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No previous study has investigated the predictive risk factors of the nursing diagnosis of risk for decreased cardiac output after coronary artery bypass grafting (CABG).This study aimed to identify the predictive risk factors of the nursing diagnosis of risk for decreased cardiac output after CABG.This was a prospective cohort study performed at a cardiac university hospital in São Paulo, Brazil and 257 adult patients undergoing CABG were included. Potential risk factors for low cardiac output in the immediate post-operative period were investigated using the patients' medical records. Univariate analysis and logistic regression were used to identify the predictive risk factors of decreased cardiac output. The area under the receiver operating characteristic curve was calculated as a measure of accuracy. The variables that could not be analysed through logistic regression were analysed through Fisher's exact test.One hundred and ninety-five patients had low cardiac output in the immediate post-operative period. The predictive risk factors included age ⩾60 years, decreased left ventricle ejection fraction, not using the radial artery graft, positive fluid balance and post-operative arrhythmia that differed from the pre-operative arrhythmia. This model predicted the outcome with a sensitivity of 62.9%, a specificity of 87.2% and an accuracy of 81.5%. The variables analysed through Fisher's exact test included heart failure, re-exploration and bleeding-related re-exploration.The predictive risk factors for the nursing diagnosis of risk for decreased cardiac output after CABG were found. These results can be used to direct nurses in patient monitoring, staff training and nursing team staffing.

The authors discuss some aspects of the concepts of values such as health and illness, theory and practice, professional power, image and space whith are the determinant factors of the concept of Nursing here presented.

As autoras discutem aspectos relacionados aos conceitos de valores, saúde e doença, teoria e prática, poder, imagem e espaço profissional, como fatores determinantes da conceituação de Enfermagem proposta no trabalho. The authors discuss some aspects of the concepts of values such as health and illness, theory and practice, professional power, image and space whith are the determinant factors of the concept of Nursing here presented.

A impotência, como uma das possíveis respostas psicossociais ao adoecer, caracteriza uma necessidade de cuidado de enfermagem. A descrição dos indicadores dessa resposta em pacientes pós-operados por insuficiência coronariana e disfunção valvar foi o núcleo do presente estudo. Os objetivos foram: descrever a impotência quanto à freqüência, intensidade e características definidoras, comparar a impotência (freqüência e intensidade) e o “locus de controle" entre os pós-operados por insuficiência coronariana e disfunção valvar, verificar a existência de associação entre impotência e o “locus de controle" nessa amostra. A coleta de dados foi feita por entrevista com base em dois instrumentos: o primeiro construído especificamente para este estudo, para avaliar a impotência, e o segundo foi a Escala de Locus de Controle da Saúde de WALLSTON, K.A; WALLSTON, B.S; DEVELLIS (1978). Houve um julgamento quanto à presença e intensidade do diagnóstico impotência. As dimensões avaliadas pela Escala de Locus de Controle foram: interno, externo e acaso. Esses procedimentos foram realizados junto a 75 doentes, sendo 45 com insuficiência coronariana e 30 com disfunção valvar, sendo 62,7% do sexo masculino; idade média de 57,2 anos; escolaridade média de 6,4 anos; tempo médio de pós-operatório à coleta dos dados de 7,5 dias. Dos 75 pacientes, 44 apresentaram impotência (leve=20; moderada= 15 e intensa= 9). Das 17 características definidoras estudadas, 12 foram significativamente mais freqüentes em nível de 5% de significância nos doentes com impotência. As proporções de impotentes nos dois grupos de pacientes com insuficiência coronariana e disfunção valvar foram semelhantes, não havendo diferenças estatisticamente significantes (p=0,848). Os pacientes pós-operados coronarianos acreditavam mais em fatores internos como fonte de controle dos que os pacientes de disfunção valvar (“locus" interno p=0,001; internalidade total p=0,002) Não houve associação entre impotência e “locus de controle" em nível de 5%, sugerindo que as dimensões de “locus de controle" não são atributos isolados essenciais do conceito de impotência. Os resultados deste estudo permitiram estabelecer outras questões de pesquisa e corroboram a importância do desenvolvimento do conhecimento sobre as respostas psicossociais do doente em situações médico-cirúrgicas. Powerlessness as one of the possible psychosocial responses of illness, characterizes a necessity for nursing care. The description of the indicators of this response in post-operative patients with coronary insufficiency and valve dysfunction was the core of this study. The objectives were: to describe powerlessness (frequency and intensity), and the “locus of control" between the post-operated patients for coronary insufficiency and valve dysfunction, and to verify the existence of association between powerlessness and the “locus of control". The data were obtained by means of interviews based on two tools: the first one was organized specifically for this study to assess powerlessness, and the second was the “Locus of Control Health Scale" of WALLSTON, K.; WALLSTON, B.S; DEVELLIS (1978). The presence and intensity of powerlessness was judged by the author. The “locus of control" dimensions assessed were: internal, external and chance. These procedures were carried out on 75 patients of which 45 had coronary insufficiency and 30 had valve dysfunction; 62.7% were male with mean age of 57.2 years; average schooling of 6.4 years; mean post-operative data collection time of 7.5 days. Of the 75 patients, 44 presented powerlessness (low=20; moderate=15; severe=9). Of the 17 defining characteristics studied, 12 were significantly more frequent (p0.05) for powerless patients. The proportion of powerlessness in the two groups (coronary insufficiency and valve dysfunction) were similar (p=0.848). The post-operated coronary patients believed more in internal factors than the patients with valve dysfunction (“internal locus" p=0.001; “total internality" p=0.002). There was no association between powerlessness and “locus of control" (p0.05), thus suggesting that the dimensions of “locus of control" are not, in essence, isolated attribute of the concept of powerlessness. The results of this study permitted further questioning of research and corroborated the importance of knowledge development on psychosocial responses of patients in medical-surgical situations.