Evidence of interventions for the risk of dry eye in critically ill patients: An integrative review.

AIMS: Identify the best scientific evidence available to eye care in order to prevent dry eye. METHOD: Review study conducted according to the three steps of the evidence-based practice, guided by the following question, grounded in the Patient, Intervention, Comparison, and Outcome strategy: "What is the best scientific evidence available to eye care related to preventing dry eye?" Two databases were used, the web portal Medical Literature Analysis and Retrieval System Online and two digital libraries. Data were organized by using three structured forms. RESULTS: Ten studies made up the final sample, in English, with evidence levels between I and III. The results pointed out differences regarding the best or most appropriate occlusion and ocular lubrication methods to prevent dry eye. CONCLUSION: Several care methods showed strong scientific evidence to prevent dry eye, related to occlusion and ocular lubrication. There is a need for further studies to determine the strength of this evidence.

Nursing diagnoses in patients with COVID-19 admitted to the intensive care unit: CROSS-MAPPING.

To identify and analyze the nursing diagnoses listed in the medical records of COVID-19 patients admitted to an intensive care unit using Taxonomy II of NANDA-I. Background: COVID-19 is a complex disease with heterogeneous behaviors, and the role of intensive care nurses in accurately identifying related signs and symptoms has become even more critical during the pandemic. Nurses rely on classification systems or taxonomies to standardize concepts and language in practice. Method: This quantitative study employed a descriptive and individual approach, utilizing the cross-mapping method. Data were collected from 57 medical records of critical care patients in a hospital in northeastern Brazil between July 2020 and March 2021. Three researchers analyzed the mapped diagnoses, and agreement was assessed using the Content Validation Index and Fleiss' Kappa. Results: Among the listed nursing diagnoses, 54.28% were found to be standardized, 45.71% had corresponding nursing diagnoses, and 5.71% did not have an equivalent diagnosis in the reference taxonomy used in the study. Due to the possibility of multiple nursing diagnoses in the same patient, the most frequent diagnoses were Risk of pressure injury in adults (66.66%), Risk of falls in adults (64.91%), and Risk of infection (45.61%). Among the 37 diagnoses mapped, the risk diagnoses were the most prevalent and could be prevented if identified early. Conclusions: The study highlights the importance of standardized nursing diagnoses in the ICU for COVID-19 patients and the need for accurate identification and prevention of risk diagnoses to enhance patient care and improve outcomes.

A Descriptive Study of Corneal Graft Failure in Retransplant Patients.

OBJECTIVE: To identify the main predictors for corneal graft failure in patients who underwent retransplantation. METHOD: This is a cross-sectional research with a quantitative and analytical approach, conducted based on data from secondary sources of a Human Eye Tissue Bank (HETB) in Northeast Brazil. Data were collected from the medical charts of all patients transplanted between January 2010 and December 2014. Descriptive statistics were used for the univariate analysis by means of absolute and relative frequencies and means. For the inferential analysis, the chi-square (X²) and the Fisher's Exact tests were used. RESULTS: A total of 241 records were reviewed, representing 258 keratoplasties, of which 27 (10.46%) were retransplantations due to corneal graft failure. Of the total, 55.56% of the individuals were female, with a mean age of 58.56 years, 55.56% of the population was brown, and the highest relative frequency of housing found was in the Central Mesoregion. Of the corneal graft failure cases, 88.89% were due to late failure, 30.77% of cases were classified as pseudophakic and 11.57% as aphakic. Through inferential analysis, a statistical association was obtained among the variable "corneal graft failure" and mesoregion of the state, presence of glaucoma, vascularization, and classification of the eye. CONCLUSION: The prognosis of keratoplasty is of multifactorial nature. Factors such as mesoregion of the State (place of residence), glaucoma, corneal vascularization, and aphakic eyes represent predictors for graft failure in the analyzed sample.

Nursing diagnosis proposal "Impaired Peripheral Venous Return": concept formation.

OBJECTIVES: to develop a nursing diagnosis proposal focused on venous return. METHODS: this is a concept analysis according to the model proposed by Walker and Avant, which is operationalized through an integrative review. The study was carried out according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses protocol recommendations. RESULTS: the analysis of the 131 studies allowed identifying attributes, antecedents and consequences. The most common attribute was decreased venous flow. The antecedents most frequently found were structural and/or functional valve deficiency, advanced age and peripheral venous thrombosis. The most common consequences were peripheral edema, venous ulcer and pain in the extremity. CONCLUSIONS: the formulated nursing diagnosis was proposed as part of Domain 4, Activity/rest, in Class 4, Cardiovascular/pulmonary responses, with eight defining characteristics, five related factors, six at-risk populations and four associated conditions.

Ocular dryness in intensive care: proposal for a new nursing diagnosis.

OBJECTIVE: to analyze the concept associated with diagnostic proposition Ocular dryness in adult patients hospitalized in an Intensive Care Unit, identifying its attributes, antecedents and consequences. METHODS: a methodological study carried out through concept analysis, operationalized by scoping review. RESULTS: the analysis of 180 studies allowed the identification of two attributes, 32 antecedents and 12 consequences. The attributes were tear film deficiency and ocular signs and/or symptoms. The prevalent antecedents were incomplete eyelid closure (lagophthalmos) and blinking mechanism decrease. Major consequences included conjunctival hyperemia and decreased tear volume. CONCLUSIONS: this study allowed constructing nursing diagnosis Ocular dryness, part of domain 11, class 2, with 12 defining characteristics, 12 related factors, seven populations at risk and 13 associated conditions. This problem-focused proposal may provide targeted care by promoting early detection and implementing interventions that reduce the risk of ocular damage.

Analysis of factors associated with hematopoietic stem-cell retransplantation: a case-control study. / Análise dos fatores associados ao retransplante de células-tronco hematopoiéticas: estudo caso-controle.

OBJECTIVE: to analyze the factors associated with the failure of Hematopoietic Stem Cell Transplantation (HSCT) in patients undergoing Hematopoietic Stem Cell Retransplantation (HSCR). METHOD: this study implemented a quantitative approach and was a case-control type which addressed patients undergoing HSCR. To do so, a paired sample of two controls was used for each case (2:1). The case group consisted of the medical records of all patients who underwent HSCR (28) and the control group (56) of those who underwent only one transplant. Three variables guided the pairing: gender, diagnosis and type of transplant. RESULTS: a total of 24 (85.71%) patients in the case group were re-transplanted due to disease relapse and four (14.29%) due to graft failure. There was a statistical difference in the analysis between patients who did not use ursodeoxycholic acid, opioid analgesics and immunosuppressants. The need for HSCR among those who used these medications inappropriately was 16.12, 12.79 and 4.5 times more likely, respectively, than those who used them correctly. CONCLUSION: there was a difference regarding the reasons which led to the retransplantation and the analyzed subjects, and this study concluded that the predictive reason for retransplantation in the studied sample was disease relapse.

Validation of nursing outcome indicators of the nursing outcomes classification: dry eye severity.

OBJECTIVE: To validate the content of the indicators of the nursing outcome Dry eye severity, of the Nursing Outcomes Classification, in adult patients admitted to the intensive care unit. METHODS: Methodological study of content validity, developed in two stages: the first, consisting of 23 specialists; and the second, of a consensus group formed by ten nurses. For analyzing the data in the first stage, we used the content validity index and binomial test for each indicator; in the second stage, the discussions of each meeting were transcripted, and the indicators that achieved 100% consensus were validated. RESULTS: Of the 14 indicators evaluated by the specialists, 7 presented a cut-off point below 0.80, but did not show statistical significance in the binomial test. In the consensus group's validation, six indicators were reformulated. CONCLUSION: This study considered the 14 indicators valid for evaluating patients admitted to the intensive care unit.

Critical thinking in nursing students from two Brazilian regions.

OBJECTIVE: To analyze the overall critical thinking and the development of each of the cognitive skills or attributes that compose it in students of the undergraduate program in nursing through the creation of concept maps in two Brazilian teaching institutions. METHOD: Before-and-after experimental study, randomized, performed in two universities of two Brazilian regions, with a sample of 21 subjects at the A school and 56 at the B school. Data were collected through sociodemographic questionnaire and the California Critical Thinking Skills Test. Intervention consisted in the creation of four concept maps. RESULTS: Scores measured for overall critical thinking do not differed between the groups of both schools; however, positive aspects among them were found for skills of evaluation, induction, and inference. CONCLUSION: We perceived validity as a facilitating teaching strategy of the use of concept maps in several aspects.

Brazilian Nursing Process Research Network contributions for assistance in the COVID-19 pandemic.

OBJECTIVE: to describe the theoretical construction process of nursing process support documents in COVID-19 care scenarios. METHODS: an experience report of the joint activity of the Brazilian Nursing Process Research Network (Rede de Pesquisa em Processo de Enfermagem) composed of Higher Education and Health Institution researchers in Brazil. RESULTS: five instruments were organized collectively, involving the elements of nursing practice (nursing diagnoses, outcomes and interventions) in assistance for community; for patients (with suspected or mild, moderate, and critical COVID-19 and residents in Nursing Homes); for nursing workers' health support, also subsidizing registration and documentation during the COVID-19 pandemic. FINAL CONSIDERATIONS: valuing the phenomena manifested by families/communities, patients and health professionals is essential for early detection, intervention, and prevention of diseases.

Clinical indicators of dry eye severity nursing outcome in intensive care unit.

OBJECTIVE: to verify the extent of impairment of the clinical indicators of the nursing outcome Dry Eye Severity in patients admitted to the Intensive Care Unit. METHOD: cross-sectional, descriptive study developed with 206 patients. Based on the result listed, six indicators of the Classification of Nursing Results were evaluated with a questionnaire containing clinical variables and the Likert scale of the Classification of Nursing Results with constructed definitions, which varies from more impaired to non-impaired. The data were analyzed using descriptive and inferential statistics. RESULTS: the decrease in lacrimal production and the presence of redness in the conjunctiva were more impaired. The other indicators were more frequent for the absence of impairment: incomplete eyelid closure 81% (167), excessive tearing 95.1%(196), excessive mucous secretion 78.7% (162) and decreased blinking mechanism 50.5% (104). The clinical characteristics of hospitalization for neurological disorders, invasive mechanical ventilation, chemosis, use of sedatives, vasoconstrictors, benzodiazepines, antibiotics and corticosteroids interfered in the impairment of the dry eye severity. CONCLUSION: the result indicators show that the clinical characteristics of patients in the intensive care unit interfere in the impairment and in the dry eyes severity. According to these results, the importance of assistance directed to the prevention of eye diseases is emphasized.

Predictive clinical factors for ocular dryness in patients admitted to the Intensive Care Unit. / Fatores clínicos preditores para o ressecamento ocular em pacientes internados na Unidade de Terapia Intensiva.

OBJECTIVE: To evaluate the predictive clinical factors for ocular dryness and for the nursing diagnosis Risk for dry eye in the ocular surface of hospitalized adult patients in an intensive care unit. METHOD: A cross-sectional study was conducted between January and July 2016, with 206 patients (412 eyes). An inference about the presence of the diagnosis in the evaluated patients was performed by diagnostic nurses. The descriptive and inferential statistics subsidized the data analysis. RESULTS: 47.6% of the patients presented Risk for dry eye, and 52.4% were already diagnosed with ocular dryness. Statistical differences between the ocular dryness diagnosis in the right eye with hyperemia, mucous secretion, eyelid edema and lagophthalmia were identified. In addition, statistical differences were observed between hyperemia and eyelid edema with Risk for dry eye in the left eye and with the nursing diagnosis Risk for dry eye. CONCLUSION: Hyperemia, mucous secretion, eyelid edema and lagophthalmia are the predictive clinical factors for the nursing diagnosis Risk for dry eye and also of ocular dryness in the intensive care unit environment which deserve special attention in the preventive evaluation.

Validation of virtual learning object to support the teaching of nursing care systematization.

OBJECTIVE: to describe the content validation process of a Virtual Learning Object to support the teaching of nursing care systematization to nursing professionals. METHOD: methodological study, with quantitative approach, developed according to the methodological reference of Pasquali's psychometry and conducted from March to July 2016, from two-stage Delphi procedure. RESULTS: in the Delphi 1 stage, eight judges evaluated the Virtual Object; in Delphi 2 stage, seven judges evaluated it. The seven screens of the Virtual Object were analyzed as to the suitability of its contents. The Virtual Learning Object to support the teaching of nursing care systematization was considered valid in its content, with a Total Content Validity Coefficient of 0.96. CONCLUSION: it is expected that the Virtual Object can support the teaching of nursing care systematization in light of appropriate and effective pedagogical approaches.

Clinical validation of fall prevention behavior in a hospital environment.

OBJECTIVE: Clinically validate the Nursing Outcome Behavior of falls prevention in hospitalized patients. METHOD: This was a cross-sectional study developed at a public university hospital with a sample of 45 patients. The data collection was performed through the evaluation of four nurses, with a double used the instrument with the constitutive and operational definitions of the indicators and magnitudes of the Fall Prevention Behavior Result, while the other pair did not use such definitions. RESULTS: When applying the non-parametric analysis of variance by the Friedman test, ten indicators showed statistical differences between the inferences made by the evaluators for each patient. In relation to the intraclass correlation coefficient, confidence interval and p value assigned to each indicator of the scale, most of the indicators were statistically significant. CONCLUSIONS: The instrument referring to the Fall Behavior Outcome Behavior was considered valid for the study population.

Dry Eye Syndrome in Intensive Care Units: a concept analysis.

PURPOSE: To analyse the concept of Dry Eye Syndrome in patients admitted to Intensive Care Units (ICU). METHOD: This is a concept analysis, according to Walker's and Avant's method, conducted using an integrative review, through search in the database. Science Direct, Scopus, Cinahl, Pubmed, Lilacs, Cochrane and Web of Science. The following keywords were used: "Keratoconjuntivite Sicca", "Risk Factors", "Dry eye Syndromes" and "Intensive Care Units". After selection, 85 articles have been kept. RESULTS: Antecedents found: age, lagophthalmos, environmental factors, use of medications, systemic diseases, mechanical ventilation and eye surgeries. Attributes: Tear Break-up Time < 10 s, Schirmer's test I < 10 mm, Schirmer's test II < 5 mm and signs and symptoms. Consequents: eye damage and discomfort; unstable vision. The Model Case and the Contrary Case were used to illustrate it. CONCLUSION: The research provided clarification of the concept and consequent understanding of the Dry Eye Syndrome, which is preventable especially in ICU.

Nursing diagnosis proposal "Impaired Peripheral Venous Return": concept formation / Proposta do diagnóstico de enfermagem "Retorno Venoso Periférico Prejudicado": formação do conceito / Propuesta del diagnóstico de enfermería "Retorno Venoso Periférico Deteriorado": formación del concepto

ABSTRACT Objectives: to develop a nursing diagnosis proposal focused on venous return. Methods: this is a concept analysis according to the model proposed by Walker and Avant, which is operationalized through an integrative review. The study was carried out according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses protocol recommendations. Results: the analysis of the 131 studies allowed identifying attributes, antecedents and consequences. The most common attribute was decreased venous flow. The antecedents most frequently found were structural and/or functional valve deficiency, advanced age and peripheral venous thrombosis. The most common consequences were peripheral edema, venous ulcer and pain in the extremity. Conclusions: the formulated nursing diagnosis was proposed as part of Domain 4, Activity/rest, in Class 4, Cardiovascular/pulmonary responses, with eight defining characteristics, five related factors, six at-risk populations and four associated conditions.

RESUMO Objetivos: desenvolver uma proposta de diagnóstico de enfermagem com foco no retorno venoso. Métodos: trata-se de uma análise de conceito segundo o modelo proposto por Walker e Avant, que é operacionalizado por meio de uma revisão integrativa. O estudo foi realizado de acordo com as recomendações do protocolo Preferred Reporting Items for Systematic Reviews and Meta-Analyses. Resultados: a análise dos 131 estudos permitiu a identificação de atributos, antecedentes e consequências. O atributo mais comum foi diminuição do fluxo venoso. Os antecedentes mais encontrados foram deficiência valvular estrutural e/ou funcional, idade avançada e trombose venosa periférica. As consequências mais comuns foram edema periférico, úlcera venosa e dor na extremidade. Conclusões: o diagnóstico de enfermagem formulado foi proposto como parte do Domínio 4, Atividade/repouso, na Classe 4, Respostas cardiovasculares/pulmonares, com oito características definidoras, cinco fatores relacionados, seis populações de risco e quatro condições associadas.

RESUMEN Objetivos: desarrollar una propuesta de diagnóstico de enfermería centrada en el retorno venoso. Métodos: se trata de un análisis de concepto según el modelo propuesto por Walker y Avant, que se operacionaliza a través de una revisión integradora. El estudio se llevó a cabo de acuerdo con las recomendaciones del protocolo Preferred Reporting Items for Systematic Reviews and Meta-Analyses. Resultados: el análisis de los 131 estudios permitió identificar atributos, antecedentes y consecuencias. El atributo más común fue la disminución del flujo venoso. Los antecedentes encontrados con mayor frecuencia fueron deficiencia valvular estructural y/o funcional, edad avanzada y trombosis venosa periférica. Las consecuencias más comunes fueron edema periférico, úlcera venosa y dolor en la extremidad. Conclusiones: el diagnóstico de enfermería formulado fue propuesto como parte del Dominio 4, Actividad/reposo, en la Clase 4, Respuestas cardiovasculares/pulmonares, con ocho características definidoras, cinco factores relacionados, seis poblaciones de riesgo y cuatro condiciones asociadas.

Ocular dryness in intensive care: proposal for a new nursing diagnosis / Sequedad ocular en cuidados intensivos: propuesta para un nuevo diagnóstico de enfermería / Ressecamento ocular em terapia intensiva: proposta de novo diagnóstico de enfermagem

ABSTRACT Objective: to analyze the concept associated with diagnostic proposition Ocular dryness in adult patients hospitalized in an Intensive Care Unit, identifying its attributes, antecedents and consequences. Methods: a methodological study carried out through concept analysis, operationalized by scoping review. Results: the analysis of 180 studies allowed the identification of two attributes, 32 antecedents and 12 consequences. The attributes were tear film deficiency and ocular signs and/or symptoms. The prevalent antecedents were incomplete eyelid closure (lagophthalmos) and blinking mechanism decrease. Major consequences included conjunctival hyperemia and decreased tear volume. Conclusions: this study allowed constructing nursing diagnosis Ocular dryness, part of domain 11, class 2, with 12 defining characteristics, 12 related factors, seven populations at risk and 13 associated conditions. This problem-focused proposal may provide targeted care by promoting early detection and implementing interventions that reduce the risk of ocular damage.

RESUMEN Objetivo: analizar el concepto asociado a la proposición del diagnóstico de enfermería Sequedad ocular en pacientes adultos internados en una unidad de cuidados intensivos, identificando sus atributos, antecedentes y consecuencias. Métodos: estudio metodológico, realizado a través del análisis de concepto operacionalizado por scoping review. Resultados: el análisis de 180 estudios permitió identificar dos atributos, 32 antecedentes y 12 consecuentes. Los atributos fueron deficiencia de película lagrimal y signos y/o síntomas oculares. Los antecedentes prevalentes fueron cierre palpebral incompleto (lagoftalmos) y disminución del mecanismo de parpadeo. Las principales consecuencias incluyeron hiperemia conjuntival y disminución del volumen lagrimal. Conclusiones: este estudio permitió la construcción del diagnóstico de enfermería Sequedad ocular, parte del dominio 11, clase 2, con 12 características definidoras, 12 factores relacionados, siete poblaciones de riesgo y 13 condiciones asociadas. Esta propuesta centrada en el problema puede brindar atención dirigida al promover la detección temprana e implementar intervenciones que reduzcan el riesgo de daño ocular.

RESUMO Objetivo: analisar o conceito associado à proposição do diagnóstico de enfermagem Ressecamento ocular em pacientes adultos internados em Unidade de Terapia Intensiva com identificação de seus atributos, antecedentes e consequentes. Métodos: estudo metodológico, realizado mediante análise de conceito operacionalizada por scoping review. Resultados: a análise dos 180 estudos permitiu identificação de dois atributos, 32 antecedentes e 12 consequentes. Os atributos foram deficiência do filme lacrimal e sinais e/ ou sintomas oculares. Os antecedentes prevalentes foram fechamento palpebral incompleto (lagoftalmia) e mecanismo de piscar diminuído. Os principais consequentes incluíram hiperemia conjuntival e volumetria lacrimal diminuída. Conclusões: este estudo permitiu a construção do diagnóstico de enfermagem Ressecamento ocular, integrante do domínio 11, classe 2, com 12 características definidoras, 12 fatores relacionados, sete populações em risco e 13 condições associadas. Essa proposta com foco no problema poderá proporcionar cuidado direcionado, promovendo detecção precoce e execução de intervenções que reduzam o risco de danos oculares.

Barreiras no preenchimento da lista de verificação para partos seguros: revisão integrativa / Barreras para completar la lista de verificación de la seguridad del parto: revisión integradora / Barriers in completing the checklist for safe deliveries: integrative review

Resumo Objetivo Identificar na literatura científica as barreiras que dificultam a aplicação da Lista de Verificação para Partos Seguros da Organização Mundial da Saúde. Métodos Revisão integrativa, realizada entre os meses de novembro de 2020 e maio de 2022, por meio das seguintes fontes de dados: Scopus, Medline®/PubMed®, Web of Science e Cinahl. O estudo foi realizado conforme as recomendações do protocolo Preferred Reporting Items for Systematic Reviews and Meta-Analyses. Resultados A amostra foi composta por 14 estudos, publicados principalmente no ano de 2021, predominando a América do Sul como continente de publicação. O idioma inglês foi o mais prevalente, assim como os estudos metodológicos e a abordagem quantitativa. O nível de evidência IV prevaleceu na amostra. Observa-se que os fatores culturais foram fortemente descritos nos estudos identificados, seguidos dos fatores estruturais e fatores relacionados ao processo de trabalho. Conclusão As principais barreiras que dificultam a aplicação da Lista de Verificação para Partos Seguros foram os fatores culturais (relações interpessoais, hierarquização das classes profissionais e má comunicação); estruturais (desenho e fonte utilizada no checklist) e relacionados ao processo de trabalho (como a lista de verificação foi implantada no serviço de saúde, postura do gerente quanto à apresentação dela e necessidade de intervenção educativa/formação para os profissionais de saúde).

Resumen Objetivo Identificar en la literatura científica las barreras que dificultan la aplicación de la Lista de verificación de la seguridad del parto de la Organización Mundial de la Salud. Métodos Revisión integradora, realizada entre los meses de noviembre de 2020 y mayo de 2022, a través de las siguientes fuentes de datos: Scopus, Medline®/PubMed®, Web of Science y Cinahl. El estudio fue realizado según las recomendaciones del protocolo Preferred Reporting Items for Systematic Reviews and Meta-Analyses. Resultados La muestra estuvo compuesta por 14 estudios, publicados principalmente en el año 2021, en los que predominó América del Sur como continente de publicación. El inglés fue el idioma predominante, así como los estudios metodológicos y el enfoque cuantitativo. El nivel de evidencia IV fue predominante en la muestra. Se observa que los factores culturales se describen con frecuencia en los estudios identificados, seguidos de los factores estructurales y los factores relacionados con el proceso de trabajo. Conclusión Las principales barreras que dificultan la aplicación de la Lista de verificación de la seguridad del parto fueron los factores culturales (relaciones interpersonales, jerarquización de las clases profesionales y mala comunicación); los factores estructurales (diseño y tipografía utilizada en la lista) y los factores relacionados con el proceso de trabajo (cómo se implementó la lista de verificación en el servicio de salud, postura del gerente con relación a la presentación de la lista y necesidad de intervención educativa/formación para los profesionales de la salud).

Abstract Objective To identify, in the scientific literature, the barriers that make it difficult to apply the Safe Childbirth Checklist of the World Health Organization. Methods An integrative review was conducted from November 2020 to May 2022, using the following data sources: Scopus, MEDLINE®/PubMed®, Web of Science, and CINAHL. This study was conducted according to the recommendations of the Preferred Reporting Items for Systematic Reviews and Meta-Analyses protocol. Results The sample consisted of 14 studies published mainly in 2021, when South America predominated as a publishing continent. The English language, methodological studies, and quantitative approaches prevailed. Level IV evidence prevailed in the sample. In the identified studies, there was a strong description of cultural factors, followed by structural factors and factors related to the work process. Conclusion Cultural (interpersonal relationships, hierarchy of professional classes, and poor communication) and structural (design and fonts used in the checklist) factors, and those related to the work process (such as the checklist implemented in the health service, the manager's attitude regarding presenting it, and need for educational/training intervention for health professionals) are the main barriers that make it difficult to apply the Safe Childbirth Checklist.

Concept Analysis of the Nursing Diagnosis of Impaired Spontaneous Ventilation in Critical Patients / Análisis de concepto del diagnóstico de la ventilación espontánea deteriorada en pacientes críticos / Análise conceitual do diagnóstico de ventilação espontânea prejudicada em pacientes críticos

Introduction: In nursing practice, this concept has been identified in studies that address the nursing diagnosis of impaired spontaneous ventilation. Nursing performance facing this unwanted human response is considered essential for the maintenance and control of vital signs, cardiovascular monitoring, gas exchange and respiratory pattern, as well as constant surveillance aimed at signs of hypoventilation and inadequate ventilation. Objective: To analyze the concept of impaired spontaneous ventilation in critically ill patients in an intensive care unit. Methodology: This study is a concept analysis, according to Walker's and Avant's method, conducted using an integrative review. All the referential steps were followed: concept selection, determining the objectives and proposals for concept analysis, identifying the possible uses of the concept, determining the defining attributes, identifying a model case, identifying a contrary case, and identifying the precedents and consequences of the concept. Results: A sample of 38 studies was selected. The following were identified as attributes: distress and fatigue, respiratory distress, tachycardia, hemodynamic instability, altered mental status, abnormal arterial blood gas results, dyspnea, anxiety, agitation, sweating, hypoxemia and hypercapnia. Antecedents: sex, age, oxygen saturation lower than 90%, diseases of the respiratory, cardiovascular, neurological, gastrointestinal, neuromuscular, and metabolic systems, respiratory infections, trauma, poisons, toxins, and sedatives. Consequences: increased heart rate, decreased partial oxygen saturation, increased use of respiratory muscles, dyspnea, increased metabolic rate and restlessness. The model case and the contrary case were used to illustrate the attributes, antecedents, and consequences. Conclusion: The study directed the strengthening of evidence about the phenomenon and demonstrated a strong occurrence in patients who need assistance in intensive care units, thus demanding critical care.

Introducción: en la práctica de enfermería, este concepto fue identificado en estudios que abordan el diagnóstico de la ventilación espontánea deteriorada. La actuación desde enfermería para enfrentar esta indeseada respuesta humana es esencial para el mantenimiento y el control de los signos vitales, el monitoreo cardiovascular, el intercambio de gases y el patrón de respiración, así como para la vigilancia constante de los signos de hipoventilación y ventilación inadecuada. Objetivo: analizar el concepto de ventilación espontánea deteriorada en pacientes críticos en una unidad de cuidado intensivo. Metodología: Este estudio es un análisis de concepto, de acuerdo con el método de Walker y Avant, conducido usando una revisión integrada. Se siguieron todos los pasos referenciales: selección del concepto, determinación de los objetivos y propuestas para el análisis de conceptos, identificación de los posibles usos del concepto, determinar los atributos definitorios, identificación del caso modelo, identificación del caso contrario e identificación de precedentes y consecuencias del concepto. Resultados: se seleccionó una muestra de 38 estudios. Se identificaron como atributos: angustia y fatiga, dificultad respiratoria, taquicardia, inestabilidad hemodinámica, estado mental alterado, gasometría arterial anormal, disnea, ansiedad, agitación, sudoración, hipoxemia e hipercapnia. Antecedentes: sexo; edad; saturación de oxígeno inferior al 90%; enfermedades de los sistemas respiratorio, cardiovascular, neurológico, gastrointestinal, neuromuscular y metabólico; infecciones respiratorias; traumatismos, y venenos, toxinas y sedantes. Consecuencias: aumento del ritmo cardíaco, disminución de la saturación parcial de oxígeno, aumento del uso de los músculos respiratorios, disnea, aumento del índice metabólico e inquietud. Se utilizaron el caso modelo y el caso contrario para ilustrar los atributos, antecedentes y consecuencias. Conclusión: el estudio dirigió el fortalecimiento de la evidencia sobre el fenómeno y demostró una fuerte ocurrencia en pacientes que necesitan asistencia en unidades de cuidados intensivos, quienes requieren, en consecuencia, de cuidados críticos.

Introdução: na prática da enfermagem, esse conceito foi identificado em estudos que abordaram o diagnóstico de ventilação espontânea prejudicada. A atuação da enfermagem para enfrentar essa resposta humana indesejável é essencial para a manutenção e o controle dos sinais vitais, da monitorização cardiovascular, das trocas gasosas e do padrão respiratório, bem como para a vigilância constante dos sinais de hipoventilação e ventilação inadequada. Objetivo: analisar o conceito de ventilação espontânea prejudicada em pacientes graves internados em uma unidade de terapia intensiva. Materiais e método: este estudo é uma análise conceitual, de acordo com o método de Walker e Avant, realizada por meio de uma revisão integrada. Todas as etapas referenciais foram seguidas: seleção do conceito, determinação dos objetivos e proposições para a análise do conceito, identificação dos possíveis usos do conceito, determinação dos atributos definidores, identificação do caso-modelo, identificação do contracaso e identificação dos precedentes e consequências do conceito. Resultados: foi selecionada uma amostra de 38 estudos. Os atributos identificados foram angústia e fadiga, angústia respiratória, taquicardia, instabilidade hemodinâmica, estado mental alterado, gases sanguíneos arteriais anormais, dispneia, ansiedade, agitação, sudorese, hipoxemia e hipercapnia. Antecedentes: sexo; idade; saturação de oxigênio inferior a 90%; doenças dos sistemas respiratório, cardiovascular, neurológico, gastrointestinal, neuromuscular e metabólico; infecções respiratórias; trauma; e venenos, toxinas e sedativos. Consequências: aumento da frequência cardíaca, diminuição da saturação parcial de oxigênio, aumento do uso dos músculos respiratórios, dispneia, aumento da taxa metabólica e inquietação. O caso-modelo e o caso oposto foram usados para ilustrar os atributos, os antecedentes e as consequências. Conclusões: o estudo teve como objetivo fortalecer as evidências sobre o fenômeno e demonstrou uma forte ocorrência em pacientes que necessitam de assistência em unidades de terapia intensiva e que, consequentemente, requerem cuidados críticos.

Acurácia dos indicadores clínicos da proposta diagnóstica de enfermagem sobre o ressecamento ocular em terapia intensiva / Precisión de los indicadores clínicos de la propuesta diagnóstica de enfermería sobre la sequedad ocular en unidad de cuidados intensivos / Accuracy of clinical indicators of the nursing diagnosis proposal on ocular dryness in intensive care

Resumo Objetivo Analisar a acurácia dos indicadores clínicos da proposta diagnóstica de enfermagem Ressecamento ocular em pacientes adultos em Unidade de Terapia Intensiva. Métodos Estudo de acurácia diagnóstica, com delineamento analítico transversal e de abordagem quantitativa. A amostra foi composta por 206 pacientes internados em uma unidade de terapia intensiva adulto. Foi aplicado um instrumento elaborado de acordo com variáveis relacionadas aos dados sociodemográficos, clínicos, indicadores clínicos, fatores etiológicos, população em risco e condições associadas do Ressecamento ocular . Um modelo de classe latente foi utilizado para identificação da prevalência do diagnóstico e identificação da especificidade e sensibilidade dos indicadores clínicos. Resultados Dentre os participantes do estudo, 52,4% eram do sexo masculino e apresentaram média de idade de 58,69 anos (±14,61). A prevalência do Ressecamento ocular foi de 76,22%. Os indicadores clínicos volume lacrimal diminuído e excesso de secreção mucoide apresentaram valores elevados de especificidade (81,63% e 99,99%, respectivamente). Além disso, vasos sanguíneos dilatados na superfície ocular, excesso de secreção mucoide, filamento mucoide e quemose apresentaram valores mais altos para sensibilidade (74,52%, 99,99%, 100,0% e 71,97%, respectivamente). Conclusão Após a análise da acurácia dos indicadores clínicos, conclui-se que cinco características definidoras foram capazes de apresentar valores elevados de especificidade ou sensibilidade. Este achado corrobora para uma inferência diagnóstica acurada, de modo a possibilitar a otimização de resultados com o intuito de impedir o declínio clínico referente à resposta humana indesejável Ressecamento ocular .

Resumen Objetivo Analizar la precisión de los indicadores clínicos de la propuesta diagnóstica de enfermería Sequedad ocular en pacientes adultos en Unidad de Cuidados Intensivos. Métodos Estudio de precisión diagnóstica, con diseño analítico transversal y de enfoque cuantitativo. La muestra estuvo compuesta por 206 pacientes internados en una unidad de cuidados intensivos adulta. Se aplicó un instrumento elaborado de acuerdo con variables relacionadas con datos sociodemográficos, clínicos, indicadores clínicos, factores etiológicos, población en riesgo y condiciones asociadas a la sequedad ocular . Se utilizó un modelo de clase latente para identificar la prevalencia del diagnóstico y para identificar la especificidad y sensibilidad de los indicadores clínicos. Resultados De los participantes del estudio, el 52,4 % era de sexo masculino y con edad promedio de 58,69 años (±14,61). La prevalencia de la sequedad ocular fue de 76,22 %. Los indicadores clínicos volumen lagrimal reducido y exceso de secreción mucoide presentaron valores elevados de especificidad (81,63 % y 99,99 %, respectivamente). Además, vasos sanguíneos dilatados en la superficie ocular, exceso de secreción mucoide, filamento mucoide y quemosis presentaron valores más altos de sensibilidad (74,52 %, 99,99 %, 100,0 % y 71,97 %, respectivamente). Conclusión Después del análisis de precisión de los indicadores clínicos, se concluye que cinco características definitorias fueron capaces de presentar valores elevados de especificidad o sensibilidad. Este descubrimiento corrobora una inferencia diagnóstica precisa, a fin de permitir la optimización de resultados con el objetivo de impedir el deterioro clínico referente a la respuesta humana indeseable sequedad ocular .

Abstract Objective To analyze the clinical indicator accuracy of Ocular dryness nursing diagnostic proposal in adult patients in the Intensive Care Unit. Methods This is a diagnostic accuracy study, with cross-sectional analytical design and quantitative approach. The sample consisted of 206 patients admitted to an adult Intensive Care Unit. An instrument designed according to variables related to sociodemographic and clinical data, clinical indicators, etiological factors, population at risk and associated conditions of Ocular dryness was applied. A latent class model was used to identify the prevalence of diagnosis and to identify clinical indicator specificity and sensitivity. Results Among the study participants, 52.4% were male and had a mean age of 58.69 years (±14.61). The prevalence of Ocular dryness was 76.22%. The reduced tear volume and excessive mucous secretion clinical indicators showed high specificity values (81.63% and 99.99%, respectively). Moreover, extended blood vessels on the ocular surface, excessive mucous secretion, mucoid filaments and chemosis presented higher values for sensitivity (74.52%, 99.99%, 100.0% and 71.97%, respectively). Conclusion After analyzing clinical indicator accuracy, it is concluded that five defining characteristics were able to present high values of specificity or sensitivity. This finding corroborates an accurate diagnostic inference, in order to enable the optimization of results in order to prevent the clinical decline related to the undesirable human response Ocular dryness .

Interrelações das Epistemologias do Sul e o cuidado transcultural nas práticas em saúde e Enfermagem / Interrelaciones de Epistemologías del Sur y cuidado transcultural en salud y prácticas de enfermería / Interrelationships of Epistemologies of the South and cross-cultural care in health and Nursing practices

Resumo Objetivo refletir sobre as interrelações do cuidado transcultural e as Epistemologias do Sul nas práticas em saúde e Enfermagem. Método trata-se um de estudo reflexivo, com base em uma revisão narrativa da literatura, destacando os conceitos da linha abissal, ecologia dos saberes e descolonização do saber do referencial das Epistemologias do Sul. Resultados após a análise reflexiva do material emergiram três eixos reflexivos, a saber: Populações ao Sul da linha abissal; Ecologia dos saberes e a interculturalidade; e Descolonização do saber nas práticas em saúde e Enfermagem: cuidado culturalmente congruente. Considerações finais e implicações para a prática a valorização da cultura de autocuidado de grupos populacionais vulneráveis ao sul da linha abissal é fundamental para oportunizar a visibilidade e a voz, retirados pelo processo de colonização no campo da saúde, fruto da supervalorização do saber biomédico. Observa-se a necessidade do diálogo entre os conhecimentos para a construção de um ambiente de aprendizagem mútua, caracterizado como ecologia dos saberes. Para isso, é preciso o processo de descolonização na perspectiva do pensamento pós-abissal, com a valorização do saber popular, em prol de um cuidado culturalmente congruente. Por fim, na Enfermagem, o referencial da Teoria da Universalidade e Diversidade do Cuidado Cultural instrumentaliza o enfermeiro para planejar e implementar o cuidado transcultural sensível.

Resumen Objetivo reflexionar sobre las interrelaciones del cuidado transcultural y las Epistemologías del Sur en las prácticas de salud y Enfermería. Método se trata de un estudio reflexivo, a partir de una revisión narrativa de la literatura, destacando los conceptos de la línea abisal, ecología del saber y descolonización del saber en el marco de las Epistemologías del Sur. Resultados luego del análisis reflexivo del material surgieron tres ejes reflexivos, a saber: Poblaciones al sur de la línea abisal; Ecología del conocimiento e interculturalidad; y Descolonización del saber en salud y prácticas de Enfermería: cuidado culturalmente congruente. Consideraciones finales e implicaciones para la práctica la valorización de la cultura del autocuidado de los grupos poblacionales vulnerables al sur de la línea abisal es fundamental para generar espacios de visibilidad y voz sustraídos por el proceso de colonización en el campo de la salud, producto de la sobrevaloración de la biomedicina conocimiento. Hay una necesidad de diálogo entre saberes para construir un ambiente de aprendizaje mutuo, caracterizado como la ecología del saber. Para ello, se necesita el proceso de descolonización desde la perspectiva del pensamiento postabismal, con la valorización del saber popular, en pro del cuidado culturalmente congruente. Finalmente, en Enfermería, el marco de la Teoría de la Universalidad y Diversidad del Cuidado Cultural equipa a los enfermeros para planificar e implementar un cuidado transcultural sensible.

Abstract Objective to reflect on the interrelationships of transcultural care and the Epistemologies of the South of health and Nursing practices. Method this is a reflective study, based on a narrative review of the literature, highlighting the concepts of abyssal line, ecology of knowledge, and decolonization of knowledge from the framework of the Epistemologies of the South. Results after the reflective analysis of the material, three reflexive axes emerged, namely: Populations south of the abyssal line; Ecology of knowledge and interculturality; and Decolonization of knowledge in health and nursing practices: culturally congruent care. Final considerations and implications for practice the appreciation of the self-care culture of vulnerable population groups south of the abyssal line is essential to create opportunities for visibility and voice removed by the colonization process in the health field, as a result of the overvaluation of biomedical knowledge. There is a need for dialogue between knowledge to build an environment of mutual learning, characterized as the ecology of knowledge. For this, the decolonization process is needed from the perspective of post-abyssal thinking, with the appreciation of popular knowledge, in favor of culturally congruent care. Finally, in nursing, the framework of the Theory of Universality and Diversity of Cultural Care equips nurses to plan and implement sensitive transcultural care.