Middle Range Theory of Nursing Diagnosis Risk of aspiration in critically ill patients
Nursing diagnosis. Critical patient. Intensive care unit. Aspiration risk. Middle Range Theory.
Aspiration is a common adverse event in the hospital environment, especially in patients admitted to the intensive care unit. In view of this, the development of a medium-range theory on the risk of aspiration in critically ill patients will allow the identification of causal relationships between risk factors and the phenomenon of interest, with a focus on prevention. Therefore, the present study aimed to develop a mid-range theory of the nursing diagnosis Risk of aspiration in critically ill patients. This is a methodological research, carried out in accordance with the references on middle-range theory. The study was operationalized through a scoping review on the subject, followed by the stages of conceptual and operational definitions; pictogram; elaboration of propositions; and, establishment of causal relationships. From 74 included studies, seven risk factors were identified, namely: low headboard, dysphagia, high gastric residual volume, underinflation of the tracheal cuff, inadequate position of the feeding tube, regurgitation, decreased gastrointestinal motility; 11 associated conditions: prolonged presence of orotracheal tube, enteral nutrition, reduced level of consciousness, sedation, reduced and/or absent cough reflex, delayed gastric emptying, gastroesophageal reflux, increased intragastric pressure, reduced laryngeal sensitivity, decreased gag reflex and invasive procedures; and, two populations at risk: elderly and critically ill patients. Its conceptual and operational definitions were established. The pictogram was presented using the Ishikawa diagram. Eleven propositions were created and, finally, the causal relationships between risk factors, associated conditions and the diagnosis Risk of aspiration in critically ill patients were determined. It is concluded that the construction of the middle-range theory on the nursing diagnosis Risk of aspiration in critically ill patients provides a consistent theoretical basis for decision-making and clinical judgment of nurses. It is suggested that further studies be carried out in order to analyze the content of the theory developed and clinically validate its elements. And, thus, continue contributing to the advancement of Nursing as a science and art.