Este estudo teve como objetivos criar um banco de itens para composição de testes para avaliação do raciocínio diagnóstico, a partir dos itens propostos por Gordon e Plunkett no Diagnostic Reasoning Test e descrever a proficiência no raciocínio diagnóstico de enfermeiras e estudantes de enfermagem. O referencial teórico assumido neste estudo foi a teoria de geração de hipóteses e a Psicometria foi o referencial metodológico utilizado para a seleção dos itens que compuseram o banco. Este estudo foi uma análise secundária das respostas a 35 itens de raciocínio diagnóstico, obtidas de 362 participantes de um estudo primário sendo 142 enfermeiras (39,2%), 212 (58,6%) estudantes de graduação em enfermagem e 8 (2,2%) sem informação; 93,4% mulheres; idade média de 29,5±9,4 anos. As enfermeiras tinham em média 13,9±8,1 anos de formadas e 84,8% dos estudantes cursavam do quinto semestre em diante. Os gabaritos das respostas aos 35 itens foram revisados e codificados, de acordo com o que as respostas do estudo primário foram pontuadas como variáveis dicotômicas. A análise pela TRI, modelo com dois parâmetros, usando o programa BILOG® indicou a exclusão de 4 dos 35 itens e forneceu os parâmetros de dificuldade e de poder de discriminação dos 31 itens restantes. Com esses parâmetros foi criada uma escala de proficiência em raciocínio diagnóstico e foram identificados os itens típicos de cada nível da escala. A análise qualitativa e comparativa dos itens típicos de cada nível permitiu descrever as habilidades diagnósticas requeridas em cada nível segundo a combinação dos seguintes fatores relacionados aos dados apresentados aos respondentes: especificidade das pistas para o diagnóstico mais provável; convergência de pistas em torno do diagnóstico mais provável; tradição do papel de enfermagem evocado pelos dados apresentados, especialização do contexto clínico e quantidade de dados disponíveis em cada item. A escala foi criada em torno de um valor médio igual a 200(±20). Os 31 itens selecionados posicionaram-se entre os níveis 200 e 340, com exceção dos níveis 220 e 340, que permaneceram sem qualquer item. A proficiência média dos enfermeiros da amostra do estudo primário foi 199,7(±13,6), a dos estudantes foi 200,3(±13,3) e não houve diferença estatística entre as duas categorias (t-student; p = 0,72). Não houve correlação significativa entre proficiência em raciocínio diagnóstico e anos de profissão para as enfermeiras (p = 0,97) e anos de graduação para as estudantes (p=0,204). O banco criado disponibiliza itens para avaliação de proficiência em raciocínio diagnóstico que podem ser aplicados a enfermeiras e estudantes de graduação em enfermagem em diversas situações de avaliação no ensino, pesquisa e assistência. Com a escala criada outros itens poderão ser desenvolvidos, especialmente para avaliar níveis de proficiência abaixo da média. A escala criada merece destaque pela discriminação das habilidades diagnósticas requeridas para o acerto dos itens de cada nível / The purpose of this study were to create an item bank for tests composition to assess diagnostic reasoning from the items proposed by Gordon and Plunkett in Diagnostic Reasoning Test and to describe the proficiency of nurses and nursing students\' diagnostic reasoning. The theory of hypothesis generation was the theoretical referential assumed in this study and Psychometry was the methodological referential used to select the items composing the bank. This study was the secondary analysis of the answers to 35 items of diagnostic reasoning, obtained from 362 participants in a primary study. The sample characteristics were: 149 (39.2%) nurses, 212 (58.6%) nursing students and 8 (2.2%) participants without information; 93.4% women; average age of 29.5±9.4 years old. The nurses had been graduated for 13.9±8.1 years on average and the students were at least at their fifth semester. The answers to the 35 items were checked and coded, according to what the answers from the primary study had been marked as dichotomous variables. The analysis by IRT, model with two parameters, using the program BILOG® indicated the exclusion of 4 out of the 35 items and provided the parameters of difficulty and discrimination power of the remaining 31 items. With these parameters, a scale of proficiency in diagnostic reasoning was created and the typical items of each level of the scale were identified. The qualitative and comparative analysis of the typical items of each level permitted describing the diagnostic skills requested in each level according to the combination of the following factors related to the data presented to the interviewees: the specificity of the clue for the most likely diagnosis; the convergence of the clue around the most likely diagnosis; tradition of the role of the nurse evoked by the presented data; specialization of the clinical context and the quantity of the data available in each item. The scale was created around an average value equal to 200(±20). The 31 selected items were between the levels 200 and 340, except for levels 220 and 340 which remained without any item. The average proficiency of the nurses assessed in the primary study\'s sample was 199.7(±13.6), while it was 200.3(±13.3) for the students, and there was no statistical difference between the two categories (t-student; p = 0.72). There was no significant correlation between the proficiency in diagnostic reasoning and years of work for the nurses (p=0.97) and years of graduation for the students (p=0.20). The created bank provides items to assess the proficiency in diagnostic reasoning which can be applied to nurses and nursing students in different situations of assessment in teaching, research and assistance. With the created scale, other items can be developed, especially to assess levels of proficiency below the average. The created scale is worth of note for its discrimination of the diagnostic skills required to mark the items of each level right

Made available in DSpace on 2015-05-08T14:47:19Z (GMT). No. of bitstreams: 1 arquivototal.pdf: 1499650 bytes, checksum: 7df9b12f2647d04acb59c48465396365 (MD5) Previous issue date: 2011-09-30 / Coordenação de Aperfeiçoamento de Pessoal de Nível Superior / Introduction: In view of the ongoing and intense process of population aging becomes essential to have knowledge of the specificities derived from the human aging. Nurses, embedded in multidisciplinary teams, professionals become indispensable for the promotion of healthy aging and longevity with quality, increasing the need for care, so systematized using a unified professional language. Objective: to build statements nursing diagnosis/outcomes and interventions for elderly and structure a ICNP® terminological subset for the elderly in the city of João Pessoa - PB, supported by the theoretical model life activities. Methods: Descriptive exploratory in nature, that to meet the objectives was developed in four stages. In the first - Client identification -, was considered the elderly aged sixty and over who live in the city of João Pessoa - PB, for a total of 240 elderly. The second - Collection of terms and concepts relevant to the client -, descriptive documentation, performed to identify the concepts considered clinically relevant and culturally for the construction of statements nursing diagnosis/outcomes and interventions. The third - Development of statements nursing diagnosis/outcomes and interventions -, applied research, which was developed based on the guidelines of the ICN, ISO 18.104 and database for the construction of nursing diagnosis/outcomes and interventions, which once built were classified according to the model of life activity. The last step - Proposal for a ICNP® terminological subset for the elderly -, emphasized the significance of the subset for nursing, the description of the theoretical model used and the relationship of statements nursing diagnosis/outcomes and interventions. Results: We built 129 statements nursing diagnosis/outcomes and 627 nursing interventions, distributed according to the factors that interfere with life activities. Structured ICNP® terminological subset for the elderly with the objectives as a guide for nurses who provide care for the elderly, the care in health clinics or at home, in the process of clinical reasoning and therapeutic and support systematic documentation of nursing care using ICNP®. The developed statements include all factors that influence the activities of life, but should be considered as a guide for use by nurses, not release, so the clinical experience, critical thinking and decision making. Conclusion: It is considered that the study's objectives were achieved, resulting in the construction of the ICNP® terminological subset for the elderly that will facilitate the implementation of the steps of the nursing consultation to the elderly, based on the theoretical model of life activity. It is recommended that further studies are developed to be made to content and clinical validation of statements nursing diagnosis/outcomes and interventions in order to verify the applicability of the same and the use of a unified language for the documentation of practice nursing care witch elderly in primary health care in the city of João Pessoa - PB. / Introdução: Tendo em vista o contínuo e intenso processo de envelhecimento populacional torna-se indispensável o conhecimento das suas especificidades. Os enfermeiros, inseridos em equipes multiprofissionais, tornam-se profissionais indispensáveis para a promoção do envelhecimento saudável e da longevidade com qualidade, aumentando a necessidade da prestação de cuidados, de modo sistematizado utilizando uma linguagem profissional unificada. Objetivo: construir afirmativas de diagnósticos/resultados e intervenções de enfermagem para idosos e estruturar um Subconjunto terminológico da CIPE® para idosos no município de João Pessoa PB, tendo como suporte teórico o Modelo de Atividade de Vida. Métodos: estudo de natureza exploratória descritiva, que para o atendimento aos objetivos foi desenvolvido em quatro etapas. Na primeira Identificação do cliente , considerou-se os idosos com sessenta anos e mais que vivem no município de João Pessoa PB, perfazendo um total de 240 idosos. A segunda Coleta de termos e conceitos relevantes para o cliente , pesquisa descritiva documental, realizada para identificar os conceitos considerados relevantes clinicamente e culturalmente para a construção das afirmativas de diagnósticos/resultados e intervenções de enfermagem. A terceira Elaboração das afirmativas de diagnósticos/resultados e intervenções de enfermagem , pesquisa aplicada, que foi desenvolvida tendo como base as diretrizes do CIE, a norma ISO 18.104 e o Banco de dados para a construção das afirmativas de diagnósticos/resultados e intervenções de enfermagem, as quais depois de construídas foram classificadas de acordo com o Modelo de Atividade de Vida. A última etapa Proposta de um Subconjunto Terminológico da CIPE® para idosos , enfatizou-se a significância do subconjunto para a Enfermagem; a descrição do modelo teórico utilizado e a relação das afirmativas de diagnósticos/resultados e intervenções de enfermagem. Resultados: Foram construídas 129 afirmativas de diagnósticos/resultados de enfermagem e 627 de intervenções de enfermagem, distribuídas de acordo com os fatores que interferem nas atividades de vida. Estruturou-se o Subconjunto Terminológico da CIPE® para idosos com os objetivos de servir de guia para os enfermeiros que prestam cuidados aos idosos, no atendimento nas Unidades de Saúde ou no domicílio, no processo de raciocínio clínico e terapêutico e dar suporte a documentação sistemática do cuidado de enfermagem, utilizando a CIPE®. As afirmativas desenvolvidas contemplam todos os fatores que influenciam as atividades de vida, e por isso deve ser consideradas como um guia para ser utilizado pelos enfermeiros, não dispensando, portanto a experiência clínica, o raciocínio crítico e a tomada de decisão. Considerações finais: Considera-se que os objetivos do estudo foram alcançados, tendo como resultado a construção do Subconjunto terminológico da CIPE® para idosos, que irá facilitar a operacionalização das etapas da consulta de enfermagem aos idosos, alicerçada no modelo teórico de atividade de vida. Recomenda-se que sejam desenvolvidos outros estudos para que seja feita a validação de conteúdo e clínica das afirmativas de diagnósticos/resultados e de intervenções de enfermagem, com o objetivo de verificar a aplicabilidade das mesmas e a utilização de uma linguagem unificada para a documentação da prática de enfermagem com idosos na atenção básica de saúde, no município de João Pessoa PB.

Este estudo teve como objetivos criar um banco de itens para composição de testes para avaliação do raciocínio diagnóstico, a partir dos itens propostos por Gordon e Plunkett no Diagnostic Reasoning Test e descrever a proficiência no raciocínio diagnóstico de enfermeiras e estudantes de enfermagem. O referencial teórico assumido neste estudo foi a teoria de geração de hipóteses e a Psicometria foi o referencial metodológico utilizado para a seleção dos itens que compuseram o banco. Este estudo foi uma análise secundária das respostas a 35 itens de raciocínio diagnóstico, obtidas de 362 participantes de um estudo primário sendo 142 enfermeiras (39,2%), 212 (58,6%) estudantes de graduação em enfermagem e 8 (2,2%) sem informação; 93,4% mulheres; idade média de 29,5±9,4 anos. As enfermeiras tinham em média 13,9±8,1 anos de formadas e 84,8% dos estudantes cursavam do quinto semestre em diante. Os gabaritos das respostas aos 35 itens foram revisados e codificados, de acordo com o que as respostas do estudo primário foram pontuadas como variáveis dicotômicas. A análise pela TRI, modelo com dois parâmetros, usando o programa BILOG® indicou a exclusão de 4 dos 35 itens e forneceu os parâmetros de dificuldade e de poder de discriminação dos 31 itens restantes. Com esses parâmetros foi criada uma escala de proficiência em raciocínio diagnóstico e foram identificados os itens típicos de cada nível da escala. A análise qualitativa e comparativa dos itens típicos de cada nível permitiu descrever as habilidades diagnósticas requeridas em cada nível segundo a combinação dos seguintes fatores relacionados aos dados apresentados aos respondentes: especificidade das pistas para o diagnóstico mais provável; convergência de pistas em torno do diagnóstico mais provável; tradição do papel de enfermagem evocado pelos dados apresentados, especialização do contexto clínico e quantidade de dados disponíveis em cada item. A escala foi criada em torno de um valor médio igual a 200(±20). Os 31 itens selecionados posicionaram-se entre os níveis 200 e 340, com exceção dos níveis 220 e 340, que permaneceram sem qualquer item. A proficiência média dos enfermeiros da amostra do estudo primário foi 199,7(±13,6), a dos estudantes foi 200,3(±13,3) e não houve diferença estatística entre as duas categorias (t-student; p = 0,72). Não houve correlação significativa entre proficiência em raciocínio diagnóstico e anos de profissão para as enfermeiras (p = 0,97) e anos de graduação para as estudantes (p=0,204). O banco criado disponibiliza itens para avaliação de proficiência em raciocínio diagnóstico que podem ser aplicados a enfermeiras e estudantes de graduação em enfermagem em diversas situações de avaliação no ensino, pesquisa e assistência. Com a escala criada outros itens poderão ser desenvolvidos, especialmente para avaliar níveis de proficiência abaixo da média. A escala criada merece destaque pela discriminação das habilidades diagnósticas requeridas para o acerto dos itens de cada nível / The purpose of this study were to create an item bank for tests composition to assess diagnostic reasoning from the items proposed by Gordon and Plunkett in Diagnostic Reasoning Test and to describe the proficiency of nurses and nursing students\' diagnostic reasoning. The theory of hypothesis generation was the theoretical referential assumed in this study and Psychometry was the methodological referential used to select the items composing the bank. This study was the secondary analysis of the answers to 35 items of diagnostic reasoning, obtained from 362 participants in a primary study. The sample characteristics were: 149 (39.2%) nurses, 212 (58.6%) nursing students and 8 (2.2%) participants without information; 93.4% women; average age of 29.5±9.4 years old. The nurses had been graduated for 13.9±8.1 years on average and the students were at least at their fifth semester. The answers to the 35 items were checked and coded, according to what the answers from the primary study had been marked as dichotomous variables. The analysis by IRT, model with two parameters, using the program BILOG® indicated the exclusion of 4 out of the 35 items and provided the parameters of difficulty and discrimination power of the remaining 31 items. With these parameters, a scale of proficiency in diagnostic reasoning was created and the typical items of each level of the scale were identified. The qualitative and comparative analysis of the typical items of each level permitted describing the diagnostic skills requested in each level according to the combination of the following factors related to the data presented to the interviewees: the specificity of the clue for the most likely diagnosis; the convergence of the clue around the most likely diagnosis; tradition of the role of the nurse evoked by the presented data; specialization of the clinical context and the quantity of the data available in each item. The scale was created around an average value equal to 200(±20). The 31 selected items were between the levels 200 and 340, except for levels 220 and 340 which remained without any item. The average proficiency of the nurses assessed in the primary study\'s sample was 199.7(±13.6), while it was 200.3(±13.3) for the students, and there was no statistical difference between the two categories (t-student; p = 0.72). There was no significant correlation between the proficiency in diagnostic reasoning and years of work for the nurses (p=0.97) and years of graduation for the students (p=0.20). The created bank provides items to assess the proficiency in diagnostic reasoning which can be applied to nurses and nursing students in different situations of assessment in teaching, research and assistance. With the created scale, other items can be developed, especially to assess levels of proficiency below the average. The created scale is worth of note for its discrimination of the diagnostic skills required to mark the items of each level right

M.Cur. / The nursing service manager is accountable for the managerial outputs of the nursing service, being quality nursing care, cost effectiveness and quality nursing staff management. These managerial responsibilities will influence the overall management efficiency of the health delivery system. There is a need for a more scientific basis of staffing in South African critical care units. Various methods are used to determine staffing needs, but the most accurate and acceptable method being used is the patient classification system. The success of a critical care patient classification system is based upon the accurate determination of the ideal nurse-patient ratio. Ideal nursepatient ratio depends on matching the competency of the critical care nurse to the severity of the critical care patient's illness. Internationally and nationally very few guidelines describe the competency requirements that the critical care nurse should have to function effectively in the critical care unit. To maintain a high standard of quality nursing care, the critical care nurse should be assigned to a critical care patient according to her competency level. The aim of this study was to describe a scientific patient classification system for critical care patients according to which workload and nursing requirements can be ascertained. Secondly, to describe guidelines for the competency requirements of a registered critical care nurse assigned to nurse the different categories of critical care patients categorised by the patient classification system as prescribed. The aim of the study is justified by means of an exploratory, descriptive, contextual research design. A critical care patient classification system has been developed and validated by a group of critical care nursing experts using a structured two phase research method. The statistical validity of each item of the critical care patient classification system was determined by means of a content validity index. All the items of the critical care patient classification system were rated as valid and therefore the critical care patient classification system as a whole has been accepted as valid. The reliability of the critical care patient classification system was tested by means of a pilot study in two selected research units. It was determined that the inter-rater reliability was within the 95 per cent confidence interval, that the system could discriminate between different critical care patients and nurse-patient ratios were effectively determined by the system. Critical care nurse competency requirements were identified by critical care nursing experts by means of a focus group interview. The results obtained from the focus group interview were verified by a literature control and peer group review. Guidelines for the competency requirements of the critical care nurse were compiled. The critical care patient classification system developed will equip the critical care manager with a scientific instrument to assign personnel to critical care units. The critical care patient classification system will furthermore assist the critical care unit manager in the daily utilisation of valuable human resources, in that critical care nurses with the appropriate level of expertise can be assigned to each patient, thus facilitating quality critical care nursing.

The thesis deals with the application of NIC, NOC classifications in patients with stoma. Every nurse uses a classification system of health care which describes activities or interventions done by nurses as a part of planning phase of nursing process in connection with creation of nursing care plan. These classifications also focus on developement of nursing care objectives and evaluating of the effect of nursing care results. Due to these classifications, the nursing care results are mesurable. In the theoretical part of the thesis, we focus on classification systems of nursing care, then on GIT diseases which lead to insertion of stoma, its care, care of patients with stoma and last but not least, on nursing documentation. Several objectives were set to meet the main target of the thesis. Firstly, to map nurses' opinion on nursing classifications; secondly, to find out which NOC indicators are usually judged by nurses in the care of patients with stoma; thirdly, to find out which activities are usually used by nurses in the care of patients with stoma; fourthly, to check up on application of NIC, NOC classification in the care of patients with stoma. The qualitative reserch was hold in two phases. In the first phase of the qualitative research, a nursing documentation was created on the basis of NIC and NOC classification related to care of the patients with stoma. In the second phase of the qualitative research, we interviewed ten nurses who had worked with the particular nursing documentation.