Sistemas de classificação de enfermagem e sua aplicação na assistência: revisão integrativa de literatura

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.

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.

Instrument to assess the nursing care product: development and content validation

OBJECTIVES

develop and validate the content of a tool about nursing care production.

METHOD

the data were collected between 2011 and 2013, based on focus groups, the application of semistructured questionnaires (prototype test) and the Delphi technique. The focus groups were used to produce the instrument items and held at three hospitals in the interior of the State of São Paulo, involving 20 nurses. A panel of 10 experts evaluated the instrument.

RESULTS

after two phases of the Delphi technique, the tool consisted of eight items. The content validity index of the scale corresponded to ≥0.9 and the content validity of the items ranged between 0.8 and 1.0, indicating the maintenance of the structure and content. The assertion on the applicability in daily nursing practice showed a content validity index of the scale equal to 0.8.

CONCLUSION

this study permitted the development and content validation of scale on nursing care production, equipping the nurses in their management practice.

Construction and validation of nursing diagnoses for people in palliative care

Objective:

to construct and validate nursing diagnoses for people in palliative care based on the Dignity-Conserving Care Model and the International Classification for Nursing Practice.

Method:

a two-stage methodological study: 1) construction of the database of clinically and culturally relevant terms for the nursing care for people in palliative care and 2) construction of nursing diagnoses from the database of terms, based on the guidelines of the International Council of Nurses.

Results:

the 262 terms validated constituted a database of terms from which 56 nursing diagnoses were developed. Of these, 33 were validated by a group of 26 experts, and classified in the three categories of the Dignity-Conserving Care Model: illness-related concerns (21); dignity-conserving repertoire (9); and social dignity inventory (3).

Conclusion:

of the 33 validated diagnoses, 18 of them could be included in the update of the Catalog of the International Classification for Nursing Practice - palliative care for a dignified death. The study contributes to support the clinical reasoning and decision making of the nurse.

Nurse's training centred on professional practice: perception of students and professors

Objective

To analyse the perception of students and nurses regarding the insertion of students in the professional nursing practice.

Method

Exploratory research with a qualitative approach based on the analysis of evaluation documents completed by students and professors of the nursing course. In this study, all the documents completed by the professors and students were used and analysed using thematic content analysis.

Results

The identified nuclei of meaning led to the following themes: "Learning from the professional context" and "The teaching and learning process: strategies used".

Conclusion

The study revealed the importance of integrating students in the hospital context to enhance learning and allow greater approximation with the reality of the nursing profession. The partnership between education and service was also highlighted, which stresses the need for permanent education that serves as a tool of reflection for professors and nursing professionals, and enhances curricular reorganisation.

Nursing terminology as a work process instrument of nurses in collective health

OBJECTIVE

To analyze the use of nursing terminology as an instrument of the nursing work process in Collective Health.

METHOD

Exploratory case study. For data collection was conducted a group interview with 24 nurses working in health units of a municipality in south central Paraná, Brazil. Data were analyzed in the light of interdependence between the structural, particular and singular dimensions contained in the Theory of Nursing Praxis Intervention in Collective Health.

RESULTS

The situations interfering with improper use were the lack of knowledge about the origin and purpose of terminology, lack of training, and non-mandatory use.

CONCLUSION

Although the nursing terminology is used as an instrument in the nursing work process in collective health, it requires training to be recognized as a classification system. At the same time, institutional policies should be employed to ensure the effective use of these instruments.

OBJETIVO

Analisar a utilização de terminologia de enfermagem como instrumento do processo de trabalho do enfermeiro em Saúde Coletiva.

MÉTODO

Estudo de caso exploratório. Para coleta de dados foi realizada entrevista em grupo com 24 enfermeiros que atuam nas unidades de saúde de um município no centro-sul do Paraná, Brasil. Os dados foram analisados à luz da interdependência entre as dimensões estrutural, particular e singular contidas na Teoria da Intervenção Práxica de Enfermagem em Saúde Coletiva.

RESULTADOS

As situações que interferiram na utilização inadequada foram o desconhecimento sobre origem e finalidade da terminologia, a falta de treinamento e a não obrigatoriedade de uso.

CONCLUSÃO

A terminologia de enfermagem, apesar de utilizada como instrumento no processo de trabalho de enfermeiros em Saúde Coletiva, necessita de capacitação para ser reconhecida como sistema classificatório. Ao mesmo tempo, políticas institucionais devem ser empregadas no intuito de garantir a efetiva utilização destes instrumentos.

Aplicabilidade dos resultados de enfermagem em pacientes com insuficiência cardíaca e volume de líquidos excessivo

RESUMO Objetivo Testar a aplicabilidade clínica da Nursing Outcomes Classification em pacientes com insuficiência cardíaca descompensada e Diagnóstico de Enfermagem Volume de Líquidos Excessivo. Métodos Estudo longitudinal conduzido em duas etapas em um hospital universitário no ano de 2013. Na primeira etapa, utilizou-se a validação por consenso de especialistas para selecionar os resultados de enfermagem e os indicadores relacionados ao diagnóstico de enfermagem; na segunda, foi realizado um estudo longitudinal para avaliação clínica dos pacientes, utilizando-se o instrumento contendo os resultados e indicadores produzidos no consenso. Resultados Foram realizadas avaliações em 17 pacientes. Na avaliação clínica, mensuraram-se os resultados de enfermagem através da avaliação de seus indicadores. Seis resultados apresentaram aumento nos escores, quando comparados às médias da primeira e da última avaliação. A utilização da Nursing Outcomes Classification na prática clínica demonstrou melhora dos pacientes internados por insuficiência cardíaca descompensada. Conclusão A Nursing Outcomes Classification foi sensível às alterações no quadro clínico dos pacientes.

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

Os sistemas de linguagens padronizadas são instrumentos importantes para lidar com a crescente complexidade do cuidado de enfermagem. Neste artigo os autores apresentam os principais benefícios que o uso desses sistemas oferece para o raciocínio clínico requerido no cuidado de enfermagem, para a construção e organização do conhecimento da disciplina e para a prática clínica de enfermagem. As potenciais contribuições dos sistemas de linguagens padronizadas nesses campos derivam do fato de tais sistemas oferecerem estrutura formal para apoiar o raciocínio clínico, organizar o conhecimento e a experiência de enfermagem.

Brazilian validation of the nursing outcomes for acute pain

PURPOSE

Validate the outcomes from the Nursing Outcomes Classification (NOC) for the Acute Pain nursing diagnosis.

METHODS

The content validation of the seven NOC outcomes and their respective indicators was performed using an adaptation of Fehring's model and was analyzed by descriptive statistics.

FINDINGS

Six were classified as critical and one was classified as supplemental. From the total of 118 indicators, 103 were validated. Of these, 27 were classified as critical and 76 as supplemental.

CONCLUSIONS

The use of the NOC is a viable alternative for the assessment and identification of best practices in nursing care.

CLINICAL RELEVANCE

Validation studies of nursing classifications corroborate the use of the component elements of these instruments in a variety of care settings.