Strategy nursing in children with compromised ventilation: Umbrella review.

PROBLEM: Changes in the ventilation demand nursing interventions duly adapted to the management of said impairment and to the adaptability of the child/parents. This revision aimed to investigate the evidence behind the interventions performed on children with impaired ventilation.' ELIGIBILITY CRITERIA: Systematic reviews of literature in English, Spanish, French, and Portuguese from studies on nursing interventions related to children with impaired ventilation in all contexts of the clinical practice. The Joanna Briggs Institute recommendations were followed. SAMPLE: We conducted a comprehensive search as of January 2022 and updated as of June 2023. The following electronic databases were searched: SCOPUS, Web of Science, Joanna Briggs Institute Database of Systematic Reviews and Implementation Reports, MEDLINE (via PubMed), CINAHL (via EBSCO), MedicLatina (via EBSCO), The Cochrane Database of Systematic Reviews (via EBSCO), and Database of Abstracts of Reviews of Effects (DARE). Nineteen articles published between 2012 and 2022 were included in this review. RESULTS: Nineteen studies investigated the efficacy of respiratory exercises (Breathing Control - relaxed breathing, pursed lip breathing, Diaphragmatic breathing exercises, respiratory expansion exercise - deep breathing exercise, thoracic expansion exercises (with device), exercises for respiratory muscle strengthening and position to optimize ventilation. In the majority of the studies, it was not possible to evaluate the interventions separately. Thirteen studies evidenced the efficacy of respiratory exercises, BIPAP, and oxygen therapy. Seven articles demonstrated the effectiveness of respiratory muscle-strengthening exercises, and only three mentioned the efficacy of positioning regarding impaired ventilation. Interventions based on respiratory exercises and respiratory muscle training were the most common ones. CONCLUSIONS: The results suggest that nursing interventions to optimize ventilation are efficient. Nevertheless, the same present a low to moderate evidence degree, justified by the population characteristics (small and heterogeneous). IMPLICATIONS: There is proof of evidence for the studied interventions. However, the lack of methodological robustness points to future research to duly describe interventions, data, and comparable results, using reliable samples in which the focus of the study is clear.

Effectiveness of Nonpharmacological Interventions in the Field of Ventilation: An Umbrella Review.

This umbrella review aimed to determine the effectiveness of nonpharmacological interventions in pulmonary ventilation and their impact on respiratory function. An individual with impaired ventilation displays visible variations manifested in their respiratory frequency, breathing rhythm ratio (I:E), thoracic symmetry, use of accessory muscles, dyspnea (feeling short of breath), oxygen saturation, diaphragm mobility, minute ventilation, peak flow, walking test, spirometry, Pimax/Pemax, diffusion, and respiratory muscle strength. Any variation in these markers demands the need for interventions in order to duly manage the signs and symptoms and to improve ventilation. METHOD: Systematic reviews of the literature published in English, Spanish, French, and Portuguese were used, which included studies in which nonpharmacological interventions were used as a response to impaired ventilation in adults in any given context of the clinical practice. The recommendations given by the Joanna Briggs Institute (JBI) for umbrella reviews were followed. This research took place in several databases such as MEDLINE, CINAHL Complete, CINHAL, MedicLatina, ERIC, Cochrane Reviews (Embase), and PubMed. The Joanna Briggs critical analysis verification list was used for the systematic review. The data extraction was performed independently by two investigators based on the data extraction tools of the Joanna Briggs Institute, and the data were presented in a summary table alongside the support text. RESULTS: Forty-four systematic reviews, thirty randomized clinical essays, and fourteen observational studies were included in this review. The number of participants varied between n = 103 and n = 13,370. Fifteen systematic revisions evaluated the effect of isolated respiratory muscular training; six systematic revisions evaluated, in isolation, breathing control (relaxed breathing, pursed-lip breathing, and diaphragmatic breathing exercises) and thoracic expansion exercises; and one systematic review evaluated, in isolation, the positions that optimize ventilation. Nineteen systematic reviews with combined interventions that reinforced the role of education and capacitation while also aiming for their success were considered. The articles analyzed isolated interventions and presented their efficacy. The interventions based on respiratory exercises and respiratory muscular training were the most common, and one article mentioned the efficacy of positioning in the compromisation of ventilation. Combined interventions in which the educational component was included were found to be effective in improving pulmonary function, diffusion, oxygenation, and functional capacity. The outcomes used in each study were variable, leading to a more difficult analysis of the data. CONCLUSIONS: The interventions that were the focus of the review were duly mapped. The results suggest that nonpharmacological interventions used to optimize ventilation are effective, with a moderate to high level of evidence. There is a strong foundation for the use of the chosen interventions. The lack of studies on the intervention of "positioning to optimize ventilation" points out the need for a deeper analysis of its effects and for studies with a clear focus. This study supports the decisions and recommendations for the prescription of these interventions to patients with impaired ventilation.

A saúde mental na transição parental e a utilização da internet mediada pelos enfermeiros / Mental health in the parental transition and the use of the internet mediated by nurses

Enquadramento: A transição parental pode ter um significado relevante na saúde mental dos pais. Facilitar esta transição é uma importante função dos enfermeiros. A informoterapia pode beneficiar tomadas de decisão parentais. Um portal orientado para a promoção das competências parentais administrado pela internet, integrado no plano de cuidados individual, pode promover competências parentais, neste caso, relativamente à segurança do recém-nascido. Objetivos: Definir um modelo de dados relativo às oportunidades de desenvolvimento do conhecimento parental sobre segurança do recém-nascido articulado com a ontologia de enfermagem, definir conteúdos multimédia necessários para uma literacia promotora da transição parental saudável. Metodologia: Análise de conteúdo ao material usado nos cursos de preparação e apoio à parentalidade e gravidez em funcionamento nos anos 2020 e 2021, no âmbito das Unidades de Cuidados na Comunidade dos Centros de Saúde da Boavista e de Paranhos. O processo de análise foi realizado por 3 investigadores sem modelo de análise à priori. Resultados: Relativamente ao conhecimento sobre segurança, foram identificadas duas categorias: segurança rodoviária e segurança não rodoviária. Na categoria segurança rodoviária foram definidas vinte subcategorias do conhecimento. Para cada subcategoria determinaram-se questões a colocar aos pais e o elenco de respostas indicativas de conhecimento facilitador ou potencial para melhorar o conhecimento. Conclusões: O conhecimento associado à transição parental pode ser alterado pela ação do enfermeiro através da informoterapia. O uso da internet mediado pelo enfermeiro pode promover a literacia em saúde como parte do processo de cuidados, facilitando a mestria dos pais e a perceção da sua saúde mental. (AU)

Background: Parental transition can impact parents’ mental health. Facilitating this transition process is an essential role of nurses. Information therapy can benefit parental decision-making. A website oriented towards the promotion of parenting skills administered over the internet, integrated into the individual care plan, can promote parenting skills such as newborn safety. Objectives: To define a data model regarding the opportunities for developing parental knowledge about newborn safety, articulated with a nursing ontology, and to define multimedia content appropriated for literacy that promotes a healthy parental transition. Methodology: A content analysis on the material used in parenting and pregnancy courses was carried out under the scope of Boavista and Paranhos Health Centers in 2020 and 2021. The analysis was performed by three independent researchers without a prior analysis model. Results: In the domain of parents’ knowledge about newborn safety, two categories were identified: newborn safety in traffic and newborn safety other than traffic. In the newborn safety in the traffic category, twenty subcategories of knowledge were identified. For each subcategory, a set of questions were defined to be answered by parents and a set of possible answers that represents accurate knowledge and lack of knowledge on each issue. Conclusions: Parents’ knowledge about newborn safety can be modified by nursing therapeutics using information therapy. Nurse-mediated internet use can promote health literacy as part of the care process by facilitating parents’ mastery and perception of their mental health. (AU)

Challenges to Systems of Long-Term Care: Mapping of the Central Concepts from an Umbrella Review.

The ageing of the population poses urgent challenges to the health and social protection sectors, including the need for greater adequacy and integration of health care services provided to older people. It is considered necessary and urgent to understand the state-of-the-art of community-based models of care for older people in institutional care and at home. This study aims to map the concepts that politicians and providers need to address through an umbrella review as a review method. Articles describing the structuring aspects of care models appropriate to the needs in long-term care and systematic reviews or meta-analyses targeting people aged 65 years or more were considered. A total of 350 studies met the inclusion criteria and were included in the review. The results identified the need to contribute to effective and more efficient integration and articulation of all the stakeholders, based essentially on professional care at the patient's homes, focused on their needs using the available technologies, empowering patients and families. Eight categories emerged that addressed factors and variables involved in care models for the long-term care needs of institutionalised and home-based older people as a guarantee of accessibility to healthcare and to enhance the well-being and quality of life of patients and family caregivers.

Information technology and patient safety in nursing practice: an international perspective.

When people become patients, they place their trust in their health care providers. As providers assume responsibility for their diagnosis and treatment, patients have a right to expect that this will include responsibility for their safety during all aspects of care. However, increasing epidemiological data make it clear that patient safety is a global problem. Improved nursing care may prevent many adverse events, and nursing must take a stronger leadership role in this area. Although errors are almost inevitable, safety can be improved, and health care institutions are increasingly making safety a top priority. Information technology provides safety benefits by enhancing communication and delivering decision-support; its use will likely be a cornerstone for improving safety. This paper will discuss the status of patient safety from an international viewpoint, provide case studies from different countries, and discuss information technology solutions from a nursing perspective.