Validação do diagnóstico de enfermagem risco de glicemia instável em pacientes submetidos à hemodiálise

Abstract

The variation in blood glucose levels is a common complication during hemodialysis and is related to the pathophysiology of kidney disease and the hemodynamic changes resulting from extracorporeal circulation. Thus, the nursing diagnosis of ineffective self-management of blood glucose pattern risk may be inferred in this population; however, the NANDA-I taxonomy does not yet identify hemodialysis as a treatment that makes patients susceptible to this risk. Therefore, the aim of this study is to analyze the validity evidence of the nursing diagnosis of ineffective self-management of blood glucose pattern risk in patients undergoing hemodialysis. This is a methodological study for the validation of the nursing diagnosis, following three stages proposed in the literature, namely: 1) theoretical-causal validity, through the construction of a mid-range theory for the nursing diagnosis; 2) content validity by experts; and 3) clinical validity. The theory construction, in the first stage conducted between May 2023 and February 2024, was operationalized through a Scoping Review, guided by the JBI Reviewer’s Manual and following the recommendations of the Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews: Checklist and Explanation, with a registered research protocol on the Open Science Framework (DOI 10.17605/OSF.IO/EGZFS). In the second stage, in March 2024, content validation was performed by eight experts who assessed the adequacy of the content constructed in the first stage using the nominal group technique. In the third stage, the elements of the nursing diagnosis were clinically validated through a case-control study with 60 patients between May and August 2024. The project was approved by the Research Ethics Committee of the responsible institution (approval number: 5.906.314). The data were analyzed using descriptive statistics and simple statistics, with Fisher and Chi-square tests performed in the third stage. Central tendency and dispersion measures were calculated, and the Shapiro-Wilk and Wilcoxon tests were applied, along with the estimation of the Odds Ratio. In the results of the first stage, 20 studies were identified in the final sample, published between 2006 and 2023, mostly in English and from 11 countries. From the articles selected in the Scoping Review, it was possible to list 18 clinical antecedents, which were subdivided into: seven risk factors, seven associated conditions, and four at-risk populations. A pictogram, six propositions, and 18 causal relationships were also created. In the second stage, the experts evaluated and considered the diagnostic proposal appropriate, with few modifications. However, the risk factor "weight loss" was removed. Thus, the final proposition resulted in six risk factors, seven associated conditions, and four at-risk populations. In the third stage, the associated conditions of Diabetes Mellitus and high-flow dialyzer use, as well as the at-risk population of patients with a longer diagnosis of diabetes mellitus and elderly individuals, were able to increase the chances of developing the risk of ineffective selfmanagement of blood glucose pattern. It is concluded that there is validity evidence for the nursing diagnosis of ineffective self-management of blood glucose pattern risk in patients undergoing hemodialysis.