A segurança da pessoa em situação crítica vítima de trauma: intervenção de enfermagem especializada / The safety of people in critical situations who are victims of trauma: specialized nursing intervention

As lesões traumáticas acarretam graves consequências pessoais, familiares e sociais. A pessoa vê-se confrontada com mudanças significativas, e por vezes definitivas, da imagem corporal, da cognição, da mobilidade e da autonomia. É frequente alguns elementos da família alterarem o quotidiano e interromper a atividade laboral para cuidar da pessoa vítima de trauma. A sociedade vê-se privada de jovens e adultos em idades produtivas, pois é uma das principais causas de morte e incapacidade, o que implica custos muito significativos. Cuidar da pessoa em situação crítica vítima de trauma é desafiante e exige do enfermeiro a mobilização de conhecimentos e competências específicos nos diversos contextos. Ao longo deste percurso, o enfermeiro mestre em enfermagem na área de especialização à pessoa em situação crítica coloca à disposição da pessoa vítima de trauma, as suas capacidades de vigilância, de monitorização e de juízo e raciocínio clínico, respondendo aos apelos de cuidados manifestados que podem ser realizados de forma direta (manifestações verbais e/ou corporais) ou de forma indireta, através da monitorização, da vigilância e do suporte vital (alterações hemodinâmicas, entre outras). A segurança na prestação de cuidados de enfermagem especializados à pessoa em situação crítica vítima de trauma é determinante, pois a implementação de medidas e processos que visem a mitigação de eventos adversos trazem ganhos em saúde para a pessoa e família. A escolha desta temática teve na sua génese motivações pessoais e profissionais, constituindo-se uma estratégia para a aquisição e desenvolvimento de competências especializadas de enfermagem na área da pessoa em situação crítica. Foi escolhido o modelo de Dreyfus de aquisição de competências e seguida a linha de pensamento de Benner para a prática de enfermagem, pois realça a importância e a necessidade da experiência e do domínio das capacidades, tendo como objetivo a melhoria da prestação de cuidados. Foi determinante a realização de estágios em contexto de urgência e cuidados intensivos, para o desenvolvimento de diversas atividades com vista ao cumprimento dos objetivos propostos e a concretização das metas definidas pela Escola Superior de Enfermagem de Lisboa para este curso de mestrado, das metas enunciadas nos descritores de Dublin para o 2º ciclo de estudos e a aquisição das competências comuns e específicas de enfermeiro especialista na área da pessoa em situação crítica, definidas legalmente pela Ordem dos Enfermeiros.

Traumatic injuries have serious personal, family and social consequences. The person is faced with significant and sometimes definitive changes in body image, cognition, mobility and autonomy. It is common for some family members to change their daily lives and interrupt their work activities to take care of the trauma victim. Society is deprived of young people and adults of productive ages, as it is one of the main causes of death and disability, which implies very significant costs. Caring for a person in a critical situation who is a victim of trauma is challenging and requires nurses to mobilize specific knowledge and skills in different contexts. Along this path, the nurse with a master's degree in nursing in the area of specialization for the person in a critical situation makes available to the person who is a victim of trauma, their surveillance, monitoring and judgment and clinical reasoning skills, responding to the manifested care calls that they can be performed directly (verbal and/or bodily manifestations) or indirectly, through monitoring, surveillance and vital support (hemodynamic changes, among others). Safety in the provision of specialized nursing care to the person in a critical situation who is a victim of trauma is crucial, as the implementation of measures and processes aimed at mitigating adverse events bring health gains to the person and family. The choice of this theme had in its genesis personal and professional motivations, constituting a strategy for the acquisition and development of specialized nursing skills in the area of the person in critical situation. The Dreyfus model of skills acquisition was chosen and Benner's line of thought for nursing practice was followed, as it emphasizes the importance and need for experience and mastery of skills, with the objective of improving care delivery. It was crucial to carry out internships in an emergency and intensive care context, for the development of various activities with a view to fulfilling the proposed objectives and achieving the goals defined by Lisbon Higher School of Nursing for this master's course, the goals set out in the Dublin descriptors for the 2nd cycle of studies and the acquisition of common and specific skills of a specialist nurse in the area of the person in critical situation, legally defined by the Ordem dos Enfermeiros.

Monitoramento avançado de enfermagem: pacientes de risco na atenção primária / Monitoreo avanzado de enfermería: pacientes de riesgo en atención primaria / Advanced nursing monitoring: At-risk patients in Primary Care

Resumo Objetivo avaliar o efeito do monitoramento de enfermagem avançado em relação ao usual para identificação do risco cardiovascular e renal, adesão medicamentosa e prática de exercícios na atenção primária à saúde. Método estudo quantitativo, quase-experimental desenvolvido na Atenção primária. Em relação a intervenção, foram consultas de enfermagem trimestrais de monitoramento avançado e laboratorial trimestral. Para coleta de dados, aplicou-se questionário sociodemográfico, escala Morisky e Questionário Internacional de Atividade Física. Resultados sexo feminino predominou nos dois grupos intervenção e controle (62,79% vs. 76,74%). O percentual de pacientes sem risco cardiovascular do grupo intervenção superou o grupo controle da consulta 1 para consulta 3, (0,00% - 25,58% vs. 6,98 - 2,33). Adesão medicamentosa máxima, ao longo do tempo, foi superior no grupo intervenção comparado ao grupo controle (48,8% vs. 23,3%). O risco cardiovascular dos usuários interferiu na atividade física de forma significativa no grupo intervenção e controle (p=0,0261 vs. 0,0438). Conclusões e implicações para a prática a monitorização avançada possibilitou uma melhor identificação de pacientes de risco e orientações aos pacientes hipertensos e diabéticos com risco cardiovascular e renal, o que favoreceu o monitoramento avançado e contribuiu ao autogerenciamento da prática de exercícios e adesão medicamentosa, a partir de consultas de enfermagem.

Resumen Objetivo evaluar el efecto de la monitorización avanzada de enfermería frente a la habitual para identificar el riesgo cardiovascular y renal, la adherencia a la medicación y la práctica del ejercicio en la atención primaria de salud. Método estudio cuasiexperimental cuantitativo desarrollado en Atención Primaria. En cuanto a la intervención, se realizaron consultas de enfermería trimestrales para seguimiento avanzado y laboratorio trimestral. Para la recopilación de datos se aplicó un cuestionario sociodemográfico, escala de Morisky y Cuestionario Internacional de Actividad Física. Resultados el género femenino predominó tanto en el grupo de intervención como en el de control (62,79% vs 76,74%). El porcentaje de pacientes sin riesgo cardiovascular en el grupo de intervención superó al grupo de control desde la cita 1 hasta la cita 3 (0,00% - 25,58% frente a 6,98 - 2,33). La adherencia máxima al fármaco, a lo largo del tiempo, fue mayor en el grupo de intervención en comparación con el grupo de control (48,8% frente a 23,3%). El riesgo cardiovascular de los usuarios interfirió significativamente con la actividad física en los grupos de intervención y control (p = 0,0261 frente a 0,0438). Conclusiones e implicaciones para la práctica la monitorización avanzada permitió identificar mejor a los pacientes en riesgo y orientar a los pacientes hipertensos y diabéticos con riesgo cardiovascular y renal, lo que favoreció el monitoreo avanzado y contribuyó al autocontrol de la práctica de ejercicio y la adherencia a la medicación, desde las consultas de enfermería.

Abstract Objective to evaluate the effect of advanced versus usual Nursing monitoring to identify cardiovascular and renal risk, adherence to medication and practice of physical exercise in Primary Health Care. Method a quantitative and quasi-experimental study developed in Primary Care. In relation to the intervention, there were quarterly Nursing advanced monitoring consultations and quarterly laboratory control. For data collection, a sociodemographic questionnaire, the Morisky scale and the International Physical Activity Questionnaire were applied. Results the female gender predominated both in the intervention and in the control group (62.79% vs. 76.74%). The percentage of patients without cardiovascular risk in the intervention group exceeded the control group from consultation 1 to consultation 3 (0.00% - 25.58% vs. 6.98 - 2.33). Maximum adherence to medication, over time, was higher in the intervention group when compared to the control group (48.8% vs. 23.3%). The users' cardiovascular risk significantly interfered with physical activity in the intervention and control groups (p=0.0261 vs. 0.0438). Conclusions and implications for the practice advanced monitoring enabled better identification of at-risk patients and guidelines for the hypertensive and diabetic patients at cardiovascular and renal risk, which favored advanced monitoring and contributed to self-management of the practice of physical exercise and adherence to medication, based on Nursing consultations.

A Quality Improvement Project for Monitoring Surgical Patients With Obstructive Sleep Apnea.

INTRODUCTION: Patients who have obstructive sleep apnea (OSA) are at a higher risk for opioid-induced respiratory depression postoperatively. Many patients who have OSA are not given a diagnosis before undergoing surgery and may not be monitored appropriately afterward. PURPOSE: The purpose of this quality improvement project was to increase the number of preoperative patients screened for OSA and improve their postoperative monitoring through a novel OSA protocol order set through the implementation of evidence-based practices. METHODS: Screening for OSA risk is performed preoperatively using the STOP-Bang instrument. High-risk patients, as well as patients with existing OSA, are monitored postoperatively using a bundle of evidence practices to identify early respiratory compromise. If respiratory events occur, a treatment intervention will be triggered. OUTCOME: Postintervention chart reviews demonstrated 100% of the qualifying patients had OSA screening completed before surgery. The OSA protocol was ordered in 28 of the 100 charts reviewed. Patient harm may have been avoided through the implementation of the protocol's standing order for continuous positive airway pressure, which was triggered by respiratory events. CONCLUSION: It is important to identify these high-risk patients before surgery through preoperative screening. These patients should be monitored closely postoperatively to identify early respiratory compromise.

Continuous Physiological Monitoring Improves Patient Outcomes.

BACKGROUND: General patient acuity is increasing in the United States, with more patients having multiple comorbidities and acute-on-chronic conditions. Hospitalizations may also be complicated by serious adverse events, often unrelated to the admitting medical diagnosis. In our facility, the late detection of patient deterioration on general medical units often resulted in increased length of stay (LOS) in the ICU and poor patient outcomes. PURPOSE: The purpose of this project was to improve patient surveillance and better identify early signs of patient deterioration through the use of continuous vital sign monitoring technology. METHODS: To improve detection of patient deterioration, a nurse-led monitoring and response system was developed using a wearable, wireless device for continuous vital sign surveillance. The patient data the device provided was used with early warning scores and sepsis screening protocols for timely goal-directed interventions. RESULTS: Ninety-seven percent of patient deterioration events were recognized and treated as a result of this continuous monitoring and response system. Rapid response team activations decreased by 53% between baseline and the intervention period. LOS among patients transferred to the ICU decreased from 2.82 to 2.19 days. Nurse satisfaction with use of the continuous monitoring device was positive, with 74% of nurses surveyed reporting that information provided by the device enhanced decision-making. CONCLUSIONS: New technology for patient surveillance, in this case a nurse-led monitoring and response system, can be successfully integrated into general care practice. Use of the nurse-led response system helped nurses recognize early signs of deterioration and continue meaningful patient interactions.

[Post-operative monitoring of a patient with severe limb trauma]. / La surveillance postopératoire d'un patient traumatisé grave des membres.

In the postoperative monitoring of a patient with severe limb trauma, the nurse's objectives are multiple: prevention and screening of complications, follow-up care, compliance with postoperative instructions. Presentation of the key elements of this monitoring, which must be systematised and personalised.

Satisfaction and Technology Acceptance of Staff Regarding Use of Continuous Video Monitoring in Comparison With Sitters.

OBJECTIVE: The purpose of this study was to determine staff satisfaction and technology acceptance of continuous video monitoring (CVM) in comparison to sitters. BACKGROUND: Traditionally, sitters have been used to prevent falls in hospitals. Continuous video monitoring has emerged to reduce costs associated with sitters while maintaining safety. METHODS: A descriptive online survey using a modified version of the Technology Acceptance Model was used to gain insight on technology acceptance and satisfaction levels of clinical staff related to CVM. RESULTS: Only 12.73% found CVM to be as effective as sitters. Statistical significance was shown comparing sitters with CVM. A positive correlation was found with perceived ease of use and perceived usefulness of CVM. CONCLUSIONS: Understanding staff satisfaction and technology acceptance is imperative for nurse leaders and administration when implementing new technologies.

Clinical cues used by nurses to recognize changes in patients' clinical states: A systematic review.

The aim of this systematic review was to examine the clinical cues used by acute care nurses to recognize changes in clinical states of adult medical and surgical patients that occurred as usual consequence of acute illness and treatment. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines and checklist were followed. Four databases and reference lists of included studies were searched: from 1,049 studies, 38 were included. There were 26 subjective and 147 objective cues identified; only 6% of all cues described improvements in patients' clinical states. The most common clinical cues used were heart rate, blood pressure and temperature. Many studies (n = 31) focused on only one element of assessment, such as physiological stability, pain, or cognition. There was a paucity of studies detailing the complexity of acute care nurses' assessment practices as they would occur in clinical practice and a disproportionate focus on the objective assessment of deterioration. Studies are needed to understand the full breadth of cues acute care nurses use to recognize clinical change that includes both improvement and deterioration.

Patient SafetyNet for the Evaluation of Postoperative Respiratory Status by Nurses: A Presurvey and Postsurvey Study.

PURPOSE: The purpose of this pre-post survey study was to assess the effect of the Patient SafetyNet system (Masimo Corp, Irvine, CA) on postoperative respiratory evaluation by nurses in general wards. Patient SafetyNet is a wireless monitoring system that evaluates respiratory rate and percutaneous oxygen saturation. DESIGN: Survey of nurses at a single medical center. METHODS: Staff nurses (n = 75) were queried using a questionnaire asking about methods and problems of postoperative respiratory monitoring, usefulness of this system, and suggestions about suitable cases of this system. FINDINGS: A total of 75 questionnaires were completed and returned. The nurses reported that central/remote (89.3%) or continuous (98.7%) monitoring was useful in the postquestionnaire. Moreover, the average frequency of clinical examination was reduced from 11.0 ± 2.3 to 5.1 ± 1.3. Using the Patient SafetyNet system led to a reported 61.3% reduction in nursing workload related to respiratory assessment postoperatively. CONCLUSIONS: Continuous monitoring of respiratory rate and percutaneous oxygen saturation after general anesthesia is recommended for patients' safety. Moreover, Patient SafetyNet can decrease the number of physical assessments of respiratory status for postoperative patients in the general wards, resulting in reduction of nurse's workload.

Reflections on vital sign measurement in nursing practice.

Physiological observations or vital sign monitoring is a fundamental tenet of nursing care within an acute care setting. Surveillance of vital signs with algorithmic early warning frameworks aids the nurse in monitoring for early symptoms of clinical deterioration. The nurse must be cognizant of the factors that can influence the vital sign measurements because the framework score is only as reliable as the data inserted. Vital sign technology has made significant progress in its ability to objectify nursing subjective assessments. Early scientists have struggled with its relationship with subjectivity, claiming it has no relevance in true science. Quantitative measurements, regardless of how objectively they were created or obtained, need a subjective lens to interpret and act on the results. The skill of "making" the vital signs can be easily taught or done with technology, but it is the "taking" of the data for analysis of truth and action that requires a higher level of expertise. This paper will examine the truth of vital sign methodology and monitoring to explore the question, "Is true objectivity in the nursing practice of vital sign measurement possible?" The truth in vital sign recognition through a subjective lens will also be explored to challenge the philosophical scientific claims that objective data are the absolute truth.

A hemotransfusão sob a perspectiva do cuidado de enfermagem / Hemotransfusion under the perspective of nursing care / La hemotransfusión bajo la perspectiva del cuidado de enfermería

Objetivo: verificar a atuação da equipe de enfermagem durante a assistência em terapêutica transfusional. Método: pesquisa descritiva e exploratória, com abordagem quanti-qualitativa. Participaram do estudo 31 membros da equipe de enfermagem lotados em um hospital público e de ensino, habilitado como unidade de alta complexidade em oncologia. Os dados foram coletados entre setembro e dezembro de 2017 em duas etapas: por intermédio de entrevistas semiestruturadas e de um checklist para observação. Os dados foram agrupados, dispostos em tabelas e apresentados em frequência simples e valores absolutos e avaliados por análise temática. Resultados: a maioria dos profissionais referiu não se sentir apta a prestar a assistência transfusional. Observou-se não conformidade em aplicar normas de biossegurança, uma ineficaz monitoração do paciente e ausência do registro de informações sobre a assistência prestada. Conclusão: destaca-se a importância da capacitação contínua dos profissionais e a implementação de instrumentos que possam assegurar a assistência transfusional segura

Objective: this paper assesses the nurses' performance throughout transfusion therapy. Methods: it is a descriptive-exploratory research with both qualitative and quantitative approaches, which was performed with 31 members of the nursing team in a highly complex oncology unit at a public teaching hospital. Data collection took place from September to December 2017 by using semi-structured interviews and a checklist for observation. The data were organized in a spreadsheet for calculating simple frequencies and absolute values. After this, data were submitted to thematic analysis. Results: most professionals reported not being able to provide transfusion care, lacked information on proper care and monitored the patients ineffectively. Furthermore, they did not meet biosecurity standards. Conclusion: it is highlighted the importance of continuous training and implementation of instruments that can ensure safe transfusion care

Objetivo: verificar la actuación del equipo de enfermería durante la asistencia en terapéutica transfusional. Método: investigación descriptiva y exploratoria, con abordaje cuantitativo. Participaron del estudio treinta y un miembros del equipo de enfermería abarrotados en un hospital público y de enseñanza, habilitado como unidad de alta complejidad en oncología. Los datos fueron recolectados entre septiembre y diciembre de 2017 en dos etapas: por intermedio de entrevistas semiestructuradas y de un check list para observación. Los datos fueron agrupados, dispuestos en tablas y presentados en frecuencia simple y valores absolutos y también evaluados por análisis temático. Resultados: la mayoría de los profesionales mencionaron no sentirse aptos para prestar la asistencia transfusional. Se observó no conformidad en aplicar normas de bioseguridad, un ineficaz monitoreo del paciente y ausencia del registro de informaciones sobre la asistencia prestada. Conclusión: se destaca la importancia de la capacitación continua de los profesionales y la implementación de instrumentos que puedan asegurar la asistencia transfusional segura

Impact of Alarm Fatigue on the Work of Nurses in an Intensive Care Environment-A Systematic Review.

BACKGROUND: In conditions of intensive therapy, where the patients treated are in a critical condition, alarms are omnipresent. Nurses, as they spend most of their time with patients, monitoring their condition 24 h, are particularly exposed to so-called alarm fatigue. The purpose of this study is to review the literature available on the perception of clinical alarms by nursing personnel and its impact on work in the ICU environment. METHODS: A systematic review of the literature was carried out according to the guidelines of the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) protocol. The content of electronic databases was searched through, i.e., PubMed, OVID, EBSCO, ProQuest Nursery, and Cochrane Library. The keywords used in the search included: "intensive care unit," "nurse," "alarm fatigue," "workload," and "clinical alarm." The review also covered studies carried out among nurses employed at an adult intensive care unit. Finally, seven publications were taken into consideration. Data were analyzed both descriptively and quantitatively, calculating a weighted average for specific synthetized data. RESULTS: In the analyzed studies, 389 nurses were tested, working in different intensive care units. Two studies were based on a quality model, while the other five described the problem of alarms in terms of quantity, based on the HTF (Healthcare Technology Foundation) questionnaire. Intensive care nurses think that alarms are burdensome and too frequent, interfering with caring for patients and causing reduced trust in alarm systems. They feel overburdened with an excessive amount of duties and a continuous wave of alarms. Having to operate modern equipment, which is becoming more and more advanced, takes time that nurses would prefer to dedicate to their patients. There is no clear system for managing the alarms of monitoring devices. CONCLUSION: Alarm fatigue may have serious consequences, both for patients and for nursing personnel. It is necessary to introduce a strategy of alarm management and for measuring the alarm fatigue level.

The influence of nursing activities score on clinical alarms service.

OBJECTIVES: to estimate the magnitude of the Nursing Activities Score effect on multiparametric monitor alarm response and staff response time. METHODS: an observational, cross-sectional study outlined as an open cohort, performed in an Adult General Intensive Care Unit. The time taken for alarms triggered by the multi-parameter monitors was timed and characterized as attended or not. RESULTS: the study obtained a total of 254 alarms triggered from the multiparameter monitors of 63 patients. The mean number of alarms triggered was 4.5 alarms per period/observation and 1.5 alarms/hour. The study showed that the Nursing Activities Score is associated with an additional probability of 4% (p < 0.05) of an alarm being met, for each additional point in the scale, and reduction in team response time. CONCLUSION: it has been verified that Nursing Activities Score has a direct relationship with the attendance and with the response time to the alarms triggered.

Educational Program for Physiologic Monitor Use and Alarm Systems Safety: A Toolkit.

Clinical alarm systems safety is a national healthcare concern in the United States. Physiologic monitors are the medical devices associated with the highest number of false and clinically insignificant alarms, producing alarm fatigue and a challenge to meet the national clinical alarm systems safety goal. Modern physiologic monitors are high-tech complex devices with multimeasurement modalities and high sensitivity for alarms. This complexity hinders safe operation of the monitors by nurses and appropriate management of associated alarms. Nurses need to integrate cognitive knowledge, psychomotor skills, and critical thinking to safely operate the monitors and support clinical decisions. Limited resources are available to support clinical education for nurses on physiologic monitor use and alarm management. This toolkit presents an educational framework for physiologic monitor use and alarm safety guided by adult learning principles. The components of the program are (1) knowledge, skills, and attitude of physiologic monitor use; (2) scenario-based learning model to support the knowledge, skills, and attitude necessary for safe monitor use; and (3) a framework for evaluating the educational program. Education should be ongoing and customized per facility to ensure safe use of complex technology and to decrease alarm fatigue, the leading cause of alarm-related sentinel events.

What is the nursing time and workload involved in taking and recording patients' vital signs? A systematic review.

AIMS AND OBJECTIVES: To synthesise evidence regarding the time nurses take to monitor and record vital signs observations and to calculate early warning scores. BACKGROUND: While the importance of vital signs' monitoring is increasingly highlighted as a fundamental means of maintaining patient safety and avoiding patient deterioration, the time and associated workload involved in vital signs activities for nurses are currently unknown. DESIGN: Systematic review. METHODS: A literature search was performed up to 17 December 2019 in CINAHL, Medline, EMBASE and the Cochrane Library using the following terms: vital signs; monitoring; surveillance; observation; recording; early warning scores; workload; time; and nursing. We included studies performed in secondary or tertiary ward settings, where vital signs activities were performed by nurses, and we excluded qualitative studies and any research conducted exclusively in paediatric or maternity settings. The study methods were compliant with the PRISMA checklist. RESULTS: Of 1,277 articles, we included 16 papers. Studies described taking vital signs observations as the time to measure/collect vital signs and time to record/document vital signs. As well as mean times being variable between studies, there was considerable variation in the time taken within some studies as standard deviations were high. Documenting vital signs observations electronically at the bedside was faster than documenting vital signs away from the bed. CONCLUSIONS: Variation in the method(s) of vital signs measurement, the timing of entry into the patient record, the method of recording and the calculation of early warning scores values across the literature make direct comparisons of their influence on total time taken difficult or impossible. RELEVANCE TO CLINICAL PRACTICE: There is a very limited body of research that might inform workload planning around vital signs observations. This uncertainty means the resource implications of any recommendation to change the frequency of observations associated with early warning scores are unknown.

Team-Based Intervention to Reduce the Impact of Nonactionable Alarms in an Adult Intensive Care Unit.

BACKGROUND: Nonactionable alarms comprise over 70% of alarms and contribute a threat to patient safety. Few studies have reported approaches to translate and sustain these interventions in clinical settings. PURPOSE: This study tested whether an interprofessional team-based approach can translate and implement effective alarm reduction interventions in the adult intensive care unit. METHODS: The study was a prospective, cohort, pre- and postdesign with repeated measures at baseline (preintervention) and post-phase I and II intervention periods. The settings for the most prevalent nonactionable arrhythmia and bedside parameter alarms were adjusted during phases I and II, respectively. RESULTS: The number of total alarms was reduced by 40% over a 14-day period after both intervention phases were implemented. The most prevalent nonactionable parameter alarms decreased by 47% and arrhythmia alarms decreased by 46%. CONCLUSIONS: It is feasible to translate and sustain system-level alarm management interventions addressing alarm fatigue using an interprofessional team-based approach.

The influence of nursing activities score on clinical alarms service / La influencia de la nursing activities score en el servicio de alarmas clínicas / A influência do nursing activities score no atendimento aos alarmes clínicos

ABSTRACT Objectives: to estimate the magnitude of the Nursing Activities Score effect on multiparametric monitor alarm response and staff response time. Methods: an observational, cross-sectional study outlined as an open cohort, performed in an Adult General Intensive Care Unit. The time taken for alarms triggered by the multi-parameter monitors was timed and characterized as attended or not. Results: the study obtained a total of 254 alarms triggered from the multiparameter monitors of 63 patients. The mean number of alarms triggered was 4.5 alarms per period/observation and 1.5 alarms/hour. The study showed that the Nursing Activities Score is associated with an additional probability of 4% (p < 0.05) of an alarm being met, for each additional point in the scale, and reduction in team response time. Conclusion: it has been verified that Nursing Activities Score has a direct relationship with the attendance and with the response time to the alarms triggered.

RESUMEN Objetivos: estimar la magnitud del efecto del Nursing Activities Score en la atención a las alarmas de los monitores multiparamétricos y en el tiempo de respuesta del equipo. Métodos: estudio observacional, seccional delineado como una cohorte abierta, realizado en una Unidad de Terapia Intensiva General de Adultos. El tiempo hasta la atención de las alarmas disparadas de los monitores multiparamétricos fue cronometrado y caracterizados como atendidos o no. Resultados: el estudio obtuvo un total de 254 alarmas disparadas de los monitores multiparamétricos de 63 pacientes. El promedio de alarmas disparadas fue de 4,5 alarmas por período/observación y 1,5 alarmas/hora. El estudio demostró que el Nursing Activities Score está asociado a una probabilidad adicional de 4% (p < 0,05) de una alarma ser atendida, para cada punto adicional en la escala, y reducción en el tiempo de respuesta del equipo. Conclusiones: se verificó que Nursing Activities Score tiene relación directa con la atención y con el tiempo de respuesta a las alarmas disparadas.

RESUMO Objetivos: estimar a magnitude do efeito do Nursing Activities Score no atendimento aos alarmes dos monitores multiparamétricos e no tempo de resposta da equipe. Métodos: estudo observacional, seccional delineado como coorte aberta, realizado em uma Unidade de Terapia Intensiva geral de adultos. O tempo até o atendimento dos alarmes disparados dos monitores multiparamétricos foi cronometrado e caracterizado como atendido ou não. Resultados: o estudo obteve um total de 254 alarmes disparados dos monitores multiparamétricos de 63 pacientes. A média de alarmes disparados foi de 4,5 alarmes por período/observação e 1,5 alarmes/hora. O estudo demonstrou que o Nursing Activities Score está associado a uma probabilidade adicional de 4% (p < 0,05) de um alarme ser atendido, para cada ponto adicional na escala, e redução no tempo de resposta da equipe. Conclusões: verificou-se que Nursing Activities Score possui relação direta com o atendimento e com o tempo de resposta aos alarmes disparados.

A vigilância da pessoa em situação crítica submetida a ventilação não invasiva: a intervenção especializada em enfermagem / Surveillance of the person in critical situation submitted to non-invasive ventilation: the specialized intervention in nursing

O presente relatório, ancorado no tema A Vigilância da Pessoa em Situação Crítica submetida a Ventilação Não Invasiva: Uma Intervenção Especializada em Enfermagem, demonstra o percurso de aquisição de competências no âmbito da Unidade Curricular Estágio com Relatório, do 9º Curso de Mestrado em Enfermagem na Área de Especialização à Pessoa em Situação Crítica da Escola Superior de Enfermagem de Lisboa. Os estágios, realizados em contexto de Unidade de Cuidados Intensivos e em Serviço de Urgência, tiveram como objetivo geral desenvolver competências especializadas na prestação de cuidados à pessoa em situação crítica submetida a ventilação não invasiva e sua família, com especial foco na vigilância. O referencial teórico escolhido foi a Teoria da Vigilância de Meyer e Lavin e a Teoria de Benner. A vigilância profissional de enfermagem reúne um estado de observação e de atenção à pessoa no seu processo de doença crítica, com identificação de sinais e sintomas clinicamente significativos; o cálculo do risco inerente à prática de enfermagem; a formação para agir de forma eficaz e eficiente, minimizando os riscos e complicações (Meyer & Lavin, 2005). A vigilância de enfermagem, dando enfase à deteção precoce de problemas, pode ser observada como uma primeira forma de defesa do indivíduo, que contribuirá para a melhoria do seu estado de saúde (Benner, 2001). A ventilação não invasiva (VNI) é utilizada cada vez mais em situações de insuficiência respiratória aguda e/ou crónica, consistindo na aplicação de um suporte ventilatório mecânico sem recurso a métodos invasivos, através de um interface, em doentes com estímulo respiratório (Fonseca & Fontes, 2013). O enfermeiro tem ao seu dispor estratégias e técnicas que contribuem não exclusivamente para o aumento da eficácia da VNI, como também para a redução dos fatores de intolerância a esta terapêutica (Maciel, 2011). Para isso, é necessária uma vigilância eficaz e eficiente por parte do enfermeiro, prevenindo ou diminuindo as complicações que possam surgir.

The present report, The Surveillance of the Person in Critical Condition treated with Non-Invasive Ventilation: A Specialized Intervention in Nursing, demonstrates the course of acquiring skills within the Curricular Internship Unit of the 9th Master's Course in Nursing, Specializing in the Area for People with Critical Conditions at the Lisbon College School of Nursing. The internships, carried out in the context of the Intensive Care Unit and in the Emergency Department, had the general objective of developing specialized skills in providing care to the person in critical condition treated with non-invasive ventilation and their family, with a special focus on surveillance. The theoretical framework chosen was Meyer and Lavin's Theory of Surveillance and Benner's Theory. Professional nursing surveillance joins a state of observation and attention to the person with a critical illness, with the identification of clinically significant signs and symptoms, the calculation of the risk inherent to nursing practice, training to act effectively and efficiently, and minimizing risks and complications (Meyer & Lavin, 2005). Nursing surveillance and the emphasis on the early detection of problems can be seen as a first form of defense for the individual, which will contribute to the improvement of their health status (Benner, 2001). Non-Invasive ventilation (NIV) is increasingly used in situations of acute and/or chronic respiratory failure, consisting of the application of mechanical ventilation support without the use of invasive methods, through an interface, in patients with respiratory stimulus (Fonseca & Fontes, 2013). The nurse has at their disposal strategies and techniques that contribute not only to increase the effectiveness of NIV, but also to reduce factors of intolerance to this therapy (Maciel, 2011). For this, effective and efficient surveillance by the nurse is necessary, preventing or reducing the complications that may arise.

Pulse oximetry and the enduring neglect of respiratory rate assessment: a commentary on patient surveillance.

Clinical surveillance provides essential data on changes in a patient's condition. The common method for performing this surveillance is the assessment of vital signs. Despite the importance of these signs, research has found that vital signs are not rigorously assessed in clinical practice. Respiratory rate, arguably the most important vital sign, is the most neglected. Poor understanding might contribute to nurses incorrectly valuing oxygen saturation more than respiratory rate. Nurses need to understand the importance of respiratory rate assessment as a vital sign and the benefits and limitations of pulse oximetry as a clinical tool. By better understanding pulse oximetry and respiratory rate assessment, nurses might be more inclined to conduct rigorous vital signs' assessment. Research is needed to understand why many nurses do not appreciate the importance of vital signs' monitoring.

Improving Access to Laboratory Monitoring in Individuals Living with Serious Mental Illness.

Safe prescribing for persons with severe mental illness requires laboratory monitoring for psychotropic drug levels and metabolic side effects. Barriers to appropriate and timely monitoring increase when clients must obtain phlebotomy services at a separate facility. This quality improvement project was conducted within a program for assertive community treatment (PACT). Specific aims were to increase access to laboratory testing, improve efficiency, and lower costs by implementing on-site specimen collection. Outcomes, measured three months post-implementation, indicate that over half of all labs were obtained on-site, clients and staff were pleased with increased efficiencies, and costs were reduced by 37%.