Contenuto dell'articolo principale
Abstract
INTRODUZIONE: Il Trapianto di Cellule Staminali Ematopoietiche (TCSE) è diventato lo standard di cura per molte malattie ematologiche che non rispondono ai trattamenti tradizionali; la terapia pre-trapianto causa ancora oggi una elevata mortalití e morbilití . Per l'elevato rischio, l'assistenza ai pazienti necessita di attenta valutazione e di interventi spesso complessi, intensivi e non privi di rischi; la classificazione NANDA-I fornisce un modo per classificare e standardizzare le aree di interesse infermieristico. Nel 2011 Speksnijder, con tecnica Delphi, ha identificato 68 diagnosi rilevanti nell'identificare i problemi di salute in ambito onco-ematologico.
OBIETTIVO: Partendo dal contributo di Speksnijder, lo studio ha cercato di identificare quali di queste diagnosi fossero rilevanti nell'identificare i problemi di salute nei pazienti sottoposti a TCSE.
METODO: E' stato condotto uno studio quantitativo-descrittivo; per la costruzione del consenso è stato utilizzato un questionario strutturato su scala Likert a 4 punti coinvolgendo 57 infermieri esperti arruolati nei Centri GITMO italiani.
RISULTATI: Delle 68 diagnosi NANDA-I definite rilevanti da Speksnijder in ambito onco-ematologico, il presente studio ne ha identificate 37 rilevanti nell'individuare i problemi di salute nei pazienti sottoposti a TCSE (34 nel 1° round, 3 nel 2° Round); inoltre ha definito importanti 12 diagnosi avendo ottenuto un consenso assoluto.
DISCUSSIONE: Utilizzare le diagnosi NANDA-I per conoscere, da un panel di esperti, i problemi di salute più importanti e rilevanti associati alla tossicití del trattamento pre-TCSE, consente di concentrare l'attenzione sugli esiti attesi e noti, cosí¬ da poter intervenire con prestazioni finalizzate a ridurne i rischi e le complicanze specifiche.
PAROLE CHIAVE: Trapianto cellule emopoietiche, Tecnica Delphi, terminologie infermieristiche strandardizzate, diagnosi infermieristiche
Relevance of NANDA-I Diagnosis in Hematopoietic stem cell transplantation patients
INTRODUCTION: Haematopoietic stem cell transplantation (HSCT) has become the standard of care for many haematological diseases unresponsive to traditional treatments; pretransplant therapy still causes high mortality and morbidity today. Due to the high risk, patient care requires careful assessment and often complex, intensive and non-risk free interventions; the NANDA-I classification provides a way to classify and standardise areas of nursing interest. In 2011, Speksnijder, using the Delphi technique, identified 68 diagnoses relevant to identify health problems in the field of oncohaematology.
OBJECTIVE: Based on Speksnijder's contribution, the study tries to identify which of these diagnoses were relevant in identifying health problems in HSCT patients.
METHOD: A quantitative-descriptive study was carried out; a structured questionnaire on a 4-point Likert scale was used to build consensus, involving 57 expert nurses enrolled in the Italian GITMO Centres.
RESULTS: Of the 68 NANDA-I diagnoses defined as relevant by Speksnijder in the oncohaematological field, this study identified 37 as relevant in detecting health problems in patients undergoing HSCT (34 in Round 1, 3 in Round 2) and also defined 12 as important diagnoses having obtained an absolute consensus.
DISCUSSION: Using the NANDA-I diagnoses to identify, from a panel of experts, the most important and relevant health problems associated with the toxicity of pre-TCSE treatment, allows to focus attention on expected and known outcomes in order to be able to intervene with performances aimed at reducing specific risks and complications.
ParOLE CHIAVE: Hematopoietic Stem Cell Transplantation, Delphi Technique, Standardized Nursing Terminology, Nursing Diagnosis.
Dettagli dell'articolo
Riferimenti
- Alexander J. & Kroposki M. (1999) Outcomes for community health nursing practice. Journal of Nursing Administration 29, 49-56.
- Burns F.M. (1998) Essential components of schizophrenia care: a Delphi approach. Acta Psychiatry Scand, 98, 400-405.
- Chiorri, C. (2010) Fondamenti di psicometria. McGraw-Hill.
- Corradini, P. & Foí , R. (2014) Manuale di ematologia. Minerva Medica
- D'Addio, L. & Calamandrei, C. (1999) I Modelli Funzionali della Salute di Marjory Gordon: un'esperienza applicativa nella formazione infermieristica di base. Nursing Oggi, 4, 24-34.
- Fain, A.J. (2004) Principi di misurazione. In Fain, A.J. La ricerca infermieristica: leggerla, comprenderla e applicarla. (2 Ed.) (pp. 125) Milano: McGraw-Hill.
- Fain, A.J. (2004) Selezione del campione. In Fain, A.J. La ricerca infermieristica: leggerla, comprenderla e applicarla. (2 Ed.) (pp. 99-115) Milano: McGraw-Hill.
- Gordon, M. (2009) Diagnosi infermieristiche Processo e applicazioni. CEA Casa Editrice Ambrosiana Milano.
- Gratwohl, A., Sureda, A., Baldomeroa, H., Gratwohl, M., Dreger, P., Krí¶ger, N., Ljungman, P., McGrath, E., Mohty, M., Nagler, A., Rambaldi, A., Ruiz de Elvira, C., Snowdenk, J., Passweg, J,. Apperley, J. & Niederwieser, D. (2015) Economics and Outcome After Hematopoietic StemCell Transplantation: A Retrospective Cohort Study. EBioMedicine, 2, 2101–2109.
- Hasson, F., Keeney, S., & McKenna, H. (2000) Research guidelines for the Delphi survey technique. Journal of Advanced Nursing, 32, 1008–1015.
- Herdman, T.H., Kamitsuru, S. (2015) Nanda-International, Diagnosi Infermieristiche Definizioni e classificazione. CEA Casa Editrice Ambrosiana Milano.
- Hsu, C.C. & Sandford, B.A. (2007) Delphi Technique. Practical Assessment, Research & Evaluation, 12, 10.
- JACIE. (2017). Hematopoietic Cellular Therapy: Accreditation Manual. Sixth edition
- Jacobs J. M. (1966) Essential assessment criteria for physical education teacher education programs: A Delphi study. Unpublished doctoral dissertation, West Virginia University, Morgantown.
- Jaing, T.H. (2011) Complications of haematopoietic stem cell transplantation. ISBT Science Series, 6, 332–336.
- Keeney, S., Hasson, F., & McKenna, H. P. (2006) Consulting the oracle: Ten lessons from using the Delphi technique in nursing research. Journal of Advanced Practice, 53, 205–212.
- Locatelli, R. & Ossola, P. (2003) Aspetti metodologici e statistiche del Delphi. Working Paper, Universití dell'Insubria.
- Lowenberg, B. (2008) Handboek Hematologie. Tijdstroom: Utrecht.
- Mosesso, K. (2015) Adverse Late and Long- Term Treatment Effects in Adult Allogeneic Hematopoietic Stem Cell Transplant Survivors. AJN, 115, 22-34.
- Muller-Staub, M., Lavin, M.A., Needham, I. & Achterberg, T. van (2006) Nursing diagnoses, interventions and outcomes – application and impact on nursing practice: systematic review. Journal of Advanced Nursing, 56, 514-531.
- NANDA International (2008) Nursing Diagnoses: Definitions and Classification 2009-2011 edition. Wiley-Blackwell.
- NANDA International (2014) Nursing Diagnoses: Definitions and Classification 2015-2017 edition. Wiley-Blackwell.
- Pesut, D. J. & Herman, J. (1999) Clinical Reasoning: The Art & Science of Critical & Creative Thinking. Delmar: Albany.
- Speksnjjder, H.T., Mank, A.P., van Achterberg, T. (2011) Nursing diagnoses (NANDA-I) in hematology-oncology: a Delphi-study. International Journal of Nursing Terminologie and Classification, 22, 77-91.
Riferimenti
Alexander J. & Kroposki M. (1999) Outcomes for community health nursing practice. Journal of Nursing Administration 29, 49-56.
Burns F.M. (1998) Essential components of schizophrenia care: a Delphi approach. Acta Psychiatry Scand, 98, 400-405.
Chiorri, C. (2010) Fondamenti di psicometria. McGraw-Hill.
Corradini, P. & Foí , R. (2014) Manuale di ematologia. Minerva Medica
D'Addio, L. & Calamandrei, C. (1999) I Modelli Funzionali della Salute di Marjory Gordon: un'esperienza applicativa nella formazione infermieristica di base. Nursing Oggi, 4, 24-34.
Fain, A.J. (2004) Principi di misurazione. In Fain, A.J. La ricerca infermieristica: leggerla, comprenderla e applicarla. (2 Ed.) (pp. 125) Milano: McGraw-Hill.
Fain, A.J. (2004) Selezione del campione. In Fain, A.J. La ricerca infermieristica: leggerla, comprenderla e applicarla. (2 Ed.) (pp. 99-115) Milano: McGraw-Hill.
Gordon, M. (2009) Diagnosi infermieristiche Processo e applicazioni. CEA Casa Editrice Ambrosiana Milano.
Gratwohl, A., Sureda, A., Baldomeroa, H., Gratwohl, M., Dreger, P., Krí¶ger, N., Ljungman, P., McGrath, E., Mohty, M., Nagler, A., Rambaldi, A., Ruiz de Elvira, C., Snowdenk, J., Passweg, J,. Apperley, J. & Niederwieser, D. (2015) Economics and Outcome After Hematopoietic StemCell Transplantation: A Retrospective Cohort Study. EBioMedicine, 2, 2101–2109.
Hasson, F., Keeney, S., & McKenna, H. (2000) Research guidelines for the Delphi survey technique. Journal of Advanced Nursing, 32, 1008–1015.
Herdman, T.H., Kamitsuru, S. (2015) Nanda-International, Diagnosi Infermieristiche Definizioni e classificazione. CEA Casa Editrice Ambrosiana Milano.
Hsu, C.C. & Sandford, B.A. (2007) Delphi Technique. Practical Assessment, Research & Evaluation, 12, 10.
JACIE. (2017). Hematopoietic Cellular Therapy: Accreditation Manual. Sixth edition
Jacobs J. M. (1966) Essential assessment criteria for physical education teacher education programs: A Delphi study. Unpublished doctoral dissertation, West Virginia University, Morgantown.
Jaing, T.H. (2011) Complications of haematopoietic stem cell transplantation. ISBT Science Series, 6, 332–336.
Keeney, S., Hasson, F., & McKenna, H. P. (2006) Consulting the oracle: Ten lessons from using the Delphi technique in nursing research. Journal of Advanced Practice, 53, 205–212.
Locatelli, R. & Ossola, P. (2003) Aspetti metodologici e statistiche del Delphi. Working Paper, Universití dell'Insubria.
Lowenberg, B. (2008) Handboek Hematologie. Tijdstroom: Utrecht.
Mosesso, K. (2015) Adverse Late and Long- Term Treatment Effects in Adult Allogeneic Hematopoietic Stem Cell Transplant Survivors. AJN, 115, 22-34.
Muller-Staub, M., Lavin, M.A., Needham, I. & Achterberg, T. van (2006) Nursing diagnoses, interventions and outcomes – application and impact on nursing practice: systematic review. Journal of Advanced Nursing, 56, 514-531.
NANDA International (2008) Nursing Diagnoses: Definitions and Classification 2009-2011 edition. Wiley-Blackwell.
NANDA International (2014) Nursing Diagnoses: Definitions and Classification 2015-2017 edition. Wiley-Blackwell.
Pesut, D. J. & Herman, J. (1999) Clinical Reasoning: The Art & Science of Critical & Creative Thinking. Delmar: Albany.
Speksnjjder, H.T., Mank, A.P., van Achterberg, T. (2011) Nursing diagnoses (NANDA-I) in hematology-oncology: a Delphi-study. International Journal of Nursing Terminologie and Classification, 22, 77-91.