Relação enfermeiro-pessoa afetada pela Tuberculose fundamentada na teoria do alcance de metas de imogene king / La relación enfermería-Persona afectada por la Tuberculosis, según la Teoría del logro de objetivos de imogene king / The nurse-tuberculosis patient relationship according to Imogene King's theory of goal achievement

Resumo Introdução: As ações desenvolvidas na Atenção Primária à Saúde são um dos pontos fortes de combate à tuberculose. Nesse nível de atenção, o contato contínuo do enfermeiro por meio da consulta de enfermagem permite manter relação com a população adoecida. Diante da relação enfermeiro-pessoa cuidada para o estabelecimento do vínculo e adesão ao tratamento contra tuberculose, compreende-se a importância do referencial teórico de Imogene King para estruturar a interação enfermeiro-pessoa cuidada e oferecer uma dinâmica para esse processo. Objetivo: Analisar a relação enfermeiro-pessoa afetada pela tuberculose fundamentada na Teoria do Alcance de Metas de Imogene King. Método: Estudo descritivo com abordagem qualitativa, com 14 enfermeiros da APS, selecionadas por conveniência. A coleta de dados ocorreu de agosto a novembro de 2018, por meio de entrevista semiestruturada, elaborada com base no Registro Meta-Orientado de Enfermagem de Imogene King. Os dados foram analisados de forme qualitativa pelo Software IRAMUTEQ. A pesquisa foi aprovada pelo Comitê de Ética. Resultados: Após a análise, emergiram quatro classes: 1) relação estabelecida com base no acolhimento; 2) relação enfermeiro-pessoa com tuberculose e o apoio de outros profissionais e familiares; 3) relação estabelecida com vistas ao cumprimento do tratamento; e 4) relação estabelecida para enfrentamento do preconceito diante da tuberculose. Conclusão: O acolhimento, a família e o vínculo entre profissional, paciente e equipe da Atenção Primária à Saúde fortalecem o enfrentamento da doença e reforçam a adesão ao tratamento medicamentoso.

Resumen Introducción: Uno de los puntos fuertes de la lucha contra la tuberculosis son las acciones desarrolladas en la atención primaria de salud. En este nivel asistencial, el contacto continuo de las enfermerías a través de la consulta de enfermería permite mantener una relación con la población enferma. Frente a la relación enfermería-persona para el establecimiento del vínculo y la adherencia al tratamiento contra la tuberculosis, se entiende la importancia del referente teórico de Imogene King para estructurar la interacción enfermería-persona y ofrecer una dinámica para este proceso. Objetivo: Análisis de la relación entre el personal de enfermería y las personas afectadas por la tuberculosis, a partir de la teoría del logro de objetivos de Imogene King. Método: Estudio descriptivo con abordaje cualitativo, con 14 enfermeras de atención primaria de salud, seleccionadas por conveniencia. La recolección de datos ocurrió de agosto a noviembre de 2018, a través de una entrevista semiestructurada, elaborada con base en el registro meta-orientado de enfermería de Imogene King. Los datos fueron analizados cualitativamente utilizando el software IRAMUTEQ. La investigación fue aprobada por el Comité de Ética. Resultados: Después del análisis, surgieron cuatro clases: 1) relación establecida con base en la recepción, 2) relación enfermería-persona con tuberculosis y apoyo de otras personas profesionales y familiares, 3) relación establecida con miras al cumplimiento del tratamiento y 4) relación establecida para combatir los prejuicios contra la tuberculosis. Conclusión: La acogida, la familia y el vínculo entre profesional, paciente y equipo de atención primaria de salud fortalecen el afrontamiento de la enfermedad y refuerzan la adherencia al tratamiento farmacológico.

Abstract Introduction: One of the main aspects in the fight against tuberculosis are the actions developed in Primary Health Care (PHC). At this level of care, the nurse's continuous contact through the nursing consultation allows them to maintain a relationship with the sick population. Regarding the nurse-patient relationship for establishing a bond and the compliance with tuberculosis treatment, we understand the importance of Imogene King's theoretical framework for structuring the nurse-patient interaction and offering a dynamic for this process. Objective: To analyze the nurse-tuberculosis patient relationship based on Imogene King's Theory of Goal Achievement. Method: A descriptive study with a qualitative approach, with 14 PHC nurses, selected by convenience. Data were collected from August to November 2018 through semi-structured interviews based on Imogene King's Meta-Oriented Nursing Record. The data were analyzed qualitatively using the IRAMUTEQ software. The research was approved by the Ethics Committee. Results: After the analysis, four classes emerged: 1) relationship established on the basis of welcoming; 2) nurse-tuberculosis patient relationship and the support of other professionals and family members; 3) relationship established towards treatment compliance; and 4) relationship established to confront prejudice associated with tuberculosis. Conclusion: The welcoming, the family, and the bond between the professional, the patient and Primary Health Care team strengthen the coping with the disease and reinforce the compliance with the pharmacological treatment.

Salud Mental en enfermeras al cuidado de pacientes en área COVID: estudio de caso / Saúde mental dos enfermeiros que prestam cuidados a doentes na área da COVID: um estudo de caso / Mental Health in nurses caring for patients in the COVID area: case study

La enfermería es la labor que abarca la atención autónoma apersonas de todas las edades, familias, grupos y comunidades,la principal característica y esencia es el cuidado, implicaestablecer una relación de comprensión y acompañamiento demanera integral, convirtiéndolos en los principales cuidadoresformales en la asistencia, lo que pone de manifiesto lanecesidad de mirar su salud mental y bienestar del personalde enfermería. El objetivo fue describir el impacto en la saludmental de un profesional de la enfermería en la atencióna pacientes del área COVID en tiempos de pandemia, enel periodo 2022-2023. Se realizó un estudio cualitativo,primero mediante el análisis documental y posteriormentemediante el método fenomenológico, descriptivo con baseen el estudio de caso, considerando la temporalidad en tresmomentos, antes, durante y después de la pandemia porCOVID. Los hallazgos dan constancia, de cambios e impactosa nivel biológico, psicológico, social y espiritual que derivanen afectaciones en salud mental que se experimentaron,y, por otro lado, de la escasez acciones para dotar a losprofesionales de la salud de un acompañamiento, capacitacióny sensibilización en salud mental para la mejora de su labory bienestar personal.(AU)

A enfermagem é o trabalho que engloba o cuidado autônomoa pessoas de todas as idades, famílias, grupos e comunidades,a principal caraterística e essência é o cuidado, envolveo estabelecimento de uma relação de compreensão eacompanhamento de forma integral, tornando-os osprincipais cuidadores formais no cuidado, o que destaca anecessidade de olhar para sua saúde mental e bem-estar daequipe de enfermagem. O objetivo foi descrever o impactona saúde mental de um profissional de enfermagem nocuidado de pacientes na área da COVID em tempos depandemia, no período de 2022-2023. Realizou-se um estudoqualitativo, primeiro por meio de análise documental edepois pelo método fenomenológico, descritivo baseadono estudo de caso, considerando a temporalidade em trêsmomentos, antes, durante e após a pandemia da COVID. Osachados evidenciam mudanças e impactos a nível biológico,psicológico, social e espiritual que conduzem às afetaçõesde saúde mental vivenciadas e, por outro lado, a escassezde ações de acompanhamento, formação e sensibilizaçãoem saúde mental para os profissionais de saúde, com vistaà melhoria do seu trabalho e bem-estar pessoal.(AU)

Nursing is the work that encompasses autonomous care topeople of all ages, families, groups and communities, themain characteristic and essence is care, it involves establishinga relationship of understanding and accompaniment in a comprehensive manner, making them the main formalcaregivers in assistance, which highlights the need to lookat their mental health and well-being of the nursing staff. Theobjective was to describe the impact on the mental health of anursing professional in the care of patients in the COVID areain times of pandemic, in the period 2022-2023. A qualitativestudy was conducted, first through documentary analysisand then through the phenomenological method, descriptivebased on the case study, considering the temporality in threemoments, before, during and after the COVID pandemic.The findings provide evidence of changes and impacts atthe biological, psychological, social and spiritual levels thatresult in mental health affectations that were experienced,and, on the other hand, of the scarcity of actions to providehealth professionals with accompaniment, training andsensitization in mental health to improve their work andpersonal wellbeing.(AU)

Cuidando al final de la vida. Un programa de intervención online para familiares de pacientes oncológicos en fase paliativa / Caring the caregivers. An online psychological intervention for family caregivers of oncological palliative patients

Resumen: Objetivo: Analizar la eficacia de un programa de intervención psicológica grupal en formato online diseñado para reducir la sobrecarga y el malestar emocional de los cuidadores informales de pacientes oncológicos en fase final de vida. Método: El programa se desarrolló para cuidadores principales de pacientes oncológicos en situación de enfermedad avanzada, con pronóstico de vida inferior a 6 meses. La intervención consistió en cuatro sesiones semanales. Los instrumentos de evaluación fueron la Escala de Detección de Malestar Emocional del Cuidador Principal y la Escala Zarit Reducida y se aplicaron al inicio y al final del programa. Además, se categorizaron las principales preocupaciones de los cuidadores a través de la Escala de Detección del Malestar del Cuidador Principal. Se utilizaron estadísticos descriptivos y t de Student. Resultados: En el estudio participaron 38 familiares de los cuales el 81,6% eran mujeres. En cuanto el grado de parentesco, el 44,7% eran descendientes del paciente. El malestar emocional se redujo significativamente después de la intervención. La incertidumbre se mantuvo como principal preocupación en ambos momentos de medida. Antes del programa, la segunda preocupación más frecuente fue el sufrimiento por el ser querido enfermo, mientras que después de la intervención fue la preocupación por el sufrimiento de otros miembros de la familia. Conclusiones: La realización de este programa de intervención psicológica grupal online demostró ser efectiva para reducir el malestar emocional en los cuidadores principales de pacientes oncológicos al final de la vida. La incertidumbre fue una preocupación constante a lo largo del programa en los familiares. (AU)

Abstract:Aim: analyze the effectiveness of an online delivered psychological intervention program for oncological palliative caregivers in order to reduce the distress and caregiver burden. Methods: The program was developed for primary caregivers of advanced cancer patients, with a life expectancy of less than 6 months. The intervention consisted of 4 weekly sessions. The assessment instruments were the Caregiver Emotional Distress Detection Scale and the Zarit’s Reduced Scale and were applied at the beginning and end of the program. In addition, the main worries of the caregivers were categorized by the Caregiver Emotional Distress Detection Scale. Descriptive statistics and Student’s t were used. Results: 38 caregivers enrolled in intervention, 81.6% of whom were women. Regarding the degree of kinship, 44.7% were descendants of the patient. The distress was significantly reduced after the intervention. Uncertainty remained the main worry at both moments of measurement. Before the program, the second most frequent worry was the suffering of the patient, while after the intervention it was worries about the suffering of other family members. Conclusions: Carrying out this online group psychological intervention program proved to be effective in reducing emotional distress in the main caregivers of cancer patients at the end of life. Uncertainty was a constant concern throughout the program in the relatives. (AU)

Estudio sobre las características de la información sanitaria en las conducciones entre centros penitenciario / Study of the characteristics of medical information in transfers between prisons

Introducción: La movilidad de la población penitenciaria precisa que la información transmitida en los traslados entre centros garantice una óptima continuidad asistencial. Objetivo: Valorar la calidad de la transmisión de información sanitaria cuando los internos son trasladados en conducción entre centros penitenciarios de todo el territorio español. Material y método: Estudio observacional, descriptivo y transversal, consistente en la revisión de historias clínicas de los internos que transitaron por el Centro Penitenciario (CP) Madrid III en un periodo de tres meses. Todas las variables medidas fueron cualitativas, expresadas en frecuencias absolutas y relativas. Resultados: Durante ese tiempo, 1.168 internos transitaron por el CP Madrid III. Solo 21 procedían de centros penitenciarios de Cataluña, País Vasco o Navarra, cuya historia clínica es diferente a la del resto del Estado, y solo el 57,14% aportaban algún tipo de información sanitaria. Del resto de internos, el 70,79% aportaba algún tipo de información: el 63,90% del total tenía medicación prescrita y el 5% metadona. De aquellos que tenían medicación, el 89,10% la tenían prescrita en la prescripción electrónica, siendo correcta en el 98% de los casos. Respecto a la metadona, solo el 75,44% lo tenía prescrito electrónicamente, siendo correcta en todos los casos. La fecha de la última dosis administrada solo se indicó en el 72,40% de los tratamientos. Discusión: Solo el 34,70% de las historias presentaban una calidad óptima en cuanto a la información transmitida, siendo en el 2,50% de los casos la información recibida deficiente. El uso de herramientas informáticas facilita la transmisión de la información, reduce la carga de trabajo y mejora la seguridad del paciente.(AU)

Introduction: The mobility of the prison population creates a need for information transmitted in transfers between centers that can guarantee optimal care continuity. Objective: To assess the quality of transmission of health information when inmates are transferred between prisons in Spain. Material and method: Observational, descriptive and cross-sectional study, consisting of a review of medical records of inmates who passed through Madrid III Prison in a three-month period. All measured variables were qualitative, and were expressed in absolute and relative frequencies. Results: 1,168 inmates passed through Madrid III Prison in this period. Only 21 came from prisons in Catalonia, the Basque Country or Navarre, where their medical records are different from those in the rest of Spain, and only 57.14% provided some type of health information. Of the remaining inmates, 70.79% provided some type of information: 63.90% of the total had prescriptions for medication and 5% were prescribed with methadone. Of those taking medication, 89.10% were prescribed it in electronic prescriptions, which were correct in 98% of the cases. For methadone, only 75.44% had electronic prescriptions,which were correct in all cases. The date of the last dose administered was only indicated in 72.40% of the treatments. Discussion: Only 34.70% of the records presented optimal quality in terms of the information transmitted, and in 2.50% of the cases the information received was deficient. The use of computerized tools facilitates the transmission of information, reduces the workload and improves patient safety.(AU)

Prevalencia de Staphylococcus aureusy su sensibilidad antibiótica en aislamientos en infecciones de piel y partes blandas en pacientes ambulatorios / Staphylococcus aureus prevalence and antimicrobial susceptibility in isolates from skin and soft tissue infections in outpatients

ntroducción: Las infecciones de piel y partes blandas (IPPB) constituyen la tercera causa de consulta en nuestro centro. S.aureus es el agente etiológico más frecuente en este tipo de infecciones y la meticilino resistencia es clínicamente el mecanismo de resistencia más importante. El objetivo de este trabajo fue analizar la prevalencia de los distintos agentes etiológicos en IPPB en pacientes ambulatorios, así como también estudiar su sensibilidad a los antibióticos y resistencias acompañantes más frecuentes. Materiales y métodos: Estudio descriptivo y retrospectivo que incluyó todas las muestras provenientes de IPPB de pacientes ambulatorios desde octubre de 2017 a abril de 2022. Resultados: Se obtuvieron 180 cultivos positivos de muestras provenientes de IPPB durante el periodo estudiado, 12 fueron infecciones polimicrobianas. En total se obtuvieron 307 aislamientos: el microorganismo aislado con mayor frecuencia fue S.aureus (111; 36,2%). Se hallaron 71 SAMR (64%) y 40 SAMS (36%). De los SAMR, 67 (95%) fueron comunitarios (SAMRC) por criterios microbiológicos, y 4 SAMR hospitalarios (5%). De las cepas SAMRC, 44 (66%) no presentaron resistencias acompañantes, 15 (22% ) fueron resistentes a eritromicina, 12 (18%) a gentamicina y 7 (10%) a clindamicina. Conclusiones: El microorganismo más frecuentemente aislado en IPPB en pacientes ambulatorios fue el S.aureus y 67 aislamientos fueron categorizados como SAMRC por lo cual es necesario considerar al SAMRC como un patógeno frecuente. Debido a la baja resistencia hallada para CLI y TMS ambos podrían ser de elección en el tratamiento empírico en las IPPB en pacientes ambulatorios

Background:S. aureus is the main cause of skin and soft tissues infections (SSTIs) in immunocompetent patients. This type of infection is the third cause of medical consultation in our center. Our objective was to evaluate the prevalence of S. aureus, as well as its sensitivity to antimicrobials, isolated from skin and soft tissue samples from outpatients at an interzonal general acute care hospital located in Buenos Aires, Argentina.Methods: Descriptive and retrospective study that included all outpatient SSTIs samples from October 2017 to April 2022.Results: We obtained 215 positive cultures of samples from SSTIs during the study period. Of a total of 276 isolates: the most frequently isolated microorganism wasS. aureus (111; 40.22%). The prevalence of S. aureuswas 51.63%. We found 71 MRSA (63.96%). Of the SAMR strains, 60.56% did not present accompanying resistance, and only 8 isolates (11.27%) showed resistance to clindamycin. All SAMRs remained sensitive to minocycline and trimethoprim-sulfamethoxazole.Conclusions: The most frequently isolated microorganism in SSTIs was S. aureus and 71 isolates were categorized as SAMR, therefore it is necessary to consider SAMR as a frequent pathogen. Due to the low resistance found for CLI and TMS, they should be considered for empirical treatment in SSTIs in outpatients

La actividad física en la enfermedad de Parkinson: identificación de los responsables de su prescripción, hábitos e impacto en la calidad de vida, y de la gravedad de la enfermedad / Physical activity in Parkinson’s disease: examining prescription sources, patterns, and the influence of quality of life and disease severity

Introducción: Escasas investigaciones han explorado la influencia de la calidad de vida (CV) y la gravedad de la enfermedad en la actividad física (AF) en pacientes con enfermedad de Parkinson (EP), así como las fuentes de prescripción de AF y consejos para esta población. Este estudio tiene como objetivo ampliar el conocimiento científico sobre estos temas. Pacientes y métodos: Se entrevistó personalmente a 211 pacientes con EP para recopilar datos sobre los niveles de AF con el International Physical Activity Questionnaire-Short Form y la CV con el Parkinson’s Disease Questionnaire-8. Un cuestionario ad hoc recopiló información sobre la gravedad de la enfermedad (etapas de Hoehn y Yahr), los comportamientos de AF y las recomendaciones de AF. Resultados: Se encontraron asociaciones débiles, pero significativas, entre los niveles de AF, la gravedad de la enfermedad (r = –0,218; p = 0,004) y la CV (r = –0,244; p = 0,001). La mayoría de los participantes (85%) recibió asesoramiento sobre AF, principalmente de neurólogos, ya sea en el momento del diagnóstico (52%) o poco después (28%). Antes del inicio de la EP, ~86% participaba en AF, lo que disminuyó al 66% después del diagnóstico. Aproximadamente el 78% informó sobre cambios en la AF, incluida una reducción en la frecuencia (18,4%) y la duración (32,8%), y la caminata era la actividad principal. Conclusiones: La gravedad de la enfermedad y la CV afectan significativamente a los niveles de AF en pacientes con EP. El diagnóstico se asocia con una disminución en la frecuencia y la duración de la AF, y la caminata es la actividad preferida. Los neurólogos aconsejan principalmente sobre AF a las personas con EP. (AU)

Introduction: Limited research has explored the influence of quality of life (QoL) and disease severity on physical activity (PA) in Parkinson’s disease (PD) patients, and the sources of PA prescription and advice for this population. This study aims to expand scientific knowledge on these topics. Patients and methods: Two-hundred eleven PD patients were personally interviewed to collect data on PA levels using the International Physical Activity Questionnaire-Short Form and QoL using the Parkinson’s Disease Questionnaire-8. An ad hoc questionnaire gathered information on disease severity (Hoehn and Yahr stages), PA behaviors, and PA recommendations. Results: Weak but significant associations were found between PA levels, disease severity (r: –0.218; p = 0.004), and QoL (r: –0.244; p = 0.001). Most participants (85%) received PA counselling, predominantly from neurologists, either at diagnosis (52%) or shortly after (28%). Before PD onset, ~86% engaged in PA, decreasing to 66% post-diagnosis. Approximately 78% reported changes in PA, including reduced frequency (18.4%) and duration (32.8%), with walking as the primary activity. Conclusions: Disease severity and QoL significantly affect PA levels in PD patients. Diagnosis is associated with decreased PA frequency and duration, and walking is the preferred activity. Neurologists primarily provide PA advice.(AU)

Unidad covid y patología psiquiátrica en el Hospital Mare De Déu De La Mercè. Presentación clínico asistencial desde septiembre 2020 a diciembre 2022 / [Covid unit and psychiatric pathology at the Mare De Déu De La Mercè Hospital. Clinical care presentation from September 2020 to December 2022]

En este artículo se hace la descripción del funcionamiento de la Unidad COVID del Hospital Mare de Déu de la Mercè en Barcelona, España, durante los años de Pandemia (2020 al 2022).Fueron ingresados 359 pacientes con patología psiquiátrica de primer inicio o exacerbación de enfermedad de base que estaban positivos al COVID, con sintomatología sistémica leve o asintomáticos. La clínica más frecuentemente presentada fue la delirante-alucinatoria (psicosis).(AU)

The present article describes the activity of the COVID Unit of the Mare de Déu de la Mercè Hospital in Barcelona, Spain during the pandemic (2020-2022). 359 patients COVID positive asymptomatic or with mild symptoms and psychiatric pathology were admitted.(AU)

Impacto de la malnutrición en la calidad de vida de los pacientes ancianos con insuficiencia cardíaca avanzada / Impact of malnutrition on the quality of life in older patients with advanced heart failure: a cohort study

Objetivos El objetivo de este estudio fue evaluar la prevalencia de malnutrición, las características clínicas asociadas con la misma y el impacto del estado nutricional en la mortalidad, la calidad de vida y las habilidades relacionadas con el autocuidado y las actividades de la vida diaria en pacientes ancianos con insuficiencia cardíaca avanzada. Métodos Entre junio de 2017 y diciembre de 2019 se llevó a cabo un estudio prospectivo multicéntrico de cohortes que incluyó a 260 pacientes ancianos con insuficiencia cardíaca avanzada que vivían en la comunidad. El estudio se llevó a cabo en 22 centros de atención primaria, tres hospitales universitarios, un hospital de agudos y una unidad de rehabilitación geriátrica de la ciudad de Barcelona (España). El estado nutricional se evaluó al inicio del estudio mediante el cuestionario Mini Nutritional Assessment (MNA) Las medidas de resultado informadas por los pacientes incluyeron calidad de vida (EQ-5D-3L), conducta de autocuidado (Escala europea de conducta de autocuidado en insuficiencia cardíaca) e impacto en las actividades de la vida diaria (índice de Barthel). Resultados Utilizando el MNA-SF, se identificó que 126 (48,5%) pacientes estaban en riesgo de malnutrición y 33 (12,7%) pacientes tenían malnutrición confirmada. En comparación con aquellos con un estado nutricional normal, los pacientes con malnutrición confirmada eran significativamente mayores, con un IMC más bajo y con niveles reducidos de hemoglobina. Durante el seguimiento (mediana de 14,9 meses, intervalo intercuartil: 4,9-26,9), 133 (51,2%) de los participantes incluidos murieron. La mortalidad fue significativamente mayor entre los pacientes con malnutrición (p<0,001). Un mayor índice de Barthel y mejores puntuaciones de calidad de vida se relacionaron inversamente con el riesgo de desnutrición (odds ratio [OR] 0,97 [intervalo de confianza del 95%: 0,96-0,98] y OR 0,98 [intervalo de confianza del 95%: 0,96-0,99]), respectivamente... (AU)

ObjectivesThe aim of this study was to assess the prevalence of malnutrition, the clinical characteristics associated with malnutrition and the impact of nutritional status on mortality, quality of life, self-care abilities, and activities of daily living in the older patients with advanced heart failure.MethodsA prospective multicentre cohort study including 260 community-dwelling elderly patients with advanced heart failure was conducted between June 2017 and December 2019. The study was carried out in 22 primary healthcare centres, three university hospitals, one acute-care hospital, and one geriatric rehabilitation unit in the city of Barcelona (Spain). Nutritional status was assessed at baseline using the Mini Nutritional Assessment (MNA) questionnaire. Patient-reported outcome measures included quality of life (EQ-5D-3L), self-care behaviour (European Heart Failure Self-care Behaviour Scale) and impact on activities of daily living (Barthel index).ResultsUsing the MNA-SF, 126 (48.5%) patients were identified as being at risk of malnutrition and 33 (12.7%) patients as having confirmed malnutrition. Compared to heart failure patients with normal nutritional status, patients with confirmed malnutrition were significantly older, with a lower BMI, and with reduced haemoglobin levels. During follow-up (median 14.9 months, interquartile range: 4.9-26.9), 133 (51.2%) of the included participants died, and mortality was significantly higher among patients identified as having malnutrition (P<.001). Better Barthel index and quality of life scores were inversely related to the risk of malnutrition (Odds Ratio [OR] 0.97 [95% confidence interval: 0.96 to 0.98] and OR 0.98 [95% confidence interval: 0.96 to 0.99]), respectively. Higher scores in the European Heart Failure Self-care Behaviour Scale, which implies worse self care, were related to higher malnutrition risk (OR 1.05 [95% confidence interval: 1.02 to 1.09])... (AU)

Impacto de la malnutrición en la calidad de vida de los pacientes ancianos con insuficiencia cardíaca avanzada / Impact of malnutrition on the quality of life in older patients with advanced heart failure: a cohort study

Objetivos El objetivo de este estudio fue evaluar la prevalencia de malnutrición, las características clínicas asociadas con la misma y el impacto del estado nutricional en la mortalidad, la calidad de vida y las habilidades relacionadas con el autocuidado y las actividades de la vida diaria en pacientes ancianos con insuficiencia cardíaca avanzada. Métodos Entre junio de 2017 y diciembre de 2019 se llevó a cabo un estudio prospectivo multicéntrico de cohortes que incluyó a 260 pacientes ancianos con insuficiencia cardíaca avanzada que vivían en la comunidad. El estudio se llevó a cabo en 22 centros de atención primaria, tres hospitales universitarios, un hospital de agudos y una unidad de rehabilitación geriátrica de la ciudad de Barcelona (España). El estado nutricional se evaluó al inicio del estudio mediante el cuestionario Mini Nutritional Assessment (MNA) Las medidas de resultado informadas por los pacientes incluyeron calidad de vida (EQ-5D-3L), conducta de autocuidado (Escala europea de conducta de autocuidado en insuficiencia cardíaca) e impacto en las actividades de la vida diaria (índice de Barthel). Resultados Utilizando el MNA-SF, se identificó que 126 (48,5%) pacientes estaban en riesgo de malnutrición y 33 (12,7%) pacientes tenían malnutrición confirmada. En comparación con aquellos con un estado nutricional normal, los pacientes con malnutrición confirmada eran significativamente mayores, con un IMC más bajo y con niveles reducidos de hemoglobina. Durante el seguimiento (mediana de 14,9 meses, intervalo intercuartil: 4,9-26,9), 133 (51,2%) de los participantes incluidos murieron. La mortalidad fue significativamente mayor entre los pacientes con malnutrición (p<0,001). Un mayor índice de Barthel y mejores puntuaciones de calidad de vida se relacionaron inversamente con el riesgo de desnutrición (odds ratio [OR] 0,97 [intervalo de confianza del 95%: 0,96-0,98] y OR 0,98 [intervalo de confianza del 95%: 0,96-0,99]), respectivamente... (AU)

ObjectivesThe aim of this study was to assess the prevalence of malnutrition, the clinical characteristics associated with malnutrition and the impact of nutritional status on mortality, quality of life, self-care abilities, and activities of daily living in the older patients with advanced heart failure.MethodsA prospective multicentre cohort study including 260 community-dwelling elderly patients with advanced heart failure was conducted between June 2017 and December 2019. The study was carried out in 22 primary healthcare centres, three university hospitals, one acute-care hospital, and one geriatric rehabilitation unit in the city of Barcelona (Spain). Nutritional status was assessed at baseline using the Mini Nutritional Assessment (MNA) questionnaire. Patient-reported outcome measures included quality of life (EQ-5D-3L), self-care behaviour (European Heart Failure Self-care Behaviour Scale) and impact on activities of daily living (Barthel index).ResultsUsing the MNA-SF, 126 (48.5%) patients were identified as being at risk of malnutrition and 33 (12.7%) patients as having confirmed malnutrition. Compared to heart failure patients with normal nutritional status, patients with confirmed malnutrition were significantly older, with a lower BMI, and with reduced haemoglobin levels. During follow-up (median 14.9 months, interquartile range: 4.9-26.9), 133 (51.2%) of the included participants died, and mortality was significantly higher among patients identified as having malnutrition (P<.001). Better Barthel index and quality of life scores were inversely related to the risk of malnutrition (Odds Ratio [OR] 0.97 [95% confidence interval: 0.96 to 0.98] and OR 0.98 [95% confidence interval: 0.96 to 0.99]), respectively. Higher scores in the European Heart Failure Self-care Behaviour Scale, which implies worse self care, were related to higher malnutrition risk (OR 1.05 [95% confidence interval: 1.02 to 1.09])... (AU)

Impact of malnutrition on the quality of life in older patients with advanced heart failure: a cohort study.

OBJECTIVES: The aim of this study was to assess the prevalence of malnutrition, the clinical characteristics associated with malnutrition and the impact of nutritional status on mortality, quality of life, self-care abilities, and activities of daily living in the older patients with advanced heart failure. METHODS: A prospective multicentre cohort study including 260 community-dwelling elderly patients with advanced HF was conducted between June 2017 and December 2019. The study was carried out in 22 primary healthcare centres, three university hospitals, one acute-care hospital, and one geriatric rehabilitation unit in the city of Barcelona (Spain). Nutritional status was assessed at baseline using the Mini Nutritional Assessment questionnaire. Patient-reported outcome measures included quality of life (EQ-5D-3L), self-care behaviour (European Heart Failure Self-care Behaviour Scale) and impact on activities of daily living (Barthel Index). RESULTS: Using the MNA-SF, 126 (48.5%) patients were identified as being at risk of malnutrition and 33 (12.7%) patients as having confirmed malnutrition. Compared to HF patients with normal nutritional status, patients with confirmed malnutrition were significantly older, with a lower BMI, and with reduced haemoglobin levels. During follow-up (median 14.9 months, Interquartile Range; 4.9-26.9), 133 (51.2%) of the included participants died, and mortality was significantly higher among patients identified as having malnutrition (p < 0.001). Better Barthel index and quality of life scores were inversely related to the risk of malnutrition, [Odds Ratio (OR) 0.97 (95% Confidence interval 0.96; 0.98) and OR 0.98 (95% Confidence interval, 0.96; 0.99)], respectively. Higher scores in the European Heart Failure Self-care Behaviour Scale, which implies worse self care, were related to higher malnutrition risk, OR 1.05 (95% Confidence interval, 1.02; 1.09. Adjusted multivariate logistic model found that malnutrition was significantly associated with poor quality of life, and adverse impacts on daily activities and self-care. CONCLUSIONS: In community-dwelling older patients with advanced HF, malnutrition was associated with worse patient reported outcome measures related to poor quality of life, and adverse impacts on self-care and daily activities. Nutritional status must be systematically addressed by primary care nurses and family doctors to improve survival rates in these patients. It would be helpful the incorporation of expert professionals in nutrition in the primary health care centres.

1ª Mostra brasileira de literacia em saúde: Pistas para o SUS e as políticas públicas / 1st Brazilian Health Literacy Exhibition: Clues for the SUS and public policies

A Promoção da Saúde defende que para produzirmos saúde é necessário termos capacidade de reconhecer e realizar desejos e projetos, satisfazer nossas necessidades, transformar e/ou criar mecanismos de convivência com a realidade social e ambiental. Nessa direção, saúde e qualidade de vida implicam em estarmos informados para decidir sobre os rumos singulares de nossas vidas e sobre os processos de determinação social que operam no cotidiano, associando-se à ideia de autonomia. O exercício da autonomia, que se distancia muito de uma liberdade individualista e ilimitada, vincula-se à ampliação da nossa capacidade reflexiva frente ao bombardeio de informações que nos cercam e nos chegam, notadamente com a presença e expansão das tecnologias digitais. Daí a importância, em especial no campo da Promoção da Saúde, da literacia em saúde. A literacia em saúde pode ser definida como a capacidade dos sujeitos em obter, compreender, avaliar criticamente e utilizar informações sobre saúde para seu próprio cuidado ou de terceiros. Ela envolve uma ampla gama de habilidades e competências, que são desenvolvidas ao longo da vida e que possuem influência de fatores demográficos, culturais, sociopolíticos e ambientais. Com as novas e crescentes exigências de compreensão e uso de informações sobre saúde na vida cotidiana, especialmente para enfrentarmos os riscos da desinformação, é fundamental ampliar o debate acerca da literacia em saúde. Esse foi o principal objetivo da I Mostra Brasileira de Literacia em Saúde, cujas conferências e trabalhos encontram-se sistematizados neste e-book.

Future directions for simulation in healthcare: A critical review.

There was a widespread discontinuation of simulation programs during and after the COVID-19 pandemic. The objective is to explore how to facilitate greater integration of simulation in healthcare organizations. A literature review was conducted in PubMed, MEDES, IBECS and DOCUMED databases. Twenty-three articles published after the pandemic were selected, categorized in seven themes and critically reviewed. In order to consistently and fully integrate simulation into the organizational culture it is recommended to prioritize the development of new strategies that enhance the efficiency and safety of healthcare delivery. And also strategies that enhance the satisfaction and well-being of all stakeholders.

The diary in the intensive care unit: Concept analysis.

INTRODUCTION: Admission to an intensive care unit can cause sequelae to both patients and family members. In some countries, the use of diaries is a preventive action. AIM: This research proposes to critically examine the concept of 'Intensive Care Unit Diary' by analysing the current state of the scientific literature to develop a precise conception of this phenomenon in nursing practice, since there are multiple unknowns regarding its use and content. METHOD: A bibliographic search was carried out in the PubMed, Cochrane Library, Scopus and CINAHL databases in January 2023. The terms used to search for their use and definitions in the databases included Nurse, Concept analysis, Family, Uci Diary, Patient Critical, Intensive Care Unit. We use Wilson's concept analysis, later developed by Walker and Avant. RESULTS: The concept analysis shows that the 'ICU Diary' is a record made in colloquial language by health workers and relatives of the patient admitted to the intensive care unit. Aimed at the patient, with an empathic and reflective style, which offers a narrative of the process, daily life and the conduct or behaviour of the patient during his stay. It is a therapeutic tool led by nurses accepted by patients, families and professionals. Its use benefits the recovery process, reducing post-traumatic stress in family members and patients. It favours communication and the bond between nurses, family members and patients, helping to express feelings and emotions. CONCLUSIONS: The concept of 'UCI Diary' is complex. Through Wilson's model, a clarification of the concept has been achieved, creating a starting point for more precise research on this phenomenon and its effects on patients, family members, professionals and the health system.

[Predictive validity of Clinical Risk Groups in chronic patients in primary healthcare]. / Validez predictiva del Clinical Risk Groups en pacientes crónicos en el ambito de la atencion primaria.

OBJECTIVE: To analyse a prediction model for admissions and hospital emergencies based on Clinical Risk Groups, in a population of complex chronic patients demanding primary care. DESIGN: A multicentric retrospective observational study, of a cohort of chronic patients with comorbidity, from January until December 2013. PLACE: The study population was assigned to the Santa Pola and Raval health centres from the Health Department of Elche. PARTICIPANTS: Cohort of chronic patients with comorbidity, from January to December 2013. INTERVENTIONS: Data about the number of admissions, reasons and complexity level associated with the admission were collected by the review of medical records. MAIN MEASURES: To determine the level of complexity, the classification included in the chronicity strategy of the Valencian Community based on Clinical Risk Groups was used. RESULTS: Five hundred and four patients were recruited with a high complexity degree (N3) and 272 with moderate/low complexity (N1-N2). A higher comorbidity was observed in N3 patients with high complexity [Charlson 2.9 (DE 1.8) vs. 1.9 (DE 1.3); P<.001], and higher dependence degree for basic diary activities [Barthel 16.1 (n=81) vs. 7.3 (n=20); P<.001]. Association between the number of admissions [0.4 (DE 0.8) vs. 0.1 (DE 0.5); P<.001] and emergency visits [0.8 (DE 1.5) vs. 0.3 (DE 0.8), P<.001] was significatively higher in patients from N3 group than N1-N2 groups. CONCLUSIONS: The predictive capacity of CRG grouper showed high sensibility for the patient classification with a high degree of complexity. Its specificity and positive predictive value were lower for the association of the N3 complexity stratum.

[Incorporation of patient-reported outcomes into pharmacy and dermatology departments, in psoriasis and atopic dermatitis patients, as a tool to improve the healthcare quality and health outcomes]. / Incorporación de resultados informados por pacientes con psoriasis y dermatitis atópica en las consultas de atención farmacéutica y dermatología: herramienta que mejora la calidad asistencial y resultados en salud.

INTRODUCTION: Patient-reported outcomes (PROs) provide subjective information about their disease, treatment, and quality of life. OBJECTIVE: To introduce a new system of work coordinated between pharmacists and dermatologists, based on the collection and analysis of PROs to assess its clinical impact as well as patients satisfaction. METHOD: A prospective single-centre observational study was conducted under clinical conditions and included adult patients diagnosed with psoriasis (PS) and atopic dermatitis (AD) between April-2021 and February-2022. Pharmacists and dermatologists agreed on this systematic work. A REDCap® database was designed to facilitate data collection and the subsequent analysis. RESULTS: A total of 288 and 41 patients with PS and AD, respectively, were included. Those who started treatment showed significant improvement with a decrease in PROs and clinical parameters (p < 0.001). The pharmacist made 168 and 7 recommendations to dermatologists for PS and AD patients, respectively, of which 66.07% and 57.1% were accepted. The most common recommendations were «consult with rheumatologist¼ (20.83%), «extend drug regimen¼ (19.64%) and «consider change in treatment¼ (11.90%). Adverse events were reported in 55 and 17 patients with PS and AD, respectively. Of 103 patients, 75% were «very satisfied¼ and 20% «satisfied¼ with the system. CONCLUSIONS: This new working system helps to evaluate the short and long-term effectiveness of treatments and also to identify adverse events, alarm symptoms and co-morbidities in order to optimize therapies. Collaboration between pharmacists and dermatologists reduces decision-making time and patients appreciate better clinical care leading to higher patient satisfaction.

[Analysis of the evolution of outpatient pharmaceutical care in hospital pharmacy services in Spain after the implementation and development of the MAPEX initiative]. / Analisis de la evolución de la atención farmacéutica al paciente externo en los servicios de farmacia hospitalaria en España tras la puesta en marcha y desarrollo de la iniciativa MAPEX.

INTRODUCTION AND OBJECTIVE: In 2015, the Spanish Society of Hospital Pharmacy (SEFH) launched the Strategic Map for Outpatient Pharmaceutical Care (MAPEX), with the purpose of adapting the activity offered in Hospital Pharmacy outpatient clinics to the new healthcare context. The aim of the present study was to analyse the evolution of outpatient pharmaceutical care in Hospital Pharmacy Services in Spain in the period 2016-2021 after the implementation and development of the MAPEX initiative. MATERIAL AND METHOD: The implementation and development of the project was carried out by a group of experts from SEFH and consisted of five phases: creation of the structure, consensus conference, situation analysis, development of strategic initiatives and evolutionary analysis. To analyse the evolutionary development, a specific 43-item questionnaire was developed that addressed aspects related to structure, context, integration, processes, outcomes and research and was answered in 2016 and 2021 (in the latter case by adding 3 additional questions). RESULTS: 141 hospitals participated in the status survey in 2016 and 138 in 2021. Significant differences were found in all dimensions analysed. None of the aspects assessed suffered a setback in this period. The most highly rated aspects at the general level were the improvement of the care model (65.0%) and at the local level, the incorporation of non-face-to-face pharmaceutical care (42.8%). Further progress in the coming years in the expansion and practical application of the methodology proposed in the project was considered a priority. CONCLUSIONS: The implementation and development of the MAPEX initiative has had a positive impact in terms of quality of care for outpatient pharmaceutical care in Hospital Pharmacy services in Spain.

Percentage of patients shifting to another treatment modality: An experience-guided decision

ABSTRACT Objective: This study aimed to assess the frequency with which orthodontic patients decided to shift to another type of orthodontic appliance, among conventional metal brackets, ceramic brackets, lingual brackets and clear aligner, based on their personal experiences of pain, ulcers, bad breath, hygiene issues and social difficulties. Material and Methods: This study comprises of patients seeking orthodontic treatment. The sample (n = 500; age group = 19-25 years) was divided equally into four groups based on the treatment modality: conventional metal brackets, ceramic brackets, lingual brackets and clear aligner. Patients rated the questionnaire using a visual analogue scale, to assess variables (such as pain, ulcer etc) that impact various treatment modalities. Subsequently, patients from all groups provided feedback regarding their treatment experiences, and expressed their preference for an alternative modality. Intergroup comparison among the four groups was done using one-way analysis of variance with Tukey's HSD post-hoc test (p ≤ 0.05). Results: Patients who received lingual brackets reported higher levels of pain and ulceration, as compared to those who received clear aligners. All four groups showed statistically significant differences for ulcers during treatment (p ≤ 0.05). Of the 125 patients who received conventional metal brackets, 28% expressed a preference for clear aligner therapy, while 20% preferred ceramic brackets. In the lingual group, 56% of 125 patients preferred clear aligner therapy, and 8% preferred ceramic brackets to complete their treatment. In the ceramic group, 83% did not want to switch, whereas 17% desired to switch to clear aligner, while in aligner group no patient desired to switch. Conclusions: A higher percentage of patients from lingual brackets group chose to shift to clear aligners, followed by conventional metal brackets group and by ceramic brackets group, in this descending order. The clear aligner group demonstrated fewer issues than the other treatment modalities.

RESUMO Objetivo: Este estudo teve como objetivo avaliar a frequência com que pacientes ortodônticos decidiram mudar para outro tipo de aparelho ortodôntico, entre braquetes convencionais de metal, braquetes cerâmicos, braquetes linguais e alinhadores transparentes, com base em suas experiências pessoais de dor, aftas, mau hálito, problemas de higiene e dificuldades sociais. Material e Métodos: Esse estudo foi composto por pacientes que procuram tratamento ortodôntico. A amostra (n = 500; faixa etária = 19-25 anos) foi dividida igualmente em quatro grupos, com base na modalidade de tratamento: braquetes metálicos convencionais, braquetes cerâmicos, braquetes linguais e alinhadores transparentes. Os pacientes responderam a um questionário, usando uma escala visual analógica, para avaliar variáveis como dor e aftas, que impactam diferentes modalidades de tratamento. Posteriormente, os pacientes de todos os grupos forneceram feedback sobre suas experiências de tratamento e expressaram sua preferência por uma modalidade alternativa. A comparação intergrupos entre os quatro grupos foi feita usando análise de variância unidirecional com teste post-hoc HSD de Tukey (p ≤ 0,05). Resultados: Os pacientes que usaram braquetes linguais relataram níveis mais elevados de dor e aftas, em comparação com aqueles que usaram alinhadores transparentes. Todos os quatro grupos apresentaram diferenças estatisticamente significativas para aftas durante o tratamento (p ≤ 0,05). Dos 125 pacientes que usaram braquetes metálicos convencionais, 28% expressaram preferência pelo tratamento com alinhadores transparentes, enquanto 20% preferiram braquetes cerâmicos. No grupo com braquetes linguais, 56% dos 125 pacientes preferiram o tratamento com alinhadores transparentes e 8% preferiram braquetes cerâmicos para completar o tratamento. No grupo com braquetes cerâmicos, 83% não queriam trocar de tratamento, enquanto 17% desejavam mudar para os alinhadores transparentes; enquanto no grupo de alinhadores nenhum paciente desejou mudar. Conclusões: Uma porcentagem maior de pacientes do grupo com braquetes linguais optou pela mudança para alinhadores transparentes, seguido pelo grupo com braquetes metálicos convencionais e pelo grupo com braquetes cerâmicos, em ordem decrescente. O grupo de alinhadores transparentes demonstrou menos problemas do que as outras modalidades de tratamento.

Use of podcasts for health education: a scoping review / Uso de podcasts para educación en salud: una revisión de alcance / Uso de podcasts para educação em saúde: uma revisão de escopo

ABSTRACT Objectives: to map the scientific evidence related to the characteristics, themes, and outcomes of using health education podcasts aimed at individuals over 18 years of age in intra or extrahospital environments. Methods: a scoping review, based on the Joanna Briggs Institute method, conducted in 11 databases, including studies from 2004 to 2022. Results: 11 studies were selected, categorized, highlighting the characteristics, evaluated outcomes, areas, and conditions of podcast application, indicating it as an effective tool for promoting behavioral change, health promotion, and social interaction, demonstrating its potential to improve well-being, quality of life, and user/client autonomy. Conclusions: the use of podcasts proves to be an effective, innovative, and low-cost tool, with a significant social impact, being effective for behavioral change, satisfaction, and social interaction. However, the lack of comprehensive studies on podcast development methodologies represents challenges to be overcome.

RESUMEN Objetivos: mapear las evidencias científicas relacionadas con las características, temáticas y resultados del uso de podcasts de educación en salud dirigidos a individuos mayores de 18 años en entornos intra o extrahospitalarios. Métodos: revisión de alcance, basada en el método del Joanna Briggs Institute, realizada en 11 bases de datos, incluyendo estudios de 2004 a 2022. Resultados: se seleccionaron 11 estudios, categorizados y destacando las características, resultados evaluados, áreas y condiciones de aplicación del podcast, señalándolo como una herramienta eficaz para promover el cambio de comportamiento, la promoción de la salud y la interacción social, evidenciando su potencial para mejorar el bienestar, la calidad de vida y la autonomía de los usuarios/clientes. Conclusiones: el uso del podcast demuestra ser una herramienta eficaz, innovadora y de bajo costo, con un impacto social significativo, siendo eficaz para el cambio de comportamiento, la satisfacción y la interacción social. Sin embargo, la falta de estudios exhaustivos sobre las metodologías de desarrollo de podcasts representa desafíos a superar.

RESUMO Objetivos: mapear as evidências científicas relacionadas às características, temáticas e desfechos do uso de podcasts de educação em saúde direcionados para indivíduos maiores de 18 anos nos ambientes intra ou extrahospitalares. Métodos: revisão de escopo, baseando-se no método do Joanna Briggs Institute, realizada em 11 bases de dados, incluindo estudos de 2004 a 2022. Resultados: foram selecionados 11 estudos, categorizados e destacando as características, desfechos avaliados, áreas e condições de aplicação do podcast, apontando-o como uma ferramenta eficaz para promover a mudança comportamental, a promoção da saúde e a interação social, evidenciando seu potencial para melhorar o bem-estar, qualidade de vida e autonomia dos usuários/clientes. Conclusões: o uso do podcast demonstra ser uma ferramenta eficaz, inovadora e de baixo custo, com impacto social significativo, sendo eficaz para mudança comportamental, satisfação e interação social. No entanto, a falta de estudos abrangentes sobre as metodologias de desenvolvimento de podcasts representam desafios a serem superados.

Repercussions of moving patients on the context of practice: perspectives of the nursing team / Repercusiones de la movilización de pacientes sobre el contexto de práctica: perspectivas del equipo de enfermería / Repercussões da movimentação de pacientes sobre o contexto de prática: perspectivas da equipe de enfermagem

Objective: to examine the nursing team's view of the repercussions of moving patients (admissions, transfers and discharges) on the organization of work and the delivery of care. Method: this is a qualitative study using the focus group technique, conducted with 23 professionals - 12 nurses, eight nurse technicians and three nurse assistants working in three inpatient units at a teaching hospital in the countryside of Sao Paulo. Four meetings took place between November 2021 and March 2022. The reports were analyzed thematically using MAXQDA software. Results: two thematic categories emerged: the influence of structural factors and work organization on the intra-hospital moving of patients; it demands time, generates work overload and interferes with the delivery of care. Conclusion: the volume of moving patient associated with unforeseen demands, care complexity and insufficient staff and resources have a negative impact on the delivery of care, with clinical risks and work overload. The findings make it possible to improve the regulation of patients entering and leaving the units, work organization and care management, avoiding clinical risks, delays, omissions and work overload.

Objetivo: examinar la perspectiva del equipo de enfermería sobre las repercusiones del movimiento de pacientes (admisiones, traslados y altas) en la organización del trabajo y en la prestación de cuidados. Método: estudio cualitativo utilizando la técnica de grupo focal llevado a cabo con 23 profesionales, incluyendo 12 enfermeros, ocho técnicos y tres auxiliares de enfermería de tres unidades de internación de un hospital universitario del interior de São Paulo. Se realizaron cuatro encuentros entre noviembre de 2021 y marzo de 2022. Los relatos fueron analizados en la modalidad temática con la ayuda del software MAXQDA. Resultados: surgieron dos categorías temáticas: la influencia de factores estructurales y de la organización del trabajo en el movimiento intrahospitalario de pacientes; y, el movimiento de pacientes demanda tiempo, genera sobrecarga de trabajo e interfiere en la prestación de cuidados. Conclusión: el volumen de movimientos de pacientes asociado a demandas imprevistas, complejidad asistencial e insuficiencia de personal y de recursos repercute negativamente en la prestación del cuidado con riesgos clínicos y sobrecarga laboral. Los hallazgos permiten mejorar la regulación de las entradas y salidas de pacientes en las unidades, la organización del trabajo y la gestión del cuidado, evitando riesgos clínicos, retrasos, omisiones y sobrecarga laboral.

Objetivo: examinar o olhar da equipe de enfermagem quanto às repercussões da movimentação de pacientes (admissões, transferências e altas) na organização do trabalho e na entrega do cuidado. Método: estudo qualitativo utilizando técnica de grupo focal conduzido junto a vinte e três profissionais sendo doze enfermeiros, oito técnicos e três auxiliares de enfermagem lotados em três unidades de internação de um hospital de ensino do interior de São Paulo. Ocorreram quatro encontros, entre novembro de 2021 e março de 2022. Os relatos foram analisados na modalidade temática com o auxílio do software MAXQDA. Resultados: emergiram duas categorias temáticas: a influência de fatores estruturais e da organização do trabalho na movimentação intra-hospitalar de pacientes; e a movimentação de pacientes demanda tempo, gera sobrecarga de trabalho e interfere na entrega do cuidado. Conclusão: o volume de movimentações de pacientes associado às demandas imprevistas, complexidade assistencial e insuficiência de pessoal e de recursos repercutem negativamente na entrega do cuidar com riscos clínicos e sobrecarga laboral. Os achados possibilitam aprimorar a regulação das entradas e saídas de pacientes nas unidades, organização do trabalho e gestão do cuidado evitando-se riscos clínicos, atrasos, omissões e sobrecarga laboral.

Transição de cuidado de pacientes internados por COVID-19 e sua relação com as características clínicas / Transición de cuidado de pacientes internados por COVID-19 y su relación con las características clínicas / Care transition for patients admitted to hospital due to COVID-19 and its relationship with clinical characteristics

Resumo Objetivo Analisar a transição do cuidado (TC), e sua relação com as características clínicas de pacientes internados por COVID-19. Métodos Estudo transversal, realizado em um hospital geral, com 165 pacientes hospitalizados em decorrência da COVID-19 e que receberam alta para o domicílio. Participaram aqueles que estiveram internados por pelo menos 24hs, maiores de 18 anos, com acesso telefônico após a alta. Excluídos aqueles que receberam alta por transferência, que evoluíram a óbito ou aqueles sem condições cognitivas. Dados coletados entre março a julho de 2021, por meio de questionário sociodemográfico e clínico, bem como o Care Transitions Measure-15. Aplicou-se análise estatística descritiva e inferencial. Resultados A média geral do Care Transitions Measure-15 foi considerada satisfatória (71,8±7,45). O fator Preferências Asseguradas obteve maior média (80,5± 9,84) e o fator Plano de Cuidados a menor (57,5± 11,4). Foram encontradas diferenças estatísticas significativas quando se associou os fatores do CTM-15 com as variáveis clínicas tempo de doença crônica (p<0,03), presença de artefato clínico (p<0,040), uso de medicação contínua (p<0,029) e a reinternação teve diferença significativa nos fatores Preparação para o Autogerenciamento (p<0,045), Preferências Asseguradas (p<0,027) e Plano de Cuidados (p<0,032). Conclusão Os pacientes hospitalizados por COVID-19 avaliaram a TC geral como satisfatória e as variáveis clínicas tempo de doença crônica, artefato clínico, medicação contínua e reinternação interferiram na TC desses pacientes.

Resumen Objetivo Analizar la transición del cuidado (TC) y su relación con las características clínicas de pacientes internados por COVID-19. Métodos Estudio transversal, realizado en un hospital general, con 165 pacientes hospitalizados como consecuencia de COVID-19, que fueron dados de alta para volver a su domicilio. Participaron aquellas personas que estuvieron internadas por lo menos 24 horas, mayores de 18 años, con acceso telefónico después del alta. Se excluyeron aquellas que fueron dadas de alta por transferencia, que fallecieron o que no tenían condiciones cognitivas. Los datos fueron recopilados entre marzo y julio de 2021, mediante cuestionario sociodemográfico y clínico, así como también el Care Transitions Measure-15. Se aplicó análisis estadístico descriptivo e inferencial. Resultados El promedio general del Care Transitions Measure-15 fue considerado satisfactorio (71,8±7,45). El factor Preferencias Aseguradas obtuvo el mayor promedio (80,5± 9,84) y el factor Plan de Cuidados, el menor (57,5± 11,4). Se encontraron diferencias estadísticas significativas cuando se asociaron los factores del CTM-15 con las variables clínicas tiempo de enfermedad crónica (p<0,03), presencia de artefacto clínico (p<0,040), uso de medicación continua (p<0,029). La reinternación tuvo una diferencia significativa en los factores Preparación para la Autogestión (p<0,045), Preferencias Aseguradas (p<0,027) y Plan de Cuidados (p<0,032). Conclusión Los pacientes hospitalizados por COVID-19 evaluaron la TC general como satisfactoria. Las variables clínicas tiempo de enfermedad crónica, artefacto clínico, medicación continua y reinternación interfirieron en la TC de estos pacientes.

Abstract Objective To analyze care transition (CT) and its relationship with the clinical characteristics of patients admitted to hospital due to COVID-19. Methods This is a cross-sectional study, carried out in a general hospital, with 165 patients admitted to hospital due to COVID-19 and who were discharged home. Participants were those who had been admitted to hospital for at least 24 hours, over 18 years of age, with telephone access after discharge. Those who were discharged by transfer, who died or those without cognitive conditions were excluded. Data collected between March and July 2021, using a sociodemographic and clinical questionnaire as well as Care Transitions Measure-15. Descriptive and inferential statistical analysis was applied. Results The overall mean of Care Transitions Measure-15 was considered satisfactory (71.8±7.45). The Important preferences factor obtained the highest mean (80.5± 9.84) and the Care Plan factor the lowest (57.5± 11.4). Significant statistical differences were found when the CTM-15 factors were associated with the clinical variables: duration of chronic disease (p<0.03); presence of clinical artifact (p<0.040); use of continuous medication (p<0.029). Readmission had a significant difference in the factors Health management preparation (p<0.045), Important preferences (p<0.027) and Care plan (p<0.032). Conclusion Patients admitted to hospital due to COVID-19 assessed the general CT as satisfactory and the clinical variables, length of chronic illness, clinical artifact, continuous medication and readmission interfered in the CT of these patients.