Avaliação do julgamento clínico de enfermeiros na aplicação das etapas do processo de enfermagem na atenção oncológica

Abstract

For the three-year period 2023-2025, it is estimated that there will be 704,000 new cases of cancer in Brazil. These individuals will present human responses that will require nursing interventions. Therefore, studies that evaluate nurses' clinical judgment skills in cancer care are relevant in order to improve nurses' clinical response to the path taken by these patients when they are diagnosed, treated and rehabilitated. The Nursing Process (NP) is the methodology that systematizes nursing care, thus, in the application of the NP stages, cognitive processes are imbricated in which critical thinking and clinical reasoning are exercised and show the nurse's fluency in the development of clinical judgment. Objective: To compare the clinical judgment performance of oncology nurses in a hospital service before and after an educational intervention. Method: This is a quasi-experimental, before-and-after study with an awareness-raising/improvement intervention. The study took place in the oncology sectors of a philanthropic hospital qualified as a High Complexity Oncology Care Unit (UNACON). Data was collected in two stages using the Lasater Clinical Judgment Rubric (LCJR) before and after an intervention. This instrument has been validated in Brazil and is structured around the phases of recognition, interpretation, response and reflection, with 11 dimensions distributed across these phases. The qualitative variables were described in percentages and whole numbers, while the quantitative variables were described using the mean and standard deviation. The paired Student's t-test was used to compare before and after in the sample studied. Differences where the probability of rejecting the null hypothesis was less than 5% (p≤0.05) were considered statistically significant. Results: 12 nurses from the oncology sectors took part in the study, 5 from the oncology inpatient unit I and II, 1 of whom was a trainee nurse, 1 from the chemotherapy outpatient unit, 1 from radiotherapy and 5 from the pediatric oncology inpatient unit, 1 of whom was a trainee nurse. The difference between the means before and after the intervention was significant for the dimensions of the LCJR, data prioritization (p=0.001), data comprehension (p=0.017) and well-planned intervention (p=0.002) after the intervention/awareness-raising. Conclusion: It can be concluded that the professionals showed improvement in three dimensions after the awareness-raising intervention, thus demonstrating the need for health services to stimulate and carry out interventions with regard to carrying out the Nursing Process in order to improve the clinical judgment of nurses, contributing to better care provided to cancer patients.