[Effect of reducing sensory and environmental stimuli during hospitalized premature infant sleep]. / Efeito da redução de estímulos sensoriais e ambientais no sono de recém-nascidos pré-termo hospitalizados.

OBJECTIVE: To compare the total sleep time of premature infant in the presence or absence of reducing sensory and environmental stimuli in the neonatal unit. METHOD: Longitudinal study in a Neonatal Intermediate Care Unit of a public hospital in Sao Paulo. The sample consisted of 13 premature infants. We used polysomnograph and unstructured observation for data collection. We analyzed 240 and 1200 minutes corresponding to the periods of the presence and absence of environmental management, respectively. Data were compared in proportion to the total sleep time in the two moments proposed by the study. RESULTS: The total sleep time in periods without environmental management was on average 696.4 (± 112.1) minutes and with management 168.5 (± 27.9) minutes, proportionally premature infant slept an average of 70.2% during periods with no intervention and 58.0% without management (p=0.002). CONCLUSION: Reducing stimulation and handling of premature infant environment periods was effective to provide greater total sleep time.

Michigan appropriateness guide for intravenous catheters in pediatrics - miniMAGIC-Brasil: translation into Brazilian portuguese.

OBJECTIVE: To perform the translation and adaptation of the Michigan Appropriateness Guide for Intravenous Catheters in Pediatrics (miniMAGIC) into Brazilian Portuguese. METHODS: Methodological study performed in five recommended stages: initial translations; synthesis of the translations; back translations; assessment of the back translations; expert committee assessment. The expert committee was composed of three registered nurses and two doctors who had a Master's and/or PhD degree, and an expertise in intravenous therapy and pediatric and neonatal care. To assess the semantic, idiomatic, experiential and conceptual adequacy, a Likert scale was applied, in which 1, "not equivalent"; 2, "inequivalent"; 3, "cannot assess"; 4, "quite equivalent"; 5, "totally equivalent". The terms mostly analyzed as negative in equivalence and with a lower than 20 score were reviewed and submitted to a new assessment, with the Delphi Technique until consensus was obtained. The results were stored in electronic spreadsheets and treated with concordance index, with a minimum acceptable result of 0.80. RESULTS: The content of all recommendations, named as miniMAGIC-Brasil, was validated by the expert committee after two stages of evaluation. All recommendations had an overall agreement index of 0.91. CONCLUSIONS: The miniMAGIC-Brazil guide was validated in respect to the adequacy of the translation after two steps.

Translation and cross-cultural adaptation of the MISSCARE Survey-Ped into Brazilian Portuguese.

OBJECTIVES: to translate and cross-culturally adapt the MISSCARE Survey-Ped for use in Brazil. METHODS: a methodological study proposed by translation, synthesis of translations, back-translation, assessment by a committee of experts and pre-testing with the target population. RESULTS: two direct translations of the instrument were carried out, followed by a consensual version between them. This synthetic version was back-translated and analyzed by a committee of five experts in pediatric nursing and patient safety, obtaining a Content Validity Index (CVI) of 0.95 and Cronbach's alpha of 0.804. The final version was sent for pre-testing with 254 Brazilian pediatric nurses, with 44 (17.3%) analyzing the instrument for understanding (CVI 0.866; Content Validity Ratio (CVR) 0.773), relevance (CVI 0.931; CVR 0.864) and relevance (CVI 0.977; CVR 0.955). CONCLUSIONS: the MISSCARE Survey-Ped Brasil was considered suitable for application in pediatric nurses' clinical practice in the country.

Operational Definition of the Concept of Success in Peripheral Intravenous Catheterization in Hospitalized Children.

The objective of this study was to operationally define the concept of success in peripheral intravenous catheterization in children considering the Walker and Avant model. This is a methodological study, carried out through the following steps: concept selection, the definition of the analysis objective, identification of possible uses of the concept, determination of critical or essential attributes, construction of a model and opposite case, and identification of antecedents and consequences. The study was carried out based on a search in international databases from January to March 2021. The sample consisted of 47 studies conducted in 17 countries between 2008 and 2021. Five attributes, 20 antecedents, 10 consequences, and an empirical reference of the studied concept were identified. Also, 2 cases, model and opposite, were elaborated, and an operational definition of the concept was developed. The Walker and Avant method enabled the operationalization of the concept of success of peripheral intravenous catheterization in children based on attributes, antecedents and consequents, and model and opposite cases.

Medication reconciliation in pediatrics: a validation of instruments to prevent medication errors.

OBJECTIVES: to develop and validate the content of two instruments for promoting medication reconciliation for the transition of care of hospitalized children. METHODS: methodological study, conducted in five stages: scope review for conceptual structure; elaboration of the initial version; content validation with five specialists using the Delphi technique; reassessment; and construction of the final version of the instruments. A content validity index of at least 0.80 was adopted. RESULTS: three rounds of evaluation were carried out to reach the validity index of the proposed contents, whereas a new analysis of 50% of the 20 items of the instrument aimed at families, and 28.5% of the 21 items aimed at professionals was necessary. The instrument aimed at families reached an index of 0.93, and the instrument for professionals, 0.90. CONCLUSIONS: the proposed instruments were validated. It is now possible to proceed with practical implementation studies to identify their influence on safety during medication reconciliation at transition of care.

Time to act sustainably: Why can't we wait any longer?

OBJECTIVES: to raise reflections on the need for health services and professionals to implement sustainable actions, aiming at their own survival and that of the planet. METHODS: reflective essay based on international reports regarding the impact of climate change on people's health and the role of institutions in this context. RESULTS: the article focused on three fundamentals: climate change continues to be a threat to the health and well-being of all beings on Earth; the institutions that should contribute to health are great agents of contamination of the environment and emission of gases that aggravate the greenhouse effect; and there are several benefits for health institutions to act sustainably. FINAL CONSIDERATIONS: we cannot wait any longer; we must develop policies and management models aimed at environmentally responsible, economically viable, and socially more collaborative healthcare.

[Care bundle to reduce central venous catheter-related bloodstream infection: an integrative review]. / Método bundle na redução de infecção de corrente sanguínea relacionada a cateteres centrais: revisão integrativa.

This is an integrative review of literature aimed to identify evidence-based interventions which make up care bundles to reduce central venous catheter-related or associated bloodstream infections. To collect data in Brazilian and international databases were used the key word bundle and the descriptors catheter-related infection, infection control and central venous catheterization, resulting in fifteen articles, after inclusion criteria application. This work showed five interventions as those commonly employed in the bundles methods: hand hygiene, chlorhexidine gluconate for skin antisepsis, use of maximal sterile barrier precaution during the catheter insertion, avoid the femoral access and daily review of catheter necessity with prompt removal as no longer essential. The majority of the studies showed a significant reduction in bloodstream infection related to or associated with central venous catheters.

[The experiences of intensive care nurses in the assessment and intervention of pain relief in children]. / Vivências de enfermeiros intensivistas na avaliação e intervenção para alívio da dor na criança.

Descriptive survey of daily practical experiences of pediatric nurses in the assessment and intervention to pain relief in children, during nursing care provided in pediatric and neonatal intensive care units, and the influence of the infrastructure of care and system organization. The sample was made up of 109 nurses. The principal results indicated that the majority of the nurses considered the academic training obtained as insufficient to support this aspect of nursing care; that they had not received local training in evaluating pain or in relief interventions; that the staff ratio is inadequate and as well as the availability of institutional guidelines to improve the quality of analgesia. It was concluded that nurses value the assessment and intervention to pain relief in children, but describe aspects which compromise practice: lack of collaborative practice, lack of processes definition, lack of formal and continuing education and lack of infrastructure. These aspects compromise the implementation of scientific evidences capable of improving practical aspects of analgesia in children under intensive care.

[Hydrogen potential of antibiotic solutions subjected to environmental conditions: a preliminary trial]. / Potencial hidrogeniônico de soluções de antibióticos submetidas a condições ambientais: ensaio preliminar.

This experimental study was performed to assess the hydrogen potential (pH) of the antimicrobials ceftriaxone sodium, vancomycin hydrochloride, metronidazole, penicillin G potassium, and amikacin sulphate, following reconstitution, diluted with NaCl 0.9% (SF) and glucose solution 5% (GS), at eight different time intervals and under the normal daily conditions of lighting and temperature within the hospital unit (no air conditioning). The objective of this study was to verify the changes in the acid-base behavior of the solutions, which indicate chemical instability and can be associated with complications during intravenous therapy. Of the 186 analyzed pH values, there were no variations greater than 1.0 and no physical alterations visible to the naked eye. All solutions had a pH less than 7, and there were no significant differences for clinical practice regarding the diluent. The mean pH values after dilution with SF and GS for vancomycin hydrochloride, metronidazole, and amikacin sulphate are a risk factor for the development of intravenous complications due to their extreme acidity.

Influence of Peripherally Inserted Central Catheters With Proximal Valves on Red Blood Cell Hemolysis During Transfusion.

The aim of this study was to verify the occurrence of hemolysis after infusion of packed red blood cells (PRBCs) in 12 peripherally inserted central catheters (PICCs) with a proximal valve, according to size and infusion rate. This was an experimental in vitro study performed under laboratory-controlled conditions, and the sample was composed of 12 PICCs with proximal valves (3F and 4F catheter). Twelve type A+ aliquots from 10 PRBCs were analyzed preinfusion and postinfusion according to PICC size and infusion rate. Hemolysis markers, total hemoglobin (g/dL), hematocrit (%), free hemoglobin (g/dL), potassium (mmol/L), lactate dehydrogenase (U/L), and rate of hemolysis (%) were studied. Data were analyzed using analysis of variance and Bonferroni multiple comparison tests. After the infusions in 3F PICCs, an increase was seen in rate of hemolysis (P = .003) and free hemoglobin (P = .014), in addition to a reduction in total hemoglobin (P = .002), with significant influence of minimum and maximum flow rates on the rate of hemolysis. The study finding indicated that the smaller catheter size and the infusion rate influenced variations in some hemolysis markers, but the alterations observed in the hemolysis markers would not contraindicate the infusion of PRBCs by 3F and 4F PICCs with proximal valves.

Validation of the Brazilian Portuguese version of the Venous International Assessment Scale and proposal of revision.

OBJECTIVE: To validate the Brazilian Portuguese translation and analyze the cultural adaptation of the Venous International Assessment Scale. METHODS: Observational study by employing the Delphi technique and an equivalence evaluation by experts. The results were analyzed using item scores and by content validity index calculations of item, scale, and universal agreement. RESULTS: Three rounds of evaluation were necessary for consensus. Explanatory contents were incorporated into the original scale throughout the process, resulting in a new version: VIA Scale - Revised. This scale obtained a content validity index of 0.96 and a universal agreement of 0.78. In the cross-cultural adequacy analysis phase, a score of 0.77 was obtained. The majority (90.5%) of the participants judged the scale's decision support property as positive. CONCLUSION: The VIA Scale was validated and culturally adapted to the Brazilian Portuguese language, resulting in the VIA Scale - Revised (VIA-R).

Stability of vancomycin hydrochloride employed in antimicrobial seal solutions of central intravenous catheters. / Estabilidade do cloridrato de vancomicina empregado em soluções de selo antimicrobiano de cateteres intravenosos centrais.

OBJECTIVE: to verify the stability of vancomycin hydrochloride in antimicrobial seal solutions with and without association of heparin sodium according to temperature and association time. METHOD: an experimental study designed for the analysis of hydrogenionic potential and concentration by means of high-efficiency liquid chromatography of vancomycin hydrochloride (n=06) and vancomycin hydrochloride and heparin sodium (n=06). The solutions studied were submitted to absence of light, as well as to 22°C and 37°C. Analyses in triplicate (n=192) were performed at the initial moment (T0) and three (T3), eight (T8) and 24 hours (T24) after preparation. The data were submitted to analysis of variance (p≤0.05). RESULTS: concentration of the antimicrobial at 22°C presented a reduction (T0-T8) and a subsequent increase (T24); hydrogenionic potential decreased significantly over time. At 37°C, the concentration increased up to T3 and decreased at T24, with a reduction of hydrogenionic potential up to 24 hours. Concentration of the vancomycin hydrochloride and heparin sodium solutions varied with a reduction at 22°C, accompanied by increased hydrogenionic potential. Precipitate formation was observed by visual inspection of the vancomycin hydrochloride-heparin sodium association (T3). CONCLUSION: pharmacological stability of vancomycin hydrochloride (5 mg/mL) and physical incompatibility with heparin sodium (100 IU/mL) were evidenced after three hours of association in the antimicrobial seal solutions studied.

Methods for measuring venous peripherally inserted central catheters in newborns.

OBJECTIVE: to analyze the results of insertion procedures of Peripherally Inserted Central Catheters in newborns using two measurement methods. METHODS: this is a randomized clinical trial, presenting descriptive and exploratory results of variables. It was held at a Neonatal Intensive Care Unit. Data were collected between September 2018 and 2019. The sample analyzed was 88 catheter insertion procedures, distributed in two groups. Study approved by an Institutional Review Board and obtained registration in the country and abroad. Descriptive analysis and logistic regression of data. RESULTS: modified measurement obtained a significant difference for the central catheter tip location. Elective removals and adverse events were not significant between groups; however, poor positioning was related to adverse events. CONCLUSIONS: between the two methods analyzed, the modified measurement obtained better results in the proper catheter tip positioning and, consequently, less risk to patients.

Hydrogen-ion potential of antibiotics according to the environment factors temperature and luminosity.

The objective of this experimental study was to measure the pH of antibiotics administered by intravenous infusion--ceftriaxone sodium, vancomycin hydrochloride, metrodinazole, penicillin G potassium and amikacin sulfate--after reconstitution with sterile water and dilution with NaCl 0.9% or dextrose 5% in water, according to temperature and luminosity of the environment. The results showed that variation in the drugs' pH was less than 1.0 value and that some antibiotics remained acidic after dilution and maintained this chemical profile in all situations studied, suggesting that the studied environmental factors did not change the solutions' acid base characteristic. Some pH values measured characterize risk for the development of chemical phlebitis and infiltration, and it is important for clinical practice to emphasize the profile of intravenous solutions of antibiotics, considering method of dilution, and time to infusion.

Patient-and Family-Centered Care and Patient Safety: reflections upon emerging proximity.

OBJECTIVE: To present reflections upon conceptual and pragmatic relationships between the Patient-and Family-Centered Care and patient safety. METHOD: A discussion about constructs related to the Patient-and Family-Centered Care and patient safety, which shows their interface with pragmatic issues of clinical nursing practice. RESULTS: Considering patients and families as partners and agents promoting safe care is mandatory for the safety culture. FINAL CONSIDERATIONS: Decreasing errors and adverse health care events can be accomplished by understanding manners to incorporate the principles of Patient-and Family-Centered Care into issues related to patient safety.

Influence of Ear Protectors on the Sleep of Preterm Newborns: A Randomized Controlled Clinical Study.

The purpose of this study was to compare the effect of ear protectors on the sleep of preterm newborns during the "quiet" times in intermediate care nursery. This was a clinical, randomized, controlled crossover study conducted in two neonatal units in São Paulo, Brazil. The sample consisted of preterm infants who met the inclusion and exclusion criteria for the study. Polysomnography and unstructured observation were used for data collection. Twenty-four preterm infants with a mean gestational age of 33.2 weeks and current weight of 1.747 g were analyzed. There was no significant difference in the total sleep time of preterm infants with and without the use of ear protectors. Newborns with lower gestational age showed a significant reduction in total sleep time with the use of ear protectors (p < .05). The use of ear protection did not increase the total sleep time for preterm infants.

Evaluation of scientific periodicals and the Brazilian production of nursing articles.

This study aimed to identify nursing journals edited in Brazil indexed in the main bibliographic databases in the areas of health and nursing. It also aimed to classify the production of nursing graduate programs in 2007 according to the QUALIS/CAPES criteria used to classify scientific periodicals that disseminate the intellectual production of graduate programs in Brazil. This exploratory study used data from reports and documents available from CAPES to map scientific production and from searching the main international and national indexing databases. The findings from this research can help students, professors and coordinators of graduate programs in several ways: to understand the criteria of classifying periodicals; to be aware of the current production of graduate programs in the area of nursing; and to provide information that authors can use to select periodicals in which to publish their articles.

Translation and cross-cultural adaptation of the MISSCARE Survey-Ped into Brazilian Portuguese / Traducción y adaptación transcultural del MISSCARE Survey-Ped al portugués brasileño / Tradução e adaptação transcultural do instrumento MISSCARE Survey-Ped para o português brasileiro

ABSTRACT Objectives: to translate and cross-culturally adapt the MISSCARE Survey-Ped for use in Brazil. Methods: a methodological study proposed by translation, synthesis of translations, back-translation, assessment by a committee of experts and pre-testing with the target population. Results: two direct translations of the instrument were carried out, followed by a consensual version between them. This synthetic version was back-translated and analyzed by a committee of five experts in pediatric nursing and patient safety, obtaining a Content Validity Index (CVI) of 0.95 and Cronbach's alpha of 0.804. The final version was sent for pre-testing with 254 Brazilian pediatric nurses, with 44 (17.3%) analyzing the instrument for understanding (CVI 0.866; Content Validity Ratio (CVR) 0.773), relevance (CVI 0.931; CVR 0.864) and relevance (CVI 0.977; CVR 0.955). Conclusions: the MISSCARE Survey-Ped Brasil was considered suitable for application in pediatric nurses' clinical practice in the country.

RESUMEN Objetivos: realizar la traducción y adaptación transcultural del instrumento MISSCARE Survey-Ped para su uso en Brasil. Métodos: estudio metodológico propuesto mediante traducción, síntesis de traducciones, retrotraducción, evaluación por comité de expertos y pretest con la población objetivo. Resultados: se realizaron dos traducciones directas del instrumento, seguidas de una versión consensuada entre ellas. Esta versión sintética fue retrotraducida y analizada por un comité de cinco expertos en enfermería pediátrica y seguridad del paciente, obteniendo un Índice de Validez de Contenido (IVC) de 0,95 y alfa de Cronbach de 0,804. La versión final fue enviada para prueba previa con 254 enfermeros pediátricos brasileños, y 44 (17,3%) analizaron el instrumento por su comprensión (CVI 0,866; Ratio de Validez de Contenido (CVR) 0,773), relevancia (CVI 0,931; RVC 0,864) y relevancia (CVI 0,977; RVC 0,955). Conclusiones: el MISSCARE Survey-Ped fue considerado adecuado para su aplicación en la práctica clínica de los enfermeros pediátricos del país.

RESUMO Objetivos: realizar a tradução e adaptação transcultural do instrumento MISSCARE Survey-Ped para uso no Brasil. Métodos: estudo metodológico proposto por tradução, síntese das traduções, retrotradução, avaliação por comitê de especialistas e pré-teste com a população-alvo. Resultados: foram realizadas duas traduções diretas do instrumento, seguidas por uma versão consensual entre as mesmas. Essa versão síntese foi retrotraduzida e analisada por um comitê de cinco especialistas em enfermagem pediátrica e segurança do paciente, obtendo um Índice de Validade de Conteúdo (IVC) de 0,95 e alfa de Cronbach de 0,804. Enviou-se a versão final para pré-teste com 254 enfermeiros pediatras brasileiros, sendo que 44 (17,3%) analisaram o instrumento quanto à sua compreensão (IVC 0,866; Razão de Validade de Conteúdo (RVC) 0,773), pertinência (IVC 0,931; RVC 0,864) e relevância (IVC 0,977; RVC 0,955). Conclusões: o MISSCARE Survey-Ped Brasil foi considerado apto para aplicação na prática clínica de enfermeiros pediatras do país.

Michigan appropriateness guide for intravenous catheters in pediatrics — miniMAGIC-Brasil: translation into Brazilian portuguese / Michigan appropriateness guide for intravenous catheters in pediatrics — miniMAGIC-Brasil: tradução para o português do Brasil

ABSTRACT Objective: To perform the translation and adaptation of the Michigan Appropriateness Guide for Intravenous Catheters in Pediatrics (miniMAGIC) into Brazilian Portuguese. Methods: Methodological study performed in five recommended stages: initial translations; synthesis of the translations; back translations; assessment of the back translations; expert committee assessment. The expert committee was composed of three registered nurses and two doctors who had a Master's and/or PhD degree, and an expertise in intravenous therapy and pediatric and neonatal care. To assess the semantic, idiomatic, experiential and conceptual adequacy, a Likert scale was applied, in which 1, "not equivalent"; 2, "inequivalent"; 3, "cannot assess"; 4, "quite equivalent"; 5, "totally equivalent". The terms mostly analyzed as negative in equivalence and with a lower than 20 score were reviewed and submitted to a new assessment, with the Delphi Technique until consensus was obtained. The results were stored in electronic spreadsheets and treated with concordance index, with a minimum acceptable result of 0.80. Results: The content of all recommendations, named as miniMAGIC-Brasil, was validated by the expert committee after two stages of evaluation. All recommendations had an overall agreement index of 0.91. Conclusions: The miniMAGIC-Brazil guide was validated in respect to the adequacy of the translation after two steps.

RESUMO Objetivo: Realizar a tradução e adaptação do miniMAGIC para a língua portuguesa do Brasil. Métodos: Estudo metodológico realizado em cinco etapas: traduções iniciais; síntese das traduções; retrotraduções; avaliação das retrotraduções; avaliação por comitê de especialistas. O comitê foi composto de três enfermeiros e dois médicos que possuíssem pós-graduação stricto sensu e experiência em acesso vascular e pediatria. Para a análise de adequação semântica, idiomática, experiencial e conceitual de cada item do instrumento, foi empregada escala tipo Likert graduada em 1, como "não equivalente"; 2, "pouco equivalente"; 3, "não sei avaliar"; 4, "bastante equivalente"; e 5, "totalmente equivalente". Os termos majoritariamente analisados como negativos quanto à equivalência e com pontuação inferior a 20 foram revisados e submetidos a nova análise segundo a técnica Delphi até que o consenso fosse alcançado. Os resultados obtidos foram armazenados em planilhas eletrônicas e tratados com análise do índice de concordância mínimo de 0,80. Resultados: O conteúdo de todas as recomendações, que receberam nomeação de miniMAGIC-Brasil, alcançou índice de concordância mínimo, segundo julgamento por comitê de especialistas, após duas etapas de avaliação. Todas as recomendações obtiveram índice de concordância ao final de 0,91. Conclusões: O guia miniMAGIC-Brasil obteve índice de concordância dos termos segundo análise da adequação da tradução após duas etapas.

Frequency of Respiratory Nursing Diagnoses and Accuracy of Clinical Indicators in Preterm Infants.

PURPOSE: To identify the frequency of the nursing diagnoses, ineffective breathing pattern, impaired gas exchange and impaired spontaneous ventilation in newborns; and, to analyze the accuracy of diagnostic indicators identified for each of these diagnoses. METHODS: This was a cross-sectional study conducted with a nonprobability sample of 92 infants. Data collected were represented by demographic and clinical variables, clinical indicators of the three respiratory nursing diagnoses from NANDA International, and were analyzed according to frequency and agreement between pairs of expert nurses (Kappa). FINDINGS: Ineffective breathing pattern was identified in 74.5% of infants; impaired gas exchange was noted in 31.5%; impaired spontaneous ventilation was found in 16.8% of subjects. Use of accessory muscles to breathe showed the highest sensitivity for ineffective breathing pattern; abnormal blood gases had the best predictive value for impaired gas exchange. Use of accessory muscles to breathe had the highest sensitivity for impaired spontaneous ventilation. CONCLUSIONS: Ineffective breathing pattern was the most frequently identified; use of accessory muscles, alteration in depth of breathing, abnormal breathing, and dyspnea were the most representative signs/symptoms. IMPLICATION FOR NURSING PRACTICE: Early recognition of respiratory conditions can support safe interventions to ensure appropriate outcomes.