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Advisor(s)
Abstract(s)
Os idosos confusos constituem uma parte significativa dos doentes dos serviços
de medicina. A Confusão tem um peso significativo para o Risco de Queda. Estando
estes idosos sujeitos à ocorrência de queda, o que pode dar origem a internamentos
prolongados e até levar à morte, por ferimentos graves, torna-se necessário que os
enfermeiros estejam despertos para a problemática e consigam, eficazmente, identificar
doentes confusos e com risco de queda, para implementar intervenções eficazes.
Pretendeu-se investigar em que medida o juízo clínico dos enfermeiros perante
os diagnósticos de Confusão e Risco de Queda se aproxima do nível de identificação
proporcionado por instrumentos de medida, devidamente validados.
Assim, efetuou-se um estudo exploratório e descritivo, em que se aplicou uma
escala de avaliação de Confusão (a Escala de Confusão Neecham) e uma escala de
avaliação de Risco de Queda (o Modelo de Hendrich II de Risco de Queda) a uma
amostra de 96 doentes com mais de 65 anos, internados num serviço de medicina (em
dois momentos distintos: na admissão e na alta). Colheram-se dados do processo
clínico, referentes aos diagnósticos de enfermagem “Confusão” e “Risco de Queda”,
efetuados pelo juízo clínico dos enfermeiros, sem recurso ao uso de instrumentos de
medida validados. No dia da alta voltou-se a consultar os processos, para a colheita de
dados referentes a eventuais episódios de queda.
Os dados obtidos permitem verificar a existência de uma correlação moderada
entre a Confusão e o Risco de Queda. A idade é um fator de risco para a Confusão e
para o Risco de Queda. Para avaliar as diferenças entre a validade discriminante na
identificação diagnóstica, resultante da recolha de dados pelos enfermeiros sem recurso
a instrumentos de medida validados e com o uso Modelo de Hendrich II de Risco de
Queda, os doentes foram divididos em dois grupos de acordo com a presença (ou
ausência) do diagnóstico de enfermagem: risco de queda.
Os resultados mostram um valor elevado de sensibilidade nos dois métodos em
análise (100%), o que traduz a capacidade dos métodos para identificar corretamente o
risco de queda entre aqueles que o possuem. Já quanto à especificidade verificamos que
o julgamento clínico dos enfermeiros para excluir corretamente aqueles que não
possuem o risco é muito fraca (5,5%), enquanto a utilização do Modelo de Hendrich II
de Risco de Queda apresenta uma especificidade moderada (37,4%) sobreponível a alguns estudos realizados com este instrumento de avaliação. Quanto ao valor preditivo
positivo (VPP) e valor preditivo negativo (VPN) do julgamento clínico dos enfermeiros
para predizer doentes que caem ou de não se ter queda, é muito fraca (5,5%). Por seu
lado, a utilização do Modelo de Hendrich II de Risco de Queda apresenta também um
valor baixo de VPP (8,1%), sendo bastante mais elevado (34,7%) o valor preditivo
negativo (VPN), ou seja, apresenta melhor capacidade para ajudar a prever qual a
possibilidade de não se ter queda.
Globalmente, podemos afirmar que a utilização do Modelo de Hendrich II de
Risco de Queda não é melhor em prever a queda do que os julgamentos clínicos dos
enfermeiros. Contudo, o mesmo não se verifica para excluir corretamente aqueles que
não possuem o risco e para prever qual a possibilidade de não se ter queda, onde o
Modelo de Hendrich II de Risco de Queda apresenta valores moderados à semelhança
de outros estudos
The confused elderly form a significant part of the medicine department users. Confusion contributes significantly to Fall Risk. Being these elderly prone to the occurrence of a fall, which can lead to longer hospital stays and even to death, through serious wounds, it is necessary that nurses are aware of the issue and become effectively able to identify confused patients with fall risk, in order to establish effective interventions. We meant to find how does nurses’ clinical judgement, in the presence of Confusion and Fall Risk, approaches the level of diagnose proportioned by properly validated assessment tools. We performed an exploratory and descriptive study, in which we applied a Confusion assessment tool (The Neecham Confusion Scale) and a Fall Risk assessment tool (Hendrich II Fall Risk Model), to a population of 96 patients over 65, hospitalized in a medicine department (in two different moments: at admission and at discharge). Data referent to the nurses’ clinical judgement on Confusion and Fall Risk (without recurring to validated assessment tools) was collected from the clinical charts. At discharge, clinical charts were consulted one more time, in order to collect data referent to possible fall episodes. The obtained data allowed us to verify a moderate correlation between Confusion and Fall Risk. Age is a risk factor both for Confusion and Fall Risk. We separated the patients in two groups (according to the presence or absence of the fall risk nursing diagnosis) in order to evaluate the difference between the discriminant validity resulting from the nurses’ judgement (without recurring to validated assessment tools) and the one resulting from the Hendrich II Fall Risk Model. Data showed us a high sensitivity value in both methods (of 100%), which indicates their capability of identifying fall risk correctly between the patients who have it. In respect to specificity, we ascertain that nurses’ judgement (to exclude correctly those who do not have fall risk) is very weak (of 5,5%), whereas the Hendrich II Fall Risk Model showed us a moderate specificity (of 37,4%), similar to other investigations which used this assessment tool. Both the nurses’ judgement’s positive predictive value (PPV) and negative predictive value (NPV), in order to foresay which clients fall or not are very weak (of 5,5%). On its part, the Hendrich II Fall Risk Model also showed a low PPV (of 8,1%), while its NPV is much higher (of 34,7%). This means that the model predicts, with more efficacy, the possibility of not falling. Overall, we can say that the Hendrich II Fall Risk Model does not predict a fall in a better way than the nurses’ judgement. However, the same does not apply to exclude correctly those who do not have the risk and to predict the possibility of not falling, in which the Hendrich II Fall Risk Model showed us moderate results, similarly to other investigations.
The confused elderly form a significant part of the medicine department users. Confusion contributes significantly to Fall Risk. Being these elderly prone to the occurrence of a fall, which can lead to longer hospital stays and even to death, through serious wounds, it is necessary that nurses are aware of the issue and become effectively able to identify confused patients with fall risk, in order to establish effective interventions. We meant to find how does nurses’ clinical judgement, in the presence of Confusion and Fall Risk, approaches the level of diagnose proportioned by properly validated assessment tools. We performed an exploratory and descriptive study, in which we applied a Confusion assessment tool (The Neecham Confusion Scale) and a Fall Risk assessment tool (Hendrich II Fall Risk Model), to a population of 96 patients over 65, hospitalized in a medicine department (in two different moments: at admission and at discharge). Data referent to the nurses’ clinical judgement on Confusion and Fall Risk (without recurring to validated assessment tools) was collected from the clinical charts. At discharge, clinical charts were consulted one more time, in order to collect data referent to possible fall episodes. The obtained data allowed us to verify a moderate correlation between Confusion and Fall Risk. Age is a risk factor both for Confusion and Fall Risk. We separated the patients in two groups (according to the presence or absence of the fall risk nursing diagnosis) in order to evaluate the difference between the discriminant validity resulting from the nurses’ judgement (without recurring to validated assessment tools) and the one resulting from the Hendrich II Fall Risk Model. Data showed us a high sensitivity value in both methods (of 100%), which indicates their capability of identifying fall risk correctly between the patients who have it. In respect to specificity, we ascertain that nurses’ judgement (to exclude correctly those who do not have fall risk) is very weak (of 5,5%), whereas the Hendrich II Fall Risk Model showed us a moderate specificity (of 37,4%), similar to other investigations which used this assessment tool. Both the nurses’ judgement’s positive predictive value (PPV) and negative predictive value (NPV), in order to foresay which clients fall or not are very weak (of 5,5%). On its part, the Hendrich II Fall Risk Model also showed a low PPV (of 8,1%), while its NPV is much higher (of 34,7%). This means that the model predicts, with more efficacy, the possibility of not falling. Overall, we can say that the Hendrich II Fall Risk Model does not predict a fall in a better way than the nurses’ judgement. However, the same does not apply to exclude correctly those who do not have the risk and to predict the possibility of not falling, in which the Hendrich II Fall Risk Model showed us moderate results, similarly to other investigations.
Description
Keywords
Queda Confusão Modelo de Hendrich II de Risco de Queda Escala de Neecham Enfermagem Falls Confusion Hendrich II Fall Risk Model Neecham Confusion Scale Nursing