Designing a telephone intervention program for family caregivers.

Objective Describing the development process of a nursing intervention program to promote the adaptation of family caregivers for people with chronic diseases in Colombia and Brazil. Method A developmental study in which an intervention program was created as proposed by the UK Medical Research Council for developing and evaluating complex interventions. Results The program was organized into five weekly sessions of 40 minutes duration applied over the telephone, which integrated the activities of Caregiver Support and Improvement in Coping. Conclusion Following the recommendations of the UK Medical Research Council allowed designing an intervention program of high methodological rigor based on existing scientific evidence, and based on a theoretical model from the nursing discipline which will increase the understanding of their mechanisms of action in improving the well-being of family caregivers.

[Pain assessment and training: the impact on pain control after cardiac surgery]. / Treinamento e avaliação sistematizada da dor: impacto no controle da dor do pós-operatório de cirurgia cardíaca.

We analyzed the effects of training and the application of a form for the systematized assessment of pain control after cardiac surgery on pain intensity and supplementary use of morphine. Three patient groups underwent a non-randomized clinical trial with standardized analgesic prescription. In Group I, the nursing staff did not receive specific training regarding the assessment and management of pain, and patients were treated following the established protocol of the institution. In Groups II and III, the nursing staff received targeted training. In Group II the nursing staff used a form for the systematized assessment of pain, which was not used in Group III. Group II presented a lower intensity of pain and greater consumption of supplementary morphine compared to Groups I and II. Training associated with the systematized assessment form increased the chance of identifying pain and influenced nurses' decision-making process, thus promoting pain relief among patients.

Features of the triggering of the yellow code and factors associated with the occurrence of adverse events.

OBJECTIVE: to analyze the characteristics of the activation of the yellow code in wards and identify the factors associated with adverse events after the Rapid Response Team. METHODS: a cross-sectional study with retrospective analysis of medical records of adults admitted to medical or surgical clinic wards of the University Hospital of São Paulo. RESULTS: among the 91 patients, the most frequent signs of triggers (n=107) were peripheral oxygen saturation of less than 90% (40.2%) and hypotension (30.8%). Regarding the associated factors the research identified each minute of attendance of the Rapid Response Team in the wards increased by 1.2% odds of adverse events (twenty-four unplanned admission in the ICU and one cardiac arrest) in the sample (p=0.014). CONCLUSIONS: decreased oxygen saturation and hypotension were the main reasons for the triggering, and the length of care was associated with the frequency of adverse events.

Effect of the national early warning score on monitoring the vital signs of patients in the emergency room.

OBJECTIVE: To verify the effect of using the National Early Warning Score (NEWS) system on the compliance of the vital signs monitoring interval with those recommended for patients in the emergency room. METHODS: This is a quasi-experimental, before-and-after study, performed in an emergency room with 280 adult patients selected by convenience. The effect of NEWS on the compliance of the vital signs monitoring interval with those recommended by the system was analyzed by linear regression. RESULTS: In the Pre-NEWS phase, 143 patients were analyzed (mean age ± standard deviation: 54.4 ± 20.5; male: 56.6%) and, in the Post-NEWS phase, 137 patients (mean age ± standard deviation: 55.5 ± 20.8; male: 50.4%). There was compliance of the vital signs monitoring interval with what is recommended by NEWS in 92.6% of vital signs records after adopting this instrument. This compliance was 9% (p < 0.001) higher in the Post-NEWS phase. CONCLUSION: The use of the NEWS system increased the compliance of the vital signs monitoring intervals with the ones recommended, but this compliance decreased when the NEWS score pointed to a shorter interval in the monitoring of vital signs.

Characteristics of music intervention to reduce anxiety in patients undergoing cardiac catheterization: scoping review.

The characteristics of music interventions for reducing anxiety in patients undergoing cardiac catheterization were mapped. A scoping review was conducted according to the Joanna Briggs Institute methodology. Searches were performed in electronic portals and databases PubMed, CINAHL, PsycINFO, Cochrane, EMBASE, Scopus, LILACS, CAPES Thesis Portal (Brazil), DART-Europe E-theses Portal, Theses Canada Portal, Pro-Quest, and Google Scholar databases, gray literature, with no limitation on the year of publication. Eighteen articles were included in the search. The characteristics of the interventions were heterogeneous and not comprehensively described in the primary studies. The songs were predominantly of a single genre, instrumental, and selected by the interventionist, with a rhythm between 60 and 80 beats per minute. The interventions were delivered in a single session, mostly in the catheterization laboratory, before or during the procedure, by means of digital audio and earphones for over 20 min. The heterogeneity of interventions and incompleteness of information in the studies compromises the advancement of knowledge on the effects of music on health outcomes.

Factors associated with caregivers' contribution to self-care in heart failure. / Fatores associados à contribuição dos cuidadores para o autocuidado na insuficiência cardíaca.

OBJECTIVE: to analyze the caregiver's contribution to self-care in heart failure and the predictor variables of this contribution. METHOD: a cross-sectional descriptive and analytical study, with the participation of 140 dyads (patients and caregivers). The contribution to self-care was assessed using the Caregiver Contribution to Self-Care of Heart Failure Index. Caregivers and patients were interviewed separately to obtain the data. Multiple linear regressions were used to verify predictor variables of caregiver contribution. RESULTS: the mean score for contribution to maintenance self-care was 62.7 (SD=7.1), for management, 62.9 (SD=20.4) and for confidence was 63.3 (SD=22.1). The variables number of patient's medications, caregiver being related to the patient, social perception of caregiver, health-related quality of life of the patient and caregiver's confidence in contributing to self-care were predictors of caregiver's contribution to maintenance or management self-care. CONCLUSION: the caregiver's contribution was insufficient. The social support perceived by the caregiver, the type of relationship the caregiver to the patient, the number of medications used by the patient, as well as the caregiver's confidence in contributing to self-care are variables that should be considered to assess the risk of insufficient contribution of the caregiver.

Quality indicators of the nursing process documentation in clinical practice.

OBJECTIVES: to propose quality indicators for clinical nursing documentation. METHODS: methodological study in which literature review guided the composition of an instrument for evaluating nursing documentation. Two independent professionals evaluated 204 medical records of adult patients. The analysis of this assessment generated quality indicators for clinical nursing documentation. Inter-rater agreement was analyzed by Cohen's kappa. RESULTS: the bibliographic review, analysis by experts and pre-test resulted in 88 evaluation items distributed in seven topics; in 88.5% of the items, inter-rater agreement between strong and almost perfect (k=0.61-1.0) was observed. Analysis of the evaluations generated a global indicator and seven partial indicators of documentation quality. Compliance in the two services ranged between 62.3% and 93.4%. The global indicator showed a 2.1% difference between services. CONCLUSIONS: seven quality indicators of clinical nursing documentation and their method of application in hospital records have been proposed.

Simulation effectiveness tool modified (SET-M): adaptation and validation for Brazil.

OBJECTIVE: to adapt the Simulation Effectiveness Tool - Modified (SET-M) to Portuguese and to verify validity and reliability indexes. METHOD: methodological study using ISPOR, Confirmatory Factor Analysis, correlation between the adapted instrument/Simulation Design Scale - Student Version/Individual Practice Assessment and reliability (test-retest and internal consistency indexes). Convenience sample with a total of 435 Nursing undergraduate and graduate students. RESULTS: Simulation Effectiveness Tool - Modified Brazilian Version obtained an average score between 2.36 to 2.94. The Confirmatory Factor Analysis had a factor load > 0.30 for 17 of the 19 items. Cronbach's alpha ranged between 0.729 and 0.874. McDonald's omega was 0.782. There was no correlation between Simulation Effectiveness Tool - Modified Brazilian Version and the Simulation Design or Individual Practical Assessment. There was a positive correlation between the Simulation Effectiveness Tool - Modified Brazilian Version and the participants' age. The scores of the volunteers in the simulations were significantly higher than those of the observers in three domains. CONCLUSION: the SET-M Brazilian Version, maintaining the 19 items and four domains of the original scale, was made available for use in Brazil to evaluate the effectiveness of the simulation, recommending studies with different samples.

Validation of the Brazilian Portuguese version of Evidence-based Practice Knowledge Assessment in Nursing (EKAN).

OBJECTIVE: The Evidence-based Practice Knowledge Assessment in Nursing (EKAN) is an objective measure of evidence-based practice (EBP) knowledge. The aims of the project were to translate the EKAN instrument into Brazilian Portuguese, test its psychometric properties, and document a baseline assessment of students' EBP knowledge. METHOD: This study used methodological design. The EKAN-Brazilian Portuguese was administered to nursing students from two baccalaureate programs. Data were analyzed using Rasch procedures. RESULTS: 123 students participated (87% ranged 19-25 years old; 60% were juniors; 38% perceived having no exposure to EBP). Validity indices showed the mean difficulty index = -2.48 to 2.07, the Infit (WMS) mean was.985 (SD = 2.13), and the Outfit (UMS) mean was.975 (SD = 0.17). Reliability indices showed sufficient item separation index (4.47); moderate person separation index (.47); high item reliability (.95); and low person reliability (.18). The mean EKAN sum score (max = 20) was 7.6 (SD = 2.13). CONCLUSION: This study on the EKAN-Brazilian Portuguese version provided sufficient evidence for validity and reliability; the person reliabilities showed the need for improvement in incorporating EBP concepts and content in nursing programs.

Effect of post-storage filters vs. pre-storage filters for leukoreduction of blood components on clinical outcomes: a systematic review protocol.

OBJECTIVE: This review will synthesize the best available evidence on the effectiveness of leukocyte reduction by comparing post-storage and pre-storage filters. The review will consider the following clinical outcomes: transfusion reactions, bacterial infection, length of stay, and mortality. INTRODUCTION: Transfusion is a relevant therapy, but it is not risk-free. Leukocyte reduction can be performed either by apheresis or by pre- or post-storage filters in order to reduce the risk of transfusion reactions, transmission of some diseases, alloimmunization, and platelet refractoriness. It can also reduce the length of hospital stay and the use of antibiotics. INCLUSION CRITERIA: Studies comparing the transfusion of leukocyte reduction through post-storage filters with pre-storage filters in patients of any age who received a transfusion and the clinical outcomes resulting from the transfusion will be considered for inclusion. Studies in Portuguese, English, and Spanish will be considered, with no publication time limit. METHODS: The research sources will include MEDLINE (PubMed), CINAHL (EBSCO), PsycINFO, Scopus, The Cochrane Library, Web of Science Core Collection, Embase, LILACS, and gray literature sources. The selection of titles and abstracts will be carried out by two independent reviewers, and the critical evaluation of the studies will be based on JBI tools. The data of interest for the review question will be extracted using JBI SUMARI. A narrative synthesis will be performed as will a meta-analysis and risk assessment of publication bias, if possible. SYSTEMATIC REVIEW REGISTRATION: PROSPERO: CRD42020192202.

Transitional care from the hospital to the home in heart failure: implementation of best practices.

OBJECTIVES: Assess the compliance of the implementation of better evidence in the transitional care of the person with heart failure from the hospital to the home. METHODS: Evidence implementation project according to the JBI methodology in a cardiology hospital in São Paulo. Six criteria were audited before and after implementing strategies to increase compliance with best practices. 14 nurses and 22 patients participated in the audits. RESULTS: In the baseline audit, compliance was null with five of the six criteria. Strategies: training of nurses; reformulation of the hospital discharge form and guidance on self-care in care contexts; and making telephone contact on the 7th, 14th and 21st days after discharge. In the follow-up audit, there was 100% compliance with five of the six criteria. CONCLUSION: The project made it possible to increase the compliance of transitional care practices in people with heart failure with the recommendations based on the best evidence.

[Psychometric properties of the Dutch Fatigue Scale and the Dutch Exertion Fatigue Scale: Brazilian version]. / Propriedades psicométricas da Dutch Fatigue Scale e Dutch Exertion Fatigue Scale: versão brasileira.

Fatigue is a human response in varied acute and chronic conditions and also in general population. This article reports a study conducted to estimate reliability and validity of the Dutch Fatigue Scale (DUFS) and the Dutch Exertion Fatigue Scale (DEFS) adapted for Brazilian use. Three-hundred heart failure patients and 64 healthier volunteers answered the DUFS and DEFS translated into Portuguese. Factorial analysis of DUFS and DEFS items yield a solution with one factor for each scale (explained variance = 53.9%), and good reliability estimates were obtained by the Chronbach's alpha (DUFS=.85 e DEFS=.92). In the patient sample, scales scores were positively associated with heart failure functional class (DUFS and DEFS p=.00), depression scores (DUFS r s=.63; p=.00 and DEFS r s=.55; p=.00), and sleep disturbance (DUFS and DEFS p=.00). Brazilian versions of DUFS and DEFS presented psychometric properties similar to those of the original ones.

Effectiveness of the Manchester Triage System on time to treatment in the emergency department: a systematic review.

OBJECTIVE: The objective of this review was to synthesize the best available evidence on the effectiveness of the Manchester Triage System (MTS) on time to treatment (TtT) for patients who visit the emergency department (ED). INTRODUCTION: The objectives of the MTS are to define a safe wait time for medical attention. Triage systems, such as the MTS, use criteria to ensure patient safety by determining appropriate wait times for each individual who visits the ED. The TtT is the time interval between arrival at the ED to initiation of therapeutic interventions. A short TtT is important in different clinical situations and may reduce infections and mortality. The MTS may have an impact on the TtT. INCLUSION CRITERIA: This review considered studies that included any patients visiting the ED with any complaints or medical diagnoses who were triaged using the MTS by nurses or doctors, and the TtT was measured. This review considered randomized controlled trials, as well as quasi-experimental, before-and-after, case-control and analytical cross-sectional studies. Studies published after 1994 in English, Spanish, Portuguese, French and German were considered for inclusion. METHOD: This systematic review was conducted in accordance with JBI methodology. The search strategy aimed to find both published and unpublished studies in MEDLINE, CINAHL, Lilacs, Web of Science, Embase, Scopus, Cochrane Central Register of Controlled Trials, Google Scholar, Banco de Teses - CAPES, and Digital Dissertations. The results of this search were assessed by one reviewer who excluded duplicate results. Titles and abstracts were screened by two independent reviewers for assessment against the inclusion criteria. The full texts of potentially eligible papers were retrieved and independently assessed by two reviewers using a standardized critical appraisal instrument from JBI. Data were extracted from studies included in the review and were presented using a narrative form. Tables were used to summarize the characteristics and findings of the studies. RESULTS: The review included two before-and-after studies, with a total of 2265 participants. One study was of moderate quality, and the other was of high quality. One study included only patients with acute ischemic stroke, while the other included patients with any complaint. Both studies were performed with consecutive samples. The median TtT was 10 minutes before implementing the MTS and 12 minutes after implementing the MTS in the study that included patients with any complaints. In the study including patients with acute ischemic stroke, the median TtT decreased by 15 minutes after implementing the MTS (from 75 to 60 minutes). Because of the heterogeneity in the characteristics of the populations of the two studies, the results could not be pooled. CONCLUSIONS: The MTS reduced the median TtT for patients triaged at the highest priority levels (orange and yellow), but it did not decrease the median TtT in all patients. The existing evidence base regarding the effectiveness of the MTS comes from two studies with methodological limitations that could not be pooled. The evidence indicates the MTS may confer benefit to some patients who visit the ED by reducing TtT, but not for all patients. Further research is needed before firm conclusions can be made.

SCHFI 6.2 Self-Care Confidence Scale - Brazilian version: psychometric analysis using the Rasch model.

OBJECTIVE: to evaluate the psychometric properties of the Self-Care Confidence Scale in heart failure in the Brazilian version of the Self Care Heart Failure Index, version 6.2, using the Rasch model criteria. METHOD: secondary study, of psychometric analysis, using the Rasch model, of the six items of the scale. The sample consisted of 409 patients with heart failure undergoing outpatient treatment [mean age 57.9 (standard deviation = 11.6) years, 54.8% male]. RESULTS: of the total of six items, one ("De maneira geral, você está confiante sobre estar livre dos sintomas de insuficiência cardíaca?") presented maladjustment to the model (Infit = 1.84 and Outfit = 1.99). After the exclusion of this item, the others showed a good fit, composed one dimension and explained 55% of the variance in the data; the categories of response to the items were adequate, the values of separation and reliability of person were 2.13 and 0.82, respectively, and Cronbach's alpha was 0.87. Items of extreme difficulty were identified and there is no differential functioning of the items in relation to sex. CONCLUSION: with the exclusion of the first item, the Self-Care Confidence Scale showed good psychometric properties, with caution in interpreting the results of the six-item scale.

Clinical judgment and diagnostic reasoning of nursing students in clinical simulation.

OBJECTIVES: to determine the degree of association between clinical judgment and diagnostic reasoning of nursing students in clinical simulation. METHODS: this is a correlational research design using a quantitative approach. The sample consisted of 41 nursing students who assisted a patient with vaso-occlusive crisis in a high-fidelity clinical simulation setting. The instruments used included the Lasater Clinical Judgment Rubric - Brazilian Version and the Diagnostic Thinking Inventory. RESULTS: clinical judgment was associated with diagnostic reasoning (r=0.313; p=0.046), as well as the "noticing" aspect of clinical judgment with diagnostic reasoning (r=0.312; p=0.047). CONCLUSIONS: the results show that skills to interpret patient data are associated with diagnostic reasoning skills. Teaching clinical judgment skills is necessary to develop the diagnostic reasoning of nursing students.

Documentation of the nursing process in public health institutions. / Documentação do processo de enfermagem em instituições públicas de saúde.

OBJECTIVE: To identify the prevalence of nursing process documentation in hospitals and outpatient clinics administered by the São Paulo State Department of Health. METHOD: A descriptive study conducted through interviews with nurses responsible for 416 sectors of 40 institutions on the documentation of four phases of the Nursing Process (data collection, diagnosis, prescription and evaluation) and nursing annotations. RESULTS: Of the 416 sectors studied, 89.9% documented at least one phase; 56.0% documented the four phases; 4.3% only documented nursing annotations; 5.8% did not document any phase, nor did the nursing notes. The types of sectors which were less documented were: ambulatory, diagnostic support, surgical center and obstetric center; while the ones which were most documented included: intensive care units, emergency rooms and hospitalization units. The data collection and diagnosis were the least documented phases, both in 78.8% of the sectors. CONCLUSION: Most of the studied sectors document the Nursing Process and do nursing annotations, but there are sectors where documentation does not meet formal requirements. The viability of documentation of all the Nursing Process phases in certain types of sectors needs to be better studied.

Evaluation of triage quality in the emergency department: a scoping review protocol.

REVIEW OBJECTIVE/QUESTIONS: The objective of this scoping review is to explore the existing literature on the evaluation of the quality of triage for patients of all ages and medical conditions in emergency departments (EDs).The question for this review is: How is triage in the ED evaluated? More specifically, we are interested in answering the following sub-questions.

Sensitivity and specificity of the Manchester Triage System in risk prioritization of patients with acute myocardial infarction who present with chest pain.

BACKGROUND: The purpose of the Manchester Triage System is to clinically prioritize each patient seeking care in an emergency department. Patients with suspected acute myocardial infarction who have typical symptoms including chest pain should be classified in the highest priority groups, requiring immediate medical assistance or care within 10 min. As such, the Manchester Triage System should present adequate sensitivity and specificity. AIMS: This study estimated the sensitivity and specificity of the Manchester Triage System in the triage of patients with chest pain related to the diagnosis of acute myocardial infarction, and the associations between the performance of the Manchester Triage System and selected variables. METHODS: This was an observational, analytical, cross-sectional, retrospective study. The sensitivity and specificity of the Manchester Triage System were estimated by verifying the triage classification received by these patients and their established medical diagnoses. RESULTS: The sample was composed of 10,087 triage episodes, in which 139 (1.38%) patients had a diagnosis of acute myocardial infarction. In 49 episodes, confirmation of medical diagnosis was not possible. The estimated sensitivity of the Manchester Triage System was 44.60% (36.18-53.27%) and the estimated specificity was 91.30% (90.73-91.85%). Of the 10,038 episodes in which the diagnosis of acute myocardial infarction was confirmed or excluded, 938 patients (9.34%) received an incorrect classification - undertriage or overtriage. CONCLUSION: This study showed that the specificity of the Manchester Triage System was very good. However, the low sensitivity based on the Manchester Triage System indicated that patients in high priority categories were undertriaged, leading to longer wait times and associated increased risks of adverse events.

Child Development: New Diagnoses for the NANDA International.

OBJECTIVE: The paper proposes new diagnoses on child development (CD) for NANDA International. METHODS: The study followed the recommended steps of Developmental Processes for NANDA International Nursing Diagnoses. It was a secondary analysis study on the findings of a concept analysis study on CD. RESULTS: A proposal of labels and components of three diagnoses: "Delayed child development," "Risk for delayed child development," and "Readiness for enhanced child development." CONCLUSIONS: The proposed diagnoses represent all the complexity of CD. IMPLICATIONS FOR NURSING PRACTICE: The proposed diagnoses can support nurses in the development of a comprehensive care plan on the health of children. OBJETIVO: propor novos diagnósticos de enfermagem para a NANDA-International que abordem o desenvolvimento infantil. MÉTODO: Este estudo seguiu as etapas recomendadas para o desenvolvimento de diagnósticos de enfermagem da NANDA-International. Foi realizado a partir dos resultados da análise de conceito do termo desenvolvimento infantil. RESULTADOS: Propostos os títulos e os componentes de três diagnósticos: "Atraso no desenvolvimento infantil," "Risco de atraso no desenvolvimento infantil," e "Disposição para desenvolvimento infantil melhorado." CONCLUSÕES: Os diagnósticos propostos contemplam toda a complexidade do desenvolvimento infantil. IMPLICAÇÕES PARA A PRÁTICA DE ENFERMAGEM: Os novos diagnósticos podem subsidiar o enfermeiro na elaboração de um plano de cuidados integrais à saúde da criança.

Non-pharmacological interventions for sleep and quality of life: a randomized pilot study.

OBJECTIVE: to estimate the effects of non-pharmacological interventions to improve the quality of sleep and quality of life of patients with heart failure. METHOD: pilot study of a randomized controlled trial with 32 individuals assigned to four groups. Sleep was assessed using the Pittsburgh Sleep Quality Inventory, while health-related quality of life was assessed using the Minnesota Living with Heart Failure Questionnaire, at the baseline and at the 12th and 24th weeks. The means of the outcomes according to intervention groups were compared using analysis of covariance; effect sizes were calculated per group. RESULTS: all groups experienced improved quality of sleep and health-related quality of life at the end of the intervention (week 12) and at follow-up (week 24), though differences were not statistically significant (p between 0.22 and 0.40). The effects of the interventions at the 12th week ranged between -2.1 and -3.8 for the quality of sleep and between -0.8 and -1.7 for quality of life, with similar values at the 24th week. CONCLUSION: the effects found in this study provide information for sample size calculations and statistical power for confirmatory studies. Brazilian Clinical Trials Registry - RBR 7jd2mm.