Construção e validação de protocolo clínico para assistência ao paciente no pós-operatório de transplante cardíaco em unidade de terapia intensiva
Data
2022-01-28
Autores
Sant’Anna, Ana Lúcia Gargione Galvão de [UNIFESP]
Orientadores
Machado, Regimar Carla [UNIFESP]
Tipo
Tese de doutorado
Título da Revista
ISSN da Revista
Título de Volume
Resumo
Objetivos: Construir e validar um protocolo para assistência ao paciente no pós-operatório de transplante cardíaco na unidade de terapia intensiva. Métodos: Estudo metodológico baseado no referencial de Spínola, referente à validação de conteúdo de um protocolo clínico que seguiu três etapas. Na etapa 1 (proposta do protocolo) construiu-se o instrumento de coleta de dados delineado em evidências da literatura científica e na experiência profissional dos pesquisadores, contendo 03 categorias, 09 tópicos, 31 itens e 106 subitens assistenciais. Na etapa 2 (validação de conteúdo) realizou-se a apreciação das variáveis da proposta do protocolo (primeira rodada de Delphi) por meio de ajuizamento com comitê de especialistas na temática. Posteriormente, realizou-se uma revisão integrativa da literatura referente as complicações no pós-operatório de transplante cardíaco composta por seis etapas e estratégia PICOT. A busca foi realizada em oito bases de dados (LILACS, MEDLINE®/PubMed®, Embase®, CINAHL, Cochrane Library®, Scopus®, Web of Science e Ovid) e para seleção dos artigos utilizou-se o programa Rayyan QCRI. Em seguida procedeu-se ao ajuizamento das variáveis do protocolo (segunda rodada de Delphi) com a avaliação por experts brasileiros e estrangeiros. Na etapa 3 realizou-se a construção das variáveis do protocolo clínico (constructo final). Este estudo foi aprovado pelo CEP UNIFESP CAAE: 18298919.6.0000.5505. Resultados: Na primeira rodada de Delphi realizou-se, por videoconferência, a análise das variáveis propostas no instrumento de coleta de dados pelo comitê de especialistas na temática, composto por 02 médicos e 02 enfermeiras, assim compôs-se de 03 categorias, 09 tópicos, 31 itens e 119 subitens. Na revisão integrativa da literatura foram incluídos 05 artigos referentes ao período pós-operatório imediato. Na segunda rodada de Delphi participaram 04 (44,4%) experts do Brasil, 04 (44,4%) da Espanha e 01 (11,1%) do Equador com prática clínica em pós-operatório de transplante cardíaco entre 2 e 30 anos. Os resultados computaram 105 (88,2%) subitens com índice de validade de conteúdo total (IVC-T) de 01 (100,0%) e demostrou que a maioria obteve o IVC > 0,80 (80,0%) estipulado para este estudo. Conclusão: O protocolo (constructo final) foi estruturado com 03 categorias, 09 tópicos, 31 itens e 119 subitens, visando ser um instrumento para garantir a segurança do paciente e a qualidade da assistência prestada articulada aos avanços tecnológicos.
Objective: Build and validate a protocol for patient care in the postoperative period of heart transplantation in the intensive care unit. Methods: Methodological study based on the Spínola reference, referring to the content validation of a clinical protocol that followed three steps. In step 1 (protocol proposal) the data collection instrument delineated in evidence from the scientific literature and in the professional experience of the researchers was constructed, containing 03 categories, 09 topics, 31 items and 106 care sub-items. In step 2 (content validation) the variables of the protocol proposal (first round of Delphi) were assessed by means of a judgement with a committee of experts on the theme. Subsequently, an integrative literature review was conducted regarding complications in the postoperative period of heart transplantation composed of six stages and PICOT strategy. The search was conducted in eight databases (LILACS, MEDLINE®/PubMed®, Embase®, CINAHL, Cochrane Library®, Scopus®, Web of Science e Ovid) and for the selection of articles, the Rayyan QCRI program was used. Next, the protocol variables (Delphi's second round) were assessed with the evaluation by Brazilian and foreign experts. In step 3, the variables of the clinical protocol (final construct) were constructed. This study was approved by cep UNIFESP CAAE: 18298919.6.0000.5505. Results: In the first round of Delphi, the analysis of the variables proposed in the data collection instrument was performed by videoconference by the committee of experts on the theme, composed of 02 physicians and 02 nurses, thus consisting of 03 categories, 09 topics, 31 items and 119 sub-items. In the integrative review of the literature, 05 articles referring to the immediate postoperative period were included. In the second round of Delphi, 04 (44.4%) experts from Brazil, 04 (44.4%) from Spain and 01 (11.1%) from Ecuador with clinical practice in the postoperative period of heart transplantation between 2 and 30 years old participated. The results computed 105 (88.2%) sub-items with total content validity index (IVC-T) of 01 (100.0%) and showed that the majority obtained the CVI > 0.80 (80.0%) stipulated for this study. Conclusion: The protocol (final construct) was structured with 03 categories, 09 topics, 31 items and 119 sub-items, aiming to be an instrument to ensure patient safety and the quality of care provided articulated to technological advances.
Objective: Build and validate a protocol for patient care in the postoperative period of heart transplantation in the intensive care unit. Methods: Methodological study based on the Spínola reference, referring to the content validation of a clinical protocol that followed three steps. In step 1 (protocol proposal) the data collection instrument delineated in evidence from the scientific literature and in the professional experience of the researchers was constructed, containing 03 categories, 09 topics, 31 items and 106 care sub-items. In step 2 (content validation) the variables of the protocol proposal (first round of Delphi) were assessed by means of a judgement with a committee of experts on the theme. Subsequently, an integrative literature review was conducted regarding complications in the postoperative period of heart transplantation composed of six stages and PICOT strategy. The search was conducted in eight databases (LILACS, MEDLINE®/PubMed®, Embase®, CINAHL, Cochrane Library®, Scopus®, Web of Science e Ovid) and for the selection of articles, the Rayyan QCRI program was used. Next, the protocol variables (Delphi's second round) were assessed with the evaluation by Brazilian and foreign experts. In step 3, the variables of the clinical protocol (final construct) were constructed. This study was approved by cep UNIFESP CAAE: 18298919.6.0000.5505. Results: In the first round of Delphi, the analysis of the variables proposed in the data collection instrument was performed by videoconference by the committee of experts on the theme, composed of 02 physicians and 02 nurses, thus consisting of 03 categories, 09 topics, 31 items and 119 sub-items. In the integrative review of the literature, 05 articles referring to the immediate postoperative period were included. In the second round of Delphi, 04 (44.4%) experts from Brazil, 04 (44.4%) from Spain and 01 (11.1%) from Ecuador with clinical practice in the postoperative period of heart transplantation between 2 and 30 years old participated. The results computed 105 (88.2%) sub-items with total content validity index (IVC-T) of 01 (100.0%) and showed that the majority obtained the CVI > 0.80 (80.0%) stipulated for this study. Conclusion: The protocol (final construct) was structured with 03 categories, 09 topics, 31 items and 119 sub-items, aiming to be an instrument to ensure patient safety and the quality of care provided articulated to technological advances.
Descrição
Citação
SANT'ANNA, A.L.G.G. Construção e validação de protocolo clínico para assistência ao paciente no pós-operatório de transplante cardíaco em unidade de terapia intensiva. São Paulo, 2022. 249 f. Tese (Doutorado em Enfermagem) - Escola Paulista de Enfermagem (EPE), Universidade Federal de São Paulo (UNIFESP), São Paulo, 2022.
Palavras-chave
Cuidados pós-operatórios, Estudos de validação, Transplante de coração, Protocolos clínicos, Unidades de terapia intensiva, Consenso, Equipe de assistência ao paciente, Técnica Delphi, Clinical protocols, Heart transplantation, Intensive care units, Postoperative care, Validation study, Delphi technique, Consensus, Patient Care Team