Evaluation of patient safety culture in a private general hospital: a case study in Brazil.

PURPOSE: The purpose is to assess the patient safety culture perceived by healthcare and administrative staff in a Brazilian hospital and examine whether education and experience are related to positive perceptions. DESIGN/METHODOLOGY/APPROACH: A descriptive-analytical case study was carried out at Ernesto Dornelles Hospital, a private Brazilian institution. The Brazilian version of the Hospital Survey on Patient Safety Culture was used to assess the perceptions of 618 participants, of whom 315 worked in healthcare assistance and 303 in administrative services. The main outcome was the percentage of positive responses, and the independent variables included the type of work, schooling and length of experience. FINDINGS: None of the twelve dimensions was strengthened. The percentage of positive responses was the highest for "Hospital management support for patient safety" (67.5%), and the lowest was for "Nonpunitive response to error" (29%). The healthcare staff had a slightly higher average than the administrative staff. The percentage of positive responses from professionals with undergraduate or graduate degrees was higher for the eight dimensions of safety culture. The length of hospital experience was not associated with any dimensions. ORIGINALITY/VALUE: This study explored the influence of education and professional experience on the perception of patient safety in healthcare and administrative staff from a private institution. These approaches allow to know with greater depth and clarity factors that are related to the patient safety culture and, thus, have more consistent evidence to support interventions in specific needs.

Role of the Nurse Navigator: integrative review. / Atuação do Nurse Navigator: revisão integrativa.

OBJECTIVE: To identify scientific literature on oncology nurses who provide patient navigation services as nurse navigators. METHODS: Integrative review of literature searches in the databases LILACS, MEDLINE/PubMed, SCOPUS, SciELO, Web of Science and Science Direct based on the descriptors patient; navigation; nurse; professional; cancer; oncology; navigator; and navigators. RESULTS: Seventeen articles were identified and grouped according to the following thematic approach: Care Processes; Patients; and Health Workers. It was observed that scientific literature on nurse navigators mostly comes from the United States, Australia, Canada, Sweden, and Demark, where the first nurse navigator programmes were introduced. No studies were found in local journals or populations. CONCLUSIONS: The nurse navigator offer a unique service for the provision of quality care. Although international research is recent, further studies on the role of these professionals are clearly needed.

Implementation of multi-professional healthcare residency at a federal university: historical trajectory. / Implementação de residência multiprofissional em saúde de uma universidade federal: trajetória histórica.

OBJECTIVE: To retrieve the historical trajectory of the implementation of a multi-professional healthcare residency at the Universidade Federal de Ciências da Saúde de Porto Alegre, in partnership with the Santa Casa de Misericórdia de Porto Alegre. METHOD: Historical research based on oral history. Interviews were conducted with six professionals of both institutions from October to December 2013. The data were subjected to content analysis. RESULTS: The oral histories led to three thematic categories, as follows: Strengthening the involved institutions; Professional qualification for intensive care; and Programme implementation. CONCLUSIONS: The historical trajectory of a multi-professional healthcare residency programme revealed the efforts of linking teaching and service to better qualify healthcare professionals and strengthen healthcare teams, and consequently change the hegemonic medical assistance model.

Implementation of transoperative and immediate postoperative nursing diagnoses in the computerized management system.

OBJECTIVE: To implement, on health management software, electronic records of the perioperative nursing process and the stages of transoperative and immediate postoperative nursing diagnoses, based on the NANDA International taxonomy. METHOD: Experience report conducted from the completion of the Plan-Do-Study-Act cycle, which allows improvement planning with a clearer purpose, directing each stage. This study was carried out in a hospital complex in southern Brazil, using the software Tasy/Philips Healthcare. RESULTS: For the inclusion of nursing diagnoses, three cycles were completed, predictions of expected results were established, and tasks were assigned, defining "who, what, when, and where". The structured model covered seven possibilities of aspects, 92 symptoms and signs to be evaluated, and 15 nursing diagnoses to be used in the transoperative and immediate postoperative periods. CONCLUSION: The study allowed implementing electronic records of the perioperative nursing process on health management software, including transoperative and immediate postoperative nursing diagnoses, as well as nursing care.

Nurses' conceptions regarding patient safety during surgical positioning.

OBJECTIVE: To know the conceptions regarding patient safety during their surgical positioning from the perspective of nurses in a Surgical Center. METHOD: Qualitative descriptive exploratory study, with seven nurses from private hospital in southern Brazil in August 2018. Data generation using the Focus Group technique, with content analysis by Bardin. RESULTS: From the data analysis, six categories emerged: "patient safety", "surgical patient risks", "nurses in the operating room", "training", "involvement of the interprofessional" team and application of the risk assessment scale. The development of injuries resulting from positioning was identified as the greatest risk for the surgical patient, highlighting the presence of the nurse in the operating room as essential for the prevention of this risk, through patient assessment and staff training. FINAL CONSIDERATIONS: Nurses identified risk to patient safety in relation to surgical positioning and considered they presence in the operating room to be indispensable.

Perioperative nursing education in Brazil: reviewing the past to survive the future.

OBJECTIVES: to summarize historical aspects related to perioperative nursing education in Brazil and to outline future perspectives. METHODS: a descriptive-reflexive essay about the historical process of Brazilian perioperative teaching at undergraduate and graduate levels. RESULTS: the reflection addresses the historical axes of perioperative nursing, teaching perioperative nursing, curriculum changes, graduate studies and relationship with the perioperative period and trends in perioperative nursing education. Curriculum changes reduced time available for teaching and learning, with a focus on the perioperative period, and diluted contents of surgical nursing in other subjects, which could cause irreversible losses for generalist nurses' training. FINAL CONSIDERATIONS: when reviewing historical aspects of national nursing curricula, it was found that the nomenclature perioperative nursing was never used in the curriculum, however, the surgical area has always been contemplated in undergraduate and graduate studies. Future trends indicate the need to integrate themes and prepare professionals with perspectives focused on global health and technology.

Central sterile services department: screening of automated cleaning in liposuction cannulae.

OBJECTIVE: To evaluate the effectiveness of automated cleaning of 4 mm liposuction cannulas using ultrasonic washer machine, screening for dirt using a cannulate microscope device and the screening of viable strains of Staphylococcus aureus, with microbiological analysis. METHOD: Experimental study with 14 units of 4 mm liposuction cannulas performed at the Central Sterile Services Department and at the Microbiology Laboratory of a Hospital Complex, located in Porto Alegre, RS, Brazil, from October 2018 to April 2019. RESULTS: Of the 14 liposuction cannulas that constituted the sample, 42.9% remained dirty despite automated cleaning, and all of them showed recovery of viable microrganisms in the microbiological laboratory. CONCLUSION: The study showed that it is not possible to ensure the cleaning efficacy of automated cleaning of 4 mm liposuction cannulas, especially due to the conformation of the material with internal spaces with accumulation of dirt.

External Ventricular Drains: Development and Evaluation of a Nursing Clinical Practice Guideline.

External ventricular drains (EVDs) are common in intensive care for neurocritical patients affected by different illnesses. Nurses play an essential role to ensure safe care, and guidelines are tools to implement evidence-based care. Thus, the aim of this study was to develop and evaluate the quality of a clinical guideline for critically ill patients with EVDs. Methodological research was conducted. The guideline development was based on a scoping review about nursing care to patients with EVDs. The guideline evaluation occurred in two phases: evaluation of its methodological rigor, with application of the Appraisal of Guidelines Research and Evaluation II to four experts on guidelines evaluation; and the Delphi technique, with a panel of nine specialists in neurocritical care, performed in two rounds. Data were analyzed by descriptive statistics and content validity ratio. In the first phase of the evaluation, three domains did not reach consensus, being reformulated. The second phase was conducted in two rounds, with nine and eight participants respectively, with 13 recommendations being reformulated and reassessed between rounds, inclusion of an EVD weaning category, and two flowcharts on patient's transport and mobility. Therefore, the guideline can be incorporated into nursing care practices. Further studies are necessary to assess its impact on clinical practice.

Simulation in cardiorespiratory arrest: assessment of satisfaction with the learning of nursing students.

OBJECTIVE: To evaluate the satisfaction and self-confidence of undergraduate nursing students' learning in a scenario of realistic clinical simulation with the theme of advanced cardiopulmonary arrest maneuvers. METHOD: Exploratory-descriptive study, with a quantitative approach. In order to evaluate the simulation activity developed undergraduate nursing students responded to the Student Satisfaction and Self-Confidence with Learning Scale. RESULTS: 19 students participated in the study. Students' satisfaction and self-confidence with learning were identified, with an average of 4.17 ± 0.59 in the developed scenario. In the subscale of satisfaction with current learning and in the subscale of self-confidence with learning, 86.3% and 76.6% of students scored the items in a maximum way (4-5), respectively. CONCLUSION: Nursing students demonstrate satisfaction and self-confidence with learning from a realistic clinical simulation scenario on the theme of advanced cardiorespiratory arrest maneuvers.

Nursing assistance in patient care with external ventricular drain: a scoping review.

OBJECTIVES: to map the available evidence about nursing care aimed at adult patients using external ventricular drain. METHODS: this is a review using the scoping review method. RESULTS: Initially, 965 studies were identified and, after the eligibility criteria, a sample of 54 publications was obtained. Each of them was assessed according to GRADE, resulting in three studies with high quality; 14 with moderate quality; 32 with low quality; and five with very low quality. It was highlighted 20 nursing care subdivided into nine categories, namely: drainage system; bed positioning and mobilization; catheter care; monitoring of intracranial pressure; and medication administration. CONCLUSIONS: the scoping review made it possible to identify the main nursing care directed to adult patients undergoing placement of external ventricular drain from the evidence available to date.

Nursing Now campaign and its impact on nursing education in a federal university.

OBJECTIVE: To report the actions developed by a group in the Nursing Now campaign and its impact on nursing education. METHOD: It is an experience report about the execution of the work group formed by nurse professors, nursing academics and master's students at a federal university in Brazil focusing on the Nursing Now campaign, developing actions in the second half of 2019. RESULTS: The actions developed involve the creation of a work group and the active participation of the group in four major events resulted in the visibility and appreciation of the work developed by the profession. CONCLUSION: The organized group promoted actions that had a positive impact inside and outside the University, expanding visibility to the profession and the actions developed. The academic environment, associated to the worldwide mobilization of the campaign, promoted a favorable context for the debate about the valorization of the category and leadership in nursing.

Nurse Navigator: development of a program for Brazil.

OBJECTIVE: to develop a Navigation Program for cancer patients, based on the model proposed by The GW Cancer Institute at George Washington University, adapted to the reality of a Brazilian High Complexity Center in Oncology. METHOD: a convergent care research applied in the development of a patient navigation care process, based on the model proposed by George Washington University, adapted for a High Complexity Center in Oncology in Brazil. Phases of the Convergent Assistance Research: conception, instrumentation, scrutiny, analysis and interpretation. These were correlated with the stages of the Program Development Cycle. Scale designed to categorize patients into navigation levels, validated by the Delphi Technique, with 12 specialists. RESULTS: in the diagnosis, patients with head and neck cancer were defined for inclusion in the Navigation Program. Planning and implementation took place simultaneously, allowing the basic formatting of the program and its processes to be designed. Navigation Needs Assessment Scale designed to select the patient to join the Program and determine the recommended support. The scale validation had a consensus index of 96.42%. Evaluation of the stages of the cycle occurred through the adapted Plan/Do/Check/Act cycle. CONCLUSION: a Navigation Program was developed adapted to the Brazilian reality, and attributions of the navigators were created.

National Early Warning Score 2: transcultural adaptation to Brazilian Portuguese.

OBJECTIVE: Cross-cultural adaptation of the National Early Warning Score 2 to Brazilian Portuguese. METHODS: A methodological study of a cross-cultural adaptation of a scale, based on the Beaton et al. framework, authorized by the Royal College of Physicians. Judges from nine Brazilian states, nurses and physicians evaluated the semantic, idiomatic, cultural, and conceptual equivalence between the original instrument and the translated versions. The nurses, working in inpatient or emergency units, conducted the pilot test, applying the final version to three case studies. Psychometric tests were used for data analysis: Content Validity Index (CVI), Kappa Coefficient, and Cronbach's Alpha. RESULTS: The adaptation showed a mean CVI of 0.98 and perfect/almost perfect inter-rater agreement, with scores above 0.80. The consistency of the scale was 0.712. CONCLUSION: The process of cross-cultural adaptation of the scale to Brazilian Portuguese was successful, providing Brazilian professionals with an instrument aligned with patient safety.

Education to prevent ventilator-associated pneumonia in intensive care unit.

OBJECTIVE: to evaluate nursing adherence to the Ventilator-Associated Pneumonia Prevention Bundle and the incidence rate, before and after Continuing education. METHODS: a quasi-experimental, retrospective study with a total of 302 patients on mechanical ventilator admitted to the Intensive Care Unit. Data obtained from the application of the bundle, from June 2017 to June 2018. In December 2017, a training on the infection was carried out with 48 professionals. RESULTS: the mean age of patients was 62.39±17.06 years old. Appropriate measures before and after training, respectively: position of the ventilator filter 94.8% and 96.2%, p=0.074; elevated headboard 88.4% and 94.5%, p<0.001; oral hygiene with chlorhexidine 89.5% and 98.2%, p<0.001; teeth brushing 80.8% and 96.4%, p<0.001; and cuff pressure 92.7% and 95.6%, p=0.002. Incidence density was 7.99 for 4.28 infections/1000 ventilators per day. CONCLUSION: the bundle application and education made it possible to increase adherence and decrease infection.

Validation methods of nursing protocols: an integrative review.

OBJECTIVE: to identify scientific production about validation methods of nursing care protocols. METHOD: an integrative review with search at Scielo, Pubmed/MEDLINE, Virtual Health Library, Web of Science, Scopus, and EBSCOhost. The descriptors "validation studies", "validation studies as topic", "protocols", "clinical protocols", "practice guidelines as topic", "nursing" and "nursing assessment" and the uncontrolled descriptor "validation" were used. RESULTS: thirty-two articles were selected, most of them Brazilian. Content validation by experts was the most frequent method, with no consensus on the number of participants for the process. The collection instruments were mostly created by the authors. Data analysis was performed using descriptive statistics and Content Validity Index, with a variable consensus rate in the analyzed articles. CONCLUSION: protocols validated by experts are robust tools for use in clinical practice, with methodological rigor in development essential for its quality.

Clinical simulation in nursing education in intensive therapy: an integrative review.

OBJECTIVE: to analyze the publications on clinical simulation practices for education in Nursing in Intensive Care. METHOD: an integrative review carried out through LILACS, PubMed, Cochrane Library, CINAHL and SciELO databases, of articles published from 2008 to 2017. RESULTS: 29 articles were selected, of which 76% discuss the use of simulation in continuing education of nursing professionals, while the others describe their use for student education. There is a higher prevalence of studies with a level of evidence 6 (17), with 28 international publications. There was an increase in scientific production, with 16 articles published in the last three years. CONCLUSION: variables after simulation use, such as confidence, communication skills, efficiency in the identification of clinical worsening of patients, development of technical skills, teamwork and clinical decision-making, presented a significant improvement, demonstrating that this tool is effective in qualifying care for critical patients.

Profile of service and satisfaction of users of the Mobile Emergency Care Service (SAMU). / Perfil de atendimento e satisfação dos usuários do Serviço de Atendimento Móvel de Urgência (SAMU).

OBJECTIVE: To know the profile of service and satisfaction of users served by the Mobile Emergency Care Service (SAMU). METHODS: A cross-sectional study of the 854 services performed by the Advanced Life Support (SAV) teams from SAMU of Porto Alegre/RS, in the first quarter of 2016. A total of 164 users or respondents answered by phone to the questions regarding the service performed. Analysis performed using the Spearman and Chi-square tests. Study approved in Ethics and Research Committee of the Institutions involved. RESULTS: A higher percentage of clinical visits (48.2%) followed by trauma care (32.8%). Regarding telephone calls, 71.4% of respondents rated the service as 'very good' while the service was classified by 76.8% of the respondents. From them, 81.1% stated that the service was resolving. CONCLUSIONS: The clinical type stands out among the assistances and the users reveal satisfaction with the service provided, considering that it serves the population resolutely.

Nursing performance in robotic surgeries: integrative review.

OBJECTIVE: To know the scientific production on the performance of the nursing staff in robotic surgeries, identifying the role of the nurse in the three perioperative periods. METHODS: Integrative review, search in the databases National Library of Medicine, National Institutes of Health, Scientific Electronic Library Online and Biblioteca Virtual em Saúde, performed from June to September, 2017; 17 selected articles met the inclusion criteria. RESULTS: Most articles were published in foreign journals in English, nine in the United States, classified with evidence level of 4 and 5. The role of nursing in the perioperative period was identified, related mainly to patient safety. The most mentioned perioperative period in the articles was the intraoperative, with greater concern in the positioning of the patient. CONCLUSION: The nursing performance and patient safety in robotic surgeries are similar to the ones in major surgeries, requiring from the patient a specific knowledge on the setting and preparation of the robot.

Project and Preliminary Evaluation of SimHosp, a Tool for Decision Making in Nursing.

Computerized simulators are important tools that support teaching in many areas. The use of these instruments is often described as significant for students and teachers. In this paper, a software piece was developed to aid decision-making in nursing, allowing the simulation of real situations, addressed in the classroom. The simulator architecture corresponds to a multi-agent system supported by a state machine model. To build the knowledge base, a list of contents was selected, including the Nursing Intervention Classification (NIC). An experiment was carried out with the participation of eleven students of the third year of the course. A questionnaire was applied and, as a result, there were more than 90% of acceptance as a relevant educational tool. The simulation, through this tool, contributed to apply theoretical knowledge to the students, besides helping in the development of the nursing decision-making ability.

Liver transplantation and the use of KAVA: Case report.

BACKGROUND: Self-medication and the belief that herbal products are free of health risks are common in Brazil. The kava (Piper methysticum), known for its anxiolytic action, has a widespread popular use. Hepatotoxicity of kava is reported, including cases of liver transplantation and death. The kava had its use prohibited or restricted in countries like Germany, France, among others. Toxicity may be related to overdosage; however, factors such as botanical characteristics of the plant, the harvesting, storage, and production process may be associated with the development of hepatotoxic substances, such as triggering idiosyncratic reactions. HYPOTHESIS: In this case, there is a suspicion that the toxicide is intrinsic to the drug; however, the possibility of adulterants and contaminants must be ruled out. STUDY DESIGN: This study reports the case of a patient who, after using the herbal kava for 52 days, evolved into acute liver failure and liver transplantation. METHODS: The data were collected directly with the patient and compared with their clinical records. Causality was determined through the RUCAM algorithm. In addition, a phytochemical analysis of the drug used was performed. RESULTS: According to the patient's report, there is no evidence of overdosage. Results from RUCAM algorithm infer causality between liver damage and the use of kava. The analysis chemical constituents did not find any possible contaminants and major changes in the active compounds. Seven months after transplantation, the patient is well and continues to be followed up by a medical team. CONCLUSION: Our investigation indicates that there was kava-induced hepatotoxicity at standard dosages. In Brazil, self-medication by herbal medicines is frequent and many patients and health professionals do not know the risks associated with their use. Diagnosing and notifying cases in which plants and herbal medicine induce liver damage is of paramount importance to increase the knowledge about DILI and to prevent or treat similar cases quickly.