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1.
Enferm. glob ; 18(54): 426-440, abr. 2019. tab
Artigo em Espanhol | IBECS | ID: ibc-183490

RESUMO

Objetivo: Evaluar los factores de riesgo de ansiedad y depresión en el período preoperatorio de la cirugía cardíaca.Método: Se trata de un estudio seccional, realizado entre enero y junio de 2017, en un hospital universitario de referencia en cardiología en el nordeste de Brasil. Se evaluaron 174 pacientes utilizando un cuestionario propio y la Escala Hospitalaria de Ansiedad y Depresión (HADS) y calculadas las Odds Ratios para evaluar el riesgo.Resultados: En la evaluación de la ansiedad, fueron factores de riesgo significativos: sexo femenino, años de estudio, ausencia de acompañante, experiencia previa de cirugía cardiaca y la cancelación de la cirugía durante el internamiento. En cuanto a la depresión, se revelaron factores de riesgo: sexo femenino y tiempo de internamiento mayor de 15 días.Conclusión: El enfermero tiene instrumentos disponibles para reconocer la ansiedad y la depresión, incluyendo los diagnósticos de enfermería y las escalas validadas, así como tiene un papel preponderante en la actuación en estos casos. Debe ser un desafío institucional dinamizar el servicio para evitar prolongaciones de la internación y cancelaciones de cirugía por cuestiones estructurales


Objetivo: avaliar os fatores de risco de ansiedade e depressão no período pré-operatório de cirurgia cardíaca. Método: Trata-se de um estudo seccional, realizado entre janeiro e junho de 2017, em um hospital universitário de referência em cardiologia no nordeste do Brasil. Foram avaliados 174 pacientes utilizando-se um questionário próprio e a Escala Hospitalar de Ansiedade e Depressão (HADS) e calculadas as Odds Ratios para avaliar o risco. Resultados: Na avaliação da ansiedade, foram fatores de risco significativos: sexo feminino, anos de estudo, ausência de acompanhante, experiência prévia de cirurgia cardíaca e o cancelamento da cirurgia durante o internamento. Quanto à depressão, revelaram-se fatores de risco: sexo feminino e tempo de internamento maior de 15 dias. Conclusão: O enfermeiro tem instrumentos disponíveis para reconhecer a ansiedade e a depressão, incluindo os diagnósticos de enfermagem e as escalas validadas, assim como tem papel preponderante na atuação nestes casos. Deve ser um desafio institucional dinamizar o serviço de forma a evitar prolongamentos do internamento e cancelamentos de cirurgia por questões estruturais


Objective: To evaluate the risk factors of anxiety and depression in the preoperative period of cardiac surgery.Method: This is a sectional study, conducted between January and June 2017, in a university hospital of reference in cardiology in northeastern Brazil. A total of 174 patients were evaluated using their own questionnaire and the Hospital Anxiety and Depression Scale (HADS) and Odds Ratios were calculated to assess the risk.Results: In the assessment of anxiety, significant risk factors were: female gender, years of study, absence of companion, previous experience of cardiac surgery and cancellation of surgery during hospitalization. As for depression, risk factors were revealed: female sex and hospitalization time greater than 15 days.Conclusion: The nurse has instruments available to recognize anxiety and depression, including nursing diagnoses and validated scales, as well as having a preponderant role in these cases. It should be an institutional challenge to streamline the service in order to avoid prolongation of hospitalization and cancellations of surgery for structural reasons


Assuntos
Humanos , Masculino , Feminino , Pessoa de Meia-Idade , Idoso , Idoso de 80 Anos ou mais , Ansiedade/epidemiologia , Depressão/epidemiologia , Procedimentos Cirúrgicos Cardíacos/psicologia , Diagnóstico de Enfermagem/métodos , Fatores de Risco , Período Pré-Operatório , Cuidados Pré-Operatórios/enfermagem , Procedimentos Cirúrgicos Cardíacos/enfermagem , Medo/psicologia , Estresse Psicológico/enfermagem
2.
J Clin Nurs ; 28(7-8): 1148-1155, 2019 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-30375697

RESUMO

AIM AND OBJECTIVE: To investigate the incidence of intraoperative blanchable erythema and pressure injuries in patients undergoing digestive surgery and to explore potential risk factors. BACKGROUND: Pressure injuries pose significant economic and healthcare burden to patients and are used as one of the key indicators of nursing in the operation room with high incidence. DESIGN: A retrospective observational study. METHODS: Basic information and the results of 3S intraoperative risk assessment scale of pressure injury were obtained from the information system. And the patients with intraoperative blanchable erythema or pressure injuries were followed up for 72 hr by the information system. The clinical data were collected to analyse risk factors for intraoperative blanchable erythema and pressure injuries by univariate analysis and logistic regression analysis. STROBE checklist for cohort studies was applied in the preparation of the paper. RESULTS: Of 5,136 surgical cases, 134 (2.61%) had blanchable erythema, 37 (0.72%) had intraoperative pressure injuries, and 8 (0.16%) had pressure injuries at 72-hr follow-up. Preoperative skin under compression, preoperative physical activity, surgical position and extra intraoperative pressure were considered independent risk factors for intraoperative pressure injuries. CONCLUSION: The incidence of pressure injuries in our study was lower than those reported in the previous studies. Accessing preoperative skin under compression, preoperative physical activity, surgical position and extra intraoperative pressure was considered to be significant for preventing pressure injuries. RELEVANCE TO CLINICAL PRACTICE: The findings suggest that preoperative skin under compression, preoperative physical activity, surgical position and extra intraoperative pressure are associated with intraoperative pressure injuries in patients undergoing digestive surgery.


Assuntos
Procedimentos Cirúrgicos do Sistema Digestório/efeitos adversos , Eritema/epidemiologia , Cuidados Pré-Operatórios/enfermagem , Lesão por Pressão/epidemiologia , Adulto , Idoso , Comorbidade , Eritema/prevenção & controle , Feminino , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , Posicionamento do Paciente/métodos , Lesão por Pressão/prevenção & controle , Estudos Retrospectivos , Medição de Risco , Fatores de Risco
3.
Medicine (Baltimore) ; 97(42): e12749, 2018 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-30334960

RESUMO

This retrospective study investigated the effect of nursing intervention (NIV) in Chinese patients under preoperative cataract (PC). A total of 70 eligible patients with PC were included. Thirty-five patients in an intervention group received regular clinical treatment and NIV before the surgery, while the other 35 patients received regular clinical treatment only. The NIV was applied 4 sessions, 1 week before the surgery. The primary outcome of satisfaction was measured by 11-points visual analog scale. The secondary outcomes were measured by the functional impairment caused by cataract (the VF-14), cooperativeness during the surgery period, and sleep quality. All the outcome measurements were assessed before and after the surgery. After NIV, patients in the intervention group exerted better outcomes in decreasing anxiety (P < .01), increasing current experience with satisfaction (P < .01), and enhancing the cooperativeness during the surgery period (P < .01), compared to those outcomes in the control group. The results of this study showed that NIV may help increase satisfaction in experience and cooperation, and decrease anxiety in Chinese patients with PC.


Assuntos
Ansiedade/enfermagem , Extração de Catarata/enfermagem , Catarata/enfermagem , Cuidados Pré-Operatórios/enfermagem , Idoso , Ansiedade/etiologia , Catarata/psicologia , Extração de Catarata/psicologia , China , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Satisfação do Paciente , Cuidados Pré-Operatórios/psicologia , Estudos Retrospectivos , Inquéritos e Questionários , Escala Visual Analógica
4.
PLoS One ; 13(10): e0205439, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-30339687

RESUMO

OBJECTIVE: Standard pre-operative assessment at our institution involves a comprehensive history and examination by a nurse practitioner. An electronic pre-operative assessment questionnaire, ePAQ-PO® (ePAQ, Sheffield, UK) has previously been developed and validated. This study aimed to determine the impact of ePAQ-PO on nurse consultation times and patient satisfaction in low-risk patients. METHODS: The duration of pre-operative assessment consultation was recorded for American Society of Anesthesiology physical classification 1 and 2 patients undergoing pre-operative assessment by an electronic questionnaire (ePAQ-PO group) and standard face-to-face assessment by a nurse practitioner (standard group). Patients were also asked to complete an eight-item satisfaction questionnaire. Eighty-six patients were included (43 in each group). RESULTS: After adjusting for the duration of physical examination, median (IQR [min-max]) consultation time was longer in the standard compared to the ePAQ-PO group (25 (18-33 [10-49]) min vs. 12 (8-17 [4-45]) min, respectively; p <0.001). Response rate for the satisfaction questionnaire was 93%. There was no significant difference in patient satisfaction scores (38/39 in standard group vs. 39/41 in ePAQ-PO group were fully satisfied with their pre-operative assessment; p = 0.494). CONCLUSION: Pre-operative assessment using ePAQ-PO is associated with a significant reduction of over 50% in the duration of the assessment without impacting on patient satisfaction.


Assuntos
Satisfação do Paciente/estatística & dados numéricos , Cuidados Pré-Operatórios/enfermagem , Consulta Remota/métodos , Adulto , Feminino , Humanos , Internet , Masculino , Pessoa de Meia-Idade , Profissionais de Enfermagem , Estudos Prospectivos , Inquéritos e Questionários , Fatores de Tempo , Reino Unido , Adulto Jovem
6.
Rev. pesqui. cuid. fundam. (Online) ; 10(3): 753-757, jul.-set. 2018.
Artigo em Inglês, Português | LILACS, BDENF - Enfermagem | ID: biblio-906468

RESUMO

Objetivo: O objetivo do estudo é reconhecer a importância da comunicação como ferramenta utilizada pelo enfermeiro no pré-operatório mediato do paciente em terapia hemodialítica indicada para transplante renal. Métodos: Trata-se de um estudo descritivo, convergente, com abordagem qualitativa. Os dados foram coletados por meio de entrevista semiestruturada com 9 enfermeiras, utilizando um roteiro pré-estabelecido com questões subjetivas das quais emergiram 2 categorias: Responsabilidade do enfermeiro na comunicação com o paciente; e Importância da comunicação enfermeiro/ paciente. Resultados: Os resultados apontam a relevância de estudar o processo da comunicação, pois, ao praticá-lo, há aperfeiçoamento do modo que o enfermeiro se comunica, evitando interferências que possam comprometer as informações prestadas. Conclusão: Ressalta-se a importância da relação enfermeiro/paciente, que possibilita o entendimento das informações educativas e o modo como são prestadas, constituindo poderosa ferramenta no pré-operatório mediato de transplante renal


Objetivo: El objetivo es reconocer la importancia de la comunicación como herramienta utilizada por los enfermeros en el paciente preoperatorio mediato en hemodiálisis indicado para el trasplante de riñón. Método: Se trata de un estudio descriptivo, convergente, con un enfoque cualitativo. Los datos fueron recogidos a través de entrevista semi-estructurada con 9 enfermeras, utilizando un guión pre-establecido con preguntas subjetivas de las que emergieron 2 categorías: Responsabilidad del enfermero en la comunicación con el paciente; e Importancia de la comunicación enfermero/ paciente. Resultados: Los resultados señalan la relevancia de estudiar el proceso de la comunicación, pues, practicándola, hay una mejora en la forma en que el enfermero se comunica, evitando interferencias que puedan poner en peligro las informaciones ofrecidas. Conclusión: Se destaca la importancia de la relación enfermero/paciente, que permite la comprensión de las informaciones educativas y la forma en que se prestan, constituyendo poderosa herramienta en el período pre-operatorio mediato de trasplante renal


Objective: The study's aim has been to recognize the importance of the communication as a tool used by the nurse over the preoperative period of patients undergoing hemodialysis therapy and indicated for having renal transplantation. Methods: It is a descriptive and convergent study with a qualitative approach. Data were collected through a semi-structured interview with 9 female nurses and using a pre-established script with subjective questions. By using this approach, the following 2 categories emerged: the nurse's responsibility in communicating to the patient; and the significance of nurse/patient communication. Results: The results point out the relevance of studying the communication process, because, by putting it into practice, there is an improvement regarding the nurse's communication skills, and then avoiding any interference that may affect the information provided. Conclusion: The significance of the nurse/patient relationship stands out, which enables understanding the educational information and the way in which they are provided, then constituting a powerful tool during the preoperative period of a renal transplantation


Assuntos
Humanos , Masculino , Feminino , Transplante de Rim/enfermagem , Relações Enfermeiro-Paciente , Cuidados Pré-Operatórios/enfermagem , Transplante de Rim/reabilitação
7.
Crit Care Nurs Q ; 41(2): 161-169, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-29494371

RESUMO

The aim of this study to examine the effects of supportive-educational nurse-led intervention on the patients' anxiety and sleep before the coronary artery bypass grafting.The current clinical trial recruited 160 patients (N = 160) waiting for the coronary artery bypass grafting by random block sampling and divided them into two 80-people experimental and control groups. Spielberger's State Anxiety Inventory was completed on the first day. The Groningen's Sleep Quality Index was also completed by the patients on the day of surgery. Data were analyzed in SPSS software version 16, using descriptive and inferential statistics tests.The mean anxiety score in the experimental group decreased to 48.39, whereas in the control group, the mean anxiety score saw a rise after the intervention (61.09). The comparison of the mean quality of sleep the night before the surgery for both groups showed that sleep in the control group compared with sleep in the experimental group had a lower quality, and statistically, it was significant (P < .001).Results showed that nonpharmacological and supportive interventions can reduce patients' anxiety and sleep disturbance before the coronary artery bypass grafting. According to the results, nonpharmacological therapies should be placed at the top of nurses' tasks.


Assuntos
Ansiedade/prevenção & controle , Ponte de Artéria Coronária/psicologia , Sono , Idoso , Ansiedade/enfermagem , Ponte de Artéria Coronária/enfermagem , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Educação de Pacientes como Assunto , Cuidados Pré-Operatórios/enfermagem , Inquéritos e Questionários , Resultado do Tratamento
8.
Crit Care Nurse ; 38(1): e1-e10, 2018 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-29437083

RESUMO

The Fontan procedure is the final procedure in staged palliation for patients with functional single-ventricle physiology. The goal of the procedure is to separate systemic and pulmonary blood flow by directing systemic venous return through the Fontan connection to the pulmonary arteries and the lungs without ventricular contribution. Following the procedure, pulmonary blood flow is completely passive and dependent on pressure gradients, resulting in complex postoperative cardiopulmonary interactions. Understanding the physiology is essential to effectively manage these patients. Critical care nurses caring for patients after a Fontan procedure must understand preoperative data, risk factors, and unique postoperative physiology so they can anticipate specific postoperative problems, recognize trends in clinical status, and develop an appropriate plan of care. This paper reviews the first 2 stages of single-ventricle palliation, relevant modifications to the Fontan procedure, important preoperative cardiac catheterization data, common postoperative problems, and outcomes after the Fontan procedure.


Assuntos
Enfermagem de Cuidados Críticos/normas , Técnica de Fontan/métodos , Técnica de Fontan/enfermagem , Cardiopatias Congênitas/cirurgia , Ventrículos do Coração/cirurgia , Guias de Prática Clínica como Assunto , Artéria Pulmonar/cirurgia , Adolescente , Criança , Pré-Escolar , Educação Continuada em Enfermagem , Feminino , Humanos , Lactente , Recém-Nascido , Masculino , Cuidados Pós-Operatórios/enfermagem , Cuidados Pré-Operatórios/enfermagem , Fatores de Risco
9.
J Clin Nurs ; 27(13-14): 2904-2916, 2018 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-29446494

RESUMO

AIMS AND OBJECTIVES: To describe preoperative communication after a person-centred intervention in nurses' consultations with patients undergoing surgery for colorectal cancer. BACKGROUND: Patients all over the world scheduled for surgery are referred to preoperative consultations with healthcare professionals. The goal is to assess the risk of perioperative complications, improving quality of care and enabling patients to be prepared for surgery and recovery. A person-centred intervention was developed, which consisted of an interactive written patient education material and person-centred communication. DESIGN: An explorative quantitative and qualitative study based on 18 audio-taped transcriptions. METHODS: Eighteen patients preoperative nursing consultations at three Swedish hospitals were analysed quantitatively regarding structure: words, time, phases, questions, discursive space, and qualitatively: topics and how the person-centred communication appeared in the consultations. RESULTS: The median time for consultations was 27 min (range 13-64 min). The nurses used two-thirds of the discursive space in the consultations with the patients. The patient education material was used as a support to structure the consultation and discuss sensitive and difficult issues. Seven topics were discussed during the consultation. Two different approaches to communication were identified: Talking with the patient versus Talking to the patient. Talking with the patient (seen as person-centred communication) was defined as: listening to the narrative and confirming each other, raising difficult topics, seeing each other as persons, building on strengths and resources, preparing for surgery and asking open questions. CONCLUSION: Ways of communicating influence how the preoperative consultation develops. Talking with the patient could be seen as person-centred communication in the preoperative care, and when using this approach, the intervention purpose of person-centred communication was met. RELEVANCE TO CLINICAL PRACTICE: Education in person-centred communication is important for nurses to improve their skills in performing preoperative consultations.


Assuntos
Neoplasias Colorretais/enfermagem , Neoplasias Colorretais/cirurgia , Comunicação , Pessoal de Saúde/psicologia , Cuidados de Enfermagem/psicologia , Assistência Centrada no Paciente/métodos , Cuidados Pré-Operatórios/métodos , Cuidados Pré-Operatórios/enfermagem , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Pesquisa Qualitativa , Suécia
10.
ENFURO: Rev. Asoc. Esp. A.T.S. Urol ; (134): 9-11, feb. 2018. graf
Artigo em Espanhol | IBECS | ID: ibc-171285

RESUMO

Los tumores urológicos son los más habituales entre la población de mayores de 70 años. En el paciente geriátrico, la evaluación preoperatoria es fundamental, pero la clasificación de riesgo ASA no ha sido específicamente diseñada para evaluar pacientes de edad avanzada. La reserva funcional y los síndromes geriátricos son aspectos a valorar en el paciente que va a ser intervenido quirúrgicamente


Urological tumours are the most frequent among population over 70 years of age. Preoperative evaluation is of pivotal importance for elderly people, but ASA has not been specifically designed to evaluate elderly patients


Assuntos
Humanos , Masculino , Feminino , Idoso , Idoso de 80 Anos ou mais , Avaliação em Enfermagem/organização & administração , Cuidados Pré-Operatórios/enfermagem , Idoso Fragilizado , Estado Nutricional , Doenças Urológicas/patologia , Doenças Urológicas/cirurgia , Inquéritos e Questionários
11.
J Clin Nurs ; 27(1-2): 288-305, 2018 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-28544205

RESUMO

AIMS AND OBJECTIVES: To evaluate the impact of implementing an evidence-based, structured preoperative protocol on day of surgery cancellations in 13 operative specialties. BACKGROUND: Surgery cancellations cause unnecessary harm for patients and organisations as many cancellations could be prevented. Preoperative care has developed in recent years, and several preoperative interventions have been introduced. However, the optimal model for organising preoperative care remains unknown. Cancellations are a commonly used indicator when evaluating the success of preoperative care. DESIGN: Observational study with two study phases: before and after. METHODS: The cancellation data were collected from the hospital register from 1 September 2013-31 May 2014 (n = 591) and from September 2015-May 2016 (n = 542). The compliance rate of the preoperative protocol was evaluated in group sessions (n = 13) during spring 2016 using the participation of preoperative healthcare professionals (n = 49). The data were analysed statistically. RESULTS: Cancellation rates varied between 1.6%-9.7% (in the first phase) and between 1.5%-7.7% (in the second phase). A remarkable decrease was found in patients who failed to attend their scheduled procedures. The mean of compliance to the preoperative protocol across all specialties was 82.3%. A correlation between the rate of cancellation and the rate of compliance with the preoperative protocol was found. CONCLUSIONS: A preoperative protocol promotes the scheduled arrival of surgical patients to the hospital and therefore decreases cancellation rates. RELEVANCE TO CLINICAL PRACTICE: An evidence-based preoperative care protocol should be introduced for all healthcare professionals working in preoperative care to ensure smooth, safe and high-quality care for surgical patients.


Assuntos
Agendamento de Consultas , Cuidados Pré-Operatórios/enfermagem , Centro Cirúrgico Hospitalar/normas , Prática Clínica Baseada em Evidências , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Centro Cirúrgico Hospitalar/estatística & dados numéricos
12.
J Clin Nurs ; 27(1-2): 86-91, 2018 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-28403569

RESUMO

AIMS AND OBJECTIVES: To assess the impact of a short hypnotic session on postoperative anxiety and pain in major orthopaedic surgery. BACKGROUND: Despite specific information given before a scheduled paediatric surgery, perioperative anxiety can become important. DESIGN: Randomised Clinical Study. METHODS: The study is an open single-centre randomised clinical study comparing a "control" group versus a "hypnosis" group receiving a short hypnosis pre-induction session as additional experimental analgesic procedure. The primary endpoint was the postoperative anxiety, blindly assessed using a visual analogue scale. RESULTS: The study involved 120 children (age 10-18 years). The results showed no difference between control group versus hypnosis group. Twenty-four hours after surgery (Day+1), the patient's anxiety score was not different between control and hypnosis groups (median [Q1-Q3]: 1 [0; 3] vs. 0 [0; 3], respectively, p = .17). Each group experienced a significant decrease in anxiety level between the day before surgery (Day-1) and the day after surgery (Day+1) (median ([Q1-Q3]) difference of the anxiety score: 2 [4; 0] and 2 [4; 0], respectively, p < .0001 in each group). The postoperative pain scores were low and not different between groups (median [Q1-Q3]: 2 [0; 3] in control group vs. 3 [1; 3] in hypnosis group, p = .57). CONCLUSION: This randomised study on a short hypnosis session performed in the operating room prior to a major surgery showed no difference in postoperative anxiety and pain levels. The decrease in anxiety and pain levels may be due to the addition of nurse pre-operative interviews and optimisation in communication in the operating room. RELEVANCE TO CLINICAL PRACTICE: As postoperative anxiety level was low in both control and hypnosis groups, nurse pre-operative interviews and nurse training in hypnosis may contribute to the optimisation of global management and decrease the postoperative anxiety level.


Assuntos
Ansiedade/terapia , Hipnose , Salas Cirúrgicas , Dor Pós-Operatória/terapia , Cuidados Pré-Operatórios/enfermagem , Adolescente , Ansiedade/psicologia , Criança , Feminino , Humanos , Masculino , Osteotomia/psicologia , Medição da Dor/métodos , Dor Pós-Operatória/psicologia , Período Pós-Operatório , Fusão Vertebral/psicologia
13.
Belo Horizonte; s.n; 2018. 155 p. ilus, graf, tab.
Tese em Português | LILACS, BDENF - Enfermagem | ID: biblio-912015

RESUMO

A infecção de sítio cirúrgico (ISC) é um grande desafio para o paciente, equipe e instituições de saúde. Um fator de risco importante na patogênese das infecções cirúrgicas ortopédicas refere-se à pele do paciente. O banho do paciente com soluções antissépticas, no pré-operatório é recomendado como medida para reduzir o risco de ISC, apesar das controvérsias. O objetivo deste estudo foi avaliar o efeito da intervenção de enfermagem, banho pré-operatório, utilizando as soluções de gluconato de clorexidina a 4%, PVP-I degermante a 10% e sabão sem antisséptico, na prevenção de ISC, em pacientes submetidos à cirurgia eletiva de artroplastia do quadril e estimar a frequência de reações alérgicas causadas pelo uso das soluções. Estudo do tipo ensaio clínico, randomizado, controlado, com mascaramento do pesquisador, paciente e estatístico, utilizando dois grupos de intervenção (clorexidina; PVP-I) e um controle (sabão sem antisséptico). A amostra foi composta por 162 pacientes adultos, submetidos à cirurgia eletiva de artroplastia total do quadril, entre agosto/2015 e outubro/2017, sem infecção no local cirúrgico e alergia às soluções e não portadores nasais de Staphylococcus aureus. A randomização foi realizada por um programa de computador. Utilizados os critérios de descontinuidade de tratamento e a análise por intenção de tratar. Cada grupo foi composto por 54 pacientes. Na consulta de enfermagem os pacientes foram orientados pela enfermeira pesquisadora a tomarem dois banhos: na véspera da cirurgia no domicílio e no dia da cirurgia no hospital. O banho no hospital foi realizado por profissional de enfermagem. Para o banho o paciente recebia um envelope pardo fechado contendo o frasco da solução sorteada, quatro esponjas e um manual que orientava sobre o procedimento. O desfecho primário foi ISC e os pacientes foram monitorados até 90 dias de pós-operatório por meio de telefonemas e nas consultas de egressos ambulatorial. O programa Statistical Package for the Social Sciences (SPSS), versão 19.0, foi utilizado para análise dos dados. O efeito aos tratamentos foi medido comparando os grupos intervenção e controle por meio da incidência de ISC, risco relativo, redução absoluta de risco. As características clínicas/epidemiológicas/cirúrgicas foram similares entre os pacientes nos três grupos. A incidência de ISC em cada grupo foi 5,5% (3/54) [IC95% 1,2-15,4]. A taxa de infecção superficial foi 4,9% e profunda 0,6%. O tempo médio para o surgimento das infecções foi 19 dias (DP ± 7,4). Não houve diferença estatística significativa entre os grupos (p=1,00). Um paciente apresentou reação alérgica com o uso da solução de PVP-I. A taxa de adesão aos dois banhos foi de 99,4% (161/162). Os resultados corroboram recentes revisões sistemáticas que não encontraram diferença nas taxas de infecção cirúrgica quando o banho pré-operatório foi realizado com soluções antissépticas ou sabão. A consulta de enfermagem no pré-operatório pode impactar a taxa de infecção profunda na cirurgia eletiva de artroplastia do quadril. O uso de soluções antissépticas pode ocasionar reações alérgicas na pele do paciente, durante o banho e precisa ser monitorada. É necessário cautela ao recomendar o banho pré-operatório com solução antisséptica como estratégia para reduzir infecção de sítio cirúrgico. A orientação do paciente no pré-operatório de cirurgia eletiva de artroplastia do quadril, quando realizada pelo enfermeiro, pode melhorar a qualidade do cuidado prestado ao paciente cirúrgico. Clinical Trials nº NCTO3001102 (AU)


Surgical site infections (SSI) are a major challenge for the patient, staff, and health institutions. An important risk factor in the pathogenesis of orthopedic surgical infections refers to the patient's skin. The patient's bath with antiseptic solutions in the preoperative period is recommended as measure to reduce the risk of SSI, despite controversies. The objective of this study was to evaluate the effect of the nursing intervention, preoperative bath, using 4% chlorhexidine gluconate solutions, 10% PVP-I and non-antiseptic soap in the prevention of SSI in patients submitted to elective hip arthroplasty surgery and the frequency of allergic reactions caused by the use of the solutions. Randomized, controlled clinical trial with masking of the researcher, patient and statistician using two intervention groups (PVP-I, chlorhexidine) and one control (non-antiseptic soap). The sample was consisted of 162 adult patients undergoing elective total hip replacement between August/2015 to October/2017, without infection at the surgical site and allergy solutions and non-nasal carriers of Staphylococcus aureus. The randomization was performed by a computer program. The criteria for treatment discontinuity and intention-to-treat analysis were used. Each group consisted of 54 patients. In nursing consultation patients were instructed by the research nurse to take two baths: the day before the surgery at home and the day of the surgery in the hospital. The bath in the hospital was performed by a nursing professional. For the bath the patient received a closed brown envelope containing the bottle of the solution drawn, four sponges, and a manual that guided about the procedure. The primary outcome was ISC and the patients were monitored up to 90 postoperative days by phone calls and outpatients visits. The Statistical Package for Social Sciences (SPSS), version 19.0, was used for analysis of the data. The effect on treatments was measured by comparing intervention and control group by incidence of ISC, Relative Risk and Absolute Risk Reduction. Clinical/epidemiological/surgical characteristics were similar among the patients of the three groups. The incidence of SSI in each group was 5.5% (3/54) [IC95% 1,2-15,4]. The superficial infection rate was 4.9% and deep 0.6%. The mean time to onset of infection was 19 days (SD ± 7.4). There was no statistically significant difference between the groups (p = 1.00). One patient presented an allergic reaction with the use of the PVP-I solution. The rate of adherence to the two baths was 99.4% (161/162). The results of this study corroborate recent systematic reviews that found no difference in surgical infection rates when the preoperative bath was performed with antiseptic solutions or soap. The preoperative nursing consultation may impact the rate of deep infection in elective hip arthroplasty surgery. The use of antiseptic solutions may cause allergic reactions on the patient's skin during bathing and needs to be monitored. Caution is required when recommending the preoperative bath with antiseptic solution as a strategy to reduce surgical site infection. The orientation of the patient in the preoperative period of elective hip arthroplasty surgeries performed by the nurse can improve the quality of care provided to the surgical patient. Clinical Trials nº. NCTO3001102..(AU)


Assuntos
Humanos , Masculino , Feminino , Adolescente , Adulto , Pessoa de Meia-Idade , Idoso , Idoso de 80 Anos ou mais , Banhos/enfermagem , Cuidados Pré-Operatórios/enfermagem , Artroplastia de Quadril/enfermagem , Sabões/uso terapêutico , Enfermagem Perioperatória , Infecção da Ferida Cirúrgica/prevenção & controle , Distribuição Aleatória , Clorexidina/uso terapêutico , Dissertação Acadêmica , Anti-Infecciosos Locais/uso terapêutico
15.
Rev Infirm ; 66(232): 32-34, 2017.
Artigo em Francês | MEDLINE | ID: mdl-28599725

RESUMO

Peristomal irritation is one of the most common complications in patients with a stoma. In many cases, prevention is limited to the care provided during the post-operative period. However, it can start before the operation by improving the physical condition of the patient. It continues during the perioperative period with the surgical technique. Prevention advice can be given during these three key stages of the patient's treatment.


Assuntos
Dermatite Irritante/enfermagem , Dermatite Irritante/prevenção & controle , Cuidados Pós-Operatórios/enfermagem , Complicações Pós-Operatórias/enfermagem , Complicações Pós-Operatórias/prevenção & controle , Humanos , Educação de Pacientes como Assunto/métodos , Cuidados Pré-Operatórios/enfermagem , Fatores de Risco , Autocuidado/métodos , Estomas Cirúrgicos
16.
Assist Inferm Ric ; 36(2): 90-97, 2017.
Artigo em Italiano | MEDLINE | ID: mdl-28652635

RESUMO

. Risk factors for delirium in intensive care unit in liver transplant patients. INTRODUCTION: Delirium is a disorder of the state of consciousness characterized by acute onset and temporal variability of cognitive abilities. It is frequent in intensive care unit (ICU) and it is associated with worst outcomes. AIM: To identify risk factors for the development of delirium in patients in intensive care unit (ICU) after orthotopic liver transplantation (OLTx). METHODS: Observational retrospective study on all the patients undergoing OLTx between January 2014 and December 2015. The daily assessment for delirium was performed with the Confusion Assessment Method for the Intensive Care Unit (CAM-ICU), by nemed nurses. RESULTS: Of the 123 patients included, 15 (12.2%) developed post-operative delirium. The main risk factor was preoperative hepatic encephalopathy (OR = 8.80, 95% CI 2.70-28.59): the deterioration of the state of consciousness (GCS pre-OLTx score < 15) increased the risk of developing delirium (OR 6.18; IC 95% 1.51 - 25.31). A high Acute Physiologic and Health Evaluation (APACHE II) score (OR=1.29, IC 95%: 1.12-1.47) showed how patients with a more severe clinical situation at ICU admission were more likely to develop delirium. CONCLUSIONS: The risk factors identified predict the development of delirium in ICU. Its prevention with the implementation of pharmacological or other strategies may reduce the onset of delirium and improve the quality of care.


Assuntos
Delírio/enfermagem , Encefalopatia Hepática/enfermagem , Unidades de Terapia Intensiva , Transplante de Fígado/enfermagem , Cuidados Pós-Operatórios/enfermagem , Cuidados Pré-Operatórios/enfermagem , Adulto , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Prognóstico , Estudos Retrospectivos , Fatores de Risco
20.
Crit Care Nurs Q ; 40(2): 99-107, 2017.
Artigo em Inglês | MEDLINE | ID: mdl-28240692

RESUMO

The focus of this literature analysis is the concept of preparing the family and children for surgery. As posited in the literature, surgery causes stress and anxiety that have a negative impact on both parents and their children. Therefore, the need for health care professionals to facilitate positive preparation for surgery to minimize anxiety and enhance postoperative recovery is important. Preparing the family and children for surgery is discussed in depth under the following themes: Preoperative Anxiety in Children, the Impact of Preoperative Anxiety on the Pediatric Patients and Parents, Preoperative Psychological Preparation for Children and Parents, and the Role of Nurse Practitioners in Preoperative Preparation. Through reviewing the literature, it would appear that some areas of preparation for parents are not as sufficient as they could be, particularly with regard to adequate preoperative education programs. The majority of studies reported that therapeutic play and clown interventions used for psychological preparation of parents and their children have been effective in minimizing and decreasing anxiety levels.


Assuntos
Ansiedade/prevenção & controle , Pais/psicologia , Cuidados Pré-Operatórios/enfermagem , Estresse Psicológico/prevenção & controle , Procedimentos Cirúrgicos Ambulatórios , Ansiedade/psicologia , Criança , Humanos , Profissionais de Enfermagem Pediátrica/psicologia , Cuidados Pré-Operatórios/métodos , Estresse Psicológico/psicologia
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