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1.
Artigo em Inglês, Português | LILACS, BDENF - Enfermagem | ID: biblio-1047996

RESUMO

Objetivo: identificar as atividades de vida diárias com dependência de cuidados de enfermagem. Método: estudo exploratório com abordagem qualitativa realizado com 52 pessoas em situação de rua na cidade de Sobral, Ceará, Brasil. Utilizou-se o modelo de atividade de vida diária proposto por Roper, Logan e Tierney para nortear a coleta e análise de dados. Resultados: as atividades de vida com maior dependência de cuidados são: alimentação, devido consumo irregular de nutrientes básicos, que promove um estado de desnutrição permanente, outra atividade foi trabalho e distração, pois os mesmos não possuem remuneração fixa e vivem do que arrecadam ao realizar atividades que geram pequenas quantias monetárias, além das atividades, morte, sexualidade, sono, respiração e eliminação, as quais também se revelaram comprometidas. Conclusão: a utilização do modelo com pessoas em situação de rua proporcionou abordagem holística aos indivíduos, por favorecer a investigação dos fatores que interferem na manutenção da saúde


Objetivo: identificar las actividades de la vida cotidiana con dependencia del cuidado de enfermeira. Método: estudio exploratorio con un enfoque cualitativo realizado con 52 personas en situación de calle en Sobral, Ceará, Brasil. El modelo de actividad de la vida diaria propuesto por Ropen, Logan y Tierney se utilizó para guiar la recolección y el análisis de datos. Resultados: las actividades de vida con mayor dependencia de cuidados son: alimentación, debido consumo irregular de nutrientes básicos, que promueve un estado de desnutrición permanente, otra actividad fue trabajo y distracción, pues los mismos no poseen remuneración fija y viven de lo que recaudan al realizar actividades que generan pequeñas cantidades monetarias, además de las actividades, muerte, sexualidad, sueño, respiración y eliminación, las cuales también se revelaron comprometidas. Conclusión: la utilización del modelo con personas en situación de calle proporcionó un enfoque holístico a los individuos, por favorecer la investigación de los factores que interfieren en el mantenimiento de la salud


Objective: identify daily Activities of Daily Living with dependence on nursing care. Method: exploratory study with a qualitative approach performed with 52 people in a street situation in Sobral, Ceará, Brazil. The daily Daily Living Activity model proposed by Ropen, Logan and Tierney was used to guide the data collection and analysis. Results: the activities of life with greater dependence on care are: food, due to irregular consumption of basic nutrients, which promotes a state of permanent malnutrition; another activity was work and entertainment, because they do not have fixed remuneration and live on what they collect by performing activities that generate small amounts of Money, besides activities such as death, sex, sleep, breathing and elimination, which are also compromised. Conclusion: the use of the model with people living on the street provided a holistic view of individuals, favoring the investigation of the factors that interfere in the maintenance of health


Assuntos
Humanos , Masculino , Feminino , Adulto , Pessoa de Meia-Idade , Qualidade de Vida , Pessoas em Situação de Rua , Modelos de Enfermagem , Pesquisa Qualitativa , Padrões de Prática em Enfermagem , Enfermagem de Atenção Primária/métodos , Cuidados de Enfermagem/métodos
2.
J Nurs Adm ; 49(10): 466-472, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31490797

RESUMO

Palliative care (PC) is a national and global priority, yet there is insufficient knowledge regarding PC among generalist clinicians. An interdisciplinary educational initiative was implemented to enhance a hospital workforce's PC knowledge and skills. More than 1000 clinicians attended at least 1 of 27 educational offerings. Measurable gains were evident in key outcome measures including PC referrals and advanced directive documentation. Changes reflected a transformation of workforce culture and resulted in 2 national awards for improving PC.


Assuntos
Educação Continuada em Enfermagem/organização & administração , Enfermagem de Cuidados Paliativos na Terminalidade da Vida/educação , Recursos Humanos de Enfermagem no Hospital/educação , Enfermagem de Atenção Primária/métodos , Adulto , Currículo , Feminino , Humanos , Masculino , Pessoa de Meia-Idade
3.
J Clin Nurs ; 28(15-16): 2745-2759, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-30970152

RESUMO

BACKGROUND: The burden of Chronic Kidney Disease (CKD) on the Australian health system is growing. Efforts to reverse this trend have not been successful. This paper evaluates the effectiveness of a targeted asynchronous web based e-learning module on general practice nurses' behavioural intentions in relation to opportunistic screening practices for people at risk of CKD. DESIGN: Double blinded pre-post interventional randomised control design. METHODS: Participants were nurses working in general practice settings in Australia. Participants were randomised to a knowledge based active control or targeted behavioural based intervention which were delivered using asynchronous e-learning modules. The intervention was designed to influence the behavioural constructs of the theory of planned behaviour (TPB): attitude, subjective norm and perceived behavioural control (PBC). RESULTS: Of the 420 participants, we analysed the primary and secondary outcomes for 212 (50.47%) who had complete follow up data. There were no significant differences (p 0.424, [d] 0.04) in behavioural intention between the intervention and control groups at follow-up, when controlling for baseline values. However, regression models assessing the relationship between the change in the TPB constructs and behavioural intention at follow-up for all participants, regardless of study arm, demonstrated a significant change in intention to initiate a kidney health check. Although these changes could not be attributed to the effect of the intervention. Attitude (r2 = 0.3525, p 0.0004) and PBC (r2 = 0.3510, p 0.0005) models accounted for approximately 35% of the explained variance in behavioural intentions and social norm (r2 = 0.3297, p 0.0171) accounted for approximately 33% of the variance. When all TPB constructs were included in the model, 37% of the variance in intention was explained. CONCLUSION: A targeted behavioural online intervention was no more effective than a knowledge based online program to improve primary health care nurses' intention to initiate a kidney health check in people at risk of chronic kidney disease. RELEVANCE TO CLINICAL PRACTICE: Collaborative efforts are required by all staff working in general practice to develop models of care to improve screening practices for chronic kidney disease. Future research should focus on interventions that improve collaboration between health care professionals in the primary care setting and public health campaigns to increase awareness of risks of CKD and the importance of screening in the primary care setting.


Assuntos
Atitude do Pessoal de Saúde , Programas de Rastreamento/enfermagem , Enfermagem de Atenção Primária/métodos , Insuficiência Renal Crônica/diagnóstico , Austrália , Método Duplo-Cego , Feminino , Promoção da Saúde , Humanos , Intenção , Masculino , Programas de Rastreamento/psicologia , Pessoa de Meia-Idade
4.
Rev Bras Enferm ; 72(suppl 1): 114-121, 2019 Feb.
Artigo em Inglês, Português | MEDLINE | ID: mdl-30942352

RESUMO

OBJECTIVE: To analyze the clinical practice of nurses in the interprofessional context of the Family Health Strategy. METHOD: Case study in a basic health unit of the city of São Paulo with a professional team of the Family Health Strategy and of the Family Health Support Center. Direct observation and interviews with thematic analysis and triangulation were conducted. RESULTS: Four empirical categories were identified: interprofessional actions guided by the logic of the user's health needs; interprofessional actions guided by the logic of expediting service; interprofessional actions with a biomedical approach and interprofessional actions with an integral/holistic approach. Six interprofessional actions that indicated the expansion of the clinical practice of the Family Health Strategy's nurses were also identified. CONCLUSION: The results express the world trend of interprofessional practice and expansion of the scope of practice of different professions, particularly that of nurses, which requires consolidation based on the population's health needs.


Assuntos
Saúde da Família/educação , Enfermagem de Atenção Primária/métodos , Prática Profissional/tendências , Brasil , Humanos , Relações Interprofissionais , Entrevistas como Assunto/métodos , Pesquisa Qualitativa
5.
Curationis ; 42(1): e1-e6, 2019 Jan 28.
Artigo em Inglês | MEDLINE | ID: mdl-30843402

RESUMO

BACKGROUND:  Integration of human immunodeficiency virus and acquired immune deficiency syndrome (HIV and AIDS) services into primary healthcare (PHC) is a key public health approach to achieving universal access to antiretroviral therapy (ART). Despite the government's efforts of integrating HIV services into PHC, an insufficient number of PHC staff and inadequate infrastructure are challenging when integrating HIV and AIDS services into PHC. This study explored the challenges of PHC nurses regarding the integration of HIV and AIDS services into PHC. OBJECTIVES:  The aim of the study was to explore the challenges of PHC nurses regarding the integration of HIV and AIDS services into PHC. METHOD:  An exploratory, descriptive and contextual qualitative research design utilising face-to-face semi-structured interviews was conducted with 12 PHC nurses from selected clinics and health centres in the Vhembe district of Limpopo province. RESULTS:  Two main themes emerged from data analysis which included challenges related to healthcare recipients and challenges related to healthcare providers. CONCLUSION:  Clear policies on the integration of HIV and AIDS services into PHC should be available and should include strategies to promote HIV testing and counselling, adherence to ART and scheduled appointments, disclosure of HIV status as well as revising the human resource policy to reduce workload.


Assuntos
Infecções por HIV/enfermagem , Enfermagem de Atenção Primária/métodos , Adulto , Instituições de Assistência Ambulatorial/organização & administração , Prestação Integrada de Cuidados de Saúde/tendências , Transmissão de Doença Infecciosa/prevenção & controle , Feminino , Acesso aos Serviços de Saúde/normas , Humanos , Entrevistas como Assunto/métodos , Masculino , Pessoa de Meia-Idade , Pesquisa Qualitativa , África do Sul
6.
J Clin Nurs ; 28(13-14): 2517-2525, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-30791154

RESUMO

AIMS: To facilitate evidence-based leg and foot ulcer management through implementation of the Champions for Skin Integrity model to education in primary health care in Australia. BACKGROUND: Leg and foot ulcers are frequently seen wounds in general practice and wound care the most frequently performed activity by practice nurses. The literature reports the lack of evidence-based leg and foot ulcer assessment, management and prevention strategies in this setting, and previous research in regard to confidence and knowledge has indicated that general practice health professionals have the greatest need for education in wound care. DESIGN: Pre-post, nonequivalent group research design. METHODS: The Champions for Skin Integrity model of evidence-based wound management utilised strategies including workshops, development of Champions and use of resources. Pre- and post-implementation health professional surveys and patient clinical audits were completed. Descriptive statistics were calculated for all variables. Paired t tests identified statistically significant differences between the pre/post staff survey data. STROBE guidelines for reporting were followed (See Appendix S1). RESULTS: One hundred nine general practice healthcare professional staff attended the workshops. Significant outcomes were noted in increased levels of confidence in ability to assess, manage and prevent all types of leg and foot ulcers, as well as to apply evidence-based practice and change management following workshops. Pre- and post-skin audits also indicated an increase in evidence-based practices. CONCLUSION: Implementation of Champions for Skin Integrity strategies in this sample of primary healthcare professionals in general practice fostered a positive change in evidence-based wound management, assessment and prevention. RELEVANCE TO CLINICAL PRACTICE: The Champions for Skin Integrity model has supported increases in evidence-based practices in treatment and management of wounds in primary healthcare professionals, similar to the positive outcomes gained in the aged care setting. This is likely to lead to positive outcomes for those with wounds in this setting.


Assuntos
Úlcera do Pé/enfermagem , Pessoal de Saúde/educação , Pele/lesões , Austrália , Enfermagem Baseada em Evidências/métodos , Úlcera do Pé/prevenção & controle , Humanos , Capacitação em Serviço/métodos , Enfermagem de Atenção Primária/métodos , Atenção Primária à Saúde/normas , Melhoria de Qualidade , Inquéritos e Questionários
7.
J Am Assoc Nurse Pract ; 31(5): 300-308, 2019 May.
Artigo em Inglês | MEDLINE | ID: mdl-30624334

RESUMO

BACKGROUND AND PURPOSE: The increasing prevalence of chronic diseases is driving health care systems to rethink their operations. Despite numerous studies supporting the advantages of primary health care nurse practitioners (PHCNPs) in chronic disease management, implementing practices that fully use the skills of these practitioners seems impeded in the Canadian province of Québec. This study explores the views of leaders involved in primary health care regarding the contributions PHCNPs can make in chronic disease management and the challenges they face in doing so. METHODS: Through semistructured interviews, an exploratory descriptive qualitative study was conducted with 20 key informants across Québec who hold a variety of professional positions connected to PHCNPs. CONCLUSIONS: Primary health care nurse practitioners were perceived to be able to improve self-management support for chronic diseases. In reality, however, PHCNPs are mainly devoting their time to clientele in acute care, and current regulations governing their practices limit their involvement in chronic disease management. IMPLICATIONS FOR PRACTICE: Integrating PHCNPs offers a unique opportunity for health care settings to redefine the roles of family physicians and registered nurses and to restructure practices toward a chronic disease-oriented system. A clinical manager should be designated to monitor this restructuring process and ensure its success.


Assuntos
Doença Crônica/enfermagem , Profissionais de Enfermagem/psicologia , Enfermagem de Atenção Primária/métodos , Gerenciamento Clínico , Humanos , Entrevistas como Assunto/métodos , Profissionais de Enfermagem/tendências , Papel do Profissional de Enfermagem , Pesquisa Qualitativa , Quebeque
8.
Rev Esc Enferm USP ; 52: e03375, 2018 Dec 03.
Artigo em Inglês, Português | MEDLINE | ID: mdl-30517298

RESUMO

OBJECTIVE: To conduct a situational diagnosis of the Nursing Care Systematization (NCS) in a Basic Health Unit from the perception of the nursing team. METHOD: This was a quantitative, descriptive-exploratory study, conducted in a Basic Health Unit in the interior of São Paulo state, Brazil. A structured questionnaire containing Likert scale was used for data collection, previously validated by specialists. RESULTS: The questionnaire was applied to 21 nursing professionals. It was verified that implementation of NCS and the nursing process is still incipient in the Basic Health Units. Regarding its use in all nursing actions: 19% of respondents believe that it is never used, 38% thought that it is rarely implemented, and 29% responded sometimes. The main difficulties identified were related to the lack of institutional structure, highlighting a lack of capacity by the institution (81%). The team has a reasonable understanding about the subject, but pointed out that professional education does not prepare them for performing NCS in primary care. CONCLUSION: Institutional interest in NCS is necessary to enable implementation. The study can contribute to the effective implementation in this unit and point out guidelines for its implementation in other similar contexts.


Assuntos
Cuidados de Enfermagem/organização & administração , Processo de Enfermagem/organização & administração , Equipe de Enfermagem/organização & administração , Enfermagem de Atenção Primária/métodos , Adulto , Idoso , Brasil , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Enfermeiras e Enfermeiros/organização & administração , Enfermeiras e Enfermeiros/estatística & dados numéricos , Inquéritos e Questionários , Adulto Jovem
9.
Rev. Rol enferm ; 41(11/12,supl): 319-324, nov.-dic. 2018.
Artigo em Inglês | IBECS | ID: ibc-179983

RESUMO

Introduction: The Dynamic Model for Assessment and Family Intervention (MDAIF), as an operative theoretical referential underlying the assessment and family inter-vention practices, was adopted for the family nursing specialty, in Portugal. Objective: To assess the impact of the professional practice of MDAIF on the as-sessment and family intervention practices of Primary Healthcare Nurses. Methods: A study descriptive case. Forty-nine nurses were invited to participate in the pre-training moment and forty-three in the post-training. Participants were as-ked to sign a written informed consent and were delivered an open-question form applied in the two moments. The data retrieved were submitted to content analysis with a posteriori categorization. Results and discussion: In the pre-training moment, the most common family as-sessment practices were: "Areas of attention MDAIF", "Evaluative data of the MDAIF"; "Attention Individual areas"; and for the most common family intervention practices", "action"; "client"; "health programmes"; "prevention levels".After the training: "MDAIF dimensions"; and "individual areas of attention", with occasional incidence. In the family intervention, the categories identified were: "MDAIF areas of attention" and "action". It is well known that knowledge transfer into practice in family health nursing is a challenge and that only a relatively small percentage of the training is effectively applied, however, in this study it is possible to observe that training had a positive impact in practice changes. The actions focused on care provided to each member of the family changed to care targeted at the family as a client. Conclusion: Training has enabled knowledge transfer to professional performance


No disponible


Assuntos
Humanos , Educação Continuada em Enfermagem/métodos , Modelos de Enfermagem , Enfermagem de Atenção Primária/métodos , Avaliação de Eficácia-Efetividade de Intervenções , Capacitação Profissional , Cobertura de Serviços de Saúde/tendências
10.
Rev Bras Enferm ; 71(suppl 5): 2295-2301, 2018.
Artigo em Inglês, Português | MEDLINE | ID: mdl-30365797

RESUMO

OBJECTIVE: to analyze how family health nurses assess quality of care; check if they have any intention of leaving their current job and nursing; estimate prevalence of professional exhaustion; and correlate these variables. METHOD: cross-sectional and correlational study with 198 nurses. The Maslach Burnout Inventory was applied, as it has questions for characterizing nurses, assessing perception on quality of care and of material and human resources, and verifying intention of leaving current work and nursing. RESULTS: most nurses assess quality of care as good, 28.0% present emotional exhaustion, there is intention of leaving current work and nursing. CONCLUSIONS: family health nurses experience professional exhaustion, which in turn presents correlation with decreased quality of care and increased intentions of leaving current work and nursing.


Assuntos
Esgotamento Profissional/etiologia , Intenção , Enfermeiras e Enfermeiros/psicologia , Adulto , Atitude do Pessoal de Saúde , Esgotamento Profissional/psicologia , Estudos Transversais , Saúde da Família , Feminino , Humanos , Satisfação no Emprego , Masculino , Enfermagem de Atenção Primária/métodos , Enfermagem de Atenção Primária/normas , Inquéritos e Questionários
11.
CCH, Correo cient. Holguín ; 22(1): 79-89, ene.-mar. 2018. tab
Artigo em Espanhol | LILACS, Repositório RHS | ID: biblio-952202

RESUMO

Introducción: recientemente, la evaluación de las competencias de los profesionales de enfermería se ha divido en dos categorías: competencias genéricas y competencias específicas. Objetivo: caracterizar las competencias genéricas profesionales de los Licenciados en Enfermería, en los escenarios laborales actuales del municipio Holguín, desde octubre del 2011 hasta abril del 2012. Métodos: se realizó una investigación de evaluación, a partir de una muestra de 125 profesionales, escogidos por selección aleatoria, en 5 policlínicos. Se emplearon métodos teóricos y empíricos; dentro de estos últimos, los cuestionarios. Resultados: se detectaron insuficiencias en la formación de pregrado, específicamente en la preparación teórico-práctica para la investigación, los programas y acciones de salud, idioma extranjero, y computación. Conclusiones: se caracterizaron las competencias profesionales genéricas de los enfermeros de la Atención Primaria de la Salud del municipio Holguín, y se determinaron las insuficiencias.


Introduction: a two category method for assessing general and specific infirmary skills, have been developed lately. Objective: to characterize registered nurses generic skills, performing in Holguín municipality, from October 2011 to April 2012. Methods: an evaluation research was conducted. A sample of 125 infirmary professionals from five polyclinics, were chosen at random. Theoretical and empirical methods, such as questionnaires, were applied. Results: there was misstraining in undergraduate education, especially in the theoretical and practical development of language, computing, research and health programs. Conclusions: generic skills of Primary Care nurses in Holguín municipality, were characterized and determined.


Assuntos
Humanos , Competência Profissional , Avaliação de Recursos Humanos em Saúde , Atenção Primária à Saúde , Cuba , Avaliação de Desempenho Profissional , Enfermagem de Atenção Primária/métodos
12.
Nurs Res ; 67(1): 35-42, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-29240658

RESUMO

BACKGROUND: Nurses in primary care organizations play a central role for patients with chronic disease. Lack of clarity in role description may be associated with underutilization of nurse competencies that could benefit the growing population of patients with chronic disease. OBJECTIVE: The purpose of the research was to describe nursing activities in primary care settings with patients with chronic disease. METHODS: A Web-based survey was sent to nurses practicing in Family Medicine Groups in the Canadian Province of Québec. Participants rated the frequency with which they carried out nursing activities in five domains: (a) global assessment, (b) care and case management, (c) health promotion, (d) nurse-physician collaboration, and (e) planning services for patients with chronic disease. Findings were summarized with descriptive statistics (means, standard deviations, and ranges). RESULTS: The survey was completed by 266 of the 322 nurses who received the survey (82.6%). Activities in the health promotion and global assessment of the patient domains were carried out most frequently. Planning services for patients with chronic disease were least frequently performed. DISCUSSION: This study provides a broad description of nursing activities with patients with chronic disease in primary care. The findings provide a baseline for clinicians and researchers to document and improve nursing activities for optimal practice for patients with chronic disease.


Assuntos
Doença Crônica/enfermagem , Competência Clínica , Papel do Profissional de Enfermagem , Relações Enfermeiro-Paciente , Enfermagem de Atenção Primária/métodos , Humanos , Avaliação em Enfermagem , Pesquisa Qualitativa , Qualidade da Assistência à Saúde
13.
J Adv Nurs ; 74(2): 279-288, 2018 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-28880393

RESUMO

AIMS: To explore the feasibility and acceptability of nurse-led chronic disease management and lifestyle risk factor reduction interventions in primary care (general practice/family practice). BACKGROUND: Growing international evidence suggests that interventions delivered by primary care nurses can assist in modifying lifestyle risk factors and managing chronic disease. To date, there has been limited exploration of the feasibility and acceptability of such interventions. DESIGN: Integrative review guided by the work of Whittemore and Knafl (). DATA SOURCES: Database search of CINAHL, Medline and Web of Science was conducted to identify relevant literature published between 2000-2015. REVIEW METHODS: Papers were assessed for methodological quality and data abstracted before thematic analysis was undertaken. RESULTS: Eleven papers met the inclusion criteria. Analysis uncovered four themes: (1) facilitators of interventions; (2) barriers to interventions; (3) consumer satisfaction; and (4) primary care nurse role. CONCLUSION: Literature supports the feasibility and acceptability of nurse-led interventions in primary care for lifestyle risk factor modification. The ongoing sustainability of these interventions rests largely on organizational factors such as funding, educational pathways and professional support of the primary care nursing role. Further robust research around primary care nurse interventions is required to strengthen the evidence base.


Assuntos
Doença Crônica/enfermagem , Gerenciamento Clínico , Promoção da Saúde/métodos , Papel do Profissional de Enfermagem , Satisfação do Paciente , Enfermagem de Atenção Primária/métodos , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade
14.
Rev Saude Publica ; 53: 04, 2018 Dec 20.
Artigo em Inglês, Português | MEDLINE | ID: mdl-30652777

RESUMO

OBJECTIVE: To verify the effectiveness of brief group intervention, performed by nurses, in reducing the hazardous or harmful alcohol use in users of a primary health care service. METHODS: Clinical and randomized trial with follow-up of three months. The sample had 180 individuals with a pattern of hazardous or harmful alcohol use, recruited in a Basic Health Unit in the city of São Paulo. A sociodemographic questionnaire and the Alcohol Use Disorders Identification Test (Audit) were applied. The experimental group underwent the Brief Group Intervention, which had four group sessions, with weekly meetings. The control group received an information leaflet about issues related to alcohol consumption. Both groups participated in the follow-up of three months. The linear mixed model was used for data analysis, in which a 5% significance level was adopted. RESULTS: Forty-four individuals under hazardous or harmful alcohol use completed all phases of the research. The experimental group had a statistically significant reduction (p < 0.01) of about 10 points in Audit score after the brief group intervention [before BGI = 15.89 (SD = 6.62) - hazardous use; after BGI = 6.40 (SD = 5.05) - low hazardous use] maintaining the low hazardous use in follow-up [6.69 (SD = 6.38) - low hazardous use]. The control group had a statistically significant reduction (p ≤ 0.01) of about three points in Audit score [before BGI = 13.11 (SD = 4.54) - hazardous use; after BGI = 9.83 (SD = 5.54) - hazardous use] and in follow-up presented the mean score of 13.00 (SD = 5.70), indicative of hazardous use. Differences between the two groups (experimental group versus control group) in reduction of consumption were statistically significant (p ≤ 0.01). CONCLUSIONS: Our evidence showed that the brief group intervention performed by the nurse in the primary health care context was effective to reduce alcohol consumption in individuals with patterns of hazardous or harmful use.


Assuntos
Alcoolismo/prevenção & controle , Enfermagem de Atenção Primária/métodos , Atenção Primária à Saúde/métodos , Psicoterapia de Grupo/métodos , Consumo de Bebidas Alcoólicas/prevenção & controle , Consumo de Bebidas Alcoólicas/psicologia , Alcoolismo/enfermagem , Alcoolismo/psicologia , Análise de Variância , Feminino , Humanos , Masculino , Enfermeiras Especialistas , Reprodutibilidade dos Testes , Fatores de Risco , Inquéritos e Questionários , Fatores de Tempo , Resultado do Tratamento
15.
ENFURO: Rev. Asoc. Esp. A.T.S. Urol ; (133): 10-15, ago. 2017. ilus
Artigo em Espanhol | IBECS | ID: ibc-171296

RESUMO

Entre las derivaciones urinarias en pacientes sometidos a una cistectomía radical por cáncer vesical infiltrante, la neovejiga ileal ortotópica, tipo Hautmann, es una excelente alternativa. Como objetivos nos planteamos: 1) exponer los cuidados de enfermería en pacientes intervenidos de cistectomía radical por cáncer vesical infiltrante a los que se les ha construido una neovejiga ileal tipo Hautmann, y 2) señalar el importante papel que juega enfermería, tanto hospitalaria como de atención primaria, en este tipo de intervención quirúrgica. Se expone un caso clínico de un paciente diagnosticado de cáncer urotelial papilar de alto grado con infiltración perineural al que se le ha construido una neovejiga. Se muestra el procedimiento seguido en el servicio, así como los protocolos empleados y actuaciones de enfermería. Como complicación presentó un íleo paralítico. La bibliografía especializada señala que el íleo paralítico es una de las complicaciones inmediatas que se da con más frecuencia en la cistectomía radical por cáncer vesical infiltrante, junto con la fístula urinaria, retención urinaria por mucus y urosepsis. Estudios de seguimientos de casos de neovejiga ileal tipo Hautmann muestran buenos resultados funcionales, una baja tasa de complicaciones, tanto inmediatas como tardías, y, sobre todo, una buena calidad de vida de estos pacientes


Orthopic ileal neobladder, type Hautmann, is currently the preferred method for urinary derivation in patients undergoing radical cystectomy for muscle-infiltrating bladder cancer. We set goals such as: 1) to supply useful information to patients with neobladder, specifically Hautmann neobladder about patients who underwent radical cystectomy due to infiltrating bladder cancer. 2) to highlight the important role that nursing staff plays by promoting quality in nursing care in this type of surgical intervention. It is described the case of a patient diagnosed with high-grade papillary urothelial carcinoma with evidence of perineural invasion. This patient underwent a radical cystectomy with neobladder reconstruction. The patient presented paralytic ileus. Paralytic ileus is a severe complication resulting from a variety of disorders, which is most commonly associated with radical cystectomy due to infiltrating bladder cancer. Other complications are urinary fistula, urinary retention due to mucus and urosepsis. Surveys aimed at monitoring the Hautmann neobladder show good functional outcomes, a low rate of complications of both immediate and late responses, and therefore, the quality of life for these patients was good


Assuntos
Humanos , Masculino , Pessoa de Meia-Idade , Cuidados de Enfermagem/organização & administração , Derivação Urinária/enfermagem , Cistectomia/enfermagem , Enfermagem de Atenção Primária/métodos , Ferida Cirúrgica/enfermagem , Evolução Clínica/enfermagem , Diagnóstico de Enfermagem/organização & administração
16.
Trials ; 18(1): 206, 2017 05 03.
Artigo em Inglês | MEDLINE | ID: mdl-28468642

RESUMO

BACKGROUND: Up to a third of patients presenting medically unexplained physical symptoms in primary care may have a somatoform disorder, of which undifferentiated somatoform disorder (USD) is the most common type. Psychological interventions can reduce symptoms associated with USD and improve functioning. Previous research has either been conducted in secondary care or interventions have been provided by general practitioners (GPs) or psychologists in primary care. As efficiency and cost-effectiveness are imperative in primary care, it is important to investigate whether nurse-led interventions are effective as well. The aim of this study is to examine the effectiveness and cost-effectiveness of a short cognitive behavioural therapy (CBT)-based treatment for patients with USD provided by mental health nurse practitioners (MHNPs), compared to usual care. METHODS: In a cluster randomised controlled trial, 212 adult patients with USD will be assigned to the intervention or care as usual. The intervention group will be offered a short, individual CBT-based treatment by the MHNP in addition to usual GP care. The main goal of the intervention is that patients become less impaired by their physical symptoms and cope with symptoms in a more effective way. In six sessions patients will receive problem-solving treatment. The primary outcome is improvement in physical functioning, measured by the physical component summary score of the RAND-36. Secondary outcomes include health-related quality of life measured by the separate subscales of the RAND-36, somatization (PHQ-15) and symptoms of depression and anxiety (HADS). Problem-solving skills, health anxiety, illness perceptions, coping, mastery and working alliance will be assessed as potential mediators. Assessments will be done at 0, 2, 4, 8 and 12 months. An economic evaluation will be conducted from a societal perspective with quality of life as the primary outcome measure assessed by the EQ-5D-5L. Health care, patient and lost productivity costs will be assessed with the Tic-P. DISCUSSION: We expect that the intervention will improve physical functioning and is cost-effective compared to usual care. If so, more patients might successfully be treated in general practice, decreasing the number of referrals to specialist care. TRIAL REGISTRATION: Dutch Trial Registry, identifier: NTR4686 , Registered on 14 July 2014.


Assuntos
Terapia Cognitivo-Comportamental/métodos , Profissionais de Enfermagem , Enfermagem de Atenção Primária/métodos , Atenção Primária à Saúde , Transtornos Somatoformes/enfermagem , Adaptação Psicológica , Protocolos Clínicos , Terapia Cognitivo-Comportamental/economia , Efeitos Psicossociais da Doença , Análise Custo-Benefício , Custos de Cuidados de Saúde , Humanos , Países Baixos , Profissionais de Enfermagem/economia , Equipe de Assistência ao Paciente , Enfermagem de Atenção Primária/economia , Atenção Primária à Saúde/economia , Resolução de Problemas , Qualidade de Vida , Projetos de Pesquisa , Transtornos Somatoformes/diagnóstico , Transtornos Somatoformes/economia , Transtornos Somatoformes/psicologia , Inquéritos e Questionários , Fatores de Tempo , Resultado do Tratamento
17.
J Adv Nurs ; 73(9): 2191-2200, 2017 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-28397984

RESUMO

AIM: To analyse the efficacy of a 12-month multifactorial intervention by primary care nurses in increasing adherence to physical activity prescription (150 min/week) in patients with two or more cardiovascular risk factors and with cardiovascular risk up to 15% determined by the REGICOR equation. BACKGROUND: In Spain, cardiovascular diseases are responsible for 30.5% of deaths. Regular physical activity decreases mortality risk due to cardiovascular diseases but the effectiveness of physical activity prescription in routine in primary care settings has been shown to be low. DESIGN: Multicentre, single-blind, parallel randomized (in two different branches) clinical trial. METHODS: At least 368 participants will be recruited (184 control and 184 intervention), to show an 8% increase in adherence to the physical activity prescription (1.2% control group and 9.2% intervention group). Participants will be patients aged 35-75 years with at least two cardiovascular risk factors and with a cardiovascular risk of up to 15% measured using the Framingham-REGICOR equation. Intervention will be performed throughout baseline and three follow-up visits. A motivational interview, the trans-theoretical stages of changes of Prochaska and DiClemente and an individualized prescription of physical exercise using physical activity assets will be used in the intervention. Data will be collected at baseline and after the 1-year intervention. DISCUSSION: The present study will allow us to find out whether this brief multifactorial intervention induces greater adherence to physical activity prescription than usual practice, improving the quality of patient care. TRIAL REGISTRATION: International Standard Randomized Controlled Trial Number (ISRCTN): ISRCTN76069254. Protocol version 1.1, 6 July 2015.


Assuntos
Doenças Cardiovasculares/terapia , Exercício , Promoção da Saúde/métodos , Cooperação do Paciente/psicologia , Cooperação do Paciente/estatística & dados numéricos , Pacientes/psicologia , Enfermagem de Atenção Primária/métodos , Adulto , Idoso , Idoso de 80 Anos ou mais , Atitude Frente a Saúde , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Fatores de Risco , Método Simples-Cego , Espanha , Inquéritos e Questionários
18.
BMJ Open ; 7(3): e014124, 2017 03 29.
Artigo em Inglês | MEDLINE | ID: mdl-28360245

RESUMO

OBJECTIVES: To explore the opportunities for interprofessional collaboration (IPC) to improve paediatric oral health in federally qualified health centres (FQHCs), to identify challenges to IPC-led integration of oral health prevention into the well-child visit and to suggest strategies to overcome barriers. SAMPLE: Nurse managers (NMs), nurse practitioners (NPs), paediatric clinical staff and administrators in six FQHCs in two states were interviewed using a semistructured format. DESIGN: Grounded theory research. Topics included feasibility of integration, perceived barriers and strategies for incorporating oral health into paediatric primary care. MEASUREMENTS: Qualitative data were coded and analysed using NVivo 10 to generate themes iteratively. RESULTS: Nurses in diverse roles recognised the importance of oral health prevention but were unaware of professional guidelines for incorporating oral health into paediatric encounters. They valued collaborative care, specifically internal communication, joint initiatives and training and partnering with dental schools or community dental practices. Barriers to IPC included inadequate training, few opportunities for cross-communication and absence of charting templates in electronic health records. CONCLUSIONS: NMs, NPs and paediatric nursing staff all value IPC to improve patients' oral health, yet are constrained by lack of oral health training and supportive charting and referral systems. With supports, they are willing to take on responsibility for introducing oral health preventive measures into the well-child visit, but will require IPC approaches to training and systems changes. IPC teams in the health centre setting can work together, if policy and administrative supports are in place, to provide oral health assessments, education, fluoride varnish application and dental referrals, decrease the prevalence of early childhood caries and increase access to a dental home for low-income children.


Assuntos
Saúde Bucal , Padrões de Prática em Enfermagem/organização & administração , Enfermagem de Atenção Primária/métodos , Instituições de Assistência Ambulatorial , Atitude do Pessoal de Saúde , Criança , Cuidado da Criança/organização & administração , Feminino , Humanos , Relações Interprofissionais , Masculino , Maryland , Massachusetts , Enfermeiras Administradoras/organização & administração , Enfermeiras Administradoras/psicologia , Profissionais de Enfermagem/organização & administração , Profissionais de Enfermagem/psicologia , Papel do Profissional de Enfermagem , Enfermeiras Pediátricas/organização & administração , Enfermeiras Pediátricas/psicologia , Enfermagem Pediátrica/organização & administração , Responsabilidade Social
19.
J Clin Nurs ; 26(17-18): 2689-2702, 2017 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-28207958

RESUMO

AIMS AND OBJECTIVES: To understand how a vision of care is formed and shared by patients and the primary care professionals involved in their care. BACKGROUND: To achieve the best health outcomes, it is important for patients and those who care for them to have a mutual understanding about what is important to the patient in their everyday life and why, and what care is necessary to realise this vision. Shared or team care does not necessarily translate to a consistent and integrated approach to a patient's care. An individual patient's care network of clinical and lay participants can be conceptualised as the patient's own 'Community of Clinical Practice' of which they are the central member. DESIGN: Working alongside a long-term conditions nursing team, we conducted a focused ethnography of nine 'Communities of Clinical Practice' in one general practice setting. METHOD: Participant observation, in-depth qualitative interviews with 24 participants including nine patients, and the patients' medical records. Data were analysed using a template organising style. FINDINGS: Primary care professionals' insight into a patient's vision of care evolves through a deep knowing of the patient over time; this is shared between 'Community of Clinical Practice' members, frequently through informal communication and realised through respectful dialogue. These common values - respect, authenticity, autonomy, compassion, trust, care ethics, holism - underpin the development of a shared vision of care. CONCLUSIONS: A patient's vision of care, if shared, provides a focus around which 'Community of Clinical Practice' members cohere. Nurses play an important role in sharing the patient's vision of care with other participants. RELEVANCE TO CLINICAL PRACTICE: A shared vision of care is an aspirational concept which is difficult to articulate but with attentiveness, sustained authentic engagement and being driven by values, it should evolve amongst the core participants of a 'Community of Clinical Practice'.


Assuntos
Atitude do Pessoal de Saúde , Relações Enfermeiro-Paciente , Cuidados de Enfermagem/métodos , Enfermagem de Atenção Primária/métodos , Assistência à Saúde , Empatia , Humanos , Satisfação do Paciente , Pesquisa Qualitativa
20.
Rev. esp. geriatr. gerontol. (Ed. impr.) ; 52(1): 15-19, ene.-feb. 2017. tab, graf
Artigo em Espanhol | IBECS | ID: ibc-159271

RESUMO

Fundamentos. La atención al paciente pluripatológico en el hogar es un hecho cada vez más frecuente. El índice de esfuerzo del cuidador es un instrumento en forma de cuestionario que está diseñado para medir la carga percibida en aquellas personas que cuidan a sus familiares. El objetivo fue la construcción de un nomograma diagnóstico de sobrecarga en el cuidador informal mediante el cuestionario del índice de esfuerzo del cuidador con los datos de un modelo predictivo. Métodos. El modelo se confeccionó mediante regresión logística binaria, siendo incluidos los ítems del cuestionario del índice de esfuerzo del cuidador como variables predictoras dicotómicas. La variable dependiente fue la puntuación final obtenida mediante el cuestionario realizándose la categorización referenciada por la bibliografía: valores entre 0 y 6 fueron considerados como no existencia de estrés del cuidador y los iguales o superiores a 7 como existencia de estrés del cuidador. Se utilizó el programa estadístico R versión 3.1.1. Para construir los intervalos de confianza de la curva ROC se utilizaron 2.000 repeticiones bootstrap. Resultados. Sobre una muestra de 67 cuidadores se confeccionó un nomograma diagnóstico, con su gráfica de calibración (índice de Brier escalado = 0,686; R2 de Nagelkerke=0,791) y con la correspondiente curva ROC (área bajo la curva de 0,962). Conclusiones. El modelo predictivo generado mediante regresión logística binaria y su nomograma contienen cuatro variables predictoras (los ítems 1, 4, 5 y 9 del cuestionario). El área bajo la curva ROC (0,96; IC al 95%: 0,994-0,941) muestra un valor alto y discriminativo. La calibración del nomograma también presenta valores altos de bondad de ajuste por lo que estimamos que puede tener utilidad clínica en la consultas de enfermería comunitaria, de gestión de casos, de medicina de familia y de geriatría (AU)


Background. Patient homecare with multiple morbidities is an increasingly common occurrence. The caregiver strain index is tool in the form of questionnaire that is designed to measure the perceived burden of those who care for their families. The aim of this study is to construct a diagnostic nomogram of informal caregiver burden using data from a predictive model. Methods. The model was drawn up using binary logistic regression and the questionnaire items as dichotomous factors. The dependent variable was the final score obtained with the questionnaire but categorised in accordance with that in the literature. Scores between 0 and 6 were labelled as 'no' (no caregiver stress) and at or greater than 7 as 'yes'. The version 3.1.1R statistical software was used. To construct confidence intervals for the ROC curve 2000 boot strap replicates were used. Results. A sample of 67 caregivers was obtained. A diagnosing nomogram was made up with its calibration graph (Brier scaled = 0.686, Nagelkerke R2=0.791), and the corresponding ROC curve (area under the curve=0.962). Findings. The predictive model generated using binary logistic regression and the nomogram contain four items (1, 4, 5 and 9) of the questionnaire. R plotting functions allow a very good solution for validating a model like this. The area under the ROC curve (0.96; 95% CI: 0.994-0.941) achieves a high discriminative value. Calibration also shows high goodness of fit values, suggesting that it may be clinically useful in community nursing and geriatric establishments (AU)


Assuntos
Humanos , Masculino , Feminino , Cuidadores/organização & administração , Cuidadores/estatística & dados numéricos , Cuidadores/normas , Atenção Primária à Saúde/métodos , Atenção Primária à Saúde/estatística & dados numéricos , Esgotamento Profissional/complicações , Esgotamento Profissional/psicologia , Enfermagem de Atenção Primária/métodos , Enfermagem de Atenção Primária/psicologia , Esgotamento Profissional/epidemiologia , Modelos Logísticos , Curva ROC , Intervalos de Confiança , Nomogramas
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