Effect of pulmonary rehabilitation on functional capacity in individuals treated for pulmonary tuberculosis: a systematic review protocol.

OBJECTIVE: The aim of this review is to synthesize the available evidence on the effectiveness of pulmonary rehabilitation on the functional capacity of people who have finished drug treatment for pulmonary tuberculosis. INTRODUCTION: Pulmonary rehabilitation is a treatment option for physical functional problems that persist after pharmacological treatment for tuberculosis; however, the results of primary studies on the subject are inconclusive. INCLUSION CRITERIA: This review will consider for inclusion studies carried out with adults (≥18 years old) who have completed pharmacological treatment for tuberculosis. Outcomes of interest will include functional capacity, quality of life, lung function, respiratory and skeletal muscle strength, subjective perception exertion, and dyspnea. METHODS: Searches for published and unpublished studies will be carried out on MEDLINE (via PubMed), LILACS, PEDro, CINAHL, Web of Science, Embase, Science Direct, Scopus, Cochrane Library (CENTRAL), Sport Medicine and Education Index, Rehabilitation and Sports Medicine Source, and SPORTDiscus. The results of the review will be reported according to PRISMA guidelines. There will be no language or time limitations. Two independent reviewers will select and critically appraise the selected studies and extract the data using standardized instruments. The certainty of evidence will be reported according to GRADE. Where appropriate, studies will be subjected to meta-analysis. Effect sizes will be expressed in odds ratios (for dichotomous data) or in standardized mean difference (for continuous data) and its 95% CI. SYSTEMATIC REVIEW REGISTRATION NUMBER: PROSPERO CRD42021254719.

A Rasch Analysis of the Chronic Pain Coping Inventory-Brazilian Version.

BACKGROUND AND PURPOSE: The Rasch model has not yet been used to evaluate the Chronic Pain Coping Inventory (CPCI), a tool used worldwide to measure coping with chronic pain. OBJECTIVE: Analyze the adjustment of the CPCI-Brazilian version and its scales to the Rasch model. METHODS: CPCI Rasch analysis with 705 outpatients from a Brazilian hospital. RESULTS: The set of Illness-Focused coping strategies presented as a one-dimensional scale. The Rasch reliability of the person item ranged between 0.33 and 0.89, and 0.29 and 0.99, respectively. There were misfits for items 35 (MNSQOutfit = 2.12) and 54 (MNSQOutfit = 2.92), and DIF of one item regarding gender. The Wright map revealed some gaps in coping measurement. CONCLUSIONS: The scales of CPCIBrazilian Version fitted to the Rasch model after adjustments in the categories of response and exclusion of items 35 and 54.

Structural validity of the Chronic Pain Coping Inventory-Brazilian version.

BACKGROUND: The Chronic Pain Coping Inventory (CPCI) has been widely used to measure coping with pain, however, the psychometric properties of the Brazilian CPCI are unknown. AIM: To verify the validity and reliability of the CPCI-Brazilian version. MATERIALS AND METHODS: A sample of 705 outpatients with chronic pain participated in the study. Cronbach's alpha, corrected item-total correlations, and confirmatory factor analysis were performed, using the method of Diagonally Weighted Least Squares. RESULTS: Construct validity was supported with a factor loading range of 0.36-0.90 (9 factors) corroborating original loads. The final model had adequate fit with items 42 and 54 excluded, D.F = 2174, TLI = 0.96; CFI = 0.96 and RMSEA = 0.051(p = 0.067). Eight of the nine CPCI scales showed satisfactory reliability (Cronbach's alpha ranged from 0.70 to 0.92). The Relaxation scale obtained a low alpha value (0.53). CONCLUSION: The CPCI-Brazilian version, after exclusion of items 42 and 54, is valid to measure chronic pain coping in Brazilian adults.

Nursing process documentation: rationale and methods of analytical study.

OBJECTIVE: to describe the methods used to analyze the associations between variables of service, nursing and the nursing process documentation in institutions of the Department of Health of the State of São Paulo. METHOD: multilevel analytical study with data obtained in the domains of institution, units of the institution and nursing professionals who work there, using standardized instruments. The analyses had as axis the degree of completeness of the nursing process documentation in units or institutions and their association with variables of nursing personnel, of units and of institutions. CONCLUSION: This study will provide important empirical evidence on the factors involved in the nursing process documentation.

Self-care in heart failure patients.

OBJECTIVE: to describe self-care behavior and its associated factors in a sample of heart failure Brazilian patients. METHOD: descriptive cross-sectional study with non-probabilistic sample of 116 ambulatory patients undergoing heart failure treatment. Self-care was evaluated using the Self-Care of Heart Failure Index, (scores ≥70 points=appropriate self-care). Association tests were applied, considering a descriptive level of 0.05. RESULTS: the mean age of participants was 57.7 (SD =11.3) years; 54.3% were male; the mean schooling was 5.5 (SD = 4.0) years; and 74.1% had functional class II-III. The mean scores on the subscales of the Self-Care of Heart Failure Index indicated inappropriate self-care (self-care maintenance: 53.2 (SD =14.3), selfcare management: 50.0 (SD = 20.3) and self-care confidence: 52.6 (SD=22.7)) and it was found low frequencies of participants with appropriate self-care (self-care maintenance, 6.9%), self-care management (14.7%) and self-care confidence (19%). Higher scores of the Self-Care of Heart Failure Index were associated with: reduced left ventricular ejection fraction (p=0.001), longer time of experience with the disease (p=0.05) and joint monitoring by physician and nurse (p=0.007). CONCLUSION: investments are needed to improve the self-care behavior and the nursing can play a relevant role in this improvement.

[Nursing concepts and theories]. / Conceitos e Teorias na Enfermagem.

The theory framework of nursing science is built in a dynamic process that arises from practice and is reproduced through research, mainly by analysis and development of concepts and theories. This study presents a theory reflection on nursing knowledge construction and points out subsidies for future studies in the area. The interrelation among theory, research, and clinical practice is required for continuous development of nursing as a profession and science. Ideally, the practice must be based on theory that is validated by research. Therefore, theory, research, and practice affect each other reciprocally and continuously.

Translation and cultural adaptation for Brazil of the Developing Nurses' Thinking model.

OBJECTIVES: to translate and culturally adapt to Brazilian Portuguese the Developing Nurses' Thinking model, used as a strategy for teaching clinical reasoning. METHOD: the translation and cultural adaptation were undertaken through initial translation, synthesis of the translations, back-translation, evaluation by a committee of specialists and a pre-test with 33 undergraduate nursing students. RESULTS: the stages of initial translation, synthesis of the translations and back-translation were undertaken satisfactorily, small adjustments being needed. In the evaluation of the translated version by the committee of specialists, all the items obtained agreement over 80% in the first round of evaluation and in the pre-test with the students, so the model was shown to be fit for purpose. CONCLUSION: the use of the model as a complementary strategy in the teaching of diagnostic reasoning is recommended, with a view to the training of nurses who are more aware regarding the diagnostic task and the importance of patient safety.

[Contribution of standardized languages for knowledge production, clinical reasoning and clinical nursing practice]. / Contribuição das linguagens padronizadas para a produção do conhecimento, raciocínio clínico e prática clínica da Enfermagem.

The standardized language systems are important tools for dealing with the increasing complexity of nursing care. In this article the authors present the main benefits that the use of these systems provide for the required clinical reasoning in nursing care, the construction and organization of knowledge of the discipline, and for the clinical practice of nursing. The potential contributions of the standardized language systems in these fields stem from the fact that these systems provide a formal structure for supporting clinical reasoning, organizing knowledge and nursing experience.

Application of a model based on fuzzy logic for evaluating nursing diagnostic accuracy of students.

PURPOSE: To describe a model for assessing nursing diagnostic accuracy and its application to undergraduate students, comparing students' performance according to the course year. METHODS: This model, based on the theory of fuzzy sets, guides a student through three steps: (a) the student must parameterize the model by establishing relationship values between defining characteristic/risk factors and nursing diagnoses; (b) presentation of a clinical case; (c) the student must define the presence of each defining characteristic/risk factors for the clinical case. Subsequently, the model computes the most plausible diagnoses by taking into account the values indicated by the student. This gives the student a performance score in comparison with parameters and diagnoses that were previously provided by nursing experts. These nursing experts collaborated with the construction of the model indicating the strength of the relationship between the concepts, meaning, they parameterized the model to compare the student's choice with the expert's choice (gold standard), thus generating performance scores for the student. The model was tested using three clinical cases presented to 38 students in their third and fourth years of the undergraduate nursing course. RESULTS: Third year students showed superior performance in identifying the presence of defining characteristic/risk factors, while fourth year students showed superior performance in the diagnoses by the model. CONCLUSIONS: The Model for Evaluation of Diagnostic Accuracy Based on Fuzzy Logic applied in this study is feasible and can be used to evaluate students' performance. In this regard, it will open a broad variety of applications for learning and nursing research. LIMITATIONS: Despite the ease in filling the printed questionnaires out, the number of steps and fields to fill in may explain the considerable number of questionnaires with incorrect or missing data. This was solved in the digital version of the questionnaire. In addition, in more complex cases, it is possible that an expert opinion can lead to a wrong decision due to the subjectivity of the diagnostic process.

Rasch Analysis of the Power as Knowing Participation in Change Tool--the Brazilian version.

OBJECTIVES: the objective of this study was to evaluate the items contained in the Brazilian version of the Power as Knowing Participation in Change Tool (PKPCT). METHOD: investigation of the psychometric properties of the mentioned questionnaire through Rasch analysis. RESULTS: the data from 952 nursing assistants and 627 baccalaureate nurses were analyzed (average age 44.1 (SD=9.5); 13.0% men). The subscales Choices, Awareness, Freedom and Involvement were tested separately and presented unidimensionality; the categories of the responses given to the items were compiled from 7 to 3 levels and the items fit the model well, except for the following/leading item, in which the infit and outfit values were above 1.4; this item has also presented Differential Item Functioning (DIF) according to the participant's role. The reliability of the items was of 0.99 and the reliability of the participants ranged from 0.80 to 0.84 in the subscales. Items with extremely high levels of difficulty were not identified. CONCLUSIONS: the PKPCT should not be viewed as unidimensional, items with extremely high levels of difficulty in the scale need to be created and the differential functioning of some items has to be further investigated.

[Attitudes of nursing staff related to the nursing process]. / Atitudes dos profissionais de enfermagem relacionadas ao Processo de Enfermagem.

The aims of the study were to describe nurses' positions on nursing process and their perception of power; and to analyse associations between positions on nursing process, power perception and selected variables. One thousand six hundred and five nurses (86.9% female, mean age=44.12 years, SD=9.55) participated in the study. Mean score on the Positions on Nursing Process (PNP) tool was 112.37 (SD=22.28); and on the Power as Knowing Participation in Change Tool - Brazilian Version (PKPCT) was 281.12 (SD=38.72). Baccalaureate nurses had statistically higher scores on PNP and PKPCT than auxiliary nurses. There was positive and moderate correlation between PNP and PKPCT scores. Auxiliary nurses' scores on PNP were associated with sex and post-graduation; auxiliary nurses' scores on PKPCT were associated with sex. For baccalaureate nurses there was association between PKPCT and administrative position. More studies should be developed in order to identify variables potentially associated with the use of nursing process in clinical practice.

Sleeping difficulties reported by patients with heart failure.

The study aimed to describe the reports of heart failure patients on the factors that cause difficulties to sleep and the association of these factors with the quality of sleep. This cross-sectional study involved a non-probabilistic sample of 400 patients (mean age 57.8 years, 64.8% were men, average education of 6.1 years, 82.5% in functional class II or III) with heart failure. The main factors associated with sleeping difficulty were: nocturia, interrupted sleep at night and breathing difficulty. Sleeping difficulties in heart failure patients are diverse and there is an association between these difficulties and quality of sleep. Most of these disorders warrant professional nursing interventions.

[Factors associated to sleep pattern in heart failure patients]. / Fatores associados ao padrão de sono em pacientes com insuficiência cardíaca.

The objective of this study was to describe sleep patterns in patients with heart failure (HF) and analyze associations between sleep and the following variables: gender, age, fatigue, fatigue on exertion, physical activity, functional class, drug therapy, dyspnea, and body mass index. The nonprobability sample consisted of 400 patients (mean age 57.8 years; 64.8% were men, average schooling of 6.1 years; 82.5% Functional Class II or III). The prevalence of poor sleepers was 68.5%, and 46.5% rated sleep as poor or very poor. Scores suggest that the bad sleeper category was associated with: female, unemployed, fatigue, fatigue on exertion, dyspnea and higher functional classes of HF. The proportion of poor sleepers among patients with HF is among the highest in chronic diseases. Dyspnea and fatigue, common symptoms of this disease, significantly increase the chance of being a bad sleeper.

Clinical validation of nursing diagnoses of acute pain in hospitalized children.

PURPOSE: Clinically validate (Fehring's model) the characteristics of the nursing diagnosis acute pain in 65 hospitalized children. METHODS: Cross-sectional study. FINDINGS: This study resulted in 13 major characteristics (expressive behavior, change of mental state, verbal report of pain, observed evidence of pain, narrowed focus, position to avoid pain, guarding behavior, sleep disturbance, protective gestures, changes in heart rate, changes in muscle tone, changes in respiratory rate, and facial mask) and in 5 minor characteristics (changes in blood pressure, coded report, changes in breathing pattern, distraction behavior, and changes in appetite). CONCLUSIONS: Characteristics with R > 0.50 and ≤ 1 were valid in the diagnosis acute pain. IMPLICATIONS FOR NURSING PRACTICE: Clinical validation studies must be reproduced in different populations.

[Publications on pain and nursing diagnosis in a Brazilian database]. / Publicações sobre dor e diagnóstico de enfermagem em uma base de dados brasileira.

The practical utilization of nursing diagnostics and interventions during professional practice and the analysis of the scientific production on diagnosis can help outline published knowledge. The objective of this study was to identify references related to the diagnosis of pain by nurses in a Brazilian nursing database (BDEnf). A systematic literature survey was carried out by electronic search, using the combination of the words "pain" and "nursing diagnosis". A total number of 21 references were found until December, 2006. Eighteen references were included in the study. In 12 studies, pain was one of the diagnoses found in articles that aimed making diagnosis in different populations. It was concluded that the studies included in that nursing database show that pain diagnosis by nurses has become a trend in the nurses' clinical practice.

Adaptation of the visual analog sleep scales to Portuguese.

This article reports the adaptation of the Visual Analog Sleep (VAS) Scales developed to assess patients' perception about their sleep on the previous 24 hours. Original scales, translated to Portuguese and submitted to content validation, were tested for reliability and validity. Convenience sample was composed of 180 patients on the first postoperative day (mean age 39.3+/-12.3 years; 68.3% female). The Disturbance Scale was kept with 7 items (alpha=.80) and the Effectiveness Scale with 5 items (alpha=.78); both maintained the original structure. Item 13 (Wake after final arousal) had to be excluded from Supplementation Scale, that kept 3 out of its 4 items (alpha=.72). There was negative correlation between Disturbance and Effectiveness (r=-.68 p<.001), as it was expected. The adapted version is suitable to sleep assessment of postoperative patients. The behavior of the excluded item has to be analyzed with other samples.

[Adaptation to the Portuguese language and validation of the Lunney Scoring Method for Rating Accuracy of Nursing Diagnoses]. / Adaptação para a língua Portuguesa e validação do Lunney Scoring Method for Rating Accuracy of Nursing Diagnoses.

The Lunney Scoring Method for Rating Accuracy of Nursing Diagnoses (LSM) is a semantic differential scale developed by Lunney to rate the accuracy of nursing diagnoses. The objective of this study was to adapt the LSM to the Portuguese language and to estimate its psychometric properties. The original scale was translated into Portuguese, back-translated into English, and the English versions were compared in order to adjust the Portuguese one (Escala de Acurácia de Diagnóstico de Enfermagem de Lunney--EADE). Four nurses were trained on the EADE and applied it on 159 diagnoses made for 26 patients of three primary studies, based on the records of patients' interviews and physical examinations. Cohen's Kappa estimates produced unacceptable inter-observer agreement rates, showing that the adapted tool has not acceptable reliability. Because of this result, validity tests were not conducted.