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The identification and clinical validation of the defining characteristics of the nursing diagnosis Alteration in Tissue Perfusion: Cardiac Item Type text; Thesis-Reproduction (electronic) Authors Kelly, David Jonathan Publisher The University of Arizona. Rights Copyright © is held by the author. Digital access to this material is made possible by the University Libraries, University of Arizona. Further transmission, reproduction or presentation (such as public display or performance) of protected items is prohibited except with permission of the author. Download date 04/10/2021 12:51:26 Link to Item http://hdl.handle.net/10150/277146 INFORMATION TO USERS The most advanced technology has been used to photo graph and reproduce this manuscript from the microfilm master. UMI films the text directly from the original or copy submitted. Thus, some thesis and dissertation copies are in typewriter face, while others may be from any type of computer printer. 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Ana Aibor, MI 48106 THE IDENTIFICATION AND CLINICAL VALIDATION OF THE DEFINING CHARACTERISTICS OF THE NURSING DIAGNOSIS ALTERATION IN TISSUE PERFUSION: CARDIAC by David Jonathan Kelly Copyright@ David Jonathan Kelly 1989 Thesis Submitted to the Faculty of the COLLEGE OF NURSING In Partial Fulfillment of the Requirements For the Degree of MASTER OF SCIENCE In the Graduate College UNIVERSITY OF ARIZONA 19 8 9 2 STATEMENT BY AUTHOR This thesis has been submitted in partial fulfillment of requirements for an advanced degree at the University of Arizona and is deposited in the University Library to be made available to borrowers under rules of the Library. Brief quotations from this thesis are allowable without special permission, provided that accurate acknowledgement of the source is made. Requests for permission for extended quotation from or reproduction of the manuscript in whole or in part may be granted by the copyright holder. SIGNED APPROVAL BY THESIS DIRECTOR This thesis has been approved on the date shown below: Dr. Anne Woodtli Date Associate Professor of Nursing 3 ACKNOWLEDGEMENTS I would like to thank those individuals who helped me with my thesis. I would like to thank my thesis chairperson, Dr. Anne Woodtli. She has been a mentor and excellent role model throughout my master's program and my thesis. I would like to thank my other thesis committee members, Dr. Murdaugh and Dr. Hose Gerber for their support and scholarly advise. I would also like to thank Fran Stier, MS, for her clinical expertise and help in collecting the data. Lastly, I would like to thank my wife Rebecca, and my mother Marjorie, for their continual moral support throughout my master's program. 4 TABLE OF CONTENTS Page LIST OF FIGURES 7 LIST OF TABLES 8 ABSTRACT 10 CHAPTER 1 11 INTRODUCTION 11 Purpose of Research 14 Conceptual Orientation 14 Nursing Diagnosis within the Nursing Process 14 Nursing Diagnosis 15 Nursing Diagnosis Taxonomy I 17 Problem Statement 20 Research Questions 21 Definitions 22 Significance to Nursing 23 Summary 26 CHAPTER 2 27 LITERATURE REVIEW 27 Nursing Diagnosis 27 Nursing Diagnosis Taxonomy 32 Nursing Diagnosis used wi£h Patients Experiencing Cardiac Problems 34 Alteration in Tissue Perfusion: Cardiac 38 Validation 39 Summary 43 CHAPTER 3 44 METHODOLOGY 44 Design 44 Sample 44 Protection of Subject's Rights 45 Site 45 Content Validity 45 Interrater Reliability 47 Data Collection Methods 48 5 TABLE OF CONTENTS CHAPTER 3 - continued Data Analysis Plan 52 Summary 53 CHAPTER 4 54 RESULTS OF DATA ANALYSIS 54 Demographic Characteristics of Sample 54 Research Questions 57 Analysis of Tool Content Validity 57 Interrater Reliability 63 Clinical Diagnostic Validity 64 Degree of Importance 79 Field Notes 92 Summary 94 CHAPTER 5 95 DISCUSSION OF FINDINGS 95 Discussion of Findings Related to Degree of Importance 98 Conclusions 98 Limitations 99 Recommendations 99 Significance to Nursing 100 Summary 101 APPENDIX A: HUMAN SUBJECTS APPROVAL LETTER 102 APPENDIX B: SUBJECT'S INFORMED CONSENT FORM 103 APPENDIX C: 105 CONTENT VALIDITY MEASUREMENT TOOL FOR THE KELLY CARDIAC ASSESSMENT TOOL 105 APPENDIX D: 109 KELLY CARDIAC ASSESSMENT TOOL (KCAT) 109 APPENDIX E: 113 INDIVIDUAL CLINICAL DIAGNOSTIC VALIDATION SCORES AND INTERRATER RELIABILITY MEASUREMENTS FOR THE SUBJECTIVE DEFINING CHARACTERISTICS 113 6 TABLE OF CONTENTS APPENDIX F: 116 INDIVIDUAL CLINICAL DIAGNOSTIC VALIDATION SCORES AND INTERRATER RELIABILITY MEASUREMENTS FOR THE OBJECTIVE DEFINING CHARACTERISTICS 116 REFERENCES 118 LIST OF FIGURES Nursing Diagnosis Model for Alteration in Tissue Perfusion: Cardiac within the Exchanging Pattern of Nursing Diagnosis Taxonomy I 8 LIST OF TABLES 1. Description of Sample by Sex, Medical Diagnosis, Marital Status, and Age 55 2. Content Validity Ratings of Subjective Defining Characteristics of Alteration in Tissue Perfusion: Cardiac 59 3. Content Validity Ratings of Objective Defining Characteristics of Alteration in Tissue Perfusion: Cardiac 62 4. Individual Clinical Diagnostic Validation Scores for the Subjective Defining Characterisitics 65 5. Individual Clinical Diagnostic Validation Scores for the Objective Defining Characteristics 67 G. Ranking of Subjective Defining Characteristics According to Individual CDV Scores 71 7. Ranking of Objective Defining Characteristics According to Individual CDV Scores 73 8. The Cluster of Clinically Validated Defining Characteristics for the Nursing Diagnosis Alteration in Tissue Perfusion: Cardiac 76 9. Defining Characteristics Retained for Further Testing 77 10. Degree of Importance of Subjective Defining Characteristics to the Nursing Diagnosis as Rated by Nurse Rater 1 81 11. Degree of Importance of Objective Defining Characteristics to the Nursing Diagnosis as Rated by Nurse Rater 1 83 9 LIST OF TABLES 12. Degree of Importance of Subj ective Defining Characteristics to the Nursing Daignosis as Rated by Nurse Rater 2 85 13. Degree of Importance of Objective Defining Characteristics to the Nursing Diagnosis as Rated by Nurse Rater 2 87 14. Comparison of Mean CDV Scores and Mean of Means of Degree of Importance of Both Nurse Raters of the Clinically Validated Defining Characteristics 90 15. Summary of Field Note Categories 93 10 ABSTRACT This exploratory study used Diagnostic Content Validity (DCV) and the Clinical Diagnostic Validation (CDV) models proposed by Fehring (1986) to clinically identify and validate the defining characteristics for Alteration in Tissue Perfusion: Cardiac. The literature based Kelly Cardiac Assessment Tool (KCAT) was designed as the data collection tool. The diagnostic content validity of the KCAT was 0.70. Twenty subjects, 18 years old and older were selected from a population who were admitted as inpatients in a southwestern university affiliated hospital. Data were collected through patient interviews, independent nurse assessment, and review of laboratory data. Using the steps described in Fehring*s CDV model (1986) one major defining characteristic and 13 minor defining characteristics were clinically validated. The tool CDV score was 0.62. The nursing diagnosis Alteration in Tissue Perfusion: Cardiac was clinically validated and one major and 13 minor defining characteristics were identified. 11 CHAPTER 1 INTRODUCTION The leading cause of death in the United States is myocardial infarction. This year an estimated 1,500,000 people will have a myocardial infarction and of those about 540,000 persons will die. There are more than 300,000 new cases of angina per year. Approximately 4,870,000 people today have a medical history of myocardial infarction, angina or both (American Heart Association, 1989). Nurses provide care to patients experiencing myocardial infarctions and myocardial ischemia in all stages of their disease. Nurses are involved with activities related to prevention of myocardial infarctions and ischemia, the care of patients during the acute phase,