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Introdução: A pessoa com cancro de cabeça e pescoço, quando submetida a cirurgias mutilantes, apresenta profundas alterações físicas e psicossociais, temporárias ou definitivas, com impacto individual e familiar. Destacam-se alterações na alimentação, hidratação, comunicação, imagem corporal, autoestima, modificação ou cessação da atividade profissional. As respostas humanas mais frequentes neste processo de doença são de natureza subjetiva, particularmente relacionadas com a imagem corporal e a autoestima. Os diagnósticos de baixa autoestima situacional e imagem corporal perturbada inserem-se no domínio de autoperceção, na taxonomia da NANDA-I, sendo indispensável investigação que contribua para a melhoria dos seus níveis de evidência. A validação diferencial emerge com esse objetivo, procurando fornecer aos enfermeiros indicadores clínicos, para o raciocínio clínico e planeamento de intervenções eficazes, atendendo às características definidoras específicas de cada diagnóstico. Objetivo: Realizar a validação clínica diferencial dos diagnósticos de imagem corporal perturbada e baixa autoestima situacional nas pessoas submetidas a cirurgia por cancro da cabeça e pescoço, com recurso à metodologia Q. Método: Estudo observacional, transversal, com recurso à metodologia Q, baseado no modelo de validação diferencial de diagnósticos de Richard Fehring. Foram incluídos 38 participantes. O instrumento de recolha de dados foi constituído pelos dados sociodemográficos e variáveis clínicas, Escala de Rosenberg, Escala de Imagem Corporal e o preenchimento do Q sorting. Para análise de dados sociodemográficos e das escalas foi usado o programa SPSS, o tratamento estatístico dos dados resultantes da aplicação da metodologia Q foi realizada com recurso ao programa PQMethod. A investigação foi autorizada pela comissão de investigação e ética da instituição onde decorreu o estudo. Resultados: A partir da análise fatorial efetuada foram apresentados três fatores que explicam a perspetiva dos participantes e que nos indicam o grau de concordância/discordância com as características definidoras dos diagnósticos de baixa autoestima situacional e imagem corporal perturbada, tendo por base o momento atual do participante após ter sido submetido a cirurgia. Foram identificadas as seguintes características definidoras: evitar olhar para o seu corpo, evitar tocar no corpo, comportamento de monitorização do corpo, despersonalização da perda através do uso de pronomes impessoais, foco na aparência passada, foco em função do passado, sentimento negativo acerca do corpo, recusa em reconhecer a mudança e desamparo. Conclusões: Da análise de consensos foram identificadas oito características definidoras para diagnóstico de imagem corporal perturbada e uma para o diagnóstico de baixa autoestima situacional. O uso da metodologia Q, neste processo de validação diferencial, permitiu o estudo de dois diagnósticos de cariz subjetivo numa população vulnerável, contribuindo para aumentar o conhecimento das suas necessidades. Este conhecimento tem implicações para a prática clínica e para o ensino.
Introduction: Head and neck cancer patients, when submitted to mutilating surgeries, present profound physical and psychosocial changes, temporary or definitive, with an impact on self and family. Changes in diet, hydration, communication, body image, self esteem, and job are regular. The most frequent human responses to this disease process are subjective in nature, particularly related to body image and self-esteem. The diagnoses of situational low self-esteem and disturbed body image are part of the self-perception domain, in the NANDA-I taxonomy, and research that contributes to the improvement of their levels of evidence is essential. Differential validation emerges with the objective of seeking to provide nurses with clinical indicators for clinical reasoning and planning of effective interventions, considering the specific defining characteristics of each diagnosis. Objective: To conduct a differential clinical validation of the nursing diagnoses of body image disorder and low situational self-esteem in patients with head and neck cancer, using Q methodology. Method: Observational cross-sectional study using Q methodology, based on Richard Fehring's differential diagnostic validation model. Thirty-eight participants were included. The data collection instrument consisted of sociodemographic data and clinical variables, Rosenberg scale, Body Image Scale and filling in the Q sorting. For the analysis of sociodemographic data and the scales, SPSS was used, the statistical treatment of the data resulting from the application of the Q methodology was performed using the PQMethod program. The study was approved by the research and ethics committee of the institution where the study took place. Results: The factor analysis concluded that three factors explained the participants' perspectives and indicate the degree of agreement/disagreement with the defining characteristics of the diagnoses of situational low self-esteem and disturbed body image, according to the specific time after participant’s surgery. The following defining characteristics were identified: avoids looking at one’s body, avoids touching at one’s body, behavior of monitoring one’s body, depersonalization of body part by use of impersonal pronouns, focus on past appearance, focus on past function, negative feeling about body, refusal at acknowledge change and helplessness. Conclusions: From the consensus analysis, eight defining characteristics were identified for the diagnosis of disturbed body image and one for the diagnosis of situational low self-esteem. The use of the Q methodology, in this process of differential validation, allowed the study of two diagnoses of a subjective nature in a vulnerable population, contributing to increase the knowledge of their needs. This knowledge has implications for clinical practice and teaching.
Introduction: Head and neck cancer patients, when submitted to mutilating surgeries, present profound physical and psychosocial changes, temporary or definitive, with an impact on self and family. Changes in diet, hydration, communication, body image, self esteem, and job are regular. The most frequent human responses to this disease process are subjective in nature, particularly related to body image and self-esteem. The diagnoses of situational low self-esteem and disturbed body image are part of the self-perception domain, in the NANDA-I taxonomy, and research that contributes to the improvement of their levels of evidence is essential. Differential validation emerges with the objective of seeking to provide nurses with clinical indicators for clinical reasoning and planning of effective interventions, considering the specific defining characteristics of each diagnosis. Objective: To conduct a differential clinical validation of the nursing diagnoses of body image disorder and low situational self-esteem in patients with head and neck cancer, using Q methodology. Method: Observational cross-sectional study using Q methodology, based on Richard Fehring's differential diagnostic validation model. Thirty-eight participants were included. The data collection instrument consisted of sociodemographic data and clinical variables, Rosenberg scale, Body Image Scale and filling in the Q sorting. For the analysis of sociodemographic data and the scales, SPSS was used, the statistical treatment of the data resulting from the application of the Q methodology was performed using the PQMethod program. The study was approved by the research and ethics committee of the institution where the study took place. Results: The factor analysis concluded that three factors explained the participants' perspectives and indicate the degree of agreement/disagreement with the defining characteristics of the diagnoses of situational low self-esteem and disturbed body image, according to the specific time after participant’s surgery. The following defining characteristics were identified: avoids looking at one’s body, avoids touching at one’s body, behavior of monitoring one’s body, depersonalization of body part by use of impersonal pronouns, focus on past appearance, focus on past function, negative feeling about body, refusal at acknowledge change and helplessness. Conclusions: From the consensus analysis, eight defining characteristics were identified for the diagnosis of disturbed body image and one for the diagnosis of situational low self-esteem. The use of the Q methodology, in this process of differential validation, allowed the study of two diagnoses of a subjective nature in a vulnerable population, contributing to increase the knowledge of their needs. This knowledge has implications for clinical practice and teaching.
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Keywords
Diagnóstico de enfermagem Imagem corporal perturbada Baixa autoestima situacional Validação diferencial Metodologia Q Nursing diagnosis Disturbed body image Situational low self-esteem Differential clinical validation Q methodology