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1.
Medicine (Baltimore) ; 98(37): e17090, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31517831

RESUMO

The decision as to whether patients should be admitted to a medical intensive care unit (ICU), in the absence of information concerning survival rates or prognostic factors in survival, is often challenging. We analyzed survival trends in relation to hospital discharge and examined patient and hospital characteristics associated with survival following ICU care, using a sample of nationwide claims data in Korea from 2002 through 2013. The Korean government implements a compulsory social insurance program that covers the country's entire population, and the Korean National Health Insurance Service-National Sample Cohort (NHIS-NSC) data from 2002 based on this program were used for this study. The NHIS-NSC is a stratified random sample of 1,025,340 subjects selected from around 46 million Koreans. We evaluated annual survival trends using the Kaplan-Meier test. Analyses of the relationship between survival and patient and hospital characteristics were performed using Cox regression analyses. Employing a multivariate model, variables were selected using the forward selection method to consider the multicollinearity of variables. A total of 32,553 patients admitted to an ICU between 2002 and 2013 were identified among the eligible beneficiaries. The number of patients who had histories of ICU admission steadily increased throughout the study period, and patients older than 80 years constituted a progressively increasing proportion of ICU admissions, from 7.3% in 2002 to 16.9% in 2007 to 23.1% in 2013. The mean number of mechanical equipment items applied consistently increased, while no difference was observed in the trend for overall 1-year survival in patients following ICU treatment across the study period: the 1-year survival rate ranged from 66.7% (year 2003) to 64.2% (year 2010). Advanced age, cancer, renal failure, pneumonia, and influenza were all associated with heightened risk of mortality within 1 year. Our results should prove useful to older patients and their clinicians in their decisions regarding whether to seek ICU care, with the goals of improving the end-of life care and optimizing resource utilization.


Assuntos
Custos de Cuidados de Saúde/estatística & dados numéricos , Unidades de Terapia Intensiva/estatística & dados numéricos , Adulto , Idoso , Idoso de 80 Anos ou mais , Estudos de Coortes , Feminino , Mortalidade Hospitalar/tendências , Hospitalização/economia , Hospitalização/estatística & dados numéricos , Humanos , Unidades de Terapia Intensiva/economia , Unidades de Terapia Intensiva/organização & administração , Estimativa de Kaplan-Meier , Masculino , Pessoa de Meia-Idade , Programas Nacionais de Saúde/economia , Programas Nacionais de Saúde/estatística & dados numéricos , Modelos de Riscos Proporcionais , República da Coreia , Análise de Sobrevida
2.
JAMA ; 322(3): 216-228, 2019 07 16.
Artigo em Inglês | MEDLINE | ID: mdl-31310297

RESUMO

Importance: The effects of intensive care unit (ICU) visiting hours remain uncertain. Objective: To determine whether a flexible family visitation policy in the ICU reduces the incidence of delirium. Design, Setting and Participants: Cluster-crossover randomized clinical trial involving patients, family members, and clinicians from 36 adult ICUs with restricted visiting hours (<4.5 hours per day) in Brazil. Participants were recruited from April 2017 to June 2018, with follow-up until July 2018. Interventions: Flexible visitation (up to 12 hours per day) supported by family education (n = 837 patients, 652 family members, and 435 clinicians) or usual restricted visitation (median, 1.5 hours per day; n = 848 patients, 643 family members, and 391 clinicians). Nineteen ICUs started with flexible visitation, and 17 started with restricted visitation. Main Outcomes and Measures: Primary outcome was incidence of delirium during ICU stay, assessed using the CAM-ICU. Secondary outcomes included ICU-acquired infections for patients; symptoms of anxiety and depression assessed using the HADS (range, 0 [best] to 21 [worst]) for family members; and burnout for ICU staff (Maslach Burnout Inventory). Results: Among 1685 patients, 1295 family members, and 826 clinicians enrolled, 1685 patients (100%) (mean age, 58.5 years; 47.2% women), 1060 family members (81.8%) (mean age, 45.2 years; 70.3% women), and 737 clinicians (89.2%) (mean age, 35.5 years; 72.9% women) completed the trial. The mean daily duration of visits was significantly higher with flexible visitation (4.8 vs 1.4 hours; adjusted difference, 3.4 hours [95% CI, 2.8 to 3.9]; P < .001). The incidence of delirium during ICU stay was not significantly different between flexible and restricted visitation (18.9% vs 20.1%; adjusted difference, -1.7% [95% CI, -6.1% to 2.7%]; P = .44). Among 9 prespecified secondary outcomes, 6 did not differ significantly between flexible and restricted visitation, including ICU-acquired infections (3.7% vs 4.5%; adjusted difference, -0.8% [95% CI, -2.1% to 1.0%]; P = .38) and staff burnout (22.0% vs 24.8%; adjusted difference, -3.8% [95% CI, -4.8% to 12.5%]; P = .36). For family members, median anxiety (6.0 vs 7.0; adjusted difference, -1.6 [95% CI, -2.3 to -0.9]; P < .001) and depression scores (4.0 vs 5.0; adjusted difference, -1.2 [95% CI, -2.0 to -0.4]; P = .003) were significantly better with flexible visitation. Conclusions and Relevance: Among patients in the ICU, a flexible family visitation policy, vs standard restricted visiting hours, did not significantly reduce the incidence of delirium. Trial Registration: ClinicalTrials.gov Identifier: NCT02932358.


Assuntos
Delírio/prevenção & controle , Família/psicologia , Unidades de Terapia Intensiva/organização & administração , Visitas a Pacientes , Ansiedade , Brasil , Esgotamento Profissional , Cuidados Críticos/psicologia , Estudos Cross-Over , Depressão , Feminino , Educação em Saúde , Hospitalização , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , Fatores de Tempo
3.
Rev Bras Enferm ; 72(3): 609-616, 2019 Jun 27.
Artigo em Inglês, Português | MEDLINE | ID: mdl-31269123

RESUMO

OBJECTIVE: To measure the magnitude of the effect of an individualized parameterization protocol for hemodynamic alarms in patients with acute myocardial infarction. METHOD: Pragmatic clinical trial, open label and single arm, whose intervention was performed through a protocol validated and tested in 32 patients using multiparametric monitors. The heart rate, blood pressure, respiratory rate, oxygen saturation and ST segment-monitoring were measured and classified for clinical consistency one hour before and after the intervention, for 64 hours. RESULTS: The protocol obtained Content Validity Index of 0.92. Of the 460 registered alarms, 261 were considered inconsistent before the intervention and 47 after it. The Relative Risk of inconsistent alarms after the protocol was 0.32 (95% CI 0.23-0.43, p <0.0001). CONCLUSION: The protocol proved to be a protective factor to the appearance of inconsistent clinical alarms of multiparametric monitors.


Assuntos
Monitorização Fisiológica/enfermagem , Infarto do Miocárdio/enfermagem , Idoso , Pressão Sanguínea/fisiologia , Alarmes Clínicos , Eletrocardiografia/enfermagem , Eletrocardiografia/normas , Feminino , Frequência Cardíaca/fisiologia , Humanos , Unidades de Terapia Intensiva/organização & administração , Unidades de Terapia Intensiva/estatística & dados numéricos , Masculino , Pessoa de Meia-Idade , Monitorização Fisiológica/normas
4.
Work ; 63(2): 191-197, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31156200

RESUMO

Patients in the medical intensive care unit (MICU) face life-threatening conditions leading to physical and psychological stress, and decreased occupational engagement. Mind-body interventions include techniques based on connecting the mind, body, brain, and behavior to positively influence health. The purpose of this study was to explore the use of mind-body interventions as a tool for use by occupational therapists (OT) to improve health and occupational performance. This was an exploratory case study completed with the patient, "Ann" in a MICU. Ann was a 57-year-old female who was admitted to the MICU for abdominal pain and later diagnosed with septic shock. Two mind-body sessions were completed with Ann and her responses were assessed via multiple variables, including: respiratory rate; blood pressure; heart rate; oxygen saturation; and anxiety. Ann stayed within normal ranges for all variables. This study demonstrates it was feasible to elicit mind-body interventions in this setting, with this patient.


Assuntos
Terapias Mente-Corpo/normas , Terapia Ocupacional/normas , Estudos de Casos e Controles , Colorado , Feminino , Humanos , Unidades de Terapia Intensiva/organização & administração , Unidades de Terapia Intensiva/estatística & dados numéricos , Pessoa de Meia-Idade , Terapias Mente-Corpo/métodos , Terapeutas Ocupacionais/tendências , Terapia Ocupacional/métodos , Estresse Psicológico/psicologia , Estresse Psicológico/terapia
5.
Zhonghua Wei Zhong Bing Ji Jiu Yi Xue ; 31(4): 397-399, 2019 Apr.
Artigo em Chinês | MEDLINE | ID: mdl-31109408

RESUMO

OBJECTIVE: In recent years, more and more people have recognized the importance of patients' family in the intensive care unit (ICU) in medical care, and advocated the use of patient- and family-centered care (PFCC) in the ICU. This article explains the content (family presence, family support, communication with family members, consultations and ICU team members, environmental issues) and significance of PFCC in the ICU, and provides guidance for the practice of PFCC in China.


Assuntos
Unidades de Terapia Intensiva/organização & administração , Assistência Centrada no Paciente/organização & administração , Relações Profissional-Família , China , Humanos
6.
Plast Surg Nurs ; 39(2): 44-47, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31136557

RESUMO

Traditional mechanical meshing methods have generally been the first-choice treatment of patients with extensive burns (>20% total body surface area). The limited availability of donor areas has sparked the development of resources such as the Meek micrografting technique. We present the case of a 43-year-old male patient with an 85% total body surface area third-degree flame burn. After the initial stabilization, there was a need for rapid and effective coverage of as much burned surface as possible. Thus, Meek micrografting was chosen. Its results in this patient are presented and discussed. The Meek technique is a useful method of skin expansion. It is indicated in patients with extensive burns, where donor areas are limited. The high rates of graft take and quality of the coverage attained make this technique appealing, albeit at a greater economic cost than with traditional mechanical meshing methods.


Assuntos
Queimaduras/cirurgia , Transplante de Pele/métodos , Adulto , Desbridamento/métodos , Humanos , Unidades de Terapia Intensiva/organização & administração , Masculino , Transplante de Pele/normas , Obtenção de Tecidos e Órgãos/métodos
7.
J Wound Ostomy Continence Nurs ; 46(3): 194-200, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31083062

RESUMO

PURPOSE: The purpose of this study was to compare the effect of pressure injuries on mortality, hospital length of stay, healthcare costs, and readmission rates in hospitalized patients. DESIGN: A case-control study. SUBJECTS AND SETTING: The sample comprised 5000 patients admitted to a tertiary hospital located in Seoul Korea; 1000 patients with pressure injuries (cases) were compared to 4000 patients who acted as controls. METHODS: We retrospectively extracted clinical data from electronic health records. Study outcomes were mortality, hospital length of stay, healthcare costs, and readmission rates. The impact of pressure injuries on death and readmission was analyzed via multiple logistic regression, hospital deaths within 30 days were analyzed using the survival analysis and Cox proportional hazards regression, and impact on the length of hospitalization and medical costs were analyzed through a multiple linear regression. RESULTS: Developing a pressure injury was significantly associated with an increased risk of in-hospital mortality (odds ratio [OR], 3.94; 95% confidence interval [CI], 2.91-5.33), 30-days in-hospital mortality (OR, 2.18; 95% CI, 1.59-3.00), and healthcare cost (ß = 11,937,333; P < .001). Pressure injuries were significantly associated with an extended length of hospitalization (ß = 20.84; P < .001) and length of intensive care unit (ICU) stay (ß = 8.16; P < .001). Having a pressure injury was significantly associated with an increased risk of not being discharged home (OR, 5.55; 95% CI, 4.35-7.08), along with increased risks of readmission (OR, 1.30; 95% CI, 1.05-1.62) and emergency department visits after discharge (OR, 1.70; 95% CI, 1.29-2.23). CONCLUSIONS: Development of pressure injuries influenced mortality, healthcare costs, ICU and hospital length of stay, and healthcare utilization following discharge (ie, readmission or emergency department visits). Hospital-level efforts and interdisciplinary approaches should be prioritized to develop interventions and protocols for pressure injury prevention.


Assuntos
Avaliação de Resultados da Assistência ao Paciente , Lesão por Pressão/complicações , Idoso , Idoso de 80 Anos ou mais , Estudos de Casos e Controles , Feminino , Mortalidade Hospitalar , Humanos , Unidades de Terapia Intensiva/organização & administração , Tempo de Internação/estatística & dados numéricos , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Razão de Chances , Pressão/efeitos adversos , Lesão por Pressão/epidemiologia , Lesão por Pressão/mortalidade , Modelos de Riscos Proporcionais , República da Coreia/epidemiologia , Estudos Retrospectivos
8.
Rev Bras Enferm ; 72(suppl 1): 2-8, 2019 Feb.
Artigo em Inglês, Português | MEDLINE | ID: mdl-30942338

RESUMO

OBJECTIVE: to identify ethical problems from the components of moral sensitivity among nurses of Intensive Care Units. METHOD: qualitative, exploratory-descriptive study developed in a hospital in the South of Brazil with 19 nurses working in intensive care units through semi-structured interviews that were analyzed through discursive textual analysis. RESULTS: ethical education, dialogue, relationships with other health team members, professional autonomy, knowledge, personal values, effective communication, leadership and patients' positive outcomes were identified as important components of nurses' moral sensitivity, and comprise the domains of moral consciousness, benevolent motivation, and spontaneous moral perception. FINAL CONSIDERATIONS: the components of moral sensitivity identified in this study facilitate nurses' instrumentalization in the face of decision making and ethical problems in the intensive care setting.


Assuntos
Enfermeiras e Enfermeiros/psicologia , Transtornos de Estresse Pós-Traumáticos/diagnóstico , Adulto , Atitude do Pessoal de Saúde , Brasil , Esgotamento Profissional/complicações , Esgotamento Profissional/psicologia , Ética , Feminino , Humanos , Unidades de Terapia Intensiva/organização & administração , Unidades de Terapia Intensiva/normas , Pessoa de Meia-Idade , Enfermeiras e Enfermeiros/tendências , Pesquisa Qualitativa , Transtornos de Estresse Pós-Traumáticos/psicologia , Inquéritos e Questionários
9.
Rev Bras Enferm ; 72(suppl 1): 88-95, 2019 Feb.
Artigo em Inglês, Português | MEDLINE | ID: mdl-30942349

RESUMO

OBJECTIVE: To standardize the duty shift in a General Adult Intensive Care Unit. METHOD: Multi-method research, which used action research, descriptive study and content validation. Participants included 11 care nurses and 4 intensive care nurses. For the data collection, a semi-structured questionnaire was used, meetings with participants and validation with specialists. In this step, the modified online Delphi Technique was used. For data treatment, the Discourse of the Collective Subject (DCS) was used, descriptive analysis and Content Validity Index. RESULTS: Three DCS on duty change, a Standard Operating Procedure (SOP) and an information registration instrument, validated in appearance, clarity, suitability and content. FINAL CONSIDERATIONS: The instrument assists in the transmission of information, strengthening patient safety and SOP will outline the shift, these tools can improve ICU shift, minimizing the risks of communication failure.


Assuntos
Padrões de Referência , Jornada de Trabalho em Turnos/normas , Adulto , Feminino , Humanos , Unidades de Terapia Intensiva/organização & administração , Masculino , Jornada de Trabalho em Turnos/efeitos adversos , Transtornos do Sono-Vigília/complicações , Transtornos do Sono-Vigília/prevenção & controle , Transtornos do Sono-Vigília/psicologia , Inquéritos e Questionários
10.
Rev Bras Enferm ; 72(suppl 1): 96-104, 2019 Feb.
Artigo em Inglês, Português | MEDLINE | ID: mdl-30942350

RESUMO

OBJECTIVE: To analyze the occurrence of presenteeism in multiprofessional team workers of an Adult Intensive Care Unit, relating it to sociodemographic and labor characteristics. METHOD: It is an analytical cross-sectional qualitative study, which used a questionnaire for sociodemographic data collection, and Stanford Presenteeism Scale(SPS-6) to assess presenteeism. RESULTS: There was predominance of women (75.9%), nursing workers (66.7%), mean age of 39.81 years, and 6 to 10 years (31.6%) of experience in the labor market. Regarding presenteeism, 48.7% presented work impairment and 31.8% presentedperformance and completion of tasks altered by this phenomenon. CONCLUSION: Expressive numbers of general presenteeism were identified, with results indicating impairment in completing work. When connecting presenteeism to sociodemographic and labor characteristics, the variables sex, dependent children and absence from work presented values with statistical significance among the studied workers.


Assuntos
Pessoal de Saúde/psicologia , Comunicação Interdisciplinar , Presenteísmo/métodos , Adulto , Brasil , Estudos Transversais , Feminino , Pessoal de Saúde/estatística & dados numéricos , Humanos , Unidades de Terapia Intensiva/organização & administração , Masculino , Pessoa de Meia-Idade , Equipe de Assistência ao Paciente/estatística & dados numéricos , Presenteísmo/normas , Presenteísmo/estatística & dados numéricos , Psicometria/instrumentação , Psicometria/métodos , Inquéritos e Questionários
11.
Rev Bras Enferm ; 72(suppl 1): 137-142, 2019 Feb.
Artigo em Inglês, Português | MEDLINE | ID: mdl-30942355

RESUMO

OBJECTIVE: To estimate the cost of nursing care required and available through the use of the Nursing Activities Score. METHOD: Quantitative study, direct costing of nursing care required and available in the Intensive Care Units. Data collection included variables of the patients, nursing professionals and nursing workload measured by the Nursing Activities Score. The cost of nursing care was estimated by multiplying the cost of each hour with the total number of hours of care per category. RESULTS: The negative difference of R$ 94,791.5 between the cost of available and required nursing care indicated an increase of 3.2 nurses and 7.0 nursing technicians. CONCLUSION: The cost of nursing care required identified through the application of the Nursing Activities Score, which is higher than the cost of available care, indicates the need to adjust the number of professionals to meet patients' demands.


Assuntos
Custos de Cuidados de Saúde/estatística & dados numéricos , Cuidados de Enfermagem/métodos , Adulto , Idoso , Brasil , Custos e Análise de Custo , Feminino , Humanos , Unidades de Terapia Intensiva/organização & administração , Unidades de Terapia Intensiva/estatística & dados numéricos , Masculino , Pessoa de Meia-Idade , Cuidados de Enfermagem/normas , Escala Psicológica Aguda Simplificada , Carga de Trabalho/psicologia , Carga de Trabalho/normas
12.
Rev Bras Enferm ; 72(suppl 1): 166-172, 2019 Feb.
Artigo em Inglês, Português | MEDLINE | ID: mdl-30942359

RESUMO

OBJECTIVE: To verify the correlation between nursing care time and care quality indicators. METHOD: Observational, correlational study, developed in 11 Intensive Care Units. The population comprised records of the number of nursing professionals, the number of patients with at least one of the Oro/Nasogastroenteral Probe (GEPRO), Endotracheal Tube (COT) and Central Venous Catheter (CVC) therapeutic devices and the occurrences related to the losses of these artifacts. RESULTS: The time corresponded to 18.86 hours (Hospital A), 21 hours (Hospital B) and 19.50 hours (Hospital C); the Unplanned Outflow Incidence of GEPRO indicator presented a mean of 2.19/100 patients/day; Unplanned Extubation of COT Incidence, 0.42/100 patients/day; and CVC Loss Incidence, 0.22/100 patients/day. There was no statistically significant correlation between time and indicators analyzed. CONCLUSION: This research may support methodological decisions for future investigations that seek the impact of human resources on the care quality and patient safety.


Assuntos
Unidades de Terapia Intensiva/estatística & dados numéricos , Indicadores de Qualidade em Assistência à Saúde/estatística & dados numéricos , Qualidade da Assistência à Saúde/normas , Fatores de Tempo , Adulto , Idoso , Correlação de Dados , Feminino , Humanos , Unidades de Terapia Intensiva/organização & administração , Masculino , Pessoa de Meia-Idade , Fatores de Risco , Recursos Humanos/normas , Carga de Trabalho/normas , Carga de Trabalho/estatística & dados numéricos
13.
Rev Bras Enferm ; 72(suppl 1): 243-251, 2019 Feb.
Artigo em Inglês, Português | MEDLINE | ID: mdl-30942369

RESUMO

OBJECTIVE: To identify the social representations of newly undergraduate nurses on the intensive care of Nursing to critical patients hospitalized in non-critical patient units. METHOD: Qualitative and descriptive research. Twenty-six newly undergraduate nurses from a private university participated. An in-depth interview was conducted with semi-structured script. The analysis was of lexical type with the help of Alceste 2012 software. RESULTS: The social representations were built according to the image of the intensive care unit, although patients were out of this environment. Care is understood as complex and specialized, requiring graduate training. Therefore, undergraduation training was considered insufficient to provide this type of care, creating fear and insecurity in the newly undergraduate nurses. FINAL CONSIDERATIONS: Intensive care confronts newly undergraduate nurses with feelings of unpreparedness to care for, but it mobilizes to broaden the knowledge to provide care. There is evidence of a theory-practice dichotomy and weaknesses in teaching-learning experiences in undergraduate education.


Assuntos
Enfermeiras e Enfermeiros/psicologia , Fatores de Tempo , Adulto , Bacharelado em Enfermagem/métodos , Bacharelado em Enfermagem/normas , Feminino , Humanos , Unidades de Terapia Intensiva/organização & administração , Entrevistas como Assunto/métodos , Masculino , Pesquisa Qualitativa , Percepção Social , Estudantes de Enfermagem/psicologia
14.
Rev Bras Enferm ; 72(2): 321-328, 2019 Mar-Apr.
Artigo em Inglês, Português | MEDLINE | ID: mdl-31017192

RESUMO

OBJECTIVE: To understand the education/training of nurses working in an intensive care unit. METHOD: Case study with qualitative approach, with an intentional sample. Data collection and analysis used different research techniques, mainly document analysis, interview and field observation. RESULTS: The data highlights feelings of well-being, satisfaction and motivation as important for education and training in a work context. Some organizational practices seem to promote interpersonal relationships and, consequently, increase the willingness of these professionals to adopt a reward perspective regarding continuing education and training, establishing a close relationship between the formal, the non-formal and the informal. FINAL CONSIDERATION: The attractiveness of this organization is related to the valorization and recognition that it can offer to the professionals. There is a reciprocity between a hospital that endorses up-to-date care and professionals who seek scientific evidence.


Assuntos
Escolaridade , Unidades de Terapia Intensiva/estatística & dados numéricos , Enfermeiras e Enfermeiros/psicologia , Atitude do Pessoal de Saúde , Brasil , Educação Continuada em Enfermagem/métodos , Educação Continuada em Enfermagem/normas , Humanos , Unidades de Terapia Intensiva/organização & administração , Entrevistas como Assunto/métodos , Satisfação no Emprego , Enfermeiras e Enfermeiros/estatística & dados numéricos , Prática Profissional/normas , Prática Profissional/tendências , Pesquisa Qualitativa , Inquéritos e Questionários
15.
Rev Bras Enferm ; 72(2): 463-467, 2019 Mar-Apr.
Artigo em Inglês, Português | MEDLINE | ID: mdl-31017211

RESUMO

OBJECTIVE: identify delirium and subsyndromal delirium in intensive care patients; age, hospitalization time, and mortality. METHOD: a retrospective, quantitative study conducted in the Intensive Care Unit, using the Richmond Agitation-Sedation Scale to evaluate sedation and the Intensive Care Delirium Screening Checklist for the identification of delirium, with the participation of 157 patients. For statistical analysis, the t-test and the Chi-square test was carried out. RESULTS: the majority presented subsyndromal delirium (49.7%). Mortality was 21.7%. The relationship between delirium and its subsyndromal with hospitalization time was statistically significant for both (p=0.035 and p <0.001), while age was significant only in the subsyndromal delirium (p=0.009). CONCLUSION: the majority of the patients presented subsyndromal delirium. The length of hospital stay was statistically significant in delirium and subsyndroma delirium. Age was significant only in subsyndromal delirium. The mortality of patients with delirium was higher than the others.


Assuntos
Delírio/diagnóstico , Adulto , Idoso , Brasil , Distribuição de Qui-Quadrado , Sedação Profunda/classificação , Sedação Profunda/métodos , Delírio/fisiopatologia , Feminino , Humanos , Unidades de Terapia Intensiva/organização & administração , Unidades de Terapia Intensiva/estatística & dados numéricos , Masculino , Pessoa de Meia-Idade , Projetos de Pesquisa , Estudos Retrospectivos
16.
Rev Bras Enferm ; 72(2): 521-530, 2019 Mar-Apr.
Artigo em Inglês, Português | MEDLINE | ID: mdl-31017218

RESUMO

OBJECTIVE: to identify studies about strategies for prevention of ventilator-associated pneumonia deployed in health services and classify their level of evidence. METHOD: integrative review of the literature, in 7 databases, which included the following descriptors: Prevention and Control AND Pneumonia Ventilator-Associated AND Intensive Care Units AND Bundle AND Patient Care. RESULTS: twenty-three scientific productions were included. Of the preventive measures identified, 9 (39.1%) correspond from three to five strategies. The most frequent were: 22 (95.6%) lying with head elevated, 19 (82.6%) oral hygiene with chlorhexidine and 14 (60.8%) reduction of sedation whenever possible. FINAL CONSIDERATION: the application of measures based on scientific evidence is proven to be effective when carried out in conjunction, impacting the reduction of the incidence of ventilator-associated pneumonia.


Assuntos
Pneumonia Associada à Ventilação Mecânica/enfermagem , Pneumonia Associada à Ventilação Mecânica/prevenção & controle , Humanos , Unidades de Terapia Intensiva/organização & administração , Unidades de Terapia Intensiva/normas , Higiene Bucal/normas
17.
Int J Gynaecol Obstet ; 146(1): 29-35, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31017650

RESUMO

Patients at risk of organ dysfunction or with established organ dysfunction should be referred to central or tertiary-level hospitals. However, even in central hospitals, intensive care unit (ICU) beds are often unavailable, which may contribute to maternal deaths. One pragmatic solution is to establish obstetric critical care units (OCCUs) in the labor wards of central hospitals; however, specific guidance on how to do this is limited. In addition, globally applicable standards of care are lacking, with uncertainty regarding who should lead obstetric critical care. In this article the specific OCCU infrastructure, equipment and human resources required to establish such units in central hospitals in low- and middle-income countries are described in sufficient detail for easy replication. Admission and discharge guidelines and operational recommendations that include quality indicators are also provided.


Assuntos
Arquitetura Hospitalar/métodos , Unidades de Terapia Intensiva/organização & administração , Obstetrícia/organização & administração , Cuidados Críticos/organização & administração , Feminino , Humanos , Morte Materna/prevenção & controle , Recursos Humanos de Enfermagem no Hospital/organização & administração , Gravidez , Complicações na Gravidez/terapia
18.
J Clin Nurs ; 28(15-16): 3033-3041, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-30938915

RESUMO

AIMS AND OBJECTIVES: To explore clinical reasoning about alarm customisation among nurses in intensive care units. BACKGROUND: Critical care nurses are responsible for detecting and rapidly acting upon changes in patients' clinical condition. Nurses use medical devices including bedside physiologic monitors to assist them in their practice. Customising alarm settings on these devices can help nurses better monitor their patients and reduce the number of clinically irrelevant alarms. As a result, customisation may also help address the problem of alarm fatigue. However, little is known about nurses' clinical reasoning with respect to customising physiologic monitor alarm settings. DESIGN: This article is an in-depth report of the qualitative arm of a mixed methods study conducted using an interpretive descriptive methodological approach. METHODS: Twenty-seven nurses were purposively sampled from three intensive care units in an academic medical centre. Semi-structured interviews were conducted by telephone and were analysed using thematic analysis. Consolidated Criteria for Reporting Qualitative Research (COREQ) reporting guidelines were used. RESULTS: Four themes were identified from the interview data: unit alarm culture and context, nurse attributes, motivation to customise and customisation "know-how." A conceptual model demonstrating the relationship of these themes was developed to portray the factors that affect nurses' customisation of alarms. CONCLUSIONS: In addition to drawing on clinical data, nurses customised physiologic monitor alarms based on their level of clinical expertise and comfort. Nurses were influenced by the alarm culture on their clinical unit and colleagues' and patients' responses to alarms, as well as their own technical understanding of the physiologic monitors. RELEVANCE TO CLINICAL PRACTICE: The results of this study can be used to design strategies to support the application of clinical reasoning to alarm management, which may contribute to more appropriate alarm customisation practices and improvements in safety.


Assuntos
Alarmes Clínicos , Tomada de Decisão Clínica/métodos , Enfermagem de Cuidados Críticos/métodos , Monitorização Fisiológica/métodos , Centros Médicos Acadêmicos , Adulto , Feminino , Humanos , Unidades de Terapia Intensiva/organização & administração , Masculino , Pessoa de Meia-Idade , Monitorização Fisiológica/psicologia , Pesquisa Qualitativa , Adulto Jovem
19.
J Clin Nurs ; 28(15-16): 2946-2952, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31013381

RESUMO

AIMS AND OBJECTIVES: To examine how nurses' knowledge of behaviours indicating pain in mechanically ventilated patients and self-perceived collaboration between nurses and physicians affects the adequacy of departmental pain management. BACKGROUND: Pain management is a vital factor of medical treatment in a hospital setting. Inadequate pain management requires attention both from a patient-focused perspective and from a departmental one. It would be particularly troubling in the case of inadequate pain management of mechanically ventilated patients. DESIGN: The study utilised a cross-sectional design. The instruments developed were validated by a focus group of 25 pain management nurses, who reviewed the questionnaire for face validity, feasibility and comprehensibility, and who did not participate in the study. The questionnaire was revised, readjusted and formulated based on their responses and comments. METHODS: A self-administered questionnaire administered in Israel with a convenience sample of 187 registered nurses (RN) from internal medicine and surgical departments and ICUs. Data were collected during February-May 2015. The "STROBE" EQUATOR checklist was used. RESULTS: Nurses working in the ICU scored significantly higher on knowledge of behaviours indicating pain in mechanically ventilated patients and on self-perceived collaboration between nurses and physicians. Self-perceived collaboration between physicians and nurses was positively correlated with perceived departmental pain treatment adequacy. Self-perceived collaboration between nurses and physicians, knowledge of behaviours indicating pain in mechanically ventilated patients and seniority (with a borderline significance) explained 27% of the variance of perceived departmental pain management. CONCLUSION: Nurses' knowledge of behaviours indicating pain in mechanically ventilated patients, as well as self-perceived collaboration between nurses and physicians, promotes reported adequate pain management. RELEVANCE TO CLINICAL PRACTICE: Pain management would benefit from being conducted as a well-performed interprofessional self-perceived collaborative practice. Knowledgeable nurses tend to critically assess the level of departmental pain management.


Assuntos
Recursos Humanos de Enfermagem no Hospital/normas , Manejo da Dor/enfermagem , Respiração Artificial/enfermagem , Adulto , Estudos Transversais , Feminino , Grupos Focais , Humanos , Unidades de Terapia Intensiva/organização & administração , Israel , Masculino , Pessoa de Meia-Idade , Recursos Humanos de Enfermagem no Hospital/psicologia , Percepção , Relações Médico-Enfermeiro , Reprodutibilidade dos Testes , Inquéritos e Questionários
20.
Rev Bras Enferm ; 72(1): 88-94, 2019 Jan-Feb.
Artigo em Inglês, Português | MEDLINE | ID: mdl-30916272

RESUMO

OBJECTIVE: To measure the average direct cost of peripherally inserted central catheterization performed by nurses in a pediatric and neonatal intensive care unit. METHOD: A quantitative, exploratory-descriptive, single-case study, whose sample consisted of the non-participant observation of 101 peripherally inserted central catheter procedures. The cost was calculated by multiplying the execution time (timed using a chronometer) spent by nursing professionals, participants in the procedure, by the unit cost of direct labor, added to the cost of materials, drugs, and solutions. RESULTS: The average direct cost of the procedure was US$ 326.95 (standard deviation = US$ 84.47), ranging from US$ 99.03 to US$ 530.71, with a median of US$ 326.17. It was impacted by material costs and the direct labor of the nurses. CONCLUSION: The measurement of the average direct cost of the peripherally inserted central catheter procedure shed light on the financials of consumed resources, indicating possibilities of intervention aiming to increase efficiency in allocating these resources.


Assuntos
Cateterismo Periférico/economia , Cateteres/economia , Enfermeiras e Enfermeiros/economia , Cateterismo Periférico/estatística & dados numéricos , Cateteres/estatística & dados numéricos , Criança , Pré-Escolar , Custos e Análise de Custo , Feminino , Humanos , Lactente , Recém-Nascido , Unidades de Terapia Intensiva/economia , Unidades de Terapia Intensiva/organização & administração , Unidades de Terapia Intensiva/estatística & dados numéricos , Masculino , Enfermeiras e Enfermeiros/estatística & dados numéricos
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