Deductive Care Methodology: Describing and testing modes of care research.

OBJECTIVE: Define the modes of procedure of the Deductive Care Methodology (DCM) in the generation of knowledge about person's health care. METHODOLOGY: Design and test of the DCM modes based on three phases: mapping of the MDC, generation of models from this methodology and testing of the models through studies in a clinical context. RESULTS: The MDC presents five levels of abstraction with three modes broken down to 16 types. The modes are: Philosophical Mode to conceptualize and obtain generalities about reality, Mathematical Mode to operate with generalities, and Physical Mode to operationally verify, validating the results and the predictive capacity of the model. This MDC allows the creation of three models: Knowledge Model about Person Care, an ontology of care, Vulnerability Model about the person and Taxonomic Triangulation Model for knowledge management. All models generate products for computational knowledge management. In addition, the models are applied in teaching and generate research with more than a hundred participations in conferences and journals, of which five impact publications (from 2008 to 2022) classified in the categories of Nursing and Informatics are analysed. CONCLUSIONS: The MDC collects prior knowledge to work with certainties, evidence and applying inferences that do not depend on the number of cases or inductive designs. This research presents a formal structure of the MDC with an interdisciplinary orientation between Health Sciences and Computer Sciences.

The Significance of Religion and Spirituality Among Turkish Women Surviving Breast Cancer Without Treatment: A Qualitative Study.

The health of breast cancer survivors is a global concern. It is crucial to adopt a holistic approach when understanding their journey from illness to wellness in order to ensure that the transition is as smooth as possible. This study focused on the experiences of Muslim women who had overcome breast cancer and were adapting to life post-treatment. Snowball sampling was used to select the participants for this qualitative study. Fifteen women who had successfully completed breast cancer treatment and been declared cancer-free were interviewed. These interviews were semi-structured, using open-ended questions to explore their experiences in-depth. The interviews were conducted by phone, and the data were analyzed using qualitative content analysis. The study identified four main themes, nine subthemes, and 41 codes. The main themes were as follows: (a) a life changed by cancer and the difficulties encountered; (b) transition from active treatment to treatment-free living; (c) coping mechanisms; and (d) future hopes and expectations. The findings highlighted the survivors' desire to move past their experience of cancer and normalize their lives, as well as emphasizing their need for support. The participants shared detailed accounts of their journey, the obstacles they encountered during this transition, and the critical role of religion and spirituality in overcoming these challenges. Understanding and effectively managing the experiences of women after breast cancer treatment is vital not only for improving survival rates but also for facilitating their healing process.

A Journey of Joy: Dr. Barbara M. Dossey's Evolution in Nursing.

Dr. Barbara M. Dossey is an internationally recognized pioneer in the holistic nursing and nurse coaching movements. She is a Florence Nightingale scholar, nurse theorist, and national and international speaker and teacher on the role of holistic, integral, and integrative nursing and nurse coaching in the integrative healthcare paradigm. Her theory of integral nursing presents the science and art of nursing. Her coauthored theory of integrative nurse coaching, a middle-range theory, is a framework to guide integrative nurse coaches in nurse coaching practice, education, research, and healthcare policy. In this column, Dr. Dossey shares her scholarly journey of joy.

Dynamic delirium - Nursing intervention to reduce delirium in patients critically Ill, a randomized control trial.

OBJECTIVE: To determine the effectiveness of a nursing intervention based on the Dynamic Symptom Model (DSM) and scientific evidence versus daily care in reducing the incidence and duration of delirium in intensive care patients. METHOD: We designed the intervention named "DyDel" (By Dynamic Delirium) based on the theoretical approach of the DSM and from scientific evidence. A double-masked clinical trial of parallel groups was developed to test DyDel, with 213 patients older than 18 admitted to the intensive care unit (ICU) randomized to the study groups. The intervention group received DyDel each shift from day 0 until discharged from the ICU, while the control group received daily care in the ICU. At the same time, all participants were followed to measure primary (incidence and duration of delirium) and secondary outcomes (level of sedation and pain, days of mechanical ventilation, stay in ICU, and physical restriction). RESULTS: Overall, the study population were older than 60 years (60.3 ± 15.2 years), the male gender (59.6 %), and the diagnosis of acute myocardial infarction (73.7 %) were predominant. Comparing groups of study, the incidence of delirium was lower in the intervention group (5.6 %) than in the control group (14.8 %) (p = 0.037). The intervention group had lower days with delirium (0.07 ± 0.308) than the control group (0.34 ± 1.28) (p = 0.016), lower pain intensity (p = 0.002) and lower days of physical restraints (p = 0.06). CONCLUSION: Non-pharmacological care, like the DyDel intervention, includes the family and focuses on the different patient's needs, which can help to reduce the incidence and duration of delirium in patients admitted to adult ICUs. IMPLICATIONS FOR CLINICAL PRACTICE: DyDel was non-pharmacological and included the family. The DyDel's activities were focused on physiological, psychological, spiritual, and social needs and the experience and trajectory of delirium. The nurse can give humanized care in the ICU by applying DyDel.

Competencies in the Robotics of Care for Nursing Robotics: A Scoping Review.

In parallel with the development and design of different technological advances, competencies in nursing have advanced. With the development of robotics, it is expected that nursing robotic competencies will also increase. The aim of this study is to review the competencies in nursing robotics. A review was conducted between January 2017 and December 2023. The search strategy was carried out in the MEDLINE database (through PubMed). This review explores the developmental competencies in nursing robotics and informatics. The data extraction in this review included an intentional search for competencies and learning outcomes in engineering and robotic programs. A total of 340 competencies and program outcomes were reviewed. The synthesis of the data established a total of 17 developmental competencies in nursing robotics based on this knowledge extraction, which we organized into five categories: assessment, diagnosis, planning, intervention (implementation) and evaluation. This review suggests that nursing robotic competencies for the development of care robotics are still scarce, and there is an opportunity for the development of competencies and the definition of new roles in the area of nursing informatics in order to adapt to the new health care demands of society.

The application of the self-care deficit nursing theory in adolescents with cystic fibrosis: A randomized controlled study.

PURPOSE: The present study evaluates the effects of the application of Self-Care Deficit Nursing Theory (SCDNT) on the self-care knowledge and skills in adolescents with Cystic Fibrosis. DESIGN AND METHODS: This randomized controlled study included 30 adolescents who were equally divided into the intervention and control groups. The data were collected by using the Sociodemographic Data Form and the Self-Care Knowledge and Skills Evaluation Forms for Adolescents with Cystic Fibrosis. A total of seven home visits were conducted with the adolescents in the intervention group, during which individualized care plans were applied based on the Self-Care Deficit Nursing Theory. The self-care needs of the adolescents in the control group were identified based on data collected during two home visits conducted at the onset of the study and after 4.5 months. RESULTS: As a result of the application of nursing interventions based on the SCDNT, a statistically significant increase was noted in the self-care knowledge and skills of the adolescents in the intervention group (p < 0.05). Additionally, after the interventions based on SCDNT, the need of adolescents for nursing interventions decreased significantly over time in all adolescents in the intervention group (p < 0.05). CONCLUSIONS: The application of nursing interventions based on the SCDNT was effective in enhancing the self-care knowledge and skills of adolescents with Cystic Fibrosis. PRACTICE IMPLICATIONS: Nurses can benefit from Orem's Self-Care Deficit Nursing Theory in the design and application of the individualized care of adolescents with Cystic Fibrosis to improve their self-care practices.

Toward diverse SOGIESC-transformative theorizing in nursing: A revisitation and expansion of Im and Meleis' guidelines for gender-sensitive theorizing.

Over two decades have passed since Im and Meleis proposed "gender-sensitive theories" as a category of nursing theories in 2001. Since then, the global conditions of women and minoritized identities across the various spectra of sexual orientation, gender identity and expression, and sexual characteristics (SOGIESC) have changed. Moreover, feminist theorizing has evolved, prompting the need to update how nurses theorize and research the interactions of gender and health in their practice. This discursive essay aims to (1) provide a summary of Im and Meleis' characterization and guidelines in the development of gender-sensitive theories in nursing and present exemplars that use these guidelines; (2) assess the gender-sensitive nursing theory guidelines in terms of gender-responsiveness; and (3) expand the transformative potential of gender-sensitive theorizing in nursing by proposing Diverse SOGIESC-Transformative Theories. Diverse SOGIESC-Transformative Theories include three additional aspects to enhance the transformative potential of gender-responsive theorizing in nursing: inclusion of diverse SOGIESC, elaboration of intersectionality, and consideration of men and masculinities.

Middle-Range Theory of Occupational Stress in Health Professionals.

Introduction: Occupational stress affects health professionals; however, no literature was found on the middle-range theory for this outcome in health professionals. Methods: Methodological study for the theoretical validation of a nursing diagnosis using the theoretical framework of Walker and Avant and the Betty Neuman systems models. The research was conducted in five stages: comprehension of the system model; selection and review of studies; development of the conceptual-theoretical-empirical structure; elaboration of a diagram and proposition of a nursing diagnosis; and evaluation of the empirical adequacy of the theory and validity of the system model. These steps were conducted using a scoping review and a sample of 138 articles selected in the Scopus, Web of Science, MEDLINE/PubMed, CINAHL, PsycINFO, LILACS, Science Direct, Cochrane Library, and Google Scholar databases. A data extraction instrument was developed, and study variables (attributes, antecedents, and clinical consequences) were analyzed using descriptive statistics (absolute and relative frequencies) and presented in tables. Results: The middle-range theory comprised 16 concepts, 20 propositions, and one diagram. A total of 15 related factors, 29 defining characteristics, six at-risk populations, and one associated condition were indicated to propose the nursing diagnosis for occupational stress. Conclusion: The middle-range theory supported elaborating elements to propose a nursing diagnosis for occupational stress.

The Usefulness of Nursing Theory in Guiding Nursing Practice in China: A Systematic Review.

Background: Nursing theory is a critical aspect of nursing practice that provides a framework for understanding, interpreting, and analyzing nursing phenomena. However, the extent to which nursing theory is used to guide nursing practice in China remains unclear. Purpose: This research reviews the literature of experimental studies in Chinese core journals to analyze the extent of use and effectiveness of nursing theory in guiding practice. Methods: This study involves literature research in multiple databases and a review and evaluation of 35 studies. Results: Nursing theory-guided interventions have a positive effect on patient outcomes across a wide range of diseases and conditions in China. The most commonly used nursing theories were King's standard theory and Newman's model of health awareness. These interventions were effective in improving self-efficacy, quality of life, and psychological state in patients with chronic diseases, acute diseases, and cancer with 11 studies rated as strong, 10 studies as moderate, and 14 studies as weak. However, despite the variation in quality, nursing theory-guided interventions were found to be superior to conventional clinical care in improving patient outcomes. Implications for Practice: Nursing theory-guided interventions have a positive impact on improving patient outcomes, including self-efficacy, quality of life, and psychological well-being. Therefore, it is crucial for Chinese nurses to integrate nursing theory into their practice to provide evidence-based and quality care to patients.

Utilization of Orem's Self-Care Deficit Nursing Theory in Self-Care Among Older Korean Immigrants With Diabetes in the United States.

Background: Diabetes is a chronic illness and increasing among older populations. Self-care is a critical element in managing diabetes. Orem's Self-Care Deficit Nursing Theory (SCDNT) has been used and applied in nursing to explain significant self-care concepts. Although older Korean immigrants are marginalized in maintaining optimal health status and accessing adequate health services, related studies are still lacking. Utilization of Orem's SCDNT allows nurses to better understand associated factors in self-care among older Korean immigrants with diabetes. Purpose: The first aim is to explain the significant concepts of SCDNT. The second aim is to examine basic conditioning factors on self-care among older Korean immigrants with diabetes based on Orem's SCDNT. Methods: Each concept and structure of Orem's SCDNT was described with a table and figure. The 10 basic conditioning factors in self-care among older Korean immigrants with diabetes were investigated based on the previous literature and discussed in terms of Orem's SCDNT. Results: By exploring the 10 basic conditioning factors among older Korean immigrants, nurses can identify related factors in the self-care of this minority immigrant group and initiate the development of culturally tailored and age-specific nursing interventions. Implications for Nursing Practice: This study provides an understanding of related self-care factors among older Korean immigrants with diabetes. Additionally, the findings will help nurses to develop customized effective interventions and implement appropriate diabetes care for this minority group.

Trends in NIH-funding to schools of nursing in the last 17 years.

BACKGROUND: Growing clinical demands, faculty retirements, fewer PhD-prepared graduates, and funding instability are challenges for nursing science. PURPOSE: The purpose of this analysis was to investigate National Institutes of Health (NIH) funding patterns in schools of nursing (SONs). METHODS: Data were extracted from the Blue Ridge Institute for Medical Research between 2006 and 2022. Growth modeling examined changes in funding over time between private and public SONs. DISCUSSION: In the last 17 years, NIH funding for SONs has risen nearly 25% but remains only 1% of the total NIH budget for extramural research. Overall, 109 (75%) of the SONs were public and 36 (25%) were private institutions. Regarding geography, 90% of the States received NIH funding except six: ID, ME, MS, NH, VT, and WY. Private SONs consistently received more funding than public SONs but the difference was only statistically significant in 2022. CONCLUSION: NIH funding has significantly increased to SONs, there is better geographic distribution but a funding disparity exists between public and private SONs.

Ready to Go Home? Nurses' Perspectives of Prolonged Admission for Patients Undergoing Video-Assisted Thoracic Surgery for Non-Small-Cell Lung Cancer in Denmark.

Enhanced recovery after surgery programs with median postoperative hospitalization of 2 days improve outcomes after lung cancer surgery. This article explores nursing care practices for patients with lung cancer who remain hospitalized despite having recovered somatically. Qualitative focus group interviews were conducted with 16 nurses. Ricoeur's phenomenological hermeneutics underpins the methodology applied in this study, and we relied on Benner and Wrubel's theory. The nurses emphasized that the thoughts of patients with a recent lung cancer diagnosis revolve around more than the surgery. Nursing comprises not only practicalities but also attending to patients' stress and their coping with being struck with lung cancer and having undergone surgery. A counterculture emerged to counteract the logic of productivity, indicating that caring as a worthy end in itself may be underestimated in protocol-driven care. Prolonging hospitalization largely depends on clinical judgment. The nurses' aim is not to keep patients in the hospital but to avoid any needless suffering, allowing them to reclaim the primacy of caring.

People living with Alzheimer's disease: Understanding the emerging phenomenon of retrograde plunge with the story theory-An inquiry method.

AIM: This study aims to (1) introduce the emergent concept of the retrograde plunge experienced by people living with Alzheimer's disease and (2) illustrate how nurses can accompany those experiencing this phenomenon, as well as their family and formal carers, using the seven-phase inquiry process proposed by Smith and Liehr. DESIGN: Discursive paper. METHODS: After describing the phenomenon and the Story Theory, the 7-phase Inquiry Process presents the fictional story of Mrs. Lurie, a nursing home resident. RESULTS: Story theory allows nurses to accompany Mrs. Lurie. The emergent concept of retrograde plunge is explained. Different tools such as genograms, story paths and eco-maps are presented. This discussion demonstrates how some perspectives can contribute to a better description of the retrograde plunge phenomenon. The narrative care approach can help give voices to people experiencing retrograde phenomena. The adoption of a perspective that considers embodied language could help to better understand the needs of a person. CONCLUSION: There is a lack of consistency and uniformity regarding the understanding of the retrograde phenomenon. This impacts the quality of care for people and the scientific knowledge, research and education of healthcare professionals. This issue should be addressed in future studies. IMPLICATIONS FOR THE PROFESSION AND/OR PATIENT CARE: This article shows how story theory helps nurses accompany those facing a retrograde plunge phenomenon, helps them tell their own stories and finds a way to resolve the situation. IMPACT: This article paves the way for further developments that must now be realized by the international community of experts involved in the care of people with Alzheimer's disease, from practical, academic and research perspectives. NO PATIENT OR PUBLIC CONTRIBUTION: No patient or public was involved in the design or drafting of the discursive paper. WHAT PROBLEM DID THE STUDY ADDRESS?: The retrograde plunge is a phenomenon in which people living with Alzheimer's disease return to their past lives and re-experience with certain events. The retrograde plunge is a well-known concept that is poorly described in scientific literature and is sometimes misunderstood by families and professional caregivers. This discursive article explains the retrograde plunge phenomenon experienced by people living with Alzheimer's disease. WHAT WERE THE MAIN FINDINGS?: This article demonstrates how story theory helps nurses and families support people with retrograde plunges. This highlights the lack of consistency and uniformity in this phenomenon, which has implications for the quality of care, education and research. Story theory and the seven-phase inquiry process proposed by Smith and Liehr (in Middle-range theory for nursing, Springer Publishing Company, 2023) help to better understand and explain the retrograde plunge phenomenon. WHERE AND ON WHOM WILL THE RESEARCH HAVE AN IMPACT?: This article advances nurses' knowledge in the different fields of practice, teaching and research. This article proposes links among the retrograde plunge phenomenon, embodied language and narrative care approach; this could offer further ways to develop nursing knowledge. This study has the potential to advance the knowledge of practice and education and offers new opportunities for research. TRIAL AND PROTOCOL REGISTRATION: There was no trial or protocol registration as this article is a discussion.

Creating 'good' hospital to home transfers in the rural north of Sweden: informal workarounds and opportunities for improvement.

Hospital to home transfers for older people require effective communication, coordination and collaboration across multiple service settings. Rural Nursing Theory and the Beyond Periphery model explain why this is particularly difficult in rural areas, but there are few examples of how rural services respond. This paper presents a case study of the district of Tärnaby in the inland north of Sweden. Data are drawn from interviews with health and care staff in Tärnaby, observations, and experiences of the researchers. Data were analyzed thematically, with four main themes emerging - role clarity, communication, geography, and understanding of the rural context. Responses to challenges included increasing opportunities for communication between service providers and improving documentation. The paper concludes that informal "workarounds" run the risk of further disconnecting rural service settings from "the city". Rather, the aim needs to be to improve contextual understanding through formally incorporating "the rural" in service design.

Situation-Specific Theory from Autonomic Dysreflexia Nursing Diagnosis Based on Roy's Adaptation Model

Introduction: Autonomic dysreflexia (AD) is a condition developed secondary to a spinal cord injury, which manifests with the loss of coordinated autonomic responses and cardiovascular control. For the care of the person, the nurse has the nursing diagnosis of AD, which allows the precise interpretation of the human responses of each individual. However, it is necessary to strengthen and update the diagnosis to the new disciplinary knowledge that evolved with nursing practice. For this, proposing a situation-specific theory is essential to explain the phenomenon of interest and guide practice. Objective: To construct a situation-specific theory for the nursing diagnosis of AD derived from the adaptation model of Sor Callista Roy. Materials and methods: Theoretical study developed in five stages: defining the approach to construct the theory, defining key concepts, developing a pictorial diagram, building propositions, and establishing causal relationships and evidence for practice. Results: The situation-specific theory included defining key concepts, developing a pictorial diagram, building propositions, and establishing causal relationships and evidence for practice. We described the concepts and their relationships through seven propositions and identified 19 ineffective behaviors and 43 environmental stimuli. Of them, 39 are focal, and four are contextual stimuli. Conclusions: This situation-specific theory offers a substantiated and comprehensive explanation of the human response to AD for supporting nursing care.

Introducción: La direflexia autónoma (DA) es una afección secundaria a una lesión en la médula espinal que se manifiesta en la pérdida de respuestas autónomas coordinadas y de control cardiovascular. Para el cuidado del paciente, las enfermeras cuentan con el diagnóstico de la DA, que permite interpretar adecuadamente las respuestas humanas de cada individuo. Sin embargo, es necesario fortalecer y actualizar el diagnóstico a los nuevos conocimientos disciplinarios que evolucionan con la práctica de la enfermería. Para esto es esencial una teoría de situación específica que explique el fenómeno de interés y guíe la práctica. Objetivo: Construir una teoría de situación específica para el diagnóstico en enfermería de la DA derivada de la adaptación del modelo de Sor Callista Roy. Materiales y métodos: Estudio teórico desarrollado en cinco etapas: definición del enfoque para construir la teoría, definición de los conceptos clave, desarrollo de un diagrama pictórico, construcción de las proposiciones y establecimiento de las relaciones causales y la evidencia para la práctica. Resultados: La teoría de situación específica incluyó la definición del enfoque para construir la teoría, la definición de los conceptos clave, el desarrollo de un diagrama pictórico, la construcción de las proposiciones y el establecimiento de las relaciones causales y la evidencia para la práctica. Se describen los conceptos y sus relaciones por medio de 7 proposiciones y se identificaron 19 comportamientos ineficaces y 43 estímulos ambientales. De ellos, 39 son focales y 4 contextuales. Conclusiones: Esta teoría de situación específica proporciona una explicación informada y completa de la respuesta humana a la DA para apoyar el cuidado en enfermería.

Introdução: a disreflexia autonômica (DA) é uma condição secundária à lesão da medula espinhal que se manifesta na perda de respostas autonômicas coordenadas e no controle cardiovascular. Para o atendimento ao paciente, os profissionais de enfermagem contam com o diagnóstico de DA que permite a interpretação adequada das respostas humanas do indivíduo. No entanto, há necessidade de fortalecer e atualizar o diagnóstico para o novo conhecimento disciplinar que evolui com a prática de enfermagem. Para isso, é essencial uma teoria situacional específica que explique o fenômeno de interesse e oriente a prática. Objetivo: Construir uma teoria situacional específica para o diagnóstico de enfermagem da DA derivada da adaptação do modelo de Sor Callista Roy. Materiais e método: estudo teórico desenvolvido em cinco etapas: definição da abordagem para construir a teoria, definição de conceitos-chave, desenvolvimento de um diagrama pictórico, construção de proposições e estabelecimento de relações causais e evidências para a prática. Resultados: a teoria específica da situação incluiu a definição da abordagem para a construção da teoria, a definição dos principais conceitos, o desenvolvimento de um diagrama pictórico, a construção de proposições e o estabelecimento de relações causais e evidências para a prática. Os conceitos e suas relações são descritos por meio de 7 proposições e foram identificados 19 comportamentos ineficazes e 43 estímulos ambientais. Destes, 39 são focais e 4 são contextuais. Conclusões: essa teoria específica da situação fornece uma explicação informada e abrangente da resposta humana à DA para apoiar a assistência de enfermagem.

Los significados de la menopausia, una mirada desde la teoría de las transiciones

Introducción: La menopausia es una etapa, si bien normal, de profundos cambios en la vida de la mujer; la transición hacia la menopausia impone un reto al profesional de enfermería, encaminado a promover la salud, facilitar la transición y apoyar la búsqueda de solución a las necesidades que se presentan. Objetivo: El presente estudio está orientado a comprender los significados de la menopausia en mujeres de Armenia, Quindío, Colombia. Metodología: Se utilizó un enfoque cualitativo, fenomenológico e interpretativo desde la teoría de las transiciones de Meléis. Se efectuaron entrevistas a profundidad a seis mujeres de Armenia, previo consentimiento informado, con muestreo intencional, grabación y diario de campo; la información se analizó con apoyo de la base de datos ATLAS.ti, mediante codificación, categorización inductiva, triangulación y contestación con la literatura. Resultados: Se encontró una percepción negativa de la menopausia por sensación de fogajes, desasosiego, depresión y disfunción sexual; para los síntomas recurren a terapias complementarias y medicación, al respecto, algunas refieren una experiencia tranquilizadora y agradable. Urgen redes de acompañamiento en salud para promoción, prevención y apoyo familiar. Las participantes solicitan programas educativos específicos desde edades tempranas. Discusión: Los resultados coinciden con la literatura en cuanto a la experiencia de las participantes y la necesidad de apoyo y orientación. Desde la teoría de Meléis, la transición es de desarrollo, organizacional, con patrones múltiples, simultáneos y relacionados. La experiencia fue sentida y vivida negativamente, se necesitan espacios de análisis, reflexión y acompañamiento desde edades tempranas, para deconstruir el concepto de menopausia y climaterio como problema de salud, y abordarlo como evento vital y de renacimiento, como apertura a una nueva forma de vivir, con estilos de vida saludables. Conclusiones: Se concluye que la menopausia es percibida y experimentada como una etapa de ansiedad, desasosiego, tristeza y desesperanza, por el poco acompañamiento, deficiente educación y preparación de la mujer; las mujeres adultas "menopaúsicas" son poco reconocidas, rechazadas, y muchas veces solo toleradas por personas cercanas. Urgen redes de acompañamiento en salud.

Introduction: Menopause is a stage, although normal, of profound changes in a woman's life. The transition to menopause imposes a challenge on the nursing professional, aimed at promoting health, facilitating the transition and supporting the search for a solution to the needs that arise. Objective: The present study is aimed at understanding the meanings of menopause in women from Armenia, Quindio Department, Colombia. Metodology: A qualitative, phenomenological and interpretative approach was used, based on Meleis's theory of transitions. In-depth interviews were carried out on six women from Armenia, with prior informed consent, with intentional sampling, recording, and field diary; the information was analyzed with support of the ATLAS.ti database, through coding, inductive categorization, triangulation, and comparison with the literature. Results: A negative perception of menopause was found due to hot flashes, restlessness, depression and sexual dysfunction; for the symptoms they resort to complementary therapies and medication, as a result, some report a calming and pleasant experience; health accompaniment networks are urgently needed for promotion and prevention, and family support. They request specific educational programs from an early age. Discussion. The results coincide with the literature regarding the experience of the participants and the need for support and guidance. From Meleis's theory, the transition is developmental, organizational, with multiple, simultaneous and related patterns. The experience was felt and lived negatively, spaces for analysis, reflection and accompaniment are needed from an early age, to deconstruct the concept of menopause and climacteric as a health problem, and address it as a vital and rebirth event, as an opening to a new way of living, with healthy lifestyles. Conclusions: It is concluded that the menopause is perceived and experienced as a stage of anxiety, restlessness, sadness and hopelessness, due to the lack of accompaniment, poor education and preparation of women; "menopausal" adult women are little recognized, rejected and, many times, only tolerated by close people. Health support networks are urgently needed.

Microteoría de enfermería en la prevención del delirium en personas mayores en la unidad de cuidados intensivos / Nursing microtheory in the prevention of delirium in older adult in the intensive care unit / Microteoria de enfermagem na prevenção do delirium em pessoas idosas na unidade de terapia intensiva

Objetivo: describir una microteoría para cuidados de enfermería en la prevención del delirio en personas mayores en la unidad de cuidados intensivos. Método: investigación teórica prescriptiva, basada en la subconstrucción. Se dedujeron constructos del Modelo de Adaptación de Roy y se indujeron datos del fenómeno de cuidados de enfermería en la prevención del delirium en personas mayores en cuidados intensivos, a partir de una revisión integrativa de la literatura. Resultados: la microteoría posee sistema teórico, operativo y modelo de cuidado. En el sistema teórico se utilizaron los constructos estímulo focal y contextual de Roy. A partir de ellos, se elaboraron los conceptos de cuidado focal y contextual y la variable respuesta adaptativa a la prevención. De las declaraciones relacionales se elaboraron cuatro axiomas, dos postulados, ocho proposiciones y una presuposición epistémica. En el sistema operativo se establecieron dos indicadores empíricos: el Confusion Assessment Method for Intensive Care Units y el historial demográfico/clínico de las personas mayores. Posteriormente, se produjeron dos declaraciones transformacionales, cuatro hipótesis y el modelo de cuidado representado en figura. Conclusión: la microteoría producida prescribe cuidados en la prevención del delirium en personas mayores en cuidados intensivos, por un constructo de interés para la enfermería, y permite intervenciones en el desarrollo de instrumentos que guían la actuación de la enfermería.

Objective: to describe a microtheory for nursing care in the prevention of delirium in older adult in the intensive care unit. Method: prescriptive theoretical research, based on substruction. Roy's Adaptation Model constructs were deduced and data from the phenomenon of nursing care in the prevention of delirium in older adult in intensive care were induced, based on an integrative literature review. Results: the microtheory has a theoretical and operational system and a model of care. In the theoretical system, Roy's focal and contextual stimulus constructs were used. From them, the concepts of focal and contextual care and the variable adaptive response to prevention were elaborated. From the relational statements, four axioms, two postulates, eight propositions and an epistemic assumption were elaborated. Two empirical indicators were established in the operating system: the Confusion Assessment Method for Intensive Care Units and the demographic/clinical history of the older adult. Subsequently, two transformational statements, four hypotheses and the model of care represented in figure were produced. Conclusion: the microtheory produced prescribes care in the prevention of delirium in older adult in intensive care, through a construct of interest to nursing, and allows interceptions for the development of instruments that guide nursing activities.

Objetivo: descrever uma microteoria para cuidados de enfermagem na prevenção do delirium em pessoas idosas na unidade de terapia intensiva. Método: pesquisa teórica prescritiva, baseada na substrução. Foram deduzidos construtos do Modelo de Adaptação de Roy e induzidos dados do fenômeno dos cuidados de enfermagem na prevenção do delirium em pessoas idosas na terapia intensiva, a partir de revisão integrativa da literatura. Resultados: a microteoria possui sistema teórico, operacional e modelo de cuidado. No sistema teórico utilizaram-se os construtos estímulo focal e contextual de Roy. A partir deles elaboraram-se os conceitos de cuidado focal, contextual e a variável resposta adaptativa à prevenção. Das declarações relacionais elaboraram-se quatro axiomas, dois postulados, oito proposições e um pressuposto epistêmico. No sistema operacional, estabeleceram-se dois indicadores empíricos: o Confusion Assessment Method for Intensive Care Units e o histórico demográfico/clínico das pessoas idosas. Posteriormente, produziram-se duas declarações transformacionais, quatro hipóteses e o modelo de cuidado representado em figura. Conclusão: a microteoria produzida prescreve cuidados na prevenção do delirium em pessoas idosas na terapia intensiva, por um construto de interesse para a enfermagem, além de permitir interceptações ao desenvolvimento de instrumentos que norteiam a atuação da enfermagem