Clinical validation of the nursing diagnosis of ineffective protection in haemodialysis patients

Aims and objectives To evaluate the clinical validity of indicators of the nursing diagnosis of “ineffective protection” in haemodialysis patients. Background Haemodialysis patients have reduced protection. Studies on the nursing diagnosis of “ineffective protection” are scarce in the literature. The use of indicators to diagnose “ineffective protection” could improve the care of haemodialysis patients. The clinical usefulness of the indicators requires clinical validation. Design This was a diagnostic accuracy study. Method This study assessed a sample of 200 patients undergoing haemodialysis in a reference clinic for nephrology during the first half of 2015. Operational definitions were created for each clinical indicator based on concept analysis and content validation by experts for these indicators. Diagnostic accuracy measurement was performed with latent class analysis with randomised effects. Results The clinical indicator of “fatigue” had high sensitivity (p = .999) and specificity (p = 1.000) for the identification of “ineffective protection.” Additionally, “maladaptive response to stress” (p = .711) and “coagulation change” (p = .653) were sensitive indicators. The main indicators that showed high specificity were “fever” (p = .987), “increased number of hospitalisations” (p = .911), “weakness” (p = .937), “infected vascular access” (p = .962) and “vascular access dysfunction” (p = .722). Conclusion A set of nine clinical indicators of “ineffective protection” were accurate and statistically significant for haemodialysis patients. Three clinical indicators showed sensitivity, and six indicators showed specificity. Relevance to clinical practice Accurate measures for nursing diagnoses can help nurses confirm or rule out the probability of the occurrence of “ineffective protection” in patients undergoing haemodialysis.