A quantitative descriptive study was conducted to establish professional nurses’ and patients’ knowledge and understanding of laparoscopic surgery and to determine whether nurses are sufficiently knowledgeable to disseminate adequate information about laparoscopic surgery to patients. Two state hospitals based in KwaZulu-Natal where laparoscopic surgery is done were selected and the respondents were selected through convenience sampling. Data were collected by administering questionnaires to theatre nurses (n=39), ward nurses (n=87) and patients (n=42) scheduled for laparoscopic surgery. The SPSS version 15 for Windows was used to compute the results. The findings revealed that the professional nurses were not sufficiently knowledgeable about laparoscopic surgery to give adequate information to patients and the patients themselves were not fully informed about all aspects of laparoscopic surgery including the possibility of conversion to open surgery, complications and advantages and after care. There is therefore a dire need for improvement of patient education to assist patients gaining optimal recovery / Health Studies / M.A. (Health Studies)

Diss. (sammanfattning) Umeå : Umeå universitet, 2010.

A quantitative, exploratory, descriptive and contextual research study was conducted to establish the effect of reinforcement of information in phase II cardiac rehabilitation of myocardial infarction patients. Its aim was to determine the sufficiency of patient education during hospitalisation and the necessity for reinforcing information during follow-up sessions after the patient's discharge from hospital. Patients from two private hospitals in Gauteng were involved in the study. A quasi-experimental research design, namely the comparison group posttest-only design, was implemented with no random assignment of subjects to the experimental and control groups. A convenient non-probability sampling method was used and data was collected by means of questionnaires. The data analysis revealed that patients received sufficient education during hospitalisation, but that discharged patients still believed follow-up sessions to be a necessity. No significant difference was found in the knowledge levels of the experimental and control groups. / 'n Kwantitatiewe, verkennende, beskrywende en kontekstuele studie is uitgevoer om ondersoek in te stel na die effek van inligtingversterking in Fase II kardialerehabilitasie van miokardiale-infarksie-pasiente. Hiermee wou die navorser bepaal of pasientonderrig in die hospitaal voldoende was, en of die opvolging van pasiente na ontslag uit twee privaat hospitale in Gauteng noodsaaklik was om inligting te versterk. Vir die implementering van die studie is van 'n kwasi-eksperimentele navorsingsontwerp, naamlik die tweegroep-posttoets-ontwerp, gebruik gemaak. Respondente is nie ewekansig aan 'n eksperimentele en 'n kontrolegroep toegewys nie. 'n Nie-waarskynlike gerieflikheidsteekproeftrekking is gedoen, en data is ingesamel deur middel van die voltooiing van 'n vraelys. Die data-analise het getoon dat die pasientonderrig in die hospitaal voldoende was, maar dat pasiente steeds van mening was dat opvolging na ontslag noodsaaklik is. Geen beduidende verskil is gevind in die kennisvlakke van die eksperimentele en die kontrolegroep nie. / Health Sciences / M.A. (Nursing)

A quantitative descriptive study was conducted to establish professional nurses’ and patients’ knowledge and understanding of laparoscopic surgery and to determine whether nurses are sufficiently knowledgeable to disseminate adequate information about laparoscopic surgery to patients. Two state hospitals based in KwaZulu-Natal where laparoscopic surgery is done were selected and the respondents were selected through convenience sampling. Data were collected by administering questionnaires to theatre nurses (n=39), ward nurses (n=87) and patients (n=42) scheduled for laparoscopic surgery. The SPSS version 15 for Windows was used to compute the results. The findings revealed that the professional nurses were not sufficiently knowledgeable about laparoscopic surgery to give adequate information to patients and the patients themselves were not fully informed about all aspects of laparoscopic surgery including the possibility of conversion to open surgery, complications and advantages and after care. There is therefore a dire need for improvement of patient education to assist patients gaining optimal recovery / Health Studies / M.A. (Health Studies)

Psychoeducational interventions are designed to assist clients to learn about their condition, to enhance their self-care practices, to promote well-being and prevent complications and to ultimately maintain or improve their life quality. Although results of individual and of meta-analytic studies supported the beneficial effects of psychoeducational interventions on multiple health-related outcomes for various client population, investigators expressed concerns regarding the quality of single-study reports. The most important criticism is the lack of explicit reference to a theoretical model guiding the design of the study, the selection of expected outcomes of the interventions, and lack of explicitly stated causal linkages between interventions and outcomes. In this research project, a comprehensive framework was developed and empirically tested as a model for evaluating the effectiveness of psychoeducational interventions, namely self-help classes, uncertainty management, and a combined intervention. Direct and moderating effects of extraneous variables (personal characteristics, severity of illness and resources), intervening variable (state anxiety) and intervention variables (components of psychoeducation and strength of intervention) on outcome variables (cognitive, behavioral, psychological and quality of life) were hypothesized. An experimental repeated measures design was used to test the hypothesized effects. Fifty-six women with breast cancer receiving adjuvant therapy were randomly assigned to one of the experimental groups. Data were collected at six points in time. Hierarchical linear modeling approach was used to analyze the data. Results indicated that although the interventions were effective in producing desired changes in selected outcomes, their effects were moderated by various extraneous and intervening variables. Education, sense of mastery, symptom extension, work status, size and use of social support strengthened the effects of the interventions, while trait anxiety, marital status, and number of symptoms experienced weakened the effects of the interventions on cognitive, behavioral, and psychological outcomes. Based on these findings, clinicians are encouraged to attend to the mode of delivery, intensity, and timing for implementation of the intervention, and to the characteristics of the intervener and clients, when planning, implementing, and evaluating psychoeducational interventions.

Bakgrund: Rökning skapar både ett fysiskt och ett psykologiskt beroende vilket gör vanan svår att bryta. En del av sjuksköterskans ansvarsområde är att arbeta hälsofrämjande och att använda sig av kunskapsbaserade metoder. En av dessa är Motivational Interviewing (MI) som är en patientcentrerad samtalsmetod som kan användas inom omvårdnad i syfte att hjälpa patienter till hälsofrämjande livsstilsförändringar. Inga tydliga riktlinjer finns dock för metodens effektivitet vid rökavvänjning. Syfte: Att undersöka forskningsresultat som stödjer eller avfärdar MI som rökavvänjningsmetod. Design: En litteraturöversikt användes i denna uppsats. Resultat: Resultatet sammanställdes utifrån den vetenskapliga litteraturen. Stöd framkom gällande rökstopp, minskat bruk av cigaretter, motivation, minskat röksug samt kostnadseffektivitet vid återfallsprevention. Avfärdande resultat framkom gällande rökstopp och kostnadseffektivitet vid rökstopp. Slutsats: Resultaten indikerar att metoden kan användas framgångsrikt om den anpassas efter de förutsättningar som ges gällande exempelvis patientens rökvanor och aktuella motivation. Mer forskning behövs dock. / Background: Smoking creates a physiological and psychological dependence which makes the habit difficult to break. Nurses are responsible, as part of their professional duty, to work with lifestyle prevention using evidence-based methods. One of them is Motivational Interviewing, MI, a patient-centered technique, which aims to help patients with health-promoting lifestyle changes. There are no clear guidelines regarding this method's efficiency on smoking cessation. Aim: To study the research findings that support or reject MI on smoking cessation. Design: A literature review was used to perform this study. Results: The results were extracted from the scientific literature. Support were found in relation to smoking cessation, reduced smoking, motivation, reduced temptation to smoke and cost-effectiveness on relapse prevention. However, rejection emerged regarding smoking cessation and cost-effectiveness on smoking cessation. Conclusion: The results indicate that the method can be successfully used if adjusted for the conditions given, for example the patient´s smoking history and current motivation. Further research is needed.

Thesis (MPhil)--Stellenbosch University, 2009. / A research assignment submitted in partial fulfilment of the requirements of the degree Master of Philosophy (MPhil) in rehabilitation at Stellenbosch University / ENGLISH ABSTRACT: Introduction: Stroke is a growing healthcare problem in South Africa. It contributes significantly to the burden of disease and is the largest cause of disability. Rehabilitation can significantly improve recovery and outcomes of stroke survivors particularly if implemented in the correct manner and through using certain approaches. The aim of this study was to examine the practice of doctors with regards to stroke rehabilitation in private acute-care hospitals in the Western Cape Metropole. In particular, attention has been given to the degree to which doctors in the private health care sector shared information with first time stroke patients. The study design was retrospective and descriptive in nature. Data collection was primarily of a quantitative nature although some qualitative data has been collected to elaborate on quantitative findings. Two self-designed questionnaires were used to collect data. Data from doctor-participants were collected to examine the use of care protocols. Data from both groups of participants were collected to determine which practices were prefered. In particular it was sought to ascertain what team work approach was favoured by doctors. To do this the method of communication among team members was examined. It was also sought to ascertain how information regarding diagnosis, prognosis, risk factors, post–acute rehabilitation options and discharge planning was shared. In total thirty-five doctors and forty-eight patients were interviewed. Quantitative data was captured on an excel spreadsheet and analysed with the help of a STATISTICA software package. A p value of less than 0.05 was deemed statistically significant. Results showed that none of the doctor participants had any formal rehabilitation qualification. It was found that stroke care protocols were used by 46% of doctor participants, while 89% acknowledged the advantages of a set protocol. The majority of doctors (57%) operated as part of a multidisciplinary team. Communication between team members regarding the patient’s management plan was done on a very informal basis with only 11% of doctors using ward rounds and none using team meetings for this purpose. Opinions differed between the two study groups on the frequency of information sessions (p = .00039). Only six % of doctors included the patient and family in the rehabilitation team. A large discrepancy was seen when it came to opinions on sharing information regarding diagnosis, prognosis, stroke risk factors, post-acute rehabilitation and discharge planning. P values ranging from 0.00013 to 0.0041 showed that the difference between the opinions of patients and doctors on these issues was statistically significant. Opinions also differed between the two groups when the frequency of information sessions was compared (p = 0.00039). Only 28% of patient participants were included in the decisionmaking process regarding further post-acute rehabilitation and in most cases the final decision was made by the doctor or the medical insurance company. Qualitative data highlighted some patients’ dissatisfaction regarding the post-acute rehabilitation process and indicated a problem with regard to the recognition of early stroke warning signs by general practitioners and the emergency treatment of these. The conclusion was that there is a great need for further motivation and education of doctors with respect to advanced research projects, further specialisation as well as the implementation of important rehabilitation modalities. It is also important that the patient himself acts as a fully-fledged team member. Recommendations were that administrators in both, the private and public health care sectors as well as non-government organisations and government welfare organisations identify the reasons for doctors’ hesitation to implement existing knowledge; that they make stroke rehabilitation training available and that they ensure that doctors implement the existing and new knowledge on all aspects of acute and post-acute stroke rehabilitation i.e. use of set care protocols, team work approach and sharing information on diagnosis, prognosis, risk factors, post–acute rehabilitation options and discharge planning when managing stroke patients. It was also recommended to promote more research projects which are implemented in the private health care sector. / AFRIKAANSE OPSOMMING: Beroerte is reeds die grootste enkele oorsaak van gestremdheid in Suid Afrika en steeds aan die toeneem in insidensie. Navorsing het bewys dat rehabilitasie geskoei op wetenskaplik bewese metodes die uitkomste van beroerte lyers beduidend kan verbeter. Daarom was dit die doel van die studie om vas te stel tot watter mate dokters, werksaam in die privaat sektor in die Wes Kaapse Metropool, bewese rehabilitasie metodes implimenteer tydens behandeling van akute beroerte pasiënte. Spesifieke areas waaraan aandag geskenk is, was die gebruik van beroerte protokolle, die volg van die interdissiplinêre spanwerk benadering, kommunikasie metodes tussen spanlede en die deurgee van inligting met betrekking tot die diagnose, prognose, risiko faktore, opvolg rehabilitasie en ontslag beplanning aan pasiënte na `n eerste beroerte. Die studie was retrospektief en beskrywend van aard. Daar was primêr kwantitatiewe data ingesamel met behulp van twee self ontwerpde vraelyste. ‘n Klein hoeveelheid kwalitatiewe data is aanvullend ingesamel om kwantitatiewe bevindings toe te lig. 35 dokters en 48 pasiënte het aan die studie deelgeneem. ‘n STATISTICA sagteware pakket is gebruik vir die analise van kwalitatiewe data. ‘n P waarde van minder as 0.05 is as statisties beduidend beskou. Nie een van die dokters wat aan die studie deelgeneem het, het nagraadse opleiding in rehabilitasie gehad nie. 46% van dokters het beroerte protokolle gebruik in hulle praktyke, terwyl 89% gevoel het dat die gebruik van protokolle voordele inhou. Waar spanwerk gebruik was (57% van dokters), is die multidissiplinêre benadering gevolg. Kommunikasie tussen spanlede het meesal op `n informele basis geskied. Geen dokter het spanvergaderings gehou nie. 11% van dokters het saalrondtes gehou waartydens met spanlede gekommunikeer is. 6% van dokters het die pasiënt en familie ingesluit in die rehabilitasie span. Volgens dokters was daar beduidend meer inligting sessies met pasiënte gehou as volgens pasiënte (p = 0.00039). Die verskil in mening tussen die twee groepe is ook waargeneem met betrekking tot die hoeveelheid inligting wat verskaf is oor diagnose, prognose, risiko faktore, post akute rehabilitasie en onslag beplanning (P waardes het gewissel van 0.00013 tot 0.0041). 25% van pasiënte het deelgeneem aan die besluitnemings proses oor opvolg rehabilitasie. Die finale besluit hieroor was in die meerderheid van gevalle deur die dokter en die mediese versekeringsskema geneem. Dit het uit die kwalitatiewe data geblyk dat van die pasiënte ongelukkig was met die opvolg rehabilitasie wat hulle ontvang het. Voorts het pasiënte gevoel dat algemene praktisyns beter ingelig behoort te wees oor die vroeë waarskuwingstekens van beroerte sowel as die noodbehandling van die tekens. Die navorser het tot die gevolgtrekking gekom dat dokters oortuig moet word van die belang van verdere navorsing, spesialisasie in rehabilitasie en die implementasie van bewese beroerte rehabilitasie metodes. Sy beveel aan dat administrateurs van beide die privaat en staatssektor sowel as verteenwoordigers van nie regerings organisasies betrokke raak om bogenoemde te bewerkstellig. Daar moet vasgestel word waarom dokters huiwerig is om bestaande kennis te implemteer. Beroerte rehabilitasie opleiding moet beskikbaar gestel word aan dokters en dokters moet aangemoedig word om bewese kennis soos die gebruik van protokolle, interdissiplinêre spanwerk en verskaffing van inligting oor diagnose, prognose, risiko faktore, opvolg rehabilitasie en ontslag beplanning toe te pas in die praktyk. Die doen van meer navorsing in die privaat sektor word ook aangemoedig.

The purpose of the study was to investigate the perception of given information at discharge from a urological ward at Akademiska sjukhuset, and to investigate whether the patients had searched for information themselves after discharge.   The study is an empirical cross -sectional study with descriptive design. All the patients inscribed as urologic patients, discharged to their home during month of March 2009, were asked to participate in the study (in total 82 patients), which led to 57 participants. The data collection method was an interview over the phone, with 20 structured questions. The interview form was sent by mail to the patients after the discharge from the ward, the authors thereafter called the participants at home and performed the interview within 10-20 days after discharge.   The most common concerns for surgical patients after discharge are wound care, pain management, daily activity, the detection of complications, handling symptoms, elimination and quality of life. This study shows that 72 % of the participants considered the given information as sufficient for handling their self-care at home. The lack of information experienced by the participants concerned daily activity, eventual complications that may occur and pain management. The majority of the discharge information was given in the patient room.   Postoperative complications that occur after discharge can be expensive for the society and is a cause of unnecessary suffering for the patient, therefore the patient need to understand what to be observant of after discharge. This requires that both doctors and nurses provide relevant information for each individual patient. / Syftet var att undersöka patienters uppfattning av information given vid utskrivning från en urologisk vårdavdelning på Akademiska sjukhuset samt att undersöka om patienterna själva sökt information efter utskrivningen.   Studien är en empirisk tvärsnittstudie med deskriptiv design. Alla patienter inskrivna som urologpatienter, som skrevs ut till hemmet från en urologisk vårdavdelning under mars månad 2009 tillfrågades att delta (sammanlagt 82 patienter), 57 patienter deltog. Som datainsamlingsmetod användes en telefonintervju med 20 strukturerade frågor. Frågorna skickades hem till patienterna efter hemgång och författarna ringde sedan upp patienterna i hemmet och genomförde intervjun.   De områden som kirurgiska patienter upplever störst bekymmer för efter utskrivning från sjukhuset är sårvård, smärthantering, daglig aktivitet, att upptäcka komplikationer, symtomhantering, elimination och livskvalitet. Studien visar att 72 % av deltagarna tyckte att den information de fått var tillräcklig för att sköta sin egenvård. Den information som saknats har varit inom områdena daglig aktivitet, eventuella komplikationer som kan uppstå och smärtlindring. Majoriteten av utskrivningssamtalen ägde rum på patientsalen.   Postoperativa komplikationer som uppträder efter utskrivning kan bli kostsamma för samhället och är källa till onödigt lidande för patienten, patienten behöver därför förstå vad denne skall vara uppmärksam på efter hemgång. Detta ställer krav på både läkare och sjuksköterskor att ge information som är relevant för varje individuell patient.

Introduction : Le traitement de la dialyse entraîne de nombreux bouleversements dans la vie du patient et nécessite d’adhérer à nombreuses recommandations. L’éducation thérapeutique, prise en charge en plein essor dans la maladie chronique, consiste à accompagner les patients dans leur parcours de soin et à les aider à acquérir des connaissances et des compétences pour vivre au mieux leur vie avec leur maladie. Ainsi, l’objectif de cette étude était d’évaluer l’impact d’un programme d’éducation thérapeutique mis en place auprès de patients en auto-dialyse. Méthode : Le programme était composé de cinq interventions collectives (représentations et vécu de la dialyse, alimentation, protection de l’abord vasculaire, prise des médicaments et satisfaction). 125 patients ont participé à l’étude (64 dans le groupe expérimental et 61 dans le groupe contrôle). Plusieurs issues (adhésion thérapeutique, qualité de vie, état anxio-dépressif) et variables médiatrices ont été mesurées (connaissances, sentiment d’auto-efficacité, stratégies de coping, etc.) avant le programme, à la fin du programme éducatif et trois mois après. Résultats : Les résultats n’ont pas montré d’effet direct du programme sur l’adhésion thérapeutique, la qualité de vie et l’anxiété. Par contre, une augmentation des symptômes dépressifs a été observée dans le groupe expérimental, sans induire d’état dépressif. Des analyses de médiations ont précisé que l’augmentation des connaissances sur l’abord vasculaire expliquait l’effet de l’éducation thérapeutique sur les symptômes dépressifs. Les résultats ont également montré que le sentiment d’auto-efficacité vis-à-vis du suivi des recommandations alimentaires diminuait chez les patients du groupe expérimental à la fin du programme. Des analyses supplémentaires ont indiqué que ce changement prédisait d’autres évolutions comme la diminution de l’adhésion thérapeutique et une augmentation de l’anxiété. Conclusion : Ces principaux résultats montrent la nécessité d’améliorer les interventions d’éducation thérapeutique auprès des patients en dialyse en adaptant la transmission des connaissances au quotidien et en travaillant davantage sur l’amélioration du sentiment d’efficacité personnelle et aussi les stratégies de coping, c’est-à-dire d’avoir une action plus ciblée sur les variables médiatrices. / Introduction: Dialysis entails numerous alterations in the life of the patient and requires adhering to many recommendations. Therapeutic Patient Education helps patients acquire knowledge and skills to manage their life with a chronic disease in the best possible way. The objective of this study was to evaluate the impact of a therapeutic educational program for dialysis patients in an out-center. Methods: The program consisted of five group sessions concerning the representations and personal experience of the dialysis, dietary regimen, protection of vascular access, taking of medicines and satisfaction about the program. The study included 125 subjects (64 in the experimental group and 61 in the control group). Several criteria (adherence, quality of life, anxiety, depression) and mediating variables were measured (knowledge, self-efficacy, social support, coping strategies, etc.) before the program, at the end and three months after the end of the program. Results: The program had no effect on adherence, quality of life and anxiety. On the other hand, an increase in depressive symptoms was observed in the experimental group, without inferring a depressive state. Analyses of mediations showed that the increase in knowledge regarding vascular access explained the effect of therapeutic education on depressive symptoms. The results also showed that self-efficacy decreased in the experimental group after the five sessions. Additional analyses indicated that this change predicted other changes such as a decrease in dietary adherence and increased anxiety.Conclusion: These main results show the need for improving educational interventions with patients in dialysis by adapting the transmission of knowledge about everyday life, and especially by working more on improving the feeling of self-efficacy and the use of coping strategies.

Este estudo teve como principais objetivos realizar a validação de conteúdo e a validação clínica das características definidoras do diagnóstico de enfermagem Conhecimento deficiente em relação à doença arterial coronariana e à revascularização do miocárdio. Foram utilizados os modelos de validação de conteúdo e de validação clínica focado no paciente, propostos por Fehring (1987). Validação de conteúdo (1ªetapa do estudo) - foram convidados a participar dessa etapa 50 enfermeiros expertos em diagnósticos de enfermagem, em assistência a pacientes com problemas cardiológicos e/ou na área da educação. Para essa etapa, foi utilizado instrumento, constituído das características definidoras do Conhecimento deficiente e de suas respectivas definições operacionais. As características definidoras, classificadas como principais pelos expertos foram: verbalização do problema (0,96), desempenho inadequado em teste (0,83) e expressar percepção incorreta acerca do seu estado de saúde (0,83). As características classificadas como secundárias foram: seguimento inadequado de instruções (0,71), memorização de informação deficiente (0,71), indicadores nãoverbais de baixo entendimento (0,69), questionamento repetitivo (0,68), desvalorização das informações (0,64), não seguir a terapêutica prescrita (0,56), indicadores não-verbais de falta de atenção (0,56), falta de integração do plano de tratamento às atividades diárias (0,53) e expressar alteração psicológica (ansiedade, depressão) (0,51). A característica comportamentos impróprios ou exagerados (0,34) foi considerada insuficiente para caracterizar o conhecimento deficiente. Validação clínica (2ªetapa do estudo) - participaram dessa etapa 80 pacientes adultos que se encontravam no período pré-operatório de revascularização do miocárdio. Essa etapa foi realizada no Hospital Beneficência Portuguesa do município de São Paulo. Foram utilizados seis instrumentos: Questionário para avaliação geral, Mini-exame do estado mental, Escala hospitalar de ansiedade e depressão, Questionário para avaliação do conhecimento em relação à doença e ao tratamento, Questionário para avaliação da valorização de informações e Escala de autoavaliação. Todos os instrumentos de coleta de dados, utilizados nessa etapa e preenchidos pela pesquisadora, foram entregues a um enfermeiro especialista com o objetivo de verificar a concordância entre esses dois profissionais na identificação das características definidoras. As características identificadas com freqüência superior a 50%, tanto pela pesquisadora como pelo enfermeiro especialista, foram: desempenho inadequado em teste e expressar alteração psicológica. Com exceção da característica verbalização do problema, na qual se obteve 27,5% de concordância entre os dois profissionais, em todas as outras foram obtidos índices de concordância superior a 68%. As características definidoras nas quais foram obtidos maiores coeficientes de confiabilidade foram desempenho inadequado em teste e expressar percepção incorreta acerca do seu estado de saúde (R = 0,91). As características definidoras nas quais foram obtidos menores coeficientes de confiabilidade foram: indicadores não-verbais de falta de atenção (R = 0,05) e indicadores nãoverbais de baixo entendimento (R = 0,06). Apenas quatro (5%) pacientes apresentaram desempenho adequado no questionário para medir conhecimento em relação à doença e ao tratamento. Pode-se concluir que as características definidoras desempenho inadequado em teste e expressar percepção incorreta acerca do seu estado de saúde constituem as melhores manifestações do Conhecimento deficiente visto que foram classificadas, na 1ªetapa do estudo como características principais e foram identificadas, na 2ªetapa do estudo, com grande freqüência / The main goals of this research were the content and clinical validation of the defining characteristics of the nursing diagnosis Deficient knowledge in relation to coronary artery disease and coronary artery bypass grafting. The Diagnostic Content Validation Model and the patient-focused Clinical Diagnostic Validity Model proposed by Fehring (1987) were used. Content validation (1st phase of the study) - to participate in this phase, 50 nurses were invited who were experts in nursing diagnosis, care delivery to patients with heart problems and/or education. For this phase, an instrument was used, comprising the defining characteristics of Deficient knowledge and their respective operational definitions. The experts classified the following as the main defining characteristics: verbalization of the problem (0.96), inaccurate performance of test (0.83) and expressing mistaken perception about health condition (0.83). The following characteristics were classified as secondary: inaccurate follow-through of instruction (0.71), lack of information recall (0.71), non-verbal indicators of low understanding level (0.69), repetitive questioning (0.68), information devaluation (0.64), not following the prescribed treatment (0.56), non-verbal indicators of lack of attention (0.56), lack of integration of treatment plan into daily activities (0.53) and expressing psychological change (anxiety, depression) (0.51). Inappropriate or exaggerated behaviors (0.34) was considered insufficient to characterize Deficient knowledge. Clinical validation (2nd phase of the study) - study participants in this phase were 80 adult patients in the preoperative period of coronary artery bypass grafting. This phase was carried out at the Beneficência Portuguesa Hospital in São Paulo City. Six instruments were used: General assessment questionnaire, Mini mental state examination, Hospital anxiety and depression scale, Questionnaire for knowledge assessment related to the disease and treatment, Questionnaire to assess information valuation and Self-assessment scale. All data collection instruments used in this phase and filled out by the researcher were passed to a specialized nurse, with a view to verifying the agreement between these two professionals in the identification of the defining characteristics. The following characteristics were identified by the researcher as well as by the specialized nurses with frequencies of more than 50%: inaccurate performance of test and expressing psychological change. Except for the verbalization of the problem characteristic, for which 27.5% of agreement was obtained between the two professionals, agreement rates exceeded 68% on all other characteristics. The defining characteristics with the highest reliability coefficients were inaccurate performance of test and expressing mistaken perception about health condition (R = 0.91). The defining characteristics with the lowest reliability coefficients were: non-verbal indicators of lack of attention (R = 0.05) and nonverbal indicators of low understanding level (R = 0.06). Only four (5%) patients displayed adequate performance on the questionnaire for knowledge assessment related to the disease and treatment. It can be concluded that the defining characteristics inaccurate performance of test and expressing mistaken perception about health condition constitute the best manifestations of Deficient knowledge, as they were identified in the 1st phase of the study as the main characteristics and were identified with high frequency levels in the 2nd phase