Lived Experiences of Nursing Professionals Providing Care to COVID-19 Patients / Experiencias y vivencias de profesionales de enfermería en el cuidado a pacientes con covid-19 / Experiências e vivências de profissionais de enfermagem no cuidado a pacientes com covid-19

Abstract Objective: To analyze nursing professionals' reports on their lived experience in the care provided to hospitalized patients with COVID-19. Materials and Methods: This is an exploratory study using a qualitative analysis, which included twelve nurses and eight nursing technicians from a public hospital in Brazil, conducted between December 2020 and February 2021. The inclusion criteria were professionals who provided care to COVID-19 patients in emergency, intensive care, and inpatient units and who had at least one year of experience in the institution. The interviews were analyzed through content and similarity analysis that generated a similarity tree; the Reinert method was used for thematic categories. Results: Most participants were female, with a mean age of 34.15 years and 4.85 years of experience. From the analysis, the words 'patient,' 'to stay,' and 'to find' were the most frequent, and for the categories, they were "nursing professionals' feelings regarding the pandemic," "the nurses' role and work with the multi-professional team in the care provided to patients with COVID-19," "precautions with the care provided to patients with COVID-19," and "nursing professionals' concern that their family members may become ill during the pandemic." Conclusions: The nursing staff is predominantly composed of females and, in their reports on the lived experience of providing care to patients with COVID-19, they pointed out that concern and fear were prevalent, with the family being one of the protective factors to withstand the risks of working against something novel that may result in death.

Resumen Objetivo: analizar los relatos de profesionales de enfermería sobre la experiencia y vivencia en la asistencia brindada a los pacientes hospitalizados con covid-19. Materiales y método: estudio exploratorio, con análisis cualitativo, en el que participaron 12 enfermeros y ocho técnicos de enfermería de un hospital público en Brasil, realizado entre diciembre de 2020 y febrero de 2021. Como criterio de inclusión estaban profesionales que brindaban asistencia a pacientes con covid-19, en unidades de emergencia, de terapia intensiva y de hospitalización y al menos un año de experiencia en la institución. El análisis de las entrevistas por el análisis de contenido y por el análisis de similitud que generó un árbol de similitud y se utilizó el método Reinert para las categorías temáticas. Resultados: la mayoría de los participantes fue mujer, con promedio de 34,15 años y experiencia de 4,85 años. De los análisis, las palabras "paciente", "ficar" ("quedar") y "achar" ("crer") fueron las más frecuentes y las categorías "sentimientos de los profesionales de enfermería ante la pandemia"; "rol del enfermero y trabajo con el equipo multiprofesional en los cuidados al paciente con covid-19"; "cuidados en la atención al paciente con covid-19" y "preocupación de los profesionales de enfermería de que sus familiares se enfermaran durante la pandemia". Conclusiones: la enfermería es predominantemente constituida por mujeres y, en sus relatos sobre la experiencia y vivencia de cuidar a paciente con covid-19, señalaron que la preocupación y el miedo fueron predominantes, siendo la familia un de los factores protectores para soportar los riesgos de trabajar en contra algo nuevo y que puede culminar con la muerte.

Resumo Objetivo: analisar os relatos de profissionais de enfermagem sobre a experiência e vivência na assistência prestada aos pacientes hospitalizados com covid-19. Materiais e método: estudo exploratório, com análise qualitativa, do qual participaram 12 enfermeiros e oito técnicos de enfermagem de um hospital público no Brasil, realizado entre dezembro de 2020 e fevereiro de 2021. Como critério de inclusão estavam profissionais que prestavam assistência a pacientes com covid-19, em unidades de emergência, de terapia intensiva e de internação e pelo menos um ano de experiência na instituição. A análise das entrevistas pela análise de conteúdo e pela análise de similitude que gerou uma árvore de similitude e foi utilizado o método Reinert para as categorias temáticas. Resultados: a maioria dos participantes foi mulher, com média de 34,15 anos e experiência de 4,85 anos. Das análises, as palavras "paciente", "ficar" e "achar" foram as mais frequentes e as categorias "sentimentos dos profissionais de enfermagem ante a pandemia"; "papel do enfermeiro e trabalho com a equipe multiprofissional nos cuidados ao paciente com covid-19"; "cuidados no atendimento ao paciente com covid-19" e "preocupação dos profissionais de enfermagem de seus familiares adoecerem durante a pandemia". Conclusões: a enfermagem é predominantemente constituída por mulheres e, nos seus relatos sobre a experiência e a vivência de cuidar de paciente com covid-19, apontaram que a preocupação e o medo foram predominantes, sendo a família um dos fatores protetores para suportar os riscos de trabalhar contra algo novo e que pode culminar com a morte.

Factors associated with reoperation due to bleeding and outcomes after cardiac surgery: a prospective cohort study.

OBJECTIVE: Identify the incidence and factors associated with reoperation due to bleeding in the postoperative of a cardiac surgery, in addition to the clinical outcomes of patients. METHOD: Prospective cohort study, conducted in an Intensive Care Unit (ICU), with adult patients undergoing cardiac surgery. Patients diagnosed with coagulopathies were excluded. The patients were followed up from hospitalization to hospital discharge. RESULTS: A total of 682 patients were included, and the incidence of reoperation was 3.4%. The factors associated with reoperation were history of renal failure (p = 0.005), previous use of anticoagulant (p = 0.036), higher intraoperative heart rate (p = 0.015), need for transfusion of blood component during intraoperative (p = 0.040), and higher SAPS 3 score (p < 0.001). The outcomes associated with reoperation were stroke and cardiac arrest. CONCLUSÃO: Reoperation was an event associated with greater severity, organic dysfunction, and worse clinical outcomes, but there was no difference in mortality between the groups.

Factors associated with infection and hospitalization due to COVID-19 in Nursing professionals: a cross-sectional study. / Fatores associados à contaminação e internação hospitalar por COVID-19 em profissionais de enfermagem: estudo transversal.

OBJECTIVE: to identify factors associated with infection and hospitalization due to COVID-19 in nursing professionals. METHOD: a cross-sectional study carried out with 415 nursing professionals in a hospital specialized in cardiology. The sociodemographic variables, comorbidities, working conditions and issues related to illness due to COVID-19 were evaluated. Chi-Square, Fisher's, Wilcoxon, Mann-Whitney and Brunner Munzel tests were used in data analysis, as well as Odds Ratio for hospitalization, in addition to binary logistic regression. RESULTS: the rate of nursing professionals affected by COVID-19 was 44.3% and the factors associated with infection were the number of people living in the same household infected by COVID-19 (OR 36.18; p<0.001) and use of public transportation (OR 2.70; p=0.044). Having severe symptoms (OR 29.75), belonging to the risk group (OR 3.00), having tachypnea (OR 6.48), shortness of breath (OR 5.83), tiredness (OR 4.64), fever (OR 4.41) and/or myalgia (OR 3.00) increased the chances of hospitalization in professionals with COVID-19. CONCLUSION: living in the same household as other people with the disease and using public transportation increased the risk of infection by the new coronavirus. The factors associated with the hospitalization of contaminated professionals were presence of risk factors for the disease, severity and type of the symptoms presented.

Factors Associated With the Illness of Nursing Professionals Caused by COVID-19 in Three University Hospitals in Brazil.

Background: The coronavirus disease 2019 (COVID-19) pandemic has demonstrated the importance of implementing strategic management that prioritizes the safety of frontline nurse professionals. In this sense, this research was aimed at identifying factors associated with the illness of nursing professionals caused by COVID-19 according to socio-demographic, clinical, and labor variables. Methods: A cross-sectional study was conducted in three Brazilian university hospitals with 859 nursing professionals, which include nurses, technicians, and nursing assistants, between November 2020 and February 2021. We present data using absolute and relative frequency. We used Chi-square test for hypothesis testing and multiple logistic regression for predictive analysis and chances of occurrence. Results: The rate of nursing professionals affected by COVID-19 was 41.8%, and the factors associated with contamination were the number of people in the same household with COVID-19 and obesity. Being a nurse was a protective factor when the entire nursing team was considered. The model is significant, and its variables represent 56.61% of the occurrence of COVID-19 in nursing professionals. Conclusion: Obesity and living in the same household as other people affected by COVID-19 increases the risk of contamination by this new coronavirus.

Fatores associados à contaminação e internação hospitalar por COVID-19 em profissionais de enfermagem: estudo transversal / Factors associated with infection and hospitalization due to COVID-19 in Nursing professionals: a cross-sectional study / Factores asociados al contagio y la hospitalización por COVID-19 en profesionales de enfermería: estudio transversal

Resumo Objetivo: identificar fatores associados à contaminação e internação hospitalar por COVID-19 em profissionais de enfermagem. Método: estudo transversal, realizado em hospital especializado em cardiologia, com 415 profissionais de enfermagem. Foram avaliadas as variáveis sociodemográficas, comorbidades, condições de trabalho e questões relacionadas ao adoecimento pela COVID-19. Na análise dos dados, utilizaram-se os testes Qui-Quadrado, Fisher, Wilcoxon, Mann-Whitney e Brunner Munzel, a razão de chances para internação hospitalar, além de regressão logística binária. Resultados: a taxa de profissionais de enfermagem acometidos pela COVID-19 foi de 44,3% e os fatores associados à contaminação foram o número de pessoas no mesmo domicílio com COVID-19 (OR 36,18; p<0,001) e o uso de transporte público (OR 2,70; p=0,044). Ter sintomas graves (OR 29,75), pertencer ao grupo de risco (OR 3,00), apresentar taquipneia (OR 6,48), falta de ar (OR 5,83), cansaço (OR 4,64), febre (OR 4,41) e/ou mialgia (OR 3,00) aumentou as chances de internação hospitalar dos profissionais com COVID-19. Conclusão: habitar o mesmo domicílio que outras pessoas com a doença e usar transporte público aumentou o risco de contaminação pelo novo coronavírus. Os fatores associados à internação hospitalar dos profissionais contaminados foram a presença de fatores de risco para doença, a gravidade e o tipo dos sintomas apresentados.

Abstract Objective: to identify factors associated with infection and hospitalization due to COVID-19 in nursing professionals. Method: a cross-sectional study carried out with 415 nursing professionals in a hospital specialized in cardiology. The sociodemographic variables, comorbidities, working conditions and issues related to illness due to COVID-19 were evaluated. Chi-Square, Fisher's, Wilcoxon, Mann-Whitney and Brunner Munzel tests were used in data analysis, as well as Odds Ratio for hospitalization, in addition to binary logistic regression. Results: the rate of nursing professionals affected by COVID-19 was 44.3% and the factors associated with infection were the number of people living in the same household infected by COVID-19 (OR 36.18; p<0.001) and use of public transportation (OR 2.70; p=0.044). Having severe symptoms (OR 29.75), belonging to the risk group (OR 3.00), having tachypnea (OR 6.48), shortness of breath (OR 5.83), tiredness (OR 4.64), fever (OR 4.41) and/or myalgia (OR 3.00) increased the chances of hospitalization in professionals with COVID-19. Conclusion: living in the same household as other people with the disease and using public transportation increased the risk of infection by the new coronavirus. The factors associated with the hospitalization of contaminated professionals were presence of risk factors for the disease, severity and type of the symptoms presented.

Resumen Objetivo: identificar los factores asociados al contagio y la hospitalización por COVID-19 en los profesionales de enfermería. Método: estudio transversal, realizado en un hospital especializado en cardiología, con 415 profesionales de enfermería. Se evaluaron las variables sociodemográficas, comorbilidades, condiciones de trabajo y preguntas relacionadas con la enfermedad por COVID-19. En el análisis de los datos, se utilizaron las pruebas de Chi-Cuadrado, Fisher, Wilcoxon, Mann-Whitney y Brunner Munzel, la razón de chance para la hospitalización, además de la regresión logística binaria. Resultados: la tasa de profesionales de enfermería afectados por el COVID-19 fue del 44,3% y los factores asociados al contagio fueron el número de personas en una misma vivienda con COVID-19 (OR 36,18; p<0,001) y el uso de transporte público (OR 2,70; p=0,044). Presentar síntomas graves (OR 29,75), pertenecer al grupo de riesgo (OR 3,00), tener taquipnea (OR 6,48), dificultad para respirar (OR 5,83), cansancio (OR 4,64), fiebre (OR 4,41) y/o mialgia (OR 3,00) aumentó las chances de hospitalización de los profesionales con COVID-19. Conclusión: vivir en el mismo domicilio que otras personas que tienen la enfermedad y utilizar el transporte público aumentó el riesgo de contagio por el nuevo coronavirus. Los factores asociados a la hospitalización de los profesionales contagiados fueron la presencia de factores de riesgo para enfermarse, la gravedad y el tipo de síntomas presentados.

Factors associated with reoperation due to bleeding and outcomes after cardiac surgery: a prospective cohort study / Factores asociados con la reintervención por sangrado y desenlaces después de cirugía cardiaca: un estudio de cohorte prospectivo / Fatores associados à reoperação por sangramento e desfechos após cirurgia cardíaca: estudo de coorte prospectivo

ABSTRACT Objective: Identify the incidence and factors associated with reoperation due to bleeding in the postoperative of a cardiac surgery, in addition to the clinical outcomes of patients. Method: Prospective cohort study, conducted in an Intensive Care Unit (ICU), with adult patients undergoing cardiac surgery. Patients diagnosed with coagulopathies were excluded. The patients were followed up from hospitalization to hospital discharge. Results: A total of 682 patients were included, and the incidence of reoperation was 3.4%. The factors associated with reoperation were history of renal failure (p = 0.005), previous use of anticoagulant (p = 0.036), higher intraoperative heart rate (p = 0.015), need for transfusion of blood component during intraoperative (p = 0.040), and higher SAPS 3 score (p < 0.001). The outcomes associated with reoperation were stroke and cardiac arrest. Conclusão: Reoperation was an event associated with greater severity, organic dysfunction, and worse clinical outcomes, but there was no difference in mortality between the groups.

RESUMEN Objetivo: Identificar la incidencia y los factores asociados con la reintervención por sangrado en el postoperatorio de cirugía cardiaca, además de los resultados clínicos de los pacientes. Método: Estudio de cohorte prospectivo, realizado en una Unidad de Cuidados Intensivos, con pacientes adultos sometidos a cirugía cardiaca. Se excluyeron a los pacientes con diagnóstico de coagulopatías. Los pacientes tuvieron un seguimiento efectuado desde el ingreso hasta el alta hospitalaria. Resultados: Se incluyeron a 682 pacientes, y la incidencia de reintervención fue del 3,4%. Los factores asociados a la reintervención fueron antecedentes de insuficiencia renal (p = 0,005), uso previo de anticoagulante (p = 0,036), mayor frecuencia cardiaca intraoperatoria (p = 0,015), necesidad de transfusión de hemocomponentes en el intraoperatorio (p = 0,040) y mayor puntaje en SAPS 3 (p < 0,001). Los desenlaces asociados con la reintervención fueron accidente cerebrovascular y paro cardiorrespiratorio. Conclusión: La reintervención fue un evento asociado con mayor gravedad, disfunción orgánica y peores desenlaces clínicos, pero no hubo diferencia en la mortalidad entre los grupos.

RESUMO Objetivo: Identificar a incidência e os fatores associados à reoperação devido sangramento no pós-operatório de cirurgia cardíaca, além dos desfechos clínicos dos pacientes. Método: Estudo de coorte prospectivo, realizado em Unidade de Terapia Intensiva (UTI), com pacientes adultos submetidos à cirurgia cardíaca. Foram excluídos pacientes com diagnóstico de coagulopatias. Os pacientes foram acompanhados desde a internação até a saída hospitalar. Resultados: Foram incluídos 682 pacientes e a incidência de reoperação foi 3,4 %. Os fatores associados à reoperação foram: histórico de insuficiência renal (p = 0,005), uso prévio de anticoagulante (p = 0,036), maior frequência cardíaca intraoperatória (p = 0,015), necessidade de transfusão de hemocomponentes no intraoperatório (p = 0,040) e maior pontuação no SAPS 3 (p < 0,001). Os desfechos associados a reoperação foram: acidente vascular encefálico e parada cardiorrespiratória. Conclusão: A reoperação foi um evento associado a maior gravidade, disfunção orgânica, e piores desfechos clínicos, porém não houve diferença de mortalidade entre os grupos.

Educating for the implementation of evidence-based healthcare in Brazil: the JBI methodology.

OBJECTIVE: To present the JBI evidence implementation methodology and report the Brazilian experience in educating health professionals. METHOD: This is an experience report on professional education in the Brazilian context as per the JBI methodology. RESULTS: In four years, 29 clinical fellows were trained in Brazil, with technical and scientific theoretical bases and tools for evidence-based practice, focusing on the transformation of the health contexts in which they are inserted. CONCLUSION: The JBI methodology offers systems and tools to evaluate existent practices; it also reinforces and disseminates evidence-based healthcare, potentializing the achievement of effective change in healthcare.

Educating for the implementation of evidence-based healthcare in Brazil: the JBI methodology / Formación para la implementación de la evidencia en salud en Brasil: la metodología del JBI / Formando para implementação de evidências em saúde no Brasil: a metodologia JBI

ABSTRACT Objective: To present the JBI evidence implementation methodology and report the Brazilian experience in educating health professionals. Method: This is an experience report on professional education in the Brazilian context as per the JBI methodology. Results: In four years, 29 clinical fellows were trained in Brazil, with technical and scientific theoretical bases and tools for evidence-based practice, focusing on the transformation of the health contexts in which they are inserted. Conclusion: The JBI methodology offers systems and tools to evaluate existent practices; it also reinforces and disseminates evidence-based healthcare, potentializing the achievement of effective change in healthcare.

RESUMEN Objetivo: Presentar la metodología para la implementación de la evidencia del JBI y reportar la experiencia brasileña en la formación de los profesionales de la salud. Método: Este es un informe de experiencia sobre la formación profesional en el contexto brasileño según la metodología del JBI. Resultados: En cuatro años, 29 clinical fellows fueron formados en Brasil con fundamentos teóricos y herramientas técnico-científicas de la práctica basada en la evidencia, con enfoque en la transformación de los contextos de salud en los que están insertos. Conclusión: La metodología del JBI ofrece sistemas y herramientas para evaluar las prácticas existentes, además de fortalecer y difundir la atención sanitaria basada en la evidencia, permitiendo lograr cambios efectivos en la atención sanitaria.

RESUMO Objetivo: Apresentar a metodologia de implementação de evidências do JBI e relatar a experiência brasileira na formação de profissionais de saúde. Método: Trata-se de relato de experiência sobre a formação profissional no contexto brasileiro segundo a metodologia JBI. Resultados: Em quatro anos, foram formados 29 clinical fellows no Brasil, com bases teóricas e ferramentas técnico-científicas da prática baseada em evidências, focando a transformação das realidades de saúde em que se inserem. Conclusão: A metodologia do JBI oferece sistemas e ferramentas que avaliam as práticas existentes, além de reforçar e disseminar o cuidado em saúde baseado em evidências, possibilitando o alcance de mudanças efetivas no cuidado em saúde.

Effectiveness of a teaching model in a first aid course: a randomized clinical trial / Efectividad de un modelo de enseñanza en un curso de primeros auxilios: un ensayo clínico aleatorizado / Efetividade de modelo de ensino em um curso de primeiros socorros: ensaio clínico randomizado

ABSTRACT Objective: to evaluate the effectiveness of the Active Teaching Model for Critical Thinking in a first aid course for undergraduate nursing students. Method: a clinical, randomized, single blind and parallel trial, conducted at the Federal University of Viçosa (Brazil) in November 2016 with 102 undergraduate nursing students divided into experimental group and control group. In the experimental group, the Problem Based Learning methodology associated with the Active Teaching Model for Critical Thinking was used and, in the control group, only the Problem Based Learning methodology was employed to assess the difference in the average knowledge level of the groups, a test with 25 questions was applied before and after the educational intervention. To identify the effect of the measurement factors on the tests, the analysis of variance was used. Result: a significant interaction effect was observed (F1.100=11.138; p=0.001), indicating that the experimental group showed an improvement in the mean value of the grades between the pre- and post-test, with a high magnitude (d=1.10) Conclusion: the teaching model was effective, being demonstrated by the performance of the experimental group, which presented significantly higher results in terms of knowledge. Brazilian Registry of Clinical Trials, number U1111-1176-5343.

RESUMEN Objetivo: evaluar la efectividad del Modelo de Enseñanza Activa para el Pensamiento Crítico en un curso de primeros auxilios para estudiantes universitarios de enfermería. Método: ensayo clínico, aleatorizado, ciego simple y paralelo, realizado en la Universidad Federal de Viçosa (Brasil) en noviembre de 2016, con 102 estudiantes universitarios de enfermería, divididos en un grupo y uno de control. En el grupo experimental se utilizó la metodología del Problem Based Learning asociada al Modelo de Enseñanza Activa para el Pensamiento Crítico y, en el grupo de control, se utilizó solamente la metodología del Problem Based Learning. Para evaluar la diferencia del nivel de conocimiento medio entre los grupos se aplicó una prueba con 25 preguntas, antes y después de la intervención educativa. Para identificar el efecto de los factores de medida de las pruebas se utilizó el análisis de varianzas. Resultado; se observó un efecto de interacción significativo (F1,100=11,138; p=0,001), lo que indica que el grupo experimental presentó una mejoría en la media de las notas entre antes y después de la prueba, con una magnitud elevada (d=1,10). Conclusión: el modelo de enseñanza fue efectivo, lo que quedó demostrado por el desempeño del grupo experimental, que presentó resultados significativamente mayores en términos de conocimiento. Registro Brasileño de Ensayos Clínicos, número U1111-1176-5343.

RESUMO Objetivo: avaliar a efetividade do Modelo de Ensino Ativo para o Pensamento Crítico em um curso de primeiros socorros para estudantes de graduação em enfermagem. Método: ensaio clínico, randomizado, unicego e paralelo, realizado na Universidade Federal de Viçosa (Brasil). Em novembro de 2016, com 102 estudantes de graduação em enfermagem divididos em grupo experimental e grupo controle. No grupo experimental, foi utilizada a metodologia do Problem Based Learning associada ao Modelo do Ensino Ativo para o Pensamento Crítico e, no grupo controle, foi utilizada apenas a metodologia do Problem Based Learning. Para avaliar a diferença do nível de conhecimento médio dos grupos, foi aplicado teste com 25 questões, antes da intervenção educativa e após. Para identificar o efeito dos fatores de medida nos testes, foi utilizado análise de variância. Resultado: foi observado efeito de interação significativo (F1,100=11,138; p=0,001), indicando que o grupo experimental apresentou melhora na média das notas entre o pré e pós-teste, com elevada magnitude (d=1,10). Conclusão: o modelo de ensino foi efetivo, sendo demonstrado pelo desempenho do grupo experimental, que apresentou resultados significativamente maiores em termos de conhecimento. Registro Brasileiro de Ensaios Clínicos número U1111-1176-5343.

Active teaching model to promote critical thinking.

OBJECTIVE: To present the experience of elaboration and implementation of the Active Teaching Model to Promote Critical Thinking (MEAPC), associated to Problem-Based Learning (PBL), for undergraduate students in Nursing. METHOD: Case report on the experience of the educational intervention (MEAPC + PBL) with undergraduate students in Nursing, in a 20-hour course on Basic Life Support (BLS). The MEAPC was validated by judges to guide the analysis of clinical cases. Critical Thinking (CT) skills were assessed using the California Critical Thinking Skills Test. RESULT: The educational intervention took place in two phases: elaboration and implementation, allowing not only the production of knowledge about BLS, but also the development of CT and exchange of experiences for teaching-learning. CONCLUSION: The association of the MEAPC to the PBL in the course of BLS organized the learning, gave opportunity to acquire knowledge and to stimulate the skills of the CT.

Active teaching model to promote critical thinking / Modelo de enseñanza activo en el desarrollo del pensamiento crítico / Modelo de ensino ativo para o desenvolvimento do pensamento crítico

ABSTRACT Objective: To present the experience of elaboration and implementation of the Active Teaching Model to Promote Critical Thinking (MEAPC), associated to Problem-Based Learning (PBL), for undergraduate students in Nursing. Method: Case report on the experience of the educational intervention (MEAPC + PBL) with undergraduate students in Nursing, in a 20-hour course on Basic Life Support (BLS). The MEAPC was validated by judges to guide the analysis of clinical cases. Critical Thinking (CT) skills were assessed using the California Critical Thinking Skills Test. Result: The educational intervention took place in two phases: elaboration and implementation, allowing not only the production of knowledge about BLS, but also the development of CT and exchange of experiences for teaching-learning. Conclusion: The association of the MEAPC to the PBL in the course of BLS organized the learning, gave opportunity to acquire knowledge and to stimulate the skills of the CT.

RESUMEN Objetivo: Presentar la experiencia de elaboración e implementación del Modelo de Enseñanza Activo para el Desarrollo del Pensamiento Crítico (MEAPC) asociado al Problem-based Learning (PBL) a estudiantes de grado en Enfermería. Método: Reporte de experiencia en la intervención educativa (MEAPC + PBL) con estudiantes de grado en Enfermería, de una materia de 20 horas sobre Soporte Básico de Vida (SBV). El MEAPC fue validado por jueces con el objetivo de orientar el análisis de casos clínicos. Las habilidades de Pensamiento Crítico (PC) fueron evaluadas por el instrumento California Critical Thinking Skills Test. Resultado: La intervención educativa ocurrió en dos fases: la elaboración y la implementación, y permitió no sólo la producción de conocimiento sobre SBV, sino también el desarrollo del PC y el intercambio de experiencias para la enseñanza-aprendizaje. Conclusión: La asociación del MEAPC al PBL en la materia de SBV organizó el aprendizaje, posibilitó la adquisición de conocimientos y el estímulo a las habilidades del PC.

RESUMO Objetivo: Apresentar a experiência de elaboração e implementação do Modelo de Ensino Ativo para o Desenvolvimento do Pensamento Crítico (MEAPC), associado ao Problem-Based Learning (PBL), para estudantes de graduação em Enfermagem. Método: Relato de experiência da intervenção educativa (MEAPC + PBL) com estudantes de graduação em Enfermagem, em um curso de 20 horas sobre Suporte Básico de Vida (SBV). O MEAPC foi validado por juízes com objetivo de nortear a análise de casos clínicos. As habilidades de Pensamento Crítico (PC) foram avaliadas pelo instrumento California Critical Thinking Skills Test. Resultado: A intervenção educativa ocorreu em duas fases: elaboração e implementação, permitindo não apenas a produção de conhecimento sobre SBV, mas também o desenvolvimento do PC e troca de experiências para o ensino-aprendizado. Conclusão: A associação do MEAPC ao PBL em curso de SBV organizou o aprendizado, oportunizou aquisição de conhecimentos e o estímulo às habilidades do PC.

Ensino do pensamento crítico para estudantes de Enfermagem: abordagens, desenho e teoria de uma intervenção educativa / Tuition of critical thinking to nursing students: approach, sketch and theory of an educational intervention

Introdução: Formar profissionais críticos, reflexivos, capazes de tomar decisões complexas e baseadas em evidências científicas, é uma exigência cada vez mais premente na atualidade. Sendo assim, é importante que o estudante de Enfermagem desenvolva e/ou aprimore suas habilidades e disposições de pensamento crítico (PC), para que sejam profissionais competentes para atuarem nos complexos sistemas de saúde e ensino. Objetivos: Avaliar como tem se dado o ensino do PC nos cursos de graduação em Enfermagem na literatura científica e nas instituições de ensino; identificar a perspectiva de docentes e discentes sobre o ensino de PC; analisar o conceito de PC; desenhar uma intervenção educativa e desenvolver uma teoria para o ensino explícito de disposições e habilidades de PC para estudantes de graduação em Enfermagem. Método: Estudo de método misto, baseado em um modelo de desenvolvimento de intervenções complexas em Enfermagem. Para compreender o problema, realizamos inicialmente, na abordagem teórica, uma revisão de escopo para identificar como tem se dado o ensino e quais os referenciais teóricos utilizados nos estudos para o desenvolvimento do PC em estudantes de graduação em Enfermagem. Na fase de abordagem empírica, desenvolvemos uma análise do conceito de PC. Na fase de abordagem experiencial, realizamos estudos observacionais descritivos e de abordagem quantitativa e qualitativa para avaliar a inserção do ensino do PC nos currículos dos Cursos de Graduação em Enfermagem das Instituições de Ensino Superior (IES) públicas brasileiras e para identificar a perspectiva de estudantes e docentes a respeito do conceito de PC, da importância do ensino de PC no curso e métodos de avaliação. Os dados foram obtidos por meio de questionários, grupo focal e entrevistas com estudantes e docentes de cursos de graduação em Enfermagem. A análise dos dados oriundos das entrevistas e grupo focal foi realizada por meio da análise de conteúdo, da qual se originaram os elementos conceituais do modelo teórico. Na sequência, definimos os ingredientes ativos, objetivos, estratégias, modo de entrega e a dose da intervenção, que embasaram a criação da Teoria do Ensino Explícito do Pensamento Crítico (TEEPC). Resultados: Foram incluídos na revisão de escopo 50 estudos. A maioria dos estudos utilizou metodologia experimental e foi desenvolvida na China. As estratégias mais avaliadas foram o Problem-Based Learning e mapa conceitual, comparados a palestras, e utilizados instrumentos para avaliar disposições e habilidades de PC. Na análise de conceito identificamos os fatores relacionados, atributos, antecedentes, consequentes e implicações do conceito de PC. Na perspectiva de docentes e discentes, o estudo de caso foi a estratégia mais citada como promotora do PC. Além disso, os docentes mencionaram a dificuldade em abordar o ensino do PC e os discentes fizeram uma crítica importante sobre o modelo de ensino tradicional, enfatizando a necessidade do ensino explícito do PC. O desenho da intervenção foi realizado considerando como ingredientes ativos as disposições e habilidades de PC e compreendeu as metas (objetivos e resultados esperados da intervenção), as atividades (estratégias de ensino e avaliação), o modo de entrega (formato e contexto) e a dose (frequência e duração). A TEEPC foi desenvolvida com base nos resultados da compreensão do problema e do desenho da intervenção. Conclusões: O ensino do PC para estudantes de Enfermagem é uma atividade complexa, porém necessária e premente. As abordagens teórica, empírica e experiencial possibilitaram o desenvolvimento do desenho e da teoria da intervenção educativa que deverá ser implementada e avaliada. Com base no desenho da intervenção educativa e na TEEPC será possível ensinar PC para estudantes de graduação em Enfermagem com embasamento consistente e instrumentalizar docentes para o ensino da temática de PC, visando ao alcance do perfil de enfermeiro com formação crítica e reflexiva.

Developing professionals that are not only critical and reflexive but also able to make complex decisions based on scientific evidence is becoming more compelling each day. Therefore, it is important that the nursing student builds up and/or enhances his/her abilities and provisions of critical thinking (CT) in a way that he/she becomes a skilled professional to act in complex systems as the health and educational ones. Objectives: Assessing how the teaching of CT in the nursing graduation courses has been happening not only through scientific literature but also in educational institutions; identifying the perspective of both professors and students regarding the tuition of CT; analyzing the concept of CT; sketching an educational intervention and developing a theory for the explicit teaching of dispositions and skills of CT for students taking a degree in nursing. Method: Assessment of mixed method, based on a model of development of complex intervention in nursing. In order to shed light on the issue we have initially reviewed the scope in the theoretical approach to identify how the tuition has been happening and which theoretical support has been used in the research for the development of CT in nursing students. In the phase of empirical approach, we have developed an analysis of the CT concept. In the experiential approach, we have performed observational descriptive studies as well as a qualitative and quantitative approach to assess the insertion of the tuition of CT in the syllabuses of Brazilian public courses of Bachelor in Nursing (higher education) and to identify the perspective of students and professors regarding the concept of CT, the importance of teaching CT in the courses and its assessment methods. Data has been obtained through questionnaires, a focus group and interviews with students and professors of nursing graduation courses. The analysis of data collected through interview and the focus group has been done through content analysis, in which concept elements of the theoretical model have been originated. After that, we have defined the active ingredients, goals, strategies, submitting form and the amount of intervention, which have all substantiated the formation of the Tuition Theory of Explicit Critical Thinking (TTECT). Results: Fifty researches were included in the scope review. The majority of the researches made use of experimental methodology and were developed in China. Problem-Based Learning and conceptual map were the most assessed strategies, they were compared to lectures, and instruments were used to measure dispositions and CT skills. In the analysis of concept we identified the correlated factors, traits, preceding and resulting factors, as well as the implications in the concept of CT. In the perspective of professors and students, the case study was the strategy most often mentioned as the fosterer of CT. Besides that, the professors mentioned the difficulty in addressing the tuition of CT and students made important criticism regarding the traditional teaching, highlighting the need of explicit tuition of CT. The intervention sketch was made taking into consideration as active ingredients the provisions and skills of CT and incorporated the goals (objectives and expected results of the intervention), the activities (teaching and assessing strategies), the submitting form (format and context) and the amount (frequency and length). TTECT was developed according to the results of problem understanding and the intervention sketch. Conclusions: The tuition of CT for nursing students is a complex activity although necessary and urgent. The theoretical, empirical and experiential approaches have made possible the development of the sketch and theory of educational intervention which should be implemented and assessed. According to the sketch of educational intervention and TTECT it will be possible to teach CT to graduation nursing students, with a consistent basis and to enable professors to the teaching of the CT topic, aiming at the nurses figure reach, with critical and reflexive education.

Inserção profissional de Egressos da Licenciatura: avaliação quantitativa / Employability of teaching credential in nursing program alumni: a quantitative evaluation / Inserción profesional de Egresados de la Licenciatura: evaluación cuantitativa

Objetivos: Caracterizar os egressos da Licenciatura em Enfermagem da Escola de Enfermagem da Universidade de São Paulo e sua inserção no mercado de trabalho e conhecer as perspectivas sobre o curso. Trata-se de um estudo exploratório, de natureza descritiva e quantitativa. Resultados: Participaram da pesquisa 66 egressos do curso de Licenciatura, no período de 2002 a 2017. A coleta de dados foi realizada por meio de questionário eletrônico. Houve predominância do sexo feminino, solteiros, sem fi lhos, e de renda entre 7 a 10 salários mínimos. A maioria concluiu a licenciatura em 4 a 5 anos (69,7%). Parte dos egressos teve inserção profissional na Licenciatura (38%) e sete (10,6%) afirmaram exercer docência como atividade principal.Conclusão: Na fala dos participantes, percebeu-se algumas fragilidades em relação ao estágio curricular, bem como falta de articulação entre as disciplinas. A autonomia gerada durante o curso de licenciatura é citada como um fortalecedor da profissão. Foi possível observar que a docência é a segunda atividade mais exercida pelos egressos, contudo o curso é considerado fundamental para o crescimento pessoal e profissional.

Objective: To describe the alumni of the teaching credential in nursing program from the School of Nursing of the University of São Paulo and their employability, and to explore their perspectives about the course. This is an exploratory, descriptive, and quantitative study. Results: A total of 66 alumni from the teaching credential in nursing program who graduated between 2002 and 2017 participated in the study. Data collection were performed by using an electronic form. Participants were mainly female, single, childless, with an income between 7 to 10 minimum wages. The majority of the alumni concluded the course in 4 to 5 years (69.7%). Some of the alumni experienced teaching activities (38%) and seven (10.6%) participants described teaching as being their main current professional activity. Conclusion: Participants reported weaknesses regarding the clinical internship, as well as the lack of articulation among the disciplines. According to the alumni, the program generates professional autonomy, which empowers the profession. Although teaching was described as the second most commonly professional activity performed by the alumni, the program is considered fundamental for personal and professional development.

Objetivos: Caracterizar a los egresados de la Licenciatura en Enfermería de la Escola de Enfermagem da Universidade de São Paulo y su inserción en el mercado de trabajo, y conocer las perspectivas sobre el curso. Es un estudio exploratorio, de naturaleza descriptiva y cuantitativa. Resultados: Participaron de la investigación 66 egresados del curso de Licenciatura, en el periodo de 2002 a 2017. La recolección de los datos fue realizada por medio de un cuestionario electrónico. Hubo predominancia del sexo femenino, solteros, sin hijos, y de ingresos económicos entre 7 a 10 salarios mínimos (37,9%). La mayoría concluyó la licenciatura en 4 o 5anos (69,7%). Parte de los egresados tuvo inserción profesional en la Licenciatura (38%) y siete (10,6%) afirmaron ejercer la docencia como actividad principal.Conclusión: En el relato de los participantes se perciben algunas fragilidades con relación a la pasantía curricular, así como la falta de articulación entre las disciplinas. La autonomía generada durante el curso de licenciatura es citada como un fortalecedor de la profesión. Fue posible observar que la docencia es la segunda actividad más ejercida por los egresados, sin embargo, el curso es considerado fundamental para el crecimiento personal y profesional.

Management of peripherally inserted central catheter use in an intensive care unit of a teaching hospital in Brazil: a best practice implementation project.

OBJECTIVE: This project aimed to promote evidence-based practice in the management of peripherally inserted central venous catheters (PICCs) in pediatric and adult patients in an intensive care unit (ICU). INTRODUCTION: A PICC provides secure vascular access to medication, blood and nutrition administration. However, their use in the ICU is limited. Gaps in training and education in the use of these catheters are barriers to improving practice and safety. METHODS: The project was conducted in an ICU of a cardiology teaching hospital in São Paulo, Brazil. The Joanna Briggs Institute Practical Application of Clinical Evidence System and Getting Research into Practice audit tools were used. A baseline audit of the management of PICCs in pediatric and adult patients was conducted, with a sample size of 22 patients and 180 nursing staff. After an educational program, a follow-up audit involving 14 patients and 180 nursing staff was conducted using the same audit criteria. RESULTS: The baseline audit indicated that PICC management concerning flushing had poor compliance of 2-20%. The results of the criteria related to the change in administration sets, including secondary sets and add-on devices, had better results, with moderate (65%) to high (100%) compliance. The follow-up audit showed improvement in all 10 criteria. Criteria related to flushing achieved 83% to 89% compliance; criteria related to dressing and change of administration sets achieved 100% compliance. CONCLUSIONS: Increased compliance with evidence-based best practices was achieved in all assessed audit criteria. The criteria that reached the highest compliance with best practice recommendations were related to the prevention of bloodstream infection and loss of the PICC due to obstruction. Future audits are planned to ensure sustainability.

Nurses in the labor market: professional insertion, competencies and skills / El enfermero en el mercado de trabajo: inserción, competencias y habilidades / O enfermeiro no mercado de trabalho: inserção, competências e habilidades

ABSTRACT Objective: to characterize nurses graduated from the School of Nursing of the University of São Paulo, from 2006 to 2012; verify their entry, facilitating factors and difficulties of these graduates in the labor market and to consider their skills and competences in the world of work. Method: an exploratory, descriptive study with a qualitative approach. Results: out of 505 graduates, 172 (34.1%) participated in the research. Entry into the labor market was mainly via public hospital institutions, in the SE of Brazil, in the caregiving sectors. The greater part remained from one to two years in their first job. Most agreed that they were prepared to meet the health needs of the population. Furthermore, they had been encouraged to seek systematic and continuous improvement in a critical, reflexive and creative way, while combining technical-scientific knowledge and personal skills. Conclusion: the results show that the University of São Paulo has been preparing nurses for work in the labor market, in accordance with the provisions of the National Curricular Guidelines.

RESUMEN Objetivo: caracterizar enfermeros egresos de la Escuela de Enfermería de la Universidade de São Paulo (EEUSP), período de 2006 a 2012; verificar la inserción, a las facilidades y dificultades de esos egresos en el mercado de trabajo y asimilar sus habilidades y competencias en el mundo del trabajo. Método: estudio exploratorio, descriptivo, de naturaleza cuantitativa. Resultados: de los 505 egresos, 172 (34,1%) participaron de la pesquisa. La inserción en el mercado de trabajo se dio mayoritariamente en instituciones hospitalarias públicas, en la región Sureste, en el área de asistencia. La mayor parte permaneció en los primeros empleos de uno a dos años. La mayoría concordó que fue preparada para el atendimiento a las necesidades de salud de la población, que fue estimulada a buscar perfeccionamiento sistemático y continuo, de forma crítica, reflexiva y creativa, aliando conocimiento técnico-científico y habilidades personales. Conclusión: los resultados evidencian que EEUSP viene preparando enfermeros para actuar en el mundo del trabajo, según preceptos de las Directrices Curriculares Nacionales.

RESUMO Objetivo: caracterizar enfermeiros egressos da Escola de Enfermagem da Universidade de São Paulo (EEUSP), período de 2006 a 2012; verificar a inserção, as facilidades e dificuldades desses egressos no mercado de trabalho e apreender suas habilidades e competências no mundo do trabalho. Método: estudo exploratório, descritivo, de natureza quantitativa. Resultados: dos 505 egressos, 172 (34,1%) participaram da pesquisa. A inserção no mercado de trabalho se deu majoritariamente em instituições hospitalares públicas, na região Sudeste, na área da assistência. A maior parte permaneceu nos primeiros empregos de um a dois anos. A maioria concordou que foi preparada para o atendimento às necessidades de saúde da população, que foi estimulada a buscar aperfeiçoamento sistemático e contínuo, de forma crítica, reflexiva e criativa, aliando conhecimento técnico-científico e habilidades pessoais. Conclusão: os resultados evidenciam que a EEUSP vem preparando enfermeiros para atuar no mundo do trabalho, conforme preceitos das Diretrizes Curriculares Nacionais.

Nurses in the labor market: professional insertion, competencies and skills.

OBJECTIVE: to characterize nurses graduated from the School of Nursing of the University of São Paulo, from 2006 to 2012; verify their entry, facilitating factors and difficulties of these graduates in the labor market and to consider their skills and competences in the world of work. METHOD: an exploratory, descriptive study with a qualitative approach. RESULTS: out of 505 graduates, 172 (34.1%) participated in the research. Entry into the labor market was mainly via public hospital institutions, in the SE of Brazil, in the caregiving sectors. The greater part remained from one to two years in their first job. Most agreed that they were prepared to meet the health needs of the population.  Furthermore, they had been encouraged to seek systematic and continuous improvement in a critical, reflexive and creative way, while combining technical-scientific knowledge and personal skills. CONCLUSION: the results show that the University of São Paulo has been preparing nurses for work in the labor market, in accordance with the provisions of the National Curricular Guidelines.

Effectiveness of rifampicin chemoprophylaxis in preventing leprosy in patient contacts: a systematic review of quantitative and qualitative evidence.

BACKGROUND: Individuals in contact with patients who have leprosy have an increased risk of disease exposure, which reinforces the need for chemoprophylactic measures, such as the use of rifampicin. OBJECTIVES: The objective of the review was to synthesize the best available evidence regarding the effectiveness of rifampicin chemoprophylaxis for contacts with patients with leprosy, and to synthesize the best available evidence on the experience and acceptability of rifampicin chemoprophylaxis as reported by the contacts and health professionals involved in the treatment of leprosy or Hansen's disease. INCLUSION CRITERIA TYPES OF PARTICIPANTS: In the quantitative component, individuals in contact with leprosy patients were included. In the qualitative component, in addition to contacts, health professionals who were in the practice of treating leprosy were included. TYPES OF INTERVENTION(S)/PHENOMENA OF INTEREST: The quantitative component considered as an intervention rifampicin at any dose, frequency and mode of administration, and rifampicin combination regimens.The qualitative component considered as phenomena of interest the experience and acceptability of rifampicin chemoprophylaxis. TYPES OF STUDIES: The quantitative component considered experimental and observational studies whereas the qualitative component considered studies that focused on qualitative data, including but not limited to, designs such as phenomenology, grounded theory, ethnography and action-research. OUTCOMES: The quantitative component considered studies that reported on outcomes such as the development of clinical leprosy in the contacts of patients who had leprosy, incidence rates, adverse effects and safety/harmful effects of the intervention. SEARCH STRATEGY: A three-step strategy for published and unpublished literature was used. The search for published studies included: PubMed, Cumulative Index to Nursing and Allied Health Literature, Cochrane Library, Scopus, Web of Science, National Institute for Health and Clinical Excellence, Latin American and Caribbean Health Sciences Literature; and Google Scholar and EVIPnet for unpublished studies. Studies published from the time of the respective database inception to January 2016 in English, Spanish, Portuguese, Japanese and Chinese were considered. METHODOLOGICAL QUALITY: Two reviewers independently assessed the studies for methodological quality using standardized critical appraisal instruments from the Joanna Briggs Institute. DATA EXTRACTION: Standardized data extraction tools developed by the Joanna Briggs Institute were used to extract quantitative and qualitative data from papers included in the review. DATA SYNTHESIS: Due to clinical and methodological heterogeneity in the interventions of the included studies, no statistical meta-analysis was possible. Quantitative and qualitative research findings are presented in narrative form. RESULTS: Following critical appraisal, eight studies were included in this review, seven quantitative and one qualitative. The reduction in incidence of leprosy, using one dose of rifampicin in the first two years, was 56.5%; in the follow up period of one to four years, the reduction was 34.9%. The combination of rifampicin and the Bacillus Calmette-Guérin vaccine showed a preventative effect of 80% against the disease. The only controlled clinical trial using two doses of rifampicin was community-based and did not indicate effectiveness of the intervention. The qualitative findings showed social acceptability of rifampicin. CONCLUSIONS: Chemoprophylaxis with one dose of rifampicin is found to be effective in preventing contacts of leprosy patients from contracting the disease. Also, there is indication that this strategy is socially accepted.

Ensino das habilidades do pensamento crítico por meio de problem based learning / Enseñanza de las habilidades del pensamiento crítico por medio de la problem based learning / Teaching critical thinking skills through problem based learning

RESUMO Objetivo: analisar comparativamente a percepção de estudantes de enfermagem, em duas turmas, sobre o ensino implícito do pensamento crítico em um curso de Suporte Básico de Vida. Método: intervenção educativa, com abordagem qualitativa, fundamentada na teoria histórico-cultural. Participaram do estudo 102 estudantes, sendo 52 no grupo intervenção, que foram ensinados por meio da metodologia Problem Based Learning associada às questões norteadoras, e 50 no grupo controle, ensinados apenas com Problem Based Learning. Os dados foram coletados de 12 a 30 de novembro de 2015, na Universidade Federal de Viçosa, através de questionário sociodemográfico, instrumento avaliativo e entrevistas semiestruturadas. O instrumento avaliativo e as entrevistas foram explorados pela análise de conteúdo de Bardin. Resultados: o curso mobilizou habilidades de pensamento crítico nos estudantes de ambos os grupos. Contudo, no grupo intervenção, expuseram com mais clareza percepções sobre as características de um pensador crítico. No grupo controle, ao qual foi aplicada apenas a metodologia Problem Based Learning, os estudantes mencionaram aquisição de habilidades técnicas. No grupo intervenção, ao qual foi aplicada a metodologia Problem Based Learning associada às questões norteadoras, além das habilidades técnicas, os estudantes relataram habilidades de um pensador crítico. Conclusão: a análise comparativa permite concluir que metodologias de ensino mobilizadoras do pensamento crítico se tornam mediadoras no desenvolvimento e aprimoramento das funções mentais superiores no ensino, abarcando capacidades cognitivas e metacognitivas. O estudo representa contribuição e avanço no âmbito do ensino de enfermagem, considerando que as questões somam-se às tecnologias de educação em saúde.

RESUMEN Objetivo: analizar comparativamente la percepción de estudiantes de enfermería, en dos clases, sobre la enseñanza implícita del pensamiento crítico en un curso de soporte básico de vida. Método: intervención educativa, con abordaje cualitativo, fundamentada en la teoría históricocultural. En el estudio participaron 102 estudiantes, siendo 52 en el grupo de intervención, que fueron enseñados por medio de la metodología del Problem Based Learning asociada a cuestiones orientadoras, y 50 en el grupo control, enseñados sólo con el Problem Based Learning. Los datos fueron recolectados de 12 a 30 de noviembre de 2015, en la Universidad Federal de Viçosa, a través de cuestionario sociodemográfico, instrumento evaluativo y entrevistas semiestructuradas. El instrumento de evaluación y las entrevistas fueron exploradas por el análisis de contenido de Bardin. Resultados: el curso movilizó habilidades de pensamiento crítico en los estudiantes de ambos grupos. Sin embargo, en el grupo de intervención, expusieron con más claridad percepciones sobre las características de un pensador crítico. En el grupo control, al que se aplicó sólo la metodología del Problem Based Learning, los estudiantes mencionaron la adquisición de habilidades técnicas. En el grupo de intervención, al que se aplicó la metodología del Problem Based Learning asociada a las cuestiones orientadoras, además de las habilidades técnicas, los estudiantes relataron habilidades de un pensador crítico. Conclusión: el análisis comparativo permite concluir que metodologías de enseñanza movilizadoras del pensamiento crítico se vuelven mediadoras en el desarrollo y perfeccionamiento de las funciones mentales superiores en la enseñanza, abarcando capacidades cognitivas y metacognitivas. El estudio representa contribución y avance en el ámbito de la enseñanza de enfermería, considerando que las cuestiones se suman a las tecnologías de educación en salud.

ABSTRACT Objective: to comparatively analyze the perception of nursing students from two class groups, regarding the implicit teaching of critical thinking in a Basic Life Support course. Method: educational intervention with a qualitative approach based on historical-cultural theory. A total of 102 students participated in the study, 52 in the intervention group, who were taught using Problem Based Learning methodology associated with guiding questions, and 50 in the control group, taught only using Problem Based Learning. Data were collected from November 12 to 30 in 2015 at the Federal University of Viçosa, through a sociodemographic questionnaire, an evaluation instrument and semi-structured interviews. The evaluative tool and interviews were explored using Bardin's content analysis. Results: the course stimulated critical thinking skills in students from both groups. However, the intervention group portrayed more perceptions about the characteristics of a critical thinker. The students in the control group, to which only the Problem Based Learning methodology was applied to, mentioned the acquisition of technical skills. In the intervention group, to which the Problem Based Learning methodology associated with the guiding questions was applied to, the students reported the skills of a critical thinker in addition to the technical skills. Conclusion: the comparative analysis allows us to conclude that teaching methodologies that stimulate critical thinking become mediators in the development and improvement of higher mental functions in teaching, encompassing cognitive and metacognitive capacities. The study represents contribution and advancement in the scope of nursing teaching, considering that the questions add to the technologies of health education.

Critical thinking: concept analysis from the perspective of Rodger's evolutionary method of concept analysis.

OBJECTIVE: to analyze the concept of critical thinking (CT) in Rodger's evolutionary perspective. METHOD: documentary research undertaken in the Cinahl, Lilacs, Bdenf and Dedalus databases, using the keywords of 'critical thinking' and 'Nursing', without limitation based on year of publication. The data were analyzed in accordance with the stages of Rodger's conceptual model. The following were included: books and articles in full, published in Portuguese, English or Spanish, which addressed CT in the teaching and practice of Nursing; articles which did not address aspects related to the concept of CT were excluded. RESULTS: the sample was made up of 42 works. As a substitute term, emphasis is placed on 'analytical thinking', and, as a related factor, decision-making. In order, the most frequent preceding and consequent attributes were: ability to analyze, training of the student nurse, and clinical decision-making. As the implications of CT, emphasis is placed on achieving effective results in care for the patient, family and community. CONCLUSION: CT is a cognitive skill which involves analysis, logical reasoning and clinical judgment, geared towards the resolution of problems, and standing out in the training and practice of the nurse with a view to accurate clinical decision-making and the achieving of effective results.

Desfechos clínicos de pacientes pediátricos tratados com oxigenação por membrana extracorpórea / Clinical outcomes of pediatric patients treated with extracorporeal membrane oxygenation

Resumo Objetivo Identificar os fatores relacionados à mortalidade e avaliar a sobrevida de pacientes pediátricos tratados com oxigenação por membrana extracorpórea. Métodos Estudo de coorte retrospectivo, que incluiu pacientes pediátricos que utilizaram o dispositivo nos últimos cinco anos. Os grupos foram divididos com base naqueles que sobreviveram ou não após a terapia. Para avaliar os fatores preditivos de morte, foi utilizada análise multivariada com regressão logística e, para a sobrevida, o método de Kaplan-Meier e Log-Rank. Resultados A fração de ejeção do ventrículo esquerdo era maior no grupo de sobreviventes (74%+14,6% vs 56,2% + 22%, p=0,038) e o número de pacientes que necessitaram de diálise foi maior no grupo de não sobreviventes (52,4% vs. 12,5%, p=0,039), sendo a sobrevida significativamente menor neste grupo (log-rank=0,020). Conclusão Disfunção ventricular prévia, evidenciada pela fração de ejeção do ventrículo esquerdo <55%, e necessidade de terapia de substituição renal concomitante aumentaram o risco de morte.

Abstract Objective To identify factors related to mortality, and evaluate the survival of pediatric patients treated with extracorporeal membrane oxygenation. Methods A retrospective cohort study that included pediatric patients using the device in the last five years. The groups were divided into those who survived after therapy, and those who did not. Multivariate logistic regression was used for assessing the predictive factors of death, and the Kaplan-Meier and log-rank for assessing survival. Results Left ventricular ejection fraction was higher in the group of survivors (74% + 14.6% vs 56.2% + 22%, p = 0.038), and the number of patients who required dialysis was higher in the group of non-survivors (52.4% vs. 12.5%, p = 0.039), showing significantly lower survival in this group (log-rank = 0.020). Conclusion Previous ventricular dysfunction, evidenced by a left ventricular ejection fraction <55%, and requirement of concomitant renal replacement therapy, increased the risk of death.