title: Clinical usefulness of the definitions for defining characteristics of activity intolerance, excess fluid volume and decreased cardiac output in decompensated heart failure: a descriptive exploratory study.
abstract: OBJECTIVE
  To assess the clinical usefulness of the operational definitions for the defining characteristics of the NANDA International nursing diagnoses, activity intolerance, decreased cardiac output and excess fluid volume, and the concomitant presence of those diagnoses in patients with decompensated heart failure.
  
  
  BACKGROUND
  Content validity of the operational definitions for the defining characteristics of activity intolerance, excess fluid volume and decreased cardiac output have been previously validated by experts. Their clinical usefulness requires clinical validation.
  
  
  METHODS
  This was a descriptive exploratory study.
  
  
  METHODS
  Two expert nurses independently assessed 25 patients with decompensated heart failure for the presence or absence of 29 defining characteristics. Interrater reliability was analysed using the Kappa coefficient as a measure of clinical usefulness. The Fisher's exact test was used to test the association of the defining characteristics of activity intolerance and excess fluid volume in the presence of decreased cardiac output, and the correlation between the three diagnoses.
  
  
  RESULTS
  Assessments regarding the presence of all defining characteristics reached 100% agreement, except with anxiety. Five defining characteristics of excess fluid volume were significantly associated with the presence of decreased cardiac output. Concomitant presence of the three diagnoses occurred in 80% of the patients. However, there was no significant correlation between the three diagnoses.
  
  
  CONCLUSIONS
  The operational definitions for the diagnoses had strong interrater reliability, therefore they were considered clinically useful. Only five defining characteristics were representative of the association between excess fluid volume and decreased cardiac output. Therefore, excess fluid volume is related to decreased cardiac output, although these diagnoses are not necessarily associated with activity intolerance.
  
  
  CONCLUSIONS
  The operational definitions may favour early recognition of the sequence of responses to decompensation, guiding the choice of common interventions to improve or resolve excess fluid volume and decreased cardiac output.
authors.affiliation: Federal University of São Paulo (UNIFESP), São Paulo, SP, Brazil.
authors.forename: Vanessa
authors.initials: V
authors.lastname: de Souza
authors.affiliation: Nursing Department of Paulista University, São Paulo, SP, Brazil.
authors.forename: Sandra Salloum
authors.initials: SS
authors.lastname: Zeitoun
authors.affiliation: School of Nursing, UNIFESP, São Paulo, SP, Brazil.|School Hospital, São Paulo University (USP), São Paulo, SP, Brazil.
authors.forename: Camila Takao
authors.initials: CT
authors.lastname: Lopes
authors.affiliation: Federal University of São Paulo (UNIFESP), São Paulo, SP, Brazil.
authors.forename: Ana Paula Dias
authors.initials: AP
authors.lastname: de Oliveira
authors.affiliation: Federal University of São Paulo (UNIFESP), São Paulo, SP, Brazil.
authors.forename: Juliana de Lima
authors.identifier: http://orcid.org/0000-0001-6915-6781
authors.initials: Jde L
authors.lastname: Lopes
authors.affiliation: School of Nursing, UNIFESP, São Paulo, SP, Brazil.
authors.forename: Alba Lucia Bottura Leite
authors.initials: AL
authors.lastname: de Barros
mesh_terms: D000368:Aged; D001826:Body Fluids; D002302:Cardiac Output; D005260:Female; D006333:Heart Failure / Q000175:diagnosis* / Q000451:nursing / Q000503:physiopathology; D006801:Humans; D008297:Male; D008875:Middle Aged; D009043:Motor Activity; D009733:Nursing Diagnosis; D015588:Observer Variation; D015203:Reproducibility of Results; D012720:Severity of Illness Index
keywords: cardiac output; heart failure; low; nursing diagnosis; validation studies