Protocolo de cuidados de enfermagem para pessoas com disfunção neurológica do trato urinário inferior pelo vírus linfotrópico de células t humana: à luz da teoria do autocuidado

Abstract

Technology in health is a product created with the objective of transforming, improving and bringing solutions to real problems of daily health care. It arises from the experiential need, from the scarcity in the literature of something scientific that supports care, constituting itself as something innovative, dynamic, applicable and replicable to the environment to which it is proposed, legitimized by a methodology that validates it. To construct and validate a nursing care protocol for people with neurological dysfunction of the lower urinary tract living with human T lymphotropic virus type 1: in light of the Self-Care Theory. To conduct a systematic review of the literature on conservative care and treatment actions for people with urinary incontinence living with human T-lymphotropic virus type 1; To know the self-care actions and self-care deficit developed by these people and to relate the Systems Theory with nursing actions. Methodological study, using the Praxic Model for the Development of Technologies that consists of 4 phases: Pragmatic, in which a systematic review of the literature was carried out that followed the Cochrane Library methodology and qualitative field research with people with the virus and complaints of neurological dysfunction, in this stage the data collection took place through focus group and individual interview. The data were imported into the WebQDA software for content organization and exploration and submitted to thematic content analysis. In the Artistic Productive phase, the protocol was built, based on the data collected in the pragmatic phase. In the Experimental phase of the method, the protocol underwent content validation, in the first round evaluated by 12 expert judges and in the second, by 08 judges who were part of the first. The entire process was conducted from the perspective of Self-Care Theory, Self-Care Deficit and Systems Theory. In the pragmatic phase, five articles were selected from the systematic review and in the interviews and focus groups were selected reports of self-care experiences, self-care deficit and levels of dependence. In the artistic production phase, the Clinical Protocol for neurological dysfunction of the lower urinary tract in people with human T-cell lymphotropic virus was developed, divided into three blocks: 1: nursing actions in primary health care; 2: care actions in clean intermittent bladder catheterization and 3: nursing actions in secondary health care. The technology was validated, in the first round, by 12 expert evaluators with a content validity index of 0.87 and an interclass correlation coefficient of 0.88 (95% CI: 0.76 – 0.96; p<0.001). After suggested modifications and adaptations for the second round, 8 judges evaluated and increased the score to 0.91 and the ICC to 0.90 (95% CI: 0.76-0.98; p<0.001), demonstrating strong agreement between the evaluations globally. The objectives were achieved, and the results published. The protocol establishes guidelines to guide clinical practice based on the scientific literature. It is an efficient and qualified instrument for the professional's decision-making; defines limits of action; reduces variability in care; risks of misconduct; promoting safety for professionals and users of the Unified Health System. It promotes an expansion in the area of activity of nurses in pelvic dysfunctions; It directs care actions in primary and secondary health units and consolidates it in the scientific literature, as an unprecedented material to be consulted scientifically and in clinical practice by health professionals. It presented limitations for not implementing the last phase of the model, the Revolutionary, as a final part of the methodology.