{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,8,15]],"date-time":"2025-08-15T02:12:58Z","timestamp":1755223978761,"version":"3.43.0"},"reference-count":64,"publisher":"Wiley","issue":"9","license":[{"start":{"date-parts":[[2024,11,11]],"date-time":"2024-11-11T00:00:00Z","timestamp":1731283200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Journal of Clinical Nursing"],"published-print":{"date-parts":[[2025,9]]},"abstract":"<jats:title>ABSTRACT<\/jats:title><jats:sec><jats:title>Aim<\/jats:title><jats:p>To test a middle\u2010range theory (MRT) for the nursing diagnosis of ineffective breathing pattern in children with congenital heart disease (CHD) based on analysis of two general propositions.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>This cross\u2010sectional study is guided by STROBE. The propositions represent hypotheses about the relationships between the concepts of this MRT to be tested empirically, and thus, log\u2010linear models were used to verify the structure of the proposition related to the stimuli. Diagnostic accuracy measures, univariate logistic regressions and the Mann\u2013Whitney test were used to analyse the structure of the propositions related to behaviours.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>The analysis of the propositions related to the stimuli (eight concepts, four of which were classified as focal stimuli and four as contextual stimuli) suggested a reclassification of the stimulus \u201cdeformities in the thoracic wall\u201d which became too focal. In the analysis of the propositions related to behaviours (17 concepts, five of which were classified as acute confirmatory, nine as acute clinical deterioration and three classified as chronic), guided changes in the operationalisation of concepts were suggested after comparing clinical findings; thus, acute confirmatory behaviours now have 10 concepts, while acute clinical deterioration behaviours and chronic behaviours continued with nine and three concepts, respectively, but with reclassifications between them.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>Changes in the operationalisation of the classification of the elements of the two propositions occurred after comparing the clinical findings with the theoretical model.<\/jats:p><\/jats:sec><jats:sec><jats:title>Relevance to Clinical Practice<\/jats:title><jats:p>By establishing precise causal relationships and describing how IBP manifests itself over time in children with CHD, empirical testing of this MRT helps nurses understand clinical reasoning based on temporal logic and spectral interaction between diagnostic components, which in turn will improve the use and accuracy of nursing diagnoses.<\/jats:p><\/jats:sec><jats:sec><jats:title>Patient Contribution<\/jats:title><jats:p>Children and adolescents with CHD were recruited for this study sharing their clinical history and physical lung examination.<\/jats:p><\/jats:sec>","DOI":"10.1111\/jocn.17533","type":"journal-article","created":{"date-parts":[[2024,11,11]],"date-time":"2024-11-11T21:58:22Z","timestamp":1731362302000},"page":"3720-3733","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Empirical Testing of a Middle\u2010Range Theory for Ineffective Breathing Pattern in Children With Congenital Heart Disease"],"prefix":"10.1111","volume":"34","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-5038-0836","authenticated-orcid":false,"given":"Nayana Maria","family":"Gomes de Souza","sequence":"first","affiliation":[{"name":"Federal University of Cear\u00e1  Fortaleza Cear\u00e1 Brazil"},{"name":"School Maternity Assis Chateubriand\/EBSERH  Fortaleza Cear\u00e1 Brazil"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8033-8831","authenticated-orcid":false,"given":"Viviane Martins","family":"da Silva","sequence":"additional","affiliation":[{"name":"Federal University of Cear\u00e1  Fortaleza Cear\u00e1 Brazil"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5867-8023","authenticated-orcid":false,"given":"Marcos Ven\u00edcios de Oliveira","family":"Lopes","sequence":"additional","affiliation":[{"name":"Federal University of Cear\u00e1  Fortaleza Cear\u00e1 Brazil"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4629-2489","authenticated-orcid":false,"given":"Emanuela Aparecida Teixeira","family":"Gueiros","sequence":"additional","affiliation":[{"name":"Federal University of Cear\u00e1  Fortaleza Cear\u00e1 Brazil"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7255-960X","authenticated-orcid":false,"given":"Ana Luisa Brand\u00e3o de Carvalho","family":"Lira","sequence":"additional","affiliation":[{"name":"Federal University of Cear\u00e1  Fortaleza Cear\u00e1 Brazil"},{"name":"Postgraduate Program of the Department of Nursing Federal University of Rio Grande do Norte  Natal Brazil"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3908-8834","authenticated-orcid":false,"given":"Rosely Leyliane","family":"dos Santos","sequence":"additional","affiliation":[{"name":"Regional University of Cariri  Crato Cear\u00e1 Brazil"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"311","published-online":{"date-parts":[[2024,11,11]]},"reference":[{"key":"e_1_2_12_2_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ijcard.2019.02.069"},{"key":"e_1_2_12_3_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00246\u2010019\u201002189\u2010x"},{"key":"e_1_2_12_4_1","doi-asserted-by":"publisher","DOI":"10.1111\/2047\u20103095.12205"},{"key":"e_1_2_12_5_1","doi-asserted-by":"publisher","DOI":"10.1590\/0034\u20107167\u20102019\u20100370"},{"key":"e_1_2_12_6_1","doi-asserted-by":"publisher","DOI":"10.1111\/jocn.12838"},{"key":"e_1_2_12_7_1","doi-asserted-by":"publisher","DOI":"10.1590\/0104\u20101169.0001.2600"},{"key":"e_1_2_12_8_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.resp.2011.06.021"},{"key":"e_1_2_12_9_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00246\u2010018\u20101976\u20107"},{"key":"e_1_2_12_10_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jpedsurg.2018.04.006"},{"volume-title":"Integrated Theory and Knowledge Development in Nursing","year":"2011","author":"Chinn P. 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