Diagnóstico de enfermagem risco de choque em pessoas com infarto agudo do miocárdio: Teoria de de Médio Alcance e Validação de Conteúdo

Abstract

Patients with acute myocardial infarction (AMI) are at imminent risk of losing their life or organ/system function, developing shock states and multisystem impairment. Identifying risk factors and conditions associated with the risk of shock allows directing nursing care to patients with AMI at risk of shock. In this sense, the general objective of this study was to validate the content of the nursing diagnosis Risk for shock in people with acute myocardial infarction based on a Middle-Range Theory. This is a methodological study, which was carried out in two stages, which were: theoretical-causal validation and content validation. The research was approved by the Ethics Committee of UFRN, through opinion No. 5,544,882 by CEP/UFRN and registered in the Brazil Platform with the Certificate of Ethical Appreciation (CAAE) No. 58803922.1.0000.5537. Data analysis was performed using descriptive and inferential statistics. The first stage involved constructing a middle-range theory operationalized through an integrative literature review. Data were extracted from the following data sources: Scopus, Web of Science, National Library of Medicine (MEDLINE/PubMed), and Science Direct. The final sample consisted of 25 studies. Four attributes, seven risk factors, and 13 conditions associated with the risk of shock in people with acute myocardial infarction were listed. The Middle-Range Theory constructed used the theoretical framework of Roy's adaptation model. Twenty-three concepts, seven propositions, and 23 causal relationships of the risk of shock in patients with acute myocardial infarction were identified. A graphical representation was constructed to explain the relationships between the concepts. The TMA-RCIAM assessment was performed in two rounds. A total of 57 judges participated in the first round. The TMA-RCIAM was considered adequate in all items related to significance, internal consistency, parsimony, testability, and empirical adequacy and pragmatic adequacy. However, the items were adjusted in order to accept the comments and suggestions, and were reassessed in the second round of evaluation, in which the TMA was evaluated by 51 judges. Finally, all items were approved. The second stage was the content validation by judges regarding the diagnostic components. Sixty-two judges participated in this stage, who validated the definition of the diagnosis and the 23 clinical indicators regarding their relevance. The conceptual and operational definitions of each indicator were evaluated for clarity and precision. All items presented agreement greater than 0.8, but some items reached IRA below 0.8 and adjustments were made based on the comments and suggestions of the evaluators. After the adjustments, a second round of evaluation was carried out with the judges, in which agreement was obtained based on the evaluation of 50 judges. It is concluded that the study contributed to the advancement of knowledge in the discipline of Nursing, since the process of validating a nursing diagnosis present in the Nanda I taxonomy is necessary to maintain the scientific evidence that supports the diagnosis, in addition to facilitating the dissemination of knowledge in this area.