PPGE - Doutorado em Enfermagem

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Validação de um conjunto de orientações para guiar a atuação da enfermeira na terapia de reposição enzimática domiciliar administrada em crianças e adolescentes com mucopolissacaridose
(Universidade Federal do Rio Grande do Norte, 2025-10-10) Oliveira, Vinicius Rodrigues de; Oliveira, Jonas Sami Albuquerque de; https://orcid.org/0000-0003-0303-409X; http://lattes.cnpq.br/4740097927047538; https://orcid.org/0000-0002-9915-0062; http://lattes.cnpq.br/0400348493272242; Fuentes, Margarita Del Rosario Baeza; Feijão, Alexsandra Rodrigues; https://orcid.org/0000-0002-8686-9502; http://lattes.cnpq.br/8649283681727209; Dantas, Dandara Nayara Azevedo; https://orcid.org/0000-0002-4759-9458; http://lattes.cnpq.br/5337191302271178; Ferrari, Rosângela Aparecida Pimenta
Enzyme replacement therapy is widely used for the treatment of mucopolysaccharidoses and should be started early, during childhood. This therapy is performed weekly or biweekly at infusion centers, with an average duration of more than three hours, which directly impacts the routine of the patient and their family, with school and work absences and long commutes. Home treatment is a promising alternative, bringing benefits that result in greater well-being and comfort for children, adolescents, and their families. However, in Brazil, there are few guidelines for this modality, especially regarding nursing care. Thus, the present study aimed to validate a set of guidelines to guide the nurse's performance in home enzyme replacement therapy administered to children and adolescents diagnosed with mucopolysaccharidosis. The philosophical framework of Emmanuel Levinas was used to promote discussion about comprehensive care throughout the study. A methodological study was conducted based on the assumptions of Pasquali's psychometrics (2010) and operationalized in three phases, namely: (1) development of the set of guidelines; (2) content validation with expert judges; (3) statistical analyses to confirm the validity of the material. The study was approved by the research ethics committee with opinion number: 7,633,703 and Certificate of Ethical Review: 87097225.2.0000.5537. In the first phase, a scoping review was conducted, analyzing 12 publications, which guided, using the PAGER strategy, the development of five categories that provided theoretical support for the preparation of the set of guidelines. The recommendations were then analyzed and adapted to the recommendations of the Appraisal of Guidelines for Research and Evaluation II tool. The second and third phases took place in two cycles (Delphi I and Delphi II). In the first cycle, 10 judges participated, evaluating the clarity, relevance, and accuracy of the material, and made 33 suggestions for improving the content. Regarding the statistical analysis of the evaluations, in this first cycle, the content validity coefficient exceeded 0.80, but 54% of the items did not reach the recommended value (≥0.80) in Cohen's Kappa coefficient test. Given this, a new cycle of evaluations was undertaken. In the second cycle, nine judges reevaluated the material, four of whom made observations about the writing of the item. In the statistical analysis, there was an increase in the content validity coefficient and in the Kappa test; in both tests, the values were above 0.80 in the evaluation per item and also overall. The final version of the set of guidelines consisted of 14 items. The set of guidelines was considered valid by the expert judges and stands out for its innovative nature at the national level. It is hoped that, when applied in practice, this material will promote positive changes in the health of children and adolescents with mucopolysaccharidosis and in the work of nurses. Furthermore, this study promoted a discussion about comprehensive care, highlighting the leading role of nurses
Avaliação da implantação das medidas de controle da tuberculose no sistema prisional da região metropolitana de Natal
(Universidade Federal do Rio Grande do Norte, 2025-09-26) Silva, Sérgio Balbino da; Pinto, Erika Simone Galvão; https://orcid.org/0000-0003-0205-6633; http://lattes.cnpq.br/2135320432342059; https://orcid.org/0000-0003-0221-2747; http://lattes.cnpq.br/3735456422623059; Souza, Nilba Lima de; https://orcid.org/0000-0002-3748-370X; http://lattes.cnpq.br/3552543432083948; Salvador, Petala Tuani Cândido de Oliveira; https://orcid.org/0000-0002-3208-6270; http://lattes.cnpq.br/5628089389342234; Silva, Sandy Yasmine Bezerra e; http://lattes.cnpq.br/5896785987764223; Silva, Bruno Neves da; https://orcid.org/0000-0001-9854-4492; http://lattes.cnpq.br/0480443971812661; Andrade, Maria Sandra; https://orcid.org/0000-0002-9551-528X; http://lattes.cnpq.br/1596573712615729
Introduction: It is estimated that every year, 10 million people develop tuberculosis worldwide. Among People Deprived of Liberty, the incidence of the disease is 26 times higher than in the general population. Prison units function as reservoirs, influencing the alarming illness rates among individuals in this context. Objective: To evaluate the influence of the prison units in the Metropolitan Region of Natal on the implementation of tuberculosis control actions. Method: This is an evaluative research study based on the Hartz perspective. The theoretical framework was anchored in Donabedian’s model as a basis for normative evaluation. The investigation was carried out in the prison units of the Metropolitan Region of Natal. Data collection took place in July 2025. The study population consisted of professionals from the Prison Health Teams and health surveillance managers from each city involved. Data were collected using a questionnaire developed by researchers and professionals working in the tuberculosis field. Quantitative data were organized and processed using the Statistical Package for Social Sciences (SPSS Statistics®) version 22.0, and presented through descriptive and inferential statistics, using both mean values and the degree of implementation of disease control actions in the prison units. Additionally, a logistic regression model was developed to identify factors associated with the degree of implementation related to the Structure and Process dimensions of actions in the prison context. Open-ended questions included in the questionnaire were processed through lexicographic analysis using the Interface de R pour les Analyses Multidimensionnelles de Textes et de Questionnaires (IRaMuTeQ) software and subsequently analyzed using Bardin’s content analysis. The study was approved by the Ethics Committee of the Federal University of Rio Grande do Norte under protocol number 7.612.481. Results: Of the 60 professionals selected, 48 participated in the final sample. Most participants were linked to the Cadeia Pública Dinorá Simas Lima Deodato (25.0%), Ceará-Mirim and the Penitenciária Estadual de Alcaçuz (22.92%), Nísia Floresta, followed by the Penitenciária Estadual de Parnamirim (18.75%) and the Complexo Penal Doutor João Chaves (12.50%) in Natal. A smaller proportion worked at the Centro de Detenção Provisório de Parnamirim (8.33%). The degree of implementation of tuberculosis infection control actions in prison units was classified as partially implemented (53.1%). The dimensions related to Structure and Process were also classified as partially implemented (52.25% and 55.06%, respectively). In the Structure dimension, the sub-dimension of administrative measures was partially implemented (71.9%), environmental control measures were not implemented (8.33%), and respiratory protection measures were partially implemented (65.9%). In the Process dimension, administrative measures (70.42%) were also partially implemented. The factors associated with the degree of implementation identified through the logistic regression model were: the use of the Respiratory Symptomatic Register Book, the existence of a differentiated schedule for suspected cases, and the presence of a tuberculosis control plan in the context. Conclusion: The degree of implementation of tuberculosis control actions in prison units was classified as partially implemented. This scenario highlights the need to strengthen actions, especially regarding the full adoption of disease control measures, to ensure the effectiveness of prevention and control strategies in the prison environment with the engagement of all actors involved. Furthermore, the prison context itself influences tuberculosis control actions, creating barriers to their full implementation and, consequently, affecting efforts to reduce disease transmission.
Extubação paliativa: desenvolvimento e validação de tecnologia educacional digital para profissionais de saúde
(Universidade Federal do Rio Grande do Norte, 2025-06-30) Gonçalves, Rafaella Guilherme; Menezes, Rejane Maria Paiva de; https://orcid.org/0000-0002-0600-0621; http://lattes.cnpq.br/5190926575194616; https://orcid.org/0000-0001-8006-8061; http://lattes.cnpq.br/7724402941238917; Silva, Carlos Jordão de Assis; https://orcid.org/0000-0002-9575-9030; http://lattes.cnpq.br/6554418704863469; Botareli, Fabiane Rocha; Carvalho, Gleyce Any Freire de Lima; https://orcid.org/0000-0003-0188-2132; http://lattes.cnpq.br/3022452351516779; Ribeiro, Katia Regina Barros; https://orcid.org/0000-0002-3513-7483; http://lattes.cnpq.br/4422189971983553; Freitas, Maria Célia; https://orcid.org/0000-0002-8158-7071; http://lattes.cnpq.br/4402888773997916
Palliative extubation is defined as the planned withdrawal of ventilatory support from patients at the end of life when such therapy is considered futile. Although it is a recognized practice, significant barriers to its implementation exist, including cultural and religious influences, lack of clear guidelines, and deficits in the training of healthcare professionals. This study aims to develop a digital educational technology, in the form of an e-book, focused on qualifying health professionals for the practice of Palliative Extubation.This methodological research, grounded in instructional design, was conducted in four stages. The first stage, called analysis, was carried out in two phases. The first phase consisted of a scoping review, which identified 44 studies, mostly published in 2023, addressing guidelines for palliative extubation practice, symptom management, time between extubation and death, institutional protocols, and emotional impact on professionals. In the second phase, a cross-sectional study was conducted with 73 healthcare professionals from two university hospitals located in the Northeast and Southeast regions of Brazil. Data were collected virtually through an electronic form and analyzed using descriptive statistics and thematic content analysis. The sample was predominantly female, with a mean age of 38.6 years, mainly composed of nurses and nursing technicians, holding specialization or master’s degrees, and an average of 7.78 years of experience in critical care units. The mean score on the knowledge test was 8.89 correct answers, with a significant association between institution and results, showing better performance among professionals from the hospital in the Southeast region (p = 0.007). The main difficulties reported included limited team qualification, lack of institutional protocols, communication failures, family resistance, and fear of legal implications. Following the analytical phase, corresponding to the second stage— design and development—an evidence-based educational e-book was developed, structured according to instructional design principles. The e-book included concepts related to palliative extubation and its technical aspects, symptom management, use of pharmacological interventions, and interactive resources. In the third stage, evaluation and validation of the educational technology, 13 expert judges participated, including six nurses, four physicians, and three physiotherapists, mostly holding doctoral degrees. The evaluators’ mean age was 42.54 years, with an average of 19 years since graduation. The obtained indices were substantial: Content Validity Index (0.95), Kappa Coefficient (0.81), and Appearance Validity Index (0.97), confirming the quality, scientific accuracy, and didactic adequacy of the technology. In the fourth and final stage - implementation - the e-book was completed and made publicly available on the eduCAPES portal in Adobe Portable Document Format. It was concluded that the educational e-book presented validated content and appearance, constituting a relevant contribution to the training of healthcare professionals by addressing palliative extubation, a topic still little explored and surrounded by taboos in critical care settings, such as Intensive Care Units.
Melhoria da assistência neonatal: validação do subconjunto terminológico da CIPE® para o cuidado de recém-nascidos com cateter venoso central de inserção periférica
(Universidade Federal do Rio Grande do Norte, 2025-07-29) Prado, Nanete Caroline da Costa; Silva, Richardson Augusto Rosendo da; https://orcid.org/0000-0001-6290-9365; http://lattes.cnpq.br/2184669241700299; https://orcid.org/0000-0002-9079-0450; http://lattes.cnpq.br/7681645618156077; Cassiano, Alexandra do Nascimento; https://orcid.org/0000-0003-0475-5825; http://lattes.cnpq.br/8009349973277666; Dantas, Ana Márcia Nóbrega; http://orcid.org/0000-0001-5729-8512; http://lattes.cnpq.br/2699892747432600; Diniz, Késsya Dantas; https://orcid.org/0000-0001-6784-3166; http://lattes.cnpq.br/6905727224383587; Cubas, Márcia Regina; https://orcid.org/0000-0002-2484-9354; http://lattes.cnpq.br/0226526134229057
As a fundamental component of intensive and specialized care, the Neonatal Intensive Care Unit (NICU) is configured as an environment designed for performing essential interventions and treatments for hospitalized neonates. Clinical practice in this context requires the execution of invasive procedures, among which the use of central venous catheters stands out. The Peripherally Inserted Central Catheter (PICC) is often the first choice for medium- to long-term treatment. PICC insertion is an advanced and complex procedure, and its management demands technical skills and clinical reasoning from nurses. This study aimed to clinically validate a Terminological Subset of the International Classification for Nursing Practice (CIPE®) for newborns with Peripherally Inserted Central Catheters in the Neonatal Intensive Care Unit, using Betty Neuman’s Systems Model as the theoretical framework. It is a prospective clinical validation study, carried out in the following stages: implementation of the Nursing Process in a medium-sized hospital in Northeastern Brazil; development of case studies; and concordance analysis among expert nurses. The Kappa concordance coefficient, Kruskal-Wallis test, and intraclass correlation coefficient (ICC) were used. The study was guided by the Standards for Quality Improvement Reporting Excellence (SQUIRE) from the Enhancing the Quality and Transparency of Health Research initiative. The sample consisted of 40 neonates hospitalized in the NICU using PICC. The study adhered to regulatory principles for research involving human subjects and was approved by the Research Ethics Committee of the Federal University of Rio Grande do Norte, under approval number 7.171.001. The diagnoses/outcomes and interventions were evaluated with near-perfect/perfect agreement and excellent ICC. The Kruskal-Wallis test showed no significant differences among the evaluations. The study clinically validated a subset of 53 nursing diagnoses/outcomes and 110 nursing interventions, demonstrating its applicability in the care of neonates with Peripherally Inserted Central Catheters.
Efeito da música no manejo da ansiedade e do estresse em pacientes no pré-operatório de angioplastia transluminal coronária: ensaio clínico randomizado
(Universidade Federal do Rio Grande do Norte, 2025-05-30) Mendes, Francisco de Cássio de Oliveira; Dantas, Rodrigo Assis Neves; https://orcid.org/0000-0002-9309-2092; http://lattes.cnpq.br/9161806467102041; http://lattes.cnpq.br/5278070572273724; Ribeiro, Katia Regina Barros; https://orcid.org/0000-0002-3513-7483; http://lattes.cnpq.br/4422189971983553; Diniz, Kessya Dantas; http://lattes.cnpq.br/6905727224383587; Silva, Mariana Pereira da; http://lattes.cnpq.br/5511376201745702; Santos, Renata Silva; https://orcid.org/0009-0006-7712-8813; http://lattes.cnpq.br/5216720159381839
Transluminal Coronary Angioplasty (TCA) is defined as a highly complex, non-surgical treatment that aims to unclog the coronary arteries. Due to the complexity of this procedure and often the psychophysiological vulnerability of the patient, this procedure may be associated with psychological stressors, such as anxiety and stress. Therefore, the objective was to evaluate the effect of music on the management of anxiety and stress in patients in the preoperative period of percutaneous coronary angioplasty. This is a prospective, randomized, controlled, double-blind clinical trial, carried out in accordance with the guidelines of the Consolidated Standards of Reporting Trials (CONSORT). The study was developed in the hemodynamics of the Onofre Lopes University Hospital, from August to December/2024, with a sample of 52 participants scheduled for the TCA procedure. The randomization of patients was performed through the “Research Randomizer” website. Patients were equally allocated into two groups: Intervention Group (IG) and Control Group (CG) with 26 patients in each group. All patients received the application of headphones before the start of the ATC procedure, but only patients in the Intervention Group (IG) received the intervention (exposure to music). Data were collected through the patient's sociodemographic and clinical data form; Beck Anxiety Inventory (BAI) and the Lipp Adult Stress Symptom Inventory (LSSI). The research was approved by the Research Ethics Committee of the Federal University of Rio Grande do Norte - UFRN, under Protocol number: 6,479,213 and the Certificate of Presentation of Ethical Appreciation (CAAE) number: 74,989,823.6.0000.5537, in addition to the Brazilian Registry of Clinical Trials - ReBEC, according to approval record: RBR-5jy7kzj. To compare the BAI and ISSL scores with the intervention and control groups, Student's t-test was applied, with a 5% significance level. The Chi-square test evaluated the relationship of variables with a significance level. The Kolmogorov-Smirnov test verified the data distribution pattern. The study concluded that the alternative hypothesis was confirmed, as evidenced in the research results, regarding the existence of the effect of music on the anxiety and stress of patients in the waiting room for percutaneous transluminal coronary angioplasty. However, although the study did not present the expected primary outcome in the overall comparison between the Intervention Groups and the Control Group, it did present the expected intergroup primary outcome, in addition to a positive secondary outcome with evidence of a reduction in Systolic Blood Pressure (SAH) and Heart Rate (HR).
Desenvolvimento de infográfico e guia operacional para apoio à educação permanente de enfermeiros no cuidado aos parceiros sorodiferentes para o HIV
(Universidade Federal do Rio Grande do Norte, 2025-03-21) Silva, Valéria Gomes Fernandes da; Souza, Nilba Lima de; https://orcid.org/0000-0002-3748-370X; http://lattes.cnpq.br/3552543432083948; https://orcid.org/0000-0003-1381-8664; http://lattes.cnpq.br/9735425260999611; Lima Neto, Alcides Viana de; Teixeira, Elizabeth; Pinto, Erika Simone Galvão; Serra, Maria Aparecida Alves de Oliveira
In the context of the Human Immunodeficiency Virus (HIV), the experience of serodifference—characterized by affective-sexual relationships in which one partner is living with the virus and the other is not—remains a topic that is still underexplored by many health professionals, particularly those working in Primary Health Care (PHC). In this scenario, educational technologies aimed at continuing health education emerge as promising strategies for professional qualification in the care of HIV serodifferent partnerships. The objective of this study is to develop an educational technology in the form of an infographic and an operational guide to support the ongoing education of nurses in the care of serodifferent partners for HIV within PHC. This is a methodological study with participatory development, which used Paulo Freire's pedagogical assumptions as its educational framework and the stages of Contextualized Instructional Design (CID) as its methodological approach. In Stage 1 (Analysis), an integrative literature review was conducted to identify the nursing care practices relevant to HIV serodifferent partners; a documentary analysis of publications from the Brazilian Ministry of Health's website was also performed; and a qualitative action research study was carried out with 13 PHC nurses to promote the participatory and collective development of the content and final format of the technologies. In Stage 2 (Design and Development), the technologies were structured into an infographic and an operational guide with the support of a team of developers. Stage 3 (Implementation) involved usability validation with the target audience and future online availability of the tools. In Stage 4 (Evaluation), content and appearance validation was conducted by 19 expert nurses in two rounds using the Delphi technique, with a Content Validity Index (CVI) greater than 0.8 as the benchmark. The study was conducted from November 2022 to February 2025 and was approved by the Research Ethics Committee of the Federal University of Rio Grande do Norte under protocol number 6.023.762. The content of the tools was structured into four thematic axes that emerged from the thematic content analysis in the Analysis phase: offering preventive strategies; considering the reproductive desires of partners; paying attention to mental health; and the nursing consultation as an ally—these were reflected in both the infographic and the guide. The infographic Acol≠IV: eu cuido was developed in a static format using textual resources and illustrations related to the topic. The operational guide consisted of 20 pages, including a cover, introduction, table of contents, four thematic axes detailing the care practices, and references used in its construction. After two Delphi rounds, the total content and appearance validity index was 1.0 for the infographic and 0.99 for the operational guide. Microsoft Excel and the Statistical Package for the Social Sciences (SPSS) version 20.0 were used for data tabulation, index calculation, and descriptive statistical analysis of the participant profiles. The infographic and the operational guide were considered valid in both content and appearance by the expert judges. It is believed that these tools may provide theoretical support to guide and strengthen nurses' care practices for HIV serodifference demands, as well as enrich the literature on the phenomenon.
Eficácia do aplicativo móvel ostocuide® no autocuidado de pessoas com estomias intestinais: ensaio clínico randomizado
(Universidade Federal do Rio Grande do Norte, 2025-03-28) Silva, Isabelle Pereira da; Costa, Isabelle Katherinne Fernandes; https://orcid.org/0000-0002-1476-8702; http://lattes.cnpq.br/5903265312273525; https://orcid.org/0000-0002-9865-2618; http://lattes.cnpq.br/6809729001592431; Teles, André Aparecido da Silva; Borges, Eline Lima; Gálvez, Javier Sánchez; Araújo, Rhayssa de Oliveira e
Intestinal stomas allow the exteriorization of portions of the intestine in the abdominal wall and are routinely performed in health services. These surgeries have a significant impact on aspects of self-care. As a way of working on self-care for this population, mobile technologies are included as resources that enable easy access in different locations, rapid obtaining of information and communication. However, there is a lack of studies on the development and evaluation of the repercussions of these software on the health of the population with stomas. Thus, the objective was to analyze the effectiveness of the Ostocuide® mobile application in the self-care of people with intestinal stomas. This is a longitudinal study with a quantitative, methodological and intervention approach, carried out from March 2023 to January 2025. The research had two studies: a methodological study to validate the content and evaluate the usability of the application and an intervention study, of the randomized clinical trial type. The methodological study was carried out from March to December 2023 and involved content validation with 10 experts, via the Google Forms platform, semantic validation and usability assessment with 10 people with ostomies at the State Center for Rehabilitation and Specialized Outpatient Care, in Natal, Rio Grande do Norte. The intervention study was carried out at the State Rehabilitation Center with people with ostomies, from July 2024 to January 2025. Simple random sampling distributed the patients into the control group, which received only conventional guidance in the nursing consultation, and the intervention group, which in addition to the consultations, used the Ostocuide® application. Both groups answered the self-care development form and were monitored for 45 days, with the instrument reapplied after 15, 30 and 45 days, via telephone contact. The results of the methodological stage showed that in the first round of evaluation by the judges, all domains presented a content validity index equal to 1.0, with the exception of the font size, which obtained 0.900. In the second round, consensus was reached. In the evaluation by the patients, the item quantity of illustrations obtained 0.800 in the first round and there was consensus in the second round. The overall usability average was 92.25 points. In the intervention study, 61 people composed the sample, 30 in the intervention group and 31 in the control group. It was observed that the knowledge domain presented a statistically significant interaction effect, which demonstrated that there was an interaction between knowledge and the groups (F=7.33, p=0.00). The averages of the intervention group were higher over time compared to the control group. The differences between the groups presented statistical significance in all domains and in the overall average. There was a moderate and significant correlation (r=0.449; p=0.013) between the number of accesses and the average final self-care assessment. All participants responded that they were satisfied with the application, and three people responded that it was not easy to access. Regarding the contributions of the application, 11 (36.7%) mentioned information regarding nutrition, 6 (20.0%) mentioned hygiene and changing the collection equipment, and 4 (13.3%) mentioned laws and rights. Therefore, it was observed that Ostocuide® is effective in the selfcare of people with intestinal ostomies. Furthermore, this study contributes to the advancement of knowledge about technologies for people with ostomies and may help to improve the lifestyle of people with ostomies. It is emphasized that further studies are needed to verify the effectiveness of the application in other contexts.
Terapias medicamentosas para manejo da dor em pacientes amputados: revisão sistemática e metanálise de rede
(Universidade Federal do Rio Grande do Norte, 2025-02-17) Leal, Nahadja Tahaynara Barros; Dantas, Daniele Vieira; https://orcid.org/0000-0003-0307-2424; Duarte, Fernando Hiago da Silva; https://orcid.org/0000-0002-2743-0452; Araújo, Gabriela de Sousa Martins Melo de; https://orcid.org/0000-0002-3096-2759; Ribeiro, Kátia Regina Barros; https://orcid.org/0000-0002-3513-7483; Silva, Mariana Pereira da
Introduction: Pain is the most prevalent clinical manifestation after amputation. Approximately 70% of amputees experience some type of pain, and even at low intensity, it causes suffering and changes their lives in some way. There is no consensus in scientific literature on the most appropriate way to manage this event, and there are numerous promising drug therapies. Evidence analysis is important to support safe therapeutic choices for the patient and to promote nursing practice based on scientific evidence. Given that the philosophical dimension permeates all nursing care, this study was developed in line with some ideas contained in the work Critique of Pure Reason by philosopher Immanuel Kant. Objective: to evaluate the efficacy and safety of drug therapies for pain management in amputee patients. Methodology: this is an overview of a systematic review and network meta-analysis, conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses for Network Meta-Analyses (PRISMA-NMA) and registered in the International prospective register of systematic reviews (PROSPERO) database (CRD42024500600). The search was carried out in September 2024, by two researchers, independently and simultaneously, in the databases: Cochrane Library, Latin American and Caribbean Literature on Health Sciences (LILACS), National Library of Medicine and National Institutes of Health (PUBMED), Scientific Electronic Library Online (SciELO), Science Direct, Web of Science, Elsevier's Scopus (SCOPUS), CINAHL and Google Scholar. A total of 2,352 texts were identified. The study included all Cochrane Systematic Reviews (CSRs) and non-Cochrane Systematic Reviews (non-CSRs) with or without meta-analysis that described the population aged 18 years or older, with the use of pharmacological therapies for pain management in patients undergoing amputation surgeries. There was no restriction on time or language of publications, and duplicate texts were excluded using Rayyan®. Results: 17 systematic reviews were included for analysis. With a population mainly of males, ages between 19 and 92 years, with amputations of extremities and presence of Residual Pain (RD) or Phantom Limb Pain (PLP), pain assessment was performed using various scales. To analyze the methodological quality, the Assessment of Multiple Systematic Reviews (AMSTAR 2) was used, and the studies were considered according to overall reliability as: “moderate”, 7 (41.2%); “critically low”, 7 (41.2%); and “low”, 3 (17.7%). Seven systematic reviews of randomized clinical trials were filtered for the network meta-analysis; the analyses were conducted using the netmeta package, through the R® software. Two outcomes were analyzed for meta-analysis and elaboration of network and sub-network diagrams: DR and DMF. The therapies contained in the three subnetworks created did not obtain statistical significance for direct and indirect comparisons. In the first sub-network, for phantom limb pain, the therapies most likely to have better results were transcranial magnetic stimulation (p-score 0.6949), followed by memantine (p-score 0.5309) and, in the second sub-network for DMF, mirror therapy (p-score 0.6058) and transcutaneous electrical nerve stimulation (0.5916). The third subnetwork was designed for residual pain and gabapentin obtained the first position in the ranking. Conclusion: given the results and limitations, the hypothesis that drug therapies do not present sufficient scientific evidence to guarantee the efficacy and safety of use for pain management in adult amputee patients, compared with the administration of placebos and/or other therapies, is accepted.
Eficácia dos Florais de Bach em indivíduos com síndrome da abstinência alcoólica: um ensaio clínico controlado aleatorizado
(Universidade Federal do Rio Grande do Norte, 2025-02-26) Rocha, Mayara Araújo; Dantas, Rodrigo Assis Neves; https://orcid.org/0000-0002-9309-2092; http://lattes.cnpq.br/9161806467102041; http://lattes.cnpq.br/5824756580847265; Duarte, Fernando Hiago da Silva; Silva, Hylarina Maria Montenegro Diniz; Ribeiro, Katia Regina Barros; Costa, Thatiane Monick de Souza
One of the most common disorders among alcohol abusers is Alcohol Withdrawal Syndrome, which manifests itself through a set of physical and psychological signs and symptoms, including anxiety and craving . It is believed that the adoption of integrative and complementary practices, such as Bach Flower Remedies, can help alleviate the most pronounced symptoms. Thus, the objective of this study is to analyze the efficacy of Bach flower therapy in individuals with Alcohol Withdrawal Syndrome. Thus, the alternative hypothesis adopted was: “Bach flower remedies are effective in reducing craving and anxiety in users with mild/moderate Alcohol Withdrawal Syndrome when compared to placebo”. This is a Randomized Controlled Trial. The study was conducted at a Psychosocial Care Center for Alcohol and Other Drugs III, in the city of Boqueirão, in the state of Paraíba, Brazil. To carry out the test, participants were allocated to an experimental group (floral) or a control group through randomization with the support of the website www.randomization.com . 36 users participated in the study. Blinding was achieved by standardizing the amber vials and by administering the questionnaire by a researcher who was unaware of the groups. The data collection instruments consisted of a sociodemographic and clinical instrument, the Clinical Institute Withdrawal Assessment for Alcohol , Revised - Brazilian version; the State-Trait Anxiety Inventory; and Alcohol Craving Questionnaire - Short Form - Revised - Brazilian Version . A measurement was performed after the use of the flower essence in five days of follow-up. Descriptive and inferential analyses were performed using the software SPSS ®. It is important to highlight that after institutional approval, the project was evaluated by the Central Research Ethics Committee of the Federal University of Rio Grande do Norte with the opinion number: CAAE 61762022.1.0000.5537. In addition, the trial was previously registered with REBEC (Brazilian Registry of Clinical Trials), obtaining the opinion number: RBR-7pzb4sw. The results showed that most participants were male (94.44%), up to 45 years old (38.8%), with incomplete elementary education (80.00%), black (41.67%) and not using continuous medication (58.33%). Regarding the abstinence parameters, the participants presented a prevalence of moderate abstinence (72.22%) in the first verification. Through the Student 's t- test, assigning a significance level of 5%, statistical differences were evidenced between the pre- and post-intervention periods (>0.001) in the patients of the floral and control groups regarding the STAI state and trait, ACQSR (factor 1). Where the patients of group II had a reduction in the variables mentioned in the study, except in the ACQ-SR - Factor 2, which occurred an increase. It is concluded that there was a reduction in craving and anxiety trait and state in the group in which the intervention with Bach Rescue Flower was carried out in individuals with Alcohol Withdrawal Syndrome.
E-book sobre estratégias educacionais para auxiliar docentes da graduação em enfermagem no ensino de pessoas com transtorno do déficit de atenção/hiperatividade
(Universidade Federal do Rio Grande do Norte, 2025-03-18) Ferreira, Lucas Batista; Medeiros, Soraya Maria de; https://orcid.org/0000-0003-2833-9762; http://lattes.cnpq.br/2068281775213576; http://lattes.cnpq.br/1553668235081566; Morais, Ildone Forte de; Costa, Raphael Raniere de Oliveira; Menezes, Rejane Maria Paiva de; Cavalcante, Rosângela Diniz
Neurodevelopmental disorders are part of a group of conditions characterized by deficits in development or differences in brain processes, with harm to the individual's personal, social, academic or occupational development. Among these conditions is attention deficit/hyperactivity disorder, defined by a persistent pattern of inattention and/or hyperactivityimpulsivity. This disorder can transcend childhood, that is, persist and be diagnosed in adolescents and adults, including those enrolled in higher education institutions, and is one of the causes of poor academic performance and professional failure in these individuals. Therefore, nursing professors may be faced with students diagnosed with attention deficit/hyperactivity disorder and lack in-depth knowledge about the disorder and/or methodological tools that are capable of assisting their professional performance in an inclusive manner. Thus, the thesis aimed to develop an e-Book on educational strategies to assist undergraduate nursing teachers in teaching people with attention deficit/hyperactivity disorder. This is a methodological study carried out in three stages, namely: 1) Scoping review with the objective of mapping strategies for teaching university students with attention deficit/hyperactivity disorder and identifying the recommended strategies for teaching these students who are studying for a degree in nursing; 2) Construction of the e-Book; 3) Content and appearance validation. For content validation, the global Content Validity Index was considered, with a cut-off point ≥ 0.90; and the Kappa Coefficient, with at least a substantive agreement (0.60-0.79). For appearance validation, the global Appearance Validity Index was considered, with a cut-off point ≥ 0.90. The study was submitted to and approved by the Research Ethics Committee of the central campus of the Federal University of Rio Grande do Norte (CAAE: 81507724.0.0000.5537) and followed the ethical principles of resolution no. 466/2012 of the National Health Council. The scope review resulted in 14 scientific articles; the mapped strategies were classified as general and active, among them: extra time and flexible hours to carry out assessments; and problem-based learning. In the context of nursing, the following were identified: promoting better communication processes, organization and prioritization of activities during clinical practice. After the construction of the e-Book, the validation stage was carried out, for which 10 expert judges participated for content validation (eight nurses and two psychologists) and five judges for appearance validation (graphic designers) which resulted in the following indices: Overall Content Validity Index of 0.97; Overall Kappa Coefficient of 0.90; and overall Appearance Validity Index of 0.91. It is concluded that the e-Book developed in this thesis offers the professor of the undergraduate nursing course a practical didactic resource, containing educational strategies that can be applied in the teaching of people with attention-deficit/hyperactivity disorder, helping them to adapt their pedagogical approaches to meet the specific needs of this public.
Diagnóstico de enfermagem mobilidade física prejudicada em pacientes submetidos à cirurgia cardíaca
(Universidade Federal do Rio Grande do Norte, 2024-12-06) Nelson, Ana Raquel Cortês; Lira, Ana Luisa Brandão de Carvalho; Moreira, Rafaella Pessoa; https://orcid.org/0000-0002-7255-960X; http://lattes.cnpq.br/4545130167501174; http://lattes.cnpq.br/4665158358760219; Lima, Maria Alzete de; https://orcid.org/0000-0002-0288-1329; http://lattes.cnpq.br/8917202234995917; Fernandes, Maria Isabel da Conceição Dias; Guedes, Nirla Gomes; Genro, Rita
The nursing diagnosis Impaired physical mobility has a high incidence in patients in the postoperative period of cardiac surgery. In this context, the objective was to analyze evidence of validity of the diagnosis Impaired physical mobility in patients in the postoperative period of cardiac surgery. This is a methodological study of validation of a nursing diagnosis, carried out in two stages proposed in the literature: 1) theoretical-causal validity, through the construction of a middle-range theory of the referred nursing diagnosis; 2) content validity by experts. In the first stage, the theoretical-causal validity was performed through the development of a middle-range theory, which was operationalized from an integrative review in four databases. In the second stage, the diagnosis was analyzed by 09 experts, through the nominal group. The research was approved by the Ethics Committee of the responsible institution. The results showed that 03 essential attributes were identified in the 19 selected articles: Difficulty moving, Difficulty changing position and contracting muscles freely, Dependent physical movement; 04 clinical antecedents: Reduced tolerance to physical effort, Angina pain, Muscle weakness, Prolonged time of bed rest; and 07 clinical consequences: Change in gait, Difficulty turning, Reduction in range of motion, Limited muscular capacity to perform fine motor activities, Limited muscular capacity to perform gross motor activities and Dyspnea on exertion. A pictogram, 05 propositions and 09 causal relationships were developed. In the second stage, the analysis of the diagnosis by the experts allowed the improvement of the title, concept of the diagnosis, 04 antecedents and 03 clinical consequences. The addition of the population at risk and associated condition, which resulted in a diagnostic structure with 07 defining characteristics, 05 related factors, 01 population at risk and 01 associated condition. It is concluded that the theoretical-causal validity, through a middle-range theory, and the content validity evidenced important elements for the diagnosis of Impaired Physical Mobility in patients undergoing cardiac surgery, which are not yet present in NANDA-I. Therefore, it is expected to contribute to the advancement of the work process of nurses, through a more precise and reliable identification of the diagnosis of Impaired Mobility in this population. In addition, it seeks to promote the strengthening of practices aimed at the development of measures that promote early mobilization and reduction of injuries aimed at the rehabilitation of patients in the postoperative period of cardiac surgery.
Diagnóstico de enfermagem risco de choque em pessoas com infarto agudo do miocárdio: Teoria de de Médio Alcance e Validação de Conteúdo
(Universidade Federal do Rio Grande do Norte, 2024-12-12) Dantas, Anna Lívia de Medeiros; Silva, Richardson Augusto Rosendo da; https://orcid.org/0000-0001-6290-9365; http://lattes.cnpq.br/2184669241700299; https://orcid.org/0000-0002-9908-2901; http://lattes.cnpq.br/6147113155473567; Lira, Ana Luisa Brandão de Carvalho; Menezes, Harlon França de; Ribeiro, Katia Regina Barros; Queiroz, Marcela Paulino Moreira da Silva; Fernandes, Maria Isabel da Conceição Dias
Patients with acute myocardial infarction (AMI) are at imminent risk of losing their life or organ/system function, developing shock states and multisystem impairment. Identifying risk factors and conditions associated with the risk of shock allows directing nursing care to patients with AMI at risk of shock. In this sense, the general objective of this study was to validate the content of the nursing diagnosis Risk for shock in people with acute myocardial infarction based on a Middle-Range Theory. This is a methodological study, which was carried out in two stages, which were: theoretical-causal validation and content validation. The research was approved by the Ethics Committee of UFRN, through opinion No. 5,544,882 by CEP/UFRN and registered in the Brazil Platform with the Certificate of Ethical Appreciation (CAAE) No. 58803922.1.0000.5537. Data analysis was performed using descriptive and inferential statistics. The first stage involved constructing a middle-range theory operationalized through an integrative literature review. Data were extracted from the following data sources: Scopus, Web of Science, National Library of Medicine (MEDLINE/PubMed), and Science Direct. The final sample consisted of 25 studies. Four attributes, seven risk factors, and 13 conditions associated with the risk of shock in people with acute myocardial infarction were listed. The Middle-Range Theory constructed used the theoretical framework of Roy's adaptation model. Twenty-three concepts, seven propositions, and 23 causal relationships of the risk of shock in patients with acute myocardial infarction were identified. A graphical representation was constructed to explain the relationships between the concepts. The TMA-RCIAM assessment was performed in two rounds. A total of 57 judges participated in the first round. The TMA-RCIAM was considered adequate in all items related to significance, internal consistency, parsimony, testability, and empirical adequacy and pragmatic adequacy. However, the items were adjusted in order to accept the comments and suggestions, and were reassessed in the second round of evaluation, in which the TMA was evaluated by 51 judges. Finally, all items were approved. The second stage was the content validation by judges regarding the diagnostic components. Sixty-two judges participated in this stage, who validated the definition of the diagnosis and the 23 clinical indicators regarding their relevance. The conceptual and operational definitions of each indicator were evaluated for clarity and precision. All items presented agreement greater than 0.8, but some items reached IRA below 0.8 and adjustments were made based on the comments and suggestions of the evaluators. After the adjustments, a second round of evaluation was carried out with the judges, in which agreement was obtained based on the evaluation of 50 judges. It is concluded that the study contributed to the advancement of knowledge in the discipline of Nursing, since the process of validating a nursing diagnosis present in the Nanda I taxonomy is necessary to maintain the scientific evidence that supports the diagnosis, in addition to facilitating the dissemination of knowledge in this area.
Glicose 25% e reflexoterapia no alívio da dor em neonatos submetidos à punção arterial: ensaio clínico randomizado
(Universidade Federal do Rio Grande do Norte, 2024-10-25) Costa, Thatiane Monick de Souza; Dantas, Daniele Vieira; https://orcid.org/0000-0003-0307-2424; http://lattes.cnpq.br/0404704679319143; https://orcid.org/0000-0002-8827-9653; http://lattes.cnpq.br/3488144292234998; Feijão, Alexsandra Rodrigues; Duarte, Fernando Hiago da Silva; Araújo, Gabriela de Sousa Martins Melo de; Medeiros, Lays Pinheiro de
Newborns are exposed to a range of painful procedures in the Neonatal Intensive Care Unit, and pain relief measures are necessary. Non-pharmacological treatment of neonatal pain seeks to reduce aggressive stimuli in the environment, prevent physiological and behavioral changes, generate comfort and reduce stress during hospitalization. In this perspective, this study aims to compare the effect of 25% glucose solution and reflexology in relieving pain in newborns undergoing arterial puncture admitted to the Neonatal Intensive Care Unit. This is a randomized, controlled, double-blind clinical trial conducted with newborns who had an indication for blood collection by arterial puncture and were admitted to a neonatal intensive care unit of a maternity hospital that is a reference for high-risk pregnancies and deliveries in Natal, Rio Grande do Norte. The sample consisted of 40 patients, 20 of whom were in the Control Group who received the oral glucose solution 25%, and 20 patients in the Experimental Group who received foot reflexology. The inclusion criteria for the study were: newborns up to one week old who were born at ≥ 32 weeks of gestational age or weighing >1500g who underwent collection of laboratory tests/blood gas analysis/blood culture through arterial puncture. To evaluate the effectiveness of the interventions applied, a data collection instrument was used, structured in three parts: data from the mother; data related to the birth and the newborn; assessment of pain during the arterial puncture procedure using the Neonatal Infant Pain Scale (NIPS) and other parameters. The primary outcome of the study was neonatal pain scores before, during and after arterial puncture. Secondary outcomes were crying time, oxygen saturation and heart rate of the newborns before, during and after the arterial puncture procedure. The data were processed in a Microsoft Office Excel 2020 software database to create descriptive tables and to apply statistical tests, the Statistical Package for the Social Sciences version 25.0 was used, through descriptive and inferential statistics. To compare the control and experimental groups, the Chi-square, Student's t-test and Analysis of Variance for repeated measures were applied, with p<0.05 for the relationship between the variables. The project was approved by the Research Ethics Committee of the Federal University of Rio Grande do Norte, CAAE 23720419.5.0000.5537 and was registered in the Brazilian Registry of Clinical Trials under number RBR-639bff. Regarding the results, the effectiveness of the foot reflexology intervention was proven when compared to the use of 25% glucose in reducing pain scores after the procedure and stabilizing vital signs. Regarding the primary outcomes, when comparing the two interventions, a significant reduction in pain scores (NIPS: 0.70) was observed in the experimental group after the painful procedure. As for the secondary outcomes, it was observed that crying time was shorter in the experimental group, and oxygen saturation also showed higher values in the reflexology group during and after the procedure. The heart rate remained within normal values and more stable (lower values) in the experimental group. Thus, the alternative hypothesis is confirmed and the proposed thesis is proven, since the findings identified in the experimental group indicated that the interventions performed caused significant effects and the Experimental Group showed a reduction in pain scores and stabilization of vital signs, thus proving the effectiveness of reflexology in relieving pain in neonates undergoing painful procedures. Finally, the results of this study contribute to the acquisition and increase of knowledge related to the use of reflexology as a complementary integrative health practice in relieving neonatal pain in patients hospitalized in the NICU. Reflexology is expected to be incorporated into hospital institutions as a way of promoting health and improving neonatal care.
Avaliação do efeito de uma intervenção educativa sobre o cuidado seguro ao paciente renal crônico submetido à hemodiálise
(Universidade Federal do Rio Grande do Norte, 2024-11-29) Paiva, Renilly de Melo; Santos, Viviane Euzébia Pereira; http://lattes.cnpq.br/5808110442588994; http://lattes.cnpq.br/9826628878441768; Saraiva, Cecilia Olivia Paraguai de Oliveira; https://orcid.org/0000-0003-4225-5194; http://lattes.cnpq.br/1716286540870612; Azevedo, Isabelle Campos de; Ferreira Júnior, Marcos Antonio; Pennafort, Viviane Peixoto dos Santos
The objective of this study was to evaluate the effect of an educational intervention on the safety of nursing care for patients in hemodialysis units. This is an evaluative study with a quantitative approach carried out in four hemodialysis units in the metropolitan region of Natal/RN. The data collection procedure was organized into: Evaluation 1: carried out in the selected units using a previously validated instrument; Intervention: an extension course with an educational character about safe care in dialysis units aimed at nurses and nursing technicians from each of the units evaluated. Evaluation 2: occurred in the same way as evaluation 1 in order to evaluate the effects related to the improvement of safe care in hemodialysis units, after the intervention. The data collection instrument was the graphic protocol for evaluating safe nursing care for chronic kidney patients on hemodialysis, in which the level of compliance was verified through items related to structure, process and result, which allows classifying the care as safe, partially safe or unsafe. The data were stored in Microsoft Excel® 2010 spreadsheets and subsequently analyzed using inferential descriptive statistics using the Statistical Package for Social Science® (SPSS) software. The Kappa coefficient was measured to determine the level of agreement between evaluators. The results for the classification of care were organized using the scores listed in the graphic protocol checklist. The Pareto Diagram was used to evaluate nonconformities. According to the evaluation, it was possible to observe that in the first evaluation, three clinics obtained scores between 7 and 11, referring to partially safe care, while in the second evaluation, all clinics obtained scores between 14 and 16, considered as safe care. The Kappa coefficient indicated substantial agreement, with values between 0.61 and 0.80 for clinic 1, 2, and 4. Clinic 3 presented perfect agreement between evaluators. It is concluded that after the intervention there was an improvement in all dimensions evaluated, which confirms that the intervention had a positive effect on all items, evidenced by the reduction of non-conformities in the dimensions studied in the four clinics.
Validação do diagnóstico de enfermagem estilo de vida sedentário em universitários
(Universidade Federal do Rio Grande do Norte, 2024-12-06) Fernandes, Renata Marinho; Lira, Ana Luisa Brandão de Carvalho; https://orcid.org/0000-0002-7255-960X; http://lattes.cnpq.br/4545130167501174; https://orcid.org/0000-0001-7358-9061; http://lattes.cnpq.br/1546080154155201; Dantas, Dandara Nayara Azevedo; Tinoco, Jessica Dantas de Sá; Lopes, Marcos Venícios de Oliveira; Fernandes, Maria Isabel da Conceição Dias
Lifestyle is a modifiable and determining factor in preventing illness. However, university students are mentioned as a vulnerable group for sedentary behavior. Therefore, the present study aims to analyze evidence of the validity of the nursing diagnosis Sedentary lifestyle in university students.This is a methodological research, developed in two stages: content analysis of the aforementioned diagnosis, proposed from a middle-range theory developed in a previous study; and clinical validation. The first stage was carried out during the first semester of 2023, with 48 judges. The judges were categorized into levels of expertise. For statistical analysis, the content validity index was calculated using the Wilcoxon test. In the second stage, a crosssectional diagnostic accuracy study was carried out in the second semester of 2023. The study included 108 undergraduate students in Nursing at the Federal University of Rio Grande do Norte. The sociodemographic and clinical numerical data were listed by mean, standard deviation, median, minimum and maximum. For the categorical variables, the relative and absolute frequencies were recorded. To establish the sensitivity and specificity measures, the latent class model with random effects was applied. The study was approved by the Research Ethics Committee. The results of the content analysis identified four defining characteristics, eight related factors, four populations at risk and one associated condition. They were further improved in terms of robustness, clarity and operability. Regarding clinical validation, the prevalence of the nursing diagnosis Sedentary lifestyle in young adult university students was 16.3%. Thus, “inadequate sleep quality” was identified as a sensitive characteristic and “lack of physical fitness” and “cardiovascular alterations” as specific characteristics. Furthermore, seven related factors were prevalent, namely: “socially imposed behaviors on the female gender”, “unfavorable environmental conditions for physical activity”, “unfavorable climatic conditions for physical activity”, “deficient knowledge about sedentary lifestyle”, “family history of sedentary lifestyle”, “prolonged sitting time ≥8h” and “excessive screen time ≥3h”. And three populations at risk: “university students”, “young adults” and “individuals living in urban areas” in the sample analyzed. It is concluded that the nursing diagnosis Sedentary lifestyle is valid for university students and presents three defining characteristics with good accuracy. Thus, based on a greater theoretical basis, it is expected to contribute to the development of health actions in the university environment and, thus, promote the adoption of healthier lifestyles, as well as contribute to increasing the level of evidence of this diagnosis in the NANDA-I taxonomy.
Gestão do cuidado transicional aos usuários com feridas de difícil cicatrização a partir da alta hospitalar
(Universidade Federal do Rio Grande do Norte, 2024-10-29) Dantas, Marianny Nayara Paiva; Oliveira, Jonas Sami Albuquerque de; https://orcid.org/0000-0003-0303-409X; http://lattes.cnpq.br/4740097927047538; https://orcid.org/0000-0002-8891-0003; http://lattes.cnpq.br/3781787663475688; Araújo, Rhayssa de Oliveira e; Medeiros, Soraya Maria de; Forte, Elaine Cristina Novatzki; Santos, Renata Silva; Mesquita, Simone Karine da Costa
Users with difficult-to-heal wounds include those with wounds that have not healed 40- 50% of their extent after four weeks of adequate analysis and clinical intervention. This health situation is related to biological, clinical, non-clinical and service delivery factors, in addition, it requires the use of multiple levels of complexity in the health care network. Therefore, to reduce the impacts of this problem on public health, Transitional Care is essential, a care modality that seeks to improve results for users, caregivers and health systems during transfers between different units, services and care levels. Thus, the present study aimed to analyze the management of Transitional Care for users with difficult-to-heal wounds in the health care network, from hospital discharge and the nurse's contributions to this process. This is an integrated single case study., of a qualitative nature and has as its unit of analysis the health care network in the city of Natal, Rio Grande do Norte. It was conducted in accordance with the guidelines of Yin (2015), its sources of evidence were semi-structured interviews with users with difficult-to-heal wounds who were discharged from hospital; to nurses who work in the management or assistance of services that make up the health care network of the municipality of analysis and a scope review, on the management of transitional care for users with wounds.The data obtained were examined using the content analysis method of Yin (2015) and using the philosophical framework of the Theory of Communicative Action, by Jurgen Habermas (2022), with support from the ATLAS TI® software. The results were presented in texts, figures, tables, tables and indicate that the transition of care for users with difficult-to-heal wounds begins during hospital admission and continues at other levels of care, with the participation of the user's multidisciplinary team and caregivers. Despite observing some necessary pillars for Transitional Care, elements such as communication between members of multidisciplinary teams and coordination between network services prove to be fragile and interfere with the continuity of care for users and their post-hospital discharge recovery. Elements related to users' vulnerability conditions also stand out as critical nodes of the phenomenon examined. In all health services included, nurses participated as active workers in managing the phenomenon studied. Its prominence was also evident in the scope review carried out, where strategies for managing Transitional Care were based on the use of technologies to improve this process in health services. The analysis of weaknesses, potentialities and strategies for improving Transitional Care provide input for reflection and improvement, with a view to reorganizing the service offered in the network and the quality of results related to users, caregivers and health services. The strategies identified in the literature are potentially replicable in health care networks and can be incorporated into environments that work with users who have wounds that are difficult to heal or other chronic health conditions.
Validação do diagnóstico de enfermagem risco de glicemia instável em pacientes submetidos à hemodiálise
(Universidade Federal do Rio Grande do Norte, 2024-12-05) Ferreira, Larissa de Lima; Lira, Ana Luisa Brandão de Carvalho; https://orcid.org/0000-0002-7255-960X; http://lattes.cnpq.br/4545130167501174; https://orcid.org/0000-0003-2567-2236; http://lattes.cnpq.br/4552838029380454; Lopes, Marcos Venícios de Oliveira; Fernandes, Maria Isabel da Conceição Dias; Salvador, Petala Tuani Cândido de Oliveira; Pennafort, Viviane Peixoto dos Santos
The variation in blood glucose levels is a common complication during hemodialysis and is related to the pathophysiology of kidney disease and the hemodynamic changes resulting from extracorporeal circulation. Thus, the nursing diagnosis of ineffective self-management of blood glucose pattern risk may be inferred in this population; however, the NANDA-I taxonomy does not yet identify hemodialysis as a treatment that makes patients susceptible to this risk. Therefore, the aim of this study is to analyze the validity evidence of the nursing diagnosis of ineffective self-management of blood glucose pattern risk in patients undergoing hemodialysis. This is a methodological study for the validation of the nursing diagnosis, following three stages proposed in the literature, namely: 1) theoretical-causal validity, through the construction of a mid-range theory for the nursing diagnosis; 2) content validity by experts; and 3) clinical validity. The theory construction, in the first stage conducted between May 2023 and February 2024, was operationalized through a Scoping Review, guided by the JBI Reviewer’s Manual and following the recommendations of the Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews: Checklist and Explanation, with a registered research protocol on the Open Science Framework (DOI 10.17605/OSF.IO/EGZFS). In the second stage, in March 2024, content validation was performed by eight experts who assessed the adequacy of the content constructed in the first stage using the nominal group technique. In the third stage, the elements of the nursing diagnosis were clinically validated through a case-control study with 60 patients between May and August 2024. The project was approved by the Research Ethics Committee of the responsible institution (approval number: 5.906.314). The data were analyzed using descriptive statistics and simple statistics, with Fisher and Chi-square tests performed in the third stage. Central tendency and dispersion measures were calculated, and the Shapiro-Wilk and Wilcoxon tests were applied, along with the estimation of the Odds Ratio. In the results of the first stage, 20 studies were identified in the final sample, published between 2006 and 2023, mostly in English and from 11 countries. From the articles selected in the Scoping Review, it was possible to list 18 clinical antecedents, which were subdivided into: seven risk factors, seven associated conditions, and four at-risk populations. A pictogram, six propositions, and 18 causal relationships were also created. In the second stage, the experts evaluated and considered the diagnostic proposal appropriate, with few modifications. However, the risk factor "weight loss" was removed. Thus, the final proposition resulted in six risk factors, seven associated conditions, and four at-risk populations. In the third stage, the associated conditions of Diabetes Mellitus and high-flow dialyzer use, as well as the at-risk population of patients with a longer diagnosis of diabetes mellitus and elderly individuals, were able to increase the chances of developing the risk of ineffective selfmanagement of blood glucose pattern. It is concluded that there is validity evidence for the nursing diagnosis of ineffective self-management of blood glucose pattern risk in patients undergoing hemodialysis.
Avaliação do contexto no atendimento das equipes de consultório na rua às pessoas com tuberculose no estado do Rio Grande do Norte
(Universidade Federal do Rio Grande do Norte, 2024-12-17) Nascimento, Camila Priscila Abdias do; Pinto, Erika Simone Galvão; https://orcid.org/0000-0003-0205-6633; http://lattes.cnpq.br/2135320432342059; https://orcid.org/0000-0002-0245-2663; http://lattes.cnpq.br/9889038077799529; Medeiros, Eliabe Rodrigues de; Silva, Maria de Lourdes Costa da; Souza, Nilba Lima de; Silva, Sandy Yasmine Bezerra e
The homeless population is 56 times more susceptible to tuberculosis and is 50% less likely to complete treatment successfully, in addition to presenting abandonment and mortality rates that are 2.9 and 2.5 times higher, respectively. Given this scenario, the Ministry of Health implemented Street Clinics to expand access to health services for this population. In this sense, the objective was to evaluate the influence of the context of the teams in the care of people with tuberculosis in the State of Rio Grande do Norte. An evaluative study of the normative type and evaluative research was carried out, with a qualitative and quantitative approach, emphasizing the degree of implementation, structure/process/result and influence of the context, of the street clinic team. The study was approved by the Research Ethics Committee of the Federal University of Rio Grande do Norte, under opinion number 6,046,884. The study population consisted of 22 professionals who work directly or indirectly in the street clinic team. With regard to evaluative research, value judgment was used to analyze the relationships between the intervention and the context. The qualitative data obtained were analyzed using the content analysis technique proposed by Bardin (2011). As results and discussions, in terms of degree of implementation, the Structure dimension was classified as partially implemented. The Process dimension, in turn, was classified as fully implemented, but with some divergences from reality, according to what was revealed by the statements of the professionals interviewed when exposing their perceptions. As results and discussions, in terms of degree of implementation, the Structure dimension was classified as partially implemented. The Process dimension, in turn, was classified as fully implemented, but with some divergences from reality, according to what was revealed by the statements of the health professionals and managers interviewed when exposing their perceptions. In relation to the perceptions mentioned by eCnaR professionals, four thematic categories were raised: (I) social determinants of health and homelessness based on Milton Santos; (II) territory as a socially produced space and the responsibilities and activities of eCnaR and health managers; (III): power relations and the influence of context on eCnaR actions; and (IV) appropriation of the territory – potentialities and challenges in daily work. Considering the divergences between practical implementation and professionals' perception, we can infer that, even in a context of partial implementation, professional practice reflects an intuitive understanding and aligned with the principles of Milton Santos' theory.
Micropolítica dos processos de trabalho de enfermeiras rurais: uma cartografia das práticas de cuidado
(Universidade Federal do Rio Grande do Norte, 2024-11-29) Silva, Bruno Neves da; Pinto, Erika Simone Galvão; https://orcid.org/0000-0003-0205-6633; http://lattes.cnpq.br/2135320432342059; https://orcid.org/0000-0001-9854-4492; http://lattes.cnpq.br/0480443971812661; Véras, Gerlane Cristinne Bertino; Silva, Ana Lucia Abrahão da; Sampaio, Cristina Andrade; Riquinho, Deise Lisboa; Zillmer, Juliana Graciela Vestena; Souza, Nilba Lima de
This study aimed to map the micropolitics of the work processes of rural nurses in the development of their care practices. It is a qualitative study, grounded in Sanna’s conceptual framework on the nursing work process and in the theoretical-methodological perspective of cartography by Gilles Deleuze and Félix Guattari. Data were collected between November and December 2022 and September 2024 through discursive interviews, the "instructions to the double" technique, and participant observation of the work process of eight rural nurses selected by intentional sampling. The interviews and "instructions to the double" were audio-recorded, transcribed, and complemented with field notes, forming an empirical corpus analyzed using Foucauldian discourse analysis and supported by the analytical flowchart proposed by Merhy. The data were interpreted in light of the adopted theoretical and conceptual frameworks. The study was approved by the Research Ethics Committee of the Federal University of Rio Grande do Norte under opinion number 5.695.462. As a result of the analysis, four discursive blocks were constructed: (1) The mesh of care practices developed by rural nurses: between approaches and distances from urban performance; (2) "There are rural professionals who don't want to get their hands dirty": the hard lines that cross the micropolitics of rural nurses' work processes; (3) The establishment of bonds as points that generate lines of flight; and (4) The constitution of the rural nurse as a subject. The understandings derived from these blocks enabled the comprehension that care practices in the "Caring" and "Managing" work processes are organized primarily around spontaneous demand and protocol-based actions guided by the Ministry of Health, reproducing urban models centered on light-hard technologies. This configuration reinforces the hegemony of the biomedical model and devalues strategies focused on health promotion and the expanded use of nursing consultations as clinical-political tools. However, points of rupture with these hard lines were identified, especially in the establishment of bonds with the population, functioning as lines of flight capable of mobilizing light technologies and producing more sensitive, integral, and territorially connected care. Within these intersecting forces, the rural nurse emerges as a subject in becoming, constituted in the folds between the instituted and the instituting, shaped by identification with the territory, lived experiences, and the ethical implications of care. The findings point to the need to strengthen public policies committed to the specificities of rural contexts, institutional practices that acknowledge territorial complexity, and academic training that includes content focused on rural care. Furthermore, cartography is highlighted as a powerful method in nursing research, enabling not only description but also a sensitive follow-up of processes in action, making visible the assemblages that organize, challenge, and recreate care in everyday life. This method allows care to emerge in cartographic form and operate as an inventive practice that strengthens bonds and contributes to improving quality of life and the well-being of rural populations. In its ethical and political dimension, this study reaffirms rural nursing as a legitimate field of knowledge and practice, still in the process of gaining visibility, and calls for new perspectives that recognize the rural territory as a living place of health production.
Construção e validação de conteúdo e aparência de fluxograma para atenção à saúde de pessoas com doenças hematológicas
(Universidade Federal do Rio Grande do Norte, 2024-09-13) Alves, Tássia Regine de Morais; Azevedo, Isabelle Campos de; http://lattes.cnpq.br/0677259394113490; https://orcid.org/0000-0002-4237-0400; http://lattes.cnpq.br/9502954025692831; Vitor, Allyne Fortes; Araújo, Jessica Naiara de Medeiros; Ferreira Júnior, Marcos Antonio; Santos, Viviane Euzébia Pereira
The construction of a flowchart, as a management technology, enables a better understanding of care practices, the organization of health care, and the structuring of the work process based on the description of the user's therapeutic journey within the Health Care Networks. The objective was to develop a flowchart for health care for people with hematologic neoplasms. This is a methodological study, with a mixed approach, anchored in Pasquali's psychometrics (2010), structured in three procedures: theoretical, analytical, and empirical. For the theoretical procedures, literature searches were carried out through an integrative review focusing on scientific evidence on health care for patients with hematologic neoplasms and a focus group consisting of health professionals. In the empirical procedures stage, a compilation of the information collected in the previous stage was made to support the construction of the flowchart. The validation of the content and appearance of the flowchart was carried out through the Delphi technique, with the evaluation of the criteria proposed by Pasquali and the Suitability Assessment of Materials. Finally, the analytical procedures occurred through the content validation coefficient and agreement between the judges. The study was approved by the Research Ethics Committee of the Federal University of Rio Grande do Norte and obtained approval under CAAE: 67213623.0.0000.5537. The results of the integrative review showed a final sample of 17 studies and revealed that the care provided to patients with hematologic neoplasms is more concentrated in the medium and high complexity levels of health care, since cancer is a pathology with therapeutic complexity that requires equipment and human resources appropriate for specialized care. The focus group included the participation of 10 nurses and one physician in different cities in the Brazilian regions, and all reported the difficulty in accessing treatment, for various reasons such as social and economic factors, the lack of qualifications of health professionals, especially in Primary Care, and timely access to specialized care. Regarding the content validation process, in the Delphi I round the flowchart reached a final CVC of 0.82 and an agreement of 53% among the judges. After adapting the flowchart, according to the judges' suggestions, in the Delphi II round, all criteria were validated, with a final CVC of 0.99 and an agreement of 93%. That said, the flowchart is considered useful and valid in its content and appearance as a management technology for the systematization of care and guidance to health professionals with elements that contemplate the therapeutic itinerary of onco-hematological patients, from the moment the user enters primary care. In addition to containing important information about reception, care flows, decision-making, referrals, consultations with multidisciplinary and nursing teams.

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