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Advisor(s)
Abstract(s)
Introdução: cuidar de um familiar ou pessoa significativa no final de vida pode acarretar sobrecarga. Vários são os estudos realizados sobre este fenómeno, no entando, escasseia investigação da sobrecarga enquanto diagnóstico de enfermagem, encontrando-se esta, identificada na NANDA-International, como Caregiver Role Strain. Este diagnóstico de enfermagem nunca foi validado clinicamente numa população de cuidadores de doentes paliativos.
Objetivo geral: validar clinicamente o diagnóstico de enfermagem Caregiver Role Strain em cuidadores de doentes paliativos.
Metodologia: estudo do tipo transversal, de natureza quantitativa, descritivo e analítico, desenvolvido em duas partes. A Parte I – estudo preliminar – compôs-se pela revisão integrativa da literatura, e pela análise de conteúdo por 18 juízes. A Parte II – validação clínica – desenrolou-se ancorada no Modelo de Validação Clínica de Fehring e nas medidas de acurácia diagnóstica (sensibilidade, especificidade, valores preditivos e curva de ROC) para análise das características definidoras; e na estatística descritiva e inferencial para estudo dos fatores relacionados. O instrumento de colheita de dados utilizado foi um formulário o qual foi aplicado a uma amostra não probabilística por conveniência de 111 cuidadores de doentes paliativos. A identificação do diagnóstico foi determinada pela presença de três critérios: Escala de Sobrecarga do Cuidador de Zarit, concordância entre duas investigadoras e perceção do cuidador sobre a presença do diagnóstico.
Resultados: através da revisão integrativa da literatura foram identificadas sete novas características definidoras, e 13 novos fatores relacionados. Foram introduzidas alterações no enunciado e na definição do diagnóstico, sendo estas aprovadas pelos juízes. Na validação clínica, foi encontrada uma prevalência do diagnóstico de 42,3%. Das 22 características validadas, nove foram consideradas principais e 13 secundárias, sendo o coping ineficaz, o humor depressivo e a fadiga, das que obtiveram valores mais elevados na área sob a curva de ROC. O score global do diagnóstico foi de 0,68. A idade do cuidador (p=0,033), o grau de parentesco (p=0,004), a perceção de saúde (p≤0,001) ou imprevisibilidade nos cuidados (p=0,003), foram alguns dos fatores associados ao diagnóstico. Em função dos resultados construído um Instrumento Diagnóstico da Sobrecarga do Cuidador em Cuidados Paliativos.
Conclusões: os resultados de estudo contribuem para o aprimoramento dos vários componentes do diagnóstico, tornando-o mais acurado. Possibilitam uma melhor decisão clínica em enfermagem, permitindo aos enfermeiros um juízo diagnóstico apoiado em evidências científicas. Este suporte à decisão diagnóstica, através do instrumento que emergiu, facilitará uma intervenção mais sensível, junto dos cuidadores de doentes paliativos.
Introduction: Taking care of a family member or of a significant person at the end of their life can be a burden. Several studies have been carried out on this phenomenon, however, there is few research about that burden as a nursing diagnosis, which is identified in NANDA-International as Caregiver Role Strain (CRS). This nursing diagnosis has never been clinically validated in a population of caregivers of palliative patients. Main objective: To clinically validate nursing diagnosis Caregiver Role Strain in caregivers of palliative patients. Methodology: cross-sectional, quantitative, descriptive and analytical study. It was developed in two parts. Part I - preliminary study – included an integrative review, and a content analysis by 18 experts. Part II – clinical validation - was based in the Fehring’s Clinical Diagnostic Validity Model and diagnostic accuracy measurements (sensitivity, specificity, predictive values and ROC curve) to analyze the defining characteristics. Descriptive and inferential statistics were used to study the related factors. The data collection instrument was a face-to-face questionnaire which was applied to a non-probabilistic sample of 111 caregivers of palliative patients. The identification of the diagnosis was determined by the presence of three criteria: Zarit Burden Interview, agreement between two researchers and the caregiver's perception of the presence of the diagnosis. Results: Seven new defining characteristics and 13 new related factors were identified through integrative review. Were introduced changes at the label and definition of the nursing diagnosis which were approved by the judges. In the clinical validation, a diagnosis prevalence of 42.3% was found. From the 22 defining characteristics validated, nine were considered major and 13 minors, being ineffective coping, depressive mood, and fatigue, those who presented higher values in the area under the curve. The total diagnosis score was 0.68. The caregiver age (p=0,033), degree of kinship (p=0,004), health perception (p≤0.001), psychological problems (p=0,003) or unpredictability in care (p = 0,003) were some of the factors related to diagnosis. The results have led us to a to build of a Caregiver Burden Diagnostic Tool at Palliative Care. Conclusions: the study results contribute to the improvement of the various components of CRS diagnosis, making it more accurate. They enable a better clinical decision in nursing, allowing nurses a diagnostic judgment based on scientific evidence. This support for the diagnostic decision, through the instrument that emerged, will facilitate a more sensitive intervention among caregivers of palliative patients.
Introduction: Taking care of a family member or of a significant person at the end of their life can be a burden. Several studies have been carried out on this phenomenon, however, there is few research about that burden as a nursing diagnosis, which is identified in NANDA-International as Caregiver Role Strain (CRS). This nursing diagnosis has never been clinically validated in a population of caregivers of palliative patients. Main objective: To clinically validate nursing diagnosis Caregiver Role Strain in caregivers of palliative patients. Methodology: cross-sectional, quantitative, descriptive and analytical study. It was developed in two parts. Part I - preliminary study – included an integrative review, and a content analysis by 18 experts. Part II – clinical validation - was based in the Fehring’s Clinical Diagnostic Validity Model and diagnostic accuracy measurements (sensitivity, specificity, predictive values and ROC curve) to analyze the defining characteristics. Descriptive and inferential statistics were used to study the related factors. The data collection instrument was a face-to-face questionnaire which was applied to a non-probabilistic sample of 111 caregivers of palliative patients. The identification of the diagnosis was determined by the presence of three criteria: Zarit Burden Interview, agreement between two researchers and the caregiver's perception of the presence of the diagnosis. Results: Seven new defining characteristics and 13 new related factors were identified through integrative review. Were introduced changes at the label and definition of the nursing diagnosis which were approved by the judges. In the clinical validation, a diagnosis prevalence of 42.3% was found. From the 22 defining characteristics validated, nine were considered major and 13 minors, being ineffective coping, depressive mood, and fatigue, those who presented higher values in the area under the curve. The total diagnosis score was 0.68. The caregiver age (p=0,033), degree of kinship (p=0,004), health perception (p≤0.001), psychological problems (p=0,003) or unpredictability in care (p = 0,003) were some of the factors related to diagnosis. The results have led us to a to build of a Caregiver Burden Diagnostic Tool at Palliative Care. Conclusions: the study results contribute to the improvement of the various components of CRS diagnosis, making it more accurate. They enable a better clinical decision in nursing, allowing nurses a diagnostic judgment based on scientific evidence. This support for the diagnostic decision, through the instrument that emerged, will facilitate a more sensitive intervention among caregivers of palliative patients.
Description
Keywords
Cuidador Caregiver Cuidados paliativos Sobrecarga Diagnóstico de enfermagem e estudos de validação Palliative care Burden Nursing diagnosis Validation studies