ICNP® terminology subset for patients with cancer-associated venous thromboembolism

Vidigal, Paula Dias; Garcia, Telma Ribeiro; Santos, Mauro Leonardo Salvador Caldeira dos; Camacho, Alessandra Conceição Leite Funchal; Souto, Marise Dutra; Borges, Giselle Gomes; Fuly, Patrícia dos Santos Claro

doi:10.1590/1982-0194201800054

Acessibilidade / Reportar erro

Brasil

Acta Paulista de Enfermagem

Español English

Brasil

Español English

sumário « anterior atual seguinte »

Sumário

Original Article • Acta Paul Enferm 31 (4) • Jul-Aug 2018 • https://doi.org/10.1590/1982-0194201800054 copy

ICNP® terminology subset for patients with cancer-associated venous thromboembolism

Authorship SCIMAGO INSTITUTIONS RANKINGS

Abstract

Objective

To develop and validate an International Classification for Nursing Practice (ICNP^®) terminology subset for patients with cancer-associated venous thromboembolism.

Methods

Four-stage methodological study, namely: integrative review of the literature, in which were sought empirical evidence of nursing diagnoses and interventions related to cancer-associated venous thromboembolism in MEDLINE, PUBMED, CINAHL, LILACS, BDENF and COCHRANE databases in the period between 2001 and 2016. In the second stage of the study, was performed the cross-mapping between terms identified in the literature and terms included in the ICNP^®, version 2017. The third stage was the construction of the ICNP^® terminology subset containing the nursing diagnosis/outcomes and interventions statements that were distributed according to the Basic Human Needs of Wanda Horta’s conceptual framework. In the fourth stage, was performed the content validation of declarations by expert nurses.

Results

Thirty-seven nursing diagnosis and intervention statements were developed. Of these, 34 diagnoses and 35 interventions were validated. The inclusion of four nursing diagnoses as pre-coordinated concepts in the ICNP^® was proposed, as follows: Unilateral peripheral edema; Chronic peripheral edema; Low Blood oxygen saturation; and Knowledge of treatment regime.

Conclusion

The instrument can be an easy-access reference for nurses by providing evidence-based care and a unified nursing language.

Oncology nursing; Venous thromboembolism; Venous thrombosis; Nursing process; Nursing diagnosis

Psychobiological needs

Basic human need affected	Diagnosis	n(%)
Oxygenation	Dyspnea Impaired respiratory system function Low Blood Oxygen Saturation Cough	4(10.8)
Hydration	Unilateral Peripheral Edema Chronic Peripheral Edema	2(5.4)
Skin and mucosal integrity	Impaired Skin Integrity Venous Ulcer Inflammation	3(8.1)
Physical integrity	Risk for medication side effect	1(2.7)
Thermal regulation	Fever	1(2.7)
Neurological regulation	Risk for fall	1(2.7)
Immunological regulation	Risk for infection	1(2.7)
Vascular regulation	Impaired peripheral tissue perfusion Impaired vascular process Tachycardia Impaired cardiovascular system Altered blood pressure Risk for impaired cardiac function Nasal bleeding Risk for hemorrhaging Risk for deep vein thrombosis	9(24.3)
Locomotion	Impaired walking	1(2.7)
Tactile perception	High peripheral sensory perception	1(2.7)
Pain perception	Acute pain Acute chest pain Chronic pain Musculoskeletal pain	4(10.8)
Therapy	Impaired ability to manage medication regime	1(2.7)

Psychosocial needs

Security	Fear Anxiety	2(5.4)
Apprenticeship (health education)	Lack of knowledge of treatment regime	1(2.7)
Self-image	Impaired adaptation	1(2.7)
Self-achievement	Negative quality of life	1(2.7)
Participation	Non adherence to therapeutic regime Lack of family support Impaired ability of caregiver to perform caretaking	3(8.1)

Nursing diagnosis	Concordance index	Adequacy	Pertinence	Clarity	Accuracy	Objectivity
Dyspnea	0.93	0.94	0.93	0.94	0.93	0.92
Impaired respiratory system function	0.89	0.89	0.89	0.87	0.90	0.90
Low blood oxygen saturation	0.86	0.86	0.88	0.84	0.86	0.86
Cough	0.81	0.82	0.80	0.81	0.81	0.82
Unilateral peripheral edema	0.82	0.82	0.82	0.83	0.83	0.82
Chronic peripheral edema	0.82	0.80	0.80	0.88	0.83	0.82
Impaired skin integrity	0.86	0.86	0.87	0.84	0.84	0.86
Venous ulcer	0.88	0.89	0.88	0.89	0.88	0.87
Inflammation	0.74	0.78	0.78	0.67	0.74	0.72
Risk for medication side effect	0.83	0.84	0.83	0.82	0.83	0.82
Fever	0.81	0.83	0.82	0.81	0.78	0.81
Risk for fall	0.91	0.92	0.91	0.92	0.92	0.91
Risk for infection	0.82	0.82	0.84	0.82	0.82	0.80
Impaired peripheral tissue perfusion	0.84	0.83	0.84	0.84	0.85	0.85
Impaired vascular process	0.84	0.85	0.86	0.83	0.84	0.83
Tachycardia	0.84	0.83	0.83	0.84	0.83	0.85
Impaired cardiovascular system	0.89	0.88	0.89	0.90	0.89	0.91
Altered blood pressure	0.86	0.86	0.85	0.88	0.85	0.88
Risk for impaired cardiac function	0.90	0.90	0.91	0.91	0.91	0.88
Nasal bleeding	0.83	0.82	0.83	0.81	0.83	0.84
Risk for hemorrhaging	0.88	0.86	0.87	0.88	0.90	0.88
Risk for deep vein thrombosis	0.89	0.88	0.87	0.90	0.90	0.90
Impaired walking	0.90	0.89	0.89	0.94	0.90	0.90
High peripheral sensory perception	0.79	0.82	0.83	0.78	0.76	0.77
Acute pain	0.83	0.82	0.87	0.84	0.80	0.83
Acute chest pain	0.79	0.76	0.79	0.82	0.78	0.80
Chronic pain	0.84	0.84	0.86	0.82	0.81	0.86
Musculoskeletal pain	0.86	0.85	0.87	0.87	0.85	0.86
Impaired ability to manage medication regime	0.81	0.83	0.83	0.78	0.79	0.80
Fear	0.86	0.88	0.85	0.85	0.87	0.87
Anxiety	0.88	0.88	0.89	0.90	0.87	0.88
Low knowledge of treatment regime	0.90	0.90	0.91	0.91	0.91	0.89
Impaired adaptation	0.86	0.86	0.86	0.86	0.88	0.87
Negative quality of life	0.86	0.87	0.88	0.82	0.86	0.85
Non adherence to therapeutic regime	0.90	0.90	0.91	0.91	0.90	0.88
Lack of Family support	0.83	0.82	0.82	0.85	0.82	0.83
Impaired ability of caregiver to perform caretaking	0.85	0.86	0.86	0.84	0.84	0.85

Nursing diagnosis with validated group of interventions/Main group intervention	Concordance index	Adequacy	Pertinence	Clarity	Accuracy	Objectivity
Dyspnea/Elevating the chest	0.92	0.94	0.94	0.92	0.91	0.90
Impaired respiratory system function/Assessing respiratory status	0.90	0.90	0.91	0.88	0.91	0.88
Low blood oxygen saturation/Monitoring blood oxygen saturation using pulse oximeter or arterial blood gas, if indicated	0.89	0.89	0.90	0.89	0.90	0.87
Cough/Observing cough: frequency, onset, duration, intensity, associated signs and symptoms, precipitating factors, attenuating factors	0.84	0.84	0.83	0.85	0.82	0.83
Unilateral peripheral edema/Obtaining data on edema: evaluating the Godet sign daily and observing associated signs and symptoms (pain, stuffing, heat, blister)	0.88	0.88	0.88	0.89	0.89	0.88
Chronic peripheral edema/Encourage resting if there is edema or discomfort	0.83	0.80	0.82	0.85	0.84	0.81
Impaired skin integrity/Obtaining data on skin: integrity, hydration, coloring and presence of other changes	0.85	0.85	0.86	0.85	0.84	0.85
Risk for medication side effect/Monitor occurrence of bleeding	0.84	0.84	0.84	0.82	0.84	0.85
Fever/Monitoring signs and symptoms of infection	0.82	0.78	0.83	0.84	0.84	0.83
Risk for fall/Identifying patients at high risk for fall and informing the team according to institutional protocol (bracelet, identification in the medical record)	0.88	0.88	0.88	0.90	0.87	0.88
Risk for infection/Training staff for environmental sanitation and precaution techniques, as needed	0.85	0.86	0.86	0.85	0.83	0.83
Impaired peripheral tissue perfusion/Obtaining data on peripheral tissue perfusion (peripheral capillary perfusion, peripheral pulse, edema, cyanosis)	0.86	0.88	0.88	0.85	0.85	0.86
Impaired vascular process/Monitoring tissue perfusion: assessing daily changes in tissue perfusion or skin; assessing ecodoppler examination result	0.87	0.86	0.87	0.86	0.88	0.88
Tachycardia/Monitoring vital signs	0.86	0.85	0.87	0.90	0.85	0.85
Impaired cardiovascular system/Monitoring cardiac condition during acute phase of venous thromboembolism by checking frequency, rhythm and alterations in the electrocardiographic tracing	0.90	0.90	0.90	0.92	0.90	0.89
Altered blood pressure/Implement cardiorespiratory physical examination by considering signs of low output and respiratory pattern	0.87	0.86	0.86	0.88	0.87	0.88
Risk for impaired cardiac function/Assessing signs of low cardiac output: oliguria, filiform pulse, cold extremities, and hypotension	0.84	0.84	0.84	0.86	0.85	0.80
Nasal bleeding/Evaluating bleeding	0.86	0.86	0.85	0.87	0.84	0.87
Risk for hemorrhaging/Evaluating signs and symptoms of bleeding in integumentary, intestinal, urinary and respiratory systems	0.87	0.88	0.88	0.87	0.88	0.88
Risk for deep vein thrombosis/Teaching about anticoagulant therapy: objective, importance of adherence, duration, side effects, follow-up consultations and situations to seek health care	0.91	0.91	0.90	0.92	0.90	0.90
Acute pain/Obtaining pain data (characteristics of pain, including location, onset, duration, frequency, quality, intensity, precipitating factors, mitigating factors, and use of pain medication)	0.85	0.84	0.87	0.85	0.83	0.86
Chronic pain/Providing guidance for patient and family on pain management (time of pharmacological analgesia, concomitant drugs, use of non-pharmacological techniques for pain relief)	0.85	0.81	0.85	0.87	0.86	0.87
Musculoskeletal pain/Guiding to rest and lift limbs for discomfort relief	0.85	0.85	0.84	0.86	0.84	0.85
Impaired ability to manage medication regime/Obtaining data on ability to perform care: ability of reading, understanding orientations, motor ability	0.91	0.90	0.91	0.90	0.92	0.91
Fear/Offering emotional support: performing active listening, user embracement, touching	0.86	0.85	0.85	0.88	0.87	0.83
Anxiety/Obtaining data on anxiety (onset, associated symptoms, precipitating factors)	0.87	0.88	0.87	0.88	0.86	0.87
Lack of knowledge of treatment regime/Obtaining knowledge data about treatment regime: time of treatment, dose, schedule of administration, side effects, warning signs and outpatient follow-up	0.87	0.88	0.89	0.88	0.86	0.85
Impaired adaptation/Protect patients’ autonomy	0.85	0.83	0.84	0.88	0.85	0.84
Negative quality of life/Promoting social support: identifying social support network, calling family and/or caregiver to participate in care; identifying basic health unit of reference, referring to social services	0.85	0.87	0.87	0.85	0.83	0.84
Non adherence to therapeutic regime/Obtaining data on adherence barriers: difficulty with understanding, functional illiteracy, lack of social/family support	0.89	0.89	0.89	0.90	0.90	0.90
Lack of family support/Calling the family and guiding on the importance of participation for therapeutic success	0.80	0.80	0.80	0.80	0.82	0.80
Impaired ability of caregiver to perform caretaking/Facilitating family’s ability to participate in the care plan: including them in guidelines on disease and therapeutic regime; invite other family members to participate in orientations; teaching the form of medication administration	0.85	0.84	0.86	0.85	0.86	0.85

Escola Paulista de Enfermagem, Universidade Federal de São Paulo R. Napoleão de Barros, 754, 04024-002 São Paulo - SP/Brasil, Tel./Fax: (55 11) 5576 4430 - São Paulo - SP - Brazil
E-mail: actapaulista@unifesp.br

Acompanhe os números deste periódico no seu leitor de RSS

[1] Corresponding author. Paula Dias Vidigal. E-mail: pdvidigal@hotmail.com