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1.
Artigo em Inglês | MEDLINE | ID: mdl-34770020

RESUMO

This study aimed to identify the terminologies of NANDA-I, NOC, NIC, and NNN linkages that have been used for nursing home (NH) residents. This study used a retrospective descriptive design. Data accrued from 57 registered nurses (RNs) in 25 Korean NHs. The RNs randomly selected one resident and assessed for applied NANDA-I, NOC, and NIC from the previous 7 days by reviewing nursing charts and records. Finally, the data of 57 residents in 25 NHs were collected. Results: We identified seven NNN linkages: risk for falls-fall prevention behavior-fall prevention; self-care deficit: bathing/hygiene-self-care: activities of daily living (ADL)-self-care assistance: bathing/hygiene; impaired memory-memory-cognitive stimulation; chronic confusion-neurological status: consciousness-medication management; chronic confusion-memory-medication management; impaired walking-mobility-exercise promotion: strength training; and impaired walking-ambulation-exercise promotion: strength training. The identified core NANDA-I, NOC, NIC, and NNN linkages for NH residents from this study provide a scope of practice of RNs working in NHs.


Assuntos
Terminologia Padronizada em Enfermagem , Atividades Cotidianas , Humanos , Diagnóstico de Enfermagem , Casas de Saúde , República da Coreia , Estudos Retrospectivos
2.
Rev Esc Enferm USP ; 55: e20210271, 2021.
Artigo em Inglês, Português | MEDLINE | ID: mdl-34673879

RESUMO

OBJECTIVE: to build a specialized nursing terminology for the prevention of falls in the elderly in primary healthcare, based on the ICNP®. METHOD: this is a methodological study developed in two stages: (1) identification of relevant terms for the prevention of falls in the elderly in official documents; (2) cross mapping of the identified terms with the terms contained in the ICNP® Seven-Axis Model, version 2019/2020. RESULTS: a total of 13,408 terms was extracted from official documents, which were submitted to manual screening, resulting in the inclusion of 391 relevant terms. Cross mapping revealed 283 constant terms (67.8% with level of equivalence 1; 32.2% with level of equivalence 2) and 108 non-constant terms (88.9% with level of equivalence 5; 6.5% with level of equivalence 4; 4.6% with level of equivalence 3). In the set of constant terms, the terms of the Focus (43.1%), Action (26.1%), and Means (13.1%) axes stood out; in non-constant terms there was a predominance of the Focus (38.0%), Means (23.1%), and Judgment (15.7%) axes. CONCLUSION: we obtained a specialized nursing terminology that will support the development of nursing diagnoses, outcomes, and interventions to contribute to the prevention of falls in the elderly in primary healthcare.


Assuntos
Terminologia Padronizada em Enfermagem , Idoso , Humanos , Programas de Rastreamento , Diagnóstico de Enfermagem , Atenção Primária à Saúde
3.
Int J Med Inform ; 154: 104544, 2021 10.
Artigo em Inglês | MEDLINE | ID: mdl-34474310

RESUMO

BACKGROUND: The use of standardised terminologies for electronic health records (EHRs) is important and a sufficient coverage of all aspects of health care is increasingly being developed worldwide. The International Classification of Functioning, Disabilities and Health (ICF) is suggested as a unifying terminology suitable in a multi-professional EHR, but the level of representation of nursing content is unclear. OBJECTIVES: The aim was to describe lexical and semantic accordance in relation to comprehensiveness and granularity of concepts between the International Classification of Nursing Practise (ICNP) and the ICF. METHODS: 806 pre-coordinated concepts for diagnoses and outcomes in the ICNP terminology were manually mapped to 1516 concepts on level 4-6 in the ICF. RESULTS: Several dimensions of nursing diagnoses and outcomes in the ICNP were missing in the ICF. 60% of the concepts for diagnosis and outcome in the ICNP could not be stated using the ICF while another 31% could only be matched either as a subordinate or as a superordinate concept. CONCLUSIONS: The lexical and semantic accordance in relation to comprehensiveness and granularity between concepts in the ICNP and ICF was rather low. A large proportion of concepts for diagnoses and outcomes in the ICNP could not be satisfactorily stated using the ICF. Standardised terminologies rooted in a nursing tradition (e.g., the ICNP) is needed for communication and documentation in health care to represent the patient's health situation as well as professional diagnostic decisions and evaluations in nursing.


Assuntos
Pessoas com Deficiência , Terminologia Padronizada em Enfermagem , Documentação , Registros Eletrônicos de Saúde , Humanos , Diagnóstico de Enfermagem
4.
Online braz. j. nurs. (Online) ; 20(supl.1): e20216512, 09 setembro 2021. tab, ilus
Artigo em Inglês, Espanhol, Português | LILACS, BDENF - Enfermagem | ID: biblio-1291344

RESUMO

OBJETIVO: Construir Diagnósticos/Resultados e Intervenções de Enfermagem utilizando a Classificação Internacional para a Prática de Enfermagem em pacientes com infecção por coronavírus. MÉTODO: Estudo exploratório, descritivo, do tipo documental retrospectivo, desenvolvido em unidades de pronto atendimento do município de João Pessoa -Paraíba. A amostra foi composta por 187 prontuários e a coleta de dados foi realizada entre junho e agosto de 2020. A análise dos dados ocorreu por meio de estatística descritiva, média, amplitude e desvio padrão. RESULTADO: Foram identificados 12 Diagnósticos/Resultados de Enfermagem (Dispneia, Febre, Tosse, Dor Muscular, Dor na cabeça, Diarreia, Olfato prejudicado, Paladar prejudicado, Falta de apetite, Deglutição, prejudicada, Dor notórax e Vômito) e 36 Intervenções de Enfermagem direcionadas aos pacientes acometidos por coronavírus. CONCLUSÃO: A identificação de Diagnósticos/Resultados e Intervenções de Enfermagem se faz indispensável para subsidiar a assistência, sobretudo no cenário atual da pandemia do COVID-19, contribuindo com a operacionalização do Processo de Enfermagem.


OBJECTIVE: To elaborate Nursing Diagnoses/Outcomes and Interventions using the International Classification for Nursing Practice in patients with coronavirus infection. METHOD: An exploratory, descriptive, retrospective and documentary study, developed in emergency care units in the municipality of João Pessoa -Paraíba. The sample consisted of 187 medical records and data collection was carried out between June and August 2020. Data analysis was performed using descriptive statistics, mean, range and standard deviation. RESULT: A total of 12 Nursing Diagnoses/Outcomes (Dyspnea, Fever, Cough, Muscle Pain, Headache, Diarrhea, Impaired Smell, Impaired Taste, Lack of Appetite, Impaired Swallowing, Chest Pain and Vomiting) and 36 Nursing Interventions targeted at patients affected by coronavirus were identified. CONCLUSION: The identification of Nursing Diagnoses/Outcomes and Interventions is indispensable to support care, especially in the current scenario of the COVID-19 pandemic, contributing to the operationalization ofthe Nursing Process.


OBJETIVO: Elaborar diagnósticos/resultados e intervenciones de enfermería utilizando la Clasificación Internacional para la práctica de enfermería en pacientes con infección por coronavirus. MÉTODO: Estudio exploratorio, descriptivo, del tipo documental retrospectivo, desarrollado en unidades de emergencia de la ciudad de João Pessoa, Paraíba. La muestra estuvo conformada por 187 historias clínicas y la recolección de datos se realizó entre junio y agosto de 2020. El análisis de los datos se realizó mediante estadística descriptiva, media, amplitud y desviación estándar. RESULTADOS: Se identificaron 12 Diagnósticos /Resultados de Enfermería (Disnea, Fiebre, Tos, Dolor Muscular, Dolor de Cabeza, Diarrea, Deterioro del sentido del Olfato, Deterioro del sentidodel Gusto, Falta de Apetito, Deterioro de la deglución, Dolor Torácico y Vómitos) y 36 Intervenciones de Enfermería dirigidas a pacientes afectados por coronavirus. CONCLUSIÓN: Identificar Diagnósticos/Resultados e Intervenciones de Enfermería es fundamental para la atención, especialmente en el escenario actual de la pandemia de COVID-19, dado que contribuye a la operacionalización del Proceso de Enfermería.


Assuntos
Humanos , Masculino , Feminino , Diagnóstico de Enfermagem , Terminologia Padronizada em Enfermagem , COVID-19/classificação , COVID-19/enfermagem , Estudos Retrospectivos , Morbidade , Cuidados de Enfermagem , Processo de Enfermagem
5.
Rev Esc Enferm USP ; 55: e20200502, 2021.
Artigo em Inglês, Português | MEDLINE | ID: mdl-34415007

RESUMO

OBJECTIVE: To develop a proposal of a terminological subset of the International Classification for Nursing Practice for burned patients. METHOD: This is a methodological study following the steps: identification of clinical findings; mapping of terms; construction of statements of diagnoses/results and nursing interventions; content validation of statements; and structuring of the subset with the theoretical model of Basic Human Needs. Content validation was performed by 26 specialist nurses, through the Content Validity Index, with statements ≥ 0.80 being considered validated. RESULTS: A total of 36 diagnoses/results and 119 interventions were validated. Among these, the ones with the highest index were: Respiratory System Function, Impaired/Respiratory System Function, Effective; Volume of Fluids, Impaired/Volume of Fluids, Effective; Burn Wound/Wound Healing, Effective; Pain, Acute/Pain, Absent, and as interventions: To Monitor Vital Signs; to Monitor Fluid Balance; to Treat Skin Condition; to Assess Response to Pain Management (Control). CONCLUSION: The validated statements depict the burned people basic human needs, with the psychobiological ones being the most prevalent.


Assuntos
Queimaduras , Terminologia Padronizada em Enfermagem , Queimaduras/terapia , Humanos , Modelos Teóricos , Dor , Manejo da Dor
6.
Rev Esc Enferm USP ; 55: e20200396, 2021.
Artigo em Inglês, Português | MEDLINE | ID: mdl-34423801

RESUMO

OBJECTIVE: To develop and validate Nursing Diagnoses statements of the International Classification for Nursing Practice (ICNP®) aimed at the care of people with chronic kidney conditions undergoing conservative treatment. METHOD: This is a methodological research structured in sequenced construction stages, cross-mapping, content validation by the Delphi Technique by specialist nurses, and categorization of Nursing Diagnoses. RESULTS: Forty-two specialist nurses participated in the first round and 34 in the second. A total of 179 Nursing Diagnoses statements were prepared, categorized according to Roy's adaptation model, of which 160 were validated for content, with Content Validity Index ≥ 0.80. CONCLUSION: The Diagnoses developed and validated show the modes of adaptation to health of people with chronic kidney conditions undergoing conservative treatment, influenced by biological, psychological, social, and cultural needs, with the Physiological Mode being the most prevalent.


Assuntos
Diagnóstico de Enfermagem , Terminologia Padronizada em Enfermagem , Tratamento Conservador , Humanos , Rim
7.
Rev Esc Enferm USP ; 55: e20200499, 2021.
Artigo em Inglês, Português | MEDLINE | ID: mdl-34423806

RESUMO

OBJECTIVE: To develop and validate a terminological subset of the International Classification for Nursing Practice for COVID-19 patients in critical care. METHOD: This is a methodological study, which followed the guidelines of the Brazilian method, using the Basic Human Needs as a theoretical model. Content validation was performed by 25 specialist nurses using the Delphi technique. RESULTS: A total of 73 diagnoses and their respective nursing results were prepared. Of these, 62 statements had a Content Validity Index ≥ 0.80, with the need for oxygenation having the highest number of statements. Of the 210 nursing interventions developed, and after suggestions from experts, 150 interventions reached an index ≥ 0.80 and comprised the terminological subset. CONCLUSION: The terminological subset developed showed statements that were validated by specialist nurses and, therefore, are relevant to the nurse's clinic in the critical care scenario associated with Covid-19.


Assuntos
COVID-19 , Terminologia Padronizada em Enfermagem , Brasil , Humanos , Diagnóstico de Enfermagem , SARS-CoV-2
8.
Rev Esc Enferm USP ; 55: e03750, 2021.
Artigo em Português, Inglês | MEDLINE | ID: mdl-34346966

RESUMO

OBJECTIVE: To construct nursing diagnosis statements of the International Classification for Nursing Practice (ICNP®) for the spinal cord rehabilitation specialty based on the Callista Roy Adaptation Model. METHOD: Descriptive study developed in sequential steps of identification and cross-mapping of terms relevant to care with the health priority, construction and cross-mapping of nursing diagnosis statements based on the ICNP®, and categorization of diagnoses according to adaptive modes. RESULTS: Ninety-two statements of nursing diagnoses were developed, of which 66 were classified in the Physiological Mode, 12 in Functional Role Mode, 10 in Self-Concept Mode and four in Interdependence Mode. CONCLUSION: The nursing diagnoses developed portray focuses of attention for nursing care to people with spinal cord injury in rehabilitation and contribute to the direction of nursing care actions in a systematic, individualized and resolutive way.


Assuntos
Cuidados de Enfermagem , Traumatismos da Medula Espinal , Terminologia Padronizada em Enfermagem , Humanos , Diagnóstico de Enfermagem , Vocabulário Controlado
9.
Jpn J Nurs Sci ; 18(4): e12439, 2021 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-34196489

RESUMO

Although nursing terminologies and classifications represent nursing knowledge across diverse clinical areas, end-of-life care seems under represented in many aspects of these instruments. NANDA- I is an international nursing diagnostic classification widely used in nursing education and research. This taxonomy is based on seven axes, including the axis of time. In this commentary we bring discussion to the need to update nursing terminology by including the term end-of-life in the time axis of NANDA-I. After describing the epidemiologic aspects of end-of-life care and discussing the relevant nursing role, we discuss patients' and family's human responses towards the end-of-life time and circumstance, which are central to defining nursing diagnoses. End-of-life care is one priority in health care, and nursing diagnoses should represent that situation as well. This paper focuses on a specific and international nursing diagnosis classification, NANDA-I, which lacks an end-of-life component to its time axis for defining labels of nursing diagnoses. Attending to the importance of classifications in clinical reasoning, nursing diagnoses could better represent responses towards this health condition, opening new opportunities for increasing nursing roles in clinical practice, and also for new studies aiming to validate nursing diagnoses, and promoting an evidence-based practice by including end-of-life in the axis time.


Assuntos
Terminologia Padronizada em Enfermagem , Morte , Humanos , Diagnóstico de Enfermagem
10.
Int J Med Inform ; 153: 104534, 2021 09.
Artigo em Inglês | MEDLINE | ID: mdl-34332469

RESUMO

INTRODUCTION: The Clinical Care Classification (CCC) system is one of the standard nursing terminologies recognized by the American Nurses Association, developed to describe nursing care through electronic documentation in different healthcare settings. The translation of the CCC system into languages other than English is useful to promote its widespread use in different countries and to provide the standard nursing data necessary for interoperable health information exchange. The aim of this study was to translate the CCC system from English to Italian and to test its clinical validity. METHODS: A translation with cross-cultural adaptation was performed in four phases: forward-translation, back-translation, review, and dissemination. Subsequently a pilot cross-mapping study between nursing activities in free-text nursing documentation and the CCC interventions was conducted. RESULTS: All elements of the CCC system were translated into Italian. Semantic and conceptual equivalences were achieved. Altogether 77.8% of the nursing activities were mapped into CCC interventions. CONCLUSIONS: The CCC system, and its integration into electronic health records, has the potential to support Italian nurses in describing and providing outcomes and costs of their care in different healthcare settings. Future studies are needed to strengthen the impact of the CCC system on clinical practice.


Assuntos
Comparação Transcultural , Terminologia Padronizada em Enfermagem , Documentação , Registros Eletrônicos de Saúde , Humanos , Semântica
11.
Rev Bras Enferm ; 74Suppl 2(Suppl 2): e20200628, 2021.
Artigo em Inglês, Português | MEDLINE | ID: mdl-34287499

RESUMO

OBJECTIVE: to clinically validate the nursing diagnosis of NANDA-I Frail Elderly Syndrome in hospitalized elderly. METHOD: a methodological study, guided by the STROBE instrument, composed of 40 elderly people admitted to a teaching hospital in Paraíba, Brazil. The last phase of Hoskins' Nursing Diagnostic Validation Model: clinical validation was adopted. Data collection took place from August to December 2018. The data were analyzed using univariate descriptive statistics. It was approved by the hospital's ethics and research committee. RESULTS: nine defining characteristics were validated; seven risk factors; six populations at risk and two associated conditions. CONCLUSION: the validation of the nursing diagnosis of the Frail Elderly Syndrome in our socio-cultural context was considered appropriate, being an important step for critical thinking that underlies the decision-making of nurses in the care of the frail elderly, as well as professional practice.


Assuntos
Diagnóstico de Enfermagem , Terminologia Padronizada em Enfermagem , Idoso , Brasil , Idoso Fragilizado , Humanos , Fatores de Risco
12.
Rev. enferm. UFPE on line ; 15(2): [1-13], jul. 2021. ilus, tab
Artigo em Português | BDENF - Enfermagem | ID: biblio-1282542

RESUMO

Objetivo: avaliar o posicionamento de pacientes ortopédicos, segundo a Nursing Outcomes Classification. Método: estudo quantitativo, descritivo, longitudinal, realizado em hospital brasileiro, com 20 pacientes ortopédicos, submetidos à artroplastia total de quadril, que foram acompanhados por até quatro dias de pós-operatório. Realizou-se a avaliação de quatro indicadores do Resultado da Nursing Outcomes Classification - Posicionamento do Corpo: autoiniciado (0203), por meio da escala Likert de cinco pontos e, para a análise, empregaram-se os testes t de Student, Equações Estimativas Generalizadas e Post Hoc de Bonferroni. Resultados: realizaram-se 76 avaliações e a média do resultado Posicionamento do Corpo: autoiniciado (0203), na primeira avaliação, foi de 2.01±0.25 pontos (muito comprometido). Alcançou-se, na última, por este resultado, média de 4.73±0.08 (levemente comprometido), p<0.001. Conclusão: demonstrou-se melhora progressiva no posicionamento de pacientes ortopédicos. Evidenciou-se a NOC como ferramenta clinicamente útil para avaliação dos resultados de pacientes, durante a implementação do Processo de Enfermagem, na prática clínica.(AU)


Objective: to evaluate the positioning of orthopedic patients using to the Nursing Outcomes Classification. Method: a quantitative, descriptive, longitudinal study was performed in a Brazilian hospital, with 20 orthopedic patients who underwent total hip arthroplasty, followed up for up to four postoperative days. Four indicators of the nursing outcome Body Positioning: self-initiated (0203) from the Nursing Outcome Classification were assessed using the five-point Likert scale. For the analysis, Student's t-tests, Generalized Estimation Equations and Bonferroni's Post Hoc tests were used. Results: 76 evaluations were performed and the mean score of Body Positioning: self-initiated (0203), in the first evaluation, was 2.01 ± 0.25 points (substantially compromised). In the last evaluation, the mean score was 4.73 ± 0.08 (mildly compromised), p <0.001. Conclusion: a progressive improvement in the positioning of orthopedic patients was found. It is concluded that NOC is a clinically useful tool for evaluating the patients' outcomes during the implementation of the nursing process in clinical practice.(AU)


Objetivo: evaluar el posicionamiento de los pacientes ortopédicos, según la Clasificación de Resultados de Enfermería. Método: estudio cuantitativo, descriptivo, longitudinal, realizado en un hospital brasileño, con 20 pacientes ortopédicos sometidos a artroplastia total de cadera, que fueron seguidos hasta cuatro días después de la cirugía. Se evaluaron cuatro indicadores del Resultado Posicionamiento Corporal: autoiniciado (0203) de la Clasificación de Resultados de Enfermería, mediante la escala Likert de cinco puntos y, para el análisis, la prueba t de Student, Ecuaciones de Estimación Generalizadas y Post Hoc de Bonferroni. Resultados: Se realizaron 76 evaluaciones y la media del resultado Posicionamiento corporal: autoiniciado (0203), en la primera evaluación, fue de 2,01 ± 0,25 puntos (muy comprometido). En el último, para este resultado se alcanzó un promedio de 4.73 ± 0.08 (levemente comprometido), p <0.001. Conclusión: hubo una mejora progresiva en el posicionamiento de los pacientes ortopédicos. La NOC se evidenció como una herramienta clínicamente útil para evaluar los resultados de los pacientes durante la implementación del Proceso de Enfermería en la práctica clínica.(AU)


Assuntos
Humanos , Masculino , Feminino , Avaliação de Resultados em Cuidados de Saúde , Enfermagem Ortopédica , Artroplastia de Quadril , Posicionamento do Paciente , Terminologia Padronizada em Enfermagem , Cuidados de Enfermagem , Processo de Enfermagem , Epidemiologia Descritiva , Estudos Longitudinais
13.
Am J Nurs ; 121(7): 13, 2021 07 01.
Artigo em Inglês | MEDLINE | ID: mdl-34156358
14.
Rev Esc Enferm USP ; 55: e0327, 2021.
Artigo em Inglês, Português | MEDLINE | ID: mdl-34161440

RESUMO

OBJECTIVE: To measure the average time spent by the nursing team in transferring patients; to compare the activities observed during the performance of this intervention with those described by the Nursing Interventions Classification and to investigate the intensity of its influence on the workload. METHOD: Observational study using timekeeping software conducted in two hospitals in the northwest region of the State of São Paulo. 200 patient transfers were monitored by the team using two validated instruments. RESULTS: The average time spent by nurses on transfers ranged from 9.3 (standard deviation = 3.5) to 12.2 (standard deviation = 2.5) minutes and by assistants/ technicians between 7.1 (standard deviation = 2,8) and 11.0 (standard deviation = 2.2) minutes. 63 transfers made by nurses and 87 by assistants/technicians were considered qualified (>70% of the score). The team expended 19.3 to 29% of the working day time in this intervention. CONCLUSION: The transfer of patients has an impact on the workload of the team and needs to be considered in the measurement of nursing activities for the calculation and distribution of personnel to improve the quality and continuity of care.


Assuntos
Recursos Humanos de Enfermagem no Hospital , Terminologia Padronizada em Enfermagem , Unidades Hospitalares , Hospitais , Humanos , Equipe de Enfermagem , Carga de Trabalho
15.
Rev Esc Enferm USP ; 55: e03711, 2021.
Artigo em Inglês, Português | MEDLINE | ID: mdl-34190880

RESUMO

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.


Assuntos
Processo de Enfermagem , Escoliose , Terminologia Padronizada em Enfermagem , Adolescente , Humanos , Registros de Enfermagem , Enfermagem Perioperatória , Escoliose/cirurgia
16.
Enferm. foco (Brasília) ; 12(1): 168-173, jun. 2021.
Artigo em Português | LILACS, BDENF - Enfermagem | ID: biblio-1280807

RESUMO

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)


Assuntos
Processo de Enfermagem , Teoria de Enfermagem , Protocolos , Recursos Humanos , Terminologia Padronizada em Enfermagem
17.
Semina cienc. biol. saude ; 42(2): 187-200, jun./dez. 2021. Tab
Artigo em Português | LILACS | ID: biblio-1293122

RESUMO

Introdução: os sistemas de classificação com linguagens padronizadas se estabelecem em um conjunto de conhecimentos estruturados, conceitos fundados de forma lógica e coerente, com base em suas similaridades. Nesse sentido, identificar um perfil junto a populações pode cooperar para uma melhor definição e compreensão situacional para aquela unidade e/ou pacientes. Objetivos: realizar mapeamento cruzado entre os diagnósticos de enfermagem da NANDA-I com os registros manuais de enfermagem em sala de recuperação pós-anestésica; e propor intervenções e resultados, segundo linguagens padronizadas. Método: estudo exploratório, retrospectivo com análise estatística descritiva de registros de enfermagem de 187 pacientes que estiveram hospitalizados no período de junho a julho de 2018, em sala de recuperação pós-anestésica de um hospital oncológico. O mapeamento cruzado foi realizado em três etapas: identificação dos indicadores dos diagnósticos; proposição de intervenções e atividades; e indicadores de resultados. Os dados foram analisados e descritos em frequências absoluta e relativa. Resultados: dos 13 domínios da NANDA-I, cinco foram representados; identificaram-se cinco diagnósticos de risco e 11 com foco no problema; observou-se 100% de frequência para os diagnósticos de: Risco de aspiração; Risco de infecção; Risco de queda; Capacidade de transferência prejudicada; Mobilidade no leito prejudicada; Integridade da pele/tissular prejudicada e Conforto prejudicado. Conclusões: para os 16 diagnósticos de enfermagem mapeados, foram selecionadas 22 intervenções e 58 atividades; 23 resultados e 48 indicadores de resultados.


Introduction: the classification systems with standardized languages are established in a set of structured knowledge, concepts founded in a logical and coherent way, based on their similarities. In this sense, identifying a profile with the populations can cooperate for a better definition and situational understanding for that unit and/or patients. Objectives: to perform cross-mapping between the nursing diagnoses of NANDA-I with the manual nursing records in the post-anesthetic recovery room; and, to propose interventions and outcomes, according to standardized language. Method: exploratory, descriptive and retrospective analysis of the nursing records of 187 patients hospitalized from June to July 2018, in the post-anesthetic recovery room of an oncology hospital. Cross-mapping was carried out in three stages: identification of diagnostic indicators; proposition of interventions and activities; and outcomes indicators. The data were analyzed and described in absolute and relative frequencies. Results: of the 13 NANDA-I domains, five were highlighted; were identified five risk diagnoses and 11 focused on the problem; 100% frequency was observed for the diagnoses of: Aspiration, infection and falling risk; Impaired transfer capacity; Impaired bed mobility; Impaired skin/tissue integrity and impaired comfort. Conclusions: from the 16 nursing diagnoses mapped, were selected 22 interventions and 58 activities; 23 results and 48 outcomes indicators.


Assuntos
Humanos , Registros de Enfermagem , Enfermagem em Pós-Anestésico , Terminologia Padronizada em Enfermagem , Anestesia
18.
Nurs Open ; 8(6): 3495-3515, 2021 11.
Artigo em Inglês | MEDLINE | ID: mdl-33955188

RESUMO

AIM: Validate a manual of care plans for people hospitalized for coronavirus disease, COVID-19. DESIGN: Validation study with a mixed-method design. METHODS: Design and validation of a care plans manual for people hospitalized by COVID-19. Care plans used standardized languages: NANDA-I, Nursing Outcomes Classification (NOC) and Nursing Intervention Classification (NIC). The design included external and internal validation with quantitative and qualitative analysis. Data collection was between March and June 2020. The study methods were compliant with the Good Reporting of a Mixed Methods Study (GRAMMS) checklist. RESULTS: The manual integrated 24 NANDA-I diagnoses, 34 NOC and 47 NIC different criteria. It was validated by experts of Scientific-Technical Commission, who recommended linking the diagnoses to an assessment. The internal validation validated 17 of 24 diagnoses, 56 of 65 NOC and 86 of the 104 NIC. During the discussion group, 6 new diagnoses proposed were validated and the non-validated diagnoses were linked to the baseline condition of the person.


Assuntos
COVID-19 , Terminologia Padronizada em Enfermagem , Lista de Checagem , Humanos , Diagnóstico de Enfermagem , SARS-CoV-2
19.
Rev Bras Enferm ; 74(2): e20200115, 2021.
Artigo em Inglês, Português | MEDLINE | ID: mdl-33950114

RESUMO

OBJECTIVES: to identify and confirm the priority nursing diagnosis of International Classification for Nursing Practice® for home nursing consultation to adults in Primary Health Care. METHODS: qualitative study, of methodological and validation type. The 5-point Likert scale was used, with a minimum Content Validity Index of 80% consensus among judges., considering the answers "priority" or "very priority" for the list of nursing diagnoses presented. 23 expert judges participated in this survey. RESULTS: a hundred and eleven nursing diagnoses of prepared statements lists have been grouped by human systems and sociodemographic characteristics. were grouped by human systems and sociodemographic characteristics. Eighty-three of them (74.77%) had a Content Validity Index equal or higher to 0.8; and 27 (32.5%) had an index of 1.0 (100%) among judges. CONCLUSIONS: nursing diagnosis validated can be used to assist clients in home nursing consultations in Primary Health Care.


Assuntos
Diagnóstico de Enfermagem , Terminologia Padronizada em Enfermagem , Adulto , Visita Domiciliar , Humanos , Encaminhamento e Consulta , Inquéritos e Questionários
20.
Rev Bras Enferm ; 74(suppl 1): e20200703, 2021.
Artigo em Inglês, Português | MEDLINE | ID: mdl-34037164

RESUMO

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.


Assuntos
COVID-19 , Processo de Enfermagem/classificação , Enfermagem/classificação , Terminologia como Assunto , Brasil , Humanos , Pandemias , SARS-CoV-2 , Terminologia Padronizada em Enfermagem
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