Validation of Anxiety by Brazilian Nurses

Abstract

PURPOSE To validate the nursing diagnosis of anxiety as applied by expert Brazilian nurses and clinicians using the NANDA defining characteristics translated into Portuguese, and to compare their judgment. METHODS A descriptive, exploratory, and comparative study was conducted using the Diagnostic Content Validation (DCV) model. A convenience sample of 120 nurses familiar with nursing diagnoses answered a semistructured questionnaire that included demographic data, the definition, and a list of defining characteristics of anxiety. Three defining characteristics of the nursing diagnosis fear were added to the list as distractors. Subjects were asked to rate each defining characteristic on a scale from 1 (not at all characteristic) to 5 (very characteristic). Descriptive analysis was used to identify the nurse experts and clinicians. Assigned weights were determined for each characteristic: 1 = 0, 2 = 0.25, 3 = 0.50, 4 = 0.75, and 5 = 1. Variance analysis using F statistics to compare averages and chi-squares for frequency distribution were applied. The defining characteristics with weight ratios >.80 were considered critical, those with weight ratios >.50 and <.80 were noncritical, and those defining characteristics with weight ratios of <.50 were not considered representative. An overall DCV score was obtained by summing individual scores and dividing by the total number of defining characteristics. Comparative analysis was used to verify differences in expert and clinician judgments using significant differences analysis. FINDINGS Among 120 nurses, 51 (44%) were expert nurses and 69 (58%) had expertise by caring for people with anxiety. Three fourths (76%) of the expert nurses and 75% of the clinicians considered the NANDA definition appropriate. Judgment of both groups of nurses was equivanent (p= .93). Experts classified 8 (11%) defining characteristics as critical, but only 2 (3%)—anxious, fidgeting—were judged critical by both expert nurses and clinicians. Two defining characteristics (increased tension, preoccupation) of the 8 had statistically different scores between the two groups. The other defining characteristics were statistically similar. A total DCV score of 0.67 ± 0.10 was obtained from expert nurses and 0.65 ± 0.10 from clinicians (nonsignificant). DISCUSSION Anxiety is a common and frequent manifestation and a nursing concept identified and recognized by Brazilian nurses who considered it clearly defined and established by NANDA. Both groups of Brazilian nurses judged signs and symptoms of anxiety in a very similar way. CONCLUSIONS According to Brazilian nurse experts, anxiety is well understood and in their view there are 8 critical defining characteristics (anxious, fidgeting, jittery, increased tension, insomnia, irritability, preoccupation, sleep disturbance) and 38 noncritical defining characteristics. The other characteristics (24) were not judged to be relevant. Further research is necessary to conduct validation studies of other nursing diagnoses and other components of nursing practice in Brazil. Such initiatives certainly will contribute the efforts of NANDA/NIC/NOC to standardize languages for nursing, decrease cultural differences, and enlarge and enrich nursing knowledge.