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SPECIALIZED NURSING TERMINOLOGY FOR PEOPLE WITH VISCERAL LEISHMANIASIS

ABSTRACT

Objective:

to create specialized Nursing terminology for the care of people with Visceral Leishmaniasis.

Method:

a methodological study carried out in two stages: identification of the relevant concepts in medical records of patients with chosen health priority admitted between 2017 and 2019 to a public and teaching hospital in the north of Minas Gerais, BR; cross-mapping of the concepts identified with the ICNP®.

Results:

a total of 57,797 simple and compound (with repetitions) concepts, were extracted, of which 624 were useful single concepts for the Nursing care to be provided to people with Visceral Leishmaniasis. 281 (45%) primitive concepts were identified as included in ICNP® 2019-2020, as well as 343 (55%) not included in the classification. The concepts related to Focus and Location stood out in the axes.

Conclusions:

a specialized ICNP® terminology was created for the care of people with Visceral Leishmaniasis, with potential impacts on the standardization of actions and on generation of indicators sensitive to the Nursing practice.

DESCRIPTORS:
Classification; Nursing; Visceral Leishmaniasis; Methodological Research in Nursing; Standardized Nursing Terminology.

RESUMO:

Objetivo:

construir uma terminologia especializada de enfermagem para o cuidado de pessoas com Leishmaniose Visceral.

Método:

estudo metodológico, realizado em duas etapas: identificação dos conceitos relevantes em prontuários de pacientes com a prioridade de saúde eleita internados em hospital público e de ensino do norte de Minas Gerais, BR, entre 2017 e 2019; e mapeamento cruzado dos conceitos identificados com a CIPE®.

Resultados:

extraíramse 57.797 conceitos simples e compostos (com repetições), dos quais, 624 foram considerados conceitos únicos úteis no cuidado de enfermagem à pessoa com Leishmaniose Visceral. Foram identificados 281 (45%) conceitos primitivos como constantes na CIPE® 2019-2020 e 343 (55%) não constantes na classificação. Nos eixos, destacaram-se os conceitos relacionados ao Foco e Localização.

Conclusões:

construiu-se uma terminologia especializada da CIPE® para o cuidado de pessoas com Leishmaniose Visceral com potenciais impactos na padronização de ações e geração de indicadores sensíveis à prática de enfermagem.

DESCRITORES:
Classificação; Enfermagem; Leishmaniose Visceral; Pesquisa Metodológica em Enfermagem; Terminologia Padronizada em Enfermagem.

RESUMEN

Objetivo:

desarrollar terminología especializada de Enfermería para la atención de personas con Leishmaniasis Visceral.

Método:

estudio metodológico realizado en dos etapas: identificación de los conceptos relevantes en historias clínicas de pacientes con la prioridad de salud elegida internados entre 2017 y 2019 en un hospital público y de enseñanza del norte de Minas Gerais, Brasil; mapeo cruzado de los conceptos identificados con los de la CIPE®.

Resultados:

se extrajeron 57 797 conceptos simples y compuestos (con repeticiones), de los cuales 624 eran conceptos únicos útiles para la atención de Enfermería provista a personas con Leishmaniasis Visceral. Se identificaron 281 (45%) conceptos primitivos incluidos en la CIPE® 2019-2020 y 343 (55%) no incluidos en la clasificación. En los ejes se destacaron los conceptos relacionados con Foco y Lugar.

Conclusiones:

se elaboró una terminología especializada de la CIPE® para la atención de personas con Leishmaniasis Visceral, con potenciales efectos sobre la estandarización de acciones y la, generación de indicadores sensibles a la práctica de Enfermería.

DESCRIPTORES:
Clasificación; Enfermería; Leishmaniasis Visceral; Investigación Metodológica de Enfermería; Terminología Estandarizada de Enfermería.

HIGHLIGHTS

  1. Specialized ICNP® terminology for people with Visceral Leishmaniasis

  2. Contribution in the development of care, management and education technologies

  3. Standardization of actions and generation of Nursing indicators

HIGHLIGHTS

  1. Specialized ICNP® terminology for people with Visceral Leishmaniasis

  2. Contribution in the development of care, management and education technologies

  3. Standardization of actions and generation of Nursing indicators

INTRODUCTION

Visceral Leishmaniasis (VL), caused by intracellular protozoa Leishmania donovani and L. infantum (syn L. chagasi), is an infection with a zoonotic transmission medium, which is initiated when the parasites are deposited on the skin by the sandfly vector11 González U, Pinart M, Sinclair D, Firooz A, Enk C, Vélez ID, et al. Vector and reservoir control for preventing leishmaniasis. Cochrane Database Syst Rev. [Internet]. 2015 [cited on 2021 Aug. 20]; 8(CD008736):1-80. Available in: https://doi.org/10.1002/14651858.CD008736.pub2.
https://doi.org/10.1002/14651858.CD00873...
-22 Kong F, Saldarriaga OA, Spratt H, Osorio EY, Travi BL, Luxon B, et al. Transcriptional profiling in experimental visceral leishmaniasis reveals a broad splenic inflammatory environment that conditions macrophages toward a disease-promoting phenotype. PLoS Pathog. [Internet]. 2017 [cited on 2021 Sept. 16]; 13(1):e1006165. Available in: https://doi.org/10.1371/journal.ppat.1006165.
https://doi.org/10.1371/journal.ppat.100...
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Currently, VL is considered as a neglected tropical disease that can cause nearly 20,000 to 40,000 deaths per year at the global level. In the American continent, VL is present in 12 countries, with 96% of the cases concentrated in Brazil, which reached a lethality rate of 7.4% in 2016. Although manifested in all Brazilian states, the highest detection coefficients are observed in the North region of the country33 Carvalho IPSF de, Peixoto HM, Romero GAS, Oliveira, MRF de. Treatment for human visceral leishmaniasis: a cost-effectiveness analysis for Brazil. Trop Med Int Health. [Internet]. 2019 [cited on 2021 Aug. 26]; 24(9):1064-77. Available in: https://doi.org/10.1111/tmi.13284.
https://doi.org/10.1111/tmi.13284...
-44 Batista FM de A, Sousa RA de, Aguiar BGA, Ibiapina AB, Albuquerque LP de A, Mendonça VJ, et al. Perfil epidemiológico e tendência temporal da leishmaniose visceral: Piauí, Brasil, 2008 a 2018. Cad Saude Publica. [internet] 2021;37(11). [cited on 2021 Oct. 03]; 12(9):e0006697. Available in: https://www.scielo.br/j/csp/a/bgMWPkYV5FP3CQhH44Hwtps/?format=pdf⟨=pt.
https://www.scielo.br/j/csp/a/bgMWPkYV5F...
. It is noted that the standardized incidence rate by age and the life years lost for VL increased from 52.8% in 1990 to 108% in 2016, being also higher than the rate of years lived with disability44 Batista FM de A, Sousa RA de, Aguiar BGA, Ibiapina AB, Albuquerque LP de A, Mendonça VJ, et al. Perfil epidemiológico e tendência temporal da leishmaniose visceral: Piauí, Brasil, 2008 a 2018. Cad Saude Publica. [internet] 2021;37(11). [cited on 2021 Oct. 03]; 12(9):e0006697. Available in: https://www.scielo.br/j/csp/a/bgMWPkYV5FP3CQhH44Hwtps/?format=pdf⟨=pt.
https://www.scielo.br/j/csp/a/bgMWPkYV5F...
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In Brazil, diagnosis, treatment and care of VL patients are in charge of the Unified Health System, in the Primary Health Care context. However, despite the actions implemented in endemic areas of the country, VL control interventions are still little successful and transmission of the disease progresses. Among the direct cots, approximately 40% correspond to the hospital care expenses, due to hospitalization for treatments with more complex therapeutic regimes33 Carvalho IPSF de, Peixoto HM, Romero GAS, Oliveira, MRF de. Treatment for human visceral leishmaniasis: a cost-effectiveness analysis for Brazil. Trop Med Int Health. [Internet]. 2019 [cited on 2021 Aug. 26]; 24(9):1064-77. Available in: https://doi.org/10.1111/tmi.13284.
https://doi.org/10.1111/tmi.13284...

4 Batista FM de A, Sousa RA de, Aguiar BGA, Ibiapina AB, Albuquerque LP de A, Mendonça VJ, et al. Perfil epidemiológico e tendência temporal da leishmaniose visceral: Piauí, Brasil, 2008 a 2018. Cad Saude Publica. [internet] 2021;37(11). [cited on 2021 Oct. 03]; 12(9):e0006697. Available in: https://www.scielo.br/j/csp/a/bgMWPkYV5FP3CQhH44Hwtps/?format=pdf⟨=pt.
https://www.scielo.br/j/csp/a/bgMWPkYV5F...
-55 Ministério da Saúde (BR). Secretaria de Vigilância em Saúde. Departamento de Vigilância Epidemiológica. Manual de vigilância e controle da leishmaniose visceral [Internet]. Brasília: Ministério da Saúde; 2006. [cited on 2021 Aug. 26]. Available in: https://bvsms.saude.gov.br/bvs/publicacoes/manual_vigilancia_controle_leishmaniose_visceral.pdf.
https://bvsms.saude.gov.br/bvs/publicaco...
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Given the need for care, nurses must implement a clinical practice grounded on scientific evidence, as well as on theoretical and practical knowledge. They should provide individual and collective support, with interventions that alleviate or improve the biological, psychological and social needs of the person, family or collective group.

In this sense, the Nursing Process (NP) is the clinical method of the profession that is employed to systematize the professional practice, even the care provided to VL patients. The NP comprises five inter-related, independent and recurrent stages66 Santos MG dos, Bitencourt JV de OV, Silva TG da, Frizon G, Quinto AS. Etapas do processo de enfermagem: uma revisão narrativa. Enferm. Focus. [Internet]. 2018 [cited on 2021 Aug. 26]; 8(4):49-53. Available in: http://revista.cofen.gov.br/index.php/enfermagem/article/view/1032/416.
http://revista.cofen.gov.br/index.php/en...
. It is essential to structure the concepts according to the Nursing scientific determination, thus enabling standardization of the professional language used in the assistance provided to VL patients77 Nóbrega MML, Cubas MR, Egry EY, Nogueira LGF, Carvalho CMG, Albuquerque LM. Desenvolvimento de subconjuntos terminológicos da CIPE® no Brasil. In: Cubas MR, Nóbrega MML. Atenção primária em saúde: diagnóstico, resultado e intervenções de enfermagem. Rio de Janeiro: Elsevier; 2015. p. 25-36..

Using specialized Nursing terminology is the main objective of the International Council of Nurses (ICN), having been pointed out as an important action to consolidate Nursing as care science and systematization88 Garcia TR, Bartz CC, Coenen AM. CIPE®: uma linguagem padronizada para a prática profissional. In: Garcia TR, (Org). Classificação Internacional para a Prática de Enfermagem (CIPE®): versão 2017. Porto Alegre: Artmed; 2017.. In this sense, the International Classification for Nursing Practice (ICNP88 Garcia TR, Bartz CC, Coenen AM. CIPE®: uma linguagem padronizada para a prática profissional. In: Garcia TR, (Org). Classificação Internacional para a Prática de Enfermagem (CIPE®): versão 2017. Porto Alegre: Artmed; 2017.) is highlighted, a classification system that structures the elements of the NP, namely: Nursing diagnoses, results and interventions. According to the World Health Organization (WHO)99 Organização Mundial de Saúde (OMS). Leishmaniose [Internet]. Genebra: OMS; 2020. [cited on 2021 Dec. 19]. Available in: https://www.who.int/en/news-room/fact-sheets/detail/leishmaniasis.
https://www.who.int/en/news-room/fact-sh...
, VL is considered one of the five priority neglected diseases for eradication, and is still a challenge in the Americas that requires action strategies based on targeted and standardized care99 Organização Mundial de Saúde (OMS). Leishmaniose [Internet]. Genebra: OMS; 2020. [cited on 2021 Dec. 19]. Available in: https://www.who.int/en/news-room/fact-sheets/detail/leishmaniasis.
https://www.who.int/en/news-room/fact-sh...
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It is also noted that, at the national and international levels, only one study1010 Souza Neto VL de, Costa C da S, Silva IKM, Negreiros RV de, Godoy ECP de, Silva BCO da, et al. Profile diagnosis of nursing for people with leishmaniose. Rev enferm Centro- Oeste Min. [Internet]. 2017 [cited on 2021 Sept. 12]; 7:e1381. Available in: http://dx.doi.org/10.19175/recom.v7i0.1381
http://dx.doi.org/10.19175/recom.v7i0.13...
was found about the Nursing diagnosis profile for people with Leishmaniasis. Thus, a gap is evidenced in the knowledge about specialized Nursing terminology for people with VL.

The objective of the current study is to create specialized Nursing terminology for the care of people with Visceral Leishmaniasis.

METHOD

A Methodological Nursing research study that followed the recommendations for the development of ICNP® terminologies in Brazil77 Nóbrega MML, Cubas MR, Egry EY, Nogueira LGF, Carvalho CMG, Albuquerque LM. Desenvolvimento de subconjuntos terminológicos da CIPE® no Brasil. In: Cubas MR, Nóbrega MML. Atenção primária em saúde: diagnóstico, resultado e intervenções de enfermagem. Rio de Janeiro: Elsevier; 2015. p. 25-36., with the following stages: 1) identification of the relevant concepts in the Nursing area for the care of chosen health priority; and 2) cross-mapping of the concepts identified with the primitive concepts from ICNP® 201920201111 Garcia TR (Org). Classificação Internacional para a Prática de Enfermagem (CIPE®): versão 2019/2020. Porto Alegre: Artmed; 2020..

In the first stage, a survey was carried out of the medical records of adult patients admitted between 2017 and 2019 with a VL diagnosis to a public and teaching hospital in the north of Minas Gerais, Brazil. It is emphasized that data collection referred to the 2017-2019 period since, during those years, Scientific Initiation students attending the undergraduate Nursing course were included in the study scenario, all linked to the research project. In addition to that, data saturation was noticed during collection in the period established, thus not impacting the final results despite the two-year time frame.

The hospital’s care structure has a Specialty Outpatient Center and a Reference Center for Older Adults’ Health Care, in addition to being a reference in Gynecology/Obstetrics care, high-risk pregnant women, victims of dog and cat bites, snakebite accidents, victims of sexual and intrafamily violence, patients in mental distress, Medical Clinic, people with Sexually Transmitted Infections, General Surgery, tuberculosis, otorhinolaryngology, level II trauma, Visceral and Cutaneous Leishmaniasis, clinical treatment in Infectology and Pediatrics. Thus, selection of the hospital is justified because it is a reference for the care of chosen health priority, as the northern region of Minas Gerais is endemic for VL.

The following inclusion criteria were established: medical records of adult patients aged at least 18 years old; with a history of hospitalization in the Medical Clinic of the study hospital between 2017 and 2019 and with a clinical VL diagnosis. The following exclusion criterion was defined: medical charts that failed to provide data of interest for the study (incomplete).

A total of 483 patients were hospitalized with a VL diagnosis in the study hospital between 2017 and 2019. Of these, two medical records did not meet the inclusion criteria because they were from patients hospitalized in the neonatal Intensive Care Unit (ICU), eight in the ICU for adults, 31 in the Emergency room, two in the Surgical Clinic and 294 in the Pediatrics sector. The final sample consisted in 146 medical charts.

In the first stage, the electronic medical charts of all 146 patients were organized by two researchers into individual files in Word for Windows®, version 2013, leaving only the textual part of the multiprofessional records (nurses, nursing technicians, physicians, nutritionists and physiotherapists), used to extract the concepts. Due to the length of the documents, three different moments were selected between the hospitalization days of each patient, adopting the following strategy: professional records referring to the patient’s admission to the Medical Clinic; the median related to the hospitalization days of each patient; and professional records belonging to the last hospitalization day of each patient in the unit. Eventually, there was a total of 430 different moments with professional records.

The files in Word for Windows®, version 2013, were converted to PDF format and applied to the PORONTO program, a tool that extracts concepts, taxonomic relationships and occurrence frequency1212 Zahfra FM, Carvalho DR, Malucelli A. Poronto: ferramenta para construção semiautomática de ontologias em português. J Health Inform. [Internet]. 2013 [cited on 2021 Aug. 26]; 5(2):52-9. Available in: https://jhi.sbis.org.br/index.php/jhi-sbis/article/view/232.
https://jhi.sbis.org.br/index.php/jhi-sb...
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Afterwards, grammatical gender and verb tense adequacy was carried out, excluding concepts referring to other areas, as well as those considered unconnected to Nursing care for people with VL.

The normalization and standardization process corresponding to the single primitive concepts (without repetitions) was then carried out by two researchers and, in case of divergence, a third researcher was consulted. This considered aspects such as synonyms, known, standardized and commonly used acronyms in Nursing team communication, medical concepts, diseases, medications and drug classes, verb tense, grammatical class, semantic meaning, and grammatical and typing errors1313 Nascimento MNR, Moreira AEA, Ramos N de M, Gomes EB, Félix ND de C, Oliveira CJ de. Specialized nursing terminology for the care of people with chronic heart failure. Esc Anna Nery. [Internet]. 2021 [cited on 2021 July 15]; 25(2):e20200306. Available in: https://doi.org/10.1590/2177-9465-ean-2020-0306.
https://doi.org/10.1590/2177-9465-ean-20...
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In the second stage, according to ISO Standard 12300:20161414 International Organization for Standardization. ISO 12300: health informatics: principles of mapping between terminological systems. Genebra: ISO; 2016., a Access for Windows®, version 2013, was used to cross-map the concepts extracted from the medical records with the primitive concepts present in the Model of the Seven Axes from ICNP® 2019-20201111 Garcia TR (Org). Classificação Internacional para a Prática de Enfermagem (CIPE®): versão 2019/2020. Porto Alegre: Artmed; 2020., comparing them and determining semantic similarity, similitude and consolidation of the specialized terminology1414 International Organization for Standardization. ISO 12300: health informatics: principles of mapping between terminological systems. Genebra: ISO; 2016. in the area of Nursing for people with VL.

The data were added to a Microsoft Excel 2013® spreadsheet and descriptive analysis was performed (absolute and relative frequency), organized in charts presenting the primitive concepts included, using the corresponding codes taken from the ICNP® browser and concepts not included, both in compliance with the seven ICNP® axes. The concepts that appeared in the analysis corpus at least 50 times were identified, with the aim of evidencing the primitive concepts from the Focus axis, as they generally stand out in frequency and because they determine the fundamental aspects for identifying Nursing diagnoses about the patients’ real and/or potential needs1010 Souza Neto VL de, Costa C da S, Silva IKM, Negreiros RV de, Godoy ECP de, Silva BCO da, et al. Profile diagnosis of nursing for people with leishmaniose. Rev enferm Centro- Oeste Min. [Internet]. 2017 [cited on 2021 Sept. 12]; 7:e1381. Available in: http://dx.doi.org/10.19175/recom.v7i0.1381
http://dx.doi.org/10.19175/recom.v7i0.13...
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This study was approved by the Research Ethics Committee of the Montes Claros State University (Universidade Estadual de Montes Claros, UNIMONTES) under opinion number: 3,037,406.

RESULTS

Of all 146 medical charts, 107 (73.3%) were of male patients. The age group varied from 18 to 89 years old, with a mean of 48.29 (SD: ±17.104). The hospitalization time varied between one and 120 days, with a mean of 16.53 (SD: ±12.001).

Among the medical charts evaluated, 57,797 simple and compound (with repetitions) concepts were extracted, of which 5,047 were single concepts (with repetitions). Subsequently, the main researcher selected the concepts inherent to Nursing care for the Leishmaniasis health priority, according to the definitions established for each of the seven ICNP® axes88 Garcia TR, Bartz CC, Coenen AM. CIPE®: uma linguagem padronizada para a prática profissional. In: Garcia TR, (Org). Classificação Internacional para a Prática de Enfermagem (CIPE®): versão 2017. Porto Alegre: Artmed; 2017., remaining 624 single, simple and compound primitive concepts.

The number of appearances of the primitive concepts varied from one to 887 times. Table 1 presents, in decreasing order, the primitive concepts with occurrence frequency in the analysis corpus equal to or greater than 50.

Table 1
Concepts that appear at least 50 times in the analysis corpus. Montes Claros, MG, Brazil, 2021

Of all 624 single primitive concepts, 281 (45%) were identified as included in ICNP® 2019-2020. Predominance was evidenced in the Focus (n=134; 47.70%) and Location (n=54; 19.20%) axes, as presented in Chart 1.

Chart 1
Primitive concepts classified as included in ICNP® 2019-2020. Montes Claros, MG, Brazil, 2021

Regarding all 343 (55%) primitive concepts not included in ICNP® 2019-2020, the Focus (n=94; 27.40%) and Location (n=82; 23.90%) axes also stood out, as pointed out in Chart 2.

Chart 2
Primitive concepts classified as not included in ICNP®2019-2020. Montes Claros, MG, Brazil, 2021

DISCUSSION

As a still uncontrolled public health problem in Brazil and in the world, VL requires attention regarding actions and services and, essentially, in terms of its direct care99 Organização Mundial de Saúde (OMS). Leishmaniose [Internet]. Genebra: OMS; 2020. [cited on 2021 Dec. 19]. Available in: https://www.who.int/en/news-room/fact-sheets/detail/leishmaniasis.
https://www.who.int/en/news-room/fact-sh...
. Nursing care stands out, which, based on a standardized language, can universalize its actions to combat and control this condition, contributing to the clinical Nursing practice and care management.

From the cross-mapping process of the primitive concepts, a considerable number of concepts not included in the ICNP® was evidenced, which shows the need to standardize the language, even more so when it comes to documentary evidence of the clinical practice. The cross-mapping process aims at recognizing the similarities and differences in the language used, with the potential to standardize and add new aspects related to that language, with a view to universalizing it1111 Garcia TR (Org). Classificação Internacional para a Prática de Enfermagem (CIPE®): versão 2019/2020. Porto Alegre: Artmed; 2020.,1414 International Organization for Standardization. ISO 12300: health informatics: principles of mapping between terminological systems. Genebra: ISO; 2016..

The identification and analysis of the terms not included indicates the need to incorporate new terms into the ICNP®. Considering that this terminology is configured as a classification system that can be employed worldwide, the importance of the constant updating process is highlighted, with potential impacts on Nursing professionals’ practice, on the communication between them and other professionals in the health area, in the Systematization of Nursing Care and in scientific Nursing research1515 Dantas AMN, Souza GLL, Nóbrega MML. Mapeamento de termos da prática de enfermagem no acompanhamento do crescimento e desenvolvimento da criança. Enferm. Foco [Internet]. 2013 [cited on 2022 Oct. 02]; 4(2):92-96. Available in: https://doi.org/10.21675/2357-707X.2013.v4.n2.533.
https://doi.org/10.21675/2357-707X.2013....
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It is also noted that most of these concepts are inherent to the practice focus. Even without employing a classification system, it was possible to verify that, in the care practice, nurses use a language specific to the profession when caring for patients with VL, given the repetition of concepts in the documents examined in the current study. In addition, a database of standardized terms contributes to better recording the care provided and, consequently, to improving the Nursing practice, consolidating care and covering the particularities of this population group1616 Ometto HS, Rocha J, Melo J, Buchhorn S. Linguagem especializada na promoção da saúde do adolescente. Rev. Enferm. UFSM [Internet]. 2022 [cited on 2022 Oct. 02]; 12(e23):1-18. Available in: https://doi.org/10.5902/2179769268960.
https://doi.org/10.5902/2179769268960...
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The Focus axis is understood as the relevant care area for Nursing1111 Garcia TR (Org). Classificação Internacional para a Prática de Enfermagem (CIPE®): versão 2019/2020. Porto Alegre: Artmed; 2020.. It is grounded on the first stage of the Nursing Process, Nursing data collection (Nursing history)1717 Chen SF, Huang LH, Chen CM, Chuang TH, Peng MT, Wang HH. The key role of Taiwanese nurses in combating COVID-19 pandemic. Hu Li ZaZhi. [Internet]. 2020 [cited on 2021 July 15]; 67(3):84-89. Available in: https://doi.org/10.6224/JN.202006_67(3).11.
https://doi.org/10.6224/JN.202006_67(3)....
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Primitive concepts included in the ICNP® were identified. In addition to that, the Focus axis concepts with high appearance frequency in the analysis corpus, such as: “elimination”, “pain”, “fever” and “edema”.

The “Elimination” primitive concept refers to constipation in VL patients. This problem can also cause abdominal distension, pain, flatulence and “vomiting”, this latter also mentioned as a primitive concept in the findings of the current study.

The “pain” primitive concept is defined as “Perception, impaired: Increased unpleasant sensation in the body; subjective report of distress, facial expression of pain, change in muscle tone, self-protective behavior, reduced attention focus, change in perception time, withdrawal from social contact, impaired thought process, distracted behavior, restlessness and loss of appetite”1111 Garcia TR (Org). Classificação Internacional para a Prática de Enfermagem (CIPE®): versão 2019/2020. Porto Alegre: Artmed; 2020..

Pain is generally related to the VL classic symptomatology itself, such as hepatosplenomegaly and abdominal distension1818 Almeida ANF de, Nascimento L de CS do, Sousa ESM de M, Oliveira AJD de, Sena MG de, Resende BM de, et al. Vigilância da leishmaniose cutânea em amostras clínicas: distribuição da Leishmania guyanensis no estado do Amapá, 2018*. Epidemiol. Serv. Health. [Internet]. 2020 [cited on 2021 July 10]; 29(1). Available in: https://doi.org/10.5123/S1679-49742020000100007.
https://doi.org/10.5123/S1679-4974202000...
, which generate physical discomfort. As well as drug treatment, in which some medications may have adverse effects such as abdominal or low back pain at the application site, headache, arthralgia and myalgia1919 Ministério da Saúde (BR). Secretaria de Vigilância em Saúde. Coordenação-Geral de Desenvolvimento da Epidemiologia em Serviços. Guia de vigilância em saúde: volume único. 3. ed. Brasília: Ministério da Saúde, [Internet]. 2019 [cited on 2021 Dec. 19]. 740. Available in: https://bvsms.saude.gov.br/bvs/publicacoes/guia_vigilancia_saude_3ed.pdf.
https://bvsms.saude.gov.br/bvs/publicaco...
. In this sense, Nursing should pay special attention to pain, as it exerts negative effects on human physical and mental health, affecting the patients’ quality of life2020 Antunes J de M, Daher DV, Ferrari MF, Pereira LC, Faria M, Sveichtizer MC, et al. Nursing practices in patients with chronic pain: an integrative review. Acta Paul. Enferm. [Internet]. 2018 [cited on 2021 Sept. 09]; 31(6):681-7. Available in: https://doi.org/10.1590/1982-0194201800093.
https://doi.org/10.1590/1982-01942018000...
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It is emphasized that, in the current study, “hepatosplenomegaly”, headache, arthralgia, myalgia and spleen were primitive concepts from the Focus and Location axes, respectively, classified as not included in the ICNP®. In an endemic area, any clinical condition that presents with febrile hepatosplenomegaly should be investigated as a suspected case of the disease2121 Almeida CP, Cavalcante FRA, Moreno J de O, Florêncio CMGD, Cavalcante KK de S, Alencar CH. Leishmaniose visceral: distribuição temporal e espacial em Fortaleza, Ceará, 2007-2017. Epidemiol. Serv. Health. [Internet]. 2020 [cited on 2021 July 10]; 29(5):e2019422 Available in: https://doi.org/10.1371/journal.pntd.0002982.
https://doi.org/10.1371/journal.pntd.000...
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The “fever” primitive concept refers to a defensive body response against pyrogenic agents due to an inflammatory reaction. Mediators such as interleukin-1B and interleukin-6 are released, resulting in an increase in the immune response and consequent protection of the human body against infectious agents2222 Salgado P de O, Silva LCR, Silva PMA, Paiva IRA, Macieira TGR, Chianca TCM. Nursing care to pacients with high body temperature: an integrative review. REME. [Internet]. 2015 [cited on 2021 July 12]; 19(1):220-26. Available in: http://www.dx.doi.org/10.5935/1415-2762.20150017.
http://www.dx.doi.org/10.5935/1415-2762....
, such as those that cause VL. A number of studies1818 Almeida ANF de, Nascimento L de CS do, Sousa ESM de M, Oliveira AJD de, Sena MG de, Resende BM de, et al. Vigilância da leishmaniose cutânea em amostras clínicas: distribuição da Leishmania guyanensis no estado do Amapá, 2018*. Epidemiol. Serv. Health. [Internet]. 2020 [cited on 2021 July 10]; 29(1). Available in: https://doi.org/10.5123/S1679-49742020000100007.
https://doi.org/10.5123/S1679-4974202000...
,2121 Almeida CP, Cavalcante FRA, Moreno J de O, Florêncio CMGD, Cavalcante KK de S, Alencar CH. Leishmaniose visceral: distribuição temporal e espacial em Fortaleza, Ceará, 2007-2017. Epidemiol. Serv. Health. [Internet]. 2020 [cited on 2021 July 10]; 29(5):e2019422 Available in: https://doi.org/10.1371/journal.pntd.0002982.
https://doi.org/10.1371/journal.pntd.000...
,2323 Góes MAO, Melo CM, Jeraldo VLS. Time series of visceral leishmaniasis in Aracaju, state of Sergipe, Brazil (1999 to 2008): human and canine aspects. Rev Bras Epidemiol. [Internet]. 2012 [cited on 2021 Oct. 29]; 15(2):298-307. Available in: https://doi.org/10.1590/S1415-790X2012000200007.
https://doi.org/10.1590/S1415-790X201200...
evidenced that this is the most frequent manifestation in VL patients, with prevalence values from 92.6% to 96.1%.

In VL, fever can be characterized as irregular and long-term2121 Almeida CP, Cavalcante FRA, Moreno J de O, Florêncio CMGD, Cavalcante KK de S, Alencar CH. Leishmaniose visceral: distribuição temporal e espacial em Fortaleza, Ceará, 2007-2017. Epidemiol. Serv. Health. [Internet]. 2020 [cited on 2021 July 10]; 29(5):e2019422 Available in: https://doi.org/10.1371/journal.pntd.0002982.
https://doi.org/10.1371/journal.pntd.000...
. Interventions for “fever” must be implemented with the intention of reducing body temperature and should be based on scientific evidence. It is fundamental that Nursing professionals know the adverse effects both of antipyretic agents and of physical fever control methods2222 Salgado P de O, Silva LCR, Silva PMA, Paiva IRA, Macieira TGR, Chianca TCM. Nursing care to pacients with high body temperature: an integrative review. REME. [Internet]. 2015 [cited on 2021 July 12]; 19(1):220-26. Available in: http://www.dx.doi.org/10.5935/1415-2762.20150017.
http://www.dx.doi.org/10.5935/1415-2762....
.

“Edema” is a condition that develops with disease progression and is a marking event in the life of these patients. The primitive concept is defined as “Retention of Liquids”1111 Garcia TR (Org). Classificação Internacional para a Prática de Enfermagem (CIPE®): versão 2019/2020. Porto Alegre: Artmed; 2020.. A number of studies2424 Belo VS. Struchiner CJ, Barbosa DS, Nascimento BWL, Horta MAP, Silva ES da, et al. Risk factors for adverse prognosis and death in American visceral leishmaniasis: a metaanalysis. PLoS Negl Trop Dis. [Internet]. 2014 [cited on 2021 Dec. 09]; 8(7):e2982. Available in: https://doi.org/10.1371/journal.pntd.0002982.
https://doi.org/10.1371/journal.pntd.000...

25 Druzian AF, Souza AS de, Campos DN de, Croda J, Higa Jr. MG, Dorval MEC, et al. Risk factors for death from visceral leishmaniasis in na urban área of Brazil. PLoS Negl Trop Dis. [Internet]. 2015 [cited on 2021 Oct. 29]; 9(8):e0003982. Available in: https://doi.org/10.1371/journal.pntd.0003982.
https://doi.org/10.1371/journal.pntd.000...
-2626 Oliveira-Sena IV, Werneck GL. Risk factors for in-hospital mortality from visceral leishmaniasis: A case-control study. J Infect Public Health. [Internet]. 2020 [cited on 2021 Sept. 12]; 13(4):538-43, 2020. Available in: https://doi.org/10.1016/j.jiph.2019.10.003.
https://doi.org/10.1016/j.jiph.2019.10.0...
point out that it is a strong predictor of mortality. The presence of edema may reflect protein malnutrition and liver or kidney failure, being described as a risk factor for an unfavorable outcome (relapses and death)2525 Druzian AF, Souza AS de, Campos DN de, Croda J, Higa Jr. MG, Dorval MEC, et al. Risk factors for death from visceral leishmaniasis in na urban área of Brazil. PLoS Negl Trop Dis. [Internet]. 2015 [cited on 2021 Oct. 29]; 9(8):e0003982. Available in: https://doi.org/10.1371/journal.pntd.0003982.
https://doi.org/10.1371/journal.pntd.000...
, as well as directly reflecting on the patient’s “weight”, being a primitive concept identified in the study, and which should be routinely monitored.

In 2006, Ordinance No. 05 of February 21st, 200655 Ministério da Saúde (BR). Secretaria de Vigilância em Saúde. Departamento de Vigilância Epidemiológica. Manual de vigilância e controle da leishmaniose visceral [Internet]. Brasília: Ministério da Saúde; 2006. [cited on 2021 Aug. 26]. Available in: https://bvsms.saude.gov.br/bvs/publicacoes/manual_vigilancia_controle_leishmaniose_visceral.pdf.
https://bvsms.saude.gov.br/bvs/publicaco...
was issued with the aim of improving the Visceral Leishmaniasis Surveillance and Control Program (Programa de Vigilância e Controle da Leishmaniose Visceral, PVCLV) through the development and application of educational and preventive measures, which can be demonstrated based on primitive concepts related to the Action axis, such as “counselling” and “informing”, to the Focus axis, such as “diet” and “medication”, and to the Client axis: “family”, “brother” and “sister”. Such aspects referred to in the present primitive concepts involve the joint construction of knowledge necessary for monitoring and treating patients with VL, who, for living with a chronic disease, need autonomy in their care process, as well as help from the family support network55 Ministério da Saúde (BR). Secretaria de Vigilância em Saúde. Departamento de Vigilância Epidemiológica. Manual de vigilância e controle da leishmaniose visceral [Internet]. Brasília: Ministério da Saúde; 2006. [cited on 2021 Aug. 26]. Available in: https://bvsms.saude.gov.br/bvs/publicacoes/manual_vigilancia_controle_leishmaniose_visceral.pdf.
https://bvsms.saude.gov.br/bvs/publicaco...
.

As in the current study, other surveys1414 International Organization for Standardization. ISO 12300: health informatics: principles of mapping between terminological systems. Genebra: ISO; 2016.,2727 Araújo DD de, Nascimento MNR, Mota EC, Ribeiro MM, Gonçalves RPF, Gusmão ROM, et al. Specialized Nursing terminology for the care of people with COVID-19. Rev. bras. enferm. [Internet]. 2021 [cited on 2021 Oct. 29]; 74(Suppl 1):e20200741. Available in: http://dx.doi.org/10.1590/0034-7167-2020-0741.
http://dx.doi.org/10.1590/0034-7167-2020...
-2828 Félix ND de C, Nascimento MNR, Ramos N de M, Oliveira CJ de, Nóbrega MML da. Terminologia especializada de enfermagem para o cuidado de pessoas com síndrome metabólica. Esc. Anna Nery. [Internet]. 2020 [cited on 2021 Sept. 12]; 24(3):e20190345. Available in: https://doi.org/10.1590/2177-9465-EAN-2019-0345.
https://doi.org/10.1590/2177-9465-EAN-20...
of specialized Nursing terminologies identified, with greater prevalence, that the primitive concepts belonging to the Focus axis are related to biological needs, reinforcing care based on the biomedical model. In this perspective, it is noted that, in addition to the biological issues, Nursing care must encompass psychosocial and spiritual aspects of the person, considering broad and comprehensive assistance.

Using a specialized terminology allows detecting concepts that assist in creating Nursing diagnoses, results and interventions, enabling the identification of the main needs according to health priorities. This recognition of the primitive concepts requires critical thinking skills and competencies from nurses to achieve positive results1010 Souza Neto VL de, Costa C da S, Silva IKM, Negreiros RV de, Godoy ECP de, Silva BCO da, et al. Profile diagnosis of nursing for people with leishmaniose. Rev enferm Centro- Oeste Min. [Internet]. 2017 [cited on 2021 Sept. 12]; 7:e1381. Available in: http://dx.doi.org/10.19175/recom.v7i0.1381
http://dx.doi.org/10.19175/recom.v7i0.13...
,2929 Silva BCO, Santos RM, Santos FR, Padilha TMS, Moreira OAA, Tavares ES et al. Specialized nursing terminology in care of people infected with AIDS. Acta Paul Enferm. [Internet]. 2021 [cited on 2021 Dec. 09]; 34:eAPE03122. Available in: https://doi.org/10.37689/acta-ape/2021AO03122.
https://doi.org/10.37689/acta-ape/2021AO...
, contributing in the future to the development of ICNP® Terminology Subsets, as an ICN recommendation in the consolidation of Nursing science and work88 Garcia TR, Bartz CC, Coenen AM. CIPE®: uma linguagem padronizada para a prática profissional. In: Garcia TR, (Org). Classificação Internacional para a Prática de Enfermagem (CIPE®): versão 2017. Porto Alegre: Artmed; 2017..

Regarding limitations, differently from the literature, the concepts included in the ICPN® were not the most frequent in this research. However, for having been conducted in medical charts, the study can more accurately reflect the particularities of Nursing care directed to people with VL. It is also noted that, due to the extension of all the information, a strategy to select the professional records at three different Nursing care moments was adopted.

CONCLUSION

It was possible to achieve the objective of the study by creating a specialized ICNP® terminology for the care of people with VL, in which 55% of the concepts are not included in the 2019-2020 version of the classification, with a higher number of primitive concepts classified in the Focus and Location axes.

It is evidenced that, even not employing any classification system in the clinical practice, nurses use language specific to the profession when caring for VL patients especially. A specialized Nursing terminology can contribute to the development of care, management and education technologies, such as structuring an ICNP® terminology subset with impacts on the standardization of actions, generation of Nursing indicators for the care of people with VL, on care quality, and on the visibility and consolidation of Nursing as a science. It is recommended to carry out studies to create an ICNP® terminology subset containing Nursing diagnoses, results and interventions for the Nursing care to be provided to people with VL.

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Associate editor: Dra. Luciana Nogueira

Publication Dates

  • Publication in this collection
    05 June 2023
  • Date of issue
    2023

History

  • Received
    20 Dec 2021
  • Accepted
    18 Nov 2022
Universidade Federal do Paraná Av. Prefeito Lothário Meissner, 632, Cep: 80210-170, Brasil - Paraná / Curitiba, Tel: +55 (41) 3361-3755 - Curitiba - PR - Brazil
E-mail: cogitare@ufpr.br