Dissertations / Theses on the topic 'Nursing diagnosis'

Thesis (Ed. D.)--Illinois State University, 1987.
Title from title page screen, viewed August 12, 2005. Dissertation Committee: John R. McCarthy (chair), Marilyn E. Feldmann, Ronald S. Halinski, Franklin G. Matsler, Charles T. Spender. Includes bibliographical references (leaves 83-89) and abstract. Also available in print.

Thesis (Ed. D.)--Illinois State University, 2003.
Title from title page screen, viewed October 19, 2005. Dissertation Committee: Dent M. Rhodes (chair), Cathy A. Toll, Eileen T. Borgia, Saundra L. Theis. Includes bibliographical references (leaves 108-116) and abstract. Also available in print.

This exploratory study used Diagnostic Content Validity (DCV) and the Clinical Diagnostic Validation (CDV) models proposed by Fehring (1986) to clinically identify and validate the defining characteristics for Alteration in Tissue Perfusion: Cardiac. The literature based Kelly Cardiac Assessment Tool (KCAT) was designed as the data collection tool. The diagnostic content validity of the KCAT was 0.70. Twenty subjects, 18 years old and older were selected from a population who were admitted as inpatients in a southwestern university affiliated hospital. Data were collected through patient interviews, independent nurse assessment, and review of laboratory data. Using the steps described in Fehring's CDV model (1986) one major defining characteristic and 13 minor defining characteristics were clinically validated. The tool CDV score was 0.62. The nursing diagnosis Alteration in Tissue Perfusion: Cardiac was clinically validated and one major and 13 minor defining characteristics were identified.

CoordenaÃÃo de AperfeiÃoamento de Pessoal de NÃvel Superior
The study looked to characterize a proposal for the nursing diagnosis of âRisk of Decreased Cardiac Outputâ, based on the judgement of 25 specialists. It was carried out in the period of September of 2007 to April of 2008, in two methodological stages: a) Elaboration of the proposal of the nursing diagnosis of Risk of Decreased Cardiac Output, according to NANDA, and the operational definition for each risk factor; b) Validation of the concept, of the risk factors and the operational definitions. For so, it was used the Diagnostic Content Validation model proposed by Fehring and the Delphi technique. All the specialists were selected based on Fehringâs criteria. Data was collected at two moments, from questionnaires. The quantitative analysis disposed of the calculation of the weighted mean of the value attributed by specialist to each risk factor, being: 1 (it does not cause vulnerability) = 0; 2 (it causes very little vulnerability) = 0,25; 3 (it causes moderate vulnerability) = 0,5; 4 (it causes very much vulnerability) = 0,75; and 5 (it completely causes vulnerability) = 1. Based on this calculation, the risk factors with score below the established cutoff point of 0,6 were discarded. For the evaluation of the items related to the operational definition (Clarity, Adequacy to the risk factor and Adequacy to the remaining proposed terms) the values were tabulated (+1, 0 and -1) and the mean calculated, in order to check the level of agreement/disagreement between the specialists. There was still calculated the Index of Content Validity, which indicates the confidence of the application of the diagnosis in practice. It was considered the explanation of the objectives to the participants, their declared consent in allowing the collection and supplying the solicited data, their freedom to refuse or give up from participating in any phase of the research process without prejudice of any kind to them, to ask for clarification as well as their right to anonymity. As result, was obtained the understanding that the label proposed is representative of a nursing diagnosis, to which the concept corresponded, in adequacy to the structure used by NANDA: âTo be in risk of developing a level of health characterized by insufficient quantity of blood pumped each minute by the heart to fulfill the physical metabolic demandsâ. Were considered representative risk factor for this phenomenon (≥ 0,6), according to the specialists judgement: myocardial dysfunction (0,887), blood loss (0,875), intrapericardial pressure increase (0,825), condition that causes alteration in the rhythm and/or electric cardiac driving (0,812), defective volume of liquids (0,725), plasma loss (0,712), ineffective tissular perfusion (0,712), electrolytic unbalance (0,7), acid-base unbalance (0,697), valve alteration (0,65), major surgery (0,65) and general deep anaesthesia/spinal anaesthesia (0,625), obtaining a Index of Content Validity of 0,739. With this proposal, it was provided the characterization of this phenomenon, as a form to orientate the process of clinical judgement, making possible a preventive act, as a way to avoid the development of the real entity and of his complications. However, because of the peculiarity of this study and the relevance of its finds, itâs essential the replication of the 10 risk factors (22%) that were located between the cutoff points of 0,5 and 0,59, as well as new submissions of the data to the specialists to obtain the consensus, and the realization of a study of clinical validation, in order to obtain evidences about the incident of this phenomenon in nursesâ practice
O estudo buscou caracterizar proposta para o diagnÃstico de enfermagem Risco para DÃbito CardÃaco diminuÃdo, com base no juÃzo de 25 especialistas. Foi realizado no perÃodo de setembro de 2007 a abril de 2008, em duas etapas metodolÃgicas: a) ElaboraÃÃo da proposta do diagnÃstico de enfermagem Risco para DÃbito CardÃaco diminuÃdo, de acordo com a NANDA, e da definiÃÃo operacional para cada fator de risco; b) ValidaÃÃo do construto, dos fatores de risco e das definiÃÃes operacionais. Para tanto, utilizou o modelo de ValidaÃÃo de ConteÃdo DiagnÃstico de Fehring e a tÃcnica Delphi. Todos os especialistas foram selecionados com base nos critÃrios de Fehring. Os dados foram coletados em dois momentos, por meio de questionÃrio. Jà a anÃlise quantitativa empregou a mÃdia ponderada do valor atribuÃdo por especialista a cada fator de risco, sendo: 1 (nÃo causador de vulnerabilidade) = 0; 2 (pouco causador de vulnerabilidade) = 0,25; 3 (moderadamente causador de vulnerabilidade) = 0,5; 4 (muito causador de vulnerabilidade) = 0,75; e 5 (totalmente causador de vulnerabilidade) = 1. Com base nesse cÃlculo, descartaram-se os fatores de risco com escore abaixo do ponto de corte estabelecido de 0,6. Para a avaliaÃÃo dos itens relacionados à definiÃÃo operacional (Clareza, AdequaÃÃo ao fator de risco e AdequaÃÃo aos demais termos propostos) seus valores foram tabulados (+1, 0 e -1) e a mÃdia calculada, com vistas a verificar o nÃvel de concordÃncia/discordÃncia entre os especialistas. Calculou-se ainda o Ãndice de Validade de ConteÃdo, o qual indica a confianÃa da aplicaÃÃo do diagnÃstico na prÃtica. Considerou-se o esclarecimento dos objetivos e da metodologia aos participantes, o consentimento declarado destes em permitir a coleta e fornecer os dados solicitados, a sua liberdade para recusar ou desistir de participar em qualquer fase do processo de pesquisa sem prejuÃzo de qualquer natureza à sua pessoa, assim como para solicitar esclarecimentos e o seu direito ao anonimato. Como resultado, obteve-se a compreensÃo do rÃtulo proposto como representativo de um diagnÃstico de enfermagem, para o qual prevaleceu o construto: âEstar em risco de desenvolver um estado de saÃde caracterizado por quantidade insuficiente de sangue bombeado pelo coraÃÃo a cada minuto para atender Ãs demandas metabÃlicas corporaisâ. Foram considerados fatores de risco representativos deste fenÃmeno (≥ 0,6), segundo o juÃzo dos especialistas: disfunÃÃo miocÃrdica (0,887), perda sangÃÃnea (0,875), aumento da pressÃo intrapericÃrdica (0,825), condiÃÃo que causa alteraÃÃo no ritmo e/ou conduÃÃo elÃtrica cardÃaca (0,812), Volume de LÃquidos deficiente (0,725), perda plasmÃtica (0,712), PerfusÃo Tissular ineficaz (0,712), desequilÃbrio eletrolÃtico (0,7), desequilÃbrio acidobÃsico (0,697), alteraÃÃo valvar (0,65), grandes cirurgias (0,65) e anestesia geral profunda/ anestesia espinhal (0,625), obtendo-se um Ãndice de Validade de ConteÃdo de 0,739. Com esta proposta, propiciou-se a caracterizaÃÃo deste fenÃmeno, como forma de orientar o processo de julgamento clÃnico, possibilitando uma atuaÃÃo de cunho preventivo, de modo a evitar o desenvolvimento da entidade real e das suas complicaÃÃes. No entanto, em virtude da sua singularidade e da relevÃncia dos seus achados, à imprescindÃvel a replicaÃÃo dos 10 fatores de risco (22%) situados entre os pontos de corte de 0,5 e 0,59, assim como novas submissÃes dos dados aos especialistas para a obtenÃÃo do consenso e a realizaÃÃo de estudo de validaÃÃo clÃnica, a fim de obter evidÃncias acerca da ocorrÃncia desse fenÃmeno na prÃtica dos enfermeiros

Conselho Nacional de Desenvolvimento CientÃfico e TecnolÃgico
To determine nursing diagnoses is a very necessary task, for it contributes to the better planning of the interventions in clients who survived after the stroke and who, in most of the cases, presented incapabilities. Due to this, the study aimed to analyze the nursing diagnoses shown in the Activity/Exercise branch in clients with stroke during the period of rehabilitation. A transversal study was done amongst 121 clients who attended one of the eight units of Cearense Beneficent Association of Rehabilitation (ABCR) in Fortaleza City- CearÃ, whose data collection occurred within the period of November, 2007 and March, 2008. The including criteria were: a) to be registered in the ABCR; b) to have suffered from stroke at least once, and presented the diagnosis confirmation by the doctor; c) to be over 18 years old. A form was used for the data collection, which had undergone content validation by two nurses expertise in the care of clients with stroke. The information was collected through interview and physical tests. To name the nursing diagnoses, the Taxonomy II proposed by the North American Nursing Diagnosis Association (NANDA), published in 2008, was followed as reference. With the data compiled in the Excel program, the statistic analysis was done within the EpiInfo and SPSS program. The level of significance adopted in the study was of 5%. All ethical recommendations were followed during the stages of the research. Taking the social and demographic data into account, it was verified that the majority of these participants was from masculine gender, elderly, without a partner, retired or pensioners and had low education and income per capita. Amongst the various risk indicators, the most frequent one was the arterial hypertension, followed by the sedentarism, dislipidemy, cardiopathies and diabetes mellitus. Half of the clients studied had at once suffered from stroke 12 months before, beginning rehabilitation in one of the units of the ABCR for at maximum seven months. The participants showed an average of 6.7 nursing diagnoses; 25.1 defining characteristics; 4.6 related factors and 10.1 risky factors. All the diagnoses of the branch studied were identified, but seven: Falling risk, Impaired physical mobility, Impaired deambulation, Sedentary lifestyle, Risk for disuse syndrome, Risk for intolerance to the activity and Impaired transference capability had the frequency of over 50% and were used for the statistic analysis. According to the tests, there was a statistically significant relation among the diagnoses, with the exception of the followings: Falling risk, Impaired physical mobility, Impaired deambulation and Impaired transference capability with the diagnosis Risk for intolerance to the activity. The defining characteristics, related factors and risky factors were statistically associated with the major part of the nursing diagnoses analyzed. Such fact can be justified by the fact that all of them are part of the same branch within the NANDA (2008). One may conclude that the majority of the nursing diagnoses showed statistically association amongst them. It is verified that the Impaired muscular force and Neuromuscular damage were the most frequent related factors found, causing thus, the main consequences for the stroke. The study permitted a deep knowledge upon the Activity/Exercise branch in clients with stroke
Determinar diagnÃsticos de enfermagem à uma atividade de assistÃncia muito necessÃria, pois contribui para o melhor planejamento de intervenÃÃes em clientes que sobreviveram ao acidente vascular encefÃlico (AVE) e que na maioria dos casos apresentam incapacidades. Diante disso, o estudo teve por objetivo analisar os diagnÃsticos de enfermagem pertencentes à classe Atividade/ExercÃcio em clientes com acidente vascular encefÃlico no perÃodo de reabilitaÃÃo. Um estudo transversal foi desenvolvido com 121 clientes que freqÃentavam uma das oito unidades da AssociaÃÃo Beneficente Cearense de ReabilitaÃÃo (ABCR) na cidade de Fortaleza-CearÃ, cuja coleta de dados ocorreu no perÃodo de novembro de 2007 a marÃo de 2008. Os critÃrios de inclusÃo foram: a) ser cadastrado na ABCR; b) ter apresentado pelo menos um episÃdio de acidente vascular encefÃlico, com diagnÃstico confirmado por mÃdico; c) ter idade acima de 18 anos. Para a coleta de dados utilizou-se um formulÃrio submetido à validaÃÃo de conteÃdo de duas enfermeiras especialistas no cuidado a clientes com acidente vascular encefÃlico. As informaÃÃes foram coletadas por meio de entrevista e exame fÃsico. Para nomeaÃÃo dos diagnÃsticos de enfermagem seguiu-se como referÃncia a Taxonomia II da North American Nursing Diagnosis Association (NANDA), publicada em 2008. Com os dados compilados no Excel fez-se a anÃlise estatÃstica no programa EpiInfo versÃo 3.2 e no SPSS versÃo 16.0. O nÃvel de significÃncia adotado no estudo foi 5%. Todas as recomendaÃÃes Ãticas foram seguidas durante as etapas da pesquisa. Quanto aos dados sociodemogrÃficos, a maioria dos participantes era do sexo masculino, idosos, sem companheiros, aposentados ou pensionistas com baixa escolaridade e baixa renda per capita. Dos diversos indicadores de risco, o mais freqÃente foi a hipertensÃo arterial, seguida do sedentarismo, dislipidemias, cardiopatias e diabetes mellitus. Metade dos clientes estudados teve um episÃdio de AVE hà doze meses, com inÃcio de reabilitaÃÃo em uma das unidades da ABCR de no mÃximo sete meses. Em mÃdia, os participantes apresentaram 6,7 diagnÃsticos de enfermagem; 25,1 caracterÃsticas definidoras; 4,6 fatores relacionados e 10,1 fatores de risco. Todos os diagnÃsticos da classe em estudo foram identificados, mas sete: Risco de queda, Mobilidade fÃsica prejudicada, DeambulaÃÃo prejudicada, Estilo de vida sedentÃrio, Risco de sÃndrome do desuso, Risco de intolerÃncia à atividade e Capacidade de transferÃncia prejudicada tiveram freqÃÃncia acima de 50% e foram utilizados para anÃlise estatÃstica. De acordo com os testes, identificou-se associaÃÃo estatisticamente significante entre os diagnÃsticos, com exceÃÃo dos seguintes: Risco de queda, Mobilidade fÃsica prejudicada, DeambulaÃÃo prejudicada e Capacidade de transferÃncia prejudicada com o diagnÃstico Risco de intolerÃncia à atividade. As caracterÃsticas definidoras, fatores relacionados e os fatores de risco estiveram associados estatisticamente com a maior parte dos diagnÃsticos de enfermagem analisados. Tal fato pode ser justificado por todos fazerem parte da mesma classe da NANDA (2008). Conclui-se que a maioria dos diagnÃsticos de enfermagem mostrou associaÃÃo estatÃstica entre eles. Destaca-se que a ForÃa muscular diminuÃda e PrejuÃzos neuromusculares foram os fatores relacionados mais freqÃentes, sendo as principais conseqÃÃncias do AVE. O estudo permitiu o conhecimento aprofundado da classe Atividade/ExercÃcio da NANDA em portadores de AVE

Using a descriptive design, this study sought to identify lifestyle modifications of Human Immunodeficiency Virus (HIV)-infected adults after knowledge of diagnosis. A sample of 101 HIV-infected adults from a multi-purpose, multi-ethnic primary health care center completed the Self-Rated Abilities and Health Practices Scale (SAHPS) and the Risk Behavior Assessment (RBA). Study findings indicated that over 91% of the sample changed their behavior after diagnosis. Correlational analysis utilizing Pearson's r revealed that changes in behavior showed significant correlations (p<.01) with frequent use of condoms, and sexual communication skills (p<.01). Other behavior changes included sexual abstinence, reduced number of sexual partners, and reduced number of times of sexual intercourse. Analysis of these findings suggest an increased awareness of safe sex practice and that condom use is the preferred method for preventing the spread or contraction of HIV.

A retrospective validation study was implemented to identify the defining characteristics of the nursing diagnosis Alteration in Comfort-Pain, specifically chest pain. The interventions instituted by coronary care nurses to relieve the chest pain were also explored. Fifty-two records were reviewed. A Demographic Instrument (DI) and Alteration in Comfort-Pain (Chest Pain) Intervention Instrument (ACPII) were developed for the study and the Alteration in Comfort-Pain Assessment Tool for Chest Pain (ACPAT-CP) was revised from the Alteration in Comfort-Pain Assessment Tool (ACPAT) for the study. The three instruments were assessed for content validity and reliability. The critical defining characteristic was determined to be a verbal complaint of chest pain with or without a specific descriptor and nurses made the appropriate nursing diagnosis for chest pain in the majority of the records reviewed. Nursing interventions documented for the relief of chest pain were interdependent interventions, specifically monitoring and an electrocardiogram. The results indicated that there is a need for improved documentation in nurses' notes.

CoordenaÃÃo de AperfeiÃoamento de Pessoal de NÃvel Superior
It is a descriptive study with the objective to analyze the applicability of the interventions proposed by the Classification of nursing interventions (NIC) nursing for the diagnosis of "Fluid volume excess" in an Intensive Therapy Unit (ITU). It was developed in three stages. At first, they were raised, along with nursing care, activities that they indicated for patients with that diagnosis. In the second step, expert nurses conducted a correspondence among the activities listed by nurse clinicians with the activities outlined in the NIC to the referred diagnosis. The third step, on its turn, consisted of two points: a) five interventions for analysis were selected and it was raised up the views of nurses about the applicability of the activities contained in NIC they have no mentioned, as well as, on the applicability of the activities they indicated in caring for adults with a diagnosis of nursing "Fluid volume excess" and not present in the NIC; b) a proposal for intervention developed from the analysis of data from the previous step was subjected to expert nurses who participated in the second stage. As a result, it was obtained a total of 73 activities indicated by nurses for the care to patients with "Fluid volume excess". In the second step, it was found that 71 of the 479 activities in the interventions of the NIC (14.82%), showed correspondence with 49 activities prescribed by nurses. The only intervention completely correspondent by the experts was âVital signs monitoringâ. As for the percentage of activities that present correspondence, the following results were gotten: âelectrolyte managementâ (12%), âfluid monitoringâ (27.27%), âhipervolemia managementâ (37.5%), âfluid managementâ (35.71%) and âelectrolytes monitoringâ (46.87%). For most of the correspondent activities to the NIC it was shown that the actions of nurses represented specific activities developed in the ITU. The five interventions selected for analysis in the third stage totaled 139 activities. Of these, 47 (33.81%) had been considered correspondent to the indicated by nurses in the first stage. Of the remaining 92 activities that were analyzed as to its completion the following results were obtained: âelectrolyte managementâ (54.54%), âfluid monitoringâ (40%), âhipervolemia managementâ (20%), âfluid managementâ (61.11%) and the âelectrolytes monitoringâ (46.87%). Regarding to the ITU implementation, the 24 activities prescribed in the first stage, and for which it was not found the corresponding in the NIC, 11 activities have reached a percentage above 80%. However, it was not noticed an apparent standard attitude among the nurses in doing these. The intervention âClinical evaluation of changes of electrolytes to risk of injuryâ, suggested by this study, included nine activities, of which six had correlation above the pre-established cut off point. It was concluded that many activities in the NIC were held in the unit of study, but there was no standard as to its implementation in the nurses practice. That a great number of interventions and activities for patients with âFluid volume excessâ offer much possibilities for new investigations and reinforces the importance of using the NIC taxonomy as key resource and as relevant to the implementation of a higher quality of care
Trata-se de um estudo descritivo com o objetivo de analisar a aplicabilidade das intervenÃÃes propostas pela ClassificaÃÃo da intervenÃÃes de enfermagem (NIC) para o diagnÃstico de enfermagem âVolume de lÃquido excessivoâ em uma Unidade de Terapia Intensiva (UTI). Foi desenvolvido em trÃs etapas. Na primeira, foram levantadas, junto aos enfermeiros assistenciais, as atividades que os mesmos indicavam para pacientes com o referido diagnÃstico. Na segunda etapa, enfermeiras peritas realizaram uma correspondÃncia entre as atividades indicadas pelos enfermeiros assistenciais com as atividades apresentadas na NIC para o diagnÃstico em questÃo. A terceira etapa, por sua vez, constituiu-se de dois momentos: a) foram selecionadas as cinco intervenÃÃes para anÃlise e levantou-se a opiniÃo dos enfermeiros acerca da aplicabilidade das atividades contidas na NIC por eles nÃo mencionadas, bem como sobre a aplicabilidade das atividades por eles indicadas no atendimento aos adultos com o diagnÃstico de enfermagem âVolume de lÃquido excessivoâ, e nÃo presentes na NIC; b) uma proposta de intervenÃÃo desenvolvida a partir da anÃlise dos dados da etapa anterior foi submetida Ãs enfermeiras peritas que participaram da segunda etapa. Como resultado, obteve-se um total de 73 atividades indicadas pelos enfermeiros para o atendimento ao paciente com âVolume de lÃquido excessivoâ. Na segunda etapa, verificou-se que 71 das 479 atividades constantes das intervenÃÃes da NIC (14,82%), apresentaram correspondÃncia com 49 atividades prescritas pelos enfermeiros. A Ãnica intervenÃÃo completamente correspondente pelas peritas foi âmonitorizaÃÃo dos sinais vitaisâ. Quanto ao percentual de atividades que apresentaram correspondÃncia, obteve-se os seguintes resultados: âcontrole de eletrÃlitosâ (12%), âmonitorizaÃÃo de lÃquidosâ (27,27%), âcontrole da hipervolemiaâ (37,5%), âcontrole de lÃquidosâ (35,71%) e âmonitorizaÃÃo de eletrÃlitos (46,87%). Para a maioria das atividades correspondentes com as da NIC, percebeu-se que as aÃÃes dos enfermeiros representavam atividades especÃficas desenvolvidas na UTI. As cinco intervenÃÃes selecionadas para anÃlise na terceira etapa somaram 139 atividades. Destas, 47 (33,81%) haviam sido consideradas correspondentes Ãs indicadas pelos enfermeiros na primeira etapa. Das 92 atividades restantes que foram analisadas quanto à sua realizaÃÃo, e obteve-se os seguintes resultados: âcontrole de eletrÃlitosâ (54,54%), âmonitorizaÃÃo de lÃquidosâ (40%), âcontrole da hipervolemiaâ (20%), âcontrole de lÃquidosâ (61,11%) e âmonitorizaÃÃo de eletrÃlitos (46,87%). Com relaÃÃo à realizaÃÃo, na UTI, das 24 atividades prescritas na primeira etapa, e para as quais nÃo foram encontrados correspondentes na NIC, 11 atividades atingiram um percentual acima de 80%. No entanto, nÃo se percebeu uma atitude uniforme entre os enfermeiros na realizaÃÃo destas. A intervenÃÃo âAvaliaÃÃo clÃnica de alteraÃÃo de eletrÃlitos para risco de injÃriaâ, sugerida pelo presente estudo, incluiu nove atividades, das quais seis apresentaram concordÃncia acima do ponto de corte prÃ-estabelecido. Concluiu-se que muitas atividades na NIC eram realizadas na unidade do estudo, porÃm nÃo havia uniformidade quanto à sua realizaÃÃo na prÃtica dos enfermeiros. Que o grande nÃmero de intervenÃÃes e atividades para pacientes com âVolume de lÃquido excessivoâ oferecem uma magnitude de possibilidades para novas investigaÃÃes e reforÃa-se a importÃncia do uso da taxonomia da NIC como recurso fundamental e pertinente para a implementaÃÃo de uma assistÃncia de maior qualidade

CoordenaÃÃo de AperfeiÃoamento de Pessoal de NÃvel Superior
A identificaÃÃo dos diagnÃsticos de enfermagem contribui para o planejamento das intervenÃÃes de enfermagem necessÃrias no intuito de prevenir e reduzir as incapacidades e recuperar a saÃde. Objetivou-se analisar o perfil de diagnÃsticos de enfermagem em pacientes com acidente vascular encefÃlico durante a hospitalizaÃÃo. Estudo transversal, realizado no perÃodo de outubro de 2007 a abril de 2008, com 91 pacientes com acidente vascular encefÃlico, internados na emergÃncia de um hospital geral localizado na cidade de Fortaleza-CearÃ. Estabeleceram-se como critÃrios de inclusÃo: a) estarem internados pelo diagnÃstico mÃdico de acidente vascular encefÃlico independente do tipo; b) terem idade igual ou superior a 18 anos; c) nÃo terem histÃria prÃvia de acidente vascular encefÃlico. Como critÃrio de exclusÃo estabeleceu-se apenas um: pacientes que durante a coleta de dados apresentarem situaÃÃes de emergÃncia com risco de morte. Para a coleta de dados utilizou-se um formulÃrio submetido à validaÃÃo de conteÃdo com quatro enfermeiras especialistas em diagnÃsticos de enfermagem ou no cuidado aos pacientes com acidente vascular encefÃlico. As informaÃÃes foram coletadas por meio de entrevista, exame fÃsico e consulta ao prontuÃrio. Para nomeaÃÃo dos diagnÃsticos de enfermagem seguiu-se como referÃncia a Taxonomia II da North American Nursing Diagnosis Association publicada em 2008. Compilaram-se os dados no Excel e fez-se a anÃlise estatÃstica no programa SPSS. O nÃvel de significÃncia adotado no estudo foi 5%. Quanto aos dados sociodemogrÃficos, conforme verificou-se, estes pacientes eram predominantemente do sexo feminino, aposentados, catÃlicos, viviam com companheiro e com baixa escolaridade e baixa renda. O acidente vascular tipo isquÃmico predominou no grupo (45,9%), seguido pelo tipo hemorrÃgico (38,5%). Segundo constatou-se, esses pacientes apresentaram uma mediana de dez diagnÃsticos de enfermagem e uma mÃdia de onze caracterÃsticas definidoras, seis fatores relacionados e cinco fatores de risco. Os diagnÃsticos de enfermagem mais freqÃentes foram: Risco de infecÃÃo (96,7%), DÃficit no autocuidado para banho/higiene (76,9%), DÃficit no autocuidado para higiene Ãntima (74,7%), DÃficit no autocuidado para vestir-se/arrumar-se (71,4%), ComunicaÃÃo verbal prejudicada (62,6%), PerfusÃo tissular ineficaz â tipo cerebral (59,3%), Risco de integridade da pele prejudicada e Mobilidade no leito prejudicada (52,7%) e Risco de aspiraÃÃo (50,5%). De modo geral, o perfil encontrado neste estudo à semelhante aos descritos em outros estudos com pacientes internados em unidades de terapia intensiva. Com exceÃÃo do diagnÃstico de enfermagem Risco de infecÃÃo, os demais mostraram associaÃÃo estatisticamente significante entre si. A totalidade das caracterÃsticas definidoras e dos fatores relacionados revelou associaÃÃo estatÃstica significativa com todos os diagnÃsticos de enfermagem, exceto com Risco de infecÃÃo. Como observado, o estudo permitiu conhecer de forma aprofundada os diagnÃsticos de enfermagem, as caracterÃsticas definidoras, os fatores relacionados e os fatores de risco manifestados pelos pacientes na fase de hospitalizaÃÃo. Destaca-se a presenÃa daqueles de carÃter biolÃgico e de risco. Os achados reforÃam a necessidade da equipe de enfermagem atuar nÃo somente no aspecto curativo, mas tambÃm na prevenÃÃo e na promoÃÃo da saÃde, tanto nos nÃveis secundÃrios de saÃde como nos terciÃrios.
The idetinfication of the diagnoses in nursing contribute to the planning of the nursing interventions in order to prevent and reduce the incapabilities. It was aimed to analize the nursing diagnosis profile in patients with stroke during hospitalization. This is a descriptive study which was done within the period of October 2007 to April 2008, involving 91 patients with stroke, who were hospitalized in an emergency department of a general hospital set in Fortaleza City - CearÃ. Some including criteria were established: a) being hospitalized due to the stroke diagnosed by the doctor, independently on the type; b) being 18 years old or over; c) not having previous history of stroke. The excluding criteria were: a) patients who, during the collection of data, presented emergencial situations as well as dead risk. A form was used for the data collection and it also undergone content validation with four nurses who are expertise in nursing diagnoses or in the care of patients with stroke. The information was collected through enterview, physical test and prontuary consultation. To name the nursing diagnoses, the Taxonomy II proposed by the North American Nursing Diagnosis Association published in 2008 was followed as reference. The data was compiled in the Excel program and the statistic analysis was done within the SPSS program. The level of significance adopted in the study was of 5%. Taking the social and demographic data into account, it was verified that the majority of these patients were from feminine gender, retired, catholics, lived with a partner and had low education and income. The ischemic type of stroke was predominant in the group (45.9%), followed by the hemorrhagic type (38.5%). According to the findings, these patients showed an avarage of nine nursing diagnoses, eleven defining characteristics, six related factors and five risky factors. The most frequent nursing diagnoses were: Risk of infection (96.7%), Self-care deficit_bathing and higiene (76.9%), Self-care deficit_intimate higiene (74.7%), Self-care deficit_self dressing (71.4%), Verbally damaged communication (62.6%), Ineffective tissular perfusion_cerebral type (59.3%), Risk of the integrity of the damaged skin (52.7%) and Risk of aspiration (50.5%). Generally, the profile found in this study is similar to the ones described in other studies with patients hospitalized in intensive therapy units. Apart from the nursing diagnosis Risk of infection, the remaining ones showed statistically significant association among themselves. The total defining characteristics and the related factors revealed significative statistic association with all nursing diagnoses, except from the Risk of infection one. As observed, the study allowed us to know in a deep way the nursing diagnoses, the defining characteristics, the related factors and the risk factors manifested in the patients during hospitalization. The presence of those with biological and risky character stands out. The findings reinforce the need that the nursing team has to act not only upon the curative aspect, but also on the prevention and the health promotion, in the secondary levels of health and the tertiary as well.

CoordenaÃÃo de AperfeiÃoamento de Pessoal de NÃvel Superior
A obstruÃÃo das vias aÃreas tem sido um grave problema de crianÃas asmÃticas. No entanto, poucos estudos se desenvolveram sobre medidas para sua melhoria. Este trabalho tem como tese que o cuidado de enfermagem com o uso da intervenÃÃo facilita a desobstruÃÃo das vias aÃreas de crianÃas asmÃticas. O objetivo geral à analisar a eficÃcia da intervenÃÃo para o diagnÃstico de enfermagem desobstruÃÃo ineficaz das vias aÃreas (DIVA) em crianÃa asmÃtica. Fez-se uma pesquisa do tipo ensaio clÃnico controlado e randomizado, de uma intervenÃÃo aplicada ao diagnÃstico de enfermagem DIVA e foram observados os seus efeitos sobre os desfechos. A pesquisa foi realizada em um hospital infantil da rede pÃblica de Fortaleza â CE nos meses de julho a setembro de 2009. A amostra se constituiu por 42 crianÃas asmÃticas de ambos os sexos em internamento (21 em cada grupo), conforme critÃrios de elegibilidade. As crianÃas selecionadas foram randomicamente divididas em dois grupos por meio de sorteio simples: grupo intervenÃÃo e controle. O grupo controle compÃs-se por crianÃas que receberam apenas o tratamento padrÃo da unidade de internamento hospitalar; e o grupo intervenÃÃo, pelas crianÃas que, alÃm de receberem o tratamento padrÃo, receberam a intervenÃÃo proposta neste estudo. Os dados organizaram-se em tabelas, analisados com base em frequÃncia absoluta e percentual e em medidas de tendÃncia central, de dispersÃo e testes de associaÃÃo (Qui-quadrado e Fisher) e de diferenÃa de mÃdia (Teste t) e coeficientes de correlaÃÃo de Pearson e Spearman. Considerou-se relaÃÃo estatisticamente significante aquelas com valor de p < 0,05. O projeto de pesquisa foi aprovado pelo Comità de Ãtica em Pesquisa da Universidade Federal do CearÃ. Os principais achados deste estudo mostram prevalÃncia do sexo masculino na amostra em geral. As crianÃas estudadas apresentaram, em mÃdia, 20,90 meses de idade (+ 10,382), peso mÃdio de 11,3 Kg (+ 2,739) e mediana de 2 dias de internaÃÃo. As caracterÃsticas definidoras prevalentes, nos dois grupos, foram ruÃdos adventÃcios respiratÃrios, tosse ineficaz e murmÃrios vesiculares diminuÃdos. O diagnÃstico de enfermagem DIVA dos participantes deste estudo relaciona-se a fatores de secreÃÃes nos brÃnquios, muco excessivo, espasmo da via aÃrea e hiperplasia das paredes brÃnquicas. De acordo com os dados do estudo, observa-se que, antes da intervenÃÃo, nÃo houve diferenÃa estatisticamente significante no estado de saÃde das crianÃas. ApÃs a intervenÃÃo, os indicadores asfixia e ruÃdos respiratÃrios anormais, apresentaram mÃdia de postos maiores no grupo intervenÃÃo, demonstrando, assim, melhoria do quadro obstrutivo das crianÃas que receberam a intervenÃÃo. No grupo intervenÃÃo, a diferenÃa entre o estado de saÃde, antes e apÃs a intervenÃÃo, foi maior que no grupo controle, em demonstraÃÃo da eficÃcia da intervenÃÃo. O rigor metodolÃgico e o embasamento cientÃfico para desenvolvimento e aplicaÃÃo da intervenÃÃo favorecem a comprovaÃÃo da tese de que o cuidado de enfermagem com o uso da intervenÃÃo facilita a desobstruÃÃo das vias aÃreas de crianÃa asmÃtica.

CoordenaÃÃo de AperfeiÃoamento de Pessoal de NÃvel Superior
A assistÃncia ao recÃm-nascido com integridade da pele prejudicada deve ser prioridade para equipe de enfermagem. Objetivou-se analisar o uso das intervenÃÃes propostas pela Nursing Intervention Classification (NIC) indicadas para o diagnÃstico de enfermagem Integridade da pele prejudicada na Unidade de Terapia Intensiva Neonatal. Estudo exploratÃrio, descritivo, utilizando-se mapeamento cruzado em trÃs unidades neonatais pÃblicas, em Fortaleza-CE-Brasil. Participaram 42 enfermeiros atuantes em Neonatologia. A coleta de dados foi realizada de maio a setembro/2011, conforme a disponibilidade dos participantes. Aprovado pelo Comità de Ãtica das instituiÃÃes pesquisadas. No primeiro momento da coleta, os enfermeiros indicaram as atividades realizadas junto aos recÃm-nascidos com o diagnÃstico de enfermagem Integridade da pele prejudicada. Em seguida, foi realizada comparaÃÃo dessas atividades com as intervenÃÃes propostas pela NIC, caracterizando o mapeamento. A anÃlise ocorreu entre outubro/2011 e janeiro/2012. Para revisÃo e refinamento do mapeamento, os resultados obtidos foram encaminhados a nove enfermeiros experts em diagnÃstico de enfermagem, por meio do correio convencional e eletrÃnico. O mapeamento revelou que das 75 atividades sugeridas na NIC, 57 corresponderam Ãs indicadas pelos enfermeiros. As mais citadas pelos enfermeiros como desempenhadas cotidianamente foram relacionadas ao cuidado com lesÃes: aplicar um curativo adequado ao tipo de lesÃo; reposicionar o paciente pelo menos a cada duas horas, conforme apropriado; posicionar o paciente, de modo a evitar a tensÃo sobre a lesÃo, conforme apropriado; e remover curativo e fita adesiva. Tratamento tÃpico: aplicar emolientes à Ãrea afetada; aplicar curativo oclusivo transparente sempre que necessÃrio; e evitar o uso de sabonete alcalino na pele. SupervisÃo da pele: examinar a pele e as mucosas quanto à vermelhidÃo, ao calor exagerado, ao edema e à drenagem; e documentar mudanÃas na pele e mucosas. As atividades sugeridas pela NIC mais realizadas segundo opiniÃo dos enfermeiros (mÃdia ponderal entre 0,8 e 1) relacionadas ao cuidado com lesÃes: aplicar um curativo adequado ao tipo de lesÃo; manter tÃcnica assÃptica durante realizaÃÃo; trocar curativos, conforme a quantidade de exsudato e drenagem; limpar com soro fisiolÃgico ou substancias nÃo tÃxicas; posicionar o paciente, de modo a evitar tensÃo sobre a lesÃo e reposicionar o paciente pelo menos a cada duas horas. Referentes ao tratamento tÃpico: manter limpas, secas e sem vincos as roupas de cama; aplicar curativo oclusivo transparente; proporcionar higiene Ãntima; aplicar antibiÃtico tÃpico à Ãrea afetada; e aplicar emolientes à Ãrea afetada. Quanto à supervisÃo da pele: observar as extremidades quanto à cor, ao calor, ao inchaÃo, aos pulsos, à textura, ao edema e Ãs ulceraÃÃes; monitorar cor e temperatura da pele; e examinar a condiÃÃo da incisÃo cirÃrgica. ApÃs submissÃo do mapeamento à avaliaÃÃo por enfermeiros peritos, foi sugerido que das 22 atividades de cuidado com a pele, 13 permaneceriam com a nomenclatura NIC. Com relaÃÃo ao tratamento tÃpico, 23 atividades tiveram discretas alteraÃÃes e 10 permaneceram inalteradas. Relativo à supervisÃo da pele, trÃs foram modificadas e nove atividades mantiveram a nomenclatura NIC. Concluiu ser possÃvel a utilizaÃÃo da NIC como terminologia padronizada para descrever os cuidados de enfermagem prescritos, uma vez que essa classificaÃÃo mostrou-se, em sua maioria, adequada à realidade neonatal.
The assistance to newborns with impaired skin integrity should be a priority for the nursing staff. Thus, we aimed to analyze the use of the interventions proposed by the Nursing Intervention Classification (NIC) indicated for the nursing diagnosis Impaired skin integrity in the Neonatal Intensive Care Unit. This is an exploratory descriptive study using cross-mapping in three public neonatal units, in Fortaleza-CE, Brazil. The population was composed of 42 nurses working in neonatology. Data collection was conducted from May to September 2011, according to the availability of participants. The study was approved by the Ethics Committee of the institutions surveyed. In the first moment of collection, nurses indicated the activities they performed along with the newborns with the nursing diagnosis Impaired skin integrity. Next, we compared these activities with the interventions proposed by NIC, characterizing the mapping. The analysis occurred between October 2011 and January 2012. To review and refinement of the mapping, the results obtained were sent to nine nurses experts in nursing diagnosis through conventional mail and e-mail. The mapping revealed that from the 75 activities suggested by NIC, 57 corresponded to those indicated by nurses. The most mentioned by nurses as routinely performed were related to the care of injuries: apply an adequate bandage for the type of injury; reposition the patient at least once every two hours, as recommended; positioning the patient in order to avoid tension on the injury, as recommended; and remove bandage and tape. Topical Treatment: apply moisturizers to the affected area; apply a transparent occlusive dressing when necessary; and avoid the use of alkaline soap on the skin. Skin surveillance: examine the skin and mucous membranes for redness, excessive heat, edema and drainage, and document changes in the skin and mucous membranes. The activities suggested by NIC most performed according to the nursesâ opinion (weighted average of 0.8-1) related to the care of injuries were: apply an appropriate bandage for the type of injury; maintain aseptic technique during performance; changing dressings according to the amount of exudate and draining; cleaning with saline or non-toxic substances; positioning the patient in order to prevent tension on the wound; and reposition the patient at least once every two hours. As regards to topical treatment: keep bed linen clean, dry and wrinkle-free; apply transparent occlusive dressing; provide intimate hygiene; apply topical antibiotics to the affected area; and apply moisturizer to the affected area. As for the skin surveillance: observe the extremities for color, warmth, swelling, pulses, texture, edema and ulceration; monitor skin color and temperature; and examine the condition of the surgical incision. After submitting the mapping to the evaluation of expert nurses, it was suggested that, of the 22 activities of skin care, 13 remain with the NIC taxonomy. Regarding the topical treatment, 23 activities had minor changes and 10 remained unchanged. On the skin surveillance, 3 activities were modified and 9 kept the NIC taxonomy. We concluded that is possible to use the NIC as a standardized terminology to describe the nursing care prescribed, once this classification has proven, in most cases, appropriate to neonatal reality.

Este estudo teve por objetivo analisar a acurÃcia das caracterÃsticas definidoras do diagnÃstico de enfermagem MemÃria prejudicada em idosos. Trata-se de um estudo de acurÃcia diagnÃstica, com corte transversal, desenvolvido em uma instituiÃÃo de longa permanÃncia para idosos, situada na cidade de Fortaleza. A amostra foi constituÃda por indivÃduos de ambos os sexos, com idade acima de 60 anos e cadastrados na referida instituiÃÃo, totalizando uma amostra de 123 idosos. Elaborou-se um instrumento especÃfico para a coleta de dados baseado nas caracterÃsticas definidoras do diagnÃstico em questÃo, conforme apresentadas na versÃo atual da NANDA Internacional, alÃm de dados sÃcio demogrÃficos dos idosos. Os dados foram analisados estatisticamente com o apoio do pacote estatÃstico R versÃo 3.0.2. Para verificar a sensibilidade e especificidade de cada caracterÃstica definidora, foi utilizado o mÃtodo de anÃlise de classes latentes. Os dados sÃcios demogrÃficos mostraram uma pequena predominÃncia do sexo masculino, predomÃnio de idosos provenientes de cidades do interior do Estado e mÃdia de idade de 74,21 anos (+7,73). AlÃm disso, verificou-se que metade da amostra tinha mais de trÃs anos de permanÃncia na instituiÃÃo, menos de 2 anos de escolaridade e renda familiar inferior a R$724,00. Todas as dez caracterÃsticas definidoras avaliadas foram encontradas na amostra. Entretanto, algumas apresentaram percentual baixo. As caracterÃsticas mais frequentes no estudo foram Incapacidade de determinar se uma aÃÃo foi efetuada (67,21%), Incapacidade de reter novas informaÃÃes (59,35%) e Incapacidade de executar habilidades previamente aprendidas (55,28%). Em todos os modelos de classe latente, a prevalÃncia estimada do diagnÃstico de enfermagem MemÃria prejudicada ficou entre 31,05% e 36,43%. As caracterÃsticas que apresentaram as melhores medidas de acurÃcia para inferÃncia de espectros iniciais do diagnÃstico em estudo foram Incapacidade de aprender novas habilidades e Incapacidade de reter novas habilidades na amostra total. No sexo masculino, a caracterÃstica Incapacidade de executar habilidades previamente aprendidas foi a Ãnica que apresentou significÃncia estatÃstica tanto para a sensibilidade quanto para a especificidade. Jà no sexo feminino, Incapacidade de aprender novas habilidades e Incapacidade de reter novas habilidades apresentaram valores altos de sensibilidade e especificidade. A importÃncia destes achados se dà frente ao potencial para auxiliar os enfermeiros no momento de inferir o diagnÃstico MemÃria prejudicada em idosos, o que contribui para um julgamento clÃnico mais preciso, o que à essencial para a elaboraÃÃo de um plano de cuidados adequado.
This study aims to analyze the accuracy of the defining characteristics of the nursing diagnosis Impaired memory in the elderly. It is a diagnostic accuracy study with a cross-sectional approach, developed in a long-term care institution in the city of Fortaleza. The sample consisted of individuals of both sexes, aged above 60 years old and registered in the long-term institution, totaling a sample of 123 elderly. A specific form for data collection was constructed based on the defining characteristics of the diagnosis in question, as presented in the current version of the NANDA-International taxonomy. The form also contained socio demographic data of the elderly. The data were statistically analyzed with the support of the statistical package R version 3.0.2. To verify the sensitivity and specificity of each defining characteristic, we used the method of latent class analysis. The data showed a small demographic predominance of males, predominance of elderly people from other cities of the State and an average age of 74.21 years (+7.73). In addition, it was found that half of the sample had more than three years of stay in the institution, less than 2 years of education and family income less than R$724. All ten defining characteristics evaluated were found in the sample. However, some of them presented low percentage. The most common defining characteristics in the study were Inability to determine whether an action was performed (67.21%), Inability to retain new information (59.35%), and Inability to perform a previously learned skill (55.28%). In all the latent class models, the estimated prevalence of the nursing diagnosis Impaired memory was between 31.05% and 36.43%. The defining characteristics that presented the best measures of accuracy in the study were Inability to learn new skills and Inability to retain new skills in the total sample. In males, the characteristic Inability to perform previously learned skills was the only one that showed statistical significance for both sensitivity and specificity. In the female, Inability to learn new skills and Inability to retain new skills presented high values of sensitivity and specificity. The importance of these findings is the potential to assist the nurses to infer the diagnosis Impaired memory in the elderly, which contributes to a more precise clinical judgment, which is essential for the elaboration of an appropriate plan of care.

This study examined the effectiveness of a training program on the ability of registered nurse students to write complete nursing diagnoses. A comparison group was used as a control. There were 47 participants in the training group and 51 participants in the comparison group who received no training. Five hypotheses were used to examine the (1) complete nursing diagnoses, (2) labels, (3) clarifiers, (4) etiologies, and (5) mislabeled medical diagnoses or clinical problems as nursing diagnoses. As a pretest and posttest, participants in both groups viewed a video tape of a nursing situation and were asked to write nursing diagnoses. The training group received nine clock hours of classroom instruction on the nursing process of which three hours were on nursing diagnosis with a focus on the inclusion of label, clarifier, and etiology necessary for a complete nursing diagnosis. In the clinical component of the educational program the training group wrote nursing diagnoses as part of the nursing process. It was assumed that the comparison group did not receive comparable education. The mean difference of proportions between the pretest and posttest was computed for each group on the item tested by the hypotheses and for the difference between the two groups. Three of the five hypotheses tested in the study were accepted. The training group did have a significant increase in the average (mean) difference of proportions in the number of complete nursing diagnoses and etiologies and a significant decrease in the number of mislabeled nursing diagnoses. There was no significant difference in the number of labels and clarifiers. The training group did show a percentage increase in the number of labels and clarifiers written. There was little or no change in the comparison group over the time period of the study.

Although gout is the most prevalent form of inflammatory arthritis, its diagnosis can be complex. To meet the gold standard for diagnosis, providers need to perform a joint aspiration and identify the presence of monosodium urate crystals (MSU) in the synovial fluid or from tophi, a challenging skill in the primary care setting. In its absence, patients have to meet several criteria before a diagnosis can be made. Not surprisingly, gout has been inconsistently diagnosed by Primary Care Providers (PCPs). Thus in 2015, the American College of Rheumatology (ACR) and the European League Against Rheumatism (EULAR) worked collaboratively to develop a new set of clinical criteria for the diagnosis of gout.

For this Doctor of Nursing Practice (DNP) Capstone Project, a review of the literature was conducted using the Chronic Care Model (CCM) as a guide to examine the evidence regarding the use of clinical guidelines for the diagnosis of gout in the primary care setting. Using a pretest-posttest reflexive control design, chart abstraction was performed and, subsequently, an educational session was conducted to see if a short learning lunch would increase PCP knowledge and documentation in the medical record related to use of the 2015 ACR/EULAR diagnostic criteria.

A total of 36 PCPs from six different primary care settings participated. Chart abstraction revealed that only 31 out of the 54 charts (57%) had adequate documentation to support a diagnosis of gout. A statistically significant improvement in knowledge was demonstrated for several domains of the diagnostic criteria at the posttest. Results from this project indicated that a short learning lunch was effective for increasing PCP knowledge of the 2015 ACR/EULAR gout classification criteria. Through clinical support, easier access to updated evidence based clinical guidelines, and continuing education, PCPs acquired new knowledge and skills essential for providing evidence-based, quality care to their patients.

Lyme disease is a multisystemic, infectious disease caused by the tick-borne spirochete Borrelia burgdorferi. The CDC designated LD as a reportable disease in 1990 and evidence suggests underreporting of the disease in Indiana. Local health department nurses have a major role in the areas of disease recognition, reporting, and education about LD. The present study assessed local health department nurses' knowledge of LD to determine their competence as LD educators.The study consisted of 428 nurses in 92 counties and three cities with independent health departments who were mailed a questionnaire containing 30 multiple-choice and/or true/false questions. Twenty-four nurses participated in a pilot study to establish the reliability of the instrument.The results were: (1) nurses did not differ in knowledge regardless of their duties, (2) urban and rural counties did not differ in knowledge, (3) experience did not make a difference in knowledge, and (4) less educated nurses were more knowledgeable. The nurses were least knowledgeable about LD reporting criteria, late stage symptoms, and and description of EM and most knowledgeable about prevention. The following are some of the recommendations suggested: more research with nurses on vector- borne diseases, better dissemination of information from CDC and ISDH, inservice programs for nursing personnel, and educational materials to distribute to the public.
School of Nursing

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Bachelors
Nursing
Nursing

Background: Brain tumors are the most common solid tumors found in children. Current research is determining whether diagnosing brain tumors earlier will help improve prognosis and reduce long-term deficits; however, childhood brain tumors are often diagnosed late with a median time of 1-4 months from onset of symptoms. Prolonged symptom intervals before diagnosis have been associated with life-threatening risks, neuro-cognitive disabilities, and detrimental professional relationships between healthcare providers and families. Pediatric brain tumor clinical presentations are often non-specific and resemble less serious illnesses; therefore, healthcare providers are failing to include this in their differential diagnoses list. Purpose: To assess healthcare provider knowledge of signs and symptoms of pediatric brain tumors using The Brain Pathways Guideline. Methods: A one group pre-test and post-test e-mailed separately to nurse practitioners that have active membership in National Association of Pediatric Nurse Practitioners (NAPNAP) Arizona Chapter. Results: The Wilcoxon Signed Rank Test revealed that the matched test scores were not statistically significant (p=0.157) after viewing The Brain Pathways Guideline educational materials. Conclusion: The results of this study did not show a statistically significant difference in the test scores and therefore it cannot be concluded that presenting an evidence-based guideline to assist healthcare providers to assess and diagnose patients with brain tumors will be helpful to improve pre-diagnostic symptom intervals.

O conhecimento sobre o raciocínio diagnóstico de enfermeiros e estudantes de enfermagem é importante para orientar decisões sobre a formação e educação permanente de enfermeiros. Os objetivos deste estudo foram adaptar o Diagnostic Thinking Inventory (DTI) para uso no Brasil, estimar as propriedades psicométricas do instrumento adaptado, e analisar o raciocínio diagnóstico de enfermeiros e estudantes de enfermagem segundo variáveis selecionadas. O DTI é um inventário de origem canadense, alicerçado na teoria da geração de hipóteses, desenvolvido para avaliar o raciocínio diagnóstico em dois domínios (grau de flexibilidade do pensamento e grau de estrutura de conhecimento na memória). O processo de adaptação do DTI resultou em uma versão brasileira que foi aplicada em uma amostra de 83 enfermeiros (28,9%); idade média de 29,7±,6,66 anos e 205 estudantes (71,1%); idade média de 24,7 ±5,61 anos. A análise fatorial confirmatória dos 41 itens do DTI mostrou ajuste moderado do modelo (2 = 1369; GFI= 0,793; AGFI= 0,771; RMSEA= 0,053; NFI= 0,458; NNFI= 0,635; CFI= 0,654 e SRMR= 0,068) e consistência interna (alfa de Crombach) boa ou aceitável para o total dos itens (0,801), para o domínio de flexibilidade (0,635) e para o domínio de estrutura (0,742). O coeficiente de correlação de Pearson para o teste e reteste mostrou que o DTI apresenta boa reprodutibilidade (0,806; p=0,001). Não houve diferença de escores médios de flexibilidade entre os enfermeiros (4,1±0,48; IC 95% 3,98 4,18) e estudantes (4,2±0,51; IC 95% 4,1 4,3) (p=0215). Também não houve diferença de escores médios de estrutura do conhecimento entre os enfermeiros (4,3±0,59; IC 95% 4,1 4,4) e os estudantes (4,3±0,53 IC 95% 4,2 4,4) (p=0,742). Quanto às demais análises de associação entre o DTI e outras variáveis, houve significância estatística entre as seguintes: ter tido ensino sobre diagnóstico de enfermagem na graduação (flexibilidade p=0,001; estrutura p=0,009); ter tido ensino sobre raciocínio clínico na graduação (flexibilidade p=0,031; estrutura p>0,001); maior contato com diagnóstico de enfermagem por meio de leituras (estrutura p=0,001); por meio de pesquisa (estrutura p=0,001); por meio da prática clínica (estrutura p<0,001); autoavaliação de alta capacidade de raciocínio clínico (flexibilidade p= 0,003 e estrutura p< 0,001) e, para os enfermeiros, a prática diária que inclui o uso de diagnósticos de enfermagem (estrutura p<0,001). As análises realizadas permitem afirmar que o uso dos diagnósticos de enfermagem e seu ensino são importantes para o raciocínio diagnóstico na enfermagem, embora a versão brasileira do DTI ainda necessite de outros estudos para confirmar sua estrutura.
The knowledge about diagnostic reasoning of baccalaureate nurses and undergraduate students is important to the development of educational strategies. This studys objectives included to culturally adapt the Diagnostic Thinking Inventory (DTI) for the Brazilian culture, analyze its psychometric properties, and describe the diagnostic rationale nurses and nursing students with selected variables. The DTI is a Canadian inventory based on the theory of hypothesis generation, created to measure the diagnostic ability. The inventory has two sub-sections (flexibility in thinking and evidence structure knowledge in memory). The DTIs translation process resulted in a Brazilian version applied to a sample of 83 nurses (28,9%); average age of 29,7 ± 6,6 years, and 205 students (71,1%); average age of 24,7 ± 5,61years. The results of the confirmatory factor analysis concerning a moderate fit for the DTI model (2 = 1369; GFI= 0,793; AGFI= 0,771; RMSEA= 0,053; NFI= 0,458; NNFI= 0,635; CFI= 0,654 e SRMR= 0,068) and the internal consistence (Cronbachs alpha) showed a good internal consistency to total score (0,801), flexibility (0,635) and evidence (0,742). Persons coefficient of correlation showed that the DTI has good reproducibility over time (0.806; p=0,001). No have difference between nurses flexibility scores (4,1±0,48; IC 95% 3,98 4,18) and students scores (4,2±0,51; IC 95% 4,1 4,3) (p=0215). No have too difference between nurses evidence structure scores (4,3±0,59; IC 95%, 4,1 4,4) and students scores (4,3±0,53 IC 95% 4,2 4,4) (p=0,742).The variables applied together with the DTI presented significant differences: nursing diagnosis in graduate course (flexibility p=0,001; evidence structure p=0,009); clinical reasoning in graduate course (flexibility p=0,031; evidence structure p>0,001); nursing diagnosis with read and research (evidence structure p=0,001); nursing diagnosis with clinical practice (evidence structure p<0,001); self-evaluation of clinical reasoning ability (flexibility p= 0,003; evidence structure p< 0,001) and for only nurses, the diary clinical practice with use of nursing diagnosis (evidence structure p<0,001).The analysis results lead to the conclusion that to use and to teach about nursing diagnosis is very important to diagnostic reasoning in nursing, although other studies are needed to confirm or adjust the Brazilian version of the DTI.

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Na complexidade do tratamento da obesidade, inclui-se a cirurgia bariÃtrica. EntÃo, conhecer os fatores relacionados e caracterÃsticas definidoras dos diagnÃsticos da classe cardiopulmonar associados no perÃodo pÃs-operatÃrio imediato de cirurgia bariÃtrica torna-se essencial para o desenvolvimento da assistÃncia de enfermagem, jà que, a partir dos diagnÃsticos de enfermagem mais prevalentes, intervenÃÃes serÃo instituÃdas. Assim, o estudo teve por objetivo avaliar o perfil de diagnÃstico de enfermagem da classe respostas cardiovasculares/pulmonares de acordo com a taxonomia II da NANDA dos pacientes no pÃs-operatÃrio de cirurgia bariÃtrica. Um estudo transversal foi desenvolvido com 59 pacientes internados em um hospital de referÃncia de cirurgia bariÃtrica no MunicÃpio de Fortaleza/CE, cuja coleta de dados ocorreu no perÃodo de junho de 2010 a junho de 2011. As informaÃÃes foram coletadas por meio de entrevista e exame fÃsico; posteriormente trÃs juÃzes realizaram a inferÃncia dos diagnÃsticos de enfermagem na classe respostas cardiovasculares/pulmonares segundo a Taxonomia da NANDA versÃo 2009-2011. Os dados foram compilados em planilha Excel e a anÃlise estatÃstica realizou-se no STATA versÃo 8.0. O nÃvel de significÃncia adotado no estudo foi 5%. Observou-se o predomÃnio do sexo feminino, com mÃdia de idade 35,3 anos. A maior parte dos pacientes apresentou diagnÃstico de obesidade mÃrbida com IMC > 40 Kg/m2. Os diagnÃsticos reais de maior concordÃncia entre os juÃzes foram PerfusÃo Tissular PerifÃrica Ineficaz (78%), DÃbito CardÃaco DiminuÃdo (76,3%), IntolerÃncia à Atividade e PadrÃo RespiratÃrio Ineficaz (47,5%). Pulsos perifÃricos diminuÃdos, edema, fadiga pÃs-carga alterada e prÃ-carga alterada foram proporcionalmente associados ao diagnÃstico DÃbito CardÃaco DiminuÃdo. AlteraÃÃes na profundidade respiratÃria, dispneia, ortopneia, uso da musculatura acessÃria para respirar, ansiedade, dor, fadiga, fadiga da musculatura respiratÃria foram proporcionalmente associados a PadrÃo RespiratÃrio Ineficaz. Desconforto aos esforÃos, relato verbal de fadiga, relato verbal de fraqueza, resposta anormal da pressÃo sanguÃnea à atividade, estilo de vida sedentÃrio, imobilidade e repouso no leito foram proporcionalmente associados a IntolerÃncia à Atividade. Edema, parestesia, pulsos diminuÃdos, hipertensÃo e tabagismo foram proporcionalmente associados à PerfusÃo Tissular PerifÃrica Ineficaz. Este estudo contribuirà para a construÃÃo da SistematizaÃÃo da AssistÃncia de Enfermagem frente aos diagnÃsticos de enfermagem da classe respostas cardiovasculares/pulmonares, como descrito nos resultados apresentados, e na fundamentaÃÃo cientÃfica para cada diagnÃstico. AlÃm da importante contribuiÃÃo para identificar as reais necessidades e facilitar a utilizaÃÃo de intervenÃÃes adequadas nessa populaÃÃo, està a capacidade de o profissional usufruir dessas informaÃÃes, vista a escassez de pesquisas realizadas com diagnÃsticos de enfermagem em pacientes submetidos à cirurgia bariÃtrica.
The bariatric surgery is included in the complexity of the treatment of obesity. Then, knowing the related factors and defining characteristics of cardiopulmonary diagnostic associated with the immediate postoperative period of bariatric surgery becomes essential for the development of nursing care, since, from the most prevalent nursing diagnoses, interventions will be instituted. Thus, the study aimed to evaluate the profile of nursing diagnosis of the class cardiovascular/pulmonary answers according to NANDA Taxonomy II of the patients after bariatric surgery. A cross-sectional study was conducted with 59 patients hospitalized in a referral hospital for bariatric surgery in the city of Fortaleza, state of CearÃ, which data collection occurred from June 2010 to June 2011. Information was collected through interviews and physical examinations; then three judges made the inference of nursing diagnoses in the class cardiovascular/pulmonary answers according to the NANDA-I Taxonomy 2009-2011. The data were compiled in an Excel spreadsheet and the statistical analysis was carried out in the STATA version 8.0. The significance level in this study was 5%. There was a predominance of females, mean age of 35.3 years. Most patients had a diagnosis of morbid obesity with BMI>40kg/m2. The actual diagnoses of greater agreement among the judges were Ineffective Peripheral Tissue Perfusion (78%), Decreased Cardiac Output (76.3%), and Activity Intolerance and Ineffective Breathing Pattern (47.5%). Decreased peripheral pulses, edema, altered preload and afterload fatigue were proportionally associated with the diagnosis Decreased Cardiac Output. Changes in respiratory depth, dyspnoea, orthopnoea, use of accessory muscles for breathing, anxiety, pain, fatigue, respiratory muscle fatigue were proportionally associated with Ineffective Breathing Patterns. Discomfort in efforts, verbal report of fatigue, verbal report of weakness, abnormal blood pressure response to activity, sedentary lifestyle, immobility and bed rest were proportionally associated with Activity Intolerance. Edema, paresthesia, decreased pulses, hypertension and smoking were proportionally associated with Ineffective Peripheral Tissue Perfusion. This study will contribute to the construction of the Systematization of Nursing Care regarding nursing diagnoses of the class cardiovascular/pulmonary answers, as described in the results presented, and in the scientific basis for each diagnosis. Besides the important contribution to identifying the real needs and facilitating the use of appropriate interventions in this population, it is the ability of the professionals in taking advantage of this information, in view of the scarcity of researches related to nursing diagnoses in patients undergoing bariatric surgery.

FundaÃÃo de Amparo a CiÃncia e Tecnologia de Pernambuco
O estudo tem como objeto a revisÃo do diagnÃstico de enfermagem Processos familiares disfuncionais relacionados a abuso de Ãlcool. Estudo metodolÃgico, desenvolvido em trÃs etapas: anÃlise de conceito, anÃlise de conteÃdo por especialistas e anÃlise da acurÃcia de indicadores clÃnicos. Para a realizaÃÃo da anÃlise de conceito, utilizou-se como referÃncia o modelo de anÃlise de conceito proposto por Walker e Avant e os passos da revisÃo integrativa da literatura. Procedeu-se à busca na literatura em trÃs bases de dados: SCOPUS, PubMed e CINAHL, com os descritores alcoolismo e famÃlia disfuncional e suas sinonÃmias nas lÃnguas inglesa e espanhola. ApÃs a aplicaÃÃo dos critÃrios de inclusÃo e exclusÃo, restaram 11 estudos de um total de 113 que subsidiaram a anÃlise do conceito. A partir da revisÃo do conceito famÃlia disfuncional e sua correlaÃÃo com o diagnÃstico de enfermagem Processos familiares disfuncionais, foi possÃvel reduzir o quantitativo de 115 caracterÃsticas definidoras para 91, por meio da exclusÃo de 24 caracterÃsticas que apresentaram significado semelhante a outros indicadores ou por nÃo se aplicarem a alcoolistas adultos. TrÃs caracterÃsticas foram condensadas em uma e foram incorporadas duas novas caracterÃsticas definidoras: abuso fÃsico e abuso sexual. Foram utilizados artigos, livros e dicionÃrios para a construÃÃo das definiÃÃes conceituais e operacionais das 91 caracterÃsticas definidoras. A segunda etapa do estudo, anÃlise de conteÃdo por especialistas, consistiu no julgamento por 23 especialistas quanto à relevÃncia, clareza e precisÃo das definiÃÃes construÃdas na etapa anterior. Dois itens foram julgados como inadequados no critÃrio relevÃncia e, portanto, excluÃdos do estudo. Dezessete itens tiveram suas definiÃÃes julgadas como inadequadas nos critÃrios clareza e/ou precisÃo e foram reformuladas. Duas caracterÃsticas tiveram seu rÃtulo modificado segundo sugestÃes dos especialistas. Para esta etapa, considerou-se o nÃvel de concordÃncia de 85%. A partir das definiÃÃes operacionais das 89 caracterÃsticas definidoras julgadas como relevantes pelos especialistas, foi construÃdo o instrumento de coleta de dados aplicado com 110 alcoolistas internados em uma unidade de cuidados prolongados para tratamento de alcoolismo crÃnico. Para a delimitaÃÃo da amostra, foi realizado cÃlculo amostral e estabelecidos critÃrios de inclusÃo e exclusÃo. Os dados foram coletados por meio de entrevista e analisou-se a presenÃa ou ausÃncia de cada indicador clinico. Os dados foram submetidos à anÃlise de classe latente, que permitiu encontrar um conjunto de vinte e quatro caracterÃsticas que apresentaram bom ajuste para a correta identificaÃÃo do diagnÃstico Processos familiares disfuncionais. As caracterÃsticas definidoras Papeis familiares interrompidos, Problemas econÃmicos e Rituais familiares interrompidos apresentaram boa sensibilidade e especificidade. As caracterÃsticas definidoras Abuso sexual, DistÃrbio no desempenho escolar em crianÃas, ManipulaÃÃo, Falta de coesÃo e Baixa autoestima crÃnica apresentaram valor de especificidade significativo. As demais mostraram valor de sensibilidade significativo: Mentiras, AngÃstia, Ansiedade, ConfusÃo, Constrangimento, Perda, Raiva, ComunicaÃÃo contraditÃria, Dificuldade com relacionamentos Ãntimos, Imaturidade, Tristeza nÃo resolvida, DeterioraÃÃo nos relacionamentos familiares, DinÃmicas familiares perturbadas, Problemas conjugais, InseguranÃa e SolidÃo. A revisÃo do diagnÃstico Processos familiares disfuncionais relacionados a abuso de Ãlcool possibilitou uma reflexÃo crÃtica acerca das caracterÃsticas definidoras constantes na NANDA-I, com vistas ao seu refinamento. Espera-se que este estudo possa auxiliar o enfermeiro na sua prÃtica assistencial a identificar o referido diagnÃstico de modo mais acurado.
The study focuses the review of the nursing diagnosis Dysfunctional family processes related to alcohol abuse. Methodological study, developed in three stages: concept analysis, content analysis by experts and analysis of the accuracy of clinical indicators. For the realization concept analysis, was used as reference the concept analysis model proposed by Walker and Avant and steps of the integrative literature review. Proceeded the literature search in three databases: SCOPUS, PubMed and CINAHL, with descriptors alcoholism and dysfunctional family and their synonyms in English and Spanish. After applying the inclusion and exclusion criteria, 11 studies remained from a total of 113 that supported the concept analysis. From the review of the concept dysfunctional family and its correlation with the nursing diagnosis of Dysfunctional family processes, it was possible to reduce the quantitative defining characteristics from 115 to 91, by deleting the 24 characteristics that were similar to other indicators or meaning is not apply to adult alcoholics. Three characteristics were condensed into one and were incorporated two new defining characteristics: Physical abuse and Sexual abuse. Articles, books and dictionaries were used to build the conceptual and operational definitions of the 91 defining characteristics. The second stage of the study, content analysis by experts consisted at trial of 23 experts for relevance, clarity and accuracy of definitions constructed in the previous step. Two items were judged as inappropriate in relevance criteria and therefore excluded from the study. 17 items had their definitions judged as inadequate on the clarity and/or precision criteria and have been reformulated. Two had their labels modified second suggestions from experts. For this step, was considered the level of agreement of 85 %. From the operational definitions of the 89 defining characteristics judged as relevant by experts, was built the instrument of data collection applied with 110 alcoholics admitted to a unit for extended care treatment of chronic alcoholism. For the delimitation of the sample, sample size calculation was performed and established criteria for inclusion and exclusion. Data were collected through interviews and analyzed for the presence or absence of each clinical indicator. The data were subjected to latent class analysis, which allowed to find a set of twenty-four characteristics that showed good fit for the correct identification of diagnostic Dysfunctional family processes. The defining characteristics Disrupted family roles, Economic problems and Disrupted family rituals showed good sensitivity and specificity. The defining characteristics Sexual abuse, Disturbances in academic performance in children, Manipulation, Lack of cohesiveness and Chronic low self-esteem showed the mean value of specificity. The other showed the mean value of sensitivity: Lying, Distress, Anxiety, Confusion, Embarrassment, Loss, Anger, Contradictory communication, Difficulty with intimate relationships, Immaturity, Complicated grieving, Deterioration in family relationships, Disturbed family dynamics, Marital problems, Insecurity and Loneliness.. A review of the diagnosis Dysfunctional family processes related to alcohol abuse provided a critical analysis of the defining characteristics listed in the NANDA-I, with a view to its refinement. It is hoped that this study can help nurses in healthcare practice to identify the diagnosis more accurately.

CoordenaÃÃo de AperfeiÃoamento de NÃvel Superior
Estudos que abordem as caracterÃsticas definidoras (CD) podem contribuir para o aprimoramento do raciocÃnio diagnÃstico, influenciando diretamente na escolha de diagnÃsticos de enfermagem mais adequados com a situaÃÃo clÃnica do paciente. Assim, este estudo analisou como os diagnÃsticos de enfermagem PadrÃo respiratÃrio ineficaz (PRI), DesobstruÃÃo ineficaz das vias aÃreas (DIVA), Troca de gases prejudicada (TGP) e VentilaÃÃo espontÃnea prejudicada (VEP) apresentam-se no perÃodo pÃs-operatÃrio em crianÃas com cardiopatias congÃnitas, determinando as medidas de acurÃcia das caracterÃsticas definidoras. Foi desenvolvido um estudo de coorte prospectiva em um hospital infantil da rede pÃblica do municÃpio de Fortaleza-CE. A amostra foi composta por 54 crianÃas com idade entre 1 e 10 anos portadoras de cardiopatias congÃnitas em pÃs-operatÃrio de cirurgia cardÃaca. As crianÃas foram acompanhadas por um perÃodo mÃnimo de cinco dias e mÃximo de dez dias. Para a coleta de dados, foi utilizado um instrumento baseado nas CD dos diagnÃsticos de enfermagem estudados e na literatura pertinente acerca da avaliaÃÃo pulmonar. Os dados foram coletados por meio de exame fÃsico da crianÃa e entrevista com os responsÃveis. As informaÃÃes obtidas foram analisadas pela pesquisadora para determinar a presenÃa ou ausÃncia das CD de PRI, DIVA, TGP e VEP e estes dados foram organizados em planilhas. Posteriormente, as planilhas foram encaminhados para enfermeiros diagnosticadores que executaram o processo de inferÃncia diagnÃstica. Foram utilizados os softwares Excel e SPSS para organizaÃÃo e anÃlise estatÃstica dos dados. O nÃvel de significÃncia adotado foi de 5%. Das crianÃas avaliadas, 30 (55,5%) desenvolveram DIVA, 25 (46,3%) desenvolveram TGP e 21 (38,8%) apresentaram PRI durante o perÃodo de acompanhamento. Para a inferÃncia de DIVA, a CD mais acurada foi ruÃdos adventÃcios respiratÃrios e para PRI, a caracterÃstica que apresentou as maiores medidas de acurÃcia foi uso da musculatura acessÃria para respirar. JÃ para a inferÃncia de TGP, a caracterÃstica mais acurada foi hipoxemia. Para o diagnÃstico de enfermagem VEP, nÃo foi possÃvel estabelecer relaÃÃes estatisticamente significantes de acurÃcia das caracterÃsticas definidoras. Com base na anÃlise de correspondÃncias mÃltiplas, as CD que mais auxiliaram na diferenciaÃÃo entre os diagnÃsticos PRI, DIVA e TGP foram: mudanÃa na frequÃncia respiratÃria, quantidade excessiva de muco, ruÃdos adventÃcios respiratÃrios, tosse ausente e taquipneia para DIVA, dispneia, batimento de asa de nariz, mudanÃa no ritmo respiratÃrio e uso da musculatura acessÃria para respirar para PRI e diÃxido de carbono diminuÃdo, gases sanguÃneos arteriais anormais, pH arterial anormal e PO2 diminuÃda para TGP. Os resultados obtidos ajudaram a identificar as CD mais representativas de PRI, DIVA e TGP em crianÃas em evoluÃÃo pÃs-operatÃria cardÃaca. Estudos desta natureza sÃo importantes por fornecer informaÃÃes sobre a capacidade preditiva das caracterÃsticas definidoras bem como a evoluÃÃo temporal e as particularidades dos diagnÃsticos de enfermagem respiratÃrios.
Studies that address the defining characteristics (DC) can contribute to the improvement of diagnostic reasoning, directly influencing the choice of nursing diagnoses most suitable for clinical situation of the patient. This study examined how nursing diagnoses ineffective breathing pattern (IBP), ineffective airway clearance (IAC), impaired gas exchange (IGE) and impaired spontaneous ventilation (ISV) presented themselves during the post-operative period in children with congenital heart diseases and showed the measures of accuracy of the defining characteristics. It was developed an cohort study in a hospital in the public network in Fortaleza-CE. The sample was consisted of 54 children aged 5-17 years with congenital heart diseases in post-operative of cardiac surgery. The children were followed for a minimum period of five and maximum of ten days. To collect the data, it was used an instrument based on the characteristics of the diagnostics studied and some relevant literature about the lung evaluation. The data were collected through examination of the child and interview with their parents. The information obtained were analyzed by the researcher to determine the presence or absence of DC of nursing diagnoses IBP, IAC, IGE e ISV and data was organized into spreadsheets. After, the spreadsheets were sent to nurses diagnosticians that performed the diagnostic inference process. It was used Excel and PASW software for organizing and analyzing statistical data. The level of significance was 5%. Among children evaluated, 30 (55,5%) developed IAC, 25 (46,3%) developed IGE e 21 (38,8%) developed IBP during the monitoring period. In order to infer IAC, the DC most accurate was respiratory rales and to IBP the characteristic that presented the highest accuracy measurements was use of accessory muscles to breathe. As for the inference IGE, the characteristic most accurate was hypoxemia. For the nursing diagnosis ISV, was not possible to establish statistically significant accuracy of defining characteristics. Based on the analysis of multiple matches, the best characteristics that assist in differentiating between the diagnoses IBP, IAC e IGE were: change in respiratory rate, excessive amount of mucus, respiratory rales, cough absent and tachypnea to IAC; dyspnea, nasal flaring, change in respiratory rate and use of accessory muscles breathing to IBP e carbon dioxide decreased, abnormal arterial blood gases, abnormal arterial pH e PO2 decreased to IGE. The results helped identify the DC more representative of IBP, IAC e IGE in children with congenital heart diseases in post-operative period. Studies of this nature are important for providing information about the predictive ability of the defining characteristics and the temporal evolution and characteristics of the respiratory nursing diagnoses.

O planejamento para direcionar o cuidado e fundamentar o conhecimento de enfermagem em situaÃÃes clÃnicas especÃficas se baseia na utilizaÃÃo de diagnÃsticos de enfermagem precisos. O uso de bons indicadores clÃnicos para predizer diagnÃsticos à fundamental para que se alcance essa precisÃo. Este estudo teve como objetivo geral determinar as medidas de acurÃcia dos indicadores clÃnicos dos diagnÃsticos de enfermagem respiratÃrios: DesobstruÃÃo ineficaz de vias aÃreas, PadrÃo respiratÃrio ineficaz, Troca de gases prejudicada e VentilaÃÃo espontÃnea prejudicada em crianÃas asmÃticas. Estudo transversal, realizado em um hospital de nÃvel secundÃrio da rede pÃblica de Fortaleza (CE), nos meses de abril a setembro de 2013. A amostra foi composta por 205 crianÃas. Os dados foram coletados por meio de uma avaliaÃÃo pulmonar e entrevista com os responsÃveis. As informaÃÃes obtidas foram analisadas para determinar a presenÃa ou ausÃncia dos indicadores clÃnicos dos diagnÃsticos em estudo. Posteriormente, esses dados foram encaminhados a enfermeiros diagnosticadores para inferÃncia diagnÃstica. Foram utilizados os softwares Excel e SPSS para organizaÃÃo e anÃlise estatÃstica dos dados. O nÃvel de significÃncia adotado foi de 5%. O estudo adotou os princÃpios Ãticos e recebeu parecer Ãtico favorÃvel (parecer n 237.389/13). Houve uma discreta prevalÃncia para o sexo masculino (52,3%) e mediana de idade de 36 meses. Das crianÃas avaliadas, 89,3% desenvolveram DesobstruÃÃo ineficaz de vias aÃreas; 86,8%, PadrÃo respiratÃrio ineficaz; 28,8%, Troca de gases prejudicada e 5,9%, VentilaÃÃo espontÃnea prejudicada. DesobstruÃÃo ineficaz de vias aÃreas apresentou dispneia, mudanÃa na frequÃncia respiratÃria, mudanÃa no ritmo respiratÃrio, ortopneia, ruÃdos adventÃcios e tosse ineficaz como indicadores mais prevalentes. MudanÃa na frequÃncia respiratÃria, mudanÃa no ritmo respiratÃrio, ortopneia, ruÃdos adventÃcios respiratÃrios, sons respiratÃrios diminuÃdo e tosse ineficaz apresentaram associaÃÃo estatisticamente significante com este diagnÃstico. E ruÃdos adventÃcios respiratÃrios e tosse ineficaz mostraram-se como os indicadores mais acurados. PadrÃo respiratÃrio ineficaz apresentou ortopneia, taquipneia e uso da musculatura acessÃria para respirar como os indicadores mais prevalentes. Evidenciou-se associaÃÃo estatisticamente significante de alteraÃÃes na profundidade respiratÃria, taquipneia, uso da musculatura acessÃria e ortopneia com PadrÃo respiratÃrio ineficaz. Uso da musculatura acessÃria para respirar, alteraÃÃes da profundidade respiratÃria e ortopneia apresentaram-se como mais acurados para padrÃo respiratÃrio ineficaz. Troca de gases prejudicada apresentou dispneia, respiraÃÃo anormal, taquicardia e hipoxemia como os indicadores mais prevalentes. Hipoxemia foi o Ãnico indicador que mostrou associaÃÃo estatisticamente significativa, alÃm de manifestar-se como mais acurado para troca de gases prejudicada. Para VentilaÃÃo espontÃnea prejudicada, dispneia, frequÃncia cardÃaca aumentada e SaO2 diminuÃda foram os indicadores mais prevalentes. CooperaÃÃo diminuÃda, SaO2 diminuÃda e uso aumentado da musculatura acessÃria para respirar estiveram associados significativamente com ventilaÃÃo espontÃnea prejudicada e uso aumentado da musculatura acessÃria para respirar apresentou-se com melhor acurÃcia. Para a associaÃÃo entre os diagnÃsticos, desobstruÃÃo ineficaz de vias aÃreas manteve relaÃÃo com padrÃo respiratÃrio ineficaz e padrÃo respiratÃrio ineficaz com Troca de gases prejudicada. VentilaÃÃo espontÃnea prejudicada nÃo apresentou associaÃÃo. Acredita-se que o conhecimento do perfil diagnÃstico de populaÃÃes especÃficas possa contribuir para que as intervenÃÃes de enfermagem sejam orientadas por decisÃes diagnÃsticas, facilitando assim, escolha de aÃÃes adequadas.
The planning to lead the care and to support the nursing knowledge in specific clinical situations is based on the use of accurate nursing diagnoses. The use of good clinical indicators for predicting diagnosis is essential in order to reach this precision. This study aimed at determining the measures of accuracy of clinical indicators for nursing diagnosis, such as: Ineffective airway clearance, Ineffective breathing pattern, Impaired gas exchange and Impaired spontaneous ventilation in asthmatic children through a cross-sectional study held in a secondary level public hospital in Fortaleza (CE), from April to September 2013. The sample consisted of 205 children with asthma whose data were collected through a pulmonary assessment and interviews with their parents. The data were analyzed by the researcher to determine the presence or absence of: Ineffective airway clearance; Ineffective breathing pattern; Impaired gas exchange and Impaired spontaneous ventilation indicators based on a research protocol and then diagnostician nurses analyzed this information for diagnostic inference. For statistical analysis, SPSS and Excel were used with a significance level of 5 %. The study adopted the ethical principles and received the assent of the Federal University of Cearà Ethics and Research (opinion No. 237.389/13). There was a slight prevalence for males (52.3 %) and average age of 36 months. 89.3% of the children assessed developed Ineffective airway clearance; 86.8 % developed Ineffective breathing pattern; 28.8 % developed Impaired gas exchange and 5.9 % of the children developed Impaired spontaneous ventilation. Ineffective airway clearance presented dyspnea, change in respiratory rate, change in respiratory rhythm, orthopnea, rales and ineffective cough as the most prevalent indicators. Change in respiratory rate, change in respiratory rhythm, orthopnea, respiratory rales, decreased breath sounds and ineffective cough showed a significant association with this diagnosis whereas ineffective cough and respiratory rales appeared as the most accurate indicators. Ineffective breathing pattern had orthopnea, tachypnea and use of accessory muscles to breathe as the most prevalent indicator. A statistically significant association between changes in respiratory depth, tachypnea, accessory muscle use and orthopnea with Ineffective breathing pattern was also observed in this study. The Use of accessory muscles for breathing, changes in respiratory depth and orthopnea were observed as more accurate for Ineffective breathing pattern. Impaired gas exchange presented dyspnea, abnormal breathing, tachycardia and hypoxemia as the most prevalent indicators. Hypoxemia was the only indicator that showed a statistically significant association, and were seen as more accurate for Impaired gas exchange. For Impaired spontaneous ventilation dyspnea, increased heart rate and decreased SaO2 were the most prevalent indicators. Decreased cooperation, decreased SaO2 and increased use of accessory muscles to breathe were significantly associated with Impaired spontaneous ventilation and increased use of accessory muscles to breathe was presented with better accuracy. For the association between diagnoses, Ineffective airway clearance remained related to Ineffective breathing pattern and Impaired gas exchange and Ineffective breathing pattern remained related to Impaired gas exchange. Impaired spontaneous ventilation showed no association. It is believed that knowledge of the diagnostic profile of specific populations may contribute to nursing interventions so that they are guided by diagnostic decisions, thus facilitating the choice of the most appropriate actions.

Conjunctivitis is the most common cause of red eye and one of the most frequent causes of visits to clinicians. There is significant controversy on the diagnosis and treatment of the disease and the use of ophthalmic antibiotics. The inconvenience of the untimely diagnostic tests led to the trend of treating conjunctivitis empirically with ophthalmic antibiotics. Subsequently, the diagnosis of bacterial conjunctivitis is higher than it should be resulting in overuse of antibiotics. Consequences of inappropriate diagnosis and treatment include increased virulence, increased health care costs, and incorrect use of antibiotics leading to possible adverse reaction and antibiotic resistance. Appropriate diagnosis and treatment will assist to reduce the diagnosis of bacterial conjunctivitis and use of ophthalmic antibiotics resulting in reduced virulence and reduced health care costs. The AdenoPlus test has been shown to be effective in appropriately diagnosing viral conjunctivitis and subsequently decreasing the use of ophthalmic antibiotics however this evidence in limited. A national retail clinic has adopted the use of this tool to assist with proper diagnosis and treatment of viral conjunctivitis. Data has not yet been analyzed to determine if the implementation of this test changes the practice of clinicians at the national retail clinic.

The recognition of good clinical indicators and characteristics of accuracy for certain nursing diagnosis allows nurses to identify more accurately the diagnosis and effectively promotes the practical application of the process of nursing work. Given the importance of identifying accurate clinical indicators, this study will be developed in order to analyze the defining characteristics (DC) and related factors (RF) of the nursing diagnosis "Sedentary Lifestyle" (SL) reviewed by Guedes (2011 ) in individuals with hypertension. It was a cross-sectional study conducted with 285 individuals with hypertension, aged between 19 and 59 years, followed at a center for outpatient care, in Fortaleza, CearÃ. Data collection was performed using a form based on empirical references of DC and RF in reviewing proposed by Guedes (2011), by interview and physical examination. The data obtained were analyzed by the researcher to determine the presence or absence of DC and RF and later were referred to specialist nurses who performed the diagnostic inference. It was used EXCEL, SPSS and R software for organizing and analyzing statistical data. The level of significance was 5%. The population was predominantly female, coming from the capital, living with a partner and holder of Diabetes mellitus. Half of the sample had up to 53 years, education time up to 10 years, per capita income up to R$ 500.00 and have a diagnosis of hypertension for over 10 years. The DC more frequent among patients with hypertension were "reduced flexibility of the articulations" (93.7%), "excess weight" (85.3%), "it does not carry out physical activities in the leisure time" (83.9 %) and "it verbalizes preference for activities with little physical exercise" (83.9%). Of total DC evaluated, only five were statistically significant. The RF more frequent were "lack of resources (money, time, place, security and equipment) for the physical exercise" (87.45%), "defective knowledge on the benefits that the physical activity brings to the health and / or on the consequences of the sedentary life style" (78.6%) and "lack of social support for the practice of physical exercise" (76.8%). A total of 11 RF evaluated, seven had a significant association with the diagnosis SL. The prevalence of the diagnosis in question was 55.8%. The DC "chooses routines without physical exercises" was the main characteristic for this diagnosis, with a sensitivity of 100% and a high specificity value (84.13%). Three defining characteristics were not statistically significant from the analysis of likelihood ratios and diagnostic odds ratio: "excess weight", "reduced flexibility of the articulations" and "reduced muscular strength." The RF "lack of motivation for practicing physical exercise" and "lack of interest in exercising" had the highest prevalence ratios (PR = 5.358). It was found in this study that most of these new elements identified in the review of Guedes (2011) are relevant to the accurate identification of diagnosis SL in people with hypertension. Thus, it is expected that this information can contribute to efficient and systematic nursing practice, with an emphasis on health promotion for people with hypertension.
O reconhecimento de bons indicadores clÃnicos e de suas caracterÃsticas de acurÃcia, para determinado diagnÃstico de enfermagem, permite que o enfermeiro identifique com maior precisÃo o diagnÃstico e favorece efetivamente a aplicaÃÃo prÃtica do processo de trabalho de enfermagem. Diante da importÃncia de se identificar indicadores clÃnicos acurados, este estudo foi desenvolvido com o objetivo de analisar as caracterÃsticas definidoras (CD) e os fatores relacionados (FR) do diagnÃstico de enfermagem âEstilo de vida sedentÃrioâ (EVS) revisado por Guedes (2011) em indivÃduos com hipertensÃo arterial (HA). Estudo do tipo transversal, realizado com 285 indivÃduos com hipertensÃo arterial, com idade entre 19 e 59 anos, acompanhados em um centro de atendimento ambulatorial, em Fortaleza, CearÃ. A coleta de dados foi realizada utilizando um formulÃrio baseado nas referÃncias empÃricas das CD e os FR propostos na revisÃo de Guedes (2011), por meio de entrevista e exame fÃsico. As informaÃÃes obtidas foram analisadas pela pesquisadora para determinar a presenÃa ou ausÃncia das CD e dos FR e, posteriormente, foram encaminhadas aos enfermeiros especialistas que executaram a inferÃncia diagnÃstica. Foram utilizados os softwares EXCEL, SPSS e R para organizaÃÃo e anÃlise estatÃstica dos dados. O nÃvel de significÃncia adotado no estudo foi 5%. A maioria da amostra era do sexo feminino, procedente da capital, morando com companheiro e com diagnÃstico de Diabetes mellitus. Metade da amostra tinha atà 53 anos, tempo de escolaridade de atà 10 anos, renda per capita de atà R$ 500,00 e diagnÃstico de hipertensÃo arterial hà mais de 10 anos. As CD mais frequentes entre os pacientes com de HA foram âflexibilidade das articulaÃÃes diminuÃdaâ (93,7%), âexcesso de pesoâ (85,3%), ânÃo realiza atividades fÃsicas no tempo de lazerâ (83,9%) e âverbaliza preferÃncia por atividades com pouco exercÃcio fÃsicoâ (83,9%). Do total de CD avaliadas, somente cinco apresentaram significÃncia estatÃstica. Os FR mais frequentes foram âfalta de recursos (tempo, dinheiro, lugar, seguranÃa, equipamento) para a prÃtica de exercÃcio fÃsicoâ (87,45%), âconhecimento deficiente sobre os benefÃcios que a atividade fÃsica traz à saÃde e/ou sobre as consequÃncias do sedentarismoâ (78,6%) e âfalta de apoio social para a prÃtica de exercÃcio fÃsicoâ (76,8%). De um total de 11 FR avaliados, sete apresentaram associaÃÃo significante com o diagnÃstico EVS. A prevalÃncia do diagnÃstico em questÃo foi 55,8%. A CD âescolhe rotina diÃria sem exercÃcio fÃsicoâ foi a principal caracterÃstica para este diagnÃstico, apresentando uma sensibilidade de 100% e um elevado valor de especificidade (84,13%). TrÃs caracterÃsticas definidoras nÃo apresentaram significÃncia estatÃstica a partir da anÃlise das razÃes de verossimilhanÃa e odds ratio diagnÃstica: âExcesso de pesoâ, âFlexibilidade das articulaÃÃes diminuÃdaâ e âForÃa muscular diminuÃdaâ. Os FRs âfalta de motivaÃÃo para a prÃtica de exercÃcio fÃsicoâ e âfalta de interesse em se exercitarâ apresentaram as maiores razÃes de prevalÃncia (RP = 5,358). Constatou-se neste estudo que a maior parte desses novos elementos encontrados na revisÃo de Guedes (2011) à relevante para a identificaÃÃo acurada do diagnÃstico EVS. Dessa forma, espera-se que estas informaÃÃes possam contribuir para uma prÃtica de enfermagem eficiente e sistematizada, com Ãnfase na promoÃÃo da saÃde de pessoas com hipertensÃo arterial.

A brain tumor diagnosis is traumatic and has a devastating impact upon the caregiver and the family unit. The effects of the tumor growth and treatment often cause significant neurologic injury and dramatically affect the quality of life (QOL) for the patient and their entire family unit. Caregivers are constantly challenged to provide care, yet they feel untrained and underprepared as they struggle to adjust to new roles and responsibilities. The purpose of this study is to gain an understanding of the lived experiences of caregivers of individuals with primary benign brain tumor (PBBT). An interpretive phenomenological analysis approach was used to explore the experiences of 10 caregivers. Bowen's family systems theory provided an understanding of how families respond to changes in their family system resulting from a member of the family having a PBBT. A nonprobability sampling technique was used to recruit participants from 2 virtual support groups. Data were collected through semistructured interviews guided by an interview template. Interviews were transcribed and analyzed following the Smith tradition of inquiry until data saturation was reached. Three major themes emerged from the data: experiencing new challenges, responding to initial diagnosis, and facing challenges with family and friends. Caregivers experience a wide variety of responsibilities that are physically and psychologically challenging, which can negatively affect the QOL for the caregiver and the patient. These findings can be used by healthcare providers to identify resources to alleviate the unanticipated demands caregivers experience. Future studies are needed to explore how best to decrease challenges experienced by caregivers of individuals with PBBT.

Anxiety and depression are common mood disorders in cancer patients, regardless of mental state prior to diagnosis. A gap in the education of oncology nurses in an eastern Caribbean island was discovered regarding their ability to identify anxiety and depression symptoms and to help patients who suffered from these disorders. The purpose of this project was to improve oncology nurses' assessment skills by reviewing appropriate use of the Hospital Anxiety and Depression Scale (HADS) tool and familiarizing nurses with resources to help patients who score high on the HADS. The Levine conservation model was the theoretical framework for this project. The research question addressed whether a staff education module regarding the use of the HADS tool would improve staff knowledge about screening cancer patients for mood disorders in a clinic setting. This project involved a staff education module with a pretest/posttest assessment and evaluation of the responses and levels of improvement. A total of 10 oncology nurses with varying academic degrees and years of experience participated in the project. The pretest showed that many had inadequate knowledge of the HADS tool. Based on posteducation assessment scores, all participants understood how to use the tool to screen for mood disorders. The implication of this study for positive social change is that oncology nurses will be able to use a screening tool to identify undiagnosed anxiety and depression symptoms in cancer patients and provide patients with appropriate resources.

This descriptive study used the Diagnostic Content Validity (DCV) and the Clinical Diagnostic Validation (CDV) models proposed by Fehring (1986) to clinically identify and validate the defining characteristics for Alteration in Tissue Perfusion: Peripheral. The Peripheral Vascular Assessment Tool (PVAT) was designed as the data collection tool; the DCV of the PVAT was 0.75. Twenty subjects, 18 years old and older, were selected from a population who were admitted as in-patients in one rural southwestern hospital. Data were collected through patient interviews, independent nurse assessment, and review of medical records. The CDV score for the validated tool was 0.62. No major defining characteristics and six minor defining characteristics were clinically validated. Differences in defining characteristics were found in the subjects with arterial occlusive disease and those with venous occlusive disease. Findings are applicable to nursing practice and research.

FundaÃÃo Cearense de Apoio ao Desenvolvimento Cientifico e TecnolÃgico
Estudos de acurÃcia diagnÃstica tÃm como finalidade apresentar indicadores clÃnicos que possam predizer as respostas humanas, gerando conhecimentos para melhorar o processo de inferÃncia diagnÃstica. Dessa forma, este estudo teve como objetivo analisar a acurÃcia dos indicadores clÃnicos do diagnÃstico de enfermagem Enfrentamento familiar comprometido no contexto de cÃncer na adolescÃncia. Trata-se de um estudo de acurÃcia diagnÃstica, com corte transversal. Participaram do estudo 236 cuidadores e adolescentes entre 10 e 19 anos completos, com diagnÃstico de cÃncer, internados ou em consulta ambulatorial ou no hospital dia de uma instituiÃÃo terciÃria de referÃncia em oncologia infatojuvenil, nos meses de marÃo a maio de 2015. A estratÃgia de amostragem foi nÃo probabilÃstica por conveniÃncia. O instrumento de coleta dados foi composto com base nos indicadores clÃnicos do diagnÃstico em estudo e foi aplicado por entrevista realizada com o adolescente e seu cuidador. Os dados foram reunidos no software Excel (2007), analisados com o apoio do pacote estatÃstico SPSS versÃo 19.0 for Windows e do software R versÃo 2.12.1 e sintetizados em 10 tabelas. A anÃlise descritiva dos dados incluiu o cÃlculo de frequÃncias absolutas, percentuais, medidas de tendÃncia central e de dispersÃo. Para as proporÃÃes de variÃveis categÃricas, foram calculados intervalos de confianÃa de 95%. Aplicaram-se os testes de Lilliefors, Qui-quadrado e Mann-Whitney. Para verificar a sensibilidade e especificidade de cada indicador clÃnico, foi utilizado o mÃtodo de anÃlise de Classes Latentes. Os resultados mostram que a maior parte dos adolescentes avaliados eram do sexo masculino, acompanhados em hospital dia. Metade dos adolescentes possuÃa idade de atà 14 anos, renda de R$ 780,00 reais e mais que cinco membros na famÃlia. Os tumores hematolÃgicos foram os mais frequentes. Os adolescentes consideraram a famÃlia como um todo importante na sua vida, mas quem mais ajuda no tratamento e mais o acompanha à a figura materna. Os indicadores clÃnicos de maior prevalÃncia foram: Pessoa significante relata entendimento inadequado, que interfere na eficÃcia dos comportamentos de apoio e Pessoa significante relata preocupaÃÃo com a reaÃÃo pessoal (p.ex. medo, pesar, culpa, ansiedade) à necessidade do cliente. O diagnÃstico Enfrentamento familiar comprometido apresentou baixa prevalÃncia tanto na populaÃÃo geral, quanto nos subgrupos amostrais de sexo, idade e tempo de diagnÃstico. Para adolescente com tempo de diagnÃstico igual ou inferior a 24 meses, foram encontradas: trÃs indicadores sensÃveis e um especÃfico. Para o sexo masculino, dois indicadores foram sensÃveis e dois especÃficos. Para o sexo feminino, foram encontrados quatro indicadores sensÃveis. Dentre estes, dois indicadores tambÃm se mostraram especÃficos. Para indivÃduos com idade menor que 14, dois indicadores revelaram-se sensÃveis e um mostrou-se especÃfico. Para indivÃduos com idade superior ou igual a 14 anos, trÃs indicadores clÃnicos obtiveram valores vÃlidos e elevados de sensibilidade e especificidade. A identificaÃÃo de indicadores clÃnicos preditores de um diagnÃstico de enfermagem à importante para a conclusÃo diagnÃstica. E este estudo contribuirà para a inferÃncia diagnÃstica de Enfrentamento familiar comprometido no contexto de cuidado de adolescentes com cÃncer.
Studies of accuracy diagnostic in family are intended to provide clinical indicators that can predict human responses, generating knowledge to improve the diagnostic inference process. Thus, this study aimed to analyze the accuracy of clinical indicators of nursing diagnosis of Compromited family coping in the context of cancer in adolescence. It is a study of diagnostic accuracy, cross-sectional. Study participants were 236 caregivers and adolescents between 10 and 19 full years, diagnosed with cancer, hospitalized or outpatient visit or hospital day of a tertiary institution of reference in infatojuvenil oncology, in the months from March to May 2015. The strategy sample was not probabilistic for convenience and the collection held by the author and academic nursing. The data collection instrument was made based on clinical indicators of diagnosis under study and was administered by interview with the teen and his caregiver. Data were gathered on Excel software (2007), analyzed with the support of statistical package SPSS version 19.0 for Windows and the R version 2.12.1 software and synthesized in 10 tables. The descriptive analysis included the calculation of absolute frequencies, percentages, measures of central tendency and dispersion. For categorical variables the proportions of 95% confidence intervals were calculated. They applied to the Lilliefors tests, chi-square and Mann-Whitney. To check the sensitivity and specificity of each clinical indicator, we used the method of analysis of Latent Classes. Most of the adolescents evaluated were male, accompanied on hospital day. Sample teen half had aged under 14 years, real income of R$ 780.00 and more than 5 members in the family. Hematological tumors were the most frequent. Teenagers consider the family as a whole important in your life, but who else helps to treat and more accompanies is the mother figure. Clinical indicators of higher prevalence were: significant person reports inadequate understanding, which interferes with the effectiveness of behavior support and significant person reports preoccupation with personal reaction (eg fear, grief, guilt, anxiety) to customer needs. Compromited family coping diagnosis showed low prevalence both in the general population, as the sample subgroups of gender, age and time of diagnosis. For teen with diagnostic time equal to or less than 24 months were found: three sensitive and specific indicators. For males, two indicators were sensitive and two specific. For females, were found four sensitive indicators. Among these, also shown two indicators are specific. For individuals younger than 14, two indicators were receptive and proved to be specific. For individuals older than or equal to 14 years, three clinical indicators obtained valid and high levels of sensitivity and specificity. Identifying predictors of clinical indicators of a nursing diagnosis is important. And this study contributed to the diagnostic inference compromised family coping in the context of adolescent care with cancer.

Bakgrund: Trots stora framgångar inom den psykiatriska vårdvetenskapen fortsätter psykiatriska sjukdomar att växa fram utbrett över hela världen. Genom coping kan en individ hantera de inre och yttre krav som ställs och överskrider individens personliga resurser. Psykiatriska diagnoser kan för en oerfaren sjuksköterska upplevas som främmande eller otäckt. Detta kan bero på bristande förståelse och kunskap kring psykiatriska diagnoser varför det är viktigt att öka kunskapen inom området. Syfte: Syftet med denna studie var att beskriva vilka copingstrategier personer med psykiatrisk diagnos använder. Metod: En beskrivande litteraturstudie, artikelsökningen genomfördes i databaserna Medline via Pubmed samt PsycINFO vilket medförde totalt tretton artiklar som inkluderas i resultatdelen. Resultatet baseras på tolv kvalitativa artiklar och en kvalitativ och kvantitativ artikel. Huvudresultat: Resultatet består av tre huvudteman, problemfokuserad, känslofokuserad och meningsbaserad coping. Dessa copingstrategier gav upphov till mening, känslor av säkerhet och sinnesro, tillhörighet, glädje och skapade verktyg för att få en förbättrad förståelse för sina känslor och minimerad stress hos personer med en psykiatrisk diagnos. Resultaten visade att flest personer använde sig av problemfokuserade copingstrategier som inriktade sig på att aktivt sträva efter att förändra eller hantera det underliggande problemet. Slutsats: Studiens syfte var att beskriva vilka copingstrategier som personer med psykiatrisk diagnos använde. Resultaten visade att personer med psykiatrisk diagnos använde sig av olika kombinationer av copingstrategier i olika situationer utifrån olika behov. Att hantera sin situation med hjälp av rutiner, yttre stöd, medicinsk behandling, kontroll och förståelse av känslor, samt livssyn och tro framkom i resultatet som väsentliga faktorer. Att ha förståelse för att personer använder sig av individuella copingstrategier kan hjälpa sjuksköterskan att uppmuntra till nya hälsofrämjande copingstrategier.

Bakgrund: Endometrios är en kronisk gynekologisk sjukdom som drabbar 10 % av alla kvinnor i fertil ålder. Endometrios innebär att rester av livmoderslemhinnan vandrar ut i kroppen, istället för att följa med menstruationsblodet ut ur kroppen. Symtom kan visa sig genom starka menstruationssmärtor, kraftiga blödningar, huvudvärk, och smärta vid samlag. Syfte: Syftet med litteraturstudien var att belysa kvinnors upplevelser av att leva med endometrios. Metod: En allmän litteraturstudie baserad på 10 kvalitativa vetenskapliga artiklar. Resultat: Två kategorier och sju underkategorier erhölls: Kategorier: Upplevelser av mötet med sjukvården och anhöriga när man har sjukdomen endometrios, faktorer som påverkar upplevelsen av livskvalitén. Underkategorier: Mötet med sjukvårdpersonal, bemötande från andra personer i sin vardag, när man inte fått en diagnos, isolering från omvärlden, att känna sig deprimerad, vikten av att känna bekräftelse, att kunna hantera sin smärta. Diskussion: Det rådde en bristande kunskap hos både vårdpersonal och samhället angående sjukdomen. Kvinnorna blev således inte tagna på allvar och blev utan diagnos i flera år. Smärtan, att de inte blev betrodda, och den långa väntan på diagnos bidrog till en känsla av ensamhet och isolering. Slutsats: Endometrios begränsade kvinnornas fysiska, psykiska och sociala livsfaktorer. Smärtan som förekom vid endometrios påverkade deras relationer negativt. För att förbättra kvinnors livskvalité behövs mer uppmärksamhet kring sjukdomen.

Communication of care is essential in the multidisciplinary health care system and the patient record is an important tool for communication. The electronic patient record was introduced to facilitate the documentation of care, as well as the communication and evaluation of care. District nurses met the patient independently of other caregivers at the surgery or in the patient’s home. Documentation by district nurses is assumed to contribute to the view of the patient so that safe care can be carried out in primary health care. This thesis investigates and analyses the electronic nursing documentation in primary health care with emphasis on the content, district nurses’ experiences of documentation and how the information in the documentation was used. A further aim was to implement and evaluate the effect on standardised nursing documentation, using patients with leg ulcer as an example. A sample of 239 district nurses, 430 general practitioners and 74 care unit managers answered questionnaires about the nursing documentation and the use of it. One hundred and nine nursing records were audited. Quantitative and qualitative methods were used for data analysis. Documentation by district nurses lacked clear nursing status, judgment (nursing diagnosis) and nursing goals. Legal requirements were not fulfilled. Medical facts were carefully documented while relevant issues to nursing occurred only seldom. District nurses stated that they were satisfied with their documentation but were in need of education. The focus of the in-service training for documentation was technical rather than involving nursing issues. Fifty-eight per cent of the general practitioners read the nursing documentation always or often and found it valuable. They had problems, however, finding the information because of the unclear nursing status, the lack of district nurses’ judgement and the large quantity of notes regarding routine activities in district nurses’ documentation. The nursing documentation was used by 75 % of the care unit managers for evaluating resources and by 51 % for evaluating care. The categories ’prioritisation’, ’inadequate nursing records’, and ’lack of interest’, illustrate for what reasons the care unit mangers did not use the documentation for evaluation of care. In order to advance district nurses documentation, a standardised nursing wound care record was designed and implemented in nine primary health care centers, with a total of 83 district nurses. Eight primary health care centers were used as a control group, including 56 district nurses. A questionnaire was sent to the district nurses and 102 nursing records were audited before and after implementation. The standardised nursing record improves the descriptions of patient’s health history and status. Nursing diagnoses were more frequently used but were of low quality. Using the standardised nursing wound care record was experienced by the district nurses as being more timeconsuming but also more informative about the patient. Furthermore the knowledge in documentation increased among the district nurses in the intervention group. Improvement of nursing documentation is necessary in order to obtain documentation that fulfills legal requirements. The managers had a great responsibility to upgrade the documentation, which can be effected by continuing support. Documentation must be seen as a means of transferring information about the patient and of determining whether the best care has been given. A standardised documentation could increase the possibility to compare and determine the value of care. Strengthening the awareness of nursing among district nurses should involve strengthening the documentation, which ought to lead to safer care for the patient.

Thesis (MCur)--University of Stellenbosch, 2011.
ENGLISH ABSTRACT: Background: In her clinical practice as nursing manager the researcher was concerned about incomplete and inaccurate documentation of patients diagnosed with tuberculosis (TB) which were compromising the management of these patients. The primary care nurses endorsed these concerns. Goals and Objective: The goal of this study was to audit nursing documentation according to the phases of the nursing process and the discharge planning of patients diagnosed with TB discharged from TB hospitals in the Western Cape. The objectives for the study were to determine whether the patients were adequately assessed and diagnosed, whether nursing care plans were formulated based on the assessment and whether they were implemented and evaluated according to the nursing process - including the discharged planning. Ethics approval was obtained from the Committee of Human Research Science at Stellenbosch University and permission was also obtained from the respective institutions. Methodology: A descriptive design with a quantitative approach was applied for the purpose of this study. The total population for the study was N=1768. A systematic random sample of 12% from each hospital was drawn: n=214, hospital A (n=142) and hospital B (n=72). Criteria included:  all adult patients older than 18 years  patients who were discharged between 01 January 2007 and 31st December 2007  all discharged patients from the two hospitals specializing in patients diagnosed with TB. Instrumentation: An audit instrument based on the objectives of the study was approved as the data collection tool. Guided by the proposed study a 10% (n=21) of the number of discharged patient files were drawn for the purpose of a pilot study. Reliability and validity was ensured through the use of experts in the field of nursing, research methodology and statistics. A pilot study was also conducted to support the reliability and validity of the study. Data collection: The researcher collected the data personally with the support of five trained field workers who only assisted at hospital B and was reluctant to assist at the second hospital. Data analysis: Data was analysed with the support of a statistician and expressed in frequencies and tables. Results: All phases of the nursing process showed a low compliance. Results showed that only n=90(42%) of the registered professional nurses checked and signed the initial assessment, furthermore only n=53(34%) showed that a recording was made of all referral documentation to the patient’s follow-up clinic. Recommendations: Recommendations based on the scientific evidence obtained from the study include the implementation of a quality assurance programme namely standardisation, auditing, case management of patients, education and training, rewarding of staff and further research. Conclusion: In conclusion guided by the research question “Are the audited discharged patient files at hospitals specialising in the management of patients with TB in the WCDoH compliant?” The researcher concludes that the discharged patient files are not compliant.
AFRIKAANSE OPSOMMING: Agtergrond: In haar kliniese praktyk as verpleegbestuurder is die navorser besorgd oor die onvolledige en onakkurate dokumentasie van pasiënte wat met tuberkulose (TB) gediagnoseer is en wat dus die versorging van hierdie pasiënte in gevaar stel. Hierdie besorgdhede is deur die primêre sorg verpleegsters bevestig. Doel en Doelwitte: Die doel van die studie is om die verpleegdokumente te ouditeer volgens die fases van die vepleegproses, asook die ontslagbeplanning van die pasiënte gediagnoseer met TB van die hospitale in die Wes-Kaap. Die doelwitte is om te bepaal of die pasiënte korrek geassesseer en gediagnoseer is en of verpleegsorgplanne opgestel is, wat gebaseer is op die assessering en versorgingsplanne wat geïmplementeer en geëvalueer is volgens die verpleegproses, insluitende die ontslagbeplanning. Etiese goedgekeuring is toegestaan deur die Komitee vir Menslike Navorsingswetenskap van die Universiteit van Stellenbosch en toestemming is ook ontvang van die onderskeie instansies. Metodologie: ’n Beskrywende ontwerp met ’n kwantitatiewe benadering is toegepas vir die doel van die studie. Die totale bevolking vir die studie is N=1786. ’n Sistematiese ewekansige geselekteerde steekproef van 12% van elke hospitaal is geneem: n=214, hospitaal A (n=142) en hospitaal B (n=72). Die kriteria sluit in:  alle volwasse pasiënte ouer as 18 jaar  pasiënte wat gedurende die periode 01 Januarie 2007 tot 31 Desember 2007 ontslaan is  alle ontslag pasiënte van die twee hospitale wat spesialiseer in pasiënte wat gediagnoseer is met TB. Instrumentasie: ‘n Ouditinstrument gebaseer op die doelwitte is goedgekeur as die dataversamelingsinstrument. Na aanleiding van die voorgestelde studie is 10% (n=21) van die aantal ontslag pasiëntlêers getrek vir die doel van die loodsondersoek. Betroubaarheid en geldigheid is verseker deur gebruik te maak van deskundiges in die verplegingsveld, die navorsingsmetodologie en statistiek. Die loodsondersoek is ook uitgevoer om die betroubaarhied en geldigheid van die studie te rugsteun. Dataversameling: Die navorser het die data persoonlik gekollekteer met die bystand van vyf opgeleide veldwerkers wat slegs hulp verleen het by hospital B en wat teësinnig was om hulp te verleen by die tweede hospitaal. Data-analise: Data is geanaliseer met die hulp van ’n statistikus en is uitgedruk in frekwensies en tabelle. Resultate: Alle fases van die verpleegproses het nie voldoen aan die vereistes nie. Resultate dui daarop dat slegs n=90 (42%) van die geregistreerde professionele verpleegsters die aanvanklike assessering nagegaan en onderteken het, vervolgens het slegs n=53 (34%) getoon dat ’n opname gemaak was van alle verwysde dokumentasie van die pasiënt se opvolgbesoek aan die kliniek. Aanbevelings: Aanbevelings is gebaseer op die wetenskaplike bewys wat verkry is van die studie vir die implementering van ’n gehalte versekeringsprogram, naamlik standardisering, ouditering, gevallebestuur van pasiente, opvoeding en opleiding, erkenning aan die personeel, en voortgesette navorsing. Samevatting: Ter afsluiting gelei deur die navorsering’s vraag nl. “Is die geouditeerde verpleegdokumente in hospitale wat spesialiseer in die bestuur van pasiente gediagnoseer met TB in die Weskaap se Department van Gesondheid bygehou?” Die navorser bevestig dat die verpleegdokumente nie bygehou was nie.

The overall aim of the thesis was to study clinical decision making in nursing. This was performed by evaluation of the quality of nurses’ diagnostic statements and comparison of the concordance between nurses and patients’ perceptions of the patients’ nursing needs, as well as patient preferences for participation in clinical decision making. Further, predictors regarding patients’ active participation were investigated.

Quasi-experimental, comparative and cross-sectional descriptive study designs were used to collect data in acute care settings from randomly selected patient records (n = 140), nurse-patient dyads (n = 80), and patients discharged from hospital care (n = 428). Data were gathered using questionnaires and review of patient records.

The quality of nurses’ diagnostic statements improved by the means of education directed to nurses and implementation of new forms for recording supporting nursing care planning (I). Discrepancies were found concerning patients and nurses’ perceptions about what constitutes a problem for the patient as well as the severity and importance of acting on the problem (II). Further, nurses perceived that their patients preferred to be more active in clinical decision making compared with the patients’ own preferences for participation (III). Gender, education, living situation, and occupation were identified as predictors for preferring an active role in clinical decision making (IV).

The conclusions are that the accuracy of diagnostic statements needs to be addressed and validated further through systematic assessment of the patients’ perceptions and preferences concerning the health situation and preferences for participation in clinical decision making. Clinical implications are that nurses need to involve patients in identifying patient problems of relevance for nursing. Further, nurses also need to be aware of patients’ preferences for participation in clinical decision making in order that they can plan care in accordance with patient preferences and allow participation to the degree preferred by the patient.

Patientens delaktighet i kliniskt beslutsfattande i omvårdnad – ett gemensamt ansvar för patienter och sjuksköterskor

Bakgrund

Patienten har, med bas i lagstiftning och förordningar, en stark ställning inom svensk hälso- och sjukvård. Det grundas delvis på en samhällelig uppfattning om betydelsen av patientens delaktighet i såväl planering som genomförande av sin egen vård. I ett etiskt perspektiv har delaktigheten ett värde i sig själv, som en förutsättning för individens autonomi och integritet. Sjuksköterskan identifierar patientens behov och problem i syfte att kunna ge en individuellt anpassad omvårdnad. Sjuksköterskan har ofta djupgående professionell kunskap om patientens omvårdnadsproblem, medan patienten har preferenser och värderingar om vårdens genomförande. Om planeringen av omvårdnaden inte utgår från patientens preferenser så finns det stor risk att patientens perspektiv inte kommer med som bedömningsgrund. En samsyn mellan patient och sjuksköterska om patientens behov av omvårdnad och roll i beslutsfattandet kan öka möjligheten att optimera omvårdnadsinsatserna och främja en hög kvalitet på omvårdnaden. Kunskapen om kliniskt beslutsfattande inom omvårdnad är bristfällig, framförallt med fokus på patientens delaktighet och graden av samsyn mellan patienternas och sjuksköterskornas subjektiva perspektiv.

Syfte

Avhandlingens övergripande syfte var att undersöka kliniskt beslutsfattande inom omvårdnad med speciellt fokus på omvårdnadsdiagnosers kvalitet, patientens delaktighet i beslutsprocessen och överensstämmelsen mellan patienters och sjuksköterskors uppfattningar om behov och problem inom omvårdnad.

Specifika syften för respektive delarbeten var att I) undersöka effekten av utbildning i omvårdnadsdiagnostik riktad till sjuksköterskor och utveckling av journaldokument på omvårdnadsdiagnosers kvalitet; II) beskriva överensstämmelse i patienters och sjuksköterskors bedömningar av förekomst, svårighetsgrad och betydelse av problem inom omvårdnaden; III) beskriva samstämmighet mellan patienters och sjuksköterskors uppfattning om patientens preferenser för delaktighet i kliniskt beslutsfattande i omvårdnaden, samt samstämmighet mellan patienters preferenser och faktiska erfarenhet av delaktighet; och IV) identifiera prediktorer för patienters preferenser att delta i kliniskt beslutsfattande om den egna omvårdnaden.

Material och metod

Studier har genomförts med beskrivande, jämförande och kvasi-experimentell design på avdelningar inom somatisk sjukhusvård. Urvalet består av 140 patientjournaler (studie I), 80 patient-sjuksköterskepar (studie II och III), samt 428 patienter som nyligen blivit utskrivna från somatisk sjukhusvård (studie IV). Data har insamlats genom granskning av innehåll i patientjournaler samt genom enkäter till patienter och sjuksköterskor. Instrumenten CAT-CH-ING och Control Preference Scale har använts tillsammans med frågeformulär som utvecklats specifikt för studien.

Resultat

Delarbete I

Kvaliteten på omvårdnadsdiagnoserna förbättrades signifikant efter att sjuksköterskorna på experimentavdelningen genomgått en utbildning och nya journaldokument hade introducerats. Störst kvarvarande svårigheter var förknippade med hur etiologin i omvårdnadsdiagnosen formulerades. Omvårdnadsdiagnosernas kvalitet förbättrades inte på motsvarande sätt på kontrollavdelningarna.

Delarbete II

Sjuksköterskorna identifierade de omvårdnadsbehov och problem som patienterna uppfattade sig ha med en sensitivitet på 0.53 och ett prediktivt värde på 0.50. Det innebär att patienterna delvis identifierade andra problem än sjuksköterskorna, framför allt var det vanligt inom områdena nutrition, sömn, smärta och känslor/andlighet. Sjuksköterskorna underskattade problemens svårighetsgrad för 47 % av de behov och problem som hade identifierats gemensamt av patienter och sjuksköterskor. En gemensam uppfattning om betydelsen av att få stöd och hjälp med att lösa omvårdnadsproblemet fanns i knappt hälften av fallen.

Delarbete III

En majoritet av sjuksköterskorna uppfattade att patienterna föredrog att vara mer aktiva i det kliniska beslutsfattandet om omvårdnad än vad patienterna själv uppgav. Sammanlagt 61 % av patienterna föredrog en passiv roll i beslutsfattandet medan sjuksköterskorna angav att 24 % ville vara passiva. Preferenser om en aktiv roll i beslutsfattande angavs av 9 % av patienterna medan sjuksköterskorna hade uppfattat att 45 % av patienterna föredrog en aktiv roll. Totalt 71 % av patienterna upplevde att de inte hade varit delaktiga i den utsträckning de själva hade föredragit, 37 % hade varit mer passiva och 34 % mer aktiva. Patienterna uppgav att de intagit en mer passiv roll än vad de hade önskat i samband med behov och problem inom områdena kommunikation, andning och smärta, medan en mer aktiv roll än önskat förekom i samband med behov och problem inom områdena aktivitet och känslor/roller.

Delarbete IV

En majoritet av patienterna i sluten somatisk vård föredrog att inledningsvis under vårdperioden inta en passiv roll i kliniskt beslutsfattande om omvårdnad. Sammanlagt 22 % av patienterna föredrog en aktiv roll. Faktorer som predicerade preferenser för att inta en aktiv roll var kön (Odds ratio [OR] = 1.8), utbildning (OR = 2.2), levnadsförhållanden (OR = 1.8) och sysselsättning, d.v.s. om personen var yrkesarbetande eller pensionär (OR = 2.0). Sannolikheten var 53 % att en pensionerad högutbildad kvinna som levde ensam föredrog att vara aktiv i beslutsfattandet om sin egen omvårdnad. Sannolikheten för att en yrkesarbetande lågutbildad man som levde tillsammans med någon annan föredrog att vara aktiv var 8 %.

Slutsats

Kvaliteten på de omvårdnadsdiagnoser som sjuksköterskan ställer kan förbättras genom utbildning men orsakerna till omvårdnadsproblemet behöver identifieras på ett tydligare sätt. Det fanns en skillnad i hur patienter och sjuksköterskor uppfattade vad som utgjorde ett omvårdnadsbehov eller problem samt problemets svårighetsgrad och betydelse. Sjuksköterskan identifierade 53 % av de omvårdnadsproblem som patienten själv identifierade, samtidigt som sjuksköterskan identifierade andra omvårdnadsproblem som inte patienten uppfattade. Uppfattningarna skiljde sig också åt om vilken roll patienten föredrog att ha i det kliniska beslutsfattande om omvårdnad. Faktorer som kunde predicera patientens preferenser att ha en aktiv roll i kliniskt beslutsfattande var kön, utbildningsnivå, boendesituation och om personen yrkesarbetade eller var pensionär.

En slutsats av den påvisade diskrepansen i uppfattningar är att sjuksköterskor i högre grad behöver involvera patienterna i en diskussion om hälsotillståndet, behovet av omvårdnad och patientens önskan att delta i beslut om sin omvårdnad. Det är nödvändigt för att så långt det är möjligt kunna uppnå en samsyn som grund för planering och genomförande av omvårdnaden. Om sjuksköterskan validerar sina egna bedömningar om behovet av omvårdnad med patienten kan kvaliteten på bedömningarna förbättras. Patientens perspektiv blir en explicit del av beslutsunderlaget vid planering av omvårdnad vilket sannolikt också påverkar omvårdnadens innehåll och därmed även omvårdnadens kvalitet. Det bästa sättet att identifiera det individuella perspektivet är genom en systematisk bedömning i dialog mellan sjuksköterskan och den enskilde patienten. Mötet och dialogen mellan patienten och sjuksköterskan är en förutsättning för en god omvårdnad men är också en central del av själva omvårdnaden.

The purpose of this descriptive study is to collect the experiences of cervical cancer survivors related to the information they received from their health care providers about how their diagnosis and treatment may impact their sexuality and sexual health. The perspectives of the cervical cancer survivors will be used to modify public domain educational materials used in oncology practices and cancer support organizations to reflect a more patient centered approach to sexual health information. Study outcomes will contribute to existing knowledge through submission to appropriate journals and conferences to improve cancer patient-provider sexual health communication.

Background:Obesity is a condition in which the individual accumulates fat to an abnormal or excessive extent, which can be harmful to health. Every year, almost 4 million people diefrom the obesity epidemic, which is seen to increase in all age groups and burden individuals as well as society. It is a complex disease state caused by various factors such as biological, behavioural, social and environmental conditions and increases the risk of developing secondary diseases and premature death. Aim: The aim of the study was to identify nursing measures in the diagnosis of obesity. Method: The study is a general literature study based on eleven scientific articles with a qualitativeapproach and was analysedwith a thematic analysis method. Results: A recurring topic in the scientific articles was screened for a latent theme: person-centered patient education. The theme is based on developed sub-themes: physical activity, autonomy,and nutrition. Conclusions: The conclusion of the study is that the nurse works based onperson-centered patient education and offers patients with obesity nursing measures that include increased physical activity, strengthen the patient's autonomy and nutritional science. The obesity epidemic is a problem that is increasing in society on a national and global level, thus the authors of this study believe that there is an increased need for supplementary research in the field.
Bakgrund: Fetma är ett tillstånd där individen ansamlar fett i en onormal eller överdriven omfattning vilket kan vara skadligt för hälsan. Årligen dör närmare 4 miljoner människor av fetmaepidemin som ses öka i alla åldersgrupper och belastar individer som samhället. Det är ett komplext sjukdomstillstånd som orsakas av olika faktorer som biologiska-, beteendemässiga-, sociala- och miljömässiga förhållanden samt ökar risken att utveckla sekundära sjukdomar och förtidig död. Syfte: Syftet med studien var att identifiera omvårdnadsåtgärder vid diagnosen fetma. Metod: Studien är en allmän litteraturstudie baserad på elva vetenskapliga artiklar med kvalitativ ansats och analyserades med tematisk analysmetod. Resultat: Ett återkommande ämne i de vetenskapliga artiklarna avskärmades till ett latent tema: personcentrerad patientutbildning. Temat utgår från framtagna subteman: fysisk aktivitet, autonomi och nutrition. Slutsatser: Slutsatsen till studien är att sjuksköterskan arbetar utifrån personcentrerad patientutbildning samt erbjuder patienter med fetma omvårdnadsåtgärder som inkluderar ökad fysisk aktivitet, förstärka patientens autonomi samt nutritionslära. Fetmaepidemin är ett problem som ökas i samhället på en nationell och global nivå, därmed anser författarna till denna studie att det finns ett utökat behov med kompletterande forskning inom området.

Bakgrund: ADHD, Attention Deficit Hyperactivity Disorder, kännetecknas av koncentrationssvårigheter med hyperaktivitet och impulsivitet. Dessutom har ADHD påverkan på personens förmågor att hantera sitt vardagliga liv. Denna störning anses bero på både ärftliga och icke ärftliga faktorer. Ett utredningsteam på en psykiatrisk mottagning ställer diagnosen ADHD till vuxna. Teamet bedömer individens svårigheter att hantera vardagen. De svenska vårdprogrammen utgör grunden för en individanpassad behandling samt ett psykosocialt stöd. Syfte: Syftet med studien är att beskriva hur personer upplever att leva med ADHD före och efter att diagnosen ställts. Metod: En litteraturöversikt enligt Friberg har genomförts. Tretton kvalitativa artiklar har använts till analysen. Artiklarna hämtas från databaserna Cinahl, PsycInfo och PubMed. Följande sökord användes: ADHD, symptoms, adults, patients experiences, quality of life och qualitative research. Resultat: Analysen resulterade i två huvudteman Livet före diagnosen och Livet efter diagnosen. Deltagarna beskriver brist på förståelse från omgivningen, svårigheter med att anpassa sig till dagliga rutiner, låg självkänsla samt känsla av isolering före diagnosticering. Efter diagnosen beskriver deltagarna effekten av medicinsk behandling och stödet efter diagnosticering och menade att sådana åtgärder bidrog till möjligheten att fungera i den sociala miljön. Diskussion: De vuxnas upplevelser av att leva med ADHD diskuteras utifrån Erikssons teori om lidande och hälsa. Även fokuserar diskussionsdelen på sjuksköterskans professionella roll och ansvar under utredning samt behandling av patienter med ADHD.
Background: ADHD, Attention Deficit Hyperactivity Disorder, is characterized by concentration difficulties with hyperactivity and impulsivity. ADHD also have an impact on a person’s ability to manage their everyday lives.  This disorder is attributed to both genetic and non-genetic factors that are biological and psychosocial reasons. Current assessment of ADHD diagnosis is usually made by an investigating team at a psychiatric clinic. The team assesses the individual's extensive difficulties in managing everyday life. The Swedish health care programs are the basis for individualized treatment and psychosocial support. Aim: The purpose of this literature review was to describe how people experience living with ADHD before and after the diagnosis. Method: A literature review according to Friberg was conducted. Thirteen qualitative articles were used for the analysis. The articles were retrieved from the databases Cinahl, PsycInfo and PubMed. The following keywords were used: ADHD, symptoms, adults, patient experiences, quality of life and qualitative research. Results: The analysis resulted in two main themes Life before the diagnosis and Life after the diagnosis. Participants report difficulties in adapting to daily routines, low self-esteem and senses of isolation before diagnosis. After diagnosis, the participants described the effect of medical treatment and support and explained that this bad contributed to the ability to work in the social environment. Their increased knowledge of ADHD diagnosis and support in daily life leads to improved problem management, giving them a new meaning in life. Discussion: The adults' experiences of living with ADHD are discussed in relation to Erikson's theory of suffering and health. The discussion section also focuses on the nurses’ professional role and responsibility during the investigation and the treatment of patients with ADHD.

Recent publicity has focused on the problems created by the usage of illicit drugs in the community. The growing use of illicit drugs throughout the Grampians region and the lack of resources and professional services available to regional and rural areas raise many questions as to treatment options and the accessibility and appropriateness of drug and alcohol and mental health services. Despite the fact that mental health professionals in rural/regional areas are expected to deliver the most appropriate care to individuals with a comorbid drug and alcohol and psychiatric disorder, a number of these rural/regional mental health professionals have limited preparation and experience in dealing with dual diagnosis issues. This phenomenological study focuses on the area of dual diagnosis, specifically the experiences of health professionals who care for clients diagnosed with a serious mental illness and a coexisting drug and alcohol disorder. Results are described in the form of four themes, which emerged from data collected during in-depth interviews with 13 mental health professionals who care for clients with a dual diagnosis. The themes captured in this research will be described using metaphors as headings. The first theme Sink or swim represents mental health professionals’ initial preparation to care for this group of complex clientele. Treading water symbolises mental health professionals’ endeavours to keep their head above water and reflects on their feelings while endeavouring to do so. Rowing against the tide describes mental health professionals’ understanding of clients’ drug misuse, which impacts greatly on the level of care.
Master of Nursing

Recent publicity has focused on the problems created by the usage of illicit drugs in the community. The growing use of illicit drugs throughout the Grampians region and the lack of resources and professional services available to regional and rural areas raise many questions as to treatment options and the accessibility and appropriateness of drug and alcohol and mental health services. Despite the fact that mental health professionals in rural/regional areas are expected to deliver the most appropriate care to individuals with a comorbid drug and alcohol and psychiatric disorder, a number of these rural/regional mental health professionals have limited preparation and experience in dealing with dual diagnosis issues. This phenomenological study focuses on the area of dual diagnosis, specifically the experiences of health professionals who care for clients diagnosed with a serious mental illness and a coexisting drug and alcohol disorder. Results are described in the form of four themes, which emerged from data collected during in-depth interviews with 13 mental health professionals who care for clients with a dual diagnosis. The themes captured in this research will be described using metaphors as headings. The first theme Sink or swim represents mental health professionals’ initial preparation to care for this group of complex clientele. Treading water symbolises mental health professionals’ endeavours to keep their head above water and reflects on their feelings while endeavouring to do so. Rowing against the tide describes mental health professionals’ understanding of clients’ drug misuse, which impacts greatly on the level of care.
Master of Nursing