Tecnologias não invasivas de cuidado utilizadas por enfermeiras obstétricas: contribuições terapêuticas / Tecnologías de atención no invasiva utilizadas por las enfermeras obstétricas: contribuciones terapêuticas / Non-invasive care technologies used by obstetric nurses: therapeutics contributions

Resumo Objetivo descrever as contribuições terapêuticas da utilização de tecnologias não invasivas de cuidado, oferecidas por enfermeiras obstétricas, durante o trabalho de parto. Método estudo qualitativo e descritivo, com oito enfermeiras obstétricas da casa de parto do Rio de Janeiro. Os dados foram coletados de setembro a dezembro de 2018, através de entrevistas semiestruturadas, e submetidos à técnica de análise temática. Resultados para aliviar a dor e promover relaxamento, recorrem ao estímulo à participação do acompanhante e à respiração consciente, à aplicação da massagem, à promoção do ambiente acolhedor e ao uso da água morna e dos óleos essenciais. Para ativar o trabalho de parto, auxiliar na descida da apresentação e correção do posicionamento fetal, incentivam posicionamentos verticalizados e movimentos corporais, com alguns instrumentos. Conclusões e implicações para a prática tecnologias não invasivas de cuidado possuem contribuições terapêuticas e conformam um cuidado desmedicalizado, respeitoso e centrado na mulher, que promove a autonomia feminina.

Resumen Objetivo describir las contribuciones terapéuticas de la utilización de tecnologías de atención no invasivas que ofrecen las enfermeras obstétricas durante el trabajo de parto. Método estudio cualitativo y descriptivo, con ocho enfermeras obstétricas de una casa de partos de Río de Janeiro. Los datos fueron recolectados de septiembre a diciembre de 2018, a través de entrevistas semiestructuradas, y sometidos a la técnica de análisis temático. Resultados para aliviar el dolor y favorecer la relajación, se recurre a fomentar la participación del acompañante y la respiración consciente, la aplicación de masajes, la promoción de un ambiente acogedor y el uso de agua tibia y aceites esenciales. Para activar el trabajo de parto, facilitan en el descenso de la presentación y corrección del posicionamiento fetal, fomentan las posiciones verticales y los movimientos corporales, con algunos instrumentos. Conclusiones e implicaciones para la práctica las tecnologías de atención no invasiva tienen aportes terapéuticos y conforman un cuidado desmedicalizado, respetuoso y centrado en la mujer que promueve la autonomía femenina.

Abstract Objective to describe the therapeutics contributions of the use of non-invasive care technologies offered by obstetric nurses during labor. Method a qualitative and descriptive study, with eight obstetric nurses from a birthing center in Rio de Janeiro. Data were collected from September to December 2018, through semi-structured interviews, and subjected to thematic analysis technique. Results to relieve pain and promote relaxation, they resort to encouraging the companion's participation and conscious breathing, the application of massage, the promotion of a supportive environment and the use of warm water and essential oils. To activate labor, assist in descending the presentation and correction of fetal positioning, they encourage vertical positioning and body movements, with some instruments. Conclusions and implications for practice non-invasive care technologies have therapeutic contributions and form a not medicalized, respectful and women-centered care that promotes female autonomy.

[An educator's perspective, defusing tensions through mediation and the encounter]. / Regard d'éducateur, désamorcer les tensions par la médiation et la rencontre.

Non-pharmacological alternatives which avoid or reduce the use of seclusion and restraint help to defuse psychological and/or physical tension to move towards appeasement. For the professional, the encounter with the patient requires questioning, reflection, availability as well as creativity. Mediation techniques such as hydrotherapy or equine assisted therapy, as well as the caregiver's general attitude, are perfect illustrations. Testimony.

O potencial terapêutico de uma oficina no território: autonomia e noção de pertença / El potencial terapéutico de un taller en el territorio: la autonomía y el sentido de pertinência / The therapeutic potential of a workshop in the territory: autonomy and sense of belonging

Objective: This study describes the therapeutic potential of a workshop in the territory for users of the Psychosocial Care Center and discuss the proposed therapy workshop and user interaction with the territory. Methods: Descriptive and exploratory research. The data resulted from participant observation and interviews as two coordinators. Thematic kind of content analysis was used for data processing. Results: As a result we obtained two thematic categories: Pool and the territory, and Benefits of a Pool Workshop. Conclusion: The workshop held in the territory allows the user to see himself/herself as part of it and also reframe the ways of living in that territory. The notion of belonging, social acceptance and citizenship are keys in building the social subject.

Objetivo: Descrever o potencial terapêutico de uma oficina no território para os usuários de saúde mental e discutir a proposta terapêutica da oficina e a interação dos usuários com o território. Método: Trata-se de estudo descritivo-exploratório. Os dados resultaram da observação participante e das entrevistas com os coordenadores, sendo utilizada a Análise de Conteúdo do tipo Temática para o tratamento dos dados. Resultados: Apresentaram-se duas categorias temáticas: Piscina e o território; e Os benefícios da Oficina de Piscina. Conclusão: A oficina realizada no território permite que o usuário se perceba parte dele e, ainda, ressignificar as formas de viver naquele território, bem como a noção de pertença, de aceitação social e cidadania que são fundamentais na construção do sujeito social.

Objetivo: El presente estudio describe el potencial terapéutico de un taller en el territorio, para los usuarios del Centro de Atención Psicosocial y discutir el taller de terapia propuesta y la interacción del usuario con el territorio. Método: La investigación descriptiva y exploratoria. Los datos de resultado de la observación participante y entrevistas como dos coordinadores. Tipo temático de análisis de contenido fue utilizado para el procesamiento de datos. Resultados: Como resultado se obtuvieron dos categorías temáticas: Piscina y el territorio; y Privilegios taller. El taller realizado en el territorio permite que el usuario se da cuenta parte de ella y también replantear las formas de vivir en ese territorio. Conclusión: La noción de pertenencia, aceptación social y la ciudadanía son clave en la construcción del sujeto social.

Strategies for Providing Low-Cost Water Immersion Therapy With Limited Resources.

At our university-affiliated medical center, a major renovation of the women's health and birthing unit resulted in the temporary loss of the permanent tub used for water immersion therapy during labor. Because 40 percent of the women in the nurse-midwifery practice utilize hydrotherapy, we undertook a rigorous search for an interim solution. We developed a safe and cost-effective strategy that can be easily replicated and utilized by others to provide hydrotherapy for laboring women.

[Support in addictology: hydrotherapy]. / Accompagnement en addictologie: une pratique de l'hydrothérapie.

Hydrotherapy is a corporal mediation treatment used with patients with addictions by the Mayenne centre for addiction support therapy and prevention. A demonstration of the benefit of hydrotherapy for these patients through a patient's case.

Development and testing of nurses' perceptions of the use of hydrotherapy in labor questionnaire.

While effective for labor pain, hydrotherapy is not often used. The purpose of this study was to develop and test an instrument of nurses' perceptions of the barriers to the use of hydrotherapy in labor. Following generation of items and review by content experts, the Nurses' Perceptions of the Use of Hydrotherapy in Labor (NPUHL) questionnaire was administered to 65 intrapartum nurses (phase I) and to 401 nurses (phase II). In phase I, the mean score of the NPUHL was significantly and negatively correlated with the Labor Support Scale (r = -.30, p = .016), indicating that nurses who demonstrated more labor-supportive behaviors also perceived fewer barriers to the use of hydrotherapy in labor. In phase II, exploratory factor analysis revealed five factors: Health Care Environment, Knowledge and Beliefs, Personal Concerns, Effort Required for Hydrotherapy, and Technology. There was a significant negative correlation (r = -.61) between use of hydrotherapy and the total NPUHL score and those of its subscales (r = -.12 to -.61); nurses with access to hydrotherapy tubs perceived fewer barriers to hydrotherapy than nurses without (t = 9.71, df= 387, p < .01). For the revised 30-item NPUHL, Cronbach's alpha was .93, and subscale alphas ranged from .58 to .93. The 30-item NPUHL scale demonstrated evidence of good initial reliability and validity.

Barriers to the use of hydrotherapy in labor.

OBJECTIVE: To determine nurses' perceived barriers to the use of hydrotherapy in labor. While effective in relieving pain, reducing anxiety, encouraging relaxation, and promoting a sense of control, hydrotherapy is rarely used during labor. DESIGN: Comparative descriptive survey design. SETTING: A national convention and perinatal listserves. PARTICIPANTS: Intrapartum nurses (N=401) attending a national convention (Association of Women's Health, Obstetric, and Neonatal Nurses, 2007; n=225) and members of perinatal listserves (n=176) were recruited. METHODS: A questionnaire was designed for this study (Nurses' Perception of the Use of Hydrotherapy in Labor). The questionnaire was available in paper format and online. RESULTS: Institutional but not individual characteristics (age, education, and role) were associated with Nurses' Perception of the Use of Hydrotherapy in Labor. Nurses who reported higher epidural rates (r=.45, p=.000) and Cesarean section rates (r=.30, p=.000) reported more barriers. There was no difference in perception of barriers for nurses at hospitals providing different levels of care; there were significant differences when primary care providers were considered. Intrapartum nurses in facilities where certified nurse-midwives do most deliveries reported significantly fewer barriers than nurses who worked in facilities where physicians attended most deliveries (F=6.84, df=2, p=.000). CONCLUSION: The culture of the birthing unit in which nurses provide care influences perception of barriers to the use of hydrotherapy in labor. Providing hydrotherapy requires a supportive environment, adequate nursing policies and staffing, and collaborative relationships among the health care team.

Observing position and movements in hydrotherapy: a pilot study.

OBJECTIVE: To observe and describe the positions and movements women choose while immersed in water during the first stage of labor. DESIGN: Descriptive, observational pilot study. SETTING: A rural community hospital that provided hydrotherapy in labor. PARTICIPANTS: Women (N = 7) who intended to use hydrotherapy in labor were recruited prenatally from a midwife-managed practice. MEASURES: For 15 minutes of each hour during the first stage of labor, position and movements of the participants were observed and recorded on a laptop computer. The observational tool was developed for this study from a review of the literature and interviews with nursing experts; 435 observations were recorded. Women were free to choose when and how long to use hydrotherapy and had no restriction on their positions and movements. RESULTS: Only 3 of the 7 participants labored in the tub. Women demonstrated a greater range of positions and movements in the tub than in bed, both throughout labor and during late first-stage labor (7-10 cm of dilatation). Women had more contractions and made more rhythmic movements while in the tub than in bed. CONCLUSIONS: Hydrotherapy may encourage upright positions and movements that facilitate labor progress and coping, helping women avoid unnecessary interventions.

Waterproofing EMG Instrumentation.

While still experimental, measurement of external uterine electromyographic (EMG) activity is a more sensitive and noninvasive method for measuring uterine contractility in human labor than the methods currently used in clinical practice. Hydrotherapy is purported to improve contractility in labor, yet there have been no reports of abdominal uterine EMG activity measured during immersion. To test telemetric EMG equipment and different waterproofing techniques under dry and immersed conditions, the authors recorded surface EMG activity from the abdominal muscles of 11 healthy, nonpregnant women, 22 to 51 years of age. After attaching one pair of electrodes to the skin on either side of the umbilicus and applying the waterproofing material, the authors tested the signal by asking participants to perform a short series of leg lifts while seated in a chair to evoke abdominal muscle contractions. They were then immersed to the chest in a hydrotherapy tub while performing two to three leg lifts over 60 s every 5 min for 60 min with 20 lb of weight suspended from their ankles to counteract the buoyancy effect of water. EMG activity was continuously recorded. They then repeated the dry-measures sequence. While waterproofing remained intact, EMG signals were essentially unchanged between dry and wet conditions. Of the 11 waterproofing applications tested, 10 failed at some point. In the data from the successful application, EMG signals in both channels exhibited stable baselines throughout and an absence of low-frequency artifact. The development of this technique allows for the recording of external uterine EMG activity during hydrotherapy. The authors have begun using it to investigate the effects of hydrotherapy on uterine contractility during human labor.

How to implement complementary therapies for laboring women.

Complementary therapies have been a part of nursing practice for centuries and are supported today as a part of nursing practice by many state boards of nursing. Some of these modalities can be used by nurses as a part of their comprehensive plan of labor support for women during the childbirth experience. This article describes five complementary therapies (aromatherapy, massage, use of birth balls, music therapy, and hydrotherapy), and how one large Midwestern hospital system implemented an educational program for nurses that helped them integrate complementary therapies into their nursing care for laboring women.

Programa de vigilancia y control de la piscina del Instituto de Ortopedia Infantil Roosevelt / Vigilance and Control Programme for the swimming pool’s area at ‘Instituto de Ortopedia Infantil Roosevelt’

El objetivo del proyecto realizado en la Especialización de Gestión en Rehabilitación fue implementar un programa de vigilancia y control del área de la piscina del Instituto de Ortopedia Infantil Roosevelt, para mejorar las condiciones sanitarias del agua y evitar la aparición y reproducción de agentes patógenos en el medio y en los usuarios que ingresan a ella.El Instituto Roosevelt es una entidad prestadora de servicios de salud ubicada en Bogotá, en donde la hidroterapia hace parte de la intervención fisioterapéutica. Al realizar un diagnóstico del área se evidenció que no se estaban haciendo los procesos indispensables que aseguraran las condiciones higiénico-sanitarias del agua de la piscina, razón por la cual se vio la necesidad de realizar una serie de actividades encaminadas a garantizar la calidad del agua y el adecuado funcionamiento del área para la protección de la salud de los pacientes, acompañantes, estudiantes, fisioterapeutas y operadores.Finalmente se logró en un alto porcentaje la implementación del Programa, siendo evidente el compromiso e interés institucional por éste

The ventilated patient undergoing hydrotherapy: a case study.

The ascending peripheral neuropathy and paralysis that result from Guillain-Barre Syndrome's (GBS) demyelination of peripheral nerves is a challenge to health professionals; the patient requires support during the acute disease process and during the remyelination recovery period, often lasting months to years. The staff of a major metropolitan teaching hospital's critical care unit (CCU) and physiotherapy departments developed a hydrotherapy treatment programme for a ventilated patient with GBS. Through careful planning and appropriate preparation, it was found that hydrotherapy could successfully and safely be incorporated into a patient's treatment regimen. The benefits included improved range of movement due to the supportive nature of water, anecdotal increased strength, size and movement of remyelinating muscles and a psychological improvement. Although this patient has not recovered from GBS to be independent, hydrotherapy was a valuable part of the treatment regimen and it could be suggested the increase muscle strength lead to improved respiratory function and enabled weaning from ventilation, reducing intensive care length of stay and cost.

The use of water immersion for treatment of massive labial edema during pregnancy.

The purpose of this article is to present a case of a pregnant woman with nephrotic syndrome who had unusually painful edema, and to share an intervention used to relieve her discomfort. The labial edema experienced by this patient was particularly problematic and interfered with normal activity; the hydrotherapy used in this case for treatment was successful in reducing the edema and the pain associated with it. When addressing atypical clinical problems such as this one, nurses can use evidence-based, inexpensive interventions to help their patients.