Evidence of internal structure validity of the nursing outcome "Mechanical Ventilation Weaning Response: Adult (0412)" for critically ill COVID-19 patients.

Abstract

Purpose: To evaluate the evidence of internal structure validity of the nursing outcome (NO) "Mechanical Ventilation Weaning Response: Adult (0412)" of the NOs classification for critically ill COVID-19 patients.

Methods: A methodological study focused on internal structural validation, part of a multicenter study, was carried out in the intensive care units of two hospitals in Brazil, from 2020 to 2021. Patients in critical condition due to COVID-19 subjected to mechanical ventilation for more than 24 h and with an invasive device attached to the ventilator in the final phase of the weaning process were evaluated. The researchers used an instrument containing sociodemographic and clinical data and a physical examination of the clinical conditions based on the indicators of the NO. An exploratory factor analysis was performed, using the Kaiser-Meyer-Olkin method, in addition to other additional adjustment indexes. Reliability was assessed using McDonald's omega, Cronbach's alpha, and Gutmann's lambda 6 coefficients.

Findings: Among the 20 indicators evaluated, 6 were included in the final structure organized into two factors, the first being composed of spontaneous respiratory rhythm, spontaneous respiratory depth, discomfort, and difficulty breathing on own, and the second of anxiety and fear. This two-dimensional structure explains about 62.9% of the total variance. The final structure showed good internal consistency, suggesting that the indicators were measuring the same construct.

Conclusions: The structure proposed for the NO was shown to be reliable and valid for practice and research to evaluate patients with COVID-19 in the final phase of ventilatory weaning.

Implications for nursing practice: The findings are expected to provide robust evidence for clinical nursing practice. The proposal to organize this NO into dimensions could facilitate the nurse's clinical reasoning and make the monitoring of indicators more organized and faster for the evaluation of patients in ventilatory weaning.