The advancement of knowledge and the new Cofen resolution on the Nursing Process

The Nursing Process (NP) concept has been known worldwide since the 1950s as a standard that provides scientificity to the clinical practice of Nursing care. This concept was used and recognized in Brazil from the 1970s onwards with the model proposed by Horta. Later, the concept of Systematization of Nursing Care (SNC) emerged in Brazil, with the premise that it would be the context in which the operationalization of the NP would take place. In their historical evolution, the concepts of SNC and NP were predominantly described as synonyms, making it difficult to understand1 and, therefore, the advancement of disciplinary knowledge, in addition to limiting compliance with the resolutions issued by the Federal Nursing Council (Conselho Federal de Enfermagem - Cofen) about the subject.

The conceptual overlaps motivated the development of studies to elucidate the origin, conditions, and repercussions of both concepts. Following this movement, Cofen, through Resolution No. 358/20092, differentiated the terms PE and SNC, which was seen as a milestone for the need to mature SNC as a concept related to organizational aspects necessary to care practice. More recently, the Brazilian Nursing Association (Associação Brasileira de Enfermagem - ABEn) promoted an event that led to discussions about the importance and differences between the SNC and NP concepts3.

A recent study found that, even today, SNC remains a not very mature concept, particularly due to the fragile consensus on its structural elements and definitions4. Nevertheless, EP is a mature concept, having well-defined operational and structural elements that can be verified through quantitative and qualitative evidence.

To advance the conceptual and terminological distinction between NP and SNC, scholars on the subject from different regions of Brazil continue to publish research findings and reflection articles dealing with the distinctive characteristics of NP. In this sense, an article published by researchers from the Nursing Process Research Network (Rede de Pesquisa em Processo de Enfermagem - RePPE) reflected on the national and global understanding of the NP concept, as well as its alignment with Brazilian legislation and current care, teaching, and research practices. In the manuscript, the authors highlighted that the creation and expansion of postgraduate programs in Nursing have boosted teaching and research on NP and have promoted nurses' awareness on the importance of using the theoretical-methodological framework of NP, associated to Standardized Language Systems (Sistemas de Linguagens Padronizadas - SLP)5.

In another article, researchers from RePPE and other collaborators brought to light the results of the discussion that took place at the 18th SENADEn and the 15th SINADEn. The text pertinently supported the need for Cofen to review Resolution No. 358/2009 in order to translate what in fact refers to the operationalization of concepts specific to Nursing6, since this regulation did not consider the conceptual and interpretative developments of the professionals involved in the current debate,.

The reflections so far presented and mediated in the different areas of entities activitysuch as RePPE; ABEn, through the Commission for Systematization for Nursing Practice (COMSISTE); and Cofen, contributed to the movement that culminated in the review of Resolution No. 358/2009. Thus, Cofen was asked by counselors from Rio de Janeiro and Brasília to create a working group (WG) to review this Resolution.

In October 2021, through Ordinance No. 12267, the WG was established in Brazil, with Alba Lucia Bottura Leite de Barros, Edeilde Machado Leal, Polyanne Aparecida Alves Moita Vieira, Rinaldo de Souza Neves, and Rosimere Ferreira Santana as members and Isabel Cristina Kowal Olm Cunha as coordinator, representing the various regions and institutions of the country. Remote meetings were held, seeking to include different actors at different stages of the review process, as to capture different opinions and knowledge. Thus, the proposal for the first draft of the Resolution, prepared in April 2022, was shared, and discussed in a remote meeting with coordinators of the technical and inspection councils of Cofen, ABEn/COMSISTE, RePPE, and other researchers from different scenarios. The draft was then reviewed by the WG based on suggestions from all over Brazil and presented July 2022 by Dr Isabel Cunha at the 15^th SINADEn in São Luís, Maranhão. Subsequently, a preliminary proposal for the Resolution was submitted to public consultation from January to March 2023. Its result was highly productive, with the participation of 134 nurses from different Brazilian states and a total of 1,352 suggestions. The final proposal was forwarded to the Cofen Plenary, being analyzed by the Technical Chamber of Legislation and Standards and the Legal Advisory, in addition to being presented by a Federal Counselor designated as rapporteur.

Therefore, the final version was approved and published as Cofen Resolution No. 736 of January 17, 2024, which “Provides for the implementation of the Nursing Process in the entire socio-environmental context where Nursing care occurs.” As main changes, it is noteworthy that the new Resolution deals exclusively with the Nursing Process; standardizes, as an object of work, Nursing care; changes the previous name of the first stage - History and data collection - to Nursing Assessment, giving dynamism to the need for the nurse's initial and ongoing assessment; clarifies the third stage with steps to carry out the care plan; revises the title of the last stage, which is now called Nursing Evolution; and above all, it demarcates the role of the Nursing technician and the Nurse, and their collaboration in Nursing care, materialized in the act of documenting the NP in Evolution (private to the nurse), in checking the prescription (technician) and in the Nursing notes (technician and nurse, in the intercurrences)8.

Thus, the recently approved Cofen Resolution No. 736/2024 clarifies the concept of Nursing Process, describing it as a work method used by the Nursing team. This Resolution states in a simple way the definition of NP, each of its stages and the legal support to the Nursing team in its execution. Furthermore, it reinforces its use in teaching and assistance provided in any environment where nursing care is offered. In this way, it also favors research and the construction of knowledge in this thematic area.

We believe that Cofen Resolution No. 736/2024 will facilitate the use of NP, allowing Nursing services to add quality and safety in the provision of care, as well as favoring society's recognition of the real value of Nursing in Brazil. We also believe that the new Resolution can give greater visibility to the identity of the Nursing profession, which has as its central core the care of the needs of people, families, and communities.

It is of the most importance to disseminate the Cofen Resolution No. 736/2024, as well as the need to train professionals across the country to implement it properly. To this end, initiatives aimed at updating Nursing professionals on the new Resolution are already being planned and/or carried out, such as: the use of the CofenPlay Platform by Cofen as a training tool; the planning of spaces for reflection on the challenges and alternatives for the NP teaching-learning process in the 16th SINADEn and the 19th SENADEn by ABEn; and the development by RePPE of guidelines aligned with the new Resolution that guide the permanent and continuous training of education processes for the implementation of NP and the development of clinical reasoning.

Finally, Brazilian Nursing is experiencing an important milestone in the history of its knowledge by assuming the existing distinction between the concepts of SNC and NP from a theoretical-conceptual and operational point of view, materialized in the review of Brazilian Nursing regulations in line with the current global understanding of the EP5. It is worth to reeinforce that the implementation of Cofen Resolution No. 736/2024 in practice will depend on the collective effort of the Nursing community in an expanded way.

REFERÊNCIAS

• 1. Fuly PSC, Leite JL, Lima SBS. Correntes de pensamento nacionais sobre sistematização da assistência de Enfermagem. Rev Bras Enferm. 2008;61(6):883-7. doi: https://doi.org/10.1590/S0034-71672008000600015
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• 2. Conselho Federal de Enfermagem (BR). Resolução Cofen nº 358 de 15 de outubro de 2009. Dispõe sobre a Sistematização da Assistência de Enfermagem e a implementação do Processo de Enfermagem em ambientes, públicos ou privados, em que ocorre o cuidado profissional de Enfermagem, e dá outras providências. Diário Oficial União. 2009 out 23 [citado 2022 set 10];146(203 Seção 1):179. Disponível em: https://pesquisa.in.gov.br/imprensa/jsp/visualiza/index.jsp?data=23/10/2009&jornal=1&pagina=179&totalArquivos=184
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• 3. Carta de São Luís para a Enfermagem Brasileira. In: 18º Seminário Nacional de Diretrizes para a Educação em Enfermagem - SENADEn e 15º Simpósio Nacional de Diagnósticos de Enfermagem - SINADEn. 2022 jul 29 [citado 2022 set 10]. São Luís: Editora ABEN. Disponível em: https://abenmg.com.br/wp-content/uploads/2022/08/CARTA-DE-SAO-LUIS-PARA-A-ENFERMAGEM-BRASILEIRA-28072022.revisada-por-sonia.-docx-1_compressed-1.pdf
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• 4. Souza JF, Zaccaro KRL, Brandão APCL, Primo CC, Santana RF, Brandão MAG. Systematization of nursing care: how did the concept mature?. Rev Bras Enferm . 2023;76(3):e20220464. doi: https://doi.org/10.1590/0034-7167-2022-0464
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• 5. Barros ALBL, Lucena AF, Morais SCRV, Brandão MAG, Almeida MA, Cubas MR, et al. Nursing process in the Brazilian context: reflection on its concept and legislation. Rev Bras Enferm . 2022;75(6):e20210898. doi: https://doi.org/10.1590/0034-7167-2021-0898
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• 6. Barros ALBL, Souza JF, Brandão MAG, Lucena AF, Silva VM, Morais SCRV, et al. Análise conceitual e operacional dos termos Sistematização da Assistência de Enfermagem e Processo de Enfermagem. In: Adamy EK, Cubas MR, organizadores. Os sentidos da inovação tecnológica no ensino e na prática do cuidado em enfermagem: reflexões do 18º SENADEN e 15º SINADEN. Brasília, DF: ABEN; 2023. p. 62-8. doi: https://doi.org/10.51234/aben.23.e20
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• 7. Conselho Federal de Enfermagem (BR). Portaria Cofen n° 1226 de 8 de outubro de 2021. Institui o Grupo de Trabalho para realizar discussões que possam contribuir para as devidas atualizações da Resolução Cofen nº 358/2009. Brasília, DF; 2021.
• 8. Conselho Federal de Enfermagem (Cofen). Resolução nº 736, de 17 de janeiro de 2024. Dispõe sobre a implementação do Processo de Enfermagem em todo contexto socioambiental onde ocorre o cuidado de Enfermagem. Brasília (DF); 2024. Disponível em: https://www.cofen.gov.br/wp-content/uploads/2024/01/Resolucao-Cofen-no-736-2024-Dispoe-sobre-a-implementacao-do-Processo-de-Enfermagem-em-todo-contexto-socioambiental-onde-ocorre-o-cuidado-de-enfermagem.pdf
  » https://www.cofen.gov.br/wp-content/uploads/2024/01/Resolucao-Cofen-no-736-2024-Dispoe-sobre-a-implementacao-do-Processo-de-Enfermagem-em-todo-contexto-socioambiental-onde-ocorre-o-cuidado-de-enfermagem.pdf

Edited by

Editor-in-chef:

João Lucas Campos de Oliveira

Publication Dates

• Publication in this collection
  17 June 2024
• Date of issue
  2024