Validation of the mapping of pressure ulcer prevention measures to the Nursing Interventions ClassificationABSTRACT
Objective: To map Nursing actions extracted from the Ministry of Health Protocol and Technical Notes on safe practices for pressure ulcer prevention to the interventions of the Nursing Interventions Classification.
Method: A descriptive study conducted between October 2023 and February 2024, developed in four stages: extraction of Nursing actions; identification of Nursing Interventions Classification interventions; cross-mapping; and expert validation. Data were analyzed using descriptive statistics.
Results: A total of 44 ministerial actions and 59 interventions from the Nursing Interventions Classification were identified. After two rounds, the 44 actions corresponded to 24 intervention titles, with emphasis on: prevention, positioning, bed rest care, and skin surveillance. Of the 44 actions, 65.9% were considered more detailed and specific. No action was identical to an intervention.
Conclusion: The Nursing actions described in the ministerial documents are more detailed and specific. The Nursing Interventions Classification includes a greater number of interventions.
DESCRIPTORS:
Pressure Ulcer; Patient Safety; Standardized Nursing Terminology; Nursing Process; Nursing
HIGHLIGHTS
1. Nursing is involved in the management of pressure ulcer prevention measures.
2. Improvement of care protocols and continuing professional training.
3. Potential incorporation of 35 new interventions into ministerial documents.
4. The study contributed to the methodological advancement of cross-mapping.
RESUMO
Objetivo: Mapear ações de Enfermagem extraídas do Protocolo e das Notas Técnicas do Ministério da Saúde sobre práticas seguras para prevenção de lesão por pressão às intervenções da Classificação das Intervenções de Enfermagem.
Método: Estudo descritivo, realizado entre outubro de 2023 e fevereiro de 2024 em quatro etapas: extração de ações de Enfermagem; identificação de intervenções da Classificação das Intervenções de Enfermagem; mapeamento cruzado; validação por peritos. A análise foi realizada por estatística descritiva.
Resultados: Identificaram-se 44 ações ministeriais e 59 intervenções da Classificação das Intervenções de Enfermagem. Após duas rodadas, 44 ações corresponderam a 24 títulos de intervenções, com destaque para: prevenção, posicionamento, cuidados com o repouso no leito e supervisão da pe e. Das 44 ações, 65,9% foram consideradas mais detalhadas e específicas. Nenhuma ação foi idêntica a uma intervenção.
Conclusão: As ações de Enfermagem nos documentos ministeriais são mais detalhadas e específicas. A Classificação das Intervenções de Enfermagem contempla maior quantitativo de intervenções.
DESCRITORES:
Úlcera por Pressão; Segurança do Paciente; Terminologia Padronizada em Enfermagem; Processo de Enfermagem; Enfermagem
HIGHLIGHTS
1. A Enfermagem atua na gestão das ações de prevenção de lesão por pressão.
2. Aprimoramento de protocolos assistenciais e formação profissional contínua.
3. Potencial incorporação de 35 novas intervenções aos documentos ministeriais.
4. A pesquisa contribuiu para o avanço metodológico do mapeamento cruzado.
RESUMEN
Objetivo: Correlacionar las acciones de enfermería extraídas del Protocolo y de las Notas Técnicas del Ministerio de Salud sobre prácticas seguras para la prevención de lesiones por presión con las intervenciones de la Clasificación de Intervenciones de Enfermería.
Método: Estudio descriptivo, realizado entre octubre de 2023 y febrero de 2024, que se desarrolló en cuatro etapas: extracción de acciones de enfermería; identificación de intervenciones de la Clasificación de Intervenciones de Enfermería; mapeo cruzado; y validación por expertos. El análisis se llevó a cabo mediante estadística descriptiva.
Resultados: Se identificaron 44 acciones ministeriales y 59 intervenciones de la Clasificación de Intervenciones de Enfermería. Tras dos rondas, las 44 acciones correspondieron a 24 títulos de intervenciones, entre las que destacaron: prevención, posicionamiento, cuidados relacionados con el reposo en cama y supervisión de la piel. De las 44 acciones, el 65,9 % se consideraron más detalladas y específicas. Ninguna acción fue idéntica a una intervención.
Conclusión: Las acciones de enfermería descritas en los documentos ministeriales son más detalladas y específicas. La Clasificación de Intervenciones de Enfermería incluye un mayor número de intervenciones.
DESCRIPTORES:
Úlcera por Presión; Seguridad del Paciente; Terminología Normalizada de Enfermería; Proceso de Enfermería; Enfermería
HIGHLIGHTS
1. La enfermería participa en la gestión de las medidas de prevención de lesiones por presión.
2. Mejora de los protocolos de atención y de la capacitación profesional continua.
3. Posible incorporación de 35 nuevas intervenciones a los documentos ministeriales.
4. La investigación contribuyó al avance metodológico del mapeo cruzado.
INTRODUCTION
Pressure Ulcer (PU) is characterized by damage to the skin and/or underlying tissues caused by pressure or by the combination of pressure and shear1, 2, and represents a global public health problem due to its significant impact on morbidity and mortality3. PU occurs over a bony prominence but may also be associated with the use of medical devices1, 2. Prevention involves repositioning, appropriate support surfaces, skin care, and nutritional care4.
An epidemiological study conducted in 204 countries using data from the Global Burden of Disease (GBD) 2021 demonstrated that the total number of PU cases increased from 300,442 in 1990 to 645,588 in 2021, highlighting the global increase in prevalence over three decades3. PU reports are indicators of service quality, reinforcing the importance of prevention to ensure patient safety and quality of care5.
In Brazil, according to the 2019–2022 report issued by the Brazilian Health Regulatory Agency (ANVISA), there were 160,000 PU reports during this period, making it the most frequently reported incident6. This high incidence poses a challenge for healthcare teams. In this context, nursing plays a fundamental role in patient safety and in promoting a safe care environment through preventive interventions. These actions contribute to the provision of harm-free care and to cost reduction in healthcare services4.
In Brazil, patient safety actions are guided by the National Patient Safety Program (PNSP), which includes protocols and technical notes aimed at preventing PU7, 8, 9. These guidelines reinforce the role of Nursing in preventing ulcers, given nurses’ close clinical contact with patients4. The diversity of these actions highlights the need to compare them with a standardized terminology to ensure uniform documentation and data interoperability.
A standardized nursing terminology promotes professional recognition, evidence-based clinical reasoning, and interprofessional communication10. The Nursing Interventions Classification (NIC) organizes independent and collaborative interventions, defined as treatments performed by nurses to improve patient outcomes11. The seventh edition includes 565 interventions structured into seven domains and 30 classes11.
The systematic adoption of standardized terminologies in electronic health records facilitates the generation, retrieval, and consistent comparison of data12, as well as their integration into large multidisciplinary repositories13. In this context, the mapping of non-standardized content is essential to expand the use of these data as an integral part of nursing practice13.
Cross-mapping makes it possible to compare terms used in clinical practice with standardized terminologies14, adapting data to a standardized language, facilitating information exchange, and improving practice through research13, 15. Mapping the NIC to the nursing actions described in the Ministry of Health protocols and technical notes may contribute to PU prevention, reduce hospitalizations and healthcare costs, improve protocols, and increase the visibility of Nursing in this field. Innovatively, this study contributes to the literature by integrating ministerial guidelines and standardized terminologies, providing a novel analysis of how these languages can improve documentation and enhance safety in PU prevention.
Furthermore, this process makes it possible to translate actions described in administrative or regulatory language into a scientific and interoperable language, promoting standardization, communication, and data integration across information systems. Therefore, this study’s objective was to map the Nursing actions extracted from the Ministry of Health (MH) Protocol and Technical Notes on safe practices for PU prevention to the interventions of the Nursing Interventions Classification.
METHOD
This was a descriptive study based on cross-mapping14, 15 between the Nursing actions described in three Brazilian Ministry of Health (MH) documents on PU prevention7, 8, 9: the Ministry of Health Protocol for Pressure Ulcer Prevention (2013) and Technical Notes No. 03/2017 and No. 05/2023, entitled Patient Safety Practices in Health Services: Pressure ulcer Prevention, and the Nursing interventions included in the Nursing Interventions Classification (NIC)11. For terminological organization, the term “actions” was used to refer to the nursing practices extracted from the MH documents7, 8, 9. In turn, the term “interventions” was used to refer to the practices described in the NIC11.
The study was conducted between October 2023 and February 2024 and comprised four stages. In the first stage, two researchers independently conducted a thorough analysis to identify, list, and categorize the nursing actions included in the PU Prevention Protocol7 and the Technical Notes8, 9.
In the second stage, the priority, suggested, and additional interventions for PU prevention established by the NANDA-I/NIC linkage, available in the sixth edition of the NIC,16 were identified based on the Nursing Diagnosis (ND) “Risk for Impaired Skin Integrity” (00046)17. The use of the sixth edition of the NIC was justified because it is the edition that presents the NANDA-I/NIC linkage adopted as the methodological reference for this stage. The seventh edition11 was used to consult the NIC taxonomic structure to identify other interventions related to PU prevention, as well as to access the full NIC interventions, since it was the most current version available during the data collection period.
The third stage consisted of developing a cross-mapping between the Nursing actions described in the Protocol and the Technical Notes and the NIC interventions. Cross-mapping consisted of a linguistic and semantic comparison between these two categories. This process made it possible to analyze the applicability of the NIC to the practices described in the Protocol and the Technical Notes. The following mapping rules were adopted15, 18: map using the context of the Nursing diagnosis; map the meaning of words rather than the words themselves; use the keyword of the Nursing action to map the NIC intervention; use verbs as keywords in the intervention; map the intervention from the title to the activity; maintain consistency between the mapped intervention and its definition; and use the most specific NIC intervention title.
The cross-mapping was independently performed by two researchers using Microsoft Excel® spreadsheets, version 2016. Discrepancies were discussed, and a single version was proposed during an in-person meeting with a third researcher. The fourth stage consisted of validating the mapping with five expert nurses using the Delphi technique19.
The initial identification of the experts was carried out through searches of the Lattes Platform/CNPq and recommendations from researchers with expertise in the study topics. Eight professionals who met the preliminary criteria were invited, of whom five agreed to participate.
Participant selection considered both quantitative and qualitative aspects to ensure that the experts were qualified in the subject under investigation20. Thus, the selection criteria20 included: a master’s or doctoral degree in Nursing; research experience in patient safety, standardized nursing terminologies, and/or PU prevention; and clinical or teaching experience in these areas. Participant selection also considered different levels of clinical and academic expertise, including years of professional experience, experience in PU prevention and management, knowledge of standardized nursing terminologies, stricto sensu graduate qualifications, and scientific publications20, to ensure a consistent and representative evaluation of the applicability of the mapped interventions.
Upon agreeing to participate in the study, the nurses received, via email, an invitation letter; a professional characterization form, which included information on age, sex, years of professional experience, academic qualifications, and experience in patient safety, standardized nursing terminologies, or clinical care related to PU prevention; a document containing the cross-mapping, including the Nursing actions extracted from the MH documents and the corresponding NIC interventions; a PDF file containing the selected NIC interventions/activities; and the Free and Informed Consent Term (FICT). A period of 20 days was established for returning the completed instruments. After this period, a reminder was sent to minimize losses and encourage greater participation.
The form containing the cross-mapping results was structured as a four-column table. The first column contained the actions extracted from the Protocol and the Technical Notes7, 8, 9. The second column presented the corresponding NIC interventions and included the domain, class, intervention title, and activities11. In the third column, the experts indicated whether they agreed or disagreed with the mapping and could provide suggestions. If they disagreed, they could suggest an alternative NIC intervention. Finally, in the fourth column, the experts classified the mapping according to the similarity and comprehensiveness of the actions/interventions classified as mapped21, as presented in Chart 1 below:
Classification of the mapping according to the similarity of the mapped actions/interventions. Belo Horizonte, MG, Brazil, 2025
The structured form was essential to ensure consistency and systematicity in the evaluation and comparison of the actions and interventions, enabling a robust and detailed validation process.
To ensure a comprehensive evaluation, the NIC interventions that were not directly mapped to the nursing actions were presented in a separate table. The purpose was to provide the experts with an additional overview of the NIC interventions that had not been initially considered. This allowed them to suggest alternative mappings by indicating whether any of the previously unmapped interventions were represented in the actions described in the ministerial documents.
Data were analyzed using Microsoft Excel®, version 2016. The characteristics of the experts, the actions described in the Protocol, and the NIC interventions were analyzed using descriptive statistics. Agreement analysis was performed to validate the mapping. The Agreement Index (AI) was calculated for each mapping item [AI = NA/(NA + ND) × 100], where NA refers to the number of agreements and ND to the number of disagreements22. The minimum agreement threshold adopted for the evaluation of the mapping and for the analysis of similarity and comprehensiveness was 80%18.
This study was approved by the Research Ethics Committee (REC) of the proposing institution under Opinion No. 3,082,700.
RESULTS
In the first stage, the analysis of the three MH documents on PU prevention resulted in the identification of 44 Nursing actions. The extracted actions were organized according to thematic similarity into six categories: 18 (40.9%) related to pressure management; nine (20.4%) to skin inspection; eight (18.2%) to general guidance; three (6.8%) to hygiene and hydration; three (6.8%) to moisture management; and three (6.8%) to nutritional management.
In the second stage, 59 NIC interventions were selected, of which 56 (94.9%) were related to the NANDA-I nursing diagnosis “Risk for Impaired Skin Integrity” (00047), and three (5.1%) additional NIC interventions were identified through consultation of the taxonomic structure11: pressure ulcer care (3520), catheter/drain care (1870), and incident reporting (7980). Of the 59 selected NIC interventions, 30 (50.9%) belonged to the basic physiological domain; 18 (30.5%) to the complex physiological domain; seven (11.9%) to the safety domain; two (3.4%) to the family domain; one (1.7%) to the health system domain; and one (1.7%) to the behavioral domain.
In the third stage, all 44 (100%) actions extracted from the Protocol and the Technical Notes were mapped to 24 (40.7%) NIC interventions. Expert nurses validated the cross-mapping in two Delphi rounds. Table 1 presents the characteristics of the experts.
In the first Delphi round of the cross-mapping, 31 (70.5%) actions achieved an AI of 100%, and 12 (27.3%) actions reached 80% and were deemed valid by the experts. The only correspondence considered invalid in the first round was the mapping of the action “to assess the presence of clinical signs of malnutrition or conditions that may predispose to changes in nutritional status” to the NIC intervention “Pressure Ulcer Prevention” (3540) (AI = 40%). In the second Delphi round, this action was resubmitted to the experts and mapped to the NIC interventions “Risk Identification” (6610), “Surveillance” (6650), “Nutrition Therapy” (1120), and “Foot Care” (1100). This correspondence subsequently achieved an AI of 100.0%.
Among the mapped NIC interventions, 11 (47.8%) belonged to the Physiological: Basic domain. The interventions corresponding to the greatest number of actions were “Pressure Ulcer Prevention” (3540), “Positioning” (0840), “Bed Rest Care” (0740), and “Skin Surveillance” (3590). Notably, 23 (52.3%) actions were mapped to more than one NIC intervention (Table 2).
Mapped interventions from the Nursing Interventions Classification and number of corresponding actions (n=24). Belo Horizonte, MG, Brazil, 2025
Regarding the classification of similarity and scope of the 44 actions in the Protocol and the mapped Technical Notes, 29 (65.9%) were considered more detailed and specific than the NIC, 12 (27.3%) were considered similar in meaning, and three (6.8%) were considered more general and broader than the NIC. None of the actions extracted from the MH documents was classified as identical to a NIC intervention/activity. Furthermore, 16 (36.4%) actions from the ministerial documents were mapped only to the title and definition of the NIC intervention, resulting in their classification as more detailed and specific than the NIC. Of these actions, five (27.3%) corresponded to the NIC intervention “Pressure Ulcer Prevention” (3540), two (9.1%) to “Risk Identification” (6610), and two (9.1%) to “Bed Rest Care” (0740).
The complete version of the mapping, following validation, is available at https://zenodo.org/records/20190362.
Chart 2 presents the 35 NIC interventions that did not correspond to the actions described in the Protocol and the Technical Notes.
Unmapped interventions from the Nursing Interventions Classification. Belo Horizonte, MG, Brazil, 2025
DISCUSSION
In the first stage, Nursing actions aimed at pressure management were identified, including pressure and shear redistribution and reduction, positioning with the head of the bed at an angle of less than 30°, supporting the feet while seated, using sliding sheets, special mattresses, and encouraging mobility in bed. These actions are consistent with a national study that identified repositioning, the use of cushions, checking for materials underneath the patient’s body, and protecting bony prominences as PU prevention measures23. However, these measures are not always implemented, often due to the unavailability of protective devices24, 25.
The ministerial documents emphasize skin inspection, particularly in areas exposed to medical devices, which increase the risk of head and lower-limb injuries24. Catheters, tubes, and drains are the most frequently used devices4. Preventive measures include the use of products containing hyperoxygenated fatty acids, early detection of the source of the lesion, secure attachment, and regular rotation of devices such as pulse oximeters4.
The category “general guidance” comprised eight actions, among which the participation of family members and caregivers in care was highlighted as an important strategy to assist in monitoring skin changes and repositioning the patient25. Another relevant action involved strategies to engage family members and caregivers in incident reporting. However, for these individuals to communicate effectively with healthcare professionals, institutional policies must provide a welcoming environment26.
Of the 59 NIC interventions, only 24 were mapped. This finding indicates that although the NIC is a useful classification for care planning and documentation, communication, data integration into information systems, effectiveness research, productivity measurement, competency assessment, reimbursement, education, and curriculum planning11, there are still gaps in the correspondence between the actions described in the ministerial documents and the interventions included in the taxonomy.
The NIC interventions that showed the greatest correspondence with the ministerial documents were “Pressure Ulcer Prevention” (3540) and “Positioning” (0840). The NIC intervention “Pressure Ulcer Prevention” (3540) was mapped to 22 actions, among which those related to skin cleansing and skin care through the use of moisturizers were particularly noteworthy. Regarding skin cleansing, it is important to emphasize the need to individualize the care provided to older adults during bed bathing. Older adults who are confined to bed have skin that is more susceptible to damage; therefore, the pressure applied during the procedure should be minimized27. The use of products that promote skin hydration is strongly recommended to reduce the risk of PU27.
Particular attention should also be given to controlling skin exposure to moisture, which is considered one of the main risk factors for the development of PU. This condition may be associated with urinary and/or fecal incontinence, excessive perspiration, and wound exudate3. In addition to changing damp bed linens, moisture control through the use of devices such as diapers and absorbent pads requires regular replacement to reduce the risk of dermatitis28.
The NIC intervention “Positioning” (0840), which was mapped to 10 actions from the ministerial documents, was the second intervention with the highest number of correspondences. This intervention recommends proper body alignment for patients who are bedridden or require support to maintain a comfortable and therapeutic position3. From this perspective, a U.S. study found that maintaining proper body alignment was one of the most frequently neglected aspects of care29. Although positioning practices are simple and effective in promoting physiological and psychological well-being, they are often not performed by the Nursing team.
A total of 35 NIC interventions were not mapped. Among these, the additional optional NIC interventions related to nutritional status and weight management, as well as those focused on mobility and movement, stood out, including “Exercise Promotion” (0200), “Stretching” (0202), “Strength Training” (0201), and “Joint Mobility” (0224). These findings highlight the need to review and expand the ministerial documents.
Nutritional care is one of the cornerstones of PU prevention. Vitamins and proteins help maintain skin integrity and prevent tissue breakdown. Moreover, malnourished individuals are not only more likely to develop PU but may also experience impaired wound healing29. Because the causes of malnutrition are multifactorial, early patient assessment at the time of admission should include questions aimed at identifying the possible causes of nutritional deficiencies. International guidelines1, 2 emphasize the importance of a multidisciplinary assessment.
Regarding physical exercise, its importance lies in the fact that impaired mobility is a risk factor for PU3. Therefore, Nursing actions that encourage active and passive range-of-motion exercises should be considered, an aspect that was not identified in the Protocol or the Technical Notes7, 8, 9.
In this study, all actions extracted from the Protocol and the Technical Notes were mapped to NIC interventions. However, several actions corresponded only to the intervention title and definition. The standardized NIC language is based on these two elements, allowing activities to be selected or modified as needed11. Thus, the NIC promotes communication through a shared meaning across different settings while allowing care to be individualized. Therefore, incorporating the Nursing actions described in the ministerial documents into the activity lists of NIC interventions may further enhance the individualization of care.
One of the actions mapped only to the title and definition of the NIC intervention “Skin Surveillance” (3590) was the recommendation to carefully assess the skin of black individuals concerning integrity, sensation, temperature, and consistency. The specificity of this action in the ministerial documents is noteworthy, particularly concerning the distinct approach to assessing the skin of black individuals, especially for identifying areas of erythema and redness, characteristics of Stage I PU that are more difficult to detect in these patients. It is important to note that the standardized NIC language does not address distinctions based on race, color, or ethnicity; however, it does include the need to inspect the skin by considering other indicators, such as warmth, edema, pulses, texture, and moisture11.
Another important finding was that none of the actions extracted from the ministerial documents was classified as identical to a NIC intervention/activity. This finding highlights the importance of standardized language, as well as the potential of Nursing taxonomies to support the standardization and greater consistency of the MH manuals.
Regarding the limitations, it is possible that some actions described in the Protocol and the Technical Notes were not extracted. However, the researchers ensured a thorough review of the documents, taking into account their narrative structure and multidisciplinary content. The established methodology, based on repeated readings, together with the expert review of the cross-mapping, facilitated the careful identification of actions and enhanced the reliability of the findings.
Another limitation concerns the sample, which consisted of only five experts and may limit the generalizability of the findings. Nevertheless, the selection of experts was based on specific criteria related to professional experience in the subject area, scientific output, and professional practice. Therefore, further studies involving a larger number of experts are recommended.
The cross-mapping highlighted the importance of standardizing Nursing documentation, which is essential for data interoperability and the efficient exchange of information across health information systems. This standardization promotes continuity of care and improves the quality of healthcare services13. The interventions identified for PU prevention demonstrated potential applicability across different healthcare institutions and Nursing specialties.
CONCLUSION
Of the 44 actions identified, 24 were mapped to NIC interventions, while 35 interventions showed no correspondence. Many actions were found to correspond only to the intervention title and definition, indicating their potential inclusion in the NIC activity lists. The lack of correspondence for a substantial number of interventions highlighted the need to incorporate these interventions into the ministerial documents, thereby strengthening PU prevention strategies and underscoring the contribution of standardized terminologies to healthcare practice. This would help reduce discrepancies between Nursing taxonomies and the official documents used in clinical practice.
The findings highlighted the importance of the Nursing team’s role in PU prevention through the wide range of actions these professionals can perform. They also underscored the imperative for nurses to recognize their role as care managers within the multidisciplinary team. The findings contributed to the development of care protocols and promoted the methodological reproducibility of cross-mapping and the use of the NIC, with potential applicability to other clinical protocols.
In conclusion, this study supported discussions on PU prevention and the use of standardized language in nursing education and professional practice. Future studies are needed to compare the mapping findings with nurses’ clinical practice, considering the global increase in PU cases and the potential challenges related to adherence to care protocols and NIC interventions.
HOW TO REFERENCE THIS ARTICLE:
Data availability:
The authors declare that the data are available in an online repository: https://zenodo.org/records/20190362
References
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1 Kottner J, Cuddigan J, Carville K, Balzer K, Berlowitz D, Law S, et al. Prevention and treatment of pressure ulcers/injuries: the protocol for the second update of the international Clinical Practice Guideline 2019. J Tissue Viability [Internet]. 2019 May [cited 2025 Dec 1];28(2):51-8. Available from: https://doi.org/10.1016/j.jtv.2019.01.001
» https://doi.org/10.1016/j.jtv.2019.01.001 -
2 Kottner J, Cuddigan J, Carville K, Balzer K, Berlowitz D, Law S, et al. Pressure ulcer/injury classification today: An international perspective. J Tissue Viability [Internet]. 2020 Aug [cited 2025 Dec 1];29(3):197-203. Available from: https://doi.org/10.1016/j.jtv.2020.04.003
» https://doi.org/10.1016/j.jtv.2020.04.003 -
3 Zhang S, Wei G, Han L, Zhong W, Lu Z, Niu Z. Global, regional and national burden of decubitus ulcers in 204 countries and territories from 1990 to 2021: a systematic analysis based on the global burden of disease study 2021. Front Public Health [Internet]. 2025 Feb 26 [cited 2026 May 17];13:1494229. Available from: https://doi.org/10.3389/fpubh.2025.1494229
» https://doi.org/10.3389/fpubh.2025.1494229 -
4 Alshahrani B, Middleton R, Rolls K, Sim J. Pressure injury prevalence in critical care settings: an observational pre-post intervention study. Nurs Open [Internet]. 2024 [cited 2026 May 17];11(2):e2110. Available from: https://doi.org/10.1002/nop2.2110
» https://doi.org/10.1002/nop2.2110 -
5 Wu J, Wang B, Zhu L, Jia X. Nurses’ knowledge on pressure ulcer prevention: an updated systematic review and meta-analysis based on the Pressure Ulcer Knowledge Assessment Tool. Front Public Health [Internet]. 2022 [cited 2025 Dec 1];10:964680. Available from: https://doi.org/10.3389/fpubh.2022.964680
» https://doi.org/10.3389/fpubh.2022.964680 -
6 Agência Nacional de Vigilância Sanitária. Boletim Segurança do Paciente e Qualidade em Serviços de Saúde n° 29: Incidentes Relacionados à Assistência à Saúde - 2014 a 2022. Anvisa [Internet]. Brasília (DF): 2022 [cited 2025 Dec 1]. 10 p. Available from: https://www.gov.br/anvisa/pt-br/centraisdeconteudo/publicacoes/servicosdesaude/boletins-e-relatorios-das-notificacoes-de-iras-e-outros-eventos-adversos-1/BR 2014 2022.pdf
» https://www.gov.br/anvisa/pt-br/centraisdeconteudo/publicacoes/servicosdesaude/boletins-e-relatorios-das-notificacoes-de-iras-e-outros-eventos-adversos-1/BR2014 2022.pdf -
7 Brasil. Ministério da Saúde; Agência Nacional de Vigilância Sanitária; Fundação Oswaldo Cruz. Protocolo para prevenção de úlcera por pressão. [Internet]; Brasília (DF): Ministério da Saúde 2013 [cited 2025 Dec 1]. 21 p. Available from: https://proqualis.fiocruz.br/sites/proqualis.fiocruz.br/files/000002429jFPtGg.pdf
» https://proqualis.fiocruz.br/sites/proqualis.fiocruz.br/files/000002429jFPtGg.pdf -
8 Agência Nacional de Vigilância Sanitária (Anvisa). Práticas seguras para prevenção de Lesão por Pressão em serviços de saúde. Nota técnica GVIMS/GGTES/Anvisa no 03/2017 [Internet]. 2017 [cited 2025 Dec 1]. 24 p. Available from: https://www.gov.br/anvisa/pt-br/centraisdeconteudo/publicacoes/servicosdesaude/notas-tecnicas/notas-tecnicas-vigentes/nota-tecnica-gvims-ggtes-no-03-2017.pdf
» https://www.gov.br/anvisa/pt-br/centraisdeconteudo/publicacoes/servicosdesaude/notas-tecnicas/notas-tecnicas-vigentes/nota-tecnica-gvims-ggtes-no-03-2017.pdf -
9 Agência Nacional de Vigilância Sanitária (Anvisa). Práticas de segurança do paciente em serviços de saúde: prevenção de lesão por pressão. Anvisa [Internet]. Brasília (DF): Ministério da Saúde; 2023 [cited 2025 Dec 1]. 31 p. Available from: https://www.gov.br/anvisa/pt-br/centraisdeconteudo/publicacoes/servicosdesaude/notas-tecnicas/notas-tecnicas-vigentes/nota-tecnica-gvims-ggtes-anvisa-no-05-2023-praticas-de-seguranca-do-paciente-em-servicos-de-saude-prevencao-de-lesao-por-pressao
» https://www.gov.br/anvisa/pt-br/centraisdeconteudo/publicacoes/servicosdesaude/notas-tecnicas/notas-tecnicas-vigentes/nota-tecnica-gvims-ggtes-anvisa-no-05-2023-praticas-de-seguranca-do-paciente-em-servicos-de-saude-prevencao-de-lesao-por-pressao -
10 Zhang T, Wu X, Peng G, Zhang Q, Chen L, Cai Z, et al. Effectiveness of standardized nursing terminologies for nursing practice and healthcare outcomes: a systematic review. Int J Nurs Knowl [Internet]. 2021 Oct [cited 2025 Dec 1];32(4):220-28. Available from: https://doi.org/10.1111/2047-3095.12315
» https://doi.org/10.1111/2047-3095.12315 - 11 Butcher HK, Dochterman JM, Bulecheck GM, Wagner CM. Nursing Intervention Classification. 7 th ed. Rio de Janeiro: Guanabara Koogan; 2020. 512 p.
-
12 Cubas MR, Lopes CT. O futuro das terminologias para o registro do Processo de Enfermagem. In: Adamy EK, Cubas MR, editors. Os sentidos da inovação tecnológica no ensino e na prática do cuidado em enfermagem: reflexões do 18° SENADEN e 15° SINADEN. Brasília, DF: Editora ABen; 2023 [cited 2026 Jan 3]. p. 69. Available from: https://publicacoes.abennacional.org.br/wp-content/uploads/2023/05/e20-sinaden-senaden-cap9.pdf
» https://publicacoes.abennacional.org.br/wp-content/uploads/2023/05/e20-sinaden-senaden-cap9.pdf -
13 Macieira TGR, Yao Y, Marcelle C, Mena N, Mino MM, Huynh TML, et al. Standardizing nursing data extracted from electronic health records for integration into a statewide clinical data research network. Int J Med Inform [Internet]. 2024 [cited 2026 Jan 3];183:105325. Available from: https://doi.org/10.1016/j.ijmedinf.2023.105325
» https://doi.org/10.1016/j.ijmedinf.2023.105325 -
14 Goossen W. Cross-mapping between three terminologies with the international standard nursing reference terminology model. Int J Nurs Terminol Classif [Internet]. 2006 [cited 2026 Jan 3];17(4):153-64. Available from: https://www.researchgate.net/publication/6679958 Cross-Mapping Between ThreeTerminologies_With_the_International_Standard_Nursing_Reference_Terminology_Model
» https://www.researchgate.net/publication/6679958Cross-Mapping Between ThreeTerminologies_With_the_International_Standard_Nursing_Reference_Terminology_Model -
15 D’Agostino F, Zeffiro V, Vellone E, Ausili D, Belsito R, Leto A, et al. Cross-mapping of nursing care terms recorded in italian hospitals into the standardized nnn terminology. Int J Nurs Knowl [Internet]. 2020 [cited 2026 Jan 3];31(1):4-13. Available from: https://doi.org/10.1111/2047-3095.12200
» https://doi.org/10.1111/2047-3095.12200 - 16 Bulechek GM, Butcher HK, Dochterman JM, Wagner C. Nursing interventions classification (NIC). 6th ed. Oxford: Elsevier Health Sciences; 2016. 554 p.
- 17 Herdman TH, Kamitsuru S, Lopes CT. NANDA International Nursing Diagnoses: Definitions & Classification, 2024-2026. 13 th ed. Porto Alegre: Artmed, 2024. 648 p.
-
18 Camargos RGF, Azevedo C, Moura CC, Manzo BF, Salgado PO, da Mata LRF. Safety protocol on medication prescription, use and administration: mapping of nursing interventions. Texto Contexto Enferm [Internet]. 2021 [cited 2026 Jan 3];30:e20200511. Available from: https://doi.org/10.1590/1980-265X-TCE-2020-0511
» https://doi.org/10.1590/1980-265X-TCE-2020-0511 -
19 Spranger J, Homberg A, Sonnberger M, Niederberger M. Reporting guidelines for Delphi techniques in health sciences: A methodological review. Z Evid Fortbild Qual Gesundhwes [Internet]. 2022 Aug [cited 2026 Jan 3];172:1-11. Available from: https://doi.org/10.1016/j.zefq.2022.04.025
» https://doi.org/10.1016/j.zefq.2022.04.025 -
20 Fehring RJ. Methods to validate nursing diagnoses. Heart Lung [Internet]. 1987 Nov [cited 2026 May 17];16(6):625-9. Available from: https://www.researchgate.net/publication/40505773_Methods_to_Validate_Nursing_Diagnoses
» https://www.researchgate.net/publication/40505773_Methods_to_Validate_Nursing_Diagnoses -
21 Zielstorff RD, Tronni C, Basque J, Griffin LR, Welebob EM. Mapping nursing diagnosis nomenclatures for coordinated care. Image J Nurs Sch [Internet]. 1998 [cited 2026 Jan 3];30(4):369-73. Available from: https://doi.org/10.1111/j.1547-5069.1998.tb01335.x
» https://doi.org/10.1111/j.1547-5069.1998.tb01335.x -
22 de Souza AC, Alexandre NMC, Guirardello EB. Psychometric properties in instruments evaluation of reliability and validity. Epidemiol Serv Saude [Internet]. 2017 [cited 2026 Jan 3];26(3):649-59. Available from: https://www.scielo.br/j/ress/a/v5hs6c54VrhmjvN7yGcYb7b/?lang=en
» https://www.scielo.br/j/ress/a/v5hs6c54VrhmjvN7yGcYb7b/?lang=en -
23 da Silva TF, Tristão FSA, Echevarria-Guanilo ME, Zillmer JGV, de Oliveira CM, Blair IJQ. Cuidados para prevenção de lesão por pressão realizada por enfermeiros em um hospital de ensino. Revista Urug Enferm [Internet]. 2023 [cited 2026 Jan 3];18(2):e205. Available from: https://doi.org/10.33517/rue2023v18n2a8
» https://doi.org/10.33517/rue2023v18n2a8 -
24 Tervo-Heikkinen T, Heikkilä A, Koivunen M, Kortteisto T, Peltokoski J, Salmela S, et al. Nursing interventions in preventing pressure injuries in acute inpatient care: a cross-sectional national study. BMC Nurs [Internet]. 2023 [cited 2026 Jan 3];22:198. Available from: https://doi.org/10.1186/s12912-023-01369-8
» https://doi.org/10.1186/s12912-023-01369-8 -
25 Li Z, Marshall AP, Lin F, Ding Y, Chaboyer W. Registered nurses’ approach to pressure injury prevention: a descriptive qualitative study. J Adv Nurs [Internet]. 2022 [cited 2026 Jan 3];78(8):2575-85. Available from: https://doi.org/10.1111/jan.15218
» https://doi.org/10.1111/jan.15218 -
26 Villar VCFL, Martins M, Rabello ET. Qualidade do cuidado e segurança do paciente: o papel dos pacientes e familiares. Saúde Debate [Internet]. 2022 [cited 2026 Jan 3]; 46(135):1174-86. Available from: https://doi.org/10.1590/0103-1104202213516
» https://doi.org/10.1590/0103-1104202213516 -
27 Konya I, Iwata H, Hayashi M, Akita T, Homma Y, Yoshida H, et al. Effectiveness of weak wiping pressure during bed baths in hospitalized older adults: a single-blind randomized crossover trial. Geriatr Nurs [Internet]. 2021 [cited 2026 Jan 3];42(6):1379-87. Available from: https://doi.org/10.1016/j.gerinurse.2021.09.008
» https://doi.org/10.1016/j.gerinurse.2021.09.008 -
28 Sheth H, Rao S, Karthik V. Clinical and health economic evaluation of a novel device for fecal management in bedridden patients. Indian J Crit Care Med [Internet]. 2023 [cited 2026 Jan 3];27(10):759-65. Available from: https://pmc.ncbi.nlm.nih.gov/articles/PMC10613872/
» https://pmc.ncbi.nlm.nih.gov/articles/PMC10613872/ -
29 Edsberg LE, Cox J, Koloms K, VanGilder-Freese CA. Implementation of pressure injury prevention strategies in acute care: results from the 2018-2019 international pressure injury prevalence survey. J Wound Ostomy Continence Nurs [Internet]. 2022 [cited 2026 Jan 3];49(3):211-19. Available from: https://doi.org/10.1097/WON.0000000000000878
» https://doi.org/10.1097/WON.0000000000000878
