Análise da acurácia do conjunto de indicadores clínicos do diagnóstico de enfermagem controle ineficaz da saúde em pessoas com hipertensão arterial
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2021-03-04
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Universidade Federal de Goiás
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The advanced nursing process early identifies the behavior of clinical practice phenomena, with self-care practices carried out by people with chronic heart diseases being one of the care pillars, especially for Arterial Hypertension (AH). To analyze the accuracy of the set of clinical indicators (CI) of the nursing diagnosis (DE) Ineffective Health Management (IHM) in people with AH undergoing outpatient treatment. In the first stage, a systematic review with meta-analysis was carried out to identify the clinical - population validity of the DE CIS. The PRISMA and STARD protocols were used to retrieve studies from databases MEDLINE via PubMed, Web of Science, SciELO, CINAHL, SCOPUS and EMBASE. For quality analysis, the modified QUADAS-2 protocol was applied. Statistical analysis was performed using software R to calculate sensitivity, specificity and Odds Ratio Diagnostic (ORD) measures with 95% confidence intervals. Heterogeneity was verified by calculating Higgins' I2 and Cochran's Q, using measures of fixed and random effect according to the obtained value. In the second stage, a clinical study of diagnostic accuracy was conducted at the Hypertension League of HC/UFG with a probabilistic sampling of 120 people by telephone consultation between September and November 2020. Cross mapping was used between the items of the Hipertension Self-Care Scale Brazilian version and the CI of the DE IHM for the definition of conceptual and operational definitions, in addition to clinical and sociodemographic instruments developed by the author. The Rasch model was used to analyze the unidimensionality of the clinical construct and the accuracy measures of the model based on the measures of efficiency, sensitivity, specificity and area under the Operator-Receiver Curve (ORC). Stage I: 11 studies were included. The four CI analyses showed ORD statistically higher than the unit value, with emphasizing on “failure to include treatment regimen in daily life” (ORD = 45). Stage II: median of 60 years of age, more frequent female (70%), brown color (55%), married (60%) and retired (36%). The main source of purchase of medicines was the popular pharmacy (66%) and 83% reported some comorbidity, with dyslipidemia being more frequent (38%). The median time of diagnosis of AH was ten years. The CI “failure to include treatment regimen in daily life” was the most frequent in the sample (70%), being more sensitive. The CI “failure to act to reduce risk factors” presented better levels of specificity. There was a frequency of 45 subjects supposedly identified with CIS in the sample (37,5; IC95%: 29,0 – 46,8). The most sensitive CI results from the incongruity of the lifestyle habits necessary for adequate control of AH. The most specific CI is the result of the initial phase of the chronic condition, being present in situations of greater severity of ND. Sociodemographic and clinical variables were similar to other clinical contexts. Nurses can use the summary measures of diagnostic accuracy obtained for early and valid identification of behaviors that predispose to the occurrence of DE IHM.
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SILVA, R. C. Análise da acurácia do conjunto de indicadores clínicos do diagnóstico de enfermagem controle ineficaz da saúde em pessoas com hipertensão arterial. 2021. 134 f. Dissertação (Mestrado em Enfermagem ) - Universidade Federal de Goiás, Goiânia, 2021.