Nirla Gomes Guedes

This study aimed to develop a middle-range theory (MRT) on the phenomenon of fatigue in individuals with chronic kidney disease. It was a methodological study, conducted through an integrative literature review in Scopus, SciELO, and PubMed databases, which included 41 studies. The theory was developed in five steps: defining the theoretical approach, identifying core concepts, establishing causal relationships supported by clinical practice, designing a representative pictogram, and constructing explanatory propositions. This MRT includes 5 essential attributes, 13 clinical antecedents, 9 empirical referents, and 8 propositions, providing a conceptual framework that strengthens clinical reasoning and supports more precise nursing interventions.

La verificación de la presión arterial y de las medidas antropométricas son importantes en la evaluación de la salud de niños y adolescentes, puesto que cada vez son más frecuentes las alteraciones cardiovasculares en esta población. El objetivo fue analizar la correlación entre las medidas antropométricas y los valores de la presión arterial considerando el sexo, la edad y la práctica de ejercicios físicos. Estudio transversal desarrollado en una escuela de la ciudad de Fortaleza-Ceará / Brasil, con 122 estudiantes de 6 a 18 años. Los datos fueron recolectados en formulario específico que incluyó datos socio-demográficos, evaluación antropométrica, verificación de la presión arterial y la práctica de actividad física. Fueron realizadas tres medidas para cada variable antropométrica y para la presión arterial y calculadas sus respectivas medias. Los datos fueron procesados y analizados con auxilio del Software SPSS versión 13.0. El nivel de significancia adoptado fue del 5% (p<0,05). Se identificó correlación entre la presión arterial y el pliegue tricipital. No se encontraron diferencias de media de las medidas antropométricas en la presencia de presión arterial alta. El índice de Masa Corporal presentó correlación con los pliegues abdominal y subescapular, con circunferencia de la cintura y de la cadera. La actividad física no tuvo influencia sobre las medidas antropométricas. El sexo femenino presentó media de pliegues tricipital e abdominal más altas que el masculino. El estudio confirma la influencia de las variables sexo y edad sobre las medidas antropométricas obtenidas. El pliegue tricipital estuvo especialmente correlacionado a la presión arterial sistòlica.

Self-management is essential for people living with HIV. Telenursing has emerged as a strategy to expand access to care, but its effectiveness for HIV self-management remains unclear. This systematic review and meta-analysis, conducted according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses and Joanna Briggs Institute guidelines, synthesized evidence from randomized controlled trials (RCTs) evaluating nurse-led telenursing interventions delivered by mobile applications, web platforms, or telephone. Searches of seven databases and gray literature up to July 2025 identified nine RCTs ( n = 1,437). Meta-analyses showed no significant effect of telenursing on antiretroviral therapy adherence (mean difference [MD] = 0.00; 95% confidence interval, −0.69 to 0.69; I ² = 0%) or self-efficacy (MD = 1.13; 95% confidence interval, −0.26 to 2.52; I ² = 17.4%). Despite null pooled effects, some studies reported improvements in patient activation, fatigue management, and confidence. Overall certainty of evidence ranged from low to moderate. Nurse-led telenursing may support short-term empowerment and symptom management but requires stronger multicenter trials.

Purpose: To develop a mid-range theory for the nursing diagnosis Ineffective infant suck-swallow response. Data Sources: Scientific findings were derived from two systematic reviews, one addressing etiological factors and the other focused on clinical indicators. Additional theoretical support from Roy's Adaptation Model guided the categorization of the elements identified in the reviews and the conceptual relationships defined during theory construction. Data Synthesis: Seven stimuli and fifteen defining characteristics were identified and classified according to causal hierarchy and behavioral timing. Findings support revising the diagnosis to “Ineffective Infant Suck–Swallow–Breathing Response” and reclassifying it under the Nutrition domain. A pictorial diagram and nine theoretical propositions were developed to depict causal links and guide nursing practice. Conclusions: The Mid-Range Theory supported revising the nursing diagnosis to “Ineffective Infant Suck–Swallow–Breathe Response,” reclassifying it under the Nutrition domain, and refining defining characteristics, at-risk populations, and associated conditions. These adjustments aim to improve diagnostic accuracy and guide targeted neonatal nursing interventions. Further validation studies are recommended. Implications for Nursing Practice: The proposed revisions can improve diagnostic accuracy, enable early identification of feeding difficulties, and guide targeted neonatal nursing interventions to promote safe and effective feeding.

Background: Clinical indicators (CI) of the nursing diagnosis (ND) ineffective health maintenance behaviors (IHMB) (00292) may be present in women who do not wish to become pregnant. Thus, nurses should to be attentive of the individual, cultural, and social characteristics of these women in order to identify behaviors (CI) that may represent a risk for unwanted pregnancy. Purpose: This study aimed to identify CI of IHMB in women of childbearing age who do not wish to become pregnant. Method: Systematic review of diagnostic test accuracy. Data sources: Scopus, PubMed/MEDLINE, Embase, Biblioteca Virtual em Saúde, PsycINFO (Searched on November 12, 2023) and Ovid, Web of Science, CINAHL, Google Scholar, and ProQuest (searched on June 10, 2024). Data synthesis: The final sample resulted in five articles, in which two CI were identified in women who manifested the ND IHMB. “Ineffective choices in daily life for meeting health goals” was identified in women when they did not discuss contraceptive methods with their partners. “Failure to perceive health risk” was identified when women had low or no perception of pregnancy risk. Conclusion: Two CI of IHMB were identified in women who do not wish to become pregnant: “ineffective choices in daily life for meeting health goals” and “failure to perceive health risk.” Implications for the profession and/or patient care: These findings will provide nurses a better understanding of behaviors expressed by women who do not wish to become pregnant that prevent them to use contraception, that way nurses can make specific interventions on these issues. Including the indicator failure to perceive health risk to the NANDA International can broaden the spectrum of nurse's assessment for the study population.

RESUMO Objetivos: analisar uma intervenção educativa com profissionais de saúde da Atenção Primária sobre promoção do desenvolvimento infantil a partir do referencial do letramento em saúde. Métodos: pesquisa participativa em saúde, realizada com quatro etapas. A amostra foi composta por 13 profissionais de saúde da Atenção Primária que atuam na vigilância em saúde da criança no município de Passira, estado de Pernambuco. A intervenção ocorreu por workshops. Para analisar os dados, seguiram-se as etapas propostas por Yin. Resultados: foram identificados mudanças e conhecimentos. Os profissionais adotaram ações assistenciais voltadas a aspectos importantes na primeira infância e uma melhor comunicação com pais/mães/cuidadores por intermédio da aplicação dos pressupostos do letramento em saúde. Considerações Finais: demonstra-se a importância da educação permanente na Atenção Primária, sugerindo-se mais pesquisas para fortalecer políticas públicas e práticas profissionais no Sistema Único de Saúde.

Objectives: to analyze an educational intervention with primary care healthcare professionals on promoting child development based on the health literacy framework. Methods: participatory health research, conducted in four stages. The sample consisted of 13 primary care healthcare professionals working in child health surveillance in the municipality of Passira, state of Pernambuco. The intervention took place through workshops. Data analysis was followed according to the stages proposed by Yin. Results: changes and knowledge were identified. Professionals adopted care actions focused on important aspects of early childhood and improved communication with parents/caregivers through the application of health literacy principles. Final Considerations: the importance of continuing education in primary care is demonstrated, suggesting the need for further research to strengthen public policies and professional practices within the Brazilian Health System.

Background: Improper handling, cleaning, and disinfection of incubators in neonatal units pose significant risks, including infections and other adverse events, which are major contributors to morbidity and mortality in these settings. Purpose: To conduct a microbiological analysis of neonatal incubators to assess bacterial contamination over time. Methods: This cross-sectional observational study involved 56 incubators from a maternity hospital in northeastern Brazil, stratified into 6 groups based on the number of days since disinfection: Recently Disinfected, Not Yet Used group (clean, no prior use), Early Use group (1-3 days), Moderate Use group (4-6 days), Extended Use group (7-9 days), Long-Term Use group (10-12 days), and Very Long-Term Use group (13-15 days). Microbiological samples were collected using swab techniques from the portholes and internal corners of the incubator surfaces and processed in a bacteriology laboratory. Results: Bacterial growth was observed in 87.35% of samples from the portholes and 82.1% from the internal corners, with significantly higher growth on the portholes. Growth patterns were similar between groups 1 and 2, as well as between groups 4, 5, and 6, with group 3 marking the plateau point for bacterial growth. Coagulase-negative Staphylococcus species were the most prevalent. Implications for Practice and Research: The findings of this study underscore the need for stringent cleaning protocols to mitigate infection risk in neonatal care. These results can inform clinical actions aimed at reducing microbial proliferation in incubators.

Background: Clinical indicators (CI) of the nursing diagnosis (ND) ineffective health maintenance behaviors (IHMB) (00292) may be present in women who do not wish to become pregnant. Thus, nurses should to be attentive of the individual, cultural, and social characteristics of these women in order to identify behaviors (CI) that may represent a risk for unwanted pregnancy. Purpose: This study aimed to identify CI of IHMB in women of childbearing age who do not wish to become pregnant. Design: Systematic review of diagnostic test accuracy. Data sources: Scopus, PubMed/MEDLINE, Embase, Biblioteca Virtual em Saúde, PsycINFO (Searched on November 12, 2023) and Ovid, Web of Science, CINAHL, Google Scholar, and ProQuest (searched on June 10, 2024). Data synthesis: The final sample resulted in five articles, in which two CI were identified in women who manifested the ND IHMB. “Ineffective choices in daily life for meeting health goals” was identified in women when they did not discuss contraceptive methods with their partners. “Failure to perceive health risk” was identified when women had low or no perception of pregnancy risk. Conclusion: Two CI of IHMB were identified in women who do not wish to become pregnant: “ineffective choices in daily life for meeting health goals” and “failure to perceive health risk.” Implications for the profession and/or patient care: These findings will provide nurses a better understanding of behaviors expressed by women who do not wish to become pregnant that prevent them to use contraception, that way nurses can make specific interventions on these issues. Including the indicator failure to perceive health risk to the NANDA International can broaden the spectrum of nurse's assessment for the study population.

Given the significant global burden of congenital heart disease, there is an urgent need for innovative solutions to support and educate parents facing this challenge. This study aimed to construct and validate a virtual reality software, called CardioVR, to support congenital heart disease counseling. The process involved collaboration with 18 experts and 30 parents in three carefully managed stages, closely following the rigorous criteria outlined in the International Organization for Standardization/International Electrotechnical Commission 25010 standards. Remarkably, CardioVR achieved a remarkable content validity coefficient of 0.91 and exceeded the International Organization for Standardization/International Electrotechnical Commission criteria with more than 70% consensus. It excelled in key areas such as organization, clarity, visual appeal, self-efficacy enhancement, cultural appropriateness, and effectiveness. In addition, the System Usability Scale evaluation yielded a commendable score of 73.3%, confirming its ease of use and comprehension. The CardioVR software was considered valid and appropriate by experts and the target audience and can be used in the future as a support instrument for healthcare professionals assisting parents and caregivers of children with congenital heart diseases.