Nurseped: educational technology for safety in the management of intravenous antibiotics in pediatrics. / Nurseped: tecnología educativa para la seguridad en el manejo de antibióticos intravenosos en pediatría.

OBJECTIVE: to develop and validate the content of a serious game on the safe management of intravenous medications in pediatrics. METHOD: methodological study for the development and content validation of an educational technology. The cases and challenges of the serious game were developed based on a literature review and validated by 11 nurses with training and experience in the area. Content validity and agreement indices were adopted to analyze agreement and internal consistency (minimum of 0.8). RESULTS: the content is based on the main antibiotics used in the clinical management of infections in hospitalized children and patient safety. Absolute agreement was obtained in 60 of the 61 items evaluated, and the minimum obtained was 0.82 in the content validation index and 0.80 in agreement. Adjustments were suggested by experts in the response statement for a specific case and implemented to improve the quality of the technology content. CONCLUSION: the content of the serious game Nurseped was validated by nurse experts in child health regarding clinical cases, question statements and multiple-choice answers, in addition to feedback that presents the user with an evidence-based answer after getting the challenge right or wrong.

Aplicação de feixes de intervenção numa unidade de terapia intensiva portuguesa / Aplicación de vigas de intervención en una unidad portuguesa de cuidados intensivos / Application of intervention bundles in a portuguese intensive care unit

Objetivo identificar a associação entre a aplicação de Feixes de Intervenção e características sociodemográficas e profissionais de enfermeiros em uma unidade de terapia intensiva portuguesa. Método estudo descritivo e transversal, com amostra de 44 enfermeiros de uma Unidade de Terapia Intensiva Portuguesa. Na coleta de dados, aplicou-se questionário de maio a junho de 2019. Tratamento incluiu estatística descritiva e inferencial. Resultados a maioria da amostra não executava auditorias (86,4%) quanto às infeções em estudo. A pontuação do Feixe de Intervenção da Infeção do Trato Urinário e da Pneumonia Associada à Intubação diferiu significativamente entre os sexos (T de Student: p<0,047 e p<0,037), bem como entre o exercício profissional total e tempo de exercício na Unidade de Terapia Intensiva, respetivamente (T de Student: p<0,001 e p<0,026). Conclusão a aplicação dos Feixes de Intervenção associou-se às características sociodemográficas e ao tempo de exercício profissional de enfermeiros de unidade de terapia intensiva portuguesa.

Objetivo identificar la asociación entre la aplicación de Vigas de Intervención y las características sociodemográficas y los profesionales de enfermería en una unidad de cuidados intensivos portuguesa. Método estudio descriptivo y transversal, con una muestra de 44 enfermeras de una Unidad de Cuidados Intensivos portuguesa. Se aplicó un cuestionario de mayo a junio de 2019 en la recolección de datos. El tratamiento incluyó estadísticas descriptivas e inferenciales. Resultados la mayoría de la muestra no realizó auditorías (86,4%) respecto a las infecciones en estudio. La puntuación del Vigas de Intervención de Infección urinaria y Neumonía Asociada a Intubación difirió significativamente entre los sexos (T de Student: p<0,047 y p<0,037), así como entre el ejercicio profesional total y el tiempo de ejercicio en la Unidad de Cuidados Intensivos, respectivamente (T de Student: p<0,001 y p<0,026). Conclusión la aplicación de los Vigas de Intervención se asoció con características sociodemográficas y tiempo de práctica profesional de las enfermeras de una unidad de cuidados intensivos portuguesa.

Objective to identify the association between the application of Intervention Bundles and sociodemographic and professional characteristics of nurses in a Portuguese intensive care unit. Method descriptive and cross-sectional study, with a sample of 44 nurses from a Portuguese Intensive Care Unit. A questionnaire was applied from May to June 2019 in the data collection. Treatment included descriptive and inferential statistics. Results the majority of the sample did not perform audits (86.4%) regarding the infections under study. The score of the Intervention Bundle of Urinary Tract Infection and Pneumonia Associated with Intubation differed significantly between the genders (Student's T: p<0.047 and p<0.037), as well as between the total professional exercise and exercise time in the Intensive Care Unit, respectively (Student's T: p<0.001 and p<0.026). Conclusion the application of the Intervention Bundles was associated with sociodemographic characteristics and time of professional practice of nurses from a Portuguese intensive care unit.

Home care nurses' identification of patients at risk of infection and their risk mitigation strategies: A qualitative interview study.

BACKGROUND: There is an increase in the number of individuals who receive care at home. A significant proportion of these patients acquire infections during their care episode. Whilst there has been significant focus on strategies for infection prevention and control in acute care environments, there is a lack of research into infection prevention in a home care setting. OBJECTIVES: To understand (1) if and how home care nurses identify patients at high risk of infection and (2) the strategies they use to mitigate that risk. DESIGN: A qualitative descriptive study, using semi-structured interviews. SETTING: A large not for profit home care agency located in the New York region of the United States. PARTICIPANTS: Fifty nurses with a range of experience in home care nursing. METHODS: Purposive and snowball sampling was used to recruit nurses from across the home care agency with varied years of work experience. Interviews were audio recorded and transcribed. The interviews explored how home care nurses evaluate their patients' risk of developing an infection and if/how they modify the plan of care based on that risk. Data were analysed using thematic analysis. RESULTS: Three themes were derived from the data; assessing a patient's risk of infection, the risk assessment process, and strategies for mitigating infection risk. Factors identified by nurses as putting a patient at higher risk of infection included being older, having diabetes, inadequate nutrition; along with inadequate clinical information available at start of care. The patient's knowledge and understanding of infection prevention, and the availability and knowledge of caregivers were also important, as was the cleanliness of the home environment. Given the context of home care, where nurses have little control over the environment and care processes in-between visits, the main strategy for infection prevention was patient and caregiver education. Nurses also discussed the importance of their own infection prevention behaviours, and the ability to adjust a patient's plan of care according to their infection risk. CONCLUSIONS: The study highlights the complexity of the risk assessment process in relation to infection. Existing guidelines for infection prevention and control do not adequately cover the home care environment and more research needs to determine which interventions (such as patient/caregiver education) would be most effective to prevent infections in the home care setting.

Infections in Heart and Lung Transplant Recipients.

Infections in heart and lung transplant recipients are complex and heterogeneous. This article reviews the epidemiology, risk factors, specific clinical syndromes, and most frequent opportunistic infections in heart and/or lung transplant recipients that will be encountered in the intensive care unit and will provide a practical approach of empirical management.

Multidrug-resistant bacteria infection and nursing quality management application in the department of physical examination.

The main problem of clinical prevention and control of multi drug resistant bacteria infection is to strengthen the monitoring of pathogenic bacteria spectrum, this study research on the multi drug-resistant bacteria infection and nursing quality management application in the department of physical examination. The results of this study showed that the number of patients with multiple drug resistant infections showed an increasing trend. Therefore, once the patients with multiple drug-resistant bacteria infection are found, the prevention and control of the patients with multiple drug-resistant bacteria should be strictly followed, and the patient's medication care should be highly valued. Also, the nurses need to be classified based on the knowledge and skill characteristics of the nurses in the department of physical examination, and compare the nursing effect before and after classification and grouping. The physicians and individuals receiving physical examinations in the department of physical examination had a higher degree of satisfaction for nursing effect after classification compared with those before classification. Classification and grouping management helps improve the nursing quality and overall quality of the nurses in the department of physical examination.

Evaluación de complicaciones de la fístula arteriovenosa para hemodiálisis según la técnica de canalización / Evaluation of complications of arteriovenous fistula for hemodialysis according to the puncture technique

Introducción: La fístula arteriovenosa es el acceso vascular de elección para los tratamientos en hemodiálisis, puncionado periódicamente tres veces por semana. Existen tres tipos de técnicas de punción: en escalera, en área de punción y buttonhole. Las técnicas convencionales son causantes de gran morbilidad a medio y largo plazo, sin embargo, el Buttonhole está asociado a priori a la mejoraría de esos problemas. Objetivo: Comparar la técnica de punción de buttonhole con respecto a las técnicas convencionales para la canulación del acceso vascular en el tratamiento de Hemodiálisis, en función del grado de dolor asociado a la técnica, tasas de infección asociadas y la repercusión sobre la supervivencia del acceso vascular. Material y Método: Revisión bibliográfica narrativa. Se incluyeron estudios experimentales y observacionales en inglés y castellano publicados entre 2010 y 2015, que compararan la técnica de punción convencional respecto a la técnica de punción Buttonhole. Selección inicial por título y resumen. Se utilizaron las escalas CASPe y STROBE para la evaluación metodológica. Resultados: Se identificaron 1.827 estudios, de los que seleccionamos 13 tras el proceso de evaluación crítica. La heterogeneidad de resultados no permite afirmar que ninguna de las técnicas analizadas mejore los resultados en dolor en la punción o supervivencia del acceso, sin embargo, se asocia un aumento de eventos infecciosos con la técnica de Buttonhole. Conclusión: no se han hallado argumentos para asegurar que el Buttonhole pueda ser considerado una técnica de primera elección, debido a la heterogeneidad de las formas de medida de los estudios revisados (AU)

Introduction: The arteriovenous fistula is the standard vascular access for the treatments in hemodialysis, punctured periodically three times per week. There are three types of puncture techniques: ladder, puncture area and buttonhole. Conventional techniques cause great morbidity in the medium and long term, however, a priori, the buttonhole technique is associated to the improvement of those problems. Objective: To compare the buttonhole puncture technique with respect to conventional techniques for vascular access cannulation in the treatment of hemodialysis, depending on the degree of pain associated with the technique, associated infection rates and the repercussion on vascular access survival. Material and Method: Narrative bibliographic review. Experimental and observational studies in English and Spanish published between 2010 and 2015 were included, comparing the conventional puncture technique versus the Buttonhole puncture technique. Initial selection by title and summary. The CASPe and STROBE scales were used for the methodological evaluation. Results: 1.827 studies were identified, of which 13 were selected after the critical evaluation process. The heterogeneity of results does not allow to affirm improvements of any of the techniques analyzed in puncture pain or survival of the access, nevertheless, it is associated an increase of infectious events with the Buttonhole technique. Conclusion: Any arguments have been found to ensure that Buttonhole technique can be considered as first choice due to the heterogeneity of the measurement methods of the reviewed studie (AU)

Nurses' knowledge and care practices for infection prevention in neutropenic patients.

BACKGROUND: Neutropenia-associated infections can prolong hospitalization, increase re-admission, mortality and morbidity rates. AIM: To determine nurses' knowledge and infection control care practices in neutropenic patients. DESIGN: This descriptive study was conducted between January 2012 and May 2012, at oncology adult inpatient units of a university hospital in Turkey. Sample consisted of 51 staff nurses. METHODS: Data were collected by a form included sociodemographic characteristics, neutropenia knowledge questions, and infection control care practices. Each nurse was observed by researcher three times for infection control care practices. RESULTS: The mean score of nurses' knowledge was 21.3 ± 2.4 (min. 17; max. 27). For all three observations hand hygiene adherence was found low both in medication preparation, administration and vital signs assessment. Sterility disrupted in almost all preparation of parenteral medications. CONCLUSIONS: Even nurses' knowledge related with neutropenia and care of neutropenic patient was found above average their infection control care practices were found insufficient.

Tecnologia educacional para a prevenção da infecção urinária na gravidez: estudo descritivo / Educational technology for the prevention of urinary tract infections during pregnancy: a descriptive study

Problema: a infecção do trato urinário é uma das principais afecções ocorridas no período gravídico, sendo causadora de importantes complicações materno-fetais que podem levar à morte. Objetivos: aplicar uma cartilha educativa sobre a prevenção da infecção urinária em um grupo de gestantes e analisar os problemas de enfermagem relacionados à ocorrência desse agravo. Método: estudo descritivo, qualitativo, realizado com 15 gestantes em uma unidade de Saúde da Família de Petrópolis/RJ, em abril de 2015. Os dados foram coletados por entrevistas ­ individual e grupal ­ e analisados por meio da técnica de triangulação dos dados. Resultado: a aplicação da cartilha evidenciou problemas de enfermagem relacionados à higiene, à alimentação, à ingestão hídrica, à eliminação intestinal e urinária, e ao coito. Conclusão: o uso da tecnologia impressa é uma importante ferramenta de discussão e aprendizado no processo de educação em saúde, e qualifica a prática assistencial do enfermeiro. (AU)

Problem: urinary tract infections are one of the main conditions that occur in the pregnancy period, causing important maternal-fetal complications that can lead to death. Aims: to implement an educational booklet on the prevention of urinary tract infections in a group of pregnant women and analyze the nursing problems related to the occurrence of this disease. Method: a descriptive, qualitative study with fifteen pregnant women at a Family Health Unit in Petrópolis, RJ, Brazil in April, 2015. Data was collected through interviews - individual and group - and was analyzed using the data triangulation technique. Results: the application of the booklet revealed nursing problems related to hygiene, food, water intake, intestinal and urinary elimination and coitus. Conclusion: the use of printed technology is an important tool for discussion and learning in the health education process, and it can be used to qualify the nurses' care practice. (AU)

Positive deviance as a strategy to prevent and control bloodstream infections in intensive care / Positive deviance como estrategia en la prevención y control de las infecciones de corriente sanguínea en los cuidados intensivos / Positive Deviance como estratégia na prevenção e controle das infecções de corrente sanguínea na terapia intensiva

Abstract OBJECTIVE To describe the application of positive deviance as a strategy to prevent and control bloodstream infections. METHOD An intervention study with nursing and medical team members working in an intensive care unit in a university hospital, between June and December 2014. The four steps of the positive defiance methodology were applied: to define, to determine, to discover and to design. RESULTS In 90 days, 188 actions were observed, of these, 36.70% (n=69) were related to catheter dressing. In 81.15% (n=56) of these dressings, the professionals most adhered to the use of flexible sterile cotton-tipped swabs to perform antisepsis at catheter entry sites and fixation dressing. CONCLUSION Positive deviance contributed to the implementation of proposals to improve work processes and team development related to problems identified in central venous catheter care.

Resumen OBJETIVO Describir la aplicación del Positive Deviance como estrategia en la prevención y control de la infección de corriente sanguínea. MÉTODO Estudio de intervención realizado en la Unidad de Cuidados Intensivos de un hospital universitario, con los miembros de los equipos de enfermería y médico, de junio a diciembre de 2014. Fueron aplicados los cuatro pasos de la metodología Positive Deviance: Definir, Determinar, Descubrir y Dibujar. RESULTADOS En 90 días 188 acciones fueron observadas; de estas, 36,70% (n=69) estaban relacionadas con los apósitos de los catéteres. En el 81,15% (n=56) de esos apósitos, el empleo del bastoncillo estéril para la realización de la antisepsia del sitio de inserción del catéter y de su placa de fijación fue la acción de mayor adhesión. CONCLUSIÓN El Positive Deviance ayudó la implantación de propuestas de mejorías de proceso laboral y el desarrollo del equipo para los problemas identificados en el cuidado con el catéter venoso central.

Resumo OBJETIVO Descrever a aplicação do Positive Deviance como estratégia na prevenção e no controle da infecção de corrente sanguínea. MÉTODO Estudo de intervenção realizado na Unidade de Terapia Intensiva de um hospital universitário, com os membros das equipes de enfermagem e médica, de junho a dezembro de 2014. Foram aplicados os quatro passos da metodologia Positive Deviance: Definir, Determinar, Descobrir e Desenhar. RESULTADOS Em 90 dias 188 ações foram observadas, destas, 36,70% (n=69) estavam relacionadas aos curativos dos cateteres. Em 81,15% (n=56) desses curativos, o uso da haste flexível estéril para realização da antissepsia do local de inserção do cateter e de sua placa de fixação foi a ação de maior adesão CONCLUSÃO O Positive Deviance auxiliou na implementação de propostas de melhorias de processo de trabalho e no desenvolvimento da equipe para os problemas identificados no cuidado com o cateter venoso central.

Intervenciones de enfermería para la prevención de neumonía asociada a ventilación mecánica (NAV) en el adulto hospitalizado en áreas críticas en segundo y tercer nivel de atención / Nursing interventions in preventing ventilator-associated pneumonia (VAP) in adult hospitalized in critical areas in second and third level of care / As intervenções de enfermagem na prevenção de pneumonia associada à ventilação mecânica (PAV) em adultos hospitalizados em áreas críticas em segundo e terceiro nível de cuidados

INTRODUCCIÓN: Las Infecciones Asociadas a la Atención en Salud (IAAS), son la primera causa de muerte debido a infecciones adquiridas en el hospital. Dentro de las IAAS más frecuentes se encuentra la Neumonía Asociada al Ventilador (NAV), complicación pulmonar que se desarrolla después de 48 a 72 horas de la intubación endotraqueal. Esta guía pone a disposición las recomendaciones basadas en la mejor evidencia disponible con la intención de estandarizar las acciones y disminuir la incidencia y mortalidad de la NAV. METODOLOGIA: Con la nemotecnia PICO se establecieron preguntas clínicas estructuradas, búsqueda y revisión sistemática de la literatura en base de datos PubMed, BVS, TripDatabase recuperando guías internacionales, meta análisis, ensayos clínicos aleatorizados y estudios observacionales publicados que respondieron a las preguntas planteadas, la discriminación de fuentes se realizó con plantillas CASPe y para las guías con las escalas GRADE. Se realizó lectura crítica y análisis de documentos, finalmente se obtienen evidencias y redactan recomendaciones y se gradan con las escalas de Shekelle y GRADE.RESULTADOS: Para la integración de evidencias y recomendaciones se utilizaron 3 guías, 5 meta-análisis, 9 revisiones sistemáticas ,1 estudios de cohorte ,3 estudios de casos y controles, 1 estudio descriptivo no experimental y 6 fuentes seleccionadas. CONCLUSIONES: La utilización de la evidencia científica permite la estandarización del cuidado para la prevención de NAV

INTRODUCTION: Infections Associated with Health Care (IAAS), they are the leading cause of death from hospital-acquired infections. Among the most frequent IAAS is Ventilator Associated Pneumonia (VAP), pulmonary complication that develops after 48 to 72 hours of endotracheal intubation. This guide provides recommendations based on the best available evidence with intent to standardize the actions and reduce the incidence and mortality of VAP.METHODOLOGY: With the PICO mnemonic questions structured clinical, research and systematic review of the literature database PubMed, BVS data were established, Tripdatabase recovering international guidelines, meta-analyzes, randomized trials and published observational studies that responded to questions raised, the discrimination sources was carried out with templates and guides CASPe with GRADE scales. critical reading and document analysis was performed finally obtained evidence and draft recommendations and degrade with scales and GRADE Shekelle. RESULTS: For the integration of evidence and recommendations 3 guides, 5 meta-analyzes, systematic reviews 9 1 cohort, 3 case-control studies, 1 non-experimental descriptive study and 6 selected sources they were used. CONCLUSIONS: The use of scientific evidence allows for standardization of care for the prevention of VAP

INTRODUÇÃO: infecções associadas a cuidados de saúde (IAAS), eles são a principal causa de morte por infecções hospitalares. Entre os IAAS mais frequente é a pneumonia associada à ventilação mecânica (PAV), complicação pulmonar que se desenvolve após 48 a 72 horas de entubação endotraqueal. Este guia fornece recomendações baseadas na melhor evidência disponível com a intenção de padronizar as ações e reduzir a incidência e mortalidade da PAV.METODOLOGIA: com o Pico perguntas mnemônicos estruturado clínica, pesquisa e revisão sistemática da base de dados da literatura de dados PubMed, BVS foram estabelecidos, Tripdatabase recuperando diretrizes internacionais, meta-análises, estudos randomizados e estudos observacionais publicados que responderam às questões levantadas, o fontes de discriminação foi realizada com modelos e orienta Caspe com escalas grau. análise de leitura e documento crítico foi realizado finalmente obtidos recomendações evidências e projectos e degradar com escalas e GRADE Shekelle. RESULTADOS: Para a integração de dados e recomendações 3 guias, 5 meta-análises, revisões sistemáticas 9 1 de coorte, 3 estudos de caso-controle, um estudo descritivo, não-experimental e 6 fontes selecionadas foram usados. CONCLUSÕES: O uso de evidências científicas permite a padronização dos cuidados para a prevenção de PAV

Cardiac Transplantation: Considerations for the Intensive Care Unit Nurse.

Heart transplantation is a recommended and curative treatment option for patients with advanced heart failure symptoms despite receiving optimal medical and device therapy. The availability of donor organs limits the number of patients able to receive a heart transplant. The overall outcome of patients able to receive a heart transplant is determined by the successful delivery of essential nursing care. Understanding the specific interventions and therapies unique to this patient population is critical to their care. This article reviews considerations for the intensive care unit clinician in the management of heart transplant patients in this setting.

Defining a Role for Nursing Education in Staff Nurse Participation in Antimicrobial Stewardship.

The role of the staff nurse in antimicrobial stewardship programs (ASPs) is not clearly defined. This study explored the ASP educational needs of staff nurses, using survey, focus group, and Delphi methods of engaging nurse educators. Low awareness of components of ASPs and areas of educational need were identified.

Baby Boy Jones Interactive Case-Based Learning Activity: A Web-Delivered Teaching Strategy.

Faced with limited resources, nurse educators are challenged with transforming nursing education while preparing enough qualified nurses to meet future demand; therefore, innovative approaches to teaching are needed. In this article, we describe the development of an innovative teaching activity. Baby Boy Jones is a Web-delivered, case-based learning activity focused on neonatal infection. It was created using e-learning authoring software and delivered through a learning management system.