Paths taken by Brazilian Nursing for the development of terminological subsets.

Abstract Objective: to discuss the paths taken by Brazilian Nursing in the development of terminological subsets of the International Classification for Nursing Practice. Method: documentary research, carried out in master’s dissertations and doctoral theses, which developed terminological subsets, available at the Bank of Doctoral Theses and Master’s Dissertations of the Under-graduation Personnel Improvement Coordination. The variables were analyzed were institution, year; academic level, type of health service, methodological approach, clientele, theoretical reference, validation of terms, cross mapping, modeling of new concepts, validation of statements, method used for elaboration, term collection, finalization and dissemination. Results: 124 doctoral theses and master’s dissertations were found, 91 were excluded and 33 were included, 23 (69.70%) of which were master’s dissertations, with the highest production in 2014 (n=10; 30.30%), with emphasis on the Northeast (36.36%); the ‘Primary Care’ scenario, with six studies (18.18%); and the predominant clientele was cancer patients. As for the methodological characteristics, in 96% of the studies, the quantitative approach was used; in 2%, a qualitative approach; and 2% associated the quantitative and qualitative approaches. As for the type of study, 60% were methodological and 24% descriptive-exploratory, with the Horta model being the most used (36%). Conclusion: the paths are successful, yet still permeated by weaknesses in the validations and potentialities to standardize the language.

a single one to create a universal language of nursing. Therefore, encouraging its use is essential, since allows the projection of trends on the needs of patients, the provision of treatments and the use of resources and results of nursing care (6)(7)(8) .
Studies demonstrate that the development of terminology subsets of the CIPE ® is still incipient in the Brazilian reality, but promising and requires more discussions in the academic and practical context of nursing to operationalize and improve the method and, consequently, disseminate terminology in the national panorama (9)(10) . This classification should be expanded through research, nursing education and its use in care practice (11)(12) .
In this sense, graduation plays a fundamental role in the development of nursing science, considering that the courses have objectives that converge to a broader and deeper education, which enables the production of qualified human resources, consolidating scientific knowledge to act in professional practice (13) . Thus, this study is justified in view of the need to summarize and discuss the content of academic production on the development of terminological subsets in order to provide a relevant research source to help choose the best strategies for structuring terminology subsets of CIPE ® , thus ensuring greater quality and reliability, as well as helping to conduct new studies.
In view of the relevance of recognizing the steps taken by the researchers and the reflexes in practice, the possibilities for contributions in this investigation occur with the aim of generating new intellectual nursing processes and validating their practice. These can be incorporated into electronic health records and used to generate nursing knowledge, in addition to demonstrating its importance as a technological resource, supporting nurses' actions in the most diverse contexts of professional practice (14) . gov.br/catalogo-teses/) whose keyword was "CIPE ® ".
Data were collected between May and July 2018. In order to decrease probable systematic errors or studies' measurement bias due to mistakes in the interpretation After their descriptive analysis, they were presented in the form of tables.
The flowchart presented below outlines the path of the bibliographic survey adopted by the researchers for the preparation of this research ( Figure 1).   and presentation of papers at scientific events in the format of abstracts (n=37).

Discussion
The analysis of studies on the development of CIPE ® terminological subsets made it possible to apprehend that the production of knowledge with a focus on the theme is unstable, as there was an increase in the production of dissertations and theses. It is believed that this reality is associated with worldwide mobilization and, mainly, with Brazil, as it is a theme that has been shown to be relevant for research and assistance. in these courses (16) . This growth may have influenced  of technological and innovation production to qualify care in the context of health (17) .
From the observed data, it appears that the  (20) .
Regarding the non-identification of the item 'health services', this is because the CIE prerogatives for the construction of subsets determine that they may also be related to a nursing phenomenon, such as cancer pain, heart failure, domestic violence, palliative care, among others. A priori, there is no determination of a health service type scenario (12) .
The concern of a research must be sustained in the feedback that it can provide to the individuals who receive the care proposed by Nursing. In this study, this was evidenced due to the results aimed at the subjects, be they men and women, in the age groups corresponding to childhood and the elderly phase, and their peculiarities in the face of a health problem. The most common problems that justified the construction of terminological subsets were due to the character and context of specialized care for chronic non-communicable diseases and the epidemiological profile that, in this case, was evidenced by the number of studies aimed at the elderly.
The researchers' concern with the health context experienced in Brazil is understood, and the nursing process can be used in favor of comprehensive care and be able to recognize the social and health needs of these individuals (21)(22)(23) .
From this point of view, the foundation that supports the research presented here are nursing theories and theoretical concepts for health. The results of this study showed a variety of views that supported them and the importance of directing the theoretical constructs in support of the nursing process, since it needs to be understood by nurses and appropriate for the reality in which the nursing service is inserted (24) . aims to consolidate and explain the practice through concepts that express the development of actions and that explain the professionals' world-view, that is, it is an integral part of the documentation of importance for Nursing and provides the very organization and presentation of the subset (25)(26) .
Regarding the methodological characteristics, for the development of the subsets, 21 studies were classified as a methodological research, since they dealt with the development, validation and evaluation of tools and require demands to evaluate solid and reliable results through rigorous testing of interventions and sophisticated procedures for obtaining data (27) .
Furthermore, methodological studies require the creation of an instrument, which demand cost and time, thus implying the search for conceptual and theoretical aspects in the choice of questions, domains and items that will better explore the construct of interest (28) .
In the background, there is the mapping which is done, by comparing the records of the patients' records or literature with the standardized language, through cross-mapping. The results of applying this technique can help professionals to visualize terms that they use daily and that are registered in a non-standardized way (30) . In the studies found in this research, the mapping was unanimous.
A multi-center Italian study pointed to crossmapping as an essential step in the development of a subset of nursing diagnoses in medical and surgical clinics, and the results contributed to the construction of statements in the identification of acute health responses, but also to the behavioral education of individuals and their self-care (31) .
Regarding The terms are considered validated when they reach a CI ≥ 0.80, as this is the value considered as ideal in the literature (33) .   (35) . These criteria are given a weight and, to be considered as an expert, the sum of the scores must reach a minimum of 5 points, but this is not a feasible indication in practice.
The literature points out that there are few studies that present comments on the subject, which can make the selection of specialists a peculiar step to be fulfilled, since the author points out the favoring of academic training over clinical experience (36) . To find these specialists, we use, for example, the Lattes Platform or participants close to the main researcher, using the sample by intention or the snowball technique.
Therefore, it is difficult to attract specialists, since few are willing to participate in the studies. what one wishes to validate (12) .
Another relatively used path for the conformation of the subset is clinical validation, an essential step, since it is able to refine the statements and ensure uniformity in the identification or classification process, which contributes to clarify the accuracy of this step of the process and to assist the selection of truly identifiable clinical indicators. In the results found in this research, the development of recent studies was evidenced, which points to the need to increase this aspect (37) .
For the Brazilian method, the clinical validation of the subset is a step subsequent to its development, but it presents, in the stages of identification of terms and in the construction of utterances, the content validation of terms and utterances. The terms validation process, isolated or pre-combined, is detailed (9) . is usually linked to a single nursing diagnosis and not to a terminological subset (9) .
On the other hand, the subsets were disseminated  (38) .
Its applicability and structuring depend on the involvement of the professional in nursing practice and on the processes that are apprehended, in a unique way, through relationships, various influences, the state of physical and emotional security, the environment, as well as individual potentialities, of beliefs, values and cultural aspects (12,39) .
In addition, these subsets can facilitate the documentation workload among nurses and facilitate the storage and retrieval of standardized data for various purposes, such as quality improvement, management decision support and research. Health documentation makes it possible to provide data that can be communicated, compared and evaluated more fluently for various health professionals and clinical environments (40) . work is still an arduous path for reading in full for the detailed search of the steps used.
Finally, the study promotes advances in the knowledge of nursing science by demonstrating the increased use of CIPE ® as a standardized language system for the terminological organization of nursing care and which is configured as a resource of unquestionable relevance for carrying out systematic assistance.
Furthermore, it points out that its use may favor clinical practice and clinical reasoning, supporting safe and planned communication, with visibility for actions in teaching, research, management and assistance.
As suggestions, it is recommended to promote discussions regarding the validations to improve the result of the subsets, since three studies contemplated clinical validation, which resumes the need to continue research and to find better strategies. This is a way of valuing nursing as a science, as it unifies its language and contributes to improving communication and the quality of care that is given to people.