Psicoprofilaxis quirúrgica en Pediatría. Evaluación de un programa fundamentado en la magia. / Surgical psychoprophylaxis in Pediatrics. Evaluation of a program based on magic

Introducción: La psicoprofilaxis quirúrgica permite poner en funcionamiento mecanismos defensivos capaces de amortiguar el impacto psicoafectivo y emocional que, potencialmente, implica la cirugía. Objetivo: Constatar la efectividad de un programa de psicoprofilaxis quirúrgica basada en la magia en la mejora de diversos indicadores de confort pre y postquirúrgicos. Método: Tras la realización de soporte psicoprofiláctico con un programa de pocos minutos basado en la magia, con grupo control equivalente, se han examinado diferentes aspectos relacionados con el dolor el estrés y la ansiedad pre y postquirúrgica en la infancia durante el ingreso e intervención quirúrgica en una muestra de 52 niños y sus correspondientes padres. Resultados y conclusión: Se han hallado evidencias de una menor presencia de estrés y ansiedad en los niños del grupo experimental frente al grupo control, así como el aumento en la transmisión de emociones positivas con los padres durante su ingreso y transcurso de la cirugía, y una significativa disminución de la ansiedad pre-quirúrgica. Por último, el grupo de psicoporfilaxis basado en la magia presenta, de manera estadísticamente significativa, menos dolor y menos ansiedad postoperatoria que el grupo control. (AU)

Introduction: the surgical psycho-prophylaxis alows us to put into action defensive mechanisms which are able to soften the psychoaffective and emotional impact which, potentially, implies the surgery. Objective: To prove the effectiveness of a surgical prophylactic programme based on the magic and in the improvement of several pre and post surgical comfort indicators. Method: After performing psycho-prophilactic support through a programme of a few minutes based on the magic, with an equivalent control group, we have examined different aspects related to pre and post surgical pain, stress and anxiety in children during their hospitalization and surgical intervention in a sample of 52 children and their parents. Results and conclusion: Evidences of lower levels of stress and anxiety have been observed in the experimental group of children in comparison with those of the control group,together with an improvement in the sharing of positive emotions with their parents during the hospitalization and surgery, and also less pre-surgical anxiety. Finally, the group of children whose prophilaxis is based on the magic shows, in a significant statistical way, less pain and less post-surgical anxiety than the control group. (AU)

Intervenciones de enfermería en la práctica social para la salud de la persona post-operada por lesión medular / Nursing interventions in social practice for the health of people post-operated by spinal injury

INTRODUCCIÓN: El profesional de enfermería colabora en la prestación de cuidado de la salud de personas que presentan invalidez congénita y adquirida. Las consecuencias asociadas a lesiones medulares no se derivan de la lesión en sí, sino de la falta de efectividad de los servicios de atención médica. OBJETIVO: Identificar intervenciones de enfermería en la práctica social para la salud de la persona posoperada por lesión medular. MÉTODO: Estudio cualitativo, abordaje descriptivo-exploratorio. Paciente posoperado por lesión medular, (Durango, México). Se utilizó la entrevista semiestructurada en el año 2020, a través del análisis de discurso oral. RESULTADOS: Se evidenció, la presencia de barreras sociales, que coartan el pleno desarrollo y participación de la persona con discapacidad por lesión medular en su diario vivir con la familia, comunidad y sociedad. También la autonomía de la persona no sólo se coarta al hecho de realizar tareas o labores o participar con otras personas. Incluso engloba las capacidades de pensar, de decidir por ellos, decidiendo por sí solo y que estas decisiones sean respetadas por los demás. CONCLUSIONES: Se hace necesaria la contribución del profesional de enfermería en las Políticas Públicas en el ámbito local y del país donde se propongan y establezcan, estrategias acordes a la prestación de servicios: atención a la enfermedad, promoción, prevención y rehabilitación incluyéndolo en las actividades y servicios sociales; por otra parte las necesidades de las personas con discapacidades deben considerarse también en las políticas, programas y proyectos desarrollados a nivel local y nacional. Estas personas deben tener acceso a los servicios acostumbrados, sostenidos con servicios especializados para mejorar de esta manera la calidad de vida de la persona con discapacidad.

INTRODUCTION: The nursing professional collaborates in the provision of health care for people with congenital and acquired disabilities. The consequences associated with spinal cord injuries do not derive from the injury itself, but from the lack of effectiveness of medical care services. OBJECTIVE: To identify nursing interventions in social practice for the health of the post-operated person for spinal cord injury. Method: Qualitative study, descriptive-exploratory approach. Postoperative patient for spinal cord injury, (Durango, Mexico). The semi-structured interview was used in the year 2020, using oral discourse analysis. RESULTS: The presence of social barriers was evidenced, which restrict the full development and participation of the person with disabilities due to spinal cord injury in her daily life with the family, community and society. Also the autonomy of the person is not only limited to the fact of carrying out tasks or tasks or participating with other people. It even encompasses the ability to think, to decide for them, deciding for themselves and for these decisions to be respected by others. CONCLUSIONS: The contribution of the nursing professional is necessary in Public Policies at the local level and in the country where strategies according to the provision of services are proposed and established: care for illness, promotion, prevention and rehabilitation, including it in the activities and social services; on the other hand, the needs of people with disabilities must also be considered in the policies, programs and projects developed at the local and national levels. These people must have access to the usual services, supported by specialized services to improve the quality of life of the person with disabilities.

Post-discharge after surgery Virtual Care with Remote Automated Monitoring-1 (PVC-RAM-1) technology versus standard care: randomised controlled trial.

OBJECTIVE: To determine if virtual care with remote automated monitoring (RAM) technology versus standard care increases days alive at home among adults discharged after non-elective surgery during the covid-19 pandemic. DESIGN: Multicentre randomised controlled trial. SETTING: 8 acute care hospitals in Canada. PARTICIPANTS: 905 adults (≥40 years) who resided in areas with mobile phone coverage and were to be discharged from hospital after non-elective surgery were randomised either to virtual care and RAM (n=451) or to standard care (n=454). 903 participants (99.8%) completed the 31 day follow-up. INTERVENTION: Participants in the experimental group received a tablet computer and RAM technology that measured blood pressure, heart rate, respiratory rate, oxygen saturation, temperature, and body weight. For 30 days the participants took daily biophysical measurements and photographs of their wound and interacted with nurses virtually. Participants in the standard care group received post-hospital discharge management according to the centre's usual care. Patients, healthcare providers, and data collectors were aware of patients' group allocations. Outcome adjudicators were blinded to group allocation. MAIN OUTCOME MEASURES: The primary outcome was days alive at home during 31 days of follow-up. The 12 secondary outcomes included acute hospital care, detection and correction of drug errors, and pain at 7, 15, and 30 days after randomisation. RESULTS: All 905 participants (mean age 63.1 years) were analysed in the groups to which they were randomised. Days alive at home during 31 days of follow-up were 29.7 in the virtual care group and 29.5 in the standard care group: relative risk 1.01 (95% confidence interval 0.99 to 1.02); absolute difference 0.2% (95% confidence interval -0.5% to 0.9%). 99 participants (22.0%) in the virtual care group and 124 (27.3%) in the standard care group required acute hospital care: relative risk 0.80 (0.64 to 1.01); absolute difference 5.3% (-0.3% to 10.9%). More participants in the virtual care group than standard care group had a drug error detected (134 (29.7%) v 25 (5.5%); absolute difference 24.2%, 19.5% to 28.9%) and a drug error corrected (absolute difference 24.4%, 19.9% to 28.9%). Fewer participants in the virtual care group than standard care group reported pain at 7, 15, and 30 days after randomisation: absolute differences 13.9% (7.4% to 20.4%), 11.9% (5.1% to 18.7%), and 9.6% (2.9% to 16.3%), respectively. Beneficial effects proved substantially larger in centres with a higher rate of care escalation. CONCLUSION: Virtual care with RAM shows promise in improving outcomes important to patients and to optimal health system function. TRIAL REGISTRATION: ClinicalTrials.gov NCT04344665.

Percepciones de profesionales de Enfermería y pacientes adultos en el proceso quirúrgico / Perceptions by nursing professionals and adult patients on the surgical process

Objetivo: conocer las percepciones del profesional de Enfermería y del paciente adulto a lo largo del proceso quirúrgico.Método: se realizó una revisión integrativa de artículos cualitativos, considerando las recomendaciones de Crossetti. Se planteó la pregunta de investigación siguiendo las recomendaciones del sistema SPICE. Se utilizó el método analítico SALSA de revisión, efectuada en las bases de datos Medline (PubMed), Web of Sciencie, SciELO, BVS, Lilacs, Benf, IBECS, CUMED, entre los años 2015-2020, utilizando los descriptores: cirugía, paciente, Enfermería, en idioma inglés, español y portugués. A los artículos encontrados se aplicaron filtros, criterios de inclusión y exclusión, y los criterios de calidad de Calderón.Resultados: se seleccionaron 22 artículos, que constataron cuatro dimensiones o áreas sobre las percepciones del paciente y de la enfermera del proceso quirúrgico: periodo preoperatorio, periodo post-operatorio, relación enfermera–paciente, seguridad.Conclusiones: es importante que el equipo de salud identifique cada una de estas áreas. Al indagar en las percepciones de profesionales y pacientes se constató que las enfermeras consideran a la persona que será intervenida quirúrgicamente como un todo, único e individual, lo cual le permite orientar su rol de gestor del cuidado en todo el proceso operatorio. El paciente, por su parte, se empeña en la existencia de una buena comunicación, que le permita disminuir sus temores.(AU)

Objective: to understand the perceptions by nursing professionals and adult patients throughout the surgical process.Method: an integrative review on qualitative articles was conducted, taking into account the recommendations by Crossetti. The research question was put forward following the SPICE system recommendations. The SALSA analytical method was used for review, conducted on the Medline (PubMed), Web of Sciencie, SciELO, BVS, Lilacs, Benf, IBECS, and CUMED databases, from 2015 to 2020, using the following descriptors in English, Spanish and Portuguese: surgery, patient, Nursing. The articles found were submitted to filters, inclusion and exclusion criteria, and the quality criteria by Calderón.Results: in total, 22 articles were selected, which confirmed four dimensions or areas on the perceptions by patients and nurses about the surgical process: perioperative period, post-operative period, nurse-patient relationship, safety.Conclusions: it is important that the healthcare team can identify each of these areas. When probing into the perceptions of professionals and patients, it was confirmed that nurses considered the person to undergo surgery as a whole, unique and individual, which allowed to orientate their role as care managers throughout the surgical process. On the other hand, patients insisted on the existence of good communication, which would allow them to reduce their fears.(AU)

Understanding the issues experienced by older people undergoing emergency surgery.

The number of older people undergoing surgery in the UK is increasing, partly due to an ageing population and advances in surgical techniques. However, outcomes for older patients who have undergone surgery are suboptimal when compared with younger people, especially following emergency surgery. To minimise the risk of adverse events affecting older people following surgery, it is essential that nurses understand how to manage common challenges for this patient group such as delirium, pain, reduced mobility and inadequate hydration.

Ansiedade perioperatória em adolescentes: manifestações e necessidades de controlo. Revisão integrativa / Perioperative anxiety in adolescents: manifestations and control needs. An integrative review

Background: In a phase of development as complex as adolescence, the surgical experience is a great challenge. While there is some knowledge about manifestations of anxiety in children, less is known about manifestations of anxiety in adolescents. Likewise, the knowledge about adolescents needs for control of anxiety in the perioperative period is missing. Aims: To synthesize the existing research on the manifestations of anxiety in adolescents in the perioperative period and to identify the adolescents needs for control of anxiety in the perioperative period. Methods: An integrative review was conducted using a literature search in five different health databases. Only original studies related to the study topic were included. A six-step method was used to develop the revision and to analyze the results. Results: Of the 251 articles initially selected, only five met the inclusion criteria. A total of 114 adolescents from five different countries were represented. The manifes-tations of anxiety were grouped in psychological, social and physical. These manifes-tations were mostly related with fear of surgery, how would they deal with pain, body image change, anxiety itself and the separation from their friends. The needs were 'to be informed' and 'to be involved in the decisions about their own care process'. Conclusions: The adolescents have manifestations of anxiety and specific needs to deal with perioperative anxiety, which need to be taken into account in the planning of perioperative care. Further research is needed to promote the development of an evidence-based program tailored to answer to the adolescent's needs and to minimize their manifestations of anxiety in the perioperative period

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Perfil diagnóstico de pacientes sometidos a retirada de órgano fundamentado en escalas de evaluación / Perfil diagnóstico de pacientes submetidos à retirada de órgão fundamentado em escalas de avaliação / Profile diagnosis in patients submitted to organ removal based on assessment scales

OBJETIVO: Identificar el perfil de los diagnósticos de enfermería de la NANDA-I de pacientes quirúrgicos sometidos a la retirada de órgano fundamentado por el uso de las escalas de evaluación y trazar el perfil socio clínico demográfico de esa población. MÉTODO: Estudio transversal. Población compuesta por 60 pacientes quirúrgicos hospitalizados en postoperatorio de cirugía de retirada de órgano, después del cálculo muestral. El análisis fue realizado por medio de medidas de tendencia central, media y mediana, y de dispersión, frecuencia absoluta y simple de las variables cuantitativas. Se utilizó el software Excel (R) 2016. Los resultados fueron expresados por medio de tablas. RESULTADOS: Se aplicaron cinco escalas de evaluación. Se obtuvieron 1022 diagnósticos de enfermería basados en la NANDA-I, 93 diagnósticos diferentes, con media de 16,39 por paciente. Siendo 67 co foco en el problema, 23 de riesgo y 3 de promoción de la salud. Los diagnósticos con frecuencia superiores al 50% totalizaron 11, los cuales fueron discutidos. Los dominios sobresalientes fueron: Actividad/Hogar y Seguridad/Protección. CONCLUSIÓN: Se identificó una alta concentración de diagnósticos en esa población. La cantidad de diagnósticos planteados y su diversidad identifican las diferentes áreas del cuidado que el enfermero debe estar apto para prestar sus cuidados, además identificar esas informaciones deposita en el enfermero mayor poder de cuidado sobre el paciente. El estudio demostró la importancia del uso de escalas de evaluación que subsidien los diagnósticos de enfermería. La investigación aún apunta la importancia del uso del diagnóstico de enfermería como forma de cuidado efectivo

OBJETIVO: Realizar o levantamento do perfil dos diagnósticos de enfermagem da NANDA-I de pacientescirúrgicos submetidos à retirada de órgão fundamentado pelo uso das escalas de avaliação e traçar operfil sócio clínico demográfico dessa população. MÉTODO: Estudo transversal. População composta por 60 pacientes cirúrgicos hospitalizados em pósoperatóriode cirurgia de retirada de órgão, após cálculo amostral. A análise foi realizada por meio demedidas de tendência central, média e mediana, e de dispersão, frequência absoluta e simples dasvariáveis quantitativas. Utilizou-se o software Excel (R) 2016. Os resultados foram expressos por meiode tabelas. RESULTADOS: Foram aplicadas cinco escalas de avaliação. Obtiveram-se 1022 diagnósticos deenfermagem baseados na NANDA-I, 93 títulos diagnósticos distintos, com média de 16,39 porpaciente. Sendo 67 com foco no problema, 23 de risco e 3 de promoção da saúde. Os diagnósticoscom frequência superior a 50% totalizaram onze, os quais foram discutidos. Os domínios queconcentraram a maior parte dos diagnósticos de enfermagem foram: Atividade/Repouso eSegurança/Proteção. CONCLUSÃO: Foi identificada uma alta concentração de diagnósticos nessa população. A quantidade dediagnósticos levantadas e sua diversidade identificam as diferentes áreas do cuidado que o enfermeirodeve estar apto para prestar seus cuidados, além de que o levantamento dessas informações depositano enfermeiro maior poder de cuidado sobre o paciente. O estudo demonstrou a importância do uso deescalas de avaliação que subsidiem os diagnósticos de enfermagem. A pesquisa ainda aponta aimportância do uso do diagnóstico de enfermagem como forma de cuidado efetivo

MAIN GOAL: Perform the survey of NANDA-I nursing diagnoses profile of surgical patients submitted toorgan removal based on the use of the evaluation scales and to trace the socio-demographic clinicalprofile of this population. METHODS: Cross-sectional study. The population comprised of 60 surgical patients hospitalized inpostoperative of organ removal surgery, after sample calculation. The analysis was performed bymeans of central, middle and median trend measures, and dispersion, absolute and simple frequency ofquantitative variables. Excel (R) 2016 software was used. The results were expressed by means oftables. RESULTS: Five scales of evaluation were applied. There were 1022 nursing diagnoses based onNANDA-I, with 93 different diagnostic titles, with an average of 16.39 per patient. Being 67 focused onthe problem, 23 risk and 3 health promotion. The diagnoses with frequency greater than 50% totaledeleven, which were discussed. The domains that concentrated the majority of the nursing diagnoseswere: Activity/Rest and Safety/Protection. CONCLUSION: A high concentration of diagnoses in this population was identified. The number ofdiagnoses raised and their diversity identifies the different areas of care that the nurse must be able toprovide care, and the collection of this information places the nurse greater power of care on the patient.The study demonstrated the importance of the use of evaluation scales that subsidize nursingdiagnoses. The research also points out the importance of using nursing diagnosis as a form of effectivecare

OR Time and Sacral Pressure Injuries in Critically Ill Surgical Patients.

Critically ill patients are at risk for developing pressure injuries during operative and other invasive procedures. The purpose of this secondary analysis was to explore the relationship of OR time to sacral pressure injuries in critically ill patients using high frequency ultrasound as a method of assessment. The 41 participants examined in this study had both time in the OR and up to eight days of pressure injury data. The multivariable model containing OR bed time, body mass index, and Braden Scale score produced the best prediction of pressure injury (area under the curve = 0.859). A higher body mass index (P = .09), shorter OR bed time (P = .01), and lower Braden Scale score (P = .05) were associated with a greater chance of pressure injury. These results suggest that use of high frequency ultrasound may identify tissue changes before observable skin changes, leading to earlier pressure injury prevention strategies.

Barriers and facilitators for implementing the WHO's safety surgical checklist: A focus group study among nurses.

The World Health's Organization's safety surgical checklist has been described as a means for increasing patient safety during surgical procedures. However, its full implementation has not yet been achieved worldwide. The aim of this study, via a focus group study among nurses, was to explore the factors that serve as barriers and facilitators for the list's implementation. Findings reveal that the use of the checklist can be compromised by many factors but also supported by others.

Study on physiological and psychological comprehensive nursing of elderly tumor patients after surgery.

The aim of this study is to formulate nursing schemes for elderly tumor patients after surgery according to their clinical characteristics, and give effective guidance for alleviating the patients’ psychological anxiety. One hundred elderly tumor patients admitted to the oncology department of the Affiliated Cancer Hospital of Harbin Medical University were included and divided into an intervention group (50) and a control group (50). Nursing intervention was performed on the intervention group, and routine nursing was performed in the control group. One day before surgery, all the patients were asked to fill in a self-rating anxiety scale (SAS) and a self-rating depression scale (SDS), and their blood pressure and heart rate data were measured. After surgery, the patients were asked to fill in a form which investigated their pain degree, recovery situation and satisfaction degree. The heart rate and blood pressure of the patients in the intervention group recovered faster than those of the control group, with lower SAS and SDS scores and shorter recovery time. In conclusion, effective nursing intervention played a crucial role in the postoperative recovery of elderly tumor patients by reducing pain and anxiety degrees, which improved the patients’ satisfaction with the nursing.

Tecnologia para segurança do cuidado intraoperatório obstétrico: validação de uma lista de verificação / Technology for the safety of intraoperative obstetric care: validation of a checklist

A segurança do paciente é uma preocupação no Centro Cirúrgico, especialmente na particularidade da obstetrícia, onde a utilização de uma lista de verificação tem o potencial para reduzir os eventos adversos. Os objetivos foram: Construir uma tecnologia - Lista de Verificação de Segurança Cirúrgica Obstétrica (LIVESCO) para o atendimento intraoperatório; Validar tal lista de verificação de segurança cirúrgica obstétrica utilizada no atendimento intraoperatório a partir dos seus itens; e Discutir os limites e possibilidades da aplicabilidade dessa tecnologia no campo de segurança da assistência obstétrica e suas contribuições aos cuidados de enfermagem. Estudo de validação, quantitativo, desenvolvido em duas fases: a primeira fase foi uma revisão integrativa para a construção da lista de verificação, que foi realizada nas bases de dados Lilacs, Medline, Cinahl e Scopus com a utilização de critérios de seleção e descritores específicos. O corpus final foi de onze artigos e a partir da síntese das evidências captou-se os itens para a construção da lista, cujo protótipo foi organizado em momentos cirúrgicos e em seções de checagem. A segunda fase foi a validação de conteúdo da lista com 37 juízes, especialistas da área, que responderam um questionário online no qual avaliaram o design da lista e o seu conteúdo quanto à relevância, concisão, precisão, pertinência e clareza com base numa escala Likert. Para análise, aplicou-se o índice de validação de conteúdo (>85%). Dois testes complementares foram realizados: o Alfa de Cronbach e o Kappa de Fleiss para avaliar a confiabilidade da lista e a concordância entre os juízes. Verificou-se que o Índice de Validade de Conteúdo foi: do design da lista de 95,0; do cabeçalho de 100,0; do primeiro momento da lista de 96,1; do segundo momento de 95,5; e do terceiro momento de 98,9. Com isso, o Índice de Validade de Conteúdo de todas as seções de checagem presentes nos três momentos cirúrgicos foi de 97,1, constatando-se que a lista apresentou relevância, concisão, precisão, clareza e pertinência nos itens presentes nas seções de checagem. O valor do Alpha de Cronbach da lista foi de 95,57% (quase-perfeita) e o valor do Kappa de Fleiss de 0,29 (concordância mediana). Os resultados da validação do conteúdo da lista evidenciaram itens que obtiveram o consenso entre os especialistas, além de recomendações acerca da inserção na lista de itens gerais e outros específicos da área obstétrica, cuja análise da pertinência foi feita no confronto com a literatura científica. Após essa fase, a versão final da lista foi criada. Espera-se que esta lista possa ser utilizada por unidades de saúde como um instrumento fortalecedor da cultura de segurança no ambiente cirúrgico, auxiliando as equipes cirúrgicas no atendimento à paciente obstétrica com segurança.

Patient safety is a concern in the Surgical Center, especially in obstetrics, where the use of a checklist has the potential to reduce adverse events. The objectives were: Building a technology - Surgical Obstetric Safety Checklist (Lista de Verificação de Segurança Cirúrgica Obstétrica, LIVESCO) for intra operative care; Validate this checklist of obstetric surgical safety used in intra operative care from its items; and Discuss the limits and possibilities of the applicability of this technology in the field of obstetric care security and its contributions to nursing care. Validation study, quantitative, developed in two phases: the first phase was an integrative review for the construction of the checklist, which was carried out in the Lilacs, Medline, Cinahl and Scopus databases using specific selection criteria and descriptors. The final corpus was eleven articles and from the synthesis of the evidence, the items for the construction of the list were captured, whose prototype was organized in surgical moments and in check sections. The second phase was the validation of the list's content with 37 judges, specialists in the field, who answered an online questionnaire in which they evaluated the list's design and its content regarding relevance, conciseness, precision, pertinence and clarity based on a Likert scale. For analysis, the content validation index (>85%) was applied. Two complementary tests were performed: Cronbach's Alpha and Fleiss' Kappa to assess the reliability of the list and the agreement between the judges. It was found that the Content Validity Index was: from the list design of 95.0; the header of 100.0; from the first moment on the 96.1 list; the second moment of 95.5; and the third moment, 98.9. Thus, the Content Validity Index of all checking sections present in the three surgical moments was 97.1, showing that the list presented relevance, conciseness, precision, clarity and relevance in the items present in the checking sections. The Cronbach's Alpha value in the list was 95.57% (almost perfect) and the Fleiss Kappa value was 0.29 (median agreement). The content validation results of the list showed items that obtained consensus among experts, in addition to recommendations about the inclusion in the list of general and other specific items in the obstetric area, whose analysis of relevance was made in comparison with the scientific literature. After this phase, the final version of the list was created. It is hoped that this list can be used by health units as an instrument to strengthen the safety culture in the surgical environment, assisting surgical teams in providing care to obstetric patients safely.

La seguridad del paciente es una preocupación en el Centro Quirúrgico, especialmente en obstetricia, donde el uso de una lista de control tiene el potencial de reducir los eventos adversos. Los objetivos fueron: Desarrollar una tecnología - Lista de control de seguridad obstétrica quirúrgica (LIVESCO, por su sigla en portugués) para la atención intraoperatoria; Aprobar esta lista de control de seguridad quirúrgica obstétrica utilizada en la atención intraoperatoria a partir de sus elementos; Discutir los límites y las posibilidades de su aplicabilidad en el campo de la seguridad de la atención obstétrica y sus contribuciones a la atención de enfermería. Estudio de validación, cuantitativo, desarrollado en dos etapas. En la primera, se llevó a cabo una revisión integradora para construir la lista de control, realizada en las bases de datos Lilacs, Medline, Cinahl y Scopus, utilizando criterios de selección y descriptores específicos. El corpus final fue de once artículos y, a partir de la síntesis de la evidencia, se recolectaron los elementos para construir la lista, cuyo prototipo se organizó en momentos quirúrgicos y en secciones de comprobación. En la segunda etapa, se validó el contenido de la lista con 37 expertos en el área, que respondieron a un cuestionario en línea en el que evaluaban el croquis de la lista y su contenido con respecto a la relevancia, concisión, precisión, pertinencia y claridad basadas en una escala Likert. Para el análisis, se aplicó el índice de validación de contenido (> 85%). Se realizaron dos pruebas complementarias: Alpha de Cronbach y Kappa de Fleiss para evaluar la confiabilidad de la lista y la concordancia entre los jueces. Se encontró que el Índice de Validez del Contenido era: 95, el croquis de la lista; 100, el encabezado; 96,1, desde el primer momento en la lista; 95,5, el segundo momento; y 98,9, el tercer momento. Así, el índice de validez de contenido de todas las secciones de verificación presentes en los tres momentos quirúrgicos fue de 97,1, lo que demuestra que la lista presenta relevancia, concisión, precisión, claridad y pertinencia en los ítems presentes en las secciones de verificación. El valor de Alfa de Cronbach en la lista fue de 95,57% (cuasi perfecto) y el valor de Kapiss de Fleiss fue de 0,29 (concordancia media). Los resultados de la validación del contenido de la lista mostraron ítems que obtuvieron consenso entre los especialistas, además de recomendaciones acerca de la inclusión en la lista de ítems generales y otros específicos en el área obstétrica, cuyo análisis de relevancia se realizó en comparación con la literatura científica. Luego de esta etapa, se creó la versión final de la lista. Se espera que esta lista pueda ser utilizada por las unidades de salud como un instrumento que fortalezca una cultura de seguridad en el entorno quirúrgico, ayudando a los equipos quirúrgicos a brindar atención a pacientes obstétricas de manera segura.

Plan de cuidados a un paciente portador de una sonda de gastrostomía / Plan of care for a patient with a gastrostomy catheter

Se expone el caso de un paciente portador de sonda de gastrostomía por presentar neoplasia del seno piriforme que impide la deglución. Cuando el paciente fue derivado a la consulta presentaba irritación importante de la piel que rodeaba la sonda de gastrostomía debido a la emisión continua de jugos gástricos, así como por pérdidas de alimentación provocadas por la holgura excesiva del estoma y dolor continuo en la zona. Dicha situación no permitía descansar al paciente, generándole sentimientos de preocupación y desánimo. Utilizando los patrones de Marjory Gordon se valoró al sujeto, identificando los diagnósticos enfermeros según la taxonomía de la North American Nursing Diagnosis Association (NANDA), los resultados según la Nursing Outcomes Classification (NOC) y las intervenciones enfermeras oportunas, siguiendo la Nursing Intervention Classification (NIC), para que el paciente adquiriera las habilidades necesarias para el manejo de su sonda de gastrostomía, supiera cómo administrar adecuadamente la alimentación y los medicamentos a través de la misma y mantuviera la integridad de la piel periestomal (AU)

We present the case of a patient with gastrostomy due to neoplasia in the pyriform sinus that prevented swallowing. When the patient was referred, he presented a major irritation of the skin around the gastrostomy catheter, due to the continuous production of gastric juices, as well as food losses caused by the excessive width of the ostomy and continuous pain in the area. Said situation prevented the patient from resting, and generated feelings of concern and discouragement. The patient was assessed using Marjory Gordon's patterns, identifying nursing diagnoses according to the taxonomy by the North American Nursing Diagnosis Association (NANDA), outcomes according to the Nursing Outcomes Classification (NOC), and the adequate nursing interventions, following the Nursing Intervention Classification (NIC), so that the patient acquired the skills needed to manage his gastrostomy catheter, learning how to administer adequately food and medications through it, and maintaining the integrity of peristomal skin (AU)

Miedo y ansiedad ante la operación quirúrgica. Técnicas e implicaciones / No disponible

A pesar de los avances producidos en los últimos años, una intervención quirúrgica representa para el paciente un momento de gran ansiedad provocado por el temor a afrontar una situación desconocida, la separación de su medio social habitual y las posibles complicaciones derivadas de la propia operación. El nivel de ansiedad que el paciente experimenta antes de la intervención predice en cierto grado la aparición de complicaciones en el posoperatorio. Es necesario que el equipo de enfermería esté presente desde el primer momento para proporcionar al paciente una estancia hospitalaria basada en un estado de confort al que le llevará la enseñanza de técnicas sencillas de relajación, una información adecuada en cuanto a su proceso y una escucha activa continua

Despite the progress made in the past years a surgical intervention represents preoperational anxiety which a common reaction experienced by patients who are anxious when facing surgery because of the unknown nature of the procedure and the outcome. The anxiety level that the patient experiences before surgery is related to how much a person believes complications can be predicted in the postoperative follow-up appointments. The presence of the nurse from the very beginning can decrease some anxiety by providing information about what can be expected. The nurse plays an essential role in preparing the patient for surgery, caring the patient during surgery and, teaching the patient breathing and relaxation exercises and facilitating the recovery, relevant information and active listening to all patients

Segurança do doente e os processos sociais na relação com enfermeiros em contexto de bloco operatório / La seguridad del enfermo y los procesos sociales en relación con enfermeros en el contexto de la sala de operaciones / Patient safety and social processes in the relationship with nurses in the operating room context

A segurança do doente é um problema global que afeta países em todos os níveis de desenvolvimento, visto os riscos de danos, lesões ou morte devido à prestação de cuidados de saúde insegura em contexto cirúrgico. Objetivou-se compreender a percepção de enfermeiros sobre a segurança do doente no contexto do bloco operatório. Estudo descritivo e exploratório, realizado em 50 momentos de observação participante e seis entrevistas semiestruturadas com enfermeiros do bloco operatório central, em um Hospital Público das ilhas de Sotavento, Cidade da Praia, em Cabo-Verde. A interpretação fundamentou-se nas técnicas de análise de conteúdo. Os preceitos éticos foram respeitados. A identidade cultural explicativa dos processos sociais naquele contexto evidenciou relação não favorável para a segurança do doente, nos aspectos lavagem cirúrgica das mãos com escovação durante 2 a 5 minutos, com solução de clorexidina, utilização de checklist para cirurgias seguras, verificação de indicadores de esterilização, gestão de conflitos e comunicação entre a equipe interdisciplinar, pessoa como centralidade dos cuidados. Os profissionais do bloco operatório e as institui- ções devem considerar normas, supervisões, auditorias e protocolos como pontos fortes para segurança do doente no contexto do bloco operatório (AU)

La seguridad del paciente es un problema global que afecta a los países en todos los niveles de desarrollo, debido a riesgo de daños, lesiones o muerte por no provisión segura de la atención de salud en el ámbito quirúrgico. El objetivo fue comprender la percepción de enfermeros sobre seguridad del paciente en el contexto de la sala de operaciones. Estudio descriptivo, en 50 momentos de la observación participante y seis entrevistas semiestructuradas con enfermeros de la sala de operaciones central en un hospital público de las Islas de Sotavento, Praia, en Cabo Verde. La interpretación se basa en técnicas de análisis de contenido. Se respetaron los principios éticos. La identidad cultural explicativa de los procesos sociales en aquello contexto señaló relación desfavorable para seguridad del paciente, en los aspectos lavado de manos quirúrgico con copelación durante 2-5 minutos con clorhexidina, uso de lista de comprobación para cirugía segura, verificación de indicadores de esterilización, gestión de conflictos y comunicación entre equipo interdisciplinario, persona como centralidad de la atención. Profesionales del quirófano y las instituciones deben considerar normas, supervisión, auditoría y protocolos como puntos fuertes para seguridad del paciente en el contexto de la sala de operaciones (AU)

Patient safety is a worldwide problem that affects countries in all levels of development, given the risk of damages, injuries or death due to unsafe health care provision in the surgical context. This study aimed to understand the perception of nurses about patient safety in the operating room context. Descriptive and exploratory study conducted in 50 moments of participant observation and 6 semistructured interviews with nurses from the central operating room in a Public Hospital of the Sotavento Islands, Praia, Cape Verde. For data interpretation, we applied content analysis techniques. The ethical principles were followed. The explanatory cultural identity of the social processes in that context revealed unfavorable relation to patient safety as regards the aspects of surgical hand scrubbing with 2- to 5-minute scrub with chlorhexidine, use of surgical safety checklist, verifying sterilization indicators, conflict management and communication among the interdisciplinary team, people as centrality of care. Both professionals in the operating room and institutions should consider standards, supervisions, audits, and protocols as strong points for patient safety in the operating room context (AU)

Caracterização da assistência ao parto em adolescentes primigestas no município de cuiabá-mt / Caracterización de la atención al parto en adolescentes primigestas en el municipio de cuiabá-mt / Characterization of pregnancy labor assistance of primigravida adolescents in the city of cuiabá-mt

RESUMO O objetivo foi analisar a assistência ao parto de adolescentes primigestas no contexto do Sistema Único de Saúde (SUS) no município de Cuiabá, Mato Grosso. Estudo transversal, descritivo e documental com amostragem aleatória simples composta por 164 prontuários de puérperas adolescentes coletados por meio de ficha estruturada durante os meses de dezembro de 2012 a maio de 2013. Foi realizada análise descritiva simples dos dados. Os resultados indicaram que o parto cesáreo apresentou taxa de 37,2%, a amniotomia foi adotada em 62,1%, a ocitocina em 53,4% e a episiotomia em 82,4%. A desproporção céfalo-pélvica representou 27,9% das indicações de cesariana e dentre as complicações maternas, a hemorragia destacou-se em ambos os tipos de parto. Conclui-se a existência de uma forte influência do modelo tecnicista sobre os resultados maternos na assistência obstétrica de adolescentes primigestas e que o fato do desconhecimento atrelado à vulnerabilidade deste grupo populacional evidencia a soberania do profissional em relação às decisões obstétricas.

RESUMEN El objetivo ha sido analizar la atención al parto de adolescentes primigestas en el contexto del Sistema Único de Salud (SUS) en el municipio de Cuiabá, Mato Grosso. Estudio transversal, descriptivo y documental con muestreo aleatorio simple compuesto de 164 registros médicos de puérperas adolescentes recogidos a través del formulario estructurado durante los meses de diciembre de 2012 hasta mayo de 2013. Fue realizado el análisis descriptivo simple de los datos. Los resultados indicaron que el parto por cesárea ha presentado tasa de 37,2%, la amniotomía fue adoptada en 62,1%, la oxitocina en 53,4% y la episiotomía en 82,4%. La desproporción cefalopélvica ha representado 27,9% de las indicaciones de la cesárea y entre las complicaciones maternas, la hemorragia se ha destacado en ambos tipos de parto. Se concluye que existe una fuerte influencia del modelo técnico sobre los resultados maternos en la atención obstétrica a las adolescentes primigestas y que el hecho del desconocimiento relacionado a la vulnerabilidad de este grupo poblacional evidencia la soberanía del profesional en relación a las decisiones obstétricas.

ABSTRACT It aimed to analyze labor assistance for primigravida adolescents in the context of the Unified Health System (SUS) in the city of Cuiabá, Mato Grosso. Cross-sectional, descriptive and documental study with a random sample composed of 164 medical records of postpartum adolescent collected through structured file during the months of December 2012 to May 2013. Data were analyzed through simple descriptive analysis. The results indicated that cesarean section showed rate of 37.2%, amniotomy was adopted in 62.1%, oxytocin 53.4% and 82.4% in the episiotomy. Cephalopelvic disproportion represented 27.9% of cesarean section indications and among maternal complications, hemorrhage stood out in both types of delivery. It is concluded that there is a strong influence of the technicist model on maternal outcomes in obstetric care to pregnant adolescents and that the lack of knowledge linked to the vulnerability of this group shows the professional sovereignty in relation to obstetric decisions.