Standardized nursing languages in orthopedics from the perspective of the nursing role effectiveness model.

OBJECTIVE: To analyze the standardized nursing languages in orthopedics from the perspective of the Nursing Role Effectiveness Model. METHOD: Mixed method research carried out in a hospital in southern Brazil between April 2016 and February 2017. Quantitative data were collected from 85 orthopedic patients using the NANDA-International, Nursing Interventions and Outcomes, and submitted to statistical analysis. Qualitative data were collected through interviews with 10 nurses and were analyzed using content analysis. RESULTS: Acute pain (96%) was a prevalent nursing diagnosis. Fall Prevention (33.3%) was the most prescribed intervention. Pain Level, Body Positioning: self-initiated and Mobility showed an increase in outcome scores (p<0.001). In the interviews, nurses indicated that priority diagnoses and nursing interventions contributed to improving mobility outcomes. CONCLUSION: The findings revealed that the focus of Standardized Nursing Languages in orthopedics from the perspective of the Nursing Role Effectiveness Model lies in the context of mobility, but it needs improvements in diagnostic accuracy and electronic health record.

Standardized nursing languages in orthopedics from the perspective of the nursing role effectiveness model / Lenguajes estandarizados de enfermería en ortopedia desde la perspectiva del nursing role effectiveness model / Linguagens padronizadas de enfermagem em ortopedia na perspectiva do nursing role effectiveness model

ABSTRACT Objective To analyze the standardized nursing languages in orthopedics from the perspective of the Nursing Role Effectiveness Model. Method Mixed method research carried out in a hospital in southern Brazil between April 2016 and February 2017. Quantitative data were collected from 85 orthopedic patients using the NANDA-International, Nursing Interventions and Outcomes, and submitted to statistical analysis. Qualitative data were collected through interviews with 10 nurses and were analyzed using content analysis. Results Acute pain (96%) was a prevalent nursing diagnosis. Fall Prevention (33.3%) was the most prescribed intervention. Pain Level, Body Positioning: self-initiated and Mobility showed an increase in outcome scores (p<0.001). In the interviews, nurses indicated that priority diagnoses and nursing interventions contributed to improving mobility outcomes. Conclusion The findings revealed that the focus of Standardized Nursing Languages in orthopedics from the perspective of the Nursing Role Effectiveness Model lies in the context of mobility, but it needs improvements in diagnostic accuracy and electronic health record.

RESUMEN Objetivo Analizar las lenguajes de enfermería en ortopedia desde la perspectiva del Nursing Role Effectiveness Model. Método Estudio de método mixto realizado en un hospital del sur de Brasil entre abril de 2016 y febrero de 2017. Los datos cuantitativos fueron 85 pacientes ortopédicos por médio de NANDA International, Clasificación de Intervenciones y Resultados de Enfermería com análisis de datos mediante estadística. Los datos cualitativos se recogieron a través de entrevistas con 10 enfermeras y se analizaron mediante análisis de contenido. Resultados Dolor agudo (96%) fue el diagnóstico de enfermería prevalente. Prevención de caídas (33,3%) fue la intervención más prescrita. Nivel de dolor, Posición del cuerpo: autoiniciado y Movilidad mostraronaumento en las puntuaciones de los resultados (p <0,001). En las entrevistas, las enfermeras indicaron que los diagnósticos prioritarios y las intervencione contribuyeron a mejorar los resultados de movilidad. Conclusión Los datos revelaron que el enfoque de los Lenguajes Estandarizados de Enfermería en ortopedia según la perspectiva del Nursing Role Effectiveness Model se encuentra en el contexto de la movilidad, pero necesita mejoras en la precisión diagnóstica y el registro electrónico de salud.

RESUMO Objetivo Analisar as Linguagens padronizadas de enfermagem em ortopedia na perspectiva do Nursing Role Effectiveness Model. Método Pesquisa com método misto realizado em um hospital do Sul do Brasil entre abril de 2016 a fevereiro de 2017. Os dados quantitativos foram coletados de 85 pacientes ortopédicos usando a NANDA-International, Classificação de Intervenções e Resultados de enfermagem, submetidos à análise estatística. Os dados qualitativos foram coletados por meio de entrevistas com 10 enfermeiros e foram analisadas mediante análise de conteúdo. Resultados Dor aguda (96%) foi diagnóstico de enfermagem prevalente. Prevenção de quedas (33,3%) foi a intervenção mais prescrita. Nível de Dor, Posicionamento do Corpo: autoiniciado e Mobilidade apresentaram aumento nos escores de resultado (p<0,001). Nas entrevistas os enfermeiros apontaram que os diagnósticos prioritários e as intervenções de enfermagem contribuíram para a melhoria dos resultados de mobilidade. Conclusão Os resultados revelaram que o foco das Linguagens padronizadas de enfermagem em ortopedia na perspectiva do Nursing Role Effectiveness Model reside no contexto da mobilidade, porém precisa de melhorias na acurácia diagnóstica e registro no prontuário do paciente.

Posicionamento de pacientes ortopédicos segundo a Nursing Outcomes Classification / Positioning of orthopedic patients according to the Nursing Outcomes Classification / Posicionamiento de los pacientes ortopédicos según la Clasificación de los Resultados de Enfermería

Objetivo: avaliar o posicionamento de pacientes ortopédicos, segundo a Nursing Outcomes Classification. Método: estudo quantitativo, descritivo, longitudinal, realizado em hospital brasileiro, com 20 pacientes ortopédicos, submetidos à artroplastia total de quadril, que foram acompanhados por até quatro dias de pós-operatório. Realizou-se a avaliação de quatro indicadores do Resultado da Nursing Outcomes Classification - Posicionamento do Corpo: autoiniciado (0203), por meio da escala Likert de cinco pontos e, para a análise, empregaram-se os testes t de Student, Equações Estimativas Generalizadas e Post Hoc de Bonferroni. Resultados: realizaram-se 76 avaliações e a média do resultado Posicionamento do Corpo: autoiniciado (0203), na primeira avaliação, foi de 2.01±0.25 pontos (muito comprometido). Alcançou-se, na última, por este resultado, média de 4.73±0.08 (levemente comprometido), p<0.001. Conclusão: demonstrou-se melhora progressiva no posicionamento de pacientes ortopédicos. Evidenciou-se a NOC como ferramenta clinicamente útil para avaliação dos resultados de pacientes, durante a implementação do Processo de Enfermagem, na prática clínica.(AU)

Objective: to evaluate the positioning of orthopedic patients using to the Nursing Outcomes Classification. Method: a quantitative, descriptive, longitudinal study was performed in a Brazilian hospital, with 20 orthopedic patients who underwent total hip arthroplasty, followed up for up to four postoperative days. Four indicators of the nursing outcome Body Positioning: self-initiated (0203) from the Nursing Outcome Classification were assessed using the five-point Likert scale. For the analysis, Student's t-tests, Generalized Estimation Equations and Bonferroni's Post Hoc tests were used. Results: 76 evaluations were performed and the mean score of Body Positioning: self-initiated (0203), in the first evaluation, was 2.01 ± 0.25 points (substantially compromised). In the last evaluation, the mean score was 4.73 ± 0.08 (mildly compromised), p <0.001. Conclusion: a progressive improvement in the positioning of orthopedic patients was found. It is concluded that NOC is a clinically useful tool for evaluating the patients' outcomes during the implementation of the nursing process in clinical practice.(AU)

Objetivo: evaluar el posicionamiento de los pacientes ortopédicos, según la Clasificación de Resultados de Enfermería. Método: estudio cuantitativo, descriptivo, longitudinal, realizado en un hospital brasileño, con 20 pacientes ortopédicos sometidos a artroplastia total de cadera, que fueron seguidos hasta cuatro días después de la cirugía. Se evaluaron cuatro indicadores del Resultado Posicionamiento Corporal: autoiniciado (0203) de la Clasificación de Resultados de Enfermería, mediante la escala Likert de cinco puntos y, para el análisis, la prueba t de Student, Ecuaciones de Estimación Generalizadas y Post Hoc de Bonferroni. Resultados: Se realizaron 76 evaluaciones y la media del resultado Posicionamiento corporal: autoiniciado (0203), en la primera evaluación, fue de 2,01 ± 0,25 puntos (muy comprometido). En el último, para este resultado se alcanzó un promedio de 4.73 ± 0.08 (levemente comprometido), p <0.001. Conclusión: hubo una mejora progresiva en el posicionamiento de los pacientes ortopédicos. La NOC se evidenció como una herramienta clínicamente útil para evaluar los resultados de los pacientes durante la implementación del Proceso de Enfermería en la práctica clínica.(AU)

Validity and reliability of the RAC adult infection risk scale: A new instrument to measure healthcare-associated infection risk.

Healthcare-associated infections represent a public health problem, and they have repercussions for patient safety. The aim of this study was to determine the psychometric properties of the Rodríguez-Almeida-Cañon (RAC) adult infection risk scale, focusing on the construct and predictive validity and reliability. The study enrolled 278 patients at a large hospital in southern Brazil. The research process involved the following three phases: construct validation, assessing predictive validity, and assessing reliability. Confirmatory factor analysis showed a good fit using a two-factor model with 15 items. The logistic regression analysis showed an association between the scale score and prediction of developing healthcare-associated infections (odds ratio: 1.18; 95% confidence interval: 1.08-1.28). The Cronbach's alpha was 0.72 for intrinsic factors subscale and 0.71 for extrinsic factors subscale. A high level of inter-rater agreement (intraclass correlation coefficient ≥0.97) was found for both subscales. The Bland and Altman method showed narrow agreement limits, demonstrating good agreement between evaluators. The findings of this study showed that the RAC adult infection risk scale is a new, reliable, and psychometrically valid instrument to assess healthcare-associated infections risk. Future research using this scale may lead to a better understanding of the healthcare-associated infections risk and assist health professionals in decision-making for interventions to improve patient safety.

Resultado de enfermagem para avaliação da dor após artroplastia de quadril / Nursing outcomes for pain assessment after hip arthroplasty / Resultado de enfermería para valoración del dolor después de una artroplastia de cadera

Resumo Introdução A Artroplastia Total de Quadril se apresenta como um procedimento eficaz para a diminuição da dor em articulações e para a melhora funcional das pessoas. Objetivo Selecionar resultados e indicadores da Nursing Outcomes Classification (NOC) e construir definições conceituais e operacionais, para avaliação da dor de pacientes após Artroplastia Total de Quadril. Materiais e Métodos Estudo de consenso entre especialistas. As definições foram construídas baseadas na literatura e experiência dos autores. Estabeleceu-se um consenso de 100% para o conteúdo do instrumento das definições conceituais e operacionais do resultado de enfermagem. Resultados Foi selecionado o resultado de enfermagem Nível de dor, com onze indicadores, a mencionar: Dor relatada, Duração dos episódios de dor, Expressões faciais de dor, Agitação, Irritabilidade, Encolhimento, Diaforese, Náusea, Frequência respiratória, Frequência do pulso radial e Pressão arterial. Cada um dos onze indicadores foi definido conceitual e operacionalmente. Discussão e Conclusões A seleção desse resultado e de seus indicadores, assim como a construção das definições podem favorecer a aplicação da NOC com maior fidedignidade nessa população, além de aprimorar a assistência e contribuir no aperfeiçoamento da classificação.

Abstract Introduction Total Hip Arthroplasty (THA) is an effective procedure to relieve joint pain and to provide functional improvement in patients. Objective Based on the outcomes and indicators from the Nursing Outcomes Classification (NOC), this study aims to create conceptual and operational definitions to assess pain in patients undergoing Total Hip Arthroplasty. Materials and Methods Consensus study among experts. Definitions were based on literature review and author experience. Complete agreement was found on instrument content in relation to the conceptual and operational definitions from nursing outcomes. Results The nursing outcome 'pain level' was selected which had eleven indicators, being notable the self-reported pain, duration of pain episodes, facial expressions of pain, agitation, irritability, muscle contraction, diaphoresis, nausea, respiratory rate, heart rate at the radial point and blood pressure. Discussion and conclusions The selection of this outcome and its indicators as well as the creation of definitions might benefit the NOC application in a more reliable manner over that population, apart from improving assistance and helping adjust this classification.

Resumen Introducción La Artroplastia Total de Cadera se presenta como un procedimiento eficaz para disminuir el dolor en las articulaciones y para alcanzar la mejora funcional de las personas. Objetivo Seleccionar resultados e indicadores de la Nursing Outcomes Classification (NOC) y construir definiciones conceptuales y operacionales para la valoración del dolor de los pacientes que son sometidos a una Artroplastia Total de Cadera. Materiales y Métodos Estudio de consenso entre especialistas. Las definiciones se construyeron con base en la literatura y en la experiencia de los autores. Se estableció un consenso de 100% para el contenido del instrumento con respecto a las definiciones conceptuales y operacionales del resultado de la enfermería. Resultados Se escogió el resultado de enfermería Nivel de dolor, con once indicadores, de los cuales vale la pena destacar: Dolor reportado, Duración de los episodios de dolor, Expresiones faciales de dolor, Agitación, Irritabilidad, Encogimiento, Diaforesis, Náuseas, Frecuencia respiratoria, Frecuencia del pulso radial y Presión arterial. Cada uno de los once indicadores se definió conceptual y operativamente. Discusión y Conclusiones La selección de este resultado y de sus indicadores, así como la construcción de las definiciones pueden favorecer la aplicación de la NOC de manera más fidedigna en esa población, además de mejorar la asistencia y contribuir a perfeccionar la clasificación.

Evaluation of Surgical Wound Healing in Orthopedic Patients with Impaired Tissue Integrity According to Nursing Outcomes Classification.

PURPOSE: To assess the surgical wound (SW) healing in orthopedic patients with Impaired tissue integrity according to the Nursing Outcomes Classification (NOC). METHODS: A prospective longitudinal study performed with 24 patients. Data collection was performed through an instrument containing the NOC indicators. FINDINGS: The indicators skin approximation, drainage, surrounding skin erythema, periwound edema, increased skin temperature, and foul wound odor presented a statistically significant increase when compared the means between the first and the last day of evaluation. CONCLUSION: The NOC indicators allowed to monitor the SW healing indicating an improvement. IMPLICATIONS FOR NURSING PRACTICE: The NOC can favor an earlier identification of the degree of commitment for each patient and enables implementation of care to achieve target outcomes.

Clinical Indicators for Evaluation of Outcomes of Impaired Tissue Integrity in Orthopedic Patients: Consensus Study.

PURPOSE: To select outcomes from the Nursing Outcomes Classification (NOC) to evaluate impaired tissue integrity in patients undergoing orthopedic surgeries, and develop conceptual and operational definitions for their indicators. METHODS: A consensus study involving 10 nurses from clinical practice. A 100% consensus was established in the outcomes selection. FINDINGS: Wound Healing: Primary intention (1102) with two indicators: (110214) Scar formation, and (110201) Skin approximation were selected. Four indicators were grouped to evaluate inflammatory signs together with foul wound odor and six for drainage. CONCLUSIONS: These indicators direct the outcomes evaluation for wound healing. IMPLICATIONS FOR NURSING PRACTICE: Support to the definition the priority interventions in nursing process documentation.

Validation of the Disordered Eating Attitude Scale for adolescents / Validação da Escala de Atitudes Alimentares Transtornadas para adolescentes

ABSTRACT Objective To perform the psychometric evaluation of the Disordered Eating Attitude Scale (DEAS) for adolescents. Methods Sample consisted of 1,119 Brazilian adolescents (12-18 years old; 59.6% female) studying at technical schools in São Paulo state-Brazil, who answered an online survey with the DEAS, the Eating Attitude Test (EAT-26), and the Restraint Scale (RS). The internal consistency of the DEAS was assessed using Cronbach’s alpha. The convergent validity of DEAS was evaluated by means of Pearson’s coefficient correlation with EAT-26 and RS. The test-retest reliability was evaluated using a sub-sample of 61 adolescents. Known-groups validity was determined by comparing female student mean scores with scores of 33 female adolescents with eating disorders. Results The reliability of the DEAS was 0.79. EAT-26 and RS scores were positively correlated with DEAS scores (EAT: 0.78 for females and 0.59 for males, p < 0.001; RS: 0.63 for females and 0.48 for males, p < 0.001). The DEAS total and subscale scores differentiated students and patients with eating disorders (p < 0.001). The intra-class correlation coefficient for test-retest reliability was 0.87. Conclusion Results indicate that the DEAS adolescent version showed good internal consistency, convergent validity, known-groups validity, and test-retest reliability, suggesting its potential in identifying disordered eating attitudes among adolescents. It could also be helpful in identifying adolescents at risk from eating disorders, assisting in prevention programs.

RESUMO Objetivo Realizar a avaliação psicométrica da Escala de Atitudes Alimentares Transtornadas (EAAT) para adolescentes. Métodos A amostra foi composta por 1.119 adolescentes (12-18 anos; 59,6% do sexo feminino) estudantes de escolas técnicas do estado de São Paulo, que responderam online à EAAT, ao Teste de Atitudes Alimentares (EAT-26) e à Escala de Restrição (RS). A consistência interna da EAAT foi avaliada usando o alpha de Cronbach e a validade convergente por meio do coeficiente de correlação de Pearson com o EAT-26 e a RS. A confiabilidade teste-reteste foi avaliada usando uma subamostra de 61 adolescentes. A validade known-groups foi determinada pela comparação dos escores médios de estudantes do sexo feminino com os escores de 33 adolescentes do sexo feminino com transtornos alimentares. Resultados A consistência interna foi de 0,79, e as pontuações no EAT-26 e na RS estiveram positivamente correlacionadas com a pontuação da EAAT (EAT: 0,78 para o sexo feminino e 0,59 para o masculino, p < 0,001; RS: 0,63 para o sexo feminino e 0,48 para o masculino, p < 0,001). O escore da EAAT diferenciou estudantes e pacientes com transtornos alimentares (p < 0,001). O coeficiente de correlação intraclasse na confiabilidade teste-reteste foi de 0,87. Conclusão A versão da EAAT para adolescentes mostrou boa consistência interna, validade convergente, known-groups e confiabilidade teste-reteste, sugerindo o seu potencial na identificação de atitudes alimentares transtornadas entre adolescentes. Ela pode, portanto, ser útil na identificação de adolescentes com risco de transtornos alimentares, auxiliando em programas de prevenção.

BYCATCH OF Helicops angulatus (LINNAEUS 1758) (REPTILIA: SQUAMATA: COLUBRIDAE) IN HOOP-TRAPS USED TO CAPTURE FRESH WATER TURTLES ON THE COAST OF PARÁ, BRAZIL / Captura accidental de Helicops angulatus (Linnaeus 1758) (Reptilia: Squamata: Colubridae) en trampas en embudo usadas para capturar tortugas dulceacuícolas en la costa de Pará, Brasil

Between September, 2007, and August, 2009, six field excursions were conducted on the northern Brazilian coast (Romana and Maiandeua islands, state of Pará) for the collection of specimens of freshwater turtles (Rhinoclemmys punctularia and Kinosternon scorpioides) in natural ponds. Hoop trap were used and 35 specimens of brown-banded water snakes, Helicops angulatus, were captured as bycatch in the traps. Thus, in addition to turtles, the procedure may be useful to sample populations of aquatic snakes.

Entre septiembre de 2007 y agosto de 2009, seis excursiones de campo se llevaron a cabo en la costa norte de Brasil (islas Romana y Maiandeua, estado de Pará) para la recolección de especímenes de tortugas de agua dulce (Rhinoclemmys punctularia y Kinosternon scorpioides) en posos naturales. Utilizamos trampas en embudo. 35 ejemplares de la serpiente acuática Helicops angulatus, fueron capturados como pesca incidental en las trampas. Por lo tanto, además de las tortugas, el procedimiento puede ser útil para la toma de muestras de las poblaciones de serpientes acuáticas.

Comparison of deactivation forces between thermally activated nickel-titanium archwires.

OBJECTIVE: The aim of the present study was to investigate and compare load-deflection characteristics of commercially available thermally activated nickel-titanium archwires using a three-point bending test. MATERIALS AND METHODS: Sixty thermally activated 0.019×0.025-inch nickel-titanium archwires from six different manufacturers were investigated. The superelastic properties of these archwires were evaluated by conducting a three-point bending test under identical testing conditions. Forces generated at deactivation for a deflection of 0.5, 1, 2 and 3 mm at a temperature of 37° C were selected for statistical comparison of the data. The results of forces of deactivation at all deflections applied were compared by two-way analysis of variance and the Tukey test. RESULTS: Statistical differences (P<0.05) were found at all force levels during deactivations. The results showed that the range of forces displayed great variation in quantitative behaviour. None of the archwires showed permanent deformation after the three-point bending test. CONCLUSIONS: This study revealed significant differences in deactivation forces among the six types of thermally activated nickel-titanium archwires tested. NiTinol Termoativado (Aditek) and NeoSentalloy F200 (GAC) produced the least amount of force in all four deactivation categories.

Sonography in the diagnosis of cervical recurrence in patients with differentiated thyroid carcinoma.

OBJECTIVE: To determine the sensitivity of thyroglobulin (Tg), iodine scanning, and sonography in the diagnosis of cervical recurrence of thyroid cancer. METHODS: This prospective study assessed 81 patients with cervical metastases or extrathyroid invasion at first appearance who underwent clinical examination, scanning, measurement of Tg after thyroxine withdrawal, and sonography about 8 months after thyroidectomy followed by radioiodine treatment. Only patients without distant metastases and without anti-Tg antibodies were included. RESULTS: Fifty patients showed persistence of the disease in the cervical region, with only 16% of them having had a suspicion on clinical examination, 33 with Tg levels of 2 ng/mL or greater (66% sensitivity), and 29 with positive scan findings (58% sensitivity). A combination of the 2 methods detected disease in 40 (80%) of 50 patients but failed to show 20% of cases that were identified by sonography and confirmed by fine-needle aspiration. Sonography had sensitivity of 96%. Specificity values for Tg, iodine scanning, and sonography were 80.6%, 90.3%, and 87%, respectively. CONCLUSIONS: Classic follow-up methods may not detect cervical disease in some patients with differentiated thyroid carcinoma, and sonography is necessary even in patients apparently free of the disease.