User embracement with risk classification in an emergency care unit: an evaluative study. / Acolhimento com classificação de risco em unidade de pronto atendimento: estudo avaliativo.

Objective Describing the evaluation of the Structure, Process and Outcome of User Embracement with Risk Classification of an Emergency Care Unit from the perspective of physicians and nurses. Method An evaluative, descriptive, quantitative study developed in Santa Catarina. Data were collected using a validated and adapted instrument consisting of 21 items distributed in the dimensions of Structure (facilities), Process (activities and relationships in providing care) and Outcome (care effects). In the analysis, descriptive statistics and the Mean Ranking and Mean Score calculations were applied. Results The sample consisted of 37 participants. From the 21 evaluated items, 11 (52.4%) had a Mean Ranking between 3 and 4, and none of them reached the maximum ranking (5 points). "Prioritization of severe cases" and "Primary care according to the severity of the case" reached a higher Mean Ranking (4.5), while "Flowchart discussion" had the lowest Ranking (2.1). The dimensions of Structure, Process and Outcome reached mean scores of 23.9, 21.9 and 25.5, respectively, indicating a Precarious evaluation (17.5 to 26.1 points). Conclusion User Embracement with Risk Classification is precarious, especially regarding the Process which obtained a lower satisfaction level from the participants.

Predictors of death in an Intensive Care Unit: contribution to the palliative approach. / Fatores preditores de óbito em Unidade de Terapia Intensiva: contribuição para a abordagem paliativista.

OBJECTIVE: To identify predictors of death in the Intensive Care Unit and relate eligible patients to preferential palliative care. METHOD: A prospective cohort study that evaluated patients hospitalized for more than 24 hours, subdivided into G1 (patients who died) and G2 (patients who were discharged from hospital). For identifying the predictors for death outcome, the intensivist physician was asked the "surprise question" and clinical-demographic data were collected from the patients. Data were analyzed by descriptive/inferential statistics (p<0.05 significance). RESULTS: 170 patients were evaluated. The negative response to the "surprise question" was related to death outcome. A greater possibility of death (p<0.05) was observed among older and more frail patients with less functionality, chronic cardiac and/or renal insufficiencies or acute non-traumatic neurological insult, with multiorgan failure for more than 5 days, and hospitalized for longer. CONCLUSION: Predictors of death were related to a subjective evaluation by the physician, the clinical condition of the patient, underlying diseases, the severity of the acute disease and the evolution of the critical illness. It is suggested that patients with two or more predictive criteria receive preferential palliative care.

Intensive care unit team perception of palliative care: the discourse of the collective subject.

OBJECTIVE: To learn the perception of health professionals in an intensive care unit towards palliative care. METHOD: This was a descriptive and qualitative study based on the converging care approach conducted at an intensive care unit in the South of Brazil. Semi-structured interviews were used to investigate the understanding of the professionals about palliative care in this unit. The data were organized and analyzed using the discourse of the collective subject method with the help of Qualiquantisoft® software. RESULTS: Participants included 37 professionals (12 nurses, 11nursing technicians, 5 physical therapists and 9 doctors). The key ideas extracted from the interviews were: care in the end stage of life that avoids futile measures; comfort care; lack of standardized care and lack of team training. CONCLUSION: The professionals perceived palliative care as appropriate in the last stages of life, with no need for futile treatment or as comfort measures. However, they are aware of the lack of standardization and lack of capacity building in this area, which leads them to conceive palliative care as terminal care, and measures are recommended to break with this stigma. OBJETIVO: Conhecer a percepção dos profissionais de saúde de uma Unidade de Terapia Intensiva acerca do cuidado paliativo. MÉTODO: Pesquisa descritiva, qualitativa do tipo Convergente Assistencial realizada em uma Unidade de Terapia Intensiva da região sul do Brasil. Utilizou-se de entrevista semiestruturada que investigou o entendimento e a compreensão sobre cuidado paliativo nesta unidade. Os dados foram organizados e analisados pela técnica do discurso do sujeito coletivo com auxílio do software Qualiquantisoft®. RESULTADOS: Participaram do estudo 37 profissionais (12 enfermeiros, 11 técnicos de enfermagem, cinco fisioterapeutas e nove médicos). As ideias centrais extraídas dos relatos: cuidado na fase terminal da vida sem medidas fúteis; cuidados de conforto; falta uniformizar a assistência e falta capacitação para a equipe. CONCLUSÃO: Os profissionais percebem o cuidado paliativo apropriado na fase terminal da vida, sem necessidade de medidas fúteis de tratamento e promotoras de conforto. No entanto, estão conscientes da falta de uniformização e da sua capacitação nesta matéria, o que os leva a conceber o paliativismo como cuidado de terminalidade, pelo que se recomendam medidas para romper com este estigma.

[Nursing intervention bundle for enteral nutrition in intensive care: a collective construction]. / Bundle de intervenções de enfermagem em nutrição enteral na terapia intensiva: uma construção coletiva.

OBJECTIVE: The collective construction of a nursing intervention bundle for patients in critical care in the hospital receiving enteral nutrition therapy, supported by evidence-based practice. METHOD: A qualitative convergent-care study with 24 nursing professionals in an intensive care unit of a public hospital in Santa Catarina. Data collection was performed from May to August 2013, with semi-structured interviews and discussion groups. RESULTS: Four interventions emerged that constituted the bundle: bedside pH monitoring to confirm the position of the tube; stabilization of the tube; enteric position of the tube; and maintaining the head of the bed elevated at 30° to 45°.
 CONCLUSION: The interventions chosen neither required additional professional workload nor extra charges to the institution, which are identified as improving the adoption of the bundle by nursing professionals at the ICU.

[Nursing practice of care to patients undergoing elective surgery in the immediate preoperative period]. / Prática do enfermeiro no cuidado ao paciente no pré-operatório imediato de cirurgia eletiva.

Research that aimed to analyze the care of nurses to patients, in the daily professional practice, provided in the preoperative period for patients undergoing elective surgery. It is a descriptive research with a qualitative approach that involved 15 nurses from Surgical Units and two nurses from the Surgical Centre of a hospital in the southern region of Brazil. Data was collected in semi-structured interviews conducted from April to July 2011. Data was analyzed using the Collective Subject Discourse (CSD) technique. The information obtained generated three CDS focused on the following ideas: administrative care, instruction in the preoperative period and surgical care in the immediate preoperative period. The results showed that caring consists mostly of giving instructions to the patient in the preoperative period. It is concluded that the care was directed to the physical aspects to the detriment of the psychological, in disagreement with the assistance methodology adopted in the hospital, supported by the Theory of Basic Human Needs.

Humanized care in the Intensive Care Unit: discourse of Angolan nursing professionals.

OBJECTIVES: to analyze the perception of nursing professionals in an intensive care unit in Angola about humanized care and identify resources necessary for its implementation. METHODS: a qualitative, descriptive study conducted with 15 professionals in June-October/2020 in intensive care unit in Angola. The data were collected through semi-structured interviews; analysis based on the collective subject discourse technique. RESULTS: five central ideas emerged: three related to the perception of humanized care ("From integral vision and empathy to a set of actions in all phases of care", "Humanizing is extending care to family members and companions", "Humanized care requires the establishment of a bond of trust and guarantee of individualized care"); and two on the resources necessary for this care ("Need for infrastructure - human and material resources", "Professional training and humanized care are interconnected"). FINAL CONSIDERATIONS: humanized care involves objectivity and subjectivity; it includes family members. An adequate infrastructure can provide it.

[Evaluation of the welcoming strategies in the Intensive Care Unit]. / Avaliação das estratégias de acolhimento na Unidade de Terapia Intensiva.

This qualitative study was performed at the adult Intensive Care Unit (ICU) of a public hospital in Southern Brazil with the objective to evaluate the implemented welcoming strategies. Participants included 13 patients and 23 relatives. Data collection was performed from July to October 2008, utilizing semi-structured interviews. All interviews were recorded. Data analysis was performed using the Collective Subject Discourse. The collected information yielded two discourses: the family recognized the welcoming strategies and the patients found the ICU team to be considerate. By including the family as a client of nursing care, relatives felt safe and confident. Results show that by committing to the responsibility of making changes in heath care practices, nurses experience a novel outlook towards ICU care, focused on human beings and associating the welcoming to the health care model that promotes the objectivity of care.

Early postoperative serum albumin levels as predictors of surgical outcomes in head and neck squamous cell carcinoma.

BACKGROUND: Malnutrition is a common issue in patients with head and neck squamous cell carcinoma and has a negative effect on surgical outcomes. OBJECTIVE: We attempted to determine which malnutrition diagnostic variables can be used as predictors of postoperative complications in patients with head and neck squamous cell carcinoma. METHODS: Forty-one patients undergoing surgery for head and neck squamous cell carcinoma were submitted to a prospective evaluation. Biochemical data, anthropometric measurements and evaluation of body composition were used in the nutritional analysis. RESULTS: Twenty-two patients (53.6%) developed complications. Serum albumin measured on the first postoperative day was the only variable that significantly differed between groups. A cut-off value of 2.8 g/dL distinguished between patients with a complicated and uncomplicated postoperative course. Normalization of albumin levels occurred more frequently and more rapidly in the noncomplicated group. CONCLUSION: Serum albumin measured on the first postoperative day was the only variable that was a predicter of postoperative complications after major head and neck squamous cell carcinoma surgery.

[Family in the waiting room of an intensive care unit revealed feelings]. / Familiares na sala de espera de uma unidade de terapia intensiva: sentimentos revelados.

This is a qualitative study that aims to understand the feelings of relatives of patients admitted to the Intensive Care Unit (ICU). The study was conducted in the ICU of a large general hospital in the western region of Santa Catarina. The data collection occurred in 2009 with a semi structured interview to eighteen families. For data treatment the collective subject discourse was used. Reports emerged of two items related to feelings: hospitalization in the ICU and while waiting to enter the unit. The analysis revealed feelings as pain, anguish, sadness, helplessness,fear, despair, anxiety and expectation infinite. It is hoped that these results may assist in the training of professionals, to host the family and its insertion in the ICU environment as an element to be integrated into nursing care, through actions welcoming, helping them to cope with hospitalization of a relative in a critical unit.

Care for unplanned extubation prevention: analysis of the validity of an instrument's content.

OBJECTIVES: to analyze the validity of a nursing care instrument content for unplanned extubation prevention in Intensive Care Units. METHODS: a methodological study carried out with 40 nurses, containing 26 interventions distributed in the components: agitation/delirium/pain management; respiratory device stability; weaning from sedation and spontaneous breathing assessment; human resource management. Content Validity Index, average and universal proportion, and Fleiss' Kappa coefficient were applied. RESULTS: Brazilian female experts stood out, with an average age of 44.9 years and a standard deviation of 7.75 years. Two interventions did not reach a valid Content Validation Index (≥0.78), when considering the set of evaluated criteria. A universal agreement of 4.0% was identified among Brazilians and 26.6% among foreigners. CONCLUSIONS: the instrument is relevant and represents "unplanned extubation prevention in Intensive Care Units", which can be implemented in Brazil and in Latin countries, in Brazilian and foreign versions.

Medical device-related pressure injuries in critical patients: prevalence and associated factors.

OBJECTIVE: To determine the prevalence of medical device-related pressure injuries in critical patients and analyze the associated factors. METHOD: Epidemiological, cross-sectional study. Sociodemographic, clinical and medical device data were collected. Inspection of the skin/mucous membranes was performed to identify and classify the injuries. Analysis using descriptive statistics, Poisson regression and the Spearman correlation coefficient. RESULTS: Ninety-three patients were evaluated and 58 developed injuries, with a prevalence of 62.4%. Injuries by the orotracheal tube (50%), nasogastric tube (44.1%) and urinary catheter (28.6%) were the most prevalent, and the most affected regions were, respectively, the auricular (79.5%), nasal ala (86.7%) and urethral meatus (76.9%). Factors associated with injuries were severe edema (p = 0.005), low Braden (p<0.001) and Glasgow (p = 0.008) scores, length of stay in intensive care (p<0.001) and hospitalization diagnosis classified as other causes (p<0.001). The use of more than one device (p<0.001) and a longer time of use (p<0.001) were correlated. CONCLUSION: The high prevalence of injuries and the associated factors indicate the need for preventive measures and risk monitoring.

Medical device-related pressure injury prevention in critically ill patients: nursing care.

OBJECTIVES: to know the care implemented by the nursing team to prevent medical device-related pressure injuries in critically ill patients. METHODS: this is a qualitative research conducted with 15 nursing professionals from Intensive Care Unit. Sampling was carried out by theoretical saturation. For data analysis, the Discourse of the Collective Subject technique was used. RESULTS: six speeches emerged, whose central ideas were interventions for medical device-related pressure injury prevention: care in fixation; frequent repositioning; protection and padding of body areas in contact; preferences for flexible materials, when available; attention of professionals so that they do not comer under patients; early assessment and removal, when clinically possible. FINAL CONSIDERATIONS: nursing care was directed mainly to respiratory devices, catheters in general and monitoring equipment, indicating that professionals have the knowledge to provide safe assistance consistent with the literature.

Social representations of comfort for patients' family members in palliative care in intensive care.

OBJECTIVE: To know the social representations of comfort for patients' family members in palliative care in intensive care. METHOD: Descriptive, qualitative study, theoretical framework adopted was Social Representations. 30 family members of patients admitted to an intensive care unit in palliative care participated. Data were collected through semi-structured individual interviews, organized and analyzed using the Collective Subject Discourse technique. RESULTS: Pointed out as central ideas, positive and negative feelings of family members, communication and interaction with the team, ICU as excellence and palliative care as a measure of comfort for the patient and the family. CONCLUSION: The social representations about the comfort of family members of hospitalized patients in an intensive care unit in palliative care are identified by the family members' feelings during the visit, communication, and the humanized care applied by nursing professionals in the patients in palliative care.

Implementation of the protocol of nursing care in trauma in aeromedical service.

OBJECTIVE: To analyze the implementation of a nursing care protocol for trauma patients before, during and after the flight. METHOD: A cross-sectional quantitative study carried out in an aeromedical service, using a checklist with 106 care: 79 before flight, 25 during, and 2 after flight. 97 patients were included in the study. RESULTS: Most care (n = 59; 55.7%) was implemented, totaling 4,435, 1,480 and 192 cares performed before, during and after the flight, respectively. They stood out as unrealized care: protect ears with ear muffler (n = 55) and avoid leaving the pulse oximeter exposed to the sun's rays (n = 22). The main reason for the non-performance was lack of appeal (n = 94). CONCLUSION: Although most protocol care has been implemented, unrealized care compromises the quality of care, which requires the management of the service to provide more incentive to nurses and adequate resources for its implementation.

Nurses' responsibilities in the aerospace environment.

OBJECTIVES: to characterize the nurses who work in the aerospace environment and to identify their most frequent responsibilities during the pre-flight, flight, and post-flight periods. METHODS: a quantitative, exploratory-descriptive research, conducted using a survey through Google forms®, from January to April of 2018, with 50 nurses from aerospace services in Brazil. Data were analyzed using descriptive statistics. RESULTS: predominance of male participants (64%), mean age of 37 years, with a mean working time in the aerospace environment of six years, in helicopter (54%), and in the southern region (42%). The main pre-flight, flight, and post-flight activities were, respectively: verification/testing of equipment functionality, nursing care for patients, and replacement of supplies and equipment. CONCLUSIONS: In the aerospace environment, nurses' work are primarily organizational and victim care actions, during all phases of the flight.

Management of bed availability in intensive care in the context of hospitalization by court order.

OBJECTIVE: to identify, from the nurse perspective, situations that interfere with the availability of beds in the intensive care unit in the context of hospitalization by court order. METHOD: qualitative exploratory, analytical research carried out with 42 nurses working in adult intensive care. The selection took place by non-probabilistic snowball sampling. Data collected by interview and analyzed using the Discursive Textual Analysis technique. RESULTS: three categories were analyzed, entitled deficiency of physical structure and human resources; Lack of clear policies and criteria for patient admission and inadequate discharge from the intensive care unit. In situations of hospitalization by court order, there is a change in the criteria for the allocation of intensive care beds, due to the credibility of professionals, threats of medico-legal processes by family members and judicial imposition on institutions and health professionals. CONCLUSION: nurses defend the needs of the patients, too, with actions that can positively impact the availability of intensive care beds and adequate care infrastructure.

[Leadership in critical care settings: reflections and challenges for the Brazilian Nursing]. / Liderança em ambientes de cuidados críticos: reflexões e desafios à Enfermagem Brasileira.

The objective of this study was to reflect on the leadership, especially in the intensive care nursing, based on the prospect of nurses, teachers, nursing students and in the literature on the subject. The leadership of the nurse in intensive care units faces challenges and paradoxes and is present in the planning of care, in the moments of ethical and bioethical conflicts, in the supervision of care, in capacity of making decisions quickly and safety, in knowing deal with the issues involving the process of living and dying.

Medical Device-Related Pressure Injuries: an integrative literature review.

OBJETIVES: To identify and analyze the scientific evidence regarding the occurrence of Medical Device-Related Pressure Injuries, considering the development sites; and to describe the devices of risk and the measures of prevention and treatment. METHOD: Integrative, search-based review: CINAHL, PubMed, Wiley InterScience, Scopus, and Web Of Science. The terms "pressure ulcer" and "medical devices" were used, including original articles and case studies published between 2010 and 2015. Nine studies were selected. RESULTS: Posterior cervical region and nose had the highest injury frequencies, respectively, 66.0% and 40.0%. Eleven risk devices were identified, with emphasis on Non-Invasive Ventilation masks and orotracheal tube. For prevention and treatment emerged recommendations specific to the device employed and general measures. CONCLUSION: Medical Device-Related Pressure Injuries are frequent problems, however, they can be prevented and treated based on the recommendations of the articles raised in this review.

Características clínicas de reanimações cardiopulmonares intra-hospitalares registradas em prontuário: estudo transversal / Clinical characteristics of in-hospital cardiopulmonary resuscitations recorded in medical records: a cross-sectional study / Características clínicas de las reanimaciones cardiopulmonares intrahospitalarias registradas en las historias clínicas: estudio transversal

Objetivo: identificar características clínicas das paradas cardiopulmonares e reanimações cardiopulmonares ocorridas em ambiente intra-hospitalar. Método: estudo quantitativo, prospectivo e observacional, a partir de informações de prontuários de pacientes submetidos a manobras de reanimação devido à parada cardiopulmonar entre janeiro e dezembro de 2021. Utilizou-se um instrumento baseado nas variáveis do modelo de registro Utstein. Resultados: em 12 meses foram registradas 37 paradas cardiopulmonares. A maioria ocorreu na unidade de terapia intensiva respiratória, com causa clínica mais prevalente hipóxia. 65% dos pacientes foram intubados no atendimento e 57% apresentaram ritmo atividade elétrica sem pulso. A duração da reanimação variou entre menos de cinco a mais de 20 minutos. Como desfecho imediato, 57% sobreviveram. Conclusão: dentre os registros analisados, a maior ocorrência de paradas cardiopulmonares foi na unidade de terapia intensiva respiratória, relacionada à Covid-19. Foram encontrados registros incompletos e ausência de padronização nas condutas.

Objective: identify the clinical characteristics of cardiopulmonary arrests and cardiopulmonary resuscitations in the in-hospital environment. Method: this is a quantitative, prospective and observational study based on information from the medical records of patients who underwent resuscitation maneuvers due to cardiopulmonary arrest between January and December 2021. An instrument based on the variables of the Utstein registration protocol was used. Results: thirty-seven cardiopulmonary arrests were recorded in 12 months. The majority occurred in a respiratory intensive care unit, with hypoxia being the most prevalent clinical cause. Sixty-five percent of the patients were intubated and 57% had pulseless electrical activity. The duration of resuscitation ranged from less than five to more than 20 min. As for the immediate outcome, 57% survived. Conclusion: among the records analyzed, the highest occurrence of cardiopulmonary arrests was in respiratory intensive care units, and they were related to Covid-19. Moreover, incomplete records and a lack of standardization in cardiopulmonary resuscitation procedures were found.

Objetivo: Identificar las características clínicas de paros cardiopulmonares y reanimaciones cardiopulmonares que ocurren en un ambiente hospitalario. Método: estudio cuantitativo, prospectivo y observacional, realizado a partir de información presente en historias clínicas de pacientes sometidos a maniobras de reanimación por paro cardiorrespiratorio entre enero y diciembre de 2021. Se utilizó un instrumento basado en las variables del modelo de registro Utstein. Resultados: en 12 meses se registraron 37 paros cardiopulmonares. La mayoría ocurrió en la unidad de cuidados intensivos respiratorios, la causa clínica más prevalente fue la hipoxia. El 65% de los pacientes fue intubado durante la atención y el 57% presentaba un ritmo de actividad eléctrica sin pulso. La duración de la reanimación varió entre menos de cinco y más de 20 minutos. Como resultado inmediato, el 57% sobrevivió. Conclusión: entre los registros analizados, la mayor cantidad de paros cardiopulmonares se dio en la unidad de cuidados intensivos respiratorios, relacionada con Covid-19. Se encontraron registros incompletos y falta de estandarización en el procedimiento.

Counter-referral in Emergency Care Units: discourse of the collective speech.

OBJECTIVE: To describe the facilities and difficulties of the counter-referral of an Emergency Care Unit in Santa Catarina State. METHOD: Descriptive, qualitative study, with the participation of three nurses and 17 physicians. The data were collected through a semi-structured interview and analyzed using the Discourse of the Collective Subject technique. For the theoretical basis, the Política Nacional de Atenção às Urgências (National Policy of Emergency Care) and the Rede de Atenção às Urgências (Network of Care to the Emergencies) was used. RESULTS: The facilities of the counter-referral correspond to the strategies of communication with the Primary Care: embracement; good interpersonal relationships; and electronic medical record network. The difficulties are related to the deficiencies of Primary Care and specialized services, such as the insufficient number of physicians and the delay in scheduling consultations and more complex exams. FINAL CONSIDERATIONS: The difficulties highlighted indicate significant challenges of the local health system in the search for integration between emergency care points.