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PURPOSE: To analyze the accuracy of nursing diagnoses determined by users of a clinical decision support system (CDSS) and to identify the predictive factors of high/moderate diagnostic accuracy. METHODS: This is an exploratory-descriptive study carried out from September 2017 to January 2018. Participants were nurses, resident nurses, and senior year undergraduates. Two written case studies provided the participants with the clinical data to fill out the assessment forms in the CDSS. The accuracy of the selected diagnostic labels was determined by a panel of experts using the Diagnostic Accuracy Scale, Version 2. Descriptive statistics were used to describe the level of accuracy according to each group of participants. Analysis of variance was used to compare the mean percentages of accuracy categories across groups. A linear regression model was used to identify the predictors of diagnostic accuracy. The significance level was 5%. The study was approved by the Ethics Committee. RESULTS: Fifteen undergraduates, 10 residents, and 22 nurses were enrolled in the study. Although resident nurses and students had selected predominantly highly accurate diagnoses (51.8 ± 19.1 and 48.9 ± 27.4, respectively), and nurses had selected mostly diagnoses of moderate accuracy (54.7 ± 14.7), there were no differences in the accuracy level of selected diagnoses across groups. According to the linear regression model, each diagnosis added by the participants decreased the diagnostic accuracy by 2.09% (p = .030), and no experience or a low level of experience using the system decreased such diagnostic accuracy by 5.41% (p = .022). CONCLUSIONS: The CDSS contributes to decision making about diagnoses of less experienced people. Adding diagnoses not indicated by the CDSS and experience with the system are predictors of diagnostic accuracy. CLINICAL RELEVANCE: In-service education regarding the use of CDSSs seems to be crucial to improve users' clinical judgment and decision making.
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Sistemas de Apoio a Decisões Clínicas , Humanos , Diagnóstico de EnfermagemRESUMO
OBJECTIVE: To develop and evaluate an online course on Basic Life Support. METHOD: Technological production research of online course guided by the ADDIE (Analysis, Design, Development, Implementation, Evaluation) instructional design model based on Andragogy and the Meaningful Learning Theory. The online course was constructed in the platform Moodle, previously assessed by a group of experts, and then presented to the students of the Nursing School of the University of São Paulo, who assessed it at the end of the course. RESULTS: The course was evaluated by the experts and obtained a mean score of 0.92 (SD 0.15), considered as good quality (between 0.90-0.94), and by the students, with a mean score of 0.95 (SD 0.03), considered as high quality (0.95-1.00). CONCLUSION: The instructional design used was found to be appropriate to the development of the online course. As an active educational strategy, it contributed to the learning on Basic Life Support during cardiac arrest-related procedures in adults. In view of the need for technological innovations in education and systematization of care in cardiopulmonary resuscitation, the online course allows the establishment of continuous improvement processes in the quality of resuscitation in the care provided by students and professionals.
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Reanimação Cardiopulmonar/educação , Educação em Enfermagem/métodos , Parada Cardíaca/terapia , Estudantes de Enfermagem , Adulto , Brasil , Educação a Distância/métodos , Tecnologia Educacional/métodos , Feminino , Humanos , Masculino , Adulto JovemRESUMO
Objective To identify the technological profile of nurses in Portuguese hospitals. Method A quantitative exploratory study conducted in two hospitals in the northern region and one in the central region of Portugal. The sample was randomly selected and included 960 nurses. Results Of the participants, 420 (46.1%) used computers, 196 (23.4%) reported having knowledge about using computers for teaching, 174 (21.1%) used computers to teach, 112 (15.1%) recognized that using computers can be a technological means to supplement classroom training, 477 (61.6%) would like to receive training on using computers, and 382 (40.9%) reported self-learning of information technology. In relation to distance education, 706 (74.9%) reported they were familiar with it and 752 (76.4%) indicated an interest in participating in training using this modality. Conclusion Organizations should be mindful of the technological profile shown by this group of nurses and look for ways to introduce educational technologies in the management of care.
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Objective To describe the experience of planning and developing online refresher courses in nursing management for nurses in the contexts of Brazil and Portugal. Method The instructional design was based on meaningful learning theory, andragogy, and dialectical methodology, so it valued interaction between the actors, emphasizing the scenarios of practice and applying the concepts covered. The course structure is divided into nine theoretical units, four case studies, and an essay exam. Results The course was positively evaluated by the participants, who reported opportunities for acquisition of new knowledge, interaction and exchange of experiences, motivation to study the topics, and self-learning. Conclusion It is expected that description of this experience will stimulate proposals for new courses and programs in distance education modalities, improving the processes of teaching and learning so as to give support to future analyses of their impact on the development and enhancement of management skills in nursing.
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OBJECTIVE: Apply Graph Theory to analyze and map knowledge about nursing diagnoses and interventions, based on records of consultations carried out by nurses, in women's health, in primary health care. METHODS: Secondary data from a cross-sectional study were used. Records of nursing consultations carried out during the month of October 2016, in 21 health units, in a Brazilian municipality were analyzed. Network analysis was carried out using Graphs from 61 nursing consultations. RESULTS: 175 diagnoses were recorded, an average of three per consultation; and 380 interventions, an average of six per consultation. In the analysis, four diagnostic and four intervention network groupings were identified. CONCLUSIONS: The mapping allowed reflection on phenomena of interest to Nursing and fostering critical thinking in decision making. The findings are useful for teaching and training nurses, as well as strengthening the use of standardized language systems.
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Diagnóstico de Enfermagem , Saúde da Mulher , Humanos , Feminino , Brasil , Estudos Transversais , Registros Eletrônicos de SaúdeRESUMO
The objective of this study was to develop an educational software program for nursing continuing education. This program was intended to incorporate applied methodological research that used the learning management system methodology created by Galvis Panqueva in association with contextualized instructional design for software design. As a result of this study, we created a computerized educational product (CEP) called ENFNET. This study describes all the necessary steps taken during its development. The creation of a CEP demands a great deal of study, dedication and investment as well as the necessity of specialized technical personnel to construct it. At the end of the study, the software was positively evaluated and shown to be a useful strategy to help users in their education, skills development and professional training.
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Reanimação Cardiopulmonar/educação , Educação Continuada em Enfermagem/métodos , Software , HumanosRESUMO
The National Telehealth Program was founded by the Ministry of Health, in partnership with the Ministry of Education (Ministério da Educação - MEC) and the Ministry of Science and Technology (Ministério da Ciência e Tecnologia - MCT), to support the development of family healthcare teams throughout the country. The São Paulo Telehealth Center has developed the Telehealth Lactation Support program, which provides primary healthcare professionals with information on diverse aspects of breastfeeding. This paper reports the development of the Lactation Support program and the nursing contributions. Project methodology included the formation of a multidisciplinary group of pediatricians, nurses, speech and language therapists, nutritionists, and dentists. Multimedia teaching resources were prepared for inclusion in the Cybertutor platform. Telehealth Lactation Support is an innovative and promising addition to continuing education for healthcare professionals and provides a framework for the development of other programs.
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Aleitamento Materno , Educação a Distância , Educação em Enfermagem/métodos , Papel do Profissional de Enfermagem , Processo de Enfermagem , Telemedicina , Brasil , Humanos , Desenvolvimento de ProgramasRESUMO
OBJECTIVE: To analyze the nursing diagnostic concordance among users of a clinical decision support system (CDSS), The Electronic Documentation System of the Nursing Process of the University of São Paulo (PROCEnf-USP®), structured according to the Nanda International, Nursing Intervention Classification and Nursing Outcome Classification (NNN) Taxonomy. MATERIALS AND METHODS: This pilot, exploratory-descriptive study was conducted from September 2017 to January 2018. Participants were nurses, nurse residents, and nursing undergraduates. Two previously validated written clinical case studies provided participants with comprehensive initial assessment clinical data to be registered in PROCEnf-USP®. After having registered the clinical data in PROCEnf-USP®, participants could either select diagnostic hypotheses offered by the system or add diagnoses not suggested by the system. A list of nursing diagnoses documented by the participants was extracted from the system. The concordance was analyzed by Light's Kappa (K). RESULTS: The research study included 37 participants, which were 14 nurses, 10 nurse residents, and 13 nursing undergraduates. Of the 43 documented nursing diagnoses, there was poor concordance (K = 0.224) for the diagnosis "Ineffective airway clearance" (00031), moderate (K = 0.591) for "Chronic pain" (00133), and elevated (K = 0.655) for "Risk for unstable blood glucose level" (00179). The other nursing diagnoses had poor or no concordance. DISCUSSION: Clinical reasoning skills are essential for the meaningful use of the CDSS. CONCLUSIONS: There was concordance for only 3 nursing diagnoses related to biological needs. The low level of concordance might be related to the clinical judgment skills of the participants, the written cases, and the sample size.
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Sistemas de Apoio a Decisões Clínicas , Processo de Enfermagem , Humanos , Projetos Piloto , Diagnóstico de Enfermagem , Vocabulário ControladoRESUMO
BACKGROUND: A cardiopulmonary arrest is a critical event whose survival rate is related to the quality of resuscitation maneuvers combined with the use of technology. It is important to understand the perception of fatigue during this procedure, aiming to improve the effectiveness of compressions to increase the chances of survival. OBJECTIVES: To apply the Borg rating of perceived exertion scale (Borg scale) to analyze the exertion perceived by nurses during cardiopulmonary resuscitation maneuvers using a feedback device. METHODS: Experimental study with a randomized distribution of nurses in a teaching hospital. Perceived exertion during simulated cardiopulmonary resuscitation with/without a feedback device was assessed using the Borg scale. The statistical significance level of 5% was adopted. RESULTS: 69 nurses working in critical and non-critical adult care units were included. Perceived exertion and heart rate were lower in the intervention group (p<0.001), influenced by the feedback device, with no significant difference between critical and non-critical units. CONCLUSIONS: The Borg scale proved to be adequate for the proposed objectives. The feedback device contributed to lower exertion and heart rate reduction during resuscitation maneuvers. The low cost and ease of application favor its use during training and real-time resuscitation attempts to assess performance using a feedback device to reduce exertion and perception of fatigue. It allows reflection on the intervening factors and resources that can influence the quality of resuscitation attempts and the chances of survival.
FUNDAMENTO: A parada cardiorrespiratória é um evento crítico cuja taxa de sobrevivência é relacionada à qualidade das manobras de reanimação, aliada à tecnologia. É importante compreender a percepção do cansaço durante esse procedimento visando a efetividade das compressões e o aumento das chances na sobrevida. OBJETIVO: Aplicar a Escala de Borg para analisar o esforço percebido por enfermeiros durante as manobras de reanimação cardiopulmonar com dispositivo de feedback. MÉTODO: Estudo experimental com distribuição randomizada de enfermeiros em hospital de ensino, simulando parada cardiorrespiratória, para avaliação da percepção do esforço utilizando a escala de Borg durante a reanimação cardiopulmonar com/sem dispositivo de feedback. Foi adotado nível de significância estatística 5%. RESULTADOS: Foram incluídos 69 enfermeiros atuantes em unidades críticas e não críticas de atendimento ao adulto. A percepção de esforço e a frequência cardíaca foi menor no grupo intervenção (p<0,001), influenciadas pelo dispositivo de feedback, sem diferença significativa quanto às unidades de atuação. CONCLUSÃO: A escala de Borg mostrou-se adequada para os objetivos propostos. O dispositivo de feedback contribuiu no menor esforço e redução da frequência cardíaca durante as manobras de reanimação. O baixo custo e a facilidade de aplicação favorecem o uso em treinamentos e atendimentos em tempo real para avaliar o desempenho durante a reanimação, utilizando dispositivo de feedback por reduzir os esforços e a percepção do cansaço. Também permite a reflexão sobre os fatores intervenientes e recursos que podem influenciar na qualidade da assistência e nas chances de sobrevivência.
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Reanimação Cardiopulmonar , Parada Cardíaca , Adulto , Humanos , Esforço Físico/fisiologia , Reanimação Cardiopulmonar/métodos , Parada Cardíaca/terapia , FadigaRESUMO
The Grupo de Estudos e Pesquisas de Tecnologia da Informação nos Processos de Trabalho em Enfermagem (Study and Research Group for Information Technology in the Nursing Working Processes, GEPETE) has the purpose of producing and socializing knowledge in information technology and health and nursing communication, making associations with research groups in this field and promoting student participation. This study was performed by the group tutors with the objective to report on the development of the virtual learning environment (VLE) and the tutors' experience as mediators of a research group using the Moodle platform. To do this, a VLE was developed and pedagogical mediation was performed following the theme of mentoring. An initial diagnosis was made of the difficulties in using this technology in interaction and communication, which permitted the proposal of continuing to use the platform as a resource to support research activities, offer lead researchers the mechanisms to socialize projects and offer the possibility of giving advice at a distance.
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Educação em Enfermagem , Pesquisa em Enfermagem , Instrução por ComputadorRESUMO
OBJECTIVE: To report the experience of using the Project-Based Learning methodology, in emergency remote teaching, with undergraduate nursing students. METHOD: The study was carried out in the course "Educational Actions in Nursing Practice", developed remotely in 2020, during the pandemic caused by the new coronavirus, in the Bachelor's and Licanciate Degrees in Nursing at a public university in the state of São Paulo. The course used Project-Based Learning through the following phases: anchoring; driving question; investigation and research; creation and development; and presentation of the results as an active learning methodology, with the formation of small groups of students and tutors and process evaluation. RESULTS: The students developed educational projects in health through a virtual learning environment, platforms, and digital tools. CONCLUSION: The methodology adopted and the use of digital technologies allowed the achievement of the proposed objectives, the motivation and autonomy of the students throughout the remote teaching process, and the development of competences for the elaboration of projects in health education for nursing training.
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Bacharelado em Enfermagem , Estudantes de Enfermagem , Brasil , HumanosRESUMO
The objective of this study was to characterize the profile of nursing undergraduate students, identify their digital fluency, knowledge, ability and interest in using virtual learning environments. This quantitative, exploratory-descriptive study, was performed with 51 nursing undergraduate students. Data collection was performed using a questionnaire. All 51 subjects (100%) reported having some knowledge in informatics, 26 (49%) of which reported having an intermediate knowledge; 47 (92%) use the Internet everyday; 51 (100%) surf the social networks and have e-mail; 51 (100%) are MSN users; 32 (62.7%) use Skype; 41 (82%) use Chat applications; 33 (64.7%) use discussion forums; 22 (43%) use blogs; 33 (64.7%) frequently use Moodle and 26 (51%) use COL; 45 (88.2 %) reported interest in using virtual learning environments. The students are digitally fluent and show knowledge, ability and significant interest regarding the use of virtual learning environments in their academic studies.
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Internet , Estudantes de Enfermagem , Humanos , Inquéritos e QuestionáriosRESUMO
The complexity involved in operationalizing the method for nursing staffing, in view of the uncountable variable related to identifying the workload, the effective working time of the staff, and the Technical Security Index (TSI) revealed the need to develop a software program named: Computerized Nursing Staffing (DIPE, in Portuguese acronyms). This exploratory, descriptive study was performed with the objective to evaluate the technical quality and functional performance of DIPE. Participants were eighteen evaluators, ten of whom where nurse faculty or nurse hospital unit managers, and eight health informatics experts. The software evaluation was performed according to norm NBR ISO/IEC 9126-1, considering the features functionality, reliability, usability, efficiency, and maintainability. The software evaluation reached positive results and agreement among the evaluators for all the evaluated features. The reported suggestions are important for proposing further improving and enhancing the DIPE.
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Recursos Humanos de Enfermagem , Reprodutibilidade dos Testes , Humanos , Enfermeiros Administradores , Recursos Humanos de Enfermagem Hospitalar , Admissão e Escalonamento de Pessoal , Software , Carga de TrabalhoRESUMO
The objective of this exploratory, descriptive study was to identify the use of computer tools by a group of elderly users of a Center of Reference and Citizenship for the Elderly in the city of São Paulo. Among the 55 subjects, it was found that 33 (60.0%) have a computer at home, 42 (76.4%) referred having taken a computer course; 22 (58.2%) have been using the computer for less than two years, and 40 (85.5%)use the tool for up to two hours a day. The most used communication tools were: e-mails by (41; 75.0%), instant messaging (25; 45.0%), dating websites (17; 31.0%). The reported purposes for using technology tools were: to update and obtain information, for research, for fun, and to talk to relatives and friends. In conclusion, nurses should be aware of this technological profile that is being outlined among the elderly population and search for ways to include computer tools in the care provided to this group.
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Relações Interpessoais , Enfermeiras e Enfermeiros , Idoso , HumanosRESUMO
OBJECTIVE: to compare the quality of the Nursing process documentation in two versions of a clinical decision support system. METHOD: a quantitative and quasi-experimental study of the before-and-after type. The instrument used to measure the quality of the records was the Brazilian version of the Quality of Diagnoses, Interventions and Outcomes, which has four domains and a maximum score of 58 points. A total of 81 records were evaluated in version I (pre-intervention), as well as 58 records in version II (post-intervention), and the scores obtained in the two applications were compared. The interventions consisted of planning, pilot implementation of version II of the system, training and monitoring of users. The data were analyzed in the R software, using descriptive and inferential statistics. RESULTS: the mean obtained at the pre-intervention moment was 38.24 and, after the intervention, 46.35 points. There was evidence of statistical difference between the means of the pre- and post-intervention groups, since the p-value was below 0.001 in the four domains evaluated. CONCLUSION: the quality of the documentation of the Nursing process in version II of the system was superior to version I. The efficacy of the system and the effectiveness of the interventions were verified. This study can contribute to the quality of documentation, care management, visibility of nursing actions and patient safety.
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Sistemas de Apoio a Decisões Clínicas , Processo de Enfermagem , Brasil , Documentação , Humanos , Registros de Enfermagem , Planejamento de Assistência ao PacienteRESUMO
AIM: Automated real-time feedback devices have been considered a potential tool to improve the quality of cardiopulmonary resuscitation (CPR). Despite previous studies supporting the usefulness of such devices during training, others have conflicting conclusions regarding its efficacy during real-life CPR. This systematic review aimed to assess the effectiveness of automated real-time feedback devices for improving CPR performance during training, simulation and real-life resuscitation attempts in the adult and paediatric population. METHODS: Articles published between January 2010 and November 2020 were searched from BVS, Cinahl, Cochrane, PubMed and Web of Science, and reviewed according to a pre-defined set of eligibility criteria which included healthcare providers and randomised controlled trial studies. CPR quality was assessed based on guideline compliance for chest compression rate, chest compression depth and residual leaning. RESULTS: The selection strategy led to 19 eligible studies, 16 in training/simulation and three in real-life CPR. Feedback devices during training and/or simulation resulted in improved acquisition of skills and enhanced performance in 15 studies. One study resulted in no significant improvement. During real resuscitation attempts, three studies demonstrated significant improvement with the use of feedback devices in comparison with standard CPR (without feedback device). CONCLUSION: The use of automated real-time feedback devices enhances skill acquisition and CPR performance during training of healthcare professionals. Further research is needed to better understand the role of feedback devices in clinical setting.
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OBJECTIVE: to reflect on empathic listening use as a welcoming strategy for nursing professionals to cope with the challenges during the pandemic caused by the new coronavirus. METHODS: this is a reflection study based on updated data surveys and theoretical-conceptual aspects of Non-Violent Communication and empathic listening. RESULTS: in the performance during the COVID-19 pandemic, nursing professionals are exposed to violence of different natures related to occupational stress, work overload, anguishes and silenced suffering, with implications for the workers' health, who can be benefited and strengthened with empathetic listening. FINAL CONSIDERATIONS: the health crisis has highlighted the weaknesses of the health system. Nursing acts as the largest contingent of the health workforce in coping with the pandemic. Empathetic listening is a powerful strategy in caring for and strengthening nursing professionals.
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Esgotamento Profissional/prevenção & controle , Esgotamento Profissional/psicologia , COVID-19/psicologia , Empatia , Recursos Humanos de Enfermagem Hospitalar/psicologia , Estresse Ocupacional/prevenção & controle , Estresse Ocupacional/psicologia , Adaptação Psicológica , Adulto , Atitude do Pessoal de Saúde , Comunicação , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Pandemias/prevenção & controle , SARS-CoV-2RESUMO
Electronic nursing documentation constitutes technical, scientific, legal, and ethical documents. The objective of this study was to develop an electronic nursing documentation system. The system was developed in four phases (conceptualization, detailing, prototype building, implementation), and the knowledge base was based on domains and classes according to the NANDA-I, NIC, and NOC unified framework. The result is an electronic system (PROCEnf--USP--Nursing Process Electronic Documentation System of the University of São Paulo) which allows documenting nursing process generating reports of nursing process, besides supporting decisions on nursing diagnosis, expected outcomes, and interventions. Integration of different fields of knowledge, as well as the institutional feature of valuing continuous theoretical and practical improvement of nursing process were factors of success of this technological project.
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Sistemas de Informação em Laboratório Clínico/organização & administração , Documentação/métodos , Sistemas de Informação Hospitalar/organização & administração , Modelos Organizacionais , Diagnóstico de Enfermagem/métodos , Diagnóstico de Enfermagem/organização & administração , Informática em Enfermagem/organização & administração , Brasil , Registros Eletrônicos de SaúdeRESUMO
The purpose of this study was to develop an educational proposal using virtual multimedia resources, to innovate, stimulate and diversify areas of communication and interaction, facilitating nurses' autonomous and reflexive process of teaching and learning. This is an applied research, following the cyclical and interactive phases of designing, planning, developing and implementing. The educational proposal was developed on the TelEduc platform, using specific tools for content organization and communication between students and administrator. The teaching modules were on the following themes: Module 1--Fundamentals of the heart anatomy and physiology in newborns; Module 2--Risk factors for the occurrence of cardiorespiratory arrest in newborns; Module 3--Planning nursing care; Module 4--Medications used in cardiopulmonary arrests in newborns; and Module 5--Cardiorespiratory arrest care in newborns. This study may contribute to innovating teaching in nursing from a virtual educational proposal on the important issue of newborn cardiopulmonary resuscitation care.
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Reanimação Cardiopulmonar/educação , Educação em Enfermagem/métodos , Internet , Informática em Enfermagem , Humanos , Recém-NascidoRESUMO
OBJECTIVE: The objective of this review was to synthesize the best available evidence on the effectiveness of the Manchester Triage System (MTS) on time to treatment (TtT) for patients who visit the emergency department (ED). INTRODUCTION: The objectives of the MTS are to define a safe wait time for medical attention. Triage systems, such as the MTS, use criteria to ensure patient safety by determining appropriate wait times for each individual who visits the ED. The TtT is the time interval between arrival at the ED to initiation of therapeutic interventions. A short TtT is important in different clinical situations and may reduce infections and mortality. The MTS may have an impact on the TtT. INCLUSION CRITERIA: This review considered studies that included any patients visiting the ED with any complaints or medical diagnoses who were triaged using the MTS by nurses or doctors, and the TtT was measured. This review considered randomized controlled trials, as well as quasi-experimental, before-and-after, case-control and analytical cross-sectional studies. Studies published after 1994 in English, Spanish, Portuguese, French and German were considered for inclusion. METHOD: This systematic review was conducted in accordance with JBI methodology. The search strategy aimed to find both published and unpublished studies in MEDLINE, CINAHL, Lilacs, Web of Science, Embase, Scopus, Cochrane Central Register of Controlled Trials, Google Scholar, Banco de Teses - CAPES, and Digital Dissertations. The results of this search were assessed by one reviewer who excluded duplicate results. Titles and abstracts were screened by two independent reviewers for assessment against the inclusion criteria. The full texts of potentially eligible papers were retrieved and independently assessed by two reviewers using a standardized critical appraisal instrument from JBI. Data were extracted from studies included in the review and were presented using a narrative form. Tables were used to summarize the characteristics and findings of the studies. RESULTS: The review included two before-and-after studies, with a total of 2265 participants. One study was of moderate quality, and the other was of high quality. One study included only patients with acute ischemic stroke, while the other included patients with any complaint. Both studies were performed with consecutive samples. The median TtT was 10 minutes before implementing the MTS and 12 minutes after implementing the MTS in the study that included patients with any complaints. In the study including patients with acute ischemic stroke, the median TtT decreased by 15 minutes after implementing the MTS (from 75 to 60 minutes). Because of the heterogeneity in the characteristics of the populations of the two studies, the results could not be pooled. CONCLUSIONS: The MTS reduced the median TtT for patients triaged at the highest priority levels (orange and yellow), but it did not decrease the median TtT in all patients. The existing evidence base regarding the effectiveness of the MTS comes from two studies with methodological limitations that could not be pooled. The evidence indicates the MTS may confer benefit to some patients who visit the ED by reducing TtT, but not for all patients. Further research is needed before firm conclusions can be made.