RESUmo
Estudo transversal, descriivo, que obje
-ivou ideniicar as aividades da Classi
-icação de Intervenções de Enfermagem consideradas prioritárias para Padrão Res
-piratório Ineicaz e não realizadas para pa
-cientes idosos, internados em um hospital escola do estado de Goiás. Pariciparam do estudo 43 proissionais de enfermagem e a coleta de dados foi realizada no período de outubro a dezembro de 2008, após aprova
-ção pelo Comitê de Éica. Observou-se que, dentre as 67 aividades consideradas prio
-ritárias para o referido diagnósico, sete eram realizadas por todos os paricipantes; as demais, com frequência percentual va
-riada, não eram realizadas, sendo o moivo principal para isto sua execução por prois
-sional de outra área. Entende-se que a não realização destas aividades pela enferma
-gem pode resultar em alterações no campo de abrangência da assistência de enferma
-gem; que há necessidade de aparato legal na descrição das aividades que compõem a práica proissional exclusiva da enferma
-gem e a de natureza interdisciplinar.
dEScRiToRES
Idoso
Sistema respiratório Diagnósico de enfermagem Cuidados de enfermagem Classiicação
The analysis of activities not performed by
the nursing team regarding the diagnosis of
ineffective breathing pattern in the elderly
*O
riginal
a
r
ticle
AbSTRAcT
The objecive of this cross-secional, de
-scripive study was to idenify the aciviies of the Nursing Intervenion Classiicaion considered as prioriies for an Inefecive Breathing Patern and not performed for el
-derly inpaients of a teaching hospital in the state of Goiás. The study paricipants were 43 nursing professionals, and data collec
-ion was performed in the period spanning October to December 2008, ater receiving approval from the Ethics Commitee. It was observed that among the 67 aciviies con
-sidered to be prioriies for the referred diag
-nosis, only seven were performed by all of the paricipants; the other aciviies, with a varied frequency, were not performed, with the main reason cited being that a profes
-sional from a diferent area completed the acivity. It is understood that the fact that the nursing staf does not perform these ac
-iviies can cause lack of complete coverage in nursing care; therefore there is a need for a legal apparatus to describe the aciviies that comprise professional pracice exclu
-sive to nursing personnel and those acivi
-ies that have an interdisciplinary nature.
dEScRiPToRS
Aged
Respiratory system Nursing diagnosis Nursing care Classiicaion
RESUmEn
Estudio transversal, descripivo, que obje
-ivó ideniicar las acividades de Clasiica
-ción de Intervenciones de Enfermería con
-sideradas prioritarias para Patrón Respira
-torio Ineicaz no realizadas para pacientes ancianos internados en hospital escuela de Goiás. Pariciparon 43 profesionales de enfermería, recolección de datos realizada entre octubre y diciembre de 2008, previa aprobación por Comité de Éica. Se obser
-vó que de las 67 acividades consideradas prioritarias para el referido diagnósico, siete eran efectuadas por todos los parici
-pantes; las demás, con frecuencia porcen
-tual variada, no eren ejecutadas, siendo que el moivo principal para ello era la eje
-cución por parte de profesionales de otras áreas. Se eniende que la no realización de tales acividades por la enfermería puede resultar en una alteración del campo abar
-cado por la atención de enfermería; que existe necesidad de aparato legal en la des
-cripción de las acividades que componen la prácica profesional exclusiva de la enfer
-mería y la de naturaleza interdisciplinaria.
dEScRiPToRES
Anciano
Sistema respiratorio Diagnósico de enfermería Atención de enfermería Clasiicación
Agueda maria Ruiz Zimmer cavalcante1, Adélia Yaeko Kyosen nakatani2,
maria márcia bachion3, Telma Ribeiro Garcia4, daniella Pires nunes5, Patrícia Silva nunes6 Análise de AtividAdes não reAlizAdAs pelA equipe de enfermAgem pArA o diAgnóstico pAdrão respirAtório ineficAz em idosos
Análisis de ActividAdes no reAlizAdAs por el equipo de enfermeríA pArA el diAgnóstico pAtrón respirAtorio ineficAz en AnciAnos
*taken from the thesis “nursing interventions for “ineffective breathing pattern” in elderly patients”, graduate nursing program, universidade federal de goiás, 2009. 1m.sc. in nursing, school of nursing, universidade federal de goiás. ph.d. student, graduate nursing program, escola paulista de enfermagem,
universidade federal de são paulo. nurse, Hospital das clínicas, universidade federal de goiás. goiânia, go, Brazil. enf_agueda@yahoo.com.br 2rn.
ph.d. in nursing. Associate professor, school of nursing, universidade federal de goiás. goiânia, go, Brazil. adeliafen@gmail.com 3rn. ph.d. in nursing.
full professor, school of nursing, universidade federal de goiás. goiânia, go, Brazil. mbachion@fen.ufg.br 4rn.ph.d. in nursing. Adjunct professor
iv, public Health nursing and psychiatry department, graduate nursing program, centro de ciências da saúde, universidade federal da paraíba. João pessoa, pB, Brazil. telmagarciapb@gmail.com 5rn. ph.d. student in public Health, university of são paulo. são paulo, sp, Brazil. dpiresnunes@yahoo.
inTRodUcTion
In recent years, studies have been developed that use classiicaion systems for Nursing pracices, observing a trend towards the use of those systems that relect clinical
diagnoses, intervenions and outcomes(1-4).
In this context, the Nursing Intervenion Classiicaion – NIC stands out, because it comprises broad intervenions of nursing pracice, can be associated with the NANDA-I taxonomy and including diferent aspects of pracice. NANDA-It is applicable in hospital and outpaient pracice, in home care, at primary health care units, in the individual, family and group context, permiing its use during the full range of nursing care(5).
The nurses can start these intervenions in response to a nursing diagnosis, or another professional can start them, ater which the nurse and/or nursing team puts them in pracice. Hence, they are deined as intervenions that are independent, interdependent and
dependent on other professionals(6).
In the health work process, it is recom
-mendable for professionals to work interde
-pendently and complementarily, permiing acivity adjustments that will improve the clinical condiions of the clients under their care. Thus, the aciviies the nurses prescribe
should be signiicant for the established ther
-apy and beneit who receives them(7).
It is important for nurses to accurately idenify the clinical signs that will guide the choice of NIC intervenions in advance, which can be selected based on the speciicity level
criterion(3). That is, in view of a nursing diag
-nosis, three diferent intervenion groups can be selected; essenial or priority intervenions for the modiicaion and/or minimizaion of
the human response (intervenions in line with the deining characterisics and related factors); suggested intervenions (necessary, but less relevant for the ideniied diagnosis); and
addiional or opional (applied to speciic paients only)(5).
In a study that ideniied that intervenions nurses praciced at a Pediatric Intensive Care Center (PICC) for the nursing diagnosis “Inefecive airway clearance related to the presence of an ariicial airway”, it was considered that the aciviies performed for the intervenions the NIC proposes are applicable and picture what the nursing
team has praciced(1).
In pracice, however, it is observed that the nursing team does not pracice many of these aciviies. A study
developed at a hospitalizaion unit to idenify the inter
-venions nurses praciced revealed that direct care is spo
-radically performed and characterizes more complex pro
-cedures, as most acions these professionals develop are related to bureaucraic aciviies or necessary for other
professionals’ performance(2). In another study, the same
authors observed that nurses remain unable to prioriize essenial nursing aciviies, performing acions they can
and should delegate to others(8). This fact is concerning
as, when people present condiions that demand nursing intervenions and these are not performed, this puts the users’ health at risk.
The populaion groups nursing atends include elderly paients. Literature calls atenion to the need for health
professionals to prepare themselves to see to this seg
-ment’s health needs(4,9-11).
Studies indicate that Inefecive Breathing Patern is
one of the most prevalent nursing diagnoses among el
-derly paients in the hospital context(10,12).
Among the main aciviies nursing performs concern
-ing elderly paients with breath-ing problems, the follow
-ing stand out: assessment of breath-ing depth, patern and sounds, skin color, cough and pulmonary secreion relexes;
pulmonary low monitoring and measure
-ment, assessing the quanity of air that is inspired and expired, and the efeciveness of bronchodilators and nebulizers used. It is
highlighted that paient educaion and orien
-taion represent important nursing care(13).
One study(14) observed that paients with
breathing alteraions always present Inefec
-ive Breathing Patern and considered that
this diagnosis precedes the development of
overlapping diagnoses due to clinical wors
-ening. In elderly paients, the presence of this diagnosis becomes more concerning, as total organic funcioning capacity in this populaion decreases. Nursing intervenions for elderly paients with Inefecive Breathing Patern are relevant for the problem-solving ability of nursing aciviies, so as to avoid the emergence of other diagnoses and minimize the number of hospitalizaions, frequently observed in this
age range. It is believed that the ideniicaion of this diag
-nosis in this populaion, as well as the implementaion of intervenions that modify this response, can avoid the need
to use health services that comprise greater complexity lev
-els, which can solve problems even at the primary care level.
It is in this context that the interest in studying prior
-ity NIC aciviies for this nursing diagnosis emerged. In a
study, those aciviies were ideniied which nursing pro
-fessionals ideniied as NIC prioriies for this diagnosis in the hospital context, which permited knowledge about the reach and range of the acions and responsibiliies Nursing develops in this context. It was perceived in that
research that nursing indicates aciviies it inds impor
-tant, but which are not performed(15).
Thus, we jusify this study, which focuses on the ac
-iviies the nursing team does not perform for the nursing
diagnosis Inefecive Breathing Patern in care for the el
-nursing interventions for elderly patients with
ineffective Breathing pattern are relevant for the problem-solving
ability of nursing activities, so as to avoid the emergence of other diagnoses and
minimize the number of hospitalizations, frequently observed in
derly. Knowing what acions are absent from nursing prac
-ice in care delivery to this diagnosis in elderly paients
can contribute to relect on clinical nursing pracice in el
-derly care, and on the quality and problem-solving ability of care delivery.
objEcTivE
To idenify priority NIC aciviies for the nursing diag
-nosis Inefecive Breathing Patern the nursing team does
not perform in care delivery to elderly paients and to an
-alyze the reasons for their non-accomplishment.
mETHod
A descripive study was developed at the Medical Clin
-ic of a large teaching hospital in the State of Goiás. The sample comprised nursing professionals who worked at the sector. Inclusion was based on having worked at the Medical Clinic for more than six months. This period was determined because it is considered the minimum period
for professionals to experience care at the sector for el
-derly people with the diagnosis of interest to the study. Ater clariicaions about the research, the professionals
were invited to paricipate through the signing of the in
-formed consent term. The study received approval (Pro
-tocol No. 007/09) from the Insituional Review Board of
the Hospital das Clínicas at Universidade Federal de Goiás.
Data collecion took place between October and De
-cember 2008 through the applicaion of a checklist ques
-ionnaire. All aciviies that corresponded to priority in
-tervenions for Inefecive Breathing Patern – Asthma
Control, Breathing Monitoring and Airway Control – were listed. The paricipant answered whether the acivity was accomplished or not in care delivery to elderly paients
with the diagnosis under analysis and, when proper, jusi
-ied the reason for its non-accomplishment, marking one
of the alternaives: acivity performed by another profes
-sional, the service does not have means for its accomplish
-ment and I don’t know what this is about.
At the ime, the nursing team at the Medical Clinic of
the study hospital consisted of 55 professionals. One pro
-fessional in this group had been working at the sector for less than six months, and ten were not contacted during three consecuive visits because they were on holiday, on leave or had repeatedly switched shits. Thus, out of 44
invited professionals, 43 accepted (78.18% of the popula
-ion), with seven nurses and 36 nursing technicians. The collected data were inserted in Staisical Package for the Social Sciences for Windows®, version 16.0, and analyzed according to simple and percentage frequencies.
RESUlTS
The female gender predominated, with the group be
-tween 31 and 40 years as the most frequent age range and inished secondary educaion as the main educaion level, which is a minimum requirement for nursing technicians. It is highlighted though, that part of them were taking a higher
educaion program or had already obtained an undergradu
-ate degree and were even taking a specializaion program. All paricipants reported experience in adult and elderly care delivery, including respiratory problems. Most (58.2%) of these professionals had been working in the sector for more than one year and 25.6% for more than 10 years.
As for the 67 aciviies present in the NIC priority inter
-venions for Inefecive Breathing Patern, which the par
-icipants analyzed, all of them indicated that seven of these were performed. These correspond to aciviies that are
commonly present in medical prescripions, such as bron
-chodilaing medicaion administraion, aerosol treatment,
oxygen therapy and posiioning, i.e. dependent or basic ac
-iviies, which both technicians and nurses perform.
The paricipants also agree that ten aciviies are not
performed, as displayed in Table 1.
Table 1 – Activities the nursing team does not perform, with 100% frequency, and distribution according to reason for non-performance - Goiânia, 2009
* fev1 (forced expiratory volume in one second); * fvc (forced vital capacity). reason 1- the service does not have the resources needed for its accomplishment. reason 2 – Activity performed by another professional.
Activities not performed Reasons for non-performance
Reason 1 Reason 2 Reason 3
4.Obtain spirometry measures (FEV1*, FVC*, FEV1/FVC ratio) before and after the use of short-acting bronchodilators.
9.3% 76.7% 14.0%
5. Monitor peak expiratory low (PEF), if adequate. 7.0% 67.4% 25.6%
6. Educate patient about use of peak expiratory low meter at home. 9.3% 65.1% 25.6%
30. Insert artiicial airway into oro/nasopharynx, as adequate. -- 100.0%
--31. Perform thorax physiotherapy, as adequate. -- 100.0%
--35. Help with incentive spirometer, as appropriate. -- 79.0% 21.0%
40. Administer treatment using an ultrasonic nebulizer. 39.5% 21.0% 39.5%
42. Remove foreign bodies with McGill Forceps when adequate. 14.0% 67.4% 18.6%
54. Monitor pulmonary function test results, particularly vital capacity, maximum inspiratory volume, forced expiratory volume in one second, forced expiratory volume/forced vital capacity, as available.
7.0% 83.7% 9.3%
--It is observed that they considered the fact that an
-other professional performed this acivity as the main reasons for non-performance of these aciviies, except for acivity 40 “Administer treatment using an ultrasonic nebulizer”, jusiied by the non-availability of material for
its accomplishment in the sector (39.5%) or by not know
-ing what this acivity was about (39.5%).
Non-performance frequencies for the other ity acivi
-ies under analysis varied. Due to the large number of ac
-iviies, only those scoring ≥ 60% were presented.
Aciviies were divided by professional category to idenify professionals’ aciviies and the reasons for non-performance.
The predominant reason for the nursing technician’s non-performance of these aciviies was their pracice by another professional.
Figure 1 – Distribution of activities the nursing technicians did not perform, with frequencies ≥ 60%, according to the reason for non --accomplishment - Goiânia, 2009
Among the aciviies the nurses did not perform, non-performance frequencies for six were ≥ 60%.
The predominant reasons for non-performance were performance by other professionals and non-availability of resources at the service/insituion.
diScUSSion
Professionals should thoroughly study and improve
nursing intervenions, working not only towards empow
-erment, but mainly to improve individual health.
In the elderly populaion, the situaion is urgent, in view of high rehospitalizaion levels within a period of up
to one year, which may be related with weak health con
-diions and with the problem-solving ability of the previ
-ously received care(9).
The NIC considers the aciviies under analysis as priori
-ies. They are necessary and fundamental for people with
the diagnosis focused on. Thus, out of 67 NIC priority ac
-iviies for Inefecive Breathing Patern, the nursing techni
-cians indicated that 16 were not performed, with frequency levels ≥ 60%, while the nurses indicated 06 with the same frequency levels. Both professional categories agreed that 10 aciviies were not performed in 100% of cases.
Most of these aciviies nursing did not perform were
indicated as acions another professional category per
-forms. Some of the NIC aciviies describe acions uncom
-mon to nursing pracice in the study context, as evidenced in paricipants’ reports, who are unfamiliar with aciviies related to the use of spirometers and other equipment (aciviies 4, 5, 6, 35, 40, 42 and 54).
Some of these aciviies refer to the accomplishment of the respiratory funcion measure test. This acivity is
important as, in elderly people, most pulmonary func
-ional capacity levels have dropped. This fact can also be observed in individuals who smoked or are smokers. Thus, it is observed that pulmonary volumes vary according to gender, age, accomplishment of physical exercise or not,
posture and weight. Therefore, knowledge about and ear
-ly ideniicaion of pulmonary volumes and capaciies can prevent, diagnose and/or quanify pulmonary/venilatory problems and disorders, contribuing to change habits
and select intervenions to beneit these individuals(16).
Aciviies 30 and 67 refer to orotracheal intubaion and
the prescripion or renewal of asthma medicaion, respec
-ively. In the Brazilian nursing context, legally, these are exclusive medical aciviies, except in cases established by
law, like some public health problems or insituional pro
-tocols. Only the medical team performs these aciviies in
the study scenario, as expected. On the other hand, orotra
-cheal intubaion is not common in elderly paients with the study diagnosis at the hospital sector under analysis.
The NIC acivity Perform thorax physiotherapy, as
appropriate does not refer to speciic physiotherapy ac
-iviies, as various aciviies that enhance adequate ven
-ilaion, through special techniques, can be considered
as respiratory physiotherapy, including: posiion changes to mobilize secreion, airway clearance, aspiraion and nebulizaion.
NIC includes a speciic intervenion called Respiratory
physiotherapy, deined as: help to the paient to move se
-creions from the peripheral to the more central airways
with a view to expectoraion and/or aspiraion(5). This
intervenion refers to broader aciviies that, when de
-scribed, are recognized in nursing pracice. This fact is bet
-ter perceived when analyzing acivity 55 in Figures 1 and
2 start respiratory physiotherapy treatments (e.g. nebuli
-zaion, if necessary). This reveals the need to adapt the names of some aciviies in this classiicaion with a view to beter use and understanding in Brazilian nursing.
In the work rouine, the nursing team performs some of these aciviies, as these are acknowledged as part of nursing work and have been accomplished in the history of the profession, like in the case of percussion. A study
emphasizes the need for nurses’ direct acion in care de
-livery to paients with respiratory problems and who need
physiotherapy, spirometry, among other types of care(1). In
elderly paients, this need is maximized as, during patho
-logical processes, individuals present related factors and typical deining characterisics that compromise health
more, deriving from the organism’s associaion in re
-sponse to biological aging and senility(13). Therefore, nurs
-ing should prescribe and perform the respiratory exercises
the NIC describes as respiratory physiotherapy with el
-derly paients, constantly assessing the improvements
produced.
It is important to take into account care comprehen
-siveness, observing individuals as holisic beings with muliple needs. Ariculaion with the paient’s singularity shows to be fundamental in nursing care pracice though.
Nurses increasingly need to put in pracice and diver
-sify direct acions oriented towards individuals’ observed
needs and which act as human response modiiers(3,17).
In Figure 1, it is observed that aciviies 18, 19, 21, 49, 50, 51, 53 and 62 are part of the physical examinaion. Each of these aciviies is useful to idenify complicaions and/or new problems, permiing the implementaion of
new nursing aciviies or intervenions. These aciviies de
-mand professionals with comprehensive knowledge about
inspecion, palpaion, percussion and auscultaion tech
-niques, which permit decision making when performed
correctly and associated with clinical knowledge(18).
Accompanied by the necessary skills, these aciviies will contribute not only to the ideniicaion of relevant clinical informaion, but also to the implementaion of nursing intervenions and the ideniicaion of probable
causes, besides permiing stronger bonds between pro
-fessionals and paients, enhancing credibility and trust
between nurses and paients and also permiing com
-parisons among paients’ clinical repercussions in view of
expected to perform these aciviies, which need theorei
-cal and praci-cal knowledge, based on scieniic founda
-ion, speciically aiming to achieve safer aciviies in the elaboraion of paient care plans.
Most nursing technicians answered that another pro
-fessional category performs that aciviiy. The non-perfor
-mance percentages for these procedures are as expected, as these procedures are not part of these professionals’ competences and atribuions.
The main physiological pulmonary funcion altera
-ions aging entails are: impairment of gaseous exchange eiciency, decreased pulmonary compliance and reduced
respiratory muscle strength, decreased oxygen transpora
-ion to issues, accompanied by a reduced cardiac debit,
body muscle mass, alveolar volume and venilaion/perfu
-sion raio(19). Therefore, nurses are responsible for recog
-nizing these changes during the physical examinaion and selecing intervenions to improve respiratory condiions within the limits expected for this age.
In Figure 2, it is observed that frequency levels for ac
-iviies 50 and 62 were also ≥ 60%. According to the nurs
-es, the predominant reason for this was the unavailability
of resources needed for their performance. For those par
-icipants who indicated non-performance, the jusiica
-ion was lack of ime, high levels of paient demands at the insituion in comparison with the small number of
available staf members, who limit themselves to funda
-mental aciviies to guarantee the service’s coninuity. A study developed at a teaching hospital to idenify
prevalent nursing diagnoses in elderly paients and com
-pare them with hospitalizaion ime evidenced the pres
-ence of Inefecive Breathing Patern as the fourth most
cited among sixty two ideniied diagnoses. For this diag
-nosis, the predominant prescripion was to watch over
the breathing patern(20).
Watching over means constant monitoring and obser
-vaion of the paient’s health condiion, and can happen
on the occasion of the physical examinaion. The NIC pri
-oriizes similar aciviies for this diagnosis. It is observed that aciviies number 63 (Monitor thorax x-ray reports)
and 58 (Observe changes in SaO2 and SvO2,in expired CO2
and in arterial gasometry levels as appropriate)(5) were as
-sociated with performance by another professional cat
-egory in the nursing technicians’ answers. Both categories menioned the irst acivity, while only the technicians menioned the second.
Observaions of changes in arterial gases can be ac
-companied by clinical alteraions in the breathing pat
-terns as well as systemic alteraions, such as decreased
consciousness level caused by excess CO2, frequently ob
-served in this age group(10,13,21).
Nurses generally perform these aciviies, which are uncommon in nursing technicians’ educaion. In this study, it was noiced that the nurses monitor the results
of the paients’ laboratory tests, observing improvements and worsening during the hospitalizaion process.
Authors emphasize the importance of recognizing inter
-venions that reveal beter results for a given problem, as
well as intervenions that are usually performed in this pro
-fessional’s acivity areas or specialies. The possibility of iden
-ifying these nursing intervenions allows them to modify the
human response when they are put in pracice(22).
In that sense, acivity 22, observed in Figures 1 and 2,
is considered necessary for elderly paients with breath
-ing problems. Ag-ing reduces efeciveness in the removal
of residues and in airway humidiicaion, thus contribut
-ing to the accumulaion of secreion and decreased ei
-cient venilatory capacity. Hydraion enhances the luidi
-icaion of secreions, contribuing towards mobilizaion
and expectoraion(21).
The professional categories manifested diferent rea
-sons for not performing this acivity. According to some professionals, a category directly involved in nutriion
should perform this acivity. At the study sector, the pres
-ence of professionals with nutriional assessment and prescripion skills for hospitalized paients is uncommon.
Concerning acivity number 15, most reported that,
frequently, either the physician or Medical, Nursing, Nu
-triion and Psychology students performed this under the
teacher’s supervision. This fact should arouse nurses’ con
-cern, as this is an important acivity to put in pracice care
in the development of the data collecion, nursing diagno
-sis, care planning and implementaion phases. This can re
-lect the absence of nursing care organizaion that is more
directed at each paient’s singulariies, based on the Nurs
-ing process and in accordance with the law that regulates professional pracice. Based on the non-performance of
these aciviies, it is inferred that other acions, also im
-portant to modify the paient’s health condiion, are not performed either.
A study developed to idenify the aciviies nurses developed at a hospital insituion considered that many professionals have praciced acions based on the rouine
established at the sector, disclosing litle efort to inno
-vate and/or improve their work(8).
The health acions put in pracice during hospitaliza
-ion should consider comprehensive elderly care, includ
-ing curaive and health promoion acions. Besides, the reality the person lives in should be taken into account, thus providing for care planning in accordance with his/ her needs, so that, ater discharge, the elderly adopt
healthy measures learned during the hospitalizaion pro
-cess and avoid rehospitalizaions(11).
categories and relect the complementariness and inter
-dependence of diferent agents acive in care delivery(7).
Absence from the performance of certain aciviies
distances the nursing team, including the nurse, from rel
-evant and useful informaion to monitor and change nurs
-ing care plann-ing, with a view to achiev-ing results(8).
Another negaive aspect observed refers to this pro
-fessional’s distancing from discussions and clinical deci
-sion making together with other profes-sionals, which would contribute to gain visibility and noteworthiness in the interprofessional team.
conclUSion
As a part of NIC priority aciviies for the diagnosis
Inefecive Breathing Patern in elderly people, it is con
-sidered that nurses’ non-performance of certain aciviies can result in important gaps in the problem-solving ability
of nursing care, as well as non-performance by other nurs
-ing team members, as it is the nurse who prescribes what care the individual needs.
In all acivity groups that were not performed, the per
-formance of these acions by other professionals was the predominant reason for not doing them. In the context, however, imprecisions are perceived among paricipants
as to what aciviies other professionals legally can and
should pracice. Hence, the need for legal support is high
-lighted in the descripion of nursing pracice aciviies,
in view of the relevant need to describe them and bet
-ter deine nursing team members’ work, thus delimiing
the acions they perform. Also, the need emerges to as
-sess, among priority nursing intervenions for Inefecive Breathing Patern, which aciviies are truly fundamental for care delivery to elderly paients with this diagnosis.
Interdisciplinarity should be taken into account, as
well as bonding with other professionals, which can con
-tribute to the treatment paients receive and enhance nurses’ credibility among professionals and paients with regard to care prescripion.
The aciviies nursing does not perform for elderly pa
-ients with Inefecive Breathing Patern permit the emer
-gence of other diagnoses that aggravate the paient’s clinical condiion, extend hospitalizaion and minimize the paient’s health.
From another perspecive, not using some acions permits the strengthening of other professionals’ clinical aciviies in areas Nursing has historically occupied, which
can entail changes in the range of nursing care. In the fu
-ture, this can lead to changes in the scope of the profes
-sion’s domain.
REfEREncES
1. Napoleão AA, Carvalho EC. Aplicabilidade de intervenções prioritárias da NIC para o diagnósico de enfermagem desob -strução ineicaz das vias aéreas. Cogitare Enferm. 2007;12(1):9-19.
2. Costa RA, Shimizy HE. Aividades desenvolvidas pelos enfer -meiros nas unidades de internação de um Hospital-Escola do Distrito Federal. Rev Laino Am Enferm. 2005;13(5):654-62.
3. Fontes CMB, Cruz DALM. Diagnósicos de enfermagem docu -mentados para pacientes de Clínica Médica. Rev Esc Enferm USP. 2007;41(3):395-402.
4. Scherb CA, Head BJ, Maas ML, Swanson EA, Moorhead S, Reed D, et al. Most frequent nursing diagnoses, nursing inter -venions and nursing-sensiive paient outcome of hospital -ized older adults with heart failure: part 1. Int J Nurs Terminol Classif. 2011;22(1):13-22.
5. Dochterman JC, Bulecheck GM. Classiicação das intervenções de enfermagem (NIC). 4ª ed. Porto Alegre: Artmed; 2008.
6. Crossei MGO, Buógo M, Kohlraush E. Ações de cuidar na enfermagem de natureza propedêuica e terapêuica e suas interfaces com os atos de outros proissionais. Rev Gaúcha Enferm. 2000;21(1):44-67.
7. Rodrigues FCP, Lima MADS. A muliplicidade de aividades realizadas pelo enfermeiro em unidades de internação. Rev Gaúcha Enferm. 2004;25(3):314-22.
8. Costa RA, Shimizu HE. Estudo das aividades desenvolvidas pelos enfermeiros em um Hospital-Escola. Rev Esc Enferm USP. 2006;40(3):418-26.
9. Alvarenga MRM, Mendes MMR. O peril das readmissões de idosos num hospital geral de Marília/SP. Rev Laino Am En -ferm. 2003;11(3):305-11.
10. Franzen E, Almeida MA, Alii G, Bercini RR, Menegon DB, Rabelo ER. Adultos e idosos com doenças crônicas: im -plicações para o cuidado de enfermagem. Revista HCPA. 2007;27(2):28-31.
11. Santos WL, Nakatani AYK, Santana RS, Bachion MM. Diag -nósicos de enfermagem ideniicados na alta hospitalar de idosos. Cogitare Enferm. 2009;14(2):304-10.
13. Woodrow P. Assessing respiratory funcion in older people. Nurs Older People. 2002; 14(3):27-8.
14. Carlson-Catalano J, Lunney M, Paradiso C, Bruno J, Luise BK, Marin T, et al. Clinical validaion of inefecive breathing patern, inefecive airway clearance and impareid gas ex -change. Imag J Nurs Sch. 1998;30(3):243-8.
15. Cavalcante AMRZ. Intervenções de enfermagem para “pa -drão-respiratório ineicaz” em idosos [dissertação]. Goiânia: Programa de Pós-Graduação em Enfermagem, Universidade Federal de Goiás; 2009.
16. Pereira CAC, Sato T, Rodrigues SC. Novos valores de referên -cia para espirometria forçada em brasileiros adultos de raça branca. J Bras Pneumol. 2007;33(4):397-406.
17. Queluci GC, Figueiredo NMA. Sobre as situações de enfer -magem e seus graus de complexidade – menor, média e maior – na práica assistencial hospitalar. Esc Anna Nery Rev Enferm. 2010;14(1):171-6.
18. Costa SP, Paz AA, Souza EM. Avaliação dos registros de en -fermagem quanto ao exame ísico. Rev Gaúcha Enferm. 2010;31(1):62-9.
19. Bickley LBS. Propedêuica médica. 7ª ed. Rio de Janeiro: Guanabara Koogan; 2005.
20. Almeida MA, Alii GB, Franzen E, Thomé EGR, Unikovsky MR, Rabelo ER, et al. Diagnósicos de enfermagem e interven -ções prevalentes no cuidado ao idoso hospitalizado. Rev La -ino Am Enferm. 2008;16(4):707-11.
21. Doenges ME, Moorhouse MF, Geissler AC. Planos de cuidado de enfermagem: orientações para o cuidado individualizado do paciente. 5ª ed. Rio de Janeiro: Guanabara Koogan; 2003.
