FCSE - Teses de Doutoramento / Doctoral Theses
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Browsing FCSE - Teses de Doutoramento / Doctoral Theses by Sustainable Development Goals (SDG) "09:Indústria, Inovação e Infraestruturas"
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- Algoritmos clínicos de apoio à tomada de decisão em enfermagem no cuidado à pessoa com ferida complexaPublication . Silva, Raquel Marques; Alves, Paulo Jorge Pereira; Lopes, MarcosIntroduction: The impact of wounds significantly affects the quality of life and places a substantial burden on healthcare systems. Clinical algorithms are believed to aid clinical reasoning and decision-making by nurses, thereby improving care for individuals with wounds. Objective: To develop and evaluate computerized clinical algorithms to support nursing decision-making in the care of adults with complex wounds. Methods: This mixed-methods study, comprising both qualitative and quantitative approaches, was structured in three phases. In the first phase, preliminary studies were conducted to design clinical algorithms, including a scoping review (according to JBI), a descriptive study using two online focus groups (13 participants, thematic analysis), and a prospective cohort study [data collection performed by nurses through mobile application (app), for six months, in nine Portugal health units, during the follow-up period for up to five weeks with six assessments and the healing time was the main outcome]. In the second phase focused on constructing clinical algorithms based on a deductive knowledge model using "if-then" logic and the Outcome-Present State-Test model, and achieving a consensus among experts and a consensus of judges developed to evaluate the content created through online questionnaires submitted to 105 participants. In the third phase, the constructed clinical algorithms were implemented in an app through a prospective cohort study (data collection performed by nurses through an app, for six months, in seven Portugal health units, during the follow-up period for up to four weeks, with three assessments. Up to three health ethics commissions approved the studies. Results: The scoping review and cohort study revealed primarily that local factors related to wound characteristics have a greater impact on healing than systemic or demographic factors. Features to be incorporated into an app for wound care should include image capture, professional communication, decision support, and action safety promotion. Clinical algorithms were created to support wound type diagnosis and therapeutic planning for intermediate and comprehensive wound monitoring, based on clinical reasoning with an emphasis on outcomes and the analysis of multiple conditions. Thirteen logical conditions for wound type, 40 informational alerts, 10 general recommendations, and 32 specific recommendations were successfully validated, with no items eliminated, and all achieved content evaluation indices statistically equal to or greater than 0.8 or within confidence intervals. In implementation, the overall agreement between the nurse's diagnosis and the algorithm-suggested diagnosis was moderate at 0.406 (CI 0.243-0.569). For therapeutic plan support algorithms, 85.3% and 90.3% of nurses followed the recommendations for comprehensive and intermediate monitoring, respectively. Alerts issued were evaluated with means of 4.34 (SD=0.82) for comprehensive monitoring and 4.33 (SD=0.97) for intermediate monitoring, on a scale of 1 to 5. Conclusion: The identified evidence on prognostic factors for delayed healing and the developed assessment tool allow nurses to improve reliability in characterizing individuals with wounds, anticipate complications, and individualize interventions. The successful implementation of clinical algorithms has practical applicability to improve care quality, reduce subjectivity in clinical reasoning and decision, and enhance action safety by incorporating updated evidence and innovative technology.