Nursing diagnoses disturbed body image (00118) and situational low self‐esteem (00120) in patients with head and neck cancer: differential clinical validation using Q methodology

Purpose: When submitted to mutilating surgery, patients with head and neck cancer may present profound physical and psychosocial changes, temporary or definitive, with an individual impact and family. The most frequent human responses to this health condition are subjective, particularly concerning body image and self-esteem. Differential validation emerges to provide nurses with clinical indicators for clinical reasoning and planning of effective interventions, considering the specific defining characteristics of each diagnosis. This study aimed at conducting a differential clinical validation of the nursing diagnoses of disturbed body image and low situational self-esteem in patients with head and neck cancer using Q methodology. Method: We performed an observational cross-sectional study using Q methodology. Thirty-eight participants were included. Data were analyzed using Q methodology procedures. The research and ethics committee approved the study. Findings: Factor analysis was performed, and eight defining characteristics were identified for the diagnosis of disturbed body image and one for situational low self-esteem: avoiding looking at one's body, avoiding touching one's body, the behavior of monitoring one's body, depersonalization of body part by use of impersonal pronouns, focus on past appearance, focus on past function, negative feeling about body, and refusal at acknowledging change and helplessness. Conclusions: The use of the Q methodology in this process of differential validation allowed the study of two diagnoses of a subjective nature, disclosing the most specific defining characteristics of each and contributing to increasing the knowledge of these human responses. Implications for nursing practice. This study contributes to a better understanding of the predominant defining characteristics of the diagnoses under study. In terms of the NANDA-I taxonomy, it helps to raise the levels of evidence for diagnoses. Using a qualitative and quantitative methodology allows for maintaining a more holistic research approach and greater rigor and acceptance of the results.