REVIEW PROTOCOL

Suggested for Nursing process mapping tools for individuals with dermatological conditions: scoping review protocol

Flávia da Silva Gatto1, Euzeli da Silva Brandão1, Daniely Maillard Monteiro1

1Universidade Federal Fluminense, Niterói, RJ, Brazil

ABSTRACT

Objective: To propose a mapping of tools to operationalize the Nursing Process for individuals with dermatological conditions in health care. Method: This is a scoping review protocol guided by the Joanna Briggs Institute (JBI) methodology, with the review question: What tools are available to operationalize the nursing process for people with skin disease in health care settings? Databases to be used will include the Virtual Health Library Portal, CINAHL, MEDLINE, PubMed, Cochrane Library, Embase, and grey literature. There will be no time frame, language, or study location restrictions. Two independent reviewers will screen studies, and disagreements will be resolved by consensus or by the decision of a third reviewer. Data will be extracted using a specially developed data collection instrument. The results will be presented in graphs, tables, or flowcharts, accompanied by a narrative discussion, and aligned with the objective of this scoping review.

Descriptors: Nursing Process; Nursing Records; Skin.

INTRODUCTION

Skin conditions or diseases encompass various changes in the skin and its appendages, with different manifestations and varying complexity and severity. They can indicate the presence of systemic disorders and affect people of all ages and social classes, causing not only physical but also social, mental, and spiritual disturbances(1).

The increase in skin diseases worldwide has become a public health problem. It has a significant economic impact on individuals and society and a negative impact on the quality of life of those affected(2). In the United States alone, skin diseases cost the public more than $39.3 billion annually(3).

In Brazil, according to the Brazilian Society of Dermatology (SBD), skin diseases are among the top three reasons for seeking health care(4). According to the Brazilian National Cancer Institute (INCA), skin cancer is the most common cancer in Brazil, accounting for 30% of all malignant tumors(5). The Epidemiological Bulletin of the Brazilian Ministry of Health (MS) reported that in 2021, 18,318 new cases of leprosy were diagnosed in Brazil, making it the second country in the world with the highest number of cases(6). In São Paulo, a 2017 study of 855 dermatology patient records found that the most common diagnoses were acne and melasma (11%), onychomycosis (9.12%), dermatosis papulosa nigra (6%), psoriasis and vitiligo (4%), and seborrheic keratosis (3%)(3).

Given the country's shortage of dermatology specialists, such data make caring for this specific clientele challenging for generalist nurses(7). According to the Brazilian Society of Dermatology Nursing (SOBENDE), only 80 nurses were certified between 2002 and 2018(8). Assessing individuals with skin diseases requires specific and specialized knowledge beyond the competencies developed during undergraduate education(4).

As a result, nurses face various dermatologic care challenges throughout their careers, from prevention to skin health restoration. The lack of specific and individualized care for this clientele may contribute to their vulnerability to biological, psychological, and social risks(9).

Therefore, there is an urgent need to adopt strategies to guide comprehensive, person-centered assessments by nurses to facilitate the identification of common nursing diagnoses in individuals with skin diseases, the appropriate nursing interventions, and the re-evaluation of the results obtained. This approach is in line with the Professional Practice Act(10) and Resolution No. 736/2024(11) of the Brazilian Federal Nursing Council (COFEN), dated January 17, 2024, which mandates the implementation of the nursing process in all socioenvironmental contexts where nursing care is provided.

The nursing process must be conducted deliberately and systematically in each socio-environmental context in which nursing care is provided. It should be based on theoretical support that may include a combination of nursing theories and models, standardized language systems, validated risk assessment tools, evidence-based protocols, and other related knowledge, such as conceptual and operational theoretical structures that have descriptive, explanatory, predictive, and prescriptive properties as their foundation. As highlighted in Resolution No. 736 of January 17, 2024(11), the nursing process is organized into five interrelated, interdependent, recurrent and cyclical stages: 1) Nursing Assessment, 2) Nursing Diagnosis, 3) Nursing Planning, 4) Nursing Implementation, and 5) Nursing Evaluation. Of these stages, nursing diagnosis and nursing prescription are the exclusive responsibility of the nurse. Nursing technicians and nursing assistants, under the supervision and direction of the nurse, participate in the nursing process through the preparation of nursing notes, the implementation of prescribed care, and its verification.
Legally, as established in COFEN Resolutions No. 736/2024(11) and No. 429/2012(12), one of the members of the nursing team's responsibilities is to document their professional actions in the patient’s file or other appropriate documents. This contributes to the continuity and quality of the care provided.

Detailed information recording is critical as it directly affects the quality and continuity of care, facilitates effective communication between nursing and the multidisciplinary team, and is a safe tool for clients and professionals(13). In this context, it is the nurse's responsibility to document all stages of the nursing process. In contrast, nursing team members are responsible for nursing notes, reviewing prescriptions, and establishing other nursing-specific records(11). This practice contributes significantly to increased visibility, professional recognition, and the ability to evaluate nursing practice(14-15).

A preliminary search of the Medical Literature Analysis and Retrieval System Online (MEDLINE) databases via PubMed, Cumulative Index to Nursing and Allied Health Literature (CINAHL), SCOPUS, Joanna Briggs Institute (JBI) Evidence Synthesis, Open Science Framework (OSF), and the Cochrane Library was conducted on August 31, 2023. No completed or ongoing review studies were identified that focused on the nursing process for dermatology clients.

Considering the impact of skin diseases, where the care of individuals with skin diseases requires a comprehensive and individualized assessment, and recognizing that failures at any stage of the nursing process have a direct impact on the quality of care provided, the following research question arises: “What tools are available to operationalize the nursing process for individuals with skin disease in health care settings?”

Thus, this scoping review aims to present a proposal for mapping the tools used in operationalizing the nursing process for people with skin disease in health services.

METHOD

This is a scoping review protocol registered on Open Science Framework (OSF) under the identifier DOI 10.17605/OSF.IO/KN6VW, guided by the JBI methodology and conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR) checklist(17). According to the JBI manual(15), this model is used when the intent is to explore the breadth of the literature, map and synthesize the evidence, and inform future research(16).

Review question

The PCC mnemonic was used to formulate the research question, where P stands for population: individuals with skin disease; C stands for concept: tools to operationalize the nursing process; and C stands for context: health care services.

Inclusion criteria

Participants

Studies involving adult individuals of both sexes with a medical diagnosis of a dermatological disease will be considered.

Concept

Studies addressing the tools used to operationalize the stages of the nursing process, either physical or electronic, professionally validated or not, will be included.

Context

Serão considerados os estudos realizados nos diversos cenários e níveis de atenção à saúde, desde cuidados ambulatoriais a níveis complexos de cuidados.

Source types

This scoping review will consider systematic reviews, meta-analyses, randomized and non-randomized clinical trials, quasi-experimental studies, and observational studies (cohort studies, case-control studies, and cross-sectional studies). Dissertations and theses, handbooks, guidelines, and recommendations from professional societies are also included. In addition, articles from the references of selected studies may be included.

There will be no time frame, language, or study location restrictions.

Exclusion criteria

Publications not available in full text and/or that do not provide a complete or detailed description of the instrument will be excluded.

Search strategy

The search will be conducted in three stages, as recommended by JBI, with librarian assistance. To construct a comprehensive search strategy, the first stage included an initial search of two online databases: MEDLINE and CINAHL, using the following descriptors: “dermatology” AND “nursing” AND “nursing process” OR “nursing records.” This preliminary search allowed exploration of the titles and abstracts of all retrieved articles.

Therefore, during the second stage of the scoping review, the following databases will be searched Virtual Health Library (VHL) Portal, CINAHL, MEDLINE, PubMed, Cochrane Library, and Embase, using all the keywords and index terms identified in the first stage. In addition, a grey literature search will be conducted through Google Scholar, Scientific Electronic Library Online (SCIELO), La Referencia, and Oasis. br. The databases and search strategies to be used are described in Figure 1.

Figure 1 – Search strategies for databases. Niterói, RJ, Brazil, 2024

In the third step, the reference lists of the publications identified and included in the review are examined. If necessary, the reviewers may contact the authors of primary sources or reviews to obtain additional information.

Selection of the source of evidence

The studies retrieved by the search strategies are organized and imported into the Endnote Web reference manager to remove duplicate studies. They are then exported to the Rayyan software for title and abstract screening. Eligible studies are organized to identify those with full-text availability.

Two independent reviewers will screen these studies, and any disagreements will be resolved by consensus or by the decision of a third reviewer. Screening will be based on this review's inclusion and exclusion criteria.

The entire review process is accompanied by the PRISMA-SCR flowchart, which details the review process.

Data extraction

Data will be extracted from the studies included in the scoping review using a data collection instrument developed by the authors. This instrument will include the following relevant information: title, authors, country, language, year of publication, type of study, objectives, context, participants, and tool used to operationalize the nursing process (Figure 2).

Figure 2 – Data collection instrument. Niterói, RJ, Brazil, 2024

A pilot test will be conducted with 3 studies to ensure all relevant results are extracted by the reviewers when completing the instrument. If necessary, adjustments will be made and reported in the final version of the review.

Analysis and presentation of results

The data collected will be presented in graphs, tables, or flowcharts accompanied by a narrative discussion consistent with the objective and research question proposed in this scoping review.

ACKNOWLEDGMENTS

We would like to thank the Brazilian Federal Nursing Council (COFEN) and the Brazilian Coordination for Superior Level Staff Improvement (CAPES).

CONFLICT OF INTERESTS

The authors have declared that there is no conflict of interests.

FUNDING

This paper was carried out with the support of the Coordination for Superior Level Staff Improvement - Brazil (CAPES). Finance Code 001.

REFERENCES

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Submission: 02-Nov-2023

Approved: 04-May-2024