Foot ulceration in patients with diabetes: a risk analysis.

The study reported in this article aimed to analyse factors associated with the risk of ulceration in the feet of patients with diabetes using a conceptual hierarchic model. It was a cross-sectional study carried out with 1515 people with diabetes mellitus aged 40 years and older. The risk of foot ulceration was of higher significance in male patients with diabetes (adjusted odds ratio (OR)=1.39 (95% confidence interval (CI) 1.11 to 1.73); p=0.020), who did not practise a regular physical activity (adjusted OR=1.58 (95% CI 1.15 to 2.15); p=0.013), with time since diagnosis over 10 years (adjusted OR=1.42 (95% CI 1.10 to 1.86); p=0.011), who used insulin (adjusted OR=1.40 (95% CI 1.09 to 1.84); p=0.012), with retinopathy (adjusted OR=1.84 (95% CI 1.38 to 2.45); p=0.001) and who had had a previous stroke (adjusted OR=1.47 (95% CI 1.09 to 2.04); p=0.018). Mycosis on the nails and the interdigital spaces of the feet was statistically associated with ulceration risk independent of other variables of the model (adjusted OR=2.48 (95%CI 1.70 to 3.63); p=0.001). Finding the factors associated with ulceration contributes to the provision of quality care by nurses.

Factors associated with foot ulceration of people with diabetes mellitus living in rural areas. / Fatores associados à ulceração nos pés de pessoas com diabetes mellitus residentes em área rural.

Objective To analyze the factors associated with the risk of ulceration in the feet of people with diabetes mellitus living in rural areas. Methods This is a cross-sectional study conducted with 293 individuals with diabetes mellitus, aged 40 years or older, living in the south of Brazil, in 2014. We analyzed socioeconomic variables, clinical conditions and foot self-care. We used the Poisson multiple regression model and the Prevalence Ratio (PR) and p-value<0.05 as a measure of association. Results 43.7% of the sample presented risk of foot ulceration. The highest prevalence of foot ulceration risk was associated with people with lower purchasing power (PRadjusted=1.62/IC95%:1.52-2.22), with retinopathy (PRadjusted=1.30/IC95%:1.12-1.68) and alteration in foot moisture (PRadjusted=1.57/IC95%:1.22-2.01). We identified low education level (64.2%), high prevalence of arterial hypertension (86.3%) and onychomycosis in the feet (72%). Conclusions Diabetic patients need an assessment of the risk of foot ulceration, especially those with longer diagnosis, chronic complications and low socio-educational level.

[Costs of reusable and disposable aprons in a public teaching hospital]. / Custos de aventais de tecido reutilizáveis e de descartáveis em hospital universtário público.

OBJECTIVE: To analyze the direct cost of reusable and disposable aprons in a public teaching hospital. METHOD: Cross-sectional study of quantitative approach, focusing on the direct cost of reusable and disposable aprons at a teaching hospital in northern Paraná. The study population consisted of secondary data collected in reports of the cost of services, laundry, materials and supplies division of the institution for the year 2012. RESULTS: We identified a lower average cost of using disposable apron when compared to the reusable apron. The direct cost of reusable apron was R$ 3.06, and the steps of preparation and washing were mainly responsible for the high cost, and disposable apron cost was R$ 0.94. CONCLUSION: The results presented are important for hospital managers properly allocate resources and manage costs in hospitals
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Hospital indicators after implementation of bed regulation strategies: an integrative review.

OBJECTIVES: to analyze the scientific evidence available in literature on hospital indicators after implementation of bed regulation strategies. METHODS: this is an integrative review conducted with studies available in five databases and in the reference database of the Center for Study and Research in Nursing Services Management in October 2019. Articles on hospital bed management, available in full in English, Spanish or Portuguese, without temporal delimitation were included. RESULTS: 1,118 eligible articles were found, of which 37 were duplicated. Among 1,081 pre-selected studies, 112 studies were eligible and 11 articles were included. Six studies addressed the emergency services. Three addressed hospital indicators in general, another focused on a psychiatric ward and one analyzed the indicators of two hospitals administered differently. CONCLUSIONS: the studies focused on emergency services, demonstrating the importance of organizing these services for health institutions.

Construction and validation of self-care educational technology for caregivers.

OBJECTIVES: to build and validate educational self-care technology for informal caregivers. METHODS: methodological study, anchored in the Delphi technique, carried out in a municipality in the state of Paraná, Brazil, between September 2018 and November 2019. It was developed in three stages: situational diagnosis; elaboration of educational technology; content and appearance validation by expert judges and informal caregivers, using the content validity index and coefficient of variation. RESULTS: after the steps of the methodological process, an educational technology called "Taking Care of Those Who Care" was produced, as an information tool that deals with the self-care of informal caregivers, receiving a content validity index above 0.86 and a variation coefficient. below 20% on all items. CONCLUSIONS: the educational technology was built and evaluated with satisfactory rates by the specialists and target audience, showing a high correlation of agreement, characterizing it as adequate and informative to informal caregivers.

Indicators of surgical patients after the implementation of an Internal Bed Regulation Committee in a university hospital.

OBJECTIVE: To analyze the indicators of surgical patients after the implementation of an Internal Bed Regulation Committee in a university hospital. METHOD: Longitudinal, quantitative, and retrospective study. The data collection was conducted in the Hospital Management Information institutional system, from which the information of patients submitted to surgical procedures from January 2015 to June 2018 were obtained. To verify the data trends, a simple linear regression model was used. RESULTS: The predominance of patients aged 20 to 39 and hospitalized on an emergency basis was observed. An ascending trend for structure indicators was verified regarding the number of surgical procedures and patients per surgical room. The process indicators were stagnant. An ascending trend was presented by the result indicators related to the number of surgical patients, hospitalized surgical patients, surgical procedures, and patients with Hospitalization Authorization. CONCLUSION: A change in the mean values of the process indicators was observed, showing the performance of this service. Organizational changes were also observed regarding the establishment of norms, processes, and flows.

Age management practices toward workers aged 45 years or older: an integrative literature review.

Age management practices refer to the development and implementation of workplace strategies to support and improve the health and productivity of workers aged 45 years or older. The objective of this study was to analyze the scientific evidence available to support age management practices toward older workers. An integrative review was conducted, with the following databases searched in February 2019: LILACS, MEDLINE, Web of Science, and SCOPUS. Inclusion criteria consisted of original primary studies with full-text availability, published in Portuguese, English or Spanish. Secondary studies were excluded. No restrictions were imposed on publication dates given the paucity of literature on this topic. The final sample consisted of 11 primary studies published between 2006 and 2017, which addressed the following age management practices: workplace health promotion; employment exit and transition to retirement; knowledge transfer, training and lifelong learning; career development; flexible working time practices; and occupational safety and health management. Age management practices are promising tools to promote a work environment that is adequate to the needs of older workers.

Factors associated with glycemic control in people with diabetes mellitus. / Fatores associados ao controle glicêmico de pessoas com diabetes mellitus.

Investigate the factors associated with the glycemic control in people with diabetes mellitus (DM). Cross-sectional study with 746 people with type-2 DM of age 40 or older. The following variables were selected: socioeconomic, clinical data, lifestyle and the risk of developing foot ulcers. Data collection occurred through interviews, medical record analysis and clinical examination of the lower limbs. We used the Poisson multiple regression model to determine the crude and adjusted prevalence ratios (PR) of the glycemic alteration. The alteration in the glycated hemoglobin (HbA1c) test was considered as a dependent variable in this study, which has been classified as high when the result was higher than 7%. The alteration in HbA1c was present in 68.9% of the participants and was more prevalent in individuals aged between 50 and 69 (PR = 1.38/IC95% = 1.09-1.75), who were taking insulin (PR = 1.35/IC95% = 1.24-1.47), obese (PR = 1.14/IC95% = 1.03-1.25) and who had foot ulceration risk (PR = 1.14/IC95% = 1.09-1.28). Individuals aged between 50 and 69; the ones who used insulin; the obese ones; and those who had a risk of foot ulceration, presented higher prevalence rates of alteration in the glycated hemoglobin.

Investigar os fatores associados ao controle glicêmico de pessoas com diabetes mellitus (DM). Estudo transversal realizado com 746 pessoas com DM tipo 2 e 40 anos ou mais de idade. Elegeu-se as seguintes variáveis: socioeconômicas, dados clínicos, estilo de vida e o risco para o desenvolvimento de úlceras nos pés. A coleta dos dados ocorreu por meio de entrevista, análise do prontuário e exame clínico dos membros inferiores. Utilizou-se o modelo de regressão múltipla de Poisson para determinação das razões de prevalência (RP) brutas e ajustadas da alteração do exame de hemoglobina glicada (HbA1c), considerada como variável dependente desta pesquisa, sendo esta classificada como elevada quando o valor apresentava resultado superior a 7%. Identificou-se a elevação da HbA1c em 68,9% dos participantes e foi mais prevalente em indivíduos com idade entre 50 e 69 anos (RP = 1,38/IC95% = 1,09-1,75), os que faziam uso de insulina (RP = 1,35/IC95% = 1,24-1,47), obesos (RP = 1,14/IC95% = 1,03-1,25) e naqueles que possuíam risco de ulceração nos pés (RP = 1,14/IC95% = 1,09-1,28). Os indivíduos na faixa etária entre 50 e 69 anos, os que faziam uso de insulina, os obesos e os que possuíam risco de ulceração nos pés apresentaram maiores taxas de prevalência de alteração na hemoglobina glicada.

Cultural adaptation of the Retirement Resources Inventory for Brazilian culture.

OBJECTIVE: To translate and adapt the Retirement Resources Inventory for Brazilian culture. METHODS: Methodological research including the stages of translation, synthesis, evaluation by committee of judges, back-translation and pre-test. The internal consistency of the instrument with Cronbach's alpha coefficient was evaluated. RESULTS: We considered the stages of translation and cultural adaptation adequate. The evaluation of the synthesis version by the judges resulted in the need to change 95.0% of the items to ensure the semantic, idiomatic, cultural and conceptual equivalence between the original and translated versions. In general consensus of the instrument, the agreement rate among the judges for the equivalences was 84.4%. As for the pre-test stage, 25 pre-retirees participated. The participants suggested adjustments in the instrument. The instrument's internal consistency was 0.85. The mean time to fill in the instrument was 18.7 minutes. CONCLUSIONS: The methodological process of cultural adaptation of the Retirement Resources Inventory resulted in adequate content validity and ease of understanding by the participants. We emphasize that this study precedes the evaluation process of the psychometric properties of the instrument, which will be carried out in new studies.

Development of a web software prototype to support retirement planning. / Desenvolvimento de um protótipo de web software de apoio ao planejamento da aposentadoria.

OBJECTIVE: To develop a web software prototype to support retirement planning. METHOD: This is a methodological research, applied and based on the principles of prototyping model, which followed the steps of communication, planning, prototype creation, functional tests and consolidation of web software version 1. RESULTS: The functions of the web software prototype were defined from a flowchart and scope. In the creation stage, the screens that integrated the prototype, composed by interview, were projected from the filling of the Retirement Resources Inventory, screen of access to support planning materials, including lectures, scientific texts, and technical materials, retirement news screen, experiences screen, which allow users to post retirement expectations and comment on other users' posts. After performing tests, the prototype was made available at www.aposentarsecomsaude.com.br . CONCLUSION: the web software prototype consists of an interactive environment in which the user feels active in the reflection process about the retirement along the different screens. With clear language and expressions that are easily understood by the public, they are applicable to users of different professional profiles.

Validation of instrument to assess software of patients' risk classification.

OBJECTIVE: Validate the content of an instrument that assesses the quality of a software applied to the risk classification of patients. METHOD: Methodological study, conducted in three stages: adaptation of the instrument, content validation through Delphi technique and pre-test. The results were analyzed through Content Validity Index, Overall Content Validity Index and Inter-rater Reliability. RESULTS: The final version of the instrument comprises 8 characteristics and 28 sub-characteristics, being 37 general questions to computer experts and nurse and 7 specific questions to computer experts, including 1 question and excluding 3 questions of the original instrument. We obtained Overall Content Validity of 92% and Inter-rater Reliability of 100% in the second Delphi round. Final considerations: The instrument has content validity, allowing to assess the technical quality and functional performance of the software applied to the risk classification of patients.

Efetividade de um algoritmo para identificar precocemente a deterioração clínica em unidades de internação adulto / Efectividad de un algoritmo para identificar precozmente el deterioro clínico en unidades de internación adulta / Effectiveness of an algorithm to identify early clinical deterioration in adult inpatient units

RESUMO Objetivo: Avaliar a ef etividade de um algoritmo para identificar precocemente a deterioração clínica em unidades de internação adulto. Método: Estudo de coorte retrospectivo, realizado em um hospital filantrópico localizado no norte paranaense. Procedeu-se à análise de tendência de indicadores referentes à produtividade, produção e qualidade. Adotou-se um erro alfa de 5%. Resultados: Os indicadores de produção mostraram tendência decrescente na taxa de ocupação, tanto dos leitos destinados a tratamentos eletivos, quanto daqueles reservados para urgência, e tendência crescente no número absoluto de internações e número de pacientes dia. Nos indicadores de produtividade, observou-se tendência estacionária no índice de renovação de leitos. Em relação à qualidade, verificou-se a predominância da tendência crescente em todas as taxas (infecção, sepse e mortalidade). Conclusão: Os resultados demonstraram que o algoritmo foi efetivo, visto que houve melhora nos indicadores de produção, que mostraram tendência decrescente na taxa de ocupação, tanto nos leitos eletivos, quanto nos de urgência; e dos indicadores de produtividade, onde observou-se tendência estacionária no índice de renovação de leitos.

RESUMEN Objetivo: evaluar la efectividad de un algoritmo para identificar precozmente el deterioro clínico en unidades de internación adulta. Método: estudio de cohorte retrospectivo, realizado en un hospital filantrópico ubicado en el norte de Paraná/Brasil. Se procedió al análisis de indicadores de tendencia referentes a la productividad, producción y calidad. Se adoptó un error alfa del 5%. Resultados: los indicadores de producción mostraron tendencia decreciente en la tasa de ocupación, tanto de las camas destinadas a tratamientos electivos, como de aquellos reservados para urgencia, y tendencia creciente en el número absoluto de internaciones y número de pacientes/día. En los indicadores de productividad, se observó tendencia estacionaria en el índice de renovación de camas. En cuanto a la calidad, se observó un predominio de la tendencia creciente en todas las tasas (infección, sepsis y mortalidad). Conclusión: los resultados demostraron que el algoritmo fue efectivo, ya que hubo mejora en los indicadores de producción, que señalaron tendencia decreciente en la tasa de ocupación, tanto en las camas electivas, como en los de urgencia; y de los indicadores de productividad, donde se observó tendencia estacionaria en el índice de renovación de camas.

ABSTRACT Objective: To evaluate the effectiveness of an algorithm for early identification of clinical deterioration in adult inpatient units. Method: Retrospective cohort study conducted in a philanthropic hospital in northern of the State of Paraná. The study analyzed the trend of indicators related to productivity, production, and quality. It adopted an alpha error of 5%. Results: The production indicators showed a decreasing trend in the occupancy rate, both of the beds destined for elective treatments and those reserved for urgency, and an increasing trend in the absolute number of hospitalizations and the number of patients per day. The productivity indicators showed a steady trend in the bed renewal index. Regarding quality, there was a predominance of increasing trend in all rates (infection, sepsis, and mortality). Conclusion: The results showed that the algorithm was effective since there was an improvement in production indicators, which showed a decreasing trend in the occupancy rate, both in elective and emergency beds, and productivity indicators, where there was a stationary trend in the bed renewal index.

Prototype of a computerized scale for the active search for potential organ donors.

OBJECTIVE:: to develop a prototype of a computerized scale for the active search for potential organ and tissue donors. METHOD:: methodological study, with the analysis of 377 electronic medical records of patients who died due to encephalic death or cardiorespiratory arrest in the intensive care units of a tertiary hospital. Among the deaths due to cardiorespiratory arrest, the study aimed to identify factors indicating underreported encephalic death cases. The Acute Physiology and Chronic Health Evaluation II and Sepsis Related Organ Failure Assessment severity indexes were applied in the protocols. Based on this, a scale was built and sent to five experts for assessment of the scale content, and subsequently, it was computerized by using a prototyping model. RESULTS:: 34 underreported encephalic death cases were identified in the medical records of patients with cardiorespiratory arrest. Statistically significant differences were found in the Wilcoxon test between the scores of hospital admissions in the intensive care unit and the opening of the encephalic death protocol for both severity indexes. CONCLUSION:: the prototype was effective for identifying potential organ donors, as well as for the identification of the degree of organ dysfunction in patients with encephalic death. OBJETIVO:: desenvolver protótipo de escala informatizada para busca ativa de potenciais doadores de órgãos e tecidos. MÉTODO:: pesquisa metodológica, com análise de 377 prontuários eletrônicos de pacientes que evoluíram a óbito, por morte encefálica, ou parada cardiorrespiratória, nas unidades de terapia intensiva de hospital terciário. Nos óbitos por parada cardiorrespiratória, buscou-se identificar fatores que indicassem subnotificação de morte encefálica. Nos protocolos, foram aplicados os índices de gravidade Acute Physiology and Chronic Health Evaluation II e Sepsis Related Organ Failure Assessment. A partir disso, construiu-se a escala que foi encaminhada a cinco especialistas, para avaliação de conteúdo, e, posteriormente, foi informatizada por modelo de prototipação. RESULTADOS:: foram identificadas 34 subnotificações de morte encefálica nos prontuários dos casos de parada cardiorrespiratória. O teste de Wilcoxon demonstrou diferença estatisticamente significativa entre os escores de admissão em unidade de terapia intensiva e abertura do protocolo de morte encefálica, para ambos os índices de gravidade. CONCLUSÃO:: o protótipo foi efetivo para identificação de potenciais doadores, bem como o grau de disfunção orgânica de pacientes em morte encefálica. OBJETIVO:: desarrollar un prototipo de escala informatizada para la búsqueda activa de potenciales donantes de órganos y tejidos. MÉTODO:: investigación metodológica, con el análisis de 377 registros médicos electrónicos de pacientes, que fallecieron por muerte encefálica o paro cardiorrespiratorio, en las unidades de cuidados intensivos de un hospital terciario. Entre las muertes por paro cardiorrespiratorio, se buscó identificar los factores que indicasen subnotificación de muerte encefálica. Las puntuaciones de los índices de gravedad Acute Physiology and Chronic Health Evaluation II y Sepsis Related Organ Failure Assessment se aplicaron en los protocolos. A partir de eso, la escala fue construida y enviada a cinco expertos para la evaluación del contenido, y posteriormente, fue informatizada mediante un modelo de prototipación. RESULTADOS:: se identificaron 34 casos de subnotificación de muerte encefálica en los registros médicos de los casos de paro cardiorrespiratorio. Se encontraron diferencias estadísticamente significativas en la prueba de Wilcoxon, entre las puntuaciones de los ingresos hospitalarios en unidad de cuidados intensivos y apertura del protocolo de muerte encefálica para ambos índices de gravedad. CONCLUSIÓN:: el prototipo fue eficaz para la identificación de potenciales donantes, así como para la identificación del grado de disfunción orgánica en pacientes con muerte encefálica.

Construção e validação de vídeo educativo sobre gestão da idade do trabalhador / Construction and validation of an educational video on occupational age management

Resumo Introdução: a gestão da idade do trabalhador de mais idade refere-se a práticas implantadas nos ambientes de trabalho direcionadas à contratação e/ou retenção de trabalhadores a partir de 45 anos. Objetivo: construir e validar um vídeo educativo sobre a gestão da idade do trabalhador de mais idade. Método: realizou-se um estudo metodológico, dividido em duas etapas: a primeira consistiu na elaboração e validação do conteúdo do vídeo; e a segunda, na produção do vídeo e sua validação por especialistas. Para análise dos dados, foram utilizados o Índice de Validade de Conteúdo Individual e Geral para cada item que compôs o vídeo e o Índice de Concordância Interavaliadores. O critério para validação foi apresentar concordância igual ou superior a 80%. Resultados: a versão final do vídeo tem 9 minutos, contendo definição, benefícios, estratégias para a implantação da gestão da idade do trabalhador pelas instituições e o papel do gestor nesse contexto. Utilizaram-se recursos de imagem do tipo animação e narração. A versão final do vídeo obteve concordância de 100% entre os especialistas para todos os itens, validando-o para aplicação. Conclusão: o processo de validação referendou o vídeo desenvolvido como um instrumento educativo adequado para difundir informações sobre a gestão da idade do trabalhador.

Abstract Introduction: age management at workplaces consists of practices implemented in work environment to hire and/or retain workers aged 45 or older. Objective: to build and validate an educational video on managing the age of the older worker. Method: a methodological study was carried out in two stages: first, the video content was elaborated and validated; second, after edited, the video was validated by experts on the topic. Data analysis was performed using the Individual and Overall Content Validity Index for each item in the video, and the Inter-rater Reliability Index. The validation criterion was presenting an agreement equal or greater than 80%. Results: in its 9-minute final version, the video presents a definition, benefits, strategies for institutions to implement occupational age management practices and the manager's role in this scenario. Editing used animation and narration. The final version obtained a 100% reliability among experts for all items, validating the video. Conclusion: the validation process endorsed the video as a suitable educational tool to disseminate information on occupational age management.

Instrumentos para avaliação das competências de liderança em enfermagem: Revisão de literatura

Resumo: Introdução: A difusão tecnológica do mercado de trabalho exige o desenvolvimento de habilidades e competências diferenciadas dos enfermeiros, para que estes possam assumir novas responsabilidades gerenciais e organizacionais. Objetivo: Identificar na literatura instrumentos para avaliação das competências necessárias à liderança em enfermagem. Método: Revisão integrativa da literatura, a qual utilizou as bases Literatura Latino-Americana e do Caribe em Ciências da Saúde (LILACS), Cumulative Index to Nursing and Allied Health Literature (CINAHL) e Scopus. Resultados: Foram selecionados 10 estudos nesta revisão os quais identificaram os seguintes instrumentos: Ambulance Nurse Competence (ANC) scale; Leadership Practives Inventory (LPI); Clinical Leadership Needs Analysis (CLeeNA) Instrument; Cotter Preceptor Selection Instrument (CPSI); Performace Evaluation Tool; Leadership and Management Inventory; Advanced Practice Nursing Competency Assessment Instrument (APNCAI); Kuopio University Hospital Transformational Leadership Scale (KUHTLS); Multisource Feedback (MSF) e um instrumento constituído por construtos para capacitar sobre os comportamentos de comunicação dos líderes em enfermagem, cujo título não foi informado pelos autores. Conclusão: Esta revisão integrativa da literatura identificou dez instrumentos para avaliar as competências essenciais à liderança em enfermagem. A comunicação foi identificada como uma das principais competências alinhada ao papel de gestor. A tomada de decisão, a habilidade social, o gerenciamento da equipe, a informação atualizada e a gestão estratégica e financeira são elementos de suma importância no exercício gerencial e assistencial do enfermeiro, para que se estabeleça uma relação harmônica entre os líderes e os liderados no processo de trabalho.

Resumen: Introducción: La difusión tecnológica del mercado de trabajo exige el desarrollo de habilidades y competencias diferenciadas de los enfermeros, para que puedan asumir nuevas responsabilidades gerenciales y organizacionales. Objetivo: Identificar instrumentos en la literatura para evaluar las habilidades necesarias para el liderazgo en enfermería. Método: Revisión integradora de la literatura que utilizó las bases Literatura Latinoamericana y del Caribe en Ciencias de la Salud (LILACS), Cumulative Index to Nursing and Allied Health Literature (CINAHL) y Scopus. Resultados: 10 estudios fueron seleccionados en esta revisión, que identificaron los siguientes instrumentos: escala Ambulance Nurse Competence (ANC); Leadership Practices Inventory (LPI); Clinical Leadership Needs Analysis (CLeeNA) Instrument; Cotter Preceptor Selection Instrument (CPSI); Performace Evaluation Tool; Leadership and Management Inventory; Advanced Practice Nursing Competency Assessment Instrument (APNCAI); Kuopio University Hospital Transformational Leadership Scale (KUHTLS); Multisource Feedback (MSF) y un instrumento que consiste en constructos para la capacitación en conductas de comunicación de los líderes de enfermería, cuyo título no fue informado por los autores. Conclusión: Esta revisión integradora de la literatura identificó diez instrumentos para evaluar las competencias esenciales para el liderazgo en enfermería. La comunicación fue identificada como una de las principales competencias alineadas con el rol de gerente. La toma de decisiones, las habilidades sociales, el manejo de equipos, la información actualizada y la gestión estratégica y financiera son elementos de suma importancia en el ejercicio gerencial y asistencial del enfermero, para que se establezca una relación armoniosa entre los líderes y quienes son conducidos en el proceso de trabajo.

Abstract: Introduction: The technological spread of the job market requires the development of differentiated skills and competences of nurses, so that they can assume new managerial and organizational responsibilities. Objective: to identify instruments in the literature to assess the skills necessary for leadership in nursing. Method: an integrative literature review which used the bases Latin American and Caribbean Literature in Health Sciences (LILACS), Cumulative Index to Nursing and Allied Health Literature (CINAHL) and Scopus. Results: 10 studies were selected in this review, which identified the following instruments: Ambulance Nurse Competence (ANC) scale; Leadership Practices Inventory (LPI); Clinical Leadership Needs Analysis (CLeeNA) Instrument; Cotter Preceptor Selection Instrument (CPSI); Performance Evaluation Tool; Leadership and Management Inventory; Advanced Practice Nursing Competency Assessment Instrument (APNCAI); Kuopio University Hospital Transformational Leadership Scale (KUHTLS); Multisource Feedback (MSF), and an instrument whose title was not informed by the authors, consisting of constructs to enable nursing leader communication behaviors. Conclusion: This integrative literature review identified ten instruments to assess essential competencies for leadership in nursing. Communication was identified as one of the main competencies aligned with the role of manager. Decision making, social skills, team management, up-to-date information, strategic and financial management are extremely important elements in the nurse's managerial and care exercise, so that a harmonious relationship is established between leaders and those who are led in the job process. Objective: to identify instruments in the literature to assess the skills necessary for leadership in nursing. Method: integrative literature review which used the bases Latin American and Caribbean Literature in Health Sciences (LILACS), Cumulative Index to Nursing and Allied Health Literature (CINAHL) and Scopus. Results: 10 studies were selected in this review, which identified the following instruments: Ambulance Nurse Competence (ANC) scale; Leadership Practices Inventory (LPI); Clinical Leadership Needs Analysis (CLeeNA) Instrument; Cotter Preceptor Selection Instrument (CPSI); Performance Evaluation Tool; Leadership and Management Inventory; Advanced Practice Nursing Competency Assessment Instrument (APNCAI); Kuopio University Hospital Transformational Leadership Scale (KUHTLS); Multisource Feedback (MSF) is an instrument whose title was not informed by the authors, consisting of constructs to enable nursing leader communication behaviors. Conclusion: This integrative literature review identified ten instruments to assess essential competencies for leadership in nursing. Communication was identified as one of the main competencies aligned with the role of manager. Decision making, social skills, team management, up-to-date information, strategic and financial management are extremely important elements in the nurse's managerial and care exercise, so that a harmonious relationship is established between leaders and those who are led in the process of the job.

Differences in foot self-care and lifestyle between men and women with diabetes mellitus.

OBJECTIVE: to investigate differences with regard to foot self-care and lifestyle between men and women with diabetes mellitus. METHOD: cross-sectional study conducted in a sample of 1,515 individuals with diabetes mellitus aged 40 years old or older. Poisson regression models were used to identity differences in foot self-care deficit and lifestyle between sexes, adjusting for socioeconomic and clinical characteristics, smoking and alcohol consumption. RESULTS: foot self-care deficit, characterized by not regularly drying between toes; not regularly checking feet; walking barefoot; poor hygiene and inappropriately trimmed nails, was significantly higher among men, though men presented a lower prevalence of feet scaling and use of inappropriate shoes when compared to women. With regard to lifestyle, men presented less healthy habits, such as not adhering to a proper diet and taking laboratory exams to check for lipid profile at the frequency recommended. CONCLUSION: the nursing team should take into account gender differences concerning foot self-care and lifestyle when implementing educational activities and interventions intended to decrease risk factors for foot ulceration. OBJETIVO: investigar as diferenças no autocuidado com os pés e no estilo de vida entre mulheres e homens diabéticos. MÉTODO: estudo transversal realizado com uma amostra de 1.515 diabéticos com 40 anos ou mais. Foram utilizados modelos de regressão de Poisson para identificar diferenças entre os sexos na prevalência de déficit de autocuidado com os pés e no estilo de vida, ajustando-se por características socioeconômicas, clínicas, tabagismo e alcoolismo. RESULTADOS: a prevalência de déficit de autocuidado com os pés, caracterizada por baixa frequência de secagem dos espaços interdigitais; da não avaliação periódica dos pés; do hábito de andar descalço; de higiene insatisfatória e corte inadequado de unhas foi significativamente maior entre os homens. Contudo, eles apresentaram menor prevalência na prática de escaldar os pés e no uso de calçados inadequados em comparação às mulheres. Em relação ao estilo de vida, os homens também apresentaram comportamentos menos saudáveis pois tem significativamente menor controle alimentar e não realizam os exames laboratoriais referentes ao perfil lipídico na frequência recomendada. CONCLUSÃO: considerar as diferenças de gênero no autocuidado com os pés e no estilo de vida permite à equipe de enfermagem direcionar atividades educacionais e intervenções nos fatores de risco à ulceração dos pés. OBJETIVO: investigar las diferencias en el autocuidado de los pies y estilo de vida entre mujeres y hombres diabéticos. MÉTODO: estudio transversal realizado con una muestra de 1.515 diabéticos con 40 años o más. Fueron utilizados los modelos de regresión de Poisson para identificar diferencias entre los sexos en la prevalencia de déficit de autocuidado de los pies y estilo de vida, ajustándolas por características socioeconómicas, clínicas, tabaquismo y alcoholismo. RESULTADOS: la prevalencia de déficit de autocuidado de los pies, caracterizada por: baja frecuencia de secado de los espacios interdigitales; falta de evaluación periódica de los pies; hábito de andar descalzo; higiene insatisfactoria; y, corte inadecuado de uñas, fue significativamente mayor entre los hombre. Sin embargo, estos presentaron menor prevalencia en la práctica de escaldar los pies y en el uso de calzados inadecuados en comparación a las mujeres. En relación al estilo de vida, los hombres también presentaron comportamientos menos saludables ya que tienen significativamente menor control alimentario y no realizan los exámenes de laboratorio referentes al perfil lipídico, con la frecuencia recomendada. CONCLUSIÓN: considerar las diferencias de género en el autocuidado de los pies y en el estilo de vida, le permite al equipo de enfermería realizar actividades educacionales e intervenciones en los factores de riesgo para la ulceración de los pies.

Sobrevida e fatores associados à mortalidade de pacientes com internações de longa permanência / Survival and mortality time of patients with long-stay hospitalizations in a hospital of high complexity / Supervivencia y factores asociados a la mortalidad en pacientes con hospitalizaciones de larga duración

Objetivo: Analisar a sobrevida e os fatores associados à mortalidade de pacientes com internações de longa permanência. Método: Estudo transversal, a partir de registros dos pacientes que tiveram internação de longa permanência, em hospital de alta complexidade, pelo Sistema Único de Saúde, de 2014 a 2017, com exclusão das reinternações. Utilizou-se a Regressão de Cox para identificação dos fatores associados à mortalidade. Dentre os pacientes internados na Unidade de Terapia Intensiva aplicou-se a curva Roc para determinar o ponto de corte do dia de maior risco de óbito. Resultados: Foram identificadas 1.209 internações de longa permanência resultando em prevalência de 7,3%. Do total de pacientes de longa permanência, 50,3% foram a óbito, a maioria com idade superior a 60 anos, com doenças do aparelho circulatório (40%). Os fatores associados à mortalidade dos pacientes com internação de longa permanência foram: ser idoso (HR=2,31; IC95%:1,89-2,81; p<0,001); internação clínica (HR=1,82; IC95%: 1,54-2,15; p<0,001) e internação em UTI (HR=12,41; IC95%: 6,74-22,8; p<0,001). A mortalidade dos pacientes que foram internados na Unidade de Terapia Intensiva foi significativamente maior a partir do nono dia (p = 0,036). Conclusão: Verificou-se uma alta taxa de mortalidade em pacientes com internação de longa permanência, principalmente, entre idosos com doenças crônico-degenerativas e em cuidados paliativos. (AU)

Objective: To analyze the survival time and factors associated with the mortality of patients with long-stay hospitalizations in a hospital of high complexity. Methods: Cross-sectional study. We included records of patients who had long-term hospitalization for the Unified Health System between 2014 and 2017, excluding rehospitalizations. Cox Regression was used to identify the factors associated with mortality. Still, among the patients who were admitted to the intensive care unit, the Roc curve was used to determine the cutoff point to identify the day on which the patients had a higher risk of death. Results: 1,209 long-stay hospitalizations were identified, resulting in a prevalence of 7.3%. Of the total long-stay patients, 50.3% died. The majority were over 60 years old, with diseases of the circulatory system (40%). The factors associated with the mortality of patients with long-term hospitalization were: elderly (HR = 2.31; 95% CI: 1.89-2.81); clinical hospitalization (HR = 1.82, 95% CI: 1.54-2.15); ICU admission (HR = 12.41, 95% CI: 6.74-22.8). Mortality of patients admitted to the intensive care unit was significantly higher after the ninth day (p = 0.036). Conclusion: There was a high mortality rate in patients with long-term hospitalization, mainly among elderly people with chronic degenerative diseases and in palliative care. (AU)

Objetivo: Analizar la supervivencia y los factores asociados a la mortalidad en pacientes con hospitalizaciones de larga duración. Métodos: Estudio transversal, basado en registros de pacientes que tuvieron hospitalización de larga duración en un hospital de alta complejidad, a través del Sistema Único de Salud, de 2014 a 2017, excluyendo reingresos. Se utilizó la regresión de Cox para identificar los factores asociados con la mortalidad. Entre los pacientes ingresados en la Unidad de Cuidados Intensivos se aplicó la curva de Roc para determinar el punto de corte del día con mayor riesgo de muerte. Resultados: Se identificaron 1.209 hospitalizaciones de larga duración, lo que resultó en una prevalencia del 7,3%. Del total de pacientes de larga evolución falleció el 50,3%, la mayoría mayores de 60 años, con enfermedades del sistema circulatorio (40%). Los factores asociados a la mortalidad de los pacientes con hospitalización de larga duración fueron: anciano (HR=2,31; IC95%:1,89-2,81); hospitalización clínica (HR=1,82; IC95%: 1,54-2,15) e ingreso a una unidad de cuidados intensivos (HR=12,41; IC95%: 6,74-22,8). Conclusion: La mortalidad de los pacientes que ingresaron en la Unidad de Cuidados Intensivos fue mayor a partir del noveno día (p=0,036). Se identificó una alta tasa de mortalidad en pacientes con hospitalización de larga duración, especialmente entre personas mayores con enfermedades crónico-degenerativas y en cuidados paliativos. (AU)

Indicators of surgical patients after the implementation of an Internal Bed Regulation Committee in a university hospital / Indicadores de los pacientes quirúrgicos tras la implantación del Comité Interno de Regulación de Camas en un hospital universitario / Indicadores de paciente cirúrgico após implantação de Núcleo Interno de Regulação de Leitos em hospital universitário

ABSTRACT Objective: To analyze the indicators of surgical patients after the implementation of an Internal Bed Regulation Committee in a university hospital. Method: Longitudinal, quantitative, and retrospective study. The data collection was conducted in the Hospital Management Information institutional system, from which the information of patients submitted to surgical procedures from January 2015 to June 2018 were obtained. To verify the data trends, a simple linear regression model was used. Results: The predominance of patients aged 20 to 39 and hospitalized on an emergency basis was observed. An ascending trend for structure indicators was verified regarding the number of surgical procedures and patients per surgical room. The process indicators were stagnant. An ascending trend was presented by the result indicators related to the number of surgical patients, hospitalized surgical patients, surgical procedures, and patients with Hospitalization Authorization. Conclusion: A change in the mean values of the process indicators was observed, showing the performance of this service. Organizational changes were also observed regarding the establishment of norms, processes, and flows.

RESUMEN Objetivo: Analizar los indicadores de los pacientes quirúrgicos tras la implantación del Comité Interno de Regulación de Camas en un hospital universitario. Método: Estudio longitudinal, cuantitativo y retrospectivo. La recolección de datos se realizó en el Sistema de Información de la Gestión Hospitalaria institucional, del cual se obtuvo la información de los pacientes sometidos a procedimientos quirúrgicos entre enero de 2015 y junio de 2018. Para verificar la tendencia de los datos, se utilizó un modelo de regresión lineal simple. Resultados: Se observó un predominio de pacientes de entre 20 y 39 años y la hospitalización de urgencia. Hubo una tendencia al alza en los indicadores de estructura relativos al número de procedimientos quirúrgicos y de pacientes por sala quirúrgica. Los indicadores de proceso fueron estables. Los indicadores de resultados relacionados con el número de pacientes quirúrgicos, los pacientes quirúrgicos hospitalizados, los procedimientos quirúrgicos y los pacientes con Autorización de Ingreso Hospitalario mostraron una tendencia al alza. Conclusión: Se observaron cambios en los valores medios de los indicadores de proceso, lo que demuestra la actuación de este servicio. También se verificaron cambios organizativos en cuanto al establecimiento de normas, procesos y flujos.

RESUMO Objetivo: Analisar os indicadores de paciente cirúrgico após a implantação de Núcleo Interno de Regulação de Leitos em hospital universitário. Método: Estudo longitudinal, quantitativo e retrospectivo. A coleta de dados foi realizada no sistema institucional Informação de Gestão Hospitalar, do qual foram obtidas as informações dos pacientes submetidos a procedimentos cirúrgicos entre janeiro de 2015 e junho de 2018. Para a verificação de tendência dos dados, foi utilizado modelo de regressão linear simples. Resultados: Observou-se predominância de pacientes com idade entre 20 e 39 anos e internação em caráter de urgência. Verificou-se a tendência crescente dos indicadores de estrutura quanto ao número de procedimentos cirúrgicos e de pacientes por sala operatória. Os indicadores de processo apresentaram-se estagnados. Apresentaram tendência crescente os indicadores de resultado relacionados aos números de pacientes cirúrgicos, pacientes cirúrgicos internados, procedimentos cirúrgicos e pacientes com Autorização de Internação Hospitalar. Conclusão: Observou-se alteração nos números médios dos indicadores de processo, demonstrando a atuação deste serviço. Também foram verificadas mudanças organizacionais quanto ao estabelecimento de normas, processos e fluxos.

Hospital indicators after implementation of bed regulation strategies: an integrative review / Indicadores hospitalarios después de implementar estrategias relacionadas con la regulación de camas: una revisión integradora / Indicadores hospitalares após implantação de estratégias relacionadas à regulação de leitos: revisão integrativa

ABSTRACT Objectives: to analyze the scientific evidence available in literature on hospital indicators after implementation of bed regulation strategies. Methods: this is an integrative review conducted with studies available in five databases and in the reference database of the Center for Study and Research in Nursing Services Management in October 2019. Articles on hospital bed management, available in full in English, Spanish or Portuguese, without temporal delimitation were included. Results: 1,118 eligible articles were found, of which 37 were duplicated. Among 1,081 pre-selected studies, 112 studies were eligible and 11 articles were included. Six studies addressed the emergency services. Three addressed hospital indicators in general, another focused on a psychiatric ward and one analyzed the indicators of two hospitals administered differently. Conclusions: the studies focused on emergency services, demonstrating the importance of organizing these services for health institutions.

RESUMEN Objetivos: analizar la evidencia científica disponible en la literatura sobre indicadores hospitalarios tras la implementación de estrategias de regulación de camas. Métodos: revisión integradora realizada con estudios disponibles en cinco bases de datos y en la base de datos de referencia del Centro de Estudios e Investigaciones en Gestión de Servicios de Enfermería en octubre de 2019. Los criterios de inclusión fueron artículos sobre manejo de camas hospitalarias, disponibles íntegramente en inglés, español o portugués, sin límite de tiempo. Resultados: se encontraron 1.118 artículos elegibles, de los cuales 37 fueron duplicados. Entre 1.081 estudios preseleccionados, 112 estudios fueron elegibles, incluidos 11 artículos. Seis estudios abordaron los servicios de emergencia. Tres indicadores hospitalarios abordados en general; otro centrado en un pabellón psiquiátrico; uno analizó los indicadores de dos hospitales administrados por separado. Conclusiones: el enfoque de los estudios está en los servicios de emergencia, lo que demuestra la importancia de organizar estos servicios para las instituciones de salud.

RESUMO Objetivos: analisar as evidências científicas disponíveis na literatura sobre indicadores hospitalares após a implantação de estratégias de regulação de leitos. Métodos: revisão integrativa realizada com estudos disponíveis em cinco bases de dados e no banco de referências do Núcleo de Estudo e Pesquisa em Gestão de Serviços de Enfermagem em outubro de 2019. Utilizaram-se como critérios de inclusão artigos sobre gestão de leitos hospitalares, disponíveis na íntegra nos idiomas inglês, espanhol ou português, sem delimitação temporal. Resultados: encontraram-se 1.118 artigos elegíveis, desses, 37 apresentavam-se duplicados. Dentre 1.081 estudos pré-selecionados, 112 estudos eram elegíveis, sendo incluídos 11 artigos. Seis estudos abordavam os serviços de emergência. Três abordavam os indicadores hospitalares em geral; outro tinha como foco uma enfermaria psiquiátrica; um analisou os indicadores de dois hospitais administrados distintamente. Conclusões: o foco dos estudos concentra-se nos serviços de emergência, demonstrando a importância da organização desses serviços para as instituições de saúde.

Efeitos da pandemia da covid-19 sob os profissionais de saúde: protocolo de revisão sistemática / Effects of the covid-19 pandemic on health professionals: a systematic review protocol / Efectos de la pandemia de covid-19 en los profesionales de la salud: protocolo de revisión sistemática

OBJETIVO: analisar a prevalência de transtornos mentais comuns e sinais e sintomas físicos ocasionados aos profissionais de saúde que prestaram assistência direta a pacientes infectados pelo SARS-CoV-2 entre os anos de 2019 a 2021 nos serviços de saúde. MÉTODO: revisão sistemática da literatura onde serão incluídos estudos observacionais que abordem os transtornos mentais comuns e sinais e sintomas físicos ocasionados aos profissionais de saúde que prestaram assistência direta à pacientes infectados pelo SARS-CoV-2 nos anos de 2019 a 2021. As buscas serão realizadas em bases de dados abrangentes, sem restrição de idiomas. Serão seguidos todos os passos metodológicos preconizados para as revisões sistemáticas. RESULTADOS: espera-se identificar estudos que apontem a prevalência de transtornos mentais comuns e sinais e sintomas mentais físicos apresentados por profissionais de saúde que prestaram assistência direta à pacientes infectados SARS-CoV-2. CONCLUSÃO: este estudo encontra-se em andamento e o protocolo está aprovado na PROSPERO sob o número CRD42020213686.

OBJECTIVE: to analyze the prevalence of common mental disorders and physical signs and symptoms in health professionals who provided direct care to patients infected with SARS-CoV-2 in the health services between 2019 and 2021. METHOD: a systematic literature review which will include observational studies that address common mental disorders and physical signs and symptoms in health professionals who provided direct care to patients infected with SARS-CoV-2 from 2019 to 2021. The searches will be carried out in comprehensive databases, with no language restrictions. All the methodological steps recommended for systematic reviews will be followed. RESULTS: it is expected to identify studies that point out the prevalence of common mental disorders and physical mental signs and symptoms presented by health professionals who provided direct care to patients infected with SARS-CoV-2. CONCLUSION: this study is ongoing and the protocol is approved by PROSPERO under number CRD42020213686.

OBJETIVO: analizar la prevalencia de trastornos mentales comunes y signos y síntomas físicos padecidos por los profesionales de la salud que brindaron atención directa a pacientes infectados por SARS-CoV-2 entre 2019 y 2021 en los servicios de salud. MÉTODO: revisión sistemática de la literatura que incluirá estudios observacionales que aborden los trastornos mentales comunes y los signos y síntomas físicos padecidos por los profesionales de la salud que brindaron atención directa a los pacientes infectados por SARS-CoV-2 entre 2019 y 2021. La búsqueda se realizará en bases de datos completas, sin restricciones de idioma. Se seguirán todos los pasos metodológicos recomendados para las revisiones sistemáticas. RESULTADOS: se espera identificar estudios que apunten a la prevalencia de trastornos mentales comunes y signos y síntomas físicos mentales presentados por profesionales de la salud que brindaron atención directa a pacientes infectados con SARS-CoV-2. CONCLUSIÓN: este estudio está en curso y el protocolo está aprobado en PROSPERO con el número CRD42020213686.