Accuracy of the defining characteristics of respiratory nursing diagnoses in patients with COVID-19.

OBJECTIVE: To analyze the accuracy of the defining characteristics of four respiratory nursing diagnoses (ND) in patients with COVID-19 and on oxygen therapy. METHODS: This is a cross-sectional study conducted in four Brazilian public hospitals in two regions of the country. A total of 474 patients with COVID-19 receiving oxygen therapy were assessed. Latent-adjusted class analysis with random effects was used to establish the sensitivity (Se) and specificity (Sp) of the defining characteristics evaluated for each ND. RESULTS: Among the ND that constituted the study (impaired spontaneous ventilatory, impaired gas exchange, ineffective airway clearance, and dysfunctional ventilatory weaning response), the following defining characteristics had the highest simultaneous Se and Sp (>0.8): decrease in tidal volume, confusion, irritability, dyspnea, decreased breath sounds, orthopnea, impaired ability to cooperate and respond to coaching, and decrease in the level of consciousness. CONCLUSIONS: Recognizing the clinical signs that predict respiratory ND in patients affected by COVID-19 can contribute to the nurse's accurate diagnostic inference and designate the appropriate nursing interventions to achieve the desired results and avoid complications.

OBJETIVO: Analisar a acurácia das características definidoras de quatro Diagnósticos de Enfermagem (DE) respiratórios em pacientes com COVID­19 e em uso de oxigenoterapia. MÉTODOS: Estudo transversal, realizado em quatro hospitais públicos brasileiros de duas regiões do país. Foram avaliados 474 pacientes diagnosticados com COVID­19 e em uso de oxigenoterapia. A análise de classe latente ajustada com efeitos randômicos foi utilizada para estabelecer a sensibilidade (Se) e especificidade (Sp) das características definidoras avaliadas para cada DE. RESULTADOS: As características definidoras volume corrente diminuído, confusão, irritabilidade, dispneia, sons respiratórios diminuídos, ortopneia, capacidade prejudicada para cooperar e responder orientações, e nível de consciência diminuído foram as que obtiveram maior sensibilidade e especificidade simultaneamente (> 0.8) dentre os diagnósticos de enfermagem compuseram o estudo: Ventilação espontânea prejudicada, Resposta disfuncional ao desmame, Desobstrução ineficaz das vias aéreas e Troca de gases prejudicada. CONCLUSÕES: Conhecer os sinais clínicos preditores dos diagnósticos de enfermagem respiratórios em pacientes acometidos por COVID­19 pode contribuir para a inferência diagnóstica acurada do enfermeiro e designar as intervenções de enfermagem apropriadas para atingir os resultados desejados e evitar complicações.

Risk for imbalanced blood pressure pattern among incarcerated women: Middle-Range Theory.

OBJECTIVES: to develop a Middle-Range Theory for the Risk for imbalanced blood pressure pattern among incarcerated women. METHODS: theoretical development study to obtain the theoretical-causal validity of the Nursing Diagnosis Risk for unstable blood pressure. The Middle-Range Theory was developed according to six stages: establishment of the approach to developing the theory; definition of the conceptual models to be later analyzed; definition of the main conceptions; a pictorial diagram; propositions; causal relationships and evidence for practice. RESULTS: two attributes and 20 antecedents related to imbalanced blood pressure were identified, a pictorial diagram was developed, and nine theoretical propositions were presented. CONCLUSIONS: the theory developed here favors the diagnostic reasoning of nurses and contributes to planning actions to promote the cardiovascular health of incarcerated women. A new proposition for the diagnosis of Risk for unstable blood pressure was also structured with a new title, definition, and etiological factors.

Ineffective coping (00069): A Walker and Avant conceptual analysis.

PURPOSE: To analyze the diagnostic concept of "ineffective coping" (00069) proposed by NANDA-I, using Walker and Avant's framework. DATA SOURCES: The theoretical framework of Walker and Avant was used for the concept analysis. A search was performed in the Virtual Health Library portal using the keywords "ineffective coping" and "enfrentamento ineficaz." DATA SYNTHESIS: According to the literature, ineffective coping is defined as an adoption of inadequate psychosocial and behavioral strategies in response to a set of contextual stressors that negatively affect well-being and lifestyle. CONCLUSIONS: The concept created for ineffective coping has the potential to address the psychosocial elements associated with life experiences in the face of coping mechanisms. IMPLICATIONS FOR NURSING PRACTICE: This analysis may contribute to the improvement of nursing care for patients experiencing difficult situations in their lives, as well as the challenges of nursing interventions that promote positive adaptation.

OBJETIVO: Analisar o conceito diagnóstico de "Enfrentamento Ineficaz" proposto pela NANDA­Internacional, por meio do referencial de Walker e Avant. FONTE DOS DADOS: O referencial teórico de Walker e Avant foi adotado para a análise de conceito. Assim, realizou­se busca no portal da Biblioteca Virtual em Saúde, por meio das palavras­chaves "ineffective coping" e "enfrentamento ineficaz." SÍNTESE DOS DADOS: Pela literatura, o enfrentamento ineficaz é definido como uma adoção de estratégias inadequadas comportamentais e psicossociais em resposta a uma configuração de estressores contextuais que negativamente afetam o bem estar e o estilo de vida. CONCLUSÃO: O conceito criado para o enfrentamento ineficaz possui potencial em ajustar os elementos psicossociais interligados às experiências de vida perante o mecanismo de enfrentamento. IMPLICAÇÕES PARA A PRÁTICA DE ENFERMAGEM: Tal análise pode contribuir na melhoria dos cuidados de enfermagem a pacientes que estejam experienciando situações limites em suas vidas, assim como os desafios para intervenções de enfermagem que favoreçam a adaptação positiva.

Educational video for self-care with arteriovenous fistula in renal patients: randomized clinical trial.

OBJECTIVE: to evaluate the effect of an educational video on the knowledge, attitude, and practice of self-care with arteriovenous fistula in patients undergoing hemodialysis treatment. METHOD: randomized controlled clinical trial, with two arms and single-blind. The intervention used an educational video on arteriovenous fistula self-care. The Fistula Self-Care Knowledge, Attitude, and Practice Scale was applied to 27 renal patients on hemodialysis in the control group and 28 in the intervention group at baseline, after seven and fourteen days. The data was analyzed using the Statistical Package for the Social Sciences software, using the chi-square test, Student's t-test, Mann-Whitney test, and Friedman's test with post-hoc analysis for multiple comparisons. RESULTS: there were statistically significant differences in the knowledge and practice of self-care with the fistula at 0, 7 and, 14 days in the intervention (p= 0.004 and p<0.001, respectively) and control groups (p<0.001 for knowledge and practice). Attitude showed a significant difference at follow-up (p<0.001), but the post-hoc analysis did not confirm the significance obtained. CONCLUSION: patients' knowledge and practice showed significant increases at follow-up in the control and intervention groups, while the increase in attitude was not significant in either group. Clinical trial, registration number: U1111-1241-6730.

Development and Psychometric Testing of Scales of Knowledge, Attitude, and Practice of Self-Care for Patients With Arteriovenous Fistula.

Background and Purpose: To validate the scales of knowledge, attitude, and practice of self-care for arteriovenous fistulas in renal patients on hemodialysis. Methods: A methodological study verified the evidence of validity based on the content, response processes, and internal structure of the scales. The content was evaluated by six judges, and the response processes were verified with six patients. In the evaluation of the internal structure, the scales were applied to 220 patients for exploratory factor analysis with evaluation of McDonald's omega adjustment and calculation indexes. Results: The scales explained variance and McDonald's omega values of 40.4%/0.896, 60.7%/0.843, and 36.9%/0.702 for the knowledge (19 items), attitude (4 items), and practice (8 items), respectively. Conclusions: The scale of attitude was valid after the analysis of the content evidence, response processes, and internal structure. The arteriovenous fistula self-care knowledge and practice scales explained less than 50% of the constructs. Therefore, it is recommended that new studies be conducted to validate scales of knowledge and practice of fistula self-care.

Concept analysis of Neonatal Near Miss.

OBJECTIVE: To analyze the concept of Neonatal Near Miss (NNM) using Walker and Avant's method. METHOD: This study employs conceptual analysis following Walker and Avant's model, involving concept selection, objective definition, identification of potential uses, determination of attributes, model case creation, additional case consideration, antecedent identification, consequent analysis, and empirical reference examination. To elucidate the concept, a scoping review was conducted across journals indexed in scientific databases such as Web of Science, EMBASE, SCOPUS, and MEDLINE/PubMed. RESULTS: The analysis encompassed 43 articles, revealing diverse definitions of neonatal near miss across different contexts. A comprehensive definition emerged from identified antecedents: risk of death, susceptibility to adverse outcomes, and potential adverse events. These antecedents were categorized into maternal conditions, neonatal conditions, and healthcare assistance. CONCLUSION: The analysis and definition of the NNM concept was successful, and its antecedents, attributes, and consequences were delineated. IMPLICATIONS: Identifying the risk factors associated with NNM cases may contribute to reducing infant morbidity and mortality and improving the quality of care, facilitating future research and improving the use of the NNM concept.

Self-efficacy and consistent condom use by people living with HIV and seroconcordant and serodiscordant sexual partners in the Ceará, Brazil.

The objectives were to assess the self-efficacy and consistent condom use by people living with HIV (PLHIV). A cross-sectional, comparative study was carried out in outpatient clinics in Ceará State, Brazil, with a sample of 190 PLHIV, 95 serodiscordant and 95 seroconcordant. Interviews were conducted using the Socio-Demographic, Clinical, Epidemiological and Vulnerability Form and the Condom Use Self-Efficacy Scale. Descriptive analysis, associations between variables, odds ratio and 95% confidence interval were determined. P < 0.05 was considered statistically significant. Of the sample, 43.1% consistently used condoms (50.5% serodiscordant and 35.7% seroconcordant). Serodiscordant PLHIV without guidance on HIV prevention (P = 0.027) and without access to testing (P = 0.002) had lower self-efficacy and 11.5 times more chances for inconsistent condom use (P = 0.006), while those satisfied with follow-up in health were less likely to use condoms inconsistently (P = 0.011). We conclude that there is low consistent use of condoms among PLHIV, which increases the risk of HIV transmission and the acquisition of other sexually transmitted infections. Consistent condom use was greater among serodiscordant individuals, although there was no difference in self-efficacy in condom use between the groups.

Content validation of the nursing diagnosis "inadequate social support network".

OBJECTIVE: To evaluate evidence of content validity of the nursing diagnosis "inadequate social support network". METHOD: A methodological study of the content validation type, carried out with 23 judges who evaluated the adequacy of the title, definition, class and domain of the nursing diagnosis "inadequate social support network". The judges also assessed the relevance of 28 clinical indicators and 32 etiological factors, which were considered valid when the Content Validity Index was ≥ 0.9. RESULTS: The judges agreed with the proposed title and suggested changes to the definition of the nursing diagnosis. They recommended its inclusion in Domain 7 - "Roles and relationships" and Class 3 - "Role performance" of the NANDA-I taxonomy. In addition, 19 clinical indicators and 27 etiological factors were considered relevant. CONCLUSION: The nursing diagnosis "inadequate social support network" had its theoretical structure validated in terms of content, which can support the practice of nurses in the operationalization of the Nursing Process.

Educational video for self-care with arteriovenous fistula in renal patients: randomized clinical trial / Video educativo para el autocuidado de la fístula arteriovenosa en pacientes renales: ensayo clínico aleatorizado / Vídeo educacional para autocuidado com a fístula arteriovenosa de pacientes renais: ensaio clínico randomizado

Objective: to evaluate the effect of an educational video on the knowledge, attitude, and practice of self-care with arteriovenous fistula in patients undergoing hemodialysis treatment. Method: randomized controlled clinical trial, with two arms and single-blind. The intervention used an educational video on arteriovenous fistula self-care. The Fistula Self-Care Knowledge, Attitude, and Practice Scale was applied to 27 renal patients on hemodialysis in the control group and 28 in the intervention group at baseline, after seven and fourteen days. The data was analyzed using the Statistical Package for the Social Sciences software, using the chi-square test, Student's t-test, Mann-Whitney test, and Friedman's test with post-hoc analysis for multiple comparisons. Results: there were statistically significant differences in the knowledge and practice of self-care with the fistula at 0, 7 and, 14 days in the intervention (p= 0.004 and p<0.001, respectively) and control groups (p<0.001 for knowledge and practice). Attitude showed a significant difference at follow-up (p<0.001), but the post-hoc analysis did not confirm the significance obtained. Conclusion: patients' knowledge and practice showed significant increases at follow-up in the control and intervention groups, while the increase in attitude was not significant in either group. Clinical trial, registration number: U1111-1241-6730.

Objetivo: evaluar el efecto de un video educacional en el conocimiento, actitud y práctica del autocuidado de la fístula arteriovenosa de pacientes en tratamiento de hemodiálisis. Método: ensayo clínico aleatorio controlado, con dos brazos y simple ciego. La intervención utilizó un video educacional sobre el autocuidado de la fístula arteriovenosa. Fue aplicada la Escala de conocimiento, actitud y práctica del autocuidado de la fístula en 27 pacientes renales en hemodiálisis del grupo control y en 28 del grupo intervención en la línea de base, después de siete y catorce días. Los datos fueron analizados con el software Statistical Package for the Social Sciences , con la aplicación de las pruebas Chi-cuadrado, T de Student, Mann-Whitney y Test de Friedman, con análisis post-hoc para comparaciones múltiples. Resultados: se verificaron diferencias estadísticamente significativas en el conocimiento y práctica del autocuidado de la fístula en el seguimiento de 0, 7 y 14 días de los grupos intervención (p= 0,004 y p<0,001, respectivamente) y control (p<0,001 para el conocimiento y práctica). La actitud presentó diferencia significativa en el seguimiento (p<0,001), pero el análisis post-hoc no confirmó la significación obtenida. Conclusión: el conocimiento y práctica de los pacientes presentaron aumentos significantes en el seguimiento en los grupos control e intervención, en cuanto que el aumento de la actitud no fue significativo en ninguno de los grupos. Ensayo clínico, número de registro: U1111-1241-6730.

Objetivo: avaliar o efeito de um vídeo educacional no conhecimento, atitude e prática de autocuidado com a fístula arteriovenosa de pacientes em tratamento hemodialítico. Método: ensaio clínico randomizado controlado, com dois braços e unicego. A intervenção utilizou um vídeo educacional sobre o autocuidado com a fístula arteriovenosa. Foi aplicada a Escala de conhecimento, atitude e prática de autocuidado com a fístula em 27 pacientes renais em hemodiálise do grupo controle e 28 do grupo intervenção na linha de base, após sete e quatorze dias. Os dados foram analisados no software Statistical Package for the Social Sciences , com a aplicação dos testes qui-quadrado, T de Student, Mann-Whitney e Teste de Friedman com análise post-hoc para comparações múltiplas. Resultados: verificaram-se diferenças estatisticamente significantes no conhecimento e prática de autocuidado com a fístula no seguimento de 0, 7 e 14 dias dos grupos intervenção (p= 0,004 e p<0,001, respectivamente) e controle (p<0,001 para o conhecimento e prática). A atitude apresentou diferença significativa no seguimento (p<0,001), mas a análise post-hoc não confirmou a significância obtida. Conclusão: o conhecimento e prática dos pacientes apresentaram aumentos significativos no seguimento nos grupos controle e intervenção, enquanto o aumento da atitude não foi significativo em nenhum dos grupos. Ensaio clínico, número de registro: U1111-1241-6730.

Validación clínica de la propuesta diagnóstica de enfermería de sed perioperatoria / Clinical validation of the nursing diagnostic proposition perioperative thirst / Validação clínica da proposição diagnóstica de enfermagem sede perioperatória

Objetivo: verificar la validez clínica de la proposición de un nuevo diagnóstico de enfermería denominado sed perioperatoria, basado en la precisión diagnóstica de sus indicadores clínicos, incluyendo la magnitud del efecto de sus factores etiológicos. Método: estudio de validación clínica diagnóstica con 150 pacientes quirúrgicos en un hospital universitario. Se recogieron variables sociodemográficas e indicadores clínicos relacionados con la sed. Se utilizó la técnica de análisis de clases latentes. Resultados: se propusieron dos modelos de clases latentes para las características definitorias. El modelo ajustado en el preoperatorio incluía: labios resecos, saliva espesa, lengua espesa, ganas de beber agua, informe del cuidador, garganta seca y deglución constante de saliva. En el postoperatorio: sequedad de garganta, saliva espesa, lengua espesa, constante deglución de saliva, ganas de beber agua, mal gusto en la boca. Los factores relacionados "temperatura ambiente elevada" y "sequedad de boca" se asocian a la presencia de sed, así como las condiciones asociadas "uso de anticolinérgicos" e "intubación". La prevalencia de sed fue del 62,6% en el preoperatorio y del 50,2% en el postoperatorio inmediato. Conclusión: la proposición diagnóstica de la sed perioperatoria mostró buenos parámetros de precisión de sus indicadores clínicos y efectos etiológicos. Esta propuesta en una taxonomía de enfermería permitirá una mayor visibilidad, apreciación y tratamiento de este síntoma.

Objective: to verify the clinical validity of the proposition of a new nursing diagnosis called perioperative thirst, based on the diagnostic accuracy of its clinical indicators, including the magnitude of effect of its etiological factors. Method: clinical diagnostic validation study with a total of 150 surgical patients at a university hospital. Sociodemographic variables and clinical indicators related to thirst were collected. The latent class analysis technique was used. Results: two models of latent classes were proposed for the defining characteristics. The model adjusted preoperatively included: dry lips, thick saliva, thick tongue, desire to drink water, caregiver report, dry throat and constant swallowing of saliva. In the postoperative period: dry throat, thick saliva, thick tongue, constant swallowing of saliva, desire to drink water, bad taste in the mouth. The factors related to "high ambient temperature" and "dry mouth" are associated with the presence of thirst, as well as the associated conditions "use of anticholinergics" and "intubation". The prevalence of thirst was 62.6% in the pre and 50.2% in the immediate postoperative period. Conclusion: the diagnostic proposition of perioperative thirst showed good accuracy parameters for its clinical indicators and etiological effects. This proposition in a nursing taxonomy will allow greater visibility, appreciation and treatment of this symptom.

Objetivo: verificar a validade clínica da proposição de um novo diagnóstico de enfermagem denominado sede perioperatória, com base na acurácia diagnóstica de seus indicadores clínicos, incluindo a magnitude de efeito de seus fatores etiológicos. Método: estudo de validação clínica diagnóstica com 150 pacientes cirúrgicos em um hospital universitário. Foram coletadas variáveis sociodemográficas e indicadores clínicos relacionados à sede. Empregou-se a técnica de análise de classe latente. Resultados: dois modelos de classes latentes foram propostos para as características definidoras. O modelo ajustado no pré-operatório incluiu: lábios ressecados, saliva grossa, língua grossa, vontade de beber água, relato do cuidador, garganta seca e constante deglutição de saliva. No pós-operatório: garganta seca, saliva grossa, língua grossa, constante deglutição de saliva, vontade de beber água, gosto ruim na boca. Os fatores relacionados Temperatura do ambiente elevada e Boca seca estão associados à presença de sede, assim como as condições associadas Utilização de anticolinérgicos e Intubação. A prevalência de sede foi de 62,6% no pré-operatório e 50,2% no pós-operatório imediato. Conclusão: a proposição diagnóstica de sede perioperatória apresentou bons parâmetros de acurácia de seus indicadores clínicos e efeitos etiológicos. Essa proposição em uma taxonomia de enfermagem permitirá maior visibilidade, valorização e tratamento desse sintoma.

Ocular dryness in intensive care: proposal for a new nursing diagnosis.

OBJECTIVE: to analyze the concept associated with diagnostic proposition Ocular dryness in adult patients hospitalized in an Intensive Care Unit, identifying its attributes, antecedents and consequences. METHODS: a methodological study carried out through concept analysis, operationalized by scoping review. RESULTS: the analysis of 180 studies allowed the identification of two attributes, 32 antecedents and 12 consequences. The attributes were tear film deficiency and ocular signs and/or symptoms. The prevalent antecedents were incomplete eyelid closure (lagophthalmos) and blinking mechanism decrease. Major consequences included conjunctival hyperemia and decreased tear volume. CONCLUSIONS: this study allowed constructing nursing diagnosis Ocular dryness, part of domain 11, class 2, with 12 defining characteristics, 12 related factors, seven populations at risk and 13 associated conditions. This problem-focused proposal may provide targeted care by promoting early detection and implementing interventions that reduce the risk of ocular damage.

Middle range theory for the nursing phenomenon Ineffective social support network.

PURPOSE: To describe a middle range theory (MRT) with conceptual and explicative capacity of cause and effect situations of Ineffective social support network in nursing. DATA SOURCES: Descriptive study developed through the Lopes, Silva, and Herdman theoretical-causal validity method, using five steps for theory construction: definition of the approach for constructing the MRT, definition of the main concepts, development of the pictorial diagram, construction of propositions, and establishment of causal relationships and evidence for practice. The foundation of these steps and the development of a predictive nursing theory occurred through Sanicola's Social Network Theory combined with studies from an integrative literature review using the six steps proposed by Whittemore and Knafl. DATA SYNTHESIS-FINDINGS: The theory presents etiological factors and clinical indicators for Ineffective social support network, connecting situations related to the person, the members and the configuration of this network, and external situations. The pictogram, symbolically created, represents the hierarchical classification of proximal, intermediate, and distal etiological factors, and their relationship with clinical indicators. CONCLUSIONS: The MRT, predictive for the nursing phenomenon Ineffective social support network, provides understanding of the person from an interpersonal perspective, which interferes with and is affected by a network of virtues and vicissitudes, and has negative influences on health outcomes. Due to its practical vocation, this theory represents an advance in the science and praxis of nursing. IMPLICATIONS FOR CLINICAL PRACTICE: The findings of this study will contribute to the understanding of the nursing phenomenon Ineffective social support network and consequently support the identification of the nursing diagnosis Ineffective social support network, proposed for inclusion in the NANDA-I classification.

OBJETIVO: Descrever uma teoria de médio alcance (TMA) com capacidade conceitual e explicativa para situações de causa e efeito do fenômeno de enfermagem Rede social de apoio ineficaz. FONTES DE DADOS: Estudo descritivo desenvolvido por meio do método de validade teórico-causal de Lopes, Silva e Herdman, que utilizou para a construção da teoria cinco etapas: Definição da abordagem para construção da TMA, definição dos conceitos principais, desenvolvimento do pictograma, construção das proposições e estabelecimento das relações causais e evidências para a prática. Para fundamentar estes passos, e desenvolver uma teoria de enfermagem preditiva, utilizou-se a Teoria de Rede social de Sanicola e estudos provenientes de uma revisão integrative da literature, a qual seguiu os seis passos propostos por Whittemore e Knafl. SÍNTESE DOS DADOS: A teoria apresenta fatores etiológicos e indicadores clínicos para a rede social de apoio ineficaz, relacionando situações relativas à pessoa, aos membros e configuração dessa rede, e a situações externas. O pictograma, criado simbolicamente, representa a classificação hierárquica dos fatores etiológicos proximais, intermediários e distais e sua relação com os indicadores clínicos. CONCLUSÕES: A teoria de médio alcance preditiva para o fenômeno enfermagem Rede social de apoio ineficaz, permite compreender a pessoa em uma perspectiva interpessoal, que interfere e é afetada por uma rede de virtudes e vicissitudes, que pode influenciar negativamente nos resultados de saúde. Por sua vocação prática, essa teoria representa um avanço na ciência e na práxis da enfermagem. IMPLICAÇÕES PARA A PRÁTICA DE ENFERMAGEM: Os achados deste estudo contribuirão para a compreensão do fenômeno enfermagem rede social de apoio ineficaz e, consequentemente, subsidiarão a identificação do diagnóstico de enfermagem rede social de apoio ineficaz, proposto para inclusão na classificação NANDA-I.

Analysis of the health advocacy concept from the perspective of the evolutionary method.

OBJECTIVE: To analyze the concept of Health Advocacy from the methodological framework of the Evolutionary Model. METHOD: The concept of interest was evaluated from the perspective of published studies identified in the databases: Web of Science, CINAHL, EMBASE, SCOPUS, MEDLINE and articles of interest. The attributes were determined from 19 scientific productions. Data were analyzed using thematic analysis, proposed by Bardin. RESULTS: The following operational definition was obtained: Health Advocacy is an intentional action, implemented jointly and in favor of individuals and communities, especially for those who suffer from health inequalities, with the aim of preserving and improving health, well-being and empowerment for health promotion. FINAL CONSIDERATIONS: Thus, a broader concept of Health Advocacy was abstracted, from the micro to the macro, which contemplates the development of the patient's autonomy; includes individuals and groups in care plans and involves them in political activities as possibilities to provide assistance and correct health inequalities.

Clinical validation of the nursing diagnostic proposition perioperative thirst. / Validación clínica de la propuesta diagnóstica de enfermería de sed perioperatoria.

OBJECTIVE: to verify the clinical validity of the proposition of a new nursing diagnosis called perioperative thirst, based on the diagnostic accuracy of its clinical indicators, including the magnitude of effect of its etiological factors. METHOD: clinical diagnostic validation study with a total of 150 surgical patients at a university hospital. Sociodemographic variables and clinical indicators related to thirst were collected. The latent class analysis technique was used. RESULTS: two models of latent classes were proposed for the defining characteristics. The model adjusted preoperatively included: dry lips, thick saliva, thick tongue, desire to drink water, caregiver report, dry throat and constant swallowing of saliva. In the postoperative period: dry throat, thick saliva, thick tongue, constant swallowing of saliva, desire to drink water, bad taste in the mouth. The factors related to "high ambient temperature" and "dry mouth" are associated with the presence of thirst, as well as the associated conditions "use of anticholinergics" and "intubation". The prevalence of thirst was 62.6% in the pre and 50.2% in the immediate postoperative period. CONCLUSION: the diagnostic proposition of perioperative thirst showed good accuracy parameters for its clinical indicators and etiological effects. This proposition in a nursing taxonomy will allow greater visibility, appreciation and treatment of this symptom.(1) Evaluates the accuracy of the proposition of the nursing diagnosis perioperative thirst; (2) Allows refined diagnosis for use in clinical practice, teaching and research; (3) Strengthens the systematization of perioperative nursing care; (4) Highlights thirst management as part of care, considering its high prevalence and discomfort; (5) Presents a structure with good accuracy parameters which are representative of thirst.

Analysis of etiological factors of nursing diagnosis of impaired comfort in children and adolescents with cancer.

AIM: To analyse the etiological factors of the nursing diagnosis of impaired comfort in children and adolescents with cancer. DESIGN: This cross-sectional study was carried out in the referral unit for the treatment of childhood cancer in a tertiary hospital located in northeastern Brazil. METHODS: A total of 200 children and adolescents who were undergoing cancer treatment were included in this study. Data collection instruments and protocols were constructed with operational and conceptual definitions of clinical indicators and etiological factors for the nursing diagnosis of impaired comfort. A latent class model with adjusted random effects was used to determine impaired comfort and measures of sensitivity and specificity of clinical indicators. A univariate logistic regression analysis was performed for each etiological factor of impaired comfort. RESULTS: The analysis of etiological factors for the nursing diagnosis of impaired comfort in children and adolescents with cancer showed the high prevalence of four factors: noxious environmental stimuli, insufficient situational control, insufficient resources and insufficient environmental control. Illness-related symptoms, noxious environmental stimuli, and insufficient environmental control increased the chance of impaired comfort occurring. CONCLUSION: The etiological factors with the highest prevalence and most significant impact on the occurrence of impaired comfort were noxious environmental stimuli, insufficient situational control and illness-related symptoms. IMPACT: The results obtained in this investigation can support more accurate nursing diagnostic inference of impaired comfort in children and adolescents with cancer. Moreover, the results can inform direct interventions for the modifiable factors that trigger this phenomenon to avoid or minimize the signs and symptoms of the nursing diagnosis.

Accuracy of the nursing diagnosis of ineffective airway clearance in intensive care unit patients.

OBJECTIVES: to analyze the accuracy of the clinical indicators of ineffective airway clearance in adult intensive care unit patients. METHODS: diagnostic accuracy study, performed in the intensive care unit of a university hospital in northeastern Brazil. The sample consisted of 104 patients hospitalized between June and October 2019. RESULTS: the prevalence of ineffective airway clearance was 36.54%. The indicators with high specificity included absence of cough (0.8326), orthopnea (0.6817), adventitious breath sounds (0.8175), and diminished breath sounds (0.8326). The clinical indicators with high sensitivity and specificity were alteration in respiratory rate (0.9999) and alteration in respiratory pattern (0.9999). CONCLUSIONS: six clinical indicators provided an accurate identification of ineffective airway clearance. The clinical indicators alteration in respiratory rate and alteration in respiratory pattern were the most accurate for critical adult patients. The findings of this study contribute to accurate diagnostic inferences and to prevention of respiratory complications in these patients.

Ineffective health management in people with hypertension: Accuracy study.

PURPOSE: To analyze the accuracy of the clinical indicators of the nursing diagnosis Ineffective Health Management in people with hypertension. METHODS: This is a cross-sectional diagnostic accuracy study. The ineffective health management was investigated in 120 people with hypertension in a referral public outpatient clinic in Brazil between August and November 2020. The accuracy measures were analyzed using Rasch analysis, considering the difficulty of clinical indicator and person's ability. RESULTS: Ineffective health management is probably present in 37.5% of people with hypertension. 'Failure to include treatment regimen in daily living' was the clinical indicator with the highest sensitivity value, and 'failure to take action to reduce risk factor' had the highest specificity value. CONCLUSIONS: Rasch analysis demonstrated that all clinical indicators contribute significantly to estimating the presence of ineffective health management in people with hypertension in the outpatient scenario. IMPLICATIONS FOR NURSING PRACTICE: This research contributes by providing accurate clinical indicators of ineffective health management, helping nurses prescribe and deliver the appropriate nursing interventions for people with hypertension by telenursing.

Diagnostic accuracy of clinical indicators of Imbalanced nutrition in pediatric patients submitted to chemotherapy.

To analyze the accuracy of clinical indicators of nursing diagnosis, Imbalanced nutrition: less than the body requirements in pediatric patients undergoing chemotherapy. A cross-sectional study was carried out in a pediatric oncohematology unit. A total of 123 children aged 5-18 years were evaluated. The Standards for Reporting Diagnostic Accuracy Studies (STARD) protocol was used. Latent class analysis was performed to obtain sensitivity and specificity of clinical indicators. The diagnosis was identified in six children (5.23%). The most frequent clinical indicator in the study was report of food intake less than recommended daily allowance (n = 61; 49.6%), followed by excessive hair loss (n = 49; 39.8%), misperception (n = 42; 34.1%), satiety immediately upon ingesting food (n = 32; 26%), lack of information (n = 30; 24.4%), and pale mucous membranes (n = 22; 17.9%). The 10 indicators that sensitivity and specificity were statistically superior to 50% were food intake less than recommended daily allowance, misperception, insufficient interest in food, lack of food, hyperactive bowel sounds, body weight 20% or more below ideal weight range, insufficient muscle tone, food aversion, abdominal cramping, and misinformation. The clinical indicators Food intake less than recommended daily allowance and Misperception can be considered the most important indicators for the initial inference of the diagnosis due to their high values of specificity and sensitivity. It is essential that nurses provide targeted and qualified assistance based on the signs and symptoms presented by patients, as they will be able to design appropriate interventions to obtain the desired results.

Clinical validation of the nursing diagnosis "Ineffective health self-management" in people living with HIV.

OBJECTIVE: Check diagnostic accuracy of the defining characteristics of the nursing diagnosis "Ineffective health self-management" in people living with HIV. METHODS: Methodological study conducted in a specialized public service for people living with HIV in Northeastern Brazil, between February and April 2021, with a sample of 203 people. Latent class analysis was used to calculate the accuracy measurements of the defining characteristics, as well as the sensitivity and specificity values with their respective 95% confidence intervals. The likelihood ratio test (G2 ) was applied to evaluate the adequacy of the fit of the models obtained (p > 0.05). RESULTS: The prevalence of Ineffective health self-management estimated through the latent class model was 67.5%. "Exacerbation of diseases symptoms," "failure to take action that reduces risk factor," "exacerbation of diseases signs," and "ineffective choices in daily living for meeting health goal" had the highest sensitivity values (0.80-0.9429). "Exhibits disease sequelae," "inattentive to diseases signs," and "inattentive to disease symptoms" had the highest specificity values (0.9999-1.0000). CONCLUSIONS: The useful characteristics for discriminating PLHIV with and without diagnosis are "exacerbation of diseases symptoms," "failure to take action that reduces risk factor," "exacerbation of diseases signs," and "ineffective choices in daily living for meeting health goal." The diagnosis can be confirmed by the indicators "exhibits disease sequelae", "inattentive to diseases signs," and "inattentive to disease symptoms." IMPLICATIONS FOR NURSING PRACTICES: The study demonstrates the levels of importance of the defining characteristics of "Ineffective health self-management" in people living with HIV contributes to suspicion and accurate diagnostic identification of nurses and researchers.

OBJETIVO: Verificar a acurácia diagnóstica das características definidoras do Diagnóstico de Enfermagem "Autogestão Ineficaz da Saúde" em pessoas vivendo com HIV. MÉTODOS: Estudo metodológico realizado em um serviço público de atendimento para pessoas que vivem com HIV no Nordeste brasileiro, entre fevereiro e abril de 2021 com amostra de 203 indivíduos. A análise de classe latente foi utilizada para calcular as medidas de acurácia das características definidoras, bem como os valores de sensibilidade e especificidade com seus respectivos intervalos de confiança a 95%. O teste da razão de verossimilhança (G2 ) foi aplicado para avaliar a adequação do ajuste dos modelos obtidos (p>0,05). RESULTADOS: A prevalência da "Autogestão Ineficaz da Saúde" estimada pelo modelo de classe latente foi de 67,5%. "Exacerbação dos sintomas da doença", "Falha em tomar medidas para reduzir os fatores de risco", "Exacerbação dos sinais da doença" e "Escolhas ineficazes na vida diária para cumprir a meta de saúde" tiveram os mais altos valores de sensibilidade (0.803-0.9429).  "Exibir sequelas da doença", "Desatento aos sinais da doença" e "Desatento aos sintomas da doença" obtiveram os mais altos valores de especificidade (0.9999-1.0000). CONCLUSÕES: As características úteis para discriminar pessoas vivendo com HIV com e sem o diagnóstico são: "Exacerbação dos sintomas da doença", "Falha em tomar medidas para reduzir os fatores de risco", "Exacerbação dos sinais da doença" e "Escolhas ineficazes na vida diária para cumprir a meta de saúde". O diagnóstico também pode ser confirmado pelos indicadores "Exibir sequelas da doença", "Desatento aos sinais da doença" e "Desatento aos sintomas da doença". IMPLICAÇÕES PARA AS PRÁTICAS DE ENFERMAGEM: Estudo demonstra os níveis de importância das características definidoras de "Autogestão Ineficaz da Saúde" em pessoas vivendo com HIV, contribui para suspeição e identificação diagnóstica acurada de enfermeiros e pesquisadores.

Analysis of the content of the nursing diagnosis deficient knowledge in individuals with heart failure.

OBJECTIVE: To analyze the content of the nursing diagnosis deficient knowledge in individuals with heart failure. METHODS: Methodological study to validate the content of a nursing diagnosis based on the predictive model of diversity, carried out through the organization of the phenomenon of interest and analysis by judges using the collective wisdom model. The NANDA-I Knowledge Deficient diagnosis was evaluated by 48 judges and considered valid when it presented a median content validity index ≥ 0.8 in the confidence intervals. RESULTS: Note that 66.6% of the judges indicated that the new definition proposed was more adequate than the definition adopted by NANDA-I. After the experts' analysis, the following defining characteristics were considered valid: inaccurate statements about the disease and/or therapy, inadequate performance in the management of intercurrences, increase in hospital readmissions, worsened quality of life, deficit in self-care performance, and follow-up of inadequate instruction; related factors are as follows: inadequate guidance offered by health professionals, nonparticipation of the patient in the planning of their health care, weakened relationship between professional and individual; populations at risk-elderly and low level of education of the individual and/or caregiver and the associated condition, mild cognitive impairment. Anxiety, depression, and impaired social interaction were elements considered not relevant to the content domain. CONCLUSION: The validation of the content of the aforementioned diagnosis in patients with heart failure, through the analysis of judges with different degrees of expertise, made it possible to improve the definition and expansion of new diagnostic indicators. IMPLICATIONS FOR NURSING PRACTICE: Updated diagnostic elements for the nursing diagnosis deficient knowledge in individuals with heart failure will facilitate accurate clinical judgment and the establishment of a therapeutic plan aimed at etiological factors modifiable by nurses.