Eventos adversos en pacientes hospitalizados reportados por enfermería: un estudio multicéntrico en México / Nursing reported hospitalized patients adverse events: A multi-centric study in Mexico / Eventos adversos em pacientes hospitalizados relatados por enfermagem: um estudo multicéntrico no México

Introducción: Los eventos adversos (EA) son un daño no intencionado derivado de la atención sanitaria que se relacionan con los recursos humanos, los factores del sistema o las condiciones clínicas del paciente. Objetivo: Analizar factores relacionados con la calidad y la seguridad del paciente a través de los reportes de EA. Metodología: Diseño transversal, multicéntrico, realizado en 5 institutos nacionales de salud y en un hospital de alta especialidad, se estudiaron los EA ocurridos durante 18 meses, para lo cual se utilizó el instrumento SYREC 2007; análisis descriptivo y evaluación de asociación entre grado de evitabilidad y factores intrínsecos, extrínsecos y del sistema; se observaron los aspectos éticos vigentes. Resultados: Se analizaron un total de 540 EA, ocurrieron 55.5% en hombres, 58.7% estaban en estado de alerta, el 92.6% de los EA ocurrió en el servicio asignado, el 55.9% no se reportó a la familia, se consideró sin duda como evitable en el 70.5%, los factores del sistema estuvieron presentes en 80.6%, hubo asociación significativa entre estos y la evitabilidad del suceso. Discusión: Los principales resultados encontrados son coincidentes con otras investigaciones internacionales tales como: To err is human 1999, el estudio ENEAS de España 2006 y con el de prevalencia IBEAS 2010; en todos ellos se hizo evidente la necesidad de reforzar la cultura de la notificación de los EA y el clima para la seguridad del paciente, además de promover una reflexión interpersonal acerca de la calidad de los servicios asistenciales. Conclusiones: Los factores relacionados con el sistema tienen un mayor peso en la aparición de EA. Es de vital importancia su identificación a fin de poder evitarlos.

Introduction: Adverse events (AE) are unintended harms derived from human health attention, system factors, or clinical conditions in the patients. Objective: To analyze factors influencing the quality of patient healthcare and safety through the review of diverse records on AEs. Methodology: This transversal and multi-centric design study was carried out in five National Institutes of Health and a high specialty hospital. AEs in an 18 month period were studied using the SYREC 2007 instrument. Descriptive analysis, as well as assessments on the association between the preventability degree and the intrinsic, extrinsic, and system factors were all performed. Current ethical issues were observed. Results: A total of 540 AEs were analyzed; 55.5% occurred in men; 58.7% occurred during state of alertness; 92.6% occurred at the assigned service; 55.9% were not reported to the families; 70.5% were considered preventable; and system factors were present in 80.6% of them. A significant association between the AEs and the possibility to prevent them was found. Discussion: The main findings were consistent with those of other international studies including: ''To err is human'', 1999, the ENEAS study in Spain, 2006, and the IBEAS prevalence study, 2010. All of these studies emphasize the need to strengthen the culture of AE-notifying and to improve the patient safety climate, as well as to promote inter-personal reflections on to the quality of care services. Conclusions: System-related factors have the strongest influence on the occurrence of AEs, and thus, their identification becomes critical in order to enhance the quality of healthcare services.

Introdução: Os Eventos Adversos (EA) são um dano não intencionado derivado da atenção sanitária que se relaciona com os recursos humanos, os fatores do sistema ou as condições clínicas do paciente. Objetivo: Analisar fatores relacionados com a qualidade e a segurança do paciente a través dos relatórios de EA. Metodologia: Desenho transversal, multicéntrico, realizado em cinco Institutos Nacionais de Saúde e um hospital de alta especialidade, estudaram-se os EA ocorridos durante 18 meses, para o qual se utilizou o instrumento SYREC 2007; análise descritiva e avaliação de associação entre grau de evitabilidade e fatores intrínsecos, extrínsecos e do sistema; observaram-se os aspectos éticos vigentes. Resultados: Analisaram-se um total de 540 EA, ocorreram 55.5% em homens, 58.7% estavam em estado de alerta, o 92.6% o EA aconteceu no serviço assignado, o 55.9% não se informou à família, considerou-se sem dúvida como evitável no 70.5%, os fatores do sistema estiveram presentes em 80.6%, houve associação significativa entre estes e a evitabilidade do evento. Discussão: Os principais resultados encontrados são coincidentes com outras pesquisas internacionais tais como: ''To err is human'' 1999, o estudo ENEAS da Espanha 2006 e com o de prevalência IBEAS 2010; em todos eles se fez evidente a necessidade de reforçar a cultura da notificação dos EA e o clima para a segurança do paciente, além de promover una reflexão interpessoal acerca da qualidade dos serviços assistenciais. Conclusões: Os fatores relacionados com o sistema têm um maior peso na aparição de EA. É de vital importância sua identificação a fim de poder evitá-los.

La enseñanza a pacientes con diabetes: significado para profesionales de enfermería / Teaching to diabetes patients: Meaning for the professionals of Nursing / O ensino a pacientes com diabetes: significado para profissionais de enfermagem

Objetivo: Describir el significado que para profesionales de enfermería tiene la enseñanza a pacientes diabéticos hospitalizados sobre su cuidado en el hogar. Método: Estudio cualitativo, fenomenológico, descriptivo, desarrollado en un hospital de Culiacán, Sinaloa. Selección de participantes con base a muestreo teórico: fueron enfermeras que laboran en servicios de medicina interna y cirugía. Número de entrevistas con base en la saturación de datos. En aspectos éticos, han sido considerados los principios de beneficencia, confidencialidad y respeto a la intimidad, así como la autorización de los participantes mediante consentimiento informado. Para recolección de datos se utilizó entrevista a profundidad. Instrumentos: guía de preguntas semiestructurada y notas de campo. El análisis y la interpretación de los datos fueron de acuerdo a la propuesta de De Sousa Minayo, basada en el análisis temático, que incluye: organización de datos, clasificación de temas y análisis final. Resultados: Se realizaron 7 entrevistas. El análisis inicial identificó que la relación intersubjetiva de la enfermera con el paciente y su familia se puede realizar en cualquier espacio de enseñanza. Se generaron dos categorías; en este manuscrito solo se referirá la categoría información que proporciona la enfermera, que incluyó tres subcategorías: información que proporciona al paciente, a la familia y momentos para enseñar. Conclusión: Los hallazgos evidencian la necesidad de redefinir el papel de la (del) enfermera(o) en la enseñanza a pacientes diabéticos y considerar la importancia del contexto en desarrollo de esta función; estos tienen utilidad en planteamiento de propuestas educativas efectivas que contribuyan a potencializar la enseñanza a estos pacientes.

Objective: To describe the meaning which Nursing professionals have about their teaching to hospitalized patients with diabetes regarding their home care. Method: This is a qualitative, phenomenological and descriptive study conducted in a Hospital in Culiacan, Sinaloa. The participants were selected on the basis of theoretical sampling and included nurses working in the services of internal medicine and surgery. Interviews were conducted until data saturation was reached. Regarding the ethical aspects, the principles of beneficence, confidentiality, and respect to the intimacy were considered as well as the participants' authorization through their informed consent. Data were collected through interviews with semi-structured questions and field notes. The analysis and interpretation was conducted following the De Sousa Minayo proposal which is based on thematic analysis, and includes: organization of data, classification of themes, and final analysis. Results: Seven interviews were conducted. In the initial analysis, it was identified that the inter-subjective relation between the nurse and the patient and family can take place in any teaching space. Two categories emerged, one of these being information which the nurse provides which included tree sub-categories: information provided to the patient, information provided to the family, and the moments to do the teaching. Conclusion: The findings suggest that there exists a necessity to re-define the role of the nurses regarding their teaching to diabetic patients, and also to consider the importance of the context in the development of this function; all these in order to generate effective educational proposals which can contribute to the improvement of their teaching to these patients.

Objetivo: Descrever o significado que tem o ensino a pacientes diabéticos hospitalizados sobre o cuidado no lar para profissionais de enfermagem. Método: estudo qualitativo, fenomenológico, descritivo, desenvolvido em um hospital de Culiacán, Sinaloa, seleção de participantes com base na amostragem teórica, foram enfermeiras que lavoram em serviços de medicina interna e cirurgia, número de entrevistas com base na saturação de dados. Em aspectos éticos têm sido considerados os princípios de beneficência, confidencialidade e respeito à intimidade, bem como a autorização de participantes através de consentimento informado. Para a coleta de dados utilizou-se entrevista a profundidade, instrumentos: guia de perguntas semiestruturada e notas de campo. A análise e interpretação de dados foi conforme à proposta de De Sousa Minayo, baseada na análise temática, que inclui: organização de dados, classificação de temas e análise final. Resultados: Realizaram-se 7 entrevistas. Análise inicial identificou que a relação intersubjetiva da enfermeira com o paciente e sua família, pode se realizar em qualquer espaço de ensino. Geraram-se duas categorias, neste manuscrito, só se referirá a categoria informação que proporciona a enfermeira que incluiu três subcategorias: informação que proporciona ao paciente, à família e momentos para ensinar. Conclusão: Os achados evidenciam a necessidade de redefinir o papel da enfermeira (o) no ensino a pacientes diabéticos e considerar a importância do contexto no desenvolvimento desta função, estes têm utilidade na abordagem de propostas educativas efetivas, que contribuem a potencializar o ensino a estes pacientes.

Autocuidado para el control de la hipertensión arterial en adultos mayores ambulatorios: una aproximación a la taxonomía NANDA-NOC-NIC / Self-Care for hypertension in elderly outpatients, an approach to the NANDA-NOC-NIC taxonomy

El uso de un lenguaje común es una característica que distingue a los profesionales. Así, la conformación y el uso de un lenguaje técnico coadyuva al desarrollo gremial, en este sentido hacer uso de las teorías del cuidado y de clasificaciones validadas por asociaciones internacionales de profesionales sintetizan y facilitan la comprensión y el avance del conocimiento. Cuando los profesionales de enfermería aplican teorías y clasificaciones para discutir sobre la gestión del cuidado, el nivel de comunicación mejora y los pacientes se ven beneficiados con la continuidad de su tratamiento. El propósito de éste trabajo, es mostrar de manera explícita como se puede vincular la teoría del autocuidado de Orem, con los diagnósticos de enfermería propuestos por la Asociación Norteamericana de Diagnósticos de Enfermería; la Clasificación de Resultados de Enfermería; y la Clasificación de Intervenciones de Enfermería. Con base en lo anterior, se proponen cuatro esquemas que pueden ser aplicables al cuidado de adultos mayores ambulatorios con hipertensión arterial.

A characteristic among professionals is the use of common language. Therefore the conformation of a technical language usage contributes to professional development, in this way, the use of care theories and classifications validated by international professional associations summarize and facilitate the comprehension and advance of knowledge. When nursing professionals apply theories and classifications to discuss about care management, the level of communication improves and patients get favored with the continuity of their treatment. The purpose of this paper work is to show in an explicit manner how Orem's theory of self care can be linked with nursing diagnosis purposed by the North American Nursing Diagnosis Association, the Nursing Outcomes Classification and the Nursing Interventions Classification. Based on previous said, five diagrams are suggested to be applied in the care of elderly outpatients with high blood pressure.

Enfoque constructivista en el aprendizaje de la asignatura de metodología de la investigación en la ENEO / constructivist approach to learning the subject of research methodology in the ENEO

ntroducción: El aprendizaje de la investigación en enfermería generalmente se realiza a través de una educación de tipo tradicional. La enseñanza con enfoque constructivista favorecen el aprendizaje significativo y la innovación de la práctica investigativa de los problemas inherentes al cuidado. Objetivo: Realizar un diagnóstico sobre la aplicación del enfoque constructivista en el aprendizaje de la asignatura de metodología de la investigación. Metodología: Estudio de investigación educativa de tipo transversal realizado a través de una encuesta donde se exploraron cinco áreas sobre la aplicación del enfoque constructivista en el aprendizaje de la asignatura de metodología de la investigación. Resultados: Durante la primera semana de diciembre de 2008, se aplicaron 116 encuestas; el análisis de ellas, mostró que la distribución percentilar del indicador de puntuación general para el aprendizaje constructivista acumulo las frecuencias más altas para las respuestas de "casi siempre" percentil 0.25 (42), mediana (48) y percentil 0.75 (54); para la respuesta "siempre" percentil 0.25 (44), mediana (49) y percentil 0.75 (51). Discusión: Acorde a la literatura la concepción constructivista implica, la disposición total por parte del alumno y la guía del profesor en la dinámica de la enseñanza misma que si se dio en la enseñanza de esta asignatura. Conclusiones: De acuerdo con los resultados, los docentes de los grupos estudiados que imparten la asignatura de metodología de la investigación si utilizan un enfoque de constructivista.

Introduction: The learning of the nursery research is generally made trough a traditional education. The teaching with a constructivist approach favors the significant learning and the innovation of research practice of the inherent problems of health care. Objective: To realize a diagnosis over the application of the constructivist approach in the research methodology subject. Methodology: Study of educational research conducted through a cross-sectional survey which explored five areas on the implementation of the constructivist approach in the learning of methodology research. Results: During the first week of December, 2008, 116 surveys were applied, the analysis of them showed that the percentile distribution of the indicator of overall score for constructivist learning accumulate higher frequencies for responses of "almost always" percentile 0.25 (42), medium (48) and percentile 0.75 (54), for the answer "always" percentile 0.25 (44), medium (49) and percentile 0.75 (51). Discussion: According to the literature, the constructive conception implies the total disposition on behalf of the student and the guide of the professor in the teaching dynamic, that has already been given in the teaching of the subject. Conclusions: According to the results, teachers of the studied groups that offer courses on research methodology do use a constructivist approach.

Cobertura de atención de enfermería y su impacto en la mortalidad en México, 2007 / Nursing care coverage and its impact on mortality in Mexico, 2007

Introducción: El estudio de la mortalidad contribuye para conocer la situación de la salud de la población e indica los retos en las políticas públicas para disminuir las muertes prematuras y/o evitables. Objetivo: Identificar como impacta el indicador de cobertura de atención de enfermería en la mortalidad infantil, perinatal, materna y en menores de cinco años. Metodología: Estudio transversal y analítico donde se utilizó información oficial de recursos humanos de enfermería y mortalidad por entidad federativa en México 2007, a partir del método de "Componentes Principales" se construyó el Índice Global de Mortalidad y se buscó asociación causal. Resultados: En México la cobertura de enfermería es de 2.11 enfermeras por cada 1,000 habitantes, sin embargo, al interior del país se observan diferencias de hasta tres veces para este indicador. El ejercicio de regresión lineal simple demuestra asociación estadísticamente significativa ya que conforme se incrementa la cobertura de enfermería se disminuye la mortalidad. Discusión: Definitivamente, la cobertura de enfermería no es el único factor que determina la mortalidad. Sin embargo, en estudios publicados en los últimos años se identifica que el cuidado de enfermería sí incrementa los niveles de salud de la población, retrasa la edad de la muerte y disminuye las muertes tempranas y evitables. Conclusiones: El estudio de la mortalidad temprana y/o evitable y su relación con la cobertura de enfermería son sólo un factor para la mejor comprensión del impacto potencial que puede llegar a tener la presencia del profesional de enfermería en el perfil de salud y la mortalidad en la población.

Introduction: The mortality study contributes to understand the health status of the population and it indicates the challenges in public policy to reduce premature and / or preventable death. Objective: To identify how nursing care coverage indicator impacts on infant mortality, perinatal mortality, maternal mortality and under five years old mortality. Methodology: Transversal and analytic study where official information of Nursing Human Resources and mortality by federal entity in Mexico 2007 was used, from the method of "Main Components" the "Global Mortality Index " was built and causal association was looked for. Results: In Mexico nursing coverage is 2.11 nurses per 1,000 inhabitants, however, within the country differences are observed of up to three times for this indicator. The exercise of simple linear regression shows statistically significant association since according to increasing nursing coverage mortality decreases. Discussion: Definitely, nursing coverage is not the only factor determining mortality. However, in studies published in recent years it is possible to identify that nursing care does increase the levels of population's health, delays age of death and reduces early and avoidable deaths. Conclusions: The study of early and / or preventable mortality and its relation to nursing coverage are only one factor for a better understanding of the potential impact that the presence of professional nurses can have in the health profile and mortality among population.

La calidad de vida en los adultos mayores y su percepción en la calidad de la atención de Enfermería / Quality of life among older adults and their perception of nursing attention

El presente trabajo aborda la importancia del nivel de Calidad de Vida (CV) en los Adultos Mayores (AM) y la percepción de la Calidad de la Atención de Enfermería (CAE). El objetivo fue conocer la percepción de la CAE que tienen los AM de acuerdo a sus características sociodemográficas de salud y a su CV. Durante junio de 2006 con el apoyo de cuatro académicos y alumnos de la ENEO se encuestó a AM en tres centros de atención médica y en diversos puntos geográficos del D. F. Resultados: se entrevistaron 82 AM, 52 mujeres y 30 hombres, la calificación que asignaron a la CAE fue considerada como: "Muy Buena" o "Buena" en 80%, el análisis de correlación entre CV y la CAE mostró baja correlación. Las conclusiones fueron que en general los AM tienen buena opinión de la CAE; las mujeres tienen una mejor opinión que los hombres, las opiniones desfavorables aumentan conforme se incrementa la edad, el bajo nivel educativo, la pobreza y la severidad del diagnóstico; las opiniones más favorables están relacionadas con la mayor necesidad de cuidado, aparentemente la CV no determina la percepción de la CAE cuando la necesidad de cuidado es mínima.

The present work investigates the importance of the quality of life (QL) in major adults (MA) and the perception of the care quality in nursery (QAN). The object was to know the perception of the QAN that the MA have according to their socio-demographic, health and QL characteristics. During June of 2006 with the support of academicians and students of the ENEO were polled MA in three centres of medical attention in diverse geographical points in Mexico City. Results: were polled 82 MA, 52 women and 30 men. The assigned qualification to (QAN) was assigned as "very good" or "good" in 80%, the correlation analysis between the (QL) and the (QAN) showed a low correlation. Conclusions were, in general that the MA have a good opinion of the (QAN), women have a better opinion of men, the unfavourable opinions are increased as increases the age, the low educative level, the poverty and the severity of the diagnosis, the most favourable opinions are related to the greater necessity of care, apparently the QL does not determine the perception on the QAN when the necessity of care is minimum.

[The epidemiology of AIDS/HIV in Mexico: from 1983 to March 1995]. / Epidemiología del SIDA/VIH en México; de 1983 a marzo de 1995.

The purpose of this study is to analyze the HIV/AIDS magnitude, distribution, frequency, patterns, trends, risk factors, risk groups, estimation and evaluation of interventions in Mexico during the last twelve years. Results of a summary of statistics and results from several sources are presented including the National Registry of AIDS cases, HIV sentinel surveillance in 18 cities of the country, analysis of death certificates, cross-sectional, longitudinal, observational, and intervention studies. As of March 1995, 34,230 AIDS cases, 120,000 HIV infections and 21,000 AIDS deaths are estimated. A damaged exponential growth with duplication of AIDS cases every 18 months can be seen. Epidemiological patterns of transmission are found primarily among men with homosexual and bisexual practices. The male:female ratio is 6 to 1. In 1992 AIDS was the 19th cause of death among the general population. At least two patterns of transmission have been identified: one is the western-urban pattern which contributes with more than 90% of cases and the other, more recent, has been described as Caribbean-rural. Blood transmission of AIDS shows a downward trend, and heterosexual and perinatal transmission is slightly increasing. Seroprevalence among adults is 0.06%: however, among groups with risk practices, rates up to 50% have been found. Risk factors are similar to those described in the literature in other countries, and have been used for designing interventions. Evaluation of interventions has been accomplished by demonstrating positive results in the prevention of blood transmission and sexual transmission among female commercial sex workers; prevention efforts directed to men with homosexual practices have not been successful. Between 77,000 and 88,000 cumulated AIDS cases are estimated in Mexico for the year 2000.

Epidemiology of AIDS and tuberculosis.

This article reviews literature on the epidemiology, pathogenicity, and control of HIV and Mycobacterium tuberculosis coinfection. Regarding pathogenicity, immune system deterioration makes HIV-infected people more likely to develop active tuberculosis on primary or secondary exposure to the bacillus or to suffer reactivation of latent infections, and to experience considerably higher rates of extrapulmonary manifestations, relapses, and death. Regarding epidemiology, as of 1990 there were an estimated 3 million people coinfected with HIV and M. tuberculosis, with some 300,000 active tuberculosis cases and 120,000-150,000 tuberculosis deaths occurring annually among those coinfected. Over 500,000 coinfected people are thought to reside in the Americas, over 400,000 of them in Latin America. In general, the impact of coinfection is evident. Relatively high and increasing prevalences of HIV infection have been detected among tuberculosis patients around the world, and tuberculosis has become a frequent complication of AIDS cases. Moreover, there is no longer any doubt that coinfection obstructs tuberculosis prevention and control. Among other things, it affects BCG vaccination policies, suggests the need to administer preventive chemoprophylaxis to HIV-infected individuals at high risk of harboring or contracting tuberculosis infections, and complicates both detection and treatment of active tuberculosis cases. The recent proliferation of M. tuberculosis strains resistant to multiple drugs, most notably in the United States, compounds the problem. Tuberculosis prevention and control are still technically and economically feasible. However, more must be done to establish surveillance programs with laboratory support. More research is needed to determine what case prevention measures are best-suited to current circumstances and the HIV/AIDS presence. More effective preventive treatment regimens that are well tolerated, well complied with, and do not pose the risk of multiresistance need to be devised. More health workers need to be trained to suspect tuberculosis and to conduct timely and appropriate tests confirming this diagnosis. And finally, more must be done to standardize the types and durations of the various curative treatment regimens employed.

[Epidemiology and etiology of infectious diarrheas. The case of Mexico]. / Epidemiología y etiología de las diarreas infecciosas. El caso de México.

Gastrointestinal infections represent a health problem. It is estimated that 1647 million cases of diarrhea and 3.2 million deaths due to this cause occur among children less than five years of age per year. Those belonging to this age group have 15 times more risk of dying because of diarrhea. Cases of liquid acute diarrhea with blood represent 80% of cases, diarrhea with blood represent 10%. Most frequent causes of liquid diarrhea are enterotoxigenic Escherichia coli and rotaviruses and most frequent causes of bloody diarrhea are Shigella, E. coli (EHEC and EPEC). Campylobacter jejuni and Entamoeba histolytica. Annually 15,000 cases of typhoid fever are reported that continue being a public health problem. A negative correlation has been observed between the use of oral rehydration and infant mortality due to diarrhea. After prevention and control measures for cholera, a decrease in morbidity and mortality due to diarrhea has been observed. However, to reduce mortality due to this cause, it is necessary to treat the cases of acute dysentery and persistent diarrhea as well as to increase coverage of health care, to standardize the studies of etiology of diarrhea in Mexico, to establish surveillance centers for the study of diarrhea that give information on the distribution, frequency and trends of microbial agents and to achieve standardized microbiological and parasitological studies of etiology of diarrhea that support public health interventions as vaccination and selective administration of antibiotics.

[Evaluation of the cold chain during the national antipoliomyelitis vaccination days. Mexico, 1987-1988]. / Evaluación de la cadena de frío en los días nacionales de vacunación antipoliomielítica México, 1987-1988.

An evaluation of the cold chain used during the "National Vaccination Days Against Poliomyelitis" in January and March of 1987 and 1988 was performed in 32 states of Mexico, both the potency of the trivalent Sabin vaccine and completion of requirements for the maintenance of the cold chain were evaluated at each level in the Ministry of Health's structure. Only 56 percent of the refrigeration units exclusively stored vaccines, more than 10 percent of refrigerators were broken, and 44 percent of the persons responsible for the cold chain system considered the storage capacity inadequate. A correlation was found between non-fulfillment of maintenance requirements for cold chain and a decreased in vaccine potency.