Desenvolvimento e validação de algoritmo para assistência de enfermagem ao paciente crítico no setor de emergência

Abstract

The Nursing Process is a structured method used to organize and direct the activities of nursing professionals, aiming at the quality of care provided to patients, families and the community. The nurse, as the person responsible for this process, organizes and plans it, in addition to executing interventions in collaboration with the nursing team, based on technical and scientific knowledge. In this way, the application of the Nursing Process enables the nurse to identify the needs of patients and direct care based on defined priorities, promoting individualized, comprehensive and personalized care. Objectives: To develop and validate an algorithm for applying the PE to critical or potentially critical adult patients in the emergency department, based on the primary assessment. Method: This methodological study aims to support the construction of a decision-making algorithm for applying the nursing process, using the NANDA-I, NIC and NOC taxonomies, based on an integrative literature review. The instrument was validated with the collaboration of experts, selected through a search on the Lattes Platform and the “snowball” technique, according to the classification based on the adaptation of the Fehring criteria. A total of six judges agreed to participate in the study. The evaluation of the algorithm items was performed based on the Content Validity Index (CVI), considering items with CVI ≥ 0.7 as acceptable. The experts’ participation was formalized by signing the Free and Informed Consent Form. Results: Six references were included in the integrative review, ensuring methodological rigor during the search process. To this end, three researchers independently selected the articles through a triple-blind process, conducted between October 2023 and January 2024. The group of experts consisted mostly of women (83.3%), with a mean age of 46.3 years (SD ± 11.3). The mean time since graduation was 22.6 years (SD ± 9.4), while the mean time working in the emergency area was 11.5 years (SD ± 6.7). Most of the judges (83.3%) had a postgraduate degree in the emergency area. Regarding experience, 66.7% had already worked in the management of the emergency and assistance sector, while 83.3% had experience in teaching urgency, emergency and Systematization of Nursing Care. A total of 66.7% reported previous experience in the construction and validation of algorithms. Regarding academic production, 83.3% of the specialists had conducted research and published articles in the emergency area, while 66.7% had publications related to the Systematization of Nursing Care and 50.0% to the construction and validation of algorithms. Despite having similar values, algorithm C presented the highest average score and algorithm A the lowest. The validation criteria for the contents of algorithms A, B, C, D and E presented p-values greater than 0.05, indicating no significant association between the contents and the length of service in the area. Thus, regardless of the length of service in the area, the experts demonstrated agreement regarding the algorithms analyzed. Conclusion: The content of a decision-making algorithm for applying the NP to critical or potentially critical patients in the emergency department was developed and validated based on primary assessment criteria A, B, C, D, E, contributing to qualified and safe care. There is a need to invest in studies to confirm its clinical validation, applicability and effectiveness, as well as the proposal to create software to facilitate the application process quickly, helping the emergency department nurse to carry out the nursing process in a complete and correct manner.