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A -EXPLANATORY Analysis of the organizational context to identify the central problem related to the implementation of the NP, as well as the selection and prioritization of problems associated with the hospital context. |
A1- Problem tree constructed in the organizational context (actors, techniques, and instruments). |
Was the need for implementing the NP discussed as the central problem identified in the organizational context? Who formulated it, and which actors were involved? What methodologies and instruments were used in this formulation? |
It is important to identify the central problem from the perspective of the multiple actors existing in the situational scenario (managers, nurses, technicians and nursing assistants, among others). Furthermore, it is relevant to adopt participatory methodologies (workshops, guided debates, conversation circles, among others) and instruments (flowcharts, situational maps, legislation, among others). |
(3) Fully performed (2) Partially performed (1) Not performed in the service |
Interview Institutional Documents (meeting records, communications, notices, reports, protocols, among others). |
| Was a problem tree constructed regarding the current situation with its causes, consequences and priority problems associated with the implementation of the NP in the unit? Which actors, methodologies and instruments were involved in this construction? |
The problem tree should be constructed based on the central problem with details of its causes/critical nodes and consequences. It should involve the study of the current situation through the identification, survey and analysis of priority problems related to the implementation of the NP. It is also necessary to identify the involvement of actors in the thematic scope, as well as the adoption of participatory methodologies (workshops, guided debates, conversation circles, among others) and instruments (flowcharts, situational maps, legislation, among others) |
(3) Fully performed (2) Partially performed (1) Not performed in the service |
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B-NORMATIVE Construction of the situation-objective for implementing the NP, as well as the actions necessary for its implementation. |
B1-Situation-objective of the NP constructed from the mission, vision and values of the institution and the nursing service, as well as the actors, techniques and instruments involved. |
How was the situation-objective of the NP constructed in the unit? Did this construction consider the mission, vision and values of the institution and the Nursing service? Which actors, methodologies and instruments were used? |
The situation-objective consists of structuring the new situation to be achieved through an intervention plan on the problems described, based on the local reality. The implementation of the NP must consider the mission, vision and values of the institution and the nursing service, in line with the recommendations of the Nursing Councils. It is necessary to involve all nursing professionals in this construction through participatory methodologies (workshops, guided debates, conversation circles, among others) and instruments (flowcharts, situational maps, legislation, among others). |
(3) Fully performed (2) Partially performed (1) Not performed in the service |
Interview Institutional documents (medical records, systems, meeting records, reports, routines, protocols, regulations, among others). |
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B2 - Existence of at least one adopted nursing theory. |
Was it discussed and defined which nursing theory to adopt as theoretical support for the stages of the NP? Who discussed it and what elements were considered for the definition of the theory? |
The NP must be based on theoretical support that guides it at all stages. Furthermore, the definition of the theory to be adopted must consider the participation of existing actors in the organizational context, as well as the care purposes and the specificities of the service. |
(3) Fully performed (2) Partially performed (1) Not performed in the service |
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B3 - Existence of operational support systems for the implementation and operationalization of the NP. |
Are there operational support systems for the implementation and operationalization of the NP? |
Accessible and easy-to-use operational support systems must be adopted for the implementation and operationalization of the NP (software, instruments, forms, among others) that address the stages of the NP, in a clear, objective manner, compatible with the organizational context and that encourage the critical-reflective thinking. |
(3) Fully performed (2) Partially performed (1) Not performed in the service |
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C-STRATEGIC Analysis of limiting and facilitating factors for implementation and execution of the NP, as well as verification of feasibility. |
C1-Carrying out a strategic assessment with the analysis of limiting and facilitating factors for the implementation and execution of the NP. |
Have the strengths, weaknesses, opportunities and threats that facilitate or limit the implementation and execution of the NP in the unit been identified? |
It is important to identify the strengths and weaknesses (advantages and disadvantages of the internal context of the analyzed services, respectively) and opportunities and threats (favorable and unfavorable aspects of the external context in which the analyzed unit is inserted, respectively) regarding the implementation of the NP, based on the specificities of the existing sectors in the hospital service (wards, intensive care services, surgical center, among others). From this, if necessary, a sector of the unit can be chosen for a pilot project to implement the NP. |
(3) Fully performed (2) Partially performed (1) Not performed in the service |
Interview Institutional documents (meeting records, reports, communications, routines, protocols, regulations, among others). |
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C2-Carrying out feasibility analysis (political, economic and institutional-organizational). |
Were the political, economic and institutional-organizational feasibility for implementing the NP analyzed? |
Feasibility analysis can be performed at three levels: political feasibility (institutional negotiations to agree on common paths of action); economic feasibility (which must respond to what is economically viable, such as acquisition of systems, implementation of programs, among others); and institutional-organizational feasibility (institutional and logistical support for the implementation and execution of the NP). |
(3) Fully performed (2) Partially performed (1) Not performed in the service |
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C3- Existence of a Permanent Education strategy for the team. |
Is there a permanent education strategy about the NP? If yes, who is it directed to? |
Permanent education is a necessary strategy for the effective implementation of NP and must involve practical training with all members of the nursing team. It should focus on problematizing everyday processes present in the work context, such as specific stages of the NP that present more obstacles to execution. |
(3) Fully performed (2) Partially performed (1) Not performed in the service |
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D-TACTICAL-OPERATIONAL Concrete action to implement the NP stages in the hospital context, as well as monitoring and evaluating the execution. |
D1 - Carrying out the nursing assessment. |
Is there data collection to obtain information about nursing care needs? Who carries it out, how and what tools are used? |
Initial and continuous subjective (interview) and objective (physical examination) data collection must be performed, using techniques (laboratory and imaging, clinical tests, validated assessment scales, institutional protocols and others) to obtain information about the nursing and health care needs relevant to practice; |
(3) Fully performed (2) Partially performed (1) Not performed in the service |
Interview Institutional documents (medical records, meeting records, reports, routines, protocols, among others). Direct observation |
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D2 - Carrying out Nursing Diagnosis Construction Practice. |
Is there practice in constructing nursing diagnoses? Who performs it, how and what tools are used? |
Nursing diagnoses must be constructed based on existing problems, conditions of vulnerability or dispositions to improve health behaviors. They must be grounded on nursing theories and compatible with the information collected by the nursing assessment. This should be an activity exclusive to nurses. |
(3) Fully performed (2) Partially performed (1) Not performed in the service |
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D3 - Carrying out nursing planning practice |
Is the nursing planning carried out? Who performs it, how and what tools are used? |
Planning must be carried out through a targeted care plan shared with the subjects of care and the Nursing and healthcare team. It must involve: Prioritization of Nursing Diagnoses; Determination of expected and achievable nursing and health results (quantitative and/or qualitative); Therapeutic decision-making, declared by the nursing prescription of interventions, actions/activities and care protocols. Prescribing nursing actions and interventions is a nurse's exclusive activity. It must contain the complete identification of the user and be in line with the materials and technological resources available in the unit, have clear and objective language, as well as adequate scheduling and checking in a safe and consistent way with the actions performed, in addition to spaces for individualized detailing of actions and materials to be used, if necessary. |
(3) Fully performed (2) Partially performed (1) Not performed in the service |
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D4-Carrying out nursing actions and interventions implementation practice. |
Is there practice of implementing nursing actions and interventions through nursing prescriptions? Who performs it, how and what tools are used? |
The planned interventions, actions and activities must be carried out by the nursing team, based on the planning, based on nursing prescriptions updated daily and whenever necessary, in an individualized manner and with an appropriate checking system, respecting the appropriate technical skills. Implementation must be supported by Nursing, Interprofessional or Health Program standards of care. |
(3) Fully performed (2) Partially performed (1) Not performed in the service |
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D5 - Carrying out Nursing evolution. |
Is there a nursing evolution practice? Who performs it, how and what tools are used? |
The evaluation must be carried out by the nursing team, daily and whenever necessary, based on the results achieved, according to recommended nursing theory, compatible with the other stages of the Nursing Process. The evaluation must also include analysis and review of the entire Nursing Process. |
(3) Fully performed (2) Partially performed (1) Not performed in the service |
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D6 - Carrying out nursing records practice. |
Is there a practice of nursing records? Who performs it, how and what tools are used? |
Records must be made by the nursing team daily and whenever necessary, in a specific operational system, with relevant data from the NP stages, in a clear and objective manner, in compliance with current resolutions of the Nursing Councils. The nurse is responsible for recording all the steps. |
(3) Fully performed (2) Partially performed (1) Not performed in the service |
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D7 - Existence of monitoring and evaluation of the NP. |
Are there continuous monitoring and evaluation strategies for the execution of the NP in the unit? Who performs it, how and what tools are used? |
It is necessary to adopt continuous monitoring and evaluation strategies for the execution of the NP, at all stages, along with members of the nursing team, based on the analysis of the implementation of actions and nursing records, verification of the degree of satisfaction of the team and users, analysis of the impact of the NP on institutional goals and updating of goals and deadlines compatible with local realities. |
(3) Fully performed (2) Partially performed (1) Not performed in the service |
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DESCRIPTION OF THE RESPONSE SCALE*: (3) Fully performed: actions are carried out fully in accordance with the parameter indicated in the matrix.(2) Partially performed: actions are carried out partially in accordance with the parameter indicated in the matrix. (1) Not performed in the service: actions are not carried out in accordance with the parameter indicated in the matrix. The total points on the response scale range from 15 (lowest value) to 45 (highest value). The higher the value, the better the service was evaluated regarding the Nursing Process. |
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Source: Research data, 2022.