Development and Validation of Indonesian Nursing Care Instruments for Patients with End-Stage Kidney Disease

Nauvila Fitrotul Aini; Nursalam Nursalam; Ika Yuni Widyawati

doi:10.26714/mki.9.1.2026.9-19

Development and Validation of Indonesian Nursing Care Instruments for Patients with End-Stage Kidney Disease

Nauvila Fitrotul Aini^(1*), Nursalam Nursalam⁽²⁾, Ika Yuni Widyawati⁽³⁾

(1) Universitas Airlangga
(2) Universitas Airlangga
(3) Universitas Airlangga
(*) Corresponding Author

Abstract

End-stage kidney disease is a global health problem with a steadily increasing prevalence. Nurses need standardized nursing care instruments to improve care quality and contribute to overall health care improvement. This study aimed to develop an Indonesian nursing care instrument for patients with end-stage kidney disease. The study used a research and development design conducted in two stages. In the first stage, 101 medical records and 11 respondents were involved, while the second stage included 9 respondents. Samples were selected using purposive sampling. Validity and reliability were tested using the Item Content Validity Index (I-CVI) and Kuder–Richardson 20 (KR-20), and data were analyzed descriptively. The instrument was developed for 10 nursing diagnoses: hypervolemia, ineffective breathing pattern, impaired gas exchange, activity intolerance, anxiety, risk of electrolyte imbalance, risk of imbalanced nutrition, risk of falling, risk of ineffective renal perfusion, and readiness for enhanced nutrition. The instrument was aligned with Indonesian nursing standards, including SDKI, SLKI, and SIKI. By providing structured guidance for diagnoses, outcomes, and interventions, this instrument supports nurses in daily practice, improves documentation accuracy, and enhances consistency and quality of nursing care. Nurses’ evaluations indicated that the instrument is feasible for clinical implementation.

Keywords

End stage kidney disease; Nursing care; Instrument; Health Care Quality; Nurses

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References

Burgos-Calderón R, Depine SÁ, Aroca-Martínez G. Population kidney health. A new paradigm for chronic kidney disease management. International Journal of Environmental Research and Public Health 2021;18:6786.

Yang C-W, Harris DCH, Luyckx VA, Nangaku M, Hou FF, Garcia GG, et al. Global case studies for chronic kidney disease/end-stage kidney disease care. Kidney International Supplements 2020;10:e24–48.

Stavropoulou A, Grammatikopoulou MG, Rovithis M, Kyriakidi K, Pylarinou A, Markaki AG. Through the Patients’ Eyes: The Experience of End-Stage Renal Disease Patients Concerning the Provided Nursing Care. Healthcare (Basel, Switzerland) 2017;5. https://doi.org/10.3390/healthcare5030036.

Eckardt K-U, Delgado C, Heerspink HJL, Pecoits-Filho R, Ricardo AC, Stengel B, et al. Trends and perspectives for improving quality of chronic kidney disease care: conclusions from a Kidney Disease: Improving Global Outcomes (KDIGO) Controversies Conference. Kidney International 2023;104:888–903.

Goh ZS, Griva K. Anxiety and depression in patients with end-stage renal disease: Impact and management challenges – A narrative review. International Journal of Nephrology and Renovascular Disease 2018;11:93–102. https://doi.org/10.2147/IJNRD.S126615.

PPNI. Standar Luaran Keperawatan Indonesia: Definisi dan Tindakan Keperawatan. 1st ed. Jakarta: DPP PPNI; 2019.

PPNI. Standar Diagnosis Keperawatan Indoensia: Definisi dan Indikator Diagnosis. 1st ed. Jakarta: DPP PPNI; 2017.

PPNI. Standar Intervensi Keperawatan Indonesia: Definisi dan Tindakan Keperawatan. Jakarta: DPP PPNI; 2018.

The United States Renal Data System. Incidence, prevalence, patient characteristics, and treatment modalities. End stage renal disease. 2023;837.

Trisno T, Nursalam N, Triharini M. Analysis of Accuracy Nursing Care Process Implementation. Jurnal Ners 2020;eISSN:2020. https://doi.org/10.20473/jn.v15i2.19784.

Mutshatshi TE, Mothiba TM. Nurses’ Practices During Implementation of the Nursing Process at a Selected Public Hospital of Limpopo Province, South Africa: A Qualitative Pilot Study Analysis. The Open Public Health Journal 2020;13:309–15. https://doi.org/10.2174/1874944502013010309.

Mykkänen M, Miettinen M, Saranto K. Standardized nursing documentation supports evidence-based nursing management. Studies in Health Technology and Informatics, vol. 225, 2016, p. 466–70. https://doi.org/10.3233/978-1-61499-658-3-466.

Tate K, Ma R, Reid RC, McLane P, Waywitka J, Cummings GE, et al. A first look at consistency of documentation across care settings during emergency transitions of long-term care residents. BMC Geriatrics 2023;23. https://doi.org/10.1186/s12877-023-03731-6.

Tasew H, Mariye T, Teklay G. Nursing documentation practice and associated factors among nurses in public hospitals, Tigray, Ethiopia. BMC Research Notes 2019;12. https://doi.org/http://dx.doi.org/10.1186/s13104-019-4661-x.

Tamir T, Geda B, Mengistie B. Documentation practice and associated factors among nurses in harari regional state and dire dawa administration governmental hospitals, eastern ethiopia. Advances in Medical Education and Practice 2021;12:453–62. https://doi.org/10.2147/AMEP.S298675.

Rodríguez-Suárez C-A, González-de la Torre H, Hernández-De Luis M-N, Fernández-Gutiérrez D-Á, Martínez-Alberto C-E, Brito-Brito P-R. Effectiveness of a Standardized Nursing Process Using NANDA International, Nursing Interventions Classification and Nursing Outcome Classification Terminologies: A Systematic Review. Healthcare (Switzerland) 2023;11. https://doi.org/10.3390/healthcare11172449.

Gligor LE, Rusu H, Domnariu CD, Müller-Staub M. The quality of nursing diagnoses, interventions, and outcomes in Romanian nursing documentation measured with the Q-DIO: A cross-sectional study. International Journal of Nursing Knowledge 2024;35:298–307. https://doi.org/10.1111/2047-3095.12446.

Nursalam. Buku Management Keperawatan : Aplikasi Dalam Praktek Keperawatan Profesional Ed 6. Jakarta: Salemba Medika; 2020.

Nursalam. Metodologi Penelitian Ilmu Keperawatan : Pendekatan Praktis. 5th ed. Jakarta: Salemba Medika; 2020.

Yusoff MSB. ABC of Content Validation and Content Validity Index Calculation. Education in Medicine Journal 2019;11:49–54. https://doi.org/10.21315/eimj2019.11.2.6.

Zamanzadeh V, Ghahramanian A, Rassouli M, Abbaszadeh A, Alavi-Majd H, Nikanfar A-R. Design and Implementation Content Validity Study: Development of an instrument for measuring Patient-Centered Communication. Journal of Caring Sciences 2015;4:165–78. https://doi.org/10.15171/jcs.2015.017.

Fraenkel, J. L., Wallen, N. E., & Hyun HH. How to design and evaluate research in education eighth edition. New York: Mc Graw Hill.; 2012.

Borrelli S, Provenzano M, Gagliardi I, Ashour M, Liberti ME, De Nicola L, et al. Sodium intake and chronic kidney disease. International Journal of Molecular Sciences 2020;21:1–13. https://doi.org/10.3390/ijms21134744.

Habas ES, Al Adab A, Arryes M, Alfitori G, Farfar K, Habas AM, et al. Anemia and Hypoxia Impact on Chronic Kidney Disease Onset and Progression: Review and Updates. Cureus 2023;15:e46737. https://doi.org/10.7759/cureus.46737.

Bhutta BS, Alghoula F, Berim I. Hypoxia., Treasure Island (FL): 2024.

Galindo RJ, Beck RW, Scioscia MF, Umpierrez GE, Tuttle KR. Glycemic Monitoring and Management in Advanced Chronic Kidney Disease. Endocrine Reviews 2020;41:756–74. https://doi.org/10.1210/endrev/bnaa017.

Kim SM, Jung JY. Nutritional management in patients with chronic kidney disease. The Korean Journal of Internal Medicine 2020;35:1279–90. https://doi.org/10.3904/kjim.2020.408.

de Carvalho TC, Dini AP. Risk of falls in people with chronic kidney disease and related factors. Revista Latino-Americana de Enfermagem 2020;28:1–8. https://doi.org/10.1590/1518-8345.3911.3289.

McGregor T, Jones S. Fluid and electrolyte problems in renal dysfunction. Anaesthesia & Intensive Care Medicine 2021;22:406–9. https://doi.org/https://doi.org/10.1016/j.mpaic.2021.05.008.

Kirkman DL, Bohmke N, Carbone S, Garten RS, Rodriguez-Miguelez P, Franco RL, et al. Exercise intolerance in kidney diseases: Physiological contributors and therapeutic strategies. American Journal of Physiology - Renal Physiology 2021;320:F161–73. https://doi.org/10.1152/AJPRENAL.00437.2020.

MT Hayden C, Begue G, Gamboa JL, Baar K, Roshanravan B. Review of Exercise Interventions to Improve Clinical Outcomes in Non-dialysis Chronic Kidney Disease. Kidney International Reports 2024. https://doi.org/https://doi.org/10.1016/j.ekir.2024.07.032.

Dziubek W, Pawlaczyk W, Rogowski L, Stefanska M, Golebiowski T, Mazanowska O, et al. Assessment of Depression and Anxiety in Patients with Chronic Kidney Disease and after Kidney Transplantation—A Comparative Analysis. International Journal of Environmental Research and Public Health 2021;18. https://doi.org/10.3390/ijerph181910517.

Yanti B, Mauliza DS, Shehzad A. Respiratory Bronchiolitis-Interstitial Lung Disease in Chronic Kidney Disease Mimicking Uremic Lung: A 2022.

MacLaughlin HL, Friedman AN, Ikizler TA. Nutrition in kidney disease: core curriculum 2022. American Journal of Kidney Diseases 2022;79:437–49.

KDIGO. Kdigo 2022 Clinical Practice Guideline on Diabetes Mangement in Chronic Kidney Disease (Confidential : Do Not Distribute Public Review Draft). Kdigo Clinical Practice Guideline on Diabetes Mangement in Chronic Kidney Disease 2022:1–152.

Olatubi MI, Oyediran OO, Faremi FA, Salau OR. Knowledge, Perception, and Utilization of Standardized Nursing Language (SNL) (NNN) among Nurses in Three Selected Hospitals in Ondo State, Nigeria. International Journal of Nursing Knowledge 2019;30:43–8. https://doi.org/10.1111/2047-3095.12197.

Fennelly O, Grogan L, Reed A, Hardiker NR. Use of standardized terminologies in clinical practice: A scoping review. International Journal of Medical Informatics 2021;149:104431. https://doi.org/10.1016/j.ijmedinf.2021.104431.

Nielsen G, Peschel L, Burgess A. Essential documentation elements: Quality tool for the Emergency Department nurse. Advanced Emergency Nursing Journal 2014;36:199–205. https://doi.org/10.1097/TME.0000000000000020.

Akhu-Zaheya L, Al-Maaitah R, Bany Hani S. Quality of nursing documentation: Paper-based health records versus electronic-based health records. Journal of Clinical Nursing 2018;27:e578–89. https://doi.org/10.1111/jocn.14097.