Diagnóstico de Enfermagem Síndrome do Idoso Frágil: revisão integrativa / Nursing Diagnosis Frail Elderly Syndrome: an integrative review

RESUMO Objetivo identificar as características definidoras e os fatores relacionados ao Diagnóstico de Enfermagem Síndrome do Idoso Frágil. Métodos revisão integrativa desenvolvida em sete bases de dados, além da utilização de literatura cinzenta no Google Scholar e no Open Grey. A estratégia Problema, Conceito e Contexto foi utilizada para elaborar a questão norteadora e selecionar os descritores. Foram incluídos oito artigos e uma tese na amostragem final. Resultados três novas características foram identificadas: Incontinência Urinária; Processos Familiares Disfuncionais e Distúrbio no Padrão de Sono. As características definidoras do Diagnóstico de Enfermagem Síndrome do Idoso Frágil mais frequentes foram: Mobilidade física prejudicada; Tolerância à atividade diminuída; Nutrição desequilibrada: menor do que as necessidades corporais e Deambulação prejudicada. Sobre os fatores relacionados, os mais presentes foram: Força muscular diminuída; Disfunção cognitiva e Equilíbrio postural prejudicado. Conclusão verificou-se que as três características definidoras que não estão presentes na NANDA-I precisam ser mais bem investigadas, a fim de serem incluídas ao Diagnóstico de Enfermagem Síndrome do Idoso Frágil. Contribuições para prática o estudo disponibiliza, ao enfermeiro, um aprofundamento no referido diagnóstico, subsidiando e fortalecendo o raciocínio clínico necessário à tomada de decisão para atribuir, corretamente, o diagnóstico ao paciente.

ABSTRACT Objective to identify the defining characteristics and factors related to the Nursing diagnosis is Frail Elderly Syndrome. Methods integrative review developed in seven databases, besides the use of Grey literature in Google Scholar and Open Grey. The Problem, Concept, and Context strategies were used to develop the guiding question and select the descriptors. Eight articles and one thesis were included in the final sampling. Results three new characteristics were identified: Urinary Incontinence; Dysfunctional Family Processes and Sleep Pattern Disorder. The most frequent defining characteristics of the Frail Elderly Syndrome Nursing Diagnosis were: impaired physical mobility; decreased activity tolerance; unbalanced nutrition: less than the body needs and impaired ambulation. Among the related factors, the most present was: impaired muscle strength; cognitive dysfunction, and impaired postural balance. Conclusion it was found that the three defining characteristics that are not present in NANDA-I need to be further investigated to be included in the Nursing Diagnosis Frail Elderly Syndrome. Contributions to practice the study provides nurses with a deeper understanding of this diagnosis, supporting and strengthening the clinical reasoning necessary for decision-making to correctly assign the diagnosis to the patient.

Clinical indicators, nursing diagnoses, and mortality risk in critically ill patients with COVID-19: a retrospective cohort.

OBJECTIVE: To identify clinical indicators and nursing diagnoses with the highest risk of mortality in critically ill patients with COVID-19. METHOD: Retrospective cohort with the population of adults and elderly people with COVID-19 from an Intensive Care Unit. Categorical variables were described using absolute and relative frequencies and risk factors for mortality using Cox regression, with a confidence interval of 95%. RESULTS: The main clinical indicators of COVID-19 patients were dyspnea, fever, fatigue, cough, among others, and the Nursing Diagnoses at higher risk of mortality were Ineffective protection, Ineffective tissue perfusion, Contamination, Ineffective Breathing Pattern, Impaired spontaneous ventilation, Acute confusion, Frailty syndrome, Obesity, and Decreased cardiac output. It is worth mentioning that there was little information about the diagnoses of Domains 9, 10, and 12. CONCLUSION: This research infers the need to monitor the clinical indicators dyspnea, fever, fatigue, cough, among others, and the Nursing Diagnoses with the highest risk of mortality Ineffective protection, Ineffective tissue perfusion, Contamination, Ineffective Breathing Pattern, Impaired spontaneous ventilation in critically ill patients.

Adverse events in critically ill patients: a cross-sectional study.

OBJECTIVE: To identify the prevalence of adverse events and the critically ill patient's need for care in an intensive care unit. METHOD: This is a cross-sectional study, carried out from January to March 2020. The adverse events investigated were pressure injury, accidental orotracheal extubation, fall, loss of central venous access, and healthcare-associated infection. The number of hours required for patient care was measured by the Nursing Activities Score. The categorical independent variables were described by absolute and relative frequencies, and the continuous ones, by central tendency. The magnitude measure was the odds ratio and a confidence interval of 95% was considered. RESULTS: of the 88 patients evaluated, 52.3% had adverse events, which were associated with a greater need for care, severity, and longer hospital stay. The mean Nursing Activities Score was 51.01% (12 h 24 min), with a deficit of 20% to 30% of nursing staff in the unit being identified. CONCLUSION: The prevalence of adverse events in the unit is high and the shortage of nursing staff in the unit revealed the need for adequate staffing to reduce the damage caused by the care provided to critically ill patients.

Adverse events in critically ill patients: a cross-sectional study / Eventos adversos en pacientes de cuidado intensivo: estudio transversal / Eventos adversos em pacientes de terapia intensiva: estudo transversal

Abstract Objective: To identify the prevalence of adverse events and the critically ill patient's need for care in an intensive care unit. Method: This is a cross-sectional study, carried out from January to March 2020. The adverse events investigated were pressure injury, accidental orotracheal extubation, fall, loss of central venous access, and healthcare-associated infection. The number of hours required for patient care was measured by the Nursing Activities Score. The categorical independent variables were described by absolute and relative frequencies, and the continuous ones, by central tendency. The magnitude measure was the odds ratio and a confidence interval of 95% was considered. Results: of the 88 patients evaluated, 52.3% had adverse events, which were associated with a greater need for care, severity, and longer hospital stay. The mean Nursing Activities Score was 51.01% (12 h 24 min), with a deficit of 20% to 30% of nursing staff in the unit being identified. Conclusion: The prevalence of adverse events in the unit is high and the shortage of nursing staff in the unit revealed the need for adequate staffing to reduce the damage caused by the care provided to critically ill patients.

RESUMEN Objetivo: identificar la prevalencia de eventos adversos y la necesidad de cuidado del paciente crítico en una unidad de cuidado intensivo (UCI). Método: estudio transversal, realizado entre enero y marzo de 2020. Los eventos adversos investigados fueron: lesión por presión, extubación oro traqueal accidental, caída, pérdida de acceso venoso central e infección relacionada a la asistencia a la salud. El número de horas necesarias para el cuidado del paciente se midió por la Nursing Activities Score. Las variables independientes categóricas fueron descriptas por frecuencia absoluta y relativa, y las continuas, por tendencia central. La medida de magnitud fue la razón de oportunidad (odds ratio) y se consideró un intervalo de confianza del 95%. Resultados: de los 88 pacientes evaluados, un 52,3% presentaron eventos adversos, los cuales fueron asociados a necesidad de cuidados más intensa, gravedad y tiempo de ingreso más extenso. El Nursing Activities Score medio fue un 51,01% (12 h 24 min), siendo identificado un déficit entre 20% y 30% de personal de enfermería en la unidad. Conclusión: la prevalencia de los eventos adversos en la unidad es alta y el déficit de personal de enfermería en la unidad reveló la necesidad de dimensionamiento adecuado de personal para reducir los daños causados por los cuidados prestados a los pacientes críticos.

RESUMO Objetivo: identificar a prevalência de eventos adversos e a necessidade de cuidado do paciente crítico em uma unidade de terapia intensiva. Método: estudo transversal, realizado de janeiro a março de 2020. Os eventos adversos investigados foram: lesão por pressão, extubação orotraqueal acidental, queda, perda de acesso venoso central e infecção relacionada à assistência à saúde. O número de horas necessárias para o cuidado do paciente foi mensurado pela Nursing Activities Score. As variáveis independentes categóricas foram descritas por frequências absoluta e relativa, e as contínuas, por tendência central. A medida de magnitude foi a razão de chance e considerou-se intervalo de confiança de 95%. Resultados: dos 88 pacientes avaliados, 52,3% apresentaram eventos adversos, os quais foram associados à maior necessidade de cuidados, gravidade e ao maior tempo de internação. O Nursing Activities Score médio foi 51,01% (12 h 24 min), sendo identificado um déficit de 20% a 30% de pessoal de enfermagem na unidade. Conclusão: a prevalência dos eventos adversos na unidade é alta e o déficit de pessoal de enfermagem na unidade revelou a necessidade de dimensionamento adequado de pessoal para reduzir os danos ocasionados pelos cuidados prestados aos pacientes críticos.

Nursing care for bed bath in patients with COVID-19: an integrative review / Cuidados de enfermería para baños en cama en pacientes con COVID-19: revisión integrativa / Cuidados de enfermagem para banho no leito em pacientes com Covid-19: revisão integrativa

ABSTRACT Objective: to identify the main nursing care procedures for performing bed bath in patients with COVID-19. Method: an integrative literature review. Five stages were followed for this research: research question elaboration (identification of the problem), search of studies in literature, study assessment, data analysis, and presentation of review. To search for primary studies, the VHL and SciELO databases were selected. Results: initially, 55 publications were found. After reading and analyzing the abstracts, the sample consisted of 15 studies. Conclusion: patients with the new coronavirus have specific care to perform a bed bath, oral, intimate and skin hygiene. It is important that professionals use adequate personal protective equipment, perform humanized care, continuously observing patients' vital signs to avoid occurrence of adverse events, promoting patient safety.

RESUMEN Objetivo: identificar los principales procedimientos asistenciales de enfermería para realizar un baño en cama en pacientes con COVID-19. Método: revisión integradora de la literatura. Se siguieron cinco etapas para esta investigación: elaboración de la pregunta de investigación (identificación del problema), búsqueda de estudios en la literatura, evaluación de estudios, análisis de datos y presentación de la revisión. Para la búsqueda de estudios primarios, se seleccionaron las bases de datos BVS y SciELO. Resultados: inicialmente se encontraron 55 publicaciones. Después de leer y analizar los resúmenes, la muestra estuvo formada por 15 estudios. Conclusión: los pacientes con el nuevo coronavirus tienen cuidados específicos para realizar un baño en la cama, higiene bucal, íntima y cutánea. Es importante que los profesionales utilicen equipos de protección personal adecuados, realicen cuidados humanizados, observando continuamente los signos vitales de los pacientes para evitar la ocurrencia de eventos adversos, promoviendo la seguridad del paciente.

RESUMO Objetivo: identificar os principais cuidados de enfermagem para a realização do banho no leito em pacientes com COVID-19. Método: revisão integrativa da literatura. Percorreram-se cinco etapas para esta pesquisa: elaboração da questão de pesquisa (identificação do problema), busca dos estudos na literatura, avaliação dos estudos, análise dos dados e apresentação da revisão. Para a busca dos estudos primários, selecionaram-se as bases de dados BVS e SciELO. Resultados: inicialmente, foram encontradas 55 publicações. Após leitura e análise dos resumos, a amostra foi composta por 15 estudos. Conclusão: pacientes com o novo coronavírus têm cuidados específicos para a realização do banho no leito, higiene bucal, íntima e com a pele. É importante que os profissionais utilizem Equipamento de Proteção Individual adequado, executem um cuidado humanizado, observando, continuamente, os sinais vitais dos pacientes para evitar a ocorrência de eventos adversos, promovendo a segurança do paciente.

Clinical indicators, nursing diagnoses, and mortality risk in critically ill patients with COVID-19: a retrospective cohort / Indicadores clínicos, diagnósticos de enfermería y riesgo de mortalidad en pacientes críticos con COVID-19: cohorte retrospectiva / Indicadores clínicos, diagnósticos de enfermagem e risco de mortalidade em pacientes críticos com COVID-19: coorte retrospectiva

ABSTRACT Objective: To identify clinical indicators and nursing diagnoses with the highest risk of mortality in critically ill patients with COVID-19. Method: Retrospective cohort with the population of adults and elderly people with COVID-19 from an Intensive Care Unit. Categorical variables were described using absolute and relative frequencies and risk factors for mortality using Cox regression, with a confidence interval of 95%. Results: The main clinical indicators of COVID-19 patients were dyspnea, fever, fatigue, cough, among others, and the Nursing Diagnoses at higher risk of mortality were Ineffective protection, Ineffective tissue perfusion, Contamination, Ineffective Breathing Pattern, Impaired spontaneous ventilation, Acute confusion, Frailty syndrome, Obesity, and Decreased cardiac output. It is worth mentioning that there was little information about the diagnoses of Domains 9, 10, and 12. Conclusion: This research infers the need to monitor the clinical indicators dyspnea, fever, fatigue, cough, among others, and the Nursing Diagnoses with the highest risk of mortality Ineffective protection, Ineffective tissue perfusion, Contamination, Ineffective Breathing Pattern, Impaired spontaneous ventilation in critically ill patients.

RESUMEN Objetivo: Identificar los indicadores clínicos y los diagnósticos de enfermería con más riesgo de mortalidad en pacientes críticos con COVID-19. Método: Cohorte retrospectiva con la población de adultos y ancianos con COVID-19 de una Unidad de Cuidados Intensivos. Las variables categóricas fueron descriptas por frecuencias absoluta y relativa y los factores de riesgo para mortalidad, por la regresión de Cox, con intervalo de confianza del 95%. Resultados: Los principales indicadores clínicos de pacientes con COVID-19 fueron disnea, fiebre, fatiga, tos, entre otros y los Diagnósticos de Enfermería de mayor riesgo de mortalidad: Protección ineficaz; Perfusión tisular ineficaz; Contaminación; Patrón Respiratorio Ineficaz; Ventilación espontánea perjudicada; Confusión aguda; Síndrome del anciano frágil; Obesidad y Débito cardíaco disminuido. Se puede destacar que había pocas informaciones sobre los diagnósticos de los Dominios 9, 10 y 12. Conclusión: Esa investigación implica que hay necesidad de monitorear los indicadores clínicos disnea, fiebre, fatiga, tos, entre otros y los Diagnósticos de Enfermería con más riesgo de mortalidad, Protección ineficaz; Perfusión tisular ineficaz; Contaminación; Patrón Respiratorio Ineficaz; Ventilación espontánea perjudicada en pacientes críticos.

RESUMO Objetivo: Identificar os indicadores clínicos e os diagnósticos de enfermagem com maior risco de mortalidade em pacientes críticos com COVID-19. Método: Coorte retrospectiva com a população de adultos e idosos com COVID-19 de uma Unidade de Terapia Intensiva. As variáveis categóricas foram descritas por frequências absoluta e relativa e os fatores de risco para mortalidade, pela regressão de Cox, com intervalo de confiança de 95%. Resultados: Os principais indicadores clínicos de pacientes com COVID-19 foram dispneia, febre, fadiga, tosse, entre outros, e os Diagnósticos de Enfermagem de maior risco de mortalidade: Proteção ineficaz; Perfusão tissular ineficaz; Contaminação; Padrão Respiratório Ineficaz; Ventilação espontânea prejudicada; Confusão aguda; Síndrome do idoso frágil; Obesidade e Débito cardíaco diminuído. Vale ressaltar que havia poucas informações sobre os diagnósticos dos Domínios 9, 10 e 12. Conclusão: Esta pesquisa infere a necessidade de vigiar os indicadores clínicos dispneia, febre, fadiga, tosse, entre outros e os Diagnósticos de Enfermagem de maior risco de mortalidade Proteção ineficaz; Perfusão tissular ineficaz; Contaminação; Padrão Respiratório Ineficaz; Ventilação espontânea prejudicada em pacientes críticos.

Nursing care for bed bath in patients with COVID-19: an integrative review.

OBJECTIVE: to identify the main nursing care procedures for performing bed bath in patients with COVID-19. METHOD: an integrative literature review. Five stages were followed for this research: research question elaboration (identification of the problem), search of studies in literature, study assessment, data analysis, and presentation of review. To search for primary studies, the VHL and SciELO databases were selected. RESULTS: initially, 55 publications were found. After reading and analyzing the abstracts, the sample consisted of 15 studies. CONCLUSION: patients with the new coronavirus have specific care to perform a bed bath, oral, intimate and skin hygiene. It is important that professionals use adequate personal protective equipment, perform humanized care, continuously observing patients' vital signs to avoid occurrence of adverse events, promoting patient safety.

Nursing care to COVID-19 patients on hemodialysis and in prone position: an experience report.

OBJECTIVE: To describe the experience report of a nurse providing care to COVID-19 patients on hemodialysis and in prone position. METHOD: Experience report. This study was conducted in a philanthropic hospital in a Brazilian capital from May to August 2020 during the Coronavirus pandemic. RESULTS: The nurse has faced several challenges concerning structure, material, human resources, and care when treating COVID-19 patients on hemodialysis and in prone position. Management based on dialogue and shared evidence-based information and implementation of a new care protocol were a foundation for care reorganization of the Nursing team for providing care to COVID-19 patients. CONCLUSION: This experience emphasizes the importance of nursing care to patients' responses, with actions based on care protocols, strengthening human relations. The conduction of different study designs is necessary to contribute to an improved nursing care and survival of patients experiencing COVID-19 complications.

Risk factors for death due to COVID-19, in the state of Acre, Brazil, 2020: a retrospective cohort study. / Fatores de risco para óbito por COVID-19 no Acre, 2020: coorte retrospectiva.

OBJECTIVE: To analyze risk factors for death in individuals with severe acute respiratory syndrome due to COVID-19. METHODS: This was a retrospective cohort study, comprised of adult individuals with COVID-19, from March to September 2020, notified by the Epidemiological Surveillance System in the state of Acre, Brazil. Cox regression was used. RESULTS: Among 57,700 individuals analyzed, the incidence was 2,765.4/100,000 inhabitants, and mortality was, 61.8/100,000 inhabitants. The risk factors for death were: being male (HR=1.48 -95% CI 1.25;1.76), age ≥60 years (HR=10.64 -95% CI 8.84;12.81), symptom of dyspnea (HR=4.20 -95% CI 3.44;5.12) and multimorbidity (HR=2.23 -95% CI 1.77;2.81), with emphasis on heart disease and diabetes mellitus. 'Sore throat' and 'headache' were symptoms present in mild cases of COVID-19. CONCLUSION: Being male, elderly, having heart disease, diabetes mellitus and dyspnea were characteristics associated with death due to COVID-19.

Linking worker safety to patient safety: recommendations and bioethical issues for the care of patients in the COVID-19 pandemic / Vinculando la seguridad del profesional a la seguridad del paciente: recomendaciones y cuestiones bioéticas para el cuidado de pacientes en la pandemia del COVID-19-19 / Vinculando a segurança do profissional à segurança do paciente: recomendações e questões bioéticas para o cuidado de pacientes na pandemia da COVID-19

ABSTRACT Objective: the aim of this article is to discuss the implications of the connection between safety and bioethical issues for evidence-based care during the COVID-19 pandemic. Method: reflective analysis with the guiding question: "How can professional and patient safety be linked to bioethical issues during the COVID-19 pandemic?" Results: the COVID-19 pandemic has challenged countries around the world, mainly due to the collapse of the health system that could threaten the safety of patients and healthcare providers. Connecting worker safety to patient safety is imperative for safe care during the COVID-19 pandemic. Aspects related to professional qualification and the provision and proper use of personal protective equipment permeate an environment of economic and political crisis that accentuates tensions and can interfere in decision-making, greatly affecting the results of the care provided. This article presents reflections and recommendations to support healthcare providers in making decisions that involve bioethical issues during the care process in times of scarce resources generated by the COVID-19 pandemic.

RESUMEN Objetivo: el objetivo de este artículo es discutir las implicaciones de la conexión entre la seguridad y las cuestiones bioéticas para el cuidado basado en evidencias, durante la pandemia del COVID-19. Método: análisis reflexivo con la pregunta orientadora: "¿Cómo la seguridad del profesional y del paciente puede vincularse a cuestiones bioéticas, durante la pandemia del COVID-19?" Resultados: la pandemia del COVID-19 desafió a los países, alrededor del mundo, principalmente debido al colapso del sistema de salud, lo que podría amenazar la seguridad de pacientes y profesionales de la salud. Conectar la seguridad del profesional a la seguridad del paciente es un imperativo para una atención segura durante la pandemia del COVID-19. Aspectos relacionados a la calificación profesional, al suministro y al uso adecuado de los Equipamientos de Protección Individual, permean un ambiente de crisis económica y política que agudiza tensiones y puede interferir en la toma de decisiones, afectando especialmente los resultados de la asistencia prestada. Este artículo presenta reflexiones y recomendaciones para apoyar a los profesionales de la salud en la toma de decisiones, en que participan cuestiones bioéticas durante el proceso de cuidar en tiempos de recursos escasos generados por la pandemia del COVID-19.

RESUMO Objetivo: o objetivo deste artigo é discutir as implicações da conexão entre a segurança e as questões bioéticas para o cuidado baseado em evidências durante a pandemia da COVID-19. Método: análise reflexiva com a questão norteadora: "como a segurança do profissional e do paciente pode vincular-se às questões bioéticas durante a pandemia da COVID-19?" Resultados: a pandemia da COVID-19 desafiou países ao redor do mundo, principalmente devido ao colapso do sistema de saúde que poderia ameaçar a segurança de pacientes e profissionais de saúde. Conectar a segurança do profissional à segurança do paciente é um imperativo para um atendimento seguro durante a pandemia da COVID-19. Aspectos relacionados à qualificação profissional e ao fornecimento e uso adequado dos Equipamentos de Proteção Individual permeiam um ambiente de crise econômica e política que acentua tensões e pode interferir na tomada de decisões, afetando sobremaneira os resultados da assistência prestada. Este artigo apresenta reflexões e recomendações para apoiar os profissionais de saúde na tomada de decisões que envolvam questões bioéticas durante o processo de cuidar em tempos de recursos escassos gerados pela pandemia da COVID-19.

Fatores de risco para óbito por COVID-19 no Acre, 2020: coorte retrospectiva / Factores de riesgo de muerte por COVID-19, en Acre, Brasil, 2020: cohorte retrospectiva / Risk factors for death due to COVID-19, in the state of Acre, Brazil, 2020: a retrospective cohort study

Objetivo: Analisar fatores de risco para óbito em indivíduos com síndrome respiratória aguda grave por COVID-19. Métodos: Coorte retrospectiva, constituída de indivíduos adultos com COVID-19, de março a setembro de 2020, notificados pelo sistema de vigilância epidemiológica do estado do Acre, Brasil. Empregou-se regressão de Cox. Resultados: Entre 57.700 indivíduos analisados, a incidência foi de 2.765,4/100 mil habitantes, e a mortalidade, de 61,8/100 mil hab. Os fatores de risco para o óbito foram ser do sexo masculino (HR=1,48 - IC95% 1,25;1,76), ter idade ≥60 anos (HR=10,64 - IC95% 8,84;12,81), sintoma de dispneia (HR=4,20 - IC95% 3,44;5,12) e apresentar multimorbidade (HR=2,23 - IC95% 1,77;2,81), com destaque para cardiopatas e diabetes mellitus. Os sintomas 'dor de garganta' e 'cefaleia' estavam presentes nos casos leves da doença. Conclusão: Ser homem, idoso, apresentar cardiopatia, diabetes mellitus e dispneia foram características associadas ao óbito pela COVID-19.

Objetivo: Analizar los factores de riesgo de muerte en individuos con Síndrome Respiratorio Agudo Grave por COVID-19. Métodos: Cohorte retrospectiva, con individuos adultos con COVID-19, entre marzo y septiembre 2020, notificado pelo Sistema de Vigilancia Epidemiológica en el estado de Acre, Brasil. Se utilizó la regresión de Cox. Resultados: 57.700 individuos evaluados, la incidencia fue de 2.765,4/100.000 habitantes y la mortalidad 61,8/100.000 habitantes. Los factores de riesgo de muerte fueron: sexo masculino (HR=1,48 - IC95% 1,25;1,76), edad ≥60 años (HR=10,64 - IC95% 8,84;12,81), disnea (HR=4,20 - IC95% 3,44;5,12), multimorbidad (HR=2,23 - IC95% 1,77;2,81), incluidos problemas cardíacos y diabetes. Los síntomas dolor de garganta y de cabeza estuvieron presentes en casos leves de la enfermedad. Conclusión: Hombres, ancianos, personas com enfermedades cardíacas, diabetes y disnea fueron características asociadas com la muerte por COVID-19.

Objective: To analyze risk factors for death in individuals with severe acute respiratory syndrome due to COVID-19. Methods: This was a retrospective cohort study, comprised of adult individuals with COVID-19, from March to September 2020, notified by the Epidemiological Surveillance System in the state of Acre, Brazil. Cox regression was used. Results: Among 57,700 individuals analyzed, the incidence was 2,765.4/100,000 inhabitants, and mortality was, 61.8/100,000 inhabitants. The risk factors for death were: being male (HR=1.48 -95% CI 1.25;1.76), age ≥60 years (HR=10.64 -95% CI 8.84;12.81), symptom of dyspnea (HR=4.20 -95% CI 3.44;5.12) and multimorbidity (HR=2.23 -95% CI 1.77;2.81), with emphasis on heart disease and diabetes mellitus. 'Sore throat' and 'headache' were symptoms present in mild cases of COVID-19. Conclusion: Being male, elderly, having heart disease, diabetes mellitus and dyspnea were characteristics associated with death due to COVID-19.

Nursing care to COVID-19 patients on hemodialysis and in prone position: an experience report / Cuidados de enfermería al paciente con COVID-19 en hemodiálisis y posición prona: informe de experiencia / Cuidados de enfermagem ao paciente com a COVID-19 em hemodiálise e posição prona: relato de experiência

ABSTRACT Objective: To describe the experience report of a nurse providing care to COVID-19 patients on hemodialysis and in prone position. Method: Experience report. This study was conducted in a philanthropic hospital in a Brazilian capital from May to August 2020 during the Coronavirus pandemic. Results: The nurse has faced several challenges concerning structure, material, human resources, and care when treating COVID-19 patients on hemodialysis and in prone position. Management based on dialogue and shared evidence-based information and implementation of a new care protocol were a foundation for care reorganization of the Nursing team for providing care to COVID-19 patients. Conclusion: This experience emphasizes the importance of nursing care to patients' responses, with actions based on care protocols, strengthening human relations. The conduction of different study designs is necessary to contribute to an improved nursing care and survival of patients experiencing COVID-19 complications.

RESUMEN Objetivo: Describir el informe de experiencia de un enfermero en el cuidado al paciente con COVID-19 en hemodiálisis y posición prona. Método: Informe de experiencia. El estudio fue realizado en un hospital filantrópico de una capital brasileña de mayo a agosto de 2020, durante la pandemia de Coronavirus. Resultados: El enfermero enfrentó varios retos estructurales, materiales, de recursos humanos y de asistencia para el cuidado del paciente con COVID-19 en hemodiálisis y posición prona. La gestión basada en el diálogo y en el intercambio de información basada en evidencias y la implementación de un nuevo protocolo asistencial fueron el fundamento para la reorganización asistencial del equipo de Enfermería para el cuidado del paciente con COVID-19. Conclusión: A partir de esta experiencia, se destaca la importancia de la atención de enfermería a las respuestas de los pacientes, respaldando sus acciones en los protocolos de asistencia y fortaleciendo las relaciones humanas. Es necesaria la realización de otros diseños de estudio para contribuir a la mejora de la asistencia de enfermería y la supervivencia de los pacientes con complicaciones de la COVID-19.

RESUMO Objetivo: Descrever o relato de experiência de um enfermeiro no cuidado ao paciente com a COVID-19 em hemodiálise e posição prona. Método: Relato de experiência. O estudo foi realizado em um hospital filantrópico de uma capital brasileira, no período de maio a agosto de 2020, durante a pandemia do Coronavírus. Resultados: O enfermeiro enfrentou diversos desafios estruturais, materiais, de recursos humanos e assistenciais para o cuidado ao paciente com a COVID-19 em hemodiálise e posição prona. A gestão fundamentada no diálogo e no compartilhamento de informações baseadas em evidências e a implementação de um novo protocolo assistencial foram o alicerce para a reorganização assistencial da equipe de Enfermagem para o cuidado ao paciente com a COVID-19. Conclusão: Diante dessa experiência, destaca-se a importância da atenção de enfermagem às respostas dos pacientes, respaldando suas ações em protocolos assistenciais e fortalecendo as relações humanas. Faz-se necessária a condução de outros delineamentos de estudos de modo a contribuir para a melhoria da assistência de enfermagem e a sobrevida de pacientes com complicações da COVID-19.

Incidence, risk factors and survival of critically-ill patients with acute kidney injury / Incidência, fatores de risco e sobrevida de pacientes em estado crítico com lesão renal aguda

ABSTRACT Objective: to analyze the incidence, risk factors and survival of critically-ill patients with acute kidney injury. Method: a concurrent cohort study, conducted with 126 participants between May and September 2019 in a public Intensive Care Unit of the state of Acre. The Kaplan-Meier method was used to estimate the probability of death (log-rank 95% test) and the Cox regression model was employed to determine the prognostic factors of death. Results: the incidence of acute kidney injury was 37.3 per 1,000 individuals admitted to the intensive Care Unit. Disease recovery was the outcome in 36.7% of the patients, and 42.9% evolved to death. The conditional probability of death was higher in the female gender and in those who did not use mechanical ventilation, with glomerular filtration rate at admission < 60 ml/min/1.73 m2 and sepsis diagnosis. Regardless of the acute kidney injury diagnosis, the risk factors associated with death in the population of critically-ill patients were serum creatinine above 1.2 mg/dl at admission and glomerular filtration rate < 60 ml/min/1.73 m2 at admission. Conclusion: in this population, survival is aggravated by gender dimorphism and by the reduction of the glomerular filtration rate.

RESUMEN Objetivo: evaluar la incidencia, los factores de riesgo y la sobrevida de pacientes en estado crítico con insuficiencia renal aguda. Método: estudio de cohorte concurrente, realizado con 126 pacientes entre mayo y septiembre de 2019 en una Unidad de Cuidados Intensivos pública del estado de Acre. Se utilizó el método Kaplan-Meier para estimar la probabilidad de fallecimiento (prueba de log-rank 95%) y se empleó el modelo de regresión de Cox para determinar los factores que pronostican el fallecimiento. Resultados: la incidencia de insuficiencia renal aguda fue de 37,3 cada 1000 individuos ingresados en la unidad de cuidados intensivos. El 36,7% de los pacientes se recuperó de la enfermedad y el 42,9% falleció. La probabilidad condicional de fallecimiento fue mayor en el sexo femenino y en las personas que no se encontraban en ventilación mecánica, con tasas de filtración glomerular al momento de la admisión < 60 ml/min/1,73 m2 y diagnóstico de sepsis. Los factores de riesgo asociados al fallecimiento en la población de pacientes en estado crítico, independientemente del diagnóstico de insuficiencia renal aguda, fueron los siguientes: creatinina sérica superior a 1,2 mg/dl y tasa de filtración glomerular < 60 ml/min/1,73 m2, ambos al momento de la admisión. Conclusión: la sobrevida en esta población se ve agravada por el dimorfismo de género y por la disminución en la tasa de filtración glomerular.

RESUMO Objetivo: avaliar a incidência, os fatores de risco e a sobrevida de pacientes críticos com lesão renal aguda. Método: coorte concorrente, realizada entre maio e setembro de 2019 em uma Unidade de Terapia Intensiva pública do estado do Acre, com 126 pacientes. Utilizaram-se o método Kaplan Meier, para estimar a probabilidade do óbito (teste de log-rank95%) e o modelo de regressão de Cox, para determinar os fatores prognósticos do óbito. Resultados: a incidência de lesão renal aguda foi de 37,3 a cada 1.000 indivíduos admitidos na unidade de terapia intensiva. A recuperação da doença ocorreu em 36,7% deles, e 42,9% evoluíram ao óbito. A probabilidade condicional de óbito foi maior no sexo feminino e naqueles que não utilizaram ventilação mecânica, taxa de filtração glomerular admissional <60 ml/min/1,73 m² e diagnóstico de sepse. Os fatores de risco associados ao óbito na população de pacientes críticos, independentemente do diagnóstico de lesão renal aguda, foram creatinina sérica maior que 1,2 mg/dl na admissão e taxa de filtração glomerular <60 ml/min/1,73 m² na admissão. Conclusão: a sobrevida nessa população é agravada pelo dimorfismo de gênero e pela redução da taxa de filtração glomerular.

Nursing diagnosis/outcomes and interventions for critically ill patients affected by covid-19 and sepsis / Diagnósticos/resultados e intervenciones de enfermería para pacientes graves afectados por covid-19 y por sepsis / Diagnósticos/resultados e intervenções de enfermagem para pacientes graves acometidos por covid-19 e sepse

ABSTRACT Objective: to relate nursing diagnoses/outcomes and interventions for critically ill patients affected by COVID-19 and sepsis in the Intensive Care Unit, according to the International Classification for Nursing Practice (ICNP®). Method: a documentary study conducted in March and April 2020 from the ICNP® terminology subset for adult patients with sepsis. The documentary corpus was composed of the list of nursing diagnoses/outcomes and interventions based on Horta's Theory of Basic Human Needs; on the 7-Axis Model of the International Classification for Nursing Practice, version 2017; on the Pathophysiological model of sepsis; as well as relying on the authors' expertise in direct care for suspected or confirmed critically ill patients affected by COVID-19. Outcomes: a total of 58 nursing diagnoses/outcomes were identified that belong to the psychobiological needs of oxygenation (13-22.4%), vascular regulation (12-20.7%), neurological regulation (10-17.2%), hydration (08-13.8%), elimination (08-13.8%), immunological regulation (04-6.9%) and thermal regulation (03-5.2%), evidencing a total of 172 nursing interventions with a mean of 03 for each nursing diagnosis/outcome. Conclusion: data analysis provided greater knowledge about the disease and the nursing process in the ICU setting, serving as a guide for the professional practice for critically ill patients hospitalized with COVID-19 and sepsis.

RESUMEN Objetivo: relacionar diagnósticos/resultados e intervenciones de enfermería para pacientes graves afectados por COVID-19 y por sepsis en la Unidad de Cuidados Intensivos, de acuerdo con la Clasificación Internacional para la Práctica de Enfermería (CIPE®). Método: estudio documental realizado en los meses de marzo y abril de 2020 a partir del subconjunto terminológico de la CIPE® para pacientes adultos con sepsis. El corpus documental estuvo compuesto por la lista de diagnósticos/resultados e intervenciones de enfermería sobre la base de la Teoría de las Necesidades Humanas Básicas de Horta; del Modelo de 7 ejes de la Clasificación Internacional para la Práctica de Enfermería, versión 2017; y del Modelo fisiopatológico de la sepsis; al igual que contó con los profundos conocimientos de los autores en el cuidado directo a pacientes graves con sospecha o confirmación de COVID-19. Resultados: se identificaron 58 diagnósticos/resultados de enfermería que pertenecen a las necesidades psicobiológicas de oxigenación (13-22,4%), regulación vascular (12-20,7%), regulación neurológica (10-17,2%), hidratación (08-13,8%), eliminación (08-13,8%), regulación inmunológica (04-6,9%) y regulación térmica (03-5,2%), evidenciando un total de 172 intervenciones de enfermería con una media de 03 para cada diagnóstico/resultado de enfermería. Conclusión: el análisis de los datos amplió el conocimiento sobre la enfermedad y el proceso de enfermería en el ámbito de la UCI, sirviendo así como guía para la práctica profesional ofrecida al paciente grave internado con COVID-19 y sepsis.

RESUMO Objetivo: relacionar diagnósticos/resultados e intervenções de enfermagem para pacientes graves acometidos por COVID-19 e sepse na Unidade de Terapia Intensiva, segundo a Classificação Internacional para a Prática de Enfermagem (CIPE®). Método: estudo documental realizado nos meses de março e abril de 2020 a partir do subconjunto terminológico da CIPE® para pacientes adultos com sepse. O corpus documental foi composto pela lista de diagnósticos/resultados e intervenções de enfermagem com base na Teoria das Necessidades Humanas Básicas de Horta; no Modelo de 7-Eixos da Classificação Internacional para a Prática de Enfermagem, versão 2017; no Modelo fisiopatológico da sepse; bem como contou com a expertise dos autores no cuidado direto a pacientes graves suspeitos ou confirmados de COVID-19. Resultados: foram identificados 58 diagnósticos/resultados de enfermagem que pertencem às necessidades psicobiológicas de oxigenação (13-22,4%), regulação vascular (12-20,7%), regulação neurológica (10-17,2%), hidratação (08-13,8%), eliminação (08-13,8%), regulação imunológica (04-6,9%) e regulação térmica (03-5,2%), evidenciando um total de 172 intervenções de enfermagem com uma média de 03 para cada diagnóstico/resultado de enfermagem. Conclusão: a análise dos dados oportunizou maior conhecimento sobre a doença e o processo de enfermagem no âmbito da UTI, servindo como um guia para a prática profissional ao paciente grave internado com COVID-19 e sepse.

Factors associated with mechanical device-related complications in tube fed patients: A multicenter prospective cohort study.

AIMS: To identify the types of nasogastric/nasoenteric tube (NGT/NET)-related adverse events and to analyze the degree of harm and the factors associated with mechanical device-related complications. MATERIALS AND METHODS: A prospective cohort study was conducted from October 2017 to April 2019 in seven Brazilian hospitals. Data from 447 adult patients with NGT/NET were collected through electronic forms. Three methods were used to assess the NGT/NET-related adverse events: (1) encouraging spontaneous reports; (2) regular visits to the wards; and (3) review of medical records. The events were classified as mechanical device-related complications and other events. The degree of harm was classified according to the World Health Organization's International Classification for Patient Safety. Data were analyzed using the R program, version 3.5.3. The following tests were applied to identify associations between the explanatory and response variables: Cochran-Armitage Chi-Square test, Fisher's exact test, and Linear-by-linear Chi-Square test. Logistic regression analysis was performed to verify the predictors of mechanical device-related complications. All analyses were performed considering a 5% significance level. RESULTS: 191 NGT/NET-related adverse events were identified in 116 patients; the majority were mechanical device-related complications and resulted in mild harm to the patient. At the moment of the event, patients had a mean of 3.27 comorbidities, were highly dependent on nursing care, with high risk of death and altered level of consciousness. There was no association between the degree of harm and the care complexity, disease severity or level of consciousness. Intensive care was the strongest predictor for mechanical device-related complications and critical patients had a four times greater likelihood of presenting this type of event when compared to patients receiving minimal care. CONCLUSION: Intensive care patients should receive special attention as the complexity of care is an important predictor for mechanical device-related complications in tube fed patients.

Intervenções de enfermagem para pacientes neurocríticos / Nursing interventions for neurocritical patients

Objetivo: identificar as intervenções de Enfermagem para pacientes neurocríticos em uma Unidade de Terapia Intensiva. Método: trata-se de um estudo quantitativo, descritivo, transversal, com 84 pacientes neurocríticos. Coletaram-se as intervenções de Enfermagem mediante os registros de Enfermagem no instrumento de Sistematização da Assistência de Enfermagem da unidade. Realizaram-se a análise estatística dos dados. Resultados: revela-se que as principais intervenções de Enfermagem identificadas foram a realização da Escala de Coma de Glasgow (87,8%), Escala de Agitação e Sedação Richmond (84,3%), avaliação das pupilas (79,7%), cabeceira elevada a 30° (100%), monitorização dos sinais vitais (46,4%) e avaliação da Escala de Braden (36,9%). Conclusão: relacionam-se as principais intervenções de Enfermagem realizadas ao posicionamento neurológico, monitorização neurológica, monitorização dos sinais vitais e à prevenção de lesão por pressão. Acredita-se que os resultados deste estudo trazem importantes contribuições para o planejamento da assistência ao paciente neurocrítico, contribuindo para a prática baseada em evidências científicas na Enfermagem.(AU)

Objective: to identify nursing interventions for neuro-critical patients in an Intensive Care Unit. Method: this is a quantitative, descriptive, cross-sectional study with 84 neuro-critical patients. Nursing interventions were collected through the Nursing records in the unit of Nursing Care Systematization of the unit. Statistical analysis of the data was performed. Results: it is revealed that the main nursing interventions identified were the Glasgow Coma Scale (87.8%), Richmond Agitation and Sedation Scale (84.3%), pupil evaluation (79.7%), headboard elevated to 30 ° (100%), monitoring of vital signs (46.4%) and evaluation of the Braden Scale (36.9%). Conclusion: the main nursing interventions performed are related to neurological positioning, neurological monitoring, monitoring of vital signs and the prevention of pressure injury. It is believed that the results of this study bring important contributions to the planning of care for neuro-critical patients, contributing to the practice based on scientific evidence in Nursing.(AU)

Objetivo: identificar intervenciones de Enfermería para pacientes neurocríticos en una Unidad de Cuidados Intensivos. Método: es un estudio cuantitativo, descriptivo, transversal con 84 pacientes neurocríticos. Las intervenciones de Enfermería se recogieron a través de los registros de Enfermería en la unidad de Sistematización de Cuidados de Enfermería de la unidad. Se realizó un análisis estadístico de los datos. Resultados: se revela que las principales intervenciones de Enfermería identificadas fueron la Escala de coma de Glasgow (87.8%), la Escala de Agitación y Sedación de Richmond (84.3%), la evaluación de los alumnos (79.7%), cabecero elevado a 30 ° (100%), monitoreo de signos vitales (46.4%) y evaluación de la Escala de Braden (36.9%). Conclusión: las principales intervenciones de Enfermería realizadas están relacionadas con el posicionamiento neurológico, el monitoreo neurológico, el monitoreo de los signos vitales y la prevención de lesiones por presión. Se cree que los resultados de este estudio hacen contribuciones importantes a la planificación de la atención de pacientes neurocríticos, contribuyendo a la práctica basada en evidencia científica en Enfermería.(AU)

Fatores de risco para a inadequação proteico-calórica em pacientes de unidade de terapia intensiva / Risk factors for protein-caloric inadequacy in patients in an intensive care unit

RESUMO Objetivo: Avaliar os fatores de risco para inadequação proteico-calórica no paciente grave. Métodos: Coorte prospectiva com pacientes internados em unidade de terapia intensiva adulto, entre fevereiro e novembro de 2017. Os pacientes foram acompanhados por 7 dias. Foi calculada a probabilidade condicional de falha na adequação, usando o método de Kaplan-Meier e teste log-rank 95%. Para avaliar o risco de falha, foram calculadas as hazard ratio (HR) bruta e ajustada, usando a regressão de Cox, com intervalo de confiança de 95%. Resultados: Dos 130 pacientes, 63,8% eram do sexo masculino, 73,8% tinham idade < 60 anos e 49,2% apresentaram diagnóstico de trauma. O APACHE II médio foi de 24 pontos e 70,0% dos pacientes tiveram adequação proteico-calórica >80%. Na análise univariada, as variáveis significativas para a falha na adequação foram o uso de droga vasoativa, interrupções da dieta e não ter iniciado a nutrição precoce. No modelo final, pacientes que apresentaram vômito/resíduo gástrico (HR ajustada = 22,5; IC95% 5,14 - 98,87), jejum para extubação (HR ajustada = 14,75; IC95% 3,59 - 60,63) e para exames e intervenções (HR ajustada = 12,46; IC95% 4,52 - 34,36) tiveram maior risco de não alcançar a adequação proteico-calórica. Conclusão: O alcance das metas nutricionais > 80,0% ocorreu na maioria dos pacientes. Os fatores de risco para inadequação proteico-calórica foram as interrupções da nutrição, especialmente por motivo de vômito/resíduo gástrico, jejum para procedimento de extubação, exames e procedimentos cirúrgicos.

ABSTRACT Objective: To evaluate the risk factors for protein-caloric inadequacy in critically ill patients. Methods: Prospective cohort study of patients hospitalized in an adult intensive care unit between February and November 2017. Patients were followed for 7 days. The conditional probability of inadequacy was calculated using the Kaplan-Meier method and the 95% log-rank test. To assess the risk of inadequacy, crude and adjusted hazard ratios (HR) were calculated using Cox regression with a 95% confidence interval. Results: Of the 130 patients, 63.8% were male, 73.8% were <60 years of age, and 49.2% were diagnosed with trauma. The mean APACHE II score was 24 points, and 70.0% of the patients had a protein-caloric adequacy >80%. In the univariate analysis, the significant variables for inadequacy were use of vasoactive drugs, interruptions of diet and failure to initiate nutrition early. In the final model, patients who presented with vomiting/gastric residue (adjusted HR = 22.5; 95%CI 5.14 - 98.87) and fasting for extubation (adjusted HR = 14.75; 95%CI 3.59 - 60.63) and for examinations and interventions (adjusted HR = 12.46; 95%CI 4.52 - 34.36) had a higher risk of not achieving protein-caloric adequacy. Conclusion: Achievement of nutritional goals > 80.0% occurred in 70.0% of patients. The risk factors for protein-caloric inadequacy were nutritional interruptions, especially due to vomiting/gastric residue and fasting for extubation, exams and surgical procedures.

Related factors of the nursing diagnosis ineffective breathing pattern in an intensive care unit. / Fatores preditores do diagnóstico de enfermagem padrão respiratório ineficaz em pacientes de uma unidade de terapia intensiva.

OBJECTIVE: to identify the predicting factors and sensitivity, specificity, positive and negative related value of nursing diagnosis Ineffective Breathing Pattern among patients of an intensive care unit. METHOD: cross-sectional study. A logistic regression was fitted to assess the simultaneous effects of related factors. RESULTS: among the 120 patients, 67.5% presented Ineffective Breathing Pattern. In the univariate analysis, the related factors were: group of diseases, fatigue, obesity and presence of bronchial secretion, and the defining characteristics were: changes in respiratory depth, auscultation with adventitious sounds, dyspnea, reduced vesicular murmurs, tachypnea, cough and use of the accessory musculature to breathe. The mean age of patients with was higher than those without this diagnosis. The defining characteristics reduced murmurs had high sensitivity (92.6%), specificity (97.4%), negative related value (86.4%) and positive related value (98.7%). The related factors of Ineffective Breathing Pattern were the related factors fatigue, age and group of diseases. CONCLUSION: fatigue, age and patients with a group of diseases were related factors of Ineffective Breathing Pattern in this study. Reduced vesicular murmurs, auscultation with adventitious sounds and cough may be defining characteristics to be added in the international classification, as well as the related factors bronchial secretion and group of diseases.

Nasogastric/Nasoenteric tube-related incidents in hospitalised patients: a study protocol of a multicentre prospective cohort study.

INTRODUCTION: Hospitalised patients with nasogastric/nasoenteric tube (NGT/NET) are at constant risk of incidents; therefore, healthcare professionals need to routinely monitor risks and adopt strategies for patient safety and quality of care. AIM: This study aimed to evaluate the NGT/NET-related incidents in hospitalised patients and associated factors. METHODS: This is a multicentre study, with a prospective cohort design. Data will be collected at the general medical ward of seven Brazilian hospitals in the north, northeast, southeast and south. The sample will consist of 391 patients that require an NGT/NET during hospitalisation. Three different methods will be used to identify the incidents: (1) healthcare professionals and patients/caregivers will be required to report any NGT/NET-related incidents; (2) researchers will visit the wards to get information about the incidents with healthcare professionals and patients/caregivers; (3) the researchers will review the medical records looking for information on the occurrence of any NGT/NET-related incidents. Demographic, clinical and therapeutic details will be obtained from the medical records and will be registered in an electronic data collection tool developed for the purposes of this study. The complexity of patients will be assessed by the Patient Classification System, and the severity of comorbid diseases will be assessed through the Charlson Comorbidity Index. IMPLICATION FOR PRACTICE: The results may encourage the use of evidence effectively to influence the scientific foundation for clinical practice and the development of evidence-based policies that will prevent, manage and eliminate complications caused by NGT/NET-related incidents, and improve the quality and safety of care provided to hospitalised patients. ETHICS AND DISSEMINATION: The study has been approved by the Research Ethics Committee. Detailed information about the study can be provided by the principal investigator. The findings will be reported through academic journals, seminar and conference presentations, social media, print media, the internet and community/stakeholder engagement activities.

Depressive symptoms in the family caregivers of patients with heart failure: an integrative review. / Sintomas depressivos em cuidadores familiares de pacientes com insuficiência cardíaca: revisão integrativa.

AIMS: Identify the occurrence of depressive symptoms in family caregivers of patients with heart failure and the correlation of other variables with depressive symptoms. DESIGN/METHOD: The literature review was conducted in the Web of Science, Medline, LILACS and PubMed databases in March 2017. Papers published between 2004 and 2016, written in English, Spanish or Portuguese were included. The descriptors used were health, heart failure, depression, caregivers, and family. RESULTS: 26 papers were selected. 6% to 64% reported depressive symptoms. Depressive symptoms were associated with patients' and caregivers' characteristics. In most cases, depressive symptoms were greater among family caregivers than in the general population and were mainly associated with care burden and quality of life. CONCLUSIONS: The studies report depressive symptoms in caregivers of patients with heart failure.