Postoperative Cardiovascular Surgery Delirium: Interrater Agreement Between Nurses and Clinical Nurse Specialist and Factors Associated With Prevalence.

PURPOSE: The aims of this study were to examine interrater agreement of delirium between clinical nurses and a clinical nurse specialist, determine delirium subtype prevalence, and examine associated patient, procedure, and hospital factors. DESIGN: A descriptive cross-sectional design and a convenience sample of nurses and patients on progressive care units were used in this study. METHODS: Clinical nurse specialist data were collected on a case report form, and clinician and patient data were obtained from electronic databases. Interrater agreement of delirium prevalence was assessed by κ statistic, and logistic regression models were used to determine patient factors associated with delirium. RESULTS: Of 216 patients, 23 had delirium; clinical nurses identified fewer cases than the clinical nurse specialist: 1.8% versus 10.7%; κ agreement, 0.27 (0.06, 0.49). By delirium subtype, hypoactive delirium was more frequent (n = 10). Factors associated with delirium were history of cerebrovascular disease (odds ratio [95% confidence interval], 2.8 [1.01-7.7]; P = .044), history of mitral valve disease (odds ratio [95% confidence interval], 0.31 [0.09-0.90]; P = .041), and longer perfusion time (odds ratio [95% confidence interval], 1.7 [1.1-2.7]; P = .016). One factor was associated with hypoactive delirium, longer perfusion time (odds ratio [95% confidence interval], 2.2 [1.3-4.2]; P = .008). CONCLUSIONS: Because clinician-clinical nurse specialist delirium agreement was low and hypoactive delirium was common, clinical interventions are needed.

Diagnósticos de enfermagem da taxonomia NANDA-I para idosos em instituição de longa permanência / Diagnósticos de enfermería de la taxonomía NANDA-I para ancianos en una institución a largo plazo / Nursing diagnoses of NANDA-I taxonomy for the elderly in a long-term institution

Resumo Objetivo identificar diagnósticos de enfermagem da Taxonomia da NANDA-I em idosos institucionalizados. Método estudo descritivo, conduzido com 116 idosos de uma instituição de longa permanência, realizado a partir da identificação de diagnósticos de enfermagem da Taxonomia da NANDA-I em um instrumento fundamentado no modelo teórico das Necessidades Humanas Básicas e validação por especialistas com suporte no raciocínio diagnóstico de Risner. Resultados identificou-se 1.555 títulos de diagnósticos de enfermagem para os 116 idosos, com uma média de 13,4 diagnósticos por idoso. Após exclusão de repetições foram obtidos 39 títulos distintos de diagnósticos. Entre eles, 26 (66,7%) são títulos de diagnósticos reais, 13 (33,3%) títulos de diagnósticos de risco e estão classificados em 8 dos 13 domínios da taxonomia da NANDA-I. Os diagnósticos de enfermagem mais frequentes foram: risco de quedas (94,8%); síndrome do idoso frágil (91,3%) e processos familiares disfuncionais (90,5%). Conclusão e implicações para a prática o perfil de diagnósticos de enfermagem identificado pode contribuir para o incremento de indicadores sensíveis à prática de enfermagem, com o planejamento e implementação de medidas assistenciais direcionadas as reais necessidades dos idosos institucionalizados impactando na autonomia, independência e consequentemente na qualidade de vida.

Resumen Objetivo identificar diagnósticos de enfermería de la taxonomía NANDA-I en ancianos institucionalizados. Método estudio descriptivo, realizado con 116 personas mayores de una residencia gerontológica, a partir de la identificación de diagnósticos de enfermería de la taxonomía NANDA-I en un instrumento basado en el modelo teórico de Necesidades Humanas Básicas y validado por especialistas con apoyo en razonamiento Diagnóstico de Risner. Resultados se indicaron 1.555 títulos de diagnóstico de enfermería para los 116 p edad adultos mayores, con un promedio de 13.4 diagnósticos por adulto mayor. Excluidas las repeticiones, se obtuvieron 39 títulos de diagnóstico diferentes. Entre ellos, 26 (66.7%) son títulos de diagnósticos reales, 13 (33.3%) son títulos de diagnósticos de riesgo, y se clasifican en 8 de los 13 dominios de la taxonomía NANDA-I. Los diagnósticos de enfermería más frecuentes fueron: riesgo de caídas (94,8%); síndrome de fragilidad del anciano (91.3%) y procesos familiares disfuncionales (90.5%). Conclusión e implicaciones para la práctica el perfil de los diagnósticos de enfermería identificados puede contribuir al aumento de indicadores sensibles a la práctica de enfermería, con la planificación e implementación de medidas de atención dirigidas a las necesidades reales de los ancianos institucionalizados, que impactan en la autonomía, independencia y consecuentemente calidad de vida.

Abstract Objective To identify nursing diagnoses of the NANDA-I Taxonomy in institutionalized older adults. Method A descriptive study, conducted with 116 older adults from a long-term institution, carried out based on the identification of nursing diagnoses of the NANDA-I Taxonomy in an instrument based on the theoretical model of Basic Human Needs and validation by experts with support in Risner's diagnosis reasoning. Results 1,555 nursing diagnosis titles were indicated for the 116 older adults, with a mean of 13.4 diagnoses per individual. After excluding repetitions, 39 different diagnosis titles were obtained. Among them, 26 (66.7%) are titles of real diagnoses, 13 (33.3%) are titles of risk diagnoses and are classified in 8 of the 13 domains of the NANDA-I taxonomy. The most frequent nursing diagnoses were the following: risk for falls (94.8%); frail elderly syndrome (91.3%), and dysfunctional family processes (90.5%). Conclusion and implications for the practice The profile of the nursing diagnoses identified can contribute to the increase of sensitive indicators to the nursing practice, with the planning and implementation of care measures directed to the real needs of institutionalized older adults, impacting on autonomy, independence and, consequently, on quality of life.

Content Validation of Clinical Evidence Related to Self-Care Deficits of Patients With Stroke.

OBJECTIVE: The aim of the study was to develop the conceptual and operational definitions for the defining characteristics of each nursing diagnosis related to self-care deficits of patients with stroke and to validate these definitions with experts. METHODS: This was a methodological study. The definitions were evaluated by 32 specialists and analyzed using binomial testing. RESULTS: All the defining characteristics analyzed were statistically significant (p < .05); three indicators showed agreement at a level lower than the ideal (<0.85). CONCLUSION: The definitions achieved validity for measuring self-care deficit for bathing, toileting, dressing, and eating. IMPLICATIONS FOR NURSING PRACTICE: These defining characteristics of each nursing diagnosis related to self-care deficits may enable more accurate assessment, driving relevant and individualized action plans in rehabilitation.

Developing and Testing the Diagnostic Accuracy of a Brief Nursing Dysphagia Screen.

PURPOSE: The aim of the study was to develop and test the Groppo-Lawless nurse-initiated screen designed to identify patients diagnosed with pneumonia who are at risk for dysphagia. DESIGN: This is a two-phase methodological study. METHODS: Phase 1 involved three steps. First, risk factors (n = 27) for dysphagia were identified from the literature. Next, frequency of these risk factors was calculated from a chart review of patients diagnosed with pneumonia (N = 301). Finally, frequency of risk factors among those patients who failed the 3-oz water trial (n = 56) were calculated, and a five-item instrument, the Groppo-Lawless Dysphagia Screen, was constructed. In Phase 2, nurses' results using the screen were compared to blinded results of speech-language pathologists. FINDINGS: Sensitivity (81.1%), specificity (96.4%), and diagnostic odds ratio (22.43) were calculated. CONCLUSIONS/CLINICAL RELEVANCE: Given the strong psychometric properties of this screen, its use by nurses may increase the number of appropriate speech-language pathologist referrals among patients diagnosed with pneumonia.

Middle-Range Theory for the Nursing Diagnosis of Low Self-Efficacy in Health.

OBJECTIVES: theoretical validation of the concept of low self-efficacy in health as a nursing diagnosis construct. METHODS: construction of a middle-range theory for validating diagnoses, comprised of five stages: definition of the approach for building the theory; definition of the main concepts; creation of a pictorial diagram; formulation of proposals; establishment of causal relationships and evidence for clinical practice. The main concepts were identified through a literature review and the studies were taken from the LILACS, SCOPUS, CINAHL and PubMed/MEDLINE databases. The final sample was comprised of 92 articles. RESULTS: eighteen etiological factors and 16 clinical indicators were identified; characterized as antecedents and manifestations for inferring a diagnosis of low self-efficacy in health. CONCLUSIONS: the related concepts of the new nursing diagnosis of low self-efficacy in health, to be applied in clinical nursing practice, were identified and defined.

Reliability, Validity and Empirical Dimensionality of the Minnesota Nurses' Perceptions of Nursing Diagnoses Scale Among Italian Nursing Students.

BACKGROUND AND PURPOSE: Perceptions toward nursing diagnosis (ND) may represent core drivers of its adoption within clinical practice. Few studies have investigated perceptions toward ND within nursing academic contexts. The study was conducted to validate the Italian version of the Minnesota Nurses' Perceptions of Nursing Diagnoses (MNPND) scale on a sample of Italian nursing students and explore the psychometric structure of perceptions in a sample drawn from this population. METHODS: A cross-sectional survey with an online self-administered questionnaire was used. The study used exploratory factor analysis (EFA) and confirmatory factor analysis (CFA). RESULTS: A three-factorstructure was obtained from parallel analysis and EFA. This was confirmed using CFA; fit statistics: MLRχ² (132) = 230.150, p <. 001; CFI = 0.94; TLI = 0.93; RMSEA = 0.05 [90% CI = 0.041-0.064]; SRMR = 0.056). CONCLUSIONS: The MNPND scale is a useful instrument to measure nursing students' perceptions of ND.

Cribado de hipertensión arterial. Variabilidad entre práctica clínica y recomendaciones actuales / Screening of hypertension. Variability between clinical practice and current recommendations

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Development of a subset of ICNP Nursing Diagnoses for the promotion of self-care in people with diabetes mellitus: a multi-center observational study.

INTRODUCTION: Self-care is a key for people with diabetes mellitus (DM) to avoid severe complications and to maintain quality of life. Person-centered and accurate nursing care plans can help nurses to deliver effective self-care promotion interventions. Few studies focused on nursing diagnoses that are specific for diabetes self-care education, and none of them used the International Classification for Nursing Practice (ICNP). International Catalogues of ICNP nursing diagnoses are missing in this field. AIMS: To identify the ICNP nursing diagnoses that are useful to promote self-care in people with DM; to describe the prevalence of ICNP nursing diagnoses in self-care of people with DM. METHODS: A subset of 55 ICNP nursing diagnoses was developed based on the Middle Range Theory of Self-care of Chronic Illness, and most recent diabetes clinical guidelines. Then, the subset was tested through a multicenter cross-sectional design involving a consecutive sample of 170 adults with confirmed diagnosis of Type 1 or Type 2 DM. Data were collected by medical records, physical examinations and semi-structured interviews. RESULTS: 1343 nursing diagnoses were identified, with an average of 8 nursing diagnoses per patient. The 100% of the nursing diagnoses were described using the pre-developed subset. Overall, the five prevalent nursing diagnoses were: Body weight problem (56.4%), Non adherence to immunization regime (53.5%), Conflicting attitude toward dietary regime (41.7%), Impaired weight monitoring (39.4%), and Lack of knowledge about blood glucose diagnostic test result (32.3%). Nursing diagnoses by self-care maintenance, monitoring and management were also described. CONCLUSIONS: A huge amount of nursing diagnoses was identified suggesting the need of intensive education. Clinicians and administrators can use this subset to improve the accuracy of the documentation of diabetes care. In Public Health, the subset can be used to assess the cost-effectiveness of diabetes healthcare services. Future research is needed to assess the effectiveness of this subset in settings that are different from the one where it was developed. Finally, this subset could be a starting point to develop and International ICNP Catalogue for diabetes care.

Fatores sociodemográficos e diagnósticos de enfermagem em pacientes submetidos às cirurgias ortopédicas / Factores sociodemográficos y diagnósticos de enfermería en pacientes sometidos a cirugías ortopédicas / Sociodemographic factors and nursing diagnoses in patients undergoing orthopedic surgeries

RESUMO Objetivo Identificar os diagnósticos de enfermagem mais frequentes e verificar suas associações com fatores sociodemográficos em pacientes submetidos às cirurgias ortopédicas. Método Estudo observacional, analítico e transversal, desenvolvido na unidade de ortopedia de um hospital escola. Para coleta de dados utilizou-se instrumentos estruturados, anamnese e exame físico. Os dados foram analisados pelo programa Statistical Package for Social Sciences. Resultados Dos 201 pacientes avaliados, 68,2% eram homens. Os diagnósticos de enfermagem mais frequentes foram: risco de infecção (100%), integridade da pele prejudicada (100%), integridade tissular prejudicada (97,5%), déficit no autocuidado para banho (90,5%), dor aguda (80,6%), risco de quedas (76,6%) e ansiedade (70%). Constatou-se associações entre a dor aguda e participação na renda familiar e entre o déficit no autocuidado para banho e estado civil. Conclusão e implicações para a prática A análise do perfil sociodemográfico de uma população favorece o planejamento de uma assistência segura e a tomada de decisões pautada em evidências científicas. Minimizar possíveis complicações, promover a apropriação de diagnósticos de enfermagem, bem como melhorar a qualidade da assistência, reduzir custos operacionais para as instituições de saúde e promover a segurança do paciente.

RESUMEN Objetivo identificar los diagnósticos de enfermería más frecuentes y verificar sus asociaciones con factores sociodemográficos en pacientes sometidos a cirugías ortopédicas. Método Estudio observacional, analítico y transversal, desarrollado en la unidad de ortopedia de un hospital docente. Para la recolección de datos utilizamos instrumentos estructurados, anamnesis y examen físico. Los datos se analizaron mediante el programa Paquete estadístico para ciencias sociales. Resultados De los 201 pacientes evaluados, el 68,2% eran hombres. Los diagnósticos de enfermería más frecuentes fueron: riesgo de infección (100%), integridad de la piel deteriorada (100%), integridad del tejido deteriorada (97.5%), déficit de autocuidado en el baño (90.5%), dolor agudo (80,6%), riesgo de caídas (76,6%) y ansiedad (70%). Se encontraron asociaciones entre el dolor agudo y la participación en el ingreso familiar y entre el déficit de autocuidado para bañarse y el estado civil. Conclusión e implicaciones para la práctica El análisis del perfil sociodemográfico de una población favorece la planificación de la atención segura y la toma de decisiones basadas en evidencia científica. Minimice las posibles complicaciones, promueva la apropiación de los diagnósticos de enfermería, mejore la calidad de la atención, reduzca los costos operativos para las instalaciones de atención médica y promueva la seguridad del paciente.

ABSTRACT Objective To identify the most frequent nursing diagnoses and verify their associations with sociodemographic factors in patients undergoing orthopedic surgeries. Method Observational, analytical and cross-sectional study, developed in the orthopedics unit of a teaching hospital. For data collection we used structured instruments, anamnesis and physical examination. Data were analyzed using the Statistical Package for Social Sciences program. Results Of the 201 patients evaluated, 68.2% were men. The most frequent nursing diagnoses were: risk of infection (100%), impaired skin integrity (100%), impaired tissue integrity (97.5%), bathing self-care deficit (90.5%), acute pain (80.6%), risk of falls (76.6%) and anxiety (70%). Associations were found between acute pain and participation in family income and between self-care deficit for bathing and marital status. Conclusion and Implications for practice The analysis of the sociodemographic profile of a population favors the planning of safe care and decision making based on scientific evidence. Minimize potential complications, promote the appropriation of nursing diagnoses, improve the quality of care, reduce operating costs for healthcare institutions, and promote patient safety.

Diagnósticos de enfermagem associados a qualidade de vida de mulheres com câncer de mama em quimioterapia / Nursing diagnostics associated with the quality of life of women with breast cancer in chemotherapy / Diagnósticos de enfermería asociados a la calidad de vida de mujeres con cáncer de mama en quimioterapia

Objetivo: Identificar diagnósticos de enfermagem em mulheres com câncer de mama em quimioterapia por meio do mapeamento cruzado dos problemas de saúde com a taxonomia NANDA-I. Método: Estudo descritivo transversal realizado com cinco enfermeiros e 75 mulheres com câncer de mama em quimioterapia, desenvolvido em três fases: levantamento dos problemas de saúde por meio de instrumentos de avaliação da qualidade de vida relacionada à saúde; mapeamento cruzado dos problemas de saúde com características definidoras, fatores relacionados, fatores de risco e títulos diagnósticos; validação do mapeamento por juízes. Resultados: Foram identificados 24 problemas de saúde associados a 13 diagnósticos de enfermagem. Oito foram identificados, com índice de validade de conteúdo ≥ 0,8. Conclusão: O estudo permitiu realizar o mapeamento de diagnósticos de enfermagem a partir de problemas de saúde identificados, por meio de instrumentos de qualidade de vida, em mulheres com câncer de mama em tratamento quimioterápico

Objective: To identify nursing diagnoses in women with breast cancer in chemotherapy through the cross-mapping of health problems with the NANDA-I taxonomy. Method: A cross-sectional descriptive study carried out with five nurses and 75 women with breast cancer in chemotherapy, developed in three phases: survey of health problems by health-related quality of life assessment instruments; cross-mapping of health problems with defining characteristics, related factors, risk factors and diagnostic titles; validation of mapping by judges. Results: 24 health problems associated with 13 nursing diagnoses were identified. Eight were identified, with content index validity ≥0.8. Conclusion: The study allowed the mapping of nursing diagnoses from identified health problems, through quality of life instruments, in women with breast cancer under chemotherapeutic treatment

Objetivo: Identificar diagnósticos de enfermería en mujeres con cáncer de mama en quimioterapia a través del mapeo cruzado de los problemas de salud con la taxonomía NANDA-I. Método: Estudio descriptivo transversal realizado con cinco enfermeros y 75 mujeres con cáncer de mama en quimioterapia, desarrollado en tres fases: levantamiento de los problemas de salud por medio de instrumentos de evaluación de la calidad de vida relacionada a la salud; el mapeo cruzado de los problemas de salud con características definidoras, factores relacionados, factores de riesgo y títulos diagnósticos; validación del mapeo por jueces. Resultados: Se identificaron 24 problemas de salud asociados a 13 diagnósticos de enfermería. Ocho fueron identificados, con índice de validez de contenido ≥0,8. Conclusión: El estudio permitió realizar el mapeo de diagnósticos de enfermería a partir de problemas de salud identificados, por medio de instrumentos de calidad de vida, en mujeres con cáncer de mama en tratamiento quimioterápico

Investigação da acurácia do raciocínio diagnóstico de enfermagem por estudantes em casos clínicos simulados / Investigation of the accuracy of nursing diagnostic reasoning by students in simulated clinical cases

Introdução: esta pesquisa buscou investigar o acurado exercício do raciocínio diagnóstico seguido da tomada de decisão clínica, baseada na teoria do duplo processamento. Objetivo geral: avaliar a acurácia do raciocínio diagnóstico de estudantes de enfermagem frente a aplicação de uma tecnologia educacional baseada no duplo processamento. Objetivos específicos: verificar a acurácia de estudantes de enfermagem em concluir corretamente a ausência ou presença do diagnóstico da "Desobstrução Ineficaz de Vias Aéreas" em casos clínicos simulados; verificar o nível de acurácia diagnóstica dos estudantes de enfermagem para o julgamento clínico da "Desobstrução Ineficaz de Vias Aéreas" em casos clínicos simulados pela aplicação da Escala de Acurácia de Diagnóstico de Enfermagem; correlacionar a identificação pelo estudante de enfermagem da relevância, especificidade e coerência de pistas, conforme conceitualização da Escala de Acurácia de Diagnóstico de Enfermagem, com os indicadores clínicos inseridos nos casos simulados. Método: ensaio clínico controlado e randomizado, do tipo unicêntrico, aleatório e cego. O experimento foi realizado com 34 estudantes de enfermagem que atuaram diante do diagnóstico de enfermagem "Desobstrução Ineficaz de Vias Aéreas" em casos clínicos simulados. Dois casos clínicos foram elaborados: o Caso clínico 1 (grupo experimental), em conformidade com um estudo de validação clínica diagnóstica, no qual foram inseridas medidas de acurácia, baseado no modelo de duplo processamento; o Caso clínico 2 (grupo controle), que foi elaborado por procedimento livre de construção. Para verificação do nível de acurácia diagnóstica dos estudantes de enfermagem foi utilizada a Escala de Acurácia de Diagnóstico de Enfermagem. Resultados: observou-se que 100% dos estudantes, de ambos os casos, erraram a inferência da nomeação do Diagnóstico de Enfermagem "Desobstrução Ineficaz de Vias Aéreas". Os estudantes do Caso clínico 1 apresentaram uma maior acurácia quando comparados aos do Caso clínico 2. Os estudantes do Caso clínico 2 apresentaram a categoria nula (35,3%), enquanto no Caso clínico 1 essa categoria não existiu. A categoria moderada foi identificada em 72,7% dos estudantes alocados no Caso clínico 2 e em 29,4% daqueles do Caso clínico 1. Além disso, 70,6% dos estudantes do Caso clínico 1 tiveram uma acurácia alta, comparados com 27,3% que vivenciaram o Caso clínico 2. Aqueles que vivenciaram o Caso clínico 1 inferiram uma média de quatro sinais e sintomas, enquanto aqueles que foram inseridos no Caso clínico 2 inferiram uma média de 0,9 sinais e sintomas. Foi possível observar que, à medida que o número de sinais e sintomas referidos aumentou, também aumentou a acurácia diagnóstica e vice-versa. Conclusão: os casos clínicos simulados que utilizam estudos de validação clínica diagnóstica baseados na teoria de duplo processamento facilitam a detecção de pistas, como sinais e sintomas, que são essenciais para proporcionar o raciocínio diagnóstico altamente acurado de estudantes de enfermagem, quando comparados a estudantes inseridos em casos clínicos simulados baseados em um reconhecimento de padrão.

Introduction: this research sought to investigate the accurate exercise of diagnostic reasoning followed by clinical decision-making, based on the double processing theory. General objective: to evaluate the accuracy of the nursing students' diagnostic reasoning when applying an educational technology based on double processing. Specific objectives: to verify the accuracy of nursing students in correctly concluding the absence or presence of the diagnosis of "Ineffective Airway Clearance" in simulated clinical cases; to verify the level of diagnostic accuracy of nursing students for the clinical judgment of the "Ineffective Airway Clearance" in clinical cases simulated by the application of the Nursing Diagnostic Accuracy Scale; correlate the nursing student's identification of the relevance, specificity and coherence of clues, according to the conceptualization of the Nursing Diagnosis Accuracy Scale, with the clinical indicators inserted in the simulated cases. Method: controlled and randomized clinical trial, single-center, random and blind type. The experiment was carried out with 34 nursing students who worked on the nursing diagnosis "Ineffective Airway Clearance" in the simulated clinical cases. Two clinical cases were elaborated: Clinical Case 1 (experimental group), according to a clinical diagnostic validation study, in which accuracy measures were inserted, based on the double processing model; o Clinical case 2 (control group), which was elaborated by a construction-free procedure. To verify the level of diagnostic accuracy of nursing students, the Nursing Diagnostic Accuracy Scale was used. Results: it was observed that 100% of students, in both cases, missed the inference of the name of the Nursing Diagnosis "Ineffective Airway Clearance". Students in Clinical Case 1 were more accurate when compared to those in Clinical Case 2. Students in Clinical Case 2 had a null category (35.3%), whereas in Clinical Case 1 this category did not exist. The moderate category was identified in 72.7% of the students allocated in Clinical Case 2 and in 29.4% of those in Clinical Case 1. In addition, 70.6% of students in Clinical Case 1 had a high accuracy, compared with 27.3% who experienced Clinical Case 2. Those who experienced Case 1 inferred an average of four signs and symptoms, while those who entered Case 2 inferred an average of 0.9 signs and symptoms. It was possible to observe that, as the number of referred signs and symptoms increased, so did the diagnostic accuracy and vice versa. Conclusion: the simulated clinical cases using diagnostic clinical validation studies based on the double- processing theory facilitate the detection of clues, such as signs and symptoms, which are essential to provide highly accurate diagnostic reasoning for nursing students, when compared to inserted students in simulated clinical cases based on pattern recognition.

Relationship between elderly stroke patient caregivers scale and nursing diagnoses.

OBJECTIVE: To describe relationships between the ECPICID-AVC scale factors and the NANDA-I domains, classes, and Nursing Diagnoses (NDs). METHOD: Cross-mapping study between the NANDA-I taxonomy and ECPICID-AVC scale was constructed based on the eight ECPICID-AVC scale factors and the 13 NANDA-I domains. A descriptive analysis was performed to present the mapped elements. RESULTS: Areas of similarity and intersection were found between the eight ECPICID-AVC factors and nine NANDA-I domains, 19 classes, and 72 NDs. All scale factors were mapped with the Domain 1/Health Promotion, Class 2/Health Management and the ND "Frail elderly syndrome". FINAL CONSIDERATIONS: The ECPICID-AVC scale factors were mapped with nine domains, their classes and diagnoses. This study demonstrates the importance of identifying nursing diagnoses and their relationship with factors that evaluate caregiving capacity. The ECPICID-AVC can help nurses generate nursing diagnoses regarding the caregiver's needs and their capacities related to care to focus such needs.

ICNP® Diagnoses of People Living with AIDS, and Empirical Indicators / Diagnósticos de la CIPE® de personas que viven con SIDA e Indicadores Empíricos / Diagnósticos da CIPE® de pessoas vivendo com AIDS e Indicadores Empíricos

ABSTRACT Objective: To analyze the association between the empirical indicators and ICNP® nursing diagnoses in people living with AIDS, as well as to identify the predictive indicators for the establishment of these diagnoses. Method: A cross-sectional study with 120 people living with AIDS, in a hospital in Northeastern Brazil, conducted from August to September 2015, following the steps: identification and validation of Empirical Indicators; preparation and validation of the ICNP® Nursing Diagnoses; and analysis of the association between the Empirical Indicators and the Nursing Diagnoses resulting from the two previous steps. To analyze the data, we used logistic regression. Results: 74 Empirical Indicators were identified, being 31 of which were validated. 55 diagnoses were elaborated and 19 were validated, of which 16 were associated with the Empirical Indicators, identifying 31 predictors. Conclusion: The diagnoses presented significant associations with the Empirical Indicators. In addition, it was observed that the predictive factors of these diagnoses involved the human responses and complications related to the disease, which should be considered during the care provided by the nurse.

RESUMEN Objetivo: Analizar la asociación entre los indicadores empíricos y diagnósticos de enfermería de la CIPE® en personas viviendo con Sida, así como identificar los indicadores predictores para el establecimiento de esos diagnósticos. Método: Estudio transversal con 120 personas viviendo con Sida, en un hospital en el Nordeste de Brasil, realizado de agosto a septiembre de 2015, siguiendo las etapas: identificación y validación de los indicadores empíricos; elaboración y validación de los diagnósticos de enfermería de la CIPE®; y análisis de la asociación entre los indicadores empíricos y los diagnósticos de enfermería resultantes de las dos etapas anteriores. Para el análisis de los datos se utilizó la regresión logística. Resultados: Se identificaron 74 indicadores empíricos, siendo 31 validados. Se elaboraron 55 diagnósticos y 19 fueron validados, de los cuales 16 obtuvieron asociación con los indicadores empíricos, identificándose 31 predicadores. Conclusión: Los diagnósticos presentaron asociaciones significativas con los indicadores empíricos. Además, se observó que los factores predictores de estos diagnósticos involucraron las respuestas humanas y complicaciones relacionadas con la enfermedad, las cuales deben ser consideradas durante la asistencia prestada por el enfermero.

RESUMO Objetivo: Analisar a associação entre os Indicadores Empíricos e Diagnósticos de Enfermagem da CIPE® em pessoas vivendo com AIDS, bem como identificar os indicadores preditores para o estabelecimento desses diagnósticos. Método: Estudo transversal com 120 pessoas vivendo com AIDS, em um hospital no Nordeste do Brasil, realizado de agosto a setembro de 2015, seguindo as etapas: identificação e validação dos Indicadores Empíricos; elaboração e validação dos Diagnósticos de Enfermagem da CIPE®; e análise da associação entre os Indicadores Empíricos e os Diagnósticos de Enfermagem resultantes das duas etapas anteriores. Para análise dos dados, foi utilizada a regressão logística. Resultados: Identificaram-se 74 Indicadores Empíricos, sendo 31 validados. Elaboraram-se 55 diagnósticos e 19 foram validados, dos quais 16 obtiveram associação com os Indicadores Empíricos, identificando-se 31 preditores. Conclusão: Os diagnósticos apresentaram associações significativas com os Indicadores Empíricos. Além disso, observou-se que os fatores preditores desses diagnósticos envolveram as respostas humanas e complicações relacionadas à doença, as quais devem ser consideradas durante a assistência prestada pelo enfermeiro.

ICNP® Diagnoses of People Living with AIDS, and Empirical Indicators.

OBJECTIVE: To analyze the association between the empirical indicators and ICNP® nursing diagnoses in people living with AIDS, as well as to identify the predictive indicators for the establishment of these diagnoses. METHOD: A cross-sectional study with 120 people living with AIDS, in a hospital in Northeastern Brazil, conducted from August to September 2015, following the steps: identification and validation of Empirical Indicators; preparation and validation of the ICNP® Nursing Diagnoses; and analysis of the association between the Empirical Indicators and the Nursing Diagnoses resulting from the two previous steps. To analyze the data, we used logistic regression. RESULTS: 74 Empirical Indicators were identified, being 31 of which were validated. 55 diagnoses were elaborated and 19 were validated, of which 16 were associated with the Empirical Indicators, identifying 31 predictors. CONCLUSION: The diagnoses presented significant associations with the Empirical Indicators. In addition, it was observed that the predictive factors of these diagnoses involved the human responses and complications related to the disease, which should be considered during the care provided by the nurse.

Useful terms for nursing practice in the care of people with leprosy.

OBJECTIVES: To identify useful terms for nursing practice in the care of people with leprosy and to cross-mapp the identified terms with the ICNP® terms. METHOD: A descriptive, documentary study that included publications of the Ministry of Health in the area of leprosy launched between 2002 and 2017. The terms identified in these publications were extracted and underwent a normalization proces and then, were cross-mapped with terms of the ICNP® version 2015 for the identification of constant and non-constant terms in this terminology. RESULTS: In total, were extracted 1,177 terms, of which 26.76% were equal, 4.59% similar, 4.26% were broader, 19.62% were more restricted, and 44.77% were totally different from the ICNP® terms. CONCLUSIONS: The large number of terms identified and not included in the ICNP® show the need for its expansion in order to contemplate the phenomena of clinical practice more effectively and allow better representation of nursing care for people with leprosy.

Nursing diagnoses for institutionalized elderly people based on Henderson's theory.

OBJECTIVE: To develop nursing diagnostic statements for institutionalized elderly people. METHOD: Descriptive study conducted with elderly subjects of a Long Stay Institution through the application of forms for the support of anamnesis and physical examination and a search of medical records. The diagnostic statements were developed based on the International Classification for Nursing Practice and categorized according to the Henderson's theoretical model. RESULTS: Participation of 203 elderly people. A total of 153 nursing diagnoses were developed and distributed as follows: 115 (75.1%) in the Biological/Physiological Component, 14 (9.1%) in the Psychological Component, 21 (13.7%) in the Social Component, and three (1.9%) in the Spiritual/Moral Component. CONCLUSION: The diagnostic statements portray situations of vulnerability to the health of institutionalized elderly that are influenced by biological, psychological, social and cultural factors and require a systematized, individualized and resolutive care for this public.

Useful terms for nursing practice in the care of people with leprosy / Términos útiles a la práctica de enfermería en la atención a personas con lepra / Termos úteis à prática de enfermagem na atenção a pessoas com hanseníase

ABSTRACT Objectives: To identify useful terms for nursing practice in the care of people with leprosy and to cross-mapp the identified terms with the ICNP® terms. Method: A descriptive, documentary study that included publications of the Ministry of Health in the area of leprosy launched between 2002 and 2017. The terms identified in these publications were extracted and underwent a normalization proces and then, were cross-mapped with terms of the ICNP® version 2015 for the identification of constant and non-constant terms in this terminology. Results: In total, were extracted 1,177 terms, of which 26.76% were equal, 4.59% similar, 4.26% were broader, 19.62% were more restricted, and 44.77% were totally different from the ICNP® terms. Conclusions: The large number of terms identified and not included in the ICNP® show the need for its expansion in order to contemplate the phenomena of clinical practice more effectively and allow better representation of nursing care for people with leprosy.

RESUMEN Objetivos: Identificar los términos útiles a la práctica de enfermería en la atención a personas con lepra y realizar mapeo cruzado entre los términos identificados y la CIPE®. Método: Estudio descriptivo, documental, que incluyó publicaciones del Ministerio de Salud en el área de lepra, editadas entre 2002 y 2017. Se realizó la extracción y normalización de términos identificados en esas publicaciones y, a continuación, el mapeo cruzado de estos términos con los de la CIPE® versión 2015 para la identificación de términos constantes y no constantes en esa terminología. Resultados: Se extrajeron 1.177 términos, de los cuales el 26,76% eran iguales, 4,59% similares, 4,26% más amplios, 19,62% más restringidos y 44,77% totalmente diferentes de los términos de la CIPE®. Conclusiones: El gran número de términos identificados y que no constan de la CIPE® evidencia la necesidad de su ampliación para contemplar de modo más efectivo, los fenómenos de la práctica clínica, y permitir mejor representación de la atención de enfermería a personas con lepra.

RESUMO Objetivos: Identificar termos úteis à prática de enfermagem na atenção a pessoas com hanseníase e realizar mapeamento cruzado entre os termos identificados e a CIPE®. Método: Estudo descritivo, documental, que incluiu publicações do Ministério da Saúde na área de hanseníase, editadas entre 2002 e 2017. Realizou-se a extração e normalização de termos identificados nessas publicações e, em seguida, o mapeamento cruzado desses termos com os da CIPE® versão 2015, para identificação de termos constantes e não constantes nessa terminologia. Resultados: Foram extraídos 1.177 termos, dos quais 26,76% eram iguais, 4,59% semelhantes, 4,26% mais amplos, 19,62% mais restritos do que os da CIPE®, e 44,77% totalmente diferentes dos termos daquela terminologia. Conclusões: O grande número de termos identificados e que não constam da CIPE® evidenciam a necessidade de sua ampliação para contemplar os fenômenos da prática clínica de modo mais efetivo, e permitir melhor representação da atenção de enfermagem a pessoas com hanseníase.

Interrupted transport by the emergency medical service in stroke/transitory ischemic attack: A consequence of changed treatment routines in prehospital emergency care.

BACKGROUND: The discovery that not all patients who call for the emergency medical service (EMS) require transport to hospital has changed the structure of prehospital emergency care. Today, the EMS clinician at the scene already distinguishes patients with a time-critical condition such as stroke/transitory ischemic attack (TIA) from patients without. This highlights the importance of the early identification of stroke/TIA. AIM: To describe patients with a final diagnosis of stroke/TIA whose transport to hospital was interrupted either due to a lack of suspicion of the disease by the EMS crew or due to refusal by the patient or a relative/friend. METHODS: Data were obtained from a register in Gothenburg, covering patients hospitalised due to a final diagnosis of stroke/TIA. The inclusion criterion was that patients were assessed by the EMS but were not directly transported to hospital by the EMS. RESULTS: Among all the patients who were assessed by the EMS nurse and subsequently diagnosed with stroke or TIA in 2015, the transport of 34 of 1,310 patients (2.6%) was interrupted. Twenty-five of these patients, of whom 20 had a stroke and five had a TIA, are described in terms of initial symptoms and outcome. The majority had residual symptoms at discharge from hospital. Initial symptoms were vertigo/disturbed balance in 11 of 25 cases. Another three had symptoms perceived as a change in personality and three had a headache. CONCLUSION: From this pilot study, we hypothesise that a fraction of patients with stroke/TIA who call for the EMS have their direct transport to hospital interrupted due to a lack of suspicion of the disease by the EMS nurse at the scene. These patients appear to have more vague symptoms including vertigo and disturbed balance. Instruments to identify these patients at the scene are warranted.

Los ingresos ectópicos y su relación con la aparición de complicaciones y estancias prolongadas / Outlier patient admissions and their relationship with the emergence of clinical complications and prolonged hospital stays

Objetivo: Analizar la relación entre el tipo de ingreso (ectópico y no ectópico) y la aparición de complicaciones clínicas y la estancia media. Métodos: Mediante un estudio epidemiológico retrospectivo de cohorte de pacientes ingresados durante un periodo de 6 meses en el Hospital Complejo Asistencial Universitario de Salamanca se identificaron los pacientes ectópicos y no ectópicos. Se utilizaron las bases de datos del servicio de admisión, el conjunto mínimo básico de datos de hospitalización, el agrupador de pacientes por grupos relacionados por el diagnóstico (GRD) y el analizador estadístico clínico-asistencial ALCOR. El análisis se amplió detallando los resultados para los cinco GRD más frecuentes en el periodo. Resultados: De un total de 11.842 ingresos, el 8,4% fueron ingresos ectópicos. En el estudio global, la estancia media fue mayor en los ectópicos (8,11 días) que en los no ectópicos (7,15 días). La mortalidad también fue superior en los ectópicos, pero aparecieron menos complicaciones (7,6% en ectópicos frente a 8,4% en no ectópicos). El análisis por GRD mantuvo estos resultados en tres de los cinco grupos analizados, con mayor estancia media, pero menos complicaciones, en los casos ectópicos. Conclusiones: Un determinado porcentaje de pacientes ingresaron ectópicos. Fueron más frecuentes los pacientes de especialidades médicas ubicados en plantas quirúrgicas. Estos pacientes ectópicos presentaron una estancia media mayor respecto a los no ectópicos. No hubo diferencias significativas en la aparición de complicaciones

Objective: To analyze the relationship between the type of hospital admission (outlier and non-outlier admissions) and the appearance of clinical complications and the average stay. Methods: From a retrospective epidemiological study of a cohort of patients admitted to the Hospital Complejo Asistencial Universitario de Salamanca (Salamanca, Spain) over a six-month period, outlier and non-outlier patients were identified. This project had access to the admissions department database, the hospital's CMBD (in Spanish, Conjunto Mínimo Básico de Datos) for hospitalisation, the AP-DRG (All Patient-Diagnosis Related Groups) and ALCOR (a clinical-statistics analytics tool). It then proceeded to break down the results by DRG, looking at the five most common DRGs in that period. Results: 8.4% of the total 11,842 admissions were medical outliers. In the overall study, the average stay was longer for outlier patients (8. 11 days) than for other patients (7.15 days). The mortality rate was, likewise, higher for outlier patients, although there was a reduced incidence of complications (7.6% for outlier patients as opposed to 8.4% for others). The analysis by DRG corroborated these results in three of the five cases investigated, showing longer average stays but fewer clinical complications in the case of outlier patients. Conclusions: On admission to hospital, a significant proportion of patients were allocated beds on inappropriate wards (outlier patients). It was more common to find medical patients placed on surgical wards than vice versa. The average stay of outlier patients was longer than that of patients admitted to the correct ward. The study found no significant difference between the two groupś in terms of clinical complication rates

Diagnósticos de enfermagem em idosos internados em unidade cirúrgica / Nursing diagnoses in elderly people admitted in surgical unit / Diagnósticos de enfermería en ancianos ingresados en unidad quirúrgica

Objetivo: identificar os diagnósticos de enfermagem em idosos internados em unidade cirúrgica, determinar a prevalência desses diagnósticos, verificar associação entre os diagnósticos mais prevalentes e as características definidoras/fatores de risco. Métodos: Estudo exploratório-descritivo, transversal, quantitativo, realizado com 38 idosos internados em um hospital universitário do sul do Brasil. A coleta de dados ocorreu por meio da aplicação do histórico de enfermagem. Para análise, utilizou-se a Taxonomia II North American Nursing Diagnosis Classification e o software SPSS versão 21.0. Resultados: Os idosos internados na clínica cirúrgica apresentaram uma média de 3,4 (±1,9) diagnósticos de enfermagem, e os mais prevalentes foram: Risco de Infecção (44,7%); Conhecimento Deficiente (42,1%); Dor (36,8%); e Risco de Quedas (26,3%). Conclusão: Os diagnósticos de enfermagem possibilitam subsidiar o planejamento e a implementação das ações de enfermagem, levando em consideração as especificidades da pessoa idosa

Objective: The study's goal has been to identify nursing diagnoses for elderly patients in surgical units, determine the prevalence of these diagnoses, and verify the association between the most prevalent diagnoses and the defining characteristics/risk factors. Methods: It is a descriptive-exploratory and cross-sectional study with a quantitative approach, which was carried out with 38 elderly patients admitted to a university hospital in the Southern region of Brazil. Data collection was performed by the application of the nursing history. The North American Nursing Diagnosis Classification and the SPSS software version 21.0 were used for analysis. Results: The elderly patients hospitalized in the surgical clinic showed an average of 3.4 (±1.9) nursing diagnoses and the most important were: Risk of Infection (44.7%); Poor Knowledge (42.1%); Pain (36.8%) and, Risk of Fall (26.3%). Conclusion: Nursing diagnoses make it possible to help the planning and implementation of nursing actions, taking into account the specificities of elderly patients

Objetivo: identificar los diagnósticos de enfermería em ancianos ingresados en una unidad quirúrgica, determinar La prevalencia de estos diagnósticos de enfermería y verificar la asociación entre los diagnósticos más prevalentes y las que características definitorias/factores de riesgo. Métodos: Estudio exploratorio-descriptivo, transversal, cuantitativo, efectuado con 38 ancianos ingresados em un hospital universitário del Sur de Brasil. La colecta de los datos ocurrió mediante la aplicación del histórico de enfermería. Para análisis, se utilizo la Taxonomía II North American Nursing Diagnosis Classification y el programa informático SPSS, versión 21.0. Resultados: Los ancianos ingresados em la clínica quirúrgica presentaron um promedio de 3,4 (±1,9) diagnósticos de enfermería, y los más prevalentes fueron: Riesgo de infección (44,7%); Conocimiento Defectuoso (42,1%); Dolor (36,8%) y Riesgo de Caídas (26,3%). Conclusión: Los diagnósticos de enfermería permiten apuntalar la planificación y la implementación de acciones de enfermería, tomando em consideración las peculiaridades de la persona de avanzada edad