Diagnósticos de enfermagem “Imagem corporal perturbada” e “Baixa autoestima situacional” em pessoas com cancro de cabeça e pescoço

: validação diferencial com recurso à metodologia Q

Abstract

Introduction: Head and neck cancer patients, when submitted to mutilating surgeries, present profound physical and psychosocial changes, temporary or definitive, with an impact on self and family. Changes in diet, hydration, communication, body image, self esteem, and job are regular. The most frequent human responses to this disease process are subjective in nature, particularly related to body image and self-esteem. The diagnoses of situational low self-esteem and disturbed body image are part of the self-perception domain, in the NANDA-I taxonomy, and research that contributes to the improvement of their levels of evidence is essential. Differential validation emerges with the objective of seeking to provide nurses with clinical indicators for clinical reasoning and planning of effective interventions, considering the specific defining characteristics of each diagnosis. Objective: To conduct a differential clinical validation of the nursing diagnoses of body image disorder and low situational self-esteem in patients with head and neck cancer, using Q methodology. Method: Observational cross-sectional study using Q methodology, based on Richard Fehring's differential diagnostic validation model. Thirty-eight participants were included. The data collection instrument consisted of sociodemographic data and clinical variables, Rosenberg scale, Body Image Scale and filling in the Q sorting. For the analysis of sociodemographic data and the scales, SPSS was used, the statistical treatment of the data resulting from the application of the Q methodology was performed using the PQMethod program. The study was approved by the research and ethics committee of the institution where the study took place. Results: The factor analysis concluded that three factors explained the participants' perspectives and indicate the degree of agreement/disagreement with the defining characteristics of the diagnoses of situational low self-esteem and disturbed body image, according to the specific time after participant’s surgery. The following defining characteristics were identified: avoids looking at one’s body, avoids touching at one’s body, 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, refusal at acknowledge change and helplessness. Conclusions: From the consensus analysis, eight defining characteristics were identified for the diagnosis of disturbed body image and one for the diagnosis of situational low self-esteem. The use of the Q methodology, in this process of differential validation, allowed the study of two diagnoses of a subjective nature in a vulnerable population, contributing to increase the knowledge of their needs. This knowledge has implications for clinical practice and teaching.

Date of Award	4 Apr 2023
Original language	Portuguese
Awarding Institution	Universidade Católica Portuguesa
Supervisor	Sílvia Caldeira (Supervisor)