Analysis of etiological factors of nursing diagnosis of impaired comfort in children and adolescents with cancer.

AIM: To analyse the etiological factors of the nursing diagnosis of impaired comfort in children and adolescents with cancer. DESIGN: This cross-sectional study was carried out in the referral unit for the treatment of childhood cancer in a tertiary hospital located in northeastern Brazil. METHODS: A total of 200 children and adolescents who were undergoing cancer treatment were included in this study. Data collection instruments and protocols were constructed with operational and conceptual definitions of clinical indicators and etiological factors for the nursing diagnosis of impaired comfort. A latent class model with adjusted random effects was used to determine impaired comfort and measures of sensitivity and specificity of clinical indicators. A univariate logistic regression analysis was performed for each etiological factor of impaired comfort. RESULTS: The analysis of etiological factors for the nursing diagnosis of impaired comfort in children and adolescents with cancer showed the high prevalence of four factors: noxious environmental stimuli, insufficient situational control, insufficient resources and insufficient environmental control. Illness-related symptoms, noxious environmental stimuli, and insufficient environmental control increased the chance of impaired comfort occurring. CONCLUSION: The etiological factors with the highest prevalence and most significant impact on the occurrence of impaired comfort were noxious environmental stimuli, insufficient situational control and illness-related symptoms. IMPACT: The results obtained in this investigation can support more accurate nursing diagnostic inference of impaired comfort in children and adolescents with cancer. Moreover, the results can inform direct interventions for the modifiable factors that trigger this phenomenon to avoid or minimize the signs and symptoms of the nursing diagnosis.

Diagnostic accuracy of clinical indicators of Imbalanced nutrition in pediatric patients submitted to chemotherapy.

To analyze the accuracy of clinical indicators of nursing diagnosis, Imbalanced nutrition: less than the body requirements in pediatric patients undergoing chemotherapy. A cross-sectional study was carried out in a pediatric oncohematology unit. A total of 123 children aged 5-18 years were evaluated. The Standards for Reporting Diagnostic Accuracy Studies (STARD) protocol was used. Latent class analysis was performed to obtain sensitivity and specificity of clinical indicators. The diagnosis was identified in six children (5.23%). The most frequent clinical indicator in the study was report of food intake less than recommended daily allowance (n = 61; 49.6%), followed by excessive hair loss (n = 49; 39.8%), misperception (n = 42; 34.1%), satiety immediately upon ingesting food (n = 32; 26%), lack of information (n = 30; 24.4%), and pale mucous membranes (n = 22; 17.9%). The 10 indicators that sensitivity and specificity were statistically superior to 50% were food intake less than recommended daily allowance, misperception, insufficient interest in food, lack of food, hyperactive bowel sounds, body weight 20% or more below ideal weight range, insufficient muscle tone, food aversion, abdominal cramping, and misinformation. The clinical indicators Food intake less than recommended daily allowance and Misperception can be considered the most important indicators for the initial inference of the diagnosis due to their high values of specificity and sensitivity. It is essential that nurses provide targeted and qualified assistance based on the signs and symptoms presented by patients, as they will be able to design appropriate interventions to obtain the desired results.

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

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

Diagnostic indicators of risk-prone health behaviors in pregnant adolescents.

PURPOSE: This study aimed to identify diagnostic indicators associated with the nursing diagnosis risk-prone health behaviors in pregnant adolescents. METHODS: We conducted a cross-sectional study. The sample consisted of 181 pregnant adolescents. A latent class analysis was conducted to verify associations between the defining characteristics of risk-prone health behaviors and diagnostic accuracy measures. Logistic regression was used to identify factors associated with the manifestation of risk-prone health behavior. FINDINGS: The prevalence of risk-prone health behaviors in this sample was 31.04%. The defining characteristics failure to take action that prevents health problems and inappropriate eating habits achieved a high sensitivity. The related factors such as insufficient social support, stressors, low self-efficacy, social anxiety, isolated region of residence, and restricted access to health services presented significant associations with risk-prone health behavior. CONCLUSIONS: The diagnostic indicators associated with the nursing diagnosis of risk-prone health behavior were failure to take action that prevents health problems inappropriate eating habits, insufficient social support, stressors, low self-efficacy, social anxiety, isolated region of residence, and restricted access to health services. IMPLICATIONS FOR NURSING PRACTICE: This study contributes to knowledge about the diagnostic indicators of risk-prone health behavior, which may help nurses reach the proper diagnosis. This will facilitate the application of clinical judgment in nursing care to assist pregnant adolescents.

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

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

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

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

Impaired Gas Exchange: Prognostic Clinical Indicators of Short-Term Survival in Children with Acute Respiratory Infection.

PURPOSE: To establish prognostic indicators of survival for impaired gas exchange (IGE) (00030). METHODS: Secondary analysis of data from an open prospective cohort developed with a group of 136 children with acute respiratory infection (ARI). FINDINGS: On Day 1, IGE (00030) was present in 42.6% of the sample. New cases arose until the last day of evaluation. With regards to defining characteristics, only hypoxemia and abnormal skin color were associated with a higher risk of developing diagnosis. CONCLUSIONS: Children with ARI who exhibit hypoxemia and abnormal skin color had a worse prognosis for IGE (00030). IMPLICATIONS FOR NURSE PRACTICE: Nurses can use the research findings as a predictive marker of the evolution of the patient's health status.

Validation of Clinical Indicators of the Nursing Diagnosis of Ineffective Protection in Adolescents With Cancer.

PURPOSE: To validate the clinical indicators of the nursing diagnosis of Ineffective protection in adolescents with cancer based on diagnostic accuracy measurements. DESIGN AND METHODS: Measurements of sensitivity and specificity for the indicators were calculated using latent class analysis with random effects in a sample of 127 adolescents between 10 and 19 years of age. RESULTS: The prevalence of diagnosis was estimated at 93.7%. The indicators deficient immunity and weakness showed higher sensitivity values, whereas opportunistic infections, recurrent infections, insomnia, mucosal lesions, and coughing showed high specificity. CONCLUSIONS: Seven indicators were clinically validated. PRACTICE IMPLICATIONS: The validation of clinical indicators provides nurses with the knowledge of useful signs and symptoms to identify early spectra of a nursing diagnosis or confirm their presence in a specific population. In clinical practice, this knowledge contributes to an accurate diagnostic inference and the planning of nursing interventions directed to the idiosyncrasies of individuals.

Análisis del concepto de Sentimiento de impotencia en individuos con accidente cerebrovascular / Análise do conceito de Sentimento de impotência em indivíduos com acidente vascular encefálico / Analysis of the concept of powerlessness in individuals with stroke

Objective: To identify and analyze the concept of the powerlessness in individuals with stroke, according to the NANDA-I Taxonomy. Methods. Concept analysis from online access of four databases using the descriptors: impotence; helplessness, learned; Stroke, depression in languages: Portuguese, English and Spanish. Results. The critical attributes of the feeling of powerlessness are: fragility, helplessness, lack of control, and power to achieve the proposed results for recovery and adaptation. Eleven new antecedents were found. It is recommended to reformulate three antecedents present in the taxonomy. Fourteen consequent were found. It is suggested to amend three consequential from the review. Conclusion. With the analysis, a more complete concept of the powerlessness was elaborated allowing clarifying the critical attributes that, in turn, will help the rehabilitating nurse to recognize the signs and symptoms and to strengthen mechanisms of tolerance and resistance to stress.(AU)

Objetivo. Analizar el concepto de sentimiento de impotencia en individuos con accidente cerebrovascular, según la Taxonomía de NANDA-I. Métodos. Análisis de concepto a partir del acceso on-line a cuatro bases de datos utilizando los descriptores: impotencia; desamparo aprendido; accidente vascular cerebral, depresión en los idiomas portugués, inglés y español. Resultados. Los atributos críticos del sentimiento de impotencia son: fragilidad, desamparo, falta de control y el no poder alcanzar los resultados propuestos para la recuperación y adaptación. Se encontraron once nuevos antecedentes. Se recomienda reformular tres antecedentes presentes en la taxonomía. Se evidenciaron 14 consecuencias y se sugiere alterar tres a partir de la revisión. Conclusión. Con este análisis se elaboró un concepto más completo del sentimento de impotencia, permitiendo clarificar los atributos críticos que, a su vez, ayudará al enfermero rehabilitador a reconocer las señales y síntomas, como también a fortalecer los mecanismos de tolerancia y enfrentamiento al estrés. (AU)

Objetivo. Identificar e analisar o conceito do sentimento de impotência em indivíduos com acidente vascular encefálico, segundo a Taxonomia da NANDA-I. Métodos. Análise de conceito a partir de acesso on-line a quatro bases de dados utilizando os descritores: impotência; desamparo aprendido; acidente vascular cerebral, depressão nas línguas português, inglês e espanhol. Resultados. Os atributos críticos do sentimento de impotência são: fragilidade, desamparo, falta de controle e poder para alcançar os resultados propostos para recuperação e adaptação. Encontrou-se onze novos antecedentes. Recomenda-se reformular três antecedentes presentes na taxonomia. Evidenciou-se quatorze consequentes; sugere-se alterar três consequentes a partir da revisão. Conclusão. Com a análise elaborou-se um conceito mais completo do sentimento de impotência permitindo clarificar os atributos críticos que, por sua vez, auxiliará ao enfermeiro reabilitador reconhecer os sinais e sintomas e fortalecer mecanismos de tolerância e enfrentamento ao estresse. (AU)

[The adequacy of the defining characteristics of the diagnostics "impaired gas exange" and spontaneous ventilation" in asmathic children]. / Adecuación de las características definitorias en los diagnósticos de deterioro del intercambio de gases y de la ventilación espontánea en niños asmáticos.

OBJECTIVE: To determine the diagnostic accuracy measures of defining characteristics of respiratory nursing diagnoses "impaired gas exchange" and "impaired spontaneous ventilation" in asmathics children in emergency department. METHODS: Observational, descriptive transversal study developed between April and September 2013 in a hospital in northeastern Brazil with a sample of 205 children. Diagnoses were established by nurses trained experts in this field. Measures of sensitivity, specificity, positive and negative value prediction right positive and negative likelihood ratio and diagnostic odds for the defining characteristics identified were calculated. RESULTS: 28.8% of the evaluated children had "impaired gas exchange". Dyspnea, abnormal breathing, tachycardia and hypoxemia had higher frequencies. Hypoxemia presented as clinical feature high sensitivity and specificity. 5.9% of the evaluated children had "impaired spontaneous ventilation" and their most frequent defining characteristics were dyspnea, increased heart rate and decreased SaO2. The increasing use of accessory muscles to breathe presented the best measures of validity for this diagnosis. CONCLUSION: The hypoxemia and increased use of accessory muscles presented the best measures of the validity respectively to "deterioration in gas exchange" and "impairment of spontaneous ventilation". These characteristics is necessary to provide for adequate definition and use of diagnostics in clinical practice.

Impaired gas exchange: accuracy of defining characteristics in children with acute respiratory infection.

OBJECTIVE: to analyze the accuracy of the defining characteristics of the Impaired gas exchange nursing diagnosis in children with acute respiratory infection. METHOD: open prospective cohort study conducted with 136 children monitored for a consecutive period of at least six days and not more than ten days. An instrument based on the defining characteristics of the Impaired gas exchange diagnosis and on literature addressing pulmonary assessment was used to collect data. The accuracy means of all the defining characteristics under study were computed. RESULTS: the Impaired gas exchange diagnosis was present in 42.6% of the children in the first assessment. Hypoxemia was the characteristic that presented the best measures of accuracy. Abnormal breathing presented high sensitivity, while restlessness, cyanosis, and abnormal skin color showed high specificity. All the characteristics presented negative predictive values of 70% and cyanosis stood out by its high positive predictive value. CONCLUSION: hypoxemia was the defining characteristic that presented the best predictive ability to determine Impaired gas exchange. Studies of this nature enable nurses to minimize variability in clinical situations presented by the patient and to identify more precisely the nursing diagnosis that represents the patient's true clinical condition.

[Analysis of risk indicators for the arterial hypertension in children and teenagers]. / Análise de indicadores de risco para hipertensão arterial em crianças e adolescentes.

The aim of this study was to evaluate the risk indicators for high blood pressure in children and teenagers. A cross-sectional study developed with 342 individuals of 6-18 years of age in a school of Fortaleza city. The most individuals were male (51.5%). The age mean was 11.7 years (+/-3.19). It was frequent the scholars with overweight/obesity (16.8%) and blood pressure above of the 90th percentile (44.7%). Sedentarism, smoking and drinking were present in 51.5%, 38% and 15.5% of the sample. The systolic blood pressure was correlated with the variable age, weight, height, waist and hip circumferences, subscapular skinfold thickness and body mass index. There was correlation of the diastolic blood pressure with age, weight, height, and waist and hip circumferences. It was confirm the influence of risk factors on the blood pressure values of children and teenagers. The systolic blood pressure was especially influenced by anthropometric indicators.