Beruflich Dokumente
Kultur Dokumente
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JudyCarlson-Catalano, RN, EdD, CS, FNP, Mu Epsilon & Epsilon Psi, Associate Professor, Radford University, Radford, VA; Margaret Lunney, RN, PhD, CS, Mu
Epsilon, is Professor, College of Staten Island, Staten Island, NY; Catherine Paradiso, RN, MSN, CS, CCRN, Medical Center of Ocean County, Brick Township,
NJ; Joan Bruno, RN, MSN, C, Mu Epsilon, Neonatal Nurse Practitioner, Beth Israel Medical Center, New York, NY; Barbara Kraynyak Luise, RN, EdD, Mu
Epsilon, Assistant Professor, College of Staten Island, Staten Island, NY; Teri Martin, RN, MS, CS, Mu Epsilon, Family Nurse Practitioner, Benedictine Medical
P.C., Hendersonville, NY; Margaret Massoni, RN, MS, Mu Epsilon, Assistant Professor, College of Staten Island, Staten Island, NY; and Susan Pachter, RN, MS,
CCRN, Epsilon Mu, Staff Nurse, Boca Raton Visiting Nurse Association, Boca Raton, FL. This study was conducted by members of the Research Committee of
the Staten Island Nursing Diagnosis Association (SINDA). The authors express deep appreciation to (a) the clinical experts who acted as raters for the study,
Jean Gordon, Faith King, Rita Magnuski, Sarah Newman, Susan Pachter, Catherine Paradiso, Corrine Settlecase, and Marian Smith; (b) the nationally known
experts in respiratory nursing who judged content validity of the instrument and six case studies, Susan Chase, Kaye Greenlee, Janet Larson, and Regina Maibusch;
(c) Arlene Farren for her contributions in the early stages of planning; (d) nurses of the two hospitals for their overall support of the study, especially nurse
executives Margaret Gallagher of St. Vincent’s Medical Center, Nancy Daurio and Josephine Nappi of Maimonides Medical Center; and (e) the College of
Staten Island Department of Nursing for its support of SINDA. Correspondence to Dr. Carlson-Catalano, Radford University, School of Nursing, Box 6964,
Radford, VA 24142. E-mail: jcarlson8runet.edu
Clinical Sidebar: Laurence Parker, PhD, Research Assistant Professor and Director of Health Services and Outcome Research, Thomas JeffersonMedical College,
Department of Radiology, Philadelphia, PA.
Accepted for publication December 3, 1997.
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The purposes of our study were to answer the research questions: 1. McDonald I1 985) 2. York (1985) 3. Capuano, Hitchlngs, &Johnson(1990)
What are the defining characteristics of IBP, IAC, and IGE? What 4. Wake, Fehring. & Fadden (1 991) 5. Clark (1994) 6. Boisvert(1995)
are the etiologies of IBP, IAC, and IGE? What are the most 7. Brukwitzki, Holmgren, & Maibusch (19961 8. Malsuki & Otani (19951
important interventions for IBP, IAC, and IGE?
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Table 2: Defining Characteristics (DCs) of Ineffective Table 4: Etiologies, Frequencies, and Percentages, for Inef-
Breathing Pattern, Ineffective Airway Clearance, and Im- fective Breathing Pattern (IBP), Ineffective Airway Clear-
paired Gas Exchange (n=76) ance (IAC), and Impaired Gas Exchange (ICE)
Etiologies IBP IAC ICE
Ineffective BreathingPattern! Ineffective Airway Clearance Impaired Gas Exchange
I f % f Yo f %
DCs :
wgt. D c s wet. DCS we. Anxiety 8 15 1 2
Means 3 Means Means Arrhythmias 1 2 1 9
Bronchospasm 3 6 2 5
Chest wall compliance, decreased 3 6
Dyspnea .67 Expresses difficulty Abnormal blood gas 36
Cough, weak 1 2 5 12
Expresses fatigue .60 with sputum .71 Expresses fatigue .50 Fatigue 20 38 12 30
Abnormal breath sounds .66 Fear 3 6 1 2 1 9
Expresses chest congestion .59 Fluid accumulation 3 6 1 2
Expresses fatigue .57 Glottis, open 2 5 2 18
Sputum .52 Hyperventilation 4 8 2 5 1 9
Infection/inflamrnation 3 6 4 9 2 18
Cough so lnspiratory muscle strength, decreased 1 2
Expresses anxiety SO Nutrition (obesity) 2 4
Mucociliary transport decreased 4 9 1 9
Note: Weighted (wgt.) means of .50 and above were accepted as DCs. Musculoskeletal impairment 3 6
Obstruction 10 19 4 9 3 27
Pain 9 17 3 7 1 9
Some possible defining characteristics that did not meet the cri- Retained secretions 1 2 4 9 t 9
terion were judged as present in a large percentage of subjects, Sputum, increased volume or viscosity 1 2 13 30
for example, pallor (skin color) was present in 56% of people
in the study. tions for smoking cessation were rated low in importance. This
In the clinical judgment of the expert raters, a majority of the was because raters believed that patients were “too sick” to ad-
patients (55%) experienced either ineffective breathing pattern dress this issue.
or ineffective airway clearance (see Table 3), while the remain-
der were experiencing two or more of the three responses. No Table 5: Degree of Importance of Nursing Interventions
patients were experiencing impaired gas exchange without ei- Determined by Weighted Means, IneffectiveBreathing Pat-
ther IBP or IAC. tern (IBP), Ineffective Airway Clearance (IAC), and Im-
As expected with the variety of medical and surgical prob- paired Gas Exchange (IGE)
lems of subjects, many different etiologies were identified (see
Table 4). Some subjects exhibited more than one etiology. NursingInterventions IBP IAC IGE
The weighted means of a majority of interventions were above Anxiety relief .51 .52 .36
the S O criterion (see Table 5). The raters’ judgments of the im- Breathing techniques .71 .64 .56
portance of interventions to each diagnosis were consistent with Pulmonary hygiene .63 .80 .75
Coughing .49 .75 .67
interventions suggested in literature sources about treatments for
Deep breathing .64 .77 .69
these diagnoses (McCloskey & Bulechek [Iowa Intervention Fluid increase .47 .69 .61
Project], 1996).For example, providing direct care for changes Humidification .38 .54 .39
in breathing techniques was considered more important for Incentive spirometry so .55 .50
people with IBP than those with IAC. Despite the fact that a Inhalation treatment .51 .72 .69
Medication therapy .63 .70 .81
high percentage of the sample consisted of smokers, interven-
Nutrition improvement .53 .54 .69
Pain relief .41 .33 .47
Table 3: Frequenciesof Ineffective Breathing Pattern (IBP), Positioning .63 .61 .75
Smoking cessation .20 .27. .19
Ineffective Airway Clearance (IAC), and Impaired Gas Ex-
Suctioning .08 .19 .11
change (IGE) (n=76) Teaching anxiety relief .56 .56 .53
Teaching breathingtechniques .79 .71 .67
Diagnosis f 70 Cumu- Cumu- Cumu- Cumu- Teaching pulmonary hygiene .67 .80 .69
lative % lative IBP lative IAC lative ICE Teaching coughing .54 .76 .61
Teaching deep breathing .71 .77 .72
I8P only 27 35.5 35.5 27 - - Teaching fluid increase .46 .70 .64
Teaching humidification .36 .50 .42
IAC only 15 19.7 55.2 - 15 - Teaching incentive spirometry .57 .56 .47
49 37 - Teaching inhalation treatment .52 .70 .72
IBP and IAC 22 28.9 84.1
Teaching medication therapy .66 .70 32
IBP and ICE 4 5.3 89.4 53 - 4 Teaching nutrition improvement .55 .57 .75
Teaching pain relief .41 .38 .53
IAC and IGE 4 5.3 94.7 - 41 8 Teaching positioning .72 .64 .72
IBP, IAC, and ICE 4 5.3 100.1 57 45 12 Teaching smoking cessation .22 .32 .19
Teaching suctioning .08 .17 .1 1
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248 Image:Journalof Nursing Scholarship Volume 30, Number 3, Third Quarter 1998