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1.
Br J Nurs ; 29(4): 212-220, 2020 Feb 27.
Artigo em Inglês | MEDLINE | ID: mdl-32105527

RESUMO

Postoperative pain remains poorly managed for many patients. Effective pain management begins with accurate pain assessment, with patient self-reporting considered the most accurate measure of pain. This literature review aimed to identify how congruent nurses' assessments of pain were with patients' self-reporting. A search identified six observational studies and one quasi-experimental study that met the inclusion criteria. The findings from these studies were summarised under two themes: nurses' underestimation of patients' pain and nurses' knowledge and understanding of pain assessment. Some nurses' pain management knowledge was deemed inadequate, with evidence of negative attitudes towards managing pain in certain groups of patients. Educational interventions have so far had limited impact on correcting the ethical and professional problem of inadequate pain relief in many patients postoperatively. Randomised controlled trials are required to identify effective education interventions that can contribute to ending this avoidable suffering.


Assuntos
Avaliação em Enfermagem/estatística & dados numéricos , Medição da Dor/estatística & dados numéricos , Dor Pós-Operatória , Autorrelato , Humanos , Medição da Dor/enfermagem , Dor Pós-Operatória/enfermagem , Ensaios Clínicos Controlados Aleatórios como Assunto , Reprodutibilidade dos Testes
2.
Australas Emerg Care ; 23(1): 62-70, 2020 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-31699613

RESUMO

BACKGROUND: Emergency nurses are responsible for the initial assessment, management and safety of critically ill patients. HIRAID, an evidence-informed emergency nursing assessment framework, is known to improve emergency nursing patient-assessment in the simulated environment however has not been evaluated in the clinical setting. METHODS: A pre-post design was used to assess the usability and impact of HIRAID on emergency nurses self-efficacy in the emergency department (ED). Nursing and medical staff from three Australian EDs were surveyed. Descriptive and optimal pooled sample t-tests statistics were conducted. RESULTS: One hundred and two emergency nurses completed the pre-intervention self-efficacy survey and 63 completed the post-intervention self-efficacy and satisfaction survey. Forty-two and 17 medical officers completed the pre- and post-intervention satisfaction surveys, respectively. Nursing staff self-efficacy levels were unchanged pre- and post-HIRAID implementation (Mean (SD): 8.8 (0.21) vs. 8.7 (0.20)) as was medical staff satisfaction (Mean (SD):7.5 (1.43) vs. 7.8 (1.07)), although there was a trend towards improved communication. CONCLUSION: The HIRAID structured approach to patient assessment is acceptable, feasible, practical and appropriate for use in the clinical environment. Further research will demonstrate the direct effects of HIRAID on clinical performance.


Assuntos
Enfermagem em Emergência/métodos , Avaliação em Enfermagem/métodos , Adulto , Atitude do Pessoal de Saúde , Enfermagem em Emergência/normas , Enfermagem em Emergência/estatística & dados numéricos , Serviço Hospitalar de Emergência/organização & administração , Serviço Hospitalar de Emergência/estatística & dados numéricos , Enfermagem Baseada em Evidências/métodos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , New South Wales , Avaliação em Enfermagem/normas , Avaliação em Enfermagem/estatística & dados numéricos , Autoeficácia , Inquéritos e Questionários
3.
Am J Nephrol ; 50(6): 489-498, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31671419

RESUMO

BACKGROUND: Selection of patients for assisted peritoneal dialysis (PD) is based on the nurse's assessment of the patient. There is no data available about the nurse's assessment of the PD patient at the initiation of PD to estimate the need for assisted PD at the national level. This study was carried out to evaluate the association between the nurse's subjective assessment of the patient's inability to be treated by self-care PD, the nurse evaluation of the patient disabilities and the utilization of nurse or family assisted PD. METHODS: This was a retrospective study of patients starting PD between July 1, 2010 and 2015 and registered in the nurse section of the French Language PD Registry (RDPLF). Poisson regression and a linear regression model with a robust variance estimator were used for the statistical analysis to determine relative risks (RRs) and risk differences (RDs). RESULTS: Of 4,101 PD patients, 403 were treated by family assisted PD, and 1,695 were treated by nurse-assisted PD. In the multivariate analysis, the nurse's subjective assessment of the patient's inability to be treated by self-care PD was associated with nurse-assisted PD (5.40 [4.58-6.35], 67% [64-70%]) and family assisted PD (11.11 [8.49-14.56], RD 62% [57-67%]). Nurse-assisted PD and family assisted PD were associated with functional impairment (RR 1.25 [95% CI 1.16-1.36], RD 14% [95% CI 10-19%] and RR 2.02 [95% CI 1.69-2.41], RD 27% [95% CI 20-34%] respectively), cognitive dysfunction (RR 1.23 [95% CI 1.15-1.32], RD 15% [95% CI 11-18%] and RR 1.73 [95% CI 1.39-2.16], RD 12% [95% CI 7-18%] respectively) and deafness (RR 1.10 [95% CI 1.04-1.16], RD 8% [95% CI 5-11%] and RR 1.46 [95% CI 1.22-1.74], RD 10% [95% CI 6-14%] respectively). CONCLUSION: Our results showed that the nurse's subjective assessment of the patient's inability to be treated by self-care PD and the patient's disabilities were strongly associated with the utilization of nurse- and family assisted PD.


Assuntos
Avaliação da Deficiência , Serviços de Assistência Domiciliar/estatística & dados numéricos , Falência Renal Crônica/terapia , Avaliação em Enfermagem/estatística & dados numéricos , Diálise Peritoneal/estatística & dados numéricos , Autocuidado/estatística & dados numéricos , Adulto , Idoso , Idoso de 80 Anos ou mais , Cuidadores/estatística & dados numéricos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Sistema de Registros/estatística & dados numéricos , Estudos Retrospectivos , Fatores de Risco
4.
Br J Nurs ; 28(19): 1256-1259, 2019 Oct 24.
Artigo em Inglês | MEDLINE | ID: mdl-31680572

RESUMO

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.


Assuntos
Monitorização Fisiológica/enfermagem , Avaliação em Enfermagem/estatística & dados numéricos , Oximetria/enfermagem , Taxa Respiratória , Humanos , Monitorização Fisiológica/métodos , Sinais Vitais
5.
J Am Assoc Nurse Pract ; 31(11): 640-647, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31584509

RESUMO

Distance graduate nursing education has been expanding. Although many didactic courses are taught through an online platform, there are often challenges to providing skill-based courses, such as advanced physical assessment, through an online format. To prepare and assess advanced practice nursing students on their clinical knowledge and physical assessment skills, an online course was developed using multisource feedback and videography. Students used videography to record themselves as they conducted physical assessments on a volunteer patient. Students then critiqued their own video, critiqued two of their colleagues' videos, and the final critiques of the videos were conducted by faculty. All students were expected to perform and pass a complete physical examination on a standardize patient as their final examination. The final scores of the students learning through the online course were equivalent to the scores achieved by the students in the traditional face-to-face physical assessment course.


Assuntos
Educação a Distância/métodos , Educação de Pós-Graduação em Enfermagem/métodos , Profissionais de Enfermagem/educação , Avaliação em Enfermagem/métodos , Competência Clínica/normas , Currículo/normas , Educação a Distância/normas , Educação a Distância/estatística & dados numéricos , Educação de Pós-Graduação em Enfermagem/normas , Retroalimentação , Humanos , Internet , Avaliação em Enfermagem/estatística & dados numéricos , Avaliação de Programas e Projetos de Saúde/métodos , Estudantes de Enfermagem/estatística & dados numéricos
6.
Wound Manag Prev ; 65(12): 32-40, 2019 12.
Artigo em Inglês | MEDLINE | ID: mdl-31895685

RESUMO

The nursing culture in long-term care (LTC) settings may affect quality measures such as pressure injury (PrI) rates. PURPOSE: The study was conducted to evaluate the relevance of an LTC facility's nursing culture to both their quality measures and their staff's perceptions of care in the context of PrI prevention. METHODS: Directors of Nursing (DONs) in 4 purposively selected Medicare/Medicaid-certified skilled nursing facilities were invited by phone, agreed to participate in the 5-day project, and completed an initial 7-item, facility-related survey. Their staff completed the Nursing Culture Assessment Tool (NCAT), a pen-and-paper instrument that comprises 19 items regarding 6 principal dimensions of nursing culture (behaviors, expectations, teamwork, communication, satisfaction, and professional commitment) and participated in focus groups to discuss the NCAT and its findings using standardized probes of the perception of survey salience in relation to PrI prevention practices. Staff, including registered nurses, licensed practical nurses, and certified nursing assistants employed either part- or full-time at each facility, were eligible for study participation over a 5-day period. All data collection and analyses were conducted by the authors. Facility-related data were descriptive only. Analyses of variance were used to test differences in standardized NCAT scores by facility, and focus group transcripts were coded and subjected to structured thematic content analysis. RESULTS: One hundred, nine (109) people completed the NCAT, and 47 participated in focus groups. NCAT scores varied significantly by facility (P value range .001-.027). Staff comments about their respective facility's results focused primarily on communication and teamwork and included both agreement or disagreement with the facility's high or low scores in the context of PrI prevention, as well as suggestions for instrument administration. CONCLUSION: Examination of nursing culture using the NCAT can provide new and targeted perspectives on how frontline workers perceive barriers and facilitators to delivery of PrI prevention in LTC. To support the evidence base regarding their values and beliefs, future research on effective workplace change in LTC settings will require nuanced assessment of the meaning and impact of the nursing culture on worker performance.


Assuntos
Avaliação em Enfermagem/normas , Lesão por Pressão/prevenção & controle , Gestão da Segurança/normas , Grupos Focais/métodos , Humanos , Assistência de Longa Duração/organização & administração , Assistência de Longa Duração/normas , Assistência de Longa Duração/estatística & dados numéricos , Avaliação em Enfermagem/métodos , Avaliação em Enfermagem/estatística & dados numéricos , Cultura Organizacional , Lesão por Pressão/enfermagem , Pesquisa Qualitativa , Estados Unidos
7.
Cancer Nurs ; 42(2): E39-E47, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-29538023

RESUMO

BACKGROUND: Oncological diseases affect the biopsychosocial aspects of a person's health, resulting in the need for complex multidisciplinary care. The quality and outcomes of healthcare cannot be adequately assessed without considering the contribution of nursing care, whose essential elements such as the nursing diagnoses (NDs), nursing interventions (NIs), and nursing activities (NAs) can be recorded in the Nursing Minimum Data Set (NMDS). There has been little research using the NMDS in oncology setting. OBJECTIVE: The aim of this study was to describe the prevalence and distribution of NDs, NIs, and NAs and their relationship across patient age and medical diagnoses. METHODS: This was a prospective observational study. Data were collected between July and December 2014 through an NMDS and the hospital discharge register in an Italian hospital oncology unit. RESULTS: On average, for each of 435 enrolled patients, 5.7 NDs were identified on admission; the most frequent ND was risk for infection. During the hospital stay, 16.2 NIs per patient were planned, from which 25.2 NAs per day per patient were delivered. Only a third of NAs were based on a medical order, being the highest percentage delivered on nursing prescriptions. The number of NDs, NIs, and NAs was not related to patient age, but differed significantly among medical diagnoses. CONCLUSIONS: An NMDS can depict patient needs and nursing care delivered in oncology patients. Such data can effectively describe nursing contribution to patient care. IMPLICATIONS FOR PRACTICE: The use of an NMDS raises the visibility of nursing care in the clinical records. Such data enable comparison and benchmarking with other healthcare professions and international data.


Assuntos
Avaliação em Enfermagem/estatística & dados numéricos , Diagnóstico de Enfermagem/estatística & dados numéricos , Serviço Hospitalar de Enfermagem/estatística & dados numéricos , Enfermagem Oncológica/organização & administração , Adulto , Benchmarking/estatística & dados numéricos , Feminino , Humanos , Itália , Masculino , Avaliação de Resultados em Cuidados de Saúde , Alta do Paciente/estatística & dados numéricos , Estudos Prospectivos
8.
Rech Soins Infirm ; (132): 7-19, 2018 Mar.
Artigo em Inglês, Francês | MEDLINE | ID: mdl-29771101

RESUMO

Hemodialysis patients constitute a vulnerable population whose quality of life is affected by the many symptoms (e.g., pain, fatigue) they experience. The presence and severity of these symptoms are significantly under-assessed by health professionals. The purpose of this study was to describe and compare the symptoms perceived by hemodialysis patients versus those detected by nurses. A total of 123 patients and 70 nurses working in six hemodialysis centers were included in the study. The results show that participating nurses detected less than 50% of the symptoms perceived by patients. Agreement between hemodialysis patients and nurses regarding symptom presence and severity was slight to fair at best (kappa < 0.47). This suggests that improving the knowledge and skills of hemodialysis nurses for detecting the symptoms of the patients in their care could go a long way toward intervening more efficiently and improving the quality of the care they offer.


Assuntos
Atitude Frente a Saúde , Avaliação em Enfermagem/estatística & dados numéricos , Pacientes/psicologia , Diálise Renal/enfermagem , Índice de Gravidade de Doença , Humanos , Pesquisa em Avaliação de Enfermagem , Qualidade de Vida
9.
J Clin Nurs ; 27(9-10): 1826-1835, 2018 May.
Artigo em Inglês | MEDLINE | ID: mdl-29603810

RESUMO

AIM AND OBJECTIVES: To describe associations between patient fall risk and common symptoms among hospitalised inpatients. BACKGROUND: Predictors of falls have been identified in a variety of populations and settings, but the role of inpatients' symptom experience has not been adequately evaluated. DESIGN: Cross-sectional. METHODS: Participants included 614 medical and elective surgical patients in an acute hospital in Norway. Patient falls during hospitalisation were assessed by self-report and incident reports. Pain intensity and the occurrence and distress of 15 other symptoms were assessed by self-report. RESULTS: Patient falls were associated with male sex and having more comorbidities. Medical patients were more likely to fall than elective surgical patients. In logistic regression analyses, higher symptom counts were associated with increased risk of fall, with each additional symptom conferring a 15% increase in fall risk. Symptom distress related to concentration difficulties, lack of energy, sleep problems, nausea, vomiting and diarrhoea was associated with increased risk of fall, even after adjusting for the influence of age, sex and comorbidities (odds ratios ranged 2.3-4.8). Severe pain, as well as symptom distress related to drowsiness, itching, dizziness or swelling of arms/legs, was also associated with patient falls, although these associations were attenuated after accounting for age, sex and comorbidities. Overall, symptom distress was more strongly associated with fall risk than symptom occurrence. CONCLUSIONS: Symptom burden and distress may help identify hospital patients at risk for fall. Additional research is needed to determine whether symptoms are useful for assessing fall risk among hospital patients and other high-risk populations. If symptoms are useful indicators of fall risk, they should be considered for inclusion in standardised risk assessments. RELEVANCE TO CLINICAL PRACTICE: Clinicians ought to pay particular attention to increased fall risk among patients reporting many symptoms and those experiencing distress from concentration difficulties, fatigue, sleep problems, nausea, vomiting and diarrhoea.


Assuntos
Acidentes por Quedas/prevenção & controle , Pacientes Internados/estatística & dados numéricos , Avaliação em Enfermagem/estatística & dados numéricos , Medição de Risco , Acidentes por Quedas/estatística & dados numéricos , Idoso , Idoso de 80 Anos ou mais , Comorbidade , Estudos Transversais , Feminino , Humanos , Pacientes Internados/psicologia , Masculino , Pessoa de Meia-Idade , Avaliação em Enfermagem/métodos , Dor/complicações , Segurança do Paciente , Fatores de Risco , Autorrelato , Avaliação de Sintomas
10.
Eur J Emerg Med ; 25(3): 216-220, 2018 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-28079561

RESUMO

OBJECTIVE: Double checking medications at initial assessment within paediatric emergency departments (EDs) has the potential to delay patient flow, and doubt has been cast on the efficacy of double checking in all but high-risk medications. We aimed to benchmark current practice for the use of Patient Group Direction (PGD) medications at initial assessment in EDs within the Paediatric Emergency Research UK and Ireland (PERUKI) network, with a focus on the use of 'single-checker' PGDs. METHODS: Online survey was distributed to the research representative at each PERUKI site. The survey was open for 5 weeks (from March 2015 to April 2015) and was completed by any appropriate clinician within the site. RESULTS: The response rate was 84% (36/43 EDs). From these, 22 out of 36 (61%) EDs were using single-checker PGDs. The commonest single-checked medications in use were paracetamol and ibuprofen for pain. Among PERUKI sites, 21.9% of EDs reported drug errors related to standard (double-checked) PGDs, whereas 13.6% of those with single-checked PGDs reported drug errors (Fisher's exact test with significance level of 0.05, P=0.501). The commonest errors reported were duplicated dose, incorrect weight, incorrect volume drawn up, contraindication missed. CONCLUSION: Single-checker PGDs are currently in use in nearly two-thirds of PERUKI sites. No evidence of increased medication errors was reported with this practice; however, more detailed studies are required to support this finding and to inform best practice.


Assuntos
Serviço Hospitalar de Emergência/normas , Erros de Medicação/enfermagem , Erros de Medicação/prevenção & controle , Preparações Farmacêuticas/normas , Gestão da Segurança/métodos , Criança , Humanos , Irlanda , Avaliação em Enfermagem/estatística & dados numéricos , Guias de Prática Clínica como Assunto , Inquéritos e Questionários , Reino Unido
11.
J Emerg Nurs ; 44(3): 258-266, 2018 May.
Artigo em Inglês | MEDLINE | ID: mdl-28750891

RESUMO

INTRODUCTION: Triage, as it is understood in the context of the emergency department, is the first and perhaps the most formal stage of the initial patient encounter. Bottlenecks during intake and long waiting room times have been linked to higher rates of patients leaving without being seen. The solution in many emergency departments has been to collect less information at triage or use an "immediate bedding" or "pull until full" approach, in which patients are placed in treatment areas as they become available without previous screening. The purpose of this study was to explore emergency nurses' understanding of-and experience with-the triage process, and to identify facilitators and barriers to accurate acuity assignation. METHODS: An exploratory qualitative study using focus-group interviews (N = 26). RESULTS: Five themes were identified: (1) "Sick or not sick," (2) "Competency/qualifications," (3) "Triaging the emergency department, not the patient," (4) "The unexpected," and (5) "Barriers and facilitators." DISCUSSION: Our participants described processes that were unit- and/or nurse-dependent and were manipulations of the triage system to "fix" problems in ED flow, rather than a standard application of a triage system. Our participants reported that, in practice, the use of triage scales to determine acuity and route patients to appropriate resources varies in accuracy and application among emergency nurses and in their respective emergency departments. Nurses in this sample reported a prevalence of "quick look" triage approaches that do not rely on physiologic data to make acuity decisions. Future research should focus on intervention and comparison studies examining the effect of staffing, nurse experience, hospital policies, and length of shift on the accuracy of triage decision making. Contribution to Emergency Nursing Practice.


Assuntos
Competência Clínica/estatística & dados numéricos , Enfermagem em Emergência/métodos , Serviço Hospitalar de Emergência , Avaliação em Enfermagem/estatística & dados numéricos , Recursos Humanos de Enfermagem no Hospital/estatística & dados numéricos , Triagem/métodos , Adulto , Idoso , Atitude do Pessoal de Saúde , Feminino , Grupos Focais , Humanos , Entrevistas como Assunto , Masculino , Pessoa de Meia-Idade , Pesquisa Qualitativa , Estados Unidos
12.
Res Nurs Health ; 40(6): 519-527, 2017 12.
Artigo em Inglês | MEDLINE | ID: mdl-28898416

RESUMO

Entry into the child protection system in the US begins with a child maltreatment report. Some evidence suggests that report source and child age are related to report outcomes, but there has been no national study of these relationships. The purpose of this secondary data analysis was to describe the distribution of report sources for child physical abuse (CPA), and examine whether (a) the source of a report and (b) child age contribute to the likelihood of substantiation of the reported abuse. Multilevel logistic regressions were conducted using a US national sample of 204,414 children investigated for CPA in 2013 in a dataset obtained from the National Child Abuse and Neglect Data System. Results showed that fewer than one in seven children reported for CPA were confirmed victims of abuse. Professionally mandated reporters initiated the majority of CPA reports, and their reports were more likely to be substantiated compared with nonprofessionals. However, reports made by even the most accurate professional group (legal/law enforcement) had only a 26% chance of substantiation, and some professional groups had a lower likelihood of substantiation than nonprofessionals. Reports made by professionals were less likely to be substantiated as child age increased. More research is warranted to develop and test the effectiveness of training programs to improve CPA reporting and identification.


Assuntos
Maus-Tratos Infantis/estatística & dados numéricos , Notificação de Abuso , Abuso Físico/estatística & dados numéricos , Criança , Feminino , Humanos , Masculino , Avaliação em Enfermagem/estatística & dados numéricos , Vigilância da População , Fatores de Risco , Estados Unidos
13.
Assist Inferm Ric ; 36(3): 144-150, 2017.
Artigo em Italiano | MEDLINE | ID: mdl-28956870

RESUMO

. The unused peripheral venous catheters in hospital: findings from a cross-sectional study. INTRODUCTION: Although the removal of peripheral venous catheters (PVCs) when no longer necessary is recommended, a high number of unused PVCs has been reported. AIMS: To describe the prevalence of unused PVCs and associated factors. METHODS: A cross-sectional study of patients ≥ 18 years, admitted to the involved units, with a PVC, was conducted. Data on individual, PVC and clinical context was collected and its association with unused PVC was analyzed. RESULTS: The prevalence of unused PVCs was 26.7% (143). Patients with a PVC inserted for several days (OR = 1.08, 95%CI= 1.02-1.14), as well as patients admitted to units with a skill mix of mostly Registered Nurses (OR = 1.06; 95%CI= 1.01-1.10), were more likely to have an unused PVC. On the contrary, patients in intensive care (OR = 0.22, 95% CI= 0.07-0.68), with infectious diseases (OR = 0.33, 95% CI= 0.14-0.82) and small cannula size (OR = 0.44; 95% CI= 0.23-0.86) were less likely to have an unused PVC. The 45% of the patients had an unused PVC for ≥ 3 days. DISCUSSION: One PVC out of four was unused, and a half of the unused PVCs had not been used for at least ≥ 3 days. This data suggests that care teams assign much more importance to other clinical aspects than the risk for infection, in defining risks and benefits associated with PVC.


Assuntos
Cateterismo Periférico/enfermagem , Cateteres de Demora , Avaliação em Enfermagem , Cateterismo Periférico/estatística & dados numéricos , Cateteres de Demora/estatística & dados numéricos , Estudos Transversais , Hospitais/estatística & dados numéricos , Humanos , Itália/epidemiologia , Avaliação em Enfermagem/estatística & dados numéricos , Prevalência
14.
J Fam Nurs ; 23(1): 13-33, 2017 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-28795937

RESUMO

The use of social media (SM) is contributing to an unprecedented state of global connectivity and occupying an increasingly prominent position in the lives of individuals and families. The more integrated these media become into society the more likely they are to play a role in overall health and family functioning, be it positively or negatively. Family systems theory provides an ideal lens through which to examine the effects of SM in today's family life. This article introduces a new SM assessment tool aligned with the principles of this foundational theory. Family nurses can use the proposed Social Media Assessment Package (SMAP) to gain an initial picture of usage patterns within a family as well as identify and support positive future SM choices. Practitioners may also use the SMAP in a personal evaluation of their practice as a means to maximize SM use in ongoing professional development.


Assuntos
Enfermagem Familiar/estatística & dados numéricos , Enfermagem Familiar/normas , Avaliação em Enfermagem/métodos , Avaliação em Enfermagem/estatística & dados numéricos , Mídias Sociais , Humanos
15.
Intensive Crit Care Nurs ; 42: 44-50, 2017 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-28552261

RESUMO

BACKGROUND: Uncertainty exists whether a therapeutic early mobility position will affect the outcome of a critically ill patient. OBJECTIVES: To evaluate the feasibility of an existing protocol to identify patients who would tolerate this position. RESEARCH METHODOLOGY/DESIGN: A non-randomised experimental pilot trail was performed. Twice weekly, all patients nursed in surgical and respiratory units were screened with the protocol. OUTCOME MEASURES: Haemodynamic parameters, mean arterial pressure and central venous oxygen saturation of included patients were tested in the baseline position followed by the testing position at 0, 3 and 10minutes. RESULTS: We screened 138 patients. Eleven patients passed the protocol, male/female (9/2) with a median (range) age of 47 (20-67) years. Placement from the 10minutes baseline position to the 0min testing position resulted in a mean difference of the mean arterial pressure of 2.03 (95% Confidence interval -1.12 to 5.18), and the mean difference of central venous oxygen saturation was 0.79 (95% Confidence interval -3.15 to 4.74). One adverse event was noted. CONCLUSION: The protocol provides healthcare professionals with an interim tool to identify patients who would tolerate a therapeutic upright position. While the results question the clinical feasibility of protocol. The effect of incorporating a therapeutic early mobility position into standard nursing care, on patient outcome can now be investigated.


Assuntos
Estado Terminal/enfermagem , Deambulação Precoce/enfermagem , Avaliação em Enfermagem/métodos , Adulto , Idoso , Deambulação Precoce/estatística & dados numéricos , Estudos de Viabilidade , Feminino , Humanos , Unidades de Terapia Intensiva/organização & administração , Unidades de Terapia Intensiva/estatística & dados numéricos , Unidades de Terapia Intensiva/tendências , Masculino , Pessoa de Meia-Idade , Avaliação em Enfermagem/normas , Avaliação em Enfermagem/estatística & dados numéricos , Projetos Piloto , África do Sul
16.
J Hosp Med ; 12(4): 256-258, 2017 04.
Artigo em Inglês | MEDLINE | ID: mdl-28411298

RESUMO

The diagnosis of sepsis requires that objective criteria be met with a corresponding subjective suspicion of infection. We conducted a study to characterize the agreement between different providers' suspicion of infection and the correlation with patient outcomes using prospective data from a general medicine ward. Registered nurse (RN) suspicion of infection was collected every 12 hours and compared with medical doctor or advanced practice professional (MD/APP) suspicion, defined as an existing order for antibiotics or a new order for blood or urine cultures within the 12 hours before nursing screen time. During the study period, 1386 patients yielded 11,489 screens, 3744 (32.6%) of which met at least 2 systemic inflammatory response syndrome (SIRS) criteria. Infection was suspected by RN and MD/APP in 5.8% of cases, by RN only in 22.2%, by MD/APP only in 7.2%, and by neither provider in 64.7%. Overall agreement rate was 80.7% for suspicion of infection (κ = 0.11, P < 0.001). Progression to severe sepsis or shock was highest when both providers suspected infection in a SIRS-positive patient (17.7%), was substantially reduced with single-provider suspicion (6.0%), and was lowest when neither provider suspected infection (1.5%) (P < 0.001). Provider disagreement regarding suspected infection is common, with RNs suspecting infection more often, suggesting that a collaborative model for sepsis detection may improve timing and accuracy. Journal of Hospital Medicine 2017;12:256-258.


Assuntos
Avaliação em Enfermagem/estatística & dados numéricos , Sepse/diagnóstico , Mortalidade Hospitalar , Humanos , Insuficiência de Múltiplos Órgãos/etiologia , Enfermeiras e Enfermeiros/estatística & dados numéricos , Médicos/estatística & dados numéricos , Estudos Prospectivos , Fatores de Risco , Sepse/mortalidade
17.
Int Emerg Nurs ; 32: 45-49, 2017 May.
Artigo em Inglês | MEDLINE | ID: mdl-28291697

RESUMO

INTRODUCTION: The Ambulance Organization of Sweden provides qualified medical assessment and treatment by ambulance nurses based on patient needs regarding appropriate levels of care. A new model for patients with non-urgent medical conditions has been introduced. The main objective of this study was to examine early prehospital assessment of non-urgent patients, and its impact on the choice of the appropriate level of care. METHODS: The study design was a 1-year, prospective study, involving an ambulance district in southwestern Sweden with a population of 78,000. Eligible patients were from18years of age, assessed as priority GREEN by Rapid Emergency Triage and Treatment System (RETTS). Ambulance nurses contacted primary care physicians on decisions on whether a patient should be transported to a primary healthcare unit or an A&E. Data was collected from electronic health records from April 2014 to July 2015. A comparison was made with a retrospective control group without consulting a physician concerning the appropriate level of care. RESULTS: 394 patients were included, 184 in the intervention group, and 210 in the control group. There were statistically significant differences in favor of the study group (p<0.001) regarding no transport, or transport and admission to an A&E. The groups did not differ significantly regarding transport to a primary care unit. CONCLUSION: This prehospital assessment model indicates a decrease in ambulance transports to an A&E and admissions to a hospital ward. Collaboration between ambulance nurses and primary physicians affects the decision for the appropriate level of care for patients with a non-urgent condition.


Assuntos
Serviços Médicos de Emergência/métodos , Avaliação em Enfermagem/métodos , Encaminhamento e Consulta/estatística & dados numéricos , Fatores de Tempo , Triagem/métodos , Adulto , Idoso , Idoso de 80 Anos ou mais , Ambulâncias/estatística & dados numéricos , Distribuição de Qui-Quadrado , Serviços Médicos de Emergência/estatística & dados numéricos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Enfermeiras e Enfermeiros/estatística & dados numéricos , Enfermeiras e Enfermeiros/tendências , Avaliação em Enfermagem/estatística & dados numéricos , Estudos Prospectivos , Encaminhamento e Consulta/tendências , Estudos Retrospectivos , Suécia , Triagem/estatística & dados numéricos
18.
BMC Res Notes ; 10(1): 81, 2017 Feb 02.
Artigo em Inglês | MEDLINE | ID: mdl-28153055

RESUMO

BACKGROUND: Skin changes caused by aging increase the risk of skin damages, such as pressure ulcers, during hospitalization of elderly patients. There is few information about the cost of wound treatment in Brazil. Conversely, skin and wound problems are highly reported among hospitalized elderly patients and caregivers. The purpose is to analyze the socio-demographic and clinical profile associated with skin and wound care in hospitalized elderly. METHODS: This is a prospective observational study. The sample consisted of 75 patients, aged 60 years or more, randomly selected in three hospitals in Rio de Janeiro, Brazil. Data extraction from nursing records of the sample, using cross mapping with Nursing Interventions Classification. Data Synthesis supported by SAS 6.11 (SAS Institute, Inc. Cary North Carolina) in association with SPSS version 14.0 and statistics analysis. RESULTS: The findings were: age standard deviation 7.8, with minimum as 60, and maximum as 91 years old. Prevalence of women and married seniors. High prevalence of long-term hospitalization. There were 21 Nursing Interventions in the nursing records and seventeen of them related to skin and wound care. They were described in 57 nursing activities, present during 376 evaluations and repeated 1756 times. A significant difference was obtained between age and the presence of the nursing interventions "Positioning" (p-0.004), Eye Care/Hygiene (p- < 0.0001) and Oral Health Maintenance (p-0.0003). CONCLUSION: The skin care to prevention and treatment of skin damages represented the major demand of nursing interventions in different clinical conditions of hospitalized elderly.


Assuntos
Serviços de Saúde para Idosos/estatística & dados numéricos , Hospitalização/estatística & dados numéricos , Pele/lesões , Ferimentos e Lesões/enfermagem , Idoso , Idoso de 80 Anos ou mais , Análise de Variância , Brasil/epidemiologia , Feminino , Humanos , Tempo de Internação , Masculino , Registros Médicos/estatística & dados numéricos , Pessoa de Meia-Idade , Avaliação em Enfermagem/métodos , Avaliação em Enfermagem/estatística & dados numéricos , Diagnóstico de Enfermagem/estatística & dados numéricos , Avaliação de Resultados em Cuidados de Saúde/métodos , Avaliação de Resultados em Cuidados de Saúde/estatística & dados numéricos , Prevalência , Estudos Prospectivos , Ferimentos e Lesões/epidemiologia , Ferimentos e Lesões/terapia
19.
J Clin Monit Comput ; 31(3): 641-649, 2017 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-27067076

RESUMO

Understanding the use of patient monitoring systems in emergency and acute facilities may help to identify reasons for failure to identify risk patients in these settings. Hence, we investigate factors related to the utilization of automated monitoring for patients admitted to an acute admission unit by introducing monitor load as the proportion between monitored time and length of stay. A cohort study of patients admitted and registered to patient monitors in the period from 10/10/2013 to 1/10/2014 at the acute admission unit of Odense University Hospital in Denmark. Admissions with at least one measurement were analyzed using quantile regression by looking at the impact of distance from nursing office, number of concurrent patients, wing type (medical/surgical), age, sex, comorbidities, and severity conditioned on how much patients were monitored during their admissions. We registered 11,848 admissions, of which we were able to link patient monitor readings to 3149 (26.6 %) with 50 % being monitored <1.4 % of total admission time. Distance from nursing office had little influence on patients monitored <10 % of their admission time. But for other patients, being positioned further away from the office reduced the level of monitoring. Higher levels of severity were related to higher degrees of monitoring, but being admitted to the surgical wing reduce how much patients were monitored, and periods with many concurrent patients lead to a small increase in monitoring. We found a significant variation concerning how much patients were monitored during admission to an acute admission unit. Our results point to potential patient safety improvements in clinical procedures, and advocate an awareness of how patient monitoring systems are utilized.


Assuntos
Enfermagem de Cuidados Críticos/estatística & dados numéricos , Cuidados Críticos/estatística & dados numéricos , Estado Terminal/epidemiologia , Estado Terminal/terapia , Serviços Médicos de Emergência/estatística & dados numéricos , Monitorização Fisiológica/estatística & dados numéricos , Admissão do Paciente/estatística & dados numéricos , Dinamarca/epidemiologia , Feminino , Hospitais Universitários/estatística & dados numéricos , Humanos , Masculino , Avaliação em Enfermagem/estatística & dados numéricos , Prevalência , Fatores de Risco , Revisão da Utilização de Recursos de Saúde
20.
Pediatr Emerg Care ; 33(4): 234-238, 2017 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-27176906

RESUMO

OBJECTIVE: This study aimed to assess the association between pediatric assessment triangle (PAT) findings during triage and markers of severity in a pediatric emergency department (PED). METHODS: During the study period, patients arriving to the PED were classified by trained nurses with the Pediatric Canadian Triage and Acuity Scale using a computer system, from which data were obtained and analyzed retrospectively. The primary outcome measure was the percentage of children hospitalized related with PAT findings. The secondary outcome measures were the admission to the intensive care unit (%), PED length of stay, and performance of blood tests (%). RESULTS: Among the 302,103 episodes included, there were abnormal PAT findings in 24,120 cases (7.9%). Multivariate analysis adjusted for age confirmed that PAT findings and triage level were independent risk factors for admission (odds ratio [OR], 2.21; 95% confidence interval [CI], 2.13-2.29; OR, 6.01; 95% CI, 5.79-6.24, respectively). Abnormal findings in appearance or in more than 1 PAT component were even more strongly associated with admission (3.99; 95% CI, 3.63-4.38; 14.99, 95% CI, 11.99-18.74, respectively). When adjusted for triage level and age, abnormal PAT findings were also an independent risk factor for intensive care unit admission (OR, 4.44; 95% CI, 3.77-5.24) and a longer stay in the PED (OR, 1.78; 95% CI, 1.72-1.84). CONCLUSIONS: Abnormal findings in the PAT applied by trained nurses at triage identify patients with a higher risk of hospitalization. The PAT seems to be a valid tool for identifying the most severe patients as a first step in the triage process.


Assuntos
Hospitalização/estatística & dados numéricos , Avaliação em Enfermagem/estatística & dados numéricos , Pediatria/métodos , Triagem/métodos , Canadá , Criança , Pré-Escolar , Enfermagem em Emergência , Serviço Hospitalar de Emergência , Feminino , Humanos , Lactente , Masculino , Estudos Retrospectivos
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