Marcos Antônio Gomes Brandão

Um perfil da produção científica de enfermagem em Hematologia, Hemoterapia e Transplante de medula óssea

OBJETIVOS: Esse e um estudo exploratorio transversal que pretendeu caracterizar a producao cientifica de enfermagem em Hematologia, Hemoterapia e Transplante de Medula Ossea, areas de interesse crescente na enfermagem, por envolver situacoes que requerem cuidado qualificado e especializado do profissional desta area. METODOS: Foram analisados os resumos dos trabalhos publicados em tres periodicos nacionais, em dois anais de congressos nacionais e da Biblioteca Virtual em Saude, BVS/BIREME. RESULTADOS: Do periodo 2000-2004, foram encontradas 88 publicacoes, a maior parte divulgada nos anais de congressos (n=73). As categorias que mais contribuiram foram docentes e discentes (n=40). Os trabalhos originaram-se principalmente no Sudeste (n=49) e predominam aqueles com abordagem quanti-qualitativa (n=29) e na area assistencial (n=51). CONCLUSOES: Apesar das limitacoes, acreditamos que esse trabalho podera estimular a discussao sobre a producao e divulgacao cientifica de enfermagem nessas areas.

Metacognição e tecnologia educacional simbólica

The National Directives for Medicine Courses list among others learn how to learn and scientific competence as main objectives for graduation curricula. The purpose of this study is to propose metacognition as a Symbolic Educational Technology. This proposition is based upon Schultzs phenomenological perspective of symbols. The following text presents four main topics. The first introduces a broad definition for Symbolic Educational Technology. The second topic deals with metacognition concepts and its educational benefits. The third one presents Schultzs phenomenology and his concept of symbols. Finally the fourth topic shows how metacognition can enhance teaching and learning by using symbols and ciphers.

Prevalence of nursing diagnosis of decreased cardiac output and the predictive value of defining characteristics in patients under evaluation for heart transplant

The purposes of the study were to identify the prevalence of defining characteristics (DC) of decreased cardiac output (DCO) in patients with cardiac insufficiency under evaluation for heart transplantation, and to ascertain the likelihood of defining characteristics being predictive factors for the existence of reduction in cardiac output. Data was obtained by retrospective documental analysis of the clinical records of right-sided heart catheterizations in 38 patients between 2004 and 2009. The results showed that 71.1% of the patients had decreased cardiac output (measured by cardiac index). The majority of the NANDA-International defining characteristics for DCO were more frequent in individuals with reduced cardiac index levels. The study emphasizes the odds ratio (OR) for increased Systemic Vascular Resistance of OR=4.533, of the third heart sound with OR=3.429 and the reduced ejection fraction with OR=2.850. By obtaining the predictive values for the defining characteristics the study identifies them as diagnostic indicators of decreased cardiac output.The purposes of the study were to identify the prevalence of defining characteristics (DC) of decreased cardiac output (DCO) in patients with cardiac insufficiency under evaluation for heart transplantation, and to ascertain the likelihood of defining characteristics being predictive factors for the existence of reduction in cardiac output. Data was obtained by retrospective documental analysis of the clinical records of right-sided heart catheterizations in 38 patients between 2004 and 2009. The results showed that 71.1% of the patients had decreased cardiac output (measured by cardiac index). The majority of the NANDA-International defining characteristics for DCO were more frequent in individuals with reduced cardiac index levels. The study emphasizes the odds ratio (OR) for increased Systemic Vascular Resistance of OR=4.533, of the third heart sound with OR=3.429 and the reduced ejection fraction with OR=2.850. By obtaining the predictive values for the defining characteristics the study identifies them as diagnostic indicators of decreased cardiac output.

Nursing students' difficulties in the learning of diagnostics in nursing, in a metacognitive perspective

Resumen El objetivo general es investigar, en la perspectiva meta cognitiva, el aprendizaje del diagnóstico en enfermería en el área hospitalaria, de alumnos concluyentes del curso de graduación. De naturaleza cualitativa, se aplicó el método fenomenológico científico a través de entrevistas individuales con diecinueve alumnos de la quinta serie, del último período de prácticas supervisadas en el área hospitalaria. El análisis temático de contenido indicó dificultades de los alumnos en el proceso de aprendizaje, relacionadas a la estructura teórica, la aplicación práctica de diagnosticar, al conocimiento y uso de las clasificaciones diagnósticas, les faltando la percepción de que esto envuelve raciocinio clínico y que resulta en el diagnóstico. Se concluye que la meta cognición, por incluir el conocimiento de estrategias de regulación de desempeño, de planificación y control del proceso de aprendizaje, pueda ser eficaz en el control de las dificultades de aprendizaje de los alumnos. Palabras claves: Aprendizaje. Diagnóstico de Enfermería. Cognición 1 Mestre em Enfermagem. Doutora pela Escola de Enfermagem Anna Nery/ UFRJ. Professora Adjunto do Depar tamento de Enfermagem Hospitalar da Universidade do Estado do Pará (UEPA). Membro do Núcleo de Pesquisa de Fundamentos do Cuidado de Enfermagem (Nuclearte). Membro do Grupo de Estudos em Aprendizagem e Cognição (GEAC). Bolsista do CNPq. Belém-PA. Brasil. E-mail: anagracinda@terra.com.br;2 Doutor em Medicina pela Faculdade de Medicina da UFRJ. Professor Adjunto e Pesquisador do Laboratório de Currículo e Ensino (LCE/NUTES). Líder do Grupo de Estudos em Aprendizagem e Cognição (GEAC). Orientador do doutorado. Rio de Janeiro – RJ. Brasil. E-mail: mpeixoto@nutes.ufrj.br;3 Doutor em Enfermagem. Professor Adjunto do Depar tamento de Enfermagem Fundamental da Escola de Enfermagem Anna Nery / UFRJ. Pesquisador Permanente do Grupo de Estudos em Aprendizagem e Cognição (GEAC). Rio de Janeiro – RJ. Brasil. E-mail: marcosagbrandao@yahoo.com.br ;4 Doutora em Enfermagem. Professora Titular do Depar tamento de Enfermagem Fundamental da Escola de Enfermagem Anna Nery/UFRJ. Pesquisadora do CNPq. Membro da Diretoria do Nuclear te. Rio de Janeiro – RJ. Brasil. E-mail: marciadeaf@ibest.com.br;5 Mestre em Enfermagem. Doutoranda pela Escola de Enfermagem Anna Nery/UFRJ. Membro do Núcleo de Pesquisa em Fundamentos do Cuidado de Enfermagem (Nuclear te). Membro do Grupo de Estudos em Aprendizagem e Cognição (GEAC). Bolsista pela CAPES. Rio de Janeiro – RJ. Brasil. E-mail: jaquelinedeandrademartins@gmail.com PESQUISA RESEARCH INVESTIGACIÓN The general objective is to investigate, in a metacognitive perspective, the learning of diagnostics with undergraduate students in a hospital nursing area. Of qualitative nature, the scientific phenomenological method was applied through individual interviews with nineteen students from the fifth year, the last supervised year of hospital area internship. The theme analysis of content indicated that the students had difficulties in their learning processes related to theoretical structure, practical diagnostic application, knowledge and use of diagnostic classifications, and lack of perception of the clinical thinking and results involved in diagnostics. Concluding that metacognition, including knowledge of regulation strategies of performance and the planning and control of the learning process, may be effective in controlling the difficulties in the students’ learning.Abstract Resumen El objetivo general es investigar, en la perspectiva meta cognitiva,el aprendizaje del diagnostico en enfermeria en el area hospitalaria,de alumnos concluyentes del curso de graduacion. De naturalezacualitativa, se aplico el metodo fenomenologico cientifico a travesde entrevistas individuales con diecinueve alumnos de la quintaserie, del ultimo periodo de practicas supervisadas en el areahospitalaria. El analisis tematico de contenido indico dificultades delos alumnos en el proceso de aprendizaje, relacionadas a laestructura teorica, la aplicacion practica de diagnosticar, alconocimiento y uso de las clasificaciones diagnosticas, les faltandola percepcion de que esto envuelve raciocinio clinico y que resultaen el diagnostico. Se concluye que la meta cognicion, por incluir elconocimiento de estrategias de regulacion de desempeno, deplanificacion y control del proceso de aprendizaje, pueda ser eficazen el control de las dificultades de aprendizaje de los alumnos.Palabras claveses: Aprendizaje. Diagnostico de Enfermeria.Cognicion

Dificuldades dos estudantes de enfermagem na aprendizagem do diagnóstico de enfermagem, na perspectiva da metacognição

Resumen El objetivo general es investigar, en la perspectiva meta cognitiva, el aprendizaje del diagnóstico en enfermería en el área hospitalaria, de alumnos concluyentes del curso de graduación. De naturaleza cualitativa, se aplicó el método fenomenológico científico a través de entrevistas individuales con diecinueve alumnos de la quinta serie, del último período de prácticas supervisadas en el área hospitalaria. El análisis temático de contenido indicó dificultades de los alumnos en el proceso de aprendizaje, relacionadas a la estructura teórica, la aplicación práctica de diagnosticar, al conocimiento y uso de las clasificaciones diagnósticas, les faltando la percepción de que esto envuelve raciocinio clínico y que resulta en el diagnóstico. Se concluye que la meta cognición, por incluir el conocimiento de estrategias de regulación de desempeño, de planificación y control del proceso de aprendizaje, pueda ser eficaz en el control de las dificultades de aprendizaje de los alumnos. Palabras claves: Aprendizaje. Diagnóstico de Enfermería. Cognición 1 Mestre em Enfermagem. Doutora pela Escola de Enfermagem Anna Nery/ UFRJ. Professora Adjunto do Depar tamento de Enfermagem Hospitalar da Universidade do Estado do Pará (UEPA). Membro do Núcleo de Pesquisa de Fundamentos do Cuidado de Enfermagem (Nuclearte). Membro do Grupo de Estudos em Aprendizagem e Cognição (GEAC). Bolsista do CNPq. Belém-PA. Brasil. E-mail: anagracinda@terra.com.br;2 Doutor em Medicina pela Faculdade de Medicina da UFRJ. Professor Adjunto e Pesquisador do Laboratório de Currículo e Ensino (LCE/NUTES). Líder do Grupo de Estudos em Aprendizagem e Cognição (GEAC). Orientador do doutorado. Rio de Janeiro – RJ. Brasil. E-mail: mpeixoto@nutes.ufrj.br;3 Doutor em Enfermagem. Professor Adjunto do Depar tamento de Enfermagem Fundamental da Escola de Enfermagem Anna Nery / UFRJ. Pesquisador Permanente do Grupo de Estudos em Aprendizagem e Cognição (GEAC). Rio de Janeiro – RJ. Brasil. E-mail: marcosagbrandao@yahoo.com.br ;4 Doutora em Enfermagem. Professora Titular do Depar tamento de Enfermagem Fundamental da Escola de Enfermagem Anna Nery/UFRJ. Pesquisadora do CNPq. Membro da Diretoria do Nuclear te. Rio de Janeiro – RJ. Brasil. E-mail: marciadeaf@ibest.com.br;5 Mestre em Enfermagem. Doutoranda pela Escola de Enfermagem Anna Nery/UFRJ. Membro do Núcleo de Pesquisa em Fundamentos do Cuidado de Enfermagem (Nuclear te). Membro do Grupo de Estudos em Aprendizagem e Cognição (GEAC). Bolsista pela CAPES. Rio de Janeiro – RJ. Brasil. E-mail: jaquelinedeandrademartins@gmail.com PESQUISA RESEARCH INVESTIGACIÓN The general objective is to investigate, in a metacognitive perspective, the learning of diagnostics with undergraduate students in a hospital nursing area. Of qualitative nature, the scientific phenomenological method was applied through individual interviews with nineteen students from the fifth year, the last supervised year of hospital area internship. The theme analysis of content indicated that the students had difficulties in their learning processes related to theoretical structure, practical diagnostic application, knowledge and use of diagnostic classifications, and lack of perception of the clinical thinking and results involved in diagnostics. Concluding that metacognition, including knowledge of regulation strategies of performance and the planning and control of the learning process, may be effective in controlling the difficulties in the students’ learning.Abstract Resumen El objetivo general es investigar, en la perspectiva meta cognitiva,el aprendizaje del diagnostico en enfermeria en el area hospitalaria,de alumnos concluyentes del curso de graduacion. De naturalezacualitativa, se aplico el metodo fenomenologico cientifico a travesde entrevistas individuales con diecinueve alumnos de la quintaserie, del ultimo periodo de practicas supervisadas en el areahospitalaria. El analisis tematico de contenido indico dificultades delos alumnos en el proceso de aprendizaje, relacionadas a laestructura teorica, la aplicacion practica de diagnosticar, alconocimiento y uso de las clasificaciones diagnosticas, les faltandola percepcion de que esto envuelve raciocinio clinico y que resultaen el diagnostico. Se concluye que la meta cognicion, por incluir elconocimiento de estrategias de regulacion de desempeno, deplanificacion y control del proceso de aprendizaje, pueda ser eficazen el control de las dificultades de aprendizaje de los alumnos.Palabras claveses: Aprendizaje. Diagnostico de Enfermeria.Cognicion

Ações participativas em uma comunidade virtual de enfermagem

Resumen This study is about interaction of nursing on vir tual environments and their importance for nursing care and learning this profession. Objectives: To propose a categorization for participating actions in messages produced by virtual identity of the nursing community; and to verify the distribution of the participating actions, to correlate with the process of interaction in a nursing virtual community. Methods: This is an exploratory study of quantitative approach, with descriptive statistics. Held inspectional reading email messages and through the nine categories were proposed for the participating actions. Results: Commentary, questioning and answer were prevalent categories. These actions were named “triad for conversation”. We made the test of kappa, obtaining result in a moderate agreement that guided the discussion to two possible hypotheses for future studies. Conclusion: Believed that exist a possibility to take the participating actions as basics elements that indicate interaction and transaction in the systemic perspective applied in nursing. This comprehension contributes for the better characterization of ambient, individual and his connections on the virtual space in the internet.

Interactive Theory of Breastfeeding: creation and application of a middle-range theory

OBJECTIVE To describe a breastfeeding theory based on Kings Conceptual System. METHOD Theoretical study that used analysis of concept, assertion synthesis, and derivation of theory for the creation of a new theory. RESULTS Kings system components were associated with elements of the breastfeeding process and a middle-range theory was created, which describes, explains, predicts, and prescribes breastfeeding by analyzing factors that precede and affect it, as well as their consequences on the breastfeeding process. CONCLUSION The Breastfeeding Interactive Model is abstract enough to be applied in different social, cultural, political, and economic contexts, because it conceptualizes breastfeeding in systemic, dynamic, and procedural aspects. Based on a conceptual model of nursing, it contributes to the scientific construction of the subject; however it can also potentially be applied by other professionals involved in breastfeeding assistance.

A conceptual framework of clinical nursing care in intensive care

Objetivo: propor um marco conceitual para uma clinica do cuidado de enfermagem na terapia intensiva.Metodo: pesquisa de campo, descritiva e qualitativa, realizada com 21 enfermeiros de uma unidade de terapia intensiva de um hospital publico federal. Realizou-se entrevista semiestruturada e analise de conteudo tematico e lexical, com apoio do software Alceste.Resultados: os elementos que caracterizam a clinica do cuidado na terapia intensiva emergem dos saberes especializados, da interacao, do contexto do trabalho, dos tipos de paciente e de enfermeiro, proprios da terapia intensiva, e dos referenciais assistenciais.Conclusao: conclui-se que o marco conceitual da clinica do cuidado de terapia intensiva articula elementos proprios da dinâmica desse cenario: objetivos em relacao as tecnologias e atencao aos equipamentos e subjetivos relacionados a interacao humana, especificos dos cuidados de enfermagem, contrapondo-se as criticas pautadas na desumanizacao.Objective: to propose a conceptual framework for clinical nursing care in intensive care. Method: descriptive and qualitative field research, carried out with 21 nurses from an intensive care unit of a federal public hospital. We conducted semi-structured interviews and thematic and lexical content analysis, supported by Alceste software. Results: the characteristics of clinical intensive care emerge from the specialized knowledge of the interaction, the work context, types of patients and nurses characteristic of the intensive care and care frameworks. Conclusion: the conceptual framework of the clinics intensive care articulates elements characteristic of the dynamics of this scenario: objective elements regarding technology and attention to equipment and subjective elements related to human interaction, specific of nursing care, countering criticism based on dehumanization.

Análise do conteúdo de uma tecnologia para raciocínio diagnóstico de enfermagem

OBJECTIVE to undergo a content analysis of a metacognitive strategy of indirect assessment in the pre-encounter with the client. METHOD methodological study. Agreement and inter-rater reliability index for the criteria: relevance, adequacy, clarity, conciseness and accuracy of a technology to the nursing diagnosis reasoning for novices through an electronic form. The sample consisted of 13 raters. Data were analyzed using descriptive statistics. RESULTS high agreement and inter-rater reliability for 85 items related to data collection stage and the strategy description. Only fi ve items did not reach the validation criteria and must be rewritten. CONCLUSION indirect assessment of the pre-encounter is relevant to the diagnostic reasoning process, being possible to develop competencies and diagnostic skills in the novice through strategies, proposals on innovative technology in the form of a diagram.

Características definidoras da Resposta Disfuncional ao Desmame Ventilatório como indicadores de acurácia do desmame ventilatório

The study aimed to analyze the defining characteristics of the Dysfunctional Ventilatory Weaning Response as an indicator of the accuracy of ventilatory weaning. Observational study of 38 events of ventilatory weaning in adult patients admitted to intensive care. For the defining characteristics, it was calculated: sensitivity, specificity, positive and negative predictive values, accuracy or efficiency, likelihood ratio positive and negative, and diagnostic odds ratio. It was also considered the median number of defining characteristics in the event of success and failure. It was considered accurate: agitation, deterioration in arterial blood gases from baseline parameters, moderate use of accessory muscles of respiration, increased respiratory rate from baseline parameters and respiratory rate increases significantly with respect to baseline parameters. There was statistical difference in the median number of defining characteristics observed. It was concluded that the defining characteristic and the number of them would influence the success of the weaning decision.Objetivou-se avaliar as caracteristicas definidoras do diagnostico Resposta Disfuncional do Desmame Ventilatorio, como indicadores de acuracia das tentativas de desmame. Estudo observacional de 38 eventos de tentativa de desmame ventilatorio em pacientes adultos internados em terapia intensiva. Para as caracteristicas definidoras foram calculadas: sensibilidade, especificidade, valores preditivos positivos e negativos, acuracia ou sensibilidade, razao de verossimilhanca e razao de chances diagnostica. Tambem foram consideradas as medianas do numero de caracteristicas definidoras nos eventos de sucesso e insucesso. Foram consideradas acuradas: agitacao, deterioracao nos gases sanguineos arteriais em relacao aos parâmetros basais, uso moderado da musculatura acessoria da respiracao, aumento da frequencia respiratoria em relacao aos parâmetros basais e frequencia respiratoria aumentada de forma significativa em relacao aos parâmetros basais. Houve diferenca estatistica nas medianas do numero de caracteristicas definidoras observadas. Conclui-se que a caracteristica definidora e o numero delas influenciariam o sucesso da decisao sobre o desmame.