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1.
BMJ Open Qual ; 9(1)2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-32075805

RESUMO

BACKGROUND: Patients with nasogastric/nasoenteric tube (NGT/NET) are at increased risk of adverse outcomes due to errors occurring during oral medication preparation and administration. AIM: To implement a quality improvement programme to reduce the proportion of errors in oral medication preparation and administration through NGT/NET in adult patients. METHODS: An observational study was carried out, comparing outcome measures before and after implementation of the integrated quality programme to improve oral medication preparation and administration through NGT/NET. A collaborative approach based on Plan-Do-Study-Act (PDSA) cycle was used and feedback was given during multidisciplinary meetings. INTERVENTIONS: Good practice guidance for oral medication preparation and administration through NGT/NET was developed and implemented at the hospital sites; nurses were given formal training to use the good practice guidance; a printed list of oral medications that should never be crushed was provided to all members of the multidisciplinary team, and a printed table containing therapeutic alternatives for drugs that should never be crushed was provided to prescribers at the prescribing room. RESULTS: Improvement was observed in the following measures: crushing enteric-coated tablets and mixing drugs during medication preparation (from 54.9% in phase I to 26.2% in phase II; p 0.0010) and triturating pharmaceutical form of modified action or dragee (from 32.8 in phase I to 19.7 in phase II; p 0.0010). Worsening was observed though in the following measures: crush compressed to a fine and homogeneous powder (from 7.4%% in phase I to 95% phase II; p 0.0010) and feeding tube obstruction (from 41.8% in phase I to 52.5% phase II; p 0.0950). CONCLUSION: Our results highlight how a collaborative quality improvement approach based on PDSA cycles can meet the challenge of reducing the proportion of errors in oral medication preparation and administration through NGT/NET in adult patients. Some changes may lead to unintended consequences though. Thus, continuous monitoring for these consequences will help caregivers to prevent poor patient outcomes.

2.
Rev. bras. ter. intensiva ; 31(4): 504-510, out.-dez. 2019. tab
Artigo em Português | LILACS-Express | ID: biblio-1058056

RESUMO

RESUMO Objetivo: Avaliar os fatores de risco para inadequação proteico-calórica no paciente grave. Métodos: Coorte prospectiva com pacientes internados em unidade de terapia intensiva adulto, entre fevereiro e novembro de 2017. Os pacientes foram acompanhados por 7 dias. Foi calculada a probabilidade condicional de falha na adequação, usando o método de Kaplan-Meier e teste log-rank 95%. Para avaliar o risco de falha, foram calculadas as hazard ratio (HR) bruta e ajustada, usando a regressão de Cox, com intervalo de confiança de 95%. Resultados: Dos 130 pacientes, 63,8% eram do sexo masculino, 73,8% tinham idade < 60 anos e 49,2% apresentaram diagnóstico de trauma. O APACHE II médio foi de 24 pontos e 70,0% dos pacientes tiveram adequação proteico-calórica >80%. Na análise univariada, as variáveis significativas para a falha na adequação foram o uso de droga vasoativa, interrupções da dieta e não ter iniciado a nutrição precoce. No modelo final, pacientes que apresentaram vômito/resíduo gástrico (HR ajustada = 22,5; IC95% 5,14 - 98,87), jejum para extubação (HR ajustada = 14,75; IC95% 3,59 - 60,63) e para exames e intervenções (HR ajustada = 12,46; IC95% 4,52 - 34,36) tiveram maior risco de não alcançar a adequação proteico-calórica. Conclusão: O alcance das metas nutricionais > 80,0% ocorreu na maioria dos pacientes. Os fatores de risco para inadequação proteico-calórica foram as interrupções da nutrição, especialmente por motivo de vômito/resíduo gástrico, jejum para procedimento de extubação, exames e procedimentos cirúrgicos.


ABSTRACT Objective: To evaluate the risk factors for protein-caloric inadequacy in critically ill patients. Methods: Prospective cohort study of patients hospitalized in an adult intensive care unit between February and November 2017. Patients were followed for 7 days. The conditional probability of inadequacy was calculated using the Kaplan-Meier method and the 95% log-rank test. To assess the risk of inadequacy, crude and adjusted hazard ratios (HR) were calculated using Cox regression with a 95% confidence interval. Results: Of the 130 patients, 63.8% were male, 73.8% were <60 years of age, and 49.2% were diagnosed with trauma. The mean APACHE II score was 24 points, and 70.0% of the patients had a protein-caloric adequacy >80%. In the univariate analysis, the significant variables for inadequacy were use of vasoactive drugs, interruptions of diet and failure to initiate nutrition early. In the final model, patients who presented with vomiting/gastric residue (adjusted HR = 22.5; 95%CI 5.14 - 98.87) and fasting for extubation (adjusted HR = 14.75; 95%CI 3.59 - 60.63) and for examinations and interventions (adjusted HR = 12.46; 95%CI 4.52 - 34.36) had a higher risk of not achieving protein-caloric adequacy. Conclusion: Achievement of nutritional goals > 80.0% occurred in 70.0% of patients. The risk factors for protein-caloric inadequacy were nutritional interruptions, especially due to vomiting/gastric residue and fasting for extubation, exams and surgical procedures.

3.
PLoS One ; 14(7): e0220248, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31365563

RESUMO

AIMS: The primary aims were to determine the rate of potential drug-drug interactions (pDDIs) in patients with nasally placed feeding tubes (NPFT) and the factors significantly associated with pDDIs. The secondary aim was to assess the change in pDDIs for patients between admission and discharge. MATERIAL AND METHODS: This multicentre study applied a cross-sectional design and was conducted in six Brazilian hospitals, from October 2016 to July 2018. Data from patients with NPFT were collected through electronic forms. All regular medications prescribed were recorded. Medications were classified according to the World Health Organization (WHO) Anatomical Therapeutic Chemical code. Drug-drug interaction screening software was used to screen patients' medications for pDDIs. Negative binomial regression was used to account for the over dispersed nature of the pDDI count. Since the number of pDDIs was closely related to the number of prescribed medications, we modelled the rate of pDDIs with the count of pDDIs as the numerator and the number of prescribed medications as the denominator; six variables were considered for inclusion: time (admission or discharge), patient age, patient gender, age-adjusted Charlson Comorbidity Index (CCI) score, type of prescription (electronic or handwritten) and patient care complexity. To account for correlation within the two time points (admission and discharge) for each patient a generalised estimating equations approach was used to adjust the standard error estimates. To test the change in pDDI rate between admission and discharge a full model of six variables was fitted to generate an adjusted estimate. RESULTS: In this study, 327 patients were included. At least one pDDI was found in more than 91% of patients on admission and discharge and most of these pDDIs were classified as major severity. Three factors were significantly associated with the rate of pDDIs per medication: patient age, patient care complexity and prescription type (handwritten vs electronic). There was no evidence of a difference in pDDI rate between admission and discharge. CONCLUSION: Patients with a NPFT are at high risk of pDDIs. Drug interaction screening tools and computerized clinical decision support systems could be effective risk mitigation strategies for this patient group.

4.
BMJ Open ; 9(7): e027967, 2019 07 24.
Artigo em Inglês | MEDLINE | ID: mdl-31345968

RESUMO

INTRODUCTION: Hospitalised patients with nasogastric/nasoenteric tube (NGT/NET) are at constant risk of incidents; therefore, healthcare professionals need to routinely monitor risks and adopt strategies for patient safety and quality of care. AIM: This study aimed to evaluate the NGT/NET-related incidents in hospitalised patients and associated factors. METHODS: This is a multicentre study, with a prospective cohort design. Data will be collected at the general medical ward of seven Brazilian hospitals in the north, northeast, southeast and south. The sample will consist of 391 patients that require an NGT/NET during hospitalisation. Three different methods will be used to identify the incidents: (1) healthcare professionals and patients/caregivers will be required to report any NGT/NET-related incidents; (2) researchers will visit the wards to get information about the incidents with healthcare professionals and patients/caregivers; (3) the researchers will review the medical records looking for information on the occurrence of any NGT/NET-related incidents. Demographic, clinical and therapeutic details will be obtained from the medical records and will be registered in an electronic data collection tool developed for the purposes of this study. The complexity of patients will be assessed by the Patient Classification System, and the severity of comorbid diseases will be assessed through the Charlson Comorbidity Index. IMPLICATION FOR PRACTICE: The results may encourage the use of evidence effectively to influence the scientific foundation for clinical practice and the development of evidence-based policies that will prevent, manage and eliminate complications caused by NGT/NET-related incidents, and improve the quality and safety of care provided to hospitalised patients. ETHICS AND DISSEMINATION: The study has been approved by the Research Ethics Committee. Detailed information about the study can be provided by the principal investigator. The findings will be reported through academic journals, seminar and conference presentations, social media, print media, the internet and community/stakeholder engagement activities.

5.
Cogitare enferm ; 24: e61984, 2019. tab, graf
Artigo em Português | LILACS, BDENF - Enfermagem | ID: biblio-1055967

RESUMO

RESUMO OBJETIVO: identificar os incidentes do tipo circunstância notificável ocorridos em um hospital de ensino de Goiás. MÉTODO: estudo descritivo, transversal, de análise retrospectiva de relatórios da equipe de enfermagem da unidade de clínica médica, entre janeiro de 2010 e dezembro de 2015. Os dados foram coletados e registrados em instrumento semiestruturado e procedeu-se à análise descritiva. RESULTADOS: foram encontradas 2.718 circunstâncias notificáveis, das quais 1.100 (40,5%) estavam relacionadas a Recursos/Gestão Organizacional, 844 (31,1%) a Dispositivos/Equipamentos Médicos, 270 (9,9%) a Documentação, 262 (9,6%) a Infraestrutura/Instalações, 109 (4,0%) a Comportamento, 80 (3,0%) a Medicações/Fluidos Endovenosos, 28 (1,0%) a Sangue/Hemoderivados, 17 (0,6%) a Dieta/Alimentação. CONCLUSÃO: o estudo permitiu identificar alta frequência de situações com potencial para gerar danos aos pacientes internados, demonstrando fragilidades organizacionais e assistenciais que precisam ser discutidas pela gestão, de modo a promover melhorias no processo de cuidado e prevenção da ocorrência de incidentes.


RESUMEN OBJETIVO: identificar los incidentes del tipo circunstancia notificable que ocurrieron en un hospital de enseñanza de Goiás. MÉTODO: estudio descriptivo, trasversal, de análisis retrospectivo de informes del equipo de enfermería de la unidad de clínica médica, hecho entre enero de 2010 y diciembre de 2015. Se obtuvieron los datos y estos se registraron por medio de instrumento semi estructurado, procediéndose al análisis descriptivo. RESULTADOS: se apuntaron 2.718 circunstancias notificables, de las cuales 1.100 (40,5%) se relacionaban a Recursos/Gestión Organizacional, 844 (31,1%) a Dispositivos/Equipos Médicos, 270 (9,9%) a Documentación, 262 (9,6%) a Infraestructura/Instalaciones, 109 (4,0%) a Comportamiento, 80 (3,0%) a Medicaciones/Fluidos Endovenosos, 28 (1,0%) a Sangre/Hemoderivados, 17 (0,6%) a Dieta/Alimentación. CONCLUSIÓN: el estudio posibilitó identificar alta frecuencia de situaciones con potencial para generar daños a los pacientes ingresados, lo que muestra fragilidades organizacionales y asistenciales que se necesitan discutir por la gestión, de manera que se promuevan mejorías en el proceso de cuidado y prevención de la ocurrencia de incidentes.


ABSTRACT OBJECTIVE: To identify incidents defined as notifiable circumstances that occurred in a teaching hospital in Goiás. METHOD: Descriptive cross-sectional study that uses retrospective analysis of reports made by the nursing team of a general medicine unit made in the January 2010-December 2015 period. Data was collected and recorded in a semi-structured instrument and descriptive analysis was performed. RESULTS: There were 2,718 notifiable circumstances, of which 1,100 (40.5%) were related to Resources/ Organizational Management, 844 (31.1%) to Medical Devices/Equipment, 270 (9.9%) to Documentation, 262 (9.6%) to Infrastructure/Facilities, 109 (4.0%) to Behavior, 80 (3.0%) to Medications/Intravenous Fluids, 28 (1.0%) to Blood/Blood derivatives, 17 (0.6%) to Diet/Food. CONCLUSION: The present study showed that situations with the potential to cause harm to hospitalized patients were very common, exposing organizational and care weaknesses that must be discussed by the management, so that improvements are implemented in the health care process and incidents are prevented.


Assuntos
Humanos , Qualidade da Assistência à Saúde , Segurança do Paciente , Cuidados de Enfermagem , Gestão de Riscos , Gestão da Qualidade
6.
Rev Bras Ter Intensiva ; 31(4): 504-510, 2019.
Artigo em Português, Inglês | MEDLINE | ID: mdl-31967225

RESUMO

OBJECTIVE: To evaluate the risk factors for protein-caloric inadequacy in critically ill patients. METHODS: Prospective cohort study of patients hospitalized in an adult intensive care unit between February and November 2017. Patients were followed for 7 days. The conditional probability of inadequacy was calculated using the Kaplan-Meier method and the 95% log-rank test. To assess the risk of inadequacy, crude and adjusted hazard ratios (HR) were calculated using Cox regression with a 95% confidence interval. RESULTS: Of the 130 patients, 63.8% were male, 73.8% were <60 years of age, and 49.2% were diagnosed with trauma. The mean APACHE II score was 24 points, and 70.0% of the patients had a protein-caloric adequacy >80%. In the univariate analysis, the significant variables for inadequacy were use of vasoactive drugs, interruptions of diet and failure to initiate nutrition early. In the final model, patients who presented with vomiting/gastric residue (adjusted HR = 22.5; 95%CI 5.14 - 98.87) and fasting for extubation (adjusted HR = 14.75; 95%CI 3.59 - 60.63) and for examinations and interventions (adjusted HR = 12.46; 95%CI 4.52 - 34.36) had a higher risk of not achieving protein-caloric adequacy. CONCLUSION: Achievement of nutritional goals > 80.0% occurred in 70.0% of patients. The risk factors for protein-caloric inadequacy were nutritional interruptions, especially due to vomiting/gastric residue and fasting for extubation, exams and surgical procedures.

7.
Rev Bras Enferm ; 71(5): 2483-2488, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-30304180

RESUMO

OBJECTIVE: To describe the experience of using participatory photographic research methods to engage nurses and researchers in a collaborative study to improve medication safety conditions, particularly in patients with feeding tubes in a nursing home for the elderly (NHE). METHOD: This qualitative study was conducted in Brazil and proceeded in iterative phases of visual and textual data collection and analysis. Interviews, subsequent nurse-led photo-narrated walkabouts, and photo elicitation were used with nurses. RESULTS: The need to transform the work design and the workplace to improve medication safety and improving medication processes through effective communication was identified. Unsafe workforce is a challenge in achieving safe medication administration practices; and lack of a patient safety culture is a barrier for adaptive learning and growth. CONCLUSION: Our findings demonstrated the effectiveness of a restorative research approach for supporting nurses to study and act on medication safety.


Assuntos
Erros de Medicação/prevenção & controle , Enfermeiras e Enfermeiros/normas , Fotografação/métodos , Adulto , Brasil , Feminino , Grupos Focais , Humanos , Entrevistas como Assunto/métodos , Masculino , Pessoa de Meia-Idade , Enfermeiras e Enfermeiros/psicologia , Fotografação/instrumentação , Pesquisa Qualitativa , Local de Trabalho/psicologia , Local de Trabalho/normas
8.
Rev. bras. enferm ; 71(5): 2483-2488, Sep.-Oct. 2018. graf
Artigo em Inglês | LILACS-Express | ID: biblio-958707

RESUMO

ABSTRACT Objective: To describe the experience of using participatory photographic research methods to engage nurses and researchers in a collaborative study to improve medication safety conditions, particularly in patients with feeding tubes in a nursing home for the elderly (NHE). Method: This qualitative study was conducted in Brazil and proceeded in iterative phases of visual and textual data collection and analysis. Interviews, subsequent nurse-led photo-narrated walkabouts, and photo elicitation were used with nurses. Results: The need to transform the work design and the workplace to improve medication safety and improving medication processes through effective communication was identified. Unsafe workforce is a challenge in achieving safe medication administration practices; and lack of a patient safety culture is a barrier for adaptive learning and growth. Conclusion: Our findings demonstrated the effectiveness of a restorative research approach for supporting nurses to study and act on medication safety.


RESUMO Objetivo: Descrever a experiência do uso de metodologias de pesquisa fotográfica participativa para envolver enfermeiros e pesquisadores em um estudo colaborativo para melhorar as condições de segurança de medicação, especialmente em pacientes que recebem alimentação enteral em uma Instituição de Longa Permanência para Idosos (ILPI). Método: Esta pesquisa qualitativa foi desenvolvida no Brasil, seguindo fases iterativas de coleta de dados visuais e textuais e análise. Entrevistas, encontros informais com narração fotográfica conduzida pelos enfermeiros, e evocação de fotografias foram utilizados com os participantes. Resultados: A necessidade de transformar o formato e o local de trabalho para melhorar a segurança e os processos de medicação através de uma comunicação efetiva foi observada. Uma força de trabalho sem segurança é um desafio para alcançar práticas seguras de administração de medicação; e a falta de uma cultura de segurança do paciente é uma barreira para a aprendizagem adaptativa e o crescimento. Conclusão: Nossos achados demonstraram a efetividade de uma abordagem de pesquisa restaurativa para ajudar enfermeiros a estudarem e agirem a favor da segurança da medicação.


RESUMEN Objetivo: Describir utilización de métodos participativos de investigación fotográfica para involucrar enfermeras e investigadores en estudio colaborativo para mejorar condiciones de seguridad de medicación, particularmente en pacientes con sondas alimentarias en asilo para ancianos (NHE). Método: Estudio cualitativo realizado en Brasil, desarrollado en fases iterativas de recolección y análisis de datos visuales y textuales. Se utilizaron entrevistas, caminatas fotográficas dirigidas por enfermeras, y obtención de fotografías con ellas. Resultados: Fue identificada la necesidad de transformar diseño de trabajo y ámbito laboral para mejorar seguridad y procesos de medicación mediante una comunicación efectiva. La mano de obra insegura constituye un desafío para obtener prácticas seguras de administración de medicamentos; la falta de cultura de seguridad del paciente dificulta el aprendizaje adaptativo y el crecimiento. Conclusión: Nuestros hallazgos demostraron la efectividad de un enfoque restaurador de investigación para apoyar a las enfermeras a estudiar y actuar sobre seguridad de la medicación.

9.
J Wound Ostomy Continence Nurs ; 45(6): 521-526, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-30260906

RESUMO

PURPOSE: The purpose of this study was to describe and compare factors that affect urinary tract infection (UTI) rates in people with spina bifida (SB) and neurogenic bladder dysfunction before and following initiation of intermittent catheterization (IC). DESIGN: A quantitative, descriptive, correlational study. SUBJECTS AND SETTING: The study included people who were from Germany, a high-income nation, and Brazil, a middle-income nation. Brazilian participants were recruited from a public rehabilitation hospital in the state of Minas Gerais. German participants were drawn from different regions of the country. The study sample included 200 participants; participants were either individuals diagnosed with SB and neurogenic bladder dysfunction and using IC, or caregivers of persons using IC for bladder management. METHODS: Data were collected through a survey questionnaire developed for urological follow-up of SB patients. A translated and validated version of the form was used to collect data in Germany. To evaluate annual episodes of UTI, we considered the number of symptomatic UTI before and after IC. RESULTS: Participants from Brazil were significantly younger than German patients (median age 9 vs 20 years, P < .001). Brazilians predominately used assisted catheterization (63.0%), whereas most Germans performed self-catheterization (61.0%). Use of IC greatly reduced the incidence of UTI in both groups (mean 2.8 episodes per year before IC vs mean 1.1 episodes after starting IC, P < .001). Women had a higher number of UTI, both before and after IC, but enjoyed greater reduction in UTI after initiating IC than men. Self-catheterization also promoted a greater reduction of UTI than assisted IC (P = .022). CONCLUSIONS: Intermittent catheterization reduced annual episodes of UTI in both samples despite differences in catheterization technique. Patients practicing and performing self-catheterization achieved a greater reduction than those who relied on assisted IC. Comparative studies among additional countries with varying median income levels are needed to better understand the needs of individuals with SB and their families, and to plan and implement safe nursing interventions.


Assuntos
Infecções Relacionadas a Cateter/complicações , Cateterismo Uretral Intermitente/efeitos adversos , Infecções Urinárias/etiologia , Adolescente , Adulto , Análise de Variância , Brasil/epidemiologia , Infecções Relacionadas a Cateter/epidemiologia , Criança , Pré-Escolar , Feminino , Alemanha/epidemiologia , Humanos , Lactente , Cateterismo Uretral Intermitente/métodos , Masculino , Meningomielocele/complicações , Meningomielocele/terapia , Pessoa de Meia-Idade , Disrafismo Espinal/complicações , Disrafismo Espinal/terapia , Estatísticas não Paramétricas , Inquéritos e Questionários , Bexiga Urinaria Neurogênica/complicações , Bexiga Urinaria Neurogênica/terapia , Infecções Urinárias/epidemiologia
10.
Rev. enferm. UFPE on line ; 12(7): 1940-1948, jul. 2018. ilus, tab
Artigo em Português | BDENF - Enfermagem | ID: biblio-986690

RESUMO

Objetivo: analisar a ressignificação do cuidado prestado por uma equipe da Estratégia de Saúde da Família às pessoas com hipertensão arterial sistêmica na perspectiva histórico-cultural. Método: estudo qualitativo em uma Estratégia de Saúde da Família, dividido em cinco fases, com base no planejamento de ações em serviços de saúde e em abordagem histórico-cultural, por meio da técnica de grupo focal e do grupo operativo. Resultados: os dados obtidos nos grupos focal e operativo organizaram-se em temas de acordo com os princípios de Vygotsky: Estratégia de Saúde da Família: espaço vivo para a relação dialógica; O papel do pesquisador e da equipe como mediadores nas interações e Significados atribuídos ao modelo assistencial. Conclusão: a equipe da Estratégia de Saúde da Família conseguiu ressignificar o cuidado prestado às pessoas com hipertensão arterial sistêmica, o que permitiu a reelaboração do modelo assistencial.(AU)


Assuntos
Humanos , Feminino , Adulto , Pessoa de Meia-Idade , Atenção Primária à Saúde , Relações Profissional-Paciente , Assistência Integral à Saúde , Estratégia Saúde da Família , Assistência à Saúde Culturalmente Competente , Planejamento em Saúde , Promoção da Saúde , Hipertensão , Pesquisa Qualitativa
11.
Esc. Anna Nery Rev. Enferm ; 22(4): e20180043, 2018. graf
Artigo em Português | LILACS, BDENF - Enfermagem | ID: biblio-953473

RESUMO

Objective: To construct and evaluate the SEMIOVAPE - a Virtual Learning Object for teaching of peripheral venous vascular semiology - based on ergonomic, pedagogical and usability criteria. Method: Methodological study, whose participants were experts in Nursing, Computer Science and Nurse undergraduate student. For the construction and validation of the Object, six steps were followed: educational design; computational modeling; environment implementation; ergonomic, pedagogical, and usability evaluation. Results: The Object was built having the characteristic of valuing student's autonomy and approached contents of anatomy and physiology, clinical reasoning and clinical examination. Concerning the ergonomic and pedagogical evaluations, the Object obtained high acceptance rates (66.70% and 70.12%, respectively), as for usability, all participants considered it very useful and were certainly satisfied (95%). Conclusions and implications: The Object is suitable to be used as an alternative source of teaching peripheral venous semiology.


Objetivo: Construir y evaluar, en cuanto a criterios ergonómicos, pedagógicos y de usabilidad, un Objeto Virtual de Aprendizaje para la enseñanza de la semiología vascular venosa periférica, el SEMIOVAPE. Método: Estudio metodológico, cuyos participantes fueron expertos en Enfermería, Informática y estudiantes de pregrado de Enfermería. Para la construcción y validación del objeto, se siguieron seis pasos: diseño educativo; modelado computacional; implementación del ambiente; evaluación ergonómica; evaluación pedagógica y evaluación de la usabilidad. Resultados: El Objeto fue construido teniendo la característica de valorización de la autonomía del alumno y abordó contenidos de anatomía y fisiología, raciocinio clínico y examen clínico. En relación a las evaluaciones ergonómica y pedagógica, el Objeto obtuvo altas tasas de aceptación (66.70% y 70.12%, respectivamente), en cuanto a la usabilidad, todos los participantes lo consideraron muy útil y sin duda alguna estaban satisfechos (95%). Conclusiones e implicaciones: El Objeto es adecuado para ser utilizado como un método alternativo de enseñanza de la semiología venosa periférica.


Objetivo: Construir e avaliar quanto a critérios ergonômicos, pedagógicos e de usabilidade um Objeto Virtual de Aprendizagem para o ensino da semiologia vascular venosa periférica, o SEMIOVAPE. Método: Estudo metodológico, cujos participantes foram peritos da enfermagem, da informática e graduandos de enfermagem. Para construção e validação do Objeto foram seguidas seis etapas: design educacional, modelagem computacional, implementação do ambiente, avaliação ergonômica, avaliação pedagógica e avaliação da usabilidade. Resultados: O Objeto foi construído tendo a característica de valorização da autonomia do aluno e abordou conteúdos de anatomia e fisiologia, raciocínio clínico e exame clínico. Quanto às avaliações ergonômica e pedagógica, o Objeto obteve elevados índices de aceitação (66,70% e 70,12%, respectivamente), quanto à usabilidade, todos os participantes consideraram-no muito útil e ficaram certamente satisfeitos (95%). Conclusões e implicações: O Objeto é adequado para ser utilizado como método alternativo do ensino da semiologia venosa periférica.


Assuntos
Humanos , Tecnologia Educacional/tendências , Educação em Enfermagem/tendências , Educação em Enfermagem/estatística & dados numéricos , Monitorização Hemodinâmica/tendências
12.
Rev Rene (Online) ; 19: e3231, jan. - dez. 2018.
Artigo em Inglês | LILACS, BDENF - Enfermagem | ID: biblio-883223

RESUMO

Objetivo: determinar os principais fatores de risco para a morte em pacientes com sepse em uma unidade de terapia intensiva. Métodos: trata-se de uma coorte retrospectiva, onde foram incluídos 124 prontuários de pacientes que tiveram diagnóstico clínico e laboratorial de sepse. A probabilidade condicional de morte foi calculada através do método de Kaplan-Meier; o risco de morte foi estimado pela razão de risco, utilizando modelo de regressão de Cox com p<0,050. Resultados: o foco principal da infecção foi o sistema respiratório. Em relação ao desfecho, morreram 40,3% pacientes com sepse, 73,9% com sepse grave e 69,2% com choque séptico. Os pacientes com sepse abdominal e que utilizaram vasopressores apresentaram maior risco de morte. Conclusão: pacientes sépticos com fonte abdominal de infecção e fazendo uso de agentes vasopressores apresentaram maior risco de morte, enquanto que pacientes traqueostomizados tiveram melhores chances de sobreviver. (AU)


Assuntos
Morte , Unidades de Terapia Intensiva , Cuidados de Enfermagem , Fatores de Risco , Sepse
13.
Int Emerg Nurs ; 33: 1-6, 2017 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-28476345

RESUMO

AIM: The aim of this study was to assess the patient safety climate from the perspective of healthcare professionals working in the emergency department of a hospital in Brazil. BACKGROUND: Emergency departments are complex and dynamic environments. They are prone to adverse events that compromise the quality of care provided and reveal the importance of patient safety culture and climate. METHODS: This was a quantitative, descriptive, cross-sectional study. The Safety Attitudes Questionnaire (SAQ) - Short Form 2006 was used for data collection, validated and adapted into Portuguese. The study sample consisted of 125 participants. RESULTS: Most of the participants were female (57.6%) and had worked in emergency department for more than 10years (56.8%). Sixty-two participants (49.6%) were nursing professionals. The participants demonstrated satisfaction with their jobs and dissatisfaction with the actions of management with regard to safety issues. Participants' perceptions about the patient safety climate were found to be negative. CONCLUSIONS: Knowledge of professionals' perceptions of patient safety climate in the context of emergency care helps with assessments of the safety culture, contributes to improvement of health care, reduces adverse events, and can focus efforts to improve the quality of care provided to patients.


Assuntos
Pessoal de Saúde/psicologia , Satisfação no Emprego , Percepção , Gestão da Segurança/normas , Adulto , Atitude do Pessoal de Saúde , Brasil , Estudos Transversais , Serviço Hospitalar de Emergência/organização & administração , Serviço Hospitalar de Emergência/normas , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Segurança do Paciente/normas , Psicometria/instrumentação , Psicometria/métodos , Inquéritos e Questionários , Local de Trabalho/psicologia
14.
J Psychosoc Nurs Ment Health Serv ; 55(3): 38-45, 2017 Mar 01.
Artigo em Inglês | MEDLINE | ID: mdl-28287674

RESUMO

The current descriptive, cross-sectional study aimed to investigate the rate of psychotropic medication use and its association with sociodemographic factors, pharmacotherapy, health history, and presence of common mental disorders in individuals in Brazilian primary health care (PHC) units. A sample of 442 individuals was interviewed in 10 PHC units. Tools used included a structured questionnaire and the Self Reporting Questionnaire-20. The rate of psychotropic medication use was 38.7%. Demographic characteristics associated with psychotropic medication use were age 60 or older with common mental disorders and physical illness, a primary-level education or less, no occupation, and family income greater than three times the minimum wage. The strongest predictor of psychotropic medication use was monthly family income. The results highlight the need for interventions to improve patient outcomes. [Journal of Psychosocial Nursing and Mental Health Services, 55(3), 38-45.].


Assuntos
Transtornos Mentais/diagnóstico , Transtornos Mentais/tratamento farmacológico , Atenção Primária à Saúde/estatística & dados numéricos , Psicotrópicos/uso terapêutico , Fatores Socioeconômicos , Adulto , Brasil , Estudos Transversais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Autorrelato , Inquéritos e Questionários
15.
Arch Psychiatr Nurs ; 31(1): 68-72, 2017 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-28104061

RESUMO

The aim of the study was to evaluate the patients' quality of life in Brazil's Family Health Strategy and its association with sociodemographic factors, presence of common mental disorders, and use of psychotropic drugs. Were interviewed 442 patients. Tools were: World Health Organization Quality of Life Assessment-Bref and Self Reporting Questionnaire. Male and low education were strongly associated with higher quality of life. Use of psychotropic drugs and the presence of CMD were strongly associated with poor quality of life. There is a pressing need for primary health care professionals to invest in tracking, and in holistic interventions that are able to cover the healthcare needs of these vulnerable groups.


Assuntos
Saúde da Família/estatística & dados numéricos , Transtornos Mentais/diagnóstico , Qualidade de Vida , Fatores Socioeconômicos , Adolescente , Adulto , Brasil , Estudos Transversais , Escolaridade , Feminino , Serviços de Saúde , Humanos , Masculino , Pessoa de Meia-Idade , Atenção Primária à Saúde/organização & administração , Psicotrópicos/efeitos adversos , Autorrelato , Fatores Sexuais , Inquéritos e Questionários
16.
Rev. latinoam. enferm. (Online) ; 25: e2933, 2017. tab, graf
Artigo em Inglês | LILACS | ID: biblio-961077

RESUMO

ABSTRACT Objective: to identify the nursing interventions associated with the most accurate and frequently used NANDA International, Inc. (NANDA-I) nursing diagnoses for patients with liver cirrhosis. Method: this is a descriptive, quantitative, cross-sectional study. Results: a total of 12 nursing diagnoses were evaluated, seven of which showed high accuracy (IVC ≥ 0.8); 70 interventions were identified and 23 (32.86%) were common to more than one diagnosis. Conclusion: in general, nurses often perform nursing interventions suggested in the NIC for the seven highly accurate nursing diagnoses identified in this study to care patients with liver cirrhosis. Accurate and valid nursing diagnoses guide the selection of appropriate interventions that nurses can perform to enhance patient safety and thus improve patient health outcomes.


RESUMO Objetivo: identificar as intervenções de enfermagem associadas aos diagnósticos de enfermagem mais acurados e mais frequentemente utilizados da NANDA International, Inc. (NANDA-I) para pacientes com cirrose hepática. Método: estudo descritivo, quantitativo e transversal. Resultados: no total, 12 diagnósticos de enfermagem foram avaliados, dos quais sete demonstraram alto grau de acurácia (IVC ≥ 0.8); 70 intervenções foram identificadas e 23 (32.86%) eram comuns a mais de um diagnóstico. Conclusão: em geral, os enfermeiros muitas vezes executam intervenções de enfermagem sugeridas na NIC para os sete diagnósticos de enfermagem de alta acurácia identificados neste estudo para cuidar de pacientes com cirrose hepática. Diagnósticos de enfermagem acurados e válidos dirigem a seleção de intervenções apropriadas que os enfermeiros podem desempenhar para reforçar a segurança do paciente e assim melhorar os resultados de saúde dos pacientes.


RESUMEN Objetivo: identificar las intervenciones de enfermería asociadas a los diagnósticos de enfermería más precisos y más frecuentemente utilizados de la NANDA International, Inc. (NANDA-I) para pacientes con cirrosis hepática. Método: estudio descriptivo, cuantitativo y transversal. Resultados: al total, 12 diagnósticos de enfermería fueron evaluados, de los cuales siete demostraron alto grado de precisión (IVC ≥ 0.8); 70 intervenciones fueron identificadas y 23 (32.86%) eran comunes a más de un diagnóstico. Conclusión: en general, los enfermeros muchas veces desempeñan intervenciones de enfermería sugeridas en la NIC para los siete diagnósticos de enfermería de alta precisión identificados en este estudio para cuidar de pacientes con cirrosis hepática. Diagnósticos de enfermería precisos y válidos orientan la selección de intervenciones apropiadas que los enfermeros pueden desempeñar para reforzar la seguridad del paciente y así mejorar los resultados de salud de los pacientes.


Assuntos
Humanos , Masculino , Feminino , Nutrição Enteral/métodos , Segurança do Paciente/normas , Cirrose Hepática/diagnóstico , Cuidados de Enfermagem/organização & administração
17.
J Clin Nurs ; 25(7-8): 1073-85, 2016 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-26876047

RESUMO

AIMS AND OBJECTIVES: To gain an understanding of medication safety culture and other quality issues in a Brazilian intensive care unit using a restorative approach. BACKGROUND: Patient safety should be considered one of the pillars of quality in health care. Thus, patient safety culture is increasingly being explored as a guide for quality improvement efforts. DESIGN: A qualitative approach. METHODS: Participatory photographic research methods from the field of ecological restoration were adapted in this study. This study used focus groups, then subsequent nurse-led photo-narrated walkabouts, and photo elicitation with 23 nurses and one physician in interactive phases of data collection and analysis over an eight-month timeframe. RESULTS: The core themes identified were: the 'medication system shapes patient safety' and the 'feeling of helplessness in the face of the prevailing organization culture'. Participants discussed supports exiting in the intensive care unit that shape medication safety, the barriers that impede safe medication management, the solutions to improve medication safety and the creation of a better medication safety culture. CONCLUSIONS: The methods used allowed participants to visualise sound practices as well as key safety issues, reflect on their day-to-day work, re-think potential improvements, and enact changes to improve medication safety and medication safety culture. However, the patient safety culture is also marked by administrative pressure. The hospital needs to adopt participatory management, where the health professionals can act together with the organisational leaders to promote a just culture. RELEVANCE TO CLINICAL PRACTICE: The participatory photographic research methods from the field of ecological restoration provided participants with a tool to promote patient safety culture and engage policy change dialogue. However, it will be important in future restorative research to track-specific safety outcomes over time to assess the cost-benefit of the adoption of participatory management models.


Assuntos
Unidades de Terapia Intensiva , Cultura Organizacional , Segurança do Paciente , Gestão da Segurança/organização & administração , Adulto , Brasil , Feminino , Grupos Focais , Humanos , Masculino , Pessoa de Meia-Idade , Melhoria de Qualidade , Adulto Jovem
18.
Gastroenterol Nurs ; 39(4): 264-72, 2016.
Artigo em Inglês | MEDLINE | ID: mdl-26425862

RESUMO

The aim of this study was to describe the process of developing a nursing assessment tool for hospitalized adult patients with liver cirrhosis. A descriptive study was carried out in three stages. First, we conducted a literature review to develop a data collection tool on the basis of the Conceptual Model of Wanda Horta. Second, the data collection tool was assessed through an expert panel. Third, we conducted the pilot testing in hospitalized patients. Most of the comments offered by the panel members were accepted to improve the tool. The final version was in the form of a questionnaire with open-closed questions. The panel members concluded that the tool was useful for accurate nursing diagnosis. Horta's Conceptual Model assisted with the development of this data collection tool to help nurses identify accurate nursing diagnosis in hospitalized patients with liver cirrhosis. We hope that the tool can be used by all nurses in clinical practice.


Assuntos
Competência Clínica , Cirrose Hepática/diagnóstico , Cirrose Hepática/enfermagem , Avaliação em Enfermagem/métodos , Adulto , Brasil , Feminino , Hospitais Universitários , Humanos , Pacientes Internados , Cirrose Hepática/mortalidade , Masculino , Pessoa de Meia-Idade , Modelos de Enfermagem , Papel do Profissional de Enfermagem
19.
Int J Nurs Pract ; 21(6): 741-8, 2015 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-24724623

RESUMO

We used participatory photographic research methods adapted from the field of ecological restoration to engage Brazilian intensive care unit nurses in a critical review of medication safety in their work environment. Using focus groups, practitioner-led photo walkabouts with photo narration, and photo elicitation focus groups in iterative phases of data collection and analysis, nurses developed and implemented several practical and cultural improvements for their unit. Participants focussed on organizing the medication room for efficient workflow and accessible supplies, improving reporting practices, and reconsidering how they could manage safety issues in their unit and in the hospital as a whole. Our results demonstrated that restorative photographic research methods enabled participants to (re)think and redesign their work environment in keeping with several recommended practices for improving medication management. It also validated the need for continuous evidence-informed improvements if nurses hope to optimize medication safety in the complex systems of intensive care.


Assuntos
Enfermagem de Cuidados Críticos , Erros de Medicação/prevenção & controle , Segurança do Paciente , Fotografação , Padrões de Prática em Enfermagem , Adulto , Brasil , Feminino , Grupos Focais , Humanos , Masculino , Pessoa de Meia-Idade , Adulto Jovem
20.
REME rev. min. enferm ; 17(4): 966-974, out.-dez. 2013.
Artigo em Inglês, Português | LILACS | ID: lil-711434

RESUMO

O objetivo foi obter a visão dos profissionais de enfermagem de uma unidade de terapia intensiva (UTI) do interior paulista, em relação aos aspectos existentes nos processos de preparo e de administração de medicamentos, o que, segundo os profissionais, contribui para a segurança do paciente ou, ao contrário, são vistos como barreiras para a administração segura dos medicamentos. O estudo foi dividido em quatro fases. Foram utilizadas técnicas diversificadas de coleta de dados: grupos focais, narração fotográfica, foto elicitation e observação em campo. A coleta e a análise dos dados ocorreram de maneira interativa, segundo a orientação teórica da pesquisa restaurativa em saúde. Seis temas foram obtidos da análise: identificando o ambiente assistencial como contribuinte para a segurança no preparo e na administração de medicamentos; identificando riscos no ambiente assistencial; percebendo o ambiente assistencial como fator de risco para os acidentes ocupacionais; tendo que conviver com o sentimento de "impotência" diante da cultura organizacional vigente; convivendo com os improvisos no dia-a-dia do trabalho; e vislumbrando possibilidades de mudanças no ambiente assistencial. A experiência de utilizar a abordagem restaurativa em saúde auxiliou na compreensão das barreiras e das medidas facilitadoras voltadas para a segurança no preparo e na administração de medicamentos. Os temas obtidos também demonstraram que os problemas existentes na UTI interferem na segurança tanto dos pacientes como dos profissionais. Logo, os líderes devem rever a forma de gerenciar a segurança na instituição.


The objective was to obtain the views of the nursing professionals from an intensive care unit (ICU) of São Paulo State, in relation to the aspects existing in the processes of medication preparation and administration that, according to professionals, may contribute to patient safety or, on the other hand, may be seen as barriers to safe medication administration. The study was divided into four phases. We used diverse data collection techniques: focus groups, photo narration, photo elicitation, and field observation. Data collection and analysis proceeded in an iterative fashion, according to the restorative approach to health systems research. Six themes were obtained from the analysis: identifying the healthcare environment as a contributor to safety in medication preparation and administration; identifying risks in the healthcare environment; realizing environmental care as a risk factor for occupational accidents; having to live with the feeling of “impotence” in the face of prevailing organizational culture; living with workaround on a day-to-day basis; and glimpsing possibilities of changes in the healthcare environment. The experience of using the restorative approach to health systems research helped the understanding of the barriers and the measures aimed at the safety of medication preparation and administration. The themes obtained also showed that the existing problems in the ICU affect the safety of both patients and professionals. Therefore, leaders should review how to manage safety within the institution.


Assuntos
Humanos , Masculino , Feminino , Gestão da Segurança , Unidades de Terapia Intensiva , Conduta do Tratamento Medicamentoso , Segurança do Paciente
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