NURSI NG PHENOMENA I DENTI FI ED I N FAMI LY
PLANNI NG VI SI TS W I TH I CNP - BETA VERSI ON 2
1Gislaine Eik o Kuahar a Cam iá2 Már cia Bar bier i3 Heim ar de Fát im a Mar in4
Cam iá GEK, Bar bier i M, Mar in HF. Nur sing phenom ena ident ified in fam ily planning v isit s w it h I CNP - Ver sion Bet a 2. Rev Lat ino- am Enfer m agem 2006 set em br o- out ubr o; 14( 5) : 674- 81.
This descr ipt iv e, ex plor at or y , r et r ospect iv e sur v ey , car r ied out at a fam ily planning ser v ice, aim ed t o ident ify nur sing phenom ena dur ing nur sing v isit s accor ding t o t he I CNP, Bet a v er sion 2. Dat a w er e collect ed based on 52 r ecor ds of nur sing v isit s, r ealized fr om Oct ober 2001 t o Decem ber 2002. To conduct t he cr oss-m appin g pr ocess, all iden t if ied n u r sin g ph en ooss-m en a w er e j oin ed, or gan ized an d cooss-m par ed accor din g t o t h e I CNP’s t er m s. Of t h e 5 1 id en t if ied n u r sin g p h en om en a/ d iag n oses, 4 6 ( 9 0 . 2 % ) sh ow ed ex act an d p ar t ial con cor dan ce. Th e iden t if ied n u r sin g ph en om en a can be u sed t o assist n u r ses t o pr ov ide car e f or clien t s in fam ily planning ser vices. The I CNP show ed t o be a com pr ehensive pr ogr am , alt hough som e t er m s need t o be r ev iew ed an d ot h er s en h an ced. How ev er , con sider in g t h at it is an in t er n at ion al classif icat ion applicable t o sev er al count r ies, t he m apping pr ocess and cr oss- r efer ences w er e v er y sat isfact or y .
DESCRI PTORS: n u r sin g; classificat ion ; v ocabu lar y
FENÓMENOS DE ENFERMERÍ A I DENTI FI CADOS EN CONSULTAS
DE PLANI FI CACI ÓN FAMI LI AR SEGÚN LA I CNP, VERSI ÓN BETA 2 .
Est a in v est igación descr ipt iv a, ex plor at or ia, r et r ospect iv a se llev ó a cabo en u n ser v icio de plan eo fam iliar. El obj et ivo fue ident ificar los fenóm enos de enferm ería en consult as según la I CNP, versión Bet a 2. La r ecolección de dat os se r ealizó en 5 2 h ist or ias clín icas, en con su lt as de en f er m er ía du r an t e el per íodo de oct ubre del 2001 a diciem bre del 2002. Para el m apeo cruzado, t odos los fenóm enos de enferm ería ident ificados fuer on com pilados, or ganizados y com par ados con los t ér m inos de la I CNP. De los 51 fenóm enos/ diagnóst icos de enferm ería ident ificados, 46 ( 90,2% ) present aron concordancia exact a y parcial. Los fenóm enos de enferm ería ident ificados podr án ay udar los enfer m er os par a el cuidado de client es que pr ocur an ser v icios de planificación fam iliar . La I CNP dem ost r ó ser ex t en so, au n qu e algu n os t ér m in os n ecesit an ser r ev isados y / o au m en t ados. Sin em bar go, llev an do en con sider ación qu e se t r at a de u n a clasif icación in t er n acion al aplicable a div er sos países, el m apeo y el cr uce de sus dat os fuer on sat isfact or ios.
DESCRI PTORES: en f er m er ía; clasif icación ; v ocabu lar io
FENÔMENOS DE ENFERMAGEM I DENTI FI CADOS EM CONSULTAS
DE PLANEJAMENTO FAMI LI AR SEGUNDO A I CNP - VERSÃO BETA 2
Sur v ey descr it iv o, ex plor at ór io, r et r ospect iv o r ealizado em um ser v iço de planej am ent o fam iliar , com o obj et iv o de iden t if icar os f en ôm en os de en f er m agem em con su lt as e m apeá- los segu n do a I CNP, v er são Bet a 2 . A colet a dos dados f oi r ealizada em 5 2 pr on t u ár ios, com con su lt as de en f er m agem do per íodo de ou t u br o de 2 0 0 1 a dezem br o de 2 0 0 2 . Par a a r ealização do m apeam en t o cr u zado t odos os f en ôm en os de en f er m ag em id en t if icad os f or am com p ilad os, or g an izad os e com p ar ad os com os t er m os d a I CNP. Dos 5 1 fenôm enos/ diagnóst icos de enfer m agem ident ificados, 46 ( 90,2% ) apr esent ar am concor dância ex at a e par cial com a I CNP. Os f en ôm en os de en f er m agem iden t if icados poder ão au x iliar os en f er m eir os n os cu idados às client es que pr ocur am ser v iços de planej am ent o fam iliar . A I CNP dem onst r ou ser abr angent e, por ém , alguns t er m os pr ecisam ser r ev ist os e ou t r os acr escen t ados, m as, lev an do em con sider ação por se t r at ar de u m a classificação in t er n acion al aplicáv el a div er sos países, o m apeam en t o e o cr u zam en t o de seu s dados for am sat isf at ór ios.
DESCRI TORES: en f er m agem ; classif icação; v ocabu lár io
1
St udy ext ract ed from t he Doct oral Dissert at ion; 2 PhD in Nursing, Facult y m em ber, Facult y of Medical Sciences of t he Sant a Casa de São Paulo, I MES Universit y, e- m ail: gislainecam [email protected] .br; 3 PhD in Nursing, Adj unct Professor, e- m ail: m [email protected] .br; 4 PhD in Science, Free Lect urer in Medical I nform at ics, Universit y of São Paulo, Adj unct Professor, e- m ail: hfm arin@at t global.net . São Paulo Federal Universit y, Paulist a Medical School
I NTRODUCTI ON
T
h e i m p o r t a n c e o f a n i n t e r n a t i o n a l l y s t a n d a r d i z e d l a n g u a g e i n n u r s i n g h a s b e e na c k n o w l e d g e d s i n c e Fl o r e n c e N i g h t i n g a l e a n d
r einfor ced in 1989, dur ing t he Seoul Congr ess, w hen
t he I nt ernat ional Council of Nursing ( I CN) decided t o
st ar t a pr oj ect for t he I nt er nat ional Classificat ion of
Nu r si n g Pr a ct i ce ( I CNP) , a i m ed a t d em o n st r a t i n g
c o n c r e t e e v i d e n c e a b o u t n u r s i n g ’ s i m p o r t a n t
co n t r i b u t i o n t o h e a l t h , b y d e v e l o p i n g o n e si n g l e
lan gu age t h at w ou ld be capable of in v olv in g global
nur sing ar ound a com m on cause( 1- 3).
Th e I CN P r e p r e s e n t s a l a n d m a r k i n t h e
unificat ion of all nursing pract ice elem ent classificat ion
sy st em s av ailab le in t h is ar ea in t h e in t er n at ion al
sph er e. I n t h e con st r u ct ion pr ocess, alt h ou gh som e
ex ist in g classif icat ion sy st em s alr eady in cor por at ed
pr act ice- r elat ed t er m s, t her e w as a need t o ident ify
and include new t er m s associat ed w it h pr im ar y car e
an d n u r sin g pr act ice in com m u n it y h ealt h ser v ices,
t o be inser t ed in healt h infor m at ion syst em s( 4).
I n 1 9 9 6 , I CN p u b l i s h e d t h e I CN P, A l f a
version, described in t hree st eps: t he ident ificat ion of
t erm s, t he grouping of t hese t erm s and t heir ranking
w it hin t he est ablished gr oups, w hich t ak es t he for m
of concept pyram ids, where specific t erm s are locat ed
at t h e bot t om an d gen er al t er m s at t h e t op( 5 ). Th e
Alfa version of t he I CNP consist ed in t he organizat ion
o f t h r e e co n ce p t p y r a m i d s: n u r si n g p h e n o m e n a ,
int er v ent ions and r esult s( 1,6- 7).
I t w as det er m ined t hat , in gener al, t he I CNP
sh ou ld b e com p r eh en siv e, sim p le, con sist en t w it h
a con cept u al st r u ct u r e, based on a cen t r al n u cleu s,
sensit iv e t o cult ur al v ar iat ions, capable of r eflect ing
t h e n u r s i n g v a l u e s y s t e m a n d u s a b l e
co m p l em en t a r i l y o r a s a p a r t o f t h e d i sea se a n d
healt h classificat ions dev eloped b y t he Wor ld Healt h
Or g an izat ion( 1 ).
S i n c e t h e p u b l i c a t i o n o f t h e I CN P, A l f a
v er sion , I CN h as r eceiv ed com m en t s an d cr it icism
t o a s s e s s a n d c o n f i r m t h i s v e r s i o n , s u c h a s
m ult inat ional v alidat ion, r esult ing fr om t he v er ificat ion
of it s use in t he Telenur se pr oj ect , w hich was led by
Randi Mor t ensen in t he Eur opean Com m unit y, as w ell
a s i n o t h e r p r o j e c t s . T h i s c o n t r i b u t e d t o i t s
r e f o r m u l a t i o n a n d t h e d e v e l o p m e n t o f t h e Be t a
v er sion( 8 ).
I n 1999, I CN pr esent ed t he Bet a v er sion of
t h e I CNP, d e m o n st r a t i n g t h e p r o j e ct ’s d y n a m i cs,
subj ect t o cont inuous changes in nursing science and
pr act ice. Alt h ou gh n u r sin g ph en om en a, act ion s an d
result s cont inue as t he m ain com ponent s, a m ult iaxial
focus is adopt ed, since t his allows for m ore t han one
d i v i s i o n o f t h e s u p e r i o r t e r m , a s w e l l a s f o r
com b in at ion s b et w een con cep t s an d d if f er en t ax es
a n d d i v i si o n s, g r a n t i n g g r ea t er so u n d n ess t o t h e
classificat ion and serving as t he basis t o diversify t he
ex pr ession of concept s( 8 ).
Nex t , v er sion Bet a 2 of t he I CNP w as issued
t o: “ t o est ablish a com m on lan gu age for descr ibin g
n u r sin g p r act ice; t o st im u lat e n u r sin g r esear ch ; t o
descr ibe t he nur sing car e of indiv iduals, fam ilies and
co m m u n i t i e s; t o r e p r e se n t co n ce p t s u se d i n t h e
set t in gs an d specialt y ar eas of n u r sin g pr act ice; t o
enable com par ison of nur sing dat a; t o pr ov ide dat a
ab o u t n u r si n g p r act i ce t h at can i n f l u en ce n u r si n g
educat ion and healt h policies and t o st im ulat e nur sing
r esear ch ”( 9 ).
I n 2 0 0 3 , t h i s v er si o n w a s t r a n sl a t ed i n t o
Po r t u g u ese, w i t h t h e au t h o r i zat i o n o f I CN, b y Dr.
Heim ar de Fát im a Mar in, r esponsible for t he Nur sing
I n f or m at ics Cen t er at São Pau lo Fed er al Un iv er sit y
and a m em ber of t he I CNP st r at egic adv isor y gr oup.
This facilit at ed t he dissem inat ion of t his classificat ion.
I n 2 0 0 5 , t h e I CNP p r og r am p u b lish ed v er sion 1 . 0 ,
w i t h so m e ch an g es i n st r u ct u r e an d co m p o n en t s.
Thus, each v er sion is changeable and dy nam ic, and
is su bm it t ed t o assessm en t an d r ev iew , in or der t o
achieve t he perm anent m aint enance t hat is necessary
for a liv ing language in pr act ice.
The m ain com ponent s of t he I CNP - Bet a 2
v er sion ar e t he Nur sing Phenom ena, Nur sing Act ions an d Nu r sin g Resu lt s, in a m u lt iax ial f ocu s. Nu r sin g Phenom ena “Aspect of healt h of relevance t o nursing
pr act ice” an d “ Nu r sin g Diagn oses is t h e label giv en
by a nurse t o t he decision about a phenom enon which
i s t h e f o cu s o f n u r si n g i n t e r v e n t i o n s. A n u r si n g
diagn osis is com posed of con cept s con t ain ed in t h e
Nur sing Phenom ena”( 10).
Th e I CN P p e r m i t s t h e u s e o f v a r i o u s
t heor et ical nur sing m odels and ser v es as a unify ing
f r am ew or k , w h ich can com b in e d if f er en t ax es an d
ex pr ess differ ent nur sing pr act ice concept s.
Classificat ion pr oposals and m odels, as w ell
pr act ice ar e st ill adv ancing. I n our m eans, t he Nor t h
Am er ican Nu r sin g Diag n osis Associat ion - NANDA’s
classificat ion is st ill one of t he best k now n ones, also
because it w as t he fir st sy st em t o be t r anslat ed int o
Po r t u g u ese.
Th e u se of ot h er n u r sin g v ocab u lar ies an d
t e r m i n o l o g i e s, su ch a s t h e Nu r si n g I n t e r v e n t i o n
Classificat ion - NI C, Nur sing Out com es Classificat ion
- NOC, Ho m e Hea l t h Ca r e Cl a ssi f i ca t i o n - HHCC,
Om aha Syst em , am ong ot hers, m obilized nurses from
all over t he world t o face t he challenge of universalizing
t heir language and ev idencing t he elem ent s of t heir
pr act ice, r esult ing in t he appr ov al of t he pr oposal t o
d ev elop an I n t er n at ion al Classif icat ion f or Nu r sin g
Pract ice - I CNP)( 11- 12).
Th e d ev el o p m en t an d m ai n t en an ce o f t h e
I CNP is a long- t erm proj ect , led and facilit at ed by t he
I n t e r n a t i o n a l Co u n ci l o f N u r se s - I CN , w i t h t h e
par t icipat ion of specialist s fr om differ ent count r ies t o
updat e and im prove it s st ruct ure, in order t o achieve
gr eat er and m or e specific applicabilit y.
Consider ing t he im por t ance of a classificat ion
t o descr ibe and docum ent nur sing pr act ice in fam ily
p l a n n i n g , t h i s st u d y l o o k s a t n u r si n g p h en o m en a
f r om t h e p er sp ect iv e of I CNP, Bet a 2 v er sion . Th e
a i m i s t o i d en t i f y t h e p h en o m en a d o cu m en t ed i n
f a m i l y p l a n n i n g a n d t h e I CN P’ s d o c u m e n t a t i o n
capacit y in t his sect or, w it h a v iew t o cont r ibut ing t o
t h e s t r e n g t h e n i n g o f k n o w l e d g e i n t h i s a r e a ,
ev idencing t he pr act icabilit y of using a st andar dized
t er m in ology in daily pr act ice.
OBJECTI VES
To i d e n t i f y n u r s i n g p h e n o m e n a d u r i n g
n u r si n g v i si t s i n a f am i l y p l an n i n g ser v i ce an d t o
m a p t h e m a c c o r d i n g t o t h e I n t e r n a t i o n a l
Cl assi f i cat i o n f o r Nu r si n g Pr act i ce ( I CNP) , Bet a 2
v e r si o n .
METHODS
A descr ipt iv e, ex plor at or y and r et r ospect iv e
st udy was car r ied out at t he Fam ily Planning Ser vice
of UNI FESP/ EPM, locat ed in t h e cit y of São Pau lo,
Br azil. The infor m at ion sour ce w as t he nur sing v isit
p r o t o co l( 1 3 ), or g an i zed accor d i n g t o t h e Fu n ct i o n al
Healt h St andards( 14), est ablished at t he UNI FESP fam ily
p l a n n i n g s e r v i c e s i n c e 1 9 9 9 , b u t w i t h s o m e
m odificat ions in t he init ial m odel. For t his st udy, records
w er e select ed of w om en aged 20 or older, w ho w er e
su bm it t ed t o t h e f ir st n u r sin g v isit an d su bsequ en t
nur sing v isit s.
Dat a w er e co l l ect ed f r o m 5 2 r eco r d s t h at
at t en ded t o t h e sam ple in clu sion cr it er ia, for w h ich
t h e v i s i t s o c c u r r e d b e t w e e n Oc t o b e r 2 0 0 1 a n d
Decem b er 2 0 0 2 , af t er au t h or izat ion b y t h e ser v ice
r esponsibles and appr ov al of t he r esear ch pr oj ect by
t he Univ er sit y ’s Et hics Com m ission.
Al l n u r s i n g p h e n o m e n a i d e n t i f i e d i n t h e
select ed records w ere com piled and organized w it h a
v iew t o cr oss- m ap p in g . Th e t er m s n u r ses u sed t o
d e s c r i b e n u r s i n g p h e n o m e n a / d i a g n o s e s w e r e
com pared w it h I CNP t erm s, t hat is, non- st andardized
d at a w er e m ap p ed in a st an d ar d ized lan g u ag e. An
adapt ed version of concordance analysis was realized,
i. e. if t he t er m found cor r esponded ex act ly w it h t he
cl assi f i cat i o n sy st em t er m , co n co r d an ce w o u l d b e
exact ; if synonym s and sim ilar concept s w er e found,
co n co r d a n ce w a s p a r t i a l ; a n d , i f t h e t e r m f o u n d
pr esent ed no sim ilar it y and t he classificat ion syst em ,
t here was no concordance( 15). To present t he analysis
r esu lt s, ex act an d par t ial con cor dan ce w er e j oin ed,
a s t h e t e r m ’ s c o n c e p t h a s t h e s a m e m e a n i n g .
Moreover, t wo fam ily planning specialist s checked t he
r esult s for cor r espondence bet w een t he t er m s found
in t he records and t he I CNP. This paper only present s
t h e n u r si n g p h e n o m e n a / d i a g n o se s t h a t a ch i e v e d
percent ages of 40.0% or m ore, as t hese are t he m ost
r ep r esen t at iv e.
RESULTS AND DI SCUSSI ON
Th e a n a l y s i s c o n s i d e r e d 5 2 r e c o r d s ,
r ep r esen t in g t h e f ir st n u r sin g v isit an d su b seq u en t
v isit s, as descr ibed abov e, and ident ified 51 nur sing
p h en om en a/ d iag n oses. For t y - six ( 9 0 . 2 % ) of t h ese
p r e s e n t e d e x a c t a n d p a r t i a l c o n c o r d a n c e ,
dem onst rat ing t he I CNP’s docum ent at ion range ( Table
1) . I t should be rem inded t hat , even when t he nursing
v isit pr ot ocol w as used, list ing diagnost ic opt ions t o
be chosen, v ar ious t er m s w er e r ecor ded in nat ur al/
Table 1 - An alogy of n u r sin g pr oblem s/ ph en om en a/ diagn oses iden t ified in pat ien t files at a fam ily plan n in g
ser v ice, pr esent ing ex act and par t ial concor dance w it h I CNP, v er sion Bet a 2
Ex act an d p ar t ial con cor d an ce w er e j oin ed
so as t o verify what t erm s of a st andardized language
lik e t h e I CNP cou ld cov er a n at u r al/ local lan gu age
used in a fam ily planning service during nursing visit s.
The m ain goal was concordance bet ween t he involved
c o n c e p t s , a n d n o t n e c e s s a r i l y w o r d - f o r - w o r d
com p ar ison .
Ta b l e 2 s h o w s t h e n u r s i n g p h e n o m e n a /
diagnoses wit h a frequency of 40.0% or higher, which
w ill be discussed below .
s e l i f e h t n i d n u o f s e s o n g a i d / a n e m o n e h p / s m e l b o r p g n i s r u
N ICNPterms
r o i v a h e b g n i v o r p m i h tl a e H )
1 Heatlhseekingbehavior
g n i n n a l p y li m a F
- Famliyplanning
m a x e -fl e s t s a e r B
- Sefl-inspecitngofthebreasts
e s i c r e x e r a l u g e R
- Frequentexercising
e c n a n e t n i a m h tl a e h d e r e tl a r o f k s i R )
2 Riskforabsenceofheatlhseekingbehavior
: o t s e c r u o s e r l a i c n a n if f o k c a L
- Insufifcientifnancialresources
e c i v r e s g n i n n a l p y li m a f e h t d n e t t a
- Famliyplanning
d o h t e m e v it p e c a r t n o c d e b i r c s e r p e h t e s a h c r u p
- Contracepitveuse
e c n a n e t n i a m h tl a e h d e r e tl A )
3 Absenceofheatlhseekingbehavior
m a x e -fl e s t s a e r B
- Sefl-inspecitngofthebreasts
n o it r o b a d e k o v o r P
- Pregnancyinterrupiton
d o h t e m e v it p e c a r t n o c f o e s U
- Contracepitveuse
g n i k o m S
- Tobaccouse
e s u g u r D
- Druguse
: s n r e t t a p y t il a u x e s d e r e tl A )
4 Atlered/impairedsexualintercourse
m s a g r o f o e c n e s b A
- Absenceofpleasure/impairedsexualrelaiton
a i n u e r a p s y D
- Dyspareunia
p e e l s d e r i a p m i/ r e d r o s i d n r e t t a p p e e l S )
5 Disturbed/impairedsleep
a i n m o s n I
- Insomnia
e u g it a F
- Faitgue
n o it p u r r e t n i p e e l S
- Interruptedsleep
: o t d e t a l e r e g d e l w o n k f o k c a l/ t i c if e d e g d e l w o n K )
6 Knowledgedeifcit/absenceofknowledge
m a x e -fl e s t s a e r B
- Sefl-inspecitngofthebreasts
d o h t e m e v it p e c a r t n o C
- Contracepitveuse
n o it a u r t s n e M
- Menstruaiton
e n e i g y h y d o B
- Seflcare:hygiene
e r u s i e l f o e c n e s b a / t i c if e d e r u s i e L )
7 Deifcit/absenceofleisureacitvity
y t e i x n A )
8 Anxiety
e s u a p o n e m / ) 5 3 r e v o ( e g A )
9 Femaleageing
g n i e b -ll e w l a u t i r i p s e s a e r c n i o t l a it n e t o P ) 0
1 Increasedspiritualwell-being
l o r t n o c n e m i g e r c it u e p a r e h t e v it c e f f E ) 1
1 Effecitvetherapeuitcregimenmanagement
n o it a p it s n o C ) 2
1 Consitpaiton
e g r a h c s i d l a n i g a v / n o it a n i m il e l a n i g a v d e r e tl A ) 3 1 s it i n i g a v o v l u v / s i s a i d i d n a c / i s a i d i d n a c / e g r a h c s i d l a n i g a v / n o it a n i m il e l a n i g a v d e r e tl A n o it c e f n i l a n i g a v /l a v l u v / s r e d r o s i d e g a m i y d o B ) 4
1 Disturbed/impairedbodyimage
n o i s n e t r e p y H ) 5
1 Hypertension
y t i s e b o / t h g i e w r e v o / s t n e m e r i u q e r y d o b n a h t e r o m : n o it i r t u n d e r e tl A ) 6
1 Atlerednutriiton/excessivefoodintake/overweight/obesity
s s e c o r p y li m a f d e r e tl A ) 7
1 Atleredfamliyprocess
s t n e m e r i u q e r y d o b n a h t s s e l : n o it i r t u n d e r e tl A ) 8
1 Atlerednutriiton/Insufifcientfoodintake
s e i g e t a r t s g n i p o c l a u d i v i d n i e v it c e f f e n I ) 9
1 Ineffecitveproblemcopingstrategies
m e e t s e -fl e s d e b r u t s i D ) 0
2 Disturbedsefl-esteem
) l a n o it a u t i s ( m e e t s e -fl e s w o L ) 1
2 Lowsefl-esteem
s r e n t r a p e l p it l u m / n o it c e f n i r o f k s i R ) 2
2 Riskforinfeciton/promiscuity
s n i e v e s o c i r a V ) 3
2 Impairedvascularfunciton
n o it a u r t s n e m f o e c n e s b a / a e h r r o n e m a / y a l e d l a u r t s n e M ) 4
2 Absenceofmenstruaiton
l o r t n o c n e m i g e r c it u e p a r e h t e v it c e f f e n I ) 5
2 Ineffecitvetherapeuitcregimenmanagement
a e r a d e r / n o i p o r t c e / s it i c i v r e C ) 6
2 Atleredmucousmembrane
a i r u s y d / n o it a n i m il e y r a n i r u f o s n r e t t a p d e r e tl A ) 7
2 Atleredurinaryeilminaiton
n o it a p it s n o c d e v i e c r e P ) 8
2 Consitpaiton
r a e F ) 9
2 Fear
r i a p s e D ) 0
3 Despair
y t il i b o m l a c i s y h p d e r i a p m I ) 1
3 Impairedmobiilty
s e i r u j n i n i k s / s ll a g / y t i r g e t n i n i k s d e r i a p m I ) 2
3 Atleredintegumentarysystem
n o it a u r t s n e m / d e t a u r t s n e M ) 3
3 Menstruaiton
g n i v e i r G ) 4
3 Grief
s t n e m e r i u q e r y d o b n a h t e r o m r o f k s i r : n o it i r t u n d e r e tl A ) 5
3 Riskfor/atlerednutriiton/excessivefoodintake
e c n e l o i v r o f k s i R ) 6
3 Riskforviolence
n o it c n u f s y d l a u x e S ) 7
3 Inadequate/impairedsexualfunciton
e n e i g y h f o k c a l / e n e i g y h s u o i r a c e r p / e n e i g y h -g n i h t a b : t i c if e d e r a c -fl e S ) 8
3 Seflcare:hygienedeifcit/absence/impairedhygiene
g n i h c t i l a n i g a v o v l u V ) 9
3 Vulva/lvaginalitching
e c n e n it n o c n i s s e r t S ) 0
4 Urinaryinconitnence/stressinconitnence
n o it c e t o r p e v it c e f f e n I ) 1
4 Compromisedimmunesystem
d e l b a s i d : s e i g e t a r t s g n i p o c y li m a f e v it c e f f e n I ) 2
4 Ineffecitvecopingstrategies
s s e r t s i d l a u t i r i p S ) 3
4 Spiritualdistress
n i a P ) 4
4 Pain
e m u l o v e n i r e t u d e s a e r c n I ) 5
4 Increaseduterus
s t n e m e r i u q e r y d o b n a h t s s e l : e m u l o v d i u lf d e r e tl A ) 6
Ta b l e 2 - D i s t r i b u t i o n o f n u r s i n g p r o b l e m s /
phenom ena/ diagnoses r egist er ed in nur sing v isit s of
w om en at t en d ed at a f am ily p lan n in g ser v ice. São
Paulo, 2002 ( n= 52)
Healt h im pr ov in g beh av ior
The frequency of t he nursing diagnosisHealt h i m p r o v i n g b e h a v i o r w a s 8 6 . 5 % ( Ta b l e 2 ) . Th i s diagnosis will need t o be specified. I n t his st udy, it is r elat ed t o t he fam ily planning t hem e separ at ely and
in com bin at ion w it h ot h er act iv it ies, su ch as br east
self- exam , Pap sm ear and regular exercise program s. I t is su r pr isin g t h at t h is diagn osis is n ot pr esen t in
100% of t he exam ined records, as it is a diagnosis of
w ell- bein g. Th e clien t ’s v isit t o t h e f am ily plan n in g
ser v ice alr eady dem on st r at es h er in t er est in h ealt h pr om ot ion. Pr ofessionals m ay sim ply hav e for got t en
t o include t his diagnosis in t he w om en’s r ecor ds.
Th e I CN P u s e s t h e t e r m H e a l t h s e e k i n g behav ior as a nur sing phenom enon, w hich is par t of t he focus of nur sing pr act ice ax is and is defined as
“ self car e act iv it y w it h t h e sp ecif ic ch ar act er ist ics: Pr edict able m anner for ident ify ing, using, m anaging
a n d secu r i n g h ea l t h ca r e r eso u r ces, ex p ect a t i o n s
r el at ed t o accep t ab l e w ay s t o r eq u est an d at t ai n
assist ance fr om ot her s”( 10).
Som e au t h or s d ef in e t h is d iag n osis as t h e
“ act iv e seek ing ( by a per son in st able healt h) of w ay s
t o a l t e r p e r s o n a l h e a l t h h a b i t s a n d / o r t h e env ir onm ent in or der t o m ov e t ow ar d a higher lev el
of healt h”( 14,16- 17).
Healt h prom ot ion should be considered as t he m ot ivat ion t o increase t he well- being and develop t he
pot ent ial for healt h and prevent ion, avoiding diseases,
det ect ing t hem ear ly or pr eser v ing t he ideal lev el of
funct ioning when t he disease is present . I t should be rem inded t hat nurses have an im port ant responsibilit y
and opport unit y t o help wom en t o underst and t he risk
f a ct o r s, m o t i v a t i n g t h e m t o a d o p t l i f e st y l e s t h a t
pr ev ent t he disease( 18).
/ s m e l b o r P g n i s r u N
s e s o n g a i D / a n e m o n e h P
y c n e u q e r F
n %
r o i v a h e b g n i v o r p m i h tl a e H .
1 45 86,5
l a i c n a n if f o e c n e s b a / e c n a n e t n i a m h tl a e h d e r e tl a r o f k s i R . 2
e m it f o e c n e s b a / s e c r u o s e
r 34 65,4
e c n a n e t n i a m h tl a e h d e r e tl A .
3 27 51,9
f o e c n e s b a / o d i b il f o e c n e s b a / s n r e t t a p y t il a u x e s d e r e tl A . 4
a i n u e r a p s y d / m s a g r
o 23 44,2
a i n m o s n i/ p e e l s d e r i a p m i/ r e d r o s i d n r e t t a p p e e l S .
5 23 44,2
n o it a m r o f n i s i d / e g d e l w o n k f o k c a l / t i c if e d e g d e l w o n K .
6 22 42,3
e r u s i e l f o e c n e s b a / t i c if e d e r u s i e L .
7 21 40,4
W h a t f a m i l y p l a n n i n g i s co n cer n ed , so m e
st udies in t his area also dem onst rat e t he presence of
t his diagnosis, as t he client ex pr esses t he desir e t o
seek infor m at ion t o pr om ot e her healt h( 13,19).
Risk for alt er ed healt h m aint enance
The nursing diagnosis Risk for alt ered healt h m aint enance ( 6 5 . 4 % ) pr esen t ed a sim ilar m ean in g: “ Risk f or t h e ab sen ce of h ealt h seek in g b eh av ior ”.
This diagnosis is par t of t he lik elihood ax is, absent ,
j u d g m e n t a n d h e a l t h s e e k i n g b e h a v i o r, w h o s e
m eaning is t he opposit e of alt ered healt h m aint enance.
The lat t er is part of t he focus of nursing pract ice axis.
Alt h ou gh t h is t er m w as n ot f ou n d in t h e I CNP, t h e
st r uct ur ed diagnosis pr esent s t he sam e m eaning.
Lack of f in an cial r esou r ces an d t im e w er e
f a ct o r s r e l a t e d t o t h i s d i a g n o si s, a s t h e r e co r d s
m ent ioned som e client s w ho could not pur chase t he
c o n t r a c e p t i v e m e t h o d , v a g i n a l c r e a m , a n t i
-hypert ensive agent s, am ong ot hers, if t he service did
not offer t hese fr ee of char ge.
Lim it ed f in an cial r esou r ces an d aw ar en ess
lead t o a lack of access t o care, delays t o seek healt h
ca r e , l e ss p r e v e n t i v e a ct i v i t i e s a n d l i t t l e p r e ci se
i n f o r m a t i o n a b o u t h e a l t h a n d t h e h e a l t h c a r e
sy st em( 18).
Lack of t im e w as indicat ed as a fact or t hat
im peded t h e m on t h ly r ealizat ion of t h e br east self
-e x a m .
Alt er ed h ealt h m ain t en an ce
As d escr ib ed ab ov e, t h e n u r sin g d iag n osis
Alt er ed healt h m aint enance ( 51. 9% ) is t he opposit e o f h e a l t h s e e k i n g b e h a v i o r. I n t h e I CN P, i t i s
denom inat ed absence of healt h seek ing behav ior. I n t his case, t he diagnosis was at t ribut ed due t o t he
non-r ealizat ion of t h e b non-r east self - ex am , n on - non-r ealizat ion
o f t h e Pap sm ear, u se o f n ox i o u s su b st an ces l i k e
alcohol, t obacco and dr ugs, int ent ional abor t ion and
n on - u se of con t r acept iv es.
I n t his st udy, t he client s knew how t o perform
t h e b r e a s t s e l f - e x a m a n d w e r e a w a r e o f t h e
im por t ance of t he Pap sm ear, but did not pract ice it
out of sham e, lack of concer n because t hey did not
b eliev e an y t h in g w ou ld h ap p en t o t h em an d t h eir
p ar t n er ’s lack of u n d er st an d in g ab ou t t h e n eed t o
Alt er ed sex ualit y pat t er ns
Th e n u r s i n g d i a g n o s i s A l t e r e d s e x u a l i t y p a t t e r n s w a s f o u n d i n 4 4 . 2 % o f t h e r e c o r d s , m ent ioning absence of libido, absence of orgasm and/
or dy spar eu n ia.
Fear of pr egnancy can also ex er t influence,
as sexualit y is not only rest rict ed t o t he genit alia and
p h y s i c a l f u n c t i o n i n g , b u t c o v e r s p s y c h o l o g i c a l ,
em ot ional, social, cult ur al and spir it ual com ponent s.
Som e au t h or s call t h is diagn osis in effect iv e
sexualit y pat t erns, defined as “ expressions of concern
r eg ar d in g ow n sex u alit y ”( 1 6 ). Th is d iag n osis is also
defined “ as t he st at e in which t he individual present s
or is at risk for sexual healt h changes. Sexual healt h
is t he int egr at ion of som at ic, em ot ional, int ellect ual
and social aspect s of t he sexual being, in a way t hat
enr iches and st r engt hens per sonalit y, com m unicat ion
and love”( 17).
I n c o m p a r i s o n w i t h t h e I CN P, t h e m o s t
adequat e diagnosis was alt ered, im paired or ineffect ive
sex u al in t er cou r se. Sex u al in t er cou r se is a n u r sin g
phenom enon fr om t he focus of nur sing pr act ice axis,
w hich is defined as a t y pe of int er dependent act ion,
w i t h t h e f o l l o w i n g c h a r a c t e r i s t i c s : b e h a v i o r a l
ex p r ession of sex u al d esir es, v alu es, at t it u d es an d
act i v i t i es am o n g i n d i v i d u al s. Al t er ed , i m p ai r ed o r
ineffect ive are part of t he j udgm ent axis. The first is
defined as “ t he affir m at ion t hat som et hing changed,
w a s m o d i f i e d o r a d j u s t e d ”, t h e s e c o n d a s “ t h e
affirm at ion t hat t he nursing phenom enon is weakened
or dam aged”, an d t h e t h ir d as “ t h e den ial t h at t h e
d e s i r e d r e s u l t i s p r o d u c e d s t r o n g l y a n d
successfully”( 10). This dem onst rat es t hat t he m eanings
of t he t erm s found are sim ilar t o t he I CNP.
Sleep pat t er n disor der
Sleep pat t ern disorder was observed in 44.2% o f t h e a n a l y ze d r e co r d s, a n d i s d e f i n e d a s “ t h e
i n t er r u p t i o n i n t h e d u r at i o n an d q u al i t y o f sl eep ,
causing discom for t or int er fer ence w it h desir ed living
act ivit ies”( 14) or as sleep pat t ern dist urbance, which is
“ t he dist urbance, during a lim it ed t im e period, in t he
quant it y or qualit y of sleep”( 16). According t o t he st udy
fr am ew or k , sleep is a nur sing phenom enon, defined
as “ Rest w it h t h e specific ch ar act er ist ics: Recu r r in g
l o w e r i n g o f b o d i l y a c t i v i t y m a r k e d b y r e d u c e d
co n sci o u sn e ss, n o t a w a k e a cco m p a n i e d w i t h n o t
a w a r e, d ep r essed m et a b o l i sm , i m m o b i l e p o st u r e,
d i m i n i sh ed b o d i l y a ct i v i t y, d i m i n i sh ed b u t r ea d i l y
r ev er sible sensit iv it y t o ex t er nal st im uli”( 10).
As t h e I CNP co n si d e r s m u l t i p l e a x e s, i t s
n o m en cl a t u r e ca n b e f l ex i b l e, w i t h a d d i t i o n s a n d
m odif icat ion s. Th u s, t er m s lik e dist u r bed or alt er ed
sleep , im p air ed sleep an d / or in t er r u p t ed sleep can
be used as conv enient .
Du r in g t h e clim act er ic, w om en can pr esen t
sleep disor der s, du e t o h or m on al ch an ges, cau sin g
v a s o m o t o r s y m p t o m s . W h a t c o n t r a c e p t i o n i s
concer ned, w om en w it h sleep alt er at ions cannot use
t h e b a s e l i n e b o d y t e m p e r a t u r e m e t h o d , d u e t o
in cr eased failu r e r at es.
Kn ow ledge deficit
Th e k n ow led g e d ef icit ab ou t con t r acep t iv e m e t h o d s , b r e a s t s e l f - e x a m a n d Pa p s m e a r
r epr esen t ed 4 2 . 3 % . Kn ow ledge is defin ed as st at u s w it h t h e specific ch ar act er ist ics: Specific con t en t of
t h i n k i n g b a sed u p o n a cq u i r ed w i sd o m o r l ea r n ed
in f or m at ion or sk ills, cogn izan ce an d r ecogn it ion of
infor m at ion( 10).
Not p er f or m in g t h e Pap sm ear an d / or t h e
b r e a st se l f - e x a m i s t h o u g h t o b e d u e t o l a ck o f
knowledge about t he im port ance of t hese procedures,
an d n ot u sin g con t r acep t iv e ag en t s or u sin g t h em
incor r ect ly due t o a lack of infor m at ion.
Mor eov er, v ar iou s clien t s f ace dif f icu lt ies t o
learn what is t ransm it t ed t o t hem . Thus, it is essent ial
t h at f am ily p lan n in g ser v ice u ser s r eceiv e n eit h er
in com p let e n or b iased in f or m at ion , an d t h at t h eir
doubt s and anx iet ies ar e solv ed in t he best possible
w ay.
Th e r e f o r e , a t t h e U N I FES P/ EPM Fa m i l y
Pl a n n i n g S e r v i c e , t h e p a r t i c i p a t o r y t e a c h i n g
m e t h o d o l o g y i s u s e d i n t h e g r o u p s , p r o m o t i n g
i n f o r m at i o n an d ex p er i en ce ex ch an g e, f aci l i t at i n g
int eract ion am ong group m em bers and wit h t he t eam
a n d i d e n t i f i ca t i o n o f t h e i r i n t e r e st s, a l l o w i n g f o r
r eflect ion and k now ledge acquisit ion needed for t he
free and conscious choice of cont racept ives, aft er t he
decision t o avoid or delay pregnancy. Moreover, visual
r eso u r ces ar e u sed , i n cl u d i n g an at o m i cal m o d el s,
car t oons and t he cont r acept iv e m et hods t hem selv es.
I t should be em phasized t hat only knowledge
is not sufficient t o provide healt hy behaviors. Wom en
need t o be convinced t hat t hey have a cert ain degree
of con t r ol ov er t h eir liv es an d t h at h ealt h y h ab it s
Recr eat ion Def icit
An o t h er n u r si n g d i ag n o si s w as Recr eat i o n deficit , found in 40. 4% of t he r ecor ds. This show ed t h a t m a n y w o m e n d o n o t i n v o l v e i n r e c r e a t i o n
a c t i v i t i e s , w h i c h i s a n i m p o r t a n t i n d i c a t o r t h a t con t r ibu t es t o t h e popu lat ion ’s qu alit y of lif e. Wor k
ov er load , cou n t less d aily r eq u ir em en t s, in su f f icien t financial resources, lack of creat ivit y, depression and/
or ot her diseases m ay have result ed in t his diagnosis.
Recr eat ion act iv it ies “ is a self car e act iv it y : div er t in g act iv it ies w it h t h e specif ic ch ar act er ist ics:
play ing gam es and r ecr eat ional act iv it ies” ( 10). No st udies were found about t he influence of
leisur e act iv it ies and t he num ber of sex ual r elat ions, or about whet her t he lat t er also const it ut es a way of
r eleasing ener gies and st r ess.
CONCLUSI ON
Th e m o st p r e v a i l i n g n u r si n g p h e n o m e n a /
d iag n oses w er e: h ealt h seek in g b eh av ior ( 8 6 . 5 % ) ,
m ainly in t er m s of fam ily planning; r isk for absence
of h ealt h beh av ior ( 6 5 . 4 % ) , du e t o t h e absen ce of
f i n an ci al r eso u r ces t o p u r ch ase t h e co n t r acep t i v e
m et hod; absence of healt h seeking behavior ( 51.9% ) ,
r e l a t e d t o t h e n o n - a cq u i si t i o n o f h e a l t h y h a b i t s,
including t he non- r ealizat ion of t he br east self- ex am
and t he Pap sm ear, alt hough t he w om en w ere aware
o f t h e i r i m p o r t a n c e ; a l t e r e d / i m p a i r e d s e x u a l
i n t e r c o u r s e ( 4 4 . 2 % ) ; d i s t u r b e d / i m p a i r e d s l e e p
( 4 4 . 2 % ) d u e t o o r g a n i c c h a n g e s , c o n c e r n s a n d
k n o w l e d g e d e f i c i t ( 4 2 . 3 % ) a b o u t t h e s e l e c t e d
co n t r a ce p t i v e m e t h o d a n d t h e b r e a st se l f - e x a m ,
dem on st r at in g t h e im por t an ce of pr ev en t iv e act ion s
in t his area.
Th e I CNP sh o w ed t o b e a co m p r eh en si v e
program , as m ost of t he nursing phenom ena ident ified
i n t h e r e c o r d s p r e s e n t e d e x a c t a n d p a r t i a l
co n co r d a n ce . So m e t e r m s e v i d e n t l y n e e d t o b e
reviewed and ot hers added but , considering t hat it is
an in t er n at ion al classificat ion applicable t o differ en t
count r ies, t he m apping pr ocess and cr oss- r efer ences
w er e sat isf act or y.
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