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CONSTRUCTION AND APPLICATION OF A DECISION-MAKING FLOWCHART FOR DIFFICULT PERIPHERAL INTRAVENOUS PUNCTURE IN CHILDREN 儿童外周静脉穿刺困难决策流程图的构建与应用
Q2 Nursing Pub Date : 2023-07-10 DOI: 10.1590/1980-265x-tce-2023-0040en
C. Floriano, Ariane Ferreira Machado Avelar, M. Peterlini
ABSTRACT Objectives: to construct and verify the clinical applicability of a flowchart for assessing children and adolescents who will undergo peripheral intravenous catheterization, according to risk factors for procedure failure. Method: this is a methodological and observational study, which followed the AGREEII instrument guidelines and steps for the construction of a decision-making flowchart for difficult peripheral intravenous puncture. Afterwards, clinical applicability with children and adolescents was verified after approval of ethical merit, with the main outcome being the success rate in the first puncture attempt. It was verified, through statistical analysis, the association of the outcome with the risk factors raised. Results: in the first stage of the study, a literature review was carried out to survey the risk factors for difficult puncture, and prematurity, less than three years, more pigmented skin, obesity, chronic diseases, dehydration, vein difficult to see and/or not palpable, history of multiple punctures and complications of intravenous therapy were found. After applying the flowchart, it was found that 96.3% of the children and adolescents assessed were at risk of being punctured more than once and that 43.9% underwent more than one procedure for success. Those who were unsuccessful on the first attempt were younger than three years old, had chronic disease, vein difficult to see, not palpable vein and a history of multiple punctures. Conclusion: flowchart construction was based on the risk factors for difficult puncture identified in the literature. Clinical applicability showed that it can be a useful tool to identify children and adolescents at risk for puncture failure.
目的:根据手术失败的危险因素,构建并验证一个评估儿童和青少年接受外周静脉留置的流程图的临床适用性。方法:采用方法学和观察性研究,遵循AGREEII器械指南和步骤,构建静脉外周穿刺困难的决策流程图。随后,经伦理道德审核,验证其在儿童和青少年中的临床适用性,主要观察指标为首次穿刺成功率。通过统计分析,验证了结果与危险因素的相关性。结果:在研究的第一阶段,我们进行了文献回顾,调查了穿刺困难的危险因素,包括早产、小于3岁、皮肤色素较多、肥胖、慢性疾病、脱水、静脉难以看到和/或不可触及、多次穿刺史和静脉治疗并发症。应用流程图后,发现96.3%的儿童和青少年有超过一次被刺穿的风险,43.9%的儿童和青少年接受了不止一次的手术以获得成功。第一次尝试失败的患者年龄小于三岁,患有慢性疾病,静脉难以看到,摸不到静脉,有多次穿刺史。结论:基于文献中确定的穿刺困难的危险因素构建流程图。临床应用表明,它可以是一个有用的工具,以确定风险的儿童和青少年穿刺失败。
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引用次数: 0
CARE TECHNOLOGY PROTOTYPE FOR FLUSHING PRACTICE IN INTRAVENOUS CATHETER MAINTENANCE 静脉导管维护中冲洗实践的护理技术原型
Q2 Nursing Pub Date : 2023-06-30 DOI: 10.1590/1980-265x-tce-2022-0302en
Gabriella da Silva Rangel Ribeiro, J. Campos, P. Parreira, Rafael Celestino da Silva
ABSTRACT Objective: to elaborate, based on the assessment of the nursing team’s flushing practice, a care technology prototype aimed at promoting good practices in intravenous catheter maintenance in intensive care. Method: a technology elaboration study, developed in three stages: flushing practice assessment through a questionnaire completed by 108 nursing professionals working in intravenous catheter maintenance in intensive care settings of a public hospital located in the city of Rio de Janeiro, Brazil. Data collection took place from November 2019 to January 2020, with descriptive and inferential data analysis; analysis of this practice regarding the existence of errors according to the main guidelines and scientific evidence, with classification of types of errors in the light of the conceptual framework of patient safety; and technology prototype development. Results: 88% of participants perform flushing in their practice; 49.5% apply the continuous pressure technique on the syringe plunger; 22% perform flushing before, between and after medication administration; predominance of use of volume and syringes with gauges of 5 ml and 10 ml. Variables related to knowledge were associated with not performing flushing. There were active and latent errors that guided the technology prototype construction. Conclusion: a care guide was built that aims to increase nursing team’s knowledge about good flushing practices and is configured as a barrier to error recurrence.
摘要目的:在评估护理团队冲洗实践的基础上,阐述一种旨在促进重症监护室静脉导管维持良好实践的护理技术原型。方法:一项技术详细研究,分三个阶段开展:通过一份问卷对冲洗实践进行评估,问卷由巴西里约热内卢市一家公立医院重症监护环境中从事静脉导管维护工作的108名护理专业人员完成。数据收集于2019年11月至2020年1月进行,并进行描述性和推断性数据分析;根据主要指导方针和科学证据对该实践中存在的错误进行分析,并根据患者安全的概念框架对错误类型进行分类;以及技术原型开发。结果:88%的参与者在练习中进行冲洗;49.5%的注射器柱塞采用连续加压技术;22%的人在给药之前、之间和之后进行冲洗;主要使用5毫升和10毫升的体积和注射器。与知识相关的变量与不进行冲洗有关。在技术原型构建过程中存在着主动误差和潜在误差。结论:建立了护理指南,旨在提高护理团队对良好冲洗规范的认识,并配置为防止错误再次发生的障碍。
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引用次数: 0
FACTORS ASSOCIATED WITH PHYSICAL ACTIVITY LEVELS IN ADOLESCENTS 与青少年身体活动水平相关的因素
Q2 Nursing Pub Date : 2023-06-26 DOI: 10.1590/1980-265x-tce-2022-0244en
Amanda Regis Furtado, Jennyfer Soares de Sá, Gleice Kelli Santana de Andrade, Bianca Cristina Ciccone Giacon-Arruda, R. Bomfim, Dirceu Santos Silva, E. Teston
ABSTRACT Objective: to analyze the factors associated with physical activity levels in adolescents. Method: cross-sectional, quantitative study, conducted with adolescents enrolled in two educational institutions in a capital of the midwest region of Brazil. Data collection occurred from April to October 2021, through a self-administered questionnaire composed of validated scales. The association between the variables was verified by logistic regression. Results: 219 adolescents participated in the study, with a mean age of 15.7 years, more than half were girls (52.5%) from medium economic class (51.1%); 55.3% were very active/active; 39.3% had low self-esteem; 17.8% were at risk for developing an eating disorder; 12.3% at risk for severe anxiety symptoms; and 13.3% at risk for moderate depression symptoms. The factors associated with the level of physical activity were self-esteem and risk for depression. Conclusion: Early screening of adolescents with low self-esteem and risk for symptoms of depression is proposed as an initial strategy to direct actions that encourage the practice of physical activity.
摘要目的:分析影响青少年身体活动水平的相关因素。方法:横断面定量研究,在巴西中西部地区首都的两个教育机构招收青少年进行。数据收集于2021年4月至10月,通过由有效量表组成的自我管理问卷进行。通过逻辑回归验证变量之间的相关性。结果:219名青少年参与研究,平均年龄15.7岁,其中一半以上为中等经济阶层(51.1%)的女孩(52.5%);55.3%非常活跃/活跃;自尊心低的占39.3%;17.8%的人有患饮食失调的风险;12.3%有出现严重焦虑症状的风险;13.3%的人有中度抑郁症状的风险。与体育锻炼水平相关的因素是自尊和患抑郁症的风险。结论:早期筛查青少年低自尊和抑郁症状的风险建议作为一个初步策略,直接行动,鼓励体育锻炼的做法。
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引用次数: 0
PERCEPTIONS OF NURSING UNDERGRADUATES ABOUT THE CHALLENGES FACED FOR TRAINING IN THE COVID-19 PANDEMIC 护理本科生对COVID-19大流行期间培训面临挑战的看法
Q2 Nursing Pub Date : 2023-06-26 DOI: 10.1590/1980-265x-tce-2022-0314en
Ana Carolina Bezerra de Lima, Danielle Christine Moura dos Santos, Edlamar Kátia Adamy, B.M.R Gomes
ABSTRACT Objective: to identify and discuss the challenges faced by nursing undergraduates of a public higher education institution during the COVID-19 pandemic. Method: exploratory, cross-sectional, quantitative study conducted with nursing undergraduates from a public university in Recife, Pernambuco State, Brazil. Data collection took place between July 2021 and February 2022, using exclusively digital questionnaires. Descriptive analyses and statistical tests such as Kolmogorov-Smirnov, Chi-square and Fisher's exact test were performed. Results: the study included 112 nursing undergraduates, mostly female, mean age of 20.9 years, white color/race, single, without children, with a family income of up to three minimum wages. The main challenges were: difficulty in adapting to remote teaching, changes in daily routine, distraction with subjects not discussed in class, fear and/or anxiety regarding the pandemic, difficulty in family support, influence of social isolation on interest in classes, need for institutional programs of financial and psychological support and government encouragement to disseminate measures against the coronavirus. Challenges such as difficulty in handling technological equipment and financial concerns were statistically associated with the variables computer and notebook ownership, quality of internet connection and private study environment. Conclusion: the study raised reflections that emerged from a scenario of health and educational crisis, indicating that the COVID-19 pandemic caused relevant challenges for undergraduate nursing students' learning.
【摘要】目的:了解并探讨2019冠状病毒病疫情期间公立高等学校护理本科生面临的挑战。方法:对巴西伯南布哥州累西腓一所公立大学的护理本科生进行探索性、横断面、定量研究。数据收集于2021年7月至2022年2月期间进行,仅使用数字问卷。进行了描述性分析和统计检验,如Kolmogorov-Smirnov、卡方检验和Fisher精确检验。结果:本研究纳入112名护理本科生,女性居多,平均年龄20.9岁,白人/种族,单身,无子女,家庭收入不超过三份最低工资。主要的挑战是:难以适应远程教学,日常生活的变化,课堂上没有讨论的科目分散了注意力,对大流行的恐惧和/或焦虑,家庭支持的困难,社会隔离对课堂兴趣的影响,需要制度性的财政和心理支持计划,以及政府鼓励传播抗击冠状病毒的措施。在统计上,处理技术设备的困难和财务问题等挑战与电脑和笔记本的所有权、互联网连接质量和私人学习环境等变量相关。结论:本研究提出了健康与教育危机情景下的思考,表明新冠肺炎大流行给护理本科学生的学习带来了相关挑战。
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引用次数: 0
CHALLENGES FACED BY NURSE-MANAGERS AT WORK IN BRAZILIAN AND PORTUGUESE HOSPITALS: A MIXED-METHODS STUDY 巴西和葡萄牙医院护士管理人员工作中面临的挑战:一项混合方法研究
Q2 Nursing Pub Date : 2023-06-26 DOI: 10.1590/1980-265x-tce-2023-0059en
Lara Vandresen, D. Pires, L. L. Trindade, Olga Ribeiro, M. Martins, Mariana Mendes
ABSTRACT Objective: to analyze the challenges found in nurse-managers' work in the Brazilian and Portuguese hospital contexts. Method: a mixed-methods research study with a sequential explanatory approach, carried out between March 2019 and March 2020 with nurse-managers from four hospitals. The study was initiated with the quantitative stage, applying a survey to 143 participants and analyzing the data by means of analytical and inferential statistics. The qualitative stage was carried out with 71 of these participants using interviews, in order to understand the challenges inherent to this job, and the data were submitted to content analysis. Integration of the findings was performed through data connection. Results: in the quantitative stage, the results evidenced that the managerial activities carried out by nurses by scenario included planning, people management, management of care processes, management of materials, quality management and leadership, with higher mean values for the first four. The qualitative stage allowed deepening the previous findings, contrasting invisibility of the planning, confirming people management as the common challenge to the realities, explaining the mean values in the national and Portuguese scopes. Integration of the findings detailed the relevance of the conflicts and the deficit of professionals in people management and leadership. Conclusion: managing people, care processes and materials are challenges for nurses in hospital management in both countries. Nurses lack structural support and ongoing training for better management and improvement of planning and leadership.
摘要目的:分析巴西和葡萄牙医院护理管理者工作中面临的挑战。方法:采用顺序解释方法的混合方法研究,于2019年3月至2020年3月期间对四家医院的护士管理人员进行了研究。本研究从定量阶段开始,对143名参与者进行调查,并采用分析统计和推论统计的方法对数据进行分析。为了了解这份工作所固有的挑战,对其中71名参与者进行了访谈,并将数据提交给内容分析。通过数据连接对调查结果进行整合。结果:在量化阶段,结果证明护士通过情景进行的管理活动包括计划、人员管理、护理流程管理、物资管理、质量管理和领导,其中前四项的平均值较高。定性阶段允许深化先前的发现,对比规划的不可见性,确认人员管理是对现实的共同挑战,解释国家和葡萄牙范围内的平均值。综合调查结果详细说明了冲突与人员管理和领导专业人员短缺的相关性。结论:人员管理、护理流程和物资管理是两国护士在医院管理中面临的挑战。护士缺乏结构性支持和持续培训,以更好地管理和改进规划和领导。
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引用次数: 3
COVID-19 IN HEALTH WORKERS: AN ECOLOGICAL STUDY FROM SINAN DATA, 2020-2021 卫生工作者中的COVID-19:来自思南数据的生态学研究,2020-2021年
Q2 Nursing Pub Date : 2023-06-23 DOI: 10.1590/1980-265x-tce-2022-0325en
Pedro Henrique Romano, Danúbia Hillesheim, A. L. L. Hallal, Fabrício Augusto Menegon, Lizandra da Silva Menegon
ABSTRACT Objective: to analyze the epidemiological and occupational profile of health workers notified for COVID-19 in Brazil, in the years 2020 and 2021. Method: this is an ecological study, which used data from the Information System of Notifiable Diseases (SINAN) and the Annual Social Information List (RAIS), from the years 2020 and 2021. Sociodemographic and occupational variables were analyzed. The prevalence rates of COVID-19 in health workers were calculated, modeled by Poisson regression in the Stata 14 software. Results: in 2020 and 2021, 35,545 health workers were affected by COVID-19. A higher prevalence of the disease was observed in females (79.0%), between 30 and 49 years (65.5%) and in blacks and browns (41.4%). Higher rates were observed in women (793.9/100,000 in 2020), young workers (839.9/100,000 in 2020), non-whites (1,497.4/100,000 in 2020) and in northern Brazil, with 1,688.1 cases per 100,000 workers in 2020. Nursing professionals, physicians and physical therapists had the highest rates of the disease in 2020 and 2021. Conclusion: there was a difference between the sexes, as well as social, racial and occupational inequities that reflect the need to expand health surveillance measures in order to ensure greater prevention, protection and assistance to health workers.
目的:分析巴西2020年和2021年COVID-19通报卫生工作者的流行病学和职业特征。方法:这是一项生态学研究,使用的数据来自2020年和2021年的法定传染病信息系统(SINAN)和年度社会信息清单(RAIS)。分析了社会人口学和职业变量。计算卫生工作者中COVID-19的患病率,并在Stata 14软件中使用泊松回归建模。结果:2020年和2021年,35545名卫生工作者受到COVID-19的影响。该病在女性(79.0%)、30至49岁(65.5%)和黑人和棕色人种(41.4%)中发病率较高。女性(2020年为793.9/10万)、年轻工人(2020年为839.9/10万)、非白人(2020年为1497.4 /10万)和巴西北部的发病率更高,2020年每10万名工人中有1688.1例。护理专业人员、医生和物理治疗师在2020年和2021年的发病率最高。结论:两性之间存在差异,社会、种族和职业方面也存在不平等,这反映出需要扩大健康监测措施,以确保对卫生工作者提供更多的预防、保护和援助。
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引用次数: 0
EXPERIENCE OF THE U-NURSING LATAM TEAM IN THE RESEARCH ENTITLED “NURSES WORKING DURING THE COVID-19 PANDEMIC (ENTRADUP)” u-nursing latam团队在“COVID-19大流行期间的护士工作(分组)”研究中的经验
Q2 Nursing Pub Date : 2023-06-23 DOI: 10.1590/1980-265x-tce-2023-e002en
María Guadalupe Casales-Hernández, Juana Jiménez-Sánchez, Paola Andrea Dixon, Javier Isidro Rodríguez-López, A. Squires
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引用次数: 0
PSYCHOMETRIC VALIDATION OF THE CARE TRANSITIONS MEASURE (CTM-15) FOR BRAZILIAN USE IN HIGH-RISK PUERPERAL WOMEN 护理过渡测量(ctm-15)在巴西用于高危产褥期妇女的心理计量学验证
Q2 Nursing Pub Date : 2023-06-19 DOI: 10.1590/1980-265x-tce-2022-0341en
Ane Gabriele Poli Petersen, Caroline Sissy Tronco, Denise Casagrande, Pâmella Pluta, Vanessa Dalsasso Batista Winter, Fernanda Fernandes de Carvalho, Adriane Cristina Bernat Kolankiewicz
ABSTRACT Objective: To analyze the reliability and validity of the psychometric properties of the Care Transitions Measure scale for use in at-risk Brazilian postpartum women. Method: This is a methodological study. Inclusion criteria: being hospitalized risk puerperal women, with access to a fixed or mobile telephone line after hospital discharge. A sociodemographic and clinical questionnaire and the Social Support Scale of the Medical Outcomes Study were applied at the bedside. Between seven and 30 days, the Care Transitions Measure was applied by telephone. The reliability of the scale was tested by Cronbach's alpha. The Chi-Square adjustment test and respective degrees of freedom were performed to test the proposed model. Exploratory factor analysis was performed to verify any possibility of factor structure. Results: The Care Transitions Measure showed high internal consistency (0.902) overall and by factors. The four-factor model was statistically more adjusted when compared to the unifactorial model. The factor loadings showed values higher than 0.664, pointing to an effective contribution of each item. Also, when assessing the capacity for discrimination between the scales, the results showed a good capacity for discrimination. Conclusion: The instrument presented valid and reliable psychometric properties to evaluate the transition of care from the perspective of at-risk postpartum women. The four-factor model was statistically more adjusted.
摘要目的:分析护理转变测量量表在巴西产后高危妇女中的信度和效度。方法:本研究为方法学研究。纳入标准:住院有风险的产褥期妇女,出院后可使用固定或移动电话。在床边应用了社会人口学和临床问卷以及医疗结果研究的社会支持量表。在7至30天期间,通过电话应用护理过渡测量。量表的信度采用Cronbach’s alpha检验。通过卡方调整检验和各自的自由度来检验所提出的模型。探索性因子分析验证因子结构的可能性。结果:护理转变量表整体和各因素具有较高的内部一致性(0.902)。与单因素模型相比,四因素模型在统计上有更大的调整。因子负荷值大于0.664,表明各因子的有效贡献。此外,在评估量表之间的区分能力时,结果显示出良好的区分能力。结论:该量表能有效、可靠地评价产后高危妇女的护理过渡。四因素模型在统计上有更大的调整。
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引用次数: 0
FROM IMPLEMENTATION TO DISSEMINATION OF KANGAROO CARE IN SANTA CATARINA: A FOUCAULT’S ANALYSIS 从圣卡塔琳娜州袋鼠式护理的实施到传播:福柯的分析
Q2 Nursing Pub Date : 2023-06-19 DOI: 10.1590/1980-265x-tce-2022-0327en
Luana Cláudia dos Passos Aires, Laís Antunes Wilhelm, M. Lima, Isadora Ferrante Boscoli de Oliveira Alves, Bruna Schiphorst Delgado, Roberta Costa
ABSTRACT Objective: to know the process of kangaroo care implementation and dissemination in the state of Santa Catarina. Method: this is socio-historical research with a qualitative approach, with data collection carried out from January to November 2019, through interviews with 12 oral sources. Analysis was carried out in the light of genealogical analysis proposed by Foucault, with the help of Atlas.ti Cloud®. Results: the process of kangaroo care implementation and dissemination in Santa Catarina happened from the breaking of resistance to the light of scientific knowledge, training and awareness that gradually captivated health professionals for the incorporation of new knowledge in neonatal care practice. Conclusion: kangaroo care implementation as a public health policy configured a paradigm shift in neonatal care in Santa Catarina. Although scientifically supported, it took years to materialize in the state and still faces resistance.
摘要目的:了解圣卡塔琳娜州袋鼠式护理的实施和推广过程。方法:这是一项采用定性方法的社会历史研究,数据收集于2019年1月至11月,通过对12名口头来源的访谈进行。根据福柯提出的系谱分析,借助Atlas进行分析。ti云®。结果:在圣卡塔琳娜实施和传播袋鼠式护理的过程是从打破抵抗到科学知识、培训和意识的曙光,逐渐吸引卫生专业人员将新知识纳入新生儿护理实践。结论:袋鼠式护理作为一项公共卫生政策的实施,在圣卡塔琳娜州的新生儿护理中配置了范式转变。尽管有科学依据,但它花了数年时间才在该州实现,并且仍然面临阻力。
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引用次数: 0
POTENTIALITIES AND CHALLENGES FOR CARE IN THE PRIMARY HEALTH CARE CONTEXT 初级卫生保健领域护理的潜力和挑战
Q2 Nursing Pub Date : 2023-06-16 DOI: 10.1590/1980-265x-tce-2022-0333en
Ivonete Heidemann, M. Durand, Jeane Barros de Souza, A. Arakawa-Belaunde, Laura Christina Macedo, Sandra Mara Correa, Leandro Martins Costa de Araujo, Kamila Soares Maciel
ABSTRACT Objective: to understand the potentialities and challenges for the care provided by professionals in the primary health care context. Method: a qualitative research study of the participatory action type, based on Paulo Freire's Research Itinerary, which consists of Thematic Investigation; Coding and Decoding; and Critical Unveiling. It was developed in the first half of 2021, with the participation of 20 professionals, including physicians, nurses, dentists, nursing technicians, dental assistants and community agents, all from a Basic Health Unit in Santa Catarina. Results: the health professionals revealed the team's engagement as potentialities, as well as welcoming, which strengthens interpersonal relationships in Primary Care. As challenges, they highlighted the limited professional appreciation and scarce material and human resources, factors that generate tensions for the assistance to be provided. Conclusion: engagement and interpersonal relationships reveal the professionals' commitment and dedication to promoting comprehensive and good quality care, seeking to overcome the limitations inherent to assistance in Primary Health Care.
摘要目的:了解初级卫生保健专业人员提供护理的潜力和挑战。方法:以保罗·弗莱雷的《研究行程》为基础,对参与式行动类型进行定性研究,其中包括主题调查;编码与解码;和关键的揭幕。该计划是在2021年上半年制定的,有20名专业人员参与,包括医生、护士、牙医、护理技术人员、牙医助理和社区代理人,他们都来自圣卡塔琳娜州的一个基本保健单位。结果:卫生专业人员显示团队的参与是潜在的,以及欢迎,这加强了初级保健中的人际关系。作为挑战,它们突出了有限的专业认识和稀少的物质和人力资源,这些因素使所提供的援助变得紧张。结论:参与和人际关系表明专业人员致力于促进全面和高质量的护理,寻求克服初级卫生保健援助固有的局限性。
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引用次数: 0
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