Episode Summary

In this episode of NandaCast, Dr. Camila Takao-Lopes interviews Dr. Pedro Melo, discussing the challenges and advancements in nursing diagnoses, particularly focusing on the Nanda International Classification and its application in community health. Dr. Melo shares insights from his extensive experience in family and community health, emphasizing the importance of integrating scientific evidence into nursing practice and the role of nurses in transforming community health.

Neste episódio do NandaCast, a Dra. Camila Takao-Lopes entrevista o Dr. Pedro Melo para discutir os desafios e os avanços nos diagnósticos de enfermagem, com foco especial na classificação da NANDA International e em sua aplicação na saúde comunitária. O Dr. Melo compartilha insights de sua ampla experiência em saúde da família e comunidade, destacando a importância de integrar evidências científicas à prática de enfermagem e o papel dos enfermeiros na transformação da saúde comunitária.

Takeaways:

• Os enfermeiros desempenham um papel fundamental na transformação da saúde comunitária.
• Integrar evidências científicas é essencial na prática de enfermagem.
• O envolvimento da comunidade é a chave para intervenções de saúde eficazes.
• Os enfermeiros devem compreender tanto os processos de saúde intencionais quanto os não intencionais.
• O modelo MAIEC auxilia na avaliação da saúde comunitária.
• Os enfermeiros devem abraçar tanto o conhecimento tecnológico quanto o teórico.
• A enfermagem do futuro deve equilibrar abordagens biomédicas e holísticas.

About Our Guest: 

PhD in Nursing

Pos-Doc student in Technology in Health at PUCPR, Brazil

Master's in Sexology at Porto University, Portugal

Specialist in Community Health Nursing and Family Health Nursing

Professor at University of Porto, School of Nursing, Portugal

Principal Investigator in MAIEC Lab at RISE-Health Research Centre, Portugal

About NANDA:

Welcome to The NANDACast, the podcast where nursing knowledge meets practice!  

Created for clinical nurses, educators and nursing students, this podcast dives into the heart of evidence-based nursing diagnoses and their critical role in delivering safe, effective, and patient-centered care. 

Brought to you by NANDA International, we’re here to facilitate the development, refinement, and use of standardized nursing diagnostic terminology. Our mission? To provide the tools and insights nurses need to communicate their clinical decisions, determine interventions, and improve patient outcomes. 

Whether you’re a seasoned nurse navigating complex care environments, a student preparing for the challenges of the profession - or an educator working to support student learning, The NANDACast delivers practical knowledge, expert conversations, and inspiration to elevate your practice and amplify your impact. 

Join us as we explore the power of words, the strength of knowledge, and the future of nursing. Let’s define the profession together—one diagnosis at a time.

Welcome to NandaCast. I am your assistant, Dr. Camila Takao-Lopes, Director of the Diagnostic of Nanda International and Professor of the São Paulo Federal University's Paulist Thank you for participating. Today I would like to introduce Dr. Pedro Mello, who been of disease at the University of Portuguesa since 2016.

and post-doctorate in Health at Pontifical Catholic of Paraná, Brazil. He is specialist in Family Health and is the of MAIEC, the Community Intervention Evaluation He a joint at the University of Porto's an Integrated at the Rise Health and a Main at MAIEC-LAB.

Thank much Dr. Camila, it's a pleasure to here with you and congratulations for this initiative by Nanda International. It's an excellent initiative to dialogue with all the people who are with us. Thank you.

We thank you. I would to know if you could talk a little bit your professional and how you involved with Ananda Ip.

Of pleasure. I start by talking about my involvement with Ananda Yi. In fact, started when I did my initial I started in 1998 and at the time we still called ourselves Taxonomy Ananda Yi. It the that was taught in the nursing And so I started by learning to do diagnosis of disease using Ananda Yi And since then, even when we went to

what we to testages, now we them lessons, was Ananda I, who was a reference for making our care either in hospital either in primary as they in Brazil, or primary as we in Portugal. And since then I have in love with the primary care area, primary health And so I started to specialize in a specialty that was called community

It my first specialty. Nowadays in Portugal we differentiate two areas, we community and public and family health. I end up having the two specialties because I the that was more comprehensive, community health, and now I family health. And I can't tell Camila, I'm going take the teacher away now if I don't care, Camila, I can't tell which one I love because I'm in with both areas.

And since then I have been 25 years. I worked for many years as a family this is the designation we give here Portugal. And then I to a public where I started working in public And then in Portugal there was a primary care therefore primary and different units in primary

The USF, are the family the UCC, which community and the USP, I'll just say these three that are the most relevant, the USP are the health So I started working in a public and then I started working in a UCC, care where I was responsible for the school So I was a health I worked with schools from pre-school.

the younger children, until secondary was our program expected, until they 17 or 18 years old. So I followed children from 3 years old to 18 years old for a few years. And then I went through with PhD, I started doing research in area of community which was area I studied, and I ended up going through for education and research. And started working at the Portuguese in 2012, where I worked

A very beautiful and interesting We know that there some challenges for the effective of the Anandaí in Portugal. What would be, in your opinion, the main challenges of Portuguese for the systematic of our classification in Portugal?

It's a very important and interesting Camila. In fact, Portugal, since 2000, maybe one or two years before, but I'll put here goal of 2000, of the year 2000, we started using CIP, that the International Classification for the Practice of Nursing, and our information therefore all clinical use CIP, therefore don't use classification at all, now we call it classification.

They use And that's a challenge because even in teaching, despite continuing to learn, to use the different taxonomies and classifications, then in clinical context our students face the use of SIP, so it's the that becomes more familiar. We here at the University of Porto and the of Nursing are currently developing, some years ago, there is a specific research for that.

are developing the ontology of the disease, which is a classification or classifications, that will integrate our information and that will drink from the different taxonomies and classifications. It has concepts and elements of NANDA, CIP, SNOMED, and on. And our students end up using this tax...

is a taxonomy. This system of clinical decision-making based on different taxonomies and classifications is called F.O. Nursing, is the name of the platform that our students use to do their diagnosis and their interventions. And soon it is hoped that will the ontology that is in the information systems in Portugal. There are other European also investing in this new ontology of information.

So I would say that there is no loss of opportunity for our students and nurses to use the Nanda because in fact she will be, for sure, she is already in Narsimontos, in this new way of looking at the ontology of the information, but I not say that we will exclusively use Nanda, and now not even NIC, not even NOC, also about the interventions and the results. What brings us here is Nanda, in fact.

Therefore, great challenge is for nurses and students to understand that the clinical of the disease, regardless of the classification they use, requires a technical or scientific that must be stressed in the investigation and in production of better evidence. And that happen. are certain classifications and taxonomies that are even included in the information

but that when we look for the source, the evidence that supports that diagnosis, it is poor, we don't find much wealth. Which doesn't happen There is no diagnosis of Nanda that doesn't go through a research that promotes its technical and scientific This is a great plus value that Nanda has and that I have sought, as an activist of a diagnosis and interventions and results, of course.

based on the best evidence, tried to pass on to our students and nurses. That's why these are the Camila, we are going through. Not only in Portugal, I in Europe, but Portugal particular is going through these challenges in relation to Nanda. Yes.

Thank you for your answer. Nanda has been used during the teaching of the right? I would like to know your opinion about how they can contribute to the diagnosis of Nanda, how they can contribute to the development of clinical in the formation of these nurses, what is the relevance of the teaching of clinical and how our Nanda can contribute to this teaching.

can contribute a lot. I may start by saying that the definition I defend of infirmary, and that is in one of my books, which is precisely called Consultations of Infirmary in the Health Care of Primary Guides of Clinical Decision, I have there a definition that is the that I really is the definition of infirmary, I defend that infirmary is the science and profession that studies as science, diagnoses, prescribes and intervenes.

in the firmness and weakness of human beings. And considering this concept, which has been me for many years, a clinical inserted in this concept helps us understand that nurses are different from all other health because when we diagnose the firmness and weakness of human beings, are talking about diseases. Of course, diseases can be into weaknesses, but look...

I may have ended up being father and not have power to exercise my parentality fully and that is a sickness, not a disease. Or I may even have a chronic imagine diabetes, but already having this disease 50 years ago and using infirmary for example, Amelie's, who defends the theory of transitions, I may already have a fluid, integrative masterly in management of this chronic

and despite being a chronic I am not sick in this relation with this chronic So I would say that nurses are present as no other profession in lives of human beings and in their firmness and firmness since they are born until they die and even after death because we have to of the family in post-death and we also take of the body of the person who died. So the disease is really I am completely in with the disease. Camila is really

science and profession that I find most fascinating in world of health. And diagnosis of the disease, of contributes a lot to the development of this clinical when a nurse, I will even with the student, when a student is developing a process of learning the clinical if they have an organized of clinical that helps them understand that a diagnosis of disease needs to data

are diagnostic based on the investigation, which tells that when that data is demonstrated, that diagnosis will have that clinical presented on a focus. This is very relevant so that later, when the student transfers that knowledge to clinical continues to be a nurse or excellent nurse and that helps our customers. I know there people who don't like the expression client, but I like it.

Our clients are that the nurse is at that moment using the data not in any way, but because the data is relevant and is criteria for him to a diagnosis that will make the difference in the life of that human person, who is our client. And nurses still need to improve their marketing of their diagnosis, telling people without fear what are the diagnoses that emerge

of their clinical with people who are the of their care, because unfortunately it unnoticed. Our clients pay a lot of to the techniques, they that nurses evaluate data, for example, the blood or they put a serum in the course, if we are in training, for example, but they don't even realize that all these interventions are involved in clinical and that when we decide

together with the client, make a certain prescription, negotiation for an intervention, it comes from a diagnosis that should be shared with the client, because he doesn't guess, he doesn't know that there a diagnosis. And this is a fight that I have had very much with our students and with our colleagues too, when I reflect with them, is that we must always say, I sometimes use the word return, the diagnoses to people, because the diagnoses are theirs, we are the bridge.

for her to a well-formed I don't know if I Camila, but I think is really fundamental to defend a well-structured

Yes, she I was paying attention to your definition of disease, of clinical in disease, and establishing a parallel with our definition of human to health and life processes that we use in Nanda. I was thinking about your work.

and how you have developed a significant in the community if you could share with us how classification of Nanda has been applied in this specific of community

We are still in development. Looking at the Nanda for example, one of areas I have worked on since 2016, related to community process. And the moment, the community process in Nanda is stressed in the new that has to with confrontation and tolerance, which makes some sense, we need to reflect on the first domain, health promotion.

related to welfare and also to disease prevention, course, if it doesn't make sense for think this community process, and I'm talking about it in the logic of the research I have developed, of It helps us understand that citizens, our clients, need to improve their leadership, their knowledge, example, in their beliefs, their decision-making.

their own coping, sense of adapting to what society is suffering with great transformations that are challenges for people's And if that doesn't make sense, maybe be to integrate into this domain of health because it really has a very big in the way health promotion's since the letter from Otava, when it was defined, helps us understand that each citizen is responsible

for making the choices that develop their health, their health And this has to in the logic of my research, with this community process, way people together can be stronger in the construction of collective health, also stronger. So I would say that Nanda already has this moment a structure very potentially listed for this health promotion, oriented towards this community process and still

needs, of as all taxonomies, as all the classifications, which is what we say now, a continuous investigation and dynamic that helps us bring new evidence so that this evidence becomes clearer, unfortunately Camila, in the whole world we still live in a world of health more oriented to the disease and less to health. We are not as healthy or hygienic as we be and it is natural because the biomedical model still has a very large

in health policies themselves. But I really that nurses, by the definition I just said, which is the I really which is definition of infirmary and which is not far from definition of NAMDA, it has a different way of saying, that we are really the main professionals in health because health promotion is the same as disease and sometimes people confuse, especially politicians, they think it's same thing. And promoting health is...

I want to eat well, do exercise to feel good and not to not have diabetes or obesity. But the programs, unfortunately, health promotion are actually prevention of disease. We make programs for people not to get sick. And that's what science and neuroscience for example, they tell us that the more we about diseases, even if we them, even if I say I don't want to get diabetes,

We our brain to stay with diabetics and that's what we don't want. And think nurses can be the key to change this paradigm. And need more nurses in the decisions, in the World Health in these world structures that make health to be change this paradigm. I talk a lot Camila, so I apologize when you ask a question, I then come up a of ideas.

but I don't think you're talking too I'm loving the answers and they are very pertinent and rich. This concept of community process is a key of your model, which was developed in your PhD, which is the MAIEC, the model of evaluation, intervention and community Could you tell us a little bit about this model, how it was built during your PhD?

Peace.

Of this is one of my children, I have another child who is 18 years who is already in independence, right? autonomy and independence. And Mayek too, so Mayek is and still, being used in so many contexts by so colleagues, that he already ceased to be my son, who lives with me here in my house, he is already free. So this model was developed during the process of doctoring, or doctorate, as they say in Brazil,

and was co-constructed with colleagues who worked in community and public in this study, it had several stages, it was developed through a constructivist which means that was built with the actors who really work with communities and populations, and we had participation of colleagues who worked in health in school health, in authorities, for example municipal

even prison in residential for elderly people, so elderly I don't know how it's in Brazil, but these houses where the elderly live in residences, We had nurses from all these types of And what did we The nurses at the explained what they with the communities, but they didn't know how to them a name. They explained, I diagnose this thing, but I don't know very well how to call

So we did an analysis, in this case of SIP, which was what we in Portugal, and we were basically doing a conceptual of the names to give to the diagnoses that after all everyone did, in a very similar but they gave different names when it was same thing. And so, from these focus we reached a first matrix of clinical that really has central the community

and has as central focus the community And then we have three diagnostic that's what we call this model, which is then the community community and community And each of them has data, has diagnostic that we need to evaluate to say that the community process is or is committed, because community management will be or is committed, according to the commitment of one of these three domains, therefore,

leadership, coping and community In addition, this model, in addition to this clinical decision of course, it also has interventions and results that give answer to these diagnoses, but it also a conceptual We have the concept of community, of community of care, of disease, there community as client, which is different from caring for an individual or a family.

different and are in concept of community as well. And we also have concept of community which means that a community has a maximum of health, which is very associated with community And so, over the years, we have managed to through an instrument that we for Portuguese from Portugal and that we also to work for Portuguese from Brazil.

which a scale that evaluates precisely the level of community And what we are doing are experimental or almost experimental because in community it is difficult to close people in a laboratory, as is obvious. And has been impressive the way we have identified that the use of the Mayec has allowed exponentially increasing the level of community of many communities for many different

from companies, business communities, hospital communities, because the hospital can be a community, school have also worked with underrepresented for example the LGBTI +, or the immigrant which in Portugal, perhaps all the now due to more restrictive in migration terms, has suffered lot, even the war are very specific

We also working compassionate We a very interesting with our colleague Alexandre, who is Rio de Janeiro, who works with favelas, the compassionate in sense of care at end of life, so palliative And we have an area where we are looking to innovate, we are developing, for example, an app that allows us to evaluate community more automatically, so people use the app to respond.

to what they is their community. And we are now post-doctoral, developing the Cristian MIEC validation to what is in CIP for the Nanda classification, which we will soon be able have transition. But it is a work that has been very interesting to realize that above all, more we that the communities, the people who live in the communities are making a of money health.

and nurses are transforming the lives of these communities. And the MAEC has a point, a motto, an argument to transform the lives of these people. Currently, Camila, it is only model, there is other, that is really oriented towards the community as a client. I'm talking about the model of the disease. So, he's actually called a model, but it's a theory of medium-range prescriptive because it...

is applicable in clinical it's not just a philosophy of infirmary or a conceptual that has only the concepts, has this matrix that helps us apply all the concepts and clinical I don't know if I explain well, but this is difficult. In a short time, explain so much.

You explained it very well. It very complete and complex and it is very interesting Professor Pedro Mello has helped us his model in our work our strength, task, in favor of diagnostics, of more diagnostics that are interesting for the community, as the subject of care, and not for individuals within the community only.

Obrigado.

So I have some idea of the of the disease for the community from your model. Could comment on the of the disease that you consider most relevant or prevalent in community in Portugal?

Yes, the experience we have had and using the MAEC, the most relevant within, we have the greater is the community which I can tell Camila that in all the communities we have worked on, been compromised. All. There is none that we had identified a community process, effective or not compromised. The dimension of diagnosis we have found

with the problems is community So we have really had very literacy in people who are members of the community, community and that does help the community to transform and use resources and efforts to solve their problems. We have very difficult to work with, more than knowledge, because knowledge we end up working from point of view of education, information.

But beliefs don't just teach and It's necessary for the nurse to be part the community, to be part of it and transform from inside out with people. Because, Camila, we often have the notion, and this has to with the reference of the biomedical that we are the detainees of total knowledge and that we have reached a community and that we are going to prescribe everything and people are to what we order and that we the world. But it's not like that.

People have their own lives, their own convictions, and we have to be, as nurses, side by side with them, to understand the perspective they have of their lives. And that's way they can change, if they have to change, the beliefs they in order to build new paths. Our writer José Saramago, who was a Nobel Prize winner a few years ago, has a wonderful to talk about this issue of community which I was saying is...

To see the island, have to leave the island. We have out the and be look at it all. And community is the same. nurses need to leave the community to observe it as a whole and understand what is happening there. What are the structures that exist the organizations, what people are the leaders and not always the leaders are the formal Imagine, we can have a president of the chamber who has no leadership and the leader is actually

It's a local that has much more power than this formal And the nurse or nurse only realizes this if she is in community with people. And therefore I would say that this diagnosis, the committed has been the with the greatest prevalence, I would say, in 100 % of communities. Then, right after, comes the committed because we have not found structures in the communities that involve all members.

Imagine, we are now working with a school community, for example, where the central is sleep, children are not sleeping well. And it is incredible how in this school community there is no structure that brings together parents, family, teachers, other professionals of the school who are not decent, health so that together they can talk and solve the problem of sleep. What actually is that

Imagine, a nurse or a classroom to talk to children about the importance of sleeping well. But then the children arrive home and the family is totally contrary to what was said in class. And therefore, do involve the families in these decision-making that's why I said it was community participation, everything very fragile because nothing will change. will change the child's but will not change the because she will continue to arrive home and the routine will be that.

This an example among many others, this is very simple, because there other much more complex that require this dialogue between the different members of the community. And we have created, together with the communities, structures, for example, a commission, a commission in community to give voice to LGBTI more. These commissions cannot only LGBTI but they have to exist, but they also members of politics, members of health.

members of the community who are LGBTI +, but need to understand what the difficulties, challenges and particularities of this community And only when all these structures do create an organizational that's what we call it, strong to ensure that will be future in this accompaniment and change in the community. And the experience tells me that takes least two to three years of continuous with the community.

to have the maximum of community An intervention of one month does change much, changes little. can change the knowledge of one thing another, but does transform the community at all. That is why, Camila, is really to better these community and especially community leadership and community have been the most fragile And above all, is necessary to do a...

a work with the communities there stressed in health and not doing, sometimes I call the expression bombeirismos, is to go there to talk about loose without having a structured with health from the diagnosis to the definition of strategies, predict the indicators that we want to evaluate, define the goals and be measure what was our intervention, because if there are no metrics, we don't know what changed with our intervention and if we know measure

didn't exist, we couldn't even politically our profession. So think that's what I to share in this very important Camila, thank you.

Your last speech was very important, establishing a parallel with something you said before, the differentiation of infirmary as doing, as a set of tasks that unfortunately is what society sees, of infirmary as a body of knowledge, of knowledge production.

and clinical decision You mentioned your answer some vulnerable some populations with higher, subject to higher risks. How can our diagnosis contribute to interventions for these vulnerable to more effective, more effective in the community

Our diagnoses are fundamental and irreplaceable. If there is no good diagnosis of disease in these most vulnerable I would say all them, but in particular, never, ever, we be able to have changes transforming these diseases that are much more evident in these most vulnerable than in those are not so vulnerable. We live today, Camila, situations of great vulnerability.

poverty is not improving, on the contrary, are increasingly having social discrepancies between people who have lot of money and those who have less less and we know that the more sick the poorer and the poorer the sick. That is why it is a cycle that we have to counteract and that nurses with their diagnoses can make big difference. Nurses have to be that their diagnoses go beyond the aspects

We have a very structured throughout all these years, oriented, for example, to the basic human more physical, therefore, to be able to eat, to able to mobilize ourselves, to able to do our self-care, and that is very important. The disease is very linked to the promotion of autonomy and independence of people in their self-care, but we must forget that self-care

is self-care of the decision, of what will be my behavior in my life. And that is not physical, it has to do with the mental of decision, where nurses are also fundamental and it is enough to promote autonomy, because the more I am able to make a decision in my life, the more autonomous I am and more I my health. And health is not, for nurses at least, is just not having an ulcer due pressure.

or not having heart related to the diabetes disease, it's not just that, it's also me knowing how a decision as a it's me knowing how to and participate in the decisions of my community and being an active in those decisions, it's being to feel that I'm free to have my identity and not have mental health associated with that non-identity, therefore, the information is much richer than just the physical of people.

and that's why we the Jacqueline Fossett. I think very important to sometimes the theories of infarction. We have many wonderful But now we Jacqueline Fossett because she says precisely that the person for nurses is only a person if we diagnose their intentional processes, have to do with these knowledge, beliefs, skills, adherence to things, right? The non-intentional and here are the physiological

and also mental because I don't choose to depression, example. So, the unintentional is all that we don't choose to I don't choose to a gastrointestinal I don't choose to an ulcer due to depression, I don't choose to depression. And nurses also diagnose these unintentional And then there are also the processes of interaction with the environment. Nurses have to evaluate the person's how they are having an impact on their decisions, the performance that people have.

because we have people with chronic and in Portugal and think in Brazil and in other countries it's the who sometimes have to choose between food and medication, because they have money for more. And if it's the nurses who are closest to people to diagnose if the family is enough or not, insufficient, no one will do it, Camila, no one. And so nurses have, once and all, realize the central importance they have in the diagnosis...

in all these dimensions, which I think Jaque Lino Fossetto organized very well. So we have to diagnose intentional, unintentional interaction with environment of That's why in our course we socianthropology, anatomy, pharmacology, religion, culture, talk about all this, because it is actually disease to deal with the firmnesses and infirmities to diagnose them.

of human beings. Now, Canila, I really the human I've heard some critics say, so if the person is not human, of course, but since I read the book by the philosopher Anna Arndt, which is called the human which I advise everyone who can read, and nurses, she tells us that the difference between being human being, which is biological, is what differs from monkeys, from dogs, and being human

which is a human being who rises to use his intelligence to guarantee his dignity and that others, makes us realize that human person is what nurses help human beings to be. If were no nurses in hospitals, we would have human beings trained in a bed We did have human people. is nurses, really, with their diagnoses, who help those human people to keep themselves human.

And that's so beautiful and so important, that's we're going to replaced by robots. Now, there's a lot fear of artificial and robots. I'm the opposite. think robots and artificial come to help us in some tasks, but nurses don't take care of them. They can delegate a task to another in a robot that carries the clothes, for example, somewhere, and even the back of the nurse or nurse's But the robot can't have this relationship.

this therapeutic that requires a human being, a nurse, to interact with another human being, which is the client. Never, never. think that infirmary is really the only profession of health, and forgive me the others who are listening us, but I am convinced that infirmary is the only profession of health that will be replaced by robots or artificial Because is not algorithmic, is possible to put in an algorithm.

of human beings. is possible to translate in diagnosis of evidence on data that allows us to say that that criterion is based on an experimental for example, that tells us that when that condition that diagnosis is possible. But is possible to this study if a human being is making a decision about that data, if it a robot, will be to I know if I clear on this, Camila, but

It is really important to think about this to give ourselves as profession.

I think it was more than clear and I was here thinking that every time I watch you, any presentation that we talk about, how interesting the way you make it transpires this incorporation of the theoretical in the day day, in who you are as professional, as scientist, so who is the person in your environment for me, what is health.

And what I am as a nurse to help this person in their relationship with health, is very interesting to see this transparency, this clarity that you have in your doing, how you really incorporate the references or the theoretical that is applied more at the moment. I think that, especially for students, is very interesting to observe this, pay attention to this.

when they hear a nurse talking to them or teaching them So, lastly, unfortunately, our time is running out. I would to know what message you would to leave to new generation of nurses and researchers who are listening to this episode.

The main is to that in future, infirmary will continue to the central and irreplaceable in lives of human and that for this, nurses and nurses of the new generations may to repress, re-centre in the science of infirmary and in all the theories, what Camila was now, we are such a rich

with so many theoretical that were founded throughout the 20th and now the 21st by so many researchers and researchers who brought us such important And what I feel is that sometimes our future nurses, the students who are finishing the course and taking the course, tend to more on the more technological and more on knowledge doing than on the knowledge of knowing about the profession.

And this is very important. new generation of nurses, I have a lot of hope that it generation that will rediscover that the science of infirmity is such an important that one day will within the consulate of universities, the that will guide all other sciences. And I'm really about the absolute such as mathematics, physics and the other applied such as medicine and psychology and the other sciences that work with us.

But we are the one who can have this vision of the person in these three processes, which I gave example of the theory of the meta-paradigm of the disease, which is the Jacqueline Fosset, but when we look at trans-culturality, example, by Madeleine Leninger, when we look at Martha Rogers, when we look at all these theories, we can perceive the richness of sciences, of the disease science, which comes from so much knowledge produced along all these...

of these two centuries that we have been in infirmary. And therefore, future nurses will never making the bridge and never let the science of infirmary be swallowed by a system oriented by the biomedical model, where the technique and the desire to know how be a more biomedical can destroy the essence of a profession that really the difference in people's lives. Because otherwise what will happen

Camila and colleagues who are listening to is that new emerge, as they are already that will give answers to what nurses will give, because they are oriented towards other things that are the pure The information oriented towards all these things that we about during our conversation. Because if I want to be a paedologist and just look at wounds, I can be, but people don't just need someone to look at the wound, that's why other professions that look at other dimensions.

of that person and it is necessary because the infirmary already looks. So we must not valuing our infirmary and our science. I think that was the main message I wanted to leave. Camila, thank you. Wonderful your question.

Dr. Pedro, thank much for your participation. It a pleasure to be with you here today. I thank our listeners and our listeners for joining us here at NandaCast. I hope you enjoyed my conversation with Dr. Pedro Mello, who gave us a view of the use of diagnostic diseases in community Don't forget to sign our newsletter at www.nanda.org and follow us on LinkedIn, Instagram and Facebook.

You can also find, if interested, links to purchase our book on classification of Nanda's on our website. you next time and we will continue to define disease a concept at a