O papel da enfermeira, da auxiliar de enfermagem e do atendente de enfermagem na assistência ao paciente em isolamento de doenças transmissíveis / The nurse's and nurse's aides role in caring the patiente in a communicable disease isolation unit

Observadores previamente treinados, realizaram um levantamento das atividades intrumentais e expressivas desempenhadas por enfermeiras, auxiliares de enfermagem e atendentes de enfermagem na assistência direta a pacientes portadores de doença transmissível, internados em unidade de isolamento de um hospital geral. Concluiram que os membros da equipe de enfermagem realizaram maior número de atividades instrumentais do que expressivas; em termos numéricos, o atendente foi quem mais executou estas atividades, seguido do auxiliar de enfermagem e, por último, da enfermeira.

Preparing the patient for bone marrow transplantation: nursing care issues.

The phases of bone marrow transplantation can be identified as the pre-transplant period, the immediate post-transplant period, and the late post-transplant period. The pre-transplant period is characterized by identification of the appropriate type of transplant to be done and, if necessary, finding an appropriate donor; entry of the patient into the transplant unit; administration of the preparative chemotherapy/irradiation regime; management of early toxicities; and pre-transplant supportive care. Nurses play an integral role during the entire transplant process. During the pre-transplant phase, nursing expertise is exemplified in the administration of chemotherapy, management of side effects, teaching of transplant procedures to patient and family, and supportive care. This paper reviews the patient care issues during the pre-transplant phase of bone marrow transplantation and identifies nursing management strategies.

Seclusion: a last resort measure.

The practice of secluding patients after violent incidents has long been a treatment used by mental health nurses. While seclusion keeps the patient from further self-inflicted pain and restores normalcy to the unit, the practice often sets up an unending cycle of negative behavior. Other methods of dealing with the violent patient are explored in this article, including early intervention by nurses, ignoring the outburst, separating the disruptive person for a shorter time, and speaking gently with the client. The conclusion reached is that nurses must keep in mind the goal: to help the patient reintegrate into the group as safely and quickly as possible.

Nosocomial gastroenteritis in paediatric patients.

Between November 1982 and April 1985, 2228 children under the age of 5 years with acute gastroenteritis were admitted to the paediatric isolation ward of Queen Mary Hospital, Department of Paediatrics, University of Hong Kong. In 56.2% the causative agent was identified as rotavirus, Salmonella, Campylobacter, Shigella, Escherichia coli or a combination of these pathogens. Our isolation procedures included cohort nursing of all diarrhoeal patients in two separate rooms (each accommodating 6 patients), barrier gowns and stringent handwashing with chlorhexidine. A total of 163 cases (13.4% of all positive cases) were identified as nosocomial infections. Rotavirus was the responsible agent for nosocomial infection in 128 cases (20% of all rotavirus infection). There were 35 patients with bacterial nosocomial infection, (7% of all the bacterial positive cases). Nosocomial rotavirus gastroenteritis was 3.4 times more frequent than nosocomial gastroenteritis due to bacterial pathogens. We conclude that modification of our present isolation procedures is necessary in order to reduce rotavirus nosocomial infection.

Reverse isolation: what patients perceive.

This study looked at patients' perceptions of reverse isolation while undergoing autologous bone marrow transplant (ABMT). Persons in reverse isolation experience both obvious and less evident stressors. To understand patients' perceptions of these stressors, semi-structured audiotaped interviews were held periodically during isolation (21-25 days) with six subjects receiving ABMT. This identified recurrent themes, which were than validated in a final interview. Most subjects understood the rationale of reverse isolation, and many prepared by bringing objects of personal value with them. Few mentioned feeling restricted by the room after the initial days. Some patients used the TV, VCR, radio, and telephone as "extensions to the world," as well as for entertainment. Subjects found visits from their main supports very important in coping with feelings of isolation. The patients' emphasis on a variety of ways to pass time was particularly interesting. The overall finding, however, was that the physical side effects of the treatment brought more distress than the isolation.

Respiratory syncytial virus (RSV) infection rate in personnel caring for children with RSV infections. Routine isolation procedure vs routine procedure supplemented by use of masks and goggles.

Respiratory syncytial virus (RSV) infections in hospitalized children were identified by indirect fluorescent antibody technique. Patients with RSV infections were assigned to one of two isolation categories. In one category, the health care workers entering the child's room did not wear masks and goggles; in the other category, the workers did wear masks and goggles. The RSV illness rate in health care workers using masks and goggles was 5%, but the rate for those not using masks and goggles was 61%. In the no mask/goggles group, the RSV illness rates in the health care workers correlated directly with the number of exposures. In this modest study, the use of masks and goggles was associated with a significant reduction of RSV illnesses in pediatric health care workers.

Psychological aspects of patients in germ-free isolation: a review of child, adult, and patient management literature.

Life-threatening medical conditions such as severe combined immunodeficiency disease, leukemia, severe aplastic anemia, radiation injury, burns, organ transplantation, and aggressive administration of chemotherapy often necessitate the isolation of the patient in a protected germ-free environment for weeks or months. This treatment milieu has the effect of extensive psychological and physical isolation from family and staff. A review of the literature was undertaken to investigate the psychological implications of such treatment and to question the possibility that this isolation therapy might produce a unique type of psychological stress. Most authors agree that patients are able to withstand the emotional stress of germ-free isolation and that behavioral changes relate more to the severity of the illness rather than to the isolation. However, there may be inherent stresses related to isolator therapy that can be alleviated by environmental manipulation. Case vignettes are included and patient management in such an environment is outlined.