Recommendations on specific precautions for companions/ visitors of patients hospitalized: characteristics and barriers to implementation / Recomendações sobre precauções específicas para acompanhantes/visitantes de pacientes hospitalizados: características e barreiras para implementação / Recomendaciones sobre precauciones específicas para acompanhantes/visitantes de pacientes hospitalizados: características y barreras para su implementación

Justification and Objectives: despite the importance of companions/visitors for hospitalized patients under specific precautions, it is noted that risks of exposure and dissemination of microorganisms in health services by this population are still incipient in the literature. Thus, the objective was to characterize the current recommendations on specific precautions for companions and visitors of hospitalized patients and to analyze the barriers to their implementation from infection preventionists' perspective. Methods: a descriptive and exploratory study with a quantitative approach, with 89 infection preventionists, between March and June 2020. Data collected by electronic questionnaire, "snowball" sampling and analyzed according to frequency of responses. Results: hand hygiene was the most recommended recommendation (>95.0%). As for non-conformities, staying in the room without attire (78.6%), going to other rooms (53.9%) and keeping doors open as aerosol precaution (51.7%) stood out. Regarding the strategies adopted to guide companions/visitors, there was a predominance of individual verbal guidance (92.4%). The main barrier cited was the lack of institutional policy (56.2%). Conclusion: there was no uniformity in the recommendations, and non-conformities and barriers were listed. The importance of specific prevention guidelines for this public and effective educational strategies for its implementation are highlighted.(AU)

Justificativa e Objetivos: apesar da importância dos acompanhantes/visitantes para pacientes hospitalizados em precauções específicas, nota-se que os riscos de exposição e disseminação de microrganismos nos serviços de saúde por essa população ainda são incipientes na literatura. Dessa forma, objetivou-se caracterizar as recomendações vigentes sobre precauções específicas para acompanhantes e visitantes de pacientes hospitalizados e analisar as barreiras para a sua implementação sob a ótica de prevencionistas de infecção. Métodos: estudo descritivo e exploratório, de abordagem quantitativa, com 89 prevencionistas de infecção, entre março e junho de 2020. Dados coletados por questionário eletrônico, com amostragem tipo "bola de neve" e analisados segundo frequência das respostas. Resultados: a higienização das mãos foi a recomendação mais indicada (>95,0%). Quanto às não conformidades, destacou-se permanecer no quarto sem paramentação (78,6%), frequentar outros quartos (53,9%) e manter portas abertas em precaução para aerossóis (51,7%). Referente às estratégias adotadas para a orientar os acompanhantes/visitantes, houve predomínio da orientação verbal individual (92,4%). A principal barreira citada foi a falta de política institucional (56,2%). Conclusão: não houve uniformidade nas recomendações, e não conformidades e barreiras foram elencadas. Destaca-se a importância de diretrizes de prevenção específicas para esse público e estratégias educativas efetivas para sua implementação.(AU)

Justificación y Objetivos: a pesar de la importancia de los acompañantes/visitantes para pacientes hospitalizados bajo precauciones específicas, se advierte que los riesgos de exposición y diseminación de microorganismos en los servicios de salud por parte de esta población son aún incipientes en la literatura. Así, el objetivo fue caracterizar las recomendaciones vigentes sobre precauciones específicas para acompañantes y visitantes de pacientes hospitalizados y analizar las barreras para su implementación desde la perspectiva de los preventivos de infecciones. Métodos: estudio descriptivo y exploratorio con enfoque cuantitativo, con 89 prevencionistas de infecciones, entre marzo y junio de 2020. Datos recolectados por cuestionario electrónico, muestreo "bola de nieve" y analizados según frecuencia de respuestas. Resultados: la higiene de manos fue la recomendación más recomendada (>95,0%). En cuanto a las no conformidades, se destacó permanecer en la habitación sin atuendo (78,6%), ir a otras habitaciones (53,9%) y mantener las puertas abiertas como precaución contra los aerosoles (51,7%). En cuanto a las estrategias adoptadas para orientar a los acompañantes/visitantes, hubo predominio de la orientación verbal individual (92,4%). La principal barrera citada fue la falta de política institucional (56,2%). Conclusión: no hubo uniformidad en las recomendaciones, y se enumeraron las no conformidades y las barreras. Se destaca la importancia de pautas de prevención específicas para este público y estrategias educativas efectivas para su implementación.(AU)

La enseñanza clínica: el caso de la recorrida de sala / Clinical instruction: the case of the bedside rounds

Posiblemente la enseñanza al lado de la cama del paciente sea tan antigua como la medicina misma. Grandes maestros de la medicina como F. Silvio o Sir W. Osler abogaron por un uso intenso de la misma destacando sus virtudes. En la era moderna se le reconoce a la enseñanza en las recorridas múltiples aspectos que no pueden ser enseñados en el aula, como el aprendizaje de las habilidades de la comunicación, de la exploración física, la enseñanza de los aspectos humanísticos, etc., pero también múltiples barreras que dificultan una exitosa implementación. En este artículo se detallan las barreras que con mayor frecuencia impiden que el docente promueva un aprendizaje significativo y profundo, y una serie propuestas prácticas que favorecen su adecuada implementación

One-day quantitative cross-sectional study of family information time in 90 intensive care units in France.

RATIONALE: Providing family members with clear, honest, and timely information is a major task for intensive care unit physicians. Time spent informing families has been associated with effectiveness of information but has not been measured in specifically designed studies. OBJECTIVES: To measure time spent informing families of intensive care unit patients. METHODS: One-day cross-sectional study in 90 intensive care units in France. MEASUREMENTS: Clocked time spent by physicians informing the families of each of 951 patients hospitalized in the intensive care unit during a 24-hr period. MAIN RESULTS: Median family information time was 16 (interquartile range, 8-30) mins per patient, with 20% of the time spent explaining the diagnosis, 20% on explaining treatments, and 60% on explaining the prognosis. One third of the time was spent listening to family members. Multivariable analysis identified one factor associated with less information time (room with more than one bed) and seven factors associated with more information time, including five patient-related factors (surgery on the study day, higher Logistic Organ Dysfunction score, coma, mechanical ventilation, and worsening clinical status) and two family-related factors (first contact with family and interview with the spouse). Median information time was 20 (interquartile range, 10-39) mins when three factors were present and 106.5 (interquartile range, 103-110) mins when five were present. CONCLUSION: This study identifies factors associated with information time provided by critical care physicians to family members of critically ill patients. Whether information time correlates with communication difficulties or communication skills needs to be evaluated. Information time provided by residents and nurses should be studied.

Guaranteed returns: investing in conversations with families of patients with cancer.

Cancer can be considered a "family affair" because a cancer diagnosis affects patients and their families. A patient's family is comprised of the individuals that the patient identifies as family and may include people not biologically related to the patient. Although nurses play a key role in communicating with patients and their families, many lack confidence in their ability to provide emotional support. In addition, many educational resources are available to address the hands-on care of patients with cancer, but few are available to educate nurses about specific interventions that can be used in conversations with families. This article reviews practical suggestions to guide these conversations and provides examples of questions to ask to facilitate communication.

Alcances de las visitas domiciliarias efectuada en la zona de Tupac Amarú, independencia por los estudiantes de la Universidad Peruana Cayetano Heredia / Domiciliary visit achievements effected in Tupac Amaru, independencia by the students of Cayetano Heredia Peruvian University

Se muestran alcances de visitas domiciliarias efectuadas en Túpac Amaru, por estudiantes de la Universidad Peruana Cayetano Heredia durante mayo de 1990, basados en hojas censales y hojas de visitas domiciliarias de 433 familias.Se efectuaron 63 visitas (12 por ciento de las familias). 81 por ciento fueron efectivas: en el cerro 94.7 por ciento, en el plano 60 por ciento. Se visitó al 85 por ciento de gestantes y 28.9 por ciento de niños menores de un año.Asentamientos Humanos con menos de 4 años de antiguedad y familias que viven a menos de 1000 metros del centro de salud fueron mas visitados. 76.1 por ciento de visitas tuvo un solo motivo registrado, mayormente seguimiento de pacientes.El cumplimiento del llenado de datos censales fue 69.8 por ciento.Se incluye que las visitas domiciliarias fueron altamente efectivas; más frecuentemente en zonas de cerro, menos antiguas y mas cercanas.Gestantes y niños menores de un año fueron los grupos mas visitados.La mayoria de visitas tuvo un motivo registrado: seguimiento de pacientes.Utilizar formularios para registrar la visita brinda buena información del trabajo efectuado