Clinical care of nursing reasoned in Parse: contribution in the transcendence process of cardiac transplantation. / Cuidado clínico de enfermagem fundamentado em Parse: contribuição no processo de transcendência de transplantados cardíacos.

OBJETIVO: To identify how the clinical and educational nursing care based on the Theory of Human Becoming can contribute to the transcendence process of heart transplant patients in pursuit of good living. METHOD: Research-intervention developed with four heart transplant patients linked to a reference transplant hospital in Ceara. Data was collected through interviews in 2014 and analyzed using Parse's theoretical framework and pertinent literature. RESULTADOS: Transplant patients revealed they gave living in such condition an ambiguous meaning, showing satisfaction and dissatisfaction. Dietary restrictions, difficulties with medication and curiosity about the transplant were identified as disharmonies involving the process. Care was developed focused on educating the transplant patients, approaching the themes healthy eating, organ rejection, immunosuppressant use and facts about heart transplantation. CONCLUSION: Educative care based on Parse favors the decision-making and autonomy of individuals regarding their health, contributing to transcendence in pursuit of good living.

Palliative Care for SARS-CoV-2 Patients in the Intensive Care Unit: A Comprehensive Study.

OBJECTIVE: To comprehend the multiprofessional actions regarding palliative care for patients in the Intensive Care Unit affected by SARS-CoV-2. METHODS: A comprehensive qualitative study conducted with 31 professionals from the Intensive Care Units of a university hospital, based on the Theory of Peaceful End of Life. RESULTS: The analysis of the discourse led to the identification of two categories: "Multidisciplinary actions to promote comfort at the end of life" and "Palliative care during the pandemic period and the promotion of emotional and spiritual comfort." FINAL CONSIDERATIONS: It became evident that local administration needs to invest in measures that reduce barriers to the implementation of palliative care during times of crisis. Understanding the discourse highlighted that non-specialized professionals can provide basic palliative care appropriately, without diminishing the importance and necessity of the presence of palliative care specialists in various hospital areas.

Clinical decision support systems for diabetic foot ulcers: a scoping review.

OBJECTIVE: Map the scientific evidence on the use of clinical decision support systems in diabetic foot care. METHOD: A scoping review based on the JBI Manual for Evidence Synthesis and registered on the Open Science Framework platform. Searches were carried out in primary and secondary sources on prototypes and computerized tools aimed at assisting patients with diabetic foot or at risk of having it, published in any language or period, in eleven databases and grey literature. RESULTS: A total of 710 studies were identified and, following the eligibility criteria, 23 were selected, which portrayed the use of decision support systems in diabetic foot screening, predicting the risk of ulcers and amputations, classifying the stage of severity, deciding on the treatment plan, and evaluating the effectiveness of interventions, by processing data relating to clinical and sociodemographic information. CONCLUSION: Expert systems stand out for their satisfactory results, with high precision and sensitivity when it comes to guiding and qualifying the decision-making process in diabetic foot prevention and care.

Ethical dilemmas at the end of life: a reflection from the Philosophical Perspective of Luigina Mortari.

OBJECTIVES: to reflect on the ethical dilemmas involved in the care of patients at the end of their lives. METHODS: this is a theoretical-reflective study based on the ethics of care proposed by Luigina Mortari. RESULTS: discussing care involves addressing the ways of being inherent to human existence and understanding the unique characteristics of this condition. Ethical care constitutes an action driven by interest in the other and by the perception of their need. Ethical dilemmas are a part of end-of-life care, making it essential to maintain respectful assistance that considers the patient's autonomy, using strategies for expressing their wishes, and ensuring continuous clear and empathetic communication among all those involved in providing care. FINAL CONSIDERATIONS: issues related to being, stemming from one's reality of dependency and vulnerability, contribute to the emergence of ethical dilemmas present in care actions.

Temporal-spatial analysis of mortality from cardiovascular diseases in the State of Ceará, Brazil, between 2009-2019.

OBJECTIVE: To analyze the spatial distribution of mortality from cardiovascular diseases in the municipalities of the state of Ceará, Brazil, between 2009-2019. METHODS: This is an ecological study with a spatial focus on the state of Ceará, considering the period from 2009 to 2019. Death data from the Brazilian Mortality Information System and population data from the Brazilian Institute of Geography and Statistics were used to calculate crude and standardized mortality rates from cardiovascular diseases. Temporal analysis was carried out using the Joinpoint Regression Program 4.9.0 software and spatial analysis of the municipalities' average mortality. The values were smoothed by the local empirical Bayesian method using QGIS 3.16. For spatial clusters, the Global and Local Moran Index was used through Moran Map and LISA Map, with analyses carried out in TerraView 4.2.2. RESULTS: A total of 132,145 deaths from cardiovascular diseases were recorded in the period, with an average increase of 3% per year. Higher mortality rates were observed in men, people aged ≥80 years, mixed-race ethnicity/skin color, married, and with lower level of education. There was the formation of clusters of municipalities with high mortality rates in the regions of Vale do Jaguaribe, Sertão Central, Centro Sul, Sertão dos Inhamuns and Serra da Ibiapaba. CONCLUSION: This study identified municipalities with high mortality and exposed the need for strategies aligned with the reality and particularities of these locations.

Art in evidence-based nursing practice from the perspective of Florence Nightingale.

OBJECTIVES: to discuss, in the light of Florence Nightingale, the historical position of art as a constituent device of evidence-based nursing practice. METHODS: reflective study anchored in the writings of Nightingale and other researchers with whom it is possible to have a profound dialogue on the theme "art in nursing". RESULTS: art is related to two essential elements in the practice of nursing: knowledge and skill. Understanding science as knowledge and art as skill leads to the idea that both make it possible to combine technical competence, compassion, ethics, and individualization of care. Final Considerations: the art of nursing is the continuous exercise of detailed perception, so that the subjective aspect becomes the center to which the nurse's gaze converges, that which will allow them to unveil the "truth" posed by the patient, resulting in the best intervention for him.

Serial album on Continuous Insulin Infusion System as an innovative educational technology in diabetes.

OBJECTIVE: to build and validate a serial album content and appearance on insulin therapy using a Continuous Infusion System. METHOD: a methodological study, carried out in three stages in Fortaleza, Ceará, Brazil, from August to November 2018. The serial album construction and content and appearance validity were carried out by experts, and assessment, by the target audience. Content Validity Index and Concordance Index were calculated. RESULTS: the judges considered the serial album content and appearance to be valid, which means that the material is suitable as an educational technology. Experts suggested adjustments, incorporated into the material for print production of the final version. The target audience also assessed the serial album positively. CONCLUSION: we realized that the serial album was considered an innovative educational technology in diabetes, valuable for promoting knowledge about Continuous Insulin Infusion System, with rich, updated content, combined with clarity, suitable format and explanatory illustrations.

Structure internal of the dimension Human Person of the Questionnaire of Health Vulnerability in Heart Failure.

OBJECTIVE: to analyze the evidence of validity of the internal structure of the dimension Human Person of the Questionnaire of Health Vulnerability in Heart Failure. METHOD: psychometric study with 1,008 people with heart failure, in a tertiary healthcare institution located in Northeastern Brazil. The internal structure was assessed by exploratory factor analysis with a polychoric correlation matrix, followed by confirmatory factor analysis to verify the quality of the model fit. Internal consistency was measured by composite reliability (CR) and McDonald's omega (ω). RESULTS: psychometric parameters revealed 22-item model, distributed in five factors, total explained variance of 64.9%, factor loadings (0.38 to 0.97) and adequate communalities (0.20 ≤ h2 ≤ 0.98) and acceptable indicators of precision (0.79 ≤ ORION ≤ 0.98), representativeness (0.89 ≤ FDI ≤ 0.99), sensitivity (1.92 ≤ SR ≤ 7.07), factor expectancy (88.3% ≤ EPTD ≤ 97.9%), replicability (0.82 ≤ H-latent ≤ 0.97; 0.81 ≤ H-observed ≤ 0.87) and reliability (CR = 0.92 and ω = 0.83). Adequate adjustment quality was achieved (TLI = 0.99; CFI = 0.99; GFI = 0.99; RMSEA = 0.04 and RMSR = 0.04). CONCLUSION: We obtained an instrument with good evidence of internal structure validity for construct measurement.

Requirements for building educational and care technology on heart failure.

OBJECTIVES: to investigate the requirements for building an educational and care application about heart failure. METHODS: exploratory study, carried out with 15 people with heart failure and 19 family members/caregivers, assisted in a tertiary unit in the Brazilian Northeast. Individual semi-structured interviews were carried out between November and December 2020. Hannah Arendt's theoretical framework was adopted. RESULTS: two units of meaning emerged: "The plurality of care in heart failure" and "Expectations on the construction and use of educational and care technology for heart failure". The requirements involved the need to know the disease and its nuances, as well as the health network, through an application that can minimize individual and social precariousness; and highlighted the importance of the participation of the multidisciplinary team in the development and dissemination of the application. CONCLUSIONS: requirements on educational and care technology were identified and will support the creation of an application that promotes care, aiming to obtain positive health outcomes.

Spatial Distribution of Mortality for Heart Failure in Brazil, 1996 - 2017. / Distribuição Espacial de Mortalidade por Insuficiência Cardíaca no Brasil, 1996-2017.

BACKGROUND: Heart failure (HF) is a leading cause of mortality and morbidity worldwide, and is associated with the high use of resources and healthcare costs. In Brazil, the HF prevalence is around 2 million patients, and its incidence is of approximately 240,000 new cases per year. OBJECTIVE: The present investigation aimed to analyze the spatiotemporal trend of mortality caused by HF in Brazil, from 1996 to 2017. METHODS: This is an ecological study developed with secondary data on HF mortality in Brazil. During the period, 1,242,014 cases of death caused by heart failure were analyzed. The existence of spatial autocorrelation of cases was calculated using the Global Moran Index (GMI) and, when significant, the Local Moran Index, considering p<0.05. The relative risk of the clusters was calculated. RESULTS: The mortality rate due to HF was diversified in all Brazilian regions, with an emphasis in the South, Southeast, and Northeast. The GMI indicated positive spatial autocorrelation (p=0.01) in all periods. Municipalities located in the South, Southeast, Northeast, and Midwest showed a higher Relative Risk for mortality from HF, and most municipalities in the North were classified as a protective factor against this cause of death. CONCLUSIONS: The study showed a decline in mortality rates across the national territory. The highest concentration of mortality rates is in the North and Northeast regions, highlighting priority vulnerable areas in the planning and controlling strategies of health services.

FUNDAMENTO: Insuficiência cardíaca (IC) é uma das principais causas de mortalidade e morbidade no mundo, e está associada ao alto uso de recursos e custos com saúde. No Brasil, a prevalência de IC é de aproximadamente 2 milhões de pacientes, e sua incidência é de aproximadamente 240.000 novos casos por ano. OBJETIVO: A investigação objetivou analisar a tendência espaço-temporal da mortalidade causada por IC no Brasil, de 1996 a 2017. MÉTODOS: Este é um estudo ecológico desenvolvido com dados secundários sobre mortalidade por IC no Brasil. Durante o período, 1.242.014 casos de morte causada por IC foram analisados. A existência da autocorrelação espacial de casos foi calculada utilizando o Índice de Moran Global (IMG) e, quando significativo, o Índice de Moran Local, considerando p <0,05. O risco relativo dos grupos foi calculado. RESULTADOS: A taxa de mortalidade causada por IC foi diversificada em regiões brasileiras, com ênfase no sul, sudeste e nordeste. O IMG indicou autocorrelação espacial positiva (p=0,01) em todos os períodos. Cidades localizadas no sul, sudeste, nordeste e centro-oeste mostraram maior risco relativo para mortalidade causada por IC, e a maioria das cidades do norte foi classificada como um fator protetivo contra esta causa de morte. CONCLUSÕES: O estudo demonstrou declínio nas taxas de mortalidade no território nacional. A maior concentração de taxas de mortalidade está nas regiões norte e nordeste, enfatizando as áreas prioritárias de vulnerabilidade no planejamento e estratégias de controle de serviços de saúde.

Benchmarking of mobile apps on heart failure.

OBJECTIVE: to analyze the mobile apps on heart failure available in the main operating systems and their usability. METHODS: benchmarking of mobile applications, systematic research, comprising 38 mobile applications for analysis of general information, functionalities and usability. Usability was assessed using System Usability Scale and Smartphone Usability Questionnaire, followed by the calculation of the agreement index and the exact binomial distribution test, with a significance level of p> 0.05 and a proportion of 0.90. RESULTS: mobile applications had English as the predominant language (73.7%), were directed to patients (71.1%) and the predominant theme was disease knowledge (34.2%). Functionalities ranged from general features to the need for an internet connection. In assessing usability, heart failure was shown to be 92.1% -94.7% and p <0.05. FINAL CONSIDERATIONS: the mobile apps on heart failure have varied content and adequate usability. However, there is a need to develop more comprehensive mobile applications.

[Prevalence and factors associated with non-enrollment for kidney transplant]. / Prevalência e fatores associados a não inscrição para transplante renal.

This study evaluated the prevalence and factors associated with lack of enrollment for kidney transplant among patients in chronic dialysis in Greater Metropolitan Fortaleza, Ceará, Brazil. The sample excluded patients with insufficient clinical status and those already in pre-kidney transplant evaluation. A semi-structured questionnaire was applied, including options for the question, "What is the main reason why you are not enrolled for kidney transplant?" Prevalence of patients considered fit but not enrolled or in pre- kidney transplant evaluation was 50.7%. The main reasons were fear of failure/loss of grafting (32.5%), difficulty with transportation or access to tests (20.9%), and temporary personal or family problems (13.7%). In the multivariate analysis, the variables associated with fear of failure or loss of graft were female sex (OR = 1.763; 95%CI: 1.224-2.540) and end-stage renal disease (ESRD) due to hypertension (OR = 1.732; 95%CI: 1.178-2.547), while monthly income (number of minimum wages) showed a protective association (OR = 0.882; 95%CI: 0.785-0.991). Time on dialysis (months) was a risk factor for difficulty with transportation and access to tests (OR = 1.004; 95%CI: 1.001-1.007), and female sex showed a protective association (OR = 0.576; 95%CI: 0.368-0.901). These results show high prevalence of patients in dialysis not enrolled on the kidney transplant waitlist. The main causes were lack of information and lack of access. Female sex, low income, and ESRD due to hypertension were risk factors for lack of enrollment on the kidney transplant waitlist due to fear of loss of graft, resulting from lack of information on this treatment modality. Male sex and longer time on dialysis were risk factors for difficulty in access to kidney transplant.

Este estudo avaliou a prevalência e os fatores associados a não procura por transplante renal entre pacientes em diálise crônica na Região Metropolitana de Fortaleza, Ceará, Brasil. Foram excluídos os pacientes sem condições clínicas e aqueles em avaliação pré-transplante renal. Um questionário semiestruturado foi aplicado, incluindo opções para a pergunta "Qual o principal motivo pelo qual o senhor/senhora não está inscrito(a) para o transplante renal?". A prevalência de pacientes considerados aptos, mas não inscritos e nem em avaliação pré-transplante renal foi de 50,7%. As principais causas foram: receio de insucesso/perda do enxerto (32,5%), dificuldade de transporte e acesso aos exames (20,9%) e problemas pessoais ou familiares temporários (13,7%). Em análise múltipla, as variáveis associadas a risco de receio do insucesso/perda do enxerto foram: sexo feminino (OR = 1,763; IC95%: 1,224-2,540) e doença renal dialítica (DRC 5-D) por hipertensão (OR = 1,732; IC95%: 1,178-2,547), tendo a renda mensal (salários mínimos) uma associação de proteção (OR = 0,882; IC95%: 0,785-0,991). O tempo em diálise (meses) foi um fator de risco para a dificuldade de transporte e acesso aos exames (OR = 1,004; IC95%: 1,001-1,007) e o sexo feminino apresentou uma associação de proteção (OR = 0,576; IC95%: 0,368-0,901). Esses resultados mostram elevada prevalência de pacientes em diálise fora de lista para transplante renal. As principais causas são reflexo da desinformação e falta de acesso. Sexo feminino, baixa renda e DRC 5-D por hipertensão foram os fatores de risco para a não procura por transplante renal por receio de perda do enxerto, reflexo da carência de informações sobre a modalidade. Sexo masculino e maior tempo em diálise foram os fatores de risco para a dificuldade de acesso à terapia.

Este estudio evalúo la prevalencia y los factores asociados a la no búsqueda de un trasplante renal entre pacientes con diálisis crónica en la Región Metropolitana de Fortaleza, Ceará, Brasil. Se excluyeron a pacientes sin condiciones clínicas y aquellos en evaluación pre-trasplante renal . Se aplicó un cuestionario semiestructurado, incluyendo opciones a la pregunta "¿cuál es el principal motivo por el cual usted no está inscrito(a) para un trasplante renal?" La prevalencia de pacientes considerados aptos, pero no inscritos y ni en evaluación pre-trasplante renal fue de un 50,7%. Las principales causas fueron: recelo al fracaso/pérdida del injerto (32,5%), dificultad de transporte y acceso a los exámenes (20,9%), así como problemas personales o familiares temporales (13,7%). En el análisis múltiple, las variables asociadas al riesgo del recelo al fracaso/pérdida del injerto fueron de sexo femenino (OR = 1,763; IC95%: 1,224-2,540) y enfermedad renal dialítica (DRC 5-D) por hipertensión (OR = 1,732; IC95%: 1,178-2,547), teniendo la renta mensual (salarios mínimos) una asociación de protección (OR = 0,882; IC95%: 0,785-0,991). El tiempo en diálisis (meses) fue un factor de riesgo para la dificultad en el transporte y acceso a los exámenes (OR = 1,004; IC95%: 1,001-1,007), y el sexo femenino tuvo una asociación de protección (OR = 0,576; IC95%: 0,368-0,901). Estos resultados muestran la elevada prevalencia de pacientes en diálisis fuera de la lista para transplante renal. Las principales causas son reflejo de la desinformación y falta de acceso. Sexo femenino, baja renta y DRC 5-D por hipertensión fueron factores de riesgo para la no búsqueda de trasplante renal por recelo a la pérdida del injerto, reflejo de la carencia de información sobre la modalidad. Sexo masculino y mayor tiempo en diálisis fueron factores de riesgo para la dificultad de acceso a la terapia. izará la atención a las vulnerabilidades individuales desde la perspectiva de la salud integral.

Social vulnerability and COVID-19 incidence in a Brazilian metropolis. / Vulnerabilidade social e incidência de COVID-19 em uma metrópole brasileira.

Vulnerability is a crucial factor in addressing COVID-19 as it can aggravate the disease. Thus, it should be considered in COVID-19 control and health prevention and promotion. This ecological study aimed to analyze the spatial distribution of the incidence of COVID-19 cases in a Brazilian metropolis and its association with social vulnerability indicators. Spatial scan analysis was used to identify COVID-19 clusters. The variables for identifying the vulnerability were inserted in a Geographically Weighted Regression (GWR) model to identify their spatial relationship with COVID-19 cases. The incidence of COVID-19 in Fortaleza was 74.52/10,000 inhabitants, with 3,554 reported cases and at least one case registered in each neighborhood. The spatial GWR showed a negative relationship between the incidence of COVID-19 and demographic density (ß=-0,0002) and a positive relationship between the incidence of COVID-19 and the percentage of self-employed >18 years (ß=1.40), and maximum per capita household income of the poorest fifth (ß=0.04). The influence of vulnerability indicators on incidence showed areas that can be the target of public policies to impact the incidence of COVID-19.

A vulnerabilidade é um fator chave no enfrentamento da COVID-19 tendo em vista que pode influenciar no agravamento da doença. Desse modo, ela deve ser considerada no controle da COVID-19, prevenção e promoção da saúde. O objetivo deste artigo é analisar a distribuição espacial da incidência de casos de COVID-19 em uma metrópole brasileira e sua associação com indicadores de vulnerabilidade social. Estudo ecológico. Foi utilizada a análise de varredura espacial (scan) para identificar aglomerados de COVID-19. As variáveis para identificação da vulnerabilidade foram inseridas em um modelo de Regressão Espacial Geograficamente Ponderado (GWR) para identificar sua relação espacial com os casos de COVID-19. A incidência de COVID-19 em Fortaleza foi de 74,52/10 mil habitantes, com notificação de 3.554 casos, sendo pelo menos um caso registrado em cada bairro. A regressão espacial GWR mostrou relação negativa entre incidência de COVID-19 e densidade demográfica (ß=-0,0002) e relação positiva entre incidência de COVID-19 e percentual de ocupados >18 anos trabalhadores autônomos (ß=1,40), assim como, renda domiciliar per capita máxima do quinto mais pobre (ß=0,04). A influência dos indicadores de vulnerabilidade sobre a incidência evidenciou áreas que podem ser alvo de políticas públicas a fim de impactar na incidência de COVID-19.

Reasons of drug use among adolescents: implications for clinical nursing care.

This is a theoretical essay which aims to reflect on the reasons for and why adolescents use drugs and their implications for clinical nursing care. It used the referential of social phenomenology of Alfred Schutz. The main reasons identified were: to attenuate existential crisis, form social bonds and to have fun. The reasons for this are related to the characteristics of adolescence, a breakdown in social and family ties and the conditions of programmatic vulnerability. Motivations provide important information for developing person-centered, not drug-abuse-centered care strategies. Nurses' caregiving action is based on emancipatory health education strategies grounded on the strategy of reducing harm and risks related to drug use and the possibility to help adolescents become aware of their biographical situation in a face-to-face relationship, so that they can (in knowing yourself) act to promote their health.

Palliative Care for SARS-CoV-2 Patients in the Intensive Care Unit: A Comprehensive Study / Cuidados Paliativos al paciente con SARS-CoV-2 en una unidad de cuidados intensivos: un estudio integral / Cuidados Paliativos ao paciente com SARS-CoV-2 em unidade de terapia intensiva: estudo compreensivo

ABSTRACT Objective: To comprehend the multiprofessional actions regarding palliative care for patients in the Intensive Care Unit affected by SARS-CoV-2. Methods: A comprehensive qualitative study conducted with 31 professionals from the Intensive Care Units of a university hospital, based on the Theory of Peaceful End of Life. Results: The analysis of the discourse led to the identification of two categories: "Multidisciplinary actions to promote comfort at the end of life" and "Palliative care during the pandemic period and the promotion of emotional and spiritual comfort." Final Considerations: It became evident that local administration needs to invest in measures that reduce barriers to the implementation of palliative care during times of crisis. Understanding the discourse highlighted that non-specialized professionals can provide basic palliative care appropriately, without diminishing the importance and necessity of the presence of palliative care specialists in various hospital areas.

RESUMEN Objetivo: Comprender las acciones multiprofesionales en la atención paliativa de pacientes en una Unidad de Cuidados Intensivos afectados por el SARS-CoV-2. Métodos: Estudio integral y cualitativo realizado con 31 profesionales de Unidades de Cuidados Intensivos de un hospital universitario, basado en la Teoría del Final de Vida Pacífico. Resultados: El análisis de los discursos llevó a la identificación de dos categorías: "Acciones multidisciplinarias para promover el confort al final de la vida" y "Cuidados paliativos durante el período de la pandemia y el fomento del confort emocional y espiritual". Conclusiones: Se evidenció la necesidad de que la administración local invierta en medidas que minimicen las barreras para la implementación de la atención paliativa durante los momentos de crisis. La comprensión de los discursos resaltó que los profesionales no especializados pueden proporcionar cuidados paliativos básicos de manera adecuada, sin desmerecer la importancia y la necesidad de contar con especialistas en Cuidados Paliativos en diferentes áreas hospitalarias.

RESUMO Objetivo: Compreender as ações multiprofissionais quanto à paliação de pacientes em Unidade de Terapia Intensiva, acometidos pelo SARS-CoV-2. Métodos: Estudo compreensivo, qualitativo, realizado com 31 profissionais de Unidades de Terapia Intensiva de um hospital universitário, com base na Teoria do Fim de Vida Pacífico. Resultados: A análise dos discursos conduziu à identificação de duas categorias: "Ações multidisciplinares para promover o conforto no fim da vida" e "Cuidado paliativo durante o período pandêmico e o estímulo ao conforto emocional e espiritual". Considerações Finais: Tornou-se evidente a necessidade de a administração local investir em medidas que minimizem as barreiras à implementação da assistência paliativa durante momentos de crise. A compreensão dos discursos ressaltou que profissionais não especializados podem fornecer cuidados paliativos básicos de maneira adequada, sem desmerecer a importância e a necessidade da presença de especialistas em Cuidados Paliativos em diferentes áreas hospitalares.

Construction and validation of educational technology on post-liver transplant for family caregivers / Construcción y validación de tecnología educativa sobre el período posterior a trasplantes hepáticos destinada a cuidadores familiares / Construção e validação de tecnologia educacional sobre o pós-transplante hepático para o familiar cuidador

ABSTRACT Objective: to construct and validate an educational booklet on post-liver transplant for family caregivers. Method: a methodological study carried out in two stages from August 2021 to July 2023: 1) Construction of the educational booklet aimed at liver transplant patient's family caregivers; and 2) Content and face validation by expert judges and semantic validity with the target audience. For the experts to analyze the validity data, the Content Validity Index was used (≥0.78 per item and ≥0.80 in total), as well as the Exact Binomial Distribution test (p>0.05 and 0.80) and the Intraclass Correlation Coefficient (95%) for greater reliability. In the semantic evaluation, the IRaMuTeQ software was used to guide the analysis of the interviews, using Descending Hierarchical Classification and Word Cloud. Results: after the bibliographic survey, four axes guided the construction of the booklet. The total Content Validity Index was 0.99 (p>0.05), with excellent reliability (ICC=0.946). The total Face Validity Index was 0.93 (p>0.05), with good reliability (ICC=0.766). In terms of semantics, the analytical categories pointed to a satisfactory level of perception and understanding of the booklet by the target audience. Conclusion: the technology is innovative, including caregivers in the education process, and is relevant to post-transplant care. The validation process shows the feasibility of understanding the booklet and the need to use it to improve home care.

RESUMEN Objetivo: construir y validar un folleto educativo sobre el período posterior a trasplantes hepáticos destinado a cuidadores familiares. Método: estudio metodológico realizado en dos etapas entre agosto de 2021 y julio de 2023: 1) Construcción del folleto educativo destinado a cuidadores familiares de pacientes sometidos a trasplantes hepáticos; y 2) Validación del contenido y la apariencia a cargo de jueces especialistas, además de la validez semántica con el público objetivo. Para el análisis de los datos de validez a cargo de los especialistas se utilizó el Índice de Validez de Contenido (≥ 0,78 por ítem y ≥ 0,80 en el total), además de la prueba Exacta de Distribución Binomial (p>0,05 y 0,80) y del Coeficiente de Correlación Intraclase (95%) para mayor confiabilidad. En la evaluación semántica se empleó el programa de software IRaMuTeQ para guiar el análisis de las entrevistas, por medio de la Clasificación Jerárquica Descendente y de una Nube de palabras. Resultados: después del relevamiento bibliográfico se identificaron cuatro ejes que guiaron la construcción del folleto. El Índice de Validez de Contenido total fue 0,99 (p>0,05), con excelente confiabilidad (CCI=0,946). El Índice de Validez de Apariencia total fue 0,93 (p>0,05), con buen nivel de confiabilidad (CCI=0,766). En el caso de la semántica, las categorías analíticas analizadas señalaron un nivel satisfactorio de percepción y comprensión del folleto entre el público objetivo. Conclusión: la tecnología demuestra ser innovadora, incluyendo a los cuidadores en el proceso de educación, además de ser relevante para la atención que debe proporcionarse después del trasplante. El proceso de validación denota la viabilidad de la comprensión expuesta en el folleto y la necesidad de emplearlo para mejorar los cuidados domiciliarios.

RESUMO Objetivo: construir e validar uma cartilha educativa sobre o pós-transplante hepático para o familiar cuidador. Método: estudo metodológico, realizado em duas etapas durante o período de agosto de 2021 a julho de 2023: 1) Construção da cartilha educativa voltada ao familiar cuidador do paciente transplantado hepático e 2) Validação de conteúdo e aparência pelos juízes especialistas e de validade semântica junto ao público-alvo. Para análise dos dados de validade pelos especialistas foi utilizado o Índice de Validade de Conteúdo, ≥ 0,78 por item e ≥ 0,80 no total, além do teste Exato de Distribuição Binomial (p>0,05 e 0,80) e do Coeficiente de Correlação Intraclasse (95%) para maior confiabilidade. Na avaliação semântica, foi utilizado o software IRaMuTeQ para nortear a análise das entrevistas, por meio da Classificação Hierárquica Descendente e da Nuvem de Palavras. Resultados: após o levantamento bibliográfico, quatro eixos nortearam a construção da cartilha. O Índice de Validade de Conteúdo total foi de 0,99 (p>0,05), com excelente confiabilidade (CCI=0,946). O Índice de Validade de Aparência total foi de 0,93 (p>0,05) e boa confiabilidade (CCI=0,766). Na semântica, as categorias analíticas analisadas apontaram um nível satisfatório de percepção e compreensão da cartilha pelo público-alvo. Conclusão: a tecnologia mostra-se inovadora, incluindo os cuidadores no processo de educação, sendo relevante para o cuidado pós-transplante. O processo de validação denota a viabilidade da compreensão exposta na cartilha e a necessidade de utilização dela para a melhoria do cuidado domiciliar.

Vulnerabilidade em saúde: evidências de validade de um banco de itens / Vulnerabilidad en salud: evidencias de validez de un banco de ítems / Health vulnerability: evidence of validity of an item bank

Resumo Objetivo Analisar as evidências de validade de conteúdo e processo de resposta de um banco de itens sobre vulnerabilidade em saúde. Métodos Estudo psicométrico, subsidiado pelo polo teórico de Pasquali. Foram selecionados 62 especialistas com características sociodemográficas e acadêmicas distintas. Desses, 15 responderam ao questionário de validade de conteúdo. Após os ajustes, o banco passou para fase de validade de processo de resposta e foi avaliado por 12 usuários dos serviços de saúde. Utilizou-se coeficiente de validade de conteúdo para avaliação dos itens e do banco, cuja confiabilidade foi verificada pelo teste binomial, considerando percentual de 80% e p-valor >0,05. Resultados O banco apresentou boa evidência de validade de conteúdo pelos especialistas, cujos coeficientes foram 0,87 para o elemento sujeito, 0,86 para o elemento social e 0,865 para o geral. O público-alvo realizou sugestões na fase de validade de processo de resposta para melhor compreensão dos itens (coeficiente total: 0,89), sendo considerado, claro, preciso e compreensível. Conclusão A versão final do banco de itens possui 535 itens, sendo 238 para o sujeito e 297 para o social. Apresenta indícios de evidência de validade de conteúdo e processo de resposta e está apto para testagem de validade de estrutura interna.

Resumen Objetivo Analizar las evidencias de validez de contenido y proceso de respuesta de un banco de ítems sobre vulnerabilidad en salud. Métodos Estudio psicométrico, fundamentado por el polo teórico de Pasquali. Se seleccionaron 62 especialistas con características sociodemográficas y académicas diferentes. Entre ellos, 15 respondieron al cuestionario de validez de contenido. Después de las adaptaciones, el banco pasó a la fase de validez del proceso de respuesta y fue evaluado por 12 usuarios de los servicios de salud. Se utilizó el coeficiente de validez de contenido para evaluar los ítems y el banco, cuya fiabilidad ser verificó mediante la prueba binominal, que consideró un porcentaje de 80 y p-valor >0,05. Resultados El banco presentó buena evidencia de validez de contenido por los especialistas, cuyos coeficientes fueron 0,87 en el elemento sujeto, 0,86 en el elemento social y 0,865 en el general. El público destinatario realizó sugerencias en la fase de validez del proceso de respuesta para una mejor comprensión de los ítems (coeficiente total: 0,89) y fue considerado claro, preciso y comprensible. Conclusión La versión final del banco de ítems contiene 535 ítems, de los cuales 238 son para el sujeto y 297 para el social. Presenta indicios de evidencia de validez de contenido y proceso de respuesta y está apto para una prueba de validez de estructura interna.

Abstract Objective To analyze the evidence of content validity and response process of a health vulnerability item bank. Methods Psychometric study with support of Pasquali's theoretical pole in which 62 specialists with different sociodemographic and academic characteristics were selected and 15 of them responded to the content validity questionnaire. After adjustments, the bank moved to the response process validity phase and was evaluated by 12 health service users. A content validity coefficient was used to evaluate the items and the bank, which had the reliability assessed by the binomial test, considering a percentage of 80% and p-value >0.05. Results The bank presented good evidence of content validity by experts. The coefficients were 0.87 for the subject element, 0.86 for the social element and 0.865 for the general element. The target audience made suggestions in the response process validity phase to better understand the items (total coefficient: 0.89), which were considered clear, accurate and understandable. Conclusion The final version of the item bank has 535 items, 238 for the subject and 297 for the social element. It presents evidence of validity of content and response process and is suitable for testing the validity of internal structure.

Repercussões psicossociais da pandemia da covid-19 para mães de crianças com transtorno do espectro autista / Psychosocial repercussions of the covid-19 pandemic for mothers of children with autism spectrum disorder / Repercusiones psicosociales de la pandemia de covid-19 en las madres de niños con trastorno del espectro autista

RESUMO Objetivo: compreender as repercussões psicossociais da pandemia da COVID-19 para mães de crianças com Transtorno do Espectro Autista. Método: estudo qualitativo, com a participação de 22 mães. Os dados foram coletados de maio a julho de 2022, no interior da Paraíba, Brasil, por meio de uma Dinâmica de Criatividade e Sensibilidade. A análise deu-se através do referencial teórico-analítico da análise de discurso francesa. Resultados: medo, ansiedade, angústia, preocupações assumiram um lugar central no movimento dialógico das mães. Diante das demandas e reconfigurações na rotina, houve uma sobrecarrega física, emocional e psicológica, com repercussões na vida materna. A solidão pôde ser evidenciada pela frágil ou inexistente rede de apoio durante o período pandêmico. Conclusão: o estudo pode subsidiar a reflexão sobre as repercussões da pandemia na vida de mães de crianças com autismo e viabilizar a elaboração de ações que priorizem a saúde mental, auxiliando-as na superação de momentos de adversidades.

ABSTRACT Objective: to understand the psychosocial repercussions of the COVID-19 pandemic for mothers of children with Autism Spectrum Disorder. Method: a qualitative study, with participation of 22 mothers. The data were collected from May to July 2022 in the inland of Paraíba, Brazil, through the Dynamics of Creativity and Sensitivity. The analysis took place through the theoretical-analytical framework of French discourse analysis. Results: fear, anxiety, anguish and concerns assumed a central place in the mothers' dialogical movement. Faced with the demands and reconfigurations in the routine, there was physical, emotional and psychological overload, with repercussions on maternal life. Loneliness can be seen in the weak or non-existent support network during the pandemic. Conclusion: the study can support reflection on the repercussions of the pandemic on the lives of mothers of children with autism and enable the development of actions that prioritize mental health, helping them to overcome moments of adversity.

RESUMEN Objetivo: comprender las repercusiones psicosociales de la pandemia de COVID-19 en las madres de niños con Trastorno del Espectro Autista. Método: estudio cualitativo, con la participación de 22 madres. Los datos fueron recolectados de mayo a julio de 2022, en el interior de Paraíba, Brasil, mediante una Dinámica de Creatividad y Sensibilidad. El análisis se realizó siguiendo el marco teórico-analítico del análisis del discurso francés. Resultados: el miedo, la ansiedad, la angustia y las preocupaciones ocuparon un lugar central en el movimiento dialógico de las madres. Ante las exigencias y reconfiguraciones de la rutina, las madres sufrieron una sobrecarga física, emocional y psicológica que afectó su vida. La soledad se puede ver en la débil o nula red de apoyo que tuvieron durante la pandemia. Conclusión: el estudio puede contribuir a la reflexión sobre las repercusiones de la pandemia en la vida de las madres de niños con autismo y posibilitar el desarrollo de acciones que prioricen la salud mental que las ayuden a superar momentos de adversidad.

Decisões do governo brasileiro no enfrentamento da covid-19: repercussões para o cuidado clínico de enfermagem / Decisiones del gobierno brasileño en el enfrentamiento de covid-19: repercusiones para el cuidado clínico de enfermería / Brazilian government decisions in the fight against covid-19: repercussions for clinical nursing care

Objetivo: analisar as repercussões das decisões do Governo Federal brasileiro no enfrentamento da COVID-19 no cuidado clínico de enfermagem. Método: estudo documental baseado nas publicações de janeiro de 2020 a junho de 2021 divulgadas no site oficial do governo federal. Obtiveram-se 144 documentos que foram analisados na íntegra, apresentados em fluxograma e em Classificação Hierárquica Descendente, esta gerada pelo software IRaMuTeQ. Resultados: a Classificação Hierárquica Descendente gerou seis classes condensadas em: COVID-19 no Brasil, âmbito social, gestão pública, economia na pandemia e direcionamento da assistência em saúde. As decisões centraram-se em reconhecer a existência do cenário pandêmico e estabelecer criação de comitês para gestão e enfrentamento, gestão de insumos hospitalares, redefinição de metas relacionadas aos indicadores de saúde e combate à violência. Considerações finais: as determinações para enfrentamento da pandemia apresentaram ações circunscritas, prioritariamente aos aspectos curativistas, que impactaram na oferta dos cuidados clínicos de enfermagem ao reforçarem o modelo biomédico de atenção à saúde.

Objetivo: analizar las repercusiones de las decisiones del Gobierno Federal brasileño en el enfrentamiento de la COVID-19 en el cuidado clínico de enfermería. Método: estudio documental basado en las publicaciones de enero de 2020 a junio de 2021 divulgadas en el sitio oficial del gobierno federal. Se obtuvieron 144 documentos que fueron analizados en su totalidad, presentados en diagrama de flujo y en Clasificación Jerárquica Descendente, esta generada por el softwareIRaMuTeQ. Resultados: La Clasificación Jerárquica Descendente generó seis clases condensadas en: COVID-19 en Brasil, ámbito social, gestión pública, economía en la pandemia y direccionamiento de la asistencia en salud. Las decisiones se centraron en reconocer la existencia del escenario pandémico y establecer comités para gestión y enfrentamiento, gestión de insumos hospitalarios, redefinición de metas relacionadas a los indicadores de salud y combate a la violencia. Consideraciones finales: las determinaciones para enfrentar la pandemia presentaron acciones circunscritas, prioritariamente a los aspectos curativos, que impactaron en la oferta de los cuidados clínicos de enfermería al reforzar el modelo biomédico de atención a la salud.

Objective: analyzing the repercussions of the decisions of the Brazilian Federal Government in confronting COVID-19 in clinical nursing care. Method: documentary study based on publications from January 2020 to June 2021 published on the official website of the federal government. We obtained 144 documents that were analyzed in full, presented in flowchart and Descending Hierarchical Classification, this generated by IRaMuTeQ software. Results: the Descending Hierarchical Classification generated six classes condensed into: COVID-19 in Brazil, social scope, public management, economy in the pandemic and direction of health care. The decisions focused on recognizing the existence of the pandemic scenario and establishing the creation of committees for management and coping, management of hospital inputs, redefinition of goals related to health indicators and combating violence. Final considerations: the determinations for coping with the pandemic presented limited actions, primarily to curative aspects, which impacted the provision of clinical nursing care by reinforcing the biomedical model of health care.

Ethical dilemmas at the end of life: a reflection from the Philosophical Perspective of Luigina Mortari / Dilemas éticos al final de la vida: una reflexión desde la Perspectiva Filosófica de Luigina Mortari / Dilemas éticos ao fim da vida: uma reflexão sob a Perspectiva Filosófica de Luigina Mortari

ABSTRACT Objectives: to reflect on the ethical dilemmas involved in the care of patients at the end of their lives. Methods: this is a theoretical-reflective study based on the ethics of care proposed by Luigina Mortari. Results: discussing care involves addressing the ways of being inherent to human existence and understanding the unique characteristics of this condition. Ethical care constitutes an action driven by interest in the other and by the perception of their need. Ethical dilemmas are a part of end-of-life care, making it essential to maintain respectful assistance that considers the patient's autonomy, using strategies for expressing their wishes, and ensuring continuous clear and empathetic communication among all those involved in providing care. Final Considerations: issues related to being, stemming from one's reality of dependency and vulnerability, contribute to the emergence of ethical dilemmas present in care actions.

RESUMEN Objetivos: reflexionar sobre los dilemas éticos presentes en la atención de pacientes al final de la vida. Métodos: este es un estudio teórico-reflexivo basado en la ética del cuidado de Luigina Mortari. Resultados: hablar de cuidado es abordar los modos de ser pertenecientes a la existencia humana y comprender las características propias de esa condición. El cuidado ético constituye una acción impulsada por el interés en el otro y por la percepción de su necesidad. Los dilemas éticos son parte de la atención al final de la vida, siendo necesario mantener una asistencia respetuosa que considere la autonomía del paciente, utilizando estrategias para la manifestación de su voluntad y garantizando la continuidad de una comunicación clara y empática entre los diversos sujetos involucrados en la atención. Consideraciones Finales: las cuestiones relacionadas con el ser, derivadas de su realidad de dependencia y vulnerabilidad, contribuyen al surgimiento de los dilemas éticos presentes en las acciones de cuidado.

RESUMO Objetivos: refletir acerca dos dilemas éticos presentes no cuidado de pacientes ao fim da vida. Métodos: trata-se de um estudo teórico-reflexivo baseado na ética do cuidado de Luigina Mortari. Resultados: falar de cuidado é abordar os modos de ser pertencentes à existência humana e compreender as características próprias dessa condição. O cuidado ético constitui uma ação movida pelo interesse no outro e pela percepção de sua necessidade. Dilemas éticos fazem parte do cuidado ao fim da vida, sendo necessário manter uma assistência respeitosa que considere a autonomia do paciente, utilizando estratégias para a manifestação de sua vontade, e garantindo a continuidade de uma comunicação clara e empática entre os diversos sujeitos envolvidos no cuidado. Considerações Finais: as questões relacionadas ao ser, decorrentes de sua realidade de dependência e vulnerabilidade, contribuem para o surgimento dos dilemas éticos presentes nas ações de cuidado.