Clinical validation of the nursing diagnoses of Impaired Tissue Integrity and Impaired Skin Integrity in patients subjected to cardiac catheterization.

AIM: To validate, clinically, the defining characteristics for the nursing diagnoses of Impaired Tissue Integrity and Impaired Skin Integrity in patients subjected to heart catheterization and to validate acute pain, haematoma, bleeding, redness, and heat as additional characteristics. BACKGROUND: In clinical practice, an applicable nursing diagnosis for patients subjected to diagnostic heart catheterization has not been well-defined. DESIGN: Cross-sectional. METHODS: This clinical validation study using Fehring's model was performed at a Brazilian general hospital between November 2009-November 2010. This study included 250 patients who received elective femoral artery catheterization. Each patient was identified as having two characteristics of Impaired Tissue Integrity and three characteristics of Impaired Skin Integrity, according to NANDA-I nursing diagnoses. Due to certain postprocedure events, five additional characteristics were added to be validated in this setting. In addition to Fehring's reliability rating, the kappa coefficient was used to evaluate inter-rater agreement during the clinical evaluation. RESULTS: The defining characteristic of damaged tissue was validated for Impaired Tissue Integrity and the defining characteristics of the invasion of body structures and the disruption of the skin surface were validated for Impaired Skin Integrity. Although the five characteristics that were added to the investigated diagnoses were not validated because of their low rate of occurrence in this setting, the measurements of acute pain, haematoma, bleeding, redness, and heat each had excellent inter-rater agreement. CONCLUSION: The validation of characteristics from both of these diagnoses suggested that these criteria could be utilized for clinical practice in a diagnostic setting. Moreover, additional characteristics should also be observed to better guide nursing intervention.

[Pain scale: implementation for patients in the immediate postoperative period of cardiac surgery]. / Escala da dor: implantação para pacientes em pós-operatório imediato de cirurgia cardíaca.

A clinical intervention study was developed in a hospital specialized in cardiology in Porto Alegre, RS, Brazil, with the objective of evaluating the implementation of the pain scale in post-operative cardiac surgery patients. It was developed in four steps: pre-test on pain, training lecture for nursing staff, and, reapplication of the pre-test at 30 and 60 days. The test consisted of ten questions weighing one point each. Scores > or =7 were determined to represent satisfactory knowledge in using the pain scale. The sample consisted of 57 nursing professionals. The scores ranged from 6.12 +/- 1.65 in the pre-test to 7.73 +/- 1.05 and 8.18 +/- 0.99 after 30 and 60 days, respectively (p<0.005). Pain intensity was correlated to medication standardized by protocol. The training improved the knowledge of the team and the type of analgesia administered in relation to pain intensity.

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

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

[Consensus on nursing diagnoses, interventions and outcomes for home care of patients with heart failure]. / Consenso de diagnósticos, resultados e intervenções de enfermagem para pacientes com insuficiência cardíaca em domicílio.

This was a consensus study with six cardiology nurses with the objective of selecting nursing diagnoses, outcomes and interventions described by NANDA International (NANDA-I), Nursing Outcomes Classification (NOC), Nursing Intervention Classification (NIC), for home care of patients with heart failure (HF). Eight nursing diagnoses (NDs) were pre-selected and a consensus was achieved in three stages, during which interventions/activities and outcomes/indicators of each NDs were validated and those considered valid obtained 70% to 100% consensus. From the eight pre-selected NDs, two were excluded due to the lack of consensus on appropriate interventions for the clinical home care scenario. Eleven interventions were selected from a total of 96 pre-selected ones and seven outcomes were validated out of 71. The practice of consensus among expert nurses provides assistance to the qualifications of the care process and deepens the knowledge about the use of tazonomies in nursing clinical practice.

[Signs and symptoms in patients with decompensated heart failure: inference of priority nursing diagnoses]. / Sinais e sintomas de pacientes com insuficiência cardíaca descompensada: inferência dos diagnósticos de enfermagem prioritários.

The aim of this study is to identify the signs and symptoms of patients admitted for decompensated heart failure (HF) in order to infer the priority nursing diagnoses (ND). This is a cross-sectional study undertaken in a university hospital. The data were collected by nurses trained to deal with HF and registered in a file containing identification items, and demographic and clinical variables. We included 303 patients. Most patients were in emergency departments (95.7%) with functional class III (65.7%). The signs and symptoms identified at the time of admission were dyspnea (91.4%), paroxysmal nocturnal dyspnea (87.5%), fatigue (67.3%), edema (63.7%), orthopnea (55.4 %) and jugular vein distention (28.7%). From the signs and symptoms raised, that became the set of relevant clues and consistent as an indicator for ND, we conclude that Decreased Cardiac Output and Fluid Volume Excess diagnoses were the priorities for this population.

Knowledge of patients with mechanical valve prostheses concerning chronic oral anticoagulant therapy.

Adherence to chronic Oral Anticoagulant Therapy (OAT) is directly related to patients' understanding of the therapy. This study verified the knowledge of patients with mechanical valve prostheses concerning OAT. This is a contemporary cross-sectional study, the sample is composed of patients with mechanical valve prostheses (MVP) in outpatient follow-up. A 10-question instrument was used; answers were 'know' (1 point), 'know partially' (half point), or 'do not know' (zero). Patients were grouped according to the result obtained: ≤ 4 points was considered insufficient knowledge; > 4 ≤ 8 equated to moderate knowledge; and > 8 was considered appropriate knowledge. Of the 110 patients, 61.8% presented moderate knowledge, 40.9% were not able to name at least one factor that may alter the INR (International Normalized Ratio) and 37.3% were not able to report their INR target range. The majority of patients presented moderate knowledge concerning the treatment. Strategies to improve knowledge on the topic should be implemented to minimize risks.

Prescribing and conducting non-pharmacological management of patients with decompensated heart failure admitted to a university hospital emergency.

This cross-sectional study aimed to describe the prescription of non-pharmacological management of patients with heart failure attending the emergency care of a hospital and the effectiveness of the practice. 256 patients aged 63 ± 13 years, 153 (60%) men, participated in the research. The most commonly prescribed non-pharmacological treatment was sodium restriction, 240 (95%), followed by weight control, 135 (53%). Fluid restriction and fluid balance were the least commonly prescribed treatments, 95 (37%) and 72 (28%), respectively. Only 38 (54%) of balances, 89 (67%) of weight controls and 69 (57%) of diuresis controls were performed. Concerning patients' previous knowledge of the treatments, 229 (90%) were advised to restrict salt intake, and 163 (64%) were advised to restrict fluid intake. Weight control was the least commonly known care, 117 (46%). Except for salt control, the other treatments were prescribed in slightly more than half of the samples, and were ineffective.

Classification of patients according to the degree of dependence on nursing care and illness severity in a post-anesthesia care unit.

This study aimed to classify patients according to their degree of dependence on nursing care (Perroca Classification System) and correlate this with the anesthetic risk (American Society of Anesthesiologists--ASA classification) in a post-anesthesia care unit. A cross-sectional study was conducted, which included 402 patients, mean age 51.57 (±16.73) years, of which 216 (54%) were female. The results indicate that patients had a degree of dependence between intermediate and semi-intensive with an ASA classification of between two and three. There was a significant relationship between degree of dependence and ASA classification. The results indicate that the post-anesthesia care unit admits patients with semi-intensive care requirements and with moderate anesthetic risk.

Severity of postoperative cardiac surgery patients: na evolution analysis according to TISS-28.

This study verified the daily TISS-28 score in the postoperative period of cardiac surgery at a cardiology intensive care unit. This cohort study included 55 postoperative cardiac surgery patients, who were sent to the intensive care unit to recover. Data were collected from patients records with daily application of the TISS-28. The obtained data revealed that the average age of the population was 61.47 years+/-12.12 years, 78.2% were male, 51.43% underwent valve repair surgery and 48.57% myocardial revascularization surgery. The severity index in the immediate postoperative period was 41.33+/-5.01. The follow-up of patients using the TISS-28 evidenced a significant decrease in the index values up to the patients discharge, averaging at 13.19+/-2.59. The results indicate that immediate postoperative cardiac surgery patients are in severe conditions, hemodynamically unstable and classified in class III according to the TISS-28, though scores gradually decrease over time.

[Adherence of patients with heart failure to treatment in a teaching hospital]. / Adesão ao tratamento de pacientes com insuficiência cardíaca em um hospital universitário.

Non-compliance in heart failure (HF) patients is one of the factors leading to hospital readmissions. Under this perspective, a study was carried out in a university hospital in Rio Grande do Sul, Brazil to describe the compliance with pharmacological and non-pharmacological treatments of patients admitted with decompensated HF, relating the compliance to the number of hospital admissions and readmissions during a years period. The pharmacological compliance was measured through Morisky scale and the non-pharmacological compliance was measured through a previously validated questionnaire. The sample was composed of 252 patients, median age 63 +/- 13, 151 (60%) male. For the pharmacological compliance, 118 (47%) patients demonstrated high compliance, and 45 (18%) adhered to non-pharmacological treatment. There was no relation found between treatment compliance (pharmacological or non-pharmacological) and readmissions. Patients who had been treated for HF, had knowledge about non-pharmacological care and were able to identify congestion symptoms demonstrated high compliance.

[Adherence to appointments and medication treatment of patients from randomized clinical trials of the industry]. / Adesão às consultas e ao tratamento medicamentoso de pacientes em ensaios clínicos randomizados da indústria.

Historical cohort study that assessed the adherence rate of patients of randomized clinical trials (RCT) of pharmaceutical industry in cardiology to appointments and follow-up medical treatment. This study was conducted at the cardiology research unit in a public university hospital in Porto Alegre, Rio Grande do Sul, Brazil. High adherence was regarded as > or = 80%. Seven RCT (120 medical records) were revised. We discovered that 117 (97%) of patients had adherence to follow-up visits to > or = 80%; 83.3% of patients had rates of > or = 80% adherence to medication in the study; the median number of tablets ingested, among patients with good adherence was 175 (72-500), and among patients with lower adherence was 500 (500-962). These results indicate that patients in studies with longer follow up and greater number of oral medication present loss in adherence

Nursing process: from literature to practice. What are we actually doing?

OBJECTIVES: To describe the steps of the nursing process as prescribed in the literature and to investigate the process as actually applied in the daily routine of a general hospital. METHODS: Cross-sectional retrospective study (May/June 2005), performed in a hospital in Porto Alegre, RS. Medical records of adult patients admitted to a surgical, clinical or intensive care unit were reviewed to identify the nursing process steps accomplished during the first 48 h after admission. The form for data collection was structured according to other reports. RESULTS: 302 medical records were evaluated. Nursing records and physical examination were included in over 90% of them. Nursing diagnosis was not found in any of the records. Among the steps performed, prescription was the least frequent. Evolution of the case was described in over 95% of the records. CONCLUSIONS: All nursing steps recommended in the literature, except for diagnosis, are performed in the research institution.

Complications of intra-aortic balloon in a cohort of hospitalized patients: implications for nursing care.

OBJECTIVES: To describe complications associated to the use of intra-aortic balloon pumps (IABP), and their relationship with dwelling time, presence of risk factors/comorbidities, and nursing records. METHODS: Retrospective cohort study, in which medical records were analyzed through the completion of specifically designed forms. RESULTS: In total, 104 patients were included, with mean age 65+/-11 years, 52% men; 26 (25%) of them presented vascular complications, more frequently ischemia (25%); peripheral vascular disease was the risk factor/comorbidity more frequently related to complications (56.3%; p=0.003). Nursing records showed that the use of catheter was recorded in 30 cases (29%), and the patient's clinical situation after its removal in 28 cases (27%). CONCLUSION: This study showed that the frequency of complications related to IABP is high. Considering risk factor/comorbidity factors, peripheral vascular disease was significantly associated to complications. Nursing records were sub-optimal.

Cohort study to evaluate nursing team performance in a theoretical test after training in cardiopulmonary arrest.

OBJECTIVES: To evaluate nursing professionals' theoretical knowledge of cardiopulmonary arrest (CPA) treatment before specific training, immediately after, and six months later. METHODS: Cohort study, performed in a cardiology hospital in Porto Alegre, Rio Grande do Sul (November/2005 to May/2006), Brazil. Nurses, nursing technicians and assistants were included. A questionnaire was administered in the three periods, and 75% of correct answers was considered a satisfactory result. RESULTS: Thirty-five nurses participated in the pre-test, and 34 in the immediate and 6-month tests. Among technicians and assistants, 232, 227, and 104 participated in the pre-test, immediate, and 6-months tests, respectively. Among nurses, 62.9% achieved an adequate percentage of correct answers in the pre-test, 94.1% in the immediate, and 64.7% in the 6-months test; for nursing technicians and assistants, these values were 36.2%, 79.3%, and 62.5%, respectively. CONCLUSION: Training in CPA improved the nursing professionals' knowledge immediately after its administration, with a reduction in the rate of correct answers after 6 months.

[Risk factors for coronary artery disease in patients admitted in hemodynamics unit]. / Fatores de risco para doença arterial coronariana em pacientes admitidos em unidade de hemodinâmica.

Transversal study aiming to evaluate the predominance of risk factor (RF) regarding to coronary artery disease (CAD) in patients submitted to cardiac procedures in hemodynamic unit. The study encloses 302 patients of 62 +/- 11-years-old, 270 (89%) predominantly white and 172 (57%) male. The most prevalent RF was 227 (75%) sedentism, followed by 220 (73%) arterial hypertension, 150 (50,5%) dyslipidemia, 87 (29%) obesity, 81 (27%) diabetes mellitus, 77 (25,5%) smoking, 67 (22%) alcohol and 15 (5%) diet poor of fruits and vegetables. The correlation was not relevant between the quantity of RF and its variables: scholarship, income, age, marital status, professional activity and gender in addition to the quantity of procedures submitted, comparing those with five or more RF for CAD; however there is a positive connection that reinforces the importance of strategies towards to reduce or remove modifiable RF.

Delay factors on the administration of thrombolytic therapy in patients diagnosed with acute myocardial infarction in a general hospital.

OBJECTIVE: To identify factors that delay the onset of thrombolysis in patients with acute myocardial infarction (AMI). METHODS: A cohort study was carried out with 146 patients, each diagnosed with AMI and subjected to thrombolytic therapy. The data was extracted from medical records between January 2002 and December 2004. RESULTS: The average age of the studied population was 57.5 +/- 9 years, 64.4% were male. The average time between the onset of pain and arrival at the hospital was 254.7 +/- 126.6 minutes, 28.1% used an ambulance for the trip to the hospital, the door-to-electrocardiogram time averaged 19.4 +/- 7.3 minutes and the door-to-needle time was 51.1 +/- 14.9 minutes. There was no significant difference between the time of arrival to the hospital and the method of transportation used (P= 0.81), and those seen by cardiologists and during the nightshift had a reduction in the door-to-needle time, respectively (P=0.014) and (P=0.034). CONCLUSIONS: Study results show that the delay in the search for medical service, and the long time taken from door-to-electrocardiogram and to reach the AMI diagnosis were the factors involved in the delay of thrombolytic treatment.

Patients with acute myocardial infarction and interfering factors when seeking emergency care: implications for health education.

With the objective of estimating the time elapsed between the beginning of the signs and symptoms of a heart attack until the arrival at the cardiology emergency service (Delta T) and the factors that influence in this process, 112 patients were studied, with an infarction diagnosis with supraunleveling ST segment. The delta T was on average of 3h59+/-2h55min; 99(88%) of those patients sought out an emergency service within 1h after the beginning of the event. Unmarried patients presented a delta T smaller in relation to the others (P=0,006), as well as those that recognized the symptoms as a heart event; thoracic pain with burning symptoms, were described by 25 (24%) of patients, and the first attitude taken, in view those symptoms, was self-medication 37(33%). The recognition of the signs and symptoms of Acute Myocardium Infarction, is a decisive factor for the seeking of a specialized service.

Prevalent nursing diagnoses and interventions in the hospitalized elder care.

OBJECTIVES: to identify the prevalent nursing diagnoses (ND) in the hospitalized elder care; to compare the prevalent ND with the duration of hospital stay and with the prescribed cares for their respective diagnoses. METHOD: Transversal historical study carried through in Porto Alegre, RS, by analyzing patient records age e60 years old, interned in clinical unities of a university hospital. RESULTS: 1665 records were analyzed; the four prevalent NANDA nursing diagnoses--within 62 identified ones--were: Self-Care Deficit--Bathing/Hygiene, Imbalanced Nutrition--Less than Body Requirements, Risk for Infection and Ineffective Breathing Patterns, varying from 14 to 17 days of hospital stay. THE MAIN CARES WERE: aiding bed bath, communicating diet acceptance, implementing routines of care in venous puncture and checking respiratory pattern. CONCLUSION: four prevalent ND were identified with the appropriate prescribed care. However, other care could have been established as a priority.

[Knowledge on chronic oral anticoagulation of patients followed up in a specialized outpatient clinic]. / Conhecimento dos pacientes sobre anticoagulação oral crônica acompanhados em ambulatório especializado.

This study was carried out to assess patients' knowledge on anticoagulant therapy in an outpatient clinic. A questionnaire with ten questions with closed answers was applied. Correct answers to about 80% of the questions were considered satisfactory. Out of the 120 evaluated patients, 77 (64.1%) showed satisfactory knowledge, with an average of 7.8 +/- 1.7 correct answers. As to the International Normalized Ratio (INR), 69.4% of the sample was beyond therapeutic range, and 42.5% had hemorrhages in the last 6 months. Factors such as education level, income, hemorrhagic event, anticoagulation time, and gender did not show statistically significant difference. There is an obvious need for a systematic follow-up by health care professionals, using educational measures, to detect the difficulties faced by patients, maintaining an optimal INR.

[Training in cardiopulmonary resuscitation: impact on the theoretical knowledge of nurses]. / Tempo decorrido do treinamento em parada cardiorrespiratória e o impacto no conhecimento teórico de enfermeiros.

This cross-sectional study aimed at evaluating the knowledge of nurses on cardiopulmonary resuscitation (CPR) as a function of the time elapsed since training was concluded. The study was performed in a general hospital in Porto Alegre, Rio Grande do Sul, during July and August, 2005. Nurses were assigned to groups 1 (33 nurses, in units equipped with a heart monitor and a cardiac defibrillator) and 2 (23 nurses, in units without this equipment). Nurses in group 1 showed better knowledge on the recognition of electrocardiographic recordings, and 91% of them recognized the ventricular fibrillation algorithm. Among nurses in group 2, 85% had knowledge on issues relative to basic care. The results showed that training in CPR generates positive results. Continued and systematic education strategies are essential to ensure better performance of the nursing team.