt-br/centraisdeconteudo/publicacoes/servicosdesaude/notas-tecnicas/notas-tecnicas-vigentes/nota-tecnica-no-03-2024-criterios-diagnosticos-de-iras/view -
3. Paiva RM, Ferreira LL, Bezerril MS, Chiavone FTB, Salvador PTC, Santos VEP. Infection factors related to nursing procedures in Intensive Care Units: A scoping review. Rev Bras Enferm [Internet]. 2021 [cited 2024 Jul 04];74:1. Available from: https://doi.org/10.1590/0034-7167-2020-0731
» https://doi.org/10.1590/0034-7167-2020-0731 - 4. Moorhead S, Johnson M, Maas M, Swanson E. Classificação dos resultados de enfermagem NOC: mensuração dos resultados em saúde. Rio de Janeiro, RJ(BR): GEN Guanabara Koogan; 2020.
-
5. Cavalcante AM, Lopes CT, Swanson E, Moorhead AS, Bachion MM, Barros AL. Validação de definições para indicadores do resultado NOC: Autocontrole da doença cardíaca. Acta Paul Enferm [Internet]. 2020 [cited 2024 Jul 04];33. Available from: https://doi.org/10.37689/acta-ape/2020AO0265
» https://doi.org/10.37689/acta-ape/2020AO0265 -
6. Pasquali L. Princípios de elaboração de escalas psicológicas. Rev Psiq Clín [Internet]. 1998 [cited 2024 Jul 04];25(5):206-13. Available from: https://ppget.ifam.edu.br/wp-content/uploads/2017/12/Principios-de-elaboracao-de-escalas-psicologicas.pdf
» https://ppget.ifam.edu.br/wp-content/uploads/2017/12/Principios-de-elaboracao-de-escalas-psicologicas.pdf -
7. Guimarães HCQCP, Pena SB, Lopes JL, Lopes CT, Barros ALBL. Experts for validation studies in nursing: New proposal and selection criteria. Int J Nurs Knowl [Internet]. 2016 [cited 2024 Jul 04];27:3. Available from: https://doi.org/10.1111/2047-3095.12089
» https://doi.org/10.1111/2047-3095.12089 -
8. Yusoff MSB. ABC of content validation and content validity index calculation. Educ Med J [Internet]. 2019 [cited 2024 Jul 04];11(2):49-54. Available from: https://doi.org/10.21315/eimj2019.11.2.6
» https://doi.org/10.21315/eimj2019.11.2.6 -
9. Lynn MR. Determination and quantification of content validity. Nurs Res [Internet]. 1986 [cited 2024 Jul 04];35(6):381-5. Available from: https://journals.lww.com/nursingresearchonline/Citation/1986/11000/Determination_and_Quantification_Of_Content.17.aspx
» https://journals.lww.com/nursingresearchonline/Citation/1986/11000/Determination_and_Quantification_Of_Content.17.aspx -
10. Graham M, Milanowski A, Miller J. Measuring and promoting inter-rater agreement of teacher and principal performance ratings. Center Educ Comp Reform [Internet]. 2012 [cited 2024 Jul 04]. Available from: https://files.eric.ed.gov/fulltext/ED532068.pdf
» https://files.eric.ed.gov/fulltext/ED532068.pdf -
11. Salgado PO, Silva LCR, Silva PMA, Chianca TCM. Physical methods for the treatment of fever in critically ill patients: A randomized controlled trial. Rev Esc Enferm USP [Internet]. 2016 [cited 2024 Jul 04];50(5):823-30. Available from: https://doi.org/10.1590/S0080-623420160000600016
» https://doi.org/10.1590/S0080-623420160000600016 -
12. Güneş ÜY, Zaybak A. Does the body temperature change in older people? J Clin Nurs [Internet]. 2008 [cited 2024 Jul 04];17(17):2284-87. Available from: https://doi.org/10.1111/j.1365-2702.2007.02272.x
» https://doi.org/10.1111/j.1365-2702.2007.02272.x - 13. Aires R, Aires S. Febre. Terapêutica em Pediatria. 4th ed. São Paulo, SP(BR): Atheneu; 2001.
-
14. Lambertucci JR, Ávila RE, Voieta I. Febre de origem indeterminada em adultos. Rev Soc Bras Med Trop [Internet]. 2005 [cited 2024 Jul 04];38(6):507-13. Available from: https://doi.org/10.1590/S0037-86822005000600012
» https://doi.org/10.1590/S0037-86822005000600012 -
15. Corrêa F, Silveira LM, Lopes NAP, Ruffino-Netto A, Stabile AM. Perfil de termorregulação e desfecho clínico em pacientes críticos com sepse. Av Enferm [Internet]. 2019 [cited 2024 Aug 26];37(3):293-302. Available from: https://doi.org/10.15446/av.enferm.v37n3.77009
» https://doi.org/10.15446/av.enferm.v37n3.77009 -
16. Schell-Chaple H, Liu K, Matthay M, Puntillo K. Rectal and bladder temperatures vs forehead core temperatures measured with SpotOn monitoring system. Am J Crit [Internet]. 2018 [cited 2024 Aug 26];27:1. Available from: https://doi.org/10.4037/ajcc2018865
» https://doi.org/10.4037/ajcc2018865 -
17. Hymczak H, Golab A, Mendrala K, Plicner D, Darocha T, Pdsiadlo P, et al. Core temperature measurement - principles of correct measurement, problems, and complications. Int J Environ Res Public Health [Internet]. 2021 [cited 2024 Aug 26];18:1-8. Available from: https://doi.org/10.3390/ijerph182010606
» https://doi.org/10.3390/ijerph182010606 - 18. Porth CM, Norris TL. Fisiopatologia. 10th ed. Rio de Janeiro, RJ(BR): Guanabara Koogan; 2021.
-
19. Oliveira LS, Macedo MP, Martins SAS, Oliveira APF, Santos VS. Pain assessment in critical patients using the Behavioral Pain Scale. BrJP [Internet]. 2019 [cited 2024 Jul 04];2(2):112-6. Available from: https://doi.org/10.5935/2595-0118.20190021
» https://doi.org/10.5935/2595-0118.20190021 -
20. Sociedade Brasileira para Estudo da Dor. 5º Sinal Vital. Hospital sem dor: diretrizes para implantação da dor como 5º sinal vital [Internet]. 2021 [cited 2024 Jul 04]. Available from: https://sbed.org.br/5o-sinal-vital/
» https://sbed.org.br/5o-sinal-vital/ -
21. Sanches MB, Silva CVF, Ali YM, Matsumoto M, Valverde Filho J, Salvetti MG. Adaptação transcultural e evidência de validade de conteúdo da versão brasileira da Nociception Coma Scale-revised. BrJP [Internet]. 2020 [cited 2024 Jul 04];3(3):253-7. Available from: https://doi.org/10.5935/2595-0118.20200180
» https://doi.org/10.5935/2595-0118.20200180
NOTES
-
ORIGIN OF THE ARTICLE
Article extracted from the thesis - Construção e validação de definições constitutivas e operacionais de indicadores da Classificação dos Resultados de Enfermagem para os resultados Gravidade da Infecção e Controle de Riscos: Processo Infeccioso, presented to the Graduate Program in Nursing, Universidade Federal de Santa Catarina, in 2022.
-
FUNDING INFORMATION
This study was financed by the Coordenação de Aperfeiçoamento de Pessoal de Nível Superior - Brazil (CAPES) - Finance Code 001
-
APPROVAL OF ETHICS COMMITTEE IN RESEARCH
Approved by the Ethics Committee in Research of the Universidade do Estado de Santa Catarina (UDESC) Research Ethics Committee, under Opinion 3559186/2019 and Certificate of Presentation for Ethical Consideration 11945519.6.0000.0118.
-
TRANSLATED BY
Letícia Belasco
