Validação de resultados de enfermagem noc para pessoas com insuficiência cardíaca com o diagnóstico de enfermagem autocontrole ineficaz da saúde
Data
2015-07-07
Autores
Cavalcante, Agueda Maria Ruiz Zimmer 
Orientadores
Barros, Alba Lucia Bottura Leite de
Tipo
Tese de doutorado
Título da Revista
ISSN da Revista
Título de Volume
Resumo
A insuficiência cardíaca (IC) é uma complexa patologia cuja progressão está relacionada a não adesão ao tratamento que inclui atividades de autocuidado. Instrumentos de avaliação são desenvolvidos visando avaliar o autocuidado permitindo intervenções direcionadas às necessidades do indivíduo. A Classificação dos Resultados de Enfermagem NOC oferece numerosas escalas de avaliação em diferentes aspectos da saúde. Dois resultados foram selecionados para o paciente com IC: “Autocontrole da doença cardíaca” e “Comportamento de adesão”. Os indicadores que compõem esses resultados são genéricos e pouco claros para estimar sua magnitude. O uso de indicadores permite acompanhar as mudanças do indivíduo tornando possível determinar e priorizar o indicador no qual intervir. A hipótese do estudo fundamentou-se em que os indicadores de autocuidado previstos na NOC são genéricos, pouco específicos e não suficientemente claros para pacientes com IC e uma busca na literatura revelaria a necessidade de acrescentar indicadores aos resultados NOC selecionados. Objetivo: identificar indicadores de resultados da NOC aplicáveis a pessoas com IC com “Autocontrole ineficaz da saúde” e realizar a validação por consenso quanto à relevância e clareza das definições conceituais e operacionais desenvolvidas para os indicadores desses resultados NOC “Autocontrole da Doença Cardíaca” e “Comportamento de Adesão” para o cuidado de pessoas com IC e diagnóstico de enfermagem “autocontrole ineficaz da saúde”. Método: estudo metodológico, desenvolvido em diferentes fases. A primeira consistiu na revisão integrativa da literatura, baseada no modelo de Withmore e Knafl (2005), para identificar os indicadores de autocuidado de pessoas com IC. Na segunda, foram construídas definições conceituais e operacionais para os indicadores dos resultados NOC e, posteriormente, submetidas à apreciação de 20 especialistas, que julgaram-nas quanto à relevância e clareza. Resultados: na revisãointegrativa da literatura, a partir da inclusão de 148 artigos, onze dimensões de autocuidado foram identificadas: adesão medicamentosa, reabilitação e prática de exercícios, monitoramento do peso, comportamentos relacionados à restrição do sódio, comportamentos relacionados com a dieta, conhecimento da doença, comportamentos relacionados à restrição hídrica, comportamentos relacionados à orientação para redução de ingestão de bebida alcoólica e tabagismo, comportamentos relacionados à orientação sobre sono/descanso e vacinação. Para o resultado NOC Autocontrole da doença cardíaca, todas as dimensões de autocuidado identificadas abrangeram tais indicadores. E, para o resultado Comportamento de adesão apenas quatro dimensões relacionaram-se aos indicadores desse resultado. Na análise das definições conceituais e operacionais dos 57 indicadores de ambos os resultados pelos especialistas, a maioria foi considerada relevante e clara. Diversas considerações e sugestões foram apontadas as quais foram analisadas e atendidas em sua maioria, sendo então refinadas. Conclusão: as dimensões de autocuidado identificadas na literatura oferecem evidência de áreas significativas do autocuidado, as quais estão contempladas por meio de indicadores mais abrangentes em ambos os resultados NOC selecionados não havendo a necessidade do acréscimo de novos indicadores. As definições elaboradas podem oferecer substrato para uma avaliação mais objetiva, clara e que possibilite a identificação minuciosa das limitações do indivíduo em controlar e aderir ao tratamento. Além de oferecer informações que auxiliam na elaboração de metas para o paciente e o cuidador.
Heart failure (HF) is a complex disease, in which progression is related to non-adherence to treatment including activities of self-care. Assessment tools are developed to evaluate self-care interventions aimed at enabling individual needs. The Nursing Outcomes Classification (NOC) offers numerous rating scales in different aspects of health. Two outcomes were selected for evaluation of patients with HF: "Cardiac Disease Self-Management" and "Adherence Behavior." The indicators that comprise these outcomes are generic and there is no clarity to estimate their magnitude. The use of indicators allows oneself to track changes in the individual, and enables the caregiver to determine and prioritize the indicator on which to intervene. The study hypothesis was based on the fact that self-care indicators under NOC are not specific to patients with HF and a search of the literature could reveal the need to add new indicators to selected NOC outcomes. Objective: To identify NOC outcomes indicators applicable to people with HF with "ineffective self-health management", and carry out the validation by consensus among experts as the relevance and clarity of conceptual and operational definitions developed for the indicators of the outcomes NOC "Cardiac Disease Self-Management" and "Adhesion Behavior", for the care of people with HF and nursing diagnosis "Ineffective self-health management". Method: a methodological study, developed at different stages. The first stage consisted of an integrative literature review based on the Whitmore and Knafl model (2005) to identify self-care indicators of people with HF. In the next stage, conceptual and operational definitions for the indicators of NOC outcomes were built and subsequently referred to the council of 20 experts, who judged the settings as to their relevance and clarity. Results: For the integrative literature, from the reading of 371 articles in full and inclusion 148 articles, eleven self-care dimensions were identified: medication adherence, rehabilitation and exercise, weight monitoring, behaviors related to sodium restriction, behaviors related to diet, knowledge of the disease,behaviors related to water stress, behaviors related to orientation to reduce alcohol consumption and smoking behaviors related to guidance on sleep / rest and vaccination. For the outcome NOC “Cardiac Disease Self-Management”, all self-care dimensions identified covered such indicators. As for the outcome “Adherence Behavior”, only four dimensions were related to the indicators of this result. In the analysis of conceptual and operational definitions of the 57 indicators of both NOC results by the experts, most were relevant and clear. Several considerations and suggestions were noted by experts, which were analyzed and complied in their majority, being subsequently refined. Conclusion: self-care dimensions identified in the literature provide evidence of significant areas of self-care, which are covered by broader indicators on both selected NOC outcomes, there was no need for the addition of new indicators. The conceptual and operational definitions developed for the indicators can provide a substrate for a more objective and clear evaluation, which enables thorough assessment with identification of the limitations of the individual to control and adhere to treatment. Additionally, it provides information to help in the development of goals for the patient and caregiver.
Heart failure (HF) is a complex disease, in which progression is related to non-adherence to treatment including activities of self-care. Assessment tools are developed to evaluate self-care interventions aimed at enabling individual needs. The Nursing Outcomes Classification (NOC) offers numerous rating scales in different aspects of health. Two outcomes were selected for evaluation of patients with HF: "Cardiac Disease Self-Management" and "Adherence Behavior." The indicators that comprise these outcomes are generic and there is no clarity to estimate their magnitude. The use of indicators allows oneself to track changes in the individual, and enables the caregiver to determine and prioritize the indicator on which to intervene. The study hypothesis was based on the fact that self-care indicators under NOC are not specific to patients with HF and a search of the literature could reveal the need to add new indicators to selected NOC outcomes. Objective: To identify NOC outcomes indicators applicable to people with HF with "ineffective self-health management", and carry out the validation by consensus among experts as the relevance and clarity of conceptual and operational definitions developed for the indicators of the outcomes NOC "Cardiac Disease Self-Management" and "Adhesion Behavior", for the care of people with HF and nursing diagnosis "Ineffective self-health management". Method: a methodological study, developed at different stages. The first stage consisted of an integrative literature review based on the Whitmore and Knafl model (2005) to identify self-care indicators of people with HF. In the next stage, conceptual and operational definitions for the indicators of NOC outcomes were built and subsequently referred to the council of 20 experts, who judged the settings as to their relevance and clarity. Results: For the integrative literature, from the reading of 371 articles in full and inclusion 148 articles, eleven self-care dimensions were identified: medication adherence, rehabilitation and exercise, weight monitoring, behaviors related to sodium restriction, behaviors related to diet, knowledge of the disease,behaviors related to water stress, behaviors related to orientation to reduce alcohol consumption and smoking behaviors related to guidance on sleep / rest and vaccination. For the outcome NOC “Cardiac Disease Self-Management”, all self-care dimensions identified covered such indicators. As for the outcome “Adherence Behavior”, only four dimensions were related to the indicators of this result. In the analysis of conceptual and operational definitions of the 57 indicators of both NOC results by the experts, most were relevant and clear. Several considerations and suggestions were noted by experts, which were analyzed and complied in their majority, being subsequently refined. Conclusion: self-care dimensions identified in the literature provide evidence of significant areas of self-care, which are covered by broader indicators on both selected NOC outcomes, there was no need for the addition of new indicators. The conceptual and operational definitions developed for the indicators can provide a substrate for a more objective and clear evaluation, which enables thorough assessment with identification of the limitations of the individual to control and adhere to treatment. Additionally, it provides information to help in the development of goals for the patient and caregiver.
Descrição
Citação
CAVALCANTE, Agueda Maria Ruiz Zimmer. Validação de resultados de enfermagem noc para pessoas com insuficiência cardíaca com o diagnóstico de enfermagem autocontrole ineficaz da saúde. 2015. 293 f. Tese (Doutorado em Enfermagem) - Escola Paulista de Enfermagem, Universidade Federal de São Paulo (UNIFESP), São Paulo, 2015.