CoordenaÃÃo de AperfeiÃoamento de Pessoal de NÃvel Superior / This PhD dissertation aimed to review the concept of the nursing outcome Fluid Balance from the Nursing Outcome Classification (NOC) in postoperative patients who underwent cardiac surgery, and develop operational definitions. For so, a concept analysis was carried out according to the Walker and Avant Model (2005), using the integrative review for searching. It was developed from October to December/2010, based on the leading questions: Which indicators allow the body fluid volume assessment on the postoperative period of cardiac surgery? How these indicators are defined and how could they be evaluated? Which features or values are indicative of normal and altered body fluid volume on the postoperative period of cardiac surgery? Water electrolyte balance, thoracic surgery, and postoperative period were used as searching descriptors. The sample consisted of articles which answered at least one of the searching question(s); with full text available through Portal da CAPES, the University of Iowa electronic system, or the interlibrary loan service; in Portuguese, English, or Spanish. Editorials, letters to the editor, qualitative studies, case report studies, proceedings, duplicate articles, and animal research were excluded. The identified works were submitted to a four step evaluation, which resulted on the selection of 48 articles (CINAHL: 12; PubMed: 12; Scopus: 21; Lilacs: 3). Predominated the narrative reviews, cohort, and descriptive studies (level of evidence IV and VI). From the analysis, 14 indicators were identified, plus the 23 present on the Fluid Balance NOC outcome. The integrative review had a limited contribution for the operational definitions construction, mainly due to the nature of the concept of interest. The concept analysis highlighted the attributes: solvent and/or solute movement (active or passive) through semi-permeable membranes and between physiological compartments; effective regulation by homeostatic mechanisms (gradient between hydrostatic and coloidosmotic pressure, electroneutrality, and neurohormonal mechanisms); and maintenance of compartments concentration and volume. The case model represented a healthy individual, with hormonal and fluid compartments control functions preserved, whereas the contrary cases opposed the attributes partially. The borderline cases consisted of morbid situations in which alterations occurred in at most two attributes. The antecedents of fluid balance corresponded to organic, behavioral, and/or environmental conditions that opposed to those listed for the unbalance, or even their absence. The consequences of unbalance encompassed the estates of fluid deficit or excess, as well as the related concepts of hydration, electrolyte balance (sodium) and systemic (volemia) and local (tissue) perfusion. The consequence of balance consisted of the fluid homeostasis or the absence of consequences of unbalance while the empirical referents corresponded to the indicators. The concept analysis allowed its scope delimitation and identify which parameters assure its presence or even its alteration (unbalance). It encompasses the electrolyte balance, perfusion, and hydration phenomena and is beyond the simple measurement and control of fluid intake and output. As initial validity phase of the nursing outcome, it requires the development of experts and clinical research. / Esta tese teve o objetivo de revisar o conceito do resultado de enfermagem EquilÃbrio HÃdrico da Nursing Outcomes Classification (NOC) em pacientes no pÃs-operatÃrio de cirurgia cardÃaca e desenvolver definiÃÃes operacionais. Para isso, realizou-se anÃlise do conceito, segundo o modelo de Walker e Avant (2005), utilizando a revisÃo integrativa para busca. A mesma foi empreendida de outubro a dezembro/2010, com base nas questÃes norteadoras: que indicadores permitem a avaliaÃÃo do volume de lÃquidos corporais no perÃodo pÃs-operatÃrio de cirurgia cardÃaca? Como esses indicadores sÃo definidos e como podem ser avaliados? Quais as caracterÃsticas ou valores indicativos de normalidade e de alteraÃÃo no volume de lÃquidos corporais, no perÃodo pÃs-operatÃrio de cirurgia cardÃaca? Para busca, utilizaram-se os descritores equilÃbrio hidroeletrolÃtico, cirurgia torÃcica e perÃodo pÃs-operatÃrio. A amostra foi composta por artigos que contemplassem pelo menos uma das questÃes norteadoras; com resumo disponÃvel; texto completo acessÃvel pelo Portal da CAPES, pelo sistema eletrÃnico da University of Iowa ou pelo sistema de comutaÃÃo; em portuguÃs, inglÃs ou espanhol. Foram excluÃdos os editoriais, cartas ao editor, estudos reflexivos, relatos de experiÃncia, anais de eventos, produÃÃes duplicadas e pesquisas com animais. ApÃs o levantamento, as produÃÃes foram submetidas a quatro etapas de avaliaÃÃo, que resultaram na seleÃÃo de 48 artigos (CINAHL: 12; PubMed: 12; Scopus: 21; Lilacs: 3). Destacaram-se os estudos de revisÃo narrativa, coorte e descritivos (nÃvel de evidÃncia IV e VI). A partir da anÃlise, identificaram-se quatorze indicadores, alÃm dos vinte e trÃs presentes no resultado EquilÃbrio HÃdrico da NOC. A revisÃo integrativa teve contribuiÃÃo limitada para a construÃÃo das definiÃÃes operacionais, sobretudo devido à natureza do conceito de interesse. A anÃlise do conceito evidenciou os atributos: movimento de solvente e/ou soluto (ativo ou passivo) atravÃs de membranas semi-permeÃveis e entre compartimentos fisiolÃgicos; regulaÃÃo efetiva por mecanismos homeostÃticos (gradiente entre a pressÃo hidrostÃtica e coloidosmÃtica, eletroneutralidade e mecanismos neuro-hormonais); e manutenÃÃo da concentraÃÃo e do volume dos compartimentos. O caso modelo refletiu indivÃduo saudÃvel, com funÃÃes hormonais e de controle dos compartimentos hÃdricos preservadas, enquanto os casos contrÃrios se opuseram aos atributos apenas em parte. Os casos limÃtrofes compreenderam as situaÃÃes mÃrbidas, nas quais ocorrem alteraÃÃo de, no mÃximo, dois atributos. Os antecedentes do EquilÃbrio HÃdrico corresponderam Ãs condiÃÃes orgÃnicas, comportamentais e/ou ambientais que se opunham Ãquelas listadas para o desequilÃbrio, ou mesmo sua ausÃncia. Os consequentes do desequilÃbrio abrangeram os estados de dÃficit e excesso de lÃquidos, bem como os conceitos relacionados de hidrataÃÃo, equilÃbrio eletrolÃtico (sÃdio) e perfusÃo, tanto sistÃmica (volemia) quando localizada (tecidual). Jà o consequente do equilÃbrio consistiu na homeostase hÃdrica ou na ausÃncia dos consequentes de desequilÃbrio, enquanto os referentes empÃricos corresponderam aos indicadores. A anÃlise do conceito permitiu delimitar seu escopo e identificar quais parÃmetros asseguram sua presenÃa ou mesmo sua alteraÃÃo (desequilÃbrio). O mesmo engloba os fenÃmenos de equilÃbrio eletrolÃtico, perfusÃo e hidrataÃÃo e està alÃm da simples mensuraÃÃo e controle das perdas e ganhos de lÃquidos. Como fase inicial da validaÃÃo do resultado de enfermagem, requer o desenvolvimento de pesquisa com experts e clÃnica.

No description available.

No description available.

Much skilled nursing practice is described by words which at face value appear low-tech and self-explanatory. Despite being acknowledged as intrinsic to practice “nursing assessment” has few operational definitions. This thesis critiques and reviews the methodological assumptions that underpin research and the frameworks commonly used to facilitate Concept Analysis (CA). Despite the apparent plethora of approaches to CA, the majority of them used (or adapted without justification or critique) the work of one author, and this was found to be simplistic and ontologically flawed. A review of the contemporary nursing literature was undertaken to identify uses of the term assessment. The subsequent Glasarian Grounded Theory Analysis revealed the Judicial as the core of seven overlapping categories. Evidence of the everyday use of the term assessment was obtained through observation and audio recording of nursing assessment practice. Following Foucault, Critical Discourse Analysis of the data recorded in the study’s field work phase was undertaken. This revealed social power and dominance facilitated through subject/object conflations and the discourses of discrimination, surveillance, repression, natural science, resistance and institutional power, and in contrast, examples of empowering practice. This thesis will argue that the process of nursing asssessment is skilled and complex, and that in order to measure and demonstrate the quality of nursing practice within an arena dominated by the hegemonic power of medicine, it requires articulation and understanding. Nurses use a matrix of approaches to build rapport and assess patients during all interactions. Their work involves integrating intuitive, predictive and logical reasoning within an empathetic and authentic communication with patients and their carers. Hierarchies of nursing practice, government policies, inter-professional agendas and dissonaces between the policy rhetoric of placing patients at the heart of assessment and actual everyday practice, produce barriers to meaningful assessments.

The purpose of study is to investigate why state certified nurses on a conversion programme to become registered general nurses score higher marks on medical - related than on nursing assessments during their fourth practical assessments. The universal sample is made up of state certified nurses on a one year conversion programme. A purposive sample consisting of 20 student nurses, 10 nurse- assessors and 5 doctor­ assessors was recruited into the exploratory quantitative study which was done at Kwekwe Hospital. A questionnaire for each of the three sample groups was used to collect data to meet the study's objectives. Data analysis yielded the main finding that students scored higher marks on nursing - related areas than on medical- related practical assessments contrary to the study's assumption. The implication is that the student nurses were able to acquire nursing care focused skills and knowledge in spite of their former medical care biased training and nursing experience. / Health Studies / M.A. (Nursing Science)

Thesis (MCurr)--Stellenbosch University, 2013. / ENGLISH ABSTRACT: Unnoticed deterioration in the clinical condition of children in ward areas can lead to near or actual cardiopulmonary arrest. Children suffering from a cardiac arrest in hospital often display abnormal physiological parameters hours prior to this event occurring (i.e., within a 24 hour period). Prevention of cardiopulmonary arrest in the wards lies in the ability of nursing and medical staff to be able to identify these abnormal physiological parameters, i.e., early signs of deterioration, and to intervene prior to this event. This study aimed to identify nurses’ experiences with regards to current knowledge, clinical practice and training in the recognition of clinical deterioration in children. It could then be determined whether a formal guideline on the early recognition of clinical deterioration in children would be perceived as being beneficial by the respondents in this study. The research question that guided this study was “what are the perceptions and experiences of registered professional nurses working in paediatric wards with regards to their recognition of unexpected clinical deterioration in children?” An exploratory descriptive study, utilising a qualitative approach was applied. The target population consisted of all registered professional nurses working in paediatric wards in academic hospitals in the Western Cape, South Africa. Ethical approval was obtained. Informed written consent was obtained from the participants. The purposive sampling method was used to select the participants (n=17) who met the criteria. Five focus group interviews were conducted to collect the data, using an interview guide. The planned methodology with its instrumentation and procedures was verified through a pilot study that was conducted on the first focus group interview. The steps of the research process included transcribing the collected data verbatim from the audio recordings and the field notes, and then analysing the data by summarising and packaging the data, identifying themes and trends in the data and verifying and drawing conclusions. The analysis themes identified were based on Donabedian’s conceptual framework, comprising Structure (the environment in which the care takes place), Process (method by which the care takes place), and Quality Assurance (the planned, organised evaluation of the patient care which has been rendered). The findings showed that the increased level of severity of illness of children nursed in paediatric wards, as well as staff shortages, gaps in training on resuscitation and clinical deterioration, limited ICU beds and staff, lack of adequate monitoring and emergency equipment in the wards, and inexperienced staff are all factors that were identified that increase the risk of staff not being able to detect clinical deterioration in children nursed in paediatric wards. Teamwork among nursing staff and other medical professionals, as well as parental involvement in the care of the children, assisted staff in being able to detect clinical deterioration. Most participants were unfamiliar with ‘early warning systems’ and reported that there are no paediatric ‘early warning scores’ (PEWS) in place. They believed such a system would be beneficial; however they had concerns regarding the time it would take to score a patient, the training involved, and the ease of use of such a tool and system. Recommendations for addressing non-recognition of clinical deterioration by nurses in paediatric wards such as appropriate knowledge and skill updating, were put forward in the study. / AFRIKAANSE OPSOMMING: ‘n Kliniese verswakking by kinders wie in pediatriese sale verpleeg word, wat nie betyds waargeneem word nie, kan dit lei tot ‘n amperse of werklike kardio-pulmonale arres. Kardio-pulmonale arres in kinders word dikwels voorafgegaan deur ‘n verandering in die fisiologiese parameters (so vroeg as 24-uur voor die arres). Die voorkoming van saalverwante kardio-pulmonale arres berus op die vermoeë van verpleeg- en mediese personeel om die abnormale fisiologiese tekens so vroeg as moontlik waar te neem en daadwerklik op te tree voordat die arres plaasvind. Die doel van hierdie studie was om die ondervindige van verpleegkundiges te identifiseer met betrekking tot die bestaande protokolle, opleiding en hulpbronne wat beskikbaar is vir die waarneming van die kliniese agteruitgang in kinders. ‘n Bepaling sal gevolglik gemaak kan word of die studie-respondente ‘n amptelike riglyn rakende die vroegtydige waarneming van kliniese agteruitgang in kinders voordelig sou vind al dan nie. Die rigtinggewende navorsingvraag vir die studie was “wat is die sieninge en ondervings van geregistreerde verpleegkundiges in pediatriese sale rakende die herkening van onverwagte kliniese agteruitgang in kinders?” ‘n Verkennende, beskrywende navorsingsmetodologie, met ‘n kwalitatiewe aanslag, is gebruik. Die teikenpopulasie het bestaan uit alle geregistreerde professionale verpleegkundiges, werksaam in die pediatriese sale van die akademiese hospitale in die Wes Kaap, Suid-Afrika. Etiese toestemming, asook ingeligte, skriftelike toestemming is vooraf verkry van elke deelnemer. ‘n Doelbewuste steekproefnemings metode is gebruik om die studie deelnemers, wat aan die navorsingskriteria voldoen het, te kies. Vyf fokusgroep onderhoude is gevoer om data in te samel en ‘n onderhoudsgids is gebruik vir dié onderhoude. Om die navorsingmetodologie, instrumentasie and prosedures te bevestig, is ‘n voortoets tydens die eerste fokusgroep onderhoud gedoen. Die stappe van die navorsingproses is gevolg om die ingesamelde data, bestaande uit klankopnames en veldnotas, woord-vir-woord oor te skryf. Die data is hierna ontleed deur middel van opsomming en samevoeging, terwyl temas en neigings geïdentifiseer is en afleidings geverifieër en gefinaliseer is. Die geïdentifiseerde ontledingstemas is basseer op Donabedian se konsepsuele raamwerk, bestaande uit Struktuur (die versorgingsomgewing), Proses (die versorgingsmetodes) en Kwaliteitsversekering (die doelbewuste en beplande evaluering van gelewerde verpleegsorg). Die navorsingsbevindinge het daarop gedui dat verskeie faktore ‘n rol speel in die risiko-toename wat verband hou met personeel wat nie die kliniese agteruitgang in kinders wat in pediatriese sale verpleeg word, waarneem nie. Die faktore sluit in: die kinders se graad van siekte, personeeltekorte, opleidings tekortkominge ten opsigte van resussitasie- en die identifikasie van kliniese agteruitgang by kinders, tekorte aan genoegsame moniterings- en noodtoerusting in die sale, en onervare personeel. Die waarneming van kliniese agteruitgang is wel bevorder deur spanwerk onder verpleegkundiges en ander mediese personeel, asook ouers wat betrokke was by die versorging van hulle kinders. Die meerderheid van die navorsingdeelnemers was nie vertroud met ‘vroeë waarskuwingsstelsel’ nie, en het aangedui dat geen ‘pediatriese vroeë waarskuwingsstelsels’ beskikbaar is nie. Alhoewel hulle van mening was dat so ‘n stelsel voordelig kon wees, het hulle bedenkinge gehad oor die tyd wat dit in beslag sou neem om die dokumentasie te voltooi, die opleiding wat hulle sou moes ontvang, en wat die moeilikheidsgraad van so ‘n stelsel sou wees. Die voortvloeiende aanbevelings van hierdie studie, wat die nie-herkenning van kliniese agteruitgang deur verpleegkundiges in pediatriese sale aanspreek, sluit in toepaslike kennis- en vaardigheids opdatering.

Thesis (MCurr)--Stellenbosch University, 2014. / ENGLISH ABSTRACT: The support for portfolio-based learning as an authentic assessment method is increasing globally. However, there are no guidelines in South Africa for a clinical practice assessment portfolio (CPAP) for primary clinical practitioner training. The study set out to develop a CPAP for the Clinical Nursing Science, Health Assessment Treatment and Care programme. An exploratory, descriptive design was used that developed over three phases. In phase one, a CPAP was developed based on an extensive review of the literature. The CPAP was validated in phase two by experts and finally, student primary clinical practitioners assessed the possible contribution of the developed CPAP to their learning in phase three. The study sample for the three phases comprised of selected relevant studies published on portfolio development (n=15); experts in the field of primary health care and education in the Cape Metropole (n=11); and student primary clinical practitioners of one higher education institution in the Cape Metropole (n=45). Structured questionnaires were used for data collection from expert and student participants after they reviewed the CPAP. Ethical approval was obtained from the Health Research Ethics Committee of the Faculty of Health Sciences (N09/09/233), Stellenbosch University. Permission to conduct the research was obtained from the higher education institution. The content validity index for items (I-CVI) was used to determine the degree to which expert participants agreed with the content of the CPAP. Results identified an I-CVI of between 0.91 and 1.00, indicating that the contents and technical format of the CPAP constitute a suitable learning tool for student practitioners. Experts suggested minor revisions regarding the clarity of items, and those were included in the final CPAP. The data analysis of the student’s responses showed that adequate guidance was provided to complete the activities in the CPAP and that the CPAP would have a positive contribution to learning. Portfolio-based learning is an important teaching and learning strategy in the Clinical Nursing Science, Health Assessment Treatment and Care programme, whereby students can demonstrate their acquired clinical competencies. Recommendations include the use of a competency framework and consensus amongst stakeholders when developing the contents of a portfolio. / AFRIKAANSE OPSOMMING: Die ondersteuning vir portefeulje-gebaseerde leer as ’n outentieke assesseringsmetode is besig om globaal te verhoog. In Suid-Afrika is daar egter nie riglyne vir ’n kliniese praktyk-assesseringsportefeulje (KPAP) vir primêre kliniese praktisynsopleiding nie. Hierdie studie het ten doel om ’n kliniese praktyk-assesseringsportefeulje vir die Kliniese Verpleegkunde-, Gesondheidsassesseringbehandeling- en Sorgprogram te ontwikkel. ’n Verkennende, beskrywende ontwerp wat oor drie fases ontwikkel het, is gebruik. In fase een is ’n KPAP ontwikkel gebaseer op ’n ekstensiewe literatuurstudie. Die geldigheid van die KPAP is in fase twee deur kundiges verklaar en in fase drie is die moontlike bydrae van die KPAP tot die leerproses deur primêre kliniese praktisynstudente geassesseer. Die studiegroep vir die drie fases het bestaan uit geselekteerde relevante studies wat handel oor portefeulje ontwikkeling (n=15), kenners op die gebied van primêre gesondheidsorg en opvoeding in die Kaapse Metropool (n=11); en primêre gesondheidsorg studentpraktisyns van een van die tersiêre instansies in die Kaapse Metropool (n=45). Gestruktureerde vraelyste is gebruik vir data-insameling van kenners en studentedeelnemers nadat hulle die KPAP ondersoek het. Etiese toestemming is verkry van die Gesondheidsnavorsingsetiekkomitee van die Fakulteit Gesondheidswetenskappe (N09/09/233), Stellenbosch Universiteit. Toestemming om die navorsing uit te voer, is van die tersiêre instansie verkry. Die inhoud van die item-geldigheidsindeks is gebruik om die mate waarmee kenner-deelnemers met die inhoud van die KPAP saamstem, te bepaal. Resultate van die inhoud van die item-geldigheidsindeks van tussen 0.91 en 1.00 is geïdentifiseer, wat ’n aanduiding is dat die inhoud en tegniese formaat van die KPAP ’n toepaslike leerinstrument vir studentpraktisyns is. Kenners het klein veranderings vir die duidelikheid van items voorgestel en dit is ingesluit in die finale KPAP. Die data-analise van die studente se antwoorde het aangedui dat genoegsame leiding voorsien was om die aktiwiteite in die KPAP te voltooi en dat die bydrae van die KPAP positief is tot die bevordering van die leerproses. Portefeulje-gebaseerde leer is ’n belangrike onderrig- en leerinstrument vir die Kliniese Verpleegkunde-, Gesondheidsassesseringbehandeling- en Sorgprogram, waardeur studente kan demonstreer dat hulle die kliniese bevoegdhede bekom het. Aanbevelings sluit in die gebruik van ’n bevoegdheidsraamwerk en konsensus onder belanghebbendes wanneer die inhoud van ’n portefeulje ontwikkel word.

Provision of complete and responsive solution to healthcare services requires a multi-tired health delivery system. One of the aspects of healthcare hierarchy is the need for nursing care of the patient. Nursing care and observation provide basis for nurses to communicate with other aspects of healthcare system. The ability of capturing and managing nursing practice is essential to the quality of human care. The thesis proposes knowledge based decision making and analyzing system for the nurses to capture and manage the nursing practice. Moreover it allows them to monitor nursing care quality, as well as to test an aspect of an electronic healthcare record for recording and reporting nursing practice. The framework used for this system is based on nursing theory and is coupled with the quantitative analysis of qualitative data. It allows us to quantify the qualitative raw natural nursing language data. The results are summarized in the graph that shows the relative importance of those attributes with respect to each other at different instances of nurse-patient encounter. Research has been conducted by the Department of Computer and Electrical Engineering and Computer Science for the College of Nursing. / by Shubhang Tripathi. / Thesis (M.S.C.S.)--Florida Atlantic University, 2010. / Includes bibliography. / Electronic reproduction. Boca Raton, Fla., 2010. Mode of access: World Wide Web.

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.

Sammanfattning Bakgrund: Intensivvårdssjuksköterskan ingår tillsammans med en narkosläkare i en Mobil Intensivvårdsgrupp (MIG). Om en patient på en vårdavdelning påvisar försämring i vitala parametrar och misstänks ha en begynnande organsvikt konsulteras MIG som tillsammans med patientansvarig läkare och sjuksköterska utvärderar och bedömer patienten. MIG rekommenderar därefter en behandling eller flyttar patienten till intensivvårdsavdelning. Syfte: Syftet med studien var att beskriva intensivvårdssjuksköterskors upplevelser av att bedöma patienter i samband med MIG-uppdrag samt vad de beaktar i samband med bedömningen. Metod: Studien genomfördes med en kvalitativ ansats och beskrivande design. Elva intensivvårdssjuksköterskor intervjuades med hjälp av semistrukturerade intervjuer. Resultat: Det framkom sex huvudkategorier i resultatet: Att vara förberedd och ha information har betydelse för bedömning, Att använda sina sinnen och erfarenhet vid bedömning, Att samarbeta med andra personalkategorier har betydelse, Att använda hjälpmedel vid bedömning, Att ha upplevelser av miljön kring patienten i samband med bedömning, och Att begränsningar inverkar vid bedömning och fortsatt vård. Intensivvårdssjuksköterskorna beskrev att strukturerad rapport, bra samarbete samt att använda hjälpmedel, klinisk blick och erfarenhet underlättade vid bedömningen. Resultatet visade även att det tycktes finnas individuella skillnader i hur bedömningen utfördes och på vilka grunder besluten togs samt att hög belastning, stress, resursbrist, vårdbegränsningar och distraktion i omkringliggande miljö kunde ha inverkan på bedömning. Slutsats: Studiens resultat har bidragit till att öka förståelsen av intensivvårdssjuksköterskornas upplevelser vid bedömning av patienter i samband med MIG-uppdrag. Studiens resultat har också uppmärksammat att hög arbetsbelastning, stress, miljö, vårdbegränsningar och personalbrist kan ha inverkan vid bedömning av patienter. Nyckelord: Intensivvårdssjuksköterska, Mobil intensivvårdsgrupp, Vårdbehovsbedömning / Abstract Background: The intensive care nurse, together with an anesthetist, is included in a Medical emergency team (MET). If a patient in a ward demonstrates deterioration in vital parameters and is suspected having organ failure, MET is consulted, which together with the patient-responsible doctor and nurse evaluates and assesses the patient. Thereafter MET recommends treatment or move the patient to intensive care unit. Aim: The aim of this study was to describe intensive care nurses experiences of assessing patients and what they consider in connection with the MET assessments. Method: The study was performed with a qualitative approach and descriptive design. Eleven intensive care nurses were interviewed with semi-structured interviews. Result: Six main categories appeared in the result: To be prepared and have information is important for assessment, To use senses and experience when assessing, To cooperate with other staff categories is important, To use assessment tools, To have experiences of the environment around the patient in connection with the assessment, and that limitations affect the assessment and further care. The intensive care nurses described that structured patient-information, good teamwork, using assessment tools, clinical judgement and experience made the assessment easier. The result also showed that there appeared to be individual differences in how the assessment was carried out and on what grounds the decisions were taken. High workload, stress, lack of resource, limitations in care and distraction in the environment could have an impact on assessment. Conclusion: The results have contributed to increasing the understanding of the intensive care nurses experiences of assessing patients in connection with MET assignments. The results have also drawn attention to the fact that high workload, stress, environment, limitations in care and lack of resource can have an impact on patient assessment. Key words: Intensive care nurse, Medical emergency team, Nursing assessment