Critérios para acolhimento noturno, segundo a equipe de um centro de atenção psicossocial / Criterios de recepción nocturna según el equipo del centro de atención psicosocial / Criteria for night reception according to the psychosocial care center team

RESUMO. O acolhimento noturno configura-se como um dos recursos oferecidos pelos Centros de Atenção Psicossociais de tipo III no cuidado aos sujeitos em sofrimento psíquico grave. Este estudo teve como objetivo identificar as percepções de profissionais de um Centro de Atenção Psicossocial tipo III sobre os critérios para inserção e alta de usuários em acolhimento noturno. Trata-se de uma pesquisa qualitativa da qual participaram nove profissionais respondendo a um roteiro semiestruturado de entrevista sobre dados sociodemográficos e questões sobre o funcionamento e os critérios para o acolhimento noturno no referido serviço e realizada análise de conteúdo temática com os dados obtidos. A análise de conteúdo temática apontou que a estabilização da crise e a proteção à vida configuram-se como critérios centrais para a inserção no acolhimento noturno, o qual pode assumir tanto o sentido de vigilância sobre o comportamento do usuário quanto de oportunidade para desenvolver vínculo com a equipe. Diante disso, conclui-se que o acolhimento noturno tem função estratégica no manejo às situações de crise em saúde mental e que muitos são os desafios enfrentados pela equipe na interlocução dos diversos pontos da rede de atenção psicossocial no cuidado aos seus usuários.

RESUMEN. La recepción nocturna está configurada como uno de los recursos ofrecidos por los Centros de Atención Psicosocial Tipo III en la atención de sujetos con angustia psicológica severa. Este estudio tuvo como objetivo identificar las percepciones de los profesionales en un Centro de Atención Psicosocial tipo III sobre los criterios de inserción y alta de los usuarios en la atención nocturna. Es una investigación cualitativa en la que participaron nueve profesionales, que respondieron a un guión de entrevista semiestructurada sobre datos socidemográficos y preguntas sobre el funcionamiento y los criterios para la recepción nocturna en el servicio referido. El análisis del contenido temático se realizó con los datos obtenidos. El análisis de contenido temático de que la estabilización de la crisis y la protección de la vida son criterios centrales para la inserción en la recepción nocturna, que puede asumir tanto un sentido de vigilancia sobre el comportamiento del usuario como una oportunidad para desarrollar un vínculo con el paciente. equipo En vista de esto, se concluye que la atención nocturna tiene un papel estratégico en el manejo de situaciones de crisis en salud mental y que el equipo enfrenta muchos desafíos al hablar sobre los diferentes puntos de la red de atención psicosocial en el cuidado de sus usuarios.

ABSTRACT. Night care is one of the resources offered by Type III Psychosocial Care Centers in the care of subjects in severe psychological distress. This study aimed to identify the perceptions of professionals in a Psychosocial Care Center type III on the criteria for insertion and discharge of users in night care. It is a qualitative research in which nine professionals participated, responding to a semi-structured interview script about socidemographic data and questions about the functioning and criteria for night reception at the referred service. Thematic content analysis was performed with the data obtained. Thematic content analysis that the stabilization of the crisis and the protection of life are central criteria for insertion in the night reception, which can assume both a sense of vigilance about the user's behavior and an opportunity to develop a bond with the patient. team. In view of this, it is concluded that night care has a strategic role in managing crisis situations in mental health and that there are many challenges faced by the team when talking about the different points of the psychosocial care network in caring for its users.

A covid-19 como um analisador do sofrimento de enfermeiras: um ensaio teórico / Covid-19 as a suffering analyzer for female nurses: a theoretical essay / El covid-19 como analizador de sufrimiento de enfermeras: un ensayo teórico

Este ensaio propõe que a Covid-19 pode operar como um analisador, dentro da perspectiva da análise institucional, iluminando um determinado modo de organização social que promove profundas desigualdades e ameaça a vida em diversos níveis e revelando as condições sociais, institucionais e políticas de produção de sofrimento no corpo profissional de Enfermagem. A pandemia desvelou um conjunto de marcas relacionadas à profissão, agravadas pela crise sanitária, reforçando a naturalização das relações de cuidado atribuídas ao feminino, bem como um conjunto de clivagens e hierarquias internas à profissão a partir da sinergia de marcadores da diferença, como gênero, cor/raça, classe e geração. Além disso, este trabalho mostra a presença de uma necropolítica nas respostas à pandemia que banaliza a vida e permite morrer determinados grupos sociais. A ideia de "profissionais de linha de frente" é criticada em suas metáforas bélicas, mas tomada como figura de linguagem em sua potência para afirmar que existem corpos que, pelas marcas sociais e históricas e pela interdependência do cuidado, são mais presentes e exigidos e, portanto, mais vulneráveis à doença e ao sofrimento dela decorrente.(AU)

The essay proposes that Covid-19 can operate as an analyzer, within the perspective of institutional analysis, illuminating a certain mode of social organization that promotes profound inequalities and threatens life at various levels, revealing the social, institutional and political conditions for the production of suffering in the professional nursing body. The pandemic would unveil a set of marks related to the profession, aggravated by the sanitary crisis, reinforcing the naturalization of the care relations attributed to the feminine, as well as a set of cleavages and internal hierarchies to the profession from the synergy of markers of difference as gender, color/race, class and generation. The work shows the presence of necropolitics in responses to the pandemic, which trivializes life and allows certain social groups to die. The idea of "front-line professionals" is criticized in its war metaphors, but taken as a figure of speech in its potency to affirm that there are bodies that by social and historical marks, and by the interdependence of care, are more present and demanded, and therefore more vulnerable to disease and the resulting suffering.(AU)

El ensayo propone que el Covid-19 puede funcionar como analizador, desde la perspectiva del análisis institucional, revelando las condiciones sociales, institucionales y políticas de producción de sufrimiento de enfermeras. La pandemia revela algunas marcas relacionadas con la profesión, agravadas por la crisis de salud, reforzando la naturalización de la atribución del cuidado a lo femenino y un conjunto de jerarquías internas de la profesión. El trabajo también muestra la presencia de una necropolítica en las respuestas a la pandemia. La idea de "profesionales de primera línea" es criticada, pero tomada como una figura del lenguaje en su potencia para afirmar que hay cuerpos que, por las marcas sociales e históricas y por la interdependencia del cuidado, están más presentes y demandados, y por lo tanto más vulnerables a la enfermedad.(AU)

Condicionantes de calidad de los cuidados enfermeros durante el turno de noche / Factors Influencing Quality of Nursing Care during the Night Shifts

Introducción: El turno nocturno provoca efectos físicos y psicológicos en las enfermeras. Fatiga, estrés, ansiedad, alteraciones del sueño y percepción negativa del entorno laboral pueden condicionar la calidad del cuidado. Objetivo: Identificar las condiciones relacionadas con la calidad de los cuidados enfermeros durante los turnos de noche en los hospitales. Métodos: Se realiza una revisión sistemática según criterios PRISMA. Se utilizó como estrategia común en las bases consultadas la combinación de las palabras clave y booleanos: ("Quality of Care") AND ("Nurse"OR"Nurses") AND ("Night shift"OR"Shift"). Se exploraron las bases de datos PubMed, Cinahl, Scopus y Cochrane. Se Incluyeron ensayos, estudios transversales, revisiones y estudios cualitativos entre 2009 y 2018. Se excluyeron los que no cumplieron requisitos de contenido y criterios de evaluación de calidad metodológica descritos a priori. Se incluyeron 20 trabajos. Conclusiones: Para la mayoría de autores la calidad de los cuidados nocturnos es menor que durante el día y puede estar condicionada por exceso de horas trabajadas, percepción de salud, fatiga, calidad del sueño, menor ratio enfermera-paciente, menor apoyo institucional y menor satisfacción profesional. Los indicadores de calidad más utilizados fueron incidencia de úlceras por presión, errores en identificación de pacientes, errores de medicación, errores de comunicación, cuidados sin realizar, desmotivación profesional, despersonalización y retención institucional. La heterogeneidad de los estudios hace que pueda aumentar el sesgo en los resultados. Muchos indicadores descritos son evaluados mediante percepciones, ocasionalmente por métodos objetivos. La identificación de condicionantes clave en la calidad de cuidados nocturnos permite iniciativas institucionales de gran impacto(AU)

Introduction: The night shift causes physical and psychological effects on nurses. Fatigue, stress, anxiety, sleep disturbances and negative perception of the work environment can affect the quality of care. Objective: To identify the conditions related to the quality of nursing care during night shifts in hospitals. Methods: A systematic review was carried out according to PRISMA criteria. As a common strategy in the consulted databases, the combination of the following keywords and Booleans was used: ("Quality of Care") AND ("Nurse "OR "Nurses") AND ("Night shift "OR "Shift"). The PubMed, Cinahl, Scopus and Cochrane databases were explored. Trials, cross-sectional studies, reviews and qualitative studies between 2009 and 2018 were included. Those that did not meet content requirements and methodological quality assessment criteria described a priori were excluded. Twenty papers were included. Conclusions: For most authors, the quality of night care is lower than during the day and may be affected by an excess of working hours, health perception, fatigue, sleep quality, lower nurse-patient ratio, lower institutional support and lower professional satisfaction. The most frequently used quality indicators were incidence of pressure ulcers, patient identification errors, medication errors, communication errors, unperformed care, professional demotivation, depersonalization and institutional retention. The heterogeneity of the studies may increase bias in the results. Many of the indicators described are assessed by perceptions, occasionally using objective methods. The identification of key determinants in the quality of night care allows for high-impact initiatives at the institutional level(AU)

Trabalho noturno e alterações de peso corporal autopercebidas pelos profissionais de enfermagem / Night work and self-perceived body weight changes among nursing professionals / Trabajo nocturno y alteraciones en el peso corporal según los trabajadores de enfermería

Objetivo: avaliar as alterações de peso corporal em trabalhadores de enfermagem do turno noturno. Metodologia: estudo quantitativo, exploratório, descritivo, realizado em um hospital federal de grande porte do Rio de Janeiro. Foram estudadas variáveis sóciodemográficas; influências do turno noturno sobre o organismo e índice de massa corporal, após aprovação do Comitê de Ética em Pesquisa da instituição. Resultados: os 89 trabalhadores de enfermagem apresentaram ganho de peso médio de aproximadamente 20Kg a partir da admissão no turno noturno, sendo que os enfermeiros referiram maior influência da ausência de sono sobre o organismo, e maior exaustão quando comparados aos dados das demais categorias. Conclusão: considerando as desordens hormonais e os impactos sociais do serviço noturno, é imprescindível a implementação de mudanças para uma cultura prevencionista, seja por programas institucionais ou pesquisas intervencionistas, capazes de desenvolver medidas que conduzam ao autorreconhecimento e à promoção do bem-estar físico, mental e social dos trabalhadores de enfermagem.

Objective: to evaluate body weight changes in nursing workers on the night shift. Methodology: this quantitative, exploratory, descriptive study, conducted at a large federal hospital in Rio de Janeiro, after approval of the institution's research ethics committee, considered socio-demographic variables, influence of the night work on the organism, and body mass index. Results: average weight gain among the 89 nursing workers was approximately 20kg since admission to night work, and nurses reported greater influence of lack of sleep on the body, and greater exhaustion as compared with data on the other categories. Conclusion: considering the hormonal disorders and social impacts of night work, it is essential to implement changes towards a culture of prevention, through either institutional programs or interventionist research able to develop measures that lead to self-recognition and promotion of nursing workers' physical, mental and social wellbeing.

Objetivo: evaluar las alteraciones de peso corporal en trabajadores de enfermería del turno nocturno. Metodología: estudio cuantitativo, exploratorio, descriptivo, realizado en un gran hospital federal en Río de Janeiro. Se estudiaron las variables sociodemográficas, la influencia reportada de la guardia nocturna en el organismo y el índice de masa corporal, tras la aprobación del Comité de Ética de Investigación de la Institución. Resultados: Los 89 trabajadores de enfermería tuvieron un aumento de peso promedio de aproximadamente 20 kg desde el ingreso en el turno nocturno, y los enfermeros informaron una mayor influencia de la falta de horas dormidas sobre el cuerpo y un mayor agotamiento en comparación con los datos de las otras categorías. Conclusión: Teniendo en cuenta los trastornos hormonales y los impactos sociales del servicio nocturno, es esencial implementar cambios hacia una cultura de prevención, ya sea a través de programas institucionales o de investigación intervencionista, capaces de desarrollar medidas que conduzcan al auto reconocimiento y a la promoción del bienestar físico, mentales y social de los trabajadores de enfermería.

Eficacia de un plan de cuidados de enfermería específico para el paciente con delirio / Effectiveness of a Specific Nursing Care Plan for the Patient with Delirium

RESUMEN Introducción: El síndrome confusional agudo o delirio es un trastorno psiquiátrico severo frecuente en pacientes mayores ingresados, tiende a agravarse en las horas del final de la tarde y nocturnas, con un gran impacto en los cuidados nocturnos. Objetivos: Evaluar la eficacia de los cuidados de enfermería específicos ante el delirio nocturno en pacientes hospitalizados. Métodos: Ensayo clínico cuasi-experimental en dos unidades de hospitalización de Medicina Interna de un hospital de alta complejidad. Se identificaron un grupo control y un grupo experimental, mediante muestreo de conveniencia. En ambos grupos, se seleccionaron pacientes con delirio, mediante la escala validada Intensive Care Delirium Screening Checklist. Se expuso al grupo experimental a plan de cuidados específico basado en bibliografía y plan de cuidados estándar al grupo control. Sobre resultados de indicadores de delirio, pre y posaplicación de planes de cuidados en ambos grupos, se realizaron pruebas de contraste (ANOVA, t-Student y Chi2-test de Fisher). Resultados: Con incidencia de 12-15 por ciento, los grupos control y experimental mostraron resultados homogéneos en el test del delirio PRE (p > 0,05). La edad, motivo de ingreso, género, y número de interrupciones durante el sueño, no mostraron repercusión sobre los resultados de delirio. Tras la aplicación de los planes de cuidados, el grupo experimental mostró reducción significativa de los índices de delirio (p < 0,05), y no se obtuvieron cambios significativos en el grupo control (p > 0,05). Conclusiones: El plan de cuidados específico a pacientes con delirio demostró ser eficaz al mejorar los indicadores del test de delirio y evitar el empeoramiento del cuadro(AU)

ABSTRACT Introduction: Acute confusional syndrome or delirium is a severe psychiatric disorder of frequent presentation in hospitalized elderly patients. It worsens likely in the late afternoon and evening hours, with a great impact on night care. Objectives: To evaluate the effectiveness of specific nursing care for sundown delirium in hospitalized patients. Methods: Quasi-experimental clinical trial in two hospitalization units of internal medicine of a high-complexity hospital. A control group and an experimental group were identified by convenience sampling. In both groups, patients with delirium were selected, using the validated scale Intensive Care Delirium Screening Checklist. The experimental group was exposed to a specific care plan, considering the bibliography; and the control group was exposed to a standard care plan. Regarding the results of delirium indicators, before and after the application of the care plans in both groups, contrast tests were performed (ANOVA, t-Student and Fisher's Chi-square test). Results: With an incidence of 12-15 percent, the control and experimental groups showed homogeneous results in the delirium test PRE (p >0.05). Age, reason for admission, gender, and number of interruptions during sleep did not show repercussion on delirium results. After the application of the care plans, the experimental group showed a significant reduction in delirium rates (p < 0.05), and no significant changes were obtained in the control group (p >0.05). Conclusions: The specific care plan for patients with delirium was shown to be effective in improving the indicators of the delirium test and avoiding the worsening of the health status(AU)

Acute myocardial infarction and primary percutaneous coronary intervention at night time / Infarto agudo do miocárdio e intervenção coronariana percutânea primária no período noturno

Background: Primary percutaneous coronary intervention is the preferred treatment in ST-elevation myocardial infarction. At night period, the delay until performing primary percutaneous coronary intervention may be determinant to prognosis worsening. Objective: To analyze the results of primary percutaneous coronary intervention performed at day and night periods. Methods: Cohort study that included patients admitted with ST-elevation myocardial infarction who underwent primary percutaneous coronary intervention from December 2013 until December 2016 in a ST-elevation myocardial infarction reference hospital of a metropolitan region in Brazil, followed from admission to hospital discharge or death, compared according to time of primary percutaneous coronary intervention (night or day). Statistical analysis comprehended the Chi-square test, the Fisher test, the Student's t-test and the analysis of variance, with significance level of 5%. Results: 446 patients were submitted to primary percutaneous coronary intervention, 159 (35.6%) at night time and 287 (64.4%) at day time. No differences were found between the two groups concerning clinical baseline characteristics. Door-to-balloon time (101 ± 81 minutes vs. 99 ± 78 minutes; p = 0,59) and onset-to-ballon time (294 ± 158 minutes vs. 278 ± 174 minutes; p = 0,32) did not differ between the groups. The incidence of combined major adverse cardiac events (15.1% vs. 14.3%; p = 0,58) and in-hospital mortality (9.4% vs. 8.0%; p = 0,61) were similar between the groups, as well as length of hospital stay (6.0 ± 4 days vs. 4.9 ± 4 days; p = 0,91). Conclusion: Primary percutaneous coronary intervention at night time showed similar results as the procedure performed at day time, without significant increase of in-hospital adverse events, length of stay or mortality

Disentangling the effects of insomnia and night work on cardiovascular diseases: a study in nursing professionals.

Cardiovascular diseases (CVDs) are known to be associated with poor sleep quality in general populations, but they have not been consistently associated with specific work schedules. Studies of CVD generally do not simultaneously consider sleep and work schedules, but that approach could help to disentangle their effects. We investigated the association between insomnia and a self-reported physician diagnosis of CVD in day and night workers, considering all sleep episodes during nocturnal and diurnal sleep. A cross-sectional study was conducted in 1307 female nursing professionals from 3 public hospitals, using baseline data from the "Health and Work in Nursing - a Cohort Study." Participants were divided into two groups: i) day workers with no previous experience in night shifts (n=281) and whose data on insomnia were related to nocturnal sleep and ii) those who worked exclusively at night (n=340) and had data on both nocturnal and diurnal sleep episodes, as they often sleep at daytime. Multiple logistic regression analysis was performed. Among day workers, insomnia complaints increased the odds of CVD 2.79-fold (95% CI=1.01-6.71) compared with workers who had no complaints. Among night workers, reports of insomnia during both nocturnal and diurnal sleep increased the odds of reported CVD 3.07-fold (95% CI=1.30-7.24). Workers with insomnia had similar probabilities of reporting CVD regardless of their work schedule, suggesting a relationship to insomnia and not to night work per se. The results also highlighted the importance of including evaluation of all sleep episodes (diurnal plus nocturnal sleep) for night workers.

Avaliação da presença de sintomas depressivos entre usuários de plantão noturno, em unidade de emergência / Assessment to the presence of depressive symptoms among users nightshift at emergency room / Evaluación de la presencia de síntomas depresivos entre usuarios de turno de noche en unidad de emergencia

Depressão é uma doença com agravos pessoais e sociais. Objetivou-se avaliar indicadores clínicos e contextuais entre usuários de plantão noturno, com sintomas depressivos, em unidade de emergência. Estudo descritivo, exploratório, transversal, realizado em 2008, em Campinas/SP, com 62 adultos em atendimento noturno. Aplicou-se questionário de identificação, contextualização e informações clínicas, bem como o Inventário de Depressão de Beck. Realizou-se análise estatística. Os resultados mostraram 62 sujeitos entre 18 e 56 anos, 75,8% mulheres, 71,8% brancas, 53,2% solteiros, todos com ocupação, nenhum analfabeto, 21% com nível superior. Apresentavam queixas digestivas e cefaleia (32,2%) e referiam problemas no trabalho (12,9%) e álcool e drogas na família (17,7%). Registraram-se sinais de depressão em 21% dos sujeitos. Encontrou-se relação significativa com fumo (p=0,021), insônia (p=0,005) e problemas econômicos (p<0,000). Conclui-se que os sintomas depressivos estavam aumentados, se comparados à amostra insuspeita, mas em acordo com os dados de depressão associada a doenças clínicas.

Depression is a disease with personal and social losses. We aimed to know the clinical and contextual factors related to the presence of depression in users of night-shift services, in a emergence unit. Descriptive, exploratory, cross-sectionalstudy conducted in 2008, Campinas/SP, with 62 adults who searched for care. A questionnaire with personal, psychosocial and clinical information and the Beck’s Depression Inventory (BID) were applied. Statistics analyses were carried out. The results showed 62 subjects were between 18 and 56 years old, 75.8% women, 71,8% white and 53,2% single, all subjects worked and none of them were illiterate, 21% had university studies; they had digestive complaints and headache (32.2%) and reported problems at work (12.9%) and alcohol and drug abuse in the family (17.7%). According to BID, 21% of the subjects were depressed. The test showed correlations for smoking (p=0.021), insomnia (p=0.005), economic problems (p<0.000). We concluded that compared to unsuspected samples, symptoms were high, but in accordance to disease-related depression.

La depresión es una enfermedad con pérdidas personales y sociales. El objetivo fue evaluar indicadores clínicosy contextuales relacionados a la presencia de síntomas depresivos entre usuarios de servicios de turno nocturno, en una unidad de emergencia. Estudio descriptivo, exploratorio y transversal, realizado en 2008, Campinas/SP-Brasil, con 62 adultos en atendimiento nocturno. Se aplicó un cuestionario de identificación, contextualización e informaciones clínicas, asi como elInventario de Depresión de Beck. Se realizó análisis estadístico. Los resultados indicaron 62 sujetos entre 18 y 56 años, 75,8% mujeres, 71,8% blancas y 53,2% solteros, todos trabajando, ninguno analfabeto, 21% con educación superior; tenían problemas digestivos y dolor de cabeza (32,2%) y reportaron problemas en el trabajo (12,9%) y abuso de alcohol y drogas en la familia (17,7%). Se registró depresión en 21% de los sujetos. Se encontró relación significativa con el tabaquismo (p=0,021), insomnio (p=0,005) y problemas económicos (p<0,000). La conclusión es que, si comparados a muestras insospechadas, los síntomas estaban aumentados, pero en acuerdo con la depresión asociada a enfermedades clínicas.

Nursing work at night in palliative oncology care.

OBJECTIVE: to understand the meaning baccalaureate nurses and nursing technicians attribute to night work in the context of clinical palliative oncology nursing care services, as well as how nursing works to attend to clients and caregivers' needs in this period. METHOD: in this exploratory and qualitative study, grounded theory was used. Seven nurses and four nursing technicians were interviewed, who composed two sample groups. Nine categories were produced and, in their comparative content analysis, a knowledge emphasis was evidenced with implications for nighttime nursing work. In this study, these aspects were discussed in two of the categories, which are: to describe care practice in order to understand nursing care management and to point out the difficulties in care practice and nursing care management. RESULTS: The results evidence the complexity in the nighttime care context, considering the clients' clinical conditions and clients and caregivers' psychological demands, mainly because of the threat of death. CONCLUSION: The team attempts to respond to these needs through communication, but reveals a lack of assistential services and an overload. Interdisciplinarity is a palliative care premise, favoring holistic care delivery, and cannot be neglected at, which requires attention and investment to develop better practices.

Nursing work at night in palliative oncology care / O trabalho noturno da enfermagem no cuidado paliativo oncológico / El trabajo nocturno de la enfermería en el cuidado paliativo oncológico

OBJECTIVE: to understand the meaning baccalaureate nurses and nursing technicians attribute to night work in the context of clinical palliative oncology nursing care services, as well as how nursing works to attend to clients and caregivers' needs in this period. METHOD: in this exploratory and qualitative study, grounded theory was used. Seven nurses and four nursing technicians were interviewed, who composed two sample groups. Nine categories were produced and, in their comparative content analysis, a knowledge emphasis was evidenced with implications for nighttime nursing work. In this study, these aspects were discussed in two of the categories, which are: to describe care practice in order to understand nursing care management and to point out the difficulties in care practice and nursing care management. RESULTS: The results evidence the complexity in the nighttime care context, considering the clients' clinical conditions and clients and caregivers' psychological demands, mainly because of the threat of death. CONCLUSION: The team attempts to respond to these needs through communication, but reveals a lack of assistential services and an overload. Interdisciplinarity is a palliative care premise, favoring holistic care delivery, and cannot be neglected at, which requires attention and investment to develop better practices. .

OBJETIVO: compreender o significado atribuído pelos enfermeiros e técnicos de enfermagem acerca do trabalho noturno, no contexto das enfermarias clínicas de cuidado paliativo oncológico, bem como o modo de trabalho da enfermagem em busca do atendimento das necessidades dos clientes e cuidadores, nesse período. MÉTODO: estudo exploratório, qualitativo, utilizando-se a Grounded Theory. Foram entrevistados sete enfermeiros e quatro técnicos de enfermagem, compondo dois grupos amostrais. Geraram-se nove categorias e na análise do conteúdo das mesmas, comparativamente, evidenciou-se conhecimento de destaque, com implicações no trabalho noturno da enfermagem. Tais aspectos foram discutidos no presente estudo em duas das categorias, a saber: descrevendo a prática para compreensão do gerenciamento do cuidado de enfermagem e apontando as dificuldades da prática e do gerenciamento do cuidado de enfermagem. RESULTADOS: evidenciam-se a complexidade do contexto no noturno, considerando o quadro clínico dos clientes e a demanda psicológica desses e dos seus cuidadores, principalmente pela ameaça da morte. CONCLUSÃO: a equipe busca atender tais necessidades a partir da comunicação, mas evidencia carência dos serviços assistenciais e sobrecarga. A interdisciplinaridade é uma premissa do cuidado paliativo, em prol da integralidade, e não pode ser negligenciada no trabalho noturno, o que requer atenção e investimento para o desenvolvimento de melhores práticas. .

OBJETIVO: comprender el significado atribuido por los enfermeros y técnicos de enfermería acerca del trabajo nocturno en el contexto de las enfermarías clínicas de cuidado paliativo oncológico, y también el modo de trabajo de la enfermería en el intento de atender a las necesidades de los clientes y cuidadores en este período. MÉTODO: estudio exploratorio, cualitativo, que utilizó la Grounded Theory (Teoría Fundamentada en los Datos). Fueron entrevistados siete enfermeros y cuatro técnicos de enfermería, incluidos en dos grupos de muestreo. Fueron generadas nueve categoría y, en el análisis de contenido de las mismas, comparativamente, fue evidenciado un conocimiento de destaque, con implicaciones en el trabajo nocturno de la enfermería. Tales aspectos fueron discutidos en el presente estudio en dos de las categorías, a saber: describiendo la práctica para comprensión de la gestión del cuidado de enfermería y indicando las dificultades de la práctica y gestión del cuidado de enfermería. RESULTADOS: los resultados evidencian la complejidad del contexto en el trabajo nocturno, considerando el cuadro clínico de los clientes y la demanda psicológica de estos y de sus cuidadores, principalmente debido a la amenaza de la muerte. CONCLUSÍON: el equipo busca atender a tales necesidades a partir de la comunicación, pero evidencia carencia de los servicios asistenciales y sobrecarga. La interdisciplinariedad es una premisa del cuidado paliativo, a favor de la integralidad, y no se la puede ignorar en el trabajo nocturno, lo que demanda atención e inversiones para el desarrollo de mejores prácticas. .

Validación de una escala de satisfacción con el cuidado nocturno de enfermería / Validation of a satisfaction scale for night nursing care

Con el objetivo de validar la escala The Night Nursing Care Instrument (NNCI) para la evaluación de la satisfacción con el cuidado enfermero nocturno en pacientes y enfermeros; entre enero y junio de 2011 se realizó en Medellín (Colombia) un estudio descriptivo de corte transversal con la participación de 194 pacientes hospitalizados en una institución de salud y de 34 enfermeros que tenían turnos nocturnos en el mismo hospital. Se utilizó la NNCI de 11 ítems, que evalúa en enfermeros y pacientes la satisfacción con los cuidados nocturnos de enfermería. Se hizo: a) traducción y retrotraducción del instrumento, b) validación semántica, c) validación de constructo con análisis de componentes principales, d) evaluación de la consistencia interna, y e) comparación de los ítems de la escala entre enfermeras y pacientes con un análisis de ANOVA de un factor. Los resultados mostraron en la validación factorial que la escala tiene tres dimensiones (intervenciones enfermeras, tratamiento médico y evaluación) en enfermeros y pacientes. La confiabilidad fue de 0,91 en enfermeros y 0,88 en pacientes. El 95,6 % de los pacientes y el 55,9 % de los enfermeros están satisfechos con el cuidado nocturno, diferencia que es estadísticamente significativa. La conclusión final de este estudio es que la escala NNCI es un instrumento con buena validez y confiabilidad y que puede ser utilizado en Colombia para evaluar la satisfacción de enfermeros y pacientes con el cuidado nocturno de enfermería(AU)

Aiming to validate The Night Nursing Care Instrument (NNCI) for evaluating satisfaction with night nursing care of patients and nurses, a cross sectional descriptive study, where 194 patients hospitalized in a health care institution and 34 nurses who had night shifts in the same hospital, was conducted between January and June 2011 in Medellin (Colombia). 11 items NNCI was used, it evaluates night nursing care satisfaction of nurses and patients. The instrument was: a) translated and retro-translated, b) semantically validated, c) construct validity with main component analysis was made, d) internal consistency was evaluated, and e) item comparison among nurses and patients with ANOVA analysis of a factor was made. Results showed in factorial validation, that the scale has three dimensions (Nurses interventions, medical treatment and evaluation) in nurses and patients. Reliability was 0,91 in nurses and 0,88 in patients. 95,6 % of patients and 55.9% of nurses were satisfied with nigh care, statistically significant difference. It was concluded that NNCI is an instrument with great validity and reliability and it can be used in Colombia to evaluate nurses' and patients' satisfaction with night nursing care(AU)

Eficacia de la insulinización nocturna en pacientes adultos con diabetes mellitus tipo 2 no controlados / Effectiveness of the night insulinization in adult patients with diabetes mellitus type 2 not controlled

Objetivos: Determinar la eficacia clínica del uso de la insulinización nocturna en pacientes con diabetes mellitus tipo 2 no controlados con hipoglicemiantes orales, atendidos en el Hospital Nacional Arzobispo Loayza de enero del 2009 a julio del 2011. Metodología: Estudio analítico observacional, retrospectivo. Se evaluó 1536 HC de las cuales 356 utilizaron insulinoterapia, por un periodo mínimo de 5 meses, de estos 100 cumplieron con los criterios de inclusión y no de exclusión. Resultados: Se evaluaron 100 casos de los cuáles se aplicaron insulinización nocturna 50 y diurna los otros 50. La edad promedio de los pacientes con insulinización nocturna es 58 ± 13 años y de los de insulinización diurna es 55 ± 14 años (p=0.259). No existe relación entre la variable sexo y el momento de insulinización nocturna o diurna (p=0.42). De igual manera, no existe relación entre la variable grado de instrucción y el momento de insulinización nocturna o diurna (p=0.16). Es decir, ambos grupos son similares por edad, sexo y grado de instrucción. El promedio post tratamiento de HbA1c (-3.38 ± 1.80 por ciento) de insulinización nocturna es menor que el promedio HbA1c (-2.06 ± 2.08 por ciento) de insulinización diurna (p=0.001). El promedio de unidades de insulina (15.08 ± 7.52) por insulinización nocturna es menor que el promedio (21.08 ± 10.36) de insulinización diurna (p=0.001) y el promedio de inyecciones (1.0) de insulinización nocturna es menor que el promedio de inyecciones (1.58 ± 0.5) de insulinización diurna (p<0.001). No hubo relación entre la variable, hipoglicemia y el momento de insulinización nocturna o diurna (p=0.749). Conclusiones: La utilización de insulinización nocturna es efectiva en el control glicémico de pacientes con diabetes mellitus tipo 2 no controlados con hipoglicemiantes orales en comparación de la insulinización diurna,...

Aim: To determine the clinical effectiveness of nocturnal insulin therapy in patients with uncontrolled type 2 diabetes with oral hypoglycemic agents; treated at the "Arzobispo Loayza" National Hospital, from January 2009 to July 2011. Methodology: This is an analytical observational, retrospective study. 1536 HC were evaluated. From this group, 356 used insulin for a minimum of 5 months. Of these, 100 met the criteria for inclusion and not for exclusion. Results: 100 cases were evaluated. Half this groups; this is, 50 patients were given nocturnal insulinization and the other 50, daylight. The average age of patients with nocturnal insulinization is 58 ± 13, and that of daylight insulinization patients is 55 ± 14 (p=0.259). There is no relationship between the variable sex and the time of day or night they are given insulinization (p=0.42). Similarly, there is no relationship between the level of education and the time of day or night of insulinization (p=0.16). That is, both groups are similar for age, sex and level of education. The average post-treatment HbA1c (-3.38 ± 1.80 per cent) nocturnal insulinization is less than the average HbA1c (-2.06 ± 2.08 per cent) daylight insulinization (p=0.001). The average number of units of insulin (15.08 ± 7.52) for nocturnal insulinization is less than the average (21.08 ± 10.36) daylight insulinization (p=0.001). Finally, the average number of injections (1.0) during nocturnal insulinization is less than the average number of injections (1.58 ± 0.5) during daylight insulinization (p<0.001). There is no relationship between the variable hypoglycemia and the timing of night or daytime of insulin therapy (p=0.749). Conclusion: The use of nocturna1 insulin therapy is effective for glycemic control, this is in patients with uncontrolled type 2 diabetes on oral hypoglycemic insulin therapy; in contrast with those in daytime therapy, with a lower average number of injections and lower average dose of insulin,...

Relationship between sleeping on the night shift and recovery from work among nursing workers - the influence of domestic work.

AIM: This paper is a report of a study on the association between sleep patterns during work nights and recovery from work among nursing workers, considering domestic work hours. BACKGROUND: Several hospitals allow nursing workers to sleep during the night shift, but this is rarely evaluated from the workers' health perspective. The need for recovery from work concept can be useful for testing the impact of night work on sleep. Recovery is not a problem if workers have enough time to recover between periods of work. Therefore, domestic work would be likely to interfere in the recovery process. METHODS: This cross-sectional study was carried out at three hospitals in 2005-2006, through a comprehensive questionnaire. All nursing teams engaged in assistance to patients were invited to participate. Analyses included female night workers with no incidence of insomnia. Participants (n = 396) were classified into those who did not sleep during night shifts, those who slept for up to 2 hours and those who slept for 2-3 hours. RESULTS: Binomial logistic regression analysis showed that sleeping on the job for 2-3 hours during night shifts is related to a better recovery from work provided the workers do not undergo long domestic work hours. CONCLUSIONS: Being allowed to sleep at work during night shifts seemed to contribute to, but was not enough to guarantee, a good recovery from work in the studied population. Recommendations to deal with sleep-deprivation among night workers should consider the complexity of gender roles on the recovery process.

[Possibilities and limits of sleep recovery for night-nursing workers]. / Possibilidades e limites da recuperaçao do sono de trabalhadores noturnos de enfermagem.

The present study had the objective of investigating the possibilities/limits of sleep recovery in women workers with medium level in nursing that develop their activities in night shifts in a first-aid clinic at a public hospital in Natal, Rio Grande do Norte, Brazil. This was an analytic study, with a qualitative approach which used the technique of thematic oral history Fifteen women workers with medium level in nursing were interviewed. The following empirical categories were defined: night shift work and night sleep and night rest at work environment Physiological and psychological sufferings are evident on their speech as well as what the lack of sleep causes in health and personal life of these women workers, making the overload of work clear and also the sociocultural imperfections of feminine gender

Aspectos do ciclo vigília-sono e estados emocionais em enfermeiros dos diferentes turnos de trabalho / Aspects of the sleep-wake cycle and mood states in nurses from different work shifts

Objetivo O objetivo principal deste estudo foi descrever o ciclo vigília-sono de enfermeiros em função de seus turnos de trabalho, identificar alterações no padrão de sono e seus estados emocionais durante o trabalho. Métodos Este estudo foi conduzido com 53 enfermeiros de diferentes turnos de um hospital universitário de Campinas (São Paulo, Brasil). Os horários de trabalho foram os seguintes: turno matutino das 6h55min às 13h10min e turno vespertino das 13h às 19h15min, ambos com jornada semanal de 30 horas; turno noturno das 19h05min às 7h05min, com turno de 12 horas de trabalho seguido de 60 horas de descanso. Os questionários utilizados foram: Avaliação do Ciclo Vigília-Sono e Lista de Estados Emocionais Presentes. Resultados Os resultados revelaram que os enfermeiros do período matutino acordavam mais cedo, porém não antecipavam o horário de dormir; o sono dos enfermeiros do período vespertino não sofria alterações; os enfermeiros do período noturno apresentavam sono diurno curto e fracionado; o perfil emocional dos enfermeiros sofria alterações no decorrer do turno. Conclusão Concluiu-se que o trabalho em turnos causou prejuízos à qualidade e duração do sono dos enfermeiros dos períodos matutino e noturno, e que as alterações dos estados emocionais podem estar relacionadas ao desgaste da atividade de prestar assistência.

Objective The main objective of this study were to describe the sleep-wake cycle of nurses as a function of their work shifts, identify changes in their sleep patterns, and identify their mood states during work. Methods This study included 53 nurses from a University Hospital in Campinas (São Paulo- Brazil) working different shifts. The 30-hour workweek shifts were as follows: mornings from 6h55 a.m. to 1h10 p.m. and afternoons from 1h p.m. to 7h15 p.m. The night shift was from 7h05 p.m. to 7h05 a.m. followed by 60 hours off duty. The following questionnaires were used: Evaluation of sleep-wake cycle and Present Mood States List. Results The results showed that morning-shift nurses woke up earlier than those of other shifts but they did not go to bed earlier. Sleep patterns of afternoon-shift nurses were not affected. Night-shift nurses slept less and woke up often during their daytime sleep. The emotional profile of the nurses changed over the work shift. Conclusion In conclusion, the morning and night shifts negatively affected the quality and duration of the nurses´ sleep and the changes in emotional states may be associated with the occupation itself.

Twelve-hour night shifts of healthcare workers: a risk to the patients?

We assessed the impact of 12h fixed night shift (19:00-07:00h) work, followed by 36h of off-time, on the sleep-wake cycle, sleep duration, self-perceived sleep quality, and work-time alertness on a group composed of 5 registered and 15 practical nurses. Wrist actigraphy (Ambulatory Monitoring, Inc.), with data analysis by the Cole-Kripke algorithm, was applied to determine sleep/wake episodes and their duration. The sleep episodes were divided into six categories: sleep during the night shift (x = 208.6; SD +/- 90.6 mins), sleep after the night shift (x = 138.7; SD +/- 79.6 min), sleep during the first night after the night work (x = 318.5; SD +/- 134.6 min), sleep before the night work (x = 104.3; SD +/- 44.1 min), diurnal sleep during the rest day (x = 70.5; SD +/- 43.0 min), and nocturnal sleep during the rest day (x = 310.4; SD +/- 188.9mins). A significant difference (p < .0001; T-test for dependent samples) was detected between the perceived quality of sleep of the three diurnal sleep categories compared to the three nocturnal sleep categories. Even thought the nurses slept (napped) during the night shift, their self-perceived alertness systematically decreased during it. Statistically significant differences were documented by one-way ANOVA (F = 40.534 p < .0001) among the alertness measurements done during the night shift. In particular, there was significant difference in the level of perceived alertness (p < .0001) between the 7th and 10th of the 12h night shift. These findings of decreased alertness during the terminal hours of the night shift are of concern, since they suggest risk of comprised patient care.

Programa de atención pediátrica domiciliaria nocturna / Nocturnal domiciliary pediatric attention program

Informe estadístico de la actividad del programa, implementado en Abril de 2000 por la Secretaría de Salud de la Ciudad de Buenos Aires. Presenta promedio mensual de consultas diarias, evolución del programa por mes y a±o, porcentajes de atenciones según edad de los pacientes, variación de llamadas a lo largo del horario del programa, demora en la atención, resolución del pedido, y principales diagnósticos

Programa de atención pediátrica domiciliaria nocturna / Nocturnal domiciliary pediatric attention program

Informe estadístico de la actividad del programa, implementado en Abril de 2000 por la Secretaría de Salud de la Ciudad de Buenos Aires. Presenta promedio mensual de consultas diarias, evolución del programa por mes y a±o, porcentajes de atenciones según edad de los pacientes, variación de llamadas a lo largo del horario del programa, demora en la atención, resolución del pedido, y principales diagnósticos

[Nursing team: experience of caring for children with cancer during night shift]. / Equipe de enfermagem: experiência do cuidar de criança com câncer nos plantões noturnos.

The present study aimed understanding some aspects of the experience of a nursing team that take care of children with cancer in night shifts. Therefore, the author used a qualitative methodology--phenomenological method--that enabled her to analyse the declarations of the nursing team about their experience. The convergences of their speech were analysed and some units of meaning were identified in order to contribute to institutionally assure the necessary work conditions to the nursing personnel as well as to prepare the team to face these circumstances.

[Views of nursing students on the curriculum development in night service]. / A visão do estudante de enfermagem sobre o desenvolvimento do estágio curricular no período noturno.

This preliminary work was based in the qualitative method, about the opinion of the College students nursing in the seventh (7th) stage of the course about the development of the curricular experience on the night shift. Thirty (30) relates were identified in the respective aspects: importance of the experiences, relationship between overseer nurse and multidisciplinary health care team; difference between day shift and night shift. The most part of the related demonstrates that it's been valid and they've given emphasis, only, in relationship between overseer nurse and multidisciplinary health care team, without emphasizing the effective contribution on the practice knowledge. The relating emphasized the difference among the shifts. It follows that is necessary an extense discussion of the teachers, nursing body and college students nursing body, under the effective objectives of the practice curricular experience for professional qualification.