Explorando a Evolução do Diagnóstico de Enfermagem com a Dra. Agueda Cavalcante

Camila Takáo Lopes (: 00:01

Welcome to NandaCast. I am Dr. Camila Takao Lopes, Director of the Diagnostic of Nanda International and Professor of the Board of the São Paulo Thank you for your participation. Today I present to you Dr. Agda Cavalcanti, who a Master in Nursing at the University of Guaias.

and a in Sciences at the São Paulo She also PhD in College of Nursing at University of Iowa in States and post-doctoral degree also by the University of Unifesp. Currently, she is a joint at the University of Goiás.

She has been a member of the Nanda Diagnostic Committee for several years, a very active, collaborative and essential in our team. She is a founding of the Brazilian in process of disease, called HEPI. She has dedicated to knowledge of new teaching to improve clinical and cure the need for disease diagnosis.

Professor Agda, welcome to NandaCast. Thank you for accepting to talk to us today. Could you start by us a little bit about your professional How was your initial with the diagnosis of disease? How did you to research and teach the diagnosis of the disease?

Agueda Zimmer Cavalcante (: 01:39

Hello, Camila. Thank much for this invitation. Thank you, Professor Ana Maria Napoleão, for the invitation, along with Professor Doutora Redder. I feel very happy and honored to be on this podcast with you. Well, my trajectory is... I usually say that the disease ended up choosing me instead of opposite. I got into the disease a little without knowing what it would be. And to tell the truth, I...

I was a little frustrated at the beginning of I didn't very well the role of the nurse and maybe the the region where I was it, I couldn't identify the role of the nurse. So, throughout the course, I tried to discover the that it was the nurse and I found this professional speak, today.

I bring this concept much clearer when I had contact with the infirmary and particularly with the infirmary At that time, we didn't have direct with Nanda, but we had through Carpenito's

It an approximation, but not directly, with the classification. I understood very clearly, already at that time, that the diagnosis could make difference and that would be what made the difference for the nurse, even without seeing much use in practice, in the context where I was. But I realized that it was from what the nurse could...

bring his knowledge, show where he can act, make a from interventions, recognize himself as a professional who brings results to the patient. So, during this period, I started to understand a little, so I developed my TCC about this and I wanted to...

Agueda Zimmer Cavalcante (: 04:01

I was in scientific and soon after I wanted to a master's So I went to Federal of Goiás, so I went to the capital, always trying to process, to think about a study that brought closer to

of the of the disease because I believed that this would make a difference, make difference for the professional I my master's in this area simultaneously, as I was working, I was a nurse at University Hospital of Goiânia, the of clinics.

So I had already tried to bring to practice the process of infirmary, the diagnosis of infirmary, even without having implemented it in the service until now. At the time, managed to a little of my research to the hospital, so I was to ask the nurses, it with the infirmary

a little bit of what the nurse does, what they understand. I didn't take a terminology or process of diagnosis of the disease, but I took terms that they could use in practice and that maybe this would bring them to their At end of my master's I already approached myself, I met Professor Heder, so I already had an approach.

I worked Nanda then, a year and a half later, I went to São Paulo and approached the group of Professor Alba. did my PhD with her and I went much deeper into the process of infirmary, the elements that constitute the classifications. So worked on my PhD thinking about Nanda and Noc, already joining

Agueda Zimmer Cavalcante (: 06:16

the diagnosis and in a specific I the sandwich, as you mentioned, in Iowa, and this opens up the mind And as commentator, also, in this period I worked at an in São Paulo that already had strongly the process of disease in practice. It one of the pioneers, is Dante Pazanese. I went...

incorporating this into my professional understanding what the nurse's the diagnosis process. I think I was really locked up in the middle of all this process as a nurse.

Camila Takáo Lopes (: 07:05

I very happy to have given you opportunity to follow some of these steps, to have traveled this path together and to have given you opportunity to meet Agda already being a reference in critical in calling our attention to aspects for which we were paying much attention, fundamental.

of the So, have known you during the doctorate period contributed a lot to who I am today, the way I think today, to my view, to the studies, to my view, to practice. So, I'm very grateful for that. That was a personal Initially, the disease process didn't have this diagnostic What do you think...

Agueda Zimmer Cavalcante (: 07:52

Camila Takáo Lopes (08:01.806)

Or how could you explain to your vision of the relevance of this insertion of the diagnosis of disease as a stage of the disease what differential it brought, what is the relevance of this stage explicitly existing in the process?

Agueda Zimmer Cavalcante (: 08:23

I don't forget an experience I had during my graduation. I in internship and I was compiling some data from my TCC. Look how long it took. Looking at the patient's looking at the data I had collected from the patient's

trying to with a certain diagnosis of disease at the time. And a nurse turned to me and I can't stand the diagnosis of disease, just a change from the medical to the diagnosis of the disease. And my will was so to answer her, saying, no, it's that, and I was a student, but it was very clear in my head that it wasn't that.

But I brought this within me, always along my journey, my professional thinking why people think that. So, why does diagnosis not make difference to some professionals, but makes to others? What do we have to show or make very clear about how representative it is of our profession?

how he manages to materialize what the nurse does. So he is the CERN of care. So I need to name things. When I name something, it becomes clearer to me. It becomes clearer because it comes out of the field of ideas, it comes out of abstraction and it makes it more concrete.

So it's easier for to have actions for her, to know how to her, or why I look at this phenomenon this way and not that way, and not from that perspective. And the diagnostic of infirmary is so complex that it makes possible different looks from what the diagnostic of infirmary So when I usually...

Agueda Zimmer Cavalcante (: 10:48

to to the students and without bringing any disadvantage to it, we do not put in levels of importance of the medical to the diagnosis of disease. Each one has its importance, but for us, for our science, we have to have greater clarity of what corresponds to our science, of what is part of our profession.

So, in the we used a lot of, ah, the problem is because the patient doesn't walk, the problem is because the patient can't swallow, the problem is that the patient is underweight. So, what can I do? But what this related to? And it's related to a problem that came before. And this, that I'm trying to name this problem, how am I seeing

visualizing it. So I realize that the diagnosis of the disease can have different nuances for different patients. This is different from the medical because the medical diagnosis is very static, although it levels of gravity that usually come through...

Agueda Zimmer Cavalcante (: 12:17

But when I bring the diagnostic of disease, I bring the details of the patient's So I like to talk to a colleague who is from epidemiology and he brings data from data sues, we talk a lot and I tell him.

It's interesting when you talk to me about how patients there the prevalence of diabetes in Brazil is so but how many of these patients have diabetes? How many possibly have a tissue integrity? How many possibly have a physical because they a member? This completely changes the structure

of a public when think about the demand for resources for a particular patient who has a diagnosis, but within this diagnosis there is a specificity of detail that is given by the diagnosis of disease. So the diagnosis of disease delivers details, nuances that we cannot see otherwise.

It is through him that we can see who this patient So I see myself that way, I know if I was able answer your question.

Camila Takáo Lopes (: 13:43

You yes, and during your answer I was also remembering for those who did have opportunity to listen to the episode with Professor Rita Gengo in Portuguese, we talked little about it too, about how those who study and who speaks more or who like the of infirmary, their elements, diagnosis of infirmary,

is seen in the wrong way as people who are contrary to medical or contrary to interdisciplinary when there is nothing of this. Everyone has knowledge of interdisciplinary and relevance of different types of diagnosis of the team and how there is still this view of renaming medical diagnosis as a diagnosis of infirmary.

Agueda Zimmer Cavalcante (: 14:38

is that.

Camila Takáo Lopes (: 14:40

and not as giving a name to a human which has an etiological which is different for each one, which has manifestations with greater or lesser gravity, which are different for each one, and that the standardization of the name does not standardize the person who has the diagnosis, because each one has a group of etiologies, each one has a gravity of manifestations, a load of manifestations.

Agueda Zimmer Cavalcante (: 14:53

Yes.

Agueda Zimmer Cavalcante (: 15:00

Peace. Peace out.

Camila Takáo Lopes (: 15:08

And all of is represented by a title that we can later use as a data to demonstrate the effectiveness of our care, the impact of the disease in an autonomous in the disaffections of people's We are walking as researchers in this area. And I kept thinking when you mentioned the problems.

Agueda Zimmer Cavalcante (: 15:29

Exactly.

Camila Takáo Lopes (: 15:35

of how previously was a disease based on isolated and the evolution that diagnostics represent in relation to looking at problems and understanding the causal the chains of consequences between them, so as to be proposing isolated solutions for each one, for the list of problems, without having the vision of addressing the causes, without having the vision of...

Agueda Zimmer Cavalcante (: 15:49

Thanks

Camila Takáo Lopes (: 16:04

to measure if indicators, manifestations, and symptoms, evidence, have improved or not. And how the diagnosis should be seen by nurses as representative of this advance of the list of problems for this thought. How do you see in this context the cure of the diagnosis, its relevance to form, to consolidate the formation of nurses?

for when they arrive at the clinical of viraleito.

Agueda Zimmer Cavalcante (: 16:40

How do we have done in the discipline and how do I think it would be important? Maybe, of course, we will create a maturity, will relearn and modify the new way of teaching, of talking about what we believe, what we like, seems that it will...

incorporating our lives. don't know if that it. But when I teach, for example, to verify if a person needs oxygen therapy, I will have to a class on oxygen therapy and all the devices. So I talk about capete, mask, re-inhalation I need to tell them which

the conditions by which the patient will need these devices. And it doesn't seem very appropriate for me to come and say, patients who have pneumonia, who have asthma, because they, okay, we will find these patients in hospital and this has already been incorporated so into the profession, right?

Our science, because we grew up in a very biomedical it seems that it is difficult for us to say, well, this patient who will use an O2 has an inefficacy So it seems that I'm teaching weird, that I'm getting out of axis, but I've tried to this movement. So what does the patient with an inefficacy have?

You mentioned the causal so that's exactly it. What are the factors that lead to patient having a typical Is it fatigue? Is it pain? Can be So, what I'm evaluating, I need to understand how that causal leads to the diagnosis and how this diagnosis manifests itself. So, from the moment that...

Agueda Zimmer Cavalcante (: 19:00

I have a study on diagnostic in a certain population. The accurate for elderly for example, dyspnea and pnea So I already tell my students that when I get to the hospital and see a patient, for example, with fatigue, with pain, who has to a respiratory test,

Possibly I will observe this through Dyspnea and Taquipnea. Because I am interested in scientific This is an advance, which is what you said. It an advance for our profession. I'm saying this from my head or just from my experience. I put everything but I have given the scientists. In addition, I tell them, look, literature really says it's this diagnostic. Because it can be.

that I another diagnosis that leaves me in doubt. And this can interfere directly with the intervention, the prescription that I am going to to my patient. So, the cure for this diagnosis gives me one step further, to make a decision more calmly, with more confidence, to tell my students to this diagnosis, you can do it. And I think we can...

I like to tell them that we can be wrong. The process of diagnosis is cyclical. So we can review the evaluation, review the patient's and come to another conclusion, another diagnosis. It is possible too. But the cure makes possible for direction.

What is the most representative for that diagnostic? I that it.

Camila Takáo Lopes (: 21:02

I was thinking about the progress of research in area of diagnosis of disease and how your group was the first to produce a systematic of related of a diagnosis, was diagnosis of uninfected health I wanted you to comment on that.

Agueda Zimmer Cavalcante (: 21:25

Mm-hmm.

Camila Takáo Lopes (: 21:30

a little bit about this advance in studies, in diagnosis which was made by this structuring of the diagnosis of disease, having etiologies, having manifestations.

Agueda Zimmer Cavalcante (: 21:49

I have always to bring the clinical with the students, to the discussion of research what we have in literature. And somehow we end up finding gaps, To say, this we still don't have. So, in case of self-management, health at time, we worked lot thinking

in patients with chronic specifically with cardiac What is for us to understand this diagnosis, how can we advance in the interventions for this diagnosis? We see many studies in area of patients with cardiac mainly ambulatory are seen as role of the nurse, in long-term

I educating this patient, helping with identifying symptoms, controlling the disease, but seemed that there missing elements that would indicate why that patient has this diagnosis. And once I understand the reason why he has this diagnosis, it me more tools.

to act, to assist this patient in his needs. These are different There patients who have insufficiency, all have it, but one has a problem with a network of support, totally unstructured, he doesn't have a support he needs this network. The other one, he doesn't understand, he doesn't accept disease, he has belief.

Agueda Zimmer Cavalcante (: 23:46

And we saw this in the hospitalized and our intervention cannot be the same. They patients who have the same diagnosis but for different And then we went with the literature to try to understand this, compile these data and it resulted in...

No,

complementary because they complement each and are very rich within the self-management are studies that are at end, some have already been others at end of the review. They are instruments of the practice that we bring to

What we have seen in the practice of lacuna to bring these answers and move forward in science. think that's what we have been to do.

Camila Takáo Lopes (: 25:21

This self-management ineffective health is one of my interest diagnoses, including for the level. Because of my experience of seeing graduate in general, our focus is always on knowledge. To assume that person has no knowledge or even assess that they do really have enough or adequate

but only to this. So let's make a map, let's make a sheet that is a general with information in general about the disease, some characteristics of self-administration of a drug, example, change of lifestyle, without considering all other etiological to self-manage your behaviors, self-manage your disease, self-monitor your symptoms.

So we have tried to talk to graduate especially about how we can only assume that changing knowledge is enough to change the behavior of a person who has so many tasks about their own health. But there is still a distance between us talking about this, studying this at the academy.

in and teaching this and what is really done in practice, in your opinion, what factors contribute to this distancing, not only for self-management and health but for the ideal of diagnostics, for implementation of diagnostics, for your use, your understanding in clinical

Agueda Zimmer Cavalcante (: 27:09

I think teaching is the first thing, really. And not criticizing, not pointing the finger, because I participated, I was in this teaching so we, as I said, we will modify even our understanding of what it and how we have to go through it. So we received it as...

as colleagues thought it was, and how they understood it, and we understand it another way. So, I like to think that this is also the advance of science, and our science is a new science, mainly thinking about diagnosis of disease, in process of disease. So, teaching, think, is the main element. How to teach, how to make students understand.

that diagnosis is the fundamental stone of the disease. I think this is the thing, it has to be loved. I like to think that each discipline will have a specific of diagnosis of disease. Obviously, my discipline, I will work with breastfeeding. So, I will have expertise with this diagnosis, but I

I colleagues who have this diagnosis. And each discipline of the course has to understand this and has to appropriate from that group of diagnosis, really itself and understand what are the interventions for this diagnosis, how this diagnosis manifests itself in different population groups within its discipline.

So, this is an important for the student to understand that where he goes, the practice, regardless of the scenario he has, can be in intensive can be in the family He will know that the diagnosis is the CERN of his action, his professional and that from there he makes the prescriptions, that he takes of patient. So, if he's taking care of...

Agueda Zimmer Cavalcante (: 29:28

So, I'm in the medical with my students. What are the types of population that I have there? So, there's a population that usually elderly, it's a population that generally has a bad respiratory they have fatigue, they have physical that is predicated, they have tolerance to decreased so they are...

I have to have control over them. I have to be safe with I have to always studying them, knowing what is new about them, interventions, accuracy, do elements? Do they clinical Because when I go, I have to say, there's a new on this diagnosis. And so should be, each disciplinary

I think this would be the first step.

Camila Takáo Lopes (: 30:31

I found your answer extremely interesting because we talked a little in other episodes of Nanda Cast about this wrong view also about who studies or who uses the diagnosis of disease, who has more...

who favors more the diagnosis of the disease, diagnosing is taking Nanda's the diagnostic that is printed reading it and trying to it in the person. And when it's the process that comes behind it, of having prior of having prior of evaluation, reasoning, of reaching a judgment, a clinical and at the end of giving the standard name.

use the classification demands these previous this deepening and about the expectation sometimes of some teachers that the student at the of graduation, regardless of the level he has, or even a practice regardless of the specialty he has, of the body of knowledge he has developed over time, that he knows how diagnose

or copy the book, don't know, 277 diagnoses that are not fit and unexpected for an association that deals with diagnoses of a classification. Are there any strategies or specific strategies that you have used in your degree to teach this content of the diagnosis of the

Agueda Zimmer Cavalcante (: 32:22

Recently we were to include, I'm still working to know if it's a good or a bad but we will have a specific on the of disease in graduation and will be more in final years. The idea would be to get that student who already gone through several disciplines and try to

to different studies of clinical and for him to about the individual. And then, thinking about the individual, he would see the needs from then identify the whole process and see what the diagnosis of disease Obviously, along with that, I have tried to get closer to the teachers. So I already have...

I've to work a little bit with women's children's and recently, think was very funny that a teacher who works in infectious diseases department, we were discussing the diagnosis, self-management and health inefficacy in patients with cardiac how this diagnosis manifests itself in this population and in other populations with chronic he said

I want talk to you because in my unit there be several diagnoses. So it's to wake up my colleagues who have potentials, a that I can't imagine, that they also do this and that they can bring to their reality. It's to change their it's to say, look, this has to be the main of

of your discipline. Not the opposite, Not sometimes a disease and then at the very end, as we saw, it was the last topic of the class, pass the diagnosis of disease for this disease here, part of my card, then came the diagnosis of disease. We saw lot that, so we have tried to change that. And also, more recently, I said that I have

Agueda Zimmer Cavalcante (: 34:46

the procedures that we will work with patient, it's a survey, a bath and always who will receive this procedure, who is person, this person is in what condition, situation of her and possible diagnosis of disease. This diagnosis has these characteristics, this cause, so because of that

Possibly this patient needs a probe, so I try to show this reasoning. And it gets much more interesting for them than just getting and doing the procedure. And then, more recently, we have put simulated We are still but the idea is to give a clinical to the students and in the middle the clinical case we don't deliver all the information.

because we want to know what questions he would ask, as if were a provoral, like a bone. So he enters the lab, there is a patient who is model plus a doll, and he is there dressed, lying in bed, for example, and he says, look, this patient is so and so, he's been years because of a wound, that's And in the lower right

And the student has to say, a wound or a right femur, let's see this wound, he has to ask. And if he asks and says, look, I'm going to take the dressing off to see this wound, says, okay, so the wound is like this, so I show the characteristics of the wound. Because if he says, oh, have a wound, then, and think of anything else but not see the wound, then he will not receive other information. So this is simulated that would happen.

Obviously, in hospital, example, in a real But we give data to this student. And from the data that we provide, having in response to his questions, in the end he can reach a certain diagnosis. But these are diagnoses that we have already worked on at a certain point.

Agueda Zimmer Cavalcante (: 37:10

In my case, for example, those I mentioned, so damaged tissue integrity, damaged tolerance, so he goes asking questions and saying, no, look, how is the characteristic of the injury? The patient has these elements here, these characteristics, this diagnosis is this. So he can do this reasoning.

with elements that we will put in as he asks, as he sees the need. And just to complement, my time is running but talking, sometimes the student gets stuck lot in the model, in the biomedical so I have a lot of this problem, I see lot, so...

Sometimes I tell students to and ask, what are the questions you would this patient? So, they are questions, what is your history of health, how many times have you been hospitalized, what medications do take, do you physical So, they are very pre-modified that would differentiate, for example, from a...

And then I tell him, now you're going go back to your patient and you're going have mind a theory, for example, I bring to him, theory of self-care of the person with chronic So I want you to ask him if he recognizes his signs and What are the signs and symptoms that you perceive in you when you start not to feel bad?

Then he looks and says, I didn't ask that question. These are questions that are... A certain theory brings a new way of looking at the patient. So, this makes the student see a possibility of new questions, new look and even identify a new diagnosis. I think these are strategies that we have used to...

Agueda Zimmer Cavalcante (: 39:28

to try to this process and make it more attractive, more fascinating.

Camila Takáo Lopes (: 39:35

Look how interesting is to introduce the idea of adopting a different in a palatable so that the person can really the practical of adopting the theoretical of having a theoretical to guide from the evaluation, to then guide the diagnostic and the diagnostic

Professor Agda, I'm very happy to talk to you and I would have many other questions. I want to follow this idea of the new discipline, this approach towards the end of course. Then I want to everything about the results, about the course, but unfortunately now we don't have much time. I thank you much for your presence here, for your time that was donated to us here at Nanda, to Nanda Cast. I hope you enjoyed my conversation with Professor Agda Cavalcón.

Don't forget to sign up our newsletter at www.nanda.org and follow on LinkedIn, Instagram and Facebook. You will be to find the links, if you interested, to acquire our book, the Diagnostic of Nanda's on our website as well. See you next time and let's continue to the knowledge of the disease. One concept at a Professor Agda, thank you

Agueda Zimmer Cavalcante (: 41:00

Obrigada!

Agueda Zimmer Cavalcante (: 41:07

a joke, my God.