Construção e validação de um protocolo de intervenções de enfermagem para promoção do conforto de pessoas idosas hospitalizadas

Abstract

Introduction: Longevity leads to multidimensional changes in the aging population and brings with it greater susceptibility to the occurrence of chronic health conditions, with risks of frailty and organic dysfunction and consequently a greater occurrence of prolonged and recurrent hospitalizations. Hospitalization, although necessary to restore health, can generate anxiety, fear and discomfort and constitute an unpleasant experience for elderly people. Although Nursing plays a preponderant role in caring for people in the context of hospitalization, through actions to promote well-being and comfort, it appears that these actions, in general, do not follow standardization, which implies the implementation of fragmented and inefficient care. Thus, in order to support nursing practice with a view to promoting the comfort of hospitalized elderly people, we propose an intervention protocol supported by Kolcaba's Comfort Theory, scientific evidence, as well as nursing interventions and activities proposed by the NIC. Objective: Build a protocol of nursing interventions to promote the comfort of hospitalized elderly people in light of Kolcaba's Theory. Method: This is a methodological study, initially starting from an integrative review of the literature to search for scientific evidence in the Database regarding interventions, activities and nursing care aimed at promoting comfort in people in the hospital environment. At the same time, the NIC Standardized Language System was used to identify the proposed Interventions for the “Impaired Comfort” Nursing Diagnosis of NANDA-I version 2021- 2023. Next, Cross Mapping of interventions and activities validated by experts in the area of knowledge was carried out. Finally, the construction and final validation was guided by the Appraisal of Guidelines for Research & Evaluation II instrument. To meet the requirements of the Guidelines and Standards for Research on Human Beings, all regulatory procedures and standards recommended by Resolution 466/2012 and 580/2018 of the CNS/MS/BRAZIL were respected, with approval from the Research Ethics Committee under CAAE no: 56816022.7.0000.5183. Results: 21 NIC interventions and information extracted from 15 studies were analyzed and validated by experts in light of theory in the physical, environmental, sociocultural and psychospiritual dimensions. A total of 604 nursing activities proposed in the NIC 7th edition were obtained, of which 176 were mapped with 137 interventions, activities and care evidenced in the literature, 13 activities did not show similarity with the proposed interventions, among which the majority were related to the psychospiritual context, with inclusion in other NANDA-I NDs, confirmed by the absence of this class of comfort in the aforementioned taxonomy. In validating the guideline, the domains 'scope and purpose', 'involvement of the parties' and 'clarity of presentation' were evaluated with maximum points, resulting in 100% suitability in the experts' assessment. In the domains ‘rigor of development’ and ‘editorial independence’, a percentage of 94% agreement was reached. In the ‘applicability’ domain, the maximum score corresponded to 93%, this being the domain that required small adjustments requested by the judges and for subsequent clinical validation. Final considerations: The relevance of the Comfort Theory supported the successful development of the nursing intervention protocol aimed at the comfort of hospitalized elderly people, demonstrating the predominance of the psycho-spiritual context as the main focus of intervention for this population. The study made it possible to identify the main evidence-based interventions in nursing and correlate them in the Standardized Nursing Language System. Continuing this study is essential to validate its practical applicability, ensuring its improvement and meeting the real needs of hospitalized elderly people.