Atendimento Pré-hospitalar Móvel. Mapeando Riscos e Prevenindo Erros

The attention with safety of the patients is important in the quality of the nursing and health care. In the pre-hospital care, such care is essential on site with the purpose of avoiding possible consequences to the individual, ensuring a fast and appropriate care, with improvement of the morbidity and reduction of the mortality. This medical attention is equally associated with the significant risks of adverse events and serious mistakes, which can be reduced with the awareness of the professionals, organization and quality management. It is a descriptive, transversal research, of quantitative approach, with the objective of identifying the risks for the safety of the patient during the mobile pre-hospital care under the view of the nurses, in a city of the Brazilian Northeast. The sample was formed by 23 nurses. The inclusion criteria: to have at least two years of experience and accept to participate on the research. The data collection was done in two steps, first photo collection, through the adapted method of photographic analysis, and the second with the application of questionnaire, divide in two parts: socio-professional data and digital photo punctuation instrument of the patient s safety. The majority of the nurses had an average working time in the mobile pre-hospital care of six years and six months, in the age group of 38 to 53 years old (69,56%) and with Lato sensu specialization (73,91%), being (29,41%) emergency and (29,41%) in intensive care. The (74%) have the Advance Cardiac Life Support (ACLS) and (100%) have the Pre-Hospital Trauma Life Support (PHTLS); (91, 30%) know the thematic safety of the patient. On the pictures it was observed a bigger variability of the categories (risks) where 44% of variance emerged on the first picture of the research. The pictures 4 and 9 with the average below 5 were classified as very insecure, while pictures 7 and 3 with an average above 7, very secure. On the results of risks observed for the patient s safety in the mobile pre-hospital care five categories emerged: organization and packaging of the equipment and materials, routines and specificities in the mobile pre-hospital care, risks on the management of medications, for traumas and infections. Starting from the analysis of these risks, it was proposed ten steps for the safety in the mobile pre-hospital care: 1- Identify the patient; 2- Safety related to prevention of infection; 3- Safety in the management of medications; 4- Safety and standardization of the packaging of equipment and materials; 5- Attention to the specificities of the mobile pre-hospital care; 6- Incentive and value the participation of the patient and family; 7- Promote the communication with the central of regulation; 8- Prevention of traumas and falls; 9- Protect the skin from additional injuries; 10- Understand the benefit of all the equipment in the ambulance. The multiple risks and their emerged combinations on the research indicate a variety of actions to be developed and stimulated, like the use of steps for the patient s safety in the mobile pre-hospital care which contributes with the aid and management of risks, reduction of mistakes, disabilities and death

Percepção do pai sobre sua presença no nascimento do filho

Coordenação de Aperfeiçoamento de Pessoal de Nível Superior

Relações interpessoais no ambiente de trabalho da equipe de enfermagem: uma ação comunicativa

The current study strives to address the interpersonal relationships of the nursing team from the perspective of the communicative action, by contributing to the health work process. It aims to analyze the interpersonal relationships of the nursing team in its work environment. This is a descriptive study with a qualitative approach. Data collection wal held from interviews, guided by a script with open questions. The study was conducted at a state hospital in the city of Natal/RN/Brazil. The research subjects were the workers of the nursing team, including nurses, nursing technicians and nursing assistants, totaling 16 subjects. The capture of information was performed in April 2012. The project was approved by the Ethics Research Committee, under CEP/UFRN protocol n. º 262/11 and Certificate of Presentation for Ethical Consideration n. º 0289.0.051.000-11. The analysis was performed from the categories that emerged from the research through a dialogue with the authors studied in the theoretical framework of the Theory of communicative action , by Jürgen Habermas, as well as The changing in the world of work, by Ricardo Antunes, and Characterization of the team , by Marina Peduzzi. The outocomes point out that the interpersonal relationship of the nursing team is very troubled, with no interaction among the individuals involved in this process, among themselves and with other health professionals. We have developed a particular concept about team, which is comprised of three essential elements: multiplicity of individuals, common objective and heterogeneity. In the studied environment, it was realized the existence of grouping teams. The interpersonal relationship of the nursing can be a facilitator or an obstacle in the workplace in such a way that causes positive or negative consequences, both to the health workers, and to the sicks. In this context, the interviewees have intensified their viewpoints with regard to the weaknesses that permeate the nursing relationship, by pointing them more frequently than the strengths. The work conditions have signaled a failing situation, which is evidenced by the constant improvisation process before the lack of human and material resources, low wages, deficit in recognizing the nursing worker, and physical and emotional wear, by creating a professional exhaustion. The devaluation of the worker also became a strong factor for this study, because it was characterized a reason of job dissatisfaction, due to the lack of valuation policies, which should be prepared by the institution or, even, they are unknown by the worker itself. The worker participation in the design of these policies has emerged as a relevant factor. The poor work conditions lead the worker to a process of professional demotivation and dissatisfaction, by causing the feeling of devaluation within its work environment. Hence, it was found in this research that the lack of communication leads to situations of inadequate interpersonal relationships, which are creators of an unsuitable environment for the performance of the nursing team

Trajetória de vida de mulheres mastectomizadas integrantes de um grupo de auto ajuda a luz da História Oral

Coordenação de Aperfeiçoamento de Pessoal de Nível Superior

A formação de conceitos no ensino de graduação em enfermagem à luz da teoria da aprendizagem significativa

The Theory of Meaningful Learning (TML) described by David Paul Ausubel offers a proposal for the teaching strategies to provide a more active and effective student learning. The projection of the TML practice is demonstrated through the development of concept maps (CM) technique, created by Joseph Donald Novak, which presents as a strategy, method or schematic feature, which is an indicator to identify the cognitive organization of the knowledge acquired by students. The survey was conducted in the light of TML in relation to learning concepts involving students of undergraduate nursing in a public university in the state of Rio Grande do Norte. Thus, the study aimed to compare the concept learning of students of undergraduate nursing, when subjected to different forms of education, to point approaches that promote more effective and meaningful results. It was a quasi - experimental study with a qualitative analysis, conducted with students of the Undergraduate Nursing of the Universidade Federal do Rio Grande do Norte (UFRN), approved by the Research Ethics Committee/UFRN Certification of Presention for Ethics Appreciation (CPEA) in 11706412.3.0000.5537. The study took place at two different times and involved content on complications mediate postoperative surgical wound in the same discipline with students who attended the 5th semester of the degree course in Nursing. For the viability of data collection, in the second half of 2013, we used the technique of CM, to represent the concept of complications mediate postoperative surgical wound covered in the classroom. CM were built at a different time from that of the discipline, with the support of tutors and preceded by a brief description and explanation about the form of preparation and application. In this study were subjected, 31 students of undergraduate nursing, registered in the discipline of Integral Attention to health I. In the first stage, 18 students participated in the survey, they had the teaching intervention based on TML, and in the second stage, all students participated in the lesson provided curriculum with the responsible teacher of the subject, on the same issue occurred. At the end of each meeting, the students 11 developed concept maps with the aid of software Cmap Tools®. Data analysis happened upon the technique of content analysis, supported by a conceptual map "glass", previously developed by researchers and aid in the preparation of the categories in which the concepts found were classified. The study found that the teaching intervention based on TML with the help of CM, managed to develop in students a more expressive teaching learning process than just classroom curriculum with the traditional teaching method, and also that the association between the intervention motion teaching with the traditional method and the use of the technique of CM encourages the student the ability to articulate the various acquired knowledge as well as apply them in real situations

Acurácia dos indicadores clínicos do diagnóstico de enfermagem volume de líquidos excessivo em pacientes submetidos à hemodiálise

Trasnversal study, with the objective of evaluating the accuracy of clinical indicators of nursing diagnosis excessive fluid volume in patients undergoing hemodialysis. The study occurred in two stages, the first consisted of the evaluation of the diagnostic indicators in study; and the second, the diagnostic inference conducted by nurse diagnosticians. The first stage occurred from december 2012 to april 2013, in a University Hospital and a Hemodialysis Clinic in Northeastern of Brazil, with a sample of 100 chronic renal failure patients on hemodialysis. The data were selected through an interview form and a physical examination, organized into spreadsheets and analyzed as to the presence or absence of the indicators of diagnosis excessive fluid volume. In the second step, the spreadsheets were sent to three nurses diagnosticians, who judged the presence or absence of diagnosis in the clientele searched. This step was conducted from july to september 2013. For analysis of the data, we used descriptive and inferential statistics. In the descriptive analysis, we used measures of central tendency and dispersion. In inferential analysis, we used the tests Chi- square, Fisher and prevalence ratios. The accuracy of the clinical indicators pertaining to the diagnosis were measured as to the specificity, sensitivity, predictive values, likelihood ratios and Diagnostic Odds Ratio. Also developed a logistic regression. The results were organized in tables and discussed with literature. This study was approved by the Ethics Committee in Research of the Federal University of Rio Grande do Norte, with Presentation Certificate for Ethics Appreciation nº 08696212.7.0000.5537. The results revealed that the diagnosis studied was present in 82% of patients. The characteristics with prevalence above 50 % that stood out were: azotemia, decreased hematocrit, electrolyte imbalance, intake exceeds output, anxiety, edema, decreased hemoglobin, oliguria and blood pressure changes. Eight defining characteristics were presented statistically significant association with the nursing diagnosis investigated: pulmonary congestion, intake exceeds output, electrolytes imbalance, jugular vein distension, edema, weight gain over short period of time, agitation and adventitious breath sounds. Among these, the 10 characteristics which showed higher prevalence ratios were: edema and weight gain over short period of time. The features with the highest sensitivity were edema, electrolytes imbalance and intake exceeds output and the standing out with greater specificity were: anasarca, weight gain over short period of time, change in respiratory pattern, adventitious breath sounds, pulmonary congestion, agitation and jugular vein distension. The indicators jugular vein distension, electrolytes imbalance, intake exceeds output, increased central venous pressure and edema, together, were identified in the logistic regression model as the most significant predictors. It is concluded that the identification of accurate clinical indicators allow a good prediction of the nursing diagnosis of excessive fluid volume in patients undergoing hemodialysis in order to assist the nurse in the inference process, which will contribute to the success of patient care. In addition, nurses will consider for diagnostic inference not only his clinical experience, but also scientific evidence of the occurrence of excessive fluid volume, contributing to the control of volemia in these patients

Assistência de enfermagem às urgências e emergências psiquiátricas no serviço de atendimento móvel de urgência em Mossoró-RN

This study aims to identify the concepts of professional nursing team on assistance in urgency and psychiatric emergencies in SAMU in Mossoró/RN, identifying the difficulties in implementing an emergency assistance to the user in psychiatric distress in this service and point strategies in pursuit of consolidation and expansion of comprehensive health care to the public. It is a descriptive research with qualitative and exploratory approach. The subjects were employees of the nursing staff of SAMU of that mentioned municipality. Semi-structured interviews are applied as tool for data collection. It was counted on the consent of the institution where the study was developed and approval by the Ethics Committee in Research of UFRN with CAAE No 17326513.0.0000.5537, besides signing the Informed Free Consent Term by the participants. Data analysis was done by means of thematic analysis proposed by Bardin. Thus , as a result of the research produced the following categories: mechanistic practice; dehumanization of care; need for qualification, barriers to assistance in urgency and psychiatric emergency and strategies in pursuit of comprehensive care, which proceeded in preparing two articles entitled "Nursing care to the emergency room and psychiatric emergencies in the mobile emergency care service" and "Barriers for emergency service and psychiatric emergencies in the mobile emergency care service". In the studied reality it was identified that nursing care offered to users in situations of urgency and psychiatric emergency is made based primarily on the use of chemical and physical restraints, as well as transportation to the general hospital, constantly using the police force support, which meets the guidelines of the Psychiatric Reform and thereby undermining the provision of an effective and humane care. This scenario is worsened by the lack of an organized network of services in mental health, where after the service the user is taken to a general hospital, considering that there is no ready or appropriate psychiatric emergency service as a Center of Psychosocial Care - CAPs III to reference it, thereby precluding the realization of a resolute and comprehensive care. Thus, it is concluded that nursing care is based on biologicist and medicine-centered model advocated by classical psychiatry, and that despite all the advances in psychiatric reform, still guides the mental health care, so the lack of service network organized in hierarchical and mental health, where the user in urgency and emergency service can be watched in full and the guidelines of the psychiatric reform can be realized in practice

Práticas populares de cuidado à criança: o saber/fazer de cuidadoras

Popular practices correspond to the resources used by households, lay people and popular therapists, whose perception of knowledge is constructed in the everyday. In this context, the sick child can become vulnerable to be dependent on a family caregiver, who often decide to employ popular practices. Thus, the child care should be shared between carer and health professional. However, they know little about the resources that the family uses to detect a grievance in infant. Therefore, the present research aimed to analyse the use of popular practices by caregivers of children with zero to five years old. We conducted an exploratory and descriptive study with a qualitative approach, together with 15 caregivers of children who were treated at the Joint Unit Felipe Shrimp, located in Natal, Rio Grande do Norte, Brazil. To select the participants, they should be age and above 18 years; be caregivers of children up to five years of age; and reside in the area ascribed the Joint Unit Felipe Shrimp. The data collection took place between September and October 2013, through in depth interview. This step was preceded by the approval of the Health Department of the city of Natal; the direction of the Joint Unit Felipe Shrimp; as well as, the Committee on Ethics in Research from the Federal University of Rio Grande do Norte with Certificate of Presentation and Consideration Ethics, No 15467013.8.0000.5537. Furthermore, the interviewees formally authorized their participation in the research by signing the consent form. The data were treated according to the technique of content analysis in the form of thematic analysis according to Bardin. This process, four categories emerged: "Types of popular practices used in the care of the child"; "Source of information of popular practices"; "Results obtained with popular practices"; "Factors that hinder the adoption of common practices." The results showed the use of popular practices by caregivers in the case of illness to children such as the homemade preparations with medicinal plants and folk healers. The family environment was referenced as the main learning space and spread of popular practices, which are influenced by cultural relations present in this context. As to the results obtained with popular features, the caregivers said to be satisfactory, and this triggers a feeling of confidence and acceptability of such measures. It is concluded that the use of popular practices in child care persists in everyday most of the participants, despite the hegemony of allopathic therapy. The caregivers stated that such practices are effective and easy to obtain, being secured in context by popular culture. In addition, health professionals, especially nurses, were seldom mentioned by the caregivers as to the information concerning popular resources used by them, which suggests the weakness in dialogic process of negotiating practices between both of them

Estágio supervisionado em enfermagem: visão de preceptores

The present study aimed to analyze the vision of tutors from a university hospital about supervised internship in nursing. It is a descriptive nature research with qualitative approach, developed at the University Hospital Onofre Lopes (HUOL), located in Natal/RN. The population was composed of eleven assisting nurses engaged the precentorship of undergraduate course students in nursing, from the Federal University of Rio Grande do Norte (UFRN). For the empirical research, conducted in the period from September to November 2013, the semi-structured interview involving questions directed to the stage was used, as advocate the national curriculum guidelines, as regards this curricular component. With the consent of the institution where the study has been developed and approved by the Research Ethics Committee of UFRN, as n° 17800613.9.0000.5537, besides CAAE signing an informed consent by participants. The analysis of the information was held from the analysis of content, thematic mode. Thereby four categories were defined a priori, namely: the supervised internship in the vision of nurses; To be preceptor; The internship concerned: contributions and difficulties; Do the institutional actors communicate? The results indicate that in the view of the supervised internship preceptors is a sine qua non for the training of nurses, considering that it prepares for professional life. Besides being a moment conducive to the exercise of management and a greater rapprochement between theory and practice, stimulates the preceptor to upgrade to better exercise the function and also provides an exchange of knowledge between students and tutors, thus contributing to optimize the service. Nevertheless, the respondents indicate the existence of a distancing and little communication with the academic institution. In summary, it is realized that the nurses understand the importance of its function of tutors and supervised stage for vocational training. It is necessary, however, to reflect on the paths to be pinched in the confrontation of difficulties in this process, especially as regards the teaching/service relationship, which, while remaining at a distance, strengthens the existing dichotomy between theory and practice

Atuação e o conhecimento dos profissionais de enfermagem quanto a morte encefálica e manutenção do potencial doador de órgãos e tecidos para transplantes

Coordenação de Aperfeiçoamento de Pessoal de Nível Superior

Investigando o cuidado em equipe de enfermagem em uma UBS da cidade do Natal-RN

On the health area, care is seen as an important concept for professionals. Recently there is a trend, the epistemological point of view, to think carefully as category allowing discuss and re (thinking) practices of humane health care. The objective of this study is to investigate the understanding of care in nursing staff in a Basic Health Unit (BHU) in the city of Natal. The participants were two nurses and two nursing technicians working on the BHU of Guarapes district, located on the west side of Natal - RN. As Theoretical support for data interpretation, was used the concept of care taking, using Heidegger’s theories as reference, through Ayre’s ideas. This is a qualitative research using autobiographical as a methodology. The methodological strategy approach used were focus group and individual interviews. The data were discussed by three angles: knowledge (concepts and theories behind the practical model), technical (the way to do), and ethics (values that bases practices) by hermeneutics Gadamer's dialectic. The results showed the necessity to expand the discussion on care, in practice the understanding of care seems to get narrower concerns with technical success by professionals. The care, as a meeting between beings, the desired humanized care, seems to be understood in parts in theory, but also distances itself from reality in professional practice.

O conforto do idoso em pós-operatório na perspectiva do enfermeiro

Objetivou-se identificar o cuidado realizado pelo enfermeiro para o conforto de pacientes idosos em pós-operatório. Especificamente objetivou-se: 1) Identificar a perspectiva dos enfermeiros sobre os desconfortos nos contextos físico, psicoespiritual, ambiental e sociocultural evidenciados em idosos no pós-operatório; 2) Verificar as características definidoras e os fatores relacionados inseridos ao diagnóstico de enfermagem conforto prejudicado, identificados pelos enfermeiros no idoso em pós-operatório; 3) Identificar as intervenções de enfermagem para promoção do conforto ao idoso em pós-operatório realizadas pelos enfermeiros no seu cuidar. Trata-se de uma pesquisa exploratória, descritiva, de abordagem quantitativa, desenvolvida em um hospital universitário do Município de Natal/RN, Brasil. A população foi constituída pelos 30 enfermeiros que trabalhavam em unidades de internação cirúrgica e terapia intensiva e que prestavam atendimento à pacientes idosos em pós-operatório. Consideraram-se critérios de inclusão: ter tempo mínimo de seis meses de atividade no setor e fazer parte da escala de serviço no período da coleta dos dados. Como critérios de exclusão: estar de licença ou férias no momento da coleta de dados. Toda população formou o grupo de sujeitos do estudo. A coleta de dados foi concretizada em maio e junho de 2014 utilizando um questionário autoexplicativo, composto por quatro partes: I - Caracterização dos enfermeiros; II - Necessidades de conforto do idoso no pós-operatório; III - Diagnóstico de Enfermagem; IV - Intervenções de enfermagem. O projeto foi aprovado pelo Comitê de Ética em Pesquisa (CEP) da Universidade Federal do Rio Grande do Norte, sob CAAE25976613.7.0000.5537. Os dados foram tabulados no Statistical Package for the Social Sciences (SPSS) 20.0 e apresentados utilizando-se frequências, percentuais e medidas de tendência central. Os resultados mostram que 96,7% dos enfermeiros conceituaram conforto como sinônimo de bem-estar. Houve maior frequência do desconforto dor (100%), ruídos excessivos (56,7%), sensação de deslocamento do ambiente residencial (76,7%) e ansiedade (93,3%). Os enfermeiros evidenciaram como sinais e sintomas que caracterizam o desconforto do idoso após cirurgia, principalmente: dor (75,9%), inquietação (58,6%), sinais vitais (41,4%) e ansiedade (34,5%). O principal fator relacionado foi o efeito secundário relacionado ao tratamento (88%). As principais intervenções realizadas foram: ouvir atentamente (100%) e controle da dor (100%). Estas foram igualmente analisadas como prioritárias para esta ação de cuidado, na porcentagem de 76,7% e 66,7%, respectivamente. Conclui-se que os enfermeiros identificam os desconfortos que afetam os idosos no pós-operatório na diversidade dos contextos estudados, com uma ênfase maior aos desconfortos físicos e em especial, a dor. Além disso, possuem uma percepção ampliada sobre os possíveis sinais e sintomas apresentados pelos idosos em pós-operatório quando estão desconfortáveis, uma vez que evidenciam outras 12 características não previstas no Diagnóstico de Enfermagem Conforto prejudicado e também identificam os fatores relacionados a estes desconfortos. Entretanto, apesar de afirmarem que realizam intervenções para amenizá-los e as registrarem, estes dados não podem ser afirmados que se trata de um padrão da prática destes profissionais, uma vez que não foi realizado a observação do cuidado prestado a esta clientela nem avaliação dos prontuários.

Concepções de mulheres com deficiência física sobre a maternidade

The study aimed to understand the concept of women with physical disabilities about their ability to gestate, give birth or care a child. This is an exploratory, descriptive study with qualitative approach developed in three non-governmental organizations in Natal, Rio Grande do Norte, Brazil. The data collection occurred in the period from April to June, 2014, through semi-structured interviews, using a script composed by sociodemographic questions and a guiding one. It was obtained a priori the permission from the association’s directors, the approval from the Research Ethics Committee, of the Federal University of Rio Grande do Norte, CAAE nº 27442814.7.0000.5537 and the assent n° 618.045, as well as the participant’s formal authorization by signing the Informed Consent Statement. Participated in the study 12 women, selected according to the following inclusion criteria: to have physical disability, to be aged 18 to 49 years old, and to affirm the existence of limiting characteristics from early childhood (0-3 years). The information obtained in the interviews were subjected to the precepts of Content Analysis according to Bardin, under the thematic analysis technique. From this process, three categories emerged: Conceiving motherhood in front of disability; Conceiving the capacity to be mother with disability; and Conceiving the support during pregnancy and puerperium period. As the theoretical framework we adopted the principles of symbolic interactionism proposed by Blumer. The discussion was supported by literature findings on women's health care in the context of reproduction. The interviewees conceive motherhood as an accomplishment and believe in their own ability to gestate, give birth and care a child. However, the desire for the maternal role tends to be influenced by adverse feelings and limitations raised by disability, social barriers and prejudices. They also referred the importance of support from partner, family and health professionals in the care of child. Upon these findings, it is understood that although there are barriers to the realization of their desire, these barriers were not enough to make them give up on becoming a mother. Therefore, it is necessary that health professionals, highlighted the nurse, be trained to care for women with disabilities in the context of reproductive health care in order to offer adequate support to their needs

Vivências do pai/ acompanhante no processo da hospitalização do filho

The presence of the man with the hospitalized child is still insignificant and the relationships established in hospitals culminate in several situations that can to influence his experience. The study aimed to analyze the experiences of the parent / caregiver during the hospitalization of their child. In intention to develop the research, it was conducted an exploratory and descriptive qualitative research approach, developed with 11 fathers who accompanied sick childen at the Paediatric Hospital in metropolitan area of Natal, Rio Grande do Norte, Brazil. As inclusion criteria men should be aged 18 years; have favorable emotional conditions to answer the questions are be accompanying his child aged between one to five years old in clinical or surgical. Data collection occurred in March and April 2014, using an interview script. This step prior to the approval of the Health Department of state of Rio Grande do Norte, approved by Universidade Federal do Rio Grande do Norte Committee on Ethics in Research by Certificate of Presentation and Ethics Consideration No. 22821513.1.0000.5537. The data treatment occurred following the content analysis method in thematic modality proposed by Bardin. According to statements the following categories emerged: "The presence of the father in the hospitalization of a child" and "Responsibilities and parental attitudes the hospitalization of a child”, which were analyzed and discussed based on the literature on the family in the hospitalization of the child and considerations about the care of the child. It was founded that the respondents the experienced institutionalization son were inserted in a context of active participation of tasks and sharing responsibilities. Thus it was considered in the study the need of enforcing rights of the father as a family entity in practice of them child care instead of social and gender issues that are still strongly rooted in contemporary society. Given this, it is necessary that the nursing staff consider the various situations faced by man during infant hospitalization with the first fruits of this approach to the care of the son process minimizing the sequelae stemming from being away from the family nucleus

Validação do conteúdo do diagnóstico de enfermagem proteção ineficaz para pacientes submetidos à hemodiálise

Methodological study, in order to validate the content of the nursing diagnosis protection ineffective in patients undergoing hemodialysis. The research took place in two stages, namely: concept analysis and content analysis of the instrument by experts. T he first step was operationalized through an integrative review of the databaes LILACS, CINAHL, PubMed, Scopus and Cochrane, with the key words protection and hemodialysis, in October and November 2013. The sample consisted of 32 articles, which were analyz ed by a c areful reading to identify the sections that correspond ed to the defining attributes , antecedents and consequences of protection in patients undergoing hemodialysis. T he interpretation for the diagnosis of effective protection was made by transpos ing the components of the diagnosis (definition, defining characteristics and related factors) to the denial form . In the second stage, we elaborated an instrument with the components of the nursing diagnostic s studied and proceeded to the analysis conduct ed in April 2014 by 22 specialists in nephrology and in the terminology of the NANDA International, selected by means of th e Lattes Platform . We used the binomial test to assess the proportion of experts who rated each item as appropriate, considering a si gnificance level of 5%. The project was approved by the Ethics Committee of the institution responsible for the research, an opinion on num b er 387 837 and CAAE 18486413.0.0000.5537. The results show that the proposal for the nursing diagnosis of ineffectiv e protection in patients undergoing hemodialysis is: definition - the same as that presented in the NANDA International Taxonomy II, location - domain safety / protection and class injury. Related factors are: Absence of routine vaccines; Non - adherence to care related to vascular access; Non - adherence to infection control measures; Non - adherence to prescribed diet; Non - adherence to drug therapy; Presence of comorbidities; Drug abuse; Immune disorders; Extremes of age; Abnormal blood profiles; Drugs that red uce immunity; and side effects and adverse treatment - related. The defining characteristics are: Presence of invading the bloodstream; Nutritional disorders; Increase in the number of hospitalizations; Uncontrolled dry weight; Infected vascular access; Vasc ular inadequate access; Increased blood pressure; fever; Bleeding disorder; Disability immunity; fatigue; weakness; itching; and maladaptive response to stress. It follows that the identification of the defining attributes, antecedents and consequences inc reased the wealth of vocabulary, allowing the construction of theoretical and empirical definitions for a broader understanding of the concept protection. Furthermore, the study contributed to the enrichment of nursing specific body of knowledge, as well a s in the direction of nursing care for patients undergoing hemodialysis.