RESUMEN
The objective was to analyze an intervention in the traditional way of teaching nursing consultation and its potential for nurses' education aiming for the practice of integrality in health. This is a participative research carried out from August to November 2011 with eight students attending the School of Nursing in a public university from the south of Brazil. The study context comprised outpatient consultations and daily life experiences of the patients. Data were collected through focus group and submitted to thematic analysis, in which two categories emerged: "The interactivity between the traditional and the extended scenario:possibilities for the integrality in education" and "The extended nursing consultation, knowledge from experience". The analysis evidenced that the experience produced knowledge coherent with the integrality in education. We conclude that the diversification of learning scenarios may configure a pedagogical strategy with potential to foster changes in the existing health care and education model.
Asunto(s)
Educación en Enfermería/métodos , Derivación y ConsultaRESUMEN
OBJECTIVE: to evaluate the performance of the quickSOFA scores and Systemic Inflammatory Response Syndrome as predictors of clinical outcomes in patients admitted to an emergency service. METHOD: a retrospective cohort study, involving adult clinical patients admitted to the emergency service. Analysis of the ROC curve was performed to assess the prognostic indexes between scores and outcomes of interest. Multivariate analysis used Poisson regression with robust variance, evaluating the relationship between variables with biological plausibility and outcomes. RESULTS: 122 patients were selected, 58.2% developed sepsis. Of these, 44.3% had quickSOFA ≥2 points, 87% developed sepsis, 55.6% septic shock and 38.9% died. In the evaluation of Systemic Inflammatory Response Syndrome, 78.5% obtained results >2 points; of these, 66.3% developed sepsis, 40% septic shock and 29.5% died. quickSOFA ≥2 showed greater specificity for diagnosis of sepsis in 86% of the cases, for septic shock 70% and for mortality 64%, whereas the second score showed better results for sensitivity with diagnosis of sepsis in 87.5%, septic shock in 92.7% and death in 90.3%. CONCLUSION: quickSOFA showed by its practicality that it can be used clinically within the emergency services, bringing clinical applicability from the risk classification of patients for the early recognition of unfavorable outcomes.
Asunto(s)
Sepsis , Choque Séptico , Adulto , Servicio de Urgencia en Hospital , Humanos , Pronóstico , Curva ROC , Estudios Retrospectivos , Sepsis/diagnóstico , Sepsis/terapiaRESUMEN
OBJECTIVE: To verify the predictors associated with sick leave from 15 days onwards among Nursing professionals of an emergency hospital service. METHOD: A cross-sectional, retrospective, and descriptive-analytical study. The sample consists of the records of sick leave (n=2,403) due to diseases of the Nursing professionals (n=197) working in an emergency hospital service in southern Brazil, from 2013 to 2018. Descriptive and statistical analysis was used, as well as the multivariate regression model. RESULTS: There was predominance of females (72.6%), white-skinned (86.3%), with a mean age of 45.05 (SD=9.77) years old, and nursing technicians (74.6%). The prevalent cause of sick leave was related to clinical diseases (62.5%). The predictors associated with sick leave from 15 days onwards were the following: Age (OR: 0.97; 95% CI=0.95-0.99) and Musculoskeletal Diseases (OR: 8.95; 95% CI=5.30-15.11). CONCLUSION: Age and musculoskeletal diseases were predictors of sick leave from 15 days onwards of the Nursing team.
Asunto(s)
Absentismo , Personal de Enfermería en Hospital , Ausencia por Enfermedad , Niño , Estudios Transversales , Servicio de Urgencia en Hospital , Femenino , Humanos , Persona de Mediana Edad , Estudios RetrospectivosRESUMEN
OBJECTIVE: To analyze the registry of the Transfer Note (NT) and the emission of the Modified Early Warning Score (MEWS) performed by the nurse in adult patients transferred from the Emergency Service as an effective communication strategy for patient safety. METHOD: A cross-sectional retrospective study developed at a teaching hospital in the South of Brazil that evaluated 8028 electronic medical records in the year 2017. A descriptive analysis was performed. RESULTS: NT reached the institutional target of 95% in January and February, falling below the target in other months. The MEWS measurement was performed in 85.6% (n = 6,870) of the medical records. Of these patients, 96.8% (n = 6,652) had unchanged MEWS. CONCLUSION: NT and MEWS are inserted in the work of the nurse, however, actions are needed to qualify patient safety, improving effective communication and therefore reducing the possibility of occurrence of adverse events.
Asunto(s)
Sistemas de Comunicación en Hospital , Registros de Hospitales , Evaluación en Enfermería , Registros de Enfermería , Seguridad del Paciente , Transferencia de Pacientes/organización & administración , Gestión de Riesgos/métodos , Índice de Severidad de la Enfermedad , Adulto , Brasil , Estudios Transversales , Registros Electrónicos de Salud , Servicio de Urgencia en Hospital , Control de Formularios y Registros , Sistemas de Comunicación en Hospital/organización & administración , Hospitales de Enseñanza/organización & administración , Humanos , Rol de la Enfermera , Indicadores de Calidad de la Atención de Salud , Estudios Retrospectivos , Medición de Riesgo , Gestión de Riesgos/organización & administraciónRESUMEN
Objective: to evaluate the performance of the quickSOFA scores and Systemic Inflammatory Response Syndrome as predictors of clinical outcomes in patients admitted to an emergency service. Method: a retrospective cohort study, involving adult clinical patients admitted to the emergency service. Analysis of the ROC curve was performed to assess the prognostic indexes between scores and outcomes of interest. Multivariate analysis used Poisson regression with robust variance, evaluating the relationship between variables with biological plausibility and outcomes. Results: 122 patients were selected, 58.2% developed sepsis. Of these, 44.3% had quickSOFA ≥2 points, 87% developed sepsis, 55.6% septic shock and 38.9% died. In the evaluation of Systemic Inflammatory Response Syndrome, 78.5% obtained results >2 points; of these, 66.3% developed sepsis, 40% septic shock and 29.5% died. quickSOFA ≥2 showed greater specificity for diagnosis of sepsis in 86% of the cases, for septic shock 70% and for mortality 64%, whereas the second score showed better results for sensitivity with diagnosis of sepsis in 87.5%, septic shock in 92.7% and death in 90.3%. Conclusion: quickSOFA showed by its practicality that it can be used clinically within the emergency services, bringing clinical applicability from the risk classification of patients for the early recognition of unfavorable outcomes.
Objetivo: avaliar o desempenho dos escores quickSOFA e Síndrome da Resposta Inflamatória Sistêmica como fatores preditores de desfechos clínicos em pacientes admitidos em um serviço de emergência. Método: coorte retrospectiva, envolvendo pacientes adultos clínicos admitidos em serviço de emergência. A análise da curva ROC foi realizada para a avaliação dos índices prognósticos entre escores e desfechos de interesse. Análise multivariável utilizou regressão de Poisson com variância robusta avaliando a relação entre as variáveis com plausibilidade biológica e os desfechos. Resultados: foram selecionados 122 pacientes, 58,2% desenvolveram sepse. Destes 44,3% tiveram quickSOFA ≥2 pontos, 87% desenvolveram sepse, 55,6% choque séptico e 38,9% morreram. Na avaliação de Síndrome da Resposta Inflamatória Sistêmica 78,5% obtiveram resultados >2 pontos, destes 66,3% desenvolveram sepse, 40% choque séptico e 29,5% morreram. O quickSOFA ≥2 apresentou maior especificidade para diagnóstico de sepse em 86% dos casos, para choque séptico 70% e para mortalidade 64%, já o segundo escore mostrou melhores resultados para sensibilidade com diagnóstico de sepse de 87,5%, choque séptico 92,7% e óbito 90,3%. Conclusão: o quickSOFA demonstrou pela sua praticidade que pode ser utilizado clinicamente dentro dos serviços de emergência trazendo aplicabilidade clínica a partir da classificação de risco de pacientes para o reconhecimento precoce de desfechos desfavoráveis.
Objetivo: evaluar el rendimiento de los puntajes quick SOFA y del Síndrome de Respuesta Inflamatoria Sistémica como predictores de desenlaces clínicos en pacientes ingresados en un servicio de emergencia. Método: cohorte retrospectiva de pacientes clínicos adultos ingresados en el servicio de emergencia. El análisis de la curva ROC se realizó para evaluar los índices de pronóstico entre puntajes y desenlaces de interés. El análisis multivariado utilizó regresión de Poisson con varianza robusta, evaluando la relación entre las variables con plausibilidad biológica y los desenlaces. Resultados: se seleccionaron 122 pacientes, 58,2% desarrollaron sepsis. De estos, el 44,3% tenía quick SOFA ≥2 puntos, el 87% desarrolló sepsis, el 55,6% shock séptico y el 38,9% falleció. En la evaluación del Síndrome de Respuesta Inflamatoria Sistémica el 78,5% obtuvo resultados ≥2 puntos, de los cuales el 66,3% desarrolló sepsis, el 40% shock séptico y el 29,5% falleció. El quick SOFA ≥2 mostró mayor especificidad para el diagnóstico de sepsis en el 86% de los casos, para shock séptico en el 70% y para mortalidad en el 64%, mientras que el segundo puntaje mostró mejores resultados de sensibilidad para el diagnóstico de sepsis de 87,5%, shock séptico 92,7% y muerte 90,3%. Conclusión: el quick SOFA demostró, por su practicidad, que se puede utilizar clínicamente dentro de los servicios de emergencia aportando aplicabilidad clínica por medio de la clasificación de riesgo de los pacientes para el reconocimiento temprano de desenlaces desfavorables.
Asunto(s)
Humanos , Adulto , Pronóstico , Choque Séptico , Curva ROC , Sepsis/diagnóstico , Sepsis/terapiaRESUMEN
Resumo OBJETIVO Analisar o registro da Nota de Transferência (NT) e a emissão do Modified Early Warning Score (MEWS) realizados pelo enfermeiro em pacientes adultos transferidos do Serviço de Emergência como estratégia de comunicação efetiva para a segurança do paciente. MÉTODO Estudo transversal retrospectivo desenvolvido em um hospital de ensino no Sul do Brasil que avaliou 8028 prontuários eletrônicos no ano de 2017. Procedeu-se a análise descritiva. RESULTADOS A realização da NT atingiu a meta institucional de 95% nos meses de janeiro e fevereiro, ficando abaixo da meta nos demais meses. A mensuração do MEWS foi realizada em 85,6% (n=6.870) dos prontuários. Destes pacientes, 96,8% (n=6.652) possuíam MEWS não alterado. CONCLUSÃO A NT e o MEWS estão inseridos no trabalho do enfermeiro, no entanto, são necessárias ações com vistas a qualificar a segurança do paciente, melhorando a comunicação efetiva e, por conseguinte, diminuindo a possibilidade de ocorrências de eventos adversos.
Resumen OBJETIVO Analizar el registro, realizado por el enfermero, la Nota de Transferencia (NT) y la emisión del Modified Early Warning Score (MEWS) en pacientes adultos transferidos del Servicio de Emergencia como estrategia de comunicación efectiva para la seguridad del paciente. MÉTODO Estudio transversal retrospectivo desarrollado en un hospital de enseñanza en el sur de Brasil que evaluó 8028 históricos electrónicos en el año 2017. Se llevó a cabo el análisis descriptivo. RESULTADOS La realización de la NT alcanzó la meta institucional del 95% en los meses de enero y febrero, quedando por debajo de la meta en los demás meses. La medición del MEWS se realizó en el 85,6% (n = 6.870) de los históricos. De estos pacientes, el 96,8% (n = 6.652) poseía MEWS no alterado. CONCLUSIÓN La NT y el MEWS están insertos en el trabajo del enfermero, sin embargo es necesario acciones con miras a calificar la seguridad del paciente, para mejor la comunicación efectiva y, por consiguiente, disminuir la posibilidad de ocurrencia de eventos adversos.
Abstract OBJECTIVE To analyze the registry of the Transfer Note (NT) and the emission of the Modified Early Warning Score (MEWS) performed by the nurse in adult patients transferred from the Emergency Service as an effective communication strategy for patient safety. METHOD A cross-sectional retrospective study developed at a teaching hospital in the South of Brazil that evaluated 8028 electronic medical records in the year 2017. A descriptive analysis was performed. RESULTS NT reached the institutional target of 95% in January and February, falling below the target in other months. The MEWS measurement was performed in 85.6% (n = 6,870) of the medical records. Of these patients, 96.8% (n = 6,652) had unchanged MEWS. CONCLUSION NT and MEWS are inserted in the work of the nurse, however, actions are needed to qualify patient safety, improving effective communication and therefore reducing the possibility of occurrence of adverse events.
Asunto(s)
Humanos , Adulto , Gestión de Riesgos/métodos , Índice de Severidad de la Enfermedad , Registros de Hospitales , Registros de Enfermería , Transferencia de Pacientes/organización & administración , Seguridad del Paciente , Evaluación en Enfermería , Gestión de Riesgos/organización & administración , Brasil , Estudios Transversales , Estudios Retrospectivos , Medición de Riesgo , Indicadores de Calidad de la Atención de Salud , Rol de la Enfermera , Servicio de Urgencia en Hospital , Registros Electrónicos de Salud , Control de Formularios y Registros , Sistemas de Comunicación en Hospital/organización & administración , Hospitales de Enseñanza/organización & administraciónRESUMEN
Objetivou-se analisar uma intervenção no modo tradicional de ensinar a consulta de enfermagem e seu potencial para a formação de enfermeiros para a prática da integralidade em saúde. Pesquisa participante, desenvolvida com oito alunos do Curso de Enfermagem de uma universidade pública do sul do Brasil, no período de agosto a novembro de 2011. O contexto de estudo constituiu-se pelas consultas ambulatoriais e por vivências no cotidiano dos usuários. Os dados coletados por meio de grupo focal foram submetidos à análise temática, emergindo duas categorias: "A interatividade entre o cenário tradicional e o ampliado: possibilidades para o aprendizado da integralidade" e "A consulta de enfermagem ampliada: saberes gerados na experiência". Evidenciou-se que a experiência foi produtora de saberes coerentes com a formação para integralidade. Conclui-se que a diversificação de cenários de aprendizagem pode configurar-se como estratégia pedagógica com potência para provocar transformações no modelo de atenção/formação em saúde vigente.
The objective was to analyze an intervention in the traditional way of teaching nursing consultation and its potential for nurses' education aiming for the practice of integrality in health. This is a participative research carried out from August to November 2011 with eight students attending the School of Nursing in a public university from the south of Brazil. The study context comprised outpatient consultations and daily life experiences of the patients. Data were collected through focus group and submitted to thematic analysis, in which two categories emerged: "The interactivity between the traditional and the extended scenario: possibilities for the integrality in education" and "The extended nursing consultation: knowledge from experience". The analysis evidenced that the experience produced knowledge coherent with the integrality in education. We conclude that the diversification of learning scenarios may configure a pedagogical strategy with potential to foster changes in the existing health care and education model.
Se analizó una intervención en el modo tradicional de enseñar la consulta de enfermería y su potencial en la formación de enfermeros para la práctica de la integralidad en salud. Se desarrolló una encuesta participante con ocho alumnos del Curso de Enfermería de una universidad pública del sur de Brasil en el período de agosto a noviembre de 2011. El contexto estudiado cubrió consultas externas y vivencias del cotidiano de vida de los usuarios. Los datos recolectados por grupo focal fueron sometidos al análisis temático del cual emergieron dos categorías: "La interactividad entre el escenario tradicional y el ampliado: posibilidades para el aprendizaje de la integralidad" y "La consulta de enfermería extendida: saberes generados en la experiencia". Quedó evidenciado que la experiencia produjo conocimientos consistentes con la formación para la integralidad. Se concluye que la diversificación de escenarios de enseñanza puede configurar una estrategia pedagógica con potencia para provocar cambios en el modelo vigente de atención/enseñanza en salud.