title: Clinical validation of the nursing diagnosis of dysfunctional family processes related to alcoholism.
abstract: OBJECTIVE
  To evaluate the clinical validity indicators for the nursing diagnosis of dysfunctional family processes related to alcohol abuse.
  
  
  BACKGROUND
  Alcoholism is a chronic disease that negatively affects family relationships. Studies on the nursing diagnosis of dysfunctional family processes are scarce in the literature. This diagnosis is currently composed of 115 defining characteristics, hindering their use in practice and highlighting the need for clinical validation.
  
  
  METHODS
  This was a diagnostic accuracy study.
  
  
  METHODS
  A sample of 110 alcoholics admitted to a reference centre for alcohol treatment was assessed during the second half of 2013 for the presence or absence of the defining characteristics of the diagnosis. Operational definitions were created for each defining characteristic based on concept analysis and experts evaluated the content of these definitions. Diagnostic accuracy measures were calculated from latent class models with random effects.
  
  
  RESULTS
  All 89 clinical indicators were found in the sample and a set of 24 clinical indicators was identified as clinically valid for a diagnostic screening for family dysfunction from the report of alcoholics. Main clinical indicators with high specificity included sexual abuse, disturbance in academic performance in children and manipulation. The main indicators that showed high sensitivity values were distress, loss, anxiety, low self-esteem, confusion, embarrassment, insecurity, anger, loneliness, deterioration in family relationships and disturbance in family dynamics.
  
  
  CONCLUSIONS
  Eighteen clinical indicators showed a high capacity for diagnostic screening for alcoholics (high sensitivity) and six indicators can be used for confirmatory diagnosis (high specificity).
authors.affiliation: Federal University of Pernambuco, Vitória de Santo Antão, Pernambuco, Brazil.
authors.forename: Suzana de Oliveira
authors.initials: Sde O
authors.lastname: Mangueira
authors.affiliation: Nursing Department, Federal University of Ceará, Fortaleza, Brazil.
authors.forename: Marcos Venícios de Oliveira
authors.identifier: http://orcid.org/0000-0001-5867-8023
authors.initials: MV
authors.lastname: Lopes
mesh_terms: D000437:Alcoholism / Q000175:diagnosis*; D002908:Chronic Disease; D005192:Family Health; D006801:Humans; D009733:Nursing Diagnosis
keywords: clinical judgement; diagnostic tests; nursing assessment; nursing diagnosis; psychiatric nursing; substance abuse