Results of the Nursing Outcomes Classification/NOC for patients with obsessive-compulsive disorder

Pires, Ananda Ughini Bertoldo; Lucena, Amália de Fátima; Behenck, Andressa; Heldt, Elizeth

doi:10.1590/0034-7167-2018-0209

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ORIGINAL ARTICLE • Rev. Bras. Enferm. 73 (1) • 2020 • https://doi.org/10.1590/0034-7167-2018-0209 copy

Results of the Nursing Outcomes Classification/NOC for patients with obsessive-compulsive disorder

Resultados de la Nursing Outcomes Classification/NOC para pacientes con trastorno obsesivo-compulsivo

Authorship SCIMAGO INSTITUTIONS RANKINGS

ABSTRACT

Objective:

To analyze the application of nursing outcomes and indicators selected from the Nursing Outcomes Classification (NOC) to evaluate patients with obsessive-compulsive disorder (OCD) in outpatient follow-up.

Method:

Outcome-based research. First, a consensus was achieved between nurses specialized in mental health (MH) and in the nursing process to select NOC-related outcomes and indicators, followed by the elaboration of their conceptual and operational definitions. Then, an instrument was created with these, which was tested in a pilot group of six patients treated at a MH outpatient clinic. The instrument was applied to patients with OCD undergoing Group Cognitive Behavioral Therapy (GCBT). The study was approved by the Research Ethics Committee of the institution.

Results:

Four NOC outcomes and 17 indicators were selected. There was a significant change in the scores of nine indicators after CBGT.

Conclusion:

The study showed feasibility for evaluating symptoms of patients with OCD through NOC outcomes and indicators in an outpatient situation.

Descriptors:
Obsessive-compulsive Disorder; Nursing Process; Nursing Care; Evaluation of Outcomes (Health Care); Mental Health

Outcomes and indicators	Mean of the indicators in the assessments (standard deviation)			p value
Outcomes and indicators	1^st evaluation (n = 6)	2^nd evaluation (n = 6)	3^rd evaluation (n = 5)	p value
Anxiety self-control (1402)
Monitors the intensity of anxiety	4.67 (0.30)	4.50 (0.20)	4.99 (0.01)	0.069
Uses effective coping strategies	3.50 (0.73)	1.67 (0.45)	4.04 (0.47)	< 0.001
Maintains social relationships	3.50 (0.56)	4.33 (0.30)	4.28 (0.49)	0.111
Monitors behavioral manifestations of anxiety	4.33 (0.45)	4.00 (0.57)	4.93 (0.06)	0.174
Fear level (1210)
Distress	1.17 (0.15)	2.00 (0.33)	2.12 (0.48)	< 0.001
Restlessness	1.17 (0.15)	1.50 (0.31)	2.07 (0.49)	0.028
Difficulty concentrating	1.33 (0.30)	3.17 (0.49)	2.96 (0.74)	< 0.001
Difficulty problem solving	3.17 (0.54)	4.17 (0.28)	3.73 (0.60)	0.103
Exaggerated concern about life events	1.17 (0.15)	1.33 (0.19)	2.01 (0.39)	0.040
Avoidance behavior	3.00 (0.57)	2.67 (0.69)	3.38 (0.61)	0.223
Anxiety level (1211)
Indecisiveness	1.33 (0.19)	1.33 (0.19)	2.66 (0.45)	0.004
Sleep disturbance	1.17 (0.15)	1.33 (0.19)	2.27 (0.65)	0.067
Decreased productivity	2.50 (0.45)	4.17 (0.43)	4.42 (0.16)	< 0.001
Personal time management (1635)
Sets time for completion of commitments	2.17 (0.68)	1.83 (0.45)	3.16 (0.33)	0.019
Plans activities by the week	3.83 (0.59)	4.83 (0.15)	4.38 (0.21)	0.103
Minimizes interruptions	2.00 (0.57)	2.33 (0.65)	3.17 (0.66)	0.040
Uses strategies to reduce anxiety	2.67 (0.69)	3.17 (0.68)	3.91 (0.57)	0.336

Associação Brasileira de Enfermagem SGA Norte Quadra 603 Conj. "B" - Av. L2 Norte 70830-102 Brasília, DF, Brasil, Tel.: (55 61) 3226-0653, Fax: (55 61) 3225-4473 - Brasília - DF - Brazil
E-mail: reben@abennacional.org.br

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[1] Corresponding Author: Ananda Ughini Bertoldo Pires E-mail: ananda.pires@gmail.com

*Outcome of the Nursing Outcomes Classification* - Anxiety self-control (1402)**
Indicators	Magnitude of the operational definition in the Likert scale
Monitors intensity of anxiety Conceptual definition: Measures the degree of distress experienced at the time of exposure to the feared situation, varying from "no anxiety" to "extreme anxiety."	1. Never 2. Rarely 3. Several times a month 4. Several times a week 5. Daily
Uses effective coping strategies Conceptual definition: Plans in advance how to behave in risky situations, considering what should be done in terms of exposure and prevention of response. For example: attempt getting distracted during risky situations, with other thoughts or practical activities, chatting with yourself, or using reminders.	1. Never use strategies 2. Rarely use a strategy 3. Monthly use at least one strategy 4. Weekly use at least one strategy 5. Daily use at least one strategy
Maintains social relationships Conceptual definition: Manages to maintain a good relationship, with a certain frequency, with people who are part of your daily life, whether in a working group, friends, or family members, playing your respective role in certain situations, despite the symptoms of OCD.	1. Never relate to close people 2. Relate to people only when necessary 3. Relate to people maintaining a certain distance 4. Relate to people, but make efforts to do so 5. Usually relate to people
Monitor behavioral manifestations of anxiety Conceptual definition: Can perceive and distinguish what are behavioral and physical manifestations of anxiety from those that would be perceived manifestations/sensations and triggered by normal situations. Monitoring related to the level of disease insight.	1. Never monitor demonstrations 2. Rarely monitor demonstrations 3. Monitor demonstrations several times a month 4. Monitor demonstrations several times a week 5. Usually monitor demonstrations
*Outcome of the Nursing Outcomes Classification* - Fear level (1210)**
Indicators	Magnitude of the operational definition
Distress Conceptual definition: Feeling of general, physical, and psychic malaise, which usually accompanies anxiety, especially after exposure exercises and prevention of responses.	1. Feel distressed every day 2. Feel distressed several times a week 3. Feel distressed several times a month 4. Rarely feel distressed 5. Never feel distressed
Restlessness Conceptual definition: Psychomotor agitation due to peaks of anxiety, which may result in increased compulsive symptoms and invasive thoughts.	1. Presents restlessness every day 2. Presents restlessness several times a week 3. Presents restlessness several times a month 4. Rarely presents restlessness 5. Never presents restlessness
Difficulty concentrating Conceptual definition: Presents difficulty to concentrate on tasks/activities due to invasive thoughts, fears, and/or unfounded concerns.	1. Never concentrates for the entire period of activity 2. Rarely concentrates for the entire period of activity 3. Concentrates for the entire period of activity several times a month 4. Concentrates for the entire period of activity several times a week 5. Usually concentrates for the entire period of activity
Difficulty problem solving Conceptual definition: Excessive difficulty in solving everyday problems, due to fears arising from invasive thoughts and slowness by performing compulsive rituals/behaviors.	1. Never succeeds in solving problems 2. Rarely succeeds in solving problems 3. Succeeds in solving problems several times a month 4. Succeeds in solving problems several times a week 5. Succeeds in solving problems whenever they arise
Exaggerated concern about life events Conceptual definition: Worries exaggeratedly about situations of everyday life that may bring unfounded risks, due to fears and invasive and obsessive thoughts. For example: worries about knowing whether you locked the door or not.	1. Usually worries 2. Worries several times a week 3. Worries several times a month 4. Rarely worries 5. Never worries
Avoidance behavior Conceptual definition: Avoids people, situations, places, and objects because of the fear that major disasters may occur due to obsessive thoughts.	1. Never exposes to risky situations 2. Rarely exposes to risky situations 3. Exposes to risky situations several times a month 4. Exposes to risky situations several times a week 5. Usually exposes to risky situations
*Outcome of the Nursing Outcomes Classification* - Anxiety level (1211)**
Indicators	Magnitude of the operational definition
Indecisiveness Conceptual definition: Manifest indecisiveness about basic choices of daily life due to the lack of confidence in yourself, because of unfounded fears.	1. Is usually undecided 2. Is undecided several times a week 3. Is undecided several times a month 4. Is rarely undecided 5. Is never undecided
Sleep disturbance Conceptual definition: Suffer from sleep disorders, being characterized both by excess and lack of sleep.	1. Usually suffer from sleep disturbances 2. Suffer from sleep disturbances several times a week 3. Suffer from sleep disturbances several times a month 4. Rarely suffer from sleep disturbances 5. Never suffer from sleep disturbances
Decreased productivity Conceptual definition: Stops doing daily or exceptional activities due to rituals/obsessions/compulsions/fears, leading to the loss of several hours of the day because of the slowness to perform the activities and consecutive interruptions.	1. Never succeeds in performing all activities of the day 2. Rarely succeeds in performing all activities of the day 3. Succeeds in performing the activities of the day several times a month 4. Succeeds in performing the activities of the day several times a week 5. Usually succeeds in performing all activities of the day
*Outcome of the Nursing Outcomes Classification* - Personal time management (1635)**
Indicators	Magnitude of the operational definition
Sets time for completion of commitments Conceptual definition: Establish a precise time to conclude daily or exceptional tasks/commitments, aiming at not being interrupted by rituals/compulsions.	1. Never establishes time to conclude taks/commitments 2. Rarely 3. Several times a month 4. Several times a week 5. Whenever concludes tasks/appointments
Plan activities by the week Conceptual definition: Succeeds in making schedule of commitments/activities for the following week and perform it, without interruptions or changes of time due to rituals/obsessions/compulsions.	1. Never succeeds in planning activities for the next week 2. Rarely succeeds in planning activities for the next week 3. Succeeds in planning activities for the next week one week a month 4. Succeeds in planning activities for the next week almost every weeks a month 5. Usually succeeds in planning activities for the next week
Minimizes interruptions Conceptual definition: Decrease the number of ritual-related interruptions (e.g., checking, repeating) during daily or exceptional tasks.	1. Usually interrupts tasks 2. Interrupts tasks several times a week 3. Interrupts tasks several times a month 4. Rarely interrupts tasks 5. Never interrupts tasks
Uses strategies to reduce anxiety Conceptual definition: Uses personal or learned strategies aimed at reducing anxiety in moments of crisis, without confusing strategies with "masked" rituals. Examples of strategies: The STOP technique, seeking to be distracted to cut the flow of invasive thoughts, doing another activity etc.	1. Never uses strategies 2. Rarely uses strategies 3. Uses strategies several times a month 4. Uses strategies several times a week 5. Usually uses strategies