Validation studies by consensus and clinical testing are important to promote the accuracy, creating opportunities to legitimize, and improve the concepts of taxonomies.

Aims and objectives To test the validity and reliability of Nursing Outcomes Classification outcomes and their clinical indicators for patients with the nursing diagnosis ‘Risk for perioperative positioning injury’. Background Surgical positioning is an essential part of perioperative nursing practice. The use of a standardised language values the clinical evaluation of the perioperative nurse, reinforcing its contribution to surgical patient care. Design Longitudinal concept validation cohort study. Methods Patients were selected based on the operating room surgical schedule. The sample included adult patients who underwent elective surgical procedures requiring anaesthesia, classified as surgical class 2, 3 or 4. Outcomes were measured with an instrument, which included 33 clinical indicators for eight outcomes. The patients were assessed at five distinct time points in the perioperative phases. This study followed the STROBE guidelines. Results A total of 50 patients were included. Each underwent five clinical assessments, for a total of 250 documented assessments. Differences in evaluations were mostly related to reduced scores of clinical indicators in the immediate postsurgical time points, which recovered to the highest score at the end of the fifth (and last) evaluation. The results of factor analysis and Cronbach's alpha calculations suggested a new configuration for this nursing outcomes, consisting of five outcomes—Circulation Status, Tissue Perfusion: peripheral, Neurological Status: peripheral, Tissue Integrity: skin and mucous membranes and Thermoregulation—and 13 clinical indicators. Conclusions Nursing Outcomes Classification outcomes and clinical indicators for the nursing diagnosis at ‘Risk for perioperative positioning injury’ are sensitive to patient states during the perioperative period. Relevance to clinical practice Use of nursing taxonomies during the perioperative period may contribute to the discussion on the role of perioperative nurses and their relevance in patient care.

Resumo OBJETIVOS Analisar a acurácia diagnóstica de enfermagem em pacientes com predição de risco de piora clínica durante internação por insuficiência cardíaca agudamente descompensada. MÉTODO Estudo de coorte com coleta de dados em prontuário de acordo com o Acute Decompensated Heart Failure National Registry risk model. Após a definição dos pacientes em risco, aplicou-se a Escala de Acurácia de Diagnósticos de Enfermagem versão 2. A escala classifica a acurácia em nula, baixa, moderada ou alta. RESULTADOS Dos 43 pacientes com risco de piora, 22(51%) não pioraram e 21(49%) pioraram; em ambos, a acurácia diagnóstica apresentou-se na categoria Moderada/Alta em 22(89%) e 16(88%), respectivamente. Apenas Débito cardíaco diminuído e Volume de líquidos excessivo foram pontuados com 100% na categoria Alta. CONCLUSÕES Pacientes agudamente descompensados e com risco de piora clínica durante a internação foram identificados com acurácia diagnóstica Moderada ou Alta pelos enfermeiros.

Introduction The aim of this study was to evaluate the effectiveness of a diuretic adjustment algorithm (DAA) in maintaining clinical stability and reducing HF readmissions using telemonitoring Technologies. Methods Randomized clinical trial of patients with an indication for furosemide dose adjustment during routine outpatient visits. In the intervention group (IG), the diuretic dose was adjusted according to the DAA and the patients received telephone calls for 30 days. In the control group (CG), the diuretic dose was adjusted by a physician at baseline only. Co-primary outcomes were hospital readmission and/or emergency department visits due to decompensated HF within 90 days, and a 2-point change in the Clinical Congestion Score and/or a deterioration in New York Heart Association functional class within 30 days. Results A total of 206 patients were included. Most patients were male ( n=119; 58%), with a mean age of 62 (SD 13) years. Four patients (2%) in the IG and 14 (7%) in the CG were hospitalized for HF (odds ratio (OR) 0.31 (0.10–0.91); p=0.04). Multivariate analysis showed a reduction of 67% in readmissions and/or emergency department visits due to decompensated HF in the IG compared with the CG (95% CI 0.13–0.88; p=0.027). Regarding the combined outcome of HF readmission and/or emergency department visits or clinical instability, the IG had 20% fewer events than the CG within 30 days (IG: n=48 (23%), CG: n=70 (34%); OR 0.80 (0.63–0.93); p=0.03). Discussion Using DAA improved the combined outcome in these outpatients, with favorable and significant results that included a reduction in HF admissions and in clinical instability. (NCT02068937)

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