The aim of this study is to evaluate the psychometric properties of INTEGRARE, an instrument based on Nursing Outcome Classification.
METHOD
A multicenter, cross-sectional, methodological design was used.
FINDINGS
The study included 3,835 patients. Internal consistency α = 0.86. Confirmatory factor analysis demonstrated the unidimensionality of the scale, indicating a good model fit (CMIN/DF = 4; GFI, CFI, NFI, IFI = 0.999; RMSEA = 0.028).
CONCLUSIONS
INTEGRARE is a valid and reliable instrument with high sensitivity, specificity, and diagnostic accuracy in measuring pressure ulcer (PU) risk in inpatients.
IMPLICATIONS FOR NURSING PRACTICE
This instrument allows us to know the effectiveness of nursing interventions, providing evidence for the validation of the diagnosis Risk for pressure ulcer (00249) as well as on health outcomes, due to the fact that PUs are nursing-sensitive outcomes.
OBJETIVO
Evaluar las propiedades psicométricas de INTEGRARE, un instrumento basado en la Clasificación de Resultados de Enfermería.
MÉTODO
Se optó por un diseño transversal multicéntrico.
RESULTADOS
El estudio incluyó a 3,835 pacientes. Consistencia interna α = 0.86. El análisis factorial confirmatorio demostró la unidimensionalidad de la escala, indicando un buen ajuste del modelo (CMIN/DF = 4; GFI, CFI, NFI, IFI = 0.999; RMSEA = 0.028).
CONCLUSIONES
INTEGRARE es un instrumento válido y fiable con alta sensibilidad, especificidad y precisión diagnóstica en la medición de riesgo de úlcera por presión (UPP) en pacientes hospitalizados. IMPLICACIONES PARA LA PRÁCTICA ENFERMERA: Este instrumento nos permite conocer la efectividad de las intervenciones enfermeras, aportando evidencia para la validación del diagnóstico Riesgo de úlcera por presión (00249), así como sobre los resultados de salud, debido a que las UPP son resultados sensibles a la práctica enfermera.
Alja'afrehM.MoslehS. M. (2013). Pressure ulcers in Jordan: A snapshot survey of a tertiary public hospital. British Journal of Nursing, 22(20), 20–25.
2.
Barrientos-TrigoS. (2015). Validez externa y convergencia de la escala INICIARE 2.0 y Care Dependency Scale: Estudio multicéntrico, Unpublished thesis, University of Seville, Seville, Spain.
3.
Bellido-VallejoJ. C.Rodríguez-TorresM. C.López-MedinaI. M.Pancorbo-HidalgoP. L. (2016). Psychometric testing of the Spanish version of the pain level outcome scale in hospitalized patients with acute pain. International Journal of Nursing Knowledge, 27(1), 10–16.
4.
ColemanS.GoreckiC.NelsonE. A.ClossS. J.DefloorT.HalfensR., … NixonJ. (2013). Patient risk factors for pressure ulcer development: Systematic review. International Journal of Nursing Studies, 50(7), 974–1003. doi.org/10.1016/j.ijnurstu.2012.11.019
5.
ConradD.HansonP.HasenauS. M.Stocker-SchneiderJ. (2012). Identifying the barriers to use of standardized nursing language in the electronic health record by the ambulatory care nurse practitioner. Journal of the American Academy of Nurse Practitioners, 24(7), 443–451. doi: 10.1111/j.1745-7599.2012.00705.x
6.
CoyerF.GardnerA.DoubrovskyA.ColeR.RyanF. M.AllenC.McNamaraG. (2015). Reducing pressure injuries in critically ill patients by using a Patient Skin Integrity Care Bundle (INSPIRE). American Journal of Critical Care, 24(3), 199–210.
7.
CronbachL. J. (1951). Coefficient alpha and the internal structure of tests. Psychometrika, 16(3), 297–334.
8.
DelmoreB.LebovitsS.SuggsB.RolnitzkyL.AyelloE. A. (2015). Risk factors associated with heel pressure ulcers in hospitalized patients. Journal of Wound, Ostomy & Continence Nursing, 42(3), 242–248.
9.
DemarréL.VanLanckerA.VanHeckeA.VerhaegheS.GrypdonckM.LemeyJ.BeeckmanD. (2015). The cost of prevention and treatment of pressure ulcers: A systematic review. International Journal of Nursing Studies, 52(11), 1754–74. doi.org/10.1016/j.ijnurstu.2015.06.006
10.
FulbrookP.AndersonA. (2016). Pressure injury risk assessment in intensive care: Comparison of inter-rater reliability of the COMHON (Conscious level, Mobility, Haemodynamics, Oxygenation, Nutrition) Index with three scales. Journal of Advanced Nursing, 72(3), 680–692.
11.
García-DíazF. J.Cabello-JaimeR.Muñoz-CondeM.Bergera-LezaunI.Blanca-BarbaF.Carrasco-HerreroJ. M. (2014). Reliability in Braden and EMINA's scales for patients in domiciliary, included in the immobilized patient's programme. Gerokomos, 25, 124–130.
12.
García-FernándezF. P.Pancorbo-HidalgoP. L.Soldevilla-AgredaJ. J. (2014). Predictive capacity of risk assessment scales and clinical judgment for pressure ulcers. Journal of Wound, Ostomy and Continence Nursing, 41(1), 24–34. doi.org/10.1097/01.WON.0000438014.90734.a2
13.
García-FernándezF. P.Pancorbo-HidalgoP. L.Soldevilla-AgredaJ. J.Rodríguez-TorresM. C. (2013). Risk assessment scales for pressure ulcers in intensive care units: A systematic review with meta-analysis. European Wound Management Association, 13(2), 7–13.
14.
GardnerL. A.PaganoM. (2013). Skin integrity, immobility, and pressure ulcers in class III obese patients. Pennsylvania Patient Safety Advisory, 10(2), 50–54.
15.
European Pressure Ulcer Advisory Panel, American National Pressure Ulcer Advisory Panel (EPUAP/NPUAP). (2014). In HaeslerE. (Ed.), Prevention and treatment of pressure ulcers: Quick reference guide. Cambridge Media: Osborne Park, Western Australia.
16.
HyunS.VermillionB.NewtonC.FallM.LiX.KaewpragP.,… LenzE. R. (2013). Predictive validity of the Braden Scale for patients in intensive care units. American Journal of Critical Care, 22(6), 514–520.
17.
JaulE.Calderon-MargalitR. (2015). Systemic factors and mortality in elderly patients with pressure ulcers. International Wound Journal, 12(3), 254–259. doi.org/10.1111/iwj.12086
18.
JiangQ.LiX.QuX.LiuY.ZhangL.SuC.,… WangJ. (2014). The incidence, risk factors and characteristics of pressure ulcers in hospitalized patients in China. International Journal of Clinical and Experimental Pathology, 7(5), 2587–3594.
19.
KeenanG.BarkauskasV.StockerJ.JohnsonM.MaasM.MoorheadS.ReedD. (2003). Establishing the validity, reliability, and sensitivity of NOC in an adult care nurse practitioner setting. Outcomes Management, 7(2), 74–83.
20.
LahmannN. A.HalfensR. J. G.DassenT. (2010). Impact of prevention structures and processes on pressure ulcer prevalence in nursing homes and acute-care hospitals. Journal of Evaluation in Clinical Practice, 16(1), 50–56. doi.org/10.1111/j.1365-2753.2008.01113.x
21.
LucenaA. F.Teixeira dos SantosC.Da Silva PereiraA. G.Abreu AlmeidaM.MendesV. L.FriedrichM. A. (2011). Clinical profile and nursing diagnosis of patients at risk of pressure ulcers. Revista Latino-Americana de Enfermagem, 19(3), 523–530.
22.
MallahZ.NassarN.KurdahiL. (2015). The effectiveness of a pressure ulcer intervention program on the prevalence of hospital acquired pressure ulcers: Controlled before and after study. Applied Nursing Research, 28(2), 106–113.
23.
Martín-GarcíaA.Brito-BritoP. R.Romero-SánchezJ. M.Paloma-CastroO.Paramio-CuevasJ. C.Oter-QuintanaC. (2014). Validez de contenido y representatividad de una herramienta basada en la NOC: CoNOCidiet-Diabetes. Libro de Ponencias: X Simposium Internacional de la Asociación Española de Nomenclatura, Taxonomía y Diagnósticos de Enfermería, 369–377.
24.
MeyersL. S.GamstG.GuarinoA. J. (2006). Applied multivariate research: Design and interpretation. Thousand Oaks, CA:Sage.
Morales-AsencioJ. M.Porcel-GálvezA. M.Oliveros-ValenzuelaR.Rodríguez-GómezS.Sánchez-ExtremeraL.Serrano-LópezF. A.,… Barrientos-TrigoS. (2015). Design and validation of the INICIARE instrument, for the assessment of dependency level in acutely ill hospitalized patients. Journal of Clinical Nursing, 24(5–6), 761–777.
27.
Morilla-HerreraJ. C.Morales-AsencioJ. M.Fernández-GallegoM. C.Berrobianco CobosE.Delgado RomeroA. (2011). Utilidad y validez de un instrumento basado en indicadores de la Nursing Outcomes Classification como ayuda al diagnóstico de pacientes crónicos de Atención Primaria con gestión ineficiente de la salud propia. Anales Del Sistema Sanitario de Navarra, 34(1), 51–61. doi.org/10.4321/S1137-66272011000100006
28.
NoonanC.QuigleyS.CurleyM. A. (2011). Using the Braden Q Scale to predict pressure ulcer risk in pediatric patients. Journal of Pediatric Nursing, 26(6), 566–575.
29.
Paloma-CastroO.Romero-SánchezJ. M.Paramio-CuevasJ. C.Pastor-MonteroS. M.Sánchez-DaldaM. C.Rozadillas-SanmiquelE.Moreno-CorralL. J. (2015). Development and psychometric evaluation of questionnaire based on the Nursing Outcomes Classification to determine the knowledge of parents on breast-feeding: Research Protocol. International Journal of Nursing Knowledge. doi: 10.1111/2047-3095.12101
30.
Pancorbo-HidalgoP. L. (2014). Epidemiología de las úlceras por presión en España en 2013: 4o Estudio Nacional de Prevalencia. Gerokomos, 25(4), 162–170. doi.org/10.4321/S1134-928X2014000400006
31.
Pancorbo-HidalgoP. L.Garcia-FernandezF. P.Lopez-MedinaI. M.Alvarez-NietoC. (2006). Risk assessment scales for pressure ulcer prevention: A systematic review. Journal of Advanced Nursing, 54(1), 94–110. doi.org/10.1111/j.1365-2648.2006.03794.x
32.
Planas-CampmanyC.Icart-IsernM. T. (2014). Indicadores sensibles a la práctica enfermera: Una oportunidad para medir la contribución de las enfermeras. Enfermería Clínica, 24(2), 142–147. doi.org/10.1016/j.enfcli.2013.07.003
33.
Porcel-GálvezA. M. (2011). Construcción y validación de un sistema de evaluación del nivel de dependencia para el cuidado de pacientes hospitalizados, Unpublished Thesis, University of Granada, Granada, Spain.
34.
SardoP.SimõesC.AvarelhaoJ.CostaC.FigueiraJ.AmadoF. (2015). Pressure ulcer risk assessment: Retrospective analysis of Braden Scale scores in Portuguese hospitalised adult patients. Journal of Clinical Nursing, 24(21-22), 3165–3176. doi:10.1111/jocn.12927
35.
ScherbC. A.HeadB. J.HertzogM.SwansonE.ReedD.MaasM. L.,… WeinbergB. (2013). Evaluation of outcome change scores for patients with pneumonia or heart failure. Western Journal of Nursing Research, 35(1), 117–140.
36.
ShahinE. S. M.DassenT.HalfenxR. J. G. (2009). Incidence, prevention and treatment of pressure ulcers in intensive care patients: A longitudinal study. International Journal of Nursing Studies, 46 (4), 413–421.
37.
Spanish National Group for the Study and Advise on Pressure Ulcers and chronic wounds & Ibero-Latin-American Society on Wounds. (2011). Declaration of Rio de Janeiro on Pressure Ulcers Prevention as a Universal Human Right. Retrieved fromhttp://www.epuap.org/wp-content/uploads/2012/02/Declaracion-de-Rio_Ingles.pdf
38.
SwansonE. (2016). La utilización de la investigación para la evaluación de los cuidados enfermeros: la Clasificación de Resultados de Enfermería (NOC) en la medición de la eficacia enfermera. In EchevarríaP., (Ed.), Investigación en Metodología y Lenguajes Enfermeros, 1st ed. Barcelona: Elservier, pp.217–230.
39.
SwetsJ. A. (1988). Measuring the accuracy of diagnostic systems. Science, 240(4857), 1285–1293.
40.
TescherA. N.BrandaM. E.O ByrneT. J.NaessensJ. M. (2012). All at-risk patients are not created equal. Analysis of Braden pressure ulcer risk scores to identify specific risks. Journal of Wound Ostomy & Continence Nursing, 39(3), 282–291.
41.
TschannenD.BatesO.TalsmaA.GuoY. (2012). Patient-specific and surgical characteristics in the development of pressure ulcers. American Journal of Critical Care, 21(2), 116–125.
42.
VanderweeK.ClarkM.DealeyC.GunningbergL.DefloorT. (2007). Pressure ulcer prevalence in Europe: a pilot study.Journal of Evaluation in Clinical Practice, 13(2), 227–235. Doi.org/10.1111/j.1365-2753.2006.00684.x.
