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.

Modeling canopy interception under drought conditions: The relevance of evaporation and extra sources of energy.

Modeling canopy interception is fundamental for understanding the forests' role in local and regional hydrology. In this study, canopy interception (CI), throughfall (TF), and stemflow (SF) were evaluated for a semi-deciduous Atlantic Forest (AFR) from 2013 to 2019, where a prolonged dry period occurred. The Gash and Liu models were analyzed in detail to determine the most appropriate for modeling CI throughout drought conditions. Thus, the climatic parameters were retrieved annually by a modified TF-based method (EI%), whereas the structural parameters represented the entire period. The contribution of the energy stored in the forest (i.e. air and biomass; Q) to CI was also assessed in the AFR stand. Both models performed well when using EI%, as the Gash model overestimated CI by 71 mm (4.6%), whereas the Liu model underestimated it by only 13 mm (0.85%). This performance is due to an increased Q and turbulent mechanisms (such as advection and strong updrafts) that occur in drought conditions and are indirectly accounted for in EI%. However, the Liu model stood out for modeling CI under a prolonged dry period, as the exponential wetting approach better represents the complex canopies of the semi-deciduous forests. Thus, we recommend the Liu model and additional energy sources when dealing with prolonged droughts, as in the case of climate change scenarios projected to the studied region.

Comparison of quality of life between patients on the waiting list and heart transplant recipients. / Comparação da qualidade de vida entre pacientes em lista de espera e pacientes submetidos a transplante cardíaco.

OBJECTIVES: To compare the quality of life (QOL) between wait-listed patients and heart transplant recipients. METHODS: Cross-sectional study of 56 adult patients at two institutions in Southern Brazil, 9(16%) wait-listed patients and 47(84%) transplant recipients. Data were collected from August to December 2012. QOL was assessed using the Medical Outcomes Study 36-Item Short-Form Health Survey (SF-36), with scores ranging from zero to 100. RESULTS: There was statistically significant difference between the two groups in the overall QOL score (p=0.010) and in four dimensions. The mean rank was 16.9 in wait-listed patients and 30.7 in transplant recipients. Wait-listed patients presented the lowest for general health (9.1) and the highest scores for role-emotional (24.8). Transplant recipients obtained the highest scores for general health (32.2) and the lowest scores for bodily pain (29.1). CONCLUSIONS: Undergoing a transplant has a positive impact on the QOL of recipients compared to that of patients awaiting transplantation.

[The challenge of tobacco control at a university hospital]. / O dasafio de controlar o tabagismo em um hospital universitário.

OBJECTIVE: To identify the actions taken by the Commission of Tobacco Control (CTC) to control smoking in the hospital environment. METHODS: Descriptive and exploratory retrospective documentary research conducted at a university hospital in southern Brazil, in 2014. The content of the minutes of CTC meetings was used to create a database, and the rounds reports were descriptively analyzed. We sought to identify the most relevant actions from 2005 to 2014. RESULTS: The CTC implemented the Tobacco-Free Environment programme restricted cigarette smoking to designated areas and subsequently deactivated these areas. The only remaining outdoor smoking area in 2014 was deactivated. CONCLUSION: CTC actions have contributed to tobacco control in the hospital environment. This study will hopefully serve as a model to encourage other institutions to implement similar actions.

Hemostasis control after femoral percutaneous approach: A systematic review and meta-analysis.

BACKGROUND: Hemostasis control after percutaneous endovascular procedures through the femoral approach remains challenging for catheterization laboratory nurses, given method variability. OBJECTIVE: To summarize the available evidence on vascular devices efficacy dedicated to hemostasis control compared to the extrinsic compression after percutaneous procedures in the femoral vein or artery. METHODS: A systematic review with meta-analysis of randomized clinical trials was conducted. We compared different hemostasis methods in adult patients who underwent diagnostic and/or therapeutic procedures through femoral access. The databases searched were PubMed, Embase, CINAHL and Cochrane CENTRAL, and updated on 03/2022. The outcomes included hematoma, pseudoaneurysm, bleeding, minor and major vascular complication, time to hemostasis, device failure, and manual compression repetition. The risk of bias was assessed using the Cochrane Risk of Bias Tool 1.0. Pooled effect sizes on continuous, categorical and proportion variables were estimated with the random effects model. The continuous variables were summarized as the difference between means weighted by the inverse of variance (WMD), and the categorical ones by the summary of relative risks (RR), estimated by the DerSimonian and Laird method. The Freeman-Tukey method was used to estimate the summary effect of proportions. RESULTS: Fifty articles were included in the systematic review. When compared to extrinsic compression, vascular closure devices resulted in a relative risk reduction (RRR) for hematoma: RR 0.82 [95%CI 0.72 to 0.94] and in shorter time to hemostasis WMD -15.06 min [95%CI -17.56 to -12.56]; no association was observed between interventions with vascular closure devices and extrinsic compression for pseudoaneurysm, bleeding, minor and major vascular complications. Compared to extrinsic compression, sealant or gel type devices were compatible with a RRR for hematoma: RR 0.73 [95%CI 0.59 to 0.90]; and metal clip or staple type devices for pseudoaneurysm: RR 0.48 [95%CI 0.25 to 0.90]; and major vascular complication: RR 0.33 [95%CI 0.17 to 0.64]. For each 100 observations, the device failure rate for metal clip or staple was 3.28% [95%CI 1.69 to 6.27]; for suture 6.84% [95%CI 4.93 to 9.41]; for collagen 3.15% [95%CI 2.24 to 4.41]; and for sealant or gel 7.22% [95% CI 5.49 to 9.45]. CONCLUSIONS: Vascular closure devices performed better in hemostasis control. The certainty of the evidence was rated as very low to moderate. REGISTRATION: PROSPERO CRD42019140794.

Nitrogen atmospheric deposition driven by seasonal processes in a Brazilian region with agricultural background.

Understanding the seasonal patterns and influencing factors of nitrogen atmospheric deposition is essential to evaluate human impacts on the air quality and nitrogen biogeochemical cycle. However, evaluation of the nitrogen deposition flux, especially in South America agricultural regions, has not been fully investigated. In this paper, we quantified the atmospheric wet deposition fluxes of total dissolved nitrogen (TDN), dissolved organic nitrogen (DON), and dissolved inorganic nitrogen (DIN), in a region with agricultural and livestock predominance in the Southern Minas Gerais region, Brazil, from May 2018 to April 2019. Deposition fluxes of nitrogen species in the wet season (October-March) were on average 4.8-fold higher than those in the dry season, which revealed significant seasonal variations driven largely by the seasonality of rainfall and agricultural operations. We also found high NO3-/NH4+ ratios (average = 8.25), with higher values in dry season (NO3-/NH4+ = 12.8) in comparison with wet season (NO3-/NH4+ = 4.48), which revealed a higher relative contribution of NOx emissions from traffic sources in dry season. We also estimated the influence of atmospheric deposition of inorganic nitrogen (N-DIN) on environmental ecosystems, being 2.01 kgNha-1 year-1 with potential risk of acidification and eutrophication of 30%. Therefore, attention should be paid to the role of wet atmospheric deposition of nitrogen as a source of nitrogen environmental pollution in agricultural regions.

Use of the ADHERE Risk Model as a Predictor of Risk of in-Hospital Worsening Heart Failure in a Cohort. / Uso do Modelo de Risco ADHERE como Preditor de Piora Intra-Hospitalar de Insuficiência Cardíaca em uma Coorte.

BACKGROUND: Patients admitted with acute decompensated heart failure (HF) are subject to developing worsening episodes that require more complex interventions. The Acute Decompensated Heart Failure National Registry (ADHERE) risk model was developed in the United States to predict the risk of in-hospital worsening HF. OBJECTIVE: To use the ADHERE risk model in the assessment of risk of in-hospital worsening HF and to determine its sensitivity and specificity in hospitalized patients. METHODS: This cohort study was conducted at a Brazilian public university hospital, and data from 2013 to 2020 were retrospectively collected. P values < 0.05 were considered statistically significant. RESULTS: A total of 890 patients with a mean age of 74 ± 8 years were included. The model showed that, in the group of 490 patients at risk, 254 (51.8%) developed in-hospital worsening HF. In the group of 400 patients not at risk, only 109 (27.2%) experienced worsening HF. The results demonstrated a statistically significant curve (area under the curve = 0.665; standard error = 0.018; P < 0.01; confidence interval = 0.609 to 0.701), indicating good accuracy. The model had a sensitivity of 69.9% and a specificity of 55.2%, with a positive predictive value of 52% and a negative predictive value of 72.7%. CONCLUSIONS: In this cohort, we showed that the ADHERE risk model was able to discriminate patients who in fact developed worsening HF during the admission period, from those who did not.

FUNDAMENTO: Pacientes hospitalizados com insuficiência cardíaca (IC) aguda descompensada estão sujeitos a desenvolver episódios de piora que requerem intervenções mais complexas. O modelo de predição de risco "Acute Decompensated Heart Failure National Registry" (ADHERE) foi desenvolvido nos Estados Unidos para prever o risco de piora intra-hospitalar da IC. OBJETIVO: Utilizar o modelo de predição de risco ADHERE para avaliar o risco de piora intra-hospitalar da IC e determinar a sua sensibilidade e especificidade em pacientes hospitalizados. MÉTODOS: O presente estudo de coorte foi realizado em um hospital universitário público brasileiro e os dados de 2013 a 2020 foram coletados retrospectivamente. Foram considerados estatisticamente significativos valores de p < 0,05. RESULTADOS: Foram incluídos 890 pacientes com idade média de 74 ± 8 anos. O modelo mostrou que no grupo de 490 pacientes de risco, 254 (51,8%) desenvolveram piora intra-hospitalar da IC. No grupo de 400 pacientes sem risco, apenas 109 (27,2%) apresentaram piora da IC. Os resultados demonstraram uma curva estatisticamente significativa (área sob a curva = 0,665; erro padrão = 0,018; p < 0,01; intervalo de confiança = 0,609 a 0,701), indicando boa precisão. O modelo apresentou sensibilidade de 69,9% e especificidade de 55,2%, com valor preditivo positivo de 52% e valor preditivo negativo de 72,7%. CONCLUSÕES: Na presente coorte, demonstramos que o modelo de predição de risco ADHERE foi capaz de discriminar pacientes que, de fato, desenvolveram piora da IC durante o período de internação daqueles que não desenvolveram.

Specific causal validation of nursing diagnosis Risk for thrombosis: A case-control study.

PURPOSE: This study aims to perform specific causal validation of nursing diagnosis Risk for thrombosis (00291) of the NANDA International (NANDA-I) classification. METHODS: This is a case-control study conducted in a university hospital from January to October 2020. A total of 516 adult patients were included-344 in the Case Group (with venous or arterial thrombosis evidenced by imaging) and 172 in the Control Group (without thrombosis). Statistical analysis was performed by univariate and multivariate logistic regression test, and odds ratios were calculated to measure the effect of exposure between groups. The study was approved by the Research Ethics Committee. FINDINGS: The patients were predominantly female and aged 59 ± 16 years. In the univariate logistic analysis, five risk factors were significantly associated with thrombosis, two at-risk populations and 12 associated conditions. In the multivariate regression model, the following risk factors remained independently associated (p < 0.05): inadequate knowledge of modifiable factors (OR: 3.03; 95% CI: 1.25-8.56) and ineffective medication self-management (OR: 3.2; 95% CI:1.77-6.26); at-risk populations with history (OR: 2.16; 95% CI: 1.29-3.66) and family history of thrombosis (OR:2.60; 95% CI: 1.03-7.49); and the conditions associated with vascular diseases (OR:6.12; 95% CI:1.69-39.42), blood coagulation disorders (OR: 5.14; 95% CI:1.85-18.37), atherosclerosis (OR:2.07; 95% CI: 1.32-3.27), critical illness (OR: 2.28; 95% CI: 1.42-3.70), and immobility (OR: 2.09; 95% CI: 1.10-4.12). CONCLUSIONS: The clinical validation allowed to establish strong evidence for the refinement of the diagnosis Risk for thrombosis and, consequently, to raise its level of evidence in the classification of NANDA-I. IMPLICATIONS FOR NURSING PRACTICE: The evidence pointed out by this study favors the establishment of thrombosis diagnosis in an accurate way by nurses in clinical practice, directing preventive interventions to patients in this risk condition.

OBJETIVO: Realizar a validação causal específica do diagnóstico de enfermagem Risco de trombose (00291) da classificação diagnóstica da NANDA International, Inc. MÉTODOS: Estudo de caso-controle, realizado em hospital universitário entre janeiro e outubro de 2020. Foram incluídos 516 pacientes adultos - 344 no Grupo Caso (com trombose venosa ou arterial evidenciada em exame de imagem) e 172 no Grupo Controle (sem trombose). A análise estatística ocorreu por teste de regressão logística univariada e multivariada, e Odds ratios calculados para medir o efeito da exposição entre os grupos. O estudo foi aprovado em Comitê de Ética. RESULTADOS: Os pacientes foram predominantemente do sexo feminino e idade de 59±16 anos. Na análise logística univariada foi associado significativamente á trombose: cinco fatores de risco, duas populações em risco e 12 condições associadas. No modelo de regressão multivariada permaneceram independentemente associados (P<0,05) os fatores de risco conhecimento inadequado sobre os fatores modificáveis (OR:3,03; IC95%:1,25-8,56) e autogestão ineficaz de medicamentos (OR:3,24; IC95%:1,77-6,26); as populações em risco com história prévia (OR:2,16; IC95%:1,29-3,66) e história familiar de trombose (OR:2,60; IC95%:1,03-7,49); e as condições associadas a doenças vasculares (OR:6,12; IC95%:1,69-39,42), distúrbios de coagulaçõo (OR:5,14; IC95%:1,85-18,37),aterosclerose (OR:2,07; IC95%:1,32-3,27), doença crítica (OR:2,28; IC95%:1,42-3,70) e imobilidade (OR:2,09; IC95%:1,10-4,12). CONCLUSÕES: A validação clínica permitiu estabelecer fortes evidências para o refinamento do diagnóstico Risco de trombose e, consequentemente, elevar seu nível de evidência na classificação da NANDA-I. IMPLICAÇÕES PARA A PRÁTICA: As evidências apontadas pelo estudo favorecem o estabelecimento deste diagnóstico de forma acurada pelos enfermeiros na prática clínica, direcionando intervenções preventivas aos pacientes nesta condiçõo de risco.

The inverted forest: Aboveground and notably large belowground carbon stocks and their drivers in Brazilian savannas.

Savannas contribute to ca. 30 % of the total terrestrial net primary productivity and are responsible for significant carbon storage. Savannas in South America are mostly found within the Cerrado Domain, which is very threatened and presents remarkable carbon pools. Herein, we used a unique dataset of 21 Cerrado sites spanning 144 permanent field plots in Southeastern Brazil to assess the general patterns of above and belowground carbon stocks. We identified the main environmental and tree diversity drivers of aboveground wood carbon and productivity, belowground carbon stocks (roots and soil), carbon ratios (root:shoot and above:below) and total carbon stocks in the Cerrado through a combination of climatic estimates, fire frequency data, field measurements of vegetation, roots, soil carbon, nutrients and texture, and assessment of different components of diversity (species, functional and phylogenetic). Our findings reveal average aboveground, root, and soil carbon stocks of 20.4, 14.24, and 123.13 Mg.ha-1, respectively. Average Root:Shoot and Above:Below confirm the "inverted forest" concept with values of 1.58 and 0.21, respectively. Total carbon was 145.62 Mg.ha-1, reinforcing the great amount of carbon storage in the Cerrado and its role in the carbon cycle and dynamics. Tree diversity variables (mainly species diversity and functional composition variables) had more significant effects over aboveground variables, whereas environmental variables had more significant effects over belowground variables. Ratios and total carbon mixed up these effects. The impressive values of carbon storage, especially belowground, point out the need to better manage and protect the Cerrado. Moreover, our findings might be particularly relevant for discussions on restoration programs focused on the trees-for­carbon idea that do not consider species diversity and belowground carbon stocks.

[Cross-cultural adaptation and validation of a questionnaire on what nurses know of heart failure]. / Adaptação transcultural e validação de um questionário de conhecimento sobre insuficiência cardíaca para enfermeiros.

This study aims to perform the cross-cultural adaptation and to verify the content validity and stability of Nurses' Knowledge of Heart Failure Education Principles to evaluate what Brazilian nurses know of heart failure. The process of cross-cultural adaptation involved translation, synthesis, back-translation, committee's proofreading and pre-test. The following psychometric properties were assessed content validity (face), reliability through internal consistency (Cronbach's Alpha) and stability (Kappa coefficient). After the cross-cultural adaptation, the instrument was applied to 54 nurses (27 from a cardiology hospital and 27 from a general hospital). The Cronbach's Alpha was 0.7. The questions 4, 5, and 11 presented a Kappa coefficient less than or equal to 0.4, and further questions presented a Kappa coefficient superior or equal to 0.7. This questionnaire was validated and proved to be adequate to assess the knowledge of this group of professionals.

Antioxidant Activity of Resveratrol Diastereomeric Forms Assayed in Fluorescent-Engineered Human Keratinocytes.

Resveratrol is a powerful antioxidant molecule. In the human diet, its most important source is in Vitis vinifera grape peel and leaves. Resveratrol exists in two isoforms, cis- and trans. The diastereomeric forms of many drugs have been reported as affecting their activity. The aim of this study was to set up a cellular model to investigate how far resveratrol could counteract cytotoxicity in an oxidant agent. For this purpose, a keratinocyte cell line, which was genetically engineered with jelly fish green fluorescent protein, was treated with the free radical promoter Cumene hydroperoxide. The antioxidant activity of the trans-resveratrol and its diastereomeric mixture was evaluated indirectly in these treated fluorescent-engineered keratinocytes by analyzing the cell number and cell proliferation index. Our results demonstrate that cells, which were pre-incubated with resveratrol, reverted the oxidative damage progression induced by this free radical agent. In conclusion, fluorescent-engineered human keratinocytes represent a rapid and low-cost cellular model to determine cell numbers by studying emitted fluorescence. Comparative studies carried out with fluorescent keratinocytes indicate that trans-resveratrol is more efficient than diastereomeric mixtures in protecting cells from the oxidative stress.

NANDA-I, NOC, and NIC linkages to SARS-CoV-2 (COVID-19): Part 3. Family response.

PURPOSE: To provide guidance to nurses caring for families with COVID-19, we developed linkages using interoperable standardized nursing terminologies: NANDA International (NANDA-I) nursing diagnoses, Nursing Interventions Classification (NIC), and Nursing Outcomes Classification (NOC). In addition, we wanted to identify gaps in the terminologies and potential new nursing diagnoses, outcomes, and interventions for future development related to nurse roles in family care during a pandemic. METHODS: Using a consensus process, seven nurse experts created the linkages focused on families during the COVID-19 pandemic using the following steps: (1) creating an initial list of potential nursing diagnoses, (2) selecting and categorizing outcomes that aligned with all components of each nursing diagnosis selected, and (3) identifying relevant nursing interventions. FINDINGS: We identified a total of seven NANDA-I nursing diagnoses as the basis for the linkage work. These are distributed in three NANDA-I Domains and based in the psychosocial dimension of the Nursing Care in Response to Pandemics model. Eighty-nine different NOC outcomes were identified to guide care based on the nursing diagnoses, and 54 different NIC interventions were suggested as possible interventions. Fifteen new proposed concepts were identified for future development across the three classifications. CONCLUSIONS: The linkages of nursing diagnoses, outcomes, and interventions provide a guide to enhance nursing practice and care documentation that could quantify the impact of nursing care to patient outcomes for families at risk for or infected by COVID-19. IMPLICATIONS FOR NURSING PRACTICE: NANDA-I, NOC, and NIC linkages identified in this paper provide resources to support clinical decisions and guide critical thinking for nurses encountering care needs of families with COVID-19. Documentation of these linkages provides data that can create new knowledge to enhance the care of families impacted by COVID-19.

NANDA-I, NOC, and NIC Linkages to SARS-Cov-2 (Covid-19): Part 1. Community Response.

PURPOSE: We developed linkages using interoperable standardized nursing terminologies, NANDA International (NANDA-I) nursing diagnoses, Nursing Interventions Classification (NIC), and Nursing Outcomes Classification (NOC), to present initial guidance for the development of care plans focused on COVID-19 for nurses practicing in community or public health roles. METHODS: Seven nurse experts identified the linkages of NANDA-I, NOC and NIC for our work related to the COVID-19 pandemic. A model was developed to guide the project. The first step in creating linkages focused on the identification of nursing diagnoses. Then, for each nursing diagnosis, outcomes aligned with all components of the diagnosis were categorized and a list of nursing interventions was selected. The experts used their clinical judgment to make final decisions on the linkages selected in this study. FINDINGS: Two community level nursing diagnoses were identified as key problems appropriate for a pandemic related to COVID-19: Deficient Community Health and Ineffective Community Coping. For the nursing diagnosis Deficient Community Health, eight nursing outcomes and 12 nursing interventions were selected. In comparison for the nursing diagnosis, Ineffective Community Coping, nine nursing outcomes and 18 nursing interventions were identified. A total of40 concepts were identified for future development across the three classifications. CONCLUSIONS: The nursing diagnoses, outcomes and interventions selected during this linkage process provide knowledge to support the community challenged with responding to the COVID-19 pandemic, provide the opportunity to quantify the impact of nursing care, and enhance nursing practice by promoting the use of three standardized terminologies. IMPLICATIONS FOR NURSING PRACTICE: NANDA-I, NOC and NIC linkages identified in this manuscript provide resources to support clinical decisions and care plan development for nurses practicing in the community.

International Collaboration and New Research Evidence on Nanda International Terminology.

OBJECTIVES: To discuss priorities and possibilities for promoting international collaboration and new research evidence on NANDA International, Inc. (NANDA-I). METHODS: Theoretical reflection article based on the literature and the authors' opinions on the subject matter, carried out by six research nurses. CONCLUSIONS: International research collaboration for NANDA-I allows the improvement of research production in an actual clinical setting, especially with multicenter and validation studies, conducted by researchers from different countries. This provides for improved understanding of patients' experiences and may help to produce robust scientific evidence. IMPLICATIONS FOR NURSING KNOWLEDGE: The generation of new evidence may lead to an increase in NANDA-I visibility and in nurses' understanding of its meaning for clinical practice and for the formulation of diagnostic hypotheses.

NANDA-I, NOC, and NIC linkages to SARS-CoV-2 (COVID-19): Part 2. Individual response.

PURPOSE: To provide guidance to nurses caring for individuals with COVID-19, we developed linkages using interoperable standardized nursing terminologies: NANDA International (NANDA-I) nursing diagnoses, Nursing Interventions Classification (NIC), and Nursing Outcomes Classification (NOC). We also identified potential new NANDA-I nursing diagnoses, NOC outcomes, and NIC interventions for future development related to nurses' role during a pandemic. METHODS: Using a consensus process, seven nurse experts created the linkages for individuals during the COVID 19 pandemic using the following steps: (a) creating an initial list of potential nursing diagnoses, (b) selecting and categorizing outcomes that aligned with all components of each nursing diagnosis selected, and (c) identifying relevant nursing interventions. FINDINGS: A total of 16 NANDA-I nursing diagnoses were identified as the foundation for the linkage work, organized in two dimensions, physiological and psychosocial. A total of 171 different NOC outcomes were identified to guide care based on the nursing diagnoses and 96 NIC interventions were identified as suggested interventions. A total of 13 proposed concepts were identified for potential future development across the three classifications. CONCLUSIONS: The linkages of nursing diagnoses, outcomes, and interventions developed in this article provide a guide to enhance nursing practice and determine the effectiveness of nurses' contribution to patient outcomes for individuals at risk for or infected by COVID-19. IMPLICATIONS FOR NURSING PRACTICE: NANDA-I, NOC, and NIC linkages identified in this paper are an important example of the value of using standardized nursing terminologies to guide and document nursing care. When included in electronic health record databases and used widely, the data generated from the care plans can be used to create new knowledge about how to better improve outcomes for patients with COVID-19.

NANDA-I, NOC, and NIC Linkages for Nutritional Problems.

PURPOSE: To determine nursing outcomes and interventions for problem-focused nursing diagnoses related to nutritional problems. METHODS: Judgment of linkages among nursing diagnoses, outcomes, and interventions using a multiple review process. Five nursing diagnoses were selected, and then outcomes and interventions were determined, based on clinical expertise and scientific literature. FINDINGS: Nursing outcomes and interventions were determined for the resolution or improvement of the nursing diagnoses, with selection of interventions that could influence the progression of the outcomes. CONCLUSIONS: This study provides knowledge for developing care plans for patients with nutritional problems and evaluating the response to the interventions. IMPLICATIONS FOR NURSING PRACTICE: NANDA-I, Nursing Outcomes Classification (NOC), and Nursing Interventions Classification (NIC) linkages facilitate nurses' ability to select nursing outcomes and interventions for patients with nutritional problems.

Hemostasis after percutaneous transfemoral access: A protocol for systematic review.

BACKGROUND: Access site hemostasis after percutaneous procedures done in the catheterization laboratory still needs to be better studied in relation to such aspects as the different results achieved with different hemostasis strategies, the impact of different introducer sheath sizes, and arterial versus venous access. The objective of this review is to synthesize the available scientific evidence regarding different techniques for hemostasis of femoral access sites after percutaneous diagnostic and therapeutic procedures. METHODS: This review is being reported in accordance with the Preferred Reporting Items for Systematic Review and Meta-Analysis Protocols (PRISMA-P). The primary outcomes will include the following vascular complications: hematoma, pseudoaneurysm, bleeding, minor, and major vascular complications. The secondary outcomes will include the following: time to hemostasis, repetition of manual compression, and device failure. A structured strategy will be used to search the PubMed/ MEDLINE, Embase, CINAHL, and CENTRAL databases. In addition, a handsearch of the reference lists of selected studies will be conducted. The ERIC research database will be queried for the gray literature and ClinicalTrials.gov, for potential results not yet published in indexed journals. Two reviewers will independently screen citations and abstracts, identify full-text articles for inclusion, extract data, and appraise the quality and risk of bias of included studies. If possible, a meta-analysis will be carried out. All estimations will be made using Review Manager 5.3. Statistical heterogeneity will be assessed by considering the I2 proxy, accompanied with qualitative indicators such as differences in procedures, interventions, and outcomes among the studies. If synthesis proves inappropriate, a narrative review will be undertaken. RESULTS: This protocol adheres to the PRISMA-P guideline to ensure clarity and completeness of reporting at all phases of the systematic review. CONCLUSION: This study will provide synthesized information on different methods used to achieve hemostasis after femoral access. ETHICS AND DISSEMINATION: Ethical approval number CAAE 19713219700005327. The results of the systematic review will be disseminated via publication in a peer-reviewed journal and through conference presentations. SYSTEMATIC REVIEW REGISTRATION: PROSPERO CRD42019140794.

Adverse Reactions to Medications: Concept Analysis and Development of a New Risk Nursing Diagnosis.

PURPOSE: To analyze the concept of adverse reaction to medications and to develop the new nursing diagnosis Risk for Adverse Reactions to Medications. METHODS: Concept analysis using Walker and Avant's eight step method. FINDINGS: Thirty-three articles indexed in four databases were included. The components of the new nursing diagnosis were determined, including possible nursing outcomes and interventions. CONCLUSIONS: The concept analysis supported the development of the new nursing diagnosis Risk for Adverse Reactions to Medications, which may help nurses to evaluate and identify patients susceptible to adverse reactions. IMPLICATIONS FOR NURSING PRACTICE: The establishment of this nursing diagnosis will provide nurses an opportunity to implement interventions to anticipate and effectively intervene with patients at risk for this condition.

Evaluation of Acute Pain in Patients Undergoing Total Hip Arthroplasty: A Cohort Study.

PURPOSE: To evaluate pain levels in patients who underwent total hip arthroplasty (THA) using the Nursing Outcomes Classification (NOC). METHODS: Prospective cohort study conducted in the surgical hospitalization units of a university hospital in southern Brazil. Twenty-four patients were evaluated and followed-up for four consecutive days after THA. FINDINGS: A significant difference was found between the first and last evaluations for the outcome pain level (2102). Two indicators also showed statistically significant differences overtime. CONCLUSIONS: The NOC outcome and indicators demonstrated the different pain levels of patients who underwent THA. IMPLICATIONS FOR NURSING PRACTICE: The NOC system is applicable to clinical practice, because it facilitated the follow-up of patient progression.

Evaluation of Patients in a Smoking Cessation Support Group Using the Nursing Outcomes Classification.

PURPOSE: To evaluate patients in a smoking cessation support group using the Nursing Outcomes Classification (NOC). METHODS: Prospective observational cohort study conducted with 21 patients participating in a smoking cessation support group. Data were collected using an instrument consisting of 2 NOC outcomes and 20 indicators, applied during each of the six support group meetings. FINDINGS: The two NOC outcomes, Smoking Cessation Behavior (1625) and Substance Withdrawal Severity (2108), showed statistically significant differences over time in many of their indicators. CONCLUSIONS: The NOC outcomes demonstrated the clinical evolution and behavioral improvement of patients during the smoking cessation process. IMPLICATIONS FOR NURSING PRACTICE: The findings highlight important elements of the evaluation of behavioral change and severity of withdrawal symptoms.