Abel Paiva e Silva

Background: Airway clearance impairment has a significant impact on self-care and quality of life. Identifying clinical data, nursing diagnoses, and nursing interventions is essential to clinical reasoning and enhancing nursing care. This study aims to map the existing evidence on clinical data, nursing diagnoses, and nursing interventions addressing the nursing focus on “airway clearance”. Methods: Research was conducted based on Joanna Briggs’s Scoping Review Methodology. We searched four databases for published studies until December 2023. Results: From the initial 1854 studies identified, 123 were included in the review. The findings highlighted two areas of nursing attention: one related to signs and symptom management, and the other related to education and coping strategies. The data that led to nursing diagnoses were divided into cognitive and clinical data. The nursing diagnoses were mostly related to secretion retention, excessive mucus production, and airway obstruction. The most commonly identified nursing interventions were educational interventions assembled into predesigned education programs rather than patient-tailored programs. Conclusions: Findings can add substantial value for systematizing the nursing process related to “airway clearance”, improving nursing decision-making and care quality. This study was prospectively registered with the Open Science Framework (OSF) on 02 December 2022, with the registration number wx5ze.

Enquadramento: a partilha de dados da prática clínica é crucial para apoiar o processo de tomada de decisão, Em Portugal a CIPE é utilizada para documentar os cuidados de enfermagem sendo necessária a uniformização deste processo de forma a evitar redundância de informação. Objetivos: (1) identificar diagnósticos e intervenções utilizados por enfermeiros portugueses relacionados com o Processo Respiratório, (2) sugerir sintaxes unificadas de diagnósticos e intervenções. Metodologia: estudo qualitativo com análise de conteúdo análise de conteúdo. A amostra incluiu dados referentes à documentação eletrónica customizada no sistema público de informação de enfermagem até 2019. Resultados: da amostra inicial de 1502 diagnósticos emergiram 28 e de 2060 intervenções surgiram 73 como os mais relevantes. Os principais achados foram: duas áreas de atenção de enfermagem, uma relacionada com função respiratória e outra com habilidades de aprendizagem do cliente, diversidade de diagnósticos e intervenções para expressarem as mesmas necessidades decorrentes de equívocos taxonómicos e de falta de linguagem padronizada. Conclusão: os diagnósticos e intervenções de enfermagem possuem duas dimensões que representam a complexidade do cuidado de enfermagem. O uso de linguagem padronizada não impede a redundância de informações resultando em diagnósticos e intervenções diferentes para expressar as mesmas necessidades.

Background: data sharing from clinical practice is crucial to support nurses' decision-making process, improve nursing outcomes, and increase the quality of care. In Portugal, International Classification for Nursing Practice is used to document care being necessary for the standardization of this process preventing information redundancy. Objectives: (1) to identify diagnoses and interventions used by Portuguese nurses related to Respiratory Process, (2) to suggest unified diagnoses and interventions syntaxes. Methodology: qualitative study with a content analysis. The sample included data regarding e-documentation of nursing diagnosis and interventions customized in the nursing public information system until 2019. Results: of the initial sample of 1502 diagnoses aroused 28 and from 2060 interventions emerged 73 as the most relevant. The main findings were: two areas of nursing attention, one related to respiratory function and the other to patient's learning abilities, diversity of diagnoses and interventions to express the same needs resulting from a variety of taxonomic misunderstandings, and lack of standardized language. Conclusions nursing documentation have two dimensions representing the complexity of nursing care. It also shows that using standardized language does not prevent information redundancy resulting in different diagnoses and interventions to express the same needs. Marco contextual: el cambio de datos resultantes de la práctica clínica es crucial para apoyar el proceso de toma de decisiones. Portugal, utiliza la CIPE para documentar la práctica clínica, siendo necesaria la estandarización de lo proceso evitando redundancia de información. Objetivos: (1) identificar diagnósticos e intervenciones utilizados por enfermeros portugueses relacionados con el Proceso Respiratorio, (2) sugerir sintaxis unificadas de diagnósticos e intervenciones. Metodología: diseño cualitativo con análisis de contenido. La muestra incluyó datos sobre documentación electrónica en el sistema de información pública de enfermería hasta 2019. Resultados: 1502 diagnósticos surgieron 28 y de 2060 intervenciones surtieron 73 como los más relevantes. Los principales hallazgos fueron: dos áreas de atención de enfermería, una relacionada con la función respiratoria y otra con las habilidades de aprendizaje del paciente, diversidad de diagnósticos e intervenciones para expresar las mismas necesidades resultantes de una variedad de malentendidos taxonómicos, falta de lenguaje estandarizado. Conclusión: los resultados muestran que la documentación de enfermería tiene dos dimensiones representando la complejidad del cuidado de enfermería. También muestra que el uso de un lenguaje estandarizado no evita la redundancia de información resultando en diferentes diagnósticos e intervenciones para expresar las mismas necesidades. Enquadramento: a partilha de dados da prática clínica é crucial para apoiar o processo de tomada de decisão, Em Portugal a CIPE é utilizada para documentar os cuidados de enfermagem sendo necessária a uniformização deste processo de forma a evitar redundância de informação. Objetivos: (1) identificar diagnósticos e intervenções utilizados por enfermeiros portugueses relacionados com o Processo Respiratório, (2) sugerir sintaxes unificadas de diagnósticos e intervenções. Metodologia: estudo qualitativo com análise de conteúdo análise de conteúdo. A amostra incluiu dados referentes à documentação eletrónica customizada no sistema público de informação de enfermagem até 2019. Resultados: da amostra inicial de 1502 diagnósticos emergiram 28 e de 2060 intervenções surgiram 73 como os mais relevantes. Os principais achados foram: duas áreas de atenção de enfermagem, uma relacionada com função respiratória e outra com habilidades de aprendizagem do cliente, diversidade de diagnósticos e intervenções para expressarem as mesmas necessidades decorrentes de equívocos taxonómicos e de falta de linguagem padronizada. Conclusão: os diagnósticos e intervenções de enfermagem possuem duas dimensões que representam a complexidade do cuidado de enfermagem. O uso de linguagem padronizada não impede a redundância de informações resultando em diagnósticos e intervenções diferentes para expressar as mesmas necessidades.

This umbrella review aimed to determine the effectiveness of nonpharmacological interventions in pulmonary ventilation and their impact on respiratory function. An individual with impaired ventilation displays visible variations manifested in their respiratory frequency, breathing rhythm ratio (I:E), thoracic symmetry, use of accessory muscles, dyspnea (feeling short of breath), oxygen saturation, diaphragm mobility, minute ventilation, peak flow, walking test, spirometry, Pimax/Pemax, diffusion, and respiratory muscle strength. Any variation in these markers demands the need for interventions in order to duly manage the signs and symptoms and to improve ventilation. Method: Systematic reviews of the literature published in English, Spanish, French, and Portuguese were used, which included studies in which nonpharmacological interventions were used as a response to impaired ventilation in adults in any given context of the clinical practice. The recommendations given by the Joanna Briggs Institute (JBI) for umbrella reviews were followed. This research took place in several databases such as MEDLINE, CINAHL Complete, CINHAL, MedicLatina, ERIC, Cochrane Reviews (Embase), and PubMed. The Joanna Briggs critical analysis verification list was used for the systematic review. The data extraction was performed independently by two investigators based on the data extraction tools of the Joanna Briggs Institute, and the data were presented in a summary table alongside the support text. Results: Forty-four systematic reviews, thirty randomized clinical essays, and fourteen observational studies were included in this review. The number of participants varied between n = 103 and n = 13,370. Fifteen systematic revisions evaluated the effect of isolated respiratory muscular training; six systematic revisions evaluated, in isolation, breathing control (relaxed breathing, pursed-lip breathing, and diaphragmatic breathing exercises) and thoracic expansion exercises; and one systematic review evaluated, in isolation, the positions that optimize ventilation. Nineteen systematic reviews with combined interventions that reinforced the role of education and capacitation while also aiming for their success were considered. The articles analyzed isolated interventions and presented their efficacy. The interventions based on respiratory exercises and respiratory muscular training were the most common, and one article mentioned the efficacy of positioning in the compromisation of ventilation. Combined interventions in which the educational component was included were found to be effective in improving pulmonary function, diffusion, oxygenation, and functional capacity. The outcomes used in each study were variable, leading to a more difficult analysis of the data. Conclusions: The interventions that were the focus of the review were duly mapped. The results suggest that nonpharmacological interventions used to optimize ventilation are effective, with a moderate to high level of evidence. There is a strong foundation for the use of the chosen interventions. The lack of studies on the intervention of “positioning to optimize ventilation” points out the need for a deeper analysis of its effects and for studies with a clear focus. This study supports the decisions and recommendations for the prescription of these interventions to patients with impaired ventilation.

The ageing of the population poses urgent challenges to the health and social protection sectors, including the need for greater adequacy and integration of health care services provided to older people. It is considered necessary and urgent to understand the state-of-the-art of community-based models of care for older people in institutional care and at home. This study aims to map the concepts that politicians and providers need to address through an umbrella review as a review method. Articles describing the structuring aspects of care models appropriate to the needs in long-term care and systematic reviews or meta-analyses targeting people aged 65 years or more were considered. A total of 350 studies met the inclusion criteria and were included in the review. The results identified the need to contribute to effective and more efficient integration and articulation of all the stakeholders, based essentially on professional care at the patient’s homes, focused on their needs using the available technologies, empowering patients and families. Eight categories emerged that addressed factors and variables involved in care models for the long-term care needs of institutionalised and home-based older people as a guarantee of accessibility to healthcare and to enhance the well-being and quality of life of patients and family caregivers.

Objetivo: conhecer quais os cuidados de enfermagem que as pessoas dependentes no autocuidado, que vivem em suas casas, necessitam, e quem lhes presta esses cuidados e com que frequência. Métodos: estudo observacional, quantitativo, descritivo, realizado na região central de Portugal. Amostra constituída por 130 pessoas dependentes no autocuidado, admitidas para cuidados no domicílio nas Equipes de Cuidados Continuados de um Agrupamento de Centros de Saúde da Região Centro de Portugal, entre julho de 2019 e março de 2020. Os dados foram analisados a partir dos resultados da estatística descritiva e inferencial.Resultados: cuidadores com mais de 75 anos foram prevalentes, 15,6% com mais de 80 anos, são mulheres e cônjuges, não apresentando, em muitos casos, capacidade para assegurar os cuidados necessários ao dependente.Conclusão: o estudo revela a necessidade de se pensar em estratégias que permitam uma oferta de cuidados profissionais, de modo a reduzir as omissões de assistência.

This study investigates the extent of under-diagnosis of acute confusion/delirium by analyzing the records of a health team and the perception of nurses concerning this phenomenon. This quantitative study was developed in a central university hospital in Portugal and used the documentary and interview techniques. The sample obtained through the application of the NeeCham's scale was composed of 111 patients with the diagnosis of acute confusion/delirium hospitalized in the medical and surgical acute care units. A rate of 12.6% of under-diagnosis was identified in the records and a rate of 30.6% was found taking into account the perception of nurses. No indicators of acute confusion/delirium were found in 8.1% of the 111 cases and only 4.5% of the patients were diagnosed with acute confusion/delirium. The results indicate there is difficulty in identifying acute confusion/delirium, with implications for the quality of care, suggesting the need to implement training measures directed to health teams.