Psychosocial changes during COVID-19 lockdown on nursing home residents, their relatives and clinical staff: a prospective observational study.

BACKGROUND: Previous works have observed an increase of depression and other psychological disorders on nursing home residents as a consequence of coronavirus disease 2019 (COVID-19) lockdown; however, there are few studies that have performed a comprehensive evaluation of all people involved in nursing homes environment. The objective of the work was to analyse the impact of lockdown on psychosocial factors of nursing home residents, relatives and clinical staff and how these variables have influenced residents' survival. METHODS: A prospective study was designed. Evaluations were performed at three different times: a) at the beginning of Spanish confinement, in March 2020; b) just before the second wave of the pandemic, with relaxation of security measures but in lockdown, and c) in January-February 2021, at the end of the second wave, when visits were already allowed. The study was conducted on three different nursing homes. Three hundred and one residents, 119 clinical staff and 51 relatives took part in the study. Anxiety and depression were evaluated in all participants. A scale on the meaning of suffering was also performed. In addition, burnout status was also determined in the clinical staff. RESULTS: All participants showed lower depression during lockdown, while at the beginning and at the end of the confinement, these values were significantly increased. In residents, these changes were dependent of cognitive status (p = 0.012). Anxiety was significantly higher in residents. The evolution of anxiety was similar than with depression, with lower values during confinement, although clinical staff showed higher anxiety levels at the beginning. The feeling of suffering was significantly lower in the clinical staff than in resident and relative groups. Residents' survival was dependent of cognitive status (p = 0.018) and voluntary confinement (p < 0.001). CONCLUSIONS: During the first COVID-19 lockdown, psychological wellbeing of residents cared in nursing homes, their relatives and staff did not seem to be seriously affected. Previous mental health in relatives and staff together with a resilient approach to the adversity might partly be protecting factors. The lack of consequences on residents' anxiety, depression and perception of social support may reflect the special attention and care they received. Finally, as in the current study only data of the first two COVID-19 waves were analysed, its findings might be partly generalized to all the pandemic.

Analyzing the concept of disruptive behavior in healthcare work: an integrative review.

OBJECTIVE: To analyze the concept of disruptive behavior in healthcare work. METHOD: An integrative review carried out in the theoretical phase of a qualitative research substantiated by the theoretical framework of the Hybrid Model of Concept Development. The search for articles was conducted in the CINAHL, LILACS, PsycINFO, PubMed and SciVerse Scopus databases in 2013. RESULTS: 70 scientific articles answered the guiding question and lead to attributes of disruptive behavior, being: incivility, psychological violence and physical/sexual violence; with their main antecedents (intrapersonal, interpersonal and organizational) being: personality characteristics, stress and work overload; and consequences of: workers' moral/mental distress, compromised patient safety, labor loss, and disruption of communication, collaboration and teamwork. CONCLUSION: Analysis of the disruptive behavior concept in healthcare work showed a construct in its theoretical stage that encompasses different disrespectful conduct adopted by health workers in the hospital context, which deserve the attention of leadership for better recognition and proper handling of cases and their consequences. OBJETIVO: Analisar o conceito comportamento destrutivo no trabalho em saúde. MÉTODO: Revisão integrativa realizada na fase teórica de pesquisa qualitativa fundamentada pelo referencial teórico-metodológico do Modelo Híbrido de Análise de Conceitos. A busca dos artigos foi realizada nas bases de dados CINAHL, LILACS, PsycINFO, PubMed e SciVerse Scopus, em 2013. RESULTADOS: 70 artigos científicos responderam à questão norteadora e atenderam aos critérios de inclusão, permitindo evidenciar os atributos do comportamento destrutivo: incivilidade, violência psicológica e violência física/sexual; seus principais antecedentes (intrapessoais, interpessoais e organizacionais): características de personalidade, estresse e sobrecarga de trabalho; e consequentes: sofrimento moral/psíquico dos trabalhadores, comprometimento da segurança do paciente, prejuízos laborais, rompimento da comunicação, da colaboração e do trabalho em equipe. CONCLUSÃO: A análise do conceito comportamento destrutivo no trabalho em saúde evidenciou, em sua fase teórica, um constructo que abrange diferentes condutas desrespeitosas adotadas por trabalhadores de saúde no contexto hospitalar, merecendo atenção de lideranças da área para maior reconhecimento e manejo adequado dos casos e suas consequências.

Evaluating the intervening factors in patient safety: focusing on hospital nursing staff.

OBJECTIVE: To evaluate intervening factors in patient safety, focusing on hospital nursing staff. METHOD: The study is descriptive, with qualitative approach, excerpt from a larger study with analytical nature. It was undertaken in a public hospital in Fortaleza, CE, Brazil, between January and June 2013, with semi-structured interviews to 70 nurses, using Thematic Content Analysis. RESULTS: The principal intervening factors in patient safety related to hospital nursing staff were staff dimensioning and workload, professional qualification and training, team work, being contracted to the institution, turnover and lack of job security, and bad practice/disruptive behaviors. These aspects severely interfere with the establishment of a safety culture in the hospital analyzed. CONCLUSION: It is necessary for managers to invest in nursing staff, so that these workers may be valued as fundamental in the promotion of patient safety, making it possible to develop competences for taking decisions with focus on the improvement of quality care.

Sociodemographic and clinical characteristics of people with ostomy and the adaptive domains of Roy's theory: A cross-sectional study.

INTRODUCTION: The adaptation of people with ostomies may be associated with and affected by sociodemographic and clinical factors. The present study aimed to investigate the association between the sociodemographic and clinical characteristics and the adaptation of people with an intestinal stoma. METHOD: An analytical study, carried out through an interview with 200 patients with ostomy for five months. For that, it was applied to scale for the level of adaptation of ostomy patients to measure the physiological domains, self-concept, role function and interdependence and a questionnaire was used in which sociodemographic and clinical information. Descriptive and multivariate analyses were performed to test the study hypothesis. RESULTS: The study pointed out statistically significant associations with male sex, age group below 60, low education level, Stoma time less than one year, below one minimum wage, temporary permanence criteria and presence of complications relation to low scores of adaptation. CONCLUSIONS: The association of sociodemographic and clinical factors with the measured adaptive modes provides important information for the planning of nursing care and other care providers, since it directs actions to the aspects that give greater adaptive difficulty to people with stomas and which are the focus of care nursing to this clientele.

Healing of Venous Leg Ulcers Influenced by Individual Aspects: Cluster Analysis in a Specialist Wound Management Clinic.

INTRODUCTION/OBJECTIVE: Venous Leg Ulcers (VLU) present a challenging healing process. Attaining healing is a primary treatment objective, commonly pursued in Primary Health Care (PHC) or Specialist Wound Management Clinics. Our objective was to examine the association and interplay between sociodemographic, health, clinical, and care factors with the outcomes of VLU treatment in patients undergoing care at a Specialist Wound Management Clinic. METHODS: Longitudinal, observational study took place in a center for the treatment of chronic injuries linked to PHC. The sociodemographic aspects, health status and habits, clinical and care aspects of patients with VLU were scrutinized over a 1-year period. RESULTS: The sample comprised 103 participants, with some still under treatment (Treatment Group-TG/ n = 60) and others having achieved VLU healing (Healing Group-HG/ n = 43). An association between sociodemographic, health, clinical, and care factors and the healing outcome (HG) was identified. A moderate correlation was observed between factors predisposing to healing in the sociodemographic group and health habits. Notably, among sociodemographic factors, the older age group and improvements in health, particularly the reduced use of alcohol/smoking, appeared to exert the most significant influence on healing. Additionally, specialized service monitoring and the application of compression therapy were contributory factors. CONCLUSIONS: These findings substantiate the hypothesis that sociodemographic, health, clinical, and care-related aspects are intertwined with VLU healing. Protective factors associated with healing interacted synergistically, fostering a positive outcome over one year of treatment.

[How to quantify the qualitative aspects of nursing outcomes classification scales with psychosociocultural indicators]. / Cómo cuantificar los aspectos cualitativos en escalas de clasificación de resultados NOC para etiquetas psico-socioculturales.

Working necessarily with Likert scales to measure Nursing Outcomes Classification (NOC) outcomes has the advantage of unification, but also presents difficulty in reducing the rating from 1 to 5, especially when the research is qualitative and thus includes the use of words and expressions, as well as observations and perceptions. What exactly does a score of 2 or 3 mean with regard to the NOC Health beliefs? In this paper, we make a number of different proposals for operationalizing concepts and transforming them to numbers; however, it should be noted that such proposals always end in a quantitative analysis. Thus, we propose the use of emic/etic qualitative observations for psychosocial and cultural indicators, following ethnographic principles. Basic and applied research on nursing languages must have correct methodological foundations and seek to satisfy the same criteria of methodological suitability as any other research.

Influence of pain on the quality of life in patients with venous ulcers: Cross-sectional association and correlation study in a brazilian primary health care lesions treatment center.

We aimed to verify the association and correlation between pain and QoL in people with VU treated in a Brazilian Primary Health Care (PHC) lesions treatment center. This is an observational, cross-sectional study with a quantitative approach, carried out in a service specialized in the treatment of chronic injuries, linked to 29 PHC units. Sociodemographic and health characterization instruments were used. The Short Form Health Survey-36 (SF-36) and Visual Analogue Pain Scale (VAPS) also were used. The Kruskal-Wallis test verified the association between the scalar variables of QoL and pain intensity. With Spearman's correlation test, we verified the level of correlation between the scales applied. A total of 103 patients participated in the study. Higher QoL scores associated with moderate pain were found, especially in the Physical role functioning, Physical functioning, and Vitality domains. Correlation analysis showed its greatest (moderate) strength in the interaction between the highest scores in the Physical role functioning and Emotional role functioning domains with the lowest pain levels.

Determinants of socioeconomic factors for quality of life and depressive symptoms in community-dwelling older people: A cross-sectional study in Brazil and Portugal.

Our aim was to analyze the association between socioeconomic status and quality of life (QoL) among older people with depressive symptoms treated through the Primary Health Care (PHC) system in Brazil and Portugal. This was a comparative cross-sectional study with a nonprobability sample of older people in the PHC in Brazil and Portugal conducted between 2017 and 2018. To evaluate the variables of interest, the socioeconomic data questionnaire, the Geriatric Depression Scale and the Medical Outcomes Short-Form Health Survey were used. Descriptive and multivariate analyses were performed to test the study hypothesis. The sample consisted of n = 150 participants (Brazil n = 100 and Portugal n = 50). There was a predominance of woman (76.0%, p = 0.224) and individuals between 65 and 80 years (88.0%, p = 0.594). The multivariate association analysis showed that in the presence of depressive symptoms, the QoL mental health domain was most associated with the socioeconomic variables. Among the prominent variables, woman group (p = 0.027), age group 65-80 years (p = 0.042), marital status "without a partner" (p = 0.029), education up to 5 years (p = 0.011) and earning up to 1 minimum wage (p = 0.037) exhibited higher scores among brazilian participants. The portuguese participants showed an association between the general health status domain and woman group (p = 0.042) and education up to 5 years (p = 0.045). The physical functioning domain was associated with income of up to 1 minimum wage (p = 0.037). In these domains, the portuguese participants exhibited higher scores than the brazilian participants. We verified the association between socioeconomic profile and QoL in the presence of depressive symptoms, which occurred mainly among woman, participants with low levels of education and low income, with QoL aspects related to mental, physical and social health and self-perceived health. The group from Brazil had higher QoL scores than the group from Portugal.

Validation of educational material for the care of people with intestinal stoma.

OBJECTIVE: to validate an educational booklet for people with intestinal stoma as a technological resource in the teaching of self-care. METHOD: a methodological research for the construction and validation of an educational booklet by nine expert judges and 25 people with stomas. The agreement index of at least 80% was considered to guarantee the validation of the material. RESULTS: regarding the objectives of the booklet, all the judges evaluated the items as "adequate" or "totally adequate", with a content validity index of 1.00. Regarding the structure and presentation of the booklet, the total index was 0.84. Regarding relevance, the total was 0.97 and the general index of the educational booklet was 0.89, confirming the validation with the judges. All items of the organization, writing style, appearance and motivation of the material were considered as validated by the target audience, reaching a total agreement index of 0.99. CONCLUSION: in the context of health education, the booklet was considered valid and suitable for the care of people with intestinal stoma, and can be used in teaching, research, extension and care for people with intestinal stoma.

Risks of enteral nutritional therapy: a clinical simulation.

OBJECTIVE: Knowing the perceptions of nursing technicians about the risks to the patient in the use of enteral nutritional therapy, in a scenario of clinical simulation. METHOD: A qualitative study, performed through a clinical simulation with nursing technicians from a university hospital in the South of Brazil, in August 2017. The simulation sessions were recorded in audio and later transcribed. Content analysis was used for data analysis. RESULTS: Four thematic categories resulted from the analysis: Risks related to the tube; Risks related to diet; Risks related to contamination and Risks related to routine. CONCLUSION: The clinical simulation allowed nursing technicians to identify risks in the practice of enteral nutritional therapy and ways to minimize them. Promoting spaces for continuing education in the service, using clinical simulation methodology, gives an opportunity for critical reflection, which can contribute to safer, effective and quality nursing care.

Patient safety culture in the maternal-child area of a university hospital.

OBJECTIVE: To describe the safety culture of the patient from the perspective of nurses and physicians working in the maternal-child area. METHOD: A cross-sectional study conducted from January to September 2018 with 41 professionals of the Obstetrics Center and obstetric hospitalization of a university hospital in the south of the country. The Hospital Survey on Patient Safety Culture was used, with 12 dimensions of the safety culture, measured by means of a general score (0 to 10) and of positive answer percentages to assess strengths and weaknesses. RESULTS: The action of supervisors/bosses can be considered a strength of patient safety, with 78.2% of positive answers; already regarding communication, it was considered a fragility, punctuating 13.24%. The general safety grade of the patient assigned to the work's unit was very good, in a confidence interval of 95%. CONCLUSION: With the identification of the strengths and weaknesses of patient safety, it is possible to plan improvement actions. We emphasize that the non-punitive approach is essential.

Protocolo gráfico de validação para avaliação da assistência de enfermagem segura em hemodiálise / Protocolo gráfico de validación para evaluación de asistencia de enfermería segura en hemodiálisis / Validation graphic protocol for assessing safe nursing care in hemodialysis

Resumo Objetivo Validar o conteúdo e a aparência de um protocolo gráfico para avaliação do cuidado seguro de enfermagem a pacientes em hemodiálise. Método Estudo metodológico com abordagem quantitativa, organizado em três procedimentos: teóricos, a partir de uma scoping review; empíricos, na qual ocorreu processo de construção do protocolo gráfico e checklist para avaliação do cuidado seguro; por fim, os analíticos, para a validação propriamente dita com uso da técnica Delphi e participação de nove juízes especialistas em duas rodadas para o alcance da concordância. Resultados Elaboraram-se o checklist e o protocolo gráfico. Quanto à validade de conteúdo, em Delphi I, três critérios obtiveram Coeficiente de Validade de Conteúdo =0,77 no checklist. No que corresponde ao Delphi II, foram alcançados 80% em todos os itens referentes ao Coeficiente de Validade de Conteúdo, e todos os índices ficaram acima de 0,80. A validação de aparência ocorreu utilizando critérios de Suitability Assessment of Materials no Delphi I. Foi possível atingir um Coeficiente de Validade de Conteúdo total maior que 0,80 em todos, enquanto que, no Delphi II, os protocolos alcançaram concordância maior que 80% e Coeficiente de Validade de Conteúdo maior que 0,88, já que o checklist apresentou maior Coeficiente de Validade de Conteúdo com 0,91. Conclusão Apresentam-se o protocolo gráfico e o checklist para avaliação do cuidado seguro aos pacientes em hemodiálise válidos em seu conteúdo e aparência.

Resumen Objetivo Validar el contenido y la apariencia de un protocolo gráfico para la evaluación del cuidado seguro de enfermería a pacientes en hemodiálisis. Métodos Estudio metodológico con enfoque cuantitativo, organizado en tres procedimientos: teórico, a partir de una scoping review; empírico, donde se realizó el proceso de elaboración del protocolo gráfico y checklist para la evaluación del cuidado seguro; y por último, analítico, para la validación propiamente dicha mediante el uso del método Delphi y la participación de nueve jueces especialistas en dos rondas para alcanzar la concordancia. Resultados Se elaboró la checklist y el protocolo gráfico. Respecto a la validez del contenido, en Delphi I tres criterios obtuvieron Coeficiente de Validez de Contenido = 0,77 en la checklist. En lo referente al Delphi II, se alcanzó el 80 % en todos los ítems relacionados con el Coeficiente de Validez de Contenido, y todos los índices fueron superiores a 0,80. La validación de la apariencia se realizó con los criterios de la Suitability Assessment of Materials en Delphi I. Se logró alcanzar un Coeficiente de Validez de Contenido total mayor a 0,80 en todos, mientras que en Delphi II, los protocolos lograron una concordancia mayor a 80 % y Coeficiente de Validez de Contenido mayor a 0,88, ya que la checklist presentó mayor Coeficiente de Validez de Contenido con 0,91. Conclusión El protocolo gráfico y la checklist para la evaluación del cuidado seguro a pacientes en hemodiálisis demostraron ser válidos en su contenido y apariencia.

Abstract Objective To validate the content and appearance of a graphic protocol for evaluating safe nursing care for hemodialysis patients. Methods Methodological study with a quantitative approach, organized into three procedures: theoretical from a Scoping Review; empirical in which the process of constructing the graphic protocol and checklist for the evaluation of safe care took place; finally, the analytics for the validation itself using the Delphi technique and the participation of nine expert judges in two rounds to reach agreement. Results The checklist and the graphic protocol were elaborated. As for content validity in Delphi I, three criteria obtained Content Validity Coefficient =0.77 in the checklist. In what corresponds to Delphi II, 80% was achieved in all items regarding the Content Validity Coefficient, all indices were above 0.80. Appearance validation took place using criteria of the Suitability Assessment of Materials in Delphi I, it was possible to achieve a total Content Validity Coefficient greater than 0.80 in all, while in Delphi II the protocols reached agreement greater than 80% and Content Validity Coefficient greater than 0.88, since the checklist showed a higher Content Validity Coefficient with 0.91. Conclusion The graphic protocol and checklist for evaluating safe care for hemodialysis patients are presented, valid in their content and appearance.

The effect of simulation on nursing students' knowledge about colostomy irrigation: a quasi-experimental study / Efecto de la simulación en los conocimientos de estudiantes de enfermería sobre irrigación de colostomía: estudio cuasiexperimental / Efeito da simulação no conhecimento de estudantes de enfermagem sobre irrigação de colostomia: estudo quase experimental

ABSTRACT Objective: to compare the effect of clinical simulation and of a lectured class on Nursing students' knowledge about the colostomy irrigation procedure. Method: a quasi-experimental study conducted in September 2019 with Nursing students attending Universidade Federal do Rio Grande do Norte in Natal, Brazil. The instruments used were a questionnaire targeted at sociodemographic issues and a knowledge analysis tool at three different moments. The Control Group had a lectured class and the Intervention Group took part in the laboratory simulation. The Chi-Square and Mann-Whitney tests were used for data analysis. Results: no statistically significant differences were observed between the groups in terms of the sociodemographic profile. In the analysis of the means of correct answers, better measures were observed in the post-test of both groups when compared to the pre-test; however, in the retention test, the students from the Intervention Group had better and statistically significant results than those from the Control Group (p-value=0.015). Conclusion: it is noticed that both teaching strategies exerted a positive effect on the students' learning process. Although both are equally important and effective, simulation showed better performance in knowledge retention. It is expected that this research enables educators to reflect on their work and allows them to use strategies that enhance their teaching practice, in order to benefit teaching and the students' development.

RESUMEN Objetivo: comparar el efecto de la simulación clínica y de una clase expositiva en los conocimientos de estudiantes de Enfermería sobre el procedimiento de irrigación de colostomía. Método: estudio cuasiexperimental realizado en septiembre de 2019 con estudiantes de Enfermería de la Universidade Federal do Rio Grande do Norte en Natal, Brasil. Como instrumentos se utilizaron un cuestionario dirigido a cuestiones sociodemográficas y una herramienta de análisis del conocimiento, en tres ocasiones diferentes. Al Grupo Control se le ofreció la clase expositiva y el Grupo Intervención participó de la simulación en laboratorio. Para el análisis de los datos se emplearon las pruebas de Chi-Cuadrado y de Mann-Whitney. Resultados: no se observaron diferencias estadísticas significativas entre los grupos en relación con el perfil sociodemográfico. En el análisis de los valores medios de respuestas correctas se observaron mejores medidas en el post-test de ambos grupos, en comparación con el pre-test; sin embargo, en el test de retención, los estudiantes del Grupo Intervención obtuvieron mejores resultados que los del Grupo Controle, además de ser estadísticamente significativos (valor p =0,015). Conclusión: se percibió que ambas estrategias de enseñanza produjeron un efecto positivo en el proceso de aprendizaje de los estudiantes. Aunque ambas son importantes y eficaces, la simulación presentó mejor desempeño en la retención de conocimientos. Se espera que este trabajo de investigación permita que los educadores reflexiones acerca de su trabajo y haga posible la utilización de estrategias que mejoren su práctica docente, a fin de beneficiar la educación y el desarrollo de los estudiantes.

RESUMO Objetivo: comparar o efeito da simulação clínica e da aula expositiva dialogada no conhecimento de estudantes de enfermagem sobre o procedimento de irrigação de colostomia. Método: estudo quase experimental, realizado em setembro de 2019 com acadêmicos de enfermagem da Universidade Federal do Rio Grande do Norte, em Natal, Brasil. Utilizaram-se como instrumentos um questionário voltado para questões sociodemográficas e um de análise de conhecimento em três diferentes ocasiões. O grupo controle teve aula expositiva dialogada e o grupo intervenção participou da simulação em laboratório. Para análise de dados foram usados os testes Qui-Quadrado e o de Mann-Whitney. Resultados: observou-se ausência de diferenças estatísticas significantes entre os grupos quanto ao perfil sociodemográfico. Na análise das médias de acertos, observaram-se melhores medidas no pós-teste dos dois grupos, quando comparado ao pré-teste, contudo, no teste de retenção os discentes do grupo intervenção tiveram resultados melhores que o grupo controle e estatisticamente significantes (p-valor=0,015). Conclusão: percebeu-se que as duas estratégias de ensino produziram efeito positivo no processo de aprendizagem dos discentes. Apesar de ambas serem importantes e eficazes, a simulação apresentou melhor desempenho na retenção do conhecimento. Espera-se que a pesquisa possibilite aos educadores a reflexão de seu trabalho e oportunize a utilização de estratégias que aprimorem sua prática docente, com vistas a beneficiar o ensino e desenvolvimento dos estudantes.

Ensino do processo de enfermagem segundo os vídeos do youtube: estudo descritivo-exploratório / Teaching the nursing process according to youtube videos: a descriptive-exploratory study / Enseñanza del proceso de enfermería según videos de youtube: estudio descriptivo-exploratorio

OBJETIVO: Identificar os vídeos do YouTube sobre o Processo de Enfermagem como temática de ensino no contexto nacional. MÉTODO: Estudo descritivo-exploratório, quanti-qualitativo, realizado com vídeos do YouTube em novembro de 2019, no qual identificou-se, principalmente, a data da postagem e total de visualizações, autor, categoria do vídeo, participante e conteúdo. RESULTADOS: Dentre os 23 vídeos da amostra final, foram identificados vídeos no período de 2016 a 2019, com predomínio do ano de 2018 (10; 43,9%), profissionais de enfermagem (17; 65,3%) na qualidade de participante, e definição de Processo de Enfermagem (12, 27,2%) como conteúdo abordado. DISCUSSÃO: A facilidade de acesso, a existência de sites de compartilhamento de vídeos, a importância do Processo de Enfermagem e o desenvolvimento de parcerias entre organizações de ensino e de saúde potencializam a construção de ferramentas audiovisuais. CONCLUSÃO: os vídeos explanam o conceito do Processo de Enfermagem e suas etapas e apresentam o conteúdo mediante uma exposição dialogada.

OBJECTIVE: To identify YouTube videos on the Nursing Process as a teaching theme in the national context. METHOD: A descriptive-exploratory and quanti-qualitative study, carried out with YouTube videos in November 2019, in which the main data identified were posting date and total views, author, video category, participant and content. RESULTS: Among the 23 videos in the final sample, videos were identified in the period from 2016 to 2019, with predominance of the year 2018 (10; 43.9%), nursing professionals (17; 65.3%) as participants, and definition of the Nursing Process (12, 27.2%) as the content addressed. DISCUSSION: Ease of access, existence of video sharing websites, the importance of the Nursing Process, and the development of partnerships between teaching and health organizations enhance the construction of audiovisual tools. CONCLUSION: The videos explain the concept of the Nursing Process and its stages and display the content through dialogical exposition.

OBJETIVO: Identificar los videos de YouTube sobre el Proceso de Enfermería como tema de enseñanza en el contexto nacional. MÉTODO: Estudio descriptivo-exploratorio cuantitativo y cualitativo, realizado con videos de YouTube en noviembre de 2019, en el cual se identificó fecha de publicación y visualizaciones totales, autor, categoría del video, participante y contenido. RESULTADOS: Entre los 23 videos de la muestra final, se identificaron videos en el período de 2016 a 2019, con predominio del año 2018 (10; 43,9%), profesionales de enfermería (17; 65,3%) como participantes, y definición del Proceso de Enfermería (12, 27,2%) como contenido abordado. DISCUSIÓN: La facilidad de acceso, la existencia de sitios para compartir videos, la importancia del Proceso de Enfermería y el desarrollo de alianzas entre organizaciones docentes y de salud potencian la construcción de herramientas audiovisuales. CONCLUSIÓN: los videos explican el concepto del Proceso de Enfermería y sus etapas y presentan el contenido a través de una exposición dialógica.

Outcome indicators of multi-professional diabetes care in a reference service / Indicadores de resultado de la atención multiprofesional en diabe-tes en servicio de referencia / Indicadores de resultado da atenção multiprofissional em diabetes em serviço de referência

ABSTRACT Objective to identify outcome indicators of the multi-professional Diabetes Mellitus care of a reference outpatient service. Method a descriptive study of evaluative nature, according to the health evaluation framework, carried out by documentary analysis of 173 medical charts, from August to October 2018. The variables were analyzed in the Statistical Package for the Social Science (SPSS), version 22.0, by descriptive statistics, as well as the association of variables, with the Chi-square, Mann-Whitney, and Wilcoxon tests being used, considering p-values ≤ 0.05 as statistically significant. Results predominance of older adult women, with a mean diagnosis time of 11.9 years. The tracking of complications due to Diabetes Mellitus occurred in 90.2% of the users, with a prevalence of 68.2%, of which 34.7% were diagnosed in the service. Absenteeism was 21.4%. The systolic and diastolic arterial pressure and total cholesterol parameters were in line with the proposed goals, while glycated hemoglobin (A1c), fasting glycaemia, HDL-c, LDL-c, triglyceride fractions, and BMI did not reach the target range. There was a significant reduction in final A1c, comparing to initial A1c, as well as an increase in the proportions of users who reached the goals in glycemic control. Conclusion a significant improvement in glycemic control, despite the fact that the parameters did not fully meet the goals, ratifying the importance of an effective assistance model for successful care strategies of Diabetes Mellitus.

RESUMEN Objetivo identificar indicadores de resultado de la atención multiprofesional en Diabetes Mellitus en servicio ambulatorio de referencia. Método estudio descriptivo, de carácter evaluativo, según el referencial de evaluación en materia de salud, llevado a cabo mediante análisis documental de 173 fichas, de agosto a octubre de 2018. Las variables fueron analizadas en el Statistical Package for the Social Science (SPSS), versión 22.0, por medio de estadística descriptiva, y de asociación de variables, habiéndose utilizado las pruebas de Chi cuadrado, Mann-Whitney y Wilcoxon, en las cuales se consideró como estadísticamente significativos los valores de p ≤ 0,05. Resultados predominio de mujeres ancianas, con tiempo medio de diagnóstico de 11,9 años. El cribado de complicaciones de la Diabetes Mellitus se produjo en el 90,2% de los usuarios, cuya prevalencia fue del 68,2%, de los cuales el 34,7% fueron diagnosticados en el servicio. El absentismo fue del 21,4%. Los parámetros de presión arterial sistólica y diastólica y colesterol total estuvieron de acuerdo con los objetivos propuestos, mientras que la hemoglobina glucosilada (A1c), glucosa en ayunas, HDL-c, fracciones de LDL-c, triglicéridos e IMC no alcanzaron el rango objetivo. Hubo una reducción significativa en la A1c final, en comparación con la A1c inicial, así como un aumento en la proporción de usuarios que lograron los objetivos de control glucémico. Conclusión mejora significativa del control glicémico, aunque los parámetros no alcancen las metas en su totalidad, hecho que confirma la importancia de contar con un modelo de atención eficaz para garantizar estrategias exitosas en la atención de la Diabetes Mellitus.

RESUMO Objetivo identificar indicadores de resultado da atenção multiprofissional em Diabetes Mellitus de serviço ambulatorial de referência. Método estudo descritivo, de caráter avaliativo, segundo referencial de avaliação em saúde, conduzido pela análise documental de 173 prontuários, de agosto a outubro de 2018. As variáveis foram analisadas no Statistical Package for the Social Science (SPSS), versão 22.0, pela estatística descritiva, bem como associação de variáveis, tendo sido utilizados os testes de qui-quadrado, Mann-Whitney e Wilcoxon, sendo considerados estatisticamente significativos os valores de p ≤ 0,05. Resultados predomínio de mulheres idosas, com tempo médio de diagnóstico de 11,9 anos. O rastreamento de complicações do Diabetes Mellitus ocorreu em 90,2% dos usuários, cuja prevalência foi de 68,2%, das quais 34,7% foram diagnosticadas no serviço. O absenteísmo foi de 21,4%. Os parâmetros de pressão arterial sistólica e diastólica e colesterol total estiveram em conformidade com as metas propostas, ao passo que hemoglobina glicada (A1c), glicemia de jejum, frações HDL-c, LDL-c, triglicerídeos e IMC não atingiram a faixa-alvo. Houve redução significativa da A1c final, em comparação com a A1c inicial, bem como aumento da proporção de usuários que alcançaram as metas de controle glicêmico. Conclusão melhora significativa do controle glicêmico, a despeito de os parâmetros não atingirem as metas em totalidade, ratificando a importância de modelo de assistência efetivo para estratégias exitosas de atenção ao Diabetes Mellitus.

Concordância interobservadores em um checklist de cuidados em terapia nutricional enteral / Concordancia interobservadores en una checklist de cuidados en terapia nutricional enteral / Interobserver agreement in a checklist of care in enteral nutrition therapy

Resumo Objetivo Avaliar a concordância interobservadores na aplicação um checklist de cuidados em Terapia Nutricional Enteral (TNE). Métodos Estudo de confiabilidade que precedeu um ensaio clínico (NCT03497221), realizado em hospital universitário do sul do Brasil (junho e julho de 2017). Checklist de 25 itens relacionado aos cuidados em TNE foi realizado por uma enfermeira (Padrão de Referência) e por nove Assistentes de Pesquisa (AP). As avaliações foram feitas concomitantemente e de modo independente. A concordância foi testada utilizando-se o Statistical Package for the Social Sciences versão 21.0. Valores de Kappa (k) foram considerados como concordância entre: pobre (0 a 0,19); relativa (0,20 a 0,39); moderada (0,40 a 0,59); substancial (0,60 e 0,79); quase perfeita (0,80 a 0,99); e perfeita (1). O estudo foi aprovado pelo Comitê de Ética da Instituição (nº 16-0534). Resultados Foram realizadas 351 observações em duplicata, sendo o menor número de observações foi com a AP 5 (n=35) e o maior com a AP 8 (n=45). Foram avaliados itens relacionados a TNE em três blocos: identificação dos frascos de infusões e bomba de infusão; materiais de apoio para administração da terapia; e cuidados ao paciente em uso de TNE. Houve concordância quase perfeita ou perfeita em todos os pares de observação, com o menor Kappa para AP 6 (k=0,890; IC95%=0.86, 0.92) e o maior para AP 3 (k=0,965; IC95%=0.93, 0.99). Conclusão A concordância interobservadores ao aplicar um checklist contendo 25 itens foi excelente, o que minimiza a ocorrência de viés de aferição nas etapas subsequentes.

Resumen Objetivo Evaluar la concordancia interobservadores en la aplicación de una checklist de cuidados en terapia nutricional enteral (TNE). Métodos Estudio de fiabilidad que precedió un ensayo clínico (NCT03497221), realizado en un hospital universitario de la región Sur de Brasil (junio y julio de 2017). Una checklist de 25 ítems relacionados con los cuidados en TNE fue realizada por una enfermera (Estándar de Referencia) y por nueve Asistentes de Investigación (AI). Las evaluaciones fueron llevadas a cabo simultánea e independientemente. La concordancia se comprobó utilizando el Statistical Package for the Social Sciences versión 21.0. Los valores de Kappa (k) se consideraron como concordancia entre: pobre (0 a 0,19); relativa (0,20 a 0,39); moderada (0,40 a 0,59); considerable (0,60 a 0,79); casi perfecta (0,80 a 0,99); y perfecta (1). El estudio fue aprobado por el Comité de Ética de la institución (n.° 16-0534). Resultados Se realizaron 351 observaciones duplicadas, de las cuales el menor número de observaciones fue de la AI 5 (n=35) y el mayor de la AI 8 (n=45). Se evaluaron ítems relacionados con la TNE en tres grupos: identificación de los frascos de infusiones y bomba de infusión, material de apoyo para la administración de la terapia y cuidados del paciente en uso de TNE. Se observó concordancia casi perfecta o perfecta en todos los pares de observación, con el menor Kappa de la AI 6 (k=0,890; IC95 %=0.86, 0.92) y el mayor de la AI 3 (k=0,965; IC95 %=0.93, 0.99). Conclusión La concordancia interobservadores al aplicar una checklist de 25 ítems fue excelente, lo que minimiza la ocurrencia de sesgo de medición en las etapas subsiguientes.

Abstract Objective To assess interobserver agreement in the application of a checklist of care in enteral nutritional therapy (ENT). Methods This is a reliability study that preceded a clinical trial (NCT03497221), carried out at a university hospital in southern Brazil (June and July 2017). A checklist of 25 items related to care in ENT was performed by a nurse (reference standard) and nine research assistants (RA). Assessments were carried out concurrently and independently. Agreement was tested using the Statistical Package for the Social Sciences, version 21.0. Kappa values (k) were considered as poor (0 to 0.19), relative (0.20 to 0.39), moderate (0.40 to 0.59), substantial (0.60 and 0.79), almost perfect (0.80 to 0.99), and perfect (1). The study was approved by an Institutional Review Board (number 16-0534). Results Three hundred fifty-one observations were made in duplicate; the lowest number of observations was with RA, 5 (n = 35) and the highest with RA, 8 (n = 45). Items related to ENT were assessed in three blocks: identification of infusion bottles and infusion pump; support materials for administering the therapy; care for patients using ENT. There was almost perfect or perfect agreement in all observation pairs, with lowest Kappa for RA 6 (k = 0.890; 95% CI = 0.86, 0.92) and the highest for RA 3 (k = 0.965; 95% CI = 0.93, 0.99). Conclusion Interobserver agreement, when applying a checklist containing 25 items, was excellent, which minimizes the occurrence of measurement bias in subsequent steps.

Patient safety culture in the maternal-child area of a university hospital / Cultura de seguridad del paciente en el área materno-infantil de un hospital universitario / Cultura de segurança do paciente na área materno-infantil de hospital universitário

ABSTRACT Objective: To describe the safety culture of the patient from the perspective of nurses and physicians working in the maternal-child area. Method: A cross-sectional study conducted from January to September 2018 with 41 professionals of the Obstetrics Center and obstetric hospitalization of a university hospital in the south of the country. The Hospital Survey on Patient Safety Culture was used, with 12 dimensions of the safety culture, measured by means of a general score (0 to 10) and of positive answer percentages to assess strengths and weaknesses. Results: The action of supervisors/bosses can be considered a strength of patient safety, with 78.2% of positive answers; already regarding communication, it was considered a fragility, punctuating 13.24%. The general safety grade of the patient assigned to the work's unit was very good, in a confidence interval of 95%. Conclusion: With the identification of the strengths and weaknesses of patient safety, it is possible to plan improvement actions. We emphasize that the non-punitive approach is essential.

RESUMEN Objetivo: Describir la cultura de seguridad del paciente en la perspectiva de enfermeros y médicos actuantes en el área materno-infantil. Método: Estudio transversal realizado de enero a septiembre de 2018 con 41 profesionales del Centro de Obstetricia y del área de internación obstétrica de un hospital universitario del sur del país. Se utilizó la Hospital Survey on Patient Safety Culture (Encuesta hospitalaria sobre la cultura de la seguridad), con 12 dimensiones de la cultura de seguridad, medidas por medio de un puntaje general (0 a 10) y de porcentajes de respuestas positivas para evaluar fortalezas y debilidades. Resultados: La acción de supervisores/jefes puede ser considerada una fortaleza de la seguridad del paciente, con el 78,2% de respuestas positivas; en lo referente a la comunicación, se la consideró una debilidad, con el 13,24%. La nota general de seguridad del paciente asignada a la unidad de trabajo fue muy buena, en un intervalo de confianza del 95%. Conclusión: Al identificar las fortalezas y debilidades en la seguridad del paciente es posible planificar acciones de mejora. Destacamos que el enfoque no punitivo es esencial.

RESUMO Objetivo: Avaliar a cultura de segurança do paciente na perspectiva de enfermeiros e médicos atuantes na área materno-infantil. Método: Estudo transversal, realizado de janeiro a setembro de 2018, com 41 profissionais do Centro Obstétrico e internação obstétrica de hospital universitário do sul do país, utilizando o Hospital Survey on Patient Safety Culture, com 12 dimensões da cultura de segurança, mensuradas por meio de um escore geral (0 a 10) e percentuais de respostas positivas para aferir fortalezas e fragilidades. Resultados: A ação de supervisores/chefes foi considerada uma fortaleza, tendo 78,2% de respostas positivas; já no que diz respeito à comunicação, considerou-se uma fragilidade, pontuando 13,2%. A nota geral de segurança do paciente foi de muito boa, nota 4, num intervalo de confiança de 95%. Conclusão: Com a identificação das fortalezas e fragilidades da segurança do paciente é possível planejar ações de melhoria. Destacamos que a abordagem não punitiva é essencial.

Validation of educational material for the care of people with intestinal stoma / Validação de material educativo para o cuidado da pessoa com estomia intestinal / Validación de material educativo para el cuidado de la persona con ostomía intestinal

Abstract Objective: to validate an educational booklet for people with intestinal stoma as a technological resource in the teaching of self-care. Method: a methodological research for the construction and validation of an educational booklet by nine expert judges and 25 people with stomas. The agreement index of at least 80% was considered to guarantee the validation of the material. Results: regarding the objectives of the booklet, all the judges evaluated the items as "adequate" or "totally adequate", with a content validity index of 1.00. Regarding the structure and presentation of the booklet, the total index was 0.84. Regarding relevance, the total was 0.97 and the general index of the educational booklet was 0.89, confirming the validation with the judges. All items of the organization, writing style, appearance and motivation of the material were considered as validated by the target audience, reaching a total agreement index of 0.99. Conclusion: in the context of health education, the booklet was considered valid and suitable for the care of people with intestinal stoma, and can be used in teaching, research, extension and care for people with intestinal stoma.

Resumo Objetivo: validar uma cartilha educativa para pessoas com estomias intestinais como recurso tecnológico no ensino do autocuidado. Método: pesquisa metodológica para a construção e validação de cartilha educativa por nove juízes especialistas e 25 pessoas com estomias. Foi considerado o índice de concordância de, no mínimo, 80% para se garantir a validação do material. Resultados: quanto aos objetivos da cartilha, todos os juízes avaliaram os itens como "adequado" ou "totalmente adequado", com índice de validade de conteúdo de 1,00. Com relação à estrutura e apresentação da cartilha, o índice total foi de 0,84. No quesito relevância, o total foi de 0,97 e o índice geral da cartilha educativa foi de 0,89, confirmando a validação junto aos juízes. Todos os itens da organização, estilo da escrita, aparência e motivação do material foram considerados validados pelo público-alvo, atingindo índice de concordância total de 0,99. Conclusão: no contexto da educação em saúde, a cartilha foi considerada válida e adequada para o cuidado das pessoas com estomias intestinais, podendo ser utilizada em ambientes de ensino, pesquisa, extensão e no cuidado à pessoa com estomia intestinal.

Resumo Objetivo: validar una guía educativa para personas con ostomías intestinales, como recurso tecnológico en la enseñanza del autocuidado. Método: investigación metodológica para la construcción y validación de una guía educativa por nueve jueces especialistas y 25 personas con ostomías. Se consideró el índice de concordancia mínimo de 80% para garantizar la validación del material. Resultados: en cuanto a los objetivos de la guía, todos los jueces evaluaron los ítems como "adecuado" o "totalmente adecuado" con índice de validación de contenido de 1,00. En relación a la estructura y presentación de la guía, el índice fue de 0,84. En el punto atinente a la relevancia, el total fue de 0,97 y el índice general de la guía educativa fue de 0,89, confirmándose la validación junto a los jueces. Todos los ítems de la organización, estilo de escritura, apariencia y motivación del material fueron validados por el público destinatario, alcanzándose el índice de concordancia total de 0,99. Conclusión: En el contexto de educación en salud, la guía se consideró válida y adecuada para el cuidado de personas con ostomías intestinales, apta para ser utilizada en el ámbito educativo, investigaciones, extensión y en el cuidado a la persona con ostomía intestinal.

Risks of enteral nutritional therapy: a clinical simulation / Riesgos de la terapia nutricional enteral: una simulación clínica / Riscos da terapia nutricional enteral: uma simulação clínica

Abstract Objective: Knowing the perceptions of nursing technicians about the risks to the patient in the use of enteral nutritional therapy, in a scenario of clinical simulation. Method: A qualitative study, performed through a clinical simulation with nursing technicians from a university hospital in the South of Brazil, in August 2017. The simulation sessions were recorded in audio and later transcribed. Content analysis was used for data analysis. Results: Four thematic categories resulted from the analysis: Risks related to the tube; Risks related to diet; Risks related to contamination and Risks related to routine. Conclusion: The clinical simulation allowed nursing technicians to identify risks in the practice of enteral nutritional therapy and ways to minimize them. Promoting spaces for continuing education in the service, using clinical simulation methodology, gives an opportunity for critical reflection, which can contribute to safer, effective and quality nursing care.

Resumen Objetivo: Conocer la percepción de los técnicos de enfermería sobre los riesgos para el paciente al emplear la terapia nutricional enteral, en un escenario de simulación clínica. Método: Estudio cualitativo, realizado a través de una simulación clínica con técnicos de enfermería de un hospital universitario en el sur de Brasil, en agosto de 2017. Las sesiones de simulación se grabaron en audio y luego fueron transcriptas. Para el análisis de los datos, se utilizó el análisis de contenido. Resultados: El resultado del análisis fueron cuatro categorías temáticas: Riesgos relacionados con la sonda; Riesgos relacionados con la dieta; Riesgos relacionados con la contaminación y Riesgos relacionados con la rutina. Conclusión: La simulación clínica permitió que los técnicos de enfermería identificasen riesgos en la práctica de administración de terapia nutricional enteral y diversas formas de minimizarlos. Promover espacios para la educación permanente en el servicio por medio de la metodología de simulación clínica brinda oportunidades de reflexión crítica, lo que puede contribuir a cuidados de enfermería más seguros, efectivos y de calidad.

Resumo Objetivo: Conhecer a percepção dos técnicos de enfermagem sobre os riscos ao paciente em uso de terapia nutricional enteral, durante um cenário de simulação clínica. Método: Estudo qualitativo, utilizou a simulação clínica com técnicos de enfermagem de um hospital universitário do Sul do Brasil, em agosto de 2017. As sessões foram gravadas em áudio e, posteriormente, transcritas. Para a análise dos dados utilizou-se a análise de conteúdo. Resultados: A análise resultou em quatro categorias: Riscos relacionados com a sonda; Riscos relacionados com a dieta; Riscos relacionados à contaminação e Riscos relacionados à rotina de cuidados. Conclusão: A simulação clínica permitiu que os técnicos de enfermagem identificassem riscos na prática de administração de terapia nutricional enteral e meios de minimizá-los. Promover espaços para a educação permanente no serviço, utilizando metodologia de simulação clínica, oportuniza a reflexão crítica, o que pode contribuir para cuidados de enfermagem mais seguros, efetivos e de qualidade.