A random sample of 600 re@stcred flofessional nurses in Nnu York State were asked to rate the relevance of The North Amcrican Nursing Diagnosis Association's list of &@zing characteristics for the six most jkquently used nursing diagnostic categories on L i h -t y p e scales. The diagnostic categories were Alteration in Comfort: Pain; Anxtity; Impaired Physical Mobility; Impaired Skin Integrity: Actual; Sey-Care Dejcit; and Knowk&e Dejcit. Based on 148 usable responses, the results indicated critical and supporting characteriitics and total contcnt validity scores for each of the six diagnostic categories. Thc only a!ejning characteristic that did not attain at least supporting status was "Regretjiul" for the diagnosis of anxiety. * * * he movement toward identifying, validating and implementing nursing diagnoses, which began in the early seventies, is escalating at a rapid pace.T Nursing diagnoses are being implemented in practice without having established a valid research base. One reason for this appears to be the existence of a widespread misunderstanding about the meaning of "accepted" or "approved" when referring to the list of nursing diagnoses generated by the North American Nursing Diagnosis Association (NANDA) (Kim, McFarland & McLane, 1984). Beginning at the First National Conference on the Classification of Nursing Diagnoses in 1973 and continuing through the fifth national conference in 1982, participants met in small groups to identify, review and revise nursing diagnoses. For the most part, these diagnoses were generated from past experience with clients by a relatively small group of nurses. Those that were considered viable by a general consensus of conference participants constitute "the list," and are approved for clinical testing. With the incorporation of NANDA, a diagnosis review committee reviews submitted additions that are substantiated by "some" clinical testing. Thus the identification of diagnostic labels along with proposed defining characteristics and etiologies can be viewed only as hypotheses that require validation.Building on the work of Gordon and Sweeny (1979), Fehring (1 986) proposed three methodological models for establishing the validity of nursing diagnostic categories. Although he sanctioned the use of relatively small, nonrepresentative samples of nurses for establishing diagnostic validity, such an approach restricts the ability to generalize findings, which is imperative for standardization.Accountability in practice dictates that nursing interventions be based on diagnoses that can be made with a reasonable degree of confidence. To determine confidence levels, a quantitative approach to establishing diagnostic validity for each accepted nursing diagnosis is suggested. The purpose of this study was to determine the diagnostic content validity (DCV) of the six most frequently used nursing diagnoses. Review of the LiteratureA review of the research related to nursing diagnoses (Levin, 1984) revealed approximately 70 studies, 35 of which were concerned with identifying...

Public health nurses (PHNs) at Lincoln-Lancaster County Health Department have used the Care Pathway tool to track client progress. Conceptually similar to critical pathways used in hospital settings, the Care Pathway is used by the PHN to document milestones of progress by trimester of pregnancy. Data for this research was gathered from chart review of 55 prenatal clients. Study results demonstrate that subjects who had from five to nine home visits by a PHN during pregnancy showed a higher average hemoglobin for the mothers and a higher average birthweight for the babies than those visited four or fewer times. None of the low birthweight babies was born to mothers in the "more visits" category. Furthermore, more breastfeeding was recorded for those who had received more PHN visits. This documentation enabled us to describe better the referent population and to begin to estimate the effect of PHN home visitation on the health outcomes of clients. In essence, we addressed the questions: (1) "Does PHN home visitation make a difference in health outcomes of clients and their families?" and (2) "If so, how can effects be measured?"

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