Revisão de conteúdo do diagnóstico de enfermagem comunicação verbal prejudicada em pacientes com Esclerose Lateral Amiotrófica

Abstract

The study aims to review the content of the nursing diagnosis Verbal Communication impaired in patients with Amyotrophic Lateral Sclerosis (ALS), basing on questioning the appropriateness of the definition of the diagnosis, the defining characteristics (DC) and related factors (RF) as well as the existence of other clinical indicators, in addition to those defined by NANDA-I. The content review was carried out using the first step of Lopes model, Silva and Araujo (2012) for a review of nursing diagnoses concept called analysis. For the implementation of the concept of analysis we used the integrative literature review based on Whittemore and Knafl method (2005) from six databases (PUBMED, SCOPUS, COCHRANE, SCIENCE DIRECT, LILACS and CINAHL), with the following descriptors: amyotrophic lateral sclerosis and disorders of communication and their respective English and Spanish. After application of the inclusion and exclusion criteria remaining 21 studies that supported the concept analysis. Given these 21 selected studies applied the method of concept analysis Walker and Avant (2011) which supported the research of the definition of the concept impaired verbal communication of RF and DC for ALS patients. This review process led to the following results, it is recommended that the definition refers to the loss in the production of speech, voice or writing due to problem in transmitting and/or understand a message. The concept of examination of the proposal incorporates sixteen RF, namely: “degeneration of motor neurons”; “tracheostomy”; “emotional lability”; “dyspnea”; “muscle paresis facial spastic”; “muscle paresis facial flaccid”; “paresis of the tongue”; “speed reduced language”; “hiperadução vocal fold‟; “hipoadução vocal fold”; “weakness of the respiratory muscles”; “velopharyngeal incompetence”; “muscle atrophy of the tongue”; “fasciculations in the tongue”; “drooling”; “cognitive deficits”. The first three are related factors that already make up the taxonomy II. The fourth factor related corresponds to what is positioned in the NANDA-I within the defining characteristics. Regarding the DC, it is recommended to incorporate twelve, namely: „dysarthria”; “decreased ability and/or willingness to social interaction‟; “aphasia”; “anarthria‟; “dysgraphia”; “agraphia”; “talk fatigue”; “impaired speech intelligibility”; “speak rate of decline”; “reduced productivity of speech”; “augmentative and alternative communication”; “negative emotions”. The first three already compose the taxonomy II of NANDA-I, and proposes the modification of the appointment of “difficulty forming words” to “dysarthria”, “refusal to speak” to “decreased ability and/or willingness to social interaction” and “difficult to verbally express thoughts” to “aphasia”. It is considered that the process of content review subsidized a direction for the diagnostic efficiency of clinical indicators of Impaired Verbal Communication, contributing to the refinement and improvement of the diagnosis and its components present in Taxonomy II of NANDA-I, however is also necessary to perform the validation by experts and clinical validation for the accuracy of results. Thus, it is essential to nursing appropriating this diagnosis in different settings for safer nursing care and in order to amplify the knowledge and professional autonomy.