Impaired physiological equilibrium syndrome in potential organ donors: identification of defining characteristics

Abstract

Introducción: La mayor parte de los diagnósticos de enfermería sobre los potenciales donantes de órganos están relacionados a alteraciones fisiológicas. Es común que estos pacientes presenten todos los diagnósticos citados para esta población. Pero todavía no existe en NANDA International un diagnóstico único que sea capaz de plantear este severo caso. Objetivo: Identificar en la literatura las posibles características definitorias para la propuesta de diagnóstico Síndrome del equilibrio fisiológico deteriorado en pacientes con muerte encefálica y potenciales donantes de órganos. Método: Revisión integrativa de la literatura con estudios publicados entre el 1997 y el 2017 en las bases de datos Web of Science, LILACS y PubMed.Resultados: La muestra constó de 37 artículos, de los cuales se identificó 44 posibles características distintas para el diagnóstico de enfermería en desarrollo. Se dividieron las características definitorias en cinco grupos principales: alteraciones endocrino-metabólicas; alteraciones hemodinámicas y/o cardiovasculares; alteraciones respiratorias; alteraciones nutricionales y alteraciones de la coagulación, inflamatorias e/o inmunológicas. Conclusiones: El desarrollo de este diagnóstico puede colaborar con la calificación de la taxonomía de NANDA Internacional, así como ampliar el conocimiento de la enfermería en el campo de mantenimiento del posible donante de órganos, lo que contribuye a la enseñanza e investigación. El empleo de este diagnóstico puede mejorar la sistematización del cuidado, auxilia en el mantenimiento del potencial donante y, en consecuencia, mejora la viabilidad de órganos para trasplante. Introduction: Most of nursing diagnoses for potential organ donors is related to physiological changes. These patients often have all diagnoses cited for this population. However, NANDA International does not have a diagnosis to address this acute condition. Objective: To identify possible defining characteristics for the diagnosis of impaired physiological equilibrium syndrome for brain death patients and for potential organ donors in the literature. Method: Integrative literature review including articles published between 1997 and 2017 in the databases Web of Science, LILACS and PubMed.Results: The sample consisted of 37 articles identifying 44 possible defining characteristics for the nursing diagnosis to be developed. The defining characteristics were divided into five major groups of changes: endocrine-metabolic changes, hemodynamic and/or cardiovascular changes, ventilatory changes, nutritional changes, coagulation changes, inflammatory and/ or immune changes.Conclusions: Developing this diagnosis can collaborate to the taxonomy of NANDA International, as well as to extend the nursing knowledge of the area of maintenance of the potential organ donor, contributing to teaching and research. The practical use of this diagnosis purpose can provide a better systematization of care, enabling the proper maintenance of the potential organ donor and consequently improving the viability of organs for transplantation. Introdução: A maior parte dos diagnósticos de enfermagem prevalentes para potenciais doadores de órgãos está relacionada com alterações fisiológicas. Não raro estes pacientes apresentam todos os diagnósticos citados para esta população. Todavia, não existe na NANDA International um diagnóstico único que aborde este quadro agudo. Objetivo: Identificar na literatura possíveis características definidoras para a proposta de diagnóstico Síndrome do equilíbrio fisiológico prejudicado para pacientes em morte encefálica e potenciais doadores de órgãos. Método: Revisão integrativa da literatura incluindo artigos publicados entre 1997 e 2017 nas bases de dados Web of Science, LILACS e PubMed.Resultados: A amostra foi constituída por 37 artigos identificando 44 possíveis características definidoras para o diagnóstico de enfermagem em desenvolvimento. As características definidoras foram divididas em cinco grandes grupos: alterações endócrino-metabólicas, alterações hemodinâmicas e/ou cardiovasculares, alterações ventilatórias, alterações nutricionais e alterações de coagulação, inflamatórias e/ou imunológicas.Conclusões: O desenvolvimento deste diagnóstico pode colaborar com a qualificação da taxonomia da NANDA International, além de ampliar o conhecimento da enfermagem na área de manutenção do potencial doador de órgãos contribuindo para o ensino e pesquisa. O uso desta proposta de diagnóstico na prática pode proporcionar uma melhor sistematização do cuidado, auxiliando a adequada manutenção do potencial doador e consequentemente melhor viabilidade dos órgãos ofertados para transplantes.

Nursing Diagnosis for Potential Organ Donors: Accuracy Study

“…As explained above, it can be observed that the indicators considered accurate for the ND Impaired physiological balance syndrome are also highlighted in the literature as recurrent physiological changes in brain-dead PODs. The international literature (Anwar & Lee, 2019;Citerio et al, 2016;Frenette et al, 2019;Menna Barreto et al, 2019Wong et al, 2017) highlights the importance of controlling these changes for better organ viability and consequently better health outcomes of the transplanted patient. Thus, regarding the accuracy of the clinical indicators of the ND in question, it is considered relevant to know the probability of the presence or absence of the ND from the indicators, assisting nurses in clinical judgment and diagnostic accuracy.…”

“…A data collection tool was built with the 25 clinical indicators, identified in an integrative literature review and validated by consensus of specialists in a previous study (Menna Barreto et al, 2019Barreto et al, , 2020, of the ND Impaired physiological balance syndrome, in addition to sociodemographic and clinical variables. Conceptual and operational definitions for each indicator were developed by researchers based on scientific literature to facilitate data collection.…”

“…It was also observed that there is no single ND in NANDA International (NANDA-I) that addresses this acute condition. Thus, 44 clinical indicators were identified through an integrative literature review and divided into five groups for the ND in development, Impaired physiological balance syndrome applied to brain-dead PODs (Menna Barreto et al, 2019).…”

Indicadores clínicos para o diagnóstico de enfermagem Síndrome do equilíbrio fisiológico prejudicado para doadores de órgãos

“…Thus, it is believed that not using NP and standardized languages in care practice, as well as the lack of tools and instruments to direct the maintenance of the potential organ donor, makes clinical reasoning difficult, being able to affect the Nursing diagnosis for organ donors Barreto LNM, Cabral EM, Chies N, Almeida MA quality of care due to its complexity. 7 In this way, the ND Impaired physiological balance syndrome may assist the nurse in choosing interventions that enable the achievement of the best results.…”

“…In this integrative review, the indicators were divided into five groups: Endocrine-metabolic changes, Hemodynamic and/or cardiovascular changes, Ventilatory changes, Nutritional changes and Coagulation changes, inflammatory and/or immunological. 7 t is noteworthy that conceptual definitions were constructed for each indicator based on scientific literature in order to ensure the understanding of each variable and enable an adequate judgment of each indicator by the panel of experts.…”