10/26/2017

Validation of the Knowledge

and Self-Management NOC
Outcomes for Adults with
Diabetes
Hyunkyoung Oh, PhD, MSN, RN1, Sue Moorhead, PhD, RN, FAAN2
1University of Wisconsin-Milwaukee, Milwaukee, WI;
2University of Iowa, Iowa City, IA

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INTRODUCTION
 Diabetes is one of the most significant chronic disease. An estimated 1.6
million deaths were directly cased by diabetes in 2015.1
 People with diabetes need to know how to self-manage their health
conditions to promote, maintain, and restore their health.
 One of standardized nursing terminologies (SNT), Nursing Outcomes
Classification (NOC) has been developed for measurement of patient
outcomes.
 Knowledge and Self-management outcomes for diabetic patients were
developed based on preventive care which is the current health focus.2
 As a measurement tool, validation of the knowledge and self-management
outcomes for diabetes is required to provide clinical evidence.3
Purpose
To validate Knowledge and Self-management NOC outcomes for adults
with diabetes published in the fifth edition of NOC.2

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METHOD
Design
 A descriptive exploratory design
 The Delphi technique with online survey

Sample
 Expert Group 1: members of NANDA International or
Fellows of the Center for Nursing Classification &
Clinical Effectiveness
 Expert Group 2: members of Midwest Nursing
Research Society in two research interest groups
related to self-management
 Have at least a master’s degree in Nursing

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METHOD
Measurement and Variables
 Adequacy of outcome definitions using a 5-point scale (1 to 5)
 Content validity (importance of outcomes and indicators) using
the Outcome Content Validity (OCV) method
 Clinical usefulness of measurement scales using a 5-point scale
(1 to 5)
Validated NOC outcomes
 Knowledge: Diabetes Management
 Definition: Extent of understanding conveyed about diabetes, its treatment,
and the prevention of complications
 Self-Management: Diabetes
 Definition: Personal actions to manage diabetes, its treatment, and to prevent
complications

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METHOD
Data Analysis
 Descriptive statistics: demographic data, adequacy of definitions, and
clinical usefulness of measurement scales
 The OCV method4 for the content validity
 Indicator ratio (importance of indicator)
 Experts’ ratings of 1 to 5 were weighted as 5=1.0, 4=.75, 3=.50, 2=.25,
1=.00
 Weighted ratios were summed and divided by the total numbers of
responses
 OCV score (importance of outcome)
 Indicator ratios were summed and divided by the total numbers of
indicators
 Interpretation of the OCV method (criteria)
 Perfect score: 1.00
 Critical level ≥ .80
 Supplemental level .60 − .79

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RESULTS

Demographics
 A total of 16 surveys were returned
 More than half were from Expert Group 2
(56.3%)
 Around 6% of respondents did not use
SNTs
 The average experience in nursing was
28.44 years
 The average experience in specialty was
20.16 years

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RESULTS

 Definition Adequacy (DA) and Clinical

Usefulness (CU) of measurement scales

Outcome Mean
DA CU
Knowledge: Diabetes management 4.00 4.25
Self-Management: Diabetes 4.19 4.25

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RESULTS
Knowledge: Diabetes management
R R
Indicators Criteria IR Indicators Criteria IR
O O

1 Correct use of insulin Critical 1.00 11 Hyperglycemia prevention Critical .953

Actions to take in response to blood glucose Importance of maintaining blood glucose

2 Critical .984 12 Critical .953
levels level

3 Prescribed oral medication regimen Critical .984 13 How to use a monitoring device Critical .953

When to obtain assistance from a health

4 Hypoglycemia and related symptoms Critical .969 14 Critical .953
professional

5 Hypoglycemia prevention Critical .969 15 Preventive foot care practices Critical .953

Procedures to be followed in treating Onset, peak and duration of prescribed

6 Critical .969 16 Critical .938
hypoglycemia insulin

7 Prescribed insulin regimen Critical .969 17 Proper medication storage Critical .938

Proper technique to draw up and administer

8 Critical .969 18 Medication adverse effects Critical .938
insulin

9 Correct use of prescribed medication Critical .969 19 Role of diet in blood glucose control Critical .922

Procedures to be followed in treating

10 Hyperglycemia and related symptoms Critical .953 20 Critical .922
hyperglycemia
RO: Rank Order
IR: Indicator Ratio

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RESULTS
Knowledge: Diabetes management
Indicators Criteria IR Indicators Criteria IR

21 Plan for rotation of injection sites Critical .922 29 Impact of acute illness on blood glucose level Critical .891

22 Proper disposal of syringes and needles Critical .922 30 Medication side effects Critical .891

Importance of dilated eye exam and vision te 31 Prescribed meal plan Critical .875
23 Critical .922
sting by an ophthalmologist

24 Reputable sources of diabetes information Critical .922 32 Role of sleep in blood glucose control Critical .859

25 Strategies to increase diet compliance Critical .906 33 Medication therapeutic effects Critical .859

26 Role of exercise in blood glucose control Critical .906 34 Cause and contributing factors Critical .828

27 Correct use of non-prescription medication Critical .906 35 Signs and symptoms of early disease Critical .813

Supple
28 Benefits of disease management Critical .906 36 Correct procedure for urine ketone testing .750
mental

Total OCV Score .923

RO: Rank Order

IR: Indicator Ratio

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RESULTS
Self-Management: Diabetes
R R
Indicators Criteria IR Indicators C. IR
O O
Reports non-healing breaks in skin to care
1 Crit. 1.00 Obtains dilated vision examination as
provider 14 Crit. .953
recommended
2 Participates in prescribed educational program Crit. .984
15 Adjusts medication when acutely ill Crit. .953
3 Performs treatment regimen as prescribed Crit. .984
16 Obtains preconception counseling Crit. .938
Performs correct procedure for blood glucose
4 Crit. .984
testing 17 Treats symptoms of hypoglycemia Crit. .906
5 Monitors blood glucose Crit. .984 18 Participates in recommended exercise Crit. .906
Uses correct procedure for 19 Monitors frequency of hypoglycemia episodes Crit. .891
6 Crit. .984
insulin administration 20 Uses effective weight control strategies Crit. .891
7 Obtains required medication Crit. .984 21 Participates in smoking cessation regimen Crit. .891
8 Uses medication as prescribed Crit. .984 22 Rotates injection sites Crit. .891
9 Participates in health care decisions Crit. .969
23 Adjusts life routine for optimal health Crit. .891
10 Treats symptoms of hyperglycemia Crit. .969
24 Accepts diagnosis Crit. .875
11 Reports symptoms of complications Crit. .969
12 Stores insulin correctly Crit. .969 25 Maintains optimum weight Crit. .875

13 Performs preventive foot care practices Crit. .953 26 Monitors medication therapeutic effects Crit. .875
RO: Rank Order
C: Criteria
IR: Indicator Ratio

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RESULTS
Self-Management: Diabetes
R R
Indicators Criteria IR Indicators C. IR
O O

27 Reports need for financial assistance Crit. .875 37 Follows recommended activity level Crit. .813
Uses preventive measures to reduce risk for
28 complications Crit. .859 38 Monitors body weight Crit. .813
Obtains health care if blood glucose levels 39 Monitors urinary glucose and ketones Supp. .797
29 fluctuate outside of recommendations Crit. .859

Uses health care services congruent with Uses only nonprescription medication
40 approved by health professional Supp. .781
30 Crit. .859
needs
41 Obtains pneumonia vaccine Supp. .766
31 Maintains plan for medical emergencies Crit. .859
Seeks information about methods to prevent 42 Follows recommended diet Supp. .750
32 complications Crit. .844

Uses diary to monitor blood glucose level Monitors for signs and symptoms of
33 Crit. .844 43 Supp. .750
over time depression

34 Keeps appointments with health professional Crit. .844 44 Follows recommendations for alcohol use Supp. .625
35 Performs usual life routine Crit. .828
36 Obtains influenza seasonal vaccine Crit. .828 Total OCV Score .887

RO: Rank Order

C: Criteria
IR: Indicator Ratio
Supp: Supplemental

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CONCLUSIONS
 Knowledge and Self-management NOC outcomes for
people with diabetes were validated, and the results
provided strong validity.
 The most important knowledge for diabetes
management was related to prescribed medication and
glucose levels.
 The most important self-management behaviors was
monitoring skin problems carefully.
 Health care providers for diabetic patients should
consider these results for patient education.
 By using these NOC outcomes, diabetic patient
outcomes would be effectively and accurately
evaluated.

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REFERENCES
1. World Health Organization [Internet]. Geneva:
World Health Organization; 2017 [cited
2017Oct13]. Diabetes. Available from:
http://www.who.int/mediacentre/factsheets/fs
312/en/
2. Moorhead S, Johnson M, Maas M, Swanson E.
Nursing Outcomes Classification (NOC):
Measurement of health outcomes. 5 ed. St
Louis, MO: Mosby: 2013
3. Burns N, Grove SK. The practice of nursing
research. 6 ed. St Louis, MO: Saunders; 2009.
4. Johnson M, Maas M. The nursing outcomes
classification. Journal of Nursing Care Quality.
1998;12(5):9-20.

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Question?

• Contact information

Hyun-Kyung Oh, Ph.D., MSN, RN

Assistant Professor

University of Wisconsin-Milwaukee
College of Nursing

oh5@uwm.edu
Office: 414-229-4183

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