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

Abstract

The validation of indicator definitions of the Nursing Outcomes Classification is still incipiently being performed in order to strengthen its reliability and minimize situations of uncertainty in choosing the most appropriate indicator for patients' health situations. Objectives: To construct and validate the semantics and content of constitutive and operational definitions for the most prevalent indicators in an Adult Intensive Care Unit, related to the Nursing Outcomes Infection Severity and Risk Control: Infectious Process. Method: methodological research developed between March 2019 and November 2021, composed of three stages. In the first stage, the prevalence in an Adult Intensive Care Unit, of nursing outcomes and their respective indicators, selected from the Nursing Diagnosis Risk of Infection, was identified. In the second step, the constitutive and operational definitions of the indicators, selected in the previous step, were built from integrative literature review and database searches, and semantically validated. The third stage comprised the content validation, by consensus of expert judges. For the analysis we used frequency distribution and analysis by tabulation of variables, besides the Item-level content validity index (I-CVI), Scale-level content validity index based on the average method (S-CVI/Ave) and Inter-Rater Agreement (InC). Results: 91.1% of the charts analyzed had the nursing diagnosis Risk of Infection. The most prevalent were the Nursing Outcomes Severity of Infection, 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". The constitutive and operational definitions of the indicators mentioned above were constructed and semantically validated, showing that only the constitutive definitions of the indicators "Uses universal precautions" and "Identifies signs and symptoms of infection" had InC values lower than 100%, but with a maximum I-CVI of 1.00 for both definitions. As for the operational definitions, three definitions, also from the result indicators Risk Control: Infectious Process, presented InC values lower than 100%, especially for the indicator "Identifies signs and symptoms of infection", whose I-CVI was 0.94. For the operational definitions of the result indicators Risk Control: Infectious Process there was an agreement considered almost perfect. The content validation of the definitions of the Infection Severity outcome indicators showed a S-CVI/Ave of 1.00, indicating perfect agreement. For the definitions of the outcome indicators Risk Control: Infectious Process, a S-CVI/Ave of 0.96 was obtained, representing almost perfect agreement between the judges. As for the operational definitions, only the indicators "Identifies risk factors for infection" and "Uses universal precautions" presented InC values lower than 100%. After making the necessary adjustments, we proceeded to validation by consensus of judges. Conclusion: The study showed that the constitutive and operational definitions constructed, related to the outcomes Risk Control: Infectious Process and Severity of Infection are valid as to semantics and content.