Transformando a Enfermagem por Meio do Diagnóstico

Camila Takáo Lopes (: 00:01

Hello, welcome to NandaCast. I am your host, Dr. Camila Takao Lopes, Director of the Diagnostic of Nanda International and Professor of School Nursing the Federal of São Paulo, Brazil. Thank you for participating. Today I would like to introduce Professor Dr. Rita Gengo.

ogram, which was initiated in: 2017

and promote a deeper articulation of the contribution of the disease to the results of care for patient, the family and the community through clinical and testing and refining the disease language specifically or more deeply, of the diagnosis of the disease. Professor Rita Jengo is assistant professor of CURSTIN.

E. Lynn College of Nursing, at Florida Atlantic University, and a of Nanda International. She is also of the Brazilian in the Process of Disease, which is called REP, and researcher of the Diagnostic Interventions and Results of the University of São Paulo's in São Paulo, also Brazil. Her research interests focus on disease

Evaluating and rationalizing the clinical of with the aim of advancing knowledge in the disease and improving the practices based on evidence and the quality of the disease She also dedicates to promoting the science of symptoms under the perspective of the disease, particularly in area of cardiovascular Over the years, Professor Rita Gengob received funding from both national and international

Camila Takáo Lopes (: 02:14

and has extensive publications in its area. She has been a member of Nanda many years and defends the use of of information, both in practice and in education and research and information. Professor Rita Gengo, welcome to NandaCash. Thank you much for accepting our invitation. I know that we have each for long time and we would have an infinity of subjects that we could discuss.

but today I would like to focus on some specific questions. To start, I would like you to tell us a little bit about your experience as a nurse when you worked in a hospital and how you see the diagnosis of disease, helping us to direct the care of the patient.

Rita Gengo (: 03:07

Hello everyone, hello Camila, thank much for the invitation, thank you for the presentation you made, I was thinking, it really me? Thank you and thank you for welcoming to the NandaCast.

I think it's an invitation that I with a of affection and I'm very happy to be here. Thank you for the opportunity. You're right, we've other for long time. I was trying to remember since when, but I couldn't remember and I didn't make much effort either, because I I'm going imagine that I'm already...

and not, you long time on the road. But we've other And I appreciate your first question, I think it's very inspiring and brings many memories to me to think about the importance of the of disease, how I...

I with them and importance in clinical this question has been me a long which is very healthy. I think that first of to contextualize, I I would like to say that my first contact with diagnosis of disease was still in graduation and I will forget that. I was

I think it was my third year of graduation, if I'm mistaken, and was the moment when I needed to a guide. No, no, I'm saying, I'm wasting time. At that moment I was in second year and I needed to an optional That was my first contact.

Rita Gengo (: 05:09

And when I looked at the of optometric one of was the of infirmary. And I kept thinking, what is this? I even know there was a of infirmary. The nurse diagnoses, I had no idea what that And then I came to ask some veterans, some other colleagues, and most of them, I don't know what that I'm not interested, I think this is nonsense.

Anyway, all these things that we already know how people treat the issue of diagnosis. And then I said, but I was curious, I I want to to see what it is, to learn what it is. And then when I the enrollment, the coordinator of the discipline is a person who very special to me, Professor Dinar.

And it my first contact with a disease and I was delighted because in the discipline it taught us how to look at a clinical situation and think about the clues and how we organized those clues and how we could give a name and look for in And I thought that great, thought was fantastic. And then, even during graduation,

When the time when I needed to what my final work would I I want my final to be with diagnosis too. But I already had my passion for cardiology, so I wanted to both things. And, amazingly, Professor Adina to have combined both things. So I was lucky enough to have her as my guide for...

for my course conclusion And it a job that was very special because it gave me opportunity to use another tool that I had learned in graduation, were health So I health functional to interview the patient, to examine the patient and determine the diagnosis of the disease.

Rita Gengo (: 07:39

So was a work that brought these two things together and by allowing to the functional health also allowed me to meet the patient as person. I wasn't just at the patient's or things like that, because I a vision of that person as a whole. And think about the answers they were presenting.

And then the exercise of talking to the teacher, saying, I thought like this, I thought like that, and she said this and that, to guide me and for us to come to consensus about diagnostics, it was an incredible And from there, I started to understand that the diagnosis of infirmary, they needed to be part of our practice. How was possible for us to communicate, document,

is to think about what we do as nurses without having a language behind it, to guide my thinking, to give a for what I'm seeing in the patient. that moment was... think my graduation was very special in that sense. And then, in clinical practice, when I got to work, one of the things that...

It bothered me a little. There was an effort by the service to have the diagnosis of the disease, but they restricted themselves to a column in the initial assessment of patient, we called the historical of the disease. And then there was a column where we documented the diagnosis. But it was not something that was very...

You what you had do? You had the history, but if part of the diagnosis was blank, that's okay. And it that one moment when we talked about diagnosis, that we documented diagnosis and then during the internazão, for the high school, it was going back to that question of diagnosis. And that was in my head.

Rita Gengo (: 10:01

What am doing here? Did the diagnoses I identified at beginning of the hospitalization improved? Did other diagnoses of infirmary I could think it was in my head, but I had no place to document it. And I even joke that in some situations I spoke in the language of diagnoses.

And then people also start to recognize me as the person who knows the diagnosis of the disease. And on top of that, not on top that, but besides that, another thing that helped people recognize me as someone who knew the diagnosis and who practiced that is that my master's

was about diagnosis and I was doing this with the comitant right at beginning of my career. So I left graduation and soon I entered the master's and at the same time I was working. So things kind of mixed little. So I started to be little recognized as that nurse who likes to diagnose. And as we were talking about this with colleagues,

There colleagues who said, oh, that's I want to too, What do you think? you this patient has this diagnosis, that diagnosis? There were colleagues who didn't even want to But I think that as we start talking about diagnosis, I remember there in hospital, the interest starts to grow. At the time, we also had a transition to the service and management

I understood the importance of talking about diagnostics and then a movement within the hospital began for us to actually diagnostics in our practice. So I participated with other colleagues in activities for us to institute or implement diagnostics in patient's electronic system.

Rita Gengo (: 12:20

that we had in hospital. And then we start to realize that the way that our colleagues and ourselves think about our care, the way we behave, the way we think, the way we plan care, it changes. I don't know if I'm kind Polian, but that's how I see it, and that's how I...

I experienced this issue of diagnosis in clinical I think that, to close, I think that my experience of using diagnosis in clinical was something transformative, That showed me why I'm there, doing what? In addition to technical and procedural So...

It me a reason to be there with my nurse.

Camila Takáo Lopes (: 13:23

Rita, loved your answer because as you were talking, I was thinking about how I recognized you from the beginning as a reference in this area of diagnostics, in to of cardiovascular in the area of the process of disease specifically in the cardiovascular which is how I you and already knew your name as a reference in this area. And it's lucky to have a person who is a mentor.

in this area. So, for those who don't know, Professor Dinar, who Professor Ritajengo is mentioning now, is Professor Dinar Cruz, who is professor at the University of Usp's Now she is retired, but she works in post-graduate in nursing, there in the program, and she is one of the authors, she has always participated in the Nanda and has contributed to the classification of diagnosis, and she is one of the co-authors.

of revised evidence of Nanda's So, an impaired researcher who was your mentor and how lucky are to find these people who change our perspective in our professional in our academic career, who always together. I think that's also a...

Rita Gengo (: 14:40

It's

Camila Takáo Lopes (: 14:48

It's very interesting of what you brought from your academic career, walking together with your professional as an assistant nurse and then as a nurse of education. Even today, I think that since our graduation and until today, unfortunately, is still a vision or confusion of finding, people thinking that...

Rita Gengo (: 15:01

Yeah.

Camila Takáo Lopes (: 15:16

the diagnosis of disease is just another way of giving a different to medical diagnoses. So, relation to these differences from medical to the diagnosis of how have you observed this use, this differentiation or this vision of nurses in clinical practice?

of trying to our knowledge, discipline our knowledge as science through the diagnosis of disease and differentiating our practice from a practice that only responds to medical diagnoses.

Rita Gengo (: 15:59

This is also a very expensive for me because I think it's very easy for us to try to the correspondences, try to a name for the to a medical

And I think this comes little from the way we learn the diagnosis of infirmary. First, it is not a discipline that is transversal throughout the curriculum, most of time. What we see are isolated where the student will learn

maybe theories, if they still teach theories. Many schools are trying not to this content, This not only in Brazil, but in several places. So, I have a discipline where they learn the theories, they will learn the qualifications, and then they learn the qualifications in a very mechanical There a case

Then give or the person brings the classification, your Nanda's and then she will try to do, I will find in the book what this person has. And the case we give to this student is a case based on a medical So I think the association is logical, if my patient has

If my patient has insufficiency, then he has intolerance to or in we talked about reduced It's easy to make this match. If you this medical then you have this diagnosis of the disease. And then turns out that in general the student understands that it is mere substitution.

Rita Gengo (: 18:11

So so we hear some people saying, oh, there's no diagnosis of disease for diabetes. When they that to me, I there's no way, how good that there is It's for having. Because the diagnosis of disease is not for diabetes. The diagnosis of disease is for the person who has diabetes.

I think this confusion ends up happening because of how we teach, how these topics are placed in the curriculum, which is not a transversal it is isolated and then we don't touch on the subject anymore, when we get to end of a class about a disease, we put the list

of of disease, of the interventions, and so, look, for a patient who has this, you will do these diagnoses. And I think it's a challenge for us to think that this is not true. If it were, it would be more or less like saying that we maybe it's a hole in the doctor's when I don't have a medical we use a diagnosis of disease and the same thing. I think the

Our challenge is to transform this understanding that the diagnosis of an does not represent a diagnosis, but it is a name that we give to an experience that the patient is presenting in the of a situation that he has in life, which may or may be a disease.

So I think this is a... I will use the word paradigm, that we need to start changing and working in terms of education. And in clinical think we...

Rita Gengo (: 20:26

I don't mean sit down, but establish with the nurses, people who have knowledge in the field and who can guide these people to better what this diagnosis of disease So think we need work in this sense, to establish

What is the clear difference between medical and disease I think another thing that may contribute to this confusion is that when we talk about medical diagnosis, everyone, even those are not from the health are more or less familiarized. So if you get to a patient, he may not know how to with the...

scientifically what diabetes is, but he will know that if doctor gave him that diagnosis it's because there's something wrong and then will understand that it's sugar in the blood that is high etc. When we talk about diagnosis of infirmary, first that patients do know that nurses diagnose

Other health professionals often do not know. The nurses who know often reject this idea of the diagnosis because they not understand what this diagnosis is, even when we look at the definition of diagnosis. When we think that the definition of the diagnosis says that the

is a clinical about a human What is this human And once one of my mentors also said, is the medical also not a human I oh, stop you'll confuse my head, But I think that talking about human and letting

Rita Gengo (: 22:47

And sometimes it's like we teach, we only talk, it's a clinical about the human and we don't explain what this human We don't go deep. So think these things all end collaborating so that this confusion exists. I said, I said, I don't know if I answered your question.

Camila Takáo Lopes (: 23:05

Of you answered, Rita, bringing all the experience you had of seeing the speeches of other people and your own reflections over time, which I also had. And I when we teach a graduate for example, sometimes there is a question they ask that makes you think all day about what you taught or the way we teach and change.

For the next time I teach, I will approach this aspect, because I had thought from this perspective. And I think that until we teach now, think about the doubts we ourselves had, the insecurities we ourselves had in the past, and that the way we solve in our head, for me too, it seems very interesting for us to be able to teach.

And besides teaching, we have a task of convincing, teaching and convincing people to give name to the phenomenon that we identify and about which we have responsibility. Would you any story to share with us, some more specific of how you approach, how you explain to someone?

Rita Gengo (: 24:08

next.

Camila Takáo Lopes (: 24:32

the of naming the situation, the human the experience of the person we are taking of.

Rita Gengo (: 24:40

Wow, I several stories, several, but I'll try to think, select one that is more representative. I think an example that comes to this, and I always talk about it when we are dealing with diagnostics, how we teach. At the time I was still at the hospital, I was...

Camila Takáo Lopes (: 24:42

You

Rita Gengo (: 25:07

I at the and I worked with the nursing homes and later on the homes. I was one of nurses who visited the nursing homes or the nursing homes and the purpose of the visit was kind of...

You to a little bit of that question of doing, doing, doing, and let's put all this in context now, let's reflect on the context. So one of first questions I asked, and it's funny that I I I kept in touch with several of the ex-prime members and residents, And one them once told me like this, when I heard the knock-knock of your shoe, I wanted to away.

Because I that she was and the question was, why does this person who is here Ternada need you as a nurse

And to give me this answer, something I asked them to elaborate, of course they could tell me the but one thing I asked them to do was to name what they were seeing. So that was a way I felt like bringing the diagnosis, and not only the diagnosis, but interventions and results too, to the experience reading while we were learning to be

who we are, what we represent as a discipline, as profession. And think that this, I don't know if they have this impression, but for me it was very interesting to see the way they thought and how they to that diagnosis And then, over time, I didn't always have opportunity to accompany the same patient for a long period of time, but

Rita Gengo (: 27:14

Sometimes I would come and did you manage to on the diagnosis? How was it? So I think that was a question... I liked to do that bring the diagnosis to what represented the need for you to there. I would ask, why you have to leave your bed at 5 am to come to hospital and take of this person? So, to make sense.

So I always liked this approach. And then I in other experiences, think thinking about the diagnosis of illness in terms of graduation, understand that I tried to it myself, not alone, was a group of people trying to

adjust the way we taught. So we tried once, at an institution, to change our, not the curriculum as a but the discipline that we were responsible for. Instead of teaching through medical diagnoses, we were teaching through diagnosis of infirmary. And I'm not denying that the student has to learn about medical diagnoses, he has to learn.

But this is not the essential. So we made this attempt, of course there was a lot of resistance, people didn't want it, because they were already used to And how am going to teach the diagnosis of disease and then I won't be to teach something else that he also has to learn? And the procedure stay? So it's a change that has to happen, not only

in the individual of the teacher with the student, of you trying to bring importance of that diagnosis to the student, also in the context as a whole, including the school. So this was another experience of trying to what we have to learn through the lens of the diagnosis of disease instead of

Rita Gengo (: 29:42

to the focus to medical diagnoses. And again, my experience, my impression, I think it was fantastic. Because we talked about the diagnosis of disease, the disease entered as part of what had to be learned, but it was not the central And I thought it was very interesting because I think it made more sense in the

to the points of the clues that we will discover later to formulate the diagnosis of disease, than having think about medical and then take a turn, change 180 degrees to think about diagnosis of disease. I think it made much more sense the way to organize the thought. So I think these are examples that always come to mind of how

We tried to the importance of diagnosis of disease to the students.

Camila Takáo Lopes (: 30:48

Rita, as you said, I was thinking about challenges that I also think about and even about relationships with colleagues who don't study, who are not very interested in the area of ​​processing of infirmary.

of the fact that when we talk about diagnosis of disease or process of disease, we are denying interdisciplinarity and we are denying the relevance and existence of medical diagnoses, which is not the case for any of us who work, who research diagnosis of disease, all elements of disease and this challenge that educators and

And think that maybe the managers and those who are in practice also still have to unlink the image of the disease, of the disease based on tasks, of the disease based on routine So I kept thinking when you asked the resident, the senior why does this person need you today?

It would so easy if we answered, because I have to do this, this and this task for all of them, regardless of who it And I'm imagining that this the you wanted, no, it shouldn't have been the answer they gave, maybe at the before realizing what you were looking but it was a very interesting that you used to unlink this their this image that unfortunately...

Rita Gengo (: 32:10

This was not a possible

Camila Takáo Lopes (: 32:32

Many of us still have, our students have, in fundamental disease when we have to teach, procedures, semiology and then semiotechnics, we go to clinical there is a lot focus on acquiring technical and doing as many procedures as and we have tried, of course we try to opportunize.

the procedures, doing the procedure and everything it involves, but to talk to them about the procedure not being their there, or the purpose of the disease as a whole, but a means for them to care among so many others that exist. So we try, but also if we try this and have this vision only in a

a moment of the training period that you also brought here for us. And if is not perpetuated later, unfortunately, this memory will be throughout the training and unfortunately throughout the career. And in this context, Rita, trying to establish or reaffirm that our knowledge in interdisciplinarity

It is important for our discipline to seen, evidenced and worked on in interdisciplinary field, which advice would give us based on your experience, your research and your studies, so we can reaffirm this, our discipline, our disciplinary within the interdisciplinary field?

Rita Gengo (: 34:19

This is a question that doesn't want to silenced. I think that if we think about the context we live today, it's impossible to think that people, each discipline, will work alone, in their corner. We are advancing in the understanding that this is no longer possible. I think that for some time we talked a lot about multi-professional

interdisciplinary and he was more or less on paper. We spoke, was beautiful to say that, but in the end it ended up that there was a dominant usually the doctor, and that he determined what the other people were going to So, we still see that, I had an experience a short time ago

of a situation where I was visiting a hospital and I ah, but this patient could go to bathroom, right? Ah, but the doctor didn't let me. So, said, but look, I can think about what the answers that this person is presenting, how is she behaving in front of the effort.

She has some risk, she have any risk. I can think about it within the specialty that I am in, for example, in cardiology. I can think about it and I can say, okay, this person can go to the shower, this person can't go to the shower. Do I really to... Now, there are situations that obviously, for example, let's say the patient had a surgery like this, like this, roasted.

and there is the process of surgery, we depend on the surgeon to say, It's that way, that way. I don't it's someone deciding for you, but it's someone instrumentalizing you to make your decision, right? In the face of a procedure that you don't master the technique and you don't know what was done, anyway. So I think there's this question. Coming back.

Rita Gengo (: 36:44

We spent a long time talking about multidisciplinarity, interdisciplinarity, and was a beautiful to talk about. It was cute but we didn't really I think we are in a movement of change now. I don't how I have not followed the research in Brazil, but here in the United States,

we more editors who require the composition of a team with people from different disciplines. It can't be people from different disciplines who work in same school, for example. I'll give a more concrete my school we have, working in the nursing school,

Statisticians, people from data nutritionists, And there are edities that they open and that they... I can't call one of these people, which is a different from mine, but it's in same school, I can't put them inside, invite them to be part of my team. I have to look for people outside my school, right?

with another training, with another discipline. So I think this movement is starting more intensely in the research area and it will be felt in clinical For now I think we're still very much in this more, although I've had some changes, but I think we're still in this

moment that there is a person who centralizes the power. Now, it's something that has no return, we will go back to say, now each discipline takes care separately of this patient, we will go back to that time. And we disappear in the middle of crowd, it's easy. If we don't know how articulate, what do we do?

Rita Gengo (: 39:07

for what we are there. And what is our contribution, which is unique, that without my presence there, that contribution will exist, if I can't articulate that, we disappear. And in general, and I'm talking only in Brazil, but I think it's general. I nurses have a lot of difficulty saying

What unique, specific do to the team? And when that happens, we become invisible. From the moment we can articulate what we do, that we can give names to those phenomena that we are responsible for taking

that we can show that, look, I see this phenomenon, there is this diagnosis, by doing A, B, C, D, I can get to this result and I show this, the thing changes in shape. Because then people can see that they need you on that team for that goal, for that result to happen.

So, think you asked what advice I would The advice I would give is to reflect about what we are and what we represent as discipline, and then the answer to the procedures it, so that we can sit at table with the other professionals and say why we are necessary.

It's not worth saying that we point between all of them.

Rita Gengo (: 41:11

Because other people could be the bridge too. But what do we do for that person we care for, who is the disease that has to do in any other profession? So what specific And think this is reflection that we have to make all the time. So think this would be my advice. And one of the...

One of ways we think about this is what are the phenomena that we, as discipline, have interest in and that we take of, and that we should address when we take of a person.

Camila Takáo Lopes (: 42:00

Rita, I loved your answer. I'm here admiring you while you speak and thinking about what I mentioned to you, that we have spoken to students about the procedures and during your speech about how we would how we would it relevant, remembering the speeches that I have heard that...

Rita Gengo (: 42:04

now.

Camila Takáo Lopes (: 42:27

Ah, and certain profession is trying to this procedure that is for the And another profession is trying to this procedure that is for the sick. In a little while we will stop existing because they are taking our procedures as if we were a set of tasks, set of procedures, as we were when we still occupied and how we will unlink ourselves from this image.

And how we need support from leaders, from managers, so they don't see the disease in this way too, so they don't make decisions of personal based on sets of tasks, as if it a tasker who is there to fulfill routines of how we need the manager to have the vision of managing carefully.

Rita Gengo (: 43:15

for them.

Camila Takáo Lopes (: 43:23

and not only the number of professionals to make that basic of tasks for everyone equally, and that sees the nurse as someone who makes clinical decision autonomously. The ICN has just updated the definition of nurse and highlights that it is a professional who has a collaborative and also has an autonomous

among other aspects that stood out and that has to base the execution or operationalization of your profession on disciplinary I'm looking at time, unfortunately Rita, we won't more time, I would really like to stay several hours more talking to you. I to thank you immensely for your participation in Nanda Cash. I hope to other opportunities to talk to

For those who are interested, Professor Rita Gengo has already recorded an episode of Nanda Cast in English. You can also listen to several platforms. I hope you enjoyed my conversation Portuguese with Professor Rita Gengo. Don't forget to sign up for our newsletter at www.nanda.org to receive the news about the association, the new releases, for example, of the podcasts themselves.

and follow us on LinkedIn, Instagram and Facebook. If you are interested in acquiring Nanda's diagnosis can find a link on our website. Until next time, we will continue to the knowledge of disease, one concept at a Thank you much, Professor Rita.

Rita Gengo (: 45:10

Obrigada, obrigada, Camila, obrigada a todos.