RESUMEN
BACKGROUND: Parent and infant separation in the neonatal unit is associated with adverse health outcomes. Family-integrated care has several advantages and the potential to reduce these adverse outcomes but requires parental presence. This study aimed to explore the views of parents and neonatal healthcare professionals (nHCPs) on barriers and facilitators to parental presence in a Swiss neonatal unit and to identify possible differences between nHCPs and parents, and between mothers and fathers. METHODS: Data were collected through semi-structured interviews with parents and focus group discussions with nHCPs. Inductive content analysis was used to identify barriers and facilitators to parental presence in the neonatal unit. RESULTS: Twenty parents (10 mothers and 10 fathers) and 21 nHCPs (10 nurses and 11 physicians) participated in the study. Parents and nHCPs experienced barriers and facilitators related to: (1) Structural factors of the institution, such as infrastructure or travel and distance to the neonatal unit. (2) Organization and time management of parental presence, daily activities, and work. (3) Resources, which include factors related to the legal situation, support services, family, and friends. (4) Physical and psychological aspects, such as pain, which mainly affected mothers, and aspects of emotional distress, which affected both parents. Self-care was an important physical and psychological facilitator. (5) Parent-professional interaction. Parental presence was influenced by communication, relationship, and interaction in infant care; and (6) Cultural aspects and language. Some perspectives differed between mothers and fathers, while the overall views of parents and nHCPs provided complementary rather than conflicting insights. Using visit plans to support the organization, educating nHCPs in knowledge skills and available resources to improve encouragement and information to parents, strengthening parent self-care, and improving nHCPs' attitudes towards parental presence were seen as possible improvements. CONCLUSIONS: Multifactorial barriers and facilitators determine parental presence and experience in the neonatal unit. Parents and nHCPs made specific recommendations to improve parental presence.
Asunto(s)
Actitud del Personal de Salud , Grupos Focales , Unidades de Cuidado Intensivo Neonatal , Padres , Investigación Cualitativa , Humanos , Femenino , Masculino , Recién Nacido , Padres/psicología , Adulto , Suiza , Relaciones Profesional-Familia , Entrevistas como AsuntoRESUMEN
AIM: The effect of different neonatal unit access hour policies on parental visiting duration is unknown. Therefore, we analysed the effects of access hours policies and parental education on parental visiting duration. METHOD: This prospective longitudinal cohort study was carried out in a level III neonatal unit from October 2020 to May 2022. Three cohorts were compared. The baseline cohort included 51 preterm infants with restricted visiting hours (October 2020 to May 2021). Cohort 1 comprised 35 preterm infants after liberalisation of visiting hours (June 2021 to November 2021). Cohort 2 consisted of 26 preterm infants after an educational program was implemented (December 2021 to May 2022). The primary outcome was the mean daily parental visiting duration. RESULTS: Mean maternal visiting duration was 172 (standard deviation, SD ± 49.2), 195 (SD ± 64.4.), and 258 (SD ± 71.1) minutes/day at baseline and in cohorts 1 and 2 (significant increase from baseline and cohort 1 to cohort 2, p < 0.001). Mean paternal visiting duration did not change significantly across the cohorts: 133 (SD ± 47.2), 135 (SD ± 83.5), and 165 (SD ± 71.3) minutes/day. CONCLUSION: Liberalisation of access hours did not increase parental visiting duration. Parental and staff education significantly increased maternal but not paternal visiting duration.
Asunto(s)
Recien Nacido Prematuro , Padres , Masculino , Lactante , Recién Nacido , Humanos , Estudios Prospectivos , Estudios Longitudinales , Políticas , PadreRESUMEN
AIMS: To examine immigrant and minority parents' experiences of having a newborn infant in the neonatal intensive care unit and explore healthcare professionals' experiences in delivering care to immigrant and minority families. DESIGN: A meta-ethnographic review informed by eMERGe guidelines. METHODS: We conducted a systematic literature review. Studies were included if they explored immigrant or minority parent experiences in neonatal intensive care units and health professional experiences delivering care to immigrant and minority families in neonatal intensive care. Reporting followed ENTREQ guidelines. DATA SOURCES: Database searches included CINAHL, MEDLINE, PubMed, PsycINFO, Scopus and Google Scholar. Boolean search strategies were used to identify qualitative studies. No limitations on commencement date; the end date was 23rd August 2022. PRISMA guidelines used for screening and article quality assessed using Joanna Briggs Institute criteria for qualitative studies. RESULTS: Initial search yielded 2468 articles, and nine articles met criteria for inclusion. Three overarching themes were identified: (1) Overwhelming Emotions, (subthemes: Overwhelming Inadequacy; Cultural Expressions of Guilt; Not Belonging), (2) Circles of Support, (subthemes: Individual Level-Spirituality; External Level-Connecting with Family; Structured Peer-to-Peer Support), (3) Negotiating Relationships with Healthcare Professionals (subthemes: Connecting; Disconnected; Linguistic Barriers). Interactions between healthcare professionals and immigrant and minority parents were the strongest recurring theme. CONCLUSIONS: There can be a mismatch between immigrant and minority families' needs and the service support provided, indicating improvements in neonatal intensive care are needed. Despite challenges, parents bring cultural and family strengths that support them through this time, and many neonatal intensive care staff provide culturally respectful care. IMPLICATIONS FOR THE PROFESSION AND/OR PATIENT CARE: Professionals should be encouraged to identify and work with family strengths to ensure parents feel supported in the neonatal intensive care unit. Findings can inform policy and practice development to strengthen health professionals capabilities to support immigrant and minority families in neonatal units. REPORTING METHOD: The Preferred Reporting Items for Systematic Reviews and Meta-Analyses checklists were used to report the screening process.
RESUMEN
Early infant development is a maturation process critically depends on the infant's interaction with primary caregivers. Hence, neonatal units prioritize their proximity. In COVID-19, parental visitation hours were limited, reducing caregivers time with their infants. This follow-up study analyzes and compares levels of maternal depression and stress, infant development, and bonding quality in preterm mother-infant dyads hospitalized, before and during the pandemic. Out of 66 dyads participated, 36 were admitted before COVID-19, and 30 during COVID-19. The assessed was two video-call sessions in which mothers completed selected questionnaires. No significant differences between mothers' levels of depression and stress. However, low birth weight was associated with greater difficulties in children's communication and interpersonal relationships. Furthermore, infants hospitalized in COVID-19 had a higher risk of experiencing delayed communication. No significant differences were observed in bonding quality. Lower infant gestational age and longer breastfeeding time were associated with better bonding quality in both groups. Psychosocial intervention is considered a valuable tool, capable of preventing maternal mental health difficulties and protecting bonding in premature infants and in highly complex healthcare settings. Nevertheless, it is essential to more actively address the socio-affective needs of newborns during their hospital stay to promote adequate development.
El desarrollo infantil temprano es un proceso de maduracion que depende críticamente de la interacción del infante consus cuidadores primarios. Por tal razón, en las unidades neonatales priorizan su proximidad. Durante el COVID19, se limitaron las horas de visitas de los progenitores, lo que redujo el tiempo que los cuidadores con sus bebés. Este estudio de seguimiento analiza y compara el nivel de depresión y estrés materno, el desarrollo infantil y la calidad del vínculo afectivo en díadas madrebebé prematuro hospitalizado al nacer, antes y durante la pandemia. De las 66 díadas participantes, 36 fueron admitidas antes del COVID199 y a 30 durante el COVID19. Se realizaron dos sesiones de vídeollamada, en las que las madres completaron los cuestionarios seleccionados. No se encontró ninguna diferencia significativa entre los niveles de depresión y estrés en las madres. Sin embargo, un bajo peso al nacer se asoció con mayores dificultades en la comunicación y las relaciones interpersonales en los niños. Además, los infantes hospitalizados durante el COVID19 presentaron mayor riesgo de experimentar retrasos en la comunicación. No se observaron diferencias significativas en la calidad del vínculo afectivo. Una menor edad gestacional del infante y mayor tiempo de lactancia materna se asociaron con una mejor calidad del vínculo afectivo en ambos grupos. Se considera la intervención psicosocial como una herramienta de valor, capaz de prevenir dificultades en la salud mental materna y de proteger el vínculo afectivo en infantes nacidos prematuramente y en entornos sanitarios altamente complejos. Sin embargo, es esencial abordarmás activamente las necesidades socioafectivas de los recién nacidos durante su estadía en el hospital para promover un desarrollo adecuado.
Asunto(s)
COVID-19 , Desarrollo Infantil , Recien Nacido Prematuro , Relaciones Madre-Hijo , Madres , Apego a Objetos , Estrés Psicológico , Humanos , COVID-19/psicología , Femenino , Recién Nacido , Relaciones Madre-Hijo/psicología , Madres/psicología , Adulto , Chile , Masculino , Depresión , SARS-CoV-2 , Hospitalización , Estudios de Seguimiento , LactanteRESUMEN
BACKGROUND: A new medical device was developed for multi-infusion in neonatal intensive care units (NICUs) with the aim to address issues related to drug incompatibilities and central line-associated bloodstream infections (CLABSI). AIM: To assess the cost-effectiveness of implementing this new perfusion system in a NICU setting. METHODS: We conducted a single-centre, observational study in all infants admitted to the NICU within the first 3 days after birth and who required central-venous line, to evaluate the cost and effectiveness before (Year 2019) and after (Year 2020) the implementation of the new perfusion system. We calculated the costs from the hospital perspective, and we examined the incidence of CLABSI, over a time horizon spanning from admission to NICU discharge. We measured the resource utilisation (infusion medical device, infection treating drugs and biological analyses), and valued corresponding costs using tariffs for year 2019. We calculated incremental cost-effectiveness ratio (ICER) expressed as euros per CLABSI avoided, and conducted one-way and multivariate sensitivity analyses. FINDINGS: Among 609 infants selected, clinical characteristics were similar across both periods. The CLABSI rate significantly decreased (rate ratio: 0.22; IC95% [0.07-0.56]), and total costs were reduced (from 65,666 to 63,932 per 1000 catheter days respectively; p<0.001), yielding to an ICER of 251 saved per CLABSI avoided. The majority of sensitivity analyses showed the new intervention remaining economically dominant. CONCLUSION: This single-centre study showed a significant decrease in the incidence of CLABSI without incurring additional costs. Further prospective multicentre randomised studies are needed to confirm these results in other NICU.
RESUMEN
INTRODUCTION: This overview aims to systematically review evidence regarding effects of interventions undertaken in neonatal units to increase breastfeeding in preterm infants. METHODS: We followed Cochrane methodology. Systematic reviews published to October 31, 2022, reporting meta-analysis of effects from original studies on breastfeeding rates in preterm infants of neonatal unit interventions designed to increase breastfeeding were included. RESULTS: Avoidance of bottles during breastfeed establishment (comparator breastfeeds with bottle-feeds) demonstrated clear evidence of benefit for any breastfeeding at discharge and exclusive breastfeeding 3 months post-discharge, and possible evidence of benefit for exclusive breastfeeding at discharge, and any breastfeeding post-discharge. Kangaroo mother care (KMC) (comparator usual care) demonstrated clear evidence of benefit for any and exclusive breastfeeding at discharge and possible benefit for any breastfeeding post-discharge. Quality improvement (QI) bundle(s) to enable breastfeeds (comparator conventional care) showed possible evidence of benefit for any breastfeeding at discharge. Cup feeding (comparator other supplemental enteral feeding forms) demonstrated possible evidence of benefit for exclusive breastfeeding at discharge and any breastfeeding 3 months after. Early onset KMC (commenced <24 h post-birth), oral stimulation, and oropharyngeal colostrum administration, showed no evidence of benefit. No meta-analyses reported pooled effects for gestational age or birthweight subgroups. CONCLUSION: There is ample evidence to support investment in KMC, avoidance of bottles during breastfeed establishment, cup feeding, and QI bundles targeted at better supporting breastfeeding in neonatal units to increase prevalence of breastfeeding in preterm infants and promote equal access to breastmilk. Stratifying effects by relevant subgroups is a research priority.
Asunto(s)
Lactancia Materna , Recien Nacido Prematuro , Método Madre-Canguro , Humanos , Recién Nacido , Mejoramiento de la Calidad , Unidades de Cuidado Intensivo Neonatal , Femenino , Alimentación con BiberónAsunto(s)
Lactancia Materna , Recien Nacido Prematuro , Humanos , Recién Nacido , Femenino , OptimismoRESUMEN
ObjectiveSerratia marcescens is a Gram-negative bacterium that is found in hospital environments and commonly associated with outbreaks in neonatal units. One S. marcescens isolate was detected from a bloodstream culture from a neonate in our hospital that was followed by an outbreak. The aim of this study was to describe the molecular epidemiology of a S. marcescens outbreak in the neonatal unit.MethodsIn order to investigate the outbreak, weekly surveillance rectal swabs were submitted for culture from all patients admitted in this unit from August to September 2018. Environmental samples were obtained from potential sources in September 2018. Typing of isolates was performed by pulsed field gel electrophoresis (PFGE). In addition, we studied the in vitro activity of chlorhexidine against S. marcescens.ResultsDuring this period, 146 infants were hospitalised in our neonatal unit, of which 16 patients had a S. marcescens-positive sample. A total of 36 environmental surveillance samples were collected, and one sample from a stethoscope from an incubator of a colonized baby was positive for S. marcescens. All the 18 isolates, including the isolate from the stethoscope, belonged to a single PFGE cluster. We found that very low concentrations of chlorhexidine, even with application times close to 0 achieved significant reductions in the amount of S. marcescens.ConclusionA unique clone of S. marcescens caused this outbreak, including isolates from patients and from one stethoscope. The outbreak was controlled with the early implementation of specific control measures.
ObjetivoSerratia marcescens(S. marcescens) es una bacteria gramnegativa que se encuentra en ambientes hospitalarios y comúnmente aparece asociada a brotes en unidades neonatales. En agosto de 2018 se detectó un aislado de esta bacteria a partir de un hemocultivo de un paciente neonatal en nuestro hospital. El objetivo de este estudio fue describir la epidemiología molecular del brote de S. marcescens en la unidad neonatal.MétodosCon el fin de investigar el brote, se enviaron semanalmente para cultivo muestras rectales de todos los pacientes ingresados en estas unidades de agosto a septiembre de 2018. Asimismo, se obtuvieron muestras ambientales de potenciales orígenes del brote en septiembre de 2018. Los aislados se genotipificaron mediante electroforesis de campo pulsado (PFGE).ResultadosDurante este período, 146 lactantes fueron hospitalizados en nuestra unidad neonatal, de los cuales 16 pacientes tenían una muestra positiva para S. marcescens. Se recogieron un total de 36 muestras de vigilancia ambiental. Una muestra de un estetoscopio de una incubadora de un bebé colonizado resultó positiva para S. marcescens. Los 18 aislamientos, incluido el aislado de la muestra ambiental, pertenecían a un solo patrón de PFGE. Se realizaron experimentos in vitro con clorhexidina y se encontró que concentraciones muy bajas incluso con tiempos de aplicación cercanos a 0 lograban reducciones significativas en la cantidad de S. marcescens.ConclusiónEstos datos confirmaron un único clon de S. marcescens en la unidad neonatal con aislamientos tanto de pacientes como ambientales. La implementación temprana de medidas de control específicas fue eficaz para limitar la transmisión nosocomial.
Asunto(s)
Humanos , Lactante , Serratia marcescens , Unidades de Cuidado Intensivo Neonatal , Cultivo de Sangre , Plantones , Lactante , Microbiología , Enfermedades Transmisibles , PacientesRESUMEN
Fonament: Des de linici de la pandèmia per SARS-CoV-2,la majoria dunitats neonatals darreu del món han aplicatprotocols de restricció de la presència de mares i pares,amb lobjectiu de protegir el personal sanitari i els nounats.Objectiu. Avaluar els efectes col·laterals derivats de la pocapresència de mares i pares al costat dels seus nadons a lesunitats neonatals, i els relacionats amb les restriccions ales plantes de maternitat. Mètode: Revisió de la literatura. Sha consultat Pubmed iGoogle Scholar utilitzant com a paraules clau SARS-CoV-2i covid-19 combinades amb neonatal, NICU i parents,family centered care i neurodevelopmental care. Shanconsultat dominis en què es recullen resums actualitzatsde levidència científica disponible sobre la pandèmia perSARS-CoV-2: www.dontforgetthebubles.com i el web de laSocietat Espanyola de Neonatologia (www.seneo.es). Laveu de les famílies sha cercat mitjançant les pàgines deles associacions que els representen i a les xarxes socials.Resultats. El model de cures centrades en el desenvolupa-ment i la família, que ha demostrat efectes positius sobre lasalut dels nadons ingressats i el neurodesenvolupament delsprematurs, es veu amenaçat si es limita la presència paren-tal. La restricció també ha demostrat tenir efectes adversossobre la lactància materna i la salut psicològica dels pares imares. Les dades disponibles fins ara posen de manifest uncomportament benigne de la infecció covid-19 en nadons.Conclusions: En un moment crucial per a la implantació delmodel de cures centrades en el desenvolupament a les uni-tats neonatals catalanes, i amb les dades disponibles, ésimprescindible redissenyar les polítiques dacompanyamentparental als nadons ingressats.(AU)
Fundamento: Desde el inicio de la pandemia por SARS-CoV-2, lamayoría de unidades neonatales de todo el mundo han aplicadoprotocolos de restricción de la presencia parental, con el objetivode proteger al personal sanitario y a los propios recién nacidos. Objetivo: Evaluar los efectos colaterales derivados de la menor pre-sencia de los padres junto a sus bebés en las unidades neonatales,y los relacionados con las restricciones en las plantas de maternidad.Método: Revisión de la literatura. Se ha realizado búsqueda enPubmed i Google Scholar utilizando como palabras clave SARS-CoV-2 y covid-19 en combinación con neonatal, NICU y pa-rents, family centered care y neurodevelopmental care. Se hanconsultado dominios donde se recogen resúmenes actualizados dela evidencia científica disponible sobre la pandemia por SARS-CoV-2: www.dontforgetthebubles.com y la web de la Sociedad Es-pañola de Neonatología (www.seneo.es). La opinión de las familiasse ha buscado en las páginas web de las asociaciones que las re-presentan y en las redes sociales. Resultados: El modelo de cuidados centrados en el desarrollo y lafamilia, que ha demostrado efectos positivos sobre la salud de losrecién nacidos ingresados y el neurodesarrollo de los prematuros,se ve amenazado si se limita la presencia parental. La restriccióntambién ha demostrado tener efectos adversos sobre la lactanciamaterna y la salud psicológica de los progenitores. Los datos dis-ponibles hasta ahora ponen de manifiesto un comportamiento be-nigno de la infección por covid-19 en recién nacidos. Conclusiones: En un momento crucial para la implantación del mo-delo de cuidados centrados en el desarrollo en las unidades neo-natales catalanas, y con los datos disponibles, es imprescindiblerediseñar las políticas de acompañamiento de los padres a sushijos recién nacidos ingresados.(AU)
Objective: To evaluate the side effects of the limitation of parentspresence with their babies in neonatal units and those related torestrictions on maternity wards access. Method: Literature review. A search using SARS-CoV-2 and CO-VID-19 as keywords combined to neonatal, NICU, parents,family centered care and neurodevelopmental care. Consulta-tion of websites containing updated and summarized scientific li-terature about the pandemic and its consequences in newbornshas also been performed: www.dontforgetthebubles.com andwww.seneo.es. The voice of the families has been mainly obtainedthrough the websites of their associations and the social networks. Results. The family-centered care model has shown positive effectson the health of sick newborns and on premature infants neuro-development. This model of care is under threat if parental accessis limited. It has been shown that these restrictions have also ad-verse effects on breastfeeding and on caregivers psychologicalwellbeing. Data from different neonatal series report a benigncourse of COVID-19 infection in neonates and preterm babies. Conclusions: At a crucial moment for the implementation of thedevelopmental centered care model in Catalan neonatal units, andwith the available data, it is essential to redesign the policies regar-ding parents who accompany their babies admitted to the units.(AU)
Asunto(s)
Humanos , Masculino , Femenino , Coronavirus Relacionado al Síndrome Respiratorio Agudo Severo , Infecciones por Coronavirus/epidemiología , Pandemias , Cuidado Intensivo Neonatal , Responsabilidad Parental , España , Aislamiento SocialRESUMEN
El documento partede una reflexión sobre la política de restricción de visitas de los padres en las unidades neonatales y del acompañamientoen las plantas de maternidad que se aplicó en los hospitales en las primeras fases de la pandemia. Casi un año tras suinicio, un grupo de neonatólogos con espíritu autocrítico trabajamos de forma conjunta, en el marco del Grup dEstudisNeonatals, con la voluntad de analizar los posibles efectos adversos de las medidas sobre aspectos fundamentales comoson el neurodesarrollo del recién nacido, la lactancia materna y la salud psicológica de los progenitores. Y, finalmente,desde el conocimiento y recursos que teníamos en ese momento, elaborar nuevas recomendaciones.(AU)
The document is based on a reflection on the policy ofrestricting parental visits in neonatal units and the accompanying in maternity wards that was applied in hospitals inthe early phases of the pandemic. Almost a year after its beginning, a group of neonatologists with a self-critical spiritworked together, within the framework of the Grup dEstudis Neonatals, with the aim of analyzing the possible adverseeffects of the measures on fundamental aspects such as the neurodevelopment of the newborn, breastfeeding andthe psychological health of the parents. And, finally, from the knowledge and resources we had at that time, to developnew recommendations.(AU)
El document parteix duna reflexiósobre la política de restricció de visites dels pares a les unitats neonatals i de lacompanyament a les plantes dematernitat que es va aplicar als hospitals a les primeres fases de la pandèmia. Gairebé un any després del seu inici,un grup de neonatòlegs amb esperit autocrític treballem conjuntament, en el marc del Grup dEstudis Neonatals,amb la voluntat danalitzar els possibles efectes adversos de les mesures sobre aspectes fonamentals com sónel neurodesenvolupament del nounat, la lactància materna i la salut psicològica dels progenitors. I, finalment, desdel coneixement i recursos que teníem en aquell moment, elaborar noves recomanacions.(AU)
Asunto(s)
Humanos , Masculino , Femenino , Pandemias , Coronavirus Relacionado al Síndrome Respiratorio Agudo Severo , Infecciones por Coronavirus/epidemiología , Unidades de Cuidado Intensivo Neonatal , Servicio de Acompañamiento de Pacientes , Visitas a Pacientes , Salud Mental , Mujeres Embarazadas/psicología , Embarazo/psicologíaRESUMEN
Objetivos: identificar dificuldades enfrentadas por mães puérperas na lactação durante o tempo em que seu recém-nascido esteve em Unidade de Terapia Intensiva ou em Unidade de Cuidados Intermediários Neonatal; descrever as orientações que mães receberam dos profissionais da saúde. Método: estudo descritivo de abordagem qualitativa, desenvolvido em uma maternidade pública na cidade de Patos/PB, com oito puérperas de bebês prematuros internados, no período de novembro de 2014. Os dados foram produzidos por meio de entrevista com análise de conteúdo temática. Resultados: o estudo indica necessidade de reorganizar modelos de assistência às mães de bebês prematuros às dificuldades da amamentação durante o período de internação. Conclusão: é necessária a promoção para a humanização no atendimento intra-hospitalar, no sentido de aprimorar o conhecimento e humanizar o acolhimento oferecido às mães puérperas na lactação.(AU)
Objectives: to identify the difficulties faced by mothers breastfeeding their newborn when they are in the Intensive Care Unit and Neonatal Intermediate Care Unit; to describe the guidelines that mothers received by the health professionals. Method: a descriptive study of a qualitative approach, developed in a public hospital in the city of Patos/PB, with eight mothers of premature babies hospitalized in November 2014. The data were produced through interviews with thematic content analysis. Results: the study indicates the need to reorganize premature babies of mothers to care models to the difficulties of breastfeeding during the hospital stay. Conclusion: promotion to the in-hospital humanization care is necessary to improve knowledge and humanize the reception given to mothers during breastfeeding.(AU)
Objetivos: identificar dificultades enfrentadas por madres em la lactancia durante el tiempo en que su recién nacido en Unidad de Terapia Intensiva o Unidad de Cuidados Intermediarios Neonatal; describir las orientaciones que madres recibieron de los profesionales de la salud. Método: estudio descriptivo de enfoque cualitativo, desarrollado en una maternidad pública en la ciudad de Patos/PB, con ocho madres de bebés prematuros internados, en el mes de noviembre de 2014. Los datos fueron producidos por medio de entrevista con análisis de contenido temático. Resultados: el estudio indica necesidad de reorganizar modelos de asistencia a las madres de bebés prematuros a las dificultades de la lactancia durante el período de internación. Conclusión: es necesaria la promoción para la humanización en el atendimiento intrahospitalario, en el sentido de mejorar el conocimiento y humanizar el acogimiento ofrecido a las madres en la lactancia.(AU)
Asunto(s)
Humanos , Femenino , Embarazo , Recién Nacido , Adolescente , Adulto , Lactancia Materna , Recien Nacido Prematuro , Unidades de Cuidado Intensivo Neonatal , Madres , Madres/psicología , Educación en Salud , Epidemiología Descriptiva , Investigación Cualitativa , MaternidadesRESUMEN
Describing and discussing the conduct of nurses before the triggering of the alarms by the electrical equipment. Methods: this is a descriptive, exploratory study with a qualitative analysis. Results: the professionals present good qualification, but act in a complex scenario that requires a differentiated staff sizing and that was not respected, a fact that may have interfered with service after the alarm was triggered. Conclusion: given the facts above, it is perceived that the training of nursing professionals and the stimulus to updating knowledge and to the compliance with the technical and operational standards of the profession are presented as well suited solution to the needs of the individual and the company and/or hospital unit, since the ultimate goal is to provide quality care and safety to the patient...
Descrever e discutir as condutas dos profissionais de enfermagem diante dos alarmes disparados pelos equipamentos eletromédicos. Métodos: trata-se de um estudo descritivo, exploratório e com análise qualitativa. Resultados: os profissionais apresentam uma boa qualificação, porém atuam num cenário complexo que exige um dimensionamento de pessoal diferenciado e que não foi respeitado, fato que pode ter interferido no atendimento ao alarme acionado. Conclusão: diante dos fatos mencionados, percebe-se que a capacitação dos profissionais de enfermagem e o estímulo à atualização de conhecimentos e ao cumprimento das normas técnicas e operacionais da profissão apresentam-se como solução bem adequada às necessidades do individuo e da empresa e/ou unidade hospitalar, visto que o objetivo final é aprestação de uma assistência de qualidade e a segurança do paciente...
Describir y discutir la conducta de las enfermeras ante las alarmas activadas por el equipo eléctrico. Métodos: se realizó un estudio descriptivo, exploratorio, con análisis cualitativo. Resultados: los profesionales tienen una buena calificación, pero actúan en un escenario complejo que requiere un dimensionamiento de personal característico y que no se observó, lo que puede haber interferido con alarma de servicio activado. Conclusión: teniendo en cuenta los hechos anteriores, se percibe que la capacitación de los profesionales de enfermería y el estímulo a la actualización de conocimientos y al cumplimiento de las normas técnicas y operativas de la profesión se presentan como una solución muy adecuada para las necesidades del individuo y la empresa y/o unidad hospitalaria, ya que el objetivo final es proporcionar una atención de calidad y seguridad al paciente...
Asunto(s)
Humanos , Recién Nacido , Sistema de Alarma y Alerta , Enfermería de Cuidados Críticos , Unidades de Cuidado Intensivo Neonatal , BrasilRESUMEN
ResumoBuscamos desvelar o significado do trabalho em equipe dentro da complexidade de uma Unidade Neonatal. As técnicas utilizadas para coleta de dados foram a análise documental, a observação participante e a entrevista. Foram entrevistados 24 profissionais que atuam numa Unidade Neonatal pública e de alta complexidade do município do Rio de Janeiro. Os dados foram desenvolvidos conforme a técnica de análise de conteúdo, na modalidade temática, com base em bibliografia sobre humanização, ergologia e processo de trabalho em saúde e em equipe. Concluímos que, mesmo no ambiente neonatal, a construção do trabalho em equipe se efetiva quando o modo de atendimento está voltado para a lógica orientada pelas necessidades de saúde dos sujeitos, considerando os bebês e suas famílias, perpassando pelas negociações, os limites da autonomia, as noções de pertencimento e o reconhecimento do outro.
AbstractThe scope of this paper was to establish the significance of teamwork within the complex interaction in a Neonatal Unit. The techniques used for data collection were document analysis, participant observation and interviews. Twenty-four professionals working in a public and highly complex Neonatal Unit in the city of Rio de Janeiro were interviewed. The data were analyzed using the thematic approach of the content analysis technique, based on the literature on humanization, health work processes, teamwork and ergology. The conclusion drawn is that even in the neonatal environment, the construction of teamwork is established when the care model is geared to the logic responding to the health needs of individuals, taking into consideration the babies and their families, encompassing negotiations, limits of autonomy and notions of belonging and the recognition of others.
Asunto(s)
Humanos , Grupo de Atención al Paciente , NegociaciónRESUMEN
Estudo observacional, prospectivo, para determinar a incidência de eventos adversos (EAs) em Unidade de Terapia Intensiva Neonatal (UTIN). Utilizou-se um "instrumento" específico, adaptado do modelo americano utilizado pela Rede Vermont-Oxford. Dos 218 recém-nascidos, 183 (84%) apresentaram EAs, correspondendo a 2,6 EA/paciente. Distúrbios da termorregulação (29%), distúrbios da glicemia (17,1%) e Infecção Relacionada à Assistência à Saúde (IRAS) de origem hospitalar (13,5%) foram os mais frequentes. Alguns EAs apresentaram associação com peso de nascimento (p < 0,05). O percentual de IRAS e a extubação não programada foi diretamente proporcional ao tempo de internamento. A incidência de EAs em UTIN é elevada entre os recém-nascidos de muito baixo peso. A qualidade da assistência torna-se primordial na elaboração das estratégias preventivas.
This was a prospective, observational study conducted in a neonatal intensive care unit to determine the incidence of adverse events. A specific trigger tool instrument was used, based on the one from Vermont-Oxford Network. A total of 218 neonates were followed and AEs were detected in 183 (84%) of them, with a rate of 2,6 AE/patient. Thermoregulation disorders (29%), disorders of glycemic control (17,1%) and nosocomial infections (13,5%) were the most frequent. Some AE were associated with birth weight (p<0.05). The accidental extubations and nosocomial infections were associated with hospital days. The incidence of AEs is high, especially among neonates with very low birth weight. Best practices regarding preventive strategies are necessary to improve quality of health care for these infants.
Estudio observacional, prospectivo para determinar la incidencia de eventos adversos (EAs) en la Unidad Neonatal de Cuidados Intensivos (UNCI). Fue utilizado un instrumento específico adaptado del modelo americano Vermont-Oxford. De los 218 recién nacidos, el 84% presentaron EA, lo que corresponde a 2,6 EA / paciente. Trastornos de la termorregulación (29%), trastornos de la glicemia (17,1%) e infección relacionada con el cuidado de la salud (IRCS) nosocomiales (13,5%) fueron los más frecuentes. Algunos presentaron asociación con el peso al nacer (p<0,05). El porcentaje de IRCS y la extubación no programada fue directamente proporcional a la duración de la estancia hospitalaria. La incidencia de EAs en la UNCI es alta entre los recién nacidos de muy bajo peso al nacer. La calidad de la asistencia es fundamental en el desarrollo de estrategias de prevención.
Asunto(s)
Humanos , Recién Nacido , Enfermedad Iatrogénica/epidemiología , Enfermedades del Recién Nacido/epidemiología , Enfermedades del Recién Nacido/etiología , Unidades de Cuidado Intensivo Neonatal , Estudios ProspectivosRESUMEN
Este artigo analisa as condições de trabalho de auxiliares de enfermagem que atuam em Unidade Neonatal, considerando a dimensão relacional da atividade de cuidado. Tendo como principais referências epistemológicas a concepção canguilhemiana de saúde e a perspectiva ergológica, a pesquisa se pautou em abordagens clínicas do trabalhar, incluindo métodos diretos (observações), indiretos (conversas e encontros sobre o trabalho com as auxiliares) e análise de documentos relativos às normas antecedentes desse trabalho. Analisou-se fundamentalmente a produção linguageira dos coletivos. Entre os resultados encontrados, destacam-se: o desenvolvimento dessa atividade de cuidado implica intensa mobilização das trabalhadoras; a possibilidade de não atender às mães que chegam para ter seus bebês parece ser mais nocivo à saúde dessas profissionais do que trabalhar com um número excessivo de pacientes. Concluiu-se que as condições precárias de trabalho são potencialmente produtoras de sofrimento patogênico, uma vez que a realização prazerosa e bem-sucedida dessa atividade é dificultada.
This paper focuses on the working conditions of nursing technicians of Neonatal Units, considering the relational dimension of the care activity. Having as main epistemological references Canguilhem's concept of health of and the Ergological perspective, the research was based on the clinical approaches of work, including the following methods: direct (observations) and indirect (talks and meetings about work with the technicians); analysis of documents on the previous norms concerning this work. The analysis dealt basically with the groups' language production. Some results can be highlighted: the development of this care activity implies intense mobilization of workers; the possibility of not assisting the mothers who arrive to have their babies seems to be more noxious to these technicians than to work with an overload of patients; the precarious conditions of work are producers of pathogenic suffering, once the pleasant and well-succeeded realization of this activity is hindered.
Asunto(s)
Humanos , Condiciones de Trabajo/efectos adversos , Asistentes de Enfermería/psicología , Atención de Enfermería , Unidades de Cuidado Intensivo Neonatal , Condiciones de Trabajo , Relaciones Profesional-PacienteRESUMEN
OBJETIVO: Determinar a incidência e o tipo de erros médicos em uma unidade de terapia intensiva neonatal e a relação entre o erro e o estado clínico do paciente. MÉTODOS: Revisamos os prontuários médicos, durante os primeiros 7 dias de hospitalização, de todos os recém-nascidos de alto risco admitidos por um período de 3 meses. RESULTADOS: Setenta e três pacientes foram admitidos durante o período de estudo. A média de peso de nascimento foi de 2.140 g (640-5.020 g), e a idade gestacional média foi de 34 semanas (25-40 semanas). Dos 73 prontuários analisados, 40 (55 por cento) apresentaram um ou mais erros. Um total de 365 dias de hospitalização foi analisado, e 95 erros médicos foram detectados (um erro por 3,9 dias de hospitalização). O erro mais freqüente esteve associado com uso de medicamentos (84,2 por cento). Uso de procedimentos terapêuticos (medicamentos, fototerapia, etc.) sem prescrição adequada no prontuário do paciente (erro de comissão) representou 7,4 por cento dos erros, e a incidência de erros de omissão foi de 8,4 por cento. A incidência de erros médicos foi significativamente maior em recém-nascidos com idade gestacional menor. CONCLUSÕES: A incidência de erros no cuidado de recém-nascidos de alto risco é elevada. Deve-se incentivar estratégias para melhorar a educação de profissionais da saúde envolvidos no cuidado e o desenvolvimento da cultura local, divulgando algoritmos claros e acessíveis para orientar o comportamento quando há ocorrência de erros.
OBJECTIVE: To determine the incidence and type of medical errors in a newborn intensive care unit and the relationship between the error and the patient's clinical status. METHODS: We reviewed the medical charts, during the first 7 days of hospitalization, of all high-risk newborn infants admitted for a period of 3 months. RESULTS: Seventy-three patients were admitted during the study period. Their mean birth weight was 2,140 g (640-5,020 g) and mean gestational age was 34 weeks (25-40 weeks). Of 73 medical charts analyzed, 40 (55 percent) had one or more errors. A total of 365 days of hospitalization was analyzed and 95 medical errors were detected (one error per 3.9 days of hospitalization). The most frequent error was associated with medication use (84.2 percent). Use of therapeutic procedures (drugs, phototherapy, etc.) without proper prescription in the patient's chart (commission error) accounted for 7.4 percent of the errors, and incidence of omission errors was 8.4 percent. Incidence of medical errors was significantly higher in newborn infants with lower gestational age. CONCLUSION: Incidence of errors in the care of high-risk newborn infants is elevated. Strategies to improve education of health professionals involved in the care and development of local culture by disseminating clear, accessible algorithms to guide behavior when errors occur must be encouraged.