The Use of Point-Of-Care Ultrasound in Teaching and Research with Nursing Diagnoses / O uso da ultrassonografia à beira leito no ensino e pesquisa com diagnósticos de enfermagem

Camila Takáo Lopes (: 00:03

Welcome, Al Nanda Cast, I Dr. Camila Takao Lopes, Director of Diagnostic at Nanda International and Professor of the School St. Paul's at the Federal of São Paulo, Brazil. Thank you for your participation. Today I present to you Dr. Vinicius Batista Santos. Dr. Vinicius is a Master and Doctor of Health at the St. Paul's at UNIFESP, where he currently works as a Professor St. Paul's

is counselor from the regional hospital of the state of São Paulo and a founding of the research in the of disease in Brazil, the REAP. He is also a member of Nanda International. He is a in the research and assistance in process of disease in the Polystery Disease of UNIFESP and also vice leader of the Center for Education and Interprofessional in Ultrasonography, Beira Leito, Latin

linked to the of Nursing of Ribeirão Preto da USP, also in Brazil. He is also an associate of the World Interactive Network Focused on Critical Ultrasound, the WinFocus. Welcome Ananda Cash, Professor Vinícius, thank you for accepting to talk to us today. And I'm going to start asking or asking you to tell us a little bit how...

and how it happened, it your involvement with Nanda International and what led to this field of study with POPOS.

Vinicius Santos, RN (: 01:34

Well, Dr. Camila and all the Nanda's I would like to thank you and say that I very honored for this participation here in this Nanda's And answering your question, I can say that I think that since I graduated or even before the end of my graduation, I always...

anda's I remember that was in: 1999

and was a work entitled Main Diagnostics of Infectious of Nanda's in Patients in Use of Intraortical Balloon and at the time we a pink When I graduated, I entered the Uniprofessional at the time, of Cardiology, here at the Federal of São Paulo and at the time the director

of São Paulo was Dr. Alba Lúcia, Professor Alba, and we had 100 % implementation of the hospitalization in the assistance units, both in the hospitalization and intensive units, implementing the hospitalization with the use of the NAND hospitalization

So, I say that my approach came from graduation, in that gray that was from taxonomy, right? The old taxonomy of Nanda, before the exchange for the standards of functional standards and since then I've been working mainly in the assistance

Vinicius Santos, RN (: 03:52

with diagnosis of disease and research. My research, as I always worked in a hospital school, we always carry out research using diagnosis of disease, at time of in patients in use of anticoagulation. Then we some work with the use of echocardiographic that could subsidize the identification of certain diagnosis of...

So I can say that in the last 24 years of my studies, my approach to diagnostics was total, both in teaching, I was also teacher at the time I was in hospital, in private universities, which my discipline was what we called the foundation of infirmary, basic

I my master's my master's in: 2013

at that time and then in mid-: 2021

free teacher at the University of São Paulo, Ribeirão Preto, to compose with her this group that was exclusively of nurses for the study of Pocos, of ultrasonography in Beira Leito, and that this year we have already expanded to an interprofessional group for research with ultrasonography, for the use of ultrasonography.

Vinicius Santos, RN (: 06:15

by health So, this is my proximity. I usually say that my proximity with Nanda's came from my training, at the when the first teacher who taught Dr. Rita de Cássia, and who came from another cardiology the Dante Pazanese which also already uses Nanda's taxonomy at least 25

I have to what I in my memory.

Camila Takáo Lopes (: 06:53

Professor Vinícius, and lately you have been dedicated to the study with the ultrasonography Beira Leito, including the opening of the center, with the composition of the center. Could you comment a little bit about how watch the technology Can it help us sustain our diagnosis of the disease?

Vinicius Santos, RN (: 07:15

The ultrasonography, POCUS, has been considered as the fifth pillar of the propaediatrics. Today, with a slightly more mature we can see two major aspects of the use of ultrasonography by nurses. It serves both to confirm certain procedures of infirmary, both confirmation and help

for implementation of certain procedures. So, for example, use of Pocos has already been proven to improve assertiveness in the peripheral It has been well studied the use of Pocos to guide the insertion of the transnasal transoral of feeding.

for evaluation, for confirmation of the of catheterization. And the other side of the ultrasonography is like the Pilar's, the propediatric one. So we have the inspection, the palpation, the percussion, the listening and the intonation. And many studies that are yet so carried out by nurses have shown us that when we compare the physical

and POCOS has shown greater sensitivity, greater specificity or greater accuracy in identifying certain changes in responses. So, is within this context that we have studied the use of POCOS as another tool in a non-invasive

Since it does use ionizing such as X-ray, tomography, it is harmless to the individual or the patient, so the use of Pocos has been studied as a guide for identifying some diagnosis of disease. So let's imagine a situation where I have, for example, a patient

Vinicius Santos, RN (: 09:38

that has a insufficiency, won't be to away much, Dr. Camila from my area of clinical that he has a cardiac insufficiency and the nurse does the consultation of the patient in the ambulatory, the patient has been referring to some clinical signs and the nurse does the pulmonary and can identify precociousness, signs of congestion, so...

it is within this north that Pocos, as a resource of clinical could identify more accurately. Other applications we also have, for example, you really evaluate the volume of waste in patients who will be subjected to invasive

to identify in a more accurate way if it has not a risk of aspiration. This is another great applicability for use of Pocos. For example, in several situations we see a patient, for example, with a in urinary and it is known if he has an urinary harmed.

because he may have hyperplasia. Does he have And often, doctor asks the nurse to give him a catheterized liver relief and today, with the ultrasonography, I can evaluate in a much more objective if this patient has a visceral What is the visceral that this patient presents for up to...

have a more assertive So, there several applications that POCUS has for the nurse's in identifying the diagnosis of the patient. I if I answered your question.

Camila Takáo Lopes (: 11:51

You yes. And taking of your answer, in the research about POCUS that you have composed, you have already you already have study results specifically to help identify disease diagnoses.

Vinicius Santos, RN (: 12:09

When we started the research on the use of Pocos, it is important to say that Pocos has been studied by nurses in other applications. The main application was venous guided by Pocos, arterial guided by Pocos and the passage of the insertion guided by Pocos. This was the first use.

that we have dated in publications of nurses using Pocos and that spread today. We have groups of intravenous in large hospitals that only perform venous regardless of whether it difficult or easy with the of Pocos. The cataract PIC, today in large health institutions in our country, here in Brazil, is performed by means

through this guided insertion by ultrasonography. Later, when we started our research Professor Fernanda had already started other research and we initially felt the need to validate some protocols, even for these protocols to be used.

in clinical that evaluated the use of POCUS in identification of certain diagnoses. So today we have already published with our research and with other researchers also from Brazil, we have already published a protocol for evaluation of the volume viscous, we have three publications.

in Brazil, if I correctly, the three that I I have a that one was from a student oriented by Professor Miria Abreu from the of Rio Grande do Sul. We have a research of a protocol published by Professor Filipe Tuari from the School of Nursing of USP São Paulo and this year a very

Vinicius Santos, RN (: 14:33

positive, very nice, of a protocol also for the evaluation of the volume viscous by the nurse Carlos Alexandre from Rio de Janeiro, which was the of his And then we also have other protocols that have already been published, one in the Nanda which is a lung-pulmonary as a guide for identifying the diagnosis of excessive volume of liquids.

We have a publication in the Acta of a protocol for evaluation of lower cavalry as as a clinical for diagnosis such as deficient excessive tolerance activity as a related or even an associated and our research has

focused on building protocols. One of them is evaluation of the volume of gastric Professor Fernanda has already completed the use of POCOS in the confirmation of the food We are building a protocol for the evaluation of the intestinal

in which it done by my master's nurse Marcelo Marinho, and he has studied the use of ultrasonography for the evaluation of fecal that could give subsides to the identification of diagnostic of intestinal Concomitantly to this, Dr. Camila, we already have some clinical one has already been

is finalized, which was the evaluation and comparison of the X-ray with POCUS in the evaluation of excessive of liquids in patients submitted to renal substitution therapy, which guided by Professor Fernanda Gimenez. And I have a research that we finished at CNPQ, in which we evaluated the association between

Vinicius Santos, RN (: 16:56

The pulmonary and the VEACAVA as a subside for identifying excessive volume tolerance and activity, we are now doing the data analysis, confronting with excessive fatigue So these are the two big studies that we but we have several other members.

of our research of Rio de Janeiro, Paraná, Minas Gerais, Sergipe, who have studied the use of POCUS as a tool for identifying this diagnosis. Currently, we are in the process of collecting data from a research by the nurse Gabriela at the Institute of Antipasanese, where she evaluated the risk of perspiration through the volume of gastric

in preoperative to confirm if the of fast that we usually leave is necessary to allow the emptying of gastric. So we have several researches that are happening. All these protocols that have already been validated with the evidence of validation of content have been submitted.

a nurse intervention classification, as new interventions, proposals of new interventions of infirmary. I if you I was very prolific.

Camila Takáo Lopes (: 18:33

You yes, I'm writing down all the diagnoses you mentioned, because you already have, you and other groups, already have some results of how ultrasonography of Beira Leito could help in the identification or manifestations of defining or etiologies of related factors, risk even of conditions associated with some diagnoses.

How you see or you see that we could transpose these results to compose Nanda's

Vinicius Santos, RN (: 19:13

So, based on the results we are achieving, most of these studies we have seen in discussion and conclusion that this data could really be a defining or a related In some situations, for example, diagnosis of a disease with excessive of liquid, does already have its defining

one of the characteristics that is lung So, in reality, we would need to a new defining but, suddenly, change the operational of the evaluation of lung In some studies that were validated the conceptual and operational of some defining

you can't find any operational with use of POCUS. So, for example, if I the damaged intestinal already has a defining is the fecal So, operational that could be for the fecal is presence of mass in the X-ray of the or the presence of feces in the rectal

But if we analyze these two operational the retal for evaluation of presence of feces or the abdominal they are not innocuous. So imagine a patient, as we had a case today in hospital, of excessive with a interoragia, and a patient with use of double anti-aggregation, plaque and anticoagulation.

So why am to a touch that can increase the chance of bleeding? Why I going to an X-ray of the which I need to transport this patient, this patient will be exposed to ionizing if I can use, for example, ultrasonography. So there are several ways that today, and it will be every case,

Vinicius Santos, RN (: 21:39

Dr. Camila, a proposal of a new defining or the proposal of the change of an operational for that defining already existing. So, for example, extension of jugular the patient has a jugular but we have data that was even a study that we received from Brands,

of Nanda Foundation, where will be studied, in to evaluation of jugular the evaluation of the distension of the jugular vein through two maneuvers, maneuver of valsalva and in the respiration, to predict venous which is the master thesis of the future candidate, José Lee, also from the Dante Pazanesi So, each

will have to be analyzed in an independent to see if there need for proposal of new clinical or just a change in the operational of these indicators.

Camila Takáo Lopes (: 22:55

For those who are listening to who may not know what an operational is the way we measure or evaluate a certain phenomenon, certain diagnostic as a defining How am going to know that there is lung Each study defines the way it will be evaluated or measured. You talk, professor.

Vinicius Santos, RN (: 23:16

For example,

Vinicius Santos, RN (: 23:22

For example, the risk-respiration has a risk called gastric How would we the gastric without an invasive Today we can, by using ultrasonography, can evaluate quantitatively the gastric and qualitatively. I can know if...

Within that content the gas, I have solid, initial, or already digested or liquid, or if I already have empty We some studies showing that depending on the patient's takes 12 hours to empty the stomach. So, for example, with this technology we can give a greater support in the clinical of the nurse.

Camila Takáo Lopes (: 24:19

Professor, have thought about how these results you have produced can reach the nurses of clinical

Vinicius Santos, RN (: 24:33

In reality, what we have discussed a lot, besides the applicability of use of ultrasonography in the implementation of procedures, in the clinical in the validation of protocols, still, for many data of the insonation, we do know the response of the learning curve.

So this is also a great challenge that we have, that is, how many insoles does the nurse need to for example, the pulmonary to say that he is having an clinical This was studied 20 years ago when the nurse started a great study on the evaluation of the exam.

How many tests, how many how tests tests tests of of of of of of many of how many of many of many tests how many tests of how many of how many tests of how many tests of

as a free our regional hospital of the state São Paulo started on Friday the first training for physical So we believe that one of the ways to bring this to the to the nurse in various sectors, various environments, is to So the regional hospital of São Paulo in this management

,: 2026

Vinicius Santos, RN (: 26:53

So is another process we need start. It's starting to study POCUS in graduation. We totally and I can say more for myself, I totally disagree that POCUS is a procedure for advanced practice are other concepts for advanced practice POCUS is an evaluation In same way,

that we have already all the universities in Brazil, physical exam discipline, X-ray exam we will have to start this in graduation and in a more advanced in post-graduation which I can say are very few post-graduation that have taught

the use of pocos in clinical We find a lot in intravenous for venous but in clinical So I totally believe that the best way to translate knowledge into clinical is to train the nurses in this...

in this practice and demonstrate together, demonstrate the evidence that when the nurse insoles the stomach before a procedure, he is not occupying any area of any other professional, he is doing an evaluation to say, patient has does not have of and if he with this stomach full

He needs to interventions to promote patient is very important to emphasize that the use of Pocos at no time has physiological ends. Because is up to the other professional, the doctor, to a diagnosis. Pocos, great difference of the virulent performed by the nurse, he has a question to be answered.

Vinicius Santos, RN (: 29:13

Is there of high Let's mention the stomach. Is there urinary Let's mention the bladder. Is there a fecal Let's mention the retention So, it always comes with a question with the nurse's So, it's within this context that we have to make very clear.

The ultrasound performed by has another objective. And ultrasound the nurse has another objective. And in the same way, when we think about what I, when I do a cardiothoracic I have a look from the nurse to identify phenomena that are treatable by the actions of the nurse. Different when the doctor...

when you are physiotherapist, because each one has his own within what competes with in the professional

Camila Takáo Lopes (: 30:16

You could quickly on your course that you are planning for the graduation of infirmary.

Vinicius Santos, RN (: 30:27

Last year we already the first elective of the Federal of São Paulo. It counted with students and with teachers where we trained the graduate students, it was a very restricted because it was elective for the evaluation of the volume of and for the evaluation of the gastric So we did

We started this discipline with theoretical instrumentation, until the student understood what ultrasonic is, how it handles equipment, what types of transducers, which is we call basic of ultrasonic sound. Then we the theoretical of physical of the residual and we did the hand zone. This hand zone was done in our

the at our university and then we the practice with the students in the patients who are hospitalized in our university So it was very positive, the evaluation of the students, they said it was very positive and then we a simulation and everyone was able to indicate ultrasonography within this scenario in an adequate

managed to the image and managed to take the conduct in of identified So, within the competencies, thinking about knowledge, ability and attitude, we saw that we this goal, mainly in the physical Other insinuations, it deserves more time, more time to practice, more supervision time, even for the nurse.

can identify or perform this enunciation in a more assertive risks of errors.

Camila Takáo Lopes (: 32:35

And talking to the students, I can say that they are anxious for the second edition, for this year also to have the possibility of doing this elective And there are other possibilities, even though you are looking at studies in center with POCOS and your association with the diagnosis of infarction.

Vinicius Santos, RN (: 32:58

Yes, are now about a group studying, thinking about the POCUS with other POCUS that has close relationship with the diagnosis of the patient. So we have a group of a doctorate working with old man's in which we want to the muscle evaluation of these patients.

to evaluate your association with this diagnosis or to predict the development of syndrome of fragility. We have some studies showing that low muscle low quantity and quality of musculature, predicts mortality, for example, in cardiac predicts the high chance of that individual

develop the syndrome of fragility, this is group. There are some researchers in our country who have started studying ultrasonography in the evaluation of injury by pressure, is, mainly the Doppler to see the blood in that injury and suddenly predict

a more difficult or not. Also, for example, evaluation of underlying in patients with pressure lesion, the evaluation of ischemic necrotic these are just a few examples. for example, of in muscle there also another research.

that has been discussed as a great necessity. So, it's very large and we believe that it can reduce, suddenly, because it's more objective with an image that allows other professionals to evaluate the same image, to come to consensus, suddenly we decrease.

Vinicius Santos, RN (: 35:18

the great variability of prevalence of some studies that we can see, for example, in a systematic with diagnostic of the disease published this year, showing, for example, variability of the same diagnosis in the same population, in the same scenario, which from 4 % to 89%. Is this really true, this variability occurs, or it occurred by a bias of evaluation? So,

It be, and I can't answer, with all certainty, that the POCUS comes to reduce and improve little more this accuracy in identifying these phenomena that match our practice.

Camila Takáo Lopes (: 36:06

And you are dedicating to these studies with POCOS, but you have a long trajectory of diagnosis of infirmary, also without use of this technology. There is a trajectory as an educator is a trajectory as a clinical there is a trajectory as an infirmary Of everything that has already been experienced, what do you believe that we still have challenge for

we can incorporate more the diagnosis into clinical so that nurses believe more in diagnosis of disease and in its use in clinical

Vinicius Santos, RN (: 36:49

We need to redefine the professional first. And understand what is finalist of the nurse. We have a very clear law. Which is a federal law, which is the law 7498 and the regulation 94406, which determines that the nurse is responsible for the care nurse.

and he responsible for the care of patients with higher complexity or high risk. So if we think that the finalist of the nurse is the care of patient, the care this care is only given, it is only carried out through clinical is no other way. So, is it clinical evaluation?

that will allow the nurse identify the diagnosis the disease in a more accurate way so that he can propose the best interventions of the disease based on the best evidence. If clinical is most important, we need to

both in graduate and postgraduate in free courses, is to improve the performance of clinical of the nurse. In other words, very direct, we need to teach the nurse to do the clinical And the clinical I'm not saying it's the assessment...

I don't understand what respiratory and hemodynamic It's evaluation of patient, and community. And according to our resolution, it's 7.3.6 special So it's evaluation of responses. The nurse needs to learn or improve, refine the evaluation of responses.

Vinicius Santos, RN (: 39:06

How do I, nurse, assess the perception and cognition? How do I elimination? How do I assess activity, exercise, sleep, rest, confrontation, tolerance or stress? Thinking about all human or in the domains of taxonomy. So, when the nurse has greater refinement in clinical the clinical his critical thinking will take him to...

to diagnosis of the disease in a more accurate So that's what we need to think What is the finalist of the assistant nurse? To manage the care, so he has to be improved, refined, perfected in clinical regardless of the area of ​​action. If it's in primary care, I usually say that primary care are the nurses who need it

to clinical Because when I'm taking intensive I have multiple catheters. In primary many times it will have instruments the data and the physical which is this technological it has. And today it can have Pocos. Pocos' allows the nurse to use in primary care in remote

in areas that are out of technology and often abbreviate suffering, improve mortality. So there are some pre-hospital who already do the fast-e-fast insonation and get in touch with the they're taking, saying, there's of bleeding in the cavity. And then the doctor goes there, when he arrives, the team alert.

to receive this patient and give greater agility in the care because our focus is to improve comfort and reduce mortality, is, improve the life of our population.

Camila Takáo Lopes (: 41:17

Is there a specific as you see, that we could motivate people to this view of identity, evaluation, identification and treatment of human responses as part of the nurse?

Vinicius Santos, RN (: 41:35

I think that this has to start from the regulations of educational educational directors who can guide the nurse from graduation to her final We need show in the evidence that when I have a nurse with great clinical he improves assistance he improves all assistance

We have show the that they reduce costs with a proper personal which is also no use having a nurse with high clinical but there are human resources So, everything is a balance, the balance in the formation of the nurse, in number of nurses.

What is the mission of the hospital, of that institution? Everything has to very interconnected. And then I think, how do we bring the diagnosis of the disease more to clinical practice, showing the finalist of the nurse, which is care We have a resolution 736, today, which puts here one of the phases of the disease the identification of the diagnosis of disease, so the law is there.

So we need see what are the means to get to that training. We need to much more rigorous in terms of training in the infirmary. Today we have a great victory that the infirmary cannot be carried out 100 % properly because our activity needs extensive practical So I think it's a fight.

constant and this integration between teaching, research and assistance. It's just teaching for assistance. Teaching has to be based on research, assistance has to be based on research, which is how we develop the construction of knowledge for the patient.

Camila Takáo Lopes (: 43:53

Professor, will ask you, we are almost out time here, I will ask you to leave a final for the clinical for the educators, for the managers, for our students.

Vinicius Santos, RN (: 44:08

I think the message I most say to my students, master's, doctorate, graduation is, don't stop studying. The nurse needs to in scientific in congresses, he needs to study, study more and more his area of affinity, his area of action, his area of expertise, because it's only in this way that he gains autonomy.

and interprofessional So my message is to study. Study a few, right? This year we the launch of a book of aberrallic for nurses. So we are still in the final of evaluation. Last year had

First international symposium on ultrasonography for nurses. This year we once again, discipline in a with several post-graduation in Brazil, giving a discipline in a about the state of art of research in ultrasonography for nurses. So, if you add, study...

is only way we can guarantee quality to the person who is receiving our care, be it the patient, family, the community or even the special

Camila Takáo Lopes (: 45:48

Professor, thank you much and do this with your peers. It's very good when we meet and work with people who believe in the same things that we believe, who support us, who receive our support. And I found that you and thank you for that and for your participation here in our podcast. Thank you to everyone who is following us here at NandaCast. I hope you enjoyed my conversation with Dr. Vinícius Batista Santos.

Don't forget to sign up for our newsletter on our website, www.nanda.org, and follow us, if possible, our pages, LinkedIn, Instagram, Facebook. You can also find the link, if you are interested in our book, Diagnostic of Nanda's also available on our website. See you next time and we will continue to define disease knowledge, knowledge of each time.