Virtual clinical simulation in nursing education: a concept analysis.

OBJECTIVES: To analyze the concept of virtual clinical simulation in nursing education. METHODS: The Walker and Avant concept analysis model guided the study process and the data collection followed the integrative literature review method. Databases searched were: CINAHL, PubMed, Education Resources Information Center, and Scopus. Search terms and Boolean operators were: e-simulation OR virtual clinical simulation OR computer-simulation OR computer simulation OR virtual gaming OR virtual reality AND nursing education OR nursing. The sample comprised 45 studies. RESULTS: Virtual clinical simulation in nursing education was defined as the innovative teaching and learning technological strategy that provides immersive self-regulated training of nursing practice, reproducing real-life experiences and feedback in a virtual environment that is safe, interactive, dynamic and enjoyable. CONCLUSIONS: Clarification of this concept contributes to the development of a standardized terminology to include in the nursing nomenclature system and its dissemination for the construction of nursing science.

[Understanding advanced practice nursing as a step towards its implementation in BrazilComprender la enfermería de práctica avanzada como un paso hacia su aplicación en Brasil]. / A compreensão da prática avançada de enfermagem como um passo à sua implementação no Brasil.

OBJECTIVE: To describe the elements of the practice of certified nurse-midwives and women's health nurse practitioners in the context of the United States of America in order to facilitate the implementation of advanced practice nursing in Brazil. METHOD: Exploratory case study describing elements of advanced practice nursing in one of the largest hospitals in New York City, United States of America. The practice of certified nurse-midwives and women's health nurse practitioners was observed between April and May 2019. The data were analyzed inductively and a category scheme was developed from the analysis of field notes. RESULTS: The results were organized into the following categories: activities that are commonly performed; foundations that support practice; differential function of these professionals; interaction with other health professionals; barriers to practice; facilitating elements; and results of the practice. CONCLUSIONS: The observation of advanced practice nursing in another context, such as the United States, is a relevant step in the process of its implementation in Brazil. Nursing professionals and other stakeholders need to understand this practice in order to truly support the implementation process.

OBJETIVO: Describir los elementos de la práctica de las enfermeras-parteras certificadas (certified nurse-midwives) y las enfermeras de la salud de la mujer (women's health nurse practitioners) en el contexto de los Estados Unidos de América a fin de facilitar la aplicación de la enfermería de práctica avanzada en Brasil. MÉTODO: Estudio de casos exploratorio con descripción de los elementos de la enfermería de práctica avanzada en uno de los hospitales más grandes de la ciudad de Nueva York, Estados Unidos de América. Se observó la práctica de las enfermeras-parteras certificadas y las enfermeras de la salud de la mujer entre abril y mayo de 2019. Los datos se analizaron de forma inductiva y se elaboró un esquema de categorías a partir del análisis de las notas de campo. RESULTADOS: Los resultados se organizaron en las siguientes categorías: actividades que se realizan comúnmente; fundamentos que sustentan la práctica; función diferencial de estos profesionales; interacción con otros profesionales de la salud; barreras presentes en la práctica; elementos facilitadores; y resultados de la práctica. CONCLUSIONES: La observación de la enfermería de práctica avanzada en otro contexto, como el estadounidense, es un paso relevante en el proceso de aplicación en Brasil. Es necesario que los profesionales de enfermería y otras partes interesadas comprendan esta práctica para poder apoyar verdaderamente el proceso de aplicación.

Delay in Growth in Adolescents: Clinical Validation of a Proposed Nursing Diagnosis.

PURPOSE: This study aims to analyse the accuracy of clinical indicators of the proposed diagnosis of delayed growth in school-aged adolescents. DESIGN AND METHODS: This is a diagnostic accuracy study of 385 adolescents in public schools from July to September 2017 that aimed to assess the accuracy of clinical indicators of the proposed nursing diagnosis of delayed growth; the sensitivity and specificity values were calculated using latent class analysis. RESULTS: Growth velocity less than expected was associated with sensitivity and specificity. The clinical indicator short stature for age and sex showed sensitivity. Low weight for age and sex, stature below genetic target and delayed sexual maturation were specific indicators. CONCLUSION: In a sample of adolescents in public schools in northeastern Brazil, a set of five clinical indicators best indicated delayed growth in adolescents. Two clinical indicators showed sensitivity, and four clinical indicators showed specificity. PRACTICE IMPLICATIONS: This study contributes to refining the diagnostic proposition of delayed growth in adolescents. Accurate measures for nursing diagnoses can help paediatric nurse practitioners confirm or exclude this diagnosis in adolescents with a similar profile.

Pruritus in hemodialysis patients: association with phosphorus intake and serum calcium level. / Prurido no paciente em hemodiálise: associação com ingestão de fósforo e nível sérico de cálcio.

OBJECTIVE: To analyze the association between the occurrence of pruritus and adherence to the prescribed diet, biochemical indicators of renal function and the quality of hemodialysis in chronic renal patients. METHOD: A cross-sectional study performed at a dialysis clinic in the Northeast of Brazil, with 200 patients undergoing hemodialysis in the first half of 2015.To analyze the data, inferential statistics were used, using Chi-Square and Fisher's Exact tests; and Mann Whitney U test. RESULTS: The pruritus was present in 51% of the sample, being associated statistically with phosphorus consumption (P = 0.024) and elevation of serum calcium (P = 0.009). CONCLUSION: Pruritus in chronic renal patients undergoing hemodialysis is influenced by adequate nonadherence to the prescribed diet, in addition to the elevation of biochemical indicators of renal function.

Understanding "patient discharge in leprosy": a concept analysis. / Compreendendo a "alta em hanseníase": uma análise de conceito.

OBJECTIVE: To analyze the concept of patient discharge in leprosy. METHODS: Theoretical study guided in the methodological framework of concept analysis. A bibliographical survey was held from December 2015 to January 2016 using the following bases: SCOPUS, CINAHL, PubMed, LILACS, SCIELO and BDENF, by use of the descriptors "Leprosy" and "Patient Discharge", resulting in 13 studies. RESULTS: The following were identified as possible uses for the concept: discharge by cure, drug use discharge, bacteriological discharge and post-discharge. The attributes defined were completion of multidrug therapy, completion of multidrug therapy for paucibacillary leprosy, completion of multidrug therapy for multibacillary leprosy and cure from leprosy. The presence of an M. leprae infection, symptoms present in skin and peripheral nerves, diagnosis and treatment and leprosy reactions were identified as antecedents. Consequents were exclusion from the active leprosy record and continuity of health care. One case model and one opposing case were presented. CONCLUSIONS: The analysis broadened the concept "discharge in leprosy", providing other meanings than the clinical definition of multidrug therapy.

Analyzing the concept of fluid overload in Chronic Kidney Disease patients in dialysis therapy: an integrative review.

Objective To analyze the concept of fluid overload in Chronic Kidney Disease patients undergoing dialysis therapy and comparing it to the Nursing Diagnosis of Excess fluid volume present in the NANDA International. Method An integrative literature review carried out in the LILACS, CINAHL and SCOPUS databases. Results The sample was comprised of 22 articles. The defining attributes of the concept were: fluid retention, fluid buildup in the body, and weight gain over a short period; while the attributes composing the definition were: fluid retention in the body (intracellular/extracellular space) expressed by weight gain over short period of time. Twenty-one (21) antecedents and 22 consequents of fluid overload in patients with renal disease in dialysis therapy were identified. Conclusion The definition evidenced by the NANDA International taxonomy for the Excess fluid volume Nursing Diagnosis and the components of this diagnosis need to be complemented in order to better target the care of patients with kidney disease undergoing dialysis therapy.

Association of socioeconomic and clinical factors and tissue integrity outcome of patients with ulcers. / Associação dos fatores socioeconômicos e clínicos e o resultado integridade tissular em pacientes com úlceras.

Objective to analyze the association between socioeconomic and clinical factors and indicators of the tissue integrity outcome in nursing among patients with venous ulcers. Methods a cross-sectional study at a university hospital in Natal, RN, Brazil, from February to June 2012, with 50 individuals. To analyze the variables, we used the Spearman correlation test and the Mann-Whitney and Kruskal-Wallis tests at a level of 5%. Results there was a correlation of low intensity between age and the indicators hydration and skin peeling, and family income and necrosis. There was also an association between gender and the indicators temperature, amount of body hair and exudation. Conclusion the associated variables provide important information for the treatment of patients with venous ulcers, and can help reduce ulcer time and the consequent discomfort, limitations and costs. This information should be considered when providing care for patients with a nursing diagnosis of impaired skin integrity and/or impaired tissue integrity.

[Prevalence of nursing diagnosis of fluid volume excess in patients undergoing hemodialysis]. / Prevalência do diagnóstico de enfermagem Volume de líquidos excessivo em pacientes submetidos à hemodiálise*

OBJECTIVE: To identify the prevalence of nursing diagnosis of fluid volume excess and their defining characteristics in hemodialysis patients and the association between them. METHOD: Cross-sectional study conducted in two steps. We interviewed 100 patients between the months of December 2012 and April 2013 in a teaching hospital and one hemodialysis clinic. The inference was performed by diagnostician nurses between July and September 2013. RESULTS: The diagnostic studied was identified in 82% of patients. The characteristics that were statistically associated: bounding pulses, pulmonary congestion, jugular vein distention, edema, change in electrolytes, weight gain, intake greater than output and abnormal breath sounds. Among these, edema and weight gain had the highest chances for the development of this diagnostic. CONCLUSION: The analyzed diagnostic is prevalent in this population and eight characteristics presented significant association.

Mid-range theory of the nursing diagnosis Overweight.

OBJECTIVE: To build a mid-range theory for the nursing diagnosis Overweight in adolescents and young adults. METHODS: A methodological study in the light of the theoretical frameworks of Roy and of Lopes, Silva and Herdman. A total of 3,925 articles were retrieved and assessed using the State of the Art Through Systematic Review software. The final sample consisted of 28 articles. RESULTS: The findings converged to 3 essential attributes, 13 antecedents, and 7 consequences. A mid-range theory was built consisting of an illustrated diagram, 11 propositions, and 12 causal relationships. FINAL CONSIDERATIONS: From the creation of the theory, it was possible to better understand the nursing diagnosis Overweight within the context of adolescents and young adults. Understanding nursing phenomena contributes to nursing science's advancement and strengthening.

Predictors of excess fluid volume in hemodialysis patients: an observational study.

OBJECTIVES: to assess risk factors for excess fluid volume in hemodialysis patients. METHODS: a retrospective case-control study was conducted. A total of 392 patients (196 cases and 196 controls) from two hemodialysis centers were included. Sociodemographic data and 23 risk factors for excess fluid volume were assessed using a data collection form. Data were analyzed using a multivariate logistic regression model. RESULTS: the insufficient knowledge (OR=2.06), excessive fluid intake (OR=2.33), inadequate fluid removal during hemodialysis (OR=2.62) and excessive sodium intake (OR=1.91) risk factors may increase the chance of occurrence of excess fluid volume in hemodialysis patients by approximately two times. Education level (OR=0.95) and age (OR=0.97) are protective factors for excessive fluid volume. CONCLUSIONS: knowing these risk factors may help nurses with accurate and rapid diagnostic inference of the risk of excessive fluid volume.

Disrupted mother-fetus dyad risk in high-risk pregnancies: a Middle-Range Theory.

OBJECTIVES: to develop and evaluate a Middle-Range Theory for the nursing diagnosis "Disrupted Mother-Fetus Dyad Risk" in high-risk pregnancies. METHODS: this methodological study was conducted in two stages: theory development and evaluation. Dorothea Orem's General Nursing Model was used as the theoretical-conceptual foundation. Evaluation was conducted using the Delphi method with seven judges, and consensus was achieved when the Content Validity Index of the evaluated items was ≥ 0.80. RESULTS: the theory identified 20 elements of the nursing diagnosis "Disrupted Mother-Fetus Dyad Risk" (10 risk factors, 4 at-risk populations, and 6 associated conditions), 14 propositions, and 1 pictogram. After two rounds of evaluation, the theory was considered consistent, with consensus reached for all items, each achieving a Content Validity Index ≥ 0.80. CONCLUSIONS: the Middle-Range Theory included biopsychosocial factors explaining the nursing phenomenon "Disrupted Mother-Fetus Dyad Risk," which aids in nurses' diagnostic reasoning.

Cultural adaptation and evaluation of the measurement properties of the Facilitator Competency Rubric for clinical simulation facilitators.

OBJECTIVE: translate and adapt the Facilitator Competency Rubric to the Portuguese language and the Brazilian culture, and analyze the measurement properties. METHOD: methodological study that completed the steps of translation, synthesis of translations, back translation, review by a Committee of Experts composed of 7 professionals, testing of the pre-final version with 33 simulation facilitators, and submission to the author of the original instrument. For content validation, the Content Validity Index and the modified Kappa Coefficient were calculated. For reliability, Cronbach's α and the Intraclass Correlation Coefficient were evaluated by 52 and 15 simulation facilitators, respectively. RESULTS: two rounds of content evaluation were carried out, resulting in changes to 19 items in the first evaluation and 3 items in the second. The overall scale achieved a Cronbach's α of 0.98 and an Intraclass Correlation Coefficient of 0.95 to 0.97. CONCLUSION: the Facilitator Competency Rubric was translated and culturally adapted to the Brazilian reality and presented content validity, reliability and stability, with safe results for use in teaching and research.

[Components of a Roy's adaptation model in patients undergoing hemodialysis]. / Componentes do modelo teórico de Roy em pacientes submetidos à hemodiálise.

Cross-sectional study aimed to identify the components of a Roy's adaptation model in patients undergoing hemodialysis at a dialysis center. 178 patients participated in a dialysis center in the Brazil Northeast region. Data collection occurred from October/2011 to February/2012 through the use of interviews and physical examinations. The components identified were: adaptive problems, behaviors and stimuli. The main adaptive problems were: intracellular fluid retention, hyperkalemia, hypothermia, edema, intolerance for performing daily activities. The behaviors were: anuria, hydroelectrolyte imbalance, gain of weight in a short period of time, elevated serum potassium concentrations, body temperature below 36 degrees C, fluid retention, fatigue, difficulty performing activities of daily living. The stimuli were: renal injury, cardiopulmonary bypass, hemodialysis, failure to observe fluid intake restriction, electrolyte disorder, cold environment, adverse effects related to treatment. We conclude that the identification of these components, classified as physiological mode, contribute to the planning of specific nursing interventions focused on the adaptation of the clientele.

Accuracy of the nursing diagnosis of ineffective airway clearance in intensive care unit patients.

OBJECTIVES: to analyze the accuracy of the clinical indicators of ineffective airway clearance in adult intensive care unit patients. METHODS: diagnostic accuracy study, performed in the intensive care unit of a university hospital in northeastern Brazil. The sample consisted of 104 patients hospitalized between June and October 2019. RESULTS: the prevalence of ineffective airway clearance was 36.54%. The indicators with high specificity included absence of cough (0.8326), orthopnea (0.6817), adventitious breath sounds (0.8175), and diminished breath sounds (0.8326). The clinical indicators with high sensitivity and specificity were alteration in respiratory rate (0.9999) and alteration in respiratory pattern (0.9999). CONCLUSIONS: six clinical indicators provided an accurate identification of ineffective airway clearance. The clinical indicators alteration in respiratory rate and alteration in respiratory pattern were the most accurate for critical adult patients. The findings of this study contribute to accurate diagnostic inferences and to prevention of respiratory complications in these patients.

Analysis of the content of the nursing diagnosis deficient knowledge in individuals with heart failure.

OBJECTIVE: To analyze the content of the nursing diagnosis deficient knowledge in individuals with heart failure. METHODS: Methodological study to validate the content of a nursing diagnosis based on the predictive model of diversity, carried out through the organization of the phenomenon of interest and analysis by judges using the collective wisdom model. The NANDA-I Knowledge Deficient diagnosis was evaluated by 48 judges and considered valid when it presented a median content validity index ≥ 0.8 in the confidence intervals. RESULTS: Note that 66.6% of the judges indicated that the new definition proposed was more adequate than the definition adopted by NANDA-I. After the experts' analysis, the following defining characteristics were considered valid: inaccurate statements about the disease and/or therapy, inadequate performance in the management of intercurrences, increase in hospital readmissions, worsened quality of life, deficit in self-care performance, and follow-up of inadequate instruction; related factors are as follows: inadequate guidance offered by health professionals, nonparticipation of the patient in the planning of their health care, weakened relationship between professional and individual; populations at risk-elderly and low level of education of the individual and/or caregiver and the associated condition, mild cognitive impairment. Anxiety, depression, and impaired social interaction were elements considered not relevant to the content domain. CONCLUSION: The validation of the content of the aforementioned diagnosis in patients with heart failure, through the analysis of judges with different degrees of expertise, made it possible to improve the definition and expansion of new diagnostic indicators. IMPLICATIONS FOR NURSING PRACTICE: Updated diagnostic elements for the nursing diagnosis deficient knowledge in individuals with heart failure will facilitate accurate clinical judgment and the establishment of a therapeutic plan aimed at etiological factors modifiable by nurses.

Diagnostic accuracy study of the clinical indicators of vascular trauma in patients undergoing antineoplastic chemotherapy in peripheral veins.

Antineoplastic chemotherapy patients are susceptible to vascular trauma. The identification of this problem is possible through accurate clinical indicators. However, there are few diagnostic accuracy studies of vascular trauma in these patients. Thus, the objective was to analyze the accuracy of clinical indicators of vascular trauma in antineoplastic chemotherapy patients. A diagnostic accuracy study was carried out with a sample of 200 patients undergoing antineoplastic chemotherapy, in an oncology reference clinic, during 2018. A data collection form was created with sociodemographic and clinical data and indicators of vascular trauma. The sensitivity and specificity of the clinical indicators were assessed using a latent class analysis of random effects. The clinical indicators of decreased vascular elasticity (0.8384), pain (0.9573), and signs of infection at the catheter insertion site (0.9999) were specific for identifying vascular trauma in antineoplastic chemotherapy patients. The prevalence of vascular trauma in these patients was 11.17%. A set of three clinical indicators was considered accurate and statistically significant for confirming vascular trauma. This study has provided accurate clinical indicators of vascular trauma in antineoplastic chemotherapy patients. These results can contribute to establishing interventions, thereby reducing costs and maximizing health outcomes in this population.

Early diagnosis of HIV/aids infection: concept analysis.

OBJECTIVES: to analyze the concept of "early diagnosis of HIV/Aids infection" in light of Walker and Avant's conceptual analysis model. METHODS: concept analysis study based on the framework proposed by Walker and Avant, instrumented by a scoping review conducted in April 2022, following the recommendations of the Joanna Briggs Institute and checklist Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews. The search was made in eight data sources, obtaining sixteen articles. RESULTS: the study found homosexual intercourses, early examination, anti-HIV antibodies, CD4 count, and sexually transmitted infection as the main attributes of the concept. As antecedents: information, risky behavior, unprotected sexual relations, prevention, and access to the service. As main consequences: antiretroviral treatment, seroconversion, transmission, and consultations. FINAL CONSIDERATIONS: the study approached the circumstantial situations of the theme, its attributes, antecedents, and consequences, qualifying the work process based on knowledge of nursing practice.

Informal caregivers of children with cerebral palsy ways of coping with the uncertainty of illness.

OBJECTIVE: To unveil the process of collective construction of interventions for coping by informal caregivers of children with cerebral palsy using the Theory of Uncertainty in Illness. METHOD: Qualitative action-research in a hybrid format with informal caregivers of children with cerebral palsy registered with the Raros group in Petrolina, Pernambuco. The research followed the planned intervention cycle, going through four phases. The analysis was carried out using the IRAMUTEQ software and content analysis. RESULTS: Interventions were designed collectively, both virtually and in person, which resulted in improvements for informal caregivers in coping with the conditions associated with the disability, promotion of self-care, empowerment and the construction of a sense of belonging to the group. There were 12 participants, all of whom were mothers. CONCLUSION: There was a facilitation of the process of coping with uncertainty in the disease on the part of the informal caregiver of children with cerebral palsy and it was evidenced that for this a prismatic perspective is necessary, which understands that the uncertainties are not only related to the conditions associated with cerebral palsy, but involve subjective aspects of the caregivers.

[Process standards of nursing care for patients with oncologic conditions: an integrative literature review]. / Sistematização da assistência de enfermagem a pacientes oncológicos: uma revisão integrativa da literatura.

This is an integrative review that aimed to present the knowledge produced on the process standards of nursing care (SAE) through the Nursing Process (NP) for cancer patients. Data was collected from September to October, 2010 in the electronic databases Scopus, Nursing and Allied Health Literature (CINAHL) and Scientific and Technical Literature of Latin America and the Caribbean (LILACS). Five articles were found. The results show that the majority of studies are descriptive and exploratory. Routinely, NP phases are not being applied as a tool and when they are, it is in an incomplete way. The conclusion of this review shows that the SAE through the NP for patients with oncologic conditions is not a common practice; however, its implementation is suggested as a way to provide holistic care with quality to individuals and their families.

Accuracy of the defining characteristics of the nursing diagnosis hypothermia in patients on hemodialysis.

OBJECTIVE: to analyze the accuracy of the defining characteristics of hypothermia in patients on hemodialysis. METHODS: a diagnostic accuracy study was assembled within a cross-sectional study with 124 patients from two dialysis centers. A latent class model was used for data analysis. RESULTS: the nursing diagnosis hypothermia was present in 13 (10.48%) study participants. The most prevalent defining characteristics were hypoxia (100%), decrease in blood glucose level (83.1%), hypertension (65.3%), piloerection (45.2%), and skin cool to touch (41.1%). The defining characteristics acrocyanosis (99.96%) and cyanotic nail beds (99.98%) had a high sensitivity. Acrocyanosis (91.8%), skin cool to touch (64.8%), and peripheral vasoconstriction (91.8%) had high specificity. CONCLUSION: specific and sensitive indicators of hypothermia work as good clinical indicators for confirming this diagnosis in patients on hemodialysis. The study findings can assist nurses in their clinical reasoning for a correct inference of hypothermia.