Modelo del queso suizo para el sustento de la cultura de seguridad del paciente en un hospital

Algunos de los roles que desarrollan las personas, coinciden en el espacio físico y mental de otros actores; estas acciones están en correspondencia con diferentes esferas temporales de la vida, como se visualiza en el modelo del queso suizo de James Reason. Esta revisión tiene el propósito de sistematizar en los supuestos teóricos del modelo del queso suizo para el sustento de la cultura de seguridad del paciente en un hospital. El modelo sostiene que cada sistema de atención posee una serie de muros o espacios que separan los elementos de la exposición a daños, ubicadas paralelamente unas con otras; sin embargo, se comunican a través de agujeros que pueden convertirse en fuentes de exposición. En la cultura justa, la persona debe conocer qué tipos de comportamientos inseguros son aceptados y cuáles no. Se concluye que la cultura de seguridad del paciente debe ser entendida como un sistema no punitivo que trata de cobrar conciencia de que las cosas pueden ir mal, que es capaz de reconocer los errores, de aprender de ellos y de actuar para mejorar, en tal sentido el modelo del queso suizo sustenta estos elementos.

Some of the roles that people develop coincide in the other actors' physical and mental space; these actions are in correspondence with different temporal spheres of life, as visualized in James Reason's Switzerland cheese model. This review purpose of systematizing the theoretical assumptions of the Switzerland cheese model for the patient safety culture support in hospitals. The model maintains that each care system has a series of walls or spaces that separate the elements of exposure to damage, located parallel to each other; however, they communicate through holes that can become sources of exposure. In the fair culture, the person must know what types of unsafe behavior are accepted and what are not. It is concluded that the patient safety culture must be understood as a non-punitive system that tries to become aware that things can go wrong, that it is capable of recognizing mistakes, learning from them and acting to improve, in this sense, the Switzerland cheese model supports these elements.

Nurses' assessment of the ethical climate of a university hospital in the South of Brazil.

Background: Ethical climate can be defined as the healthcare professionals' perceptions of the ethical treatment of healthcare issues and human interactions in their work environment. A number of studies on ethical climate are being carried out in several countries. In Brazil, however, research on the matter is still incipient, especially among hospital nurses. Aim: To assess nurses' perception of the ethical climate in a university hospital in the South of Brazil. Methods: Cross-sectional study carried out with 269 nurses from a university hospital, using a sociodemographic and occupational profiling survey and the Hospital Ethical Climate Survey - Brazilian version. Data analysis was done through descriptive statistics. Results: The nurses' perception of the ethical climate was positive (3.68 ± 0.55). Among the five assessment factors, 'peers' had the highest score (4.07 ± 0.57), whereas 'physicians' had the lowest score (3.26 ± 0.70) for ethical climate. Conclusion: In general, the ethical climate was perceived as positive, with small variations between the factors of the instrument. Ethical climate could be enhanced through strategies that encourage interpersonal relationships. This study shows the importance of a positive ethical climate based on good relationships between healthcare professionals for ensuring better care.

Referentes teóricos que sustentan un sistema de vigilancia de eventos adversos en unidades de cuidados intensivos

El estudio de los fundamentos teóricos permite profundizar en los procesos asociados a la asistencia en los cuidados progresivos. Es objetivo de esta investigación analizar los referentes teóricos para el diseño de un sistema de vigilancia de eventos adversos en unidades de cuidados intensivos. Para tal fin se realizó una revisión bibliográfica, desde el referente, avanzado para su tiempo, de Florence Nightingale; pasando por los supuestos teóricos de Madeleine Leininger; hasta la conexión con el modelo del Queso Suizo de Reason y la teoría general de los sistemas de Ludwing Von Bertalanffy. La integración de dichas teorías resultó de gran valor para el planteamiento de un sistema de vigilancia fundamentado científicamente, aplicable con vistas a lograr otros productos que se sustenten posteriormente en la práctica.

The study of the theoretical foundations allows delving into the processes associated with assistance in progressive care. The objective of this research is to analyze the theoretical references for the design of a surveillance system for adverse events in intensive care units. For this purpose, a bibliographic review was carried out, from the referent, advanced for its time, by Florence Nightingale; going through the theoretical assumptions of Madeleine Leininger; to the connection with Reason's Swiss Cheese model and Ludwig Von Bertalanffy's general systems theory. The integration of these theories was of great value for the approach of a scientifically based surveillance system, applicable with a view to achieving other products that are later supported in practice.

Efeitos do Trabalho em Turnos e Coping em Profissionais de Enfermagem Hospitalar / Effects of Shift Work and Coping in Hospital Nursing Professionals

Introdução: Respostas de coping podem influenciar na adaptação dos profissionais ao trabalho em turnos, contribuindo para manutenção da saúde e qualidade de vida. Assim, objetivou-se verificar a associação entre coping e efeitos do trabalho em turnos sobre a saúde dos profissionais de enfermagem. Materiais e Métodos: Estudo transversal, realizado com 124 profissionais de enfermagem em um hospital universitário, no período de agosto a novembro de 2014. Utilizou-se o questionário Coping com o Trabalho por Turnos, instrumentos para avaliação de efeitos do trabalho em turnos na saúde e avaliação da qualidade de vida. Dados analisados estatisticamente, considerando-se significância de 0,05. Resultados: Observou-se associação inversa entre efeitos do trabalho em turnos e escore total do coping (p=0,003). Domínios do coping apresentaram correlações diretas com domínios de qualidade de vida (p<0,05). Das participantes, 46 (37%) profissionais apresentavam efeitos do trabalho em turnos na saúde. Discussão: O uso do coping contribui com menor ocorrência dos efeitos negativos do trabalho em turnos sobre a saúde, dentre estes, funções cognitivas, sono, hábitos alimentares e gástricos, e estresse. Ainda, podendo cooperar para manutenção do bem estar psíquico e físico, adaptação laboral, e melhor qualidade de vida. Conclusões: O conhecimento da relação entre coping e efeitos do trabalho em turnos na saúde pode auxiliar na identificação de meios para promover melhores condições de trabalho, preservando o bem-estar físico e psíquico, e a saúde do profissional de enfermagem.

Introduction: Coping responses can influence the adaptation of health care professionals to shift work, contributing to the maintenance of health and quality of life. Thus, this study aimed to verify the association between coping and the effects of shift work on the health of nursing professionals. Materials and Methods: This was Cross-sectional study, conducted with 124 nursing professionals in a university hospital between August and November 2014. The Shift Work Coping Strategies questionnaire was used as an instrument for assessing the effects of shift work on the health and quality of life of participants. Data were statistically analyzed, considering a significance level of 0,05. Results: An inverse association was observed between the effects of shift work and the total coping score (p = 0,003). Coping domains showed direct correlations with quality-of-life domains (p <0,05). Among participants, 46 (37%) professionals reported having effects of shift work on their health. Discussion: The use of coping contributes to a lower occurrence of the negative effects of shift work on health, among these, cognitive functions, sleep, eating and gastric habits, and stress. Also, being able to cooperate to maintain psychic and physical well-being, work adaptation, and better quality of life. Conclusions: By understanding the relationship between coping strategies and the effects of shift work on health, several means can be identified to promote better working conditions and maintain the physical and psychological well-being and health of nursing professionals

Introducción: Las respuestas de coping pueden influir en la adaptación de los profesionales al trabajo por turnos, contribuyendo al mantenimiento de la salud y la calidad de vida. Por lo tanto, el objetivo fue verificar la asociación entre coping y los efectos del trabajo por turnos en la salud de los profesionales de enfermería. Materiales y métodos: Estudio transversal, realizado con 124 profesionales de enfermería en un hospital universitario, de agosto a noviembre de 2014. Se utilizó el cuestionario Coping con el trabajo por turnos, instrumentos para evaluar los efectos del trabajo por turnos en la salud, y evaluación de la calidad de vida. Datos analizados estadísticamente considerando una significancia de 0.05. Resultados: Se observó asociación inversa entre los efectos del trabajo por turnos y la puntuación total del coping (p=0,003). Los dominios del coping presentaron correlaciones directas con los dominios de calidad de vida (p<0,05). De los participantes, 46 (37%) profesionales presentaban efectos del trabajo por turnos en la salud. Discusión: El uso del coping contribuye a una menor ocurrencia de los efectos negativos del trabajo por turnos sobre la salud, incluidas las funciones cognitivas, el sueño, la alimentación, los hábitos gástricos y el estrés. También puede contribuir al mantenimiento del bienestar psicológico y físico, la adaptación laboral y una mejor calidad de vida. Conclusiones: Conocimiento de la relación entre coping y los efectos del trabajo por turnos sobre la salud puede ayudar en la identificación de medios para promover mejores condiciones de trabajo, preservando el bienestar físico y psicológico y la salud de los profesionales de enfermería.

Sistemas de notificación de eventos adversos en unidades de cuidados intensivos para gestión de riesgo / Adverse Events Notification Systems in Intensive Care Units for Risk Management

Introducción: La ocurrencia de eventos adversos en sistemas de salud es de gran significación para el aumento de la morbilidad, la mortalidad, en el momento del tratamiento de pacientes y en los costos de la asistencia sanitaria. Objetivo: Sistematizar el conocimiento sobre sistemas de notificación de eventos adversos en unidades de cuidados intensivos para gestión de riesgos. Métodos: Revisión sistemática en bancos de datos: BVS, SciELO, BDenf, y PUBMed, considerándose los descriptores indexados. Fueron incluidos15 artículos para el análisis, según la estrategia de búsqueda, en los años comprendidos entre el 2013 y el 2017, enmarcados en los modelos desarrollados en distintos países sobre notificación, así como su abordaje para la implementación y resultados obtenidos. Los estudios fueron agrupados en 4 categorías: sistemas de notificación existentes, características de sistemas de notificación, barreras para la notificación y eventos adversos que ocurren durante la hospitalización. Conclusiones: Los sistemas de notificación son una herramienta importante para aumentar la calidad de los servicios, los cambios en el proceso ampliarán la seguridad del paciente y los servicios libre de fallas y riesgos. Los eventos adversos detectados fueron: relacionado con el manejo de accesos vasculares y drenajes, con el cuidado y medicación(AU)

Introduction: The occurrence of adverse events in health systems is of great significance concerning the increase in morbidity and mortality, at the time of patient treatment and regarding health care costs. Objective: To systematize the knowledge about adverse events notification systems in intensive care units for risk management. Methods: Systematic review in the databases BVS, SciELO, BDenf, and PUBMed, considering the indexed descriptors. Fifteen articles were included for the analysis, according to the search strategy, from the years between 2013 and 2017, framed in the models developed in different countries and about notification, as well as their approach to implementation and outcomes obtained. The studies were grouped into four categories: existing reporting systems, characteristics of reporting systems, barriers to reporting, and adverse events that occur during hospitalization. Conclusions: Notification systems are an important tool for increasing the quality of services. Changes in the process will expand patient safety and services free from failures and risks. The adverse events detected were those related to the management of vascular accesses and drains, and other related with care and medication(AU)

Trastornos/dolor músculoesquelético en estudiantes de enfermería de una universidad comunitaria del sur del Brasil / Distúrbios/dor musculoesquelética em estudantes de enfermagem de uma universidade comunitária do sul do Brasil / Musculoskeletal disorders/pain in undergraduate nursing students in a community university in southern Brazil

Objetivo: Describir el perfil académico y evaluar la prevalencia de trastornos/dolor musculoesquelético en estudiantes de graduación en Enfermería de una universidad comunitaria del sur brasileño. Método: Estudio descriptivo, cuantitativo, del tipo encuesta, con 149 estudiantes de enfermería a través del instrumento compuesto por preguntas referentes a las variables sociodemográficas, hábitos de vida y salud, así como por la versión brasileña Standardized Nordic Questionnaire. Resultados: La mayoría era del sexo femenino, con 18 y 25 años de edad, soltera, vive con la familia, no tiene hijos, no recibe beca o ayuda de la familia y trabaja en hospitales. Prevalencia de síntomas musculoesqueléticos en la región dorsal y baja de la espalda y hombros. Conclusiones: La prevalencia de estos síntomas entre los estudiantes señala la necesidad de implementar acciones preventivas y de promoción de la salud para contribuir a una mejor calidad de vida y salud, en el ámbito académico y en el futuro como profesionales (AU)

Objetivo: Descrever o perfil acadêmico e avaliar prevalência de distúrbios/dor musculoesquelética em estudantes do curso de graduação em Enfermagem de uma universidade comunitária do Sul do Brasil. Método: Estudo descritivo de natureza quantitativa do tipo survey, realizado com 149 estudantes de enfermagem, por meio da aplicação do instrumento composto por questões referentes às variáveis sociodemográficas, hábitos de vida e saúde, como pela versão brasileira Standardized Nordic Questionnaire. Resultados: A maioria dos participantes é do sexo feminino, com idade de 18 e 25 anos, sem companheiro, residem com a família, não possuem filhos, não recebem bolsa ou ajuda familiar e trabalham em hospitais. A prevalência de sintomas musculoesqueléticos foi na região dorsal e lombar e ombros. Conclusões: A prevalência desses sintomas entre os estudantes aponta necessidade de implementar ações preventivas e de promoção da saúde, a fim de contribuir para melhor qualidade de vida e saúde tanto no âmbito acadêmico quanto futuramente como profissionais (AU)

Goal: To describe the academic profile and assess the prevalence of musculoskeletal disorders/pain in undergraduate nursing students in a Community University in Southern Brazil. Method: It has been a descriptive quantitative study with a survey approach, and has been conducted with 149 nursing students, through the employment of an instrument with questions regarding sociodemographic variables, life, and health habits, as for Standardized Nordic Questionnaire. Results: Most participants were female, age ranging from 18 to 25, unmarried, living with the family, with no children, not receiving government support or family aid, and working for hospitals. The prevalence of musculoskeletal was in the dorsal and lumbar region and shoulders. Conclusions: The prevalence of such symptoms amongst the students leads to the need of implementing preventive and health promotion actions, in order to contribute for the improvement of life quality in both the academic scope and in the future as professionals (AU)

Arterial hypertension in nursing personnel of an emergency hospital.

Risk factors related to the workplace environment are being studied to identify positive associations with hypertension disorders. Hypertension is considered as one of the main modifiable risk factors and most important public health issues. The study aims to describe the prevalence of hypertension and associate it with sociodemographic, labour and health aspects, in the health-care nursing staff of an emergency hospital.Cross-sectional study enrolled 606 nursing workers. The data were collected from February to June, and the analysis was conducted in November 2010. Arterial blood pressure, body mass index (BMI), waist-to-hip ratio (WHR) were assessed, and sociodemographic and labour variables were investigated by means of a questionnaire. The data were analysed by descriptive statistics, univariate and multivariate analysis. The prevalence of hypertension was 32% (n = 388), with positive associations with age > 49 years (OR = 2.55 (CI: 1.19 to 5.43)), ethnicity (non-white) (odds ratio (OR) = 2.22, confidence interval (CI) 1.16 to 1.24), BMI (OR = 2.24 (CI: 1.25 to 4.01)) and WHR (OR = 2.65 (CI: 1.95 to 7.763)). Arterial hypertension was frequent in the nursing staff of this emergency hospital. Further studies are needed to better understand the relationship between occupational aspects and arterial hypertension.