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.

Middle-Range Theory of Ineffective Breathing Pattern in children with Congenital Heart Disease.

OBJECTIVE: to develop and evaluate a middle-range theory for the Nursing Diagnosis of Ineffective Breathing Pattern in children with congenital heart disease. METHOD: a methodological study carried out in two stages: 1) development of a middle- range theory for Ineffective Breathing Pattern in children with congenital heart diseases from the analysis of the NANDA-International taxonomy, Callista Roy's Adaptation Model and a literature review; and 2) assessment of the middle-range theory developed using expert panel evaluation. RESULTS: after three panel evaluations, the final version of the middle-range theory resulted in four metaparadigms, two key concepts, two pictorial diagrams, two propositions and a description of the interrelationships between the key concepts of Ineffective Breathing Pattern in children with congenital heart diseases and evidence for the Nursing practice. CONCLUSION: the middle-range theory developed and evaluated by experts identified stimuli and behaviors that can assist nurses in identifying the reasons why Ineffective Breathing Pattern is diagnosed and how it manifests itself in children with congenital heart disease, increasing understanding of the relationships between the causes and their temporality.

Middle-Range Theory of Ineffective Breathing Pattern in children with Congenital Heart Disease / Teoria de Médio Alcance do Padrão Respiratório Ineficaz em Crianças com Cardiopatia Congênita / Teoría de Mediano Alcance del Patrón de Respiración Ineficiente en niños con cardiopatías congénitas

Abstract Objective: to develop and evaluate a middle-range theory for the Nursing Diagnosis of Ineffective Breathing Pattern in children with congenital heart disease. Method: a methodological study carried out in two stages: 1) development of a middle- range theory for Ineffective Breathing Pattern in children with congenital heart diseases from the analysis of the NANDA-International taxonomy, Callista Roy's Adaptation Model and a literature review; and 2) assessment of the middle-range theory developed using expert panel evaluation. Results: after three panel evaluations, the final version of the middle-range theory resulted in four metaparadigms, two key concepts, two pictorial diagrams, two propositions and a description of the interrelationships between the key concepts of Ineffective Breathing Pattern in children with congenital heart diseases and evidence for the Nursing practice. Conclusion: the middle-range theory developed and evaluated by experts identified stimuli and behaviors that can assist nurses in identifying the reasons why Ineffective Breathing Pattern is diagnosed and how it manifests itself in children with congenital heart disease, increasing understanding of the relationships between the causes and their temporality.

Resumo Objetivo: desenvolver e avaliar uma teoria de médio alcance para o Diagnóstico de Enfermagem de Padrão Respiratório Ineficaz em crianças com cardiopatia congênita. Método: um estudo metodológico realizado em duas etapas: 1) desenvolvimento de uma teoria de médio alcance para padrão respiratório ineficaz em crianças com doenças cardíacas congênitas a partir da análise da taxonomia NANDA-Internacional, modelo de adaptação de Callista Roy e uma revisão da literatura; e 2) avaliação da teoria de médio alcance desenvolvida por meio da avaliação de painéis de especialistas. Resultados: após três avaliações de painéis, a versão final da teoria de médio alcance resultou em quatro metaparadigmas, dois conceitos-chave, dois diagramas pictóricos, duas propostas e uma descrição das inter-relações entre os conceitos-chave do Padrão Respiratório Ineficaz em crianças com cardiopatias congênitas e evidências para a prática de Enfermagem. Conclusão: a teoria do médio alcance desenvolvida e avaliada por especialistas identificou estímulos e comportamentos que podem auxiliar os enfermeiros na identificação das razões pelas quais o Padrão Respiratório Ineficaz é diagnosticado e como ele se manifesta em crianças com cardiopatia congênita, aumentando a compreensão das relações entre as causas e sua temporalidade.

Resumen Objetivo: desarrollar y evaluar una teoría de mediano alcance para el Diagnóstico de Enfermería "Patrón de Respiración Ineficiente" en niños con cardiopatías congénitas. Método: estudio metodológico desarrollado en dos etapas: 1) Desarrollo de una teoría de mediano alcance para el Patrón de Respiración Ineficiente en niños con cardiopatías congénitas a partir del análisis de la taxonomía NANDA-Internacional, del Modelo de Adaptación de Callista Roy y de una revisión de la literatura; y 2) Evaluación de la teoría de mediano alcance desarrollada por medio de una evaluación de un panel de expertos. Resultados: después de tres evaluaciones a cargo del panel, la versión final de la teoría de mediano alcance derivó en cuatro metaparadigmas, dos conceptos clave, dos pictogramas, dos propuestas y una descripción de las interrelaciones entre los conceptos clave del Patrón de Respiración Ineficiente en niños con cardiopatías congénitas y evidencia para la práctica de Enfermería. Conclusión: la teoría de mediano alcance desarrollada y evaluada por expertos identificó estímulos y comportamientos que pueden ayudar a los enfermeros a identificar los motivos por los cuales se diagnostica el Patrón de Respiración Ineficiente y cómo se manifiesta en niños con cardiopatías congénitas, mejorando así la comprensión de las relaciones entre las causas y su temporalidad.

Surgical site infection prevention bundle for children submitted to cardiac surgery.

OBJECTIVE: To build and validate the content and appearance of a surgical site infection prevention bundle for children submitted to cardiac surgery. METHOD: Methodological study in two phases: 1) Bundle construction from an integrative literature review from which interventions have been extracted to compose the instrument; 2) Bundle content and appearance validation by 24 judges. RESULTS: The 24 found articles presented 17 interventions for surgical site infection prevention in this population. Out of them, seven intervention proposals have been chosen to compose the bundle and sent for assessment by judges. The final proposal includes all the seven items chosen in the construction phase and has achieved a content validity index over 0.8 in all items referring to content and appearance. CONCLUSION: The content and appearance of the developed bundle proposes care for the prevention of surgical site infection throughout the perioperative period.

Content validity of the nursing diagnostic Breathing Pattern, Ineffective, in children with congenital heart defects.

OBJECTIVE: To estimate the content validity of the nursing diagnostic Breathing Pattern, Ineffective, in children with congenital heart defects. METHOD: Methodological study in two stages: 1) integrative literature review; 2) content validation, with 23 nurses. An instrument with 10 related factors and 21 defining characteristics for data collection was used. The analysis by the evaluators was carried out using the relevance criteria. The Content Validity Index was used. Valid results were those above 0.9 with a Wilcoxon test above 0.05. RESULTS: The final proposal incorporates nine from the ten causal factors. From them, five do not belong in the NANDA-I list. Regarding the defining characteristics, they were all considered to be relevant, and five are not among the list of signs and symptoms of the NANDA-I taxonomy. CONCLUSION: The findings of this study include specific elements of the pediatric population with congenital heart defect which are not present in the structure of the diagnostic being studied.

Surgical site infection prevention bundle for children submitted to cardiac surgery / Bundle para la prevención de la infección de sitio quirúrgico en los niños sometidos a cirugía cardíaca / Bundle de prevenção de infecção de sítio cirúrgico em crianças submetidas à cirurgia cardíaca

ABSTRACT Objective: To build and validate the content and appearance of a surgical site infection prevention bundle for children submitted to cardiac surgery. Method: Methodological study in two phases: 1) Bundle construction from an integrative literature review from which interventions have been extracted to compose the instrument; 2) Bundle content and appearance validation by 24 judges. Results: The 24 found articles presented 17 interventions for surgical site infection prevention in this population. Out of them, seven intervention proposals have been chosen to compose the bundle and sent for assessment by judges. The final proposal includes all the seven items chosen in the construction phase and has achieved a content validity index over 0.8 in all items referring to content and appearance. Conclusion: The content and appearance of the developed bundle proposes care for the prevention of surgical site infection throughout the perioperative period.

RESUMEN Objetivo: Construir y validar el contenido y la apariencia de un bundle para la prevención de las infecciones de sitio quirúrgico en niños sometidos a cirugía cardiaca. Método: Estudio metodológico en dos etapas: 1) Construcción del bundle a través de una revisión integrativa de la literatura de la cual se extrajeron las intervenciones para componer el instrumento; 2) Validación de contenido y apariencia del bundle, con 24 jueces. Resultados: Se encontraron 24 artículos que evidenciaron 17 intervenciones para la prevención de la infección de sitio quirúrgico en esta población. De estas, siete propuestas de intervención fueron elegidas para componer el bundle y enviadas para la apreciación de los jueces. La propuesta final incorpora todos los siete ítems elegidos en la etapa de construcción, llegando a un índice de validez de contenido superior a 0.8 para todos los ítems referentes al contenido y a la apariencia. Conclusión: El contenido y apariencia del bundle desarrollado propone cuidados para la prevención de la infección de sitio quirúrgico en todo el período perioperatorio.

RESUMO Objetivo: Construir e validar o conteúdo e a aparência de um bundle de prevenção de infecções de sítio cirúrgico em crianças submetidas à cirurgia cardíaca. Método: Estudo metodológico em duas etapas: 1) Construção do bundle a partir de uma revisão integrativa da literatura, na qual foram extraídas as intervenções para compor o instrumento; 2) Validação de conteúdo e aparência do bundle, com 24 juízes. Resultados: Foram encontrados 24 artigos que evidenciaram 17 intervenções para prevenção de infecção de sítio cirúrgico na referida população. Destas, sete propostas de intervenção foram elencadas para compor o bundle e enviadas para apreciação dos juízes. A proposta final incorpora todos os sete itens elencados na fase de construção, alcançando um índice de validade de conteúdo superior a 0,8 para todos os itens referentes ao conteúdo e aparência. Conclusão: O conteúdo e aparência do bundle desenvolvido propõe cuidados para prevenção de infecção de sítio cirúrgico em todo o período perioperatório.

Content validity of the nursing diagnostic Breathing Pattern, Ineffective, in children with congenital heart defects / Validez de contenido del diagnóstico de enfermería Estándar Respiratoria Ineficaz en niños con cardiopatías congénitas / Validade de conteúdo do diagnóstico de enfermagem Padrão Respiratório Ineficaz em crianças com cardiopatias congênitas

ABSTRACT Objective: To estimate the content validity of the nursing diagnostic Breathing Pattern, Ineffective, in children with congenital heart defects. Method: Methodological study in two stages: 1) integrative literature review; 2) content validation, with 23 nurses. An instrument with 10 related factors and 21 defining characteristics for data collection was used. The analysis by the evaluators was carried out using the relevance criteria. The Content Validity Index was used. Valid results were those above 0.9 with a Wilcoxon test above 0.05. Results: The final proposal incorporates nine from the ten causal factors. From them, five do not belong in the NANDA-I list. Regarding the defining characteristics, they were all considered to be relevant, and five are not among the list of signs and symptoms of the NANDA-I taxonomy. Conclusion: The findings of this study include specific elements of the pediatric population with congenital heart defect which are not present in the structure of the diagnostic being studied.

RESUMEN Objetivo: Estimar validez de contenido del diagnóstico de enfermería Estándar Respiratoria Ineficaz en niños con cardiopatías congénitas. Métodos: Estudio metodológico realizado en dos etapas: 1) revisión integrativa de literatura; 2) validez del contenido, con 23 enfermeros. Utilizó instrumento conteniendo 10 factores relacionados y 21 características definidoras para recogida de datos. Jueces realizaron el análisis con base en criterio de relevancia. Utilizado Índice de Validez de Contenido diagnóstico, considerado válido si superior a 0,9 y si test de Wilcoxon mayor que 0,05. Resultados: Propuesta final incorpora nueve de los diez factores causales. De ellos, cinco no pertenecen a la lista de la NANDA-I. Cuanto a características definidoras, todas han consideradas relevantes, y cinco no pertenecen al rol de señales y síntomas de la taxonomía NANDA-I. Conclusión: Los hallados de esto estudio incluyen elementos específicos de población pediátrica con cardiopatía congénita que no están presentes en la estructura del diagnóstico en estudio.

RESUMO Objetivo: Estimar a validade de conteúdo do diagnóstico de enfermagem Padrão Respiratório Ineficaz em crianças com cardiopatias congênitas. Métodos: Estudo metodológico realizado em duas etapas: 1) revisão integrativa da literatura; 2) validade do conteúdo, com 23 enfermeiros. Utilizou-se instrumento contendo 10 fatores relacionados e 21 características definidoras para coleta de dados. Os juízes realizaram a análise com base no critério de relevância. Foi utilizado o Índice de Validade de Conteúdo diagnóstico, considerado válido se superior a 0,9 e se teste de Wilcoxon maior que 0,05. Resultados: A proposta final incorpora nove dos dez fatores causais. Deles, cinco não pertencem à lista da NANDA-I. Quanto às características definidoras, todas foram consideradas relevantes, e cinco não pertencem ao rol de sinais e sintomas da taxonomia NANDA-I. Conclusão: Os achados deste estudo incluem elementos específicos da população pediátrica com cardiopatia congênita que não estão presentes na estrutura do diagnóstico em estudo.

Associação do estado nutricional e os desfechos clínicos em cirurgia cardíaca pediátrica / Relación del estado nutricional y los resultados clínicos en cirugía cardíaca pediátrica / Association of nutritional status and clinical outcomes in pediatric cardiac surgery

Resumo Objetivo Verificar a associação do fator pessoal biológico estado nutricional, das crianças submetidas à cirurgia cardíaca, com os seguintes comportamentos: mortalidade/alta hospitalar, tempo de internação na Unidade de Terapia Intensiva (UTI) e tempo de ventilação mecânica (VM). Métodos Estudo transversal, retrospectivo realizado com 786 prontuários de crianças menores de cinco anos, submetidas à cirurgia cardíaca. O modelo de Nola J. Pender foi usado para analisar os dados. Aplicou-se o teste Qui-Quadrado de Pearson para verificar associação entre o fator pessoal biológico e o comportamento mortalidade/alta hospitalar. O teste Kruskal-Wallis foi utilizado para verificar a diferença entre medianas do fator pessoal biológico e os comportamentos tempo de VM e de UTI. Resultados A associação entre os fatores pessoais biológicos (pobre estado nutricional, desnutrição aguda e desnutrição crônica) com o comportamento mortalidade foi de OR 2,18 (1,42 - 3,34), p=0,003, OR 0,75 (0,46 - 1,2), p=0,24 e OR 2,7 (1,77 - 4,12), p<0,0001, respectivamente. A mediana de tempo em dias de uso de VM e tempo em dias de UTI foi, respectivamente de 3 (p<0,0001) e 8 (p<0,0001) para o pobre estado nutricional, 2 (p=0,041) e 6,5 (p=0,006) para a desnutrição aguda, 3 (p<0,0001) e 8 (p<0,0001) para a desnutrição crônica. Conclusão Os fatores pessoais biológicos que tiveram associação significativa com o comportamento mortalidade foram o pobre estado nutricional e desnutrição aguda. Foi verificado que as crianças com déficits nutricionais analisados tiveram uma superior mediana de tempo de VM e tempo de UTI quando comparadas com as crianças sem déficits nutricionais.

Resumen Objetivo Verificar la relación del factor personal biológico estado nutricional de niños sometidos a cirugía cardíaca, con los siguientes comportamientos: mortalidad/alta hospitalaria, tiempo de internación en Unidad de Cuidados Intensivos (UCI) y tiempo de ventilación mecánica (VM). Métodos Estudio transversal, retrospectivo realizado con 786 historias clínicas de niños menores de cinco años sometidos a cirugía cardíaca. Para analizar los datos se utilizó el modelo de Nola J. Pender. Se aplicó la prueba χ2 de Pearson para verificar la relación entre el factor personal biológico y el comportamiento mortalidad/alta hospitalaria. La prueba de Kruskal-Wallis fue utilizada para verificar la diferencia entre medianas del factor personal biológico y los comportamientos tiempo de VM y de UCI. Resultados La relación entre los factores personales biológicos (mal estado nutricional, desnutrición aguda y desnutrición crónica) y el comportamiento mortalidad fue de OR 2,18 (1,42 - 3,34), p=0,003, OR 0,75 (0,46 - 1,2), p=0,24 y OR 2,7 (1,77 - 4,12), p<0,0001, respectivamente. La mediana del tiempo en días de uso de VM y tiempo en días de UCI fue de 3 (p<0,0001) y 8 (p<0,0001) respectivamente para el mal estado nutricional, 2 (p=0,041) y 6,5 (p=0,006) para la desnutrición aguda, 3 (p<0,0001) y 8 (p<0,0001) para la desnutrición crónica. Conclusión Los factores personales biológicos que tuvieron relación significativa con el comportamiento mortalidad fueron el mal estado nutricional y la desnutrición aguda. Se verificó que los niños con deficiencias nutricionales estudiados tuvieron una mediana mayor de tiempo de VM y tiempo de UCI en comparación con niños sin deficiencias nutricionales.

Abstract Objective To find the association of the biological personal factor 'nutritional status' of children undergoing cardiac surgery with the following behaviors: mortality/hospital discharge, length of stay in the Intensive Care Unit (ICU) and time in mechanical ventilation (MV). Methods Cross-sectional, retrospective study of 786 medical records of children under five years of age who underwent cardiac surgery. Nola J. Pender's model was used for data analysis. The Pearson's Chi-Square test was applied to find the association between the biological personal factor and the mortality/hospital discharge behavior. The Kruskal-Wallis test was used to assess the difference between medians of the biological personal factor and the behaviors of time in MV and ICU length of stay. Results The association between personal biological factors (poor nutritional status, acute malnutrition and chronic malnutrition) with mortality behavior was OR 2.18 (1.42 - 3.34), p=0.003, OR 0.75 (0.46 - 1.2), p=0.24 and OR 2.7 (1.77 - 4.12), p<0.0001, respectively. The median time in days of MV use and ICU length of stay in days was, respectively, 3 (p<0.0001) and 8 (p<0.0001) for poor nutritional status, two (p=0.041) and 6.5 (p=0.006) for acute malnutrition, 3 (p<0.0001) and 8 (p<0.0001) for chronic malnutrition. Conclusion The personal biological factors with a significant association with mortality behavior were poor nutritional status and acute malnutrition. Children with analyzed nutritional deficits had a higher median time of MV and time of ICU compared with children without nutritional deficits.

Evaluation of color-coded drug labeling to identify endovenous medicines.

OBJECTIVE: To analyze the opinion of nursing professionals on the design, practicality of use and the usefulness of color-coded drug labeling in a pediatric intensive care unit. METHODS: A cross-sectional study with 42 nursing professionals. A structured questionnaire was used based on a five-level Likert scale. To assess the proportions, a binomial test was used. RESULTS: Concordance ratio >0.8 for all propositions related to design, practicality and most of the propositions related to error prevention. CONCLUSION: According to the opinion of the nursing team, the implemented technology has an adequate design, as well as being practical and useful in the prevention of medication errors in the population at the ICU.

Evaluation of color-coded drug labeling to identify endovenous medicines / Evaluación de los etiquetados con código de colores para la identificación de medicamentos endovenosos / Avaliação da rotulagem com código de cores para identificação de medicamentos endovenosos

ABSTRACT Objective: To analyze the opinion of nursing professionals on the design, practicality of use and the usefulness of color-coded drug labeling in a pediatric intensive care unit. Methods: A cross-sectional study with 42 nursing professionals. A structured questionnaire was used based on a five-level Likert scale. To assess the proportions, a binomial test was used. Results: Concordance ratio >0.8 for all propositions related to design, practicality and most of the propositions related to error prevention. Conclusion: According to the opinion of the nursing team, the implemented technology has an adequate design, as well as being practical and useful in the prevention of medication errors in the population at the ICU.

RESUMEN Objetivo: Analizar la opinión de los profesionales de Enfermería acerca del diseño, la practicidad del uso y la utilidad de los etiquetados con código de colores en una unidad de terapia intensiva pediátrica. Método: Estudio transversal, realizado con 42 profesionales de enfermería. Se utilizó un cuestionario estructurado basado en una escala Likert de cinco niveles. Para el análisis de las proporciones, se utilizó la prueba binomial. Resultados: Se encontró la proporción de concordancia >0,8 para todas las proposiciones relacionadas con el diseño, la practicidad del uso y la mayoría de las proposiciones relacionadas con la prevención de errores. Conclusión: Según la opinión del equipo de enfermería frente al objeto de estudio, la tecnología implementada tiene un diseño adecuado, además de ser práctica y útil en la prevención de errores de medicamentos en población atendida en la UTI.

RESUMO Objetivo: Analisar a opinião dos profissionais de enfermagem sobre o design, a praticidade do uso e a utilidade da rotulagem com código de cores em uma unidade de terapia intensiva pediátrica. Método: Estudo transversal, realizado com 42 profissionais de enfermagem. Utilizou-se um questionário estruturado com base em uma escala Likert de cinco níveis. Para a análise das proporções, utilizou-se o teste binomial. Resultados: Houve proporção de concordância >0,8 para todas as proposições relacionadas ao design, à praticidade do uso e à maioria das proposições relacionadas à prevenção de erros. Conclusão: De acordo com a opinião da equipe de enfermagem, frente ao objeto de estudo, a tecnologia implementada tem design adequado, além de ser prática e útil na prevenção de erros de medicamentos em população atendida na UTI.

Urinary Syndecan-1 and acute kidney injury after pediatric cardiac surgery.

INTRODUCTION: Acute kidney injury (AKI) is a common occurrence after pediatric cardiac surgery. Plasma syndecan-1 is a biomarker of endothelial glycocalyx damage and it is associated with AKI. Syndecan-1 is also expressed in renal tubular cells but there is no study evaluating urinary syndecan-1 in predicting AKI. METHODS: Prospective cohort study with 86 patients ≤18 years submitted to cardiac surgery at one reference institution. Postoperative urinary syndecan-1 was collected within the first 2 h after cardiac surgery. Severe AKI - defined according to KDIGO as stage 2 or 3 - doubling of serum creatinine from the preoperative value or need for dialysis during hospitalization was the main outcome. Analyses were adjusted for clinical cofounders. RESULTS: Postoperative urinary syndecan-1 levels were higher in patients with severe AKI and even after adjustment for several clinical variables; the fourth quartile was significantly associated with severe AKI. The AUC-ROC for postoperative urinary syndecan-1 showed good discriminatory capacity (AUC-ROC = 0.793). The addition of urinary syndecan-1 improved the discrimination capacity of a clinical model (0.78 to 0.84). It also improved risk prediction, as measured by net reclassification improvement (NRI). CONCLUSION: Urinary syndecan-1 predicts severe AKI after pediatric cardiac surgery. Moreover, it appears to add capacity to predict severe AKI into a clinical model.

Padrão respiratório ineficaz em crianças com cardiopatias congênitas: construção e validação por juízes de uma teoria de médio alcance / Ineffective respiratory pattern in children with congenital heart defects: construction and validation by judges of a medium-range theory

Para compreender a dinâmica do Padrão respiratório ineficaz em crianças com cardiopatias congênitas, é necessário aprofundar o estudo em torno de seus fatores causais, atributos essenciais e indicadores clínicos, além de entender como eles se relacionam entre si. Uma ferramenta útil para realizar esse tipo de análise é a Teoria de médio alcance (TMA). Mediante isto, este estudo tem como objetivo verificar a validade da estrutura do diagnóstico de enfermagem Padrão Respiratório Ineficaz (PRI) em crianças com cardiopatias congênitas pela realização de duas etapas, a saber: construção de uma teoria de médio alcance (TMA) e análise por juízes. A primeira etapa do estudo foi desenvolvida com base no modelo proposto por Lopes, Silva e Herdman (2015). A construção da Teoria de Médio Alcance para o diagnóstico de enfermagem Padrão respiratório ineficaz em crianças com cardiopatias congênitas foi embasada à luz do Modelo de Adaptação de Roy (MAR), de uma revisão integrativa da literatura e da taxonomia da NANDA Internacional, Inc. (NANDA-I). A revisão integrativa concretizou-se por meio de uma ampla busca na literatura a partir de quatro bases de dados (SCOPUS, CINAHL, PUBMED e Web of Science). Após aplicação dos critérios de inclusão e exclusão, foram selecionados 50 estudos que fundamentaram a construção da Teoria de médio alcance. Após leitura e análise dos referenciais teóricos, identificaram-se 10 estímulos do diagnóstico PRI, dos quais seis não apresentam correspondência com os fatores relacionados reportados na NANDA-I; 21 comportamentos foram encontrados dos quais cinco não constam no rol de características definidoras da NANDA-I. Os estímulos e os comportamentos foram incorporados à estrutura do diagnóstico. Em seguida, foram desenvolvidas definições conceituais e operacionais para cada estímulo e comportamento. Foram descritas proposições que explicassem a relação entre PRI e seus componentes estruturais, bem como estabelecidas as relações de causalidade do diagnóstico. Para sintetizar as proposições e relações causais, um pictograma foi criado. A segunda etapa do presente estudo contou com a participação de 23 juízes especialistas em terminologias de enfermagem e/ou com prática clínica. Os mesmos julgaram os estímulos e comportamentos da TMA, bem como suas definições conceituais e operacionais com base nos critérios de relevância, clareza e precisão. A proposta final do processo de validação incorpora nove estímulos, a saber: aumento da resistência das vias aéreas, redução da complacência pulmonar, aumento na concentração de dióxido de carbono, aumento na concentração de hidrogênio, posição do corpo que inibe expansão pulmonar, deformidades da parede do tórax, esforço físico,ansiedade e dor. Com relação aos comportamentos, todos foram considerados como relevantes, a saber: uso de músculos acessórios à respiração, alterações na profundidade respiratória, taquipneia, mudanças no ritmo respiratório, dispneia, ortopneia, hipóxia, hipoxemia, cianose, distúrbios respiratórios do sono, fadiga da musculatura respiratória, fase de expiração prologada, batimentos de asa de nariz, bradpneia, excursão torácica alterada, pressão expiratória diminuída, pressão inspiratória diminuída, ventilação minuto-diminuída, respiração com os lábios franzidos, diâmetro antero-posterior aumentado e assumir posição de três pontos. Com exceção do estímulo idade menor que dois anos, as definições conceituais e operacionais construídas para os estímulos e os comportamentos apresentaram índice de validade de conteúdo diagnóstico superiores a 0,9. Considera-se que processo de validação da estrutura do diagnóstico de enfermagem Padrão Respiratório Ineficaz (PRI) em crianças com cardiopatias congênitas subsidiou o refinamento e o aprimoramento desse diagnóstico e de seus componentes. É imprescindível à enfermagem apropriar-se desse diagnóstico no contexto do cuidado da criança cardiopata. Sugere-se que um estudo de validação clínica seja conduzido para avaliar os componentes de PRI ainda não incorporados à NANDA-I, bem como para verificar a validade das proposições e relações de causalidade apontadas na TMA.(AU)

Analysis of Surgical Mortality for Congenital Heart Defects Using RACHS-1 Risk Score in a Brazilian Single Center.

Introduction: Risk Adjustment for Congenital Heart Surgery 1 (RACHS-1) score is a simple model that can be easily applied and has been widely used for mortality comparison among pediatric cardiovascular services. It is based on the categorization of several surgical palliative or corrective procedures, which have similar mortality in the treatment of congenital heart disease. Objective: To analyze the in-hospital mortality in pediatric patients (<18 years) submitted to cardiac surgery for congenital heart disease based on RACHS-1 score, during a 12-year period. Methods: A retrospective date analysis was performed from January 2003 to December 2014. The survey was divided in two periods of six years long each, to check for any improvement in the results. We evaluated the numbers of procedures performed, complexity of surgery and hospital mortality. Results: Three thousand and two hundred and one surgeries were performed. Of these, 3071 were able to be classified according to the score RACHS-1. Among the patients, 51.7% were male and 47.5% were younger than one year of age. The most common RACHS-1 category was 3 (35.5%). The mortality was 1.8%, 5.5%, 14.9%, 32.5% and 68.6% for category 1, 2, 3, 4 and 6, respectively. There was a significant increase in the number of surgeries (48%) and a significant reduction in the mortality in the last period analysed (13.3% in period I and 10.4% in period II; P=0.014). Conclusion: RACHS-1 score was a useful score for mortality risk in our service, although we are aware that other factors have an impact on the total mortality.

Proposal of an Integrated Health Care Network System for Patients with Congenital Heart Defects.

The perspective of the integrated health system has a network of care with multiple integration dimensions among subsystems as nuclear representation, relating the clinical aspects and governance to the representations and collective values. The normative integration aims to ensure coherence between the system of representations and values of society simultaneously with the interfaces of clinical and functional integration. It builds a bridge with governance, which allows, through their skills, management of all system components, encouraging cooperation, communication and information, in order to ensure the population under their responsibility to access excellence services, exceeding their expectations. The integration of care consists of a durable coordination of clinical practices for those who suffer from health problems in order to ensure continuity and full range of the required professional services and organizations, coordinated in time and space, in accordance with the available knowledge. It is possible to establish the type of health equipment for each level of care for patients with congenital heart diseases. This strategy intends to offer timely care in appropriate moments and places, efficiently, operating cooperatively an interdependently, with ongoing exchange of its resources. Thus, situational integration establishes the system connection with the assessment environment that proposes to carry out value judgment, guided by an objective worldview, about an intervention or any of its components, in order to objectify the decision making.

Syndecan-1 improves severe acute kidney injury prediction after pediatric cardiac surgery.

OBJECTIVE: Acute kidney injury is a common occurrence after pediatric cardiac surgery and is associated with adverse patient outcomes. Syndecan-1 is a biomarker of endothelial glycocalyx damage, and its early increment after surgery can be associated with acute kidney injury. METHODS: We performed a prospective cohort study with 289 patients aged less than 18 years who underwent cardiac surgery at 1 reference institution. Postoperative plasma syndecan-1 was collected within the first 2 hours after cardiac surgery. Severe acute kidney injury, defined according to Kidney Disease: Improving Global Outcomes stage 2 or 3, doubling of serum creatinine from the preoperative value, or need for dialysis during hospitalization, was the main outcome. Analyses were adjusted for clinical variables and "renal angina index" components (early decrease in estimated creatinine clearance from baseline and increase in percent of intensive care unit fluid overload on the first postoperative day). RESULTS: Plasma syndecan-1 levels measured early in the postoperative period were independently associated with severe acute kidney injury. The accuracy of postoperative syndecan-1 for the diagnosis of severe acute kidney injury was moderate (area under the curve receiver operating characteristic, 0.77; 95% confidence interval, 0.68-0.85). The addition of syndecan-1 improved the discrimination capacity of a clinical model from 0.80 to 0.86 (P = .004) and improved risk prediction, as measured by net reclassification improvement and integrated discrimination improvement. Postoperative sundecan-1 levels also were independently associated with longer length of intensive care unit and hospital stay. CONCLUSIONS: Postoperative plasma syndecan-1 is associated with subsequent severe acute kidney injury and poor outcomes among children undergoing cardiac surgery. It may be useful to identify patients who are at increased risk for acute kidney injury after cardiac surgery.

Proposal of an integrated health care network system for patients with congenital heart defects

ABSTRACT The perspective of the integrated health system has a network of care with multiple integration dimensions among subsystems as nuclear representation, relating the clinical aspects and governance to the representations and collective values. The normative integration aims to ensure coherence between the system of representations and values of society simultaneously with the interfaces of clinical and functional integration. It builds a bridge with governance, which allows, through their skills, management of all system components, encouraging cooperation, communication and information, in order to ensure the population under their responsibility to access excellence services, exceeding their expectations. The integration of care consists of a durable coordination of clinical practices for those who suffer from health problems in order to ensure continuity and full range of the required professional services and organizations, coordinated in time and space, in accordance with the available knowledge. It is possible to establish the type of health equipment for each level of care for patients with congenital heart diseases. This strategy intends to offer timely care in appropriate moments and places, efficiently, operating cooperatively an interdependently, with ongoing exchange of its resources. Thus, situational integration establishes the system connection with the assessment environment that proposes to carry out value judgment, guided by an objective worldview, about an intervention or any of its components, in order to objectify the decision making.

Analysis of surgical mortality for congenital heart defects using rachs-1 risk score in a brazilian single center

ABSTRACT Introduction: Risk Adjustment for Congenital Heart Surgery 1 (RACHS-1) score is a simple model that can be easily applied and has been widely used for mortality comparison among pediatric cardiovascular services. It is based on the categorization of several surgical palliative or corrective procedures, which have similar mortality in the treatment of congenital heart disease. Objective: To analyze the in-hospital mortality in pediatric patients (<18 years) submitted to cardiac surgery for congenital heart disease based on RACHS-1 score, during a 12-year period. Methods: A retrospective date analysis was performed from January 2003 to December 2014. The survey was divided in two periods of six years long each, to check for any improvement in the results. We evaluated the numbers of procedures performed, complexity of surgery and hospital mortality. Results: Three thousand and two hundred and one surgeries were performed. Of these, 3071 were able to be classified according to the score RACHS-1. Among the patients, 51.7% were male and 47.5% were younger than one year of age. The most common RACHS-1 category was 3 (35.5%). The mortality was 1.8%, 5.5%, 14.9%, 32.5% and 68.6% for category 1, 2, 3, 4 and 6, respectively. There was a significant increase in the number of surgeries (48%) and a significant reduction in the mortality in the last period analysed (13.3% in period I and 10.4% in period II; P=0.014). Conclusion: RACHS-1 score was a useful score for mortality risk in our service, although we are aware that other factors have an impact on the total mortality.

Epidemiology of congenital heart disease in Brazil.

INTRODUCTION: Congenital heart disease is an abnormality in the structure or cardiocirculatory function, occurring from birth, even if diagnosed later. It can result in intrauterine death in childhood or in adulthood. Accounted for 6% of infant deaths in Brazil in 2007. OBJECTIVE: To estimate underreporting in the prevalence of congenital heart disease in Brazil and its subtypes. METHODS: The calculations of prevalence were performed by applying coefficients, giving them function rates for calculations of health problems. The study makes an approach between the literature and the governmental registries. It was adopted an estimate of 9: 1000 births and prevalence rates for subtypes applied to births of 2010. Estimates of births with congenital heart disease were compared with the reports to the Ministry of Health and were studied by descriptive methods with the use of rates and coefficients represented in tables. RESULTS: The incidence in Brazil is 25,757 new cases/year, distributed in: North 2,758; Northeast 7,570; Southeast 10,112; South 3,329; and Midwest 1,987. In 2010, were reported to System of Live Birth Information of Ministry of Health 1,377 cases of babies with congenital heart disease, representing 5.3% of the estimated for Brazil. In the same period, the most common subtypes were: ventricular septal defect (7,498); atrial septal defect (4,693); persistent ductus arteriosus (2,490); pulmonary stenosis (1,431); tetralogy of Fallot (973); coarctation of the aorta (973); transposition of the great arteries (887); and aortic stenosis 630. The prevalence of congenital heart disease, for the year of 2009, was 675,495 children and adolescents and 552,092 adults. CONCLUSION: In Brazil, there is underreporting in the prevalence of congenital heart disease, signaling the need for adjustments in the methodology of registration.

Epidemiology of congenital heart disease in Brazil / Epidemiologia da cardiopatia congênita no Brasil

Abstract Introduction: Congenital heart disease is an abnormality in the structure or cardiocirculatory function, occurring from birth, even if diagnosed later. It can result in intrauterine death in childhood or in adulthood. Accounted for 6% of infant deaths in Brazil in 2007. Objective: To estimate underreporting in the prevalence of congenital heart disease in Brazil and its subtypes. Methods: The calculations of prevalence were performed by applying coefficients, giving them function rates for calculations of health problems. The study makes an approach between the literature and the governmental registries. It was adopted an estimate of 9: 1000 births and prevalence rates for subtypes applied to births of 2010. Estimates of births with congenital heart disease were compared with the reports to the Ministry of Health and were studied by descriptive methods with the use of rates and coefficients represented in tables. Results: The incidence in Brazil is 25,757 new cases/year, distributed in: North 2,758; Northeast 7,570; Southeast 10,112; South 3,329; and Midwest 1,987. In 2010, were reported to System of Live Birth Information of Ministry of Health 1,377 cases of babies with congenital heart disease, representing 5.3% of the estimated for Brazil. In the same period, the most common subtypes were: ventricular septal defect (7,498); atrial septal defect (4,693); persistent ductus arteriosus (2,490); pulmonary stenosis (1,431); tetralogy of Fallot (973); coarctation of the aorta (973); transposition of the great arteries (887); and aortic stenosis 630. The prevalence of congenital heart disease, for the year of 2009, was 675,495 children and adolescents and 552,092 adults. Conclusion: In Brazil, there is underreporting in the prevalence of congenital heart disease, signaling the need for adjustments in the methodology of registration. .

Resumo Introdução: Cardiopatia congênita é uma anormalidade na estrutura ou função cardiocirculatória, ocorrente desde o nascimento, mesmo que diagnosticada posteriormente. Pode resultar em morte intraútero, na infância ou na idade adulta. Foi responsável por 6% dos óbitos infantis, no Brasil, em 2007. Objetivo: Estimar a subnotificação na prevalência das cardiopatias congênitas no Brasil e seus subtipos. Métodos: Os cálculos das prevalências foram realizados aplicando-se coeficientes, atribuindo-lhes função de taxas para cálculos dos agravos. O estudo faz aproximação entre a literatura e os registros governamentais. Adotou-se estimativa de 9:1000 nascimentos e taxas de prevalências para subtipos, aplicadas aos nascimentos de 2010. As estimativas de nascimentos com cardiopatia congênita foram comparadas com as notificações ao Ministério da Saúde. Foram estudados por métodos descritivos com uso de taxas e coeficientes, representados em tabelas. Resultados: A incidência, no Brasil, é de 25.757 novos casos/ano, distribuídos em: Norte 2.758; Nordeste 7.570; Sudeste 10.112; Sul 3.329; e Centro-Oeste 1.987. Em 2010, foram notificados ao SINASC/MS 1.377 casos de nascidos com cardiopatias congênitas, o que representa 5,3% do estimado para Brasil. No mesmo período, os subtipos mais frequentes foram: comunicação interventricular (7.498); comunicação interatrial (4.693); persistência do canal arterial (2.490); estenose pulmonar (1.431); tetralogia de Fallot (973); coarctação da aorta (973); transposição das grandes artérias (887); e estenose aórtica 630. A prevalência de cardiopatias congênitas, para o ano de 2009, foi 675.495 crianças e adolescentes e 552.092 adultos. Conclusão: Há, no Brasil, subnotificação na prevalência das cardiopatias congênitas, sinalizando para a necessidade de adequações na metodologia de seu registro. .

[World-view, cultural care and environmental concept, the daily care of the elderly with diabetes mellitus]. / Visão do mundo, cuidado cultural e conceito ambiental: o cuidado do idoso com diabetes Mellitus.

This study aimed to analyze the daily care of the elderly with DM in the light of the theoretical assumptions of Leininger. This is a study descriptive, qualitative, with the participation of 8 elderly patients with DM in a health unit in Fortaleza. Information was collected through interviews with semi-structured. Data analysis was performed in a second categorical groupings analogue and contemplating pre-analysis, material investigation and treatment and interpretation of data obtained. The categories that emerged from testimony in the light of the concepts of Leininger are: world vision, care and cultural context environmental. We believe that older people with diabetes mellitus feel health through the cultivation of faith in religion, in the use of medicinal plants, and support for health professionals.