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Objetivo: analisar os fatores intervenientes na gerência do cuidado de enfermagem à criança hospitalizada com cardiopatia reumática. Método: estudo descritivo-exploratório com abordagem qualitativa, que utilizou a Teoria Fundamentada em Dados e o Interacionismo Simbólico, respectivamente, como referencial metodológico e teórico. A coleta de dados foi realizada em uma instituição especializada em atendimento cardiológico, no munícipio do Rio de Janeiro. Foram entrevistados 19 profissionais de enfermagem através de um roteiro semiestruturado. Resultado: emergiram os seguintes fatores intervenientes na prática da gerência do cuidado: condição socioeconômica da família, comportamento da criança, condições de trabalho, comunicação ineficaz, educação permanente, trabalho em equipe e experiência profissional. Conclusão: os resultados apontam para a necessidade de proposição de estratégias de ação e interação que facilitem a prática gerencial de cuidado à criança com cardiopatia reumática e sua família face aos fatores intervenientes identificados.
Objective: to analyze the factors involved in the management of nursing care for children hospitalized with rheumatic heart disease. Method: this is a descriptive-exploratory study with a qualitative approach, which used Data-Based Theory and Symbolic Interactionism, respectively, as methodological, and theoretical references. Data was collected in an institution specializing in cardiac care in the city of Rio de Janeiro. Nineteen nursing professionals were interviewed using a semi-structured script. Result: the following intervening factors in the practice of care management emerged: the family's socioeconomic status, the child's behavior, working conditions, ineffective communication, continuing education, teamwork, and professional experience. Conclusion: the results point to the need to propose strategies for action and interaction that facilitate management practice in caring for children with rheumatic heart disease and their families, given the intervening factors identified.
Objetivo: analizar los factores que intervienen en la gestión del cuidado de enfermería al niño hospitalizado con cardiopatía reumática. Método: estudio descriptivo-exploratorio con enfoque cualitativo, cuyos marcos metodológico y teórico fueron la Teoría Fundamentada y el Interaccionismo Simbólico, respectivamente. La recolección de datos se realizó en una institución especializada en atención cardiológica, en la ciudad de Río de Janeiro. Fueron entrevistados 19 profesionales de enfermería mediante un cuestionario semiestructurado. Resultado: surgieron los siguientes factores intervinientes en la práctica de la gestión del cuidado: condición socioeconómica de la familia, comportamiento del niño, condiciones de trabajo, comunicación ineficaz, educación continua, trabajo en equipo y experiencia profesional. Conclusión: los resultados indican que es necesario proponer estrategias de acción e interacción que faciliten la práctica de la gestión del cuidado al niño con cardiopatía reumática y a sus familiares, con respecto a los factores intervinientes identificados.
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Resumen Introducción : La planificación compartida de la atención (PCA) es un proceso reflexivo, deliberativo y estructurado. Involucra a la persona enferma y su en torno afectivo. Los profesionales sanitarios reconocen barreras para iniciar la PCA. La autoeficacia percibida es un principal predictor del éxito en los procesos de aprendizaje. Objetivos: 1) Adaptar transculturalmente la escala de autoeficacia percibida en PCA en español para Argentina (ACP-SEs); 2) Explorar la confiabilidad y la validez de la escala y 3) Explorar la autoeficacia en PCA en profesionales argentinos. Métodos : Estudio instrumental exploratorio realizado a profesionales de la salud que asisten pacientes con enfermedades crónicas avanzadas, interdisciplinarios, a través de una prueba de comprensión del instrumento ACP-SEs y la validación psicométrica en una muestra intencional de profesionales. Se analizaron variables sociodemográficas y la experiencia previa. Resultados : Luego de la prueba de comprensión y adaptación lingüística de la escala a través de un test cognitivo con 8 profesionales con experiencia con pa cientes crónicos avanzados se logró la versión de la escala ACP-SEs Ar. Participaron en la exploración 236 profesionales, el 83% asistía pacientes con enfermedad crónica avanzada; el 52.9% médicos; 52% recibió formación informal en PCA y 11% tenía un documento de directivas anticipadas personal. La consistencia interna de la escala fue alta (alfa de Cronbach = 0.89). Las preguntas sobre pronóstico, objetivos y preferencias de tratamiento, y reevaluación de los objetivos de cuidados mostraron diferencias sig nificativas entre médicos y no médicos. Conclusión : La escala ACP-SEs Ar demostró propie dades psicométricas adecuadas.
Abstract Introduction : Shared care planning (ACP) is a reflec tive, deliberative and structured process involving the sick person and his or her caring environment.Health professionals recognize barriers to initiating ACP.Per ceived self-efficacy is one of the main predictors of success in learning processes. Objectives: 1) To cross-culturally adapt the ACP self-efficacy scale in Spanish for Argentina (ACP-SEs); 2) To explore the reliability and validity of the scale; and 3) To explore self-efficacy in ACP in Argentinean professionals. Method : Exploratory instrumental study carried out on health professionals who assist patients with ad vanced chronic diseases, interdisciplinary through a comprehension test of the ACP-SEs instrument and psychometric validation in a purposive sample of pro fessionals. Sociodemographic variables and previous experience were analyzed. Results : After the comprehension test and linguistic adaptation of the scale through cognitive testing with eight professionals with experience with advanced chronic patients, the ACP-SEs Ar version of the scale was achieved. 236 professionals participated in the exploration, 83% attended patients with advanced chronic disease, 52.9 % were physicians, 52% received informal training in ACP, and 11% had a personal advance directive document. The scale's internal con sistency was high (Cronbach's alpha = 0.89). Questions about prognosis, treatment options, goals, treatment preferences, and reassessment of goals of care showed significant differences between physicians and non-physicians. Conclusion : We explored PCA self-efficacy in health professionals with the ACP-SEs Ar scale validated for the first time in Argentina.
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Introducción: La esclerosis lateral amiotrófica (ELA) es la forma más común de enfermedad degenerativa de motoneurona en la edad adulta y es considerada una enfermedad terminal. Por lo mismo, el accionar del fonoaudiólogo debe considerar el respeto a los principios bioéticos básicos para garantizar una asistencia adecuada. Objetivo: Conocer aquellas consideraciones bioéticas relacionadas al manejo y estudio de personas con ELA para luego brindar una aproximación hacia el quehacer fonoaudiológico. Método: Se efectuó una búsqueda bibliográfica en las bases de datos PubMed, Scopus y SciELO. Se filtraron artículos publicados desde 2000 hasta junio de 2023 y fueron seleccionados aquellos que abordaban algún componente bioético en población con ELA. Resultados: Aspectos relacionados al uso del consentimiento informado y a la toma de decisiones compartidas destacaron como elementos esenciales para apoyar la autonomía de las personas. Conclusión: Una correcta comunicación y una toma de decisiones compartida son claves para respetar la autonomía de las personas. A su vez, la estandarización de procedimientos mediante la investigación clínica permitirá aportar al cumplimiento de los principios bioéticos de beneficencia y no maleficencia, indispensables para la práctica profesional.
Introduction: Amyotrophic lateral sclerosis (ALS) is the most common form of degenerative motor neuron disease in adulthood and is considered a terminal disease. For this reason, the actions of the speech therapist must consider respect for basic bioethical principles to guarantee adequate assistance. Objective: To know those bioethical considerations related to the management and study of people with ALS to then provide an approach to speech therapy. Methodology: A bibliographic search was carried out in the PubMed, Scopus, and SciELO databases. Articles published from 2000 to June 2023 were filtered and those that addressed a bioethical component in the population with ALS were selected. Results: Aspects related to the use of informed consent and shared decision-making stood out as essential elements to support people's autonomy. Conclusion: Proper communication and shared decision-making are key to respecting people's autonomy. In turn, the standardization of procedures through clinical research will contribute to compliance with the bioethical principles of beneficence and non-maleficence, essential for professional practice.
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Abstract Introduction: The scientific literature supports the limited effect of the Advance Directives Document (ADD) in clinical decision-making. There are implementation barriers that prevent the fulfillment its purpose. The content of the ADD has not been explored in Colombia. Objective: To describe the contents of the ADD used in the pain and palliative care services. Methods: Cross-sectional study. Based on the national legislation and the rights that may be included in an ADD as described in the scientific literature, a checklist was designed with 20 variables to assess the forms, collecting data on the legal validity criteria and the contents for specific clinical and ethical directives. A predefined scale was used to describe the overall content of the form. Results: A total of 24 forms around the country were analyzed; the most comprehensive document included 14 of the 20 variables evaluated. In accordance with the definition used, 70 % of the forms had a maximum of 10 variables and were classified as "low content". Four forms were not formalized and only the forms formalized before the treating physician met the legal standard. 50 % of the forms included closed statements. Conclusions: The ADD forms exhibit a number of inadequacies in terms of the legal and clinical criteria for a high quality content, leading to difficulties for their applicability in the clinical setting. In Colombia, a standard form validated by the palliative care associations is required.
Resumen Introducción: La literatura científica respalda el limitado efecto del Documento de Voluntades Anticipadas (DVA) en las decisiones clínicas. Hay barreras en su implementación que impiden el cumplimiento de su propósito. En Colombia, el contenido de los formularios del DVA no ha sido explorado. Objetivo: Describir el contenido del formulario del DVA que se utiliza en los servicios de dolor y cuidado paliativo. Métodos: Estudio de corte transversal. Con base en la legislación nacional y los derechos descritos en la literatura científica que se pueden incluir en un DVA, se diseñó una lista de verificación con 20 variables para evaluar los formularios, extrayendo datos sobre los criterios de validez legal y de contenido para voluntades clínicas y éticas específicas. Se aplicó una escala predefinida para describir el contenido general del formulario. Resultados: Se analizaron 24 formularios en todo el país; el más completo tenía 14 variables de las 20 evaluadas. El 70 % de los formularios contenían un máximo de 10 variables, categorizadas como "Contenido bajo", de acuerdo con la definición aplicada. Cuatro formularios no tenían un tipo de formalización. Solo los formularios formalizados ante médico tratante cumplen la norma legal. El 50 % de los formularios contenían enunciados cerrados. Conclusiones: Los formularios de DVA presentan deficiencias en los criterios legales, éticos y clínicos para un contenido de alta calidad, lo que conlleva un problema para su aplicabilidad en el escenario clínico. En Colombia, se necesita un formulario estándar validado por las asociaciones médicas de cuidado paliativo.
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O objetivo no presente estudo foi avaliar o desempenho de discentes, que participaram do Programa de Monitoria no Curso de Odontologia da Universidade Federal de Juiz de Fora em disciplinas com práticas clínicas, em relação à construção do diagnóstico e plano de tratamento, comparando essas habilidades com as apresentadas por alunos não monitores. Para isso foi aplicado um questionário a 12 alunos que haviam participado do programa de monitoria em disciplinas com práticas clínicas e a 12 alunos não monitores. O questionário foi composto por seis questões sobre o perfil dos discentes monitores e a experiência desses alunos com o programa; e por três casos clínicos fictícios, que permitiram a avaliação da construção do diagnóstico e do plano de tratamento. As respostas das questões sobre o perfil dos discentes foram apresentadas em frequências absolutas e relativas. Testes t para amostras independentes foram utilizados para comparar as notas dos discentes monitores e não monitores para cada caso clínico. Os resultados obtidos mostraram que não houve diferença significativa entre os dois grupos avaliados nas pontuações obtidas pelas respostas aos casos clínicos. Dentre os motivos que levaram os discentes a participar dos programas de monitoria, destacam-se: "oportunidade de reforçar o conhecimento", "aumentar a pontuação do currículo" e "por causa da remuneração". O interesse pela docência foi a justificativa menos prevalente. Pode-se concluir que, mesmo queo resultado não tenha mostrado diferença entre os discentes, a prática da monitoria tem sido relevante, colaborando para o desenvolvimento de competências e habilidades que são indispensáveis à formação do cirurgião-dentista (AU).
El objetivo del presente estudio fue evaluar el desempeño de los estudiantes que participaron del Programa de Tutoría de la Carrera de Odontología de la Universidade Federal de Juiz de Foraen materias con prácticas clínicas, en relación a la construcción del plan dediagnóstico y tratamiento, comparando estas habilidades con las presentadas por estudiantes no tutores. Para ello se aplicó un cuestionario a 12 estudiantes que habían participado en el programa de tutoría en asignaturas con prácticas clínicas y a 12 estudiantes no tutores. El cuestionario constaba de seis preguntas sobre el perfil de los estudiantes tutores y su experiencia con el programa; y tres casos clínicos ficticios, que permitieron evaluar la construcción del diagnóstico y plan de tratamiento. Las respuestas a las preguntas sobre el perfil de los estudiantes se presentaron en frecuencias absolutas y relativas. Se utilizaron pruebas T para muestras independientes para comparar las puntuaciones de los estudiantes tutores y no tutores para cada caso clínico. Los resultados obtenidos mostraron que no hubo diferencia significativa entre los dos grupos evaluados en las puntuaciones obtenidas de las respuestas a los casos clínicos. Entre los motivos que llevaron a los estudiantes a participar en programasde tutoría destacan: "oportunidad de reforzar conocimientos", "aumentar la puntuación del currículo" y "por la remuneración". El interés por la enseñanza fue la justificación menos frecuente. Se puede concluir que, si bien el resultado no mostró diferencia entre los estudiantes, la práctica de tutoría ha sido relevante, contribuyendo al desarrollo de habilidades y habilidades esenciales para la formación de los cirujanos dentistas (AU).
The aim of the present study was to evaluate the performance of students, who participated in the Monitoring Program of the Dentistry Course at the Federal University of Juiz de Fora, in subjects with clinical practices, relative to construction of the diagnosis and treatment plan, to compare these skills with those presented by non-monitor students. For this purpose, a questionnaire was applied to 12 students who had participated in the monitoring program in subjects with clinical practices, and to 12 students who werenot monitors. The questionnaire consisted of six questions about the profile of student monitors and their experience with the program; and three fictitious clinical cases that allowed evaluation of the construction of the diagnosis and treatment plan. The answers to the questions about the students' profile were presented in absolute and relative frequencies. For each clinical case, T-tests for independent samples were used to compare the scores of student monitors and students who were not monitors. The results obtained showed that there was no significant difference between the two groups evaluated, relative to the scores attributed to the responses to the clinical cases. Among the reasons that led students to participating in monitoring programs, the following were outstanding: "opportunity to reinforce knowledge", "increase the CV score" and "because of the remuneration". Interest in teaching was the least prevalent justification. It can be concluded that although the result did not show a difference between students, the practice of monitoring has been relevant, by contributing to the development of skills and abilities that are essential to the training of dental surgeons (AU).
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Humans , Patient Care Planning , Students, Dental , Health Knowledge, Attitudes, Practice , Mentoring , Cross-Sectional Studies/methods , Surveys and Questionnaires , Statistics, NonparametricABSTRACT
Advance care planning(ACP)is designed to ensure that patients lacking autonomous decision-making capacity receive medical services in accordance with their expectations and preferences.Individuals with advanced cancer are a crucial target for ACP implementation.However,the current practice of ACP in this group in China is suboptimal,demanding high-quality implementation evidence to strengthen ACP in the clinical practice of patients with advanced cancer.The existing literature can be summarized into 27 pieces of evidence across 7 dimensions,including initiation time,intervention content,intervention providers,intervention modalities,communication skills,outcome indicators,and environmental support.The aforementioned evidence could provide crucial support for improving ACP implementation for patients with advanced cancer.Subsequent research efforts should integrate patient preferences and explore the most suitable implementation strategies for ACP in the Chinese population with advanced cancer,considering diverse aspects such as traditional culture,ACP education and training,legislative support,and healthcare system refinement.
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Objective:To explore the barrier factors in the implementation of advance care planning for critically ill and end-life patients in China. Provide reference for the implementation of advance care planning in critically ill and end-life patients in China.Methods:The literature from CNKI, Chinese Biomedical Literature Database, Wanfang database, VIP, PubMed and Web of Science database on the implementation of advance care planning for critically ill and end-life patients in China were searched. The search deadline was from database establishment to January 15, 2023. To analyze the literature meeting the inclusion and exclusion criteria.Results:A total of 18 literatures were included, and the barrier factors to the implementation of advance care planning for critically ill and end-life patients in China included six categories (27 types): social and cultural factors (4 types), patient factors (4 types), family factors (5 types), medical staff factors (8 types), interpersonal interaction factors (4 types), policy and legal factors (2 types).Conclusions:The implementation of advance care planning for critically ill and end-life patients in China is affected by a variety of barrier factors. The improvement measures should be formulated according to the modifiable barrier factors to promote the implementation of advance medical care plan for critically ill and end-life patients in China.
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Objectives: There are known barriers to advance care planning practices for both health care providers and patients. Since physicians were the main occupations that introduce ACP, the goal of this study was to clarify where the difficulties were felt in the practice of ACP by looking back on the practice of physicians who were working in a designated cancer hospital. Methods: Semi-structured interviews were conducted with 10 physicians who were recommended by the palliative care team as physicians who clinically practice ACP for cancer patients. Interviews were transcribed verbatim, coded, and analyzed using content analysis by Graneheim et al. Results: We finally classified into 6 major categories as follows: Insufficient readiness of patients/Insufficient readiness of medical staff/Discrepancy in communication/Lack of evaluation index of ACP/Dilemma with professional ethics. Conclusion: Patients and health care providers each lacked readiness for ACP, and physicians found it difficult due to the resulting communication discrepancies and lack of colleagues with whom they could collaborate.
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Introduction: Epileptic patients have a higher risk of death than healthy individuals. Advance care planning (ACP) is also important for epileptic patients, but is not well recognized. We experienced two cases in which ACP was performed by family and medical staff for epileptic patients with intellectual disability. Case1: The patient was a 29-year-old male. It was important to continue spending his daily life as he currently did. Although his family wanted to provide palliative care at the end of life, there were no decisions about which medical interventions may not work at his end of life. It was decided that the family and medical staff would continue to make shared decision making. Case2: The patient was an 18-year-old female. It was important to continue spending her daily life as she currently did. Her family and medical team decided to provide palliative care at the end of life. Based on the opinions of the family members in both cases, the importance and widespread use of ACP in epileptic patients were obtained. Conclusions: ACP enabled families and medical staff to make shared decisions about what is best for epileptic patients with intellectual disability. ACP for epileptic patients seems to need to be promoted.
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Discussing the cognition, attitude and influencing factors of the family members of organ donors towards advance care planning (ACP) to provide a basis for the further promotion of ACP in the field of organ donation. Using qualitative research methods, 8 family members of organ donors were selected purposefully for semi-structured interviews, and the 7-step of Colaizzi was used to analyze and summarize the themes of the interview data. The results showed that the cognition status of the family members of organ donors of ACP could be summarized into 3 themes: problems faced by ACP implementation, positive recognition of the implementation of ACP, factors affecting the promotion of ACP. Organ donors’ family members are unfamiliar with the concept of ACP and have unclear cognition, but think that the implementation of ACP is of positive significance. It is suggested to further strengthen the publicity of ACP, medical autonomy, death education, so as to promote the development of ACP and improve the willing to donate organ.
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Resumo Objetivo O objetivo do estudo foi determinar a relação entre a dependência de cuidados pré-operatórios e a qualidade de recuperação no pós-operatório de pacientes submetidos à cirurgia. Métodos A amostra do estudo descritivo, transversal e correlacional foi composta por 215 pacientes. Um formulário de informações do paciente, a Care Dependency Scale e o questionário Quality of Recovery-40 item foram aplicados aos pacientes usando a técnica de entrevista face a face para a coleta de dados entre junho e dezembro de 2018. A ferramenta Strengthening the Reporting of Observational Studies in Epidemiology foi utilizada neste estudo. Resultados Houve uma diferença estatisticamente significativa entre as pontuações médias da Care Dependency Scale e do Quality of Recovery-40 item Scale dos pacientes e seus domínios conforto físico, independência física e dor em termos de faixas etárias e sexo (p<0,05). Foi encontrada uma correlação positiva e moderada entre a dependência de cuidados dos pacientes e a independência física. Conclusão Quando o nível de dependência de cuidados diminuiu, os pacientes precisaram de menos assistência durante a recuperação no período pós-operatório, pois conseguiram realizar suas atividades diárias de forma independente.
Resumen Objetivo El objetivo del estudio fue determinar la relación entre la dependencia de cuidados preoperatorios y calidad de recuperación en el posoperatorio de pacientes sometidos a cirugía. Métodos La muestra del estudio descriptivo, transversal y correlacional estuvo compuesta por 215 pacientes. Se aplicó a los pacientes un formulario de información del paciente, la Care Dependency Scale y el cuestionario Quality of Recovery-40 item, mediante la técnica de entrevista cara a cara para la recopilación de datos, entre junio y diciembre de 2018. Se utilizó la herramienta Strengthening the Reporting of Observational Studies in Epidemiology en este estudio. Resultados Hubo una diferencia estadísticamente significativa entre el puntaje promedio de la Care Dependency Scale y del Quality of Recovery-40 item Scale de los pacientes y los dominios bienestar físico, independencia física y dolor en términos de grupos de edad y sexo (p<0,05). Se observó una correlación positiva y moderada entre la dependencia de cuidados de los pacientes y la independencia física. Conclusión Cuando el nivel de dependencia de cuidados disminuyó, los pacientes necesitaron menos atención durante la recuperación en el período posoperatorio, ya que pudieron realizar sus actividades diarias de forma independiente.
Abstract Objective The purpose of the study was to determine the relationship between preoperative care dependency and postoperative quality of recovery in patients undergoing surgery. Methods The sample of the descriptive, cross-sectional and correlational study consisted of 215 patients. A Patient Information Form, the Care Dependency Scale and the Recovery Quality-40 Scale were applied to the patients through face-to-face interview technique in order to collect the data between June and December 2018. This study adhered to Strengthening the Reporting of Observational Studies in Epidemiology guidelines. Results There was a statistically significant difference between Care Dependency Scale and the Recovery Quality-40 Scale mean scores of the patients and their physical comfort, physical independence, and pain in terms of age groups and genders (p<.05). A positive and moderate correlation was found between the patients' care dependency and physical independence. Conclusion It was observed that when the care dependency level decreased, the patients needed less assistance throughout the postoperative recovery period, as they were able to carry out their daily activities independently.
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Resumo Objetivo Mapear a produção científica sobre cuidados de enfermagem a pessoas com pé diabético na atenção primária à saúde. Métodos Esta revisão de escopo foi realizada no período de outubro-dezembro de 2022. Nela, foram usadas a metodologia do Joanna Briggs Institute e as seguintes fontes de informação: PubMed, CINAHL, Web of Science, Scopus, BDENF, LILACS e SciELO, artigos nos idiomas Inglês, Português e Espanhol. Os textos foram exportados para o aplicativo Rayyan, sendo suprimidos os duplicados. Resultados Foram identificados 334 estudos; após remoção de duplicatas, 318 deles permaneceram para seleção por títulos e resumos. Nesta etapa, 235 estudos foram excluídos pois não atendiam aos critérios pré-estabelecidos, resultando em 81 estudos para avaliação em texto completo. Nesta revisão, 14 deles foram selecionados, identificando pessoas com pé diabético como os principais cuidados de enfermagem na atenção primária à saúde: exame dos pés, educação em saúde sobre cuidados com os pés, cuidados com a ferida, controle glicêmico, visita domiciliar e encaminhamento ao serviço especializado de pessoas com pé diabético. Conclusão Evidências sobre cuidados de enfermagem a pessoas com pé diabético na atenção primária à saúde foram mapeadas e a análise mostrou que esta condição é complexa e multidimensional.
Resumen Objetivo Mapear la producción científica sobre los cuidados de enfermería a personas con pie diabético en la atención primaria de salud. Métodos Esta revisión de alcance se realizó durante el período de octubre a diciembre de 2022. Se utilizó la metodología del Joanna Briggs Institute y las siguientes fuentes de información: PubMed, CINAHL, Web of Science, Scopus, BDENF, LILACS y SciELO, artículos en los idiomas inglés, portugués y español. Los textos se exportaron a la aplicación Rayyan y se eliminaron los duplicados. Resultados Se identificaron 334 estudios. Luego de eliminar los duplicados, quedaron 318 para la selección por títulos y resúmenes. En esta etapa, se excluyeron 235 estudios que no cumplían con los criterios prestablecidos y quedaron 81 estudios para el análisis del texto completo. En esta revisión, se seleccionaron 14 artículos, donde se identificaron personas con pie diabético. Los principales cuidados de enfermería en la atención primaria de salud fueron: examen de pies, educación para la salud sobre cuidados de los pies, cuidados de las heridas, control glucémico, visita domiciliaria y derivación al servicio especializado de personas con pie diabético. Conclusión Se mapearon evidencias sobre cuidados de enfermería a personas con pie diabético en la atención primaria de salud y el análisis demostró que esta condición es compleja y multidimensional.
Abstract Objective To map scientific production on nursing care for people with diabetic foot in primary health care. Methods This scoping review was carried out between October and December 2022. In it, the Joanna Briggs Institute methodology and the following sources of information were used: PubMed, CINAHL, Web of Science, Scopus, BDENF, LILACS and SciELO, articles were written in English, Portuguese and Spanish. The texts were exported to the Rayyan application, and duplicates were removed. Results 334 studies were identified; after removing duplicates, 318 of them remained for selection by titles and abstracts. At this stage, 235 studies were excluded as they did not meet the pre-established criteria, resulting in 81 studies for full text evaluation. In this review, 14 of them were selected, identifying people with diabetic foot as the main nursing care in primary health care: foot examination, health education on foot care, wound care, glycemic control, home visit and referral for specialized service for people with diabetic foot. Conclusion Evidence on nursing care for people with diabetic foot in primary health care was mapped and the analysis showed that this condition is complex and multidimensional.
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ABSTRACT Objective: to develop a theoretical model on the nursing care management for hospitalized children with rheumatic heart disease. Method: a qualitative study developed in light of the theoretical and methodological frameworks, respectively, Symbolic Interactionism and Data Grounded Theory. Nineteen nursing professionals participated in the study, divided into two sample groups. Data were collected through semi-structured interviews, and were analyzed follow the coding stages: open, axial, and integration. Results: the theoretical model identifies the central category/phenomenon: nursing care management for hospitalized children with rheumatic heart disease and their families. It reveals both direct and indirect care provided to the child and family, as well as action/interaction strategies within interprofessional relationships, relationships with the child and family, and their consequences in symbolic care interactions. Conclusion: the theoretical model aids in understanding nursing care management practices for hospitalized children with rheumatic heart disease, serving as an action guide for nursing professionals to enhance the quality of life for the child and family within ethical and technical professional boundaries.
RESUMEN Objetivo: desarrollar un modelo teórico sobre la gestión del cuidado de enfermería al niño hospitalizado con cardiopatía reumática. Método: estudio cualitativo desarrollado a la luz de los referentes teóricos y metodológicos, respectivamente, el Interaccionismo Simbólico y la Teoría Basada en Datos. Participaron de la investigación 19 profesionales de enfermería, organizados en dos grupos muestreo. Los datos fueron recolectados a través de entrevistas semiestructuradas y analizados siguiendo las etapas de codificación: abierta, axial e integración. Resultados: el modelo teórico presenta como categoría/fenómeno central la gestión del cuidado de enfermería al niño hospitalizado con cardiopatía reumática y su familia. Se revelan los cuidados directos e indirectos desarrollados con los niños y sus familias, así como estrategias de acción/interacción en el ámbito de las relaciones interprofesionales, las relaciones con el niño y la familia, y sus consecuencias en las interacciones simbólicas de cuidado. Conclusión: el modelo teórico permite comprender la práctica de gestión del cuidado de enfermería al niño hospitalizado con cardiopatía reumática, y sirve como guía de acción para que los profesionales de enfermería, dentro de los límites éticos y técnicos de su práctica profesional, contribuyan a la promoción de calidad de vida del niño y su familia.
RESUMO Objetivo: elaborar um modelo teórico sobre a gerência do cuidado de enfermagem à criança hospitalizada com cardiopatia reumática. Método: estudo qualitativo desenvolvido à luz dos referenciais teórico e metodológico, respectivamente, Interacionismo Simbólico e Teoria Fundamentada em Dados. Participaram da pesquisa 19 profissionais de enfermagem, organizados em dois grupos amostrais. Os dados foram coletados por meio da entrevista semiestruturada e foram analisados seguindo as etapas de codificação: aberta, axial e integração. Resultados: o modelo teórico apresenta como categoria/fenômeno central: gerência do cuidado de enfermagem à criança hospitalizada com cardiopatia reumática e sua família. São revelados os cuidados diretos e indiretos desenvolvidos junto à criança e seus familiares, bem como as estratégias de ação/interação no âmbito das relações interprofissionais, relações com a criança e com a família, e suas consequências nas interações simbólicas de cuidado. Conclusão: o modelo teórico possibilita compreender a prática da gerência do cuidado de enfermagem à criança hospitalizada com cardiopatia reumática, conformando-se como guia de ação para que profissionais de enfermagem, nos limites éticos e técnicos de seu exercício profissional, contribuam para a promoção da qualidade de vida da criança e sua família.
ABSTRACT
Abstract Objective: to analyze the reliability of the items that compose the instrument for classifying newborns according to the degree of dependence on nursing care in a neonatal intensive care unit. Method: methodological study that analyzed the agreement and reliability of the instrument in a neonatal intensive care unit. Six care nurses and a research nurse assessed 35 newborns and completed the instrument, which was made up of 15 areas of care. The weighted Kappa coefficient and the Intraclass Correlation Coefficient were used for analysis. Results: the areas of: weight (92%), oxygenation (93%) and catheter control (95%) had almost perfect agreement and the area of reaction to stimuli (50%) had poor agreement. The areas of elimination and vital signs showed low reliability, due to the low variability of responses. The Intraclass Correlation Coefficient was 0.94. Conclusion: there are variations in the evaluations of some areas of care due to the imprecise description of items to which scores are assigned, however the instrument is reliable for categorizing the type of care (minimal, intermediate and intensive). Its use can contribute to measuring the quality and safety of newborn care.
Resumo Objetivo: analisar a confiabilidade dos itens que compõem o instrumento para classificação de recém-nascido de acordo com o grau de dependência dos cuidados de enfermagem em uma unidade de terapia intensiva neonatal. Método: estudo metodológico que analisou a concordância e a confiança do instrumento em uma unidade de terapia intensiva neonatal. Seis enfermeiros assistenciais e uma enfermeira pesquisadora avaliaram 35 recém-nascidos e preencheram o instrumento, composto por 15 áreas de cuidado. O coeficiente Kappa ponderado e o Coeficiente de Correlação Intraclasse foram utilizados para análise. Resultados: as áreas peso (92%), oxigenação (93%) e controle de cateteres (95%) obtiveram concordância quase perfeita, e a área reação a estímulos (50%) obteve concordância fraca. As áreas eliminações e sinais vitais apresentaram baixa confiabilidade, devido à pouca variabilidade de respostas. O Coeficiente de Correlação Intraclasse foi de 0,94. Conclusão: há variações nas avaliações de algumas áreas de cuidado devido à descrição imprecisa de itens aos quais são atribuídos escores, entretanto, o instrumento é confiável para categorização do tipo de cuidado (mínimo, intermediário e intensivo). Sua utilização pode contribuir para o dimensionamento de qualidade e para a segurança da assistência ao recém-nascido.
Resumen Objetivo: analizar la confiabilidad de los ítems que componen el instrumento para clasificación de recién nacido de acuerdo con el grado de dependencia de los cuidados de enfermería en una unidad de terapia de cuidados intensivos neonatal. Método: estudio metodológico que analizó la concordancia y la confianza del instrumento en una unidad de terapia de cuidados intensivos neonatal. Seis enfermeros asistenciales y una enfermera investigadora evaluaron 35 recién nacidos y completaron el instrumento, compuesto por 15 áreas de cuidado. El coeficiente Kappa ponderado y el Coeficiente de Correlación Intraclase fueron utilizados para el análisis. Resultados: las áreas peso (92%), oxigenación (93%) y control de catéteres (95%) obtuvieron una concordancia casi perfecta y el área reacción a estímulos (50%) obtuvo una concordancia débil. Las áreas eliminaciones y signos vitales presentaron baja confiabilidad, debido a la poca variabilidad de respuestas. El Coeficiente de Correlación Intraclase fue de 0,94. Conclusión: hay variaciones en las evaluaciones de algunas áreas de cuidado debido a la descripción imprecisa de ítems a los cuales se les atribuyen puntuaciones, sin embargo, el instrumento es confiable para la categorización del tipo de cuidado (mínimo, intermedio e intensivo). Su utilización puede contribuir a la planificación de calidad y a la seguridad de la atención al recién nacido.
Subject(s)
Humans , Patient Care Planning , Health Evaluation , Intensive Care Units, Neonatal , Neonatal Nursing , Validation Study , Nursing CareABSTRACT
Abstract Objective: Dentistry from the Universidade Federal de Alfenas who were enrolled in the seventh period and who took the Integrated Clinic I Discipline (ICID) in the emergency remote learning model (ERLM). Material and Methods: This is a qualitative and descriptive study. The information was collected through questionnaires applied by the Professors during the ICID. Subsequently, the professor evaluated the treatment developed in virtual form by each student regarding its logical sequence and the most appropriate treatment for each case. The results of the answers were transcribed and submitted to lexicographical textual, Descending Hierarchical Classification, and Similitude analysis in the Interface de R pour les Analyses Multidimensionnelles de Textes et de Questionnaires (IRAMUTEQ) program. Results: The students described the online situational treatment planning in five essential steps: adequacy of the oral environment, restorative need, prosthetic need, rehabilitation by prosthesis on the implant, and corrective orthodontic treatment. Conclusion: It was observed that the students who enrolled in ICID presented well-integrated planning during ERLM, despite the COVID-19 pandemic hindering these students' contact between theoretical teaching and the integrated practices in dentistry offered by the educational institution.
Subject(s)
Humans , Male , Female , Students, Dental , Health Knowledge, Attitudes, Practice , Dental Clinics , Qualitative Research , Surveys and QuestionnairesABSTRACT
La prevalencia de personas con demencias ha aumentado progresivamente y actualmente constituye un desafío en salud pública. Además de fortalecer las herramientas necesarias para su diagnóstico y tratamiento, es necesario desarrollar estrategias que promuevan el respeto de quienes la padecen y mejorar su participación social. El deterioro cognitivo interfiere progresivamente en la toma de decisiones, especialmente en la etapa final de la enfermedad, generando conflictos en torno al respeto por la autonomía y la atención clínica. Las Voluntades Anticipadas y la Planificación Anticipada de Cuidados ofrece la oportunidad de reflexionar sobre valores, deseos y preferencias de atención a futuro, así como la posibilidad de comunicarlos a familiares y equipos de atención, promoviendo el respeto por la autonomía y disminuyendo los conflictos asociados a la atención, especialmente en la etapa terminal. En Chile se ha avanzado progresivamente, pero aun es un desafío implementar las estrategias para consolidar este proceso, superando las barreras existentes y potenciando sus beneficios.
The prevalence of people with dementia has progressively increased and currently constitutes a public health challenge. In addition, to strengthening the necessary tools for diagnosis and treatment, it is essential to develop strategies that promote respect for those who suffer from it and improve their social participation. Cognitive impairment progressively interferes with decision-making, especially in the final stages of the disease, generating conflicts regarding autonomy and clinical care. Advance Directives and Advance Care Planning offer the opportunity to reflect on values, desires, and future care preferences, as well as the possibility to communicate them to family members and care teams, promoting respect for autonomy and reducing conflicts associated with care, especially in the terminal stage. In Chile, there has been gradual progress, but it is still a challenge to implement the strategies to consolidate this process, overcoming existing barriers and maximizing its benefits.
ABSTRACT
La adecuación del esfuerzo terapéutico reemplaza la expresión limitación terapéutica y se define como la decisión de no iniciar medidas diagnósticas y terapéuticas o de suspenderlas en respuesta a la condición del paciente, para evitar conductas potencialmente inapropiadas y redireccionar los objetivos de tratamiento hacia el confort y el bienestar. En la población pediátrica, esta decisión es aún más desafiante debido a la naturaleza de la relación médico-paciente-familia y a la escasez de guías que orienten su implementación. La adecuación del esfuerzo terapéutico está enmarcada en principios éticos y legales, pero existen diversos retos a nivel práctico. Cada proceso de adecuación es único y dinámico, y debe abordarse contemplando a quién realizarlo, cuándo, cómo y con qué medidas.
The term "therapeutic limitation" has been replaced by "adequacy of therapeutic effort" and is defined as the decision to withhold or withdraw diagnostic and therapeutic measures in response to the patient's condition, avoiding potentially inappropriate behaviors and redirectong treatment goals towards comfort and well-being. In the pediatric population, this decision is even more challenging given the nature of the physician-patient-family relationship and the paucity of guidelines to address treatment goals. The adequacy of therapeutic effort is framed by ethical and legal principles, but, in practice, there are several challenges. Each adequacy process is unique and dynamic, and should be addressed by taking into account with what measures, how, when, and in whom it should be implemented
Subject(s)
Humans , Physician-Patient Relations , Withholding Treatment , Decision MakingABSTRACT
Objetivo: avaliar os fatores associados ao autocuidado praticado por pessoas com estomias de eliminação. Método: estudo transversal analítico, baseado nas respostas de 153 pessoas com estomia de eliminação, atendidas em um ambulatório de referência no cuidado de pessoas com estomas, no município de Teresina. A coleta de dados ocorreu por meio de um formulário semiestruturado com dados demográficos e acerca do autocuidado. Os dados foram analisados mediante estatística descritiva e inferencial. O teste Qui-quadrado de Pearson foi utilizado na análise inferencial. Resultados: o esvaziamento da bolsa, limpeza do estoma, secagem da pele periestoma, descolamento da placa, medição do estoma, realização do molde, adaptação, autoestima e isolamento social apresentaram associação significativa com o autocuidado (p<0,05). Conclusão: evidenciou-se que os fatores associados ao autocuidado foram os cuidados com o estoma e com o equipamento coletor, além dos impactos na autoestima e na vida social(AU)
Objective: to evaluate the factors associated with self-care practiced by people with elimination stomas. Method: analytical cross-sectional study, based on the responses of 153 people with elimination stoma, treated at a reference outpatient clinic for the care of people with stoma, in the city of Teresina. Data collection took place through a semi-structured form with demographic data and about self-care. Analyzes were performed using inferential statistics, using the chi-square test. Results: Emptying the pouch, cleaning the stoma, drying the peristomal skin, detaching the plaque, measuring the stoma, making the mold, fitting, , self-esteem and social isolation were significantly associated with self-care (p<0.05). Conclusion: it was evident that the factors associated with self-care were care for the stoma and the collection equipment, in addition to the impacts on self-esteem and social life(AU)
Objetivo: evaluar los factores asociados al autocuidado practicado por personas con estomas de eliminación. Método: estudio transversal analítico, basado en las respuestas de 153 personas con estoma de eliminación, atendidos en un ambulatorio de referencia para la atención de personas con estoma, en la ciudad de Teresina. Se realizó la recolección de datos a través de un formulario semiestructurado con datos demográficos y sobre autocuidado. Los datos se analizaron utilizando estadística descriptiva e inferencial, utilizando la prueba Chi-cuadrado de Pearson. Resultados: vaciar la bolsa, limpiar la estoma, secar la piel periestomal, despegar la placa, medir la estoma, hacer el molde, adaptarlo, vaciar la bolsa, la autoestima y el aislamiento social se asociaron significativamente con el autocuidado (p<0,05). Conclusión: se evidenció que los factores asociados al autocuidado fueron el cuidado de la estoma y del equipo de recolección, además de los impactos en la autoestima y la vida social(AU)
Subject(s)
Humans , Male , Female , Adult , Middle Aged , Aged , Self Care , Self Concept , Adaptation, Psychological , Surgical Stomas , Chi-Square Distribution , Cross-Sectional Studies , Statistical InferenceABSTRACT
ABSTRACT BACKGROUND AND OBJECTIVES: Social isolation, as experienced in the context of the COVID-19 pandemic, has triggered psychological and neuropsychiatric problems; these conditions can aggravate chronic pain crises. It is also known that social relationships play an important role in pain and emotions. Chronic pain (CP) is a challenging disease, especially in terms of its multifaceted mechanisms and treatment. Thus, the aim of this study was to provide a better understanding of nurses' work with patients with CP and the impact of social isolation resulting from the COVID-19 pandemic. CONTENTS: This is an integrative review, carried out in the Virtual Health Library (Biblioteca Virtual em Saúde - BVS) and Medline via Pubmed databases of the National Library of Medicine. To select the articles, the following descriptors in health sciences and Medical Subject Headings (DeCS/MeSh) were considered: "Social isolation", "Chronic pain", "COVID-19", "Nursing care" and "Patient care planning", with their synonyms/alternative terms. A total of 45,703 articles were found; based on the inclusion and exclusion criteria, 27 articles were selected. This study hoped to answer the following guiding questions: "how do nurses work with individuals with CP during the social isolation caused by COVID-19?", and "what are the consequences of social isolation for this population due to the COVID-19 pandemic?". Of the 27 articles, most were published in North America and Europe, and three in Brazil. The population most affected by CP are seniors, women and people on low incomes. In terms of profession, only three of the 27 articles were published by nurses. The data was discussed considering the work of nurses with individuals with CP, especially through telehealth, as well as the impacts that people with CP have suffered from social isolation during the coronavirus pandemic. CONCLUSION: There is a significant gap in the literature regarding the role of nurses with individuals with CP in social isolation, suggesting the need for further studies in this area, mainly at the national level. From the studies found, it was evidenced that individuals who live with CP have the multiple dimensions of the human being affected, but that in this moment of social isolation due to the COVID-19 pandemic, the worst commitment was the emotional one. Thus, with the continued rise of telehealth and the possibility of future pandemics, it is recommended to move the existing guidelines for the formal development of telehealth competencies towards relevant curricular content and clinical experience for all nursing programs.
RESUMO JUSTIFICATIVA E OBJETIVOS: O isolamento social, como vivenciado no contexto da pandemia da COVID-19, desencadeou problemas psicológicos e neuropsiquiátricos; essas condições podem agravar as crises de dor crônicas. Além disso, é sabido que as relações sociais têm um papel importante na dor e nas emoções. A dor crônica (DC) apresenta-se como uma doença desafiadora, sobretudo quanto aos seus mecanismos multifacetados e ao seu tratamento. Assim, o objetivo do presente estudo foi trazer uma maior compreensão da atuação do enfermeiro nos pacientes com DC e do impacto do isolamento social decorrente da pandemia da COVID-19. CONTEÚDO: Trata-se de uma revisão integrativa, realizada nas bases de dados Biblioteca Virtual em Saúde (BVS) e Medline via Pubmed da National Library of Medicine. Para a seleção dos artigos foram considerados os descritores em ciências da saúde e Medical Subject Headings (DeCS/MeSh): "Isolamento social", "Dor crônica", "COVID-19", "Cuidados de enfermagem" e "Planejamento de assistência ao paciente", com os seus sinônimos/termos alternativos. Foram encontrados 45.703 artigos; a partir dos critérios de inclusão e exclusão, foram selecionados 27 artigos. Este estudo esperou responder às seguintes perguntas norteadoras: "qual a atuação do enfermeiro com o indivíduo com DC durante o isolamento social da COVID-19?", e "quais as consequências do isolamento social devido à pandemia da COVID-19 para essa população?". Dos 27 artigos, a maior parte foi publicada na América do Norte e Europa, e três no Brasil. A população mais afetada pela DC são idosos, mulheres e pessoas de baixa renda. Em relação à profissão, dos 27 artigos somente três foram publicados por enfermeiros. Os dados foram discutidos considerando a atuação do enfermeiro para com o indivíduo com DC, em especial por meio da telessaúde, bem como os impactos que as pessoas com DC sofreram com o isolamento social durante a pandemia do novo coronavírus. CONCLUSÃO: Há uma significativa lacuna na literatura no que tange à atuação do enfermeiro com indivíduos com DC em isolamento social, sugerindo a necessidade de maiores estudos nessa área, principalmente a nível nacional. Nos estudos encontrados, foi evidenciado que indivíduos que vivem com DC possuem as múltiplas dimensões humanas afetadas, mas nesse momento de isolamento social devido à pandemia da COVID-19 a dimensão de pior comprometimento foi a emocional. Assim, com o aumento contínuo da telessaúde e a possibilidade de futuras pandemias, recomenda-se mover as diretrizes existentes para o desenvolvimento formal de competências da telessaúde por conteúdo curricular relevante e experiência clínica para todos os programas de enfermagem.