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Am J Hosp Palliat Care ; 38(2): 199-203, 2021 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-32875819


CONTEXT: Due to the need for isolation of inpatients with suspected COVID-19, accuracy in identifying these cases in Emergency Department (ED) has great relevance, especially in Palliative Oncology Care Unit (PCU). OBJECTIVE: To evaluate the efficiency of clinical criteria adopted to identify suspected cases of COVID-19 by the ED in PCU. METHODS: All patients admitted to PCU between April and June 2020 from ED were included. The clinical criteria adopted to identify suspected COVID-19 cases were: being in contact with a suspected or confirmed case less than 14 days ago and / or presenting fever with no defined focus and / or respiratory symptoms not explained by oncological disease and / or suggestive image in radiological examination (if necessary). All suspected cases were submitted to deep nasal and throat swab for SARS COV-2 investigation by Reverse Transcription Polymerase Chain Reaction Test, adopted as gold standard. Inpatients hospitalized by ED, without suspicion, and then diagnosed with COVID-19 within 10 days of hospitalization were considered as false-negative cases. RESULTS: During the period, 327 patients were admitted from ED. Of these, 69 (21%) were considered suspects, of whom 34 (49%) tested positive for COVID-19. The sensitivity of the clinical criterion to identify suspected cases was 87%, specificity was 88%, positive predictive value was 49%, negative was 98% and accuracy was 88%. CONCLUSION: The clinical criteria adopted to identify suspected cases of COVID-19 at ED proved to be efficient, with low risk of spreading in-hospital infection, avoiding unnecessary isolation of patients.

/estatística & dados numéricos , Neoplasias/complicações , Cuidados Paliativos/métodos , /isolamento & purificação , /complicações , Serviços Médicos de Emergência , Serviço Hospitalar de Emergência , Feminino , Enfermagem de Cuidados Paliativos na Terminalidade da Vida , Humanos , Masculino
Rev. enferm. UERJ ; 28: e49901, jan.-dez. 2020.
Artigo em Inglês, Português | LILACS, BDENF - Enfermagem | ID: biblio-1123419


Objetivo: identificar elementos da Síndrome de terminalidade a partir do cruzamento de termos registrados pelos enfermeiros no cuidado ao fim de vida em idosos com demência avançada. Método: estudo observacional, retrospectivo, da ferramenta metodológica mapeamento cruzado. Foram coletados registros dos últimos 10 dias de vida de 38 prontuários de pessoas com demência avançada. Resultados: foram identificados 97 termos de respostas humanas, e através do mapeamento cruzado, foram elencados 22 diagnósticos de enfermagem, desses 11 diagnósticos de enfermagem apresentaram relevância estatística em 50% ou mais dos pacientes e oito diagnósticos de enfermagem apresentaram-se relevantes estatisticamente quando avaliados de acordo com a prevalência nas 380 observações. A Síndrome de terminalidade foi verificada em todas 380 avaliações, em média 7,5 diagnósticos da síndrome foram observados. Conclusão: a alta prevalência da Síndrome de terminalidade sustenta a inclusão do diagnóstico de enfermagem na Taxonomia II da NANDA-I, dado que os enfermeiros já a observam e a registram em sua prática(AU)

Objective: to identify elements of Terminal Syndrome by cross-referencing terms recorded by nurses providing end-of-life care for elderly people with advanced dementia. Method: in this retrospective, observational study, using a cross-mapping methodological tool, records of the last 10 days of life were collected from 38 medical records of people with advanced dementia. Results: 97 human-response terms were identified, and by cross-mapping, 22 nursing diagnoses were listed; of these, 11 nursing diagnoses displayed statistical importance in 50% or more of the patients, while eight nursing diagnoses were statistically important when assessed by prevalence in the 380 observations. Terminal Syndrome was found in all 380 evaluations, averaging 7.5 diagnoses of the syndrome. Cases were observed Conclusion: the high prevalence of Terminal Syndrome supports the inclusion of this nursing diagnosis in the NANDA-I Taxonomy II, as nurses already observe and record in practice(AU)

Objetivo: identificar elementos del síndrome terminal mediante términos de referencia cruzada registrados por enfermeras que brindan atención al final de la vida a personas mayores con demencia avanzada. Método: en este estudio observacional retrospectivo, utilizando una herramienta metodológica de mapeo cruzado, se recolectaron registros de los últimos 10 días de vida de 38 historias clínicas de personas con demencia avanzada. Resultados: Se identificaron 97 términos de respuesta humana y, mediante mapeo cruzado, se enumeraron 22 diagnósticos de enfermería; de estos, 11 diagnósticos de enfermería mostraron importancia estadística en el 50% o más de los pacientes, mientras que ocho diagnósticos de enfermería fueron estadísticamente importantes cuando se evaluaron por prevalencia en las 380 observaciones. El síndrome terminal se encontró en las 380 evaluaciones, con un promedio de 7,5 diagnósticos del síndrome. Se observaron casos Conclusión: la alta prevalencia de Síndrome Terminal apoya la inclusión de este diagnóstico de enfermería en la Taxonomía II de NANDA-I, ya que las enfermeras ya observan y registran en la práctica(AU)

Humanos , Masculino , Feminino , Idoso , Idoso de 80 Anos ou mais , Diagnóstico de Enfermagem , Cuidados Paliativos na Terminalidade da Vida , Demência , Enfermagem de Cuidados Paliativos na Terminalidade da Vida , Brasil , Registros de Enfermagem/classificação , Estudos Retrospectivos , Terminologia Padronizada em Enfermagem , Hospitais para Doentes Terminais
Artigo em Alemão | MEDLINE | ID: mdl-33185710


BACKGROUND: Palliative care supply increased in Germany in recent years. But how many people use which forms of palliative care and how does this differ between regions? METHOD: Retrospective cohort study with claims data from insured persons who died in 2016: Based on services billed at least once in the last six months of life, we determined the use of primary palliative care (PPC), specialized palliative homecare (SPHC), as well as inpatient palliative and hospice care, using regional billing codes for PPC and SPHC services for the first time. RESULTS: Of the 95,962 deceased in the study population, 32.7% received palliative care nationwide, with variations from 26.4% in Bremen to 40.8% in Bavaria. PPC services were billed at 24.4% (16.9% in Brandenburg to 34.1% in Bavaria). SPHC services received 13.1% (6.3% in Rhineland-Palatinate to 18.9% in Brandenburg and 22.9% in Westphalia-Lippe with different SPHC practices). Inpatient palliative care was received by 8.1% (6.7% in Schleswig-Holstein/Hesse to 13.0% in Thuringia); 3.3% (1.6% in Bremen to 5.6% in Berlin) with hospice services. CONCLUSION: SPHC is used more frequently than previously reported, while PPC is declining. Utilization seems to be based less on objective needs than on region-specific framework conditions. Besides needs criteria, further development of palliative care should be oriented more towards outcomes and relevant framework conditions.

Enfermagem de Cuidados Paliativos na Terminalidade da Vida , Assistência Terminal , Berlim , Alemanha , Humanos , Cuidados Paliativos , Estudos Retrospectivos
J Hosp Palliat Nurs ; 22(6): 432-434, 2020 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-32925490


The COVID-19 pandemic has caused health care facilities to restrict visitors for patients in all care settings. Most pediatric care facilities have restricted visitation to one parent at a time, unfortunately even if the child is in critical condition or is terminally ill. These situations have necessitated the use of technology such as the Zoom platform to have difficult conversations concerning complex medical decision-making and goals of care. In cases where the child is deemed at immediate end of life, many facilities will allow both parents to be at the bedside, but no other family or friends that may be integral support to the parents or child. These situations have compelled the use of FaceTime, Zoom, or Skype technology to facilitate real-time support at end of life for these young patients and their caregivers. This article presents a case where technologies such as these were utilized to assist a family in goals-of-care discussions and at end of life for an infant in the intensive care unit at a large urban pediatric care facility during the COVID-19 pandemic.

Infecções por Coronavirus/epidemiologia , Cuidados Paliativos , Pais , Pneumonia Viral/epidemiologia , Doente Terminal , Comunicação por Videoconferência , Visitas a Pacientes , Betacoronavirus , Feminino , Enfermagem de Cuidados Paliativos na Terminalidade da Vida , Humanos , Lactente , Controle de Infecções , Unidades de Terapia Intensiva Pediátrica , Pandemias
Rech Soins Infirm ; (141): 60-69, 2020 06.
Artigo em Francês | MEDLINE | ID: mdl-32988191


Nurses in Lebanon are poorly prepared to provide palliative care (PC), and practice in this area is poorly documented. This qualitative descriptive study aimed to understand the reality of nursing practice in PC, with terminally ill cancer patients, within an interdisciplinary team. A simple case study was conducted with eleven nurses, three families, an interdisciplinary team, and national experts in PC. Data analysis, carried out with triangulation of both methods and sources, highlighted a humanist relationship characterized by caring, transcending the five central emerging themes : the perception of PC as a means of offering a better quality of life, comprehensive patient care, interdisciplinarity, spirituality, and family support during PC. The results could provide empirical foundations to guide the development of PC nursing practice in the country.

Enfermagem de Cuidados Paliativos na Terminalidade da Vida , Neoplasias/enfermagem , Equipe de Assistência ao Paciente/organização & administração , Humanos , Líbano , Estudos de Casos Organizacionais , Pesquisa Qualitativa
Palliat Med ; 34(9): 1202-1219, 2020 10.
Artigo em Inglês | MEDLINE | ID: mdl-32799739


BACKGROUND: The importance of caring for children with complex and serious conditions means that paediatric palliative care must continue during pandemics. The recent pandemic of Coronavirus Disease 2019 (COVID-19) provides a natural experiment to study health communication during pandemic times. However, it is unknown how communication within consultations might change during pandemics. AIM: This study, a sub-study of a larger project, aimed to examine real-world instances of communication in paediatric palliative care consultations prior to and during the COVID-19 pandemic to understand how clinicians and families talk about the pandemic. DESIGN: Paediatric palliative care consultations prior to, during, and immediately following the initial peak of COVID-19 cases in Australia were video recorded and analysed using Conversation Analysis methods. SETTING/PARTICIPANTS: Twenty-five paediatric palliative care consultations (including face-to-face outpatient, telehealth outpatient and inpatient consultations) were video recorded within a public children's hospital in Australia. Participants included 14 health professionals, 15 child patients, 23 adult family members and 5 child siblings. RESULTS: There was a pervasive relevance of both serious and non-serious talk about COVID-19 within the consultations recorded during the pandemic. Topics typical of a standard paediatric palliative care consultation often led to discussion of the pandemic. Clinicians (55%) and parents (45%) initiated talk about the pandemic. CONCLUSIONS: Clinicians should not be surprised by the pervasiveness of COVID-19 or other pandemic talk within standard paediatric palliative care consultations. This awareness will enable clinicians to flexibly address family needs and concerns about pandemic-related matters that may impact health and wellbeing.

Infecções por Coronavirus/enfermagem , Enfermagem de Cuidados Paliativos na Terminalidade da Vida/organização & administração , Enfermagem de Cuidados Paliativos na Terminalidade da Vida/estatística & dados numéricos , Pandemias/estatística & dados numéricos , Enfermagem Pediátrica/organização & administração , Pneumonia Viral/enfermagem , Consulta Remota/estatística & dados numéricos , Telemedicina/organização & administração , Adolescente , Austrália , Criança , Pré-Escolar , Feminino , Humanos , Lactente , Recém-Nascido , Masculino , Enfermagem Pediátrica/estatística & dados numéricos , Telemedicina/estatística & dados numéricos
Palliat Med ; 34(9): 1220-1227, 2020 10.
Artigo em Inglês | MEDLINE | ID: mdl-32736486


BACKGROUND: Hospital palliative care is an essential part of the COVID-19 response, but relevant data are lacking. The recent literature underscores the need to implement protocols for symptom control and the training of non-specialists by palliative care teams. AIM: The aim of the study was to describe a palliative care unit's consultation and assistance intervention at the request of an Infectious Diseases Unit during the COVID-19 pandemic, determining what changes needed to be made in delivering palliative care. DESIGN: This is a single holistic case study design using data triangulation, for example, audio recordings of team meetings and field notes. SETTING/PARTICIPANTS: This study was conducted in the Palliative Care Unit of the AUSL-IRCCS hospital of Reggio Emilia, which has no designated beds, consulting with the Infectious Diseases Unit of the same hospital. RESULTS: A total of 9 physicians and 22 nurses of the Infectious Diseases Unit and two physicians of the Palliative Care Unit participated in the study.Our Palliative Care Unit developed a feasible 18-day multicomponent consultation intervention. Three macro themes were identified: (1) new answers to new needs, (2) symptom relief and decision-making process, and (3) educational and training issues. CONCLUSION: From the perspective of palliative care, some changes in usual care needed to be made. These included breaking bad news, patients' use of communication devices, the limited time available for the delivery of care, managing death necessarily only inside the hospital, and relationships with families.

Infecções por Coronavirus/terapia , Pessoal de Saúde/educação , Enfermagem de Cuidados Paliativos na Terminalidade da Vida/educação , Enfermagem de Cuidados Paliativos na Terminalidade da Vida/normas , Infectologia/educação , Infectologia/normas , Pneumonia Viral/terapia , Guias de Prática Clínica como Assunto , Adulto , Betacoronavirus , Feminino , Enfermagem de Cuidados Paliativos na Terminalidade da Vida/métodos , Enfermagem de Cuidados Paliativos na Terminalidade da Vida/estatística & dados numéricos , Humanos , Infectologia/métodos , Infectologia/estatística & dados numéricos , Itália/epidemiologia , Masculino , Pessoa de Meia-Idade , Pandemias , Pesquisa Qualitativa
Palliat Med ; 34(9): 1182-1192, 2020 10.
Artigo em Inglês | MEDLINE | ID: mdl-32736494


BACKGROUND: The increased number of deaths in the community happening as a result of COVID-19 has caused primary healthcare services to change their traditional service delivery in a short timeframe. Services are quickly adapting to new challenges in the practical delivery of end-of-life care to patients in the community including through virtual consultations and in the provision of timely symptom control. AIM: To synthesise existing evidence related to the delivery of palliative and end-of-life care by primary healthcare professionals in epidemics and pandemics. DESIGN: Rapid systematic review using modified systematic review methods, with narrative synthesis of the evidence. DATA SOURCES: Searches were carried out in Medline, Embase, PsychINFO, CINAHL and Web of Science on 7th March 2020. RESULTS: Only five studies met the inclusion criteria, highlighting a striking lack of evidence base for the response of primary healthcare services in palliative care during epidemics and pandemics. All were observational studies. Findings were synthesised using a pandemic response framework according to 'systems' (community providers feeling disadvantaged in terms of receiving timely information and protocols), 'space' (recognised need for more care in the community), 'staff' (training needs and resilience) and 'stuff' (other aspects of managing care in pandemics including personal protective equipment, cleaning care settings and access to investigations). CONCLUSIONS: As the COVID-19 pandemic progresses, there is an urgent need for research to provide increased understanding of the role of primary care and community nursing services in palliative care, alongside hospices and community specialist palliative care providers.

Infecções por Coronavirus/terapia , Assistência à Saúde/organização & administração , Pessoal de Saúde/psicologia , Enfermagem de Cuidados Paliativos na Terminalidade da Vida/organização & administração , Cuidados Paliativos/organização & administração , Pneumonia Viral/terapia , Atenção Primária à Saúde/organização & administração , Assistência Terminal/organização & administração , Adulto , Epidemias , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Pandemias , Papel Profissional
Nursing (Säo Paulo) ; 23(267): 4502-4507, ago.-2020.
Artigo em Português | LILACS, BDENF - Enfermagem | ID: biblio-1140150


Objetivo: Compreender como o paciente oncológico em cuidado paliativo vivencia o processo de adoecimento. Método: O estudo é uma avaliação qualitativa de caráter exploratória descritiva, foi realizado no Centro de Pesquisas Oncológicas, em Florianópolis, de outubro de 2017 a fevereiro de 2018. Participaram 10 pacientes internados na unidade de cuidados paliativos. Foi utilizada a análise de conteúdo de Bardin e constituídas três categorias temáticas. Foram respeitados os preceitos éticos de pesquisa. Resultados: pesquisados tinham mediana de 57 anos, ensino fundamental completo, eram viúvos (40%) e casados (30%). Os pacientes oncológicos precisam ser compreendidos em sua integralidade. Foi evidenciado que as crenças ajudam a enfrentar a doença. Cada indivíduo expressou uma forma diferenciada de enfrentar o câncer. Conclusão: É fundamental a comunicação efetiva com o paciente sobre seu real estado de saúde. Considera-se necessárias pesquisas futuras que abordem a temática tratada neste estudo, afim de melhorar os conhecimentos sobre o tema.(AU)

Objective: To understand how the oncology patient in palliative care experiences or becomes ill. Method: The study is a qualitative assessment of the exploratory descriptive character, carried out at the Oncological Research Center, in Florianópolis, from October 2017 to February 2018. Participated 10 patients admitted to palliative care units. A Bardin content analysis was used and three thematic categories were constituted. The ethical precepts of the research were respected. Results: surveyed had a median of 57 years, complete elementary school, were widowed (40%) and married (30%). Cancer patients need to be fully understood. It was evidenced as the victims of a disease attack. Each individual expresses a different way to fight cancer. Conclusion: Effective communication with patients about their real health status is essential. Consider the following future research that addresses the theme addressed in this study, to improve knowledge on the topic.(AU)

Objetivo: comprender cómo el paciente de oncología en cuidados paliativos experimenta el proceso de la enfermedad. Metodología: El estudio es una evaluación descriptiva cualitativa y exploratoria, realizada en el Centro de Investigación Oncológica, en Florianópolis, de octubre de 2017 a febrero de 2018. Participaron 10 pacientes ingresados en la unidad de cuidados paliativos. Se utiliza el análisis de contenido de Bardin. Se respetaron los preceptos de la investigación ética. Resultados: los pacientes con cáncer deben entenderse completamente. Se ha demostrado que las criaturas ayudan a enfrentar la enfermedad. Cada individuo expresa una forma diferente de tratar el cáncer. Conclusión: se cree que la comunicación efectiva con el paciente acerca de su estado de salud esencial real. La investigación futura se considera necesaria para abordar el tema abordado en este estudio, con el fin de mejorar el conocimiento sobre el tema.(AU)

Humanos , Cuidados Paliativos , Enfermagem de Cuidados Paliativos na Terminalidade da Vida , Neoplasias , Cuidados Paliativos na Terminalidade da Vida
Recurso na Internet em Português | LIS - Localizador de Informação em Saúde | ID: lis-47716


A prática dos cuidados paliativos é definida como a assistência ao paciente incurável, que visa a oferecer dignidade e redução de sofrimento. O contato próximo e a inclusão da família no ambiente de UTI são medidas que garantem o bem-estar dos indivíduos que sofrem de doenças graves.Diante da pandemia do novo coronavírus, a especialidade passa por uma situação atípica: isolamento do paciente, contato limitado e evolução rápida, que mal permite ações de conforto. Inclusive, essa é uma das grandes questões da área: o acionamento precoce dos cuidados paliativos...(AU)

Cuidados Paliativos/tendências , Infecções por Coronavirus , Pneumonia Viral , Enfermagem de Cuidados Paliativos na Terminalidade da Vida , Pandemias
Palliat Med ; 34(9): 1193-1201, 2020 10.
Artigo em Inglês | MEDLINE | ID: mdl-32706299


BACKGROUND: COVID-19 has directly and indirectly caused high mortality worldwide. AIM: To explore patterns of mortality during the COVID-19 pandemic and implications for palliative care, service planning and research. DESIGN: Descriptive analysis and population-based modelling of routine data. PARTICIPANTS AND SETTING: All deaths registered in England and Wales between 7 March and 15 May 2020. We described the following mortality categories by age, gender and place of death: (1) baseline deaths (deaths that would typically occur in a given period); (2) COVID-19 deaths and (3) additional deaths not directly attributed to COVID-19. We estimated the proportion of people who died from COVID-19 who might have been in their last year of life in the absence of the pandemic using simple modelling with explicit assumptions. RESULTS: During the first 10 weeks of the pandemic, there were 101,614 baseline deaths, 41,105 COVID-19 deaths and 14,520 additional deaths. Deaths in care homes increased by 220%, while home and hospital deaths increased by 77% and 90%, respectively. Hospice deaths fell by 20%. Additional deaths were among older people (86% aged ⩾ 75 years), and most occurred in care homes (56%) and at home (43%). We estimate that 22% (13%-31%) of COVID-19 deaths occurred among people who might have been in their last year of life in the absence of the pandemic. CONCLUSION: The COVID-19 pandemic has led to a surge in palliative care needs. Health and social care systems must ensure availability of palliative care to support people with severe COVID-19, particularly in care homes.

Causas de Morte , Infecções por Coronavirus/epidemiologia , Infecções por Coronavirus/mortalidade , Enfermagem de Cuidados Paliativos na Terminalidade da Vida/organização & administração , Enfermagem de Cuidados Paliativos na Terminalidade da Vida/estatística & dados numéricos , Pandemias/estatística & dados numéricos , Pneumonia Viral/epidemiologia , Pneumonia Viral/mortalidade , Adulto , Idoso , Idoso de 80 Anos ou mais , Betacoronavirus , Inglaterra/epidemiologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Modelos Estatísticos , Vigilância da População , País de Gales
Palliat Support Care ; 18(4): 379-381, 2020 08.
Artigo em Inglês | MEDLINE | ID: mdl-32631459


As the COVID-19 pandemic continues, more patients will require palliative and end-of-life care. In order to ensure goal-concordant-care when possible, clinicians should initiate goals-of-care conversations among our most vulnerable patients and, ideally, among all patients. However, many non-palliative care clinicians face deep uncertainty in planning, conducting, and evaluating such interactions. We believe that specialists within palliative care are aptly positioned to address such uncertainties, and in this article offer a relevant update to a concise framework for clinicians to plan, conduct, and evaluate goals-of-care conversations: the GOOD framework. Once familiar with this framework, palliative care clinicians may use it to educate their non-palliative care colleagues about a timely and critical component of care, now and beyond the COVID-19 era.

Infecções por Coronavirus/terapia , Enfermagem de Cuidados Paliativos na Terminalidade da Vida/organização & administração , Objetivos Organizacionais , Cuidados Paliativos/organização & administração , Planejamento de Assistência ao Paciente/organização & administração , Pneumonia Viral/terapia , Assistência Terminal/organização & administração , Incerteza , Betacoronavirus , Humanos , Pandemias
Palliat Support Care ; 18(4): 400-402, 2020 08.
Artigo em Inglês | MEDLINE | ID: mdl-32576325


The emergence of the Coronavirus Disease 2019 (COVID-19) pandemic has necessitated an interim restructuring of the healthcare system in accordance with public health preventive measures to mitigate spread of the virus while providing essential healthcare services to the public. This article discusses how the Palliative Care Team of the Komfo Anokye Teaching Hospital in Ghana has modified its services in accordance with public health guidelines. It also suggests a strategy to deal with palliative care needs of critically ill patients with COVID-19 and their families.

Infecções por Coronavirus/terapia , Enfermagem de Cuidados Paliativos na Terminalidade da Vida/normas , Hospitais de Ensino/normas , Cuidados Paliativos/normas , Pneumonia Viral/terapia , Guias de Prática Clínica como Assunto , Betacoronavirus , Gana , Humanos , Pandemias
J Hosp Palliat Nurs ; 22(4): 260-269, 2020 08.
Artigo em Inglês | MEDLINE | ID: mdl-32511171


With the daily number of confirmed COVID-19 cases and associated deaths rising exponentially, social fabrics on a global scale are being worn by panic, uncertainty, fear, and other consequences of the health care crisis. Comprising more than half of the global health care workforce and the highest proportion of direct patient care time than any other health professional, nurses are at the forefront of this crisis. Throughout the evolving COVID-19 pandemic, palliative nurses will increasingly exercise their expertise in symptom management, ethics, communication, and end-of-life care, among other crucial skills. The literature addressing the palliative care response to COVID-19 has surged, and yet, there is a critical gap regarding the unique contributions of palliative nurses and their essential role in mitigating the sequelae of this crisis. Thus, the primary aim herein is to provide recommendations for palliative nurses and other health care stakeholders to ensure their optimal value is realized and to promote their well-being and resilience during COVID-19 and, by extension, in anticipation of future public health crises.

Infecções por Coronavirus/enfermagem , Enfermagem de Cuidados Paliativos na Terminalidade da Vida/organização & administração , Papel do Profissional de Enfermagem , Pandemias , Pneumonia Viral/enfermagem , Infecções por Coronavirus/epidemiologia , Previsões , Humanos , Pneumonia Viral/epidemiologia