Decreasing length of limb immobilisation following nonelective transfemoral percutaneous coronary intervention: A randomised clinical trial.

AIMS AND OBJECTIVES: To assess the intensity and frequency of pain, use of analgesic drugs, and the incidence of paraesthesia, urinary retention and vascular complications upon decreasing affected limb immobilisation from 4-2 hrs after sheath removal in patients submitted to transfemoral percutaneous coronary intervention (PCI). BACKGROUND: After sheath removal from the femoral artery following urgent or emergency PCI, patients are maintained with limb immobilisation for a mean period of 4 hr. DESIGN: Randomised clinical trial (RCT) based on the CONSORT guidelines. METHOD: Randomised clinical trial was performed in patients with Acute Coronary Syndrome submitted to transfemoral PCI. The intervention group was submitted to a supine position with the head of the bed elevated (30-degree angle) with affected limb immobilisation for 2 hr after sheath removal and the control group for 4 hrs. The outcomes were pain complaints, need for analgesic drugs, incidence of paraesthesia, urinary retention and vascular complications. The outcomes were assessed immediately, 6, 12 and 24 hr after release from limb immobilisation before the patients were released from bed rest. RESULTS: A total of 150 patients (75 in each group) participated in the study. No significant differences in outcomes were observed between the groups, except in relation to the haematoma formation that was higher in the intervention group. CONCLUSION: A reduced length of limb immobilisation after sheath removal following PCI does not change the frequency and intensity of pain, need of analgesic drugs, urinary retention and paraesthesia. The incidence of haematoma was higher in the intervention group, without significant clinical manifestations. RELEVANCE TO CLINICAL PRACTICE: The results of this study can be considered for patients submitted to elective, urgent or emergency PCI, who have a lower risk of complications, thereby allowing for decreased periods of limb immobilisation.

Predictive Factors of Anxiety and Depression in Patients with Acute Coronary Syndrome.

OBJECTIVE: To identify the predictive factors of anxiety and depression in patients with acute coronary syndrome. METHODS: Cross-sectional and retrospective study conducted with 120 patients hospitalized with acute coronary syndrome. Factors interfering with anxiety and depression were assessed. RESULTS: Anxiety was related to sex, stress, years of education, and depression, while depression was related to sex, diabetes mellitus, obesity, years of education, and trait-anxiety. CONCLUSIONS: Obesity and anxiety were considered predictive factors for depression, while depression and fewer years of education were considered predictive factors for anxiety.

Anxiety, stress and depression in family members of patients with heart failure.

OBJECTIVE: Identifying the level of anxiety, stress and depression symptoms in family members of patients with heart failure; identifying the relationship between these feelings with sociodemographic and clinical variables. METHOD: A cross-sectional study carried out with 100 family members. Depression, anxiety, and stress were evaluated by the Beck Depression and Anxiety Inventories and the Perceived Stress Scale - 10. The relationship between feelings and variables was performed through the t-test, Mann-Whitney or Kruskal-Wallis. RESULTS: Mean depression was 8.24, anxiety was 77.95, and stress was 17.43. The correlation coefficient between depression and anxiety and depression and stress was 0.53, and it was 0.66 between anxiety and stress. Females (p=0.002, p=0.031), smoking (p=0.05, p=0.011) and sedentary lifestyle (p=0.023, p=0.001) were related to anxiety and stress, respectively. Family income lower than five minimum wages (p=0.012) was related to depression, and regular/poor self-perceived health status related to the three feelings. CONCLUSION: Family members did not present high levels of these feelings. The scales were directly correlated with each one another and some variables were related to stress, anxiety and depression. OBJETIVO: Identificar o nível de ansiedade, estresse e sintomas de depressão de familiares de pacientes com insuficiência cardíaca; identificar a relação entre esses sentimentos com as variáveis sociodemográficas e clínicas. MÉTODO: Estudo transversal composto por 100 familiares. A depressão, a ansiedade e o estresse foram avaliados pelos Inventários de Depressão e Ansiedade de Beck e pela Escala de Estresse Percebido ‒ 10. A relação dos sentimentos com as variáveis foi realizada pelo teste t, Mann-Whitney ou Kruskal-Wallis. RESULTADOS: A média de depressão foi de 8,24, ansiedade, 7,95 e estresse, 17,43. O coeficiente de correlação entre depressão e ansiedade e depressão e estresse foi de 0,53 e de 0,66 entre ansiedade e estresse. Sexo feminino (p=0,002; p=0,031), tabagismo (p=0,05; p=0,011) e sedentarismo (p=0,023; p=0,001) se relacionaram com a ansiedade e estresse respectivamente. Renda familiar menor que cinco salários mínimos (p=0,012) se relacionou com a depressão, e autoavaliação de saúde regular/ruim se relacionou com os três sentimentos. CONCLUSÃO: Os familiares não apresentaram níveis elevados desses sentimentos. As escalas foram diretamente correlacionadas entre si e algumas variáveis se relacionaram com estresse, ansiedade e depressão.

Excessive bleeding predictors after cardiac surgery in adults: integrative review.

AIMS AND OBJECTIVES: To integrate literature data on the predictors of excessive bleeding after cardiac surgery in adults. BACKGROUND: Perioperative nursing care requires awareness of the risk factors for excessive bleeding after cardiac surgery to assure vigilance prioritising and early correction of those that are modifiable. DESIGN: Integrative literature review. METHODS: Articles were searched in seven databases. Seventeen studies investigating predictive factors for excessive bleeding after open-heart surgery from 2004-2014 were included. RESULTS: Predictors of excessive bleeding after cardiac surgery were: Patient-related: male gender, higher preoperative haemoglobin levels, lower body mass index, diabetes mellitus, impaired left ventricular function, lower amount of prebypass thrombin generation, lower preoperative platelet counts, decreased preoperative platelet aggregation, preoperative platelet inhibition level >20%, preoperative thrombocytopenia and lower preoperative fibrinogen concentration. Procedure-related: the operating surgeon, coronary artery bypass surgery with three or more bypasses, use of the internal mammary artery, duration of surgery, increased cross-clamp time, increased cardiopulmonary bypass time, lower intraoperative core body temperature and bypass-induced haemostatic disorders. Postoperative: fibrinogen levels and metabolic acidosis. CONCLUSIONS: Patient-related, procedure-related and postoperative predictors of excessive bleeding after cardiac surgery were identified. RELEVANCE TO CLINICAL PRACTICE: The predictors summarised in this review can be used for risk stratification of excessive bleeding after cardiac surgery. Assessment, documentation and case reporting can be guided by awareness of these factors, so that postoperative vigilance can be prioritised. Timely identification and correction of the modifiable factors can be facilitated.

Clinical usefulness of the definitions for defining characteristics of activity intolerance, excess fluid volume and decreased cardiac output in decompensated heart failure: a descriptive exploratory study.

AIMS AND OBJECTIVES: To assess the clinical usefulness of the operational definitions for the defining characteristics of the NANDA International nursing diagnoses, activity intolerance, decreased cardiac output and excess fluid volume, and the concomitant presence of those diagnoses in patients with decompensated heart failure. BACKGROUND: Content validity of the operational definitions for the defining characteristics of activity intolerance, excess fluid volume and decreased cardiac output have been previously validated by experts. Their clinical usefulness requires clinical validation. DESIGN: This was a descriptive exploratory study. METHODS: Two expert nurses independently assessed 25 patients with decompensated heart failure for the presence or absence of 29 defining characteristics. Interrater reliability was analysed using the Kappa coefficient as a measure of clinical usefulness. The Fisher's exact test was used to test the association of the defining characteristics of activity intolerance and excess fluid volume in the presence of decreased cardiac output, and the correlation between the three diagnoses. RESULTS: Assessments regarding the presence of all defining characteristics reached 100% agreement, except with anxiety. Five defining characteristics of excess fluid volume were significantly associated with the presence of decreased cardiac output. Concomitant presence of the three diagnoses occurred in 80% of the patients. However, there was no significant correlation between the three diagnoses. CONCLUSIONS: The operational definitions for the diagnoses had strong interrater reliability, therefore they were considered clinically useful. Only five defining characteristics were representative of the association between excess fluid volume and decreased cardiac output. Therefore, excess fluid volume is related to decreased cardiac output, although these diagnoses are not necessarily associated with activity intolerance. RELEVANCE TO CLINICAL PRACTICE: The operational definitions may favour early recognition of the sequence of responses to decompensation, guiding the choice of common interventions to improve or resolve excess fluid volume and decreased cardiac output.

Predictors of red blood cell transfusion after cardiac surgery: a prospective cohort study.

OBJECTIVE: To identify predictors of red blood cell transfusion (RBCT) after cardiac surgery. METHOD: A prospective cohort study performed with 323 adults after cardiac surgery, from April to December of 2013. A data collection instrument was constructed by the researchers containing factors associated with excessive bleeding after cardiac surgery, as found in the literature, for investigation in the immediate postoperative period. The relationship between risk factors and the outcome was assessed by univariate analysis and logistic regression. RESULTS: The factors associated with RBCT in the immediate postoperative period included lower height and weight, decreased platelet count, lower hemoglobin level, higher prevalence of platelet count <150x10(3)/mm (3), lower volume of protamine, longer duration of anesthesia, higher prevalence of intraoperative RBCT, lower body temperature, higher heart rate and higher positive end-expiratory pressure. The independent predictor was weight <66.5Kg. CONCLUSION: Factors associated with RBCT in the immediate postoperative period of cardiac surgery were found. The independent predictor was weight.

Development and validation of a case study to aid in the diagnostic reasoning of nursing students and nurses.

PURPOSE: The aim of this study is to develop and validate a case study to aid in the diagnostic reasoning of nursing students and nurses. METHODS: It is a validation study using a case study based on Lunney's method including (1) content validation of the case study by nurse experts through the Delphi technique, (2) identification of nursing diagnoses (NDs) in the case, (3) evaluation of diagnostic accuracy, and (4) establishment of a priority diagnosis by nurse experts. FINDINGS: The case study was developed from the findings of a narrative literature review on the cues of the NDs with a prevalence > 50% in patients with peripheral arterial occlusive disease. Two rounds of expert evaluation were required to validate the case study. The experts identified 18 NDs with different degrees of accuracy. The highly accurate diagnoses most frequently identified by the experts were: Ineffective peripheral tissue perfusion (100%), impaired walking (83%), impaired comfort (50%), and chronic pain (50%). The diagnosis considered a priority by all experts was ineffective peripheral tissue perfusion. CONCLUSIONS: The case study was developed and had its content validated. High-accuracy diagnoses were identified, and a priority was determined. IMPLICATIONS FOR NURSING PRACTICE: The validated case study may be used by students and nurses to facilitate the development of diagnostic reasoning and critical thinking in practice, teaching or research.

Evidence of validity of the Smoking Cessation Counseling scale - Brazilian version.

OBJECTIVE: to evaluate the evidence of validity of the internal structure and reliability of the Brazilian version of the Smoking Cessation Counseling instrument. METHOD: psychometric study of confirmatory factor analysis and reliability carried out on 250 nurses in clinical practice. For the analysis of the convergent validity of the factor model, Average Variance Extracted values were calculated, and discriminant analysis was carried out using the Fornell-Larcker criterion. Reliability was examined using Cronbach's alpha coefficient and composite reliability. RESULTS: it was necessary to exclude seven items from the Advanced Counseling domain and one item from the Basic Counseling domain in order to properly obtain the Average Variance Extracted values and the Fornell-Larcker criterion. The composite reliability ranged from 0.76 to 0.86 and the overall Cronbach`s alpha coefficient was 0.86, ranging from 0.53 to 0.84 depending on the domain assessed. The final version of the instrument was made up of 16 items divided into 4 domains. CONCLUSION: the Brazilian version of Smoking Cessation Counseling obtained adequate psychometric evidence of validity and reliability. Further studies are needed to refine the instrument. BACKGROUND: (1) Instrument shows adequate internal consistency and validity. BACKGROUND: (2) Evaluate counseling practices and their impact on patient care. BACKGROUND: (3) Instrument for evaluating smoking cessation counseling. BACKGROUND: (4) Provides important information for planning nursing care.

Evidence of content validity of the nursing outcome "sexual functioning" from the nursing outcome classification.

PURPOSE: To evaluate the content validity evidence of the nursing outcome "sexual functioning" from the Nursing Outcomes Classification (NOC). METHODS: A multi-method study, including a methodological study analyzing the content validity evidence of the NOC outcome and sexual functioning, and a quantitative, descriptive, cross-sectional study. In the first phase, a literature review was conducted to map and identify clinical indicators associated with sexual functioning to construct the conceptual (CD) and operational definitions (ODs) of each outcome indicator. In the second phase, experts assessed the CD and OD for clarity, theoretical relevance, and theoretical pertinence. The critical validity ratio (CVR) was calculated for each indicator. In the third phase, a pilot test of sexual functioning measurement was conducted with 33 patients hospitalized for coronary artery disease. Internal consistency was calculated through Cronbach's alpha. RESULTS: The CD and OD were constructed based on 120 articles and analyzed by 13 experts; four rounds were required to achieve the critical CVR in each phase. In the pilot test, the nursing outcome achieved a Cronbach's alpha of 0.95, and the mean assessment time was 26 min. Indicators with the highest mean scores were related to knowledge of personal needs and capabilities and comfort with one's own body. CONCLUSION: The CD and OD developed for the NOC outcome, sexual functioning, had adequate evidence of content validity. The outcome content has high internal consistency. Further studies on the validity of the nursing outcome should be conducted to increase its validity. IMPLICATIONS FOR PRACTICE: The nursing outcome, sexual functioning, can be a tool used by nurses to evaluate the effect of nursing education and interventions on sexual functioning in the adult population.

PURPOSE: Desenvolver e avaliar as evidências de validade de conteúdo das definições conceituais e operacionais dos indicadores do resultado de Enfermagem "Funcionamento Sexual" da Classificação dos Resultados de Enfermagem (NOC). METHODS: Estudo metodológico dividido em três fases. Na primeira fase foi realizada uma revisão de literatura para mapear e identificar os indicadores clínicos associados ao funcionamento sexual para a construção das definições conceituais (DC) e operacionais (DO) de cada indicador do resultado de enfermagem em estudo. Na segunda fase foi realizada a análise das evidências de validade de conteúdo das DC e DO dos indicadores por meio da avaliação pelos especialistas. Na terceira fase foi realizada um pré­teste do resultado de enfermagem em 33 pacientes hospitalizados por doença arterial coronariana. RESULTS: Foram selecionados 120 artigos que serviram de base para a construção das definições conceituais e operacionais analisadas por 13 especialistas, necessário quatro rodadas para alcançar o coeficiente de validade de conteúdo crítico estabelecido para o número de juízes respondentes. pré­testeo resultado de enfermagem estudado um alfa de Cronbach de 0,95 e o tempo médio de aplicação foi de 26 minutos. Os indicadores com maiores médias estavam relacionados ao conhecimento das necessidades e capacidade pessoais e conforto com o próprio corpo. CONCLUSION: As DC e DO dos indicadores do resultado "Funcionamento Sexual" da NOC desenvolvidas apresentaram adequadas evidências de validade de conteúdo. O pré­teste o apresentou elevado nível de consistência interna. Outros estudos de evidências de validade do resultado estudado devem ser realizados visando o aumento no nível de validade do resultado. IMPLICATION FOR PRACTICE: O resultado estudado pode ser uma ferramenta utilizada pelo enfermeiro para avaliação do funcionamento sexual na população adulta visando a individualização das orientações e intervenções de enfermagem.

Telephone messages regarding preventive measures against COVID-19.

OBJECTIVE: To analyze the evidence of content validity of telephone messages regarding preventive measures against COVID-19. METHOD: Methodological study, in which messages containing text and image were developed through a narrative literature review and whose content was evaluated by eight judges in terms of clarity, practical relevance, theoretical relevance and vocabulary. The content validity index (CVI) was calculated, and messages that reached levels above 90% were considered to have adequate evidence of validity. RESULTS: Eighteen text messages/images were developed containing information about COVID-19, hand hygiene, use and handling of masks and the importance of social distancing. After second round of evaluation, a content validity index above 90% was obtained in all evaluated indicators. CONCLUSION: The telephone messages were developed and showedadequate evidence of content validity.

Effect of video on satisfaction and self-confidence in simulation training: a randomized clinical trial.

OBJECTIVES: to identify the effect on satisfaction and self-confidence of undergraduate nursing students after using a validated bed bath video during the simulation. METHODS: blinded parallel randomized clinical trial. Participants were allocated to the control group (simulation with tutor) or intervention (simulation with video). After the interventions, the Student Satisfaction and Self Confidence with Learning Scale was used to assess satisfaction and self-confidence. The study was approved by the Ethics Committee and Brazilian Registry of Clinical Trials. Mann Whitney, Fisher Exact and Student t statistical tests were used. A significance level of 5% was adopted. Results: fifty eight students (30, control; and 28, intervention) were evaluated. There was no significant difference between the groups regarding satisfaction (p=0.832) and self-confidence (p>0.999). CONCLUSIONS: satisfaction and self-confidence were similar between the groups, and the two strategies could be used in the simulated practice of bed bathing.

King's Parkinson's Disease Pain Questionnaire: reliability and convergent construct validity.

OBJECTIVES: to assess the evidence of reliability and convergent construct validity of the King's Parkinson's Disease Pain Questionnaire. METHODS: psychometric study of 75 older adults with Parkinson's disease. The instrument was applied by two researchers separately and reapplied by one researcher 15 days later. In terms of reliability, internal consistency was assessed using the Cronbach's alpha test and stability using the intraclass correlation coefficient. Scores of the King's Parkinson's Disease Pain Questionnaire were compared to those of the Geriatric Pain Measure in the assessment of construct validity. RESULTS: the mean Cronbach's alpha obtained between the three assessments was above 0.60, the intraclass correlation between the three assessments was above 0.90, and there was a weak but significant correlation between the two applied scales. CONCLUSIONS: the instrument showed adequate evidence of convergent construct validity and reliability, and can be used in clinical practice.

Development and content validity of a website for patients with coronary artery disease.

OBJECTIVES: to develop and analyze content validity evidence of a website for patients with coronary artery disease. METHODS: a methodological study, carried out in the phases: Definition - determined contents for inclusion in the website, architecture and design; Implementation - subjects included in the website; Assessment - website submitted to analysis by 13 experts and eight laypersons regarding organization, content and design, on a scale of 1 (no agreement) to 4 (complete agreement). Items that reached Content Validity Ratio (CVR) higher than the established critical values and Content Validity Index greater than 0.80 were considered valid. RESULTS: eight domains related to secondary prevention in coronary heart disease were included on the website. Critical CVR and adequate CVI were obtained according to professional and lay experts. CONCLUSIONS: the website was developed, achieving adequate content validity evidence, and can be used as an educational tool for this population.

Effect of a Supervised Exercise Program on Overweight and Obese Adolescents in the School Environment: A Pretest-Posttest Design.

This study is taken up to evaluate the effect of an exercise program on adolescents' obesity and overweight profile. For this purpose, a 1-group pretest-posttest study was conducted with 72 adolescents who underwent a physical activity program supervised by one health professional 5 times a week; the sessions were distributed over 12 weeks and lasted from 50 to 60 minutes. The primary outcomes were anthropometric measurements, whereas the secondary outcomes were lipid profile, blood glucose, and blood pressure. Outcomes were assessed before the intervention and 1 day after the program ended; significance was established at P < .05. As a result, a significant improvement was verified in all the primary outcomes (P< .001) and in most secondary outcomes (capillary blood glucose, P = .0001; triglycerides, P = .0001; and systolic blood pressure, P = .005). In conclusion, the supervised exercise program significantly reduced anthropometric measurements and blood glucose, triglycerides, and systolic blood pressure levels.

Relationships between Depressive Symptoms, Appetite, and Quality of Life in Heart Failure.

This analytical, cross-sectional study aimed to analyze the relationship between depressive symptoms, appetite, and quality of life (QoL) in 86 patients hospitalized with heart failure. Patients were assessed for depressive symptoms, appetite, and QoL using the Beck Depression Inventory-II, the Simplified Nutritional Appetite Questionnaire, and the Minnesota Living with Heart Failure Questionnaire, respectively. Relationships between sociodemographic and clinical variables, depressive symptoms, appetite, and QoL were analyzed using bivariate tests and linear regression models, with p < .05 considered significant. The factors associated with QoL were dependence for four activities of daily living (ADLs) (estimate = 15.4, 95% CI = 0.23 to 30.64, p = .046), minor depressive symptoms (estimate = -20.0, 95% CI = -28.3 to -11.73, p < .001), and appetite (estimate = -11.08, 95% CI = -20.5 to -1.62, p = .022). These results can support multi-professional assessment and development of interventions to promote better QoL, including addressing impaired appetite and food intake, the presence or increased intensity of depressive symptoms, especially in patients dependent for ADLs.

Secondary prevention in coronary artery disease: development and content validity of educational messages for mobile phones.

OBJECTIVE: To identify information needs of patients with coronary artery disease and develop and validate the content of educational messages for mobile phones for these patients. METHOD: The study was carried out in three phases: 1) Identification of information needs in relation to coronary artery disease of patients hospitalized for an acute coronary event; 2) Development of templates containing text and pictures about the disease and treatment; 3) Content validity analysis of template evidence through the assessment of 10 experts. Templates were considered validated when the Content Validity Ratio (CVR) was equal to or greater than 0.80. RESULTS: A total of 67 patients were included, and all the information that emerged about the disease was classified as important to very important. Thirty templates were developed (heart function, recommendations on nutrition and exercise, treatments and medications, and clinical signs related to the disease and risk factor control), and the CVR obtained was greater than 0.80. CONCLUSION: All information needs were categorized by patients as important or very important. The templates were developed and validated considering content and design.

Effectiveness of educational intervention with manual for anxiety and stress reduction: controlled clinical trial.

OBJECTIVE: To evaluate the effectiveness of the educational intervention through an informative manual in reducing anxiety, stress, and changes in vital signs in patients awaiting cardiac catheterization. METHODS: Parallel, randomized, controlled, blind clinical trial. The study excluded patients waiting for cardiac catheterization; those who received the information manual were randomized to the intervention group, and those who received routine information from the unit went to the control group. The study used the State Anxiety Inventory and Perceived Stress Scale and the ANOVA test to analyze the outcomes between the groups. Clinical Trials NCT03369873. RESULTS: There was no change concerning time, first and second moment (anxiety, P=0.225; and stress, P=0.696), interaction (anxiety, P=0.183; and stress, P=0.444), or groups, control, and intervention (anxiety, P=0.341; and stress, p=0.624). CONCLUSION: Although the educational intervention performed did not have an impact on the reduction of anxiety and stress, this type of intervention should be maintained for greater comfort and safety of patients and family members.

Needs of family members of patients in a coronary care unit.

OBJECTIVE: To identify the need of family members of patients hospitalized in a coronary intensive care unit and their degree of satisfaction with the care provided. METHODS: An observational and cross-sectional study including family members of patients hospitalized in the coronary intensive care unit for acute coronary syndrome in Killip I or II. After the second visit of the same family member to the patient in the unit, a 43-item inventory of needs and stressors of family members was applied. Family members assessed each need for its importance and satisfaction using a four-point Likert scale. The scores in each dimension of importance and satisfaction were compared using the Wilcoxon test, considering a value of p<0.05 as significant. RESULTS: One hundred family members were interviewed. The most important needs were related to assurance and information. Family members had satisfaction scores corresponding to be very satisfied or totally satisfied, but with lower scores when compared to the needs scores (p<0.01). CONCLUSION: The most important needs of family members of patients hospitalized in the coronary intensive care unit were related to assurance and information. Multiprofessional interventions involving better communication of patient information to family members should be incorporated into the coronary intensive care unit.

Modifiable risk factors for cardiovascular diseases and quality of life among first-year nursing students.

OBJECTIVE: To describe the risk factors for cardiovascular diseases and the quality of life of first-year college students. METHODS: A cross-sectional study conducted with first-year undergraduate nursing students attending a public university located in São Paulo, Brazil. The students completed nine questionnaires and the students'cervical and abdominal circumferences were measured along with their weight and height, blood pressure, lipid profile, and capillary blood glucose. RESULTS: 67 undergraduate students were included. Half of the students were physically inactive (73.1%), 7.5% reported smoking, 40.3% alcohol consumption, 25.4% overweight, and 16,4% increased total cholesterol. Depressive symptoms, anxiety, and stress were also reported, as well as excessive daytime sleepiness, risk of sleep apnea, and risky and harmful consumption of alcohol. As for the quality of life, the domains with the lowest scores were vitality and emotional aspects. CONCLUSION: The most prevalent risk factors found in undergraduates were sedentary lifestyle, excessive daytime sleepiness and stress.

Effect of a guide for clinical reasoning on Nursing students' diagnostic accuracy: A clinical trial. / Efeito de guia para raciocínio clínico na acurácia diagnóstica de estudantes de enfermagem: ensaio clínico.

OBJECTIVE: to evaluate the effect of the Self-Instructional Guide for Clinical Reasoning on the diagnostic accuracy of undergraduate Nursing students. METHOD: a randomized, parallel and double-blind (researchers and outcome evaluators) clinical trial, carried out with undergraduate Nursing students. Validated case studies were applied in two phases to identify the patient's Nursing diagnosis/problem, etiology and clues, using the Guide with the intervention group in the second phase. The outcomes - diagnostic and etiological accuracy and number of clues - were evaluated using validated rubrics. Descriptive statistics were used to analyze demographic data; Fisher's exact test for similarities in prior education and confidence; Mann-Whitney's test for age; and non-parametric ANOVA test in the evaluation of the hypothesis of differences in performance. RESULTS: final sample composed of 24 students in the control group and 27 in the intervention group; no difference as to gender, age and schooling. There was a difference in diagnostic (p=0.041) and etiological (p=0.0351) accuracy in the intervention group, showing a negative effect of using the Guide. CONCLUSION: the one-time self-instruction was not effective in impacting the diagnostic accuracy of students solving case studies. Repeated application of the Guide as a teaching tool can be effective in improving such outcome. REBEC: RBR-4bhr78.