Video summary

Curso sobre a RESOLUÇÃO COFEN Nº 736/2024 E A PRESCRIÇÃO DE ENFERMAGEM

Main summary

Key takeaways

Educational

Main ideas and lessons conveyed

  • Telehealth course purpose: Presents a course based on COFEN/COFEM Resolution 736/2024, focused on the Nursing Process—especially nursing prescription as an exclusive nursing responsibility within that process.
  • Nursing identity and autonomy: The nursing process is portrayed as the foundation of nursing’s professional identity—not just routine tasks. Nursing prescription is framed as the “nurse’s exclusive” act, requiring reclaiming its value and visibility across the team (nurses, technicians, assistants).
  • Beyond bureaucracy: The nursing process must be deliberate and systematic across care contexts, and not reduced to paperwork. It begins as clinical thinking and becomes visible through documentation.
  • International-aligned language and practice: The course argues that inconsistent terminology (e.g., systematization vs. nursing process) creates confusion. It advocates aligning with the international concept of the nursing process, supported by standardized classification systems.

  • Five-stage nursing process (updated framing):

    1. Nursing Assessment
    2. Diagnosis
    3. Nursing Planning
    4. Nursing Implementation
    5. Nursing Evolution (evaluation/reevaluation) These stages are cyclical and adapted as the patient’s condition changes.

  • Nursing diagnosis vs. medical diagnosis:

    • Nursing diagnosis focuses on human responses/needs.
    • Medical diagnosis focuses on disease. Nursing prescription responds to nursing diagnoses, not diseases directly.

  • Documentation matters: Documentation in the patient record (physical or electronic) is emphasized as providing scientific/professional safeguard, continuity of care, and enabling research and visibility of nursing practice.

  • Shared care planning: Planning includes a shared care plan with care recipients and the care team, prioritizing nursing diagnoses and outcomes—culminating in the nursing prescription.
  • Nursing prescription definition and role:
    • A nursing prescription is a recorded plan of nursing interventions/actions based on nursing diagnoses, intended to meet human needs and achieve expected outcomes.
    • It includes how/when/where/how often/who will perform actions (with some elements potentially inherent to the unit/protocol).
    • It should be effective, efficient, person-centered, and safe, and it impacts supply planning, people management, and system costs.
  • Standardized languages/classifications: Uses and recommends tools such as:
    • NANDA (nursing diagnoses structure)
    • NOC (expected outcomes—mentioned)
    • NIC / NCI (nursing interventions taxonomy)
    • NCI (NIC) 2020 described as having 7 domains, 30 classes, 565 interventions, and ~13,000 activities/actions.
  • Practical selection of interventions: When prescribing, nurses should select interventions based on:
    • the diagnosis structure
    • related/risk factors and defining characteristics
    • best available evidence
    • practicality and availability in the service
    • patient acceptance
    • nurse competence
    • and contextual protocols/resources.
  • Case-based training: Examples show how assessment leads to diagnosis and then to prescription, including:
    • selecting interventions using NIC (e.g., constipation)
    • building a prescription for a case with multiple needs (anxiety, nutrition imbalance, and fluid/sedentary risks)

Methodology / “how to do it” (detailed bullet instructions)

A) Build the nursing process correctly (conceptual workflow)

  1. Start with nursing assessment

    • Collect subjective data (interview/anamnese).
    • Collect objective data (initial and continuous physical examination).
    • Identify relevant information about family/community/special groups when applicable.
    • Use instruments when helpful (e.g., scales, protocols), but note assessment can be done even without specialized tools (e.g., using a blank record form).
    • Purpose: obtain information to understand nursing-relevant needs/responses, not merely to “request tests.”

  2. Formulate the nursing diagnosis

    • Nursing diagnoses represent needs/human responses identified by the nurse via clinical judgment.
    • Nursing diagnoses should be derived from assessment data and expressed according to standardized logic.
    • Emphasis: nursing diagnosis addresses what nursing must address, not the disease diagnosis (medical).

  3. Plan care (nursing planning stage)

    • Develop a shared care plan with the patient (and family) and the team.
    • Prioritize nursing diagnoses (avoid listing many diagnoses without choosing what matters first for the patient).
    • Define achievable expected outcomes.
    • Decide on the nursing prescription through clinical decision-making.

  4. Implement the nursing prescription

    • Execute the care plan and check execution of what was prescribed.
    • Ensure prescriptions are implemented by appropriate team members under nursing supervision/guidance.

  5. Evolve/evaluate

    • Evaluate results and patient health status.
    • Reassess priorities when the clinical condition changes.
    • Update nursing assessment/diagnosis/prescription as needed (cyclical process).

B) Write a nursing prescription (practical elements)

Ensure the prescription is:

  • Indicated and recorded by the nurse (exclusive nursing responsibility).
  • Based on nursing diagnosis and aligned with expected outcomes.
  • A plan coordinating the nursing team’s actions to meet needs within nursing responsibility.

Include, when applicable:

  • What to do
  • How to do it
  • When to do it
  • Where to do it
  • How often
  • For how long
  • Who should do it

Accept that some elements may be inherent to the care setting (e.g., technician-specific monitoring routines per unit norms), but still link them back to the diagnosis and assessment logic.

C) Nursing diagnosis structure (NANDA logic referenced)

For composing a nursing diagnosis, include:

  • Problem-focused diagnosis statement
  • Related factors (causal/contributing elements)
  • Risk factors (vulnerability elements that can lead to the problem)
  • Defining characteristics (signs/symptoms or clinical evidence)

D) Select NIC/NCI interventions correctly

Use NIC/NCI by:

  • Identifying the relevant domain/class/intervention matching the diagnosis.
  • Selecting actions appropriate to the case’s etiology/risk factors and outcomes.

Choose interventions considering:

  • expected outcomes tied to the diagnosis
  • best available evidence
  • service practicality and available resources
  • patient acceptance and preferences
  • professional competence/skills

E) Example logic shown in the training

  • Constipation example

    • Assessment indicators → constipation diagnosis (including distinctions such as “perceived constipation” when the patient self-recognizes and uses laxatives).
    • Expected outcome → constipation improvement and reduced laxative use.
    • Prescription includes education (diet, fluid, activity), monitoring signs/symptoms, and scheduled reassessment.

  • Pediatric/anxiety/psychosocial case example

    • Identify three priority nursing diagnoses.
    • For each: define outcomes and propose interventions (e.g., therapeutic listening; nutritional guidance; encouragement and health education related to exercise and motivation).

Additional contextual points discussed (legal/organizational aspects)

  • Team collaboration: Technicians/assistants document observations and execute prescribed care under nursing guidance, supporting data collection for diagnosis/prescription.
  • Common barrier identified: Many services treat “nursing” as only procedures/technocratic tasks, leading to underuse of nursing diagnoses and prescription documentation.
  • Emergency/UPA and high demand: Guidance implies prioritizing patient needs/diagnoses in emergencies and recording nursing priorities within competence.
  • Protocols and service agreements: For medication requests, exam requests, and procedures, execution must respect:
    • institutional/service protocols
    • municipal/SUS agreements
    • legal competencies (referenced laws/decrees)

Clarifications discussed (from coordinators):

  • Nurses prescribing medications require institutional protocols.
  • Nurses requesting certain tests is competence-dependent and must align with protocols accepted by laboratories/municipalities and with SUS/private agreements.
  • Aspiration competence example (resolution referenced):
    • For acutely ill ICU patients leaving ICU → aspiration should be nurse-performed (as described in the coordinator’s clarification).
    • For chronic patients with long-term use → technician may perform (per the same referenced clarification).

Speakers / sources featured (identified in subtitles)

  • Dr. Diego Dias Araújo (tenured professor; collaborating researcher; main instructor)
  • Maria do Socorro Pena (vice-president of COREN MG)
  • Bruno Fis (referred to as President of COREN/COREN MG in the message)
  • Andreia (representative/coordinator of technical chamber; key listener/source)
  • Luciana (nursing technician; participant question/story; pediatrics/tracheostomy context)
  • Silvana Aparecida Penha (participant question about standardized nursing care in ER context)
  • Paloma (participant question about standards of care / UPA)
  • Fernando (participant question about who nursing notes are for)
  • Participant identified as “Daane” (question about exam requests in imaging clinics)
  • Davi from Bahia (mentioned as someone to join a future discussion/live stream)
  • Conrado from Minas (mentioned similarly for a future discussion/live stream)

Sources and references repeatedly cited:

  • COFEN Resolution 736/2024
  • Resolution 358/2009
  • Law 7498 and Federal Decree 94406
  • NANDA (nursing diagnosis elements)
  • NOC (outcomes taxonomy)
  • NCI/NIC (International Classification of Nursing Interventions; taxonomy described)

Original video