RESUmEN
Objeivo: Ideniicar los cuidados de enfer-mería prescritos para pacientes hospitali-zados con riesgos de caídas y compararlos con las intervenciones de la Nursing Inter-venions Classiicaions (NIC). Método: Es-tudio transversal realizado en un hospital universitario del sur de Brasil. La recolec-ción de datos fue retrospeciva en un sis-tema informaizado de registros de enfer-mería. La muestra se consituyó por 174 pacientes adultos internados en unidades clínicas y quirúrgicas con el Diagnósico de Enfermería Riesgo de Caídas. Los cuidados prescritos fueron comparados con las in-tervenciones de la NIC por el método de mapeo cruzado. Resultados: Los cuidados más prevalentes fueron: mantener baran-das en la cama, orientar al paciente y fa-milia en relación a los riesgos y prevención de caídas, mantener el imbre al alcance del paciente y mantener las pertenencias cerca al paciente. Estos fueron mapeados en las intervenciones Control del Ambien-te: Seguridad y Protección contra Caídas.
Conclusión: Los cuidados prescritos en la prácica clínica fueron corroborados por el referencial de la NIC.
dEScRiPtoRES
Diagnósico de enfermería Cuidados de enfermería Accidentes por caídas Pacientes internos Hospitalización
RESUmo
Objeivo: Ideniicar os cuidados de enfer-magem prescritos para pacientes hospitali-zados com risco de quedas e compará-los com as intervenções da Nursing Interven-ions ClassiicaInterven-ions (NIC). Método: Estu-do transversal realizaEstu-do em um hospital universitário doSul do Brasil. A coleta de dados foi retrospeciva em sistema infor-maizado de registros de enfermagem. A amostra se consituiu de 174 pacientes adultos internados em unidades clínicas e cirúrgicas com o Diagnósico de Enferma-gem Risco de quedas. Oscuidados pres-critos foram comparados com as interven-ções da NIC pelo método de mapeamento cruzado. Resultados: Os cuidados mais prevalentes foram: manter grades no leito, orientar paciente/família quanto aos riscos e prevenção de quedas, manter campainha ao alcance do paciente e manter pertences próximos ao paciente, mapeadas nas inter-venções Controle do Ambiente: Segurança e Prevenção contra Quedas. Conclusão: Os cuidados prescritos na práica clínica foram corroborados pelo referencial da NIC.
dEScRitoRES
Diagnósico de enfermagem Cuidados de enfermagem Acidentes por quedas Pacientes internados Hospitalização
AbStRAct
Objecive: Idenifying the prescribed nur-sing care for hospitalized paients at risk of falls and comparing them with the inter-venions of the Nursing Intervenions Clas-siicaions (NIC). Method: A cross-secional study carried out in a university hospital in southern Brazil. It was a retrospecive data collecion in the nursing records system. The sample consisted of 174 adult paients admited to medical and surgical units with the Nursing Diagnosis of Risk for falls. The prescribed care were compared with the NIC intervenions by the cross-mapping method. Results: The most prevalent care were the following: keeping the bed rails, guiding paients/family regarding the risks and prevenion of falls, keeping the bell within reach of paients, and maintaining paients’ belongings nearby, mapped in the intervenions Environmental Management: safety and Fall Prevenion. Conclusion: The treatment prescribed in clinical pracice was corroborated by the NIC reference.
dEScRiPtoRS
Nursing diagnosis Nursing care Accidental falls Inpaients Hospitalizaion
Nursing care mapping for patients
at risk of falls in the
Nursing
Interventions Classification
*melissa de Freitas Luzia1, miriam de Abreu Almeida2, Amália de Fátima Lucena3
MAPEAMENTO DE CUIDADOS DE ENFERMAGEM PARA PACIENTES COM RISCO DE QUEDAS NA NURSING INTERVENTIONS CLASSIFICATION
MAPEO DE CUIDADOS DE ENFERMERÍA PARA PACIENTES CON RIESGO DE CAÍDAS EN LA
NURSING INTERVENTIONS CLASSIFICATION
* Extracted from the thesis titled “Análise do Diagnóstico de Enfermagem Risco de quedas em pacientes adultos hospitalizados”, Universidade Federal do Rio Grande do Sul, 2012. 1 Master in Nursing from the School of Nursing, Federal University of Rio Grande do Sul, Porto Alegre, RS, Brazil. 2 Associate
Professor, School of Nursing, Federal University of Rio Grande do Sul, Porto Alegre, RS, Brazil. 3 Adjunct Professor, School of Nursing, Federal University
of Rio Grande do Sul, Porto Alegre, RS, Brazil.
DOI: 10.1590/S0080-623420140000400009
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Falls are one of the major adverse events in hospi-tals, accouning for two in every ive episodes related to paient care(1). The occurrence of injuries resultant from
falls can vary from excoriaions and contusions, to frac-tures and head traumas, and even death. Such damage can cause limitaions and physical disability, increase the length of hospital stay, and the costs related to treatment with ethical and legal implicaions for the insituion(2-3).
The repercussions of falls may also be psychological, espe-cially in the elderly, expressed by the fear of falling, inse-curity in walking, worsening of funcional decline, depres-sion and social isolaion(4)..
Paient safety is a priority for the World Health Orga-nizaion (WHO) that launched the World Alliance for Pa-ient Safety in October 2004, aiming to raise awareness for the improvement of safety in health care(5). Following
this trend, in April 2013, the Ministry of Health and the Brazilian Health Surveillance Agency (ANVISA) created the Naional Paient Safety Program (Programa Nacional de Segurança do Paciente - PNSP) aiming to promote acions for paient safety in health services of the country(6).
The prevenion of falls is one of the six internaional safety goals set by the WHO and also represents one of the safety protocols of the PNSP. There is an apparent concern of nursing in this context, when searching for grants in order to carry out intervenions that enable a safer, quality and harm-free care.
One of the strategies has been the use of the nurs-ing process, a systematic and scientifically grounded method of work that guides the care and documenta-tion of professional practice(7), allowing the evaluation
of patients and the identification of risk factors for falls. In this clinical situation, nurses can determine the Nurs-ing Diagnosis (ND) Risk for falls(8), aimed at preventing
falls through interventions.
The ND Risk for falls of the NANDA Internaional (NAN-DA-I) is deined as risk for increased suscepibility to fall-ing that may cause physical harm. It is based on risk fac-tors that contribute to increased vulnerability of paients to falls, and has been used as a guide for planning nursing acions prevenive of this event(8). The Nursing
Interven-ions Classiicaion (NIC) on its turn, has priority
interven-ions for this ND in order to establish special precauinterven-ions for paients at risk of injury due to falling(9).
Several studies, mainly in the context of community, provide evidence that mulifactorial intervenions are ca-pable of reducing the rate of falls and injuries resuling from the event(10-12). However, there is a limited number of
studies addressing the speciic nursing intervenions tar-geted to paients at risk of falling in Brazilian hospital
set-ings(13-15), and with the descripion of such intervenions
using a standardized classiicaion system as the NIC(9).
Hence, arose the need to exploit the knowledge of nursing intervenions implemented for prevening falls in hospital seings. This study was developed for this rea-son, aiming to idenify the prescribed nursing care for hospitalized paients with the ND Risk for falls and com-paring it with the NIC intervenions.
The purpose is to explain what nursing has prescribed in the clinical pracice of a Brazilian hospital to prevent falls, in addiion to making this prescripion of care visible by using an internaional system called Nursing
Interven-ion ClassiicaInterven-ion (NIC).
mEthod
This is a cross-secional study carried out in a univer-sity hospital located in southern Brazil, where the nursing process is computerized, the ND follows the NANDA-I ter-minology(8) and nursing intervenions are listed based on
the literature, clinical pracice and the NIC(9).
The sample consisted of 174 paients, calculated based on a study previously carried out at the insitu-ion(16). The prevalence of the ND Risk for falls was
esi-mated at 13%, the conidence interval of 95% and a mar-gin of error of 0.05.
Inclusion criteria were adults hospitalized in clinical and surgical units of the hospital with the ND Risk for falls in 2011. Paients who had more than one hospitalizaion during the study period were excluded to avoid repeaing data of the same paient.
A retrospecive data collecion was carried out in the nursing records informaion system. Data were organized in spreadsheets of the Excel for Windows, and the
Staisi-cal Package for the Social Sciences (SPSS) version 18.0 was
used for staisical analysis.
The prescribed nursing care for paients were com-pared with intervenions described in the NIC by the cross-mapping method(17-18).
For reaching this end came the following steps: 1) se-lecion of an NIC intervenion for each prescribed nurs-ing care for the ND Risk for falls, considernurs-ing as a starnurs-ing point the connecion levels between the NANDA-I nursing diagnosis and the NIC intervenions (priority, suggested and opional addiional); 2) selecion of the NIC inter-venion based on the similarity between the prescribed care and the deiniion of intervenion and its aciviies; 3) grouping of the prescribed nursing care according to the NIC intervenion.
RESULtS
Prescripions for 174 paients with ND of Risk for falls were analyzed, with 48 diferent types in total. The num-ber of prescribed treatments per paient was 4.8±3 on av-erage (Table 1).
Table 1 – Nursing care prescribed for patients with ND Risk for falls - Porto Alegre, 2012
Nursing Care N (%)
Keeping the bed rails 145 83.3
Guiding patients/family regarding the risks and prevention of falls 86 49.4
Keeping the bell within reach of patients 71 40.8
Keeping patient’s belongings nearby 56 32.2
Taking vital signs 52 29.8
Assisting in the shower 41 23.5
Sensory assessment 40 22.9
Keeping company during ambulation 36 20.6
Sensory monitoring 33 18.9
Reporting altered level of consciousness 33 18.9
Care implementation with mechanical restraint 32 18.4
Assisting patients in sitting on the chair 27 15.5
Evaluating altered level of consciousness 25 14.3
Maintaining constant vigilance 24 13.7
Assisting in ambulation 22 12.6
Assisting patients in using the bathroom 19 10.9
Reporting signs of pain 17 9.7
Performing bed bath 15 8.6
Inspecting skin in search for hyperemic or ischemic points 14 8.0
Sitting patients on the chair 14 8.0
Making sure that patients/family understood the guidance 14 8.0
Hygiene of the scalp 11 6.3
Assisting in changing clothes 10 5.7
Implementing care of facial hair removal 9 5.1
Guiding patients/family 9 5.1
Teaching the proper use of crutches, walker, cane, prosthesis 9 5.1
Assessing pain using the intensity scale 9 5.1
Removing from the environment objects that may offer risks to patients 8 4.5
Monitoring patients during their mobilization 8 4.5
Performing perineal hygiene after each bowel movement 8 4.5
Reporting complaints of visual changes 7 4.0
Stimulating hygiene care 7 4.0
Observing signs of sedation, slowness 5 2.8
Guiding on ways to adapt to one’s limitations 5 2.8
Assisting in feeding 5 2.8
Taking patients to the shower 4 2.3
Assisting in active movements 3 1.7
Offering a wheelchair 3 1.7
Performing body hygiene in the shower 3 1.7
Communicating changes in blood pressure 3 1.7
Assessing pain intensity 3 1.7
Administering analgesia after evaluation 3 1.7
Offering a mobile intravenous drip stand 2 1.1
Evaluating the eficacy of analgesia 2 1.1
Communicating changes during analgesia infusion 2 1.1
Guiding the patients 1 0.5
Explaining the responsibilities for patients/family 1 0.5
Monitoring patient response to medication 1 0.5
Nursing care and its related correspondence with the priority intervenions suggested by the NIC for the
resolu-Chart 2 – Nursing care grouped according with the optional additional interventions and those without connection between the NIC and the ND Risk for falls - Porto Alegre, 2012
Type of care NIC intervention Level of connection NIC and ND
- Assessing pain intensity
Pain Management Optional aditional
- Administering analgesia after evaluation - Reporting signs of pain
- Evaluating the eficacy of analgesia - Monitoring patient response to medication* - Communicating changes during analgesia infusion* - Assessing pain using the intensity scale
- Maintaining constant vigilance Surveillance Optional aditional
- Sensory assessment*§
Neurological monitoring Unconnected
- Sensory monitoring*§
- Reporting altered level of consciousness*§
- Evaluating altered level of consciousness*§
- Reporting complaints of visual changes* - Observing signs of sedation, slowness* - Assisting in the shower
Bathing Unconnected
- Performing body hygiene in the shower - Performing bed bath
Continued...
ion or improvement of the ND Risk for falls are described in Chart 1.
Chart 1 – Nursing care actions grouped according to priority interventions suggested by the NIC for the ND Risk for Falls - Porto Alegre, 2012
Type of care mapped NIC intervention Level of connection NIC and ND
- Keeping the bed rails
Environmental Management: Safety Priority
- Keeping the bell within reach of patients* - Keeping patients’ belongings nearby
- Removing from the environment objects that may offer risks to patients* - Guiding patients/family regarding the risks and prevention of falls
Fall Prevention Priority
- Making sure that patients/family understood the guidance - Guiding patient/family
- Teaching the proper use of crutches, walker, cane, prosthesis - Guiding the patients
- Guiding on ways to adapt to one’s limitations - Explaining the responsibilities for patients/family - Assisting in ambulation
- Keeping company during ambulation - Offering a wheelchair
- Monitoring patients during their mobilization - Assisting in active movements
- Taking vital signs§
Vital Signs Monitoring Suggested
- Communicating changes in blood pressure§
- Assisting patients in sitting on the chair*
Self-Care Assistance: transfer Suggested
- Sitting patients on the chair
- Offering a mobile intravenous drip stand
- Assisting patients in using the bathroom Self-Care Assistance: Using the toilet Suggested
* This care is also included in the intervention Fall Prevention.
§ This care is also included in the intervention Surveillance.
Below are described the nursing care and the
diScUSSioN
This study ideniied the prescribed nursing care for prevenion of falls in the hospital clinical pracice mapped with the NIC. The most relevant intervenions for paients with the ND Risk for falls, considering number of prescrip-ions and the number of diferent care found were:
Envi-ronmental Management: Safety and Fall Prevenion.
Among the 48 types of prescribed care, 42 were re-lated to factors intrinsic to paients. However, the nursing care of keeping the bed rails, which is related to an envi-ronmental condiion, had the highest number of prescrip-ions by nurses.
The Environmental Management: Safety
interven-ion, deined as monitoring and manipulaion of the physical environment to promote safety(9) included
map-ping the most frequently prescribed nursing care acions (keeping the bed rails, keeping the bell and belongings close to paients and removing from the environment any object that may ofer risks). These care acions are important in prevening falls among hospitalized pa-ients, especially the elderly and paients with physical or cogniive limitaions(3).
Somewhat diferent indings were demonstrated in a study that ideniied the most frequently used nursing intervenions for three groups of hospitalized elderly paients, in which the intervenion Surveillance was the most frequently prescribed for those with risk for falls(14).
In the present study, the intervenion Surveillance was used less frequently, showing that nursing care vary in diferent insituional contexts and are directed to the speciic problems and characterisics of paients. This intervenion included mapping the care acion of main-taining constant vigilance, in addiion to other acions of care that could also be mapped in more speciic inter-venions, such as taking vital signs, reporing changes in blood pressure (Vital Signs Monitoring) and sensory as-sessing and monitoring, evaluaing and reporing altered levels of consciousness (Neurological monitoring). How-ever, it is noteworthy that paient safety is directly re-lated to supervision. This intervenion is recommended for prevening falls in hospitalized paients according to
the PNSP guidelines that suggest the periodic monitor-ing to evaluate the comfort and safety of paients, and the development of mechanisms to supervise those us-ing medicaions that increase the risk of falls(19).
The condiion of hospitalizaion is knowingly related to increased risk for falls not only by the presence of acute illness, comorbidiies and treatments, but also by envi-ronmental factors such as height of paients’ bed, the in-adequacy of the bed rails, lack of support equipment and unfamiliar environment(20-21). Therefore, it is important to
consider environmental issues in both the risk assessment of paients and the strategies for prevening falls.
Problems related to the hospital environment such as high beds and no grids, process failures such as grids that remained lowered and no requests for nursing assis-tance, were ideniied in a study that evaluated the risk factors and the incidence of falls in neurosurgical paients in the pre and postoperaive periods(22). The
ideniica-ion of environmental hazards such as the following: slip-pery or uneven loors; low-light places; periodic checking of condiions of beds; latches; wheelchairs; grab bars; in addiion to guidance of paients regarding the use of as-sisive devices for ambulaion, allows detecing priority needs and developing strategies for the prevenion of accidental falls(23).
It was found that although the nursing care related to environmental safety correspond to the highest numbers of prescripions, the greatest diversity of prescribed care is mapped in the NIC intervenion Fall Prevenion, deined as insituing special precauions with paients at risk for injury from falling. Among the 48 diferent treatments prescribed for paients with ND Risk for falls, 12 were mapped in this intervenion, seven targeted the guiding the paients/family and ive the assising and monitoring of ambulaion. Besides these, 13 acions of care mapped in other intervenions were also included in the interven-ion l Fall Prevenion, showing that it covers a variety of aciviies related to paients and the environment (intrin-sic and extrin(intrin-sic factors) in the prevenion of falls.
Studies indicate that mulifactorial intervenions (us-ing two or more areas of an intervenion, in which every
Type of care NIC intervention Level of connection NIC and ND
- Taking patients to the shower
Bathing Unconnected
- Hygiene of the scalp
- Performing perineal hygiene after each bowel movement - Implementing care of facial hair removal
- Inspecting skin in search for hyperemic or ischemic points
- Care implementation with mechanical restraint Physical restraint Unconnected
- Assisting in changing clothes Self-Care Assistance: dressing/grooming Unconnected
- Stimulating hygiene care Self-Care Assistance: bathing/hygiene Unconnected
- Assisting in feeding Self-Care Assistance: feeding Unconnected
* This care is also included in the intervention Fall Prevention.
§ This care is also included in the intervention Surveillance.
paient receives a combinaion of care according to the risk assessment)(10-11) and muliple intervenions (using
two or more areas of an intervenion for all paients), such as the Fall Prevenion, are capable of reducing the occur-rence of falls in hospital seings(24-25). Once the event has
a character of muliple causes, it requires acions focused on the diferent risk factors ideniied in paients.
This idea is corroborated by the results of a study carried out in a university hospital in Japan. A reducion in the rate of falls among hospitalized paients was ob-served with the use of a mulidisciplinary fall prevenion program based on intervenions such as: risk assessment by instrument, protocol implementaion, modiicaions for environment safety and educaion of paients/family and staf(25).
The intervenion Fall Prevenion, according to the NIC includes ten aciviies related to guidance and educaion of paients/family. In nursing prescripions for paients with ND Risk for falls this type of care was also ideniied, highlighing that ‘guiding paients/family regarding the risks and prevenion of falls’ was the second most fre-quently prescribed care by nurses. This care is also includ-ed in the prevenive acions of the Protocol for Prevenion of Falls/PNSP, which recommends adoping educaional strategies involving paients and family about the risk of falls, and prevenion measures at admission and through-out paients’ stay in hospital(19).
The other care prescribed by nurses related to ori-entaion/educaion were: making sure that paients/ family understood the guidance; guiding paients/fam-ily; teaching the proper use of crutches, walker, cane and prosthesis; guiding the paients; guiding on ways to adapt to one’s limitaions and explaining the responsi-biliies for paients/family.
The guidance of paients and families to understand the presence of risk and fall prevenion measures must be a commitment of the healthcare team. Paients need to understand these as really important issues for their safety, because in most imes they do not see themselves as vulnerable to the event, and therefore do not adhere to recommendaions for prevenion(26).
Implemening efecive intervenions for reducing falls is a challenge due to the complexity of the event. Ideal ap-proaches involve interdisciplinary collaboraion, atenion to coexising medical condiions, environmental monitor-ing and risk reducion, i.e., considermonitor-ing intrinsic and ex-trinsic factors to paients(4,23-24).
Among these factors, it was found that neurological changes (intrinsic factors to paients) and the nursing ac-iviies directed to these condiions consituted the third most prevalent grouping of prescribed care for paients with the ND Risk for falls included in the intervenion
Neu-rological monitoring. According to the NIC, this intervenion
has no connecion with the ND Risk for falls, but the litera-ture indicates neurological problems as major risk factors for falls(1,16,27). In the present study, the prevalence of
pre-scribed care for paients related to the neurological assess-ment corroborates the literature, and demonstrates that this intervenion is important for prevening falls in hos-pital seings.
The main cogniive funcions responsible for balance and posture are atenion, orientaion, and memory. When limited by neurological changes, they lead to im-pairments in adaptaion to the environment, of judge-ment, and in the performance of aciviies that may pose a risk for falls(28). Thus, it is important to carry out
a neurological assessment of paients, idenify changes related to increased risk for falls, and to establish the most appropriate prevenive measures to the condiion of each one.
Neurological diseases can cause scenarios of psycho-motor agitaion and aggressiveness, especially during hospitalizaion, which lead to the need to install mea-sures that prevent them from causing any damage to themselves and the team(29). One of such measures is
the physical restraint, a technique widely used in clinical pracice, but also discussed among health professionals and the family, since issues such as the paient’s dignity and psychological impact are addressed. Although there is no scieniic evidence on the real beneits and risks of this conduct, it is criical to do an accurate assessment of the paient’s condiion based on clinical judgment, the involvement of the mulidisciplinary team and, when-ever possible, of the family(30).
In the present study, these issues may be related to the low prevalence of the intervenion Physical restraint, which included the nursing care of ‘care implementaion with mechanical restraint’ in 32 prescripions (3.3%). The use of physical restraint is done to prevent falls in agitated, semiconscious, unconscious or demented, pa-ients as well as in those addicted or with withdrawal syndrome, and should be performed in a humane man-ner, according to the recommendaions of insituional protocols and legal parameters(31).
Some prescribed nursing care not directly aimed at prevening falls was ideniied, such as in the
interven-ion Bathing (performing bed bath, hygiene of the scalp,
implemening care of facial hair removal and inspecing skin in search for hyperemic or ischemic points),
Self-Care Assistance: bathing/hygiene (simulaing hygiene
care) and Self-Care Assistance: feeding (assising in feed-ing). Such intervenions have no direct link with the ND Risk for falls according to the NIC(9). However, these care
Most prescribed care for paients at risk of falls in hospital clinical pracice showed consistency with the in-tervenions recommended by the Ministry of Health and ANVISA to reduce the occurrence of falls in hospitals. This includes the implementaion of measures that address risk assessment, mulidisciplinary care, safe environment and promoing the educaion of paients and family(19).
coNcLUSioN
The most prevalent nursing care prescribed for pa-ients with ND Risk for falls were: keeping the bed rails, guiding paients/family regarding the risks and pre-venion of falls, keeping bell within reach of paients and keeping paients’ belongings nearby, which were mapped in the intervenions Environmental
Manage-ment: safety and FallPrevenion.
These intervenions for the ND Risk for falls included the largest number of prescripions and diversity of care regarding guiding paients/family, mobilizaion/ambula-ion, environmental safety and monitoring of neurological disorders. Thus, these were really a priority for the ND Risk for falls because its aciviies include the mulifactorial
as-pect of the event, which is corroborated by the NIC, litera-ture and the naional protocol for paient safety and clinical pracice. These indings may assist in planning the preven-ion of falls in hospitals, contribuing to a safer nursing care. The process of cross-mapping between the prescribed care and the NIC intervenions for the ND Risk for falls was arduous, since this classiicaion has more than 500 intervenions with more than 12,000 aciviies. Thus, in this process are admited some limitaions relaing to the possibility of not having mapped the care of all available NIC intervenions. However, the methodological accuracy used ensures that the data presented here include most of them, considering the speciic scenario of care to pa-ients with the ND Risk for falls.
The inclusion of the intervenion Neurological
moni-toring is suggested among those recommended to solve/
improve the ND Risk for falls in the chapter of links be-tween the NIC and the NANDA-I. This is due to the fact of this intervenion being the third most prevalent group of prescribed care, showing its importance in prevening falls in hospital seings. The intervenion Surveillance could also be part of the links as opional addiional because it involves aciviies of monitoring and risk detecion.
REFERENcES
1. Correa AD, Marques IAB, Marinez MC, Laurino OS, Leão ER, Chimentão DMN. The implementaion of a hospital`s fall management protocol: results of a four-year follow-up. Rev Esc Enferm USP [Internet]. 2012 [cited 2012 Oct 30];46(1): 67-74. Available from: htp://www.scielo.br/pdf/reeusp/v46n1/ en_v46n1a09.pdf
2. Centers for Disease Control and Prevenion; Naional Center for Injury Prevenion and Control. Falls among older adults: an overview [Internet]. Atlanta: CDC; 2011 [cited 2012 Oct 23]. Available from: htp://www.cdc.gov/homeandrecreaional-safety/falls/adulfalls.html
3. Abreu C, Mendes A, Monteiro J, Santos FR. Falls in hospital seings: a longitudinal study. Rev Laino Am Enfermagem [Internet]. 2012 [cited 2013 May 17];20(3):597-603. Available from: htp://www.scielo.br/pdf/rlae/v20n3/a23v20n3.pdf
4. Vind AB, Andersen HE, Pedersen KD, Joergensen T, Schwarz P. Efect of a program of mulifactorial fall prevenion on health-related quality of life, funcional ability, fear of falling and psychological well-being. A randomized controlled trial. Aging Clin Exp Res. 2010;22(3):249-54.
5. World Health Organizaion. World Alliance for Paient Safety. Sumary of the evidence on paient safety: implicaions for re-search. Geneva; 2008.
6. Brasil. Ministério da Saúde. Portaria n. 529, de 1º de abril de 2014. Insitui o Programa Nacional de Segurança do Pa-ciente (PNSP) [Internet]. Brasília; 2013 [citado 2014 jun. 9]. Disponível em: htp://bvsms.saude.gov.br/bvs/saudelegis/ gm/2013/prt0529_01_04_2013.html
7. Conselho Federal de Enfermagem. Resolução COFEN n◦ 358 de 15 de outubro de 2009. Dispõe sobre a Sistemaização da Assistência de Enfermagem e a implementação do Processo de Enfermagem em ambientes públicos ou privados, em que ocorre o cuidado proissional de Enfermagem e dá outras providências [Internet]. Brasília: COFEN; 2009 [citado 2013 maio 17]. Disponível em: htp://novo.portalcofen.gov.br/res-oluo-cofen-3582009_4384.html
8. NANDA Internaional. Diagnósicos de enfermagem da NAN-DA: deinições e classiicação 2012-2014. Porto Alegre: Art-med; 2013.
9. Bulechek GM, Butcher HK, Dochterman JM, Wagner C. Nurs-ing Intervenions Classiicaion (NIC). 6th ed. Missouri: Else-vier; 2013.
11. Cameron ID, Gillespie LD, Robertson MC, Murray GR, Hill KD, Cumming RG, et al. Intervenions for prevening falls in older people in care faciliies and hospitals. Cochrane Database Syst Rev. 2012;(12):CD005465.
12. McClure R, Turner C, Peel N, Spinks A, Eakin E, Hughes K. Populaion-based intervenions for the prevenion of fall-related injuries in older people. Cochrane Database Syst Rev. 2005;(1):CD004441.
13. Freitas R, Santos SSC, Hammerschmidt KSA, Silva ME, Pel-zer MT. Cuidado de enfermagem para prevenção de quedas em idosos: proposta para ação. Rev Bras Enferm [Internet]. 2011 [citado 2013 set. 9];64(3):478-85. Disponível em: htp://www.scielo.br/pdf/reben/v64n3/v64n3a11.pdf
14. Shever LL, Titler M, Dochterman J, Fei Q, Picone DM. Pat-terns of nursing intervenion use across 6 days of acute care hospitalizaion for three older paient populaions. Int J Nurs Terminol Classif [Internet]. 2007 [cited 2013 Sept 9];18(1):18-29. Available from: htp://www.ncbi.nlm.nih. gov/pubmed/17430534
15. Lightbody E, Watkins C, Leathley M, Sharma A, Lye M. Evalu-aion of a nurse-led falls prevenion programme versus usual care: a randomized controlled trial. Age Ageing [Inter-net] 2002 [cited 2013 Sept 9]31(3):203-10. Available from: htp://ageing.oxfordjournals.org/content/31/3/203.long
16. Costa SGRF, Monteiro DR, Hemesath MP, Almeida MA. Car-acterização das quedas do leito sofridas por pacientes inter-nados em um hospital universitário. Rev Gaúcha Enferm [In-ternet]. 2011 [citado 2012 out. 10];32(4):676-81. Disponível em: htp://seer.ufrgs.br/RevistaGauchadeEnfermagem/ar-icle/view/18753/14441
17. Moorhead S, Delaney C. Mapping nursing intervenion data into the nursing intervenions classiicaion (NIC): process and rules. Nurs Diagn. 1997;8(4):137- 44.
18. Lucena AF, Barros ALBL. Mapeamento cruzado: uma alternai-va para a análise de dados em enfermagem. Acta Paul Enferm [Internet]. 2005 [citado 2012 out.10];18(1):82-8. Disponível em: htp://www.scielo.br/pdf/ape/v18n1/a11v18n1.pdf
19. Brasil. Ministério da Saúde; Agência Nacional de Vigilân-cia Sanitária; Fundação Oswaldo Cruz. Programa Nacional de Segurança do Paciente (PNSP). Anexo 01: Protocolo de Prevenção de Quedas [Internet]. Brasília; 2013 [citado 2014 jun. 9]. Disponível em: htp://www.anvisa.gov.br/hotsite/ segurancadopaciente/documentos/julho/Protocolo%20 -%20Preven%C3%A7%C3%A3o%20de%20Quedas.pdf
20. Dykes PC, Carroll DL, Hurley A, Lipsitz S, Benoit A, Chang F, et al. Fall prevenion in acute care hospitals: a randomized trial. JAMA [Internet]. 2010 [cited 2012 Oct 10];304(17):1912-18. Available from: htp://www.ncbi.nlm.nih.gov/pmc/aricles/ PMC3107709/
21. Vitori AF, Lopes MVO, Araújo TL. Diagnósico de enferma-gem risco de quedas em pacientes com angina instável. Rev RENE [Internet]. 2010 [citado 2012 out. 22];11(1):105-13. Disponível em: htp://www.revistarene.ufc.br/vol11n1_ht-ml_site/a11v11n1.htm
22. Diccini S, Pinho P, Silva FO. Assessment of risk and incidence of falls in neurosurgical inpaients. Rev Laino Am Enferma-gem [Internet]. 2008 [cited 2012 Oct 10];16(4):752-7. Avail-able from: htp://www.scielo.br/pdf/rlae/v16n4/16.pdf
23. Almeida RAR, Abreu CCF, Mendes AMOC. Quedas em doen-tes hospitalizados: contributos para uma práica baseada na prevenção. Rev Enferm Ref [Internet]. 2010 [citado 2013 set. 9];3(2):163-72. Disponível em: htp://www.scielo.oces. mctes.pt/pdf/ref/v3n2/v3n2a17.pdf
24. Ang E, Mordii SZ, Wong HB. Evaluaing the use of a target-ed muliple intervenion strategy in rtarget-educing paient falls in an acute care hospital: a randomized controlled trial. J Adv Nurs. 2011;67(9):1984-92.
25. Ohde S, Terai M, Oizumi A, Takahashi O, Deshpande GA, Takekata M, et al. The efeciveness of a mulidisciplinary QI acivity for accidental fall prevenion: staf compliance is criical. BMC Health Serv Res [Internet]. 2012 [cited 2013 Sept 9];12:197. Available from: htp://www.ncbi.nlm.nih. gov/pmc/aricles/PMC3502440/?tool=pubmed
26. Dykes PC, I-Ching EH, Soukup JR, Chang F, Lipsitz S. A case control study to improve accuracy of an electronic fall pre-venion toolkit. AMIA Annu Symp Proc [Internet]. 2012 [cited 2013 Sept 3];170-9. Available from: htp://www.ncbi. nlm.nih.gov/pmc/aricles/PMC3540550/pdf/amia_2012_ symp_0170.pdf
27. Morais HCC, Holanda GF, Oliveira ARS, Costa AG, Ximenes CMB, Araujo TL. Ideniicação do diagnósico de enferma-gem “risco de quedas” em idosos com acidente vascular cerebral”. Rev Gaúcha Enferm [Internet]. 2012 [citado 2012 out.10];33(2):117-24. Disponível em: htp://seer.ufrgs.br/ RevistaGauchadeEnfermagem/aricle/view/20217/19501
28. Ferreira DCO, Yoshitome AY. Prevalência e caracterísicas das quedas de idosos insitucionalizados. Rev Bras Enferm [Internet]. 2010 [citado 2013 set. 3];63(6):991-7. Disponível em: htp://www.scielo.br/pdf/reben/v63n6/19.pdf
640
Rev Esc Enferm USP2014; 48(4):632-40 Nursing care mapping for patients at risk of falls in the Nursing Interventions Classiication
30. Paes MR, Borba LO, Matum MA. Contenção ísica de pes-soas com transtorno mental: percepções da equipe de enfer-magem. Ciênc Cuid Saúde [Internet]. 2011 [citado 2014 jun. 3];10(2):240-47. Disponível em: htp://www.periodicos.uem. br/ojs/index.php/CiencCuidSaude/aricle/view/9295/pdf
31. Fundação Hospitalar do Estado de Minas Gerais. Protocolos Clínicos. Contenção ísica de pacientes [Internet]. Belo Hori-zonte; 2013[citado 2014 jun. 3]. Disponível em: htp://www. hemig.mg.gov.br.
