Development of mid-range nursing theory for impaired health literacy
Health Literacy; Nursing diagnosis; Nursing Theory
This study has as its research object the development of a Mid-Range Theory (AMR) for nursing on Impaired Health Literacy. The research is consistent with the trend of studies worldwide regarding the encouragement of scientific investigations by considering Health Literacy (HL) as an essential element for the care and improvement of the individual's ability to respond to their health status. The recent inclusion of the SL in Nanda Internacional (NANDA-I) reinforces the importance and the need to work on theoretical and practical aspects of the SL, especially from the perspective of Nursing science. In this way, theorizing on the subject in question provides a framework of knowledge to strengthen nursing as a discipline and science, in addition to providing limits for professional performance based on ethical precepts and guidelines for professional practice. TMA studies have been developed in order to support and contribute to the development of NANDA-I in order to clarify concepts or even insert diagnoses not yet covered. This study aims to develop a Middle Range Theory for Impaired Health Literacy. This is a methodological study of a diagnostic proposal for Impaired Health Literacy from the development of a TMA. Thus, the study was carried out in two stages, namely: 1) Theoretical-Causal Validity for the development of the TMA for Impaired Health Literacy and 2) Content analysis by judges of the proposed nursing diagnosis Impaired Health Literacy. The theoretical-causal validity was operationalized from an integrative literature review, developed in five data sources, namely: SCOPUS, WEB OF SCIENCE, LILACS, MEDLINE AND SCIENCE DIRECT. After applying the inclusion and exclusion criteria, 78 studies made up the final sample of the first stage. The content analysis by judges took place through the participation of 44 judges according to previously established criteria, whose diagnostic proposition constructed from the causal theoretical validity was refined according to criteria of relevance, clarity and precision evaluated. For the descriptive analysis of the characterization of the participants, the frequencies, measures of the distribution center and their variability were considered. The Kolmogorov-Smirnov test was applied to verify the normality of the cases. A statistical analysis was performed to calculate the CVI to identify the proportion of judges who consider the instrument with its respective clinical indicators and etiological factors to be adequate. This study obtained a favorable opinion from the Research Ethics Committee (CEP) of the Federal University of Rio Grande do Norte (UFRN) (ANNEX A) with number 4,745,373 and CAAE 46968421.4.0000.5537. In the first stage, 14 etiological factors, eight defining characteristics, two populations at risk and three associated conditions were identified. The TMA made it possible to construct nine propositions and establish causal relationships between the phenomenon and clinical practice, in addition to the construction of the pictogram. In the second stage, the judges considered the diagnostic proposal adequate, considering 15 etiological factors, eight defining characteristics, four associated conditions and five populations at risk. It was concluded that the development of the TMA enabled the construction of a diagnosis focused on the problem until now, non-existent in the NANDA International taxonomy, which was considered valid by the specialists, based on the content analysis.