Deductive Care Methodology: Describing and testing modes of care research.

OBJECTIVE: Define the modes of procedure of the Deductive Care Methodology (DCM) in the generation of knowledge about person's health care. METHODOLOGY: Design and test of the DCM modes based on three phases: mapping of the DCM, generation of models from this methodology and testing of the models through studies in a clinical context. RESULTS: The DCM presents five levels of abstraction with three modes broken down to 16 types. The modes are: Philosophical Mode to conceptualize and obtain generalities about reality, Mathematical Mode to operate with generalities, and Physical Mode to operationally verify, validating the results and the predictive capacity of the model. This MDC allows the creation of three models: Knowledge Model about Person Care, an ontology of care, Vulnerability Model about the person and Taxonomic Triangulation Model for knowledge management. All models generate products for computational knowledge management. In addition, the models are applied in teaching and generate research with more than a hundred participations in conferences and journals, of which five impact publications (from 2008 to 2022) classified in the categories of Nursing and Informatics are analysed. CONCLUSIONS: The DCM collects prior knowledge to work with certainties, evidence and applying inferences that do not depend on the number of cases or inductive designs. This research presents a formal structure of the DCM with an interdisciplinary orientation between Health Sciences and Computer Sciences.

Validation of the Health Index in the Postoperative Period: Use of the Nursing Outcome Classification to Determine the Health Level.

BACKGROUND: The postoperative period is the recovery time after surgery and is defined as an individual process whose purpose is to return the person to the state of normality and integrity that they had prior to surgery. AIM: Demonstrate the modification of the level of health of people in the early postoperative period through the development and validation of the Health Index Instrument, which is built from the Nursing Outcomes Classification (NOC) standardized language. DESIGN: The design used a mixed method, which involved a first phase of instrument development and a second phase of instrument validation. METHODS: The methods was based on focus group techniques with text analysis techniques, internal validation with a group of care language experts, external validation with a group of clinical nursing experts and a clinical validation with quantitative and qualitative analysis. A panel of experts in Language of Care evaluated the (NOC) labels and their correlation with the 11 Health Variables to construct the instrument. The instrument developed was subjected to external validation with a panel of clinical nurse experts in post-anesthesia care. The clinical validation included a cross-sectional descriptive study in a postoperative unit. The final sample of the cross-sectional descriptive study was 139 cases. RESULTS: Of the 89 NOCs proposed in the preliminary construction phase of the instrument, 36 passed through the first round. Of those 36 NOCs, 25 passed through to the second round with a review performance and 11 directly as approved. The total number of approved NOCs were 4. The results of the research show that there are changes in the global score of the health level and in each health variable. It is observed that there was a significant increase in the scores of the health variables at admission and discharge (p < 0.001). CONCLUSIONS: The results of the data analysis show that six groups present a similar pattern of evolution of the health variables. A correlation was found between the time of stay in the unit with the scores obtained in the health variables, the physical functioning, comfort status and the presence of symptoms being particularly significant.

Competencies in the Robotics of Care for Nursing Robotics: A Scoping Review.

In parallel with the development and design of different technological advances, competencies in nursing have advanced. With the development of robotics, it is expected that nursing robotic competencies will also increase. The aim of this study is to review the competencies in nursing robotics. A review was conducted between January 2017 and December 2023. The search strategy was carried out in the MEDLINE database (through PubMed). This review explores the developmental competencies in nursing robotics and informatics. The data extraction in this review included an intentional search for competencies and learning outcomes in engineering and robotic programs. A total of 340 competencies and program outcomes were reviewed. The synthesis of the data established a total of 17 developmental competencies in nursing robotics based on this knowledge extraction, which we organized into five categories: assessment, diagnosis, planning, intervention (implementation) and evaluation. This review suggests that nursing robotic competencies for the development of care robotics are still scarce, and there is an opportunity for the development of competencies and the definition of new roles in the area of nursing informatics in order to adapt to the new health care demands of society.

Active and Healthy Confinement: Care Recommendations on Activity, Sleep and Relationships.

Persons that lived through periods of confinement suffered an impact on their physical and mental health. The adaptation of the lifestyle in relation to activity, sleep and social relationships is key to facing these periods of confinement. The aim is to validate a series of care recommendations aimed at being able to maintain an active and healthy confinement, which serves to prepare the population for future health crises. This study is part of a general strategy based on a care recommendation guide for COVID-19. The validation was carried out by a group of experts using the Delphi technique through a questionnaire that uses the Content Validity Index (CVI) and considers high validation those with a score >0.80. A total of 75 care recommendations are proposed: 30 on activity-exercise (CVI = 0.82), 14 on sleep-rest (CVI = 0.83) and 31 on roles-relationships (CVI = 0.83). Additionally, 49 recommendations achieve high validation. The care recommendations integrate a person-centred model, which addresses individual characteristics (age, health status, professional role). An active and healthy confinement requires respecting social distance measures, maintaining a balance between physical activity and sleep, and using technologies to promote social contact, which promote well-being and avoid depression and anxiety.

Care Robotics: An Assessment of Professional Perception in the Face of the COVID-19 Pandemic.

The COVID-19 crisis accelerated the adoption of technologies. Technological advancement is also expected in robotics applied to any sector, including in healthcare. The aim is to assess the professional perception of care robotics facing COVID-19. This study aimed to (1) select a tool for assessing different aspects of healthcare, (2) analyse the professional perception about the development, usefulness and helpfulness of technologies and robotics in the field of healthcare and (3) evaluate the correlation between the perceived helpfulness of care robotics and the selected tool. We implement five validated clinical tests which integrate 80 items about a person and their clinical situation. From the sample of 46 professionals, 95.65% affirmed that technology was moderately to completely useful for professional performance in the context of the pandemic, lowering to 67.39% when asked only about robotics; 93.48% stated that the inclusion of robotics in at least one health area affected by COVID-19 would have helped them. Finally, the variables extracted from clinical tests corresponded to the most relevant health areas as identified by the professionals. This research shows the potential of care robotics oriented towards healthcare from a care paradigm.

Competence in Spiritual and Emotional Care: Learning Outcomes for the Evaluation of Nursing Students.

Spiritual and emotional care is an important part of the person, especially in situations such as changes in health or a community coping with a pandemic. However, nurses report scarce university training in this area of care. The aim of the study is to define a catalogue of learning outcomes for spiritual and emotional care for undergraduate nurses. The design used a mixed method for the development and validation of learning outcomes. The first phase designs the catalogue of learning outcomes through a coordinating group and uses a bibliographic search and nursing legislation. The second phase validates the proposal through a group of experts, with a questionnaire using the modified Delphi technique in two rounds. The initial proposal was 75 learning outcomes, of which 17 were eliminated, 36 changed their wording and the experts proposed 7 new ones. The experts validated 65 learning outcomes: 14 for Assessment and diagnosis; 5 for Planning; 17 for Intervention; 4 for Evaluation and quality; 8 for Communication and interpersonal relationship and 17 for Knowledge and intrapersonal development. In conclusion, the academic curriculum can include these learning outcomes to help undergraduate nurses in the process of acquiring knowledge, skills and attitudes in spiritual and emotional care.

Care Recommendations for the Chronic Risk of COVID-19: Nursing Intervention for Behaviour Changes.

The COVID-19 pandemic is a challenge for health systems. The absence of prior evidence makes it difficult to disseminate consensual care recommendations. However, lifestyle adaptation is key to controlling the pandemic. In light of this, nursing has its own model and language that allow these recommendations to be combined from global and person-centred perspectives. The purpose of the study is to design a population-oriented care recommendation guide for COVID-19. The methodology uses a group of experts who provide classified recommendations according to Gordon's functional patterns, after which a technical team unifies them and returns them for validation through the content validity index (CVI). The experts send 1178 records representing 624 recommendations, which are unified into 258. In total, 246 recommendations (95.35%) are validated, 170 (65.89%) obtain high validation with CVI > 0.80, and 12 (4.65%) are not validated by CVI < 0.50. The mean CVI per pattern is 0.84 (0.70−0.93). These recommendations provide a general framework from a nursing care perspective. Each professional can use this guide to adapt the recommendations to each individual or community and thus measure the health impact. In the future, this guideline could be updated as more evidence becomes available.

Validation and reliability of the Care Vulnerability Index: A study by interrater agreement and test-retest method.

AIM: The aim of this study is to determine the validity and reliability of the Care Vulnerability Index (CVI) as a tool to estimate the need and competence of care. DESIGN: A cross-sectional survey including a longitudinal component. METHODS: Content validity ratio (CVR) was calculated by interrater agreement of a group of 11 experts in two rounds. The test-retest analysis was measured in an urban population of Colombia with 96 participants through two statistical tests: Pearson's correlation coefficient and the difference in means. RESULTS: Care Vulnerability Index turned out to be valid with a CVR of 0.879. Reliability by Pearson correlation between test-retest was 0.912 (CI95: 0.872-0.941; p-value <.01) and there was no significant mean difference between test and retest in global score and in clustered groups of variables. Validating CVI will make it possible to prioritize healthcare resources in the population and identify people susceptible to care problems.

Usability Evaluation by Nurses of a Knowledge-Based System of Care Plans for People Hospitalized by COVID-19.

The aim of this study is to analyze the usability by nurses of the Knowledge-Based System "Diagnostics care for COVID-19." A convenience sample of 16 nurses was selected, among hospital workers and external experts. The group was divided into three subgroups intentionally to obtain different usability perspectives. Usability was evaluated by the System Usability Scale questionnaire. The participants completed the questionnaire on general usability, data inputs, and information output, after completing a minimum of 12 care plans. The first subgroup used real cases and the "think aloud" technique, the second simulated cases from the same hospital, and the third subgroup performed the external simulation. The highest scores were obtained in data inputs (94.38-97.50); and the lowest, in general usability (90.00-95.00). The subgroup of external experts scored the highest (93.13-95.63), and the first subgroup, which carried out real cases, gave the lowest score (90.00-94.38). The "think aloud" technique found an improvement in including more diagnoses and being able to carry out several plans for one person at the same time. The usability obtained was "excellent" in all subgroups and questionnaires, although the application showed limitations related to its characteristics imposed in the requirements specification.

Validation of a manual of care plans for people hospitalized with COVID-19.

AIM: Validate a manual of care plans for people hospitalized for coronavirus disease, COVID-19. DESIGN: Validation study with a mixed-method design. METHODS: Design and validation of a care plans manual for people hospitalized by COVID-19. Care plans used standardized languages: NANDA-I, Nursing Outcomes Classification (NOC) and Nursing Intervention Classification (NIC). The design included external and internal validation with quantitative and qualitative analysis. Data collection was between March and June 2020. The study methods were compliant with the Good Reporting of a Mixed Methods Study (GRAMMS) checklist. RESULTS: The manual integrated 24 NANDA-I diagnoses, 34 NOC and 47 NIC different criteria. It was validated by experts of Scientific-Technical Commission, who recommended linking the diagnoses to an assessment. The internal validation validated 17 of 24 diagnoses, 56 of 65 NOC and 86 of the 104 NIC. During the discussion group, 6 new diagnoses proposed were validated and the non-validated diagnoses were linked to the baseline condition of the person.

Diagnostics of care about environment: A systematic review through nursing taxonomies.

AIM: To analyse the representation of the environment in nursing diagnostic taxonomies. DESIGN: Systematic scoping review through nursing taxonomies. METHODS: The first phase identified nursing diagnostic taxonomies by systematic review. The diagnoses were associated with the environment by analysis of terms into the diagnosis label and definition. Data analysis was quantitative with frequency measurements. The second phase mapped the identified diagnoses to establish equivalences using analysis by terms in the diagnostic labels. Finally, the findings obtained in the first phase were compared with the OMAHA System. RESULTS: The bibliographic search identified 112 studies and 16 standardized languages for diagnoses. NANDA-I and ICNP were the most frequent taxonomies; ATIC, the most recent; and OMAHA, the oldest. 2,062 diagnoses from four diagnostic taxonomies were analysed, and 361 associations corresponding to 352 environmental diagnoses were identified. All taxonomies included the environment but with different weight relative to the interpersonal and geopolitical category.

Nursing Diagnoses for Coronavirus Disease, COVID-19: Identification by Taxonomic Triangulation.

PURPOSE: To identify the nursing care problems related to the clinical process of disease by COVID-19. METHOD: The study applied the taxonomic triangulation technique on a clinical management guide to coronavirus disease, COVID-19, from the World Health Organization. The technique is divided into the phases: extraction of knowledge in natural language about assessment, planning and intervention, translation into standard language NOC and NIC, linking to NANDA-I diagnoses, triangulation looking for diagnostic matches in the three sets, and, finally, validation by a panel of experts from a hospital and a university. FINDINGS: The extraction identified 159 terms in natural language that were translated into 173 variables: 34 NOC for assessment, 19 NOC for planning, and 120 NIC for intervention. The relationships to NANDA-I diagnoses recorded 2,182 links and the triangulation returned 109 diagnoses, 54 of them for a critical situation. The panel of experts unanimously validated the 29 diagnoses with the highest number of links. CONCLUSION: Coronavirus disease, COVID-19, involves a complex situation with multiple associated care problems that can be identified using the taxonomic triangulation technique. IMPLICATIONS FOR NURSING PRACTICE: The links between taxonomies and the taxonomic triangulation technique are an important tool for generating knowledge. The results of this study may guide the diagnosis and treatment of coronavirus disease, COVID-19, as well as similar processes that occur with acute respiratory distress syndrome.

Validation of an evaluation instrument for responders in tactical casualty care simulations.

OBJECTIVE: to construct and validate a tool for the evaluation of responders in tactical casualty care simulations. METHOD: three rubrics for the application of a tourniquet, an emergency bandage and haemostatic agents recommended by the Hartford Consensus were developed and validated. Validity and reliability were studied. Validation was performed by 4 experts in the field and 36 nursing participants who were selected through convenience sampling. Three rubrics with 8 items were evaluated (except for the application of an emergency bandage, for which 7 items were evaluated). Each simulation was evaluated by 3 experts. RESULTS: an excellent score was obtained for the correlation index for the 3 simulations and 2 levels that were evaluated (competent and expert). The mean score for the application of a tourniquet was 0.897, the mean score for the application of an emergency bandage was 0.982, and the mean score for the application of topical haemostats was 0.805. CONCLUSION: this instrument for the evaluation of nurses in tactical casualty care simulations is considered useful, valid and reliable for training in a prehospital setting for both professionals who lack experience in tactical casualty care and those who are considered to be experts.

Taxonomic Triangulation of Care in Healthcare Protocols: Mapping of Diagnostic Knowledge From Standardized Language.

Taxonomic triangulation is a data mining technique for the management of care knowledge. This technique uses standardized languages, such as North American Nursing Diagnosis Association International, Nursing Outcomes Classification, and Nursing Interventions Classification, as well as logic. Its purpose is to find patterns in the data and identify care diagnoses. Triangulation can be applied to databases (clinical records) or to bibliographic sources (eg, protocols). The objective of this study is to identify the care diagnoses implicit in the nursing care protocols of the Community of Madrid. The method followed has three phases: knowledge extraction for mapping of variables, linking to diagnoses, and triangulation with analysis. The study analyzes six protocols, and 344 variables (167 assessment, 29 planning, and 148 intervention) and 6118 links have been extracted. Triangulation identified 165 NANDA diagnoses (68.48%), and only 25 labels were not revealed through this process. As a limitation, the results depend on the knowledge presented in protocols and change with language editions. Some labels included in the sample are recent and are not included in the links with nursing outcomes classification and nursing interventions classification. In conclusion, taxonomic triangulation makes it possible to manage knowledge, discover data patterns, and represent care situations.

Validation of an evaluation instrument for responders in tactical casualty care simulations / Validação de um instrumento de avaliação para a prática de cuidados de saúde estratégicos / Validación de un instrumento de evaluación para la práctica de la atención sanitaria táctica

Objective: to construct and validate a tool for the evaluation of responders in tactical casualty care simulations. Method: three rubrics for the application of a tourniquet, an emergency bandage and haemostatic agents recommended by the Hartford Consensus were developed and validated. Validity and reliability were studied. Validation was performed by 4 experts in the field and 36 nursing participants who were selected through convenience sampling. Three rubrics with 8 items were evaluated (except for the application of an emergency bandage, for which 7 items were evaluated). Each simulation was evaluated by 3 experts. Results: an excellent score was obtained for the correlation index for the 3 simulations and 2 levels that were evaluated (competent and expert). The mean score for the application of a tourniquet was 0.897, the mean score for the application of an emergency bandage was 0.982, and the mean score for the application of topical haemostats was 0.805. Conclusion: this instrument for the evaluation of nurses in tactical casualty care simulations is considered useful, valid and reliable for training in a prehospital setting for both professionals who lack experience in tactical casualty care and those who are considered to be experts.

Objetivo: construir e validar um instrumento de avaliação da prática, por meio da simulação, nos cuidados de saúde estratégicos. Método: três instrumentos para práticas de avaliação de aplicação do torniquete, bandagem de emergência e agente hemostático recomendados pelo Consenso de Hartford foram desenvolvidos e validados. A validade e a confiabilidade foram estudadas. A validação foi realizada por quatro especialistas da área e trinta e seis enfermeiros participantes selecionados por amostragem por conveniência. Três instrumentos de avaliação com 8 itens foram avaliados (com exceção da bandagem de emergência, que tinha 7 itens para avaliar). Cada prática foi avaliada por três especialistas. Resultados: uma pontuação excelente foi obtida no cálculo do índice de correlação para as três práticas e nos dois níveis avaliados (competente e especialista). A pontuação média para a aplicação do torniquete foi de 0,897, para o curativo de emergência foi de 0,982 e para a aplicação de agentes hemostáticos tópicos foi de 0,805. Conclusão: este instrumento de avaliação da prática por meio de simulação nos cuidados de saúde estratégicos é considerado útil, válido e confiável para o treinamento no contexto pré-hospitalar tanto dos profissionais que não possuem experiência nos cuidados estratégicos quanto nos considerados peritos.

Objetivo: construir y validar un instrumento de evaluación de la práctica, mediante simulación, en la atención sanitaria táctica. Método: se construyeron y validaron tres rúbricas de las prácticas de aplicación del torniquete, vendaje de emergencia y agente hemostático recomendadas por el Consenso Hartford. Se estudió la validez y fiabilidad. La validación se realizó por cuatro expertos en la materia y treinta y seis participantes enfermeros que fueron la muestra de conveniencia. Se evaluaron tres rúbricas con 8 ítems (excepto para el vendaje de emergencia que fueron 7 ítems a evaluar). Cada práctica fue evaluada por tres expertos. Resultados: se ha obtenido una excelente puntuación en el cálculo del índice de correlación para las tres prácticas y en los dos niveles evaluados (competente y experto). La puntuación media para la rúbrica de aplicación del torniquete fue de 0.897, la del vendaje de emergencia 0.982 y para la aplicación de hemostáticos tópicos 0.805. Conclusión: este instrumento de evaluación de la práctica mediante simulación en la atención sanitaria se considera útil, válido y fiable para la formación en el entorno prehospitalario tanto de profesionales que carecen de experiencia en atención táctica como de aquellos considerados como expertos.

The value of nursing care in the paradigm of chronicity and dependency. New roles and redesigns.

The future of Healthcare Systems not only faces financial troubles, but also--perhaps worse, the need to redesign its service offers. It is necessary to work for all the knowledge available to be placed at the service of patients and society, generating much more efficient services and opening to a redesign where nurses lead in new services supported on the strategy of effective care. Additionally, it is hoped that patients assume a responsibility and nurses another: that of accompanying patients during their disease process to become for them a support in their self-care efforts. The new role that must be assumed by community nurses is that of becoming the coaches of chronic patients and of their caregivers so they can reach a situation of equilibrium, between their desires and what they must do, to, thus, assume their responsibility in the self-provision of Basic Care.

El valor del cuidado de enfermería en el paradigma de la cronicidad y la dependencia. Nuevos roles y rediseños / O valor do cuidado da enfermagem no paradigma da cronicidade e a dependência. Novos papéis e redesenho / The value of nursing care in the paradigm of chronicity and dependency. New roles and redesigns

El futuro de los Sistemas Sanitarios no solo atraviesa por problemas de financiación, sino, tal vez mucho más, por la necesidad de rediseñar su oferta de servicios. Es necesario trabajar para que todo el conocimiento disponible se ponga al servicio de los pacientes y la sociedad, generando servicios mucho más eficientes y abriéndose a una rediseño en el cual las enfermeras lideren nuevos servicios que se apoyen en la estrategia de un cuidado eficaz. Además, se trata de que los pacientes asuman una responsabilidad y las enfermeras una más importante: la de acompañarlos en su proceso de enfermedad como apoyo en sus esfuerzos de autocuidado. El nuevo rol que deben asumir las enfermeras comunitarias es el de ser las entrenadoras de los pacientes crónicos y de sus cuidadores para que alcancen una situación de equilibrio entre sus deseos y lo que deben de hacer, para que así puedan asumir responsabilidad en la autoprovisión de Cuidados Básicos...

The future of Healthcare Systems not only faces financial troubles, but also – perhaps worse, the need to redesign its service offers. It is necessary to work for all the knowledge available to be placed at the service of patients and society, generating much more efficient services and opening to a redesign where nurses lead in new services supported on the strategy of effective care. Additionally, it is hoped that patients assume a responsibility and nurses another: that of accompanying patients during their disease process to become for them a support in their self-care efforts. The new role that must be assumed by community nurses is that of becoming the coaches of chronic patients and of their caregivers so they can reach a situation of equilibrium, between their desires and what they must do, to, thus, assume their responsibility in the self-provision of Basic Care...

O futuro dos Sistemas Sanitários não só atravessa por problemas de financiamento, senão talvez bem mais, pela necessidade de redesenhar sua oferta de serviços. É necessário trabalhar para que todo o conhecimento disponível se ponha ao serviço dos pacientes e a sociedade, gerando serviços bem mais eficientes e abrindo-se a um redesenho onde as enfermeiras liderem novos serviços que se apoiem na estratégia de um cuidado eficaz. Ademais se trata que os pacientes assumam uma responsabilidade e as enfermeiras outra: a de acompanhar aos pacientes em seu processo de doença a fim de ser para eles um apoio em seus esforços de autocuidado. O novo papel que deve ser assumido pelas enfermeiras comunitárias é o de ser as treinadoras dos pacientes crônicos e de seus cuidadores para que atinjam uma situação de equilíbrio, entre seus desejos e o que devem de fazer, para que assim possam assumir sua responsabilidade na auto-provisão de Cuidados Básicos...