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Purpose To clinically validate indicators of the nursing outcomes "Breastfeeding establishment: Infant (1000)" and "Breastfeeding establishment: maternal (1001)", and their conceptual and operational definitions in infants admitted to a neonatal unit and their mothers. Method This study utilized several methods in a stepwise approach including an integrative review of the literature, content validation, and clinical validation. The content validity index was performed by eight experts, who evaluated revised content of the studied nursing outcomes. In the clinical validation, 61 mother-infant dyads were evaluated by two pairs of nurses: one pair used an instrument with developed definitions, whereas the other used an instrument without definitions. The evaluations were compared using Fleiss' kappa and weighted kappa. Results The agreement between all evaluators was considered excellent for almost all nursing outcome indicators related to the mothers. The pair of evaluators using the definitions had an agreement greater than 0.80 for most indicators. For the pair that did not use the definitions, agreement was poor. Conclusion There was an increase in uniformity and accuracy between the assessments when using the conceptual and operational definitions for the nursing outcome indicators related to Breastfeeding establishment. Implications for nursing practice This study contributed to the development of terms within the Nursing Outcomes Classification, and enriched the body of nursing knowledge.

Purpose This article explores the current structure of NANDA-I nursing diagnoses (ND) labels. Methods Critical analysis of the ND labels, as categorized in the NANDA-I terminology. Findings Most of the 244 ND labels are composed of terms from the focus and judgment axes. Conclusions The specificity of the human responses toward health and life transitions may not be totally represented in the two most common axes, as categorized within taxonomy II. Implications for nursing practice Improvements in NANDA-I diagnosis labels would contribute to an advanced terminology and to increased specificity and accuracy of the diagnostic process that is needed in clinical practice. Completeness of the ND labels would reflect clinical reasoning preciseness and help students and nurses in delivering more personalized, safe, and effective patient-centered care. Objetivo Este artigo explora os titulos dos diagnosticos de enfermagem da NANDA-I. METODOS: Analise critica dos titulos dos diagnosticos de enfermagem da NANDA-I. Resultados A maioria dos 244 diagnosticos de enfermagem classificados sao compostos essencialmente por termos referentes ao foco e ao julgamento. CONCLUSOES: A especificidade das respostas as transicoes de saude e vida pode nao estar totalmente representada nos dois eixos mais comuns, como apresentado na taxonomia II. IMPLICACOES PARA A PRATICA: Melhorias nos diagnosticos da NANDA-I em relacao ao seu aspeto multiaxial contribuiriam no desenvolvimento da sua terminologia e poderiam melhorar a especificidade e acuracia do processo diagnostico que e necessario a pratica clinica. Complementar os titulos dos diagnosticos de enfermagem poderia refletir a acuracia do raciocinio clinico e ajudar os estudantes e enfermeiros em prestarem cuidados centrados no paciente mais personalizados, seguros e eficazes.

PURPOSE To critically evaluate 2014 American Academy of Nursing (AAN) call-to-action plan for generating interoperable nursing data. DATA SOURCES Healthcare literature. DATA SYNTHESIS AAN's plan will not generate the nursing data needed to participate in big data science initiatives in the short term because Logical Observation Identifiers Names and Codes and Systematized Nomenclature of Medicine – Clinical Terms are not yet ripe for generating interoperable data. Well-tested viable alternatives exist. CONCLUSIONS Authors present recommendations for revisions to AAN's plan and an evidence-based alternative to generating interoperable nursing data in the near term. These revisions can ultimately lead to the proposed terminology goals of the AAN's plan in the long term.

Purpose To identify the frequency of the nursing diagnoses, ineffective breathing pattern, impaired gas exchange and impaired spontaneous ventilation in newborns; and, to analyze the accuracy of diagnostic indicators identified for each of these diagnoses. Methods This was a cross-sectional study conducted with a nonprobability sample of 92 infants. Data collected were represented by demographic and clinical variables, clinical indicators of the three respiratory nursing diagnoses from NANDA International, and were analyzed according to frequency and agreement between pairs of expert nurses (Kappa). Findings Ineffective breathing pattern was identified in 74.5% of infants; impaired gas exchange was noted in 31.5%; impaired spontaneous ventilation was found in 16.8% of subjects. Use of accessory muscles to breathe showed the highest sensitivity for ineffective breathing pattern; abnormal blood gases had the best predictive value for impaired gas exchange. Use of accessory muscles to breathe had the highest sensitivity for impaired spontaneous ventilation. Conclusions Ineffective breathing pattern was the most frequently identified; use of accessory muscles, alteration in depth of breathing, abnormal breathing, and dyspnea were the most representative signs/symptoms. Implication for nursing practice Early recognition of respiratory conditions can support safe interventions to ensure appropriate outcomes.

Purpose To describe a predictive middle range theory (MRT) that provides a process for validation and incorporation of nursing diagnoses in clinical practice. Data Sources Literature review. Data Synthesis The MRT includes definitions, a pictorial scheme, propositions, causal relationships, and translation to nursing practice. Conclusions The MRT can be a useful alternative for education, research, and translation of this knowledge into practice. Implications for Nursing Practice This MRT can assist clinicians in understanding clinical reasoning, based on temporal logic and spectral interaction among elements of nursing classifications. In turn, this understanding will improve the use and accuracy of nursing diagnosis, which is a critical component of the nursing process that forms a basis for nursing practice standards worldwide.

Purpose To identify and summarize clinical data supporting selection of nursing diagnoses related to the respiratory system for pediatric and neonatal populations. Method A literature review conducted in indexed publications was used. Findings The final sample consisted of 13 studies conducted in children with cardiac disease, respiratory infection, and asthma with nursing diagnoses such as ineffective breathing pattern, impaired gas exchange, and ineffective airway clearance. Conclusion The higher frequency defining characteristics were dyspnea, abnormal breathing pattern, use of accessory muscle to breathe, change in frequency and respiratory rate, decreased SaO2, and agitation. Implication for Nursing Knowledge This literature review may provide a basis for consideration of important diagnostic criteria in the pediatric population; however, clinical validation in different stages of development is critical for ensuring diagnostic accuracy.

OBJECTIVE:To report the experience of an outpatient nursing education clinic caring for people with chronic heart failure.EXPERIENCE REPORT:In this service, qualified “listening,” recreational educational actions about the disease and its treatment are conducted, based on the interventions from the

Purpose To construct and validate a data collection instrument (DCI), and a corresponding instructional guide, for assessment of the nursing diagnosis, risk for infection, in patients following cardiac surgery. Methods Construction of conceptual and operational definitions for risk factors based on literature, content validation by experts, and clinical validation by clinical nurses. Findings There were significant internal consistency and reproducibility in the content validation. In the clinical validation, agreement among nurses was higher than 70% for all risk factors. Conclusions The DCI was constructed and validated. Implications for Nursing Practice This DCI could be used for assessment of adult patients after cardiac surgeries worldwide because of its detailed cues for risk factors, which facilitate clinical reasoning and diagnostic judgment. Objetivo Construir e validar um instrumento de coleta de dados (ICD) e seu roteiro instrucional (RI) para avaliacao do diagnostico de enfermagem Risco de infeccao em pacientes pos-cirurgia cardiaca. Metodos Construcao de definicoes conceituais e operacionais dos fatores de risco baseada na literatura, validacao de conteudo por experts e validacao clinica por enfermeiras assistenciais. Resultados Consistencia interna e reprodutibilidade significativas na validacao de conteudo. Na validacao clinica, a concordância foi maior que 70% para todos os fatores de risco. Conclusoes O ICD foi construido e validado. Implicacoes Para Pratica De Enfermagem O ICD poderia ser utilizado para avaliacao de adultos pos-cirurgia cardiaca internacionalmente devido as suas pistas detalhadas sobre os fatores de risco, que facilitam o raciocinio clinico julgamento diagnostico.

Objetivo: descrever o julgamento clínico de enfermagem para identificar diagnósticos NANDA e desenvolver um plano de tratamento NIC para uma criança em pós-operatório de cirurgia cardíaca em terapia intensiva. Método: estudo de caso com coleta de dados retrospectiva no prontuário. Resultados: três enfermeiras identificaram diagnósticos NANDA e intervenções NIC. Criança de 6 meses, submetida a cirurgia cardíaca, necessitou oxigenação extracorpórea por membrana no pós-operatório. Foram identificados quatro principais diagnósticos, aos quais foram direcionadas dez intervenções. A proposta de intervenções para responder às necessidades humanas prioritárias da criança foi otimizada pelo uso das terminologias padronizadas. Todos os diagnósticos foram sustentados por indicadores diagnósticos; todas as intervenções foram cientificamente sustentadas. Conclusão: espera-se que os enfermeiros abordem não somente as respostas fisiológicas, mas também aquelas dos domínios psicossociais.

PURPOSE To examine the historical, legal/organizational, informatics, clinical, economic, and policy contexts underlying economic consequences of nursing diagnoses on patient outcomes. DATA SOURCES Published literature, online material. DATA SYNTHESIS Nursing diagnoses influence diagnostic-specific patient outcomes and other outcome variables such as length of hospital stay, morbidity, and mortality. CONCLUSIONS Examination of the economic ramifications of nursing diagnosis on patient outcomes can be facilitated using standardized language and databases containing nursing-sensitive measures.

The standardized language systems are important tools for dealing with the increasing complexity of nursing care. In this article the authors present the main benefits that the use of these systems provide for the required clinical reasoning in nursing care, the construction and organization of knowledge of the discipline, and for the clinical practice of nursing. The potential contributions of the standardized language systems in these fields stem from the fact that these systems provide a formal structure for supporting clinical reasoning, organizing knowledge and nursing experience.

Aline Helena Appoloni, MSN, RN, is a Doctoral student, Graduate Program in Fundamental Nursing, Universidade do SaoPaulo—Ribeirao Preto, College of Nursing, Ribeirao Preto, Sao Paulo, Brazil; T. Heather Herdman, PhD, RN, FNI, is theCEO/Executive Director at NANDA International, Inc., Kaukauna, Wisconsin; Anamaria Alves Napoleao, PhD, RN, is anAdjunct Professor in the Department of Nursing, Universidade Federal de Sao Carlos (UFSCar), Sao Carlos, Sao Paulo,Brazil; Emilia Campos de Carvalho, PhD, RN, is a Professor in the School of Nursing of Ribeirao Preto, University of SaoPaulo, Ribeirao Preto, Sao Paulo, Brazil; and Priscilla Hortense, PhD, RN, is an Adjunct Professor in the Department ofNursing, UFSCar, Sao Carlos, Sao Paulo, Brazil.

This column describes the work of the Nursing Diagnosis Extension and Classification (NDEC) research team, which works in a collaborative agreement with NANDA to refine and extend the diagnosis classification.

PURPOSE. The Diagnosis Development Committee (DDC) of NANDA International frequently receives proposed “physiologic” and “surveillance diagnosis” submissions that may not meet the current definition of nursing diagnosis (NANDA, 2007, p. 332). There has been a request for a vote on newly proposed definitions of nursing diagnosis, risk diagnosis, and syndromes. The purpose of this article is to provide information which enables members and interested nurses to continue the dialogue and to share their thoughts and also to consider the thoughts and information generated by the participants in the NANDA-I interest survey on the definition of nursing diagnoses. DATA SOURCES. An electronic survey of the current NANDA-I definitions, and potential changes to those definitions, was distributed via the NANDA-I Web site. This article summarizes the overall findings of that survey and provides an overview of commentary received from the 269 participants. CONCLUSIONS. It is necessary to continue the dialogue on this important decision and to provide a mechanism for input from members and interested nurses before reaching any conclusions on this subject. NURSING IMPLICATIONS. NANDA-I has been recognized as the leader in the development and implementation of nursing diagnoses and must act responsibly in assessing the changing and emerging trends in nursing practice and in responding to these trends.

This column describes the work of the Nursing Diagnosis Extension and Classification (NDEC) research team, which works in a collaborative agreement with NANDA to refine and extend the nursing diagnosis classification. Information in this column is for feedback and dialog only, and does not indicate NANDA acceptance of the content. NDEC contributions and recommendations will be processed by NANDA through its DRC Committee. Postscript. A joint meeting of members from NANDA and NDEC occurred in Boston after this column was submitted. Present were: Dr. Dorothy Jones (President, NANDA), Drs. Marjory Gordon and T. Heather Herdman (Co-chairs, DRC Committee), and Dr. Martha Craft-Rosenberg (Co-principal investigator, NDEC). The purpose of the meeting was to clarify and strengthen the collaborative relationship between NANDA and NDEC. NDEC's guidelines for development and evaluation of diagnoses vary somewhat from NANDA criteria for staging nursing diagnoses. For example, NDEC guidelines state that a nursing diagnosis label is a noun phrase, whereas NANDA's definition of a diagnosis label is “a concise term or phrase that represents a pattern of related cues” (NANDA, 1999, pp. 149–150). The people at the recent meeting determined that guideline development would occur jointly, along with a periodic review of those guidelines. The next issue of tills column will be devoted to highlighting the ongoing collaborative relationship between NANDA and NDEC. It is our hope that this format will stimulate dialogue among the readership.