"Two Cultures in Favor of a Dying Patient": Experiences of Health Care Professionals Providing Snakebite Care to Indigenous Peoples in the Brazilian Amazon.

In the Brazilian Amazon, deaths and disabilities from snakebite envenomations (SBEs) are a major and neglected problem for the indigenous population. However, minimal research has been conducted on how indigenous peoples access and utilize the health system for snakebite treatment. A qualitative study was conducted to understand the experiences of health care professionals (HCPs) who provide biomedical care to indigenous peoples with SBEs in the Brazilian Amazon. Focus group discussions (FGDs) were carried out in the context of a three-day training session for HCPs who work for the Indigenous Health Care Subsystem. A total of 56 HCPs participated, 27 in Boa Vista and 29 in Manaus. Thematic analysis resulted in three key findings: Indigenous peoples are amenable to receiving antivenom but not to leaving their villages for hospitals; HCPs require antivenom and additional resources to improve patient care; and HCPs strongly recommend a joint, bicultural approach to SBE treatment. Decentralizing antivenom to local health units addresses the central barriers identified in this study (e.g., resistance to hospitals, transportation). The vast diversity of ethnicities in the Brazilian Amazon will be a challenge, and additional studies should be conducted regarding preparing HCPs to work in intercultural contexts.

Perceptions of nurses regarding the management of snakebite envenomations: Limits and possibilities.

Snakebites can be caused by harmless or venomous snakes and, according to their severity and frequency, can be considered events of medical importance. In health facilities in remote areas, nurses work in the first line of care of patients that are victims of these envenomations. The aim was to discover the perception of nurses regarding the management of snakebites, its limitations and possibilities, with a view to professional empowerment in the context of primary health care. This is exploratory and descriptive research, with a qualitative approach, developed at FMT-HVD in Manaus, Amazonas state, Brazil, in the year 2021. The participants were nurses who work in basic health units in the municipalities of Careiro da Várzea, Ipixuna and Boa Vista do Ramos in the state of Amazonas. For data collection, the focus group strategy was adopted. Thematic content analysis was employed, which was carried out in the stages of pre-analysis; exploration or coding of the material; treatment of the results, inference and interpretation. After processing the data obtained, four topics emerged from the coding: Topic 1 - limitations in the primary care. Topic 2 - the need for infrastructure and personnel. Topic 3 - the need for continuing education. Topic 4 - the perception of training regarding the management of snakebite envenomations. The results showed a lack of antivenom in the healthcare units where nurses work. Another aspect highlighted by the nurses is the absence of a doctor in situ to perform the primary care or out of hours care in the units. The nurses' perceptions regarding the management of snakebite envenomations revealed the existence of failures in relation to the subject, such as the lack of antivenom, poor infrastructure in the units and the lack of a doctor, which must be solved, since the nurses are the most active professionals in primary health care, in addition to the high incidence of snakebite envenomations in the Brazilian Amazon.

Perspectives on snakebite envenoming care needs across different sociocultural contexts and health systems: A comparative qualitative analysis among US and Brazilian health providers.

With the advancements in therapeutics and available treatment options, almost all deaths and permanent disabilities from snakebite envenoming (SBE) are preventable. The challenge lies in implementing these evidence-based treatments and practices across different settings and populations. This study aims to compare data on provider perceptions of SBE care across health systems and cultural contexts to inform potential implementation science approaches. We hypothesize different health systems and cultural contexts will influence specific perceived needs to provide adequate snakebite care within central tenets of care delivery (e.g., cost, access, human resources). We previously conducted exploratory descriptive studies in the US and Brazil in order to understand the experience, knowledge, and perceptions of health professionals treating SBE. In the US, in-depth interviews were performed with emergency physicians from January 2020 to March 2020. In BR, focus group discussions were conducted with health professionals from community health centers at the end of June 2021. The focus group discussions (BR) were originally analyzed through an inductive thematic analysis approach. We conducted a secondary qualitative analysis in which this codebook was then applied to the interviews (US) in a deductive content analysis. The analysis concluded in August 2022. Brazil participants were physicians (n=5) or nurses (n=20) from three municipalities in the State of Amazonas with an average of three years of professional experience. US participants were emergency physicians (n=16) with an average of 15 years of professional experience. Four main themes emerged: 1) barriers to adequate care on the patient and/or community side and 2) on the health system side, 3) perceived considerations for how to address SBE, and 4) identified needs for improving care. There were 25 subthemes within the four themes. These subthemes were largely the same across the Brazil and US data, but the rationale and content within each shared subtheme varied significantly. For example, the subtheme "role of health professionals in improving care" extended across Brazil and the US. Brazil emphasized the need for task-shifting and -sharing amongst health care disciplines, whereas the US suggested specialized approaches geared toward increasing access to toxicologists and other referral resources. Despite similar core barriers to adequate snakebite envenoming care and factors to consider when trying to improve care delivery, health professionals in different health systems and sociocultural contexts identified different needs. Accounting for, and understanding, these differences is crucial to the success of initiatives intended to strengthen snakebite envenoming care. Implementation science efforts, with explicit health professional input, should be applied to develop new and/or adapt existing evidence-based treatments and practices for SBE.

Validation of a Culturally Relevant Snakebite Envenomation Clinical Practice Guideline in Brazil.

Snakebite envenoming (SBE) is a neglected tropical disease with significant global morbidity and mortality. Even when antivenom is available in low-resource areas, health workers do not receive adequate training to manage SBEs. This study aims to develop and validate a clinical practice guideline (CPG) for SBE management across Brazil. A panel of expert judges with academic and/or technical expertise in SBE management performed content validation. The content validity index (CVI) score was 90% for CPG objectives, 89% for structure and presentation and 92% for relevance and classified the CPG as valid. A semantic validation was performed by analyzing focus group discussions with doctors and nurses from three municipalities of the Brazilian Amazon, after a 5-day meeting during which the CPG was presented. Two central themes emerged: knowledge acquired during the meeting and recommendations for improving the CPG. Based on these results, the CPG was revised into a final version. This study presents the successful development and validation process of a CPG for SBE management, which is targeted to a specific low-resource, high-burden setting. This development and validation process can be adapted to other settings and/or other neglected tropical diseases.

Validation of a culturally relevant snakebite envenomation clinical practice guideline in Brazil

Snakebite envenoming (SBE) is a neglected tropical disease with significant global morbidity and mortality. Even when antivenom is available in low-resource areas, health workers do not receive adequate training to manage SBEs. This study aims to develop and validate a clinical practice guideline (CPG) for SBE management across Brazil. A panel of expert judges with academic and/or technical expertise in SBE management performed content validation. The content validity index (CVI) score was 90% for CPG objectives, 89% for structure and presentation and 92% for relevance and classified the CPG as valid. A semantic validation was performed by analyzing focus group discussions with doctors and nurses from three municipalities of the Brazilian Amazon, after a 5-day meeting during which the CPG was presented. Two central themes emerged: knowledge acquired during the meeting and recommendations for improving the CPG. Based on these results, the CPG was revised into a final version. This study presents the successful development and validation process of a CPG for SBE management, which is targeted to a specific low-resource, high-burden setting. This development and validation process can be adapted to other settings and/or other neglected tropical diseases

Enfermeiros da área perioperatória no período da pandemia: aspectos institucionais e atitudinais / Nurses in the perioperative area during the pandemic period: institutional and attitudinal aspects / Enfermeras en el área perioperatoria durante el período pandémico: aspectos institucionales y actitudinales

Objetivo: analisar aspectos institucionais e atitudinais que emergem da atuação de enfermeiros da área perioperatória no período da pandemia do coronavírus. Método: estudo transversal descritivo, realizado no Amazonas, Pará e Roraima, Brasil. A coleta foi feita com 36 enfermeiros que atuam na área perioperatória, realizada em ambiente virtual, com aplicação de questionário entre os meses de julho e agosto de 2020. A análise foi por meio da estatística descritiva. Resultados: sobre a oferta de condições para o cumprimento das recomendações e normas somente quanto ao recebimento de EPI houve pleno atendimento. Sobre as atitudes dos enfermeiros diante das recomendações e normas não houve pleno cumprimento. Sobre estar atuando em contexto de pandemia, tiveram que fazer alterações na rotina e sentiram medo e insegurança. Conclusão: evidenciou-se que tanto na perspectiva institucional como atitudinal não se atingiu plenamente o estabelecido nas recomendações e normas, sendo importante a implementação de estratégias de educação permanente. (AU)

Objective: To analyze institutional and attitudinal aspects of nurses who worked in the perioperative area during the coronavírus pandemic period. Methods: Descriptive cross sectional study, carried out in Amazonas, Pará and Roraima, Brazil. The collection was made with 36 nurses working in the perioperative area, performed in a virtual environment, with the application of a questionnaire between the months of July and August 2020. The analysis was through descriptive statistics. Results: Regarding the offer of conditions for the fulfillment of the recommendations and rules only regarding the receipt of individual protection equipment there was full service. Regarding the nurses' attitudes towards the recommendations and standards, there was no full compliance. About being in a pandemic context, they had to make changes to their routine and felt fear and insecurity. Conclusion: It became evident that both from an institutional and an attitudinal perspective, what was established in the recommendations and standards was not fully achieved, with the implementation of permanent education strategies being important. (AU)

Objetivo: Analizar aspectos institucionales y actitudinales de los enfermeros que laboraron en el área perioperatoria durante el período pandémico del coronavirus. Métodos: Estudio descriptivo transversal, realizado en Amazonas, Pará y Roraima, Brasil. La recolección se realizó con 36 enfermeros que laboran en el área perioperatoria, realizada en un ambiente virtual, con la aplicación de un cuestionario entre los meses de julio y agosto de 2020. El análisis fue a través de estadística descriptiva. Resultados: En cuanto a la oferta de condiciones para el cumplimiento de las recomendaciones y normas solo en cuanto a la recepción de equipo de protección individual, hubo servicio completo. En cuanto a las actitudes de las enfermeras hacia las recomendaciones y estándares, no hubo pleno cumplimiento. Al estar en un contexto de pandemia, tuvieron que hacer cambios en su rutina y sintieron miedo e inseguridad. Conclusión: Se hizo evidente que tanto desde una perspectiva institucional como actitudinal, lo establecido en las recomendaciones y estándares no se cumplió en su totalidad, siendo importante la implementación de estrategias de educación permanente. (AU)

Protocolo de cirurgia segura: análise da produção e execução em dois hospitais terciários / Surgical safety checklist: analysis of its elaboration and implementation in two tertiary hospitals / Protocolo de cirugía segura: análisis de producción y ejecución en dos hospitales terciarios

Objetivo: Analisar o processo de produção e execução do protocolo de cirurgia segura em dois hospitais terciários do município de Manaus. Método: Pesquisa guiada pelo design thinking, com ênfase na técnica do duplo diamante, realizada em dois hospitais públicos no município de Manaus, de julho de 2018 a março de 2019. Foi feita nas etapas: investigativa (observação e questionário) e interventiva (síntese, ideação e entrega). Resultados: Na primeira etapa, com 120 horas de observação, constatou-se que as três fases do protocolo não foram cumpridas; analisando-se as repostas a 63 questionários, reforçou-se a não adesão ao checklist. Com base nesses achados, na etapa de síntese, elegeu-se como foco a aplicação do checklist do protocolo; na etapa de ideação, realizou-se a proposição de solução e a testagem-piloto; a etapa de entrega da solução aos hospitais encerrou o ciclo. Conclusão: A análise do processo de execução do protocolo indicou seu descumprimento, o que sugere o comprometimento da segurança do paciente. A solução testada poderá, após entrega e implementação, contribuir para a execução efetiva do protocolo.

Objective: To analyze the process of elaboration and implementation of the surgical safety checklist in two tertiary hospitals in the city of Manaus. Method: This study was based on design thinking, focusing on the double diamond technique. It was conducted in two public hospitals in Manaus, from July 2018 to March 2019. The following stages were adopted for this research: investigation (observation and questionnaire) and intervention (synthesis, ideation, and delivery). Results: The first stage, consisting of 120 hours of observation, showed the non-fulfillment of the three phases of the process. After analyzing the answers to the 63 questionnaires, we confirmed the non-adherence to the checklist. Based on these findings, the synthesis phase focused on the use of the checklist; the ideation phase involved the proposal of solutions and the pilot testing; the delivery phase concluded the cycle by providing solutions to the hospitals. Conclusion: The analysis of the process of implementation of the checklist indicated non-compliance, suggesting risk to patient safety. After delivery and implementation, the tested solution may contribute to the effective execution of the checklist.

Objetivo: Analizar el proceso de producción y ejecución del Protocolo de Cirugía Segura en dos hospitales terciarios de la ciudad de Manaus. Método: Investigación guiada por Design Thinking, con énfasis en la técnica Double Diamond, llevada a cabo en dos hospitales públicos de la ciudad de Manaus, desde julio de 2018 hasta marzo de 2019. Se realizó por etapas: de investigación (observación y cuestionario) e intervencionista (síntesis, ideación y entrega). Resultados: En la primera etapa, con 120 horas de observación, se encontró que las tres fases del protocolo no se cumplieron; En base a las respuestas a 63 cuestionarios, se reforzó la no adhesión a la lista de verificación. Con base en estos hallazgos, en la etapa de síntesis, la aplicación de la lista de verificación del protocolo fue elegida como el foco; en la etapa de ideación, se llevaron a cabo la propuesta de solución y la prueba piloto;La etapa de entrega de la solución a los hospitales finalizó el ciclo. Conclusión: El análisis del proceso de ejecución del protocolo indicó incumplimiento, lo que sugiere comprometer la seguridad del paciente. La solución probada puede, después de la entrega y la implementación, contribuir a la ejecución efectiva del protocolo.

Conhecimento da equipe de enfermagem sobre trombose venosa profunda: subsídios para tecnologia educacional / Knowledge of the team nursing about deep venous thrombosis: subsidies for educational technology

Objetivo: Analisar o conhecimento da equipe de enfermagem sobre trombose venosa profunda com vistas a produção de tecnologia educacional. Metodologia: Estudo exploratório com abordagem qualitativa, realizado em hospital do norte do Brasil, por meio de questionário e entrevista semiestruturada, de fevereiro a junho de 2019, com 12 profissionais de centro cirúrgico, clínica cirúrgica, sala de recuperação pós-anestésica. Análise de conteúdo do tipo temática. Aprovado pelo Comitê de Ética em Pesquisa. Resultados: Dentre os enfermeiros (seis), o mesmo quantitativo dos sexos feminino e masculino, idade entre 26 e 41 anos; tempo de trabalho de 01 há 13 anos. Em relação aos técnicos de enfermagem (seis), todos do sexo feminino, idade entre 25 e 43 anos, de 01 há 6 anos de atuação. Emergiram cinco temas: trombose venosa profunda; fatores de risco; complicações; procedimentos que prejudicam a mobilidade; cuidados pós-operatórios com os pacientes de risco. Dos temas elaborou-se o quadro de convergências entre temas e evidências para subsidiar a construção de tecnologia educacional. Conclusão: enfermeiros e técnicos de enfermagem demostraram ter entre conhecimento adequado e parcialmente adequado, o que indica a necessidade de tecnologia educacional para a equipe de enfermagem.

Objective: To analyze the knowledge of the nursing team about deep venous thrombosis with a view to the production of educational technology. Methodology: it is an exploratory study with a qualitative approach, carried out in a hospital in northern Brazil, through a questionnaire and semi-structured interview, from February to June 2019, with 12 professionals from the operating room, surgical clinic, post-anesthetic recovery room. Approved by the Research Ethics Committee, opinion 94738318.9.0000.5016. Results: Among nurses (six), the same number of women and men, aged between 26 and 41 years; 01 working time for 13 years. Regarding nursing technicians (six), all female, aged between 25 and 43 years, from 01 to 6 years of experience. Five themes emerged: deep vein thrombosis; risk factors; complications; procedures that impair mobility; postoperative care for patients at risk. Of the themes, the framework for convergences between emerging themes and evidence and another for themes and content to subsidize educational technology were elaborated. Conclusion: nurses and nursing technicians demonstrated having adequate and partially adequate knowledge, which indicates the need for educational technology for the nursing team.

Validação de manual de cuidados de idosos após cirurgia cerebral / Validation of elderly care manual after brain surgery

Objetivo: validar a tecnologia educacional "Manual de cuidados familiares com a pessoa idosa submetida à cirurgia cerebral". Método: trata-se de um estudo metodológico realizado em duas etapas: validação de conteúdo com 11 juízes especialistas e validação semântica com oito representantes do público-alvo. Aplicou-se, em cada etapa, um questionário validado do tipo Likert. Utilizou-se a estatística descritiva para a obtenção do índice de validade de conteúdo e índice de validade semântica. Resultados: revela-se que o índice de validade de conteúdo entre os juízes especialistas foi de 0,80 e o índice da validade semântica entre o público-alvo foi de 0,98. Conclusão: validou-se o manual em conteúdo e aparência como tecnologia educacional para apoiar familiares de pessoas idosas submetidas à cirurgia cerebral e mediar o trabalho educativo da equipe multidisciplinar, principalmente o enfermeiro, podendo repercutir positivamente no cuidado pós-alta hospitalar. (AU)

Objective: to validate the educational technology "Manual of family care for the elderly subjected to brain surgery". Method: this is a methodological study conducted in two stages: content validation with 11 expert judges and semantic validation with eight representatives of the target audience. At each stage, a validated Likert questionnaire was applied. Descriptive statistics was used to obtain the content validity index and semantic validity index. Results: it is revealed that the content validity index among expert judges was 0.80 and the semantic validity index among the target audience was 0.98. Conclusion: the manual was validated in content and appearance as educational technology to support relatives of elderly people undergoing brain surgery and mediate the educational work of the multidisciplinary team, especially the nurse, and can positively impact post-discharge care.(AU)

Objetivo: validar la tecnología educativa "Manual de cuidados familiares para ancianos sometidos a cirugía cerebral". Método: este es un estudio metodológico realizado en dos etapas: validación de contenido con 11 jueces expertos y validación semántica con ocho representantes del público objetivo. En cada etapa, se aplicó un cuestionario de Likert validado. Se utilizó la estadística descriptiva para obtener el índice de validez de contenido y el índice de validez semántica. Resultados: se revela que el índice de validez de contenido entre los jueces expertos fue de 0,80 y el índice de validez semántica entre el público objetivo fue de 0,98. Conclusión: el manual fue validado en contenido y apariencia como tecnología educativa para apoyar a los familiares de personas mayores que se someten a cirugía cerebral y mediar en el trabajo educativo del equipo multidisciplinario, especialmente el enfermero, y puede tener un impacto positivo en la atención posterior al alta.(AU)

A trajetória da produção de uma tecnologia educacional: cuidados domiciliares ao idoso pós-neurocirurgia / THE TRAJECTORY OF AN EDUCATIONAL TECHNOLOGY PRODUCTION: HOME CARE TO THE ELDERLY IN POST-NEUROSURGERY

Objetivo: relatar a trajetória da produção de uma tecnologia educacional paraorientação dos cuidados domiciliares dispensados à pessoa idosa pós-neurocirurgia. Método:relato descritivo de experiência sobre a produção de uma Tecnologia Educacional voltada aoscuidados domiciliares de pessoas idosas pós-neurocirurgia, desenvolvida no período de junhode 2015 a junho de 2016. A trajetória foi dividida em três passos: valorização da experiênciaprofissional, revisão integrativa e elaboração de um manual impresso. Resultados: aconstrução do manual impresso intitulado “Cuidados familiares com a pessoa idosa submetidaa cirurgia cerebral”, traz orientações para subsidiar o tratamento domiciliar dos longevos.Conclusão: a produção de uma tecnologia educacional voltada aos cuidados domiciliarespara idosos pós-neurocirurgia, vem contribuir como estratégia de educação em saúde,proporcionando uma assistência de enfermagem humanizada e voltada para a melhoria daqualidade de vida dessas pessoas.

Aim: to report the trajectory of an educational technology production to guidehome care given to the elderly person after neurosurgery. Method: descriptive report ofexperience on the production of an Educational Technology aimed at the home care of theelderly in post neurosurgery, developed from June 2015 to June 2016. The trajectory wasdivided in three steps: valorization of professional experience, integrative revision andpreparation of a printed manual. Results: the construction of the printed manual titled "Familycare with the elderly who underwent brain surgery”, provides guidelines to subsidize the hometreatment for the elderly. Conclusion: the production of an educational technology aimed athome care for the elderly after neurosurgery has contributed as a strategy for health education,providing humanized nursing care, aimed at improving the quality of life of these people.

Objetivo: relatar la trayectoria de la producción de una tecnología educativa paraorientación de los cuidados domiciliarios dispensados a la persona anciana posneurocirugía.Método: relato descriptivo de experiencia sobre la producción de una tecnología educativaorientada a los cuidados domiciliarios de personas ancianas posneurocirugía, desarrollada enel período de junio de 2015 a junio de 2016. La trayectoria fue dividida en tres pasos:valorización de la experiencia profesional, revisión integrativa y elaboración de un manualimpreso. Resultados: la construcción del manual impreso intitulado "Cuidados familiares conla persona anciana sometida a cirugía cerebral", presenta orientaciones para subsidiar eltratamiento domiciliar de los longevos. Conclusión: la producción de una tecnología educativaorientada a los cuidados domiciliarios para ancianos posneurocirugía, contribuye comoestrategia de educación en salud, proporcionando una asistencia de enfermería humanizada yorientada a la mejora de la calidad de vida de esas personas.