ABSTRACT
OBJECTIVES: To implement evidence-based practice related to care and flushing of nasogastric tubes inserted for feeding, in a general medicine ward. INTRODUCTION: Nasogastric tube feeding is a widely used nutritional support form. Although performed by qualified professionals, it is not a harm-free intervention. Progression to the trachea during initial insertion, aspiration of gastric contents, improper position for patient feeding, and/or a blocked tube are examples of problems that can occur. METHODS: The project used JBI's methodological approach of the Clinical Evidence System and Getting Research into Practice audit and feedback tool. A baseline audit focused on nursing procedures related to the maintenance of nasogastric tube feeding, based on 14 criteria informed by the JBI evidence summaries, was performed for a month. Education sessions and other engagement strategies and resources were used to increase nasogastric tube maintenance. This best-practice implementation was conducted in Portugal, between January 2020 and April 2021, in a 33-bed general medicine ward with a staff of 30 registered nurses. RESULTS: Different samples, for each audited procedure, were obtained from a universe of 25 nurses and 14 episodes of patients with nasogastric tube in baseline and 10 in follow-up audit. At baseline, compliance with the criteria ranged from 0 to 88%. Ten of the 14 criteria were below 50%. The follow-up audit showed significant improvement in all compliance criteria (ranging from 44.4 to 100%). Criteria 1 and 2, which were aimed at preventing adverse consequences related to wrong placement or displacement of the nasogastric tube, showed a high postimplementation compliance level (89.3 and 90%). CONCLUSION: With an integrated plan incorporating interventions, strategies, and resources, tailored for this context, we improved nurses' knowledge of nasogastric tube maintenance and achieved significantly increased compliance with nasogastric tube care best-practice. We suggest maintaining current strategies, and reinforcing clinical supervision and regular assessment.
Subject(s)
Clinical Competence , Intubation, Gastrointestinal , Humans , Portugal , Evidence-Based PracticeABSTRACT
O objetivo deste trabalho foi descrever as guildas funcionais dos besouros rola-bostas (Scarabaeidae: Scarabaeinae) e analisar a influência da granulometria do solo na estruturação destas guildas e inferir possíveis processos geradores. Para isso, foram coletados besouros rola-bostas e amostras de solo, em áreas de floresta semidecidual, na região norte (módulos do PPbio) e sudoeste (22 reservas de fazendas) do estado de Mato Grosso. Para as coletas dos besouros foram utilizados 85 armadilhas pitfall, iscado com fezes humanas expostas por 48 horas, na região norte e 132 armadilhas na região sudoeste. As duas regiões apresentaram estrutura de guilda similar, com dominância de paracoprídeos, seguido de telecoprídeos e endocoprídeos. Padrão coerente com o padrão Neotropical, o que reforça a teoria da existência de uma estrutura determinística taxonômica e funcional para as subamostras na região. A concentração de argila apresentou efeitos distintos para ambas as regiões estudadas. Na região norte causou redução na abundância de endocoprídeos e telecoprídeos pequenos e reduziu a riqueza de paracoprídeos grandes, enquanto na região sudoeste influenciou principalmente a redução de paracoprídeos pequenos e aumento de telecoprídeos pequenos e endocoprídeos grandes. A concentração de argila no solo influenciou a estrutura das guildas funcionais apenas em nível de micro-habitat. As guildas dos paracoprídeos e telecoprídeos pequenos são as mais afetadas pela variação da granulometria. O aumento da concentração de argila levou a redução dos paracoprídeos pequenos e aumento dos telecoprídeos pequenos.
This study aimed to describe the structure functional guilds of dung beetles (Scarabaeidae: Scarabaeinae) and analyze the effects of the concentration of clay in soil in this structure. The studies were developed in the north and southwest in the state of Mato Grosso. The dung beetles and soil samples were collected in the north (PPBio) and southwest (22 farms reserve) in Mato Grosso. The dung beetle were captured with pitfall traps baited with human feces exposed for 48 hours. In the north region were utilized 85 traps and 132 in the southwest. Both regions, the results showed similarity at guild structure, with paracoprids dominance, followed by telecoprids and endocoprids. Which demonstrates consistency with the Neotropical pattern. Which emphasizes the theory of the existence of a deterministic taxonomic and functional structure for the subsamples in this region. The concentration of clay showed different effects for both regions studied. To the north caused the reduction in the abundance of endocoprids and small telecoprids and reduced the richness of large paracoprids. In the southwest region had mainly influences on reducing of small paracoprids, the increase of small telecoprids and also the large endocoprids. In micro-habitat scale, concentration of clay in the soil showed an important structural element of the functional guilds of dung beetles. The Guilds of the small paracoprids and small telecoprids were most affected by the variation of soil granulometry.
