Clinical Validation of Ineffective Breathing Pattern, Ineffective Airway Clearance, and Impaired Gas Exchange


  • Clinical Sidebar: Laurence Parker, PhD, Research Assistant Professor and Director of Health Services and Outcome Research, Thomas Jefferson Medical College, Department of Radiology, Philadelphia, PA.

  • This study was conducted by members of the Research Committee of the Staten Island Nursing Diagnosis Association (SINDA). The authors express deep appreciation to (a) the clinical experts who acted as raters for the study, Jean Gordon, Faith King, Rita Magnuski, Sarah Newman, Susan Pachter, Catherine Paradiso, Corrine Settlecase, and Marian Smith; (b) the nationally known experts in respiratory nursing who judged content validity of the instrument and six case studies, Susan Chase, Kaye Greenlee, Janet Larson, and Regina Maibusch; (c) Arlene Farren for her contributions in the early stages of planning; (d) nurses of the two hospitals for their overall support of the study, especially nurse executives Margaret Gallagher of St. Vincent's Medical Center, Nancy Daurio and Josephine Nappi of Maimonides Medical Center; and (e) the College of Staten Island Department of Nursing for its support of SINDA.

Dr. Carlson-Catalano, Radford University, School of Nursing, Box 6964, Radford, VA 24142. E-mail:


Purpose: To describe the clinical validation of symptoms or defining characteristics of three respiratory diagnoses. The contributing factors or etiologies of the diagnoses were identified and the degree of importance of 30 nursing interventions, 15 direct care and 15 teaching, was rated for each diagnosis and each patient. Three nursing diagnoses—ineffective breathing pattern (IBP), ineffective airway clearance (IAC), and impaired gas exchange (ICE)—were among the most frequently used, yet no reported clinical studies validated the defining characteristics of these diagnoses. This study answers the research questions: What are the defining characteristics of IBP, IAC, and ICE? What are the etiologies of IBF IAC, and IGE? What are the most important interventions for IBF, IAC, and IGE?

Design: Standardized clinical validation using a convenience sample of 76 people hospitalized with medical and surgical diagnoses, in one U.S. city and identified as having one of the three diagnoses. Data were collected in 1992–1993.

Methods: A literature-based concept analysis generated 37 possible defining characteristics for the three diagnoses which were included in the instrument. The nurse experts conducted a health history and physical examination of each patient and decided (a) whether the 37 defining characteristics were present or absent, (b) the degree of importance of each possible defining characteristic for making one or more of the diagnoses, (c) the etiologies, and (d) which of the 30 nursing interventions were important for each diagnosis and patient.

Findings: For each diagnosis, many of the 37 possible defining characteristics were judged as present but few reached the criterion of.50 as important for making one of the diagnoses. Two of the possible defining characteristics reached this criterion for IBP, seven for IAC, and two for IGE. In contrast to the defining characteristics approved by NANDA, the subjective cues of “expresses fatigue” and “expresses anxiety” were judged as important for making one or more of the diagnoses.

Conclusions: Clinical validation methods allow discriminating among defining characteristics. Data that are present are not necessarily characteristic of a diagnosis, and the subjective cues of expresses fatigue or anxiety may be important for making these diagnoses.