The construction of instrument to evaluate the accuracy of diagnosis / Construção de instrumento para a avaliação da acurácia diagnóstica

AUTOR(ES)
DATA DE PUBLICAÇÃO

2006

RESUMO

The accuracy of a variable consists of its capacity to actually represent what it was meant to represent. The conceptual definition of diagnosis accuracy is based on the presupposition that there is a wide variety of possible diagnosis in clinical situations, besides those diagnoses that are highly accurate. This research has set out to develop an instrument to estimate the accuracy of nursing diagnoses from the written data of patient evaluation. A quantitative study of methodological development was carried out, in 3 phases: a theoretical, an empirical and an analytical one. In the theoretical phase, the definition of accuracy of nursing diagnosis and the items of the instrument were shaped and subjected to content validation and pilot testing; in the empirical phase, the instrument defined previously was applied by nurses who are specialists in nursing diagnosis, aiming at estimating the validity and reliability of the instrument in the analytical phase. The instrument was named Escala de Acurácia de Diagnóstico de Enfermagem - EADE, and was structured according to the concept that the accuracy of a nursing diagnosis is the judgment of a rater in relation to the degree of relevance, specificity and coherence of the existing cues for the diagnosis. The instrument was made of 4 items: Presence of cues (manifestations of those patients who represent evidences, vestiges, signals, indications or characteristics of a nursing diagnosis - item graded as “yes” or “no”); Relevance of the cue (the property of a cue being important as an indicator of a nursing diagnosis - item graded as “high/moderate” or “low”); Specificity of the cue (the property of a cue being proper and distinctive of a nursing diagnosis - item graded as “high/moderate” or “low/nil”); Coherence of the cue (the property of a clue being consistent with the amount of information available - item graded as “high/moderate” or “low/nil”). As an indicator of the validity of the EADE, the statistic data showed that the 4 items of the instrument were important to predict accurate nursing diagnoses: Cue (OR 1,95 /IC 95% [1,78 ? 2,14], p = 0,000) Relevance (OR 1,73 /IC 95% [1,52 ? 1,98], p = 0,000); Specificity (OR 2,41 IC 95% [2,11 ? 2,76], p = 0,000); Coherence (OR 3,92 /IC 95% [3,40 ? 4,53], p = 0,000). The EADE had the Kuder-Richardson coefficient of reliability of 0.92 and the Hoyt coefficient of 0,92, which indicates high reliability. The EADE showed good sensitivity and specificity: area under curve ROC = 0,79, p = 0.000 and IC 95% [0,78 ? 0,79]. This study has led to the development of an instrument to assess the accuracy of nursing diagnoses from written data. The EADE shall be refined in future studies

ASSUNTO(S)

nursing diagnoses results reproducibility reprodutibilidade de resultados construção do teste diagnóstico de enfermagem test construction

ACESSO AO ARTIGO

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