Original ArticleClinical validation of the nursing outcome falls prevention behavior in people with stroke
Introduction
People with stroke commonly have physical alterations that compromise balance and gait, and increase the risk for falls. Regarding risk, which is a potential problem, stimulating adherence to preventive behaviors that focus on the risks presented by each patient is essential, with the development of safety measures that can prevent the occurrence or recurrence of falls (Baixinho & Dixe, 2014).
The occurrence of falls in this population is greater in the home environment. Falls from a standing height represent important clinical situations that may lead to injury, need for hospitalization, and a major financial burden. Nurses are essential professionals in this context because they can minimize complications arising from falls by identifying risks early, planning and implementing preventive strategies (Costa, Oliveira, Moreira, Cavalcante, & Araujo, 2010). In this context, the nursing outcomes enable the professionals to quantify the changes in the patient's health status uniformly before and after interventions, therefore following his/her progress. It is possible to measure specific states from the use of indicators, defined as measures to evaluate the outcomes of interventions. Thereby, the evaluation of nursing outcomes involves deciding the best outcome indicator to be used, the manner and the time after which it will be measured (Moorhead, Johnson, Mass, & Swanson, 2013).
Of the nursing classifications most widely used and studied, the Nursing Outcomes Classification (NOC) presents outcomes to be evaluated by nurses, including Fall Prevention Behavior, which compiles indicators that focus on fall prevention and can be evaluated from the dimensions of the patient and the caregiver. This outcome is defined as personal or family caregiver actions to minimize risk factors that might precipitate falls in the personal environment (Moorhead et al., 2013).
The continuous assessment of personal behaviors towards prevention of falls leads to the possibility of early nursing intervention in order to avoid the event and its complications (Costa, 2014).
Furthermore, NOC outcomes require continuous validations in specific social, population and regional contexts. As the outcomes and their indicators are identified and refined, we intend to expand the understanding and applicability of the classification (Moorhead et al., 2013).
Validation studies can group different steps, among which the content validation and clinical validation stages are emphasized. The first stage aims to establish the suitability of the indicators for the concept of the phenomenon, through expert review on the issue, indicating its relevance to the outcome. Clinical validation aims to confirm whether the components of outcomes, such as titles, definitions and magnitudes, developed and validated by experts, are supported by actual clinical data from a specific population, and to apply tests that demonstrate statistical associations and configure the level of empirical validity of the instrument (Oliveira, Costa, Lima, Damasceno, & Araujo, 2013).
Thus, the aim of the study was to review and clinically validate the nursing outcome, Fall Prevention Behavior, and its indicators, in people with stroke in the home context.
Section snippets
Materials and methods
This is a Methodological study, performed in the outpatient clinic of two referral hospitals that offer multidisciplinary care aimed at patients with previous hospital admissions in those hospitals due to stroke. The study was approved by the Ethics Committee on Institutional Research under protocol numbers 49.912 and 392.531. Patients and caregivers were informed about the research objectives and provided authorization for participation by signing the consent form.
The population was composed
Results
The information was provided by the primary source (patient) (43.4%), by patients and caregivers (32.1%), or only by caregivers (24.5%). The patients were mostly male (51.9%), married (50.9%), widowed (23.6%) or divorced (12.3%). Only four participants had some sort of paid work, the other received around a minimum wage and had low per capita income, which suggests that financial resources were shared with other family members who lived with them. Other variables characterizing the sample are
Discussion
In the choice of clients for this clinical validation, the assumption that the choice of large samples is beneficial for this step was addressed, and the study included individuals of different ages, making it possible to increase the power of generalization of findings (Silva et al., 2011). Conducting a pre-test to evaluate the feasibility, efficiency and cost of survey methodologies, reproducibility and accuracy of measurements was also an alternative used by other authors to improve
Limitations
The choice of a specific population may have limited the findings and hinders the generalizability. Moreover, the restriction of the study to a single region brings a unique cultural context. Culture, in turn, directly influences the adherence to a behavior, and this may have contributed to the impossibility of validating some indicators and also prevented the exclusion of indicators, as these may not suit the population studied, but may be ideal to measure the actions proposed in another group
Conclusions
The results confirmed the efficiency of the construction process of empirical referents and adequacy for a specific population, in order to guide the actions of the nurse and standardize the concepts and terms used. Also, the use of definitions makes the measure of a nursing outcome more clear and uniform by the nurses.
Also, it should be noted that many indicators imply not only changing habits but also the acquisition of equipment and implementation of environmental adaptations that represent
Acknowledgements
The National Council for Scientific and Technological Development (CNPq).
This work was supported by the National Council for Scientific and Technological Development (CNPq), Brazil, granting process number 475490/2012-6.
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This research is part of the PhD dissertation entitled Nursing Outcome Fall Prevention Behavior — validation of indicators. There is no conflict of interest involved.