• assessment;
  • clinical judgment;
  • nursing diagnosis



To validate, clinically, the defining characteristics for the nursing diagnoses of Impaired Tissue Integrity and Impaired Skin Integrity in patients subjected to heart catheterization and to validate acute pain, haematoma, bleeding, redness, and heat as additional characteristics.


In clinical practice, an applicable nursing diagnosis for patients subjected to diagnostic heart catheterization has not been well-defined.




This clinical validation study using Fehring's model was performed at a Brazilian general hospital between November 2009–November 2010. This study included 250 patients who received elective femoral artery catheterization. Each patient was identified as having two characteristics of Impaired Tissue Integrity and three characteristics of Impaired Skin Integrity, according to NANDA-I nursing diagnoses. Due to certain postprocedure events, five additional characteristics were added to be validated in this setting. In addition to Fehring's reliability rating, the kappa coefficient was used to evaluate inter-rater agreement during the clinical evaluation.


The defining characteristic of damaged tissue was validated for Impaired Tissue Integrity and the defining characteristics of the invasion of body structures and the disruption of the skin surface were validated for Impaired Skin Integrity. Although the five characteristics that were added to the investigated diagnoses were not validated because of their low rate of occurrence in this setting, the measurements of acute pain, haematoma, bleeding, redness, and heat each had excellent inter-rater agreement.


The validation of characteristics from both of these diagnoses suggested that these criteria could be utilized for clinical practice in a diagnostic setting. Moreover, additional characteristics should also be observed to better guide nursing intervention.