Protocolo de admisión del paciente diabetico. Un enfoque desde los factores básicos condicionantes y la agencia de autocuidado / Diabetic patient admission protocol. An approach from the basic conditioning factors and the self-care agency

El Consejo Internacional de Enfermeras (CIE) define a la Enfermería como los cuidados, autónomos y en colaboración, que se prestan a las personas de todas las edades, familias, grupos y comunidades, enfermos o sanos, en todos los contextos. Incluye la promoción de la salud, la prevención de la enfermedad y los cuidados de los enfermos, discapacitados y personas moribundas. A su vez Berbiglia y Banfield citan a Orem, ésta plantea que la práctica de la Enfermería en relación con los individuos se institucionaliza alrededor del proceso de una persona, la/el enfermera/o, que proporciona ayuda directa a otra persona, cuando ésta persona es total o parcialmente incapaz de ayudarse a sí misma en el cumplimiento de los cuidados diarios relacionados con la salud, a causa de la situación de salud existente. La misma autora define al estado de salud que indica la necesidad de asistencia enfermera como "la incapacidad de las personas de proporcionarse por sí mismas y continuamente el autocuidado (AC) de calidad y cantidad necesarios según las situaciones de la salud personal". Expresa también que los factores básicos condicionantes son "los factores internos o externos a los individuos que afectan sus habilidades para involucrarse en el autocuidado o afectan el tipo y cantidad de autocuidado requeridos". El objetivo, Sistematizar y acordar las intervenciones y cuidados de enfermería en la admisión del paciente con diabetes, con un enfoque desde los factores básicos condicionantes del autocuidado y la capacidad de la agencia de Autocuidado, que ingresan al servicio de urgencias de adultos, de un Hospital público, 2020. En este sentido el profesional de Enfermería cumple un rol fundamental dentro del equipo de salud para identificar el déficit de autocuidado y promover, gestionar e impulsar diversas estrategias para la promoción de la salud, la prevención de la enfermedad y su tratamiento[AU]

O Conselho Internacional de Enfermeiras (ICN) define Enfermagem como cuidado autônomo e colaborativo, prestado a pessoas de todas as idades, famílias, grupos e comunidades, doentes ou saudáveis, em todos os contextos. Inclui a promoção da saúde, a prevenção de doenças e o atendimento de doentes, deficientes e moribundos. Berbiglia e Banfield, por sua vez, citam Orem, que afirma que a prática de enfermagem em relação aos indivíduos é institucionalizada em torno do processo de uma pessoa, a enfermeira, que fornece ajuda direta a outra pessoa, quando essa pessoa é total ou parcialmente incapaz de ajudar a si mesma na realização dos cuidados diários relacionados à saúde, devido à situação de saúde existente. O mesmo autor define o estado de saúde que indica a necessidade de assistência de enfermagem como "a incapacidade das pessoas de proverem a si mesmas e continuamente o autocuidado (CA) de qualidade e quantidade necessárias de acordo com as situações de saúde pessoal". Também expressa que os fatores condicionantes básicos são "fatores internos ou externos aos indivíduos que afetam suas habilidades para se envolver em autocuidado ou afetam o tipo e a quantidade de autocuidado necessária". O objetivo sistematizar e acordar intervenções e cuidados de enfermagem na admissão do paciente com diabetes, com foco nos fatores condicionantes básicos do autocuidado e na capacidade da agência de Autocuidado, que entra no pronto-socorro de adultos, de um hospital público, 2020. Nesse sentido, o profissional de enfermagem desempenha papel fundamental dentro da equipe de saúde para identificar o déficit de autocuidado e promover, gerenciar e promover diversas estratégias de promoção da saúde, prevenção e tratamento de doenças[AU]

The International Nurses Council (INC ­ 2015) defines Nursery as the independent and accompanied care given to people of all ages, ethnicity, gender, rather family, group and communities, ill or heathy in all sort of contexts. Including Heath`s promotion, sickness prevention and different cares of patients, disable and dying people. In turn, Berbiglia and Banfield cite Orem, which states that the practice Nursing practice as the relationship individuals, which is institutionalized around the process of one person the Nurse, the one who helps directly to the other person, when this one is not fully or partially capable on their own means to help themselves to take charge of their daily health care, caused by the actual health situation remaining. The same author defines the state of health that indicates the Nurses assistance as "The non-capacity of people to assure by themselves the continued self-care, nor in quality and quantity necessary according to the situation of personal health". On the other hand, the author, also states that the basic conditioning factors are "internal or external factors handled by individuals who affect their abilities to engage in self-care or affect the type and amount of self-care required ". The objective is to systematize and agree on interventions and nursing care in the admission of the patient with diabetes, with an approach from the basic conditioning factors of self-care and the capacity of the Self-care agency, who enter the emergency department of adults, of a public hospital, 2020 In this sense, the nursing professional plays a fundamental role within the health team to identify the deficit of self-care and promote, manage and promote various strategies for health promotion, disease prevention and treatment[AU]

Development of a subset of ICNP Nursing Diagnoses for the promotion of self-care in people with diabetes mellitus: a multi-center observational study.

INTRODUCTION: Self-care is a key for people with diabetes mellitus (DM) to avoid severe complications and to maintain quality of life. Person-centered and accurate nursing care plans can help nurses to deliver effective self-care promotion interventions. Few studies focused on nursing diagnoses that are specific for diabetes self-care education, and none of them used the International Classification for Nursing Practice (ICNP). International Catalogues of ICNP nursing diagnoses are missing in this field. AIMS: To identify the ICNP nursing diagnoses that are useful to promote self-care in people with DM; to describe the prevalence of ICNP nursing diagnoses in self-care of people with DM. METHODS: A subset of 55 ICNP nursing diagnoses was developed based on the Middle Range Theory of Self-care of Chronic Illness, and most recent diabetes clinical guidelines. Then, the subset was tested through a multicenter cross-sectional design involving a consecutive sample of 170 adults with confirmed diagnosis of Type 1 or Type 2 DM. Data were collected by medical records, physical examinations and semi-structured interviews. RESULTS: 1343 nursing diagnoses were identified, with an average of 8 nursing diagnoses per patient. The 100% of the nursing diagnoses were described using the pre-developed subset. Overall, the five prevalent nursing diagnoses were: Body weight problem (56.4%), Non adherence to immunization regime (53.5%), Conflicting attitude toward dietary regime (41.7%), Impaired weight monitoring (39.4%), and Lack of knowledge about blood glucose diagnostic test result (32.3%). Nursing diagnoses by self-care maintenance, monitoring and management were also described. CONCLUSIONS: A huge amount of nursing diagnoses was identified suggesting the need of intensive education. Clinicians and administrators can use this subset to improve the accuracy of the documentation of diabetes care. In Public Health, the subset can be used to assess the cost-effectiveness of diabetes healthcare services. Future research is needed to assess the effectiveness of this subset in settings that are different from the one where it was developed. Finally, this subset could be a starting point to develop and International ICNP Catalogue for diabetes care.

Meeting the challenges posed by an escalating diabetes healthcare burden: A mixed methods study.

Background: The ongoing escalation in the incidence of diabetes is contributing to a growing burden on health services because patients with diabetes as a co-morbidity are now spread throughout the hospital (rather than being located in specific areas). Thus, there is a need for expertise in diabetes care throughout services to ensure optimal care and reduce threats to patient safety.Aims and objectives: To identify new strategies to maintain optimal care for patients with diabetes while in hospital.Design: Mixed methods underpinned by Appreciative Inquiry.Methods: The Diabetes Knowledge Questionnaire Survey (DKQS) (n = 173); focus group interviews with nurses and midwives (n = 40), and individual interviews with recently discharged hospital patients (n = 6). Quantitative data were analysed using descriptive statistics and qualitative data by thematic analysis.Results: Highlight a need to enhance knowledge and confidence of diabetes management among nursing, midwifery, medical and ancillary staff through the introduction of focused education strategies. This, together with improved communication and team work, is required to relieve the burdens on frontline nursing staff and patients caused by delays in prescribing and reviewing insulin requirements and in accessing needed food for people with diabetes.Conclusions: In seeking solutions to the challenges in caring for hospitalised patients with diabetes there is a need to work across the entire hospital workforce and to develop effective and efficient methods for ensuring appropriate skills and knowledge of diabetes management for staff across complex and rapidly changing hospital systems.Relevance to clinical practice: The introduction and implementation of innovative educational and organisational strategies are needed to assist in meeting the challenges posed by an escalating diabetes healthcare burden. The safety of patients with diabetes can be optimised with the timely availability of appropriate meals and snacks, and enhanced coordination and communication between and within multidisciplinary teams.

The clinical effectiveness of nursing models of diabetes care: A synthesis of the evidence.

OBJECTIVES: To determine the clinical effectiveness (glycemic control, other biological measures, cost-effectiveness and patient satisfaction) of primary care nurse-led interventions for diabetes. DESIGN: A systematic review following methods described for complex interventions and using PRISMA guidelines for reporting was undertaken. Nurse-led care for diabetes can be regarded as a complex intervention requiring the measurement of more than one outcome and for this reason we chose a range of outcomes clinical (symptoms), patient-centred (experiences) and organisational (cost-effectiveness). DATA SOURCES: An extensive literature search using MEDLINE (PubMed) EMBASE, and CINAHL was conducted. REVIEW METHODS: Primary studies with adults in primary care with both quantitative (comparison with physician-led care and cost-effectiveness) and qualitative (patient experiences of nurse-led care) methodologies from 2003 until June 2018. All studies were appraised using the Cochrane Collaboration's tool for assessing risk of bias. The appraisal involved evaluation of the degree of risk of bias in selection, performance, detection, attrition and reporting. Because of the complexity of multiple outcomes (quantitative and qualitative) a narrative synthesis was undertaken. RESULTS: The search generated 18 published studies that met our eligibility criteria. Three randomized controlled trials and one historical control trial found statistically significant differences in glycemic levels in favour of the nurse-led interventions. Two cluster randomized trials, two randomized pragmatic trials and two randomized controlled trials found no differences between groups. The three open-label studies found statistically significant improvements in HbA1c levels. The audit identified that more patients had lower HbA1c levels after the initiation of a nurse-led intervention. Three randomized controlled trials found significant improvements in biological outcomes and one did not. The four studies measuring cost-effectiveness found the nurse-led intervention was associated with less costs. Four studies examined patient satisfaction with nurse-led care and found this was very good. CONCLUSION: This review which incorporated a broad range of studies to capture the complexity of nurse-led interventions has identified that there is evolving evidence that nurse-led interventions for community treatment of diabetes may be more clinically effective than usual physician-led care.

Demographic and spatial trends in diabetes-related virtual nursing examinations.

Diabetes currently affects nearly 30 million Americans, but the distribution of cases is not uniform across all demographics or every state. In the course of their education, nurses learn how to become important conduits for information on diabetes management during their eventual interactions with patients. Exploring the status and trends of diabetes-related knowledge in nursing students is one method to explore the idea that one's community affects how one sees disease. However, they are not yet experts, which places them in a period of transition. This study used data mined from the Shadow Health Digital Clinical Experience™ virtual patient exams conducted by nursing students between the years of 2012 and 2015 to find any potential demographic or spatial trends within simulation performance results from nursing students who examined a virtual patient with self-managed diabetes. Findings of the analysis indicated that age and experience affected the way in which an examination was conducted, where older and more experienced nursing students asked 8% fewer examination questions, yet showed 32% more empathy and offered 76% more educational statements than their younger counterparts. Spatial trends were less pronounced, although deeper analysis revealed that students in states closer to the national mean for population rate with diabetes perform better, show more empathy, and offer more educational statements during examinations compared to states well above or well below the national mean. This suggests that targeted information may be preferable to "one-size-fits-all" public health awareness and education programs for diabetes programs used uniformly across the country.

Estratégia Saúde da Família e pessoas com hipertensão e diabetes: redes sociais e longitudinalidade / Family Health Care and peaple with hypertension and diabetes: social networks and longitudinally

Este estudo possui como objeto "as relações entre os profissionais da Estratégia de Saúde da Família (ESF) e sua influência na assistência às linhas de cuidado de hipertensão e diabetes, na perspectiva do cuidado e da longitudinalidade, segundo a ótica da Análise de Redes Sociais". Objetivos: Analisar como se configuram as relações entre os profissionais da ESF quanto à assistência aos usuários com hipertensão e diabetes, segundo a ótica da Análise de Redes Sociais; identificar qual a influência destas relações e posições na perspectiva do cuidado e da longitudinalidade. Metodologia: Estudo descritivo, com abordagem qualitativa e quantitativa, possuindo como participantes da pesquisa profissionais da equipe de ESF (enfermeiros, médicos, técnicos de enfermagem, agentes comunitários de saúde e auxiliares administrativos), tendo como cenário duas Unidades de Saúde da Família (USF) de um município de grande porte localizado na região do Médio Paraíba no Sul, no estado do Rio de Janeiro. As unidades foram codificadas como U1 e U2. Para a coleta dos dados, foi utilizada entrevista semiestruturada mediante roteiro, permitindo respostas em narrativa. Foram entrevistados 12 profissionais da U1 e 09 profissionais da U2, totalizando 21 sujeitos entrevistados. Os dados foram analisados, para o segmento quantitativo, mediante Análise de Redes Sociais (ARS), o qual permite gerar medidas de centralidades dos atores e construção do sociograma, utilizando-se para isto, os softwares Ucinet e Netdraw; para o segmento qualitativo, foi utilizada a Análise de Conteúdo Temático-categorial. Resultados: A conformação das redes sociais estudadas, interferem diretamente nos resultados da análise destas. Os conceitos de Pierre Bourdieu quanto aos capitais e habitus foram claramente identificados nas redes no campo da atenção básica das USF estudadas. As relações e posições nas redes pesquisadas parecem interferir positivamente quanto à gestão da equipe, no processo de trabalho desta, e nas tentativas quanto à continuidade do cuidado ao usuário com hipertensão e diabetes. Foi visualizada a dificuldade quanto ao cuidado integral ao usuário ao longo da vida, bem quanto ao estabelecimento de vínculo entre profissionais e usuários. O profissional mais citado e com maior valor central em ambas redes foram as médicas das duas equipes; este fato, atrelado a outros que foram discutidos ao longo do estudo, influencia negativamente no cuidado e longitudinalidade à pessoa com hipertensão e diabetes, apontando para a centralidade do modelo biomédico e para um possível retorno à APS seletiva no contexto da realidade estudada.

The aim of this study is  "relationships between professionals in the Family Health Care Sector (ESF) and the influence on  hypertension and diabetic care given to patients, from the perspective of the longitudinally that the care provides, according to the Social Networks Analysis".  Objectives: Analyze how relationships between ESF professionals and patients with hypertension and diabetes are shaped in the viewpoint of Social Network Analysis and identifying the influence of these relations and positions in the perspective of care and longitudinality. Metodology: The following is a descriptive study, mixed with both a quantitative and qualitative approach, the research participants are professionals from the basic ESF team (nurses, doctors, medical technicians, community health agents, and administrative assistants) having the setting as two Municipal Family Health Care Units, one located in the Middle of Paraíba and the other in the State of Rio de Janeiro. The Units were coded as U1 and U2. To collect data, a semi-structured interview was used according to a script, containing open questions that allowed answers to be responded in a narrative format. There were 12 U1 professionals interviewed as well as 09 U2 professionals, totaling 21 interviews. The interviews/narratives were analyzed and for the quantitative portion, through social media analysis, initiating sociograms in which the position and role of the actors in the networks can be analyzed, according to the measures of centrality and intermediation. This part of the study is conducted using the Ucinet software and its graphic component NetDraw. As for the qualitative approach the analysis of thematic-categorial material was used. Results: The information from the studied social networks, interfere directly with the results from the analysis. Pierre Bourdieu concepts in regard to capitals and habitus were clearly identified in the networks. In regards to relationships and positions in the studied networks, they seem to have a positive effect in the management of the team, in the work process and in attempts regarding the continuity of the patients care with hypertension and diabetes. The difficulty was seen regarding essential care throughout the patient's lifelong, as well as to establish a link between professionals and the patient. The most trusted professionals as well as the ones with a greater central value in both networks were the doctors from both teams. Considering this fact as well as others that were discussed throughout the study , negatively influences the care and longitudinality of the person with hypertension and diabetes, pointing to the centrality of a biomedical model and to a possible return of APS in the context of the reality studied.

Diabetes care in care home and residential settings.

An increasing number of people require insulin to manage their diabetes, many of them in supported environments such as residential care homes. Community nursing teams are likely to have a growing caseload of care home residents who require diabetes care, including insulin injections, and many unregistered practitioners are being asked to take on this role. If community nurse leads, matrons, frailty teams and pharmacy teams work together to provide training to staff in care homes (particularly unregistered practitioners), diabetes care can be improved. This has to be suitable for groups and for people with different levels of understanding, and supported by written resources. Courses are interactive to engage and motivate all learners, and methods of teaching include group work, visual teaching aids and games. Self-assessment around competencies, using a competency framework, not only demonstrates the development of staff but also highlights key areas of diabetes care.

LEADS Case Study: Partnering to Offer a Diabetes Management e-Learning Module to Nursing and Allied Health Staff.

Newfoundland and Labrador (NL) has the highest prevalence of diabetes in Canada. In 2011, Eastern Health (EH) selected diabetes as its chronic disease management focus in response to national statistics on the disease. In 2012, EH partnered with Saint Elizabeth (SE) to offer a free e-learning module on diabetes management to its healthcare providers. In this paper, the Engage Others domain of the LEADS in a Caring Environment Framework is used to describe the EH-SE partnership for this e-learning including strategies used to engage nursing and allied health staff.

Diabetes-Attributable Nursing Home Costs for Each U.S. State.

OBJECTIVE: To estimate the diabetes-attributable nursing home costs for each state. RESEARCH DESIGN AND METHODS: We used a diabetes-attributable fraction (AF) approach to estimate nursing home costs attributable to diabetes (in 2013 dollars) in aggregate and per person with diabetes in each state. We calculated the AFs as the difference in diabetes prevalence between nursing homes and the community. We used the Centers for Medicare & Medicaid Services 2013-2015 Minimum Data Set to estimate the prevalence of diabetes in nursing homes and to adjust for the intensity of care among people with diabetes in nursing homes. Community prevalence was estimated using the Behavioral Risk Factor Surveillance System (BRFSS). State nursing home expenditures were from the 2013 State Health Expenditure Accounts. RESULTS: The fraction of total nursing home expenditures attributable to diabetes ranged from 12.3% (Illinois) to 22.5% (Washington, DC; median AF of 15.6%, New Jersey). The median AF was highest in the 19-64 years age-group and lowest in the 85 years or older age-group. Nationally, diabetes-attributable nursing home costs were $18.6 billion. State-level diabetes-attributable costs ranged from $21 million in Alaska to $2.0 billion in California. Diabetes-attributable nursing home costs per person ranged from $374 in New Mexico to $1,610 in Washington, DC (median of $799 in Maine). CONCLUSIONS: Our estimates provide state policymakers with an improved understanding of the economic burden of diabetes in each state's nursing homes. These estimates could serve as critical inputs for planning and evaluating diabetes prevention and management interventions that can keep people healthier and living longer in their communities.

Improving Population Health Among Uninsured Patients with Diabetes.

Diabetes is a leading cause of morbidity and mortality; prevalence of diabetes is especially high in the southeastern United States among minority populations and those from lower socioeconomic sectors without access to health care services. The purpose of this project was to evaluate the clinical and financial outcomes of a nurse-led, interprofessional collaborative practice model that provides care coordination and transitional care for uninsured patients with diabetes. Data for this study were collected and evaluated from medical records of patients seen at the Providing Access to Health Care (PATH) Clinic between August 1, 2015, through May 30, 2017. Clinical outcomes were evaluated by comparing hemoglobin A1c (HbA1c) values before and after referral to the PATH Clinic. Cost savings to the academic medical center were evaluated by comparing costs associated with inpatient or emergency department encounters before and after referral to the PATH Clinic. A significant decrease in HbA1c (P < .0005) was noted for patients attending the PATH Clinic. In addition, financial analyses revealed a 55% decrease in pre to post PATH Clinic patients' direct costs. Similarly, a 42% decrease in the pre to post PATH Clinic patients' direct cost per encounter was noted. Average length of stay also was reduced when these patients were readmitted to the academic medical center. Results from this study support the effectiveness of the PATH Clinic model in caring for uninsured patients with clinically complex medical and social needs, often with behavioral health problems, who incur high health care spending and are often readmitted.

Construção e validação de simulador de baixo custo para capacitação de pacientes com diabetes mellitus e/ou de seus cuidadores na aplicação de insulina / Construction and validation of a low-cost simulator for training patients with diabetes mellitus and/or their caregivers in insulin administration

Objective: The objective of this study was to construct and validate a low-cost simulator to train diabetes mellitus patients and their caregivers on the administration of insulin. Method: Action research study with a qualitative approach, through a validation methodological study. Results: A low-fidelity simulator was constructed with the areas recommended for insulin administration adapted to allow skill training. Validation was done by nine experts on the subject. Conclusions: The prototype has low cost and greater anatomical functional fidelity than the models currently available in the market. Implications for practice: The simulator developed can be used by health professionals, caregivers or by the patients themselves as a tool in the training for insulin administration. Its use may favor the identification of critical points related to the application technique, allowing the planning of more directive and effective educational interventions.

Objetivo: Este estudio tuvo como objetivo la construcción y validación de un simulador de bajo costo para uso en la capacitación de pacientes con diabetes mellitus y de sus cuidadores para la aplicación de insulina. Método: Investigación-acción de abordaje cualitativo y estudio metodológico de validación. Resultados: Se ha construido un simulador de baja fidelidad con las áreas recomendadas para la aplicación de insulina adaptadas para permitir el entrenamiento de la habilidad. La validación fue hecha por nueve expertos en el tema. Conclusiones: El prototipo presenta bajo costo y mayor fidelidad anatómica funcional que los modelos actualmente disponibles en el mercado. Implicaciones para la práctica: El simulador desarrollado puede ser utilizado por profesionales de la salud, cuidadores o por los propios pacientes como herramienta en la capacitación para aplicación de insulina. Su uso puede favorecer la identificación de puntos críticos relacionados con la técnica de aplicación, permitiendo la planificación de intervenciones educativas más directivas y eficaces.

Objetivo: Este estudo teve como objetivo a construção e validação de um simulador de baixo custo para uso na capacitação de pacientes com diabetes mellitus e de seus cuidadores para a aplicação de insulina. Método: Pesquisa-ação de abordagem qualitativa e estudo metodológico de validação. Resultados: Foi construído um simulador de baixa fidelidade com as áreas recomendadas para aplicação de insulina adaptadas para permitir o treinamento da habilidade. A validação foi feita por nove experts no assunto. Conclusões: O protótipo apresenta baixo custo e maior fidelidade anatômico funcional do que os modelos atualmente disponíveis no mercado. Implicações para prática: O simulador desenvolvido pode ser utilizado por profissionais da saúde, cuidadores ou pelos próprios pacientes como ferramenta na capacitação para aplicação de insulina. Seu uso pode favorecer a identificação de pontos críticos relacionados a técnica de aplicação, permitindo o planejamento de intervenções educacionais mais diretivas e eficazes.

Instrumentos de avaliação do cuidado em diabetes na perspectiva do paciente e da equipe multiprofissional / Instruments of assessment of diabetes care from the perspective of the patient and the multiprofessional care

O crescimento das doenças crônicas não-transmissíveis está relacionado ao envelhecimento da população, à rápida urbanização não planejada, e à globalização de estilos de vida insalubres, entre outros. Nessa direção, as doenças crônicas nãotransmissíveis têm sido reconhecidas como um problema de saúde pública nacional e internacional e está elencada como prioridade na agenda nacional de pesquisa em saúde no Brasil, com destaque para o cuidado em diabetes mellitus. A Enfermagem em consonância com as políticas públicas da Organização Mundial e Ministério da Saúde desenvolve atividades de atenção em saúde às populações com condições crônicas visando o gerenciamento das doenças nos diferentes níveis de atenção. Para o avanço do conhecimento com repercussões no ensino, pesquisa e assistência, um objetivo estratégico é a expansão de estudos que visem à melhoria da relação custoefetividade de forma sustentável aos cuidados e gerenciamento em condições crônicas. No entanto, constata-se que ainda há lacunas na produção e utilização do conhecimento voltado para a primeira etapa do processo de Enfermagem que é a coleta de dados. Desse modo, é preciso ampliar evidencias acerca de instrumentos que subsidiem as informações do paciente com diabetes, mas em duas óticas diferenciadas, uma sob o olhar da perspectiva multiprofissional, e a outra da perspectiva do paciente na avaliação do seu cuidado, como elemento essencial para o desenvolvimento no setor saúde. Na expectativa de fornecer evidências científicas que possam instrumentalizar profissionais e pacientes no gerenciamento das condições crônicas, esta dissertação apresenta a validação de dois instrumentos de coleta de dados do paciente com diabetes. O primeiro, realizou uma validação do Roteiro para Atendimento Multiprofissional à pessoa com Diabetes Mellitus e /ou Hipertensão Arterial segundo a análise semântica e de conteúdo. E o segundo a validação de correspondência e fatorial do instrumento Patient Assessment Chronic Illness Care (PACIC). Desta forma, torna-se disponível dois instrumentos, um o Roteiro para Atendimento Multiprofissional à pessoa com Diabetes Mellitus e /ou Hipertensão Arterial e o outro a versão brasileira do PACIC, ambos, válidos e reprodutíveis, o que pode contribuir para a assistência de pessoas com condições crônicas

The growth of nontransmissible chronic diseases is related to the population aging, fast and unplanned urbanization, globalization, and unhealthy lifestyles, among others. In this sense, nontransmissible chronic diseases have been recognized as a national and international public health problem, being classified as a priority in the Brazilian national health research agenda, in which diabetes mellitus care stands out. In consonance with public policies of the World Health Organization and the Brazilian Ministry of Health, the nursing field develops healthcare activities to the population with chronic conditions, aiming at the management of diseases at different healthcare levels. In order to broaden knowledge and impact teaching, research and care, a strategic objective is increasing studies aimed at improving the cost-effectiveness relationship of care and the management of chronic conditions in a sustainable manner. However, there are still gaps in the production and use of knowledge aimed at the first step of the nursing process, that is, data collection. Hence, it is necessary to broaden evidence on the instruments that support the information of patients with diabetes, from two different angles - one under the multiprofessional perspective, and the other from the perspective of patients in the assessment of their care, as an essential element for the development of the health sector. With the intention to provide scientific evidence that can support professionals and patients in the management of chronic diseases, this dissertation presents the validation of two data collections instruments for patients with diabetes. The first was the validation of a Multiprofessional Care Script for People with Diabetes Mellitus and/or Arterial Hypertension, according to a semantic and content analysis. And the second was the correspondence and factor validation of the instrument Patient Assessment Chronic Illness Care (PACIC). Therefore, two instruments were made available, the Multiprofessional Care Script for People with Diabetes Mellitus and/or Arterial Hypertension and the Brazilian version of the PACIC. Both instruments are valid and reproducible, and can contribute to the care of people with chronic conditions

A percepção do idoso com diabetes acerca de sua doença e o cuidado de enfermagem / La percepción de los ancianos con diabetes sobre su enfermedad y cuidados de enfermería / The perception of the elderly with diabetes on their disease and the nursing care

RESUMO A Diabetes tornou-se um importante problema de Saúde Pública, frente ao envelhecimento populacional. O enfermeiro deve dispor de um atendimento holístico no cuidado aos idosos diabéticos, visando a sua qualidade de vida. Objetivou-se conhecer a percepção dos idosos com diabetes sobre essa doença e o cuidado de enfermagem na atenção básica. Trata-se de uma pesquisa exploratória descritiva com abordagem qualitativa, realizada no município de Sobral-CE, em outubro de 2013. Participaram 13 idosos, que foram entrevistados por meio de visitas domiciliares. Após a realização da técnica de análise temática, emergiram como categorias: Percepções dos idosos acerca do diabetes; Autocuidado do idoso com diabetes; O olhar dos idosos com diabetes sobre o cuidado de enfermagem na atenção básica. Percebeu-se que os idosos não tinham um conhecimento adequado sobre a doença, mas adotam práticas de autocuidado por reconhecer as complicações da doença na sua qualidade de vida. Sobre os cuidados de enfermagem, observou-se nos discursos diferentes opiniões com relação ao estabelecimento de vínculos entre enfermeiros-idosos. Portanto, aponta-se a necessidade de investir em ações de educação em saúde, além de superar as fragilidades da assistência de enfermagem, já que o estabelecimento de vínculos entre profissionais e usuários é um fator determinante no processo de cuidar.

RESUMEN La diabetes se ha convertido en un importante problema de salud pública, en comparación con el envejecimiento de la población. La enfermera debe tener un cuidado integral a la atención de los diabéticos de edad avanzada, en busca de su calidad de vida. Este estudio tuvo como objetivo conocer la percepción de las personas mayores con diabetes sobre la enfermedad y los cuidados de enfermería en la atención primaria. Se trata de un estudio exploratorio descriptivo con un enfoque cualitativo, realizado en Sobral, Ceará municipio, en octubre de 2013. Los participantes incluyeron 13 ancianos que fueron entrevistados mediante visitas a domicilio. Una vez completado el análisis temático, surgido como categorías: Percepción de la tercera edad sobre la diabetes; El autocuidado de las personas mayores con la diabetes; La mirada de las personas mayores con diabetes acerca de cuidados de enfermería en la atención primaria. Se observó que las personas mayores no tienen un conocimiento suficiente acerca de la enfermedad, pero adoptan prácticas de autocuidado para reconocer las complicaciones de la enfermedad en su calidad de vida. Acerca de los cuidados de enfermería, se observó en los diferentes dictámenes discursos en relación con el establecimiento de vínculos entre las enfermeras de la tercera edad. Por lo tanto señala la necesidad de invertir en actividades de educación para la salud, además de superar las deficiencias de la atención de enfermería, desde el establecimiento de vínculos entre los profesionales y los usuarios es un factor determinante en el proceso de atención.

ABSTRACT Diabetes has become an important public health problem, in the face of an aging population. The nurse must have a holistic care in the care to diabetic elderly, aiming at their quality of life. The objective was to know the perception of the elderly with diabetes on the disease and the nursing care in basic care. This is a descriptive, exploratory study, with a qualitative approach, carried out in the municipality of Sobral-CE, in October 2013. It involved 13 elderly people, interviewed through home visits. After the thematic analysis, the following categories emerged: Perceptions of the elderly on diabetes; Self-care of the elderly with diabetes; The view of the elderly with diabetes on nursing care in basic care. The elderly did not have an adequate knowledge on the disease, but adopted self-care practices by recognizing the complications of the disease in their quality of life. Regarding nursing care, there were different opinions in the discourses regarding the establishment of bonds between nursing and elderly people. Therefore, it is necessary to invest in health education actions, in addition to overcoming the weaknesses of nursing care, since establishing bonds between professionals and users is a determining factor in the care process.

Atuação dos enfermeiros da estratégia saúde da família na prevenção do pé diabético / La práctica de la familia de la enfermera estrategia de salud en la prevención de pie diabético / Practice nurse family health strategy in the prevention of diabetic foot

To identify guidelines provided by nurses for people with DM about foot care; investigate the frequency of the examination of the feet and the aspects evaluated; check which health education activities are carried out by nurses for people with DM. Methods: a descriptive study with a quantitative approach, performed with 38 nurses of the Family Health Strategy, through a questionnaire, during May to July/2013. Data were analyzed using descriptive statistics. This study was approved by the CCS CEP/UFPB, CAEE nº 03459112.1.0000.5188. Results: it was found that 26 (68,4%) nurses guide on the use of comfortable shoes; 19 (50,0%) nurses assess hair and nails monthly; 12 (31,6%) nurses develop guidelines as health education activity. Conclusion: role of nurses in the Family Health Strategy helps in the prevention of diabetic foot, providing the realization of self-care...

Identificar orientações fornecidas pelos enfermeiros às pessoas com DM sobre o cuidado com os pés; investigar a frequência da realização do exame dos pés e os aspectos avaliados; verificar quais atividades de educação em saúde são realizadas pelos enfermeiros para as pessoas com DM. Métodos: estudo descritivo com abordagem quantitativa, realizado com 38 enfermeiros da Estratégia Saúde da Família, através de um questionário, durante maio a julho/2013. Os dados foram analisados com base na estatística descritiva. Estudo aprovado pelo CEP do CCS/UFPB, CAEE nº 03459112.1.0000.5188. Resultados: constatou-se que 26(68,4%) enfermeiros orientam quanto ao uso de calçados confortáveis; 19(50,0%) enfermeiros avaliam os pelos e as unhas mensalmente; 12 (31,6%) enfermeiros realizam orientações como atividade de educação em saúde. Conclusão: a atuação dos enfermeiros da Estratégia Saúde da Família contribui na prevenção do pé diabético, proporcionando a realização do autocuidado...

Identificar las pautas proporcionadas por enfermeras y para las personas con DM sobre el cuidado del pie; investigar la frecuencia del examen de los pies y los aspectos evaluados; comprobar que la educación sanitaria actividades se llevan a cabo por enfermeras y para las personas con DM. Métodos: estudio descriptivo, con abordaje cuantitativo, realizado con 38 enfermeros de la Estrategia Salud de la Familia, a travésde un cuestionario, de mayo a julio/2013. Los datos se analizaron mediante estadística descriptiva. Este estudio fue aprobado por el CCS CEP/UFPB,CAEE No 03459112.1.0000.5188. Resultados: se encontró que 26 (68,4%) enfermeras guía sobre el uso de calzado cómodo; 19 (50,0%) enfermeras evalúan la mensual y las uñas; 12 (31,6%) enfermeras desarrollan pautas como la actividad de educación para la salud. Conclusión: el papel de las enfermeras en la Estrategia de Salud de la Familia ayuda en la prevención del pie diabético, que proporciona la realización de auto-cuidado...

Can a pharmacy intervention improve the metabolic risks of mental health patients? Evaluation of a novel collaborative service.

BACKGROUND: The pressure on healthcare services worldwide has driven the incorporation of disease state management services within community pharmacies in developed countries. Pharmacists are recognised as the most accessible healthcare professionals, and the incorporation of these services facilitates patient care. In Australia, the opportunity to manage pharmacy patients with mental illness has been underutilised, despite the existence of service models for other chronic conditions. This paper is an independent evaluation of a novel service developed by a community pharmacy in Perth, Western Australia. The service represents collaboration between a nurse practitioner and community pharmacy staff in the management of mental health patients with metabolic risks. METHODS: We applied practice service standards for Australian community pharmacies to develop an evaluation framework for this novel service. This was followed by semi-structured interviews with staff members at the study pharmacy to explore service processes and procedures. Descriptive analysis of interviews was supplemented with analysis of patients' biometric data. All data were evaluated against the developed framework. RESULTS: The evaluation framework comprised 13 process, 5 outcomes, and 11 quality indicators. Interview data from eight staff members and biometric data from 20 community-dwelling mental health patients taking antipsychotics were evaluated against the framework. Predominantly, patients were managed by the pharmacy's nurse practitioner, with medication management provided by pharmacists. Patients' biometric measurements comprised weight, blood pressure, blood glucose levels, lipid profiles and management of obesity, smoking, hypertension and diabetes. Positive outcomes observed in the patient data included weight loss, smoking cessation, and improved blood pressure, blood glucose and lipid levels. CONCLUSIONS: The developed framework allowed effective evaluation of the service, and may be applicable to other pharmacy services. The metabolic clinic met key process, quality and outcomes indicators. The positive patient outcomes may assist in securing further funding.

Valoración de enfermería del dolor neuropático asociado a pie diabético en el paciente adulto mayor / Nursing evaluation of neuropathic pain related to diabetic foot in elderly pacients

En relación al contexto de la diabetes mellitus y el aumento de la población longeva es relevante estudiar el proceso de valoración del dolor neuropático asociado al síndrome del pie diabético en el adulto mayor desde todas sus multidimensiones, por su gran impacto en los sistemas de salud, laboral económico y calidad de vida de la persona. La valoración de Enfermería en este grupo humano cobra real importancia para lograr una correcta valoración, evaluación y tratamiento del dolor en las personas de edad avanzada que padecen este síndrome. Metodología: Revisión bibliográfica sobre “Valoración de Enfermería del dolor neuropático asociado a pie diabético en el paciente adulto mayor”. La búsqueda de información fue realizada en bases de datos Up To Date, Scopus, Medline, Envejecimiento en Red, Pubmed. Los descriptores en inglés y en español que se utilizaron en la búsqueda fueron: painful (dolor), pain (dolor), neuropathy (neuropatía), diabetic (diabetes), epidemiology (epidemiologia). Para la combinación de estos términos se utilizó los conectores booleanos NOT, AND y OR. Para la búsqueda en español se utilizaron los siguientes descriptores: epidemiologia, diabetes, Chile, dolor, percepción, envejecimiento, valoración, enfermeira...

Regarding to the context of diabetes mellitus and the increasingly aging population number, it is relevant to study the process of evaluation of neuropathic pain associated to the diabetic foot syndrome in elderly people from a multidimensional point of view, due to the great impact on health and working systems, and people`s quality of life. The nursing valuation in this human group has a great importance in order to achieve a correct evaluation, valuation, and treatment of the pain on the elderly people who suffer from this syndrome. Methodology: Bibliographic revision about “Nursing Evaluation of neuropathic pain related to diabetic foot in elderly patients”. The information research was elaborated from data bases: Up to Date, Scopus, Medline, Envejecimiento en Red, Pubmed. The English and Spanish descriptors used on this research were: painful (dolor), pain (dolor), neuropathy (neuropatía), diabetic (diabetes), epidemiology (epidemiología). On the combination of these terms were used Boolean connectors: NOT, AND, OR. On the Spanish research were used the following descriptors: epidemiology, diabetes, Chile, pain, perception, aging, valuation, and nursing...

Development of a Diabetes Learning Needs Assessment Tool to Promote an Individualized Predischarge Patient Education Plan.

The purpose of this article is to feature a nursing staff initiative to improve patients' understanding of their diabetes management by empowering them with knowledge for successful glycemic control. This initiative also enhanced patient and family-centered care and patient safety through individualized, targeted instruction.

[Health care for women over 50: programmatic vulnerability in the Family Health Strategy]. / Atenção à saúde da mulher após os 50 anos: vulnerabilidade programática na Estratégia Saúde da Família.

OBJECTIVE: To assess the health care process for women over 50 at a Family Health Unit based on the concept of programmatic vulnerability. METHOD: This study is inserted in the field of health care assessments. The framework proposed by Donabedian was used to analyze 90.5% of the 790 records of women registered at the unit. RESULTS: It was observed that none of the women that did not have a diagnosed pathology attended the recommended consultations or underwent the recommended tests. Of the total number of women with hypertension or diabetes, 20.7% were registered in the Hiperdia Programme and less than 1.0% had attended the consultations and undergone the necessary tests. Only 11.9% of the women had had a gynaecological examination, a clinical breast examination and a mammography the year before data collection. CONCLUSION: It is concluded that women over 50 are in a situation of programmatic vulnerability in terms of the indicators established in this study. Knowledge of this reality can help nurses provide care that is best suited for this group.

Health care for women over 50: programmatic vulnerability in the Family Health Strategy / Atención a la salud de la mujer después de 50 años: la vulnerabilidad programática de la Estratégia de Salud de la Família / Atenção à saúde da mulher após os 50 anos: vulnerabilidade programática na Estratégia Saúde da Família

OBJECTIVE: To assess the health care process for women over 50 at a Family Health Unit based on the concept of programmatic vulnerability. METHOD: This study is inserted in the field of health care assessments. The framework proposed by Donabedian was used to analyze 90.5% of the 790 records of women registered at the unit. RESULTS: It was observed that none of the women that did not have a diagnosed pathology attended the recommended consultations or underwent the recommended tests. Of the total number of women with hypertension or diabetes, 20.7% were registered in the Hiperdia Programme and less than 1.0% had attended the consultations and undergone the necessary tests. Only 11.9% of the women had had a gynaecological examination, a clinical breast examination and a mammography the year before data collection. CONCLUSION: It is concluded that women over 50 are in a situation of programmatic vulnerability in terms of the indicators established in this study. Knowledge of this reality can help nurses provide care that is best suited for this group. .

OBJETIVO: evaluar el proceso de atención a las mujeres a partir de los 50 años de edad en la Unidad de Salud de la Familia, tomando como referencia el concepto de vulnerabilidad del programa. MÉTODO: Estudio insertado en la evaluación de programas de salud, tuvo Donabediam como referencia, siendo analizados el 90,5% de los 790 registros médicos de mujeres inscritas en la unidad. Fueran creados indicadores de evaluación. RESULTADOS: Ninguna mujer sin patología diagnosticada realizó consultas y exámenes recomendados. De todas las hipertensas y diabéticas, 20,7% estaban inscritas en el Programa Hiperdia y menos del 1,.0% había realizado consultas y exámenes necesarios. Sólo el 11.9% de las mujeres había realizado el examen ginecológico, examen clínico de los senos y la mamografía en el año anterior a la recolección de datos. CONCLUSIÓN: Concluye que las mujeres mayores de 50 años están en situación de vulnerabilidad programática en relación con los indicadores definidos en este estudio. Por lo tanto, conocer la realidad puede resultar en la atención de enfermería más adecuada para este grupo. .

OBJETIVO: Avaliar o processo de atenção prestada a mulheres, a partir dos 50 anos de idade, em Unidade de Saúde da Família, tomando-se como referência o conceito de vulnerabilidade programática. MÉTODO: Estudo inserido no campo da avaliação de programas de saúde; utilizou-se o referencial proposto por Donabediam, sendo analisados 90.5% dos 790 prontuários de mulheres matriculadas na Unidade. RESULTADOS: Observou-se que nenhuma mulher sem patologia diagnosticada realizou consultas e exames preconizados. Do total de hipertensas e diabéticas, 20.7% estavam inscritas no Programa Hiperdia e menos de 1.0% tinha realizado as consultas e exames necessários. Apenas 11.9% das mulheres tinham realizado exame ginecológico, exame clínico das mamas e mamografia, no ano que antecedeu a coleta de dados. CONCLUSÃO: Conclui-se que as mulheres com mais de 50 anos estão em situação de vulnerabilidade programática, relacionada aos indicadores definidos neste estudo. Logo, conhecer a realidade poderá resultar no atendimento de enfermagem mais adequado para esse grupo. .