eHealth Promoting Stoma Self-care for People With an Elimination Ostomy: Focus Group Study.

BACKGROUND: The construction of an elimination stoma has a physical, psychological, and social impact on the person. The development of stoma self-care competence contributes to the adaptation to a new health condition and improvement of quality of life. eHealth refers to everything associated with information and communication technology and health care, including telemedicine, mobile health, and health informatics. The use of eHealth platforms by the person with an ostomy, as a digital application that includes websites and mobile phone apps, can bring scientific knowledge and well-informed practices to individuals, families, and communities. It also allows functionalities that enable the person to describe and identify early signs and symptoms and precursors of complications and to be guided to an adequate health response for their problems. OBJECTIVE: This study aimed to define the most relevant content and features to promote ostomy self-care integrated into an eHealth platform as a digital app or website to be used by patients for self-management of stoma care. METHODS: We developed a descriptive, exploratory study with a qualitative approach using the focus group methodology, which was oriented to reach a consensus of at least 80%. A convenience sample of 7 participants consisting of stomatherapy nurses was used. The focus group discussion was recorded, and field notes were taken. The focus group meeting was fully transcribed, and a qualitative analysis was performed. The research question was: Which content and features for ostomy self-care promotion should be integrated into an eHealth platform as a digital app or website? RESULTS: An eHealth platform, which can be a smartphone app or website, for people with ostomy should provide content aimed at promoting self-care, namely in the field of knowledge and self-monitoring, as well as the possibility of interacting with a stomatherapy care nurse. CONCLUSIONS: The stomatherapy nurse has a decisive role in promoting adaptation to life with a stoma, namely through the promotion of stoma self-care. Technological evolution has emerged as a useful tool to enhance nursing interventions and promote self-care competence. The development of an eHealth platform aimed at promoting ostomy self-care should include the capabilities for telehealth and help with decision-making regarding self-monitoring and seeking differentiated care.

Dor e evento adverso: a relação entre esses dois conceitos / Pain and adverse occurences: the relationship between these two concepts

Este estudo teórico reflexivo teve como objetivo pontuar os conceitos de dor, eventos adversos e qualidade da assistência, apontando aspectos relevantes de sua estreita relação, assim como os prejuizos para o organismo na vigência de um quadro álgico. Considerou-se a capacitação e qualificação profissional, a necessidade do mercado de trabalho de enfermeiros cientes de sua competência e responsabilidade e uma formação reflexiva acerca dos direitos dos pacientes, por meio de referncial teórico.

[Effect of the implementation of a guideline for venous thromboembolism prophylaxis in surgical patients]. / Efeito da implementação de diretriz para profilaxia de tromboembolismo venoso em pacientes cirúrgicos.

INTRODUCTION: Effective strategies for prevention of venous thromboembolism (VTE) are widely available, but still remain underused, mainly in our country. OBJECTIVE: Our aim was to verify whether the implementation of a guideline for VTE prophylaxis for surgical patients influenced the prescription of prophylaxis by the medical staff. METHODS: This was a retrospective preintervention-postintervention study. Charts of 150 patients before guideline implementation (BGI) and 150 after (AGI) were randomized among all patients admitted during one year in each period. INCLUSION CRITERIA: >40 years-old, major abdominal or orthopedic surgeries. EXCLUSION CRITERIA: Incomplete files and use of anticoagulants for any reason at admission. Data registered: demographic data, reference to VTE risk factors, VTE prophylaxis prescription, diagnosis of deep venous thrombosis or pulmonary embolism during hospitalization. Results. The two groups, BGI and AGI were similar for demographic data and duration of prophylaxis (5.6 x 6.6 days). Frequency of prophylaxis in percentages was BGI x AGI respectively, before surgery: pharmacologic prophylaxis (PP), 6 x 9; graduated compression stockings (GCS), 4 x 3; intermittent pneumatic compression (IPC), 2 x 3. After surgery: PP, 53 x 53; GCS, 23 x 40 (P<0.05); IPC, 26 x 32. Including all patients, prophylaxis was prescribed for 60.5% BGI and 66.5% AGI, but was considered adequate only in 34% BGI and 32% AGI. CONCLUSION: Adoption of a guideline, although increasing concern about prophylaxis, expressed by greater use of GCS, only minimally improved quality of prophylaxis , indicating that other active and continuous interventions are necessary to enforce compliance.

Efeito da implementação de diretriz para profilaxia de tromboembolismo venoso em pacientes cirúrgicos / Effect of the implementation of a guideline for venous thromboembolism prophylaxis in surgical patients

INTRODUÇÃO: Estratégias efetivas para profilaxia do tromboembolismo venoso (TEV) são amplamente disponíveis, mas são ainda subutilizadas, principalmente no nosso meio. OBJETIVO: Avaliar o efeito da implementação de diretriz para profilaxia do TEV, em pacientes cirúrgicos, sobre a conduta da equipe de saúde na prescrição dessa profilaxia. Método. Estudo retrospectivo pré-intervenção - pós-intervenção. Prontuários de 150 pacientes antes e 150 depois da implementação de uma diretriz para a profilaxia (AID e DID) foram sorteados dentre pacientes de mais de 40 anos internados para cirurgia maior abdominal ou ortopédica. Foram registrados dados demográficos, referência a risco de TEV no prontuário, prescrição de profilaxia para TEV e diagnóstico de TEV durante a internação. RESULTADOS: Não houve diferença entre os dois grupos, AID e DID, quanto aos dados demográficos e ao tempo de profilaxia (5,6 x 6,6 dias). A frequência de profilaxia AID x DID antes da cirurgia foi: profilaxia farmacológica (PF), 6 por cento x 9 por cento; meias de compressão graduada (MCG), 4 por cento x 3 por cento; compressão pneumática intermitente (CPI), 2 por cento x 3 por cento. Após cirurgia: PF 53 por cento x 53 por cento; MCG, 23 por cento x 40 por cento (P<0,05); CPI, 26 por cento x 32 por cento . No total, AP, foi prescrita profilaxia para 60,5 por cento dos pacientes AID e para 66,5 por cento DID, mas a profilaxia foi considerada adequada em 34 por cento dos pacientes AID e em 32 por cento DID. Conclusão. A adoção do protocolo, embora com maior a preocupação com a profilaxia, traduzida pelo aumento na prescrição de MCG, melhorou minimamente sua qualidade, indicando a necessidade de outras intervenções ativas e contínuas para aumentar a aderência ao mesmo.

INTRODUCTION: Effective strategies for prevention of venous thromboembolism (VTE) are widely available, but still remain underused, mainly in our country. OBJECTIVE: Our aim was to verify whether the implementation of a guideline for VTE prophylaxis for surgical patients influenced the prescription of prophylaxis by the medical staff. METHODS: This was a retrospective preintervention-postintervention study. Charts of 150 patients before guideline implementation (BGI) and 150 after (AGI) were randomized among all patients admitted during one year in each period. Inclusion criteria: >40 years-old, major abdominal or orthopedic surgeries. Exclusion criteria: Incomplete files and use of anticoagulants for any reason at admission. Data registered: demographic data, reference to VTE risk factors, VTE prophylaxis prescription, diagnosis of deep venous thrombosis or pulmonary embolism during hospitalization. Results. The two groups, BGI and AGI were similar for demographic data and duration of prophylaxis (5.6 x 6.6 days). Frequency of prophylaxis in percentages was BGI x AGI respectively, before surgery: pharmacologic prophylaxis (PP), 6 x 9; graduated compression stockings (GCS), 4 x 3; intermittent pneumatic compression (IPC), 2 x 3. After surgery: PP, 53 x 53; GCS, 23 x 40 (P<0.05); IPC, 26 x 32. Including all patients, prophylaxis was prescribed for 60.5 percent BGI and 66.5 percent AGI, but was considered adequate only in 34 percent BGI and 32 percent AGI. CONCLUSION: Adoption of a guideline, although increasing concern about prophylaxis, expressed by greater use of GCS, only minimally improved quality of prophylaxis , indicating that other active and continuous interventions are necessary to enforce compliance.