Implementing Patient-Centered Trauma-Informed Care for the Perinatal Nurse.

Adverse childhood experiences and trauma significantly impact physical and mental health. Increased maternal perinatal depression/anxiety, preterm labor, and low birth weight, as well as infant morbidity and mortality, are some examples of the impact of trauma on perinatal health. Trauma-informed care begins with knowledge about trauma, the ability to recognize signs of a trauma response, responding to patients effectively, and resisting retraumatization. As holistic providers, perinatal nurses can create safe care environments, establish collaborative patient relationships based on trust, demonstrate compassion, offer patients options when possible to support patient autonomy, and provide resources for trauma survivors. This can prevent or reduce the negative impact of trauma and improve the health and well-being of infants, mothers, and future generations. This clinical article outlines key strategies for implementation of patient-centered trauma-informed perinatal nursing care.

Opioid Analgesics for Sedation and Analgesia During Mechanical Ventilation.

Neonates are exposed to repetitive pain and stress during their stay in a NICU, which can lead to chronic complications related to their neurodevelopment and neurobehavior. Approximately 20 percent of all neonates in a NICU are intubated, mechanically ventilated, and require suctioning, which can cause both acute and chronic pain. Pain management in the neonate can be challenging. Nurses and other caregivers need to be well trained to assess pain in the neonate to effectively identify and provide appropriate pain management strategies. There is a lack of evidence to support routine administration of opiates in the neonate. As with any medication, the possibility of short- and long-term adverse reactions must be considered. Nonpharmacologic therapy should be used as much as possible.

Long-term Outcomes of Critically Ill Patients With Stroke Requiring Mechanical Ventilation.

BACKGROUND: Data on outcomes of critically ill patients requiring mechanical ventilation at the onset of stroke are limited. OBJECTIVE: To assess the hospital and long-term functional outcomes of patients with stroke who require mechanical ventilation. METHODS: This retrospective single-center cohort study performed from 1994 to 2008 involved adult patients within 7 days of stroke onset and who required intensive care unit admission and mechanical ventilation. RESULTS: A total of 274 patients requiring mechanical ventilation at the onset of stroke were analyzed. Indications for intubation included coma in 195 patients (71%). The median (interquartile range) score on the Glasgow Coma Scale at admission to the intensive care unit was 6 (3-9). Forty-four patients (16%) had sepsis at intensive care unit admission. The overall hospital mortality rate was 53%. After adjustment for confounders, severity of illness at admission as assessed by the Simplified Acute Physiology Score II (odds ratio, 1.07; 95% CI, 1.05-1.10), anisocoria (odds ratio, 5.26; 95% CI, 1.76-15.80), and sepsis at intensive care unit admission (odds ratio, 0.40; 95% CI, 0.19-0.85) were associated with outcome. At 1 year, median (interquartile range) modified Rankin Scale score was 6 (2-6). Only 89 patients (32%) exhibited mild to moderate neurologic impairment. CONCLUSION: In this study, adult patients requiring mechanical ventilation at the onset of stroke experienced high 1-year mortality, with survivors having poor functional status.

Eventos adversos relacionados con las prácticas asistenciales: una revisión integradora / Eventos adversos relacionados às práticas assistenciais: uma revisão integrativa / Adverse events related to assistance practices: an integrative review

Objetivo: Identificar las publicaciones científicas sobre eventos adversos relacionados con las prácticas asistenciales y discutir la cultura de seguridad del paciente. Métodos: Se realizó una revisión bibliográfica del tipo integrador, con búsqueda en MEDLINE, LILACS y BDENF disponibles en la BVS, utilizando los siguientes descriptores; seguridad del paciente, asistencia al paciente, vigilancia de eventos centinela, gestión de la seguridad. Cumplieron los criterios de inclusión 26 artículos científicos publicados en el período delimitado para esta revisión de 2005 a 2015. Resultados: El análisis de los artículos reveló cinco categorías principales: características de los eventos adversos relacionados con las prácticas asistenciales, implicaciones de la ocurrencia de eventos adversos, medidas para la prevención de eventos adversos, notificaciones de los eventos adversos y los factores intervenientes y el conocimiento y la cultura de la seguridad. Conclusión: La cultura punitiva aparece como responsable de la subnotificación y omisión de los eventos adversos, que constituyen un obstáculo para la aplicación efectiva de las investigaciones. Es esencial estimular una cultura de seguridad para establecer estrategias que aseguren la prestación de cuidados libres de daños (AU)

Objetivo: Identificar as publicações científicas sobre eventos adversos relacionados às práticas assistências e discutir a cultura de segurança do paciente. Métodos: Foi realizada uma revisão de literatura do tipo integrativa, com busca nas bases de dados MEDLINE, LILACS e BDENF disponíveis na BVS, utilizando-se os descritores segurança do paciente, assistência ao paciente, vigilância de evento sentinela, gestão da segurança. Atenderam aos critérios de inclusão 26 artigos científicos publicados no período delimitado para esta revisão, 2005 a 2015. Resultados: A análise dos artigos revelou cinco categorias importantes: características dos eventos adversos relacionados às práticas assistências, implicações da ocorrência de eventos adversos, medidas de prevenção de eventos adversos, notificações de eventos adversos e os fatores intervenientes e o conhecimento e a cultura de segurança. Conclusão: A cultura punitiva aparece como responsável pela subnotificação e omissão dos eventos adversos, constituindo-se uma barreira para realização de investigações eficazes. É imperativo estimular a cultura de segurança para que se estabeleçam estratégias que garantam a prestação de cuidados livres de danos (AU)

Objective: To identify the scientific publications about adverse events related to practical assistance and discuss the culture of patient safety. Methods: An integrative literature review was done through research in MEDLINE, LILACS and BDENF available in BVS, using the following descriptors: patient safety, patient assistance, surveillance of sentinel event, safety management. 26 scientific articles published in the period defined for this review, 2005 to 2015 met the inclusion criteria. Results: The analysis of the articles revealed five major categories: characteristics of adverse events related to practical assistance, adverse events occurrence implications, measures for the prevention of adverse events, notifications of adverse events and the intervenient factors and the knowledge and the culture of safety. Conclusion: The punitive culture comes as responsible for underreporting and omission of adverse events, being constituted a barrier to effective implementation of investigations. It is essential to foster a safety culture to establish strategies that ensure the care provision free of damage (AU)

Factores que influyen en la automedicación del personal de enfermería a nivel técnico y de estudiantes / Factors influencing self medication nursing staff and students technical level

La automedicación, es “el consumo de medicamentos, hierbas y remedios caseros por iniciativa o consejo de otra persona, sin consultar al médico”, considerada también como un fenómeno que se ha incrementado a través del tiempo, convirtiéndose en un serio problema de salud pública. En México no existen estudios o publicaciones que permitan valorar la real magnitud de esta práctica en la población. Objetivo: Conocer los factores que influyen en la automedicación del personal de enfermería a nivel técnico y estudiantes del Instituto Nacional de Neurología y Neurocirugía.

Self-medication, is “the use of drugs, herbs and home remedies or advice on the initiative of another person, without consulting a doctor”, also regarded as a phenomenon that has been increasing over time, becoming a serious public health problem. In Mexico, there are no studies or publications to assess the real magnitude of this practice in the population. Objective: Understanding the factors that influence self-medication nursing staff technical level, and students of the National Institute of Neurology and Neurosurgery.