Instrumento para identificação dos cuidados de transição em adultos com características da síndrome pós-cuidados intensivos

Abstract

Critical illness is associated with a multiplicity of heterogeneous conditions, however, given the imposed hemodynamic instability, it predisposes the individual to the need for advanced means of life support. From 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 care during their return home and in daily activities, with the nursing professional 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 individuals with characteristics of Post-Intensive Care Syndrome. This is a theoretical study, of methodological development, with a quantitative approach and use of Psychometric Data Theory. The total sample consisted of 194 participants, including 10 judges, 30 Nursing students and 154 evaluations on individuals with characteristics of Post-Intensive Care Syndrome, with data collection between August 2022 and May 2023, after a favorable opinion from the Research Committee. Research Ethics 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 the Theory of Transition. In Stage 1, the instrument was constructed based on theoretical bases and a Scoping review, which followed the recommendations of the Joanna Briggs Institute and the Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews checklist. The initial version of the instrument had 33 items distributed across 5 dimensions. In Stage 2, the initial instrument was submitted to content validity by 10 judges, in 2 rounds after adjustments the instrument was reduced by 3 items. 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 Stage 3, in 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 its items. The assumption of unidimensionality was verified through principal components analysis, and according to the Gradual Response Model, the discrimination parameter ranged from 0.097 to 3.265. It was found that most items have moderate to very high discrimination power. Factorial validity, model quality parameters were evaluated: Chi-square test, Comparative Fit Index, Model Adequacy Index and Mean Square Root Index of Approximation Error. Therefore, analyzing the statistics of the final model, the tests described previously indicated a good fit of the model. Therefore, the instrument proved to be reliable and with consistent evidence of content, face and construct validity to identify transitional care in individuals with characteristics of Post-Intensive Care Syndrome