Introduction: The nursing diagnosis (ND) “Ineffective Self-Management of
Lymphedema” (000278) is defined as unsatisfactory management of symptoms,
treatment regimen, physical, psychosocial and spiritual consequences, and lifestyle
changes inherent to living with edema related to obstruction or dysfunction of lymph
nodes or lymphatic vessels, which may be evidenced in the population of women
who have undergone mastectomy. Validation studies refer to the degree to which
evidence and theories support the interpretation of a diagnosis as well as its defining
characteristics. Thus, studies of this nature are necessary for better utilization of the
nursing diagnosis in nursing practice. Objective: To verify the validity evidence of the
nursing diagnosis “Ineffective Self-Management of Lymphedema” in women who
have undergone mastectomy. Method: This is a methodological study, divided into
two different stages. The first stage refers to concept analysis, according to the
Walker and Avant model (2011), conducted between July and August 2022, with an
update in February 2023. The second stage refers to content validation conducted
from July to October 2023, using a semi-structured questionnaire sent online to 80
judges. Fifty-two specialist judges agreed to participate. The study was approved by
the Research Ethics Committee, CAAE nº 63063922.0.0000.5078. The elements
judged in the content analysis were evaluated for their relevance to the ND
Ineffective Self-Management of Lymphedema. To assess the relevance of the
components of the ND, the Aiken's V coefficient (V ≥ 0.09) was applied for content
validation with a confidence interval (95%) for each item. The Cronbach's alpha index
was 0.96, used to analyze the consistency of the judges' evaluations. Results: In the
first stage of the study, concept analysis, through eight steps, attributes, antecedents,
and consequences were identified from a literature review analyzing 43 articles, and
a model case and a contrary case were constructed. The 51 terms described and
identified as a result of the conceptual analysis were submitted to validation by
specialist judges in the second stage, content analysis. The terms “psychological and
cognitive limitations” for associated conditions and “mastectomized women” as a
population at risk were validated. The specialist judges also suggested the inclusion
of the term “breast cancer survivors” for the at-risk population, “access to healthcare
services,” and “lack of medical information” as elements of related factors. Twenty-
eight terms, among defining characteristics and related factors, were considered valid
for the ND Ineffective Self-Management of Lymphedema: psychological suffering,
interference in work and daily activities, decreased quality of life, concern with
appearance and aesthetics, muscle weakness, progression of swelling, dysfunction
of the affected limb, loss of self-esteem, occupational suffering,
embarrassment/shame, sensation of heaviness, physical discomfort, use of clothing
to conceal swelling, pain, physical limitations, excess weight, psychological suffering,
negative experiences with compression garments, psychological and cognitive
limitations, self-care deficits, treatment costs, lack of resources for self-care, difficulty
integrating physical exercise and drainage into daily routine, lack of knowledge about
self-care, limitations in knowledge about lymphedema, knowledge about
lymphedema management, and absence of training for self-care. Conclusion:
Through concept analysis, it was possible to identify fundamental elements for
understanding the concept of Lymphedema Self-Management, while also identifying
the need for tools that evaluate this nursing diagnosis in women who have undergone
mastectomy, to assist in identifying the elements validated by the judges during
content analysis. A limitation is the lack of similar studies for comparison of results which points to the need for the inclusion of new elements that can contribute both to
increasing the level of evidence of the ND proposed by the NANDA-I taxonomy and
to establishing and developing standardized language for nursing that is useful for
clinical practice. Thus, it is suggested that this study be followed up with clinical
validation, to apply the findings in women who have undergone mastectomy.
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