Acurácia de indicadores clínicos do diagnóstico de enfermagem “desobstrução ineficaz das vias aéreas” em pacientes no período pós-operatório de cirurgias cardíacas

Abstract

The use of good clinical indicators contributes to the assignment of nursing diagnoses making the care plan more effective. Accuracy determines the direct relationship between defining characteristics and the presence or absence of a specific nursing diagnose. The need for research focused on diagnoses’ accuracy motivated the development of this study, whose purpose is to examine the accuracy of clinical indicators of "Ineffective airway clearance" (IAC) in patients in post-operative period of cardiac surgeries. Cross-sectional study developed in the post-operative unit of a specialized hospital of Fortaleza-CE. A sample of 98 patients was selected consecutively and it was composed by individuals of both sexes, age above 18 years old and evaluated in the immediate post-operative (up to 48 hours). The data collection occurred within the period of January to April/2010 from a form, which had been subjected to a pilot test and applied by research project participants, focused on nursing terminologies, after training and evaluations. The components of the nursing diagnose IAC were evaluated according to the NANDA-I Taxonomy. Clinical cases were formulated after the data collection and five specialists performed the diagnostic inference. For the organization and statistical analysis of data collected, the software Excel and PASW were used. The level of significance adopted in the study was 5%. The proportion of men and women was equal in the sample, with predominance of people with low income and low scholarship, with average of 55.89 years old and living with a partner. The clinical diagnosis angina and coronary diseases were more prevalent, increasing the incidence of reconstructive surgeries in the sample. The high incidence of smoking was showed as a favorable factor for dysfunction in the process of airway clearance. The prevalence of ICA was 33.7%. Four of thirteen defining characteristics have significant associations with the studied diagnosis: "dyspnea", "absence of cough", "adventitious breath sounds" and "ineffective cough", and the last two were accurate. Some of related factors were more specific that sensitive: "asthma", "hyperplasia", "allergic airways" and "infection", and the last two were the most accurate. The related factors: "smoking", "retained secretions" and "excessive mucus" increased the risk for IAC. Peculiarities of post-operative period and the high incidence of smoking were identified as elements linked to the incidence of clinical indicators. Contributions left by specialists were suggestions concerning the modification of the nomenclature and the inclusion of a related factor for post-operative period. The study demonstrated the existence of difference in the specificities and sensitivities, which are influenced by population characteristics. The need of further studies development in other contexts was emphasized. Changes in the trial of the specialists were attributed to differences in their interpretations. The study gave us a direction towards the diagnostic efficiency for some clinical indicators contributing to improve the accuracy of these elements.