Navegando por Palavras-chave "Diagnóstico De Enfermagem"
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- ItemSomente MetadadadosAdaptação transcultural para a língua portuguesa do Brasil de um guia autoinstrucional para avaliação do raciocínio clínico de estudantes de enfermagem(Universidade Federal de São Paulo (UNIFESP), 2020-05-28) Guandalini, Lidia Santiago [UNIFESP]; Barros, Alba Lucia Bottura Leite De [UNIFESP]; Universidade Federal de São PauloIntroduction The use of clinical reasoning prompts (CRP) for nursing students can increase their diagnostic accuracy during the resolution of case studies, contributing to the teaching-learning process and patient safety. Objective: To estimate the validity of the CRP for assessing the clinical reasoning of nursing students. Method: A methodological study of translation and cross-cultural adaptation into Brazilian Portuguese of: 1) CRP; 2) case studies; 3) a questionnaire on students’ perceptions during decision making in case studies; 4) a scoring manual to correct the case studies. To carry out translation and cross-cultural adaptation, steps 1 to 8 of the Guidelines for Establishing Cultural Equivalency of Instruments of the Research Diagnostic Criteria for Temporomandibular Disorders (RDC/TMD) Consortium Network were adopted: 1) Translation from the original language to the target language; 2) Synthesis and resolution of discrepancies of the two or more translations; 3) Back translation; 4) Review of back translation by the author of the original instrument; 5) Review and iterative development related to items with translation and back-translation problems; 6) Consolidation of all translation and assessment in a single instrument suitable for internal assessment; 7) Review by a committee of experts regarding cultural equivalence and content validity (clarity and practical relevance). The agreement values among experts > 80% and content validity coefficient (CVC)> 0.8 were considered satisfactory; 8) Preparation of the pre-final instrument and 9) Pre-test: randomized clinical trial with 24 nursing students (Intervention Group, n=14, using CRP to solve case studies and Control Group, n=10, without using the CRP). Results: the GARC was translated and adapted to the Portuguese language in Brazil, being placed for the location of agreement between the judges above 80% and the CVC above 0.80 with respect to content validity. Regarding face validation, adequate agreement was obtained in the assessment by the students. In the pre-test, there was no difference in the accuracy of nursing diagnoses between the Intervention and Control groups. Conclusion: The GARC was translated and adapted to the Portuguese spoken in Brazil and indicated according to the indication of face and content. The preliminary use of GARC, however, was not associated with an improvement in the diagnostic accuracy of nursing students.
- ItemSomente MetadadadosDiagnósticos de enfermagem de alta acurácia em pessoas com insuficiência cardíaca(Universidade Federal de São Paulo (UNIFESP), 2020-08-27) Souza, Larissa Maiara Da Silva Alves [UNIFESP]; Barros, Alba Lucia Bottura Leite De [UNIFESP]; Universidade Federal de São PauloIntroduction: Heart failure (HF) is a complex clinical syndrome secondary to cardiac structural and functional abnormalities. The existence of comorbidities such as hypertension, diabetes, physical inactivity and dyslipidemia and non-adherence to drug and non-drug treatment, as well as a lack of knowledge of the exacerbation symptoms of the disease are associated with hospitalizations. It is estimated that around 2 million new cases appear worldwide each year. In 2018, there were 200,814 hospital admissions registered in the Unified Health System (UHS) associated with HF, with 9,156 admissions registered in the state of São Paulo. Today, approximately 5.1 million Americans have HF. It is believed that this number tends to increase 46% by 2030, reaching eight million individuals diagnosed with HF. In this scenario, the performance of nursing can be circumstantial. When identifying the nursing diagnoses (ND) associating them to clinical signs and symptoms, the nurse unifies the individual's needs so that the elaborated interventions are aimed at solving these identified NDs. These diagnoses, when elaborated in an accurate way, make possible a more assertive care, with higher rates of resolution, reduction of complications and improvement of health status. The Nursing Diagnosis Accuracy Scale version-2 (NDAS-2) assesses the degree to which the statement of the ND is confirmed through a set of clinical information of the patient being used to measure the degree of accuracy of the listed NDs. Objectives: to identify highly accurate NDs present on admission and discharge of patients hospitalized for HF; identify the prevalence of NDs on admission and discharge from patients hospitalized for HF; test the reliability of the NDAS-2 within the between evaluators regarding the degree of accuracy of the diagnoses; Method: prospective cohort of diagnostic accuracy conducted in the Emergency Room of a large reference hospital in cardiology in a Brazilian metropolis, from August 2018 to July 2019, 155 patients hospitalized for HF participated in the research. Socio-demographic, clinical and drug treatment data were collected from an instrument developed by the researchers and previously tested. Subsequently, two researchers applied EADE-2 to NDs registered on admission and discharge of hospitalized HF patients. The variables were presented by means of descriptive statistics (absolute and relative frequencies) and by mean ± standard deviation. Fisher's exact test was used and associations with a descriptive level≤0.05 were considered significant. To assess the agreement between the evaluators, the Kappa coefficient was used, which varies from 0 to 1, and the closer to one, the greater the agreement. Results: The average age of hospitalized patients was 62.6 years, the majority being male (61.3%), white (54.19%) and incomplete elementary school (49.03%). The predominant hemodynamic profile was B (73.5%), the most frequent etiologies were cardiomyopathies (19.4%) and chagas disease (16.1%), with 25.16% not having a classification. Acute coronary syndrome was the most frequent pathology, observed in 43 patients (27.7%), the most prevalent comorbidities were hypertension (74.19%), diabetes (40.64%) and dyslipidemia (40.64%). Among the 18 NDs identified, four were prevalent both at admission and at discharge: Risk for Infection, Risk for Fall, Risk for decreased cardiac output and Fluid volume excess. These DEs had a good agreement between evaluators, with the Fluid volume excess being the one with the highest correlation at admission (0.7) and at discharge (0.9). Considering all NDs 85% were classified as highly accurate on admission and about 66% on hospital discharge. The NDs that stood out in this high accuracy classification were: Risk for Infection and Risk for decreased cardiac output on admission; and at discharge, he kept the Risk for infection together with the Risk for fall. Conclusion: The results of the study possibled to identify highly accurate nursing diagnoses. In addition, ND Risk for infection was the most prevalent and highly accurate, although it is not directly related to pathology such as the Risk for decreased cardiac output and the Fluid volume excess that are NDs related to the pathophysiological conditions of HF, demonstrating that there is the need to prioritize those NDs of greater clinical relevance in critical situations such as admission and discharge. Considering that nurses, through signs and symptoms, physical examination, laboratory and image exams, can identify other NDs, and thus make decisions in view of the current and real conditions of patients, the identification of highly accurate NDs will help them during systematic care, enabling appropriate nursing planning and care.
- ItemSomente MetadadadosElaboração e validação de um estudo de caso para o desenvolvimento do raciocínio diagnóstico de estudantes e enfermeiros(Universidade Federal de São Paulo (UNIFESP), 2020-09-24) Leandro, Daniela Luana Fernandes [UNIFESP]; Lopes, Juliana De Lima [UNIFESP]; Universidade Federal de São PauloIntroduction: Case studies are teaching tools that can be used for the development and improvement of diagnostic reasoning, contributing to an evidence-based nursing practice and with better health indicators for the patient. Therefore, they must be prepared based on the literature and their content must be validated. In the literature, there are few validated case studies and, to the best of our knowledge, none addressing peripheral arterial disease (PAD). Due to the high prevalence of this disease in the world population, it is relevant that nurses are able to identify the human responses common to patients with PAD. Objective: Develop and validate a case study to assist in the development of the diagnostic reasoning of students and nurses. Method: Methodological study, carried out in three stages: 1) preparation of the case study; 2) content validation of the case study and identification of the nursing diagnoses present; 3) assessment of diagnostic accuracy and establishment of priority diagnosis. This study was approved by the Unifesp Research Ethics Committee, Protocol 1550/2017. Participants: Twelve nurses specialized in Nursing Process selected according to pre-defined criteria. Results: The case study was based on a narrative review of the literature, which allowed the identification of clues related to the most frequent nursing diagnoses (ND) in patients with PAD, selected as the central health problem of the case. For the construction of the case, Lunney's eight assumptions were followed for the elaboration of case studies. The content of the case study was validated in the second evaluation round and the experts identified 18 ND with different degrees of accuracy. The most frequent diagnoses were: ineffective peripheral tissue perfusion (100%), impaired ambulation (83%), impaired comfort (50%) and chronic pain (50%). The diagnosis considered a priority by all specialists was "Ineffective peripheral tissue perfusion". Conclusion: The validated case study can be used by students and nurses to facilitate the development of diagnostic reasoning and critical thinking in the context of care practice, teaching and research.
- ItemSomente MetadadadosFatores Preditores Do Diagnóstico De Enfermagem Padrão Respiratório Ineficaz Em Pacientes De Uma Unidade De Terapia Intensiva(Universidade Federal de São Paulo (UNIFESP), 2017-11-30) Prado, Patricia Rezende Do [UNIFESP]; Lopes, Juliana De Lima [UNIFESP]; Universidade Federal de São Paulo (UNIFESP)Objective: To identify the prevalence, the related factors (RF), the defining characteristics (DC), the accuracy measures and the predictive factors of the nursing diagnosis of ineffective breathing pattern (IBP) in adults and elderly patients of an intensive care unit). Method: this thesis consists of two articles, an integrative review of the literature and a cross sectional paper. The integrative review aimed to identify the DC and RF of the IBP diagnosis. Articles were used between the years 1980 and 2016, which presented these indicators in newborns, children, adults and the elderly. The research question was formulated using the PICOT (Patient, Intervention, Comparation, Outcomes and Time) strategy. The quality of the articles was evaluated by the New Castle Ottawa scale. The cross-sectional study aimed to identify the prevalence, RF, DC, accuracy measures and predictive factors of IBP. For this, the sample consisted of adults and elderly patients hospitalized in an ICU in the city of Rio Branco, Acre. To be considered as having IBP, patients should present three or more defining characteristics (DC), as well as having a low inspiratory pressure obtained by the manovacuometer test. The patients were divided into two groups, with and without the IBP diagnosis. The independent variables were identified in the NANDA International classification (NANDA-I), literature (bronchial secretion, cough, decreased vesicular murmurs, altered respiratory depth and auscultation with adventitious sounds) and included some variables of interest identified in the clinical practice of researchers (age, medical diagnosis and smoking). Data were analyzed descriptively by means of absolute and relative frequencies. For all defining characteristics and related factors of dichotomous nature, accuracy measurements were presented through sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV). In order to evaluate the simultaneous effects of the defining characteristics and related factors (predictor variables), on the presence of IBP (dependent variable), logistic regressions were adjusted. For the final model, having as predictors the related factors, the fitting adequacy of the final model was evaluated by Hosmer and Lemeshow test. Sensitivity and specificity were calculated from the ROC curve. Results: In the integrative literature review, the main RF identified in children was bronchial secretion (81.8%), followed by hyperventilation (22.4%). The main DC were: dyspnea (97,9%), tachypnea (82,9%), cough (74,3%), use of accessory breathing muscles (70,3 %), orthopnea (69,9%) and adventitious noise (67,5%). In adults, the main RF were fatigue (28.8%), pain (17.5%) and obesity (16.7%). The main DC were dyspnea (40.3%), tachypnea (16.7%) and orthopnea (15.6%). In the cross-sectional study, of the 120 patients, 67.5% presented IBP. In the univariate analysis, the variables that were associated with this nursing diagnosis were: group of disease (p = 0.008), RFs fatigue (p <0.001), obesity (p = 0.01) and secretion in the bronchi (p = 0.01), and the DC were changes in respiratory depth, auscultation with adventitious sounds, dyspnea, decreased vesicular murmurs, tachypnea, cough and use of accessory musculature to breathe, all with p-value <0.001. The DC decreased vesicular murmurs had high sensitivity (92.6%), specificity (97.4%), negative predictive value (86.4%) and positive (98.7%) and mean age of patients with positive IBP was higher than those with negative PRI (p = 0.003). The predictive factors of IBP in this ICU were: fatigue (OR = 61.96, p <0.001), age (OR = 1.06, p = 0.001) and group of diseases as the cardiocirculatory system (OR=0,07; p=0,02), trauma (OR=1; p=0,013) and other diagnoses (OR=0,15; p=0,009). Conclusion: Fatigue, age and group of diseases were predictors of IBP nursing diagnosis in this intensive care unit. Decreased vesicular murmurs, auscultation with adventitious sounds, and cough may be defining characteristics to be added in the NANDA-I classification, as well as secretion in the bronchi and group of disease as a related factor. It is emphasized the importance of investigating and identifying early these predictive factors with the intention of planning and implementing a care to improve the prognosis of patients with this nursing diagnosis.