Prevalence, defining characteristics, and predictors of the nursing diagnosis of spiritual distress in cancer patients undergoing chemotherapy: A longitudinal study.

INTRODUCTION: Cancer patients are exposed to several types of treatments, including chemotherapy. In this context, patients experience several nursing diagnoses, including spiritual distress. The definition of the diagnosis of spiritual distress is grounded in lack of meaning and purpose in life, a sense of suffering, and a feeling of disconnected. PURPOSE: The aim of this study was to determine the prevalence, sensitivity, specificity, and predictors of the nursing diagnosis of spiritual distress of cancer patients undergoing chemotherapy. DESIGNS: The study used a longitudinal questionnaire design with quarterly data collection points over a 12-month period. Participants were recruited through random sampling, in an outpatients' setting in one oncology day unit in Portugal. FINDINGS: The highest prevalence of spiritual distress was found at 3 months after patients started chemotherapy. The highest value of specificity was lack of meaning in life and express suffering, and the highest values of sensitivity concerned spiritual distress diagnosis. The predictors of spiritual distress were express suffering, alienation, questioning meaning in life, lack of serenity, questioning the meaning of suffering, hopelessness, and lack of meaning in life. CONCLUSIONS: Spiritual distress is a human response that is current in patients undergoing chemotherapy, and the highest prevalence seems to occur at 3 months after commencing chemotherapy. Express suffering and lack of meaning in life play the role not only of defining characteristics (DC) in this study, but also of predictors in the diagnosis of spiritual distress. CLINICAL RELEVANCE: The identification of the prevalence, predictors, sensitivity, and specificity of the DC of the nursing diagnosis of spiritual distress in cancer patients undergoing chemotherapy may facilitate nurses' clinical reasoning and improve the planning of nursing care in clinical practice in order to improve spiritual well-being in cancer patients.

End-of-life: An urgent update in nursing terminology.

Although nursing terminologies and classifications represent nursing knowledge across diverse clinical areas, end-of-life care seems under represented in many aspects of these instruments. NANDA- I is an international nursing diagnostic classification widely used in nursing education and research. This taxonomy is based on seven axes, including the axis of time. In this commentary we bring discussion to the need to update nursing terminology by including the term end-of-life in the time axis of NANDA-I. After describing the epidemiologic aspects of end-of-life care and discussing the relevant nursing role, we discuss patients' and family's human responses towards the end-of-life time and circumstance, which are central to defining nursing diagnoses. End-of-life care is one priority in health care, and nursing diagnoses should represent that situation as well. This paper focuses on a specific and international nursing diagnosis classification, NANDA-I, which lacks an end-of-life component to its time axis for defining labels of nursing diagnoses. Attending to the importance of classifications in clinical reasoning, nursing diagnoses could better represent responses towards this health condition, opening new opportunities for increasing nursing roles in clinical practice, and also for new studies aiming to validate nursing diagnoses, and promoting an evidence-based practice by including end-of-life in the axis time.

Spiritual Distress in Patients With Cancer Initiating Chemotherapy: A Cross-Sectional Study.

PURPOSE: To assess spiritual distress in patients with cancer who were initiating chemotherapy. METHODS: This was a quantitative, observational, cross-sectional study. Data collection was conducted between February and June of 2019. The Spiritual Distress Scale (SDS) was administered to 332 patients with cancer. FINDINGS: Most participants (56.6%) were female, with the mean age at 60.3 years (SD = ±11.73). The mean SDS score was 56.6 (SD = ±13.39), with 30% of the participants reporting moderate and 9.6% reporting high levels of spiritual distress. Younger age (ß = -0.687, p = .008) and participants having no religious affiliation were predictors of SDS (ß = -8.322, p = .035) in patients with cancer initiating chemotherapy. CONCLUSIONS: Given the degree of spiritual distress reported, this study provides further evidence to support the need for nurses to assess spirituality in order to provide holistic care inclusive of spiritual domain. CLINICAL RELEVANCE: These results are relevant to clinical practice and indicate a need for nurses to use the clinical reasoning process to assess spiritual distress and to plan nursing interventions aimed at meeting the spiritual needs of patients with cancer who are initiating chemotherapy.

The Contribution of the Rasch Model to the Clinical Validation of Nursing Diagnoses: Integrative Literature Review.

PURPOSE: To analyze the knowledge related to the use of the Rasch model in validation of nursing diagnoses. METHODS: Integrative literature review with search in LILACS, PUBMED, CINAHL, and SCOPUS. FINDINGS: Five studies comprised the sample, which analyzed unidimensionality, local independence, item calibration, item reliability, separation of items and people, and differential item functioning for analyzing nursing diagnoses. CONCLUSIONS: The Rasch model seems to be a useful method to validate nursing diagnoses and probably also for the validation of nursing outcomes in the Nursing Outcomes Classification. The use of this model is promising, considering the advantages that it can be used in studies with several methodological designs. IMPLICATIONS FOR NURSING: Methods that are able to provide more robust evidence of nursing diagnosis validity are needed to support highly accurate diagnostic findings in clinical practice.

Clinical Validation of the Indicators and Definitions of the Nursing Outcome "Tissue Integrity: Skin and Mucous Membranes" in People With Diabetes Mellitus.

PURPOSE: The study aimed to validate clinically the indicators of the nursing outcome "Tissue Integrity: Skin and Mucous Membranes" and its conceptual and operational definitions in people with diabetes mellitus. METHODS: A methodological study was conducted with an evaluation of 100 participants for two pairs: one of these pairs used the indicators without the definitions and the other used the indicators with their definitions. FINDINGS: The pair who used the definitions presented greater concordance and similarity in the ratings. CONCLUSIONS: The indicators and their definitions have been validated clinically. IMPLICATIONS FOR NURSING PRACTICE: The use of indicators with definitions can contribute to reliable and accurate evaluation of the tissue integrity of the feet in people with diabetes mellitus and, thus, assist in the measurement of the effectiveness of the nursing care provided. OBJETIVO: Validar clinicamente os indicadores do resultado de enfermagem "Integridade Tissular: pele e mucosas" e suas definições conceituais e operacionais em pessoas com diabetes mellitus. MÉTODOS: Estudo metodológico que consistiu na avaliação de 100 participantes por duas duplas de avaliadores: uma dupla utilizou os indicadores sem as definições e, a outra dupla, os indicadores com suas definições. RESULTADOS: A dupla que utilizou as definições apresentou maior concordância e similaridade nas avaliações. CONCLUSÃO: Os indicadores e suas definições foram validados clinicamente. IMPLICAÇÕES PARA A PRÁTICA DE ENFERMAGEM: A utilização de indicadores com suas respectivas definições pode contribuir para a avaliação confiável e precisa da integridade tissular dos pés de pessoas com diabetes mellitus e, assim, auxiliar na mensuração da eficácia da assistência de enfermagem.

Cultural adaptation and analysis of the psychometric properties of the Brazilian version of the Spiritual Distress Scale.

AIMS AND OBJECTIVES: To culturally adapt and test the psychometric properties of the Brazilian version of the Spiritual Distress Scale. BACKGROUND: In Brazil, there is currently a lack of validated instruments that assess the spiritual dimension, which includes the spiritual distress phenomenon that can be experienced at different moments in a person's life. This can include times when a person is affected by a disease such as cancer, which occurs suddenly and causes significant life changes. DESIGN: Methodological and cross-sectional study. METHODS: Cultural adaptation of the Spiritual Distress Scale was performed using translation and back-translation stages, evaluation of cultural equivalence, committee review and pretesting. An interview using the Brazilian version of the scale was conducted with 170 patients in a cancer treatment unit of a charitable general hospital (not state funded). The following psychometric properties were evaluated: construct validity (divergence and factor analysis) and internal consistency/reliability (Cronbach's α and Kappa). RESULTS: Reliability analysis in the intra- and inter-rater phase showed that more than half of the items had Kappa values > 0·75. A correlation between the Spiritual Well-Being Scale and the Spiritual Distress Scale was found. Overall, the Spiritual Distress Scale showed a Cronbach's α of 0·87, with three of its four domains showing significant parameters. CONCLUSION: The Brazilian version of the Spiritual Distress Scale proved to be a reliable, valid and efficient instrument that is capable of assessing spiritual distress. The Brazilian Spiritual Distress Scale presented reliability and validity parameters that correspond to the original English version of the scale. RELEVANCE TO CLINICAL PRACTICE: The existence of an internationally validated instrument that assesses spiritual distress will assist healthcare professionals and researchers in recognising this phenomenon in clinical practice.

Anxiety and performance of nursing students in regard to assessment via clinical simulations in the classroom versus filmed assessments.

OBJECTIVE: To compare the level of anxiety and performance of nursing students when performing a clinical simulation through the traditional method of assessment with the presence of an evaluator and through a filmed assessment without the presence of an evaluator. METHODOLOGY: Controlled trial with the participation of Brazilian public university 20 students who were randomly assigned to one of two groups: a) assessment through the traditional method with the presence of an evaluator; or b) filmed assessment. The level of anxiety was assessed using the Zung test and performance was measured based on the number of correct answers. RESULTS: Averages of 32 and 27 were obtained on the anxiety scale by the group assessed through the traditional method before and after the simulation, respectively, while the filmed group obtained averages of 33 and 26; the final scores correspond to mild anxiety. Even though there was a statistically significant reduction in the intra-groups scores before and after the simulation, there was no difference between the groups. As for the performance assessments in the clinical simulation, the groups obtained similar percentages of correct answers (83% in the traditional assessment and 84% in the filmed assessment) without statistically significant differences. CONCLUSION: Filming can be used and encouraged as a strategy to assess nursing undergraduate students.

Auriculoterapia efeito sobre a ansiedade / Efecto de la auriculoterapia sobre la ansiedad / Effect of auriculotherapy on anxiety

Introdução: A vida agitada, rotina excessiva, estresse e a aparência de conflito estão aumentando hoje e pode causar ansiedade, comprometendo a saúde física e mental das pessoas. Objetivos: identificar evidências na literatura sobre o efeito de orelha em protocolo de ansiedade e tratamento. Métodos: uma pesquisa bibliográfica no PubMed, LILACS, Science Direct e IBECS com palavras-chave · Ansiedade / Ansiedade · e · Auriculoterapia / Auriculoterapia · e · Ansiedade / Ansiedade · e · fone de ouvido / Acupuntura, Orelha · adaptada a cada base, com os critérios de inclusão: trabalhos apresentados em Português, Inglês e Espanhol, publicados nos últimos dez anos. Resultados: 78,11 porcento dos estudos analisados ??mostraram acupuntura auricular como uma intervenção eficaz para reduzir a ansiedade. É relacionada com o protocolo de auricular ·· ele descobriu que não há consenso entre os especialistas sobre o número de sessões, duração do tratamento e os pontos aplicados para a ansiedade. Apesar desta diversidade, auricolotherapy pode ser identificado como o método preferido: aplicação da técnica por meio de uma agulha (50 porcento), unilateral (42,9 porcento) em pontos Shenmen (64,3 porcento) e relaxamento (28,6 porcento), com o manual e estimulação (78,6 porcento) por semana (21,4 porcento), com número variável de sessões utilizando para avaliar o efeito da técnica, os marcadores e os instrumentos de avaliação psicométrica ansiedade (78,6 porcento). Conclusões: Sugere-se a realização de novos ensaios clínicos para a compreensão da técnica de ouvido, uma vez que ela foi positiva para a redução da ansiedade, além de protocolo do estudo de validação(AU)

Introducción: la agitada vida, rutina excesiva, el estrés y la aparición de situaciones de conflicto están aumentando hoy en día y pueden causar ansiedad, lo que compromete la salud física y mental de las personas. Objetivos: identificar la evidencia en la literatura sobre el efecto de la auriculoterapia en la ansiedad, así como el protocolo de tratamiento. Métodos: búsqueda de la literatura en PubMed, LILACS, Science Direct y IBECS, con las palabras clave "Ansiedade/ Anxiety" and "Auriculoterapia/ Auriculotherapy" e "Ansiedade/ Anxiety" and "Acupuntura auricular/ Acupuncture, Ear" , adaptada para cada base, con los criterios de inclusión: trabajos presentados en portugués, inglés y español, publicados en los últimos diez años. Resultados: en 78,11 por ciento de los estudios analizados la auriculoterapia se mostró como una intervención eficaz para la reducción de la ansiedad. Relacionado con el protocolo del auriculoterapia ​​ se encontró que no existe un consenso de los expertos en relación con el número de sesiones, duración del tratamiento y puntos aplicados para la ansiedad. A pesar de esta diversidad, la auricoloterapia puede identificarse como el método más utilizado: aplicación de la técnica a través de una aguja (50 por ciento), de forma unilateral (42,9 por ciento) en los puntos Shenmen (64,3 por ciento) y Relajación (28,6 por ciento) , con la estimulación manual (78,6 por ciento) y semanal (21,4 por ciento) con número variable de sesiones, utilizando, para evaluar el efecto de la técnica, marcadores e instrumentos de evaluación psicométrica de ansiedad (78,6 por ciento). Conclusiones: se sugiere llevar a cabo más ensayos clínicos para el conocimiento de la técnica del auriculoterapia, una vez que ella fue positiva para la reducción de la ansiedad, además de la validación del protocolo de estudio(AU)

Introduction: The hectic life, excessive routine, stress and the appearance of conflict are increasing today and can cause anxiety, compromising the physical and mental health of people. Objectives: to identify evidence in the literature on the effect of ear in anxiety and treatment protocol. Methods: A literature search in PubMed, LILACS, Science Direct and IBECS with keywords · Ansiedade / Anxiety · and · Auriculoterapia / Auriculotherapy · e · Ansiedade / Anxiety · and · headset / Acupuncture Acupuncture, Ear · adapted to each basis, with the inclusion criteria: papers presented in Portuguese, English and Spanish, published in the last ten years. Results: 78.11 percent of the studies analyzed showed ear acupuncture as an effective intervention to reduce anxiety. It related to the protocol of auricular ·· it found that there is no consensus among experts regarding the number of sessions, duration of treatment and dots applied for anxiety. Despite this diversity, auricolotherapy can be identified as the preferred method: applying the technique through a needle (50 percent), unilateral (42.9 percent) in Shenmen points (64.3 percent) and relaxation (28.6 percent), with manual and stimulation (78.6 percent) Weekly (21.4 percent) with variable number of sessions using to evaluate the effect of the technique, markers and psychometric assessment instruments anxiety (78.6 percent). Conclusions: It is suggested to conduct further clinical trials for understanding the technique of Ear, once she was positive for anxiety reduction, plus validation study protocol(AU)

Nursing actions in the perioperative period and in preparing prostatectomy patients for discharge / Acciones de enfermería en el perioperatorio y en la preparación para el alta hospitalaria del paciente prostatectomizado / Intervenções de enfermagem no perioperatório e no preparo para alta hospitalar do paciente prostatectomizado

Objective. To identify nursing actions in the perioperative period and in preparing prostatectomy patients for discharge. Methodology. Cross-sectional, retrospective study. Data were collected from medical record of patients who underwent partial or total prostatectomy between August 2009 and August 2010 at hospitals in Divinopolis, Minas Gerais, Brazil. Results. A total of 121 patients were identified; the mean age was 67 years. The most frequent diagnosis was prostate cancer (70%). Main preoperative activities were measuring vital signs (55%), administering drugs (52%), educating patients about fasting (50%), and managing edema (45%). After surgery, the most frequent tasks were measuring vital signs (100%), measuring urine and emptying the urinary bag (100% for each), facilitating the healing of surgical wounds (77%), and evaluating Penrose drain discharge (48%). Among the 25 types of care observed, the activity that nurses performed most often for patients about to be discharged was providing education about urinary catheter manipulation (16%). Conclusion. This study identified weaknesses in care delivery for prostatectomy patients, particularly regarding home care education.

Objetivo. Identificar las acciones de enfermería en el perioperatorio y en la preparación para el alta hospitalaria del paciente prostatectomizado. Metodología. Estudio de corte transversal con toma de información retrospectiva. La recolección de los datos se hizo a partir de las historias clínicas de los pacientes sometidos a prostatectomía parcial o radical entre agosto de 2009 a agosto de 2010 en hospitales de Divinópolis, Minas Gerais, Brasil. Resultados. Se identificaron 121 pacientes, cuya edad promedio era de 67 años. El diagnóstico más frecuente fue el cáncer de próstata (70%). Los principales cuidados preoperatorio fueron: la medición de los signos vitales (55%), la administración de medicamentos (52%), la educación sobre el ayuno (50%) y la administración del enema (45%). En el postoperatorio, entre los que mayores porcentajes presentaron estuvieron: la toma de signos vitales (100%), la medición de la orina y el vaciado de la bolsa recolectora (100% cada uno), la curación de la herida quirúrgica (77%) y la evaluación de la secreción del drenaje de Penrose (48%). Para el alta hospitalaria, de 25 tipos de cuidados observados, el más realizado fue el de la educación sobre la manipulación del catéter urinario (16%). Conclusión. El estudio identificó debilidades en la atención del paciente prostatectomizado, especialmente en la educación para el cuidado en el hogar.

Objetivo. Caracterizar o perfil de pacientes prostatectomizados em relação às variáveis sócio-demográficas e clínicas, e identificar ações de enfermagem realizadas no perioperatório e no preparo para alta hospitalar. Metodologia. Estudo transversal, retrospectivo. A coleta de dados foi realizada a partir de registros clínicos de pacientes submetidos a prostatectomia parcial ou radical entre agosto de 2009 a agosto de 2010 em hospitais de Divinópolis, Minas Gerais, Brasil. Resultados. Foram identificados 121 prontuários, cuja idade média foi de 67 anos. O diagnóstico mais frequente foi de câncer de próstata (70%). Os principais cuidados pré-operatórios foram: avaliação de sinais vitais (55%), administração de medicamentos (52%), ensino quanto ao jejum (50%) e lavagem intestinal (45%). No pós-operatório, os cuidados que apresentaram percentuais mais elevados foram: avaliação dos sinais vitais (100%), esvaziamento e mensuração de urina em bolsa coletora (100%), curativo de incisão cirúrgica (77%) e avaliação de secreção do dreno de penrose (48%). Para alta hospitalar, de 25 cuidados registrados, o mais realizado foi quanto o ensino sobre manuseio da sonda vesical (16%). Conclusão. O estudo identificou fragilidades no cuidado do paciente prostatectomizado, principalmente quanto ao ensino para o cuidado domiciliar.

Concept analysis and validation of the nursing diagnosis, delayed surgical recovery.

OBJECTIVE: To analyze the human response of delayed surgical recovery, approved by NANDA-I, and to validate its defining characteristics (DCs) and related factors (RFs). METHOD: This was a two-part study using a concept analysis based on the method of Walker and Avant, and diagnostic content validation based on Fehring's model. RESULTS: Three of the original DCs, and three proposed DCs identified from the concept analysis, were validated in this study; five of the original RFs and four proposed RFs were validated. CONCLUSIONS: A revision of the concept studied is suggested, incorporating the validation of some of the DCs and RFs presented by NANDA-I, and the insertion of new, validated DCs and RFs. IMPLICATIONS FOR NURSING PRACTICE: This study may enable the extension of the use of this diagnosis and contribute to quality surgical care of clients.

Proposed revisions for the nursing diagnoses sexual dysfunction and ineffective sexuality patterns.

PURPOSE: A literature search was used to verify the relevance of the nursing diagnoses Sexual Dysfunction and Ineffective Sexuality Patterns to their titles and to determine whether their defining characteristics address biological, psychological, and social aspects involving human sexuality. METHODS: This nonexperimental, descriptive study utilized content analysis based on a bibliographic review and nurse expert analysis of the definitions of the nursing diagnoses being studied in terms of the adequacy of the titles and their respective definitions as proposed by NANDA. FINDINGS: The title Sexual Dysfunction is pertinent; however, based upon the results of this study, the definition and defining characteristics should address the three human sexual response phases: desire, excitation, and orgasm. The title and definition of Ineffective Sexuality Patterns should be maintained; however, based upon the findings of this study, psychosocial aspects of sexuality should be included in the defining characteristics of this diagnosis. RECOMMENDATIONS. The location of Sexual Dysfunction in domain 8 (Sexuality) and class 2 (Sexual Function) is appropriate. It is recommended that Ineffective Sexuality Patterns remain in domain 8, but it should be transferred to class 1, as it refers to Sexual Identity.

A pilot study of a relaxation technique for management of nausea and vomiting in patients receiving cancer chemotherapy.

This study was designed to determine the effect of a progressive muscle relaxation intervention on nausea and vomiting associated with anticancer chemotherapy. Subjects were 30 hematology patients who were hospitalized and received chemotherapy treatment at a large hospital in the interior of São Paulo, Brazil. The results indicated that progressive muscle relaxation lead to statistically significant changes in physiological and muscle conditions and in nausea and vomiting levels. Therefore, this relaxation technique may be an effective nursing intervention method to allay or alleviate nausea and vomiting in patients receiving chemotherapy. For future studies, we suggest using a control group, a homogeneous sample in terms of antiemetic and chemotherapy type and dosage, and the longitudinal following of subjects during chemotherapy.

[The history of the nursing interunits doctoral program and its contribution to Brazilian nursing]. / A trajetória histórica do programa interunidades de doutoramento em enfermagem e sua contribuição para a enfermagem brasileira.

Authors aimed at describing the history of the Nursing Interunits Doctoral Program offered at the São Paulo and Ribeirão Preto campi from 1981 to 2004. Data were collected based on the Program documents (resolutions, opinion, students' records, reports, etc). The Nursing Interunits Doctoral Program was approved by the University of São Paulo Graduate Council in May 25, 1981. During the past several years, until the beginning of the 1990s, the demand was centered in the students from the Schools responsible for the Program, followed by faculty from other Nursing Schools in Brazil. The Program has resulted in the formation of researchers from different Brazilian and South American Universities, leading the creation of research groups and originating new graduate programs.

Las representaciones sociales de los familiares de pacientes quemados / Social representations of the relatives of burnt patients

Este estudio tuvo como objetivo caracterizar las representaciones sociales de la familia de pacientes quemados ingresados en la Unidad de Quemados del Hospital de las Clínicas de la Universidad de Sao Paulo, en cuanto a las secuelas dejadas por quemaduras. Los datos fueron recolectados a través de entrevistas semiestructuradas, individuales, durante el horario de visita, en dos momentos: la fase mediata y la tardía de la quemadura. Posteriormente, los datos fueron sometidos a un análisis temático e interpretados con base en la teoría de las representaciones sociales propuesta por Moscovici S. Se concluye que, en la fase mediata de la quemadura, gran parte de los familiares de pacientes que sufrieron trauma térmico desconocen sus consecuencias, pasando a tener algún conocimiento en la fase tardía, cuando las secuelas están visibles. Entre tanto, se observa que la representación de las secuelas del trauma térmico, en la fase mediata y tardía, hecha por los familiares, es que este tipo de accidente deja marcas, cicatrices, y atribuyen un valor negativo a esta situación, expresando sentimientos de indignación e incoformidad. Así, los familiares entienden que en la convivencia social, las otras personas presentarán reacciones negativas frente a las secuela y por este motivo, expresan alivio cuando vislumbran la posibilidad de esconderlas.