Análise de conteúdo do diagnóstico de enfermagem perfusão tissular periférica ineficaz em pacientes com pé diabético

Abstract

Diabetes mellitus is a chronic condition that can lead the patient to develop various types of vascular complications, one of which is the diabetic foot that is characterized by the presence of ulcers, infection and destruction of tissues in the lower limbs. This problem can incapacitate the individual and generate major socioeconomic impacts. The present study aimed to analyze the content of the nursing diagnosis Ineffective peripheral tissue perfusion (PTPI) in patients with diabetic foot using a Middle Range Theory (TMA). This theory corresponds to a set of ideas that seeks to relate a small number of clearly defined concepts and propositions to minimize gaps in knowledge and offer quality assistance. This is a methodological study composed of two stages: preparation of a TMA and analysis of content by judges. The first stage was developed following the steps of the integrative literature review with a broad search in the databases BDENF, LILACS, MEDLINE, PUBMED and CINAHL. The following descriptors were used: diabetic angiopathies, diabetes mellitus, diabetic foot, diabetic neuropathy and peripheral arterial disease in English and Portuguese. 28 studies were selected that supported the construction of the TMA about the etiological factors and clinical indicators of the studied nursing diagnosis. These elements were based on Wanda de Aguiar Horta's Theory of Basic Human Needs. With the help of the material obtained, it was possible to identify 12 etiological factors and 22 clinical indicators, elaborate conceptual and operational definitions of each element, build a pictogram with the possible relationships between these components and establish eight propositions and their causal relationships. The second stage consisted of content analysis of the components of the diagnosis found in the first stage. The judges were nurses with clinical / theoretical / research experience with the theme diabetes and / or with nursing diagnoses. These judged the etiological factors and clinical indicators, as well as their conceptual and operational definitions, regarding the criteria of relevance, clarity and precision, being considered significant the items that presented p value> 0.05 and Content Validity Index (CVI) ≥ 0.9. All 12 etiological factors analyzed were considered relevant for the diagnostic identification, however, five showed inconsistencies regarding the clarity and / or precision of their operational definitions, requiring adjustments. As for the 22 clinical indicators evaluated, only the indicator Color does not return the leg when it is lowered after 1 minute of elevation was not considered relevant, because despite having a significant p-value, the CVI was <0.9, the same occurred for the indicator and cold foot, however, referred to the precision of its operational definition. Therefore, this study contributed to support the professional practice of nurses, through the early identification of etiological factors and clinical indicators aimed at the population with diabetic foot and as a proposal to suggest to NANDA-I taxonomy the inclusion of new defining characteristics and related factors for the PTPI diagnosis to have a more robust diagnostic inference, and thus provide benefits to the population through targeted and effective assistance.