RESUMEN
Introdução: A classificação de risco é definida como uma ferramenta utilizada nos serviços de urgência e emergência que auxilia na identificação de pacientes que necessitam atendimento prioritário. Em obstetrícia o surgimento de um protocolo específico por intermédio do Ministério da Saúde que conta com 12 fluxogramas tem sido uma medida adotada para organização e humanização dos serviços que atendem obstetrícia, no intuito de minimizar danos relacionados à saúde dessas usuárias que aguardam atendimento . O objetivo do estudo foi: determinar o grau de concordância interavaliador na aplicação do protocolo de acolhimento e classificação de risco em obstetrícia do Ministério da Saúde em uma unidade de pronto atendimento obstétrico. Métodos: Trata-se de um estudo transversal, com abordagem metodológica, que analisou a reprodutibilidade do protocolo em obstetrícia do Ministério da saúde. Para a coleta dos dados: foram avaliados prontuários com o registro de atendimentos ocorridos entre novembro 2019 e maio de 2020. Foram entrevistados enfermeiros que possuem treinamento em classificação de risco e também enfermeiros que não possuem treinamento em classificação de risco. Para análise estatística dos dados foram calculados através do coeficiente de Kappa, sensibilidade e especificidade. Resultados: Os resultados do estudo demonstraram que o grau de confiabilidade interavaliadores foi considerado de moderado a forte representado pelo coeficiente Kappa que variou entre (0,47 e 0,77), foi observado também uma tendência na subestimação do grupo prioritário vermelho e amarelo, e uma tendência de superestimação nas prioridades clínicas amarelo e verde. Apesar de ter acontecido casos de subestimação e superestimação não ocorreram diferenças significativas nos grupos de enfermeiros treinados versus não treinados para utilização do protocolo de A&CR-O. Assim, os resultados desta dissertação corroboram com a hipótese que o protocolo de A&CR O é confiável para o que se propõe. Conclusão: Esse estudo possibilitou verificar que o protocolo é confiável para sua utilização no campo da obstetrícia, uma vez que demonstrou concordância moderada a forte entre os grupos de avaliadores, além disso contribuiu para a análise da reprodutibilidade do protocolo de classificação de risco em obstetrícia que vem sendo implantado desde se sua publicação podendo ser utilizado com maior segurança por Enfermeiros. Palavras-chave: Protocolos. Protocolos clínicos. Confiabilidade. Obstetrícia. Classificação de risco. Serviços de emergência obstétrica. Reprodutibilidade. Enfermagem. Enfermagem Obstétrica. Estudos de avaliação.
Introduction: Risk classification is defined as a tool used in urgent and emergency services that helps to identify patients who need priority care. In obstetrics, the emergence of a specific protocol through the Ministry of Health, which has 12 flowcharts, has been a measure adopted to organize and humanize the services that attend obstetrics, in order to minimize the health-related damage of these users who are awaiting care. The objective of the study was: to determine the degree of inter-rater agreement in the application of the welcoming protocol and risk classification in obstetrics of the Ministry of Health in an obstetric emergency care unit. Methods: This is a cross-sectional study, with a methodological approach, which analyzed the reproducibility of the protocol in obstetrics of the Ministry of Health. For data collection: medical records were evaluated with the record of visits that took place between November 2019 and May 2020. Nurses who have training in risk classification and nurses who do not have training in risk classification were interviewed. For statistical analysis of the data, they were calculated using the Kappa coefficient, sensitivity and specificity. Results: The results of the study showed that the degree of inter-rater reliability was considered moderate to strong, represented by the Kappa coefficient that varied between (0.47 and 0.77), a tendency was also observed in the underestimation of the red and yellow priority group, and a tendency to overestimate the yellow and green clinical priorities. Despite cases of underestimation and overestimation, there were no significant differences in the groups of trained versus untrained nurses to use the A & CR-O protocol. Thus, the results of this dissertation corroborate the hypothesis that the A&CR - O protocol is reliable for what it is proposed. Conclusion: This study made it possible to verify that the protocol is reliable for its use in the field of obstetrics, since it demonstrated mode rate to strong agreement between the groups of evaluators, in addition it contributed to the analysis of the reproducibility of the risk classification protocol in obstetrics that it has been implemented since its publication and can be used more safely by nurses.
Asunto(s)
Humanos , Masculino , Femenino , Adulto , Persona de Mediana Edad , Acogimiento , Obstetricia , Reproducción , Grado de Riesgo , Estudios de Evaluación como Asunto , Evaluación en Enfermería/estadística & datos numéricosRESUMEN
BACKGROUND: Skin changes caused by aging increase the risk of skin damages, such as pressure ulcers, during hospitalization of elderly patients. There is few information about the cost of wound treatment in Brazil. Conversely, skin and wound problems are highly reported among hospitalized elderly patients and caregivers. The purpose is to analyze the socio-demographic and clinical profile associated with skin and wound care in hospitalized elderly. METHODS: This is a prospective observational study. The sample consisted of 75 patients, aged 60 years or more, randomly selected in three hospitals in Rio de Janeiro, Brazil. Data extraction from nursing records of the sample, using cross mapping with Nursing Interventions Classification. Data Synthesis supported by SAS 6.11 (SAS Institute, Inc. Cary North Carolina) in association with SPSS version 14.0 and statistics analysis. RESULTS: The findings were: age standard deviation 7.8, with minimum as 60, and maximum as 91 years old. Prevalence of women and married seniors. High prevalence of long-term hospitalization. There were 21 Nursing Interventions in the nursing records and seventeen of them related to skin and wound care. They were described in 57 nursing activities, present during 376 evaluations and repeated 1756 times. A significant difference was obtained between age and the presence of the nursing interventions "Positioning" (p-0.004), Eye Care/Hygiene (p- < 0.0001) and Oral Health Maintenance (p-0.0003). CONCLUSION: The skin care to prevention and treatment of skin damages represented the major demand of nursing interventions in different clinical conditions of hospitalized elderly.
Asunto(s)
Servicios de Salud para Ancianos/estadística & datos numéricos , Hospitalización/estadística & datos numéricos , Piel/lesiones , Heridas y Lesiones/enfermería , Anciano , Anciano de 80 o más Años , Análisis de Varianza , Brasil/epidemiología , Femenino , Humanos , Tiempo de Internación , Masculino , Registros Médicos/estadística & datos numéricos , Persona de Mediana Edad , Evaluación en Enfermería/métodos , Evaluación en Enfermería/estadística & datos numéricos , Diagnóstico de Enfermería/estadística & datos numéricos , Evaluación de Resultado en la Atención de Salud/métodos , Evaluación de Resultado en la Atención de Salud/estadística & datos numéricos , Prevalencia , Estudios Prospectivos , Heridas y Lesiones/epidemiología , Heridas y Lesiones/terapiaRESUMEN
Objective To analyze the production of scientific knowledge about the use of patients’ classification instruments in care and management practice in Brazil. Method Integrative literature review with databases search in: Latin American and Caribbean Literature on Health Sciences (LILACS), Medical Literature Analysis and Retrieval System on-line (MEDLINE), Cumulative Index to Nursing and Allied Health Literature (CINAHL) and SCOPUS, between January 2002 through December 2013. Results 1,194 studies were found, 31 met the inclusion criteria. We observed a higher number of studies in the category care plans and workload (n=15), followed by the category evaluation of psychometric properties (n=14). Conclusion Brazilian knowledge production has not yet investigated some purposes of using instruments for classifying patients in professional nursing practice. The identification of unexplored areas can guide future research on the topic. .
Objective To analyze the production of scientific knowledge about the use of patients’ classification instruments in care and management practice in Brazil. Method Integrative literature review with databases search in: Latin American and Caribbean Literature on Health Sciences (LILACS), Medical Literature Analysis and Retrieval System on-line (MEDLINE), Cumulative Index to Nursing and Allied Health Literature (CINAHL) and SCOPUS, between January 2002 through December 2013. Results 1,194 studies were found, 31 met the inclusion criteria. We observed a higher number of studies in the category care plans and workload (n=15), followed by the category evaluation of psychometric properties (n=14). Conclusion Brazilian knowledge production has not yet investigated some purposes of using instruments for classifying patients in professional nursing practice. The identification of unexplored areas can guide future research on the topic. .
Objetivo Analizar la producción del conocimiento científico acerca de la utilización de instrumentos de clasificación de pacientes en la práctica asistencial y de gestión en Brasil. Método Revisión integradora de la literatura con consulta a las bases de datos: Literatura Latinoamericana y del Caribe en Ciencias de la Salud (LILACS), Medical Literature Analysis and Retrieval System on-line (MEDLINE), Cumulative Index to Nursing and Allied Health Literature (CINAHL) y SCOPUS, relativas al período de enero de 2002 a diciembre de 2013. Resultados De las 1.194 publicaciones encontradas, 31 atendieron a los criterios de selección. Se observó una mayor cantidad de artículos en la categoría perfil asistencial y carga laboral (n=15), seguidos de la categoría evaluación de las propiedades psicométricas (n=14). Conclusión La producción nacional todavía no ha investigado algunas finalidades de utilización de instrumentos de clasificación de pacientes en la práctica profesional del enfermero. La identificación de áreas aún no exploradas podrá orientar futuras investigaciones acerca de la temática. .
Asunto(s)
Humanos , Bibliometría , Proceso de Enfermería/estadística & datos numéricos , Brasil , Evaluación en Enfermería/estadística & datos numéricos , Psicometría , Reproducibilidad de los ResultadosRESUMEN
OBJECTIVE: To analyze the production of scientific knowledge about the use of patients' classification instruments in care and management practice in Brazil. METHOD: Integrative literature review with databases search in: Latin American and Caribbean Literature on Health Sciences (LILACS), Medical Literature Analysis and Retrieval System on-line (MEDLINE), Cumulative Index to Nursing and Allied Health Literature (CINAHL) and SCOPUS, between January 2002 through December 2013. RESULTS: 1,194 studies were found, 31 met the inclusion criteria. We observed a higher number of studies in the category care plans and workload (n=15), followed by the category evaluation of psychometric properties (n=14). CONCLUSION: Brazilian knowledge production has not yet investigated some purposes of using instruments for classifying patients in professional nursing practice. The identification of unexplored areas can guide future research on the topic.â©
Asunto(s)
Bibliometría , Proceso de Enfermería/estadística & datos numéricos , Brasil , Humanos , Evaluación en Enfermería/estadística & datos numéricos , Psicometría , Reproducibilidad de los ResultadosRESUMEN
BACKGROUND AND PURPOSE: Fall risk assessment is a necessary component of fall prevention programs. Accurate instruments to predict the risk of falling are paramount in identifying the correct patients in need of fall prevention measures. The purpose of this study was to prospectively validate the Hester Davis Scale (HDS) for fall risk assessment in an acute care setting in the South Central United States. METHODS: The HDS was prospectively validated in 1,904 patients on a neurosciences unit. RESULTS: Using an initial cut score of 7 produced a sensitivity of 100% and specificity of 24.9%. Receiver Operating Characteristic Analysis evidenced a cut score of 10 that would produce a more desirable sensitivity and specificity of 90.9% and 47.1%, respectively. CONCLUSION: The results of the psychometric evaluation and validation of the HDS support its use in clinical practice.
Asunto(s)
Accidentes por Caídas/prevención & control , Evaluación Geriátrica/métodos , Enfermedades del Sistema Nervioso/enfermería , Evaluación en Enfermería/métodos , Evaluación en Enfermería/normas , Accidentes por Caídas/estadística & datos numéricos , Adulto , Anciano , Femenino , Evaluación Geriátrica/estadística & datos numéricos , Humanos , Masculino , Persona de Mediana Edad , Enfermedades del Sistema Nervioso/epidemiología , Evaluación en Enfermería/estadística & datos numéricos , Personal de Enfermería en Hospital , Variaciones Dependientes del Observador , Valor Predictivo de las Pruebas , Estudios Prospectivos , Psicometría/métodos , Psicometría/normas , Psicometría/estadística & datos numéricos , Reproducibilidad de los Resultados , Medición de Riesgo/métodos , Factores de Riesgo , Sensibilidad y EspecificidadRESUMEN
The goal of this study was to examine the prevalence, assessment and management of pediatric pain in a public teaching hospital. The study sample consisted of 121 inpatients (70 infants, 36 children, and 15 adolescents), their families, 40 physicians, and 43 nurses. All participants were interviewed except infants and children who could not communicate due to their clinical status. The interview included open-ended questions concerning the inpatients’ pain symptoms during the 24 h preceding data collection, as well as pain assessment and pharmacological/non-pharmacological management of pain. The data were obtained from 100% of the eligible inpatients. Thirty-four children/adolescents (28%) answered the questionnaire and for the other 72% (unable to communicate), the family/health professional caregivers reported pain. Among these 34 persons, 20 children/adolescents reported pain, 68% of whom reported that they received pharmacological intervention for pain relief. Eighty-two family caregivers were available on the day of data collection. Of these, 40 family caregivers (49%) had observed their child’s pain response. In addition, 74% reported that the inpatients received pharmacological management. Physicians reported that only 38% of the inpatients exhibited pain signs, which were predominantly acute pain detected during clinical procedures. They reported that 66% of patients received pharmacological intervention. The nurses reported pain signs in 50% of the inpatients, which were detected during clinical procedures. The nurses reported that pain was managed in 78% of inpatients by using pharmacological and/or non-pharmacological interventions. The findings provide evidence of the high prevalence of pain in pediatric inpatients and the under-recognition of pain by health professionals.
Asunto(s)
Adolescente , Niño , Preescolar , Humanos , Lactante , Recién Nacido , Evaluación en Enfermería/estadística & datos numéricos , Dimensión del Dolor , Manejo del Dolor/métodos , Cuidadores , Hospitales de Enseñanza/estadística & datos numéricos , Pautas de la Práctica en Medicina , Prevalencia , Dolor/epidemiología , Encuestas y CuestionariosRESUMEN
The goal of this study was to examine the prevalence, assessment and management of pediatric pain in a public teaching hospital. The study sample consisted of 121 inpatients (70 infants, 36 children, and 15 adolescents), their families, 40 physicians, and 43 nurses. All participants were interviewed except infants and children who could not communicate due to their clinical status. The interview included open-ended questions concerning the inpatients' pain symptoms during the 24 h preceding data collection, as well as pain assessment and pharmacological/non-pharmacological management of pain. The data were obtained from 100% of the eligible inpatients. Thirty-four children/adolescents (28%) answered the questionnaire and for the other 72% (unable to communicate), the family/health professional caregivers reported pain. Among these 34 persons, 20 children/adolescents reported pain, 68% of whom reported that they received pharmacological intervention for pain relief. Eighty-two family caregivers were available on the day of data collection. Of these, 40 family caregivers (49%) had observed their child's pain response. In addition, 74% reported that the inpatients received pharmacological management. Physicians reported that only 38% of the inpatients exhibited pain signs, which were predominantly acute pain detected during clinical procedures. They reported that 66% of patients received pharmacological intervention. The nurses reported pain signs in 50% of the inpatients, which were detected during clinical procedures. The nurses reported that pain was managed in 78% of inpatients by using pharmacological and/or non-pharmacological interventions. The findings provide evidence of the high prevalence of pain in pediatric inpatients and the under-recognition of pain by health professionals.
Asunto(s)
Evaluación en Enfermería/estadística & datos numéricos , Manejo del Dolor/métodos , Dimensión del Dolor , Adolescente , Cuidadores , Niño , Preescolar , Hospitales de Enseñanza/estadística & datos numéricos , Humanos , Lactante , Recién Nacido , Dolor/epidemiología , Pautas de la Práctica en Medicina , Prevalencia , Encuestas y CuestionariosRESUMEN
OBJECTIVE: The development of operational definitions leads to accurate assessments of health conditions. Many health indicators in the Nursing Outcomes Classification require the development of operational definitions. We sought to determine the validity of operational definitions for indicators of nursing outcomes that assess respiratory status in children with congenital heart disease. PATIENTS AND METHODS: Eight trained nurses evaluated 45 children with congenital heart disease who were aged ≤ 1 year and previously diagnosed with ineffective breathing patterns. The statistical analysis included median differences, intraclass correlations, and cluster analyses. RESULTS AND CONCLUSIONS: The nonuse of definitions produced inconsistencies in evaluations among evaluators. This inconsistency was not evident in the group using operational definitions. Two indicators were significant in all statistical analyses: asymmetrical chest expansion and percussed sounds.
Asunto(s)
Disnea/enfermería , Cardiopatías Congénitas/enfermería , Evaluación en Enfermería/métodos , Evaluación en Enfermería/estadística & datos numéricos , Diagnóstico de Enfermería/estadística & datos numéricos , Insuficiencia Respiratoria/enfermería , Disnea/diagnóstico , Femenino , Cardiopatías Congénitas/diagnóstico , Humanos , Lactante , Recién Nacido , Capacitación en Servicio , Masculino , Variaciones Dependientes del Observador , Oxígeno/sangre , Reproducibilidad de los Resultados , Insuficiencia Respiratoria/diagnóstico , Ruidos RespiratoriosRESUMEN
Estudo metodológico, com objetivo de identificar quanto o garroteamento pode interferir na visualização e caracterização do calibre das veias periféricas. Fotografias (antebraço/mão) foram avaliadas quanto aos critérios de visualização ecalibre, e 19 pares tiveram concordância unânime de três avaliadores para os critérios mencionados. Estas fotos, aos pares (com e sem garrote), foram apresentadas a 61 enfermeiros intensivistas que avaliaram as mudanças entre ambas, utilizando uma escala numérica de 11 pontos (zero= ausência de modificação visual e 10= melhora máxima da visualização).Os dados submetidos à análise fatorial evidenciam que em 63,5 por cento dos fatos houve melhora (>50 por cento) da visualização dos vasos depois de garroteados; as fotos julgadas como sem alteração da visualização retratam veias de difícil visualização e menos calibrosas, em sua maioria. A caracterização prévia da veia quanto ao calibre, visualização e o emprego do critério visual (fotografias) pode ter interferido nas avaliações.
Asunto(s)
Humanos , Evaluación en Enfermería/estadística & datos numéricos , Torniquetes/estadística & datos numéricos , Vasos SanguíneosRESUMEN
BACKGROUND: Pressure ulcers are a common complication among elderly patients confined to bed for long periods. The Braden scale is a commonly used risk assessment tool. AIM: To evaluate the use of Braden scale. PATIENTS AND METHODS: Seventy women aged 61 to 96 years, admitted to the Internal Medicine Service of Barros Luco-Trudeau Hospital, were studied. Their risk was evaluated using the Braden scale. The presence of pressure ulcer was diagnosed according to the National Pressure Ulcer Advisory Panel on admission, two weeks later and at discharge. RESULTS: On admission, mean Braden scale score was 16.6+/-2.8 and 34 women had a score of 16 or less, that is considered of risk. Twenty five women (20 with a score of 16 or less) developed pressure ulcers, mostly superficial. The odds ratio of a score of 16 or less for the development of ulcers was 4.2 (95% CI 1.8-11.7, p <0.001). The sensitivity and specificity of such score were 80 and 69% respectively. CONCLUSIONS: The Braden scale predicts the risk of developing pressure ulcers with a good sensitivity and specificity in female elderly patients.
Asunto(s)
Evaluación en Enfermería/métodos , Úlcera por Presión/etiología , Anciano , Anciano de 80 o más Años , Métodos Epidemiológicos , Femenino , Humanos , Persona de Mediana Edad , Evaluación en Enfermería/estadística & datos numéricos , Úlcera por Presión/clasificación , Úlcera por Presión/prevención & controlRESUMEN
This paper starts from a research on the reliability and validity assessment of Perroca's patient classification instrument. Its purpose is to analyze the construct validity of this instrument, as well as to check its use in nursing management practice. Study participants were a hundred forty-one patients, allocated in Intensive Care and Hospitalization Units of a school hospital in the interior of São Paulo State, Brazil. Several statistical techniques were used to show the construct validity of the instrument. Research results revealed the importance of all critical indicators, each of which has its own role in determining the patient's complexity degree in relation to nursing care. Therefore, the study showed that the instrument shows evidence of validity. Hence, it is useful for nursing management practice, as a guide to the patient's care needs as well as to the nursing team's workload.
Asunto(s)
Evaluación en Enfermería/normas , Pacientes/clasificación , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Humanos , Persona de Mediana Edad , Evaluación en Enfermería/estadística & datos numéricosRESUMEN
Este trabalho tem como finalidade identificar o conhecimento das gestante acerca dos sinais e sintomas do início do trabalho de parto. Foi realizado em uma maternidade do município de Ribeirão Preto, onde a população assistida, gestantes de baixo risco, é dependente do Sistema Único de Saúde (SUS), em 2001. Para identificar o conhecimento da gestante, foi aplicado um formulário (perguntas abertas e check-list), o qual foi respondido por 30 gestantes de acordo com o seu conhecimento na primeira consulta pré-natal na referida maternidade, na segunda consulta subseqüente e na admissão para resolução da gravidez. Os resultados mostraram que a maioria das gestantes, apesar de conhecer os sinais de início de trabalho de parto, fica ansiosa e, muitas vezes, adianta a ida à maternidade
Asunto(s)
Humanos , Femenino , Embarazo , Embarazo , Evaluación en Enfermería/estadística & datos numéricos , Evaluación en Enfermería/métodos , Inicio del Trabajo de Parto/fisiología , Inicio del Trabajo de Parto/psicología , Atención Prenatal , Educación en Salud/tendenciasRESUMEN
The present study evaluates through nursing registers the assistance afforded to two newborns groups. These children were evaluated by the pediatrician in the delivery room. After that they were conducted to newborn unit, where received the first hygienic care. However, the study shows that the evaluation made by the nurse in the newborn admission, resulted in two groups: one of them composed by children which had signals of difficulty to life adaptation, and the other group composed by children with normal reactions. The nursing assistance given to those newborns is the subject of this paper.