Study finds communication between parents and children’s nurses is vital, but negotiating care needs roles to be defined clearly Aim To increase understanding of parents’ perspectives on the negotiation of care. Method A translated and validated questionnaire was completed by 444 parents of children admitted over a 16-month period to one hospital in Portugal. Results The overwhelming majority of participating parents believed that parents should always stay with their child in hospital and provide basic care, including being woken in the night to do so. However, over one third thought that their participation might disrupt the nurses’ routines and a similar percentage felt uncomfortable telling nurses if they did not want to participate in care. Parents with higher levels of education and those aged over 30 were more likely to report good communication with the nursing team. Conclusions Communication between parents and nurses is essential to partnership in care. Effective negotiation requires a clear definition of nurses’ and parents’ roles, as well as agreement on the level of participation in care by parents.

Objective: To implement the nursing process, based on the Neuman Systems Model and the International Classification of Nursing Practice terminology, in the care of an adolescent who underwent corrective surgery for juvenile idiopathic scoliosis. Method: This is a qualitative study of the type of single case, with triangulation of data collection techniques (formal clinical interview, notes in a field diary and medical record information), developed with a 17-year-old adolescent and indication for corrective surgery. The empirical materials generated with the interviews carried out at admission and at discharge, observation and medical record information were treated with categorical content analysis. Results: The categories of personal condition, anxiety, selfconcept, meaningful people, facilitating health resources, school, free time and leisure were recurrent. Diagnoses were defined with a focus on Anxiety, Knowledge on pain management (control) and Willingness (or readiness) to learn, associating them with the respective nursing interventions. Conclusion: The Model contributed to assess and recognize surgery stressors for the adolescent and to theoretically base the nursing process. The classification allowed systematizing nursing care records, elements of clinical practice, unifying vocabulary and codes.

Background: Airway clearance impairment has a significant impact on self-care and quality of life. Identifying clinical data, nursing diagnoses, and nursing interventions is essential to clinical reasoning and enhancing nursing care. This study aims to map the existing evidence on clinical data, nursing diagnoses, and nursing interventions addressing the nursing focus on “airway clearance”. Methods: Research was conducted based on Joanna Briggs’s Scoping Review Methodology. We searched four databases for published studies until December 2023. Results: From the initial 1854 studies identified, 123 were included in the review. The findings highlighted two areas of nursing attention: one related to signs and symptom management, and the other related to education and coping strategies. The data that led to nursing diagnoses were divided into cognitive and clinical data. The nursing diagnoses were mostly related to secretion retention, excessive mucus production, and airway obstruction. The most commonly identified nursing interventions were educational interventions assembled into predesigned education programs rather than patient-tailored programs. Conclusions: Findings can add substantial value for systematizing the nursing process related to “airway clearance”, improving nursing decision-making and care quality. This study was prospectively registered with the Open Science Framework (OSF) on 02 December 2022, with the registration number wx5ze.

EHR Interoperability is crucial to obtain a set of benefits. This can be achieved by using data standards, like ontologies. The Portuguese Nursing Ontology (NursingOntos) is a reference model describing a set of nursing concepts and their relationships, to represent nursing knowledge in the Electronic Health Records (EHR). The purpose of this work was to define a set of correspondences between Nursing Ontology concepts of NursingOntos and other terminologies, which have the same or similar meaning. In this project, we are using the ISO/TR12300:2016 standard on the principles of mapping between terminological systems. Regarding the domain of “airway clearance”, we can say that Portuguese Nursing Ontology has a good level of mapping with other terminologies. In conclusion, we can say that Portuguese Nursing Ontology can be used in EHR with the purpose of a global digitalization of health.

Objective: To develop a nursing intervention model for adolescents and parents experiencing parental cancer.

Background: data sharing from clinical practice is crucial to support nurses' decision-making process, improve nursing outcomes, and increase the quality of care. In Portugal, International Classification for Nursing Practice is used to document care being necessary for the standardization of this process preventing information redundancy. Objectives: (1) to identify diagnoses and interventions used by Portuguese nurses related to Respiratory Process, (2) to suggest unified diagnoses and interventions syntaxes. Methodology: qualitative study with a content analysis. The sample included data regarding e-documentation of nursing diagnosis and interventions customized in the nursing public information system until 2019. Results: of the initial sample of 1502 diagnoses aroused 28 and from 2060 interventions emerged 73 as the most relevant. The main findings were: two areas of nursing attention, one related to respiratory function and the other to patient's learning abilities, diversity of diagnoses and interventions to express the same needs resulting from a variety of taxonomic misunderstandings, and lack of standardized language. Conclusions nursing documentation have two dimensions representing the complexity of nursing care. It also shows that using standardized language does not prevent information redundancy resulting in different diagnoses and interventions to express the same needs. Marco contextual: el cambio de datos resultantes de la práctica clínica es crucial para apoyar el proceso de toma de decisiones. Portugal, utiliza la CIPE para documentar la práctica clínica, siendo necesaria la estandarización de lo proceso evitando redundancia de información. Objetivos: (1) identificar diagnósticos e intervenciones utilizados por enfermeros portugueses relacionados con el Proceso Respiratorio, (2) sugerir sintaxis unificadas de diagnósticos e intervenciones. Metodología: diseño cualitativo con análisis de contenido. La muestra incluyó datos sobre documentación electrónica en el sistema de información pública de enfermería hasta 2019. Resultados: 1502 diagnósticos surgieron 28 y de 2060 intervenciones surtieron 73 como los más relevantes. Los principales hallazgos fueron: dos áreas de atención de enfermería, una relacionada con la función respiratoria y otra con las habilidades de aprendizaje del paciente, diversidad de diagnósticos e intervenciones para expresar las mismas necesidades resultantes de una variedad de malentendidos taxonómicos, falta de lenguaje estandarizado. Conclusión: los resultados muestran que la documentación de enfermería tiene dos dimensiones representando la complejidad del cuidado de enfermería. También muestra que el uso de un lenguaje estandarizado no evita la redundancia de información resultando en diferentes diagnósticos e intervenciones para expresar las mismas necesidades. Enquadramento: a partilha de dados da prática clínica é crucial para apoiar o processo de tomada de decisão, Em Portugal a CIPE é utilizada para documentar os cuidados de enfermagem sendo necessária a uniformização deste processo de forma a evitar redundância de informação. Objetivos: (1) identificar diagnósticos e intervenções utilizados por enfermeiros portugueses relacionados com o Processo Respiratório, (2) sugerir sintaxes unificadas de diagnósticos e intervenções. Metodologia: estudo qualitativo com análise de conteúdo análise de conteúdo. A amostra incluiu dados referentes à documentação eletrónica customizada no sistema público de informação de enfermagem até 2019. Resultados: da amostra inicial de 1502 diagnósticos emergiram 28 e de 2060 intervenções surgiram 73 como os mais relevantes. Os principais achados foram: duas áreas de atenção de enfermagem, uma relacionada com função respiratória e outra com habilidades de aprendizagem do cliente, diversidade de diagnósticos e intervenções para expressarem as mesmas necessidades decorrentes de equívocos taxonómicos e de falta de linguagem padronizada. Conclusão: os diagnósticos e intervenções de enfermagem possuem duas dimensões que representam a complexidade do cuidado de enfermagem. O uso de linguagem padronizada não impede a redundância de informações resultando em diagnósticos e intervenções diferentes para expressar as mesmas necessidades.