Análisis del significado y validación del diagnóstico enfermero "riesgo de deterioro parental" desde el enfoque de la parentalidad positiva

• Autores: Montserrat García Sastre
• Directores de la Tesis: Juana Cristina Francisco del Rey (dir. tes.), Raquel Gragera Martínez (codir. tes.)
• Lectura: En la Universidad de Alcalá ( España ) en 2021
• Idioma: español
• Tribunal Calificador de la Tesis: Carmelo Andrés García Pérez (presid.), María Teresa Lluch Canut (secret.), Diego José Feria Lorenzo (voc.)
• Programa de doctorado: Programa de Doctorado en Ciencias de la Salud por la Universidad de Alcalá
• Materias:
  • Ciencias médicas
• Enlaces
  • Tesis en acceso abierto en: TESEO
• Resumen
  • español

    Introducción: Promover la salud y el desarrollo en las primeras etapas de la vida se considera una prioridad internacional. La familia y, concretamente el desempeño del rol parental, actúan como determinantes sociales de la salud. Las enfermeras han de fomentar la Parentalidad Positiva y la Salud Familiar. Los modelos de cuidados y los lenguajes enfermeros estandarizados representan herramientas fundamentales para garantizar cuidados de calidad. Incrementar la investigación básica en diagnósticos enfermeros es considerada críticamente necesaria.

    Objetivos: Analizar el significado del diagnóstico "Riesgo de deterioro parental" y realizar su validación en el contexto español.

    Metodología: Investigación básica apoyada en un estudio descriptivo para la identificación de conocimientos, actitudes y grado de utilización del diagnóstico, la validación conceptual y de contenido del diagnóstico siguiendo la metodología aceptada por NANDA-I.

    Resultados: La etiqueta NANDA-I Riesgo de deterioro parental es reconocida pero escasamente aplicada. Según se confirma, las enfermeras han recibido nula o escasa formación previa sobre el diagnóstico. Según los hallazgos obtenidos, el riesgo de infra diagnóstico es elevado. En relación a la validación conceptual del diagnóstico, el estudio aporta suficiente evidencia empírica que permite describir el concepto y el fenómeno a estudio. Respecto a la validación de contenido, el índice de validez de diagnóstico obtenido confirma su validez alcanzando un nivel de evidencia 2.3 según la propuesta de NANDA, aunque con limitaciones susceptibles de análisis e investigación.

    Conclusiones: El estudio demuestra que en el contexto español las enfermeras están motivadas y suficientemente cualificadas para desarrollar la validación de diagnósticos NANDA.

    Se pone de manifiesto la preocupación y el compromiso de las enfermeras por el fenómeno de la Parentalidad y el bienestar infanto-juvenil, identificando escasa formación y aplicabilidad clínica del diagnóstico Riesgo de deterioro parental. Las enfermeras consideran necesario profundizar sobre la Parentalidad Positiva y el diagnóstico, además de sensibilizar sobre su uso en los distintos ámbitos del ejercicio disciplinar dada su repercusión en el desarrollo y bienestar de la infancia y la familia.

  • English

    Introduction: The importance of the well-being of Humanity and Development has always been valued in different civilizations and from different schools of thought. In the current stage, the Sustainable Development Goals have acquired special prominence since they serve to operationalize these purposes. Within this framework, the promotion of health is considered an international priority in order to improve the quality of life of people, sustainability, conservation of the planet and global prosperity. Specifically, the health and development of children and adolescents is even more important for their own well-being and happiness, as well as for their greater vulnerability. Good health, and the opportunities to learn self-care and internalize healthy lifestyles in the early stages of life, represent the foundation on which the health of the future is based and conditioned. Health depends on various conditioning factors, recognized as the Social Determinants of Health, among which is the family due to its special significance. The family, as the first context of reference for individuals, offers an environment in which care is provided and self-care is learned, mutual support ties are established, health is promoted or, on the contrary, risk factors concur which can precipitate the appearance of harmful processes. Among the most important functions of the family is the upbringing and care of children, that is, the exercise of parenthood. Nurses, key agents as health promoters, recognize the importance of promoting Family Health and Positive Parenting. For the practice of the profession, models of care and standardized nursing languages are fundamental tools to ensure quality care. Increasing basic research in nursing diagnostics is considered critically necessary. Specifically, the validation of NANDA-I diagnoses related to parenting represents a niche of nursing research of special relevance due to its impact on child and family development and wellbeing. At present, there are no validation studies of the diagnosis Risk of parental deterioration, which is key for the promotion of parenting, health promotion and prevention of risk situations that condition the health of children and adolescents.

    Objectives of the study: The study analyzes the meaning of the NANDA diagnosis Risk of parental deterioration from the approach of Positive Parenting and Family Health in the Spanish context by determining the level of knowledge, assessment and use of the diagnosis in the professional practice of nurses and by performing the conceptual and content validation of the diagnosis.

    Method: The research was carried out in three phases combining different techniques: a crosssectional descriptive study using a questionnaire for data collection, a conceptual validation study following the Walker and Avant model, and for the content validation study the Ferhing model based on expert consensus using the Delphi technique.

    Results: The NANDA-I Risk of Parental Impairment label is recognized but poorly considered. Nurses are confirmed to have received little or no prior training on the diagnosis. According to the findings obtained, the risk of underdiagnosis is high. Regarding the conceptual validation of the diagnosis, the study provides sufficient empirical evidence to describe the concept and the phenomenon under study. Regarding the content validation, the diagnostic validity index obtained confirms its validity, although with limitations that could be analyzed and investigated. This result could be useful to enable the continuity of the diagnosis within the framework of the NANDA-I taxonomy, since a level of evidence 2.3 has been reached. The results show that the consensus reached is moderate, with a large number of risk factors to be ruled out and purified. It is considered necessary to strengthen research on the diagnosis in order to strengthen the process of validation of the diagnosis content through qualitative techniques and its clinical validation.

    Conclusions: Nurses have at their disposal, within the framework of standardized nursing languages, specific diagnoses related to Family Health and Parenting. The study shows that in the Spanish context nurses are motivated and sufficiently qualified on the basis of the expert criteria suggested by Ferhing to develop the validation of these diagnoses and other labels of the taxonomy. Although the study shows the concern, interest and commitment of nurses to the phenomenon of parenting and child and adolescent well-being, little training and consideration of the diagnosis Risk of parental deterioration is identified, which may imply a lower number of nursing interventions in favor of Positive Parenting, Family Health and the promotion of children's health and development.

    The research highlights that nurses identify the need to implement a strategy that makes visible and improves the knowledge associated with Positive Parenting and diagnosis, in addition to raising awareness about its use in the different areas of disciplinary practice. The need to increase the evidence associated with the diagnosis is recognized. In addition, other lines of research are opened towards other NANDA-I diagnoses related to parenting, the research methodology itself in validation of diagnoses, as well as in relation to the phenomenon of parenting and its impact on health per se from the perspective and contribution of nurses.