O processo de enfermagem para pacientes em pós-operatório de cirurgia bariátrica: elaboração de material instrucional

Abstract

Introduction: The Nursing Process enables a systematized and qualified assistance. However, Nurses still have difficulties in using the diagnosis reasoning and in registering the Nursing Process. Hence, in attending to a request of the institution, the organization of a didactic material was proposed for the surgical clinic unit for the care of the bariatric patient. Objectives: To identify the Nursing diagnoses and interventions most prevalent in bariatric post-surgical patients; To prepare the protocol of Nursing diagnoses and interventions, and the case studies that are part of the instructional material; To evaluate the content of the instructional material. Method: This is a Technological Development Applied Research that followed three stages: Integrative Review; Case Studies Preparation; and Instructional Material preparation. Literature review was directed by the question: What are the Nursing diagnoses and Interventions/Care related to the bariatric surgery post-surgical patient? In the data bases: Medical Literature Analysis and Retrieval System Online (MEDLINE) and Literatura Latino-Americana e do Caribe em Ciências da Saúde (LILACS), with descriptors "cirurgia bariátrica" and "enfermagem"; “bariatric surgery” and “nursing”. The inclusion criteria were: original papers published from 2013 to 2018, in Portuguese, English or Spanish. For the preparation of Case Studies, the literature review data was used, as well as 10 real case studies, which were collected in patients in bariatric post-surgery at the study hospital. The instructional material used the category system of the Basic Human Needs of Horta, the NANDA-I Classification and the Nursing Interventions Classification. The material was evaluated by 20 nurses, members of the clinical body of a university hospital in the Southwest of Brazil. The evaluation by judges was done in March 2020. The data analysis used the content validity index, the Q test of Cochran, and alfa of Cronbach. Results: The review was comprised of seven papers. The instructional material was comprised of 10 case studies and one protocol with Nursing diagnoses, interventions and activities. The material was evaluated as adequate, with nearly perfect reliability (Cronbach α=92), it is clearly written, and it represents typical patient situations, having received more than 80% of judges’ agreement. Product: The instructional material containing case studies and a protocol with Nursing diagnoses, interventions and activities, based in clinical evidence, and in the standardized classifications enables the Nurse to train the diagnosis reasoning for accuracy in clinical judgement, and to make decisions in a reliable manner, as well as contributing in planning a better assistance to the patient at bariatric post-surgery, as well as in documenting the Nursing process. Conclusion: The instructional material may contribute in the professional education, in patient safety, and in consolidating the nursing process in the institution. The material may also be used by undergraduate students that have practical classes, curricular and extra-curricular internships at the surgical clinic, and those who assist bariatric post-surgery. The protocol was included in the electronic registry system, and the instructional material was made available for all Nurses at the institution.