Banca de DEFESA: JESSIKA WANESSA SOARES COSTA

Uma banca de DEFESA de DOUTORADO foi cadastrada pelo programa.
STUDENT : JESSIKA WANESSA SOARES COSTA
DATE: 28/07/2023
TIME: 14:00
LOCAL: DEPARTAMENTO DE ENFERMAGEM (UFRN)
TITLE:

Instrument for identifying transitional care in
adults with Post-Intensive Care Syndrome characteristics.

KEY WORDS:

Nursing; Survivors; Critical Care; Transitional Care; Validation Study.

PAGES: 165
BIG AREA: Ciências da Saúde
AREA: Enfermagem
SUMMARY:

Critical illness is associated with a multitude of heterogeneous conditions,
however, given the imposed hemodynamic instability, it predisposes the individual to
the need for advanced means of life support. In this perspective, individuals who face a
critical illness and a long period of hospitalization in the Intensive Care Unit are
exposed to the development of Post-Intensive Care Syndrome, characterized and related
to physical, cognitive and psychological dysfunctions. Consequently, survivors of the
syndrome and their support network face difficulties in providing care when returning
home and in daily activities, with nursing professionals being one of the main
responsible for training self-care and the support network for hospital discharge. With
this, the objective was to build and validate an instrument to identify transitional care in
adults with characteristics of Post-Intensive Care Syndrome. This is a theoretical study,
of methodological development, with a quantitative approach and use of the
Psychometric Data Theory. The total sample consisted of 194 participants, including 10
judges, 30 Nursing students and 154 assessments of adults with Post-Intensive Care
Syndrome characteristics. Data collection took place between August 2022 and May
2023, after a favorable opinion from the Research Ethics Committee under no
5.388.801. The construction of the instrument was arranged in three stages: Stage 1:
Operationalization of the construct; Step 2: Content Validity and Face Validity; and
Step 3: Construct Validity and Instrument Reliability. The conceptual theoretical basis
is anchored in the Theory of Basic Human Needs and in the Theory of Transition. In
Step 1, the construction of the instrument was carried out based on the theoretical bases
and a Scoping review, which followed the recommendations of the Joanna Briggs

Institute and the checklist Preferred Reporting Items for Systematic reviews and Meta-
Analyses extension for Scoping Reviews. The preliminary version of the instrument had

33 items divided into 5 dimensions. In Step 2, the instrument was submitted to content
validity by 10 judges, in 2 rounds, resulting in a pre-final version with 30 items and 5
dimensions: D1 - Clinical aspects (9 items); D2 – Feeding and physiological
eliminations (4 items); D3 – Mobility, hygiene, comfort and safety (4 items); D4 – Skin
and mucous membranes (4 items); and D5 – Cognitive and psychological (9 items). In
round 1, dimension 5 underwent changes in the writing of item 24, initially written as
“How is the communication?” passing the formulation “How is communication after
admission to the ICU?”, with such modification obtained a Kappa coefficient of 1.00, in
round 2. Still in dimension 5, items 25, 26, 27 and 28 were regrouped as the item “25 -
How is the sensory perception?”, obtaining Kappa with perfect agreement (1.00), the
Operational Guide followed the reformulation changes of the items, without impact on
the operational definitions of the initial version. In face validation, carried out with
judges and Nursing students, the instrument followed the pre-final version without
changes, with perfect Kappa in general analysis, by dimension and items. In Step 3,
regarding construct validity and internal reliability, the instrument proved to be valid
and reliable, with a total Cronbach's Alpha equal to 0.835, not indicating the presence of
redundancy or duplication of it’s items. The assumption of unidimensionality was
verified through the analysis of principal components and it was detected that the first
factor is able to explain 30.1% of the variance, that is, it can be considered that the

instrument has a dominant factor, validating the assumption of unidimensionality and,
therefore, of local Independence. According to the Gradual Response Model, the
discrimination parameter ranged from 0.097 to 3.265. It was found that most items have
a moderate to very high power of discrimination. For factorial validity, the model
quality parameters were evaluated: χ2., CFI, TLI and RMSEA. Thus, analyzing the
statistics of the final model, it should be noted that by TLI and CFI, it is possible to
verify that they presented values above 0.90 (CFI = 0.92 and TLI = 0.90), which
indicates a good fit of model. The RMSEA presented a value of 0.086, below the
maximum limit of 0.10, which also indicates a good model fit. Therefore, the instrument
proved to be reliable and has consistent evidence of content, face and construct validity
to identify transitional care in adults with characteristics of Post-Intensive Care
Syndrome.

COMMITTEE MEMBERS:
Externo à Instituição - ELIABE RODRIGUES DE MEDEIROS
Externa ao Programa - 2553720 - KATIA REGINA BARROS RIBEIRO - nullExterno ao Programa - 3143237 - RAPHAEL RANIERE DE OLIVEIRA COSTA - nullInterna - 347635 - REJANE MARIA PAIVA DE MENEZES
Presidente - 1214075 - SORAYA MARIA DE MEDEIROS
Externa à Instituição - YANNA GOMES DE SOUSA