Validação clínica do diagnóstico de enfermagem
: sobrecarga do cuidador (Caregiver Role Strain) em cuidadores familiares de doentes paliativos

Translated title of the thesis: Clinical validation of nursing diagnosis: caregiver burden (Caregiver Role Strain) in family caregivers of palliative patients
  • Tânia Marlene Gonçalves Lourenço

Student thesis: Doctoral Thesis


Introduction: Taking care of a family member or of a significant person at the end of their life can be a burden. Several studies have been carried out on this phenomenon, however, there is few research about that burden as a nursing diagnosis, which is identified in NANDA-International as Caregiver Role Strain (CRS). This nursing diagnosis has never been clinically validated in a population of caregivers of palliative patients. Main objective: To clinically validate nursing diagnosis Caregiver Role Strain in caregivers of palliative patients. Methodology: cross-sectional, quantitative, descriptive and analytical study. It was developed in two parts. Part I - preliminary study – included an integrative review, and a content analysis by 18 experts. Part II – clinical validation - was based in the Fehring’s Clinical Diagnostic Validity Model and diagnostic accuracy measurements (sensitivity, specificity, predictive values and ROC curve) to analyze the defining characteristics. Descriptive and inferential statistics were used to study the related factors. The data collection instrument was a face-to-face questionnaire which was applied to a non-probabilistic sample of 111 caregivers of palliative patients. The identification of the diagnosis was determined by the presence of three criteria: Zarit Burden Interview, agreement between two researchers and the caregiver's perception of the presence of the diagnosis. Results: Seven new defining characteristics and 13 new related factors were identified through integrative review. Were introduced changes at the label and definition of the nursing diagnosis which were approved by the judges. In the clinical validation, a diagnosis prevalence of 42.3% was found. From the 22 defining characteristics validated, nine were considered major and 13 minors, being ineffective coping, depressive mood, and fatigue, those who presented higher values in the area under the curve. The total diagnosis score was 0.68. The caregiver age (p=0,033), degree of kinship (p=0,004), health perception (p≤0.001), psychological problems (p=0,003) or unpredictability in care (p = 0,003) were some of the factors related to diagnosis. The results have led us to a to build of a Caregiver Burden Diagnostic Tool at Palliative Care. Conclusions: the study results contribute to the improvement of the various components of CRS diagnosis, making it more accurate. They enable a better clinical decision in nursing, allowing nurses a diagnostic judgment based on scientific evidence. This support for the diagnostic decision, through the instrument that emerged, will facilitate a more sensitive intervention among caregivers of palliative patients.
Date of Award20 Dec 2019
Original languagePortuguese
Awarding Institution
  • Universidade Católica Portuguesa
SupervisorLuís Sá (Supervisor)


  • Palliative care
  • Burden
  • Nursing diagnosis
  • Validation studies


  • Doutoramento em Enfermagem

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