Beliefs and practices of the nursing team related to pressure injury preventive measures: A analysis of social representations.

AIMS AND OBJECTIVES: To analyse the process of elaborating social representations about pressure injury preventive measures by the nursing team (nurses and nurse technicians) and how this process relates to preventive practices for hospitalized patients. DESIGN: Qualitative study, with the application of the theory of social representations in its procedural methodological approach. METHODS: The study was carried out in an inpatient clinic of a public hospital in the state of Rondônia, Brazil. Totally, 28 nursing professionals in the medical clinic sectors who had worked directly with patient care for more than 6 months participated. The data were collected between July and September 2021 via in-depth interviews with the application of a semi-structured instrument. Analysis was carried out with the help of ALCESTE software, which performed a lexicographic analysis, and also via thematic analysis. The COREQ guided the presentation of the research report. RESULTS: The social representations were developed based on the professionals' symbolic beliefs about the visibility/invisibility of the results of applying preventive care. These symbolic constructions mobilized positive and negative feelings among the nursing team, which guided the classification of prevention practices as being of greater or lesser priority among other care activities. There were favourable attitudes among professionals, which included applying prevention measures in their daily routines, and unfavourable attitudes of non-adherence to the institution's protocol for preventing pressure injuries. CONCLUSIONS: The nursing team's perception of pressure injury prevention is influenced by symbolic, affective, values, and social dimensions. Non-adherence behaviours are attributed to the belief in the invisibility of prevention outcomes, resulting in a reluctance to implement preventive measures. RELEVANCE TO CLINICAL PRACTICE: Understanding the subjective logic that explains the thinking and actions of the nursing team suggests the need to incorporate discussions on beliefs, values, sentiments, and attitudes of nursing professionals into educational programs on pressure injury prevention. PATIENT OR PUBLIC CONTRIBUTION: No public contribution.

Labelling of intravenous drug delivery devices in critically ill patients: A scoping review.

BACKGROUND: Labelling is a strategy that contributes to the correct and faster identification of drugs, minimizing misidentification. There is a gap in knowledge on optimal labelling standards for intravenous (IV) devices applied to the care of critically ill patients. AIM: The goal of this article was to map existing knowledge on the labelling of IV drug delivery devices in critically ill patients for the prevention of medication errors. STUDY DESIGN: This was a scoping review conducted according to the JBI methodology in the LILACS, MEDLINE, CINAHL, IBECS, Scopus, Embase and Web of Science databases, and on the websites of specialized institutions. Searches were conducted up to December 2022 for scientific articles and grey literature that addressed the labelling of IV devices in intensive care units, emergency departments, and anaesthesia units. The data were collected using a structured form and were later classified, summarized, and aggregated to map the knowledge related to the review question. RESULTS: Twenty-one documents were included, which demonstrated variability in label use with IV drug delivery devices. The following features of structure and design stood out: printed format, colour coding, letter size differentiation, and the use of sturdy material. In terms of information, the name of the drug, dose, date and time of preparation, identification of the patient, and who prepared it were found. CONCLUSIONS: The identified patterns contributed to the reduction of drug misidentification and the development of timelier drug labelling and administration. RELEVANCE TO CLINICAL PRACTICE: The evidence supports the development of standardized labels for the prevention of medication errors.

Flushing in Intravenous Catheters: Observational Study of Nursing Practice in Intensive Care in Brazil.

An observational study was developed with 108 nursing professionals who managed vascular access devices in 4 intensive care units of a university hospital in Rio de Janeiro, Brazil. The objective was to analyze the practice of the nursing staff in performing flushing for the maintenance of vascular access devices in critically ill patients. Data were collected by observing the flushing procedure using a structured checklist and analyzed using descriptive and inferential statistics. In 23% of the 404 observations, there was no flushing. When performed at some point during catheter management (77%), flushing was predominant after drug administration with 1 or 2 drugs administered. There were flaws in the flushing technique applied in terms of volume and method of preparation. Time of professional experience >5 years, knowledge about recommendations, and training on flushing were variables associated with technique performance. It was concluded that the flushing procedure did not meet the recommendations of good practices, with failures that constituted medication errors.

Effect of rapid cycle deliberate practice in peripheral intravenous catheters insertion training: A simulation experimental study.

AIM: to compare the effect of rapid cycle deliberate practice simulation training with skill-training simulation on peripheral intravenous catheter insertion for Licensed Practical Nurses. BACKGROUND: The use of peripheral intravenous catheters is associated with high rates of complications, although it is widely used in clinical practice. Training strategies to ensure good performance can minimize the risks inherent to this procedure. DESIGN: A randomized simulation experimental pre-post interventional study. METHODS: Sixty participants were allocated to intervention (n = 30) or control (n = 30) groups. Participants allocated to the intervention group were trained through the Rapid cycle deliberate practice simulation strategy, while participants in the control group were trained through the skill-training simulation strategy. A pre-test was applied before any intervention and a post-test after intervention. The primary outcome was the performance in the peripheral intravenous catheter insertion skill. The comparison of correct performance in the tests was analyzed intergroup and intragroup. The effect size of the interventions was also analyzed. The t-Student and Mann-Whitney tests compared the difference between the groups. The training effect was calculated by Cohen's dm and Glass's Δ measures. RESULTS: Performance between the pre-post-test increased from 59.4% to 96% (p < 0.001) in the intervention group and from 57.8% to 93.5% in the control group (p < 0001). There was no statistical difference between the groups after intervention (p = 0225). Cohen's dm measurement was 2.95 and 3.59 in the control and intervention groups, respectively. CONCLUSIONS: The rapid cycle deliberate practice simulation strategy resulted in Licensed Practical Nurses' performance improvements in peripheral intravenous catheter insertion, evidenced by the increase of correct performance actions in the post-test compared to the pre-test. However, with no statistical difference compared to the skill-training simulation strategy.

Can support surfaces characteristics influence high-quality chest compression? manikin experiment with a mechanical device.

BACKGROUND: Support surfaces variables, such as size, material, and density, can determine chest compression depth in cardiopulmonary resuscitation. OBJECTIVE: to analyze the force required to do a high-quality chest compression concerning different surfaces in CPR. METHOD: This experimental study was developed using a Little Anne manikin and a mechanical device to perform chest compressions. Nine sets of surfaces were tested and compared to a control. RESULTS: 230 experimental tests were done in sets of bed or stretcher + mattress and presence or absence of different backboards. In the control condition, the average force to reach 5 cm of depth was 42.14±0.97 (kgf). Set 9, compatible with a narrow stretcher with a thin mattress, had the best surfaces to reach recommended depth, with or without a backboard. All other sets required significantly more force for high-quality chest compression. Regression analysis confirms that backboard size is not significant for the force for high-quality chest compression. CONCLUSION: There is an association of dimensions and types of beds or stretchers and mattresses with a force increase. Type and dimensions of the backboard are not relevant for the force required, regardless of the characteristics of the set of the bed or stretcher and mattress.

Radiodermatitis: severity, predictive factors and discontinuation of radiotherapy in patients with anal and rectal cancer.

OBJECTIVE: to determine the prevalence of radiodermatitis, severity grades and predictive factors of its occurrence in patients with anal and rectal cancer followed up by the nursing consultation, and to analyze the association of severity grades of radiodermatitis with temporary radiotherapy interruption. METHOD: a quantitative, cross-sectional and retrospective study, carried out with 112 medical records of patients with anal and rectal cancer undergoing curative radiotherapy followed up in the nursing consultation. Data were collected using a form and analyzed using analytical and inferential statistics. RESULTS: 99.1% of patients had radiodermatitis, 34.8% of which were severe. The predictive factors were female sex, age greater than 65 years, anal canal tumor, treatment with cobalt device and IMRT technique. Treatment interruption occurred in 13% of patients, associated with severe radiodermatitis. CONCLUSION: there was a high prevalence of radiodermatitis, mainly severe, which resulted in treatment interruption.

Radiodermatitis: severity, predictive factors and discontinuation of radiotherapy in patients with anal and rectal cancer / Radiodermitis: gravedad, factores predictivos y suspensión de la radioterapia en pacientes con cáncer anal y rectal / Radiodermatite: severidade, fatores preditivos e interrupção da radioterapia em pacientes com câncer anal e de reto

ABSTRACT Objective: to determine the prevalence of radiodermatitis, severity grades and predictive factors of its occurrence in patients with anal and rectal cancer followed up by the nursing consultation, and to analyze the association of severity grades of radiodermatitis with temporary radiotherapy interruption. Method: a quantitative, cross-sectional and retrospective study, carried out with 112 medical records of patients with anal and rectal cancer undergoing curative radiotherapy followed up in the nursing consultation. Data were collected using a form and analyzed using analytical and inferential statistics. Results: 99.1% of patients had radiodermatitis, 34.8% of which were severe. The predictive factors were female sex, age greater than 65 years, anal canal tumor, treatment with cobalt device and IMRT technique. Treatment interruption occurred in 13% of patients, associated with severe radiodermatitis. Conclusion: there was a high prevalence of radiodermatitis, mainly severe, which resulted in treatment interruption.

RESUMEN Objetivo: determinar la prevalencia de radiodermatitis, los grados de severidad y los factores predictores de su ocurrencia en pacientes con cáncer anal y rectal seguidos de la consulta de enfermería, y analizar la asociación de los grados de severidad de la radiodermatitis con la interrupción temporal de radioterapia. Método: investigación cuantitativa, transversal y retrospectiva, realizada con 112 prontuarios de pacientes con cáncer anal y rectal en tratamiento con radioterapia curativa seguidos en la consulta de enfermería. Los datos fueron recolectados mediante un formulario y analizados mediante estadística analítica e inferencial. Resultados: el 99,1% de los pacientes presentaban radiodermatitis, de las cuales el 34,8% eran graves. Los factores predictores fueron sexo femenino, edad mayor de 65 años, tumor del canal anal, tratamiento con aparato de cobalto y técnica de IMRT. La interrupción del tratamiento se produjo en el 13% de los pacientes, asociada a radiodermitis grave. Conclusión: hubo una alta prevalencia de radiodermatitis, principalmente severa, lo que obligó a la interrupción del tratamiento.

RESUMO Objetivo: determinar a prevalência da radiodermatite, os graus de severidade e os fatores preditivos da sua ocorrência em pacientes com câncer de canal anal e reto acompanhados pela consulta de enfermagem, e analisar a associação dos graus de severidade da radiodermatite com a interrupção temporária da radioterapia. Método: pesquisa quantitativa, seccional e retrospectiva, realizada com 112 prontuários de pacientes com câncer de canal anal e reto submetidos à radioterapia curativa acompanhados na consulta de enfermagem. Dados foram coletados por formulário e analisados empregando-se estatística analítica e inferencial. Resultados: 99,1% dos pacientes apresentaram radiodermatite, sendo 34,8% graus severos. Os fatores preditivos foram sexo feminino, idade maior que 65 anos, tumor de canal anal, tratamento com aparelho de cobalto e técnica IMRT. A interrupção do tratamento ocorreu em 13% dos pacientes, associada à radiodermatite severa. Conclusão: houve alta prevalência de radiodermatite, principalmente grau severo, que resultou em interrupção do tratamento.

Intensive care nurses' practice related to experience and shift worked.

OBJECTIVE: To analyse the social representations of nurses about intensive care practices comparing the variables 1) time since graduation and 2) shift worked. METHOD: Qualitative field research using social representation theory. Individual interviews were conducted and lexical analysis was applied. STUDY SETTING: Intensive Care Unit of a federal hospital with 21 clinical nurses. FINDINGS: Day shift nurses are more pragmatic and operationally oriented because they deal directly with the general functioning of the unit. Less experienced nurses face difficulties dealing with intensive care contexts, but have a critical view of their practices, while more experienced nurses apply practical knowledge in their decision-making and actions. CONCLUSION: The relationship of proximity or distance from patients, mediated by technology, is related to the domains of knowledge that are required to manage technology and to the role technology plays in intensive care.

A conceptual framework of clinical nursing care in intensive care.

OBJECTIVE: to propose a conceptual framework for clinical nursing care in intensive care. METHOD: descriptive and qualitative field research, carried out with 21 nurses from an intensive care unit of a federal public hospital. We conducted semi-structured interviews and thematic and lexical content analysis, supported by Alceste software. RESULTS: the characteristics of clinical intensive care emerge from the specialized knowledge of the interaction, the work context, types of patients and nurses characteristic of the intensive care and care frameworks. CONCLUSION: the conceptual framework of the clinic's intensive care articulates elements characteristic of the dynamics of this scenario: objective elements regarding technology and attention to equipment and subjective elements related to human interaction, specific of nursing care, countering criticism based on dehumanization.

[Styles of nurses' caring in Intensive Therapy mediated by technology]. / Estilos de cuidar de enfermeiras na Terapia Intensiva mediados pela tecnologia.

The objective was to identify the social representations of the intensive therapy nurses about the care practices in face of the technology. Participant observation and interviews were conducted with twenty one nurses of an intensive therapy center, at a Rio de Janeiro public hospital. Lexical analysis was applied, using the Alceste 2010. The results were organized in two categories, each of them with three lexical classes. The first brought the meaning of the technology in intensive therapy and the organization of the styles of caring; the second showed the client's condition and its impact on nurses' care practices. It was concluded that the technology organizes the nurses' styles of caring, that are built on client assistance in the work context. These lead nurses to assign meaning to their practices driving them to the elaboration of ways of acting in face of the technologies.

[Technology in nursing care: an analysis from the conceptual framework of Fundamental Nursing]. / Tecnologia no cuidado de enfermagem: uma analise a partir do marco conceitual da Enfermagem Fundamental.

This is a qualitative, field research, whose purpose was to discuss the use of technologies in the nursing care in intensive therapy, taking as reference the theoretical conceptual framework of Fundamental Nursing. Observation and interviews were conducted with twenty two nurses of an intensive therapy unit, with ethnographic analysis. The technology, from the domain of a technological language, provides conditions so that the fundamentals of the nursing care can be effectively incorporated to the nurse practice. The idea of dehumanization linked to the technology can be explained by the way that the nurse ads sense to the things related to his daily life, which will guide his action. The conclusion is that the technologies help to promote life and to rescue the human.

[The practice of intensive care nursing: alliance among technique, technology and humanization]. / Clínica do cuidado de enfermagem na terapia intensiva: aliança entre técnica, tecnologia e humanização.

A qualitative, field research study whose aim was to characterize the specific practice of intensive care nursing. Observation and interviews were conducted with 21 nurses in an intensive care unit. The results evidenced eight characteristics of this care, which included subjectivity and objectivity, translated into: interaction, dialogue, humanistic principles, vigilance, knowledge, and mastery of machinery. Because of this practice, subjectivity is not always expressed in a clear way, and objectivity requires training of nurses to perform intensive care. It is concluded that the practice of intensive care nursing combines technique, technology and humanization, which underlie the nursing care performed at the unit.

[Characteristics of the nurses from a technologic unit: implications for nursing care]. / Características dos enfermeiros de uma unidade tecnológica: implicações para o cuidado de enfermagem.

The purpose was to describe characteristics of formation and qualification of the nurses of a unit of intensive cares, and to argue its implications in the nursing assistance, how much to the use of technologies. Descriptive-exploratory study, with accomplishment of half-structuralized interview. Citizens: twenty and four operating nurses in cardio-intensive unit. Predominance of women with two years acting in the sector and course of specialization. Great part did not participate of courses for manuscript of technologies, six had not chosen the sector and eleven are inexperienced. It had balance in the time of professional formation. The professional profile must be considered to work in the sectors of intensive cares. Not to take care of this profile can bring risks to the customers.

[Technology in intensive care and its effects on nurses' actions]. / Tecnologia na terapia intensiva e suas influências nas ações do enfermeiro.

The objective of this study was to identify the social representations that nurses have about technology applied to intensive care, and relate them to their ways of acting while caring for patients. This qualitative study was performed using social representations as the theoretical-methodological framework. Interviews were performed with 24 nurses, in addition to systematic analysis and thematic content analysis. The results were organized into three categories about the lack of technological knowledge, approach strategies, mastering that knowledge and using it. The knowledge necessary to handle the technology, and the time of experience using that technology guide the nurses' social representations implying on their care attitudes. In conclusion, the staffing policy for an intensive care setting should consider the nurses' experiences and specialized education.