Cardiovascular diseases (CVD) and diabetes are the most significant chronic diseases globally due to their high prevalence and mortality. People with CVD or diabetes need to know how to self-manage their health conditions to promote, maintain, and restore their health status. The Nursing Outcomes Classification (NOC) has assisted nurses and other health care providers to evaluate and quantify the status of the patient and has reflected the current health care issues that are to prevent progression of chronic diseases. Based on the current health focus, additional knowledge and self-management NOC outcomes were developed and added to the latest edition of NOC published in 2013. Generally, validation of measurement tools is required to provide trustworthy evidence for use in practice. As measurement tools, NOC outcomes with their definitions, indicators, and measurement scales need to be validated for accuracy, meaningfulness, and usefulness before they are widely used in various health settings. To provide clinical evidence for effective nursing practice such as accurate assessments and evaluations, validation of NOC outcomes is required. The purpose of this study was to validate 12 NOC outcomes focused on knowledge and self-management for people with CVD and diabetes.
A descriptive exploratory design was used to validate the selected NOC outcomes, and a two round survey using the Delphi technique was used to collect data from the invited experts via email. Two subject populations were invited. The first expert group was related to standardized nursing languages (SNL) and invited experts were members of NANDA International or a fellow of the Center for Nursing Classification and Clinical Effectiveness (CNC). The second expert group was related to self-management and invited experts were members of two research interest groups which are Health Promoting Behaviors Across the Lifespan and Self Care in the Midwest Nursing Research Society (MNRS). Descriptive statistics were used to determine the definition adequacy, clinical usefulness of measurement scales, and similarity between content of knowledge and self-management outcomes. The Outcome Content Validity (OCV) method was used for the content validity of outcomes and their indicators.
A total of 46 and 27 nurse experts participated in the first and second round surveys, respectively. The mean age of participants was 51.87 years (SD=13.03) and the mean of experience in nursing was 27.67 (SD=14.75) years. Most participants had experience using SNL (82.6%). Each outcome reported acceptable psychometric properties. The range of definition adequacy of the 12 NOC outcomes was from 3.71 to 4.29 (perfect score is 5.0). The range of clinical usefulness for using measurement scales was from 3.77 to 4.29. The range of content similarity of the six pairs was from 3.88 to 4.35. Every evaluated NOC outcome identified as critical with over .80 OCV scores (perfect score 1.0). More than 80% of indicators were categorized in the critical level in the first round. Thus, psychometric properties of the 12 NOC outcomes were acceptable to use in the clinical settings.
By using validated NOC outcomes, nurses caring of patients with CVD or diabetes can evaluate patient outcomes effectively, and determine the effect of nursing interventions accurately. Development of new NOC outcomes and validation of them will provide nurses with measurement tools to use with patients, clinical evidence for quality improvement and knowledge development in nursing.