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- ItemSomente MetadadadosDiagnósticos de enfermagem de alta acurácia em pessoas com insuficiência cardíaca(Universidade Federal de São Paulo (UNIFESP), 2020-08-27) Souza, Larissa Maiara Da Silva Alves [UNIFESP]; Barros, Alba Lucia Bottura Leite De [UNIFESP]; Universidade Federal de São PauloIntroduction: Heart failure (HF) is a complex clinical syndrome secondary to cardiac structural and functional abnormalities. The existence of comorbidities such as hypertension, diabetes, physical inactivity and dyslipidemia and non-adherence to drug and non-drug treatment, as well as a lack of knowledge of the exacerbation symptoms of the disease are associated with hospitalizations. It is estimated that around 2 million new cases appear worldwide each year. In 2018, there were 200,814 hospital admissions registered in the Unified Health System (UHS) associated with HF, with 9,156 admissions registered in the state of São Paulo. Today, approximately 5.1 million Americans have HF. It is believed that this number tends to increase 46% by 2030, reaching eight million individuals diagnosed with HF. In this scenario, the performance of nursing can be circumstantial. When identifying the nursing diagnoses (ND) associating them to clinical signs and symptoms, the nurse unifies the individual's needs so that the elaborated interventions are aimed at solving these identified NDs. These diagnoses, when elaborated in an accurate way, make possible a more assertive care, with higher rates of resolution, reduction of complications and improvement of health status. The Nursing Diagnosis Accuracy Scale version-2 (NDAS-2) assesses the degree to which the statement of the ND is confirmed through a set of clinical information of the patient being used to measure the degree of accuracy of the listed NDs. Objectives: to identify highly accurate NDs present on admission and discharge of patients hospitalized for HF; identify the prevalence of NDs on admission and discharge from patients hospitalized for HF; test the reliability of the NDAS-2 within the between evaluators regarding the degree of accuracy of the diagnoses; Method: prospective cohort of diagnostic accuracy conducted in the Emergency Room of a large reference hospital in cardiology in a Brazilian metropolis, from August 2018 to July 2019, 155 patients hospitalized for HF participated in the research. Socio-demographic, clinical and drug treatment data were collected from an instrument developed by the researchers and previously tested. Subsequently, two researchers applied EADE-2 to NDs registered on admission and discharge of hospitalized HF patients. The variables were presented by means of descriptive statistics (absolute and relative frequencies) and by mean ± standard deviation. Fisher's exact test was used and associations with a descriptive level≤0.05 were considered significant. To assess the agreement between the evaluators, the Kappa coefficient was used, which varies from 0 to 1, and the closer to one, the greater the agreement. Results: The average age of hospitalized patients was 62.6 years, the majority being male (61.3%), white (54.19%) and incomplete elementary school (49.03%). The predominant hemodynamic profile was B (73.5%), the most frequent etiologies were cardiomyopathies (19.4%) and chagas disease (16.1%), with 25.16% not having a classification. Acute coronary syndrome was the most frequent pathology, observed in 43 patients (27.7%), the most prevalent comorbidities were hypertension (74.19%), diabetes (40.64%) and dyslipidemia (40.64%). Among the 18 NDs identified, four were prevalent both at admission and at discharge: Risk for Infection, Risk for Fall, Risk for decreased cardiac output and Fluid volume excess. These DEs had a good agreement between evaluators, with the Fluid volume excess being the one with the highest correlation at admission (0.7) and at discharge (0.9). Considering all NDs 85% were classified as highly accurate on admission and about 66% on hospital discharge. The NDs that stood out in this high accuracy classification were: Risk for Infection and Risk for decreased cardiac output on admission; and at discharge, he kept the Risk for infection together with the Risk for fall. Conclusion: The results of the study possibled to identify highly accurate nursing diagnoses. In addition, ND Risk for infection was the most prevalent and highly accurate, although it is not directly related to pathology such as the Risk for decreased cardiac output and the Fluid volume excess that are NDs related to the pathophysiological conditions of HF, demonstrating that there is the need to prioritize those NDs of greater clinical relevance in critical situations such as admission and discharge. Considering that nurses, through signs and symptoms, physical examination, laboratory and image exams, can identify other NDs, and thus make decisions in view of the current and real conditions of patients, the identification of highly accurate NDs will help them during systematic care, enabling appropriate nursing planning and care.
- ItemAcesso aberto (Open Access)Enfermagem(Assoc Brasileira Enfermagem, 2016) Ferreira, Anali Martegani [UNIFESP]; da Rocha, Elisiane do Nascimento; Lopes, Camila Takao [UNIFESP]; Bachion, Maria Marcia [UNIFESP]; Lopes, Juliana de Lima [UNIFESP]; de Barros, Alba Lucia Bottura Leite [UNIFESP]Objective: to identify nursing diagnoses in intensive care unit (ICU) patients by means of a cross-mapping of terms contained in nursing records with the NANDA-I taxonomy. Method: an exploratory, descriptive study with a retrospective analysis of nursing records in 256 medical records of patients that were hospitalized in the general ICU of a hospital in the western border of the state of Rio Grande do Sul. Terms indicating conditions demanding nursing interventions were collected from the records; cross-mapping of these terms with the NANDA-I taxonomy diagnoses was performed and confirmed in a nursing focus group. Data were analyzed through descriptive statistics. Results: a total of 832 terms and expressions referring to 52 different diagnoses in 9 of the 13 domains of the NANDA-I taxonomy were identified. Conclusion: the present study enabled the identification of nursing diagnoses in patients hospitalized in ICUs, affecting care management, the training process of experts in the area, and information systems.
- ItemAcesso aberto (Open Access)A Humanização na Prática de Enfermeiros em uma Unidade Hospitalar de Clínica Médico Cirúrgica(Universidade Federal de São Paulo (UNIFESP), 2008-07-30) Magalhães, Juliana Barbosa [UNIFESP]; Maia, José Antonio [UNIFESP]; Universidade Federal de São Paulo (UNIFESP)O presente estudo teve por objetivo apreender, na ótica de enfermeiros atuantes em uma Unidade de Clínica Médico Cirúrgica de um hospital de grande porte da cidade de São Paulo, seus conceitos e suas formações a respeito da prática humanizada no cuidado ao paciente hospitalizado. A pesquisa, de natureza qualitativa, consistiu de uma análise descritiva e transversal, utilizando como instrumentos de coletas de dados questionários e entrevistas com roteiro semi-estruturado. Os resultados foram estudados por intermédio da análise temática, considerando-se aproximações de significados. Os profissionais não expressaram clareza a respeito de seu conceito de “humanização”, preferindo citar exemplos de “prática humanizada”. Coerentemente, o contato, durante a formação dos profissionais com discussões a respeito da humanização dos cuidados, foi escasso e tardio. Contudo, observou-se que todos expressavam a importância de uma prática humanizada, citando como fatores limitantes à mesma aspectos institucionais, relativos à sobrecarga de trabalho, dentre outros. Um dos dados considerado mais importante deste estudo foi o desejo, pela maioria dos profissionais, no seu aprimoramento para uma assistência mais humanizada, por intermédio de programas de educação continuada. Os dados indicam a importância de intervenções educativas nas equipes, que, se por um lado mostram-se sensibilizadas para a temática da humanização, por outro apontam para a lacuna de processos formativos, de cunho essencialmente reflexivo.
- ItemAcesso aberto (Open Access)Nursing Interventions in the Clinical Practice of an Intensive Care Unit(Escola de Enfermagem de Ribeirão Preto / Universidade de São Paulo, 2010-10-01) Lucena, Amália de Fátima [UNIFESP]; Gutiérrez, Maria Gaby Rivero de [UNIFESP]; Echer, Isabel Cristina; Barros, Alba Lucia Bottura Leite de [UNIFESP]; Universidade Federal do Rio Grande do Sul Escola de Enfermagem; Universidade Federal de São Paulo (UNIFESP)This cross-sectional study was carried out at a university hospital to describe the nursing interventions most frequently performed in the clinical practice of an intensive care unit, based on nursing care prescriptions, and to investigate their similarity to the Nursing Interventions Classification (NIC). The sample consisted of 991 hospitalizations of patients. Data were retrospectively collected from the computer database and analyzed through descriptive statistics and cross-mapping. A total of 57 different NIC interventions frequently used in the unit were identified; most of them in the complex (42%) and basic physiological (37%) domains, in the classes respiratory management and self-care facilitation . Similarity between the nursing care prescribed and nursing interventions/NIC was found in 97.2% of the cases. The conclusion is that the interventions/NIC used in the clinical practice of this intensive care unit reflects the level of complexity of nursing care, which is mainly directed at the regulation of the body s physical and homeostatic functioning.
- ItemSomente MetadadadosO processo de enfermagem na assistência a parturiente: diagnósticos e intervenções(Universidade Federal de São Paulo (UNIFESP), 2002) Sumita, Satie Lucia Nishimaru [UNIFESP]; Marin, Heimar de Fátima [UNIFESP]Esta pesquisa de carater descritivo foi desenvolvida no Centro Obstetrico do Hospital Municipal Vereador Jose Storopolli (HMVJS) do Municipio de São Paulo. Apresentou como objetivos elaborar e testar um instrumento estruturado de coleta de dados para assistencia a parturiente; identificar e relacionar os diagnosticos de enfermagem mais frequentes e propor intervencoes de enfermagem. A amostra constituiu-se de 180 parturientes com gestacao a termo; foram excluidas as que no momento da coleta de dados encontravam-se no periodo de transicao para o expulsivo ou no expulsivo e as com intercorrencias clinico-obstetricas. 0 instrumento de coleta de dados foi elaborado com base na estrutura da Taxonomia II, segundo os Padroes de Saúde - Modelo Multiaxial. A pesquisadora realizou a coleta de dados no periodo de outubro de 2000 a setembro de 2001 durante a admissao da parturiente no Centro Obstetrico e quando a mesma ja se encontrava internada, independente do tempo de internacao. Foram identificados 29 diferentes diagnosticos, com frequencia, variando de 0,5 por cento a 100º/a, cuja media foi de 11,8 diagnosticos por parturiente. Os diagnosticos de enfermagem observados em 100 por cento das parturientes foram: Risco para infeccao e Risco para perfusao tissular materno-fetal ineficaz, os fatores de riscos mais frequentes foram, respectivamente, toque vaginal e contracao uterina. Os diagnosticos identificados entre 75 e 99,0 por cento das parturientes foram: Conforto alterado (91,7 por cento), Dor aguda (90,6 por cento), Nutricao desequilibrada para menos que a necessidade (83,9 por cento) e Medo (76,1 por cento). As caracteristicas definidoras mais frequentes reconhecidas para os diagnosticos foram, respectivamente, dor (98,8 por cento), evidencia observada (100 por cento), relato ou evidencia falta de comida (100 por cento) e identificacao do objeto do medo/dor (86,8 por cento). Os fatores relacionados identificados em 100 por cento...(au)
- ItemAcesso aberto (Open Access)Systematization of nursing care and the formation of professional identity(Assoc Brasileira Enfermagem, 2017) Rivero de Gutierrez, Maria Gaby [UNIFESP]; Ramalho Vasconcelos Morais, Sheila CoelhoThe aim of this study is to explore arguments that broaden the understanding of possible links between the organization of nursing care and the structuring of professional identity. For that purpose, some aspects related to these themes are addressed, highlighting issues regarding differences in the concepts of the organization of nursing care and the nursing process, as well as the performance of this activity and its possible impact on the establishment of its relationship with the professional identity. Emphasis is given to the need to stimulate the debate on the subject by nursing professionals involved in the training of human resources and the provision of care, as well as in class entities, in order to deepen understanding of these concepts as significant elements for strengthening our professional identity.