Content validation of the operational definitions of the nursing diagnoses of activity intolerance, excess fluid volume, and decreased cardiac output in patients with heart failure.

OBJECTIVES: To consensually validate the operational definitions of the nursing diagnoses activity intolerance, excessive fluid volume, and decreased cardiac output in patients with decompensated heart failure. METHOD: Consensual validation was performed in two stages: analogy by similarity of defining characteristics, and development of operational definitions and validation with experts. RESULTS: A total of 38 defining characteristics were found. Operational definitions were developed and content-validated. One hundred percent of agreement was achieved among the seven experts after five rounds. "Ascites" was added in the nursing diagnosis excessive fluid volume. CONCLUSION: The consensual validation improves interpretation of human response, grounding the selection of nursing interventions and contributing to improved nursing outcomes. IMPLICATIONS FOR PRACTICE: Support the assessment of patients with decompensated heart failure.

Consensual validation of the nursing diagnoses fear and anxiety identified at the immediate preoperative period in patients undergoing elective surgery.

PURPOSE: To identify the most frequent defining characteristics (DCs) for the diagnoses fear and anxiety in Brazilian patients in the immediate preoperative period following elective cardiac surgery; to develop conceptual and operational definitions for the DCs; to develop consensual validation. METHODS: Clinical and observational, descriptive study developed in two phases. FINDINGS: Forty DCs were identified for fear and 19 for anxiety. One expert judged it necessary to include "altered bowel motility" as a DC for fear. There was 100% agreement among the five experts in relation to the DCs. CONCLUSIONS: To add "altered bowel motility" to the DCs for the nursing diagnosis fear. IMPLICATIONS FOR PRACTICE: To enable nurses to more accurately assess patients for these diagnoses.

A prospective, randomized study of ventilator-associated pneumonia in patients using a closed vs. open suction system.

The objective of this study was to verify the incidence of nosocomial pneumonia in intubated and extended mechanically ventilated patients having endotracheal suctioning by an open vs. closed suction method aiming to decrease nosocomial pneumonia. Twenty-four (51.1%) patients received open-tracheal suction and 23 (48.9%) received closed-tracheal suction. The inclusion criteria were: surgical and medical patients older than 13 years, undergoing mechanical ventilation for more than 48 hours. Additional data were gathered using the Acute Physiology and Chronic Health Evaluation II, and details on smoking, alcoholism, diabetes mellitus, renal failure, previous lung disease, and previous use of antibiotics, steroids, H2 antagonists and antacids. Among the 24 patients having open-tracheal suction, 11 developed nosocomial pneumonia while of the 23 patients undergoing closed-tracheal suction, seven developed infection (P = 0.278). Risk factors for nosocomial pneumonia were not significantly different between the two groups. In the final logistical regression model the following variables remained: groups (open and closed) [odds ratio (OR) = 0.014; confidence interval (CI) = 0.001-0.416; P = 0.014] and use of prior antibiotics (OR = 2.297; CI = 1.244-4.242; P = 0.008). Use of a closed suction system did not decrease the incidence of nosocomial pneumonia when compared with the open system. The exogenous risk factors were the most important for acquiring this infection.

[Anxiety generating situations among nurses and strategies to control it: preliminary study]. / Situações geradoras de ansiedade e estratégias para seu controle entre enfermeiras: estudo preliminar.

The purposes of this study were: to identify situations that are considered sources of anxiety in nurse's daily activities and to identify the conscious strategies these nurses use in order to lower the level of anxiety. The sample was composed of 54 nurses from a larger general teaching hospital that answered a questionnaire with open and closed questions. The answers pointed situations, both quotidian and unsuspected, that generate anxiety in the following areas: direct care, management and teaching. Nurses also pointed the activities they usually do in order to cope with stress, during the crisis or in their quotidian life. Findings demonstrate that even though the nurses are exposed to stressing situations that generate anxiety, they also use adequate coping strategies. We observe that more studies are needed, in order to propose new alternatives to improve nurses' quality of life.

[Fluid management: a nursing intervention for the patient with fluid volume excess]. / Controlar líquidos: uma intervenção de enfermagem para o paciente com excesso de volume de líquidos.

The objective of this research is to identify which nursing activities contained in the fluid management intervention proposed by the Nursing Intervention Classification (NIC) are realized and considered important by nurses, to attend patients who received fluid volume excess as a nursing diagnosis, as proposed by the North American Nursing Diagnoses Association (NANDA). Data were collected in three hospitals. The sample included 77 nurses, who chose the best alternative on a Likert scale, to indicate the realization of which of those actives they considered important and which activities are realized in their daily care practice. It was concluded that most of the nursing activities were always considered important and were always performed by the nurses. These activities were classified as independent and dependent.