Classification tree for the assessment of sedentary lifestyle among hypertensive

OBJECTIVE

To develop a classification tree of clinical indicators for the correct prediction of the nursing diagnosis "Sedentary lifestyle" (SL) in people with high blood pressure (HTN).

METHODS

A cross-sectional study conducted in an outpatient care center specializing in high blood pressure and Mellitus diabetes located in northeastern Brazil. The sample consisted of 285 people between 19 and 59 years old diagnosed with high blood pressure and was applied an interview and physical examination, obtaining socio-demographic information, related factors and signs and symptoms that made the defining characteristics for the diagnosis under study. The tree was generated using the CHAID algorithm (Chi-square Automatic Interaction Detection).

RESULTS

The construction of the decision tree allowed establishing the interactions between clinical indicators that facilitate a probabilistic analysis of multiple situations allowing quantify the probability of an individual presenting a sedentary lifestyle. The tree included the clinical indicator Choose daily routine without exercise as the first node. People with this indicator showed a probability of 0.88 of presenting the SL. The second node was composed of the indicator Does not perform physical activity during leisure, with 0.99 probability of presenting the SL with these two indicators. The predictive capacity of the tree was established at 69.5%.

CONCLUSION

Decision trees help nurses who care HTN people in decision-making in assessing the characteristics that increase the probability of SL nursing diagnosis, optimizing the time for diagnostic inference.

Association of socioeconomic and clinical factors and tissue integrity outcome of patients with ulcers

Objective to analyze the association between socioeconomic and clinical factors and indicators of the tissue integrity outcome in nursing among patients with venous ulcers. Methods a cross-sectional study at a university hospital in Natal, RN, Brazil, from February to June 2012, with 50 individuals. To analyze the variables, we used the Spearman correlation test and the Mann-Whitney and Kruskal-Wallis tests at a level of 5%. Results there was a correlation of low intensity between age and the indicators hydration and skin peeling, and family income and necrosis. There was also an association between gender and the indicators temperature, amount of body hair and exudation. Conclusion the associated variables provide important information for the treatment of patients with venous ulcers, and can help reduce ulcer time and the consequent discomfort, limitations and costs. This information should be considered when providing care for patients with a nursing diagnosis of impaired skin integrity and/or impaired tissue integrity.

Características definidoras do diagnóstico de enfermagem "desobstrução ineficaz de vias aéreas"

RESUMO Objetivo: analisar as características definidoras do diagnóstico de enfermagem "desobstrução ineficaz de vias aéreas" em crianças com infecção respiratória aguda. Método: estudo transversal, descritivo, desenvolvido em dois hospitais especializados no atendimento a crianças. Realizou-se avaliação respiratória detalhada da criança para a identificação das características definidoras do diagnóstico em estudo. Resultados: foram avaliadas 249 crianças, sendo 55,8% do sexo masculino e com mediana de idade de 13,76 meses. Desobstrução ineficaz de vias aéreas foi identificado em 222 crianças (89,2%). As seguintes características definidoras apresentaram associação estatisticamente significante: dispneia, expectoração, ortopneia, ruídos adventícios respiratórios, sons respiratórios diminuídos e tosse ineficaz. Sons respiratórios diminuídos, tosse ineficaz e ruídos adventícios respiratórios compuseram o modelo de regressão logística. Conclusão: as características sons respiratórios diminuídos, tosse ineficaz e ruídos adventícios respiratórios apresentam melhor capacidade de predição para o diagnóstico "desobstrução ineficaz de vias aéreas" em crianças com infecção respiratória aguda.

Clinical Differentiation of Respiratory Nursing Diagnoses among Children with Acute Respiratory Infection

The aim of this study was to identify the defining characteristics that allow clinical differentiation of the nursing diagnoses, ineffective breathing pattern (IBP), ineffective airway clearance (IAC), and impaired gas exchange (IGE). A secondary analysis with a cohort design was developed from 1128 records obtained during the hospital stay of 136 children with acute respiratory infection. Groups of defining characteristics with greater differentiation capacity were identified by multiple correspondence analyses. The results showed that the defining characteristics that better differentiate the studied diagnoses are agitation, irritability and diaphoresis for IGE; dyspnea, use of accessory muscles to breathe, orthopnea, and abnormal breathing pattern for IBP and excessive sputum, absence of cough, difficulty verbalizing, nasal flaring, and adventitious breath sounds for IAC. Twelve defining characteristics that can assist clinicians to differentiate the three main respiratory nursing diagnoses among children with acute respiratory infection were identified in this study.

Diagnóstico de enfermagem Conhecimento Deficiente em usuárias de anticoncepcional oral combinado

Objetivou-se analisar a acurácia das características definidoras do diagnóstico de enfermagem “Conhecimento Deficiente” em usuárias de AOC. Estudo transversal realizado com 97 mulheres em idade fértil em centro de saúde da família do nordeste brasileiro. A coleta de dados ocorreu de setembro a outubro de 2011, por meio de entrevista para identificação das características definidoras e dos fatores relacionados da Taxonomia II da NANDA-I 2012. O diagnóstico de enfermagem em questão apresentou prevalência de 58,8%; a característica definidora “seguimento inadequado de instruções” (57,7%) e o fator relacionado “interpretação errônea de informações” (58,8%) foram os mais prevalentes. “Seguimento inadequado de instruções” apresentou maior sensibilidade, 96,61(88.46 - 99.07), elevado valor preditivo positivo (VPP=98,28) e elevado valor preditivo negativo (VPN=95,35). Todas as características definidoras apresentaram a mesma especificidade, 97,62(87.68 - 99.58). Conclui-se que as características definidoras estudadas apresentaram sensibilidade, especificidade, valores preditivos positivos e negativos altos para o diagnóstico de enfermagem analisado.

Estilo de vida sedentário em indivíduos com hipertensão arterial

RESUMO Objetivo: identificar a prevalência do diagnóstico de enfermagem Estilo de Vida Sedentário (EVS) e analisar sua associação com os indicadores clínicos (IC) e fatores relacionados (FR) em indivíduos com hipertensão arterial (HA). Método: estudo transversal com 285 pacientes com HAS em um centro de referência em atendimento ambulatorial no nordeste do Brasil. Para a coleta de dados, utilizou-se instrumento baseado nas definições operacionais dos IC e FR validados anteriormente. Quatro enfermeiros classificaram EVS como presente ou ausente. Para avaliar a associação entre IC e FR com a presença de EVS aplicou-se o Teste de Qui-quadrado. Calculou-se a razão de prevalência e intervalo de confiança para verificar a magnitude do efeito entre FR e EVS. Resultados: identificou-se EVS em 55,8% da amostra. Cinco IC e seis FR apresentaram associação estatística significante com EVS. Conclusão: o estudo identificou os principais indicadores para inferência de EVS, bem como seus possíveis fatores causais entre pessoas com HAS.

[The adequacy of the defining characteristics of the diagnostics "impaired gas exange" and spontaneous ventilation" in asmathic children]

OBJECTIVE

To determine the diagnostic accuracy measures of defining characteristics of respiratory nursing diagnoses "impaired gas exchange" and "impaired spontaneous ventilation" in asmathics children in emergency department.

METHODS

Observational, descriptive transversal study developed between April and September 2013 in a hospital in northeastern Brazil with a sample of 205 children. Diagnoses were established by nurses trained experts in this field. Measures of sensitivity, specificity, positive and negative value prediction right positive and negative likelihood ratio and diagnostic odds for the defining characteristics identified were calculated.

RESULTS

28.8% of the evaluated children had "impaired gas exchange". Dyspnea, abnormal breathing, tachycardia and hypoxemia had higher frequencies. Hypoxemia presented as clinical feature high sensitivity and specificity. 5.9% of the evaluated children had "impaired spontaneous ventilation" and their most frequent defining characteristics were dyspnea, increased heart rate and decreased SaO2. The increasing use of accessory muscles to breathe presented the best measures of validity for this diagnosis.

CONCLUSION

The hypoxemia and increased use of accessory muscles presented the best measures of the validity respectively to "deterioration in gas exchange" and "impairment of spontaneous ventilation". These characteristics is necessary to provide for adequate definition and use of diagnostics in clinical practice.

Desobstrução ineficaz de vias aéreas: acurácia dos indicadores clínicos em crianças asmáticas

RESUMOObjetivo:analisar as medidas de acurácia dos indicadores clínicos do diagnóstico de enfermagem Desobstrução ineficaz de vias aéreas.Método:estudo transversal, realizado com 205 crianças asmáticas atendidas no setor de emergência de um hospital municipal da cidade de Fortaleza – CE. Utilizou-se roteiro de entrevista e avaliação pulmonar para a coleta de dados.Resultados:o diagnóstico Desobstrução ineficaz de vias aéreas esteve presente em 89,3% da amostra. Os indicadores clínicos mais prevalentes foram dispnéia, mudança na frequência respiratória, mudança no ritmo respiratório, ortopnéia, ruídos adventícios e tosse ineficaz. Os indicadores clínicos de maior sensibilidade foram dispnéia, mudança na frequência respiratória, mudança no ritmo respiratório, ortopnéia e ruídos adventícios respiratórios. Tosse ineficaz e ruídos adventícios respiratórios foram os indicadores com melhor especificidade.Conclusão:o indicador clínico ruídos adventícios respiratórios foi o melhor preditor para desobstrução ineficaz de vias aéreas em crianças asmáticas atendidas em emergência.

Cardiovascular risk rate in hypertensive patients attended in primary health care units: the influence of pharmaceutical care

Cardiovascular complications are relevant due to their frequency and severity on the hypertension scenario. Studies refer Pharmaceutical Care (PC) as capable of decreasing cardiovascular risk rate (%CVR) on hypertensive patients. This study aimed to investigate, through a randomized clinical assay, the influence of PC service on the %CVR of hypertensive patients assisted in a health primary care unit from Fortaleza-Ceará. Two study groups were formed: i. Intervention Group (IG), which received orientation about taking medicines, actions aiming to prevent/solve medicine interactions and adverse effects and non-pharmacological interventions for 9 months and, ii. Control Group (CG), which received traditional assistance of the unit and was monitored during the same period. It was observed a statistically significant reduction on %CVR (10.76 to 7.86; p=0.04) and systolic blood pressure levels (SBP) (137.69 to 131.54; p<0.01) in the IG, while, in the CG, there was no significant alteration. 151 Drug Related Problem (DRP) were identified and it was realized 124 pharmaceutical interventions, with 89.2% of them resulting on solution/prevention of the problem. Our findings indicated that the inclusion of the PC service in the hypertensive health assistance was more effective at the %CVR and the SBP reduction in comparison to the traditional assistance offered.

Instrument for evaluation of sedentary lifestyle in patients with high blood pressure

OBJECTIVE

this article describes the diagnostic accuracy of the International Physical Activity Questionnaire to identify the nursing diagnosis of sedentary lifestyle.

METHOD

a diagnostic accuracy study was developed with 240 individuals with established high blood pressure. The analysis of diagnostic accuracy was based on measures of sensitivity, specificity, predictive values, likelihood ratios, efficiency, diagnostic odds ratio, Youden index, and area under the receiver-operating characteristic curve.

RESULTS

statistical differences between genders were observed for activities of moderate intensity and for total physical activity. Age was negatively correlated with activities of moderate intensity and total physical activity.

CONCLUSION

the analysis of area under the receiver-operating characteristic curve for moderate intensity activities, walking, and total physical activity showed that the International Physical Activity Questionnaire present moderate capacity to correctly classify individuals with and without sedentary lifestyle.

Acurácia na inferência de diagnósticos de enfermagem de pacientes com insuficiência cardíaca

RESUMO Insuficiência cardíaca (IC) é causa frequente de internação exigindo do enfermeiro precisão na conduta clínica e adequado julgamento dos diagnósticos de enfermagem. Objetivo: verificar acurácia na determinação dos diagnósticos de enfermagem fadiga, intolerância à atividade e débito cardíaco diminuído em paciente com IC hospitalizados. Método: estudo descritivo aplicado aos enfermeiros experientes em diagnósticos de enfermagem NANDA-I e/ou IC. Avaliação da acurácia foi realizada a partir do cálculo das medidas: eficácia (E), falso negativo (FN), falso positivo (FP) e tendência (T). Foram aptos os enfermeiros com inspeção aceitável para dois diagnósticos. Resultados: o diagnóstico de enfermagem fadiga foi o mais erroneamente identificado pelos enfermeiros avaliadores. Discussão: a busca pelo aperfeiçoamento da acurácia diagnóstica reafirma a necessidade de treinamento contínuo e específico para a melhora da capacidade diagnosticadora do enfermeiro. Conclusão: o treinamento permitiu o exercício do raciocínio clínico e melhor acurácia dos enfermeiros.

Impaired gas exchange: accuracy of defining characteristics in children with acute respiratory infection

OBJECTIVE

to analyze the accuracy of the defining characteristics of the Impaired gas exchange nursing diagnosis in children with acute respiratory infection.

METHOD

open prospective cohort study conducted with 136 children monitored for a consecutive period of at least six days and not more than ten days. An instrument based on the defining characteristics of the Impaired gas exchange diagnosis and on literature addressing pulmonary assessment was used to collect data. The accuracy means of all the defining characteristics under study were computed.

RESULTS

the Impaired gas exchange diagnosis was present in 42.6% of the children in the first assessment. Hypoxemia was the characteristic that presented the best measures of accuracy. Abnormal breathing presented high sensitivity, while restlessness, cyanosis, and abnormal skin color showed high specificity. All the characteristics presented negative predictive values of 70% and cyanosis stood out by its high positive predictive value.

CONCLUSION

hypoxemia was the defining characteristic that presented the best predictive ability to determine Impaired gas exchange. Studies of this nature enable nurses to minimize variability in clinical situations presented by the patient and to identify more precisely the nursing diagnosis that represents the patient's true clinical condition.

Clinical Validation of the “Sedentary Lifestyle” Nursing Diagnosis in Secondary School Students

This study clinically validated the nursing diagnosis of “sedentary lifestyle” (SL) among 564 Brazilian adolescents. Measures of diagnostic accuracy were calculated for defining characteristics, and Mantel–Haenszel analysis was used to identify related factors. The measures of diagnostic accuracy showed that the following defining characteristics were statistically significant: “average daily physical activity less than recommended for gender and age,” “preference for activity low in physical activity,” “nonengagement in leisure time physical activities,” and “diminished respiratory capacity.” An SL showed statistically significant associations with the following related factors: insufficient motivation for physical activity; insufficient interest in physical activity; insufficient resources for physical activity; insufficient social support for physical activity; attitudes, beliefs, and health habits that hinder physical activity; and insufficient confidence for practicing physical exercises. The study highlighted the four defining characteristics and six related factors for making decisions related to SL among adolescents.

Validation of educational hypermedia about peripheral venipuncture

The objective was to validate an educational hypermedia about peripheral venipuncture. This is a methodological study, conducted from January to October 2012, among nursing specialists and students. Binomial and paired t-tests were used for the analysis, where values of p<0.05 were considered statistically significant. The hypermedia content was considered effective by the specialists, because the values of the proportion among the specialists were greater than 85%. The hypermedia was classified as "very good" and "good" by 92.3% and 7.7% of students, respectively. It was deemed to be a resource that facilitates and complements the teaching-learning process. The hypermedia will assist the practice of nursing in the area of peripheral venipuncture, providing opportunities for future nurses to be qualified and able to promote health among the patients in their care.

Construction and validation of indicators and respective definitions for the nursing outcome Swallowing Status

OBJECTIVE

to develop indicators for the nursing outcome Swallowing Status and the respective conceptual and operational definitions validated by experts and in a clinical setting among patients after having experienced a stroke.

METHOD

methodological study with concept analysis and content and clinical validations. The Content Validation Index was verified for the scores assigned by 11 experts to indicators. Two pairs of nurses assessed 81 patients during the clinical validation: one pair used an instrument with definitions and the other used an instrument without definitions. The resulting assessments were compared using Intraclass Correlation Coefficient, Friedman's test, and Minimal Important Difference calculation.

RESULTS

All the indicators, with the exception of the indicator Ability to bring food to mouth, presented Content Validation Index above 0.80. The pair using the instrument with definitions presented an Intraclass Correlation Coefficient above 0.80 for all the indicators and similarity was found in all the assessments, according to the Minimal Important Difference calculation. The pair using the instrument without definitions presented a low coefficient (ρ<0.75) for all the indicators.

CONCLUSION

the results showed that greater uniformity and accuracy was achieved by the pair of nurses using the conceptual and operational definitions for the indicators of the nursing outcome Swallowing Status.

Clinical factors predicting risk for aspiration and respiratory aspiration among patients with Stroke

Objective:

to investigate the association of risk factors with the Risk for aspiration nursing diagnosis and respiratory aspiration.

Method:

cross-sectional study assessing 105 patients with stroke. The instrument used to collect data addressing sociodemographic information, clinical variables and risk factors for Risk for aspiration. The clinical judgments of three expert RNs were used to establish the diagnosis. The relationship between variables and strength of association using Odds Ratio (OR) was verified both in regard to Risk for aspiration and respiratory aspiration.

Results:

risk for aspiration was present in 34.3% of the patients and aspiration in 30.5%. The following stood out among the risk factors: Dysphagia, Impaired or absent gag reflex, Neurological disorders, and Impaired physical mobility, all of which were statistically associated with Risk for aspiration. Note that patients who develop such a diagnosis were seven times more likely to develop respiratory aspiration.

Conclusion:

dysphagia, Impaired or absent gag reflex were the best predictors both for Risk for aspiration and respiratory aspiration.

PROMOÇÃO DA SAÚDE E POLÍTICAS PÚBLICAS DO ÁLCOOL NO BRASIL: REVISÃO INTEGRATIVA DA LITERATURA

O uso nocivo de álcool é um grave problema de saúde pública que traz consequências negativas para o indivíduo, a família e a sociedade. O estudo teve como objetivo investigar a inserção da promoção da saúde no contexto das políticas públicas do álcool no Brasil. Realizou-se uma revisão integrativa da literatura e foram selecionados quatro documentos oficiais e quinze artigos para análise. Os critérios de inclusão foram: ser artigo completo de pesquisa; estar publicado nos idiomas português, inglês ou espanhol; estar disponível eletronicamente e abordar a temática em estudo. As políticas públicas do álcool abordam a promoção da saúde de modo ainda pontual, com estratégias direcionadas à redução de danos. A literatura ressalta a necessidade de reformulação das políticas públicas do álcool de forma a priorizar a promoção da saúde e a assistência nos diversos níveis de atenção à saúde para grupos vulneráveis, tais como mulheres, adolescentes e indígenas.

Defining the key clinical indicators for ineffective breathing pattern in paediatric patients: a meta-analysis of accuracy studies

AIMS AND OBJECTIVES

The purpose of this study was to identify the key clinical indicators of ineffective breathing pattern among paediatric patients.

BACKGROUND

When nurses perform clinical reasoning, certain characteristics represent the clinical indicators necessary to confirm the presence of a particular diagnosis. Some quantitative studies have reported the prevalence of ineffective breathing pattern in different samples of patients. However, these findings should be synthesised.

DESIGN

Meta-analysis of quantitative nursing studies.

METHODS

Studies were identified via systematic searches of CINAHL, LILACS, PubMed and Scopus using the key search terms 'ineffective', 'breathing' and 'pattern'. Additional quality-related inclusion criteria were gleaned from the Cochrane Collaboration for Systematic Reviews of Diagnostic Test Accuracy, the Standards for Reporting of Diagnostic Accuracy and the Quality Assessment of Diagnostic Accuracy Studies. The pertinent results from each study were extracted and analysed via meta-analysis.

RESULTS

Six studies using paediatric populations met the inclusion criteria. Summary measures indicated that the following defining characteristics had the highest accuracy values for ineffective breathing pattern among children: bradypnoea, dyspnoea, nasal flaring, orthopnoea, tachypnoea and the use of accessory muscles to breathe.

CONCLUSION

This meta-analysis provides information regarding the accuracy of the clinical indicators of ineffective breathing pattern from studies sampling diverse paediatric populations.

RELEVANCE TO CLINICAL PRACTICE

Nurses can better use clinical indicators to infer the presence of ineffective breathing pattern when they are aware of the most relevant defining characteristics. Nursing students and professionals can also improve their critical thinking abilities and diagnostic reasoning based on these findings.

Profile of nursing diagnoses in patients with respiratory disorders

OBJECTIVE

Identify the profile of nursing diagnoses in patients with respiratory disorders.

METHODOLOGY

A descriptive and cross-sectional study involving 38 patients with respiratory problems, of referral hospitals, in a city in northeastern Brazil, in the period from August to October, 2012. Data collection was performed using a form and diagnostic inference was made according with the Taxonomy II of NANDA I.

RESULTS

The average age of the patients was 46 years and males predominated (60.5%). The most frequent nursing diagnoses were: Risk for infection (97.3%), Acute pain (68.4%), Poor knowledge (68.4%), Sedentary lifestyle (65.7%), Ineffective airway clearance (65.7%), Risk-prone health behavior (63.1%), Activity intolerance (52.6%) and Disturbed sleep pattern (33.3%). Evaluated patients exhibited an average of 8.6 nursing diagnoses (SD = 2.8). With respect to the defining characteristics and related factors the average per person was 7.2 and 9.3, respectively.

CONCLUSION

In this group of patients the most frequent diagnoses were the domain activity/rest. Knowledge of nursing diagnoses profile presented by people with respiratory disorders is important, because it is part of the Nursing Process and nurses who take care of such patients should exercise them in their care practice. Knowledge of the mains nursing diagnosis presented by patients with respiratory disorders are important for the practice of nurses who care for these patients, because it allows the choice of responses to problems of their clientele.