Contribuição das linguagens padronizadas para a produção do conhecimento, raciocínio clínico e prática clínica da Enfermagem

Indicadores clínicos da Nursing Outcomes Classification para avaliar o paciente submetido à biópsia renal percutânea

Objetivos: selecionar indicadores clínicos dos resultados de Enfermagem Coagulação Sanguínea (0409), Estado Circulatório (0401), Gravidade da perda de Sangue (0413), Nível de dor (2102) e Estado de Conforto: físico (2010) da Nursing Outcomes Classification e elaborar suas definições conceituais e operacionais para avaliação de pacientes submetidos à biópsia renal percutânea. Método: estudo de consenso de especialistas realizado em um hospital universitário do Sul do Brasil. A amostra foi de 12 especialistas. A coleta de dados ocorreu por meio de formulário eletrônico no Google Forms, no qual foram listados os indicadores clínicos a serem selecionados para avaliar pacientes submetidos ao procedimento de biópsia renal. Foram selecionados os indicadores que obtiveram concordância mínima de 80% entre os especialistas. Os dados foram organizados em um quadro para a elaboração das definições de cada indicador. Resultados: foram selecionados 11 indicadores clínicos: sangramento, hematoma, hematúria, pressão arterial sistólica, pressão arterial diastólica, distensão abdominal, palidez da pele e das mucosas, dor relatada, expressões faciais de dor, bem-estar físico e posição confortável. Posteriormente, com base na literatura, foram elaboradas as definições conceituais e operacionais para esses indicadores. Conclusão: os indicadores clínicos selecionados estão em consonância com as possíveis complicações da biópsia renal percutânea descritas na literatura, podendo auxiliar os enfermeiros na avaliação dos pacientes submetidos ao procedimento. Infere-se que as definições conceituais e operacionais reduzem a subjetividade e facilitam avaliações mais acuradas dos pacientes na prática clínica.

Nursing outcomes and interventions associated with the nursing diagnoses: Risk for or actual frail elderly syndrome

PURPOSE

To clinically validate nursing outcomes and interventions associated with the nursing diagnoses of Risk for Frail elderly syndrome or Frail elderly syndrome.

METHODS

This cross-sectional study utilized an instrument containing assessment cues, nursing diagnoses, outcomes, and interventions in a sample of 28 older adults. The Generalized Estimation Equation model, complemented by the Bonferroni test, was used for statistical analysis.

RESULTS

Twenty-three (82%) older adults were diagnosed with Risk for Syndrome and five (18%) with Frail elderly syndrome. Ten outcomes and three interventions were validated with significant differences statistically.

CONCLUSIONS

The clinical validation made it possible to demonstrate the clinical evolution of these patients under follow-up.

IMPLICATIONS FOR NURSING PRACTICE

Those outcomes and interventions are a linkages proposal between them and the nursing diagnoses.

OBJETIVO

Validar clinicamente os resultados e intervenções de enfermagem associados ao diagnóstico de enfermagem Risco para Síndrome do Idoso Frágil ou Síndrome do Idoso Frágil. MÉTODOS: Estudo transversal que utilizou um instrumento contendo possibilidades de avaliação, diagnóstico de enfermagem, resultados e intervenções em uma amostra de 28 idosos. A análise estatística utilizou o modelo de Equações de Estimativas Generalizadas, complementado pelo teste de Bonferroni.

RESULTADOS

Vinte e três (82%) idosos foram diagnosticados com Risco de Síndrome e cinco (18%) idosos com Síndrome. Dez resultados e três intervenções foram validados com diferença estatisticamente significativa. CONCLUSÕES: A validação clínica permitiu demonstrar a evolução clínica desses pacientes em acompanhamento. Implicações para a prática de enfermagem. Esses resultados e intervenções são uma proposta de vínculo entre eles e os diagnósticos de enfermagem.

SNOMED-CT as a standardized language system model for nursing: an integrative review

OBJECTIVE

To describe the use of the Systematized Nomenclature of Medicine - Clinical Terms (SNOMED-CT) as a model for interoperability of the nursing terminology in the national and international contexts.

METHODS

This is an integrative literature review according to Cooper, which searched for articles in Portuguese, English and Spanish, published between September 2011 and November 2018 in the BVS, PubMed, SCOPUS, CINAHL, EMBASE, and Web of Science databases, ending in a sample of 15 articles.

RESULTS

The SNOMED-CT is a multi-professional nomenclature used by nursing in different care contexts, being associated with other standardized languages of the discipline, such as ICNP®, NANDA-I, and the Omaha System.

CONCLUSION

This review has shown that the use of SNOMED- CT is incipient in the national context, justifying the need to develop studies aimed at mapping the interoperability of existing systems of standardized language, especially NANDA-I, ICNP and Omaha System, in order to adapt the implementation of SNOMED-CT.

Quality indicators of the nursing process documentation in clinical practice

OBJECTIVES

to propose quality indicators for clinical nursing documentation.

METHODS

methodological study in which literature review guided the composition of an instrument for evaluating nursing documentation. Two independent professionals evaluated 204 medical records of adult patients. The analysis of this assessment generated quality indicators for clinical nursing documentation. Inter-rater agreement was analyzed by Cohen's kappa.

RESULTS

the bibliographic review, analysis by experts and pre-test resulted in 88 evaluation items distributed in seven topics; in 88.5% of the items, inter-rater agreement between strong and almost perfect (k=0.61-1.0) was observed. Analysis of the evaluations generated a global indicator and seven partial indicators of documentation quality. Compliance in the two services ranged between 62.3% and 93.4%. The global indicator showed a 2.1% difference between services.

CONCLUSIONS

seven quality indicators of clinical nursing documentation and their method of application in hospital records have been proposed.

Development of a nursing outcome for a percutaneous procedure

OBJECTIVES

To develop a nursing outcome, consistent with the standardized format of outcomes within the nursing Outcomes Classification (NOC). This outcome will include an outcome label, an outcome definition, and clinical indicators. The proposed use for this outcome is to evaluate the access site of a percutaneous procedure.

METHODS

Concept analysis with a scoping review. Initially, content experts were recruited to validate the indicators of the proposed outcome in order to complete a consensus validation. After consensus validation, a review of the proposed outcome and its indicators was completed by two of the editors of the NOC team to confirm that the outcome label, definition, and indicators were consistent with the NOC taxonomy. During this review, edits were made on the label name and definition.

FINDINGS

After a series of reviews, the initial outcome of Vascular Status: Percutaneous Procedure Access was changed to Tissue Injury Severity: Percutaneous Procedure. In addition, the original definition of the condition of an access site for percutaneous procedure by venous or arterial puncture and health of surrounding tissues was edited to: Severity of complications from a needle-puncture access through the skin and into deeper tissues. The outcome has 11 indicators to be used to formulate a target rating for use in the clinical setting. The indicators were not edited over the course of the reviews.

CONCLUSION

The proposed outcome will assist nurses in evaluating the access site of percutaneous procedures and in identifying possible complications.

IMPLICATIONS FOR THE NURSING PRACTICE

This research contributes to the refinement of the NOC taxonomy by having a new outcome that meets clinical practice needs.

Filling a gap in standardized nursing terminology. Development of a new nursing diagnosis proposal on heart failure self-care

PURPOSE

Heart failure is a highly prevalent chronic health problem associated with poor quality-of-life and negative outcomes. Self-care is a cornerstone in patients suffering from heart failure. Nurses are commonly engaged in enhancing patients' self-care behaviors, but the specific condition of deficit on self-care is not clearly identified by nurses. No nursing diagnoses focused on self-care of heart failure patients is currently available. This study aimed to develop a new nursing diagnosis that focuses on self-care in heart failure patients.

DATA SOURCES

A concept and content analysis were used. Some steps of the concept analysis were performed through an integrative literature review conducted searching in PUBMED and CINAHL databases to identify attributes, antecedents, and consequences of the diagnosis. Forty-five articles were selected from the 1450 studies found. Then, the content analysis was performed by an international panel of 29 experts. Two Delphi rounds were used to achieve consensus and an item content validity index was calculated for each diagnostic element.

DATA SYNTHESIS

Integrative review proposed four diagnostic labels, two definitions, 15 defining characteristics, and 44 related factors. After the two Delphi rounds a consensus was reached for each diagnostic indicator with a content validity index ranging from 82.8% to 100%. The nursing diagnosis-labeled heart failure self-care deficit-was validated with a definition, eight defining characteristics, 15 related factors, and five at-risk populations.

CONCLUSIONS

This diagnosis allows nurses to document patients' self-care in daily clinical practice through a standard nursing terminology, by naming this health problem, describing its etiology, and clinical manifestations.

IMPLICATIONS FOR NURSING PRACTICE

This new diagnosis is expected to assist nursing clinicians, educators, and students in clinical reasoning with the aim to improve diagnostic accuracy in identifying patients with a heart failure self-care deficit, to select the most appropriate interventions and pursue better outcomes.

Moving Beyond Nursing Standardized Language for Substance Use Problems

Nursing knowledge has been accompanied by the evolution of nursing standardized language systems (SLS) that can help nurses to systematize nursing care. We analyzed referential integrity (diagnosis, results, interventions) of substance related problems in Nursing SLS through documentary analysis: ICNP^®, NANDA-I, Nursing Intervention Classification (NIC), Nursing Outcome Classification (NOC), NANDA NIC NOC (NNN). ICNP^® has a definition of "substance abuse" but there are no clinical indicators or related factors to help formulate a diagnosis. NANDA-I does not define any related diagnosis, although it appears as related to or as a risk factor in 36 diagnoses. In NIC and NOC there are interventions and outcomes related. The phenomenon is omitted in NANDA-I and treated in a stigmatized manner by ICNP. Clear clinical indicators may be needed to help nursing diagnosis and to lead clinical reasoning.

ICNP® nursing diagnostics for people in-home care

OBJECTIVES

to identify ICNP® nursing diagnoses in people attended in a home care program.

METHODS

cross-sectional study with 131 patients of Home Health Care in a northern municipality of Minas Gerais, Brazil, applied a questionnaire based on Basic Human Needs. It was performed the identification and validation by consensus of specialists with support in Risner's diagnostic reasoning, of the nursing diagnoses of ICNP®, version 2019.

RESULTS

from 77 nursing diagnoses, most are inserted in the psychobiological needs (n = 66) and refer to the domains Nutrition; Hydration and electrolytic regulation; Cutaneous-mucous integrity; Locomotion, body mechanics and mobility; Body care; and Learning, Sociability, Recreation, and leisure. From total, forty are negative, followed by positive formulations (n = 15), clinical findings (n = 15) and risk (n = 7).

CONCLUSIONS

a profile of the nursing phenomena common to home care is presented, which can be used by nurses in clinical practice, teaching, research, and management.

Diagnósticos de enfermagem da taxonomia NANDA-I para idosos em instituição de longa permanência

Resumo Objetivo identificar diagnósticos de enfermagem da Taxonomia da NANDA-I em idosos institucionalizados. Método estudo descritivo, conduzido com 116 idosos de uma instituição de longa permanência, realizado a partir da identificação de diagnósticos de enfermagem da Taxonomia da NANDA-I em um instrumento fundamentado no modelo teórico das Necessidades Humanas Básicas e validação por especialistas com suporte no raciocínio diagnóstico de Risner. Resultados identificou-se 1.555 títulos de diagnósticos de enfermagem para os 116 idosos, com uma média de 13,4 diagnósticos por idoso. Após exclusão de repetições foram obtidos 39 títulos distintos de diagnósticos. Entre eles, 26 (66,7%) são títulos de diagnósticos reais, 13 (33,3%) títulos de diagnósticos de risco e estão classificados em 8 dos 13 domínios da taxonomia da NANDA-I. Os diagnósticos de enfermagem mais frequentes foram: risco de quedas (94,8%); síndrome do idoso frágil (91,3%) e processos familiares disfuncionais (90,5%). Conclusão e implicações para a prática o perfil de diagnósticos de enfermagem identificado pode contribuir para o incremento de indicadores sensíveis à prática de enfermagem, com o planejamento e implementação de medidas assistenciais direcionadas as reais necessidades dos idosos institucionalizados impactando na autonomia, independência e consequentemente na qualidade de vida.

International Collaboration and New Research Evidence on Nanda International Terminology

OBJECTIVES

To discuss priorities and possibilities for promoting international collaboration and new research evidence on NANDA International, Inc. (NANDA-I).

METHODS

Theoretical reflection article based on the literature and the authors' opinions on the subject matter, carried out by six research nurses.

CONCLUSIONS

International research collaboration for NANDA-I allows the improvement of research production in an actual clinical setting, especially with multicenter and validation studies, conducted by researchers from different countries. This provides for improved understanding of patients' experiences and may help to produce robust scientific evidence.

IMPLICATIONS FOR NURSING KNOWLEDGE

The generation of new evidence may lead to an increase in NANDA-I visibility and in nurses' understanding of its meaning for clinical practice and for the formulation of diagnostic hypotheses.

Conceptual and operational definition of nursing outcomes regarding the breastfeeding establishment

OBJECTIVE

to construct conceptual and operational definitions of Nursing Outcomes "Breastfeeding establishment: infant (1000)" and "Breastfeeding establishment: maternal (1001)".

METHOD

integrative literature review in the following databases: PUBMED (United States National Library of Medicine); LILACS (Latin American and Caribbean Health Sciences Literature); CINAHL (Cumulative Index to Nursing and Allied Health Literature); SciVerse SCOPUS; Web of Science; BDENF (Brazilian Nursing Database) and EMBASE (Excerpta Medica Database). The gray literature was explored to elucidate topics not covered by the articles. Of 3242 articles, 96 were selected to be read in full, and 43 were used for constructing the definitions. Five theses, three dissertations, three books and two manuals were selected.

RESULTS

all the results were reviewed. The definitions facilitated the improvement of the content proposed by the Nursing Outcomes Classification, favoring its application in clinical practice and supporting the development of research and teaching.

CONCLUSION

it was proposed to change the definition of the two outcomes, as well as to change the title of one of them to "Breastfeeding establishment: newborn & infant" (1000), modifying seven of its indicators and excluding one. For the outcome related to the mother, it was proposed to modify two indicators and exclude one.

Health education: the effectiveness of interventions in patients with heart failure

OBJECTIVES

To evaluate the effectiveness of NIC interventions "Teaching: Disease Process", "Health Education" and "Cardiac Care" in the improvement of NOC results in individuals with Heart Failure (HF), and the Nursing Diagnosis (ND) "Ineffective Health Control".

METHODS

Retrospective cohort, conducted at a Health Education in Nursing outpatient clinic. Fourteen patients with HF had follow-up for one year in six bimonthly consultations. The effectiveness of interventions was verified through the change of the result scores through the Friedman's Non-Parametric Test and Analysis of Non-Parametric Variance for repeated measures. The level of significance was 5%.

RESULTS

The interventions were implemented in consultations in a variety of activities. There was a significant improvement in the result scores until the fourth visit (p<0.001).

CONCLUSIONS

The interventions were effective in improving outcomes in patients with HF and Ineffective Health Control.

USE OF THE TERMINOLOGICAL SUBSET "COMMUNITY NURSING" FOR HYPERTENSIVE AND/OR DIABETIC USERS

ABSTRACT Objective: to determine the accuracy measures of clinical indicators of nursing diagnoses contained in the Terminological Subset "Community Nursing" for hypertensive and/or diabetic users. Method: methodological diagnostic accuracy study. The study population consisted of 363 hypertensive and/or diabetic users under follow-up care in three Health Centers in the city of Campinas, from August 2017 to February 2018. Data were collected through anamnesis. Data analysis consisted of the characterization of the population through descriptive statistics, and the analysis of clinical indicators and their respective Nursing Diagnoses was performed through accuracy measures. Results: 25 Nursing diagnoses were listed, related to 37 clinical indicators, which could be used in the hypertensive and/or diabetic population. It is emphasized that three were not contained in the Terminological Subset "Community Nursing", and it is recommended that they be introduced in the International Council of Nurses. Conclusion: through the evaluation of accuracy measures, the Terminological Subset "Community Nursing" can and should be used in Brazil in the hypertensive and/or diabetic population.

Nursing diagnoses in a home-based program: cross-mapping and NANDA-I Taxonomy

OBJECTIVE

to identify Nursing diagnoses in patients in home care by cross-mapping terms obtained in the anamnesis and clinical examination, with NANDA-I Taxonomy.

METHOD

descriptive exploratory study, transversal type, performed with 131 patients from a home health care program in northern Minas Gerais State. With the aid of an instrument based on the theoretical model of Basic Human Needs, the terms indicators of conditions that required nursing interventions were extracted. The cross-mapping of these terms was also performed with NANDA-I Taxonomy diagnoses.

RESULTS

378 terms and expressions referring to 49 different diagnoses were identified in 11 of the 13 domains of NANDA-I Taxonomy.

CONCLUSION

the profile of identified nursing diagnoses can contribute to care management and organizational processes of nurses who provide care to patients in home care.

Simpósio Nacional de Diagnóstico de Enfermagem: building a knowledge field for Nursing

OBJECTIVE

to recount the story of the Simpósio Nacional de Diagnóstico de Enfermagem (National Nursing Diagnosis Symposium), from 1991 to 2018, describing the official themes and main recommendations; and reflect on the construction, in this process, of a specific field of knowledge for Nursing.

RESULTS

the manuscript became a historical study, using official documents resulting from the thirteen Symposiums conducted in the period from 1991 to 2018 as the primary source of empirical data. The outcomes were divided into two stages, from 1991 to 1992, when the event was linked to Interest Groups in Nursing Diagnosis; and from 1996 to 2018, when ABEn Nacional took over the organization and execution of the event.

FINAL CONSIDERATIONS

the socialization and exchange of knowledge about systematization of care, Nursing Process and nursing terminologies, themes focused on SINADEn, contributed decisively to the construction of a fruitful field of knowledge for Nursing.

Elaboration and validation of an ICNP® terminology subset for patients with acute myocardial infarction

ABSTRACT Objective: To elaborate a terminological subset for the International Classification for Nursing Practice (ICNP®) for patients with acute myocardial infarction using the Activities of Living Model. Method: A methodological study which followed the guidelines of the International Nursing Council and was based on theoretical framework of the Activities of Living Model for its elaboration. Content validation was performed by 22 nursing specialists. Results: Twenty-two (22) diagnoses and 22 nursing outcomes were elaborated. Of these, 17 nursing diagnosis statements and 17 nursing outcome statements presented Content Validity Index (CVI) ≥ 0.80. Of the 113 elaborated nursing interventions, 42 reached a CVI ≥ 0.80, and 51 interventions made up the terminological subset after the expert suggestions. Conclusion: The ICNP® was suitable for use with the Activities of Living Model, having compatible terms with those used in clinical nursing practice, and valid for construction of the terminological subset for patients with acute myocardial infarction and most likely to facilitate clinical nursing judgment.

USE OF COMPUTATIONAL TOOLS AS SUPPORT TO THE CROSS-MAPPING METHOD BETWEEN CLINICAL TERMINOLOGIES

ABSTRACT Objective: to reflect on the use of computational tools in the cross-mapping method between clinical terminologies. Method: reflection study. Results: the cross-mapping method consists of obtaining a list of terms through extraction and normalization; the connection between the terms of the list and those of the reference base, by means of predefined rules; and grouping of the terms into categories: exact or partial combination or, in more detail, similar term, more comprehensive term, more restricted term and non-agreeing term. Performed manually in many studies, it can be automated with the use of the Unified Medical Language System (UMLS). Obtaining the terms list can occur automatically by natural language processing algorithms, being that the use of rules to identify information in texts allows the expert's knowledge to be coupled to the algorithm, and it can be performed by techniques based on Machine Learning. When it comes to mapping terms using the 7-Axis model of the International Classification for Nursing Practice (ICNP®), the process can also be automated through natural language processing algorithms such as POS-tagger and the syntactic parser. Conclusion: the cross-mapping method can be intensified by the use of natural language processing algorithms. However, even in cases of automatic mapping, the validation of the results by specialists should not be discarded.

Diagnóstico de enfermagem risco de sangramento como indicador de qualidade assistencial à segurança de pacientes

Resumo OBJETIVO Descrever a implantação de um indicador de qualidade assistencial associado ao diagnóstico de enfermagem de pacientes com alto risco de sangramento, com base nos resultados alarmantes de tempo de protombina (TP), tempo de tromboplastina parcialmente ativada (TTPa) e plaquetas. MÉTODOS Relato de experiência retrospectivo de ações multidisciplinares desenvolvidas em um hospital universitário. As etapas do estudo envolveram reuniões de equipes, busca de estratégias de comunicação efetiva e criação de um novo indicador de qualidade assistencial. RESULTADOS O indicador foi denominado “Conformidade do Diagnóstico de Enfermagem Risco de Sangramento”, monitorado mensalmente desde junho de 2016. A ficha técnica contempla as características e atributos do indicador. Com base nas suas análises são estabelecidos planos de ações para sua qualificação. CONCLUSÃO A implantação do indicador de qualidade assistencial associado ao diagnóstico de enfermagem aprimorou o processo de comunicação, monitoramento e cuidado de enfermagem a pacientes com risco de sangramento.

Cross-mapping of results and Nursing Interventions: contribution to the practice

OBJECTIVE

To evaluate, through cross-mapping, the correspondence of the expected results and prescriptions written by nurses among those contained in the Interventions Classifications and Nursing Results, for the diagnosis "Ineffective peripheral tissue perfusion".

METHOD

Descriptive study, using the case study and the mapping. The content of the case study was validated, with a rate of 93.75%. In the mapping of the statements of the nursing phenomena, written by the participants with the standardized language systems, a concordance index of 100% and 90% was obtained.

RESULTS

Three statements of expected results and 19 prescribed care were analyzed. Of these, four presented correspondences with the classification of results and the same number with the classification of the interventions.

CONCLUSION

The mapping allowed the correspondence of the terms adopted by the nurses with the standardized language systems and showed a didactic material to verify the pertinence of the decision making.

SEQUÊNCIA DE ROBIN ISOLADA: DIAGNÓSTICOS DE ENFERMAGEM

RESUMO Objetivo: identificar os diagnósticos de enfermagem em lactentes com Sequência de Robin isolada. Método: estudo descritivo desenvolvido em um hospital especializado em anomalias craniofaciais e síndromes relacionadas, no período de novembro de 2015 a março de 2016. Participaram 20 lactentes com Sequência de Robin isolada. Para a coleta de dados utilizou-se o histórico de enfermagem. Os diagnósticos de enfermagem foram elencados segundo a Nanda-Internacional. Para confecção dos resultados utilizou-se a análise estatística descritiva. Resultados: foram identificados oito diagnósticos, sendo cinco com foco no problema e três de risco, incluindo: risco de aspiração (n=20, 100%); risco de infecção (n=20, 100%); amamentação ineficaz (n=19, 95%); nutrição desequilibrada: menor do que as necessidades corporais (n=19, 95%); padrão ineficaz de alimentação do lactente (n=19, 95%); risco de integridade da pele prejudicada (n=18, 90%); desobstrução ineficaz das vias aéreas (n=11, 55%) e ventilação espontânea prejudicada (n=11, 55%). Conclusão: lactentes com Sequência de Robin isolada apresentaram diagnósticos de enfermagem que se relacionaram a problemas respiratórios, alimentares, de segurança e conforto e favoreceram o planejamento e implementação dos cuidados de enfermagem ao traçarem um perfil assistencial.

Subconjunto terminológico da CIPE® para assistência à mulher e à criança em processo de amamentação

Resumo OBJETIVO Descrever o processo de elaboração de um subconjunto terminológico da Classificação Internacional para a Prática de Enfermagem para assistência à mulher e à criança em processo de amamentação. MÉTODO Estudo metodológico desenvolvido em seis etapas seguindo as diretrizes recomendadas pelo Conselho Internacional de Enfermeiras(os). RESULTADO Foram elaborados 74 diagnósticos/resultados e 213 intervenções de enfermagem, classificados de acordo com o modelo teórico utilizado, a “Teoria Interativa de Amamentação”. CONCLUSÃO Acredita-se que o subconjunto poderá orientar de forma segura e sistemática os enfermeiros que trabalham na área materno-infantil, favorecendo a execução do Processo de Enfermagem e promovendo a qualidade da assistência, centrada na mulher, na criança e na família que estão vivenciando o processo de amamentação.

Jacobson and Truax Method: evaluation of the clinical effectiveness of a home care program after prostatectomy

OBJECTIVE

to exemplify the applicability of the Jacobson and Truax Method in a nursing intervention study that analyzed the effectiveness of a home care teaching program after radical prostatectomy.

METHOD

this is a descriptive study concerning the applicability of the Jacobson and Truax Method in the data analysis of a clinical trial. The intervention consisted of a teaching program for hospital discharge after radical prostatectomy through oral guidance, writing, and telephonic reinforcement. Thirty-four men participated in the intervention group and 34 men participated in the control group. A reliable index of change and clinical significance was calculated for the knowledge variable in both groups. Scatterplots were presented to demonstrate the effectiveness of the method.

RESULTS

for 30 individuals in the intervention group, the intervention presented clinically relevant change than in knowledge. In the control group, none of the 34 individuals presented clinical significance of the results related to this variable, that is, the statistical significance identified by the inferential tests did not have clinically relevant changes in the knowledge variable.

CONCLUSION

the educational intervention carried out through the combination of oral, written and telephone counseling was shown to be clinically effective in improving knowledge about home care.

Use of the Diffusion of Innovation Model in venous ulcers by specialized professionals

Objective:

To analyze the influence of the evidence and of the opinion of peers on the decisions of specialists regarding the agreement with recommendations for prevention and treatment of venous ulcer.

Methods:

This is a quasi-experimental study with two interventions: provision of studies with the evidence of the recommendations and provision of the opinion of peers, with sample of 73 specialized doctors and nurses. Delphi technique was used in the search for agreement, with three rounds.

Results:

The participants evaluated 82 recommendations organized into eight domains: evaluation of patient and wound; documentation of clinical findings; care with the wound and surrounding skin; indication of dressing; use of antibiotics; improvement of venous return and prevention of recurrence; referrals of patients; and professional training. The interventions resulted in statistically significant changes in four domains.

Conclusion:

The interventions were able to change the opinion of participants, leading them to agreement regarding the recommendations, regardless of the level of evidence.

Objetivo:

Analisar a influência das evidências e da opinião dos pares sobre as decisões dos especialistas quanto à concordância com recomendações para prevenção e tratamento de úlcera venosa.

Método:

Estudo quase-experimental com duas intervenções: fornecimento de estudos com as evidências das recomendações e opinião dos pares, com amostra de 73 especialistas médicos e enfermeiros. Utilizou-se a técnica Delphi na busca de concordância, com 3 rodadas.

Resultados:

Os participantes avaliaram 82 recomendações organizadas em 8 domínios: avaliação do paciente e de sua lesão; documentação dos achados clínicos; cuidado com a lesão e pele ao redor; indicação da cobertura; uso de antibiótico; melhoria do retorno venoso e prevenção de recidiva; encaminhamentos dos pacientes; e capacitação profissional. As intervenções resultaram em mudanças estatisticamente signifi cativas em 4 domínios.

Conclusão:

As intervenções foram capazes de modificar a posição dos participantes, levando-os para a posição de concordância a respeito das recomendações, independentemente do nível de evidência.

Conceptual definitions of indicators for the nursing outcome "Knowledge: Fall Prevention"

ABSTRACT Objective: to construct conceptual definitions for indicators of nursing outcome Knowledge: Fall Prevention, selected for evaluation of hospitalized patients with the nursing diagnosis Risk for falls. Method: integrative literature review performed in the LILACS, MEDLINE and Web of Science databases, comprising articles published in English, Spanish and Portuguese languages from 2005 to 2015. Results: the final sample of the study was composed of 17 articles. The conceptualizations were constructed for 14 indicators of nursing outcome Knowledge: Fall Prevention focused on hospitalized patients. Conclusion: the theoretical support of the Nursing Outcomes Classification (NOC), through the process of constructing the conceptual definitions of the indicators of its results, allows nurses to accurately implement this classification in clinical practice and to evaluate the effectiveness of their interventions through the change of the patients' status over time.

Accuracy of nursing diagnoses for identifying domestic violence against children

ABSTRACT Objective Identify nursing diagnoses involving a hypothetical situation of domestic violence against a child and the respective degrees of accuracy. Method An exploratory, evaluative, case study was conducted using a quantitative and qualitative approach, with data collected using an online instrument from 26 nurses working in the Municipal Health Network, between June and August 2010, in Curitiba, and also during the first half of 2014 in São Paulo. Both of these cities are in Brazil. Nursing diagnoses and interventions from the International Classification of Nursing Practices in Collective Health were provided, and accuracy was verified using the Nursing Diagnosis Accuracy Scale. Results Thirty-nine nursing diagnoses were identified, 27 of which were common to both cities. Of these, 15 were scored at the null level of accuracy, 11 at high accuracy and 1 at medium accuracy. Conclusion The difficulty the nurses had in defining diagnoses may be associated with the fact that nursing care generally focuses on clinical problems, and signs expressing situations of domestic violence against children go unnoticed. The results demonstrated the difficulty of participants in selecting the appropriate nursing diagnosis for the case in question.

Nursing diagnoses in intensive care: cross-mapping and NANDA-I taxonomy

RESUMO Objetivo: identificar diagnósticos de enfermagem em pacientes hospitalizados em UTI por meio do mapeamento cruzado de termos contidos nas anotações de enfermagem, com a Taxonomia da NANDA-I. Método: estudo exploratório descritivo, mediante análise retrospectiva dos registros de enfermagem em 256 prontuários de pacientes que estiveram hospitalizados na UTI geral de um hospital da fronteira oeste do Rio Grande do Sul. Extraíram-se, dos registros, termos que indicavam condições que demandavam intervenções de enfermagem, realizou-se mapeamento cruzado dos mesmos com os diagnósticos da Taxonomia da NANDA-I e confirmação em grupo focal de enfermeiros. Analisaram-se os dados utilizando-se estatística descritiva. Resultados: identificaram-se 832 termos e expressões que se referiam a 52 diferentes diagnósticos em nove dos 13 domínios da Taxonomia da NANDA-I. Conclusão: este estudo permitiu identificar diagnósticos de enfermagem presentes em pacientes hospitalizados na UTI, trazendo implicações para gestão do cuidado, processo de formação de especialistas na área e sistemas de informação.

Communication of nursing students in listening to patients in a psychiatric hospital

Abstract Qualitative exploratory and descriptive study with the aim of analyzing the communication of nursing students in the listening to patients in mental suffering admitted in a psychiatric hospital. The study was carried out from April to May 2013, with 23 nursing students regularly enrolled in a public higher education institution in the Southeast of Brazil. The data were collected based on artistic production and interviews, analyzed and categorized according to their thematic content. Proxemic nonverbal communication was unanimously indicated by the students based on personal-body position of face, neck, and, shoulders adopted in the listening to patients in mental suffering. The conscious use of proxemics favored clinical reasoning, improving interaction and listening in speech and thought disorders. Attentive, effective, and affective listening demands availability, control of fear, tension, anxiety, and insecurity.

Nursing diagnoses and interventions in children submitted to cochlear implantation

Abstract OBJECTIVE Identifying the main nursing diagnoses and interventions in children submitted to cochlear implant in the immediate postoperative period. METHOD A cross-sectional study conducted between February and April 2016, considering nursing history (anamnesis and physical examination) and nursing diagnoses (NANDA - International) with their respective interventions (Nursing Intervention Classification - NIC). Descriptive statistical analysis was used to construct the results. RESULTS A total of 19 children participated in this study. The main nursing diagnoses listed were: impaired verbal communication, impaired skin integrity, risk for infection, risk for falls, and risk for bleeding (n=19; 100%). Regarding the nursing interventions, the following prevailed: Improvement in communication: auditory deficit, Skin surveillance, Protection against infection, Prevention of falls and Precautions against bleeding (n=19; 100%). CONCLUSION Nursing diagnoses and interventions related to the cochlear implant postoperative period were related to communication, bleeding control, surgical wound care, infection prevention, comfort and well-being.

Diagnósticos, resultados e intervenções de enfermagem para pacientes em diálise peritoneal

Resumo Objetivo: Identificar os principais diagnósticos, resultados e intervenções de enfermagem, e validar uma proposta de plano de cuidados para pacientes em diálise peritoneal. Métodos: Estudo transversal com 68 pacientes em centro de referência para doenças renais, seguindo as etapas: elaboração dos Diagnósticos de Enfermagem a partir da NANDA-Internacional; proposta inicial de resultados e intervenções de enfermagem, conforme a Nursing Outcomes Classification e Nursing Interventions Classification; e elaboração de um plano de cuidados com validação por especialistas. Resultados: Identificaram-se seis diagnósticos com frequência acima de 50% e foram propostos 16 resultados e 35 intervenções de enfermagem. No processo de validação realizado por enfermeiros especialistas, foram selecionados oito resultados e 21 intervenções com índice de concordância muito bom (≥0,8). Conclusão: O estudo permitiu identificar diagnósticos e selecionar resultados e intervenções de enfermagem para aplicação na prática clínica, com vistas a subsidiar o processo de cuidado e o conhecimento das taxonomias de enfermagem.

Scientific evidence of dockworker illness to nursing clinical reasoning

OBJECTIVE

To identify scientific evidence of occupational illness of dockworkers published in the literature.

METHOD

systematic review of the literature, developed according to the Cochrane method. The databases searched were: Cochrane, LILACS, MEDLINE/PubMed, CINAHL and SciELO. Studies from 1988 to 2014 were selected. The data were analyzed according to the level of evidence and Strengthening the Reporting of Observational Studies in Epidemiology.

RESULTS

We included 14 studies, in which 11 (78.6%) were from international journals. The year of 2012 showed greater number of studies. All studies were classified as: Level of Evidence 4, highlighting lung cancer, musculoskeletal and ischemic diseases, causal link in chemical risks.

CONCLUSION

The development of preventive measures should especially include chemical exposure of workers applying the clinical reasoning of nurses' environmental knowledge to care for illnesses.

OBJETIVO

Identificar evidências científicas de adoecimento ocupacional do trabalhador portuário publicadas na literatura.

MÉTODO

Revisão sistemática da literatura, construída conforme o método Cochrane. As bases de dados pesquisadas foram Cochrane, LILACS, MEDLINE/PubMed, CINAHL e SciELO. Foram selecionados artigos publicados de 1988 a 2014. Os dados foram analisados conforme o Nível de Evidência e Strengthening the Reporting of Observational Studies in Epidemiology.

RESULTADOS

Foram selecionadas 14 publicações, das quais 11 (78,6%) de revistas internacionais. O ano de 2012 reuniu maior número de publicações no período de estudo. Todas as publicações pertenciam ao Nível de Evidência 4, destacando o câncer pulmonar, doenças osteomusculares e isquêmicas, com nexo causal nos riscos químicos.

CONCLUSÃO

A elaboração de medidas preventivas deve prever especialmente a exposição química do trabalhador, aplicando ao raciocínio clínico do enfermeiro um conhecimento ambiental para a assistência aos adoecimentos.

Knowledge produced from the outcomes of the "Nursing Outcomes Classification - NOC": integrative review

Objective: To identify the knowledge produced from the outcomes of the Nursing Outcomes Classification (NOC). Method: A literature review using the integrative databases: Latin American and Caribbean Health Sciences (LILACS), US National Library of Medicine (PubMed), Cumulative Index to Nursing & Allied Health Literature (CINAHL) and Scopus Info Site (SCOPUS), during the months of August and September 2014. Results: The review consisted of 21 articles that addressed different issues: Translation and Cultural adaptation (4.77%); Applicability in clinical practice (33.33%); and, Validation (63.90%). Analysis of these articles showed that the knowledge produced from the Nursing Outcomes Classification includes translation and cultural adaptation, evaluation of applicability and validation of its items. Conclusion: Considering the continuous evolution of this classification, periodic reviews should be carried out to identify the knowledge, use and effects of the NOC.

Clinical applicability of nursing outcomes in the evolution of orthopedic patients with Impaired Physical Mobility

AIM

to evaluate the clinical applicability of outcomes, according to the Nursing Outcomes Classification (NOC) in the evolution of orthopedic patients with Impaired Physical Mobility

METHOD

longitudinal study conducted in 2012 in a university hospital, with 21 patients undergoing Total Hip Arthroplasty, evaluated daily by pairs of trained data collectors. Data were collected using an instrument containing five Nursing Outcomes, 16 clinical indicators and a five point Likert scale, and statistically analyzed.

RESULTS

The outcomes Body Positioning: self-initiated, Mobility, Knowledge: prescribed activity, and Fall Prevention Behavior presented significant increases in mean scores when comparing the first and final evaluations (p<0.001) and (p=0.035).

CONCLUSION

the use of the NOC outcomes makes it possible to demonstrate the clinical progression of orthopedic patients with Impaired Physical Mobility, as well as its applicability in this context.

Concept Analysis and Content Validation of Risk of Injury to the Urinary Tract: Nursing Diagnosis

PURPOSE

To elaborate, propose, and validate risk for urinary tract injury as a nursing diagnosis.

METHODS

Methodology was divided into three phases: analysis of the concept of urinary tract injury, elaboration of the diagnosis, and validation by a group of specialists.

FINDINGS

Diagnosis label, definition, and inclusion in taxonomy were validated. In 15 risk factors proposed, 12 were validated.

CONCLUSIONS

Risk of urinary tract injury was validated as a nursing diagnosis to contemplate the vulnerability of patients using urinary catheters.

IMPLICATIONS FOR NURSING PRACTICE

Identification of these risk factors contributes to the elaboration of care plans to improve quality of care.

Construção da Matriz de Competência Profissional do enfermeiro em emergências

Objetivo: Propor Matriz de Competência Profissional para o enfermeiro atuar em serviços de emergências. Métodos: Trata-se estudo descritivo que detalha aspectos quantitativos, nominais e conceituais das competências propostas. A criação da matriz de Competência foi realizada com base na experiência profissional das pesquisadoras, evidências empíricas e literatura especializada. Resultados: A Matriz de Competências Profissionais proposta foi constituída por oito competências básicas, sendo-lhes atribuídas 31 Competências Associadas. Conclusão: A matriz proposta direciona a prática do enfermeiro em nível de excelência, diante das premissas qualidade e acesso no atendimento dos clientes em emergências.