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Rev Bras Enferm ; 74(suppl 6): e20201029, 2021.
Artigo em Inglês, Português | MEDLINE | ID: mdl-34495214


OBJECTIVES: to develop an application for a mobile device for the registration of the Nursing Process by nurses of the Mobile Emergency Care Service. METHODS: applied research with technology development based on software engineering and Apple's Human Interface Guidelines. It had the support of an application developer and a designer. The proposal was built in four steps (scope definition, planning, prototype creation and development). RESULTS: the application "Nursing APHMóvel" allows to record the steps of the Nursing Process, such as history, nursing diagnoses, outcomes and interventions with the possibility of storing the data and/or file in printable format. The technological innovation has location features, scales with automatic sum of items, touchscreen, and offline operation. CONCLUSIONS: it was possible to develop the application with the potential for computerized documentation of the Nursing Process by nurses working in the Mobile Emergency Care Service.

Serviços Médicos de Emergência , Aplicativos Móveis , Cuidados de Enfermagem , Processo de Enfermagem , Documentação , Humanos
Rev Esc Enferm USP ; 55: e03775, 2021.
Artigo em Português, Inglês | MEDLINE | ID: mdl-34346970


OBJECTIVE: To know the nursing team work process in Children and Adolescents Psychosocial Care Centers in a city of the state of São Paulo. METHOD: This is a qualitative, descriptive, and exploratory study, based on the approach of historical and dialectical materialism, carried out with the nursing team through participant observation and semi-structured interviews. RESULTS: Eleven subjects from the nursing team participated in the study. The nursing team work process emerges from the dialectical tension of two categories: the non-knowledge, based on the alienation of the nursing work process and subordination to the knowledge of the multidisciplinary team, and the knowledge based on the nursing clinic outlined within the biological and relational perspectives. CONCLUSION: The nursing team work process takes place when guided by a non-knowledge resulting from alienation due to the knowledge of the other, and by knowledge through the implementation of the Nursing Process through the Nursing Care Systematization based on a biological perspective, considering relational and administrative aspects, which emerges as a contradiction.

Cuidados de Enfermagem , Processo de Enfermagem , Reabilitação Psiquiátrica , Adolescente , Criança , Humanos , Equipe de Enfermagem
Rev Bras Enferm ; 74(3): e20201355, 2021.
Artigo em Inglês, Português | MEDLINE | ID: mdl-34320097


OBJECTIVES: to propose quality indicators for clinical nursing documentation. METHODS: methodological study in which literature review guided the composition of an instrument for evaluating nursing documentation. Two independent professionals evaluated 204 medical records of adult patients. The analysis of this assessment generated quality indicators for clinical nursing documentation. Inter-rater agreement was analyzed by Cohen's kappa. RESULTS: the bibliographic review, analysis by experts and pre-test resulted in 88 evaluation items distributed in seven topics; in 88.5% of the items, inter-rater agreement between strong and almost perfect (k=0.61-1.0) was observed. Analysis of the evaluations generated a global indicator and seven partial indicators of documentation quality. Compliance in the two services ranged between 62.3% and 93.4%. The global indicator showed a 2.1% difference between services. CONCLUSIONS: seven quality indicators of clinical nursing documentation and their method of application in hospital records have been proposed.

Cuidados de Enfermagem , Processo de Enfermagem , Adulto , Documentação , Humanos , Registros Médicos , Indicadores de Qualidade em Assistência à Saúde
Rev Esc Enferm USP ; 55: e03766, 2021.
Artigo em Português, Inglês | MEDLINE | ID: mdl-34259756


To analyze the implications of the Nursing Care Systematization in Brazilian professional practice. Theoretical and reflective study, which listed as analytical categories the regulatory framework of systematization, the implications for professional practice, the limits and possibilities. In the legal frameworks, an evolution of understanding about Systematization was identified, which resulted in an update in the resolution that deals with the theme. It is emphasized that the implications for professional practice can be elucidated when the concepts, method, personnel and instruments are better understood, the three pillars of systematization, since they do not have conceptual and operational definitions in the current resolution. The lack of conceptual clarity about the term, as well as the lack of conceptual and operational definitions of its pillars and constituent elements, have made the understanding of the Nursing Care Systematization difficult, impacting the perception of its contribution to professional practice, since it is not rarely used as a synonym for the Nursing Process. The production of knowledge about Systematization must consider its limits and possibilities. Thus, contributing to the demarcation of the production of knowledge that is representative of this epistemological object.

Cuidados de Enfermagem , Processo de Enfermagem , Brasil , Humanos , Conhecimento , Prática Profissional
Rev Esc Enferm USP ; 55: e03711, 2021.
Artigo em Inglês, Português | MEDLINE | ID: mdl-34190880


OBJECTIVE: To implement the nursing process, based on the Neuman Systems Model and the International Classification of Nursing Practice terminology, in the care of an adolescent who underwent corrective surgery for juvenile idiopathic scoliosis. METHOD: This is a qualitative study of the type of single case, with triangulation of data collection techniques (formal clinical interview, notes in a field diary and medical record information), developed with a 17-year-old adolescent and indication for corrective surgery. The empirical materials generated with the interviews carried out at admission and at discharge, observation and medical record information were treated with categorical content analysis. RESULTS: The categories of personal condition, anxiety, selfconcept, meaningful people, facilitating health resources, school, free time and leisure were recurrent. Diagnoses were defined with a focus on Anxiety, Knowledge on pain management (control) and Willingness (or readiness) to learn, associating them with the respective nursing interventions. CONCLUSION: The Model contributed to assess and recognize surgery stressors for the adolescent and to theoretically base the nursing process. The classification allowed systematizing nursing care records, elements of clinical practice, unifying vocabulary and codes.

Processo de Enfermagem , Escoliose , Terminologia Padronizada em Enfermagem , Adolescente , Humanos , Registros de Enfermagem , Enfermagem Perioperatória , Escoliose/cirurgia
Notas enferm. (Córdoba) ; 20(37): 5-14, jun. 2021.
Artigo em Espanhol | LILACS, BDENF - Enfermagem, BINACIS, UNISALUD | ID: biblio-1283101


Introducción: el Síndrome Respiratorio Agudo Severo Coronavirus 2 es el agente causal de la COVID-19, una enfermedad emergente pandémica que requiere cuidados de enfermería basados en el proceso de enfermería desde el autocuidado. Objetivo: Aplicar el proceso de enfermería desde la perspectiva teórica del autocuidado a un adulto mayor con diagnóstico de diabetes tipo 2 hospitalizado por complicaciones de la COVID-19. Métodos: estudio de caso con Proceso de Enfermería a adulto mayor con COVID-19, para valoración se utilizó una cédula basada en conceptos de la Teoría General del Déficit de autocuidado de Orem, escala de ansiedad de Halminton y escala de riesgo de caídas, para la deducción diagnóstica, resultados e intervenciones se utilizó la taxonomía NANDA 2018-2020, clasificación de Resultados NOC, guías de práctica clínica y la clasificación de intervenciones NIC, respectivamente. Resultados: se identificaron 8 diagnósticos de enfermería, de los cuales, 4 son reales, 3 de riesgo, 1 de promoción a la salud. Se elaboraron 8 planes de cuidados con enfoque de educación para la salud e intervenciones con criterios de resultados del NOc e intervenciones de enfermería basadas en NIC y 4 Guías de práctica clínica sobre las respuestas humanas prioritarias; deterioro del intercambio de gases, diarrea, ansiedad y riesgo de glicemia inestable. Conclusiones: el Proceso de Enfermería vinculado con la teoría de Dorothea Orem permitió mejorar las prácticas de autocuidado y por consiguiente el autocontrol de la enfermedad respiratoria y metabólica en el adulto mayor[AU]

introduction: the Severe Acute Respiratory Syndrome Coronavirus 2 is the causal agent of COVID-19, an emerging pandemic disease that requires nursing care based on the nursing process from self-care. Objective: to apply the nursing process from the theoretical perspective of self-care to an older adult diagnosed with type 2 diabetes hospitalized for complications of COVID-19. Methods: case study with the Nursing Process of an elderly person with COVID-19, for assessment a card based on concepts of the General Theory of Deficit of Orem's self-care deficit, Halminton anxiety scale and risk of falls scale was used. For the diagnostic deduction, results and interventions, the 2018-2020NANDA taxonomy, NOC Results classification, clinical practice guidelines and the NIC intervention classification were used, respectively. Results: Eight nursing diagnoses were identified, of which 4 are real, 3 of risk, 1 of health promotion. 8 care plans were developed with a focus on health education and interventions with NOCresults criteria and NIC-based nursing interventions and 4 clinical practice guidelines on priority human responses; impaired gas exchange, diarrhea, anxiety and risk of unstable blood glucose. Conclusions: the Nursing Process linked to Dorothea Orem's theory allowed to improve self-care practices and consequently the self-control of respiratory and metabolic disease in the elderly[AU]

a Síndrome Respiratória Aguda Grave Coronavírus 2 é o agente causal da COVID-19, uma doença pandêmica emergente que requer cuidados de enfermagem baseados no processo de enfermagem a partir do autocuidado. Objetivo: aplicar o processo de enfermagem na perspectiva teórica do autocuidado a um idoso com diagnóstico de diabetes tipo 2 internado por complicações do COVID-19. Métodos: estudo de caso com o Processo de Enfermagem de uma pessoa idosa com COVID-19, para avaliação de uma ficha baseada nos conceitos da Teoria Geral do Déficit do Déficit de Autocuidado de Orem, Escala de Ansiedade Halminton e Escala de Risco de Quedas. Dedução diagnóstica, resultados e intervenções, a taxonomia NANDA2018-2020, classificação de resultados NOC, diretrizes de prática clínica e a classificação de intervenção NIC foram usados, respectivamente. Resultados: foram identificados 8 diagnósticos de enfermagem, sendo 4 reais, 3 de risco, 1 de promoção da saúde. 8 planos de cuidados foram desenvolvidos com foco em educação em saúde e intervenções com critérios de resultados NIC e intervenções de enfermagem baseadas em NIC e 4 diretrizes de prática clínica em respostas humanas prioritárias; alteração das trocas gasosas, diarreia, ansiedade e risco de glicose sanguínea instável. Conclusões: o Processo de Enfermagem atrelado à teoria de Dorothea Orem permitiu aprimorar as práticas de autocuidado e consequentemente o autocontrole das doenças respiratórias e metabólicas em idosos[AU]

Humanos , Idoso , Idoso de 80 Anos ou mais , Ansiedade , Autocuidado , Diagnóstico de Enfermagem , Síndrome Respiratória Aguda Grave , Diabetes Mellitus Tipo 2 , COVID-19 , Cuidados de Enfermagem , Processo de Enfermagem , Relatos de Casos
Enferm. foco (Brasília) ; 12(1): 111-117, jun. 2021.
Artigo em Português | LILACS, BDENF - Enfermagem | ID: biblio-1255229


Objetivo: descrever o desenvolvimento do processo de enfermagem nas dimensões psíquicas e emocionais dos pacientes em um hospital geral. Metodologia: pesquisa exploratória de abordagem qualitativa com participação de nove enfermeiros de um hospital de Curitiba, Paraná, em 2018. Os dados foram coletados por entrevista semiestruturada e submetidos à Análise de Conteúdo. Utilizou-se como matriz analítica as fases do Processo de Enfermagem descritas na Resolução 358/2009 do Conselho Federal de Enfermagem. Resultados: os participantes descreveram a observação, percepção, busca ativa em prontuários, comunicação como estratégias para a coleta de dados de enfermagem; demonstraram dificuldades em utilizar os diagnósticos de enfermagem, planejar e implementar cuidados específicos na dimensão psicossocial. Foram enfatizados os cuidados colaborativos junto à equipe multiprofissional. Afirmaram que algumas avaliações de enfermagem foram prejudicadas devido ao tempo reduzido de permanência dos pacientes nos serviços. Conclusões: o desenvolvimento do Processo de Enfermagem com foco nas dimensões psíquicas e emocionais em hospital geral é um desafio para a Enfermagem. As instituições de saúde devem investir em educação permanente a fim de capacitar a equipe de enfermagem para o cuidado de qualidade. (AU)

Objective: to describe the development of the nursing process in the psychic and emotional dimensions of patients in a general hospital. Methodology: exploratory and qualitative research with the participation of nine nurses from a hospital in Curitiba, Paraná, Brazil, in 2018. Data were collected through semi-structured interviews and submitted to Content Analysis. The phases of the Nursing Process described in Resolution 358/2009 of the Federal Nursing Council were used as an analytical matrix. Results: the participants described the observation, perception, active search in medical records, communication as strategies for collecting nursing data; demonstrated difficulties in using nursing diagnoses, planning and implementing specific care in the psychosocial dimension. Collaborative care with the multiprofessional team was emphasized. They stated that some nursing evaluations were impaired due to the reduced time spent by patients in the services. Conclusions: the development of the nursing process with a focus on the psychological and emotional dimensions in a general hospital is a challenge for nursing. Health institutions should invest in permanent education to train the nursing staff for quality care. (AU)

Objetivo: describir el desarrollo del proceso de enfermería en las dimensiones psíquicas y emocionales de los pacientes en un hospital general. Metodología: investigación exploratoria con un enfoque cualitativo con la participación de nueve enfermeras de un hospital en Curitiba, Paraná, Brasil, en 2018. Los datos se recopilaron a través de entrevistas semiestructuradas y se sometieron a Análisis de Contenido. Las fases del Proceso de Enfermería descritas en la Resolución 358/2009 del Consejo Federal de Enfermería se utilizaron como una matriz analítica. Resultados: los participantes describieron la observación, la percepción, la búsqueda activa en los registros médicos, la comunicación como estrategias para recopilar datos de enfermería; demostró dificultades en el uso de diagnósticos de enfermería, planificación e implementación de cuidados específicos en la dimensión psicosocial. Se enfatizó la atención colaborativa con el equipo multiprofesional. Afirmaron que algunas evaluaciones de enfermería se vieron perjudicadas debido al tiempo reducido que los pacientes pasaron en los servicios. Conclusiones: el desarrollo del proceso de enfermería con un enfoque en las dimensiones psicológicas y emocionales en un hospital general es un desafío para la enfermería. Las instituciones de salud deben invertir en educación permanente para capacitar al personal de enfermería para una atención de calidad. (AU)

Enfermagem , Prática Profissional , Hospitais Gerais , Processo de Enfermagem
Enferm. foco (Brasília) ; 12(1): 139-146, jun. 2021. tab, ilus
Artigo em Português | LILACS, BDENF - Enfermagem | ID: biblio-1255352


Objetivo: Identificar competências para o fortalecimento do ensino-aprendizagem da consulta de enfermagem considerando o cuidado integral. Método: Revisão integrativa de artigos publicados em português, inglês ou espanhol, nos últimos dez anos, nas bases: LILACS, MEDLINE, BDENF, PubMed, Web of Science, SCOPUS, EMBASE e CINHAL, utilizando a seguinte questão norteadora: Quais competências permeiam o ensino-aprendizagem da consulta de enfermagem, considerando a integralidade do cuidado? Resultados: A busca resultou em 95 estudos, após a aplicação dos critérios de inclusão e exclusão foram selecionados e analisados 10 artigos. Foram elencadas e discutidas as seguintes competências: comprometimento do educador na busca de conhecimento, aproximação teórico-prática, estímulo à reflexão, prioridade à prática, incentivo à pesquisa, apropriação da situação apresentada pelo usuário, ética e humanização, execução do ouvir, envolver o paciente no planejamento do cuidado e, apropriação da sistematização da assistência de enfermagem. Conclusões: Esta revisão integrativa elencou dez competências para o fortalecimento da consulta de enfermagem, enfatizando o processo de formação do enfermeiro para a prática do cuidado integral na atenção primária à saúde. Ressalta-se a necessidade de mais estudos voltados para a formação do enfermeiro nesta temática. (AU)

Objective: To identify competencies to strengthen the teaching of nursing consultation considering integral care. Method: Integrative review of articles published in Portuguese, English or Spanish, in the last ten years, based on: LILACS, MEDLINE, BDENF, PubMed, Web of Science, SCOPUS, EMBASE and CINHAL, using the following guiding question: Which competencies permeate the teaching-learning of nursing consultation, considering the integrality of care? Results: The search resulted in 95 studies, after applying the inclusion and exclusion criteria 10 articles were selected and analyzed. The following competences were listed and discussed: the educator's commitment in the search for knowledge, theoretical-practical approach, encouragement to reflection, priority to practice, incentive to research, appropriation of the situation presented by the user, ethics and humanization, execution of listening, involving the in planning care and appropriating the systematization of nursing care. Conclusions: This integrative review listed ten competencies for strengthening nursing consultation, emphasizing the process of training nurses to practice comprehensive care in primary health care. It is emphasized the need for more studies focused on the training of nurses in this theme. (AU)

Objetivo: identificar competencias para fortalecer la enseñanza de la consulta de enfermería considerando la atención integral. Método: Revisión integral de artículos publicados en portugués, inglés o español, en los últimos diez años, basados en: LILACS, MEDLINE, BDENF, PubMed, Web of Science, SCOPUS, EMBASE y CINHAL, utilizando la siguiente pregunta orientadora: ¿Qué competencias impregnan el enseñanza-aprendizaje de la consulta de enfermería, considerando la integralidad de la atención? Resultados: La búsqueda resultó en 95 estudios, luego de aplicar los criterios de inclusión y exclusión, se seleccionaron y analizaron 10 artículos. Se enumeraron y discutieron las siguientes competencias: el compromiso del educador en la búsqueda de conocimiento, enfoque teórico-práctico, estímulo a la reflexión, prioridad a la práctica, incentivo a la investigación, apropiación de la situación presentada por el usuario, ética y humanización, ejecución de la escucha, involucrando el en la planificación de la atención y la apropiación de la sistematización de la atención de enfermería. Conclusiones: Esta revisión integradora enumeró diez competencias para fortalecer la consulta de enfermería, enfatizando el proceso de capacitación de enfermeras para practicar la atención integral en atención primaria de salud. Se enfatiza la necesidad de más estudios enfocados en la capacitación de enfermeras en este tema. (AU)

Educação em Enfermagem , Atenção Primária à Saúde , Enfermagem , Integralidade em Saúde , Processo de Enfermagem
Enferm. foco (Brasília) ; 12(1): 168-173, jun. 2021.
Artigo em Português | LILACS, BDENF - Enfermagem | ID: biblio-1280807


Objetivo: Analisar os pilares da Sistematização da Assistência de Enfermagem e seus elementos constituintes. Método: Estudo teórico-reflexivo, que estabeleceu como categorias analíticas Método, Pessoal, Instrumentos. Resultados: Se decompôs cada pilar estruturante da Sistematização, o que permitiu identificar seus elementos constituintes, e ampliou-se a compreensão do que é Sistematização da Assistência de Enfermagem, considerando-a como fenômeno distinto do Processo de Enfermagem. Conclusão: Descortinaram-se os elementos que compõem cada pilar da Sistematização da Assistência de Enfermagem, permitindo melhor entendimento quando se discute a organização do trabalho profissional a partir desta, bem como, ampliou-se a compreensão do termo, conceitual e operacionalmente. (AU)

Objective: To analyze the pillars of the Nursing Care Systematization and its constituent elements. Method: Theoretical-reflective study, which established as analytical categories Method, Personnel, Instruments. Results: Each structuring pillar of the Systematization was decomposed, which allowed the identification of its constituent elements, and the understanding of what is Systematization of Nursing Care was expanded, considering it as a distinct phenomenon of the Nursing Process. Conclusion: The elements that make up each pillar of the Systematization of Nursing Assistance were revealed, allowing a better understanding when discussing the organization of professional work from it, as well as the understanding of the term, conceptually and operationally, was expanded. (AU)

Objetivo: Analizar los pilares de la Sistematización del Cuidado de Enfermería y sus elementos constitutivos. Método: Estudio teórico-reflexivo, que establece como categorías analíticas Método, Personal, Instrumentos. Resultados: se descompuso cada pilar estructurador de la Sistematización, lo que permitió la identificación de sus elementos constitutivos, y se amplió la comprensión de lo que es la Sistematización de la Atención de Enfermería, considerándolo como un fenómeno distinto del Proceso de Enfermería. Conclusión: se revelaron los elementos que componen cada pilar de la Sistematización de la Asistencia de Enfermería, lo que permitió una mejor comprensión al analizar la organización del trabajo profesional a partir de ella, así como la comprensión del término, conceptual y operativamente, se amplió. (AU)

Processo de Enfermagem , Teoria de Enfermagem , Protocolos , Recursos Humanos , Terminologia Padronizada em Enfermagem
Rev Esc Enferm USP ; 55: e03717, 2021.
Artigo em Inglês, Português | MEDLINE | ID: mdl-34037201


OBJECTIVE: To identify the steps of the Nursing Process and integral care. METHOD: Document analysis study on medical and nursing consultations records during postpartum conducted in primary health units in inland São Paulo state. The analysis comprised the registered steps, the sequence of steps, and the approach of psychosocial questions. The data are presented by frequency, percentage, and the expressed content of care. RESULTS: The analyzed records amounted to 341. Out of these, 100% presented History; 62.2%, Nursing Diagnosis; 5.3%, Planning; 99.1%, Implementation; and 50.1%, Evaluation. Regarding the sequence of steps, 47.5% of the medical records presented three steps. In the incorporation of the principle of integrality, a more frequent presence of the biological approach was observed. CONCLUSION: This study shows the change of practice of nurses, with efforts to register the Nursing Process, and that the integrality of care constitutes a challenge to surpass a model of care which is fragmented and decontextualized from the life conditions of people.

Processo de Enfermagem , Feminino , Humanos , Período Pós-Parto , Atenção Primária à Saúde , Encaminhamento e Consulta
Comput Methods Programs Biomed ; 207: 106128, 2021 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-34015737


BACKGROUND AND OBJECTIVES: The nursing assessment in the psychiatric department differ from those used in other departments considerably. We developed a psychiatric knowledge-based clinical decision support system (Psy-KBCDSS), which may aid nurses in solving patients' problems in the psychiatric department. In addition, we compared the sensitivity and specificity for the nursing diagnoses between the psychiatric nursing process system (Psy-NPS) and Psy-KBCDSS to determine that the Psy-KBCDSS can assist nurses in performing the nursing assessment and diagnosis. METHODS: Visual Studio 2019 was adopted as the primary software development tool, and C# as the main development language. The concept of the nursing process was applied to develop the Psy-KBCDSS user interface. We developed a clinical diagnostic validity inference engine to calculate the frequencies of the nursing assessment items and nursing diagnoses in clinical tasks in the Psy-NPS for generating a knowledge-based database of the Psy-KBCDSS. The sensitivity and specificity for nursing diagnoses formulated by senior and junior nurses were used to determining the effectiveness of adopting Psy-NPS and Psy-KBCDSS. RESULTS: This study include 22 nursing diagnoses commonly encountered in psychiatric wards. The top eight most common diagnoses in the Psy-NPS and Psy-KBCDSS were altered thought processes, ineffective coping, sensory and perceptual alterations, insomnia, risk for other-directed violence, anxiety, impaired social interaction, and risk for suicide. Compared with the Psy-NPS, the Psy-KBCDSS had significantly higher sensitivity for sensory and perceptual alterations, ineffective coping, and insomnia and significantly higher specificity for ineffective coping. CONCLUSIONS: Considering its high sensitivity and specificity for various nursing diagnoses, the Psy-KBCDSS, as an empirical patient-oriented nursing clinical decision-making support system, can assist nurses in clinical nursing tasks including nursing process-based patient assessment and nursing diagnosis.

Sistemas de Apoio a Decisões Clínicas , Processo de Enfermagem , Enfermagem Psiquiátrica , Suicídio , Humanos , Diagnóstico de Enfermagem
Online braz. j. nurs. (Online) ; 20: e20216478, 05 maio 2021. ilus, tab
Artigo em Inglês, Espanhol, Português | LILACS, BDENF - Enfermagem | ID: biblio-1223159


OBJETIVO: Identificar os vídeos do YouTube sobre o Processo de Enfermagem como temática de ensino no contexto nacional. MÉTODO: Estudo descritivo-exploratório, quanti-qualitativo, realizado com vídeos do YouTube em novembro de 2019, no qual identificou-se, principalmente, a data da postagem e total de visualizações, autor, categoria do vídeo, participante e conteúdo. RESULTADOS: Dentre os 23 vídeos da amostra final, foram identificados vídeos no período de 2016 a 2019, com predomínio do ano de 2018 (10; 43,9%), profissionais de enfermagem (17; 65,3%) na qualidade de participante, e definição de Processo de Enfermagem (12, 27,2%) como conteúdo abordado. DISCUSSÃO: A facilidade de acesso, a existência de sites de compartilhamento de vídeos, a importância do Processo de Enfermagem e o desenvolvimento de parcerias entre organizações de ensino e de saúde potencializam a construção de ferramentas audiovisuais. CONCLUSÃO: os vídeos explanam o conceito do Processo de Enfermagem e suas etapas e apresentam o conteúdo mediante uma exposição dialogada.

OBJECTIVE: To identify YouTube videos on the Nursing Process as a teaching theme in the national context. METHOD: A descriptive-exploratory and quanti-qualitative study, carried out with YouTube videos in November 2019, in which the main data identified were posting date and total views, author, video category, participant and content. RESULTS: Among the 23 videos in the final sample, videos were identified in the period from 2016 to 2019, with predominance of the year 2018 (10; 43.9%), nursing professionals (17; 65.3%) as participants, and definition of the Nursing Process (12, 27.2%) as the content addressed. DISCUSSION: Ease of access, existence of video sharing websites, the importance of the Nursing Process, and the development of partnerships between teaching and health organizations enhance the construction of audiovisual tools. CONCLUSION: The videos explain the concept of the Nursing Process and its stages and display the content through dialogical exposition.

OBJETIVO: Identificar los videos de YouTube sobre el Proceso de Enfermería como tema de enseñanza en el contexto nacional. MÉTODO: Estudio descriptivo-exploratorio cuantitativo y cualitativo, realizado con videos de YouTube en noviembre de 2019, en el cual se identificó fecha de publicación y visualizaciones totales, autor, categoría del video, participante y contenido. RESULTADOS: Entre los 23 videos de la muestra final, se identificaron videos en el período de 2016 a 2019, con predominio del año 2018 (10; 43,9%), profesionales de enfermería (17; 65,3%) como participantes, y definición del Proceso de Enfermería (12, 27,2%) como contenido abordado. DISCUSIÓN: La facilidad de acceso, la existencia de sitios para compartir videos, la importancia del Proceso de Enfermería y el desarrollo de alianzas entre organizaciones docentes y de salud potencian la construcción de herramientas audiovisuales. CONCLUSIÓN: los videos explican el concepto del Proceso de Enfermería y sus etapas y presentan el contenido a través de una exposición dialógica.

Filme e Vídeo Educativo , Educação em Enfermagem , Webcasts como Assunto , Processo de Enfermagem
Rev Lat Am Enfermagem ; 29: e3426, 2021.
Artigo em Inglês, Português, Espanhol | MEDLINE | ID: mdl-34037121


OBJECTIVE: to compare the quality of the Nursing process documentation in two versions of a clinical decision support system. METHOD: a quantitative and quasi-experimental study of the before-and-after type. The instrument used to measure the quality of the records was the Brazilian version of the Quality of Diagnoses, Interventions and Outcomes, which has four domains and a maximum score of 58 points. A total of 81 records were evaluated in version I (pre-intervention), as well as 58 records in version II (post-intervention), and the scores obtained in the two applications were compared. The interventions consisted of planning, pilot implementation of version II of the system, training and monitoring of users. The data were analyzed in the R software, using descriptive and inferential statistics. RESULTS: the mean obtained at the pre-intervention moment was 38.24 and, after the intervention, 46.35 points. There was evidence of statistical difference between the means of the pre- and post-intervention groups, since the p-value was below 0.001 in the four domains evaluated. CONCLUSION: the quality of the documentation of the Nursing process in version II of the system was superior to version I. The efficacy of the system and the effectiveness of the interventions were verified. This study can contribute to the quality of documentation, care management, visibility of nursing actions and patient safety.

Sistemas de Apoio a Decisões Clínicas , Processo de Enfermagem , Brasil , Documentação , Humanos , Registros de Enfermagem , Planejamento de Assistência ao Paciente
Rev Bras Enferm ; 74(suppl 1): e20200703, 2021.
Artigo em Inglês, Português | MEDLINE | ID: mdl-34037164


OBJECTIVE: to build a term database relevant to nursing practice in the context of COVID-19 infections. METHODS: this is a methodological, documentary study, carried out from March to June 2020 at ICNP®/ Universidade Federal da Paraíba center, considered a reference for research and dissemination of ICNP® in Brazil. The findings were collected in databases and analyzed using the PorOnto tool, the consensus technique and the mapping of terms with ICNP®, version 2019/2020. RESULTS: 1,134 relevant terms were identified in literature. When submitted to the mapping technique with the terms of ICNP® Seven Axis Model, it resulted in 531 constant terms and 603 nonconstant terms in this classification. FINAL CONSIDERATIONS: It is proven that nursing practice terms, even in a specific context, are present in the literature and are representative in ICNP®, which will enable the future development of a terminological subset in the context of coronavirus infections.

COVID-19 , Processo de Enfermagem/classificação , Enfermagem/classificação , Terminologia como Assunto , Brasil , Humanos , Pandemias , SARS-CoV-2 , Terminologia Padronizada em Enfermagem
Rev Bras Enferm ; 74(suppl 4): e20190844, 2021.
Artigo em Inglês, Português | MEDLINE | ID: mdl-33909807


OBJECTIVE: To estimate the content validity of the nursing diagnostic Breathing Pattern, Ineffective, in children with congenital heart defects. METHOD: Methodological study in two stages: 1) integrative literature review; 2) content validation, with 23 nurses. An instrument with 10 related factors and 21 defining characteristics for data collection was used. The analysis by the evaluators was carried out using the relevance criteria. The Content Validity Index was used. Valid results were those above 0.9 with a Wilcoxon test above 0.05. RESULTS: The final proposal incorporates nine from the ten causal factors. From them, five do not belong in the NANDA-I list. Regarding the defining characteristics, they were all considered to be relevant, and five are not among the list of signs and symptoms of the NANDA-I taxonomy. CONCLUSION: The findings of this study include specific elements of the pediatric population with congenital heart defect which are not present in the structure of the diagnostic being studied.

Cardiopatias Congênitas/diagnóstico , Diagnóstico de Enfermagem/normas , Processo de Enfermagem/normas , Transtornos Respiratórios/diagnóstico , Respiração , Criança , Humanos , Pesquisa em Enfermagem , Reprodutibilidade dos Testes
J. nurs. health ; 11(2): 2111220246, abr.2021.
Artigo em Português | LILACS, BDENF - Enfermagem | ID: biblio-1282021


Objetivo: conhecer estratégias que facilitam e dificultam a implementação da Sistematização da Assistência de Enfermagem na Atenção Primária à Saúde. Método: revisão integrativa na Scientific Electronic Library Online e Biblioteca Virtual em Saúde, artigos publicados de 2015 a 2019, descritores em português e inglês: Enfermeiras e Enfermeiros, Atenção Primária à Saúde, Processo de Enfermagem. Realizou-se análise de conteúdo segundo técnica de Bardin. Resultados: 10 artigos analisados e duas categorias temáticas emergidas: "Dificuldades para implementação da Sistematização da Assistência de Enfermagem na Atenção Básica" versando sobre fatores que influenciam negativamente na aplicação do processo de enfermagem; e "Facilidades para implementação da Sistematização da Assistência de Enfermagem na Atenção Básica" abordando viabilidades no que se refere a organização/planejamento da equipe de enfermagem para tal conduta. Conclusão: há extrema relevância da implementação da Sistematização da Assistência de Enfermagem na Atenção Primária à Saúde, pois, promove melhor assistência ao usuário e autonomia do(a) enfermeiro(a).(AU)

Objective: to know strategies that facilitate and hinder the implementation of the Systematization of Nursing Care in Primary Health Care. Method: integrative review in Scientific Electronic Library Online and Virtual Health Library, articles published from 2015 to 2019, descriptors in Portuguese and English: Nurses, Primary Health Care, Nursing Process. Content analysis was performed according to Bardin's technique. Results: 10 articles analyzed and two thematic categories emerged: "Difficulties in implementing the Systematization of Nursing Care in Primary Care" dealing with factors that negatively influence the application of the nursing process; and "Facilities for the implementation of the Systematization of Nursing Care in Primary Care" addressing feasibility regarding the organization/planning of the nursing team for such conduct. Conclusion: the implementation of the Systematization of Nursing Care in Primary Health Care is extremely relevant, as it promotes better user assistance and nurses' autonomy.(AU)

Objetivo: conocer estrategias que faciliten y dificulten la implementación de la Sistematización de la Atención de Enfermería en Atención Primaria de Salud. Método: revisión integradora en Scientific Electronic Library Online y Biblioteca Virtual en Salud, artículos publicados de 2015 a 2019, descriptores en portugués e inglés: Enfermeras y Enfermeros, Atención Primaria de Salud, Proceso de Enfermería. El análisis de contenido se realizó según Bardin. Resultados: se analizaron 10 artículos y emergieron dos categorías temáticas: "Dificultades en la implementación de la Sistematización de la Atención de Enfermería en Atención Primaria"; y "Instalaciones para la implementación de la Sistematización de la Atención de Enfermería en Atención Primaria" abordando la viabilidad en cuanto a la organización/planificación del equipo de enfermería para dicha conducta. Conclusión: la implementación de la Sistematización de Enfermería en la Atención Primaria es de suma relevancia, ya que promueve una mejor atención al usuario y la autonomía del enfermero.(AU)

Atenção Primária à Saúde , Enfermeiras e Enfermeiros , Processo de Enfermagem
Nurse Educ Today ; 99: 104759, 2021 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-33540350


BACKGROUND: Physical assessment skills are taught in pre-registration nursing programs to equip nurses with the competencies to provide holistic nursing care. However, only a fraction of the skills they acquired during training are routinely performed in clinical practice thus highlighting a disconnect between learning and practicing. OBJECTIVE: To better understand the issues surrounding the teaching and practice of physical assessment skills among nurses as described in the literature. DESIGN: A systematic review based on the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines was used. REVIEW METHOD: A search of databases including PubMed, EMBASE, CINAHL and Scopus was conducted from January 1970 to December 2019. Two independent researchers performed the methodological quality assessment using the Joanna Briggs Institute's Critical Appraisal Checklists. Twenty-one papers, including two qualitative studies, 17 quantitative studies and two mixed methods study, were selected in this review. Data were synthesised narratively. RESULTS: The review identified six overarching themes: (1) role ambiguity, (2) reliance on technology, (3) collegial support and culture, (4) practice variations across specialties, (5) a lack of confidence and knowledge, and (6) over-teaching using biomedical model. CONCLUSION: This review identified the need to improve the teaching of the physical assessment skills. There is also a need to evaluate the physical assessment content taught within nursing curricula, with emphasis on depth rather than breadth of skills. The ability to interpret physical assessment observations and develop clinical judgement need to be incorporated into the curriculum. To aid in the development of an effective care plan, the physical assessment framework should move away from a biomedical framework to include nursing models such as nursing process and clinical reasoning model. This revised framework can be used in future studies in the development and testing of teaching and evaluation tools for physical assessment skills.

Educação em Enfermagem , Processo de Enfermagem , Currículo , Humanos , Aprendizagem , Exame Físico
Gac. sanit. (Barc., Ed. impr.) ; 35(1): 42-47, ene.-feb. 2021. tab
Artigo em Inglês | IBECS | ID: ibc-202094


OBJECTIVE: This study explores nurses' perspectives on how the financial crisis and austerity measures introduced in the Spanish Health System affected their ability to provide care in these new circumstances. METHOD: Cross-sectional observational study. In 2013, during an international annual congress in Spain, 123 nurses out of a total of 350 attendees completed a 14-item open-ended response questionnaire to examine the perceived impact of the financial crisis and austerity measures on quality of services and their experiences at work. RESULTS: 84% of the sample were women and the mean age of the respondents was 40 (standard deviation: 11.13). Seventy-seven percent of the nurses reported austerity measures introduced in their workplace. The nurses voiced strong disagreement with austerity measures (86%), due to the negative repercussions on nurses' working conditions (47%), a decrease in human resources (37%), negative effects such as work overload (37%); a perceived deterioration in the quality of healthcare (77%) and pharmaceutical services (86%); and worsening conditions in access to health services by vulnerable populations (43%), leading to ethical dilemmas in clinical practice (26%). CONCLUSION: This study showed that nurses participating in this study overwhelmingly opposed austerity measures imposed on the National Health System as a response to the financial crisis, which had a negative effect both on nurses' working conditions and on the quality of health services. Institutional measures to improve recruitment and retention of nurses including policies for preventing stress and burnout, a decrease of patient-nurse ratio, and greater work stability should be considered

OBJETIVO: Explorar la perspectiva de las enfermeras sobre cómo la crisis financiera y las medidas de austeridad en el Sistema Nacional de Salud afectan al cuidado que prestan en España. MÉTODO: Estudio observacional transversal. Durante un congreso internacional anual celebrado en España en 2013, 123 enfermeras de un total de 350 asistentes completaron un cuestionario compuesto por 14 ítems de respuesta abierta, para examinar las consecuencias percibidas de la crisis financiera y las medidas de austeridad en la provisión de los cuidados. RESULTADOS: El 84% de la muestra eran mujeres con una media de edad de 40 años (desviación estándar: 11,13). El 77% reportó medidas de austeridad en su lugar de trabajo y el 86% mostró un fuerte desacuerdo con las medidas de austeridad debido al descenso en los recursos humanos (37%), la sobrecarga de trabajo (37%) y el deterioro de sus condiciones de trabajo (47%), de la calidad de los servicios de salud (77%) y farmacéuticos (86%), y del acceso a los servicios de salud de las poblaciones vulnerables (43%), que lleva a dilemas éticos en la práctica clínica (26%). CONCLUSIÓN: Las enfermeras que participaron en este estudio se oponían de manera abrumadora a las medidas de austeridad impuestas al Sistema Nacional de Salud como respuesta a la crisis financiera, que han tenido efecto negativo tanto en sus condiciones de trabajo como en la calidad de los servicios. Se necesitan medidas institucionales para mejorar el reclutamiento y la retención de enfermeras, incluidas políticas para prevenir el estrés y el agotamiento, una disminución de la relación paciente-enfermera y una mayor estabilidad laboral

Humanos , Feminino , Adulto , Processo de Enfermagem/economia , Custos de Cuidados de Saúde , Percepção , Sistemas Nacionais de Saúde/economia , Serviços de Saúde/economia , Pessoal de Saúde/economia , Espanha , Estudos Transversais , Inquéritos e Questionários , Relações Enfermeiro-Paciente
Pflege ; 34(2): 92-102, 2021 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-33535840


Effects of Guided Clinical Reasoning on the Advanced Nursing Process quality - An experimental intervention study Abstract. Background: The correctly applied Advanced Nursing Process leads demonstrably to more accurate nursing diagnoses and better nursing outcomes. It requires nurses' knowledge, clinical decision-making competency, and a positive attitude. Former Guided Clinical Reasoning (GCR) trainings significantly enhanced the Advanced Nursing Process quality. However, the congruence between nursing records, care situations, and patient interviews was not yet investigated. Research question: Which effects has GCR on nurses' knowledge, attitude, clinical performance, and on the quality of the Advanced Nursing Process? Methods: An experimental intervention study was carried out from 2016 until 2018 in a Swiss hospital. The 5-month intervention contained four seminar days and GCR-case meetings and was investigated by an evaluation model (n = 95 nurses, n = 24 patients, n = 225 nursing records). Results: After GCR training, nurses showed greater knowledge (p < 0,0001) and a more positive attitude (p = 0,004) on the Advanced Nursing Process than the control group. The congruence of nursing diagnoses, interventions, and outcomes between observations, interviews, and nursing records was higher in the intervention group. At the last measurement point, nursing diagnoses were stated significantly more accurate, interventions were more effective, and better patient outcomes were achieved (all p < 0,0005). Conclusions: GCR trainings should be used to enhance the Advanced Nursing Process quality, so that based on more accurate nursing diagnoses better patient outcomes are achieved.

Prática Avançada de Enfermagem , Raciocínio Clínico , Processo de Enfermagem , Humanos , Diagnóstico de Enfermagem , Pesquisa em Avaliação de Enfermagem , Registros de Enfermagem