Editor’s Note
This article is part of a monthly series highlighting the impact of research supported by the International Nursing Knowledge Association (INKA) Foundation.
Through the generosity of donors, the Foundation supports nursing research that strengthens clinical reasoning, nursing knowledge development, and evidence-informed practice. Ricardo Costa da Silva, RN, MSN, PhD, received Foundation support for Clinical Validation of the Nursing Diagnosis – Risk for Unstable Blood Pressure (RUBP) – Among Hospitalized Patients.
In this article, da Silva shares how Foundation funding supported the clinical validation of this nursing diagnosis, including the acquisition of high-precision equipment, research supplies, and personnel support needed for standardized data collection among patients hospitalized with cardiovascular conditions.
If you would like to support the work of the INKA Foundation and help make future nursing research possible, please visit https://nanda.org/support-inka-foundation/.
Looking Beyond a Single Blood Pressure Reading
Risk nursing diagnoses are essential to clinical nursing practice, representing nurses’ predictions of the occurrence of specific human responses in a timely way. This is particularly important in the cardiovascular field, where response time can be critical across various stages of health.
Recent evidence indicates that variations in blood pressure levels below and/or above desired individual levels can also serve as markers of cardiovascular impairment. This is closely connected to clinical nursing practice, as nurses are primarily responsible for blood pressure measurement, documentation, and related clinical decision-making.
But a blood pressure reading tells us what is happening at a particular moment. A different question is whether we can identify the factors that place a hospitalized patient at risk of blood pressure imbalance before it occurs.
In collaboration with my doctoral supervisors, Dr. Agueda Maria Ruiz Zimmer Cavalcante, from the Federal University of Goiás, and Dr. Viviane Martins da Silva, from the Federal University of Ceará, we conducted the study Clinical Validation of the Nursing Diagnosis – Risk for Unstable* Blood Pressure (RUBP) – Among Hospitalized Patients.
*Terminology note: The grant-supported project and study used the term Risk for Unstable Blood Pressure. This terminology was selected based on analyses of the content and concept of the phenomenon. The current NANDA ®-I Nursing Diagnoses: Definitions and Classification, 2024–2026 uses the revised diagnostic label Risk for Imbalanced Blood Pressure. This article retains unstable when referring specifically to Ricardo Costa da Silva’s study and its associated research outputs.
The project was carried out in two stages. We first aimed to assess the relevance of the causal factors associated with the RUBP diagnosis based on expert opinion, using different aggregation metrics. We then sought to determine the magnitude of these potential causal factors through a case-cohort study involving adults hospitalized for cardiovascular decompensation.
From Potential Risk Factors to Stronger Diagnostic Evidence
Following an in-depth concept analysis, we identified approximately 18 potential risk factors in the literature that, across different spectra, may influence blood pressure balance in the hospital setting.
These factors were then evaluated by 54 Brazilian nursing and medical specialists. Fourteen risk factors were considered relevant to the diagnostic causal structure using a multi-aggregation technique involving eight major content-validity indices analyzed through Generalizability Theory.
We then analyzed and explained these factors in terms of their causal relationships through the proposal of a middle-range theory.
This stage of the work has since been published in the International Journal of Nursing Knowledge as Risk for Unstable Blood Pressure in Hospitalized Cardiac Patients – A Multi-Aggregation Content Analysis (da Silva et al., 2026).
The practical significance lies in strengthening the evidence nurses can draw upon when recognizing patients who may be at risk of blood pressure imbalance. A risk diagnosis is most useful when its contributing factors are clearly defined and supported by evidence.
Taking the Diagnosis Into the Clinical Setting
To establish evidence of clinical validity, we evaluated these risk factors in patients hospitalized for a range of cardiovascular conditions who exhibited some degree of clinical decompensation.
Patients were assessed daily for up to seven days of hospitalization by a team comprising more than ten nurses and nursing students. Follow-up concluded in June 2026, and the data are currently undergoing statistical processing.
This clinical stage allows us to move beyond expert evaluation and examine how the proposed risk factors behave among the patients for whom the diagnosis is intended.
The results will help us better understand the magnitude of these potential causal factors and provide further evidence regarding the clinical validity of the diagnosis.
What Foundation Support Made Possible
The funding provided by the INKA Foundation was essential to conducting this study. Without this support, the project likely would not have been feasible.
The grant enabled us to acquire top-quality equipment, including high-precision digital sphygmomanometers. This allowed the research team to standardize data collection and helped ensure greater reliability and security in the measurements being gathered.
The funding also covered the biosafety and office supplies necessary for clinical research, as well as personnel to assist with data collection.
For this project, those resources were directly connected to the quality and feasibility of the research. Clinical validation depends on consistent patient follow-up and reliable measurements, and the Foundation grant provided practical support for both.
Sharing and Extending the Work
At the most recent INKA international conference in Lisbon, we presented findings regarding content validity evidence and the middle-range theory of risk for imbalanced blood pressure in patients hospitalized with cardiac conditions in hospitalized cardiac patients and received the Poster Recognition Award.
We plan to present the clinical evidence results at the 2027 International Nursing Knowledge Conference, taking place June 9–11, 2027, in Pamplona, Spain, hosted by Universidad de Navarra.
The research has also contributed to a growing body of scholarly work related to risk for imbalanced blood pressure, nursing diagnosis, and the clinical application of standardized nursing knowledge.
The content-validation component was published in the International Journal of Nursing Knowledge, while related work has explored the use of NANDA-I, NIC, and NOC for successful aging in older adults at risk of blood pressure imbalance. My doctoral thesis also documents the broader evidence developed through this research.
Together, these presentations, publications, and ongoing clinical analyses allow the work to move beyond the original study and contribute to wider discussion and development of nursing diagnostic knowledge.
Why Supporting This Research Is Important
By supporting research in the field of nursing diagnoses, particularly work led by early-career researchers, the INKA Foundation fosters a commitment to nursing science.
For me, this support has helped make more robust research possible while also strengthening the visibility of nursing practice and deepening my sense of belonging to the institution and its scientific community.
I am deeply grateful for this opportunity and hope the Foundation continues to grow stronger so that more researchers can access this type of funding.
A blood pressure measurement may appear to be one of the simplest pieces of information collected in clinical care. Understanding which patients are at risk of clinically significant changes in blood pressure, and why, requires a much deeper evidence base.
That is the work we are continuing to build.
If you would like to support the work of the INKA Foundation and help make future nursing research possible, please visit https://nanda.org/support-inka-foundation/.
Related Publications and Research Outputs
Publication arising from the content-validation phase
da Silva, R. C., Lopes, M. V. O., da Silva, V. M., & Cavalcante, A. M. R. Z. (2026). Risk for unstable blood pressure in hospitalized cardiac patients: A multi-aggregation content analysis. International Journal of Nursing Knowledge. Advance online publication. https://doi.org/10.1177/20473087261460979
Related publication
da Silva, R. C., de Araujo, C. S. L., & Cavalcante, A. M. R. Z. (2026). NANDA-I, NIC, NOC for successful aging in older adults with risk for imbalance blood pressure: Cross-mapping. International Journal of Nursing Knowledge. Advance online publication. https://doi.org/10.1177/20473087261462595
Doctoral thesis
da Silva, R. C. (2025). Evidências de validade para o diagnóstico de enfermagem “risco de pressão arterial instável” em adultos cardiopatas hospitalizados [Doctoral dissertation, Universidade Federal de Goiás].
Conference dissemination
Findings on content validity evidence and the middle-range theory of blood pressure risk in hospitalized cardiac patients were presented at the INKA international conference in Lisbon, where the work received the Poster Recognition Award. Clinical evidence from the next phase is planned for presentation at the 2027 International Nursing Knowledge Conference in Pamplona, Spain.
Webinar
Costa da Silva also presented the middle-range theory developed through this work in an INKA online research webinar, ND Risk for imbalanced blood pressure in patients with cardiac conditions in the hospital.
About the Author
Ricardo Costa da Silva, RN, MSN, PhD, is an Adjunct Professor at the State University of Goiás and a Cardiovascular Nurse at the Clinical Hospital of the Federal University of Goiás in Brazil. He is also a member of the Nursing Process Research Network (RePPE).
His Foundation-supported research, Clinical Validation of the Nursing Diagnosis – Risk for Unstable Blood Pressure (RUBP) – Among Hospitalized Patients, has contributed content-validity evidence and is progressing through analysis of the clinical-validation phase. Findings from the work have been presented at the INKA international conference in Lisbon, where the project received the Poster Recognition Award, and have contributed to related publications in the International Journal of Nursing Knowledge.
If you would like to support the work of the INKA Foundation and help make future nursing research possible, please visit https://nanda.org/support-inka-foundation/.
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