Validação clínica dos fatores relacionados do diagnóstico de enfermagem controle ineficaz da saúde em indivíduos com doença celíaca

Abstract

This study aimed to validate the related factors (FR) of the Nursing Diagnosis (DE) Ineffective health management (CIS) in celiac participants. The interest in developing this study was based on the need to define nursing interventions to control the health of celiac patients. However, due to the scarcity of scientific evidence that supports interventions, and to address the diagnosis CIS with this population, it was decided to investigate which FR increase the chance of developing it. A cross-sectional study was conducted with 83 celiac patients of both gender who lived in Ceará state, Brazil, selected from the Celiac Association of Brazil-Ceará and in the networks and social media linked to this association. Data collection was performed from May to September 2017. An instrument with the defining characteristics (CD) and FR of CIS and clinical/sociodemographic variables was applied. For data analysis, a Latent Class method and logistic regression model were applied. The following tests were used: Wald, Omnibus, Hosmer-Lemeshow, R2 of Cox & Snell and R² of Nagelkerke. In accordance with the guidelines from Resolution 466/2012, this study was submitted to and approved by the Ethics Research Committee at the Federal University of Ceará. The majority of celiac participants were female, white, employed, had no partner, declared being a member of religion which uses gluten in its rituals, lived in Fortaleza in the II and IV regional, had no children, had health insurance, declared not using or having never used the Brazilian Unified Health System for celiac care. It was verified that half of the celiac patients were up to 33 years, had 18 years of formal education, declared a per capita income of R$ 2,333.33, had no children, lived with three relatives, had been diagnosed with celiac disease for 48 months, and were members of a celiac association for 24 months. The number of people living in the same house was significantly lower among the celiac patients who did not have CIS (p=0.009). The prevalence of CIS was 55.69%. The most prevalent CD were: Failure to include treatment regimen in daily living (96.4%), Failure to take action to reduce risk factor (80.7%) and Ineffective choices in daily living for meeting health goal (72.3%). Among the celiac patients who had CIS, the most prevalent FR were: Perceived barrier, Fatigue, Complex treatment regimen, Anxiety and Complexity of healthcare system. Perceived benefit (p=0.034 and OR= 0.298) and Excessive demands (p=0.013 and OR=0.304) had a statistical association with CIS; therefore, in the absence of these RFs, celiacs were approximately 70% less likely to develop CIS. According to the logistic regression, the celiac patients with the FR Complex treatment regimen (p=0.011), Depression (p=0.034) and Excessive demands (p=0.049) presented, respectively, a chance of 4.48; 3.29; 2.81 for developing CIS. These FR influence in 22.5% the establishment of CIS. It is believed that this study may contribute to expand publications about celiac disease and nursing care and improve early actions and strategies to avoid comorbidities and/or health complications.