A úlcera por pressão, considerada um evento adverso, compromete a segurança do paciente sob os cuidados dos profissionais de saúde. Uma das formas de proporcionar segurança é por meio da prática baseada em evidência que pode ser implementada com estudantes pelo uso de metodologias ativas de ensino- aprendizagem. O objetivo geral do estudo foi propor uma metodologia de ensino para estudantes do curso de Enfermagem da Universidade Estadual de Londrina, pela avaliação do risco de desenvolvimento da úlcera por pressão em pacientes internados em uma unidade médico-cirúrgica e pela identificação das prescrições de enfermagem para a prevenção nos registros em prontuários. A pesquisa foi aprovada pelo Comitê de Ética e Pesquisa institucional e realizou-se utilizando métodos quantitativos e qualitativos, com delineamento descritivo, ocorrendo em três fases. A primeira foi um workshop sobre prática baseada em evidência. A segunda foi desenvolvida pelos estudantes e pesquisadora e a coleta de dados foi realizada com 21 pacientes hospitalizados em unidade médico-cirúrgica durante 15 dias sequenciais, em que avaliou-se o risco para úlcera por pressão por meio da Escala de Braden e os registros das prescrições de enfermagem relacionados ao uso das evidências para prevenção de úlcera por pressão. A terceira foi desenvolvida com os estudantes para investigar o significado da experiência com a metodologia de ensino. Os 21 pacientes avaliados tinham a média de idade de 44,76 anos e diagnósticos médicos mais frequentes de doenças do sistema osteomuscular e do tecido conjuntivo (42,86%). No primeiro dia de avaliação, considerando a escore total da Escala de Braden, 17 pacientes (80,95%) tinham risco entre moderado e muito alto. Na inspeção da pele foram identificadas 25 úlceras por pressão, sendo a localização mais frequente na região sacral (44%) e as classificações predominantes foram no estágio I e II. Na análise dos prontuários, não foram identificadas anotações dos enfermeiros referentes à avaliação do risco e nem ao uso da Escala de Braden. As prescrições de enfermagem mais frequentes para a prevenção da úlcera foram mudança de decúbito, uso de coxins, proteção contra a umidade e uso de cremes hidratantes, e a menos frequente foi a manutenção da cabeceira até 30 graus. Não foi encontrada associação entre as medidas de prevenção prescritas e os subescores da escala de Braden. O significado das experiências de oito estudantes que participaram da pesquisa foi investigado pela análise de conteúdo das falas obtidas nas discussões em grupo e identificaram-se duas categorias: aprendendo sobre o tema úlcera por pressão e conhecendo a realidade da instituição e da enfermagem sobre a úlcera por pressão. Concluiu-se que os estudantes relacionaram a teoria à prática, identificaram as competências do enfermeiro na avaliação do paciente com risco para úlcera por pressão, aprimoraram o conhecimento nos estágios da úlcera por pressão e identificaram a Escala de Braden como suporte para avaliação de risco para a úlcera por pressão. Os estudantes, ainda, identificaram a falta de cuidados pela equipe de enfermagem e a importância da presença da família e perceberam a necessidade da prática segura em relação à úlcera por pressão / Pressure ulcers, considered an adverse event, compromise the safety of patients under the care of health professionals. One way to provide safety is through evidence-based practice, which can be implemented with students through the use of active teaching-learning methods. The general study objective was to propose a teaching method for students from the Nursing program at the Universidade Estadual de Londrina, to assess the risk of pressure ulcer development in patients hospitalized at a medical-surgical unit and to identify the nursing prescriptions for this prevention in the records in patient files. Approval for the research was obtained from the institutional Research Ethics Committee and quantitative and qualitative methods were applied, with a descriptive design, involving three phases. The first was a workshop on evidence-based practice. The second was developed by the students and researcher and the data were collected with 21 patients, hospitalized at the medical-surgical unit for 15 continuous days, in which the risk of pressure ulcer was assessed through the Braden Scale and the records of the nursing prescriptions related to the use of evidences to prevent pressure ulcers. The third was developed with the students to investigate the meaning of the experience with the teaching method. The 21 patients assessed had a mean age of 44.76 years and the most frequent medical diagnoses were diseases of the musculoskeletal system and connective tissue (42.86%). On the first assessment day, considering the total score on the Braden Scale, 17 patients (80.95%) had a moderate to very high risk. In the skin inspection, 25 pressure ulcers were identified, with the sacral region as the most frequent location (44%) and stages I and II as the predominant classifications. In the analysis of the files, no nursing notes were identified with regard to the risk assessment, nor related to the use of the Braden Scale. The most frequent nursing prescriptions to prevent ulcers were decubitus change, use of cushions, protection against humidity and use of hydrating creams, and the least frequent was the maintenance of the headrest at 30 degrees. No association was found between the prescribed prevention measures and the subscores of the Braden scale. The meaning of the experience of the eight students who participated in the research was investigated by means of the content analysis of the statements obtained in the group discussions and two categories were identified: learning about the theme pressure ulcer and getting to know the reality of the institution and nursing with regard to pressure ulcer. In conclusion, the students related the theory with the practice, identified the nurses\' competences in the assessment of patients with risk of pressure ulcers, improved the knowledge on the pressure ulcer stages and identified the Braden Scale to support the risk assessment for pressure ulcer. The students also identified the lack of care by the nursing team and the importance of the family\'s presence and perceived the need for safe practice with regard to pressure ulcers

Made available in DSpace on 2016-04-29T13:17:56Z (GMT). No. of bitstreams: 1 Cassia Leal da Hora.pdf: 1433192 bytes, checksum: eaa1159b3d744fdef0688a3354bd0fa3 (MD5) Previous issue date: 2015-11-18 / Applied Behavior Analysis (ABA) interventions have been recommended for individuals with ASD since the 1980s as the main treatment for deficits arising from the disorder. There was a growing demand for professionals who can work with ABA interventions. At the same time, there have been several proposals for alternative treatments without sufficient evidences to their recommendation. Was established a controversial atmosphere about the effectiveness of ABA interventions and questions about the quality of the professionals who delivered such services. This thesis aims, in Study 1, critically evaluate and identify the criteria used by systematic reviews and meta-analysis research for generating conclusions about the effectiveness of ABA intervention for individuals with ASD. In Study 2, the goal was identifying behaviour analytic recommendations about minimum skills and competencies to delivery of high quality services by Supervisor/Planner and Applicator of ABA interventions. Results showed, from different criteria used by the meta-analysis research, most of the conclusions were moderate/medium or strong/large effect sizes of ABA interventions. The results of study1 showed that Baer, Wolf and Risley (1968) s criteria aren t considered by the meta-analysis for ABA interventions evidences evaluating, they are still proving effective and being considered as an evidence-based practice for the individuals with TEA treatment. Study 2 showed that there is little similarity between documents of recommendations about both professional s competencies who work at ABA intervention for ASD. This results indicating that Supervisor/Planner and Applicator s repertoire should be different. Based documents analysis and synthesis, this study presented a new proposal on possible skills, competencies, functions and expertise that the Supervisor/Planner and the Applicator of such intervention should have. In the face of several challenges to increase knowledge and effectiveness about ABA interventions and their professional s efficiency, future research should be realized to increase access and recognition of this kind of information to scientific community from other biomedical sciences and consumers of ABA s delivery services for individuals with ASD / Intervenções com base em Análise do Comportamento Aplicada (ABA) têm sido indicadas para indivíduos com TEA desde a década de 1980 como o principal tratamento para os déficits decorrentes do transtorno. Houve o crescimento da demanda por profissionais que trabalhassem com intervenções ABA. Em paralelo, surgiram muitas propostas de tratamentos alternativos sem evidências suficientemente comprovadas para sua recomendação. Estabeleceu-se um clima de controvérsia sobre a eficácia das intervenções baseadas em ABA e questionamentos sobre a qualidade dos profissionais que prestavam esse tipo de serviço. O presente trabalho tem como objetivos, no Estudo 1, identificar e avaliar criticamente os critérios utilizados por revisões sistemáticas com metanálise para gerar conclusões a cerca da eficácia de intervenções ABA para indivíduos com TEA. No Estudo 2, o objetivo foi identificar as recomendações analítico-comportamentais sobre as habilidades e competências mínimas para a prestação de serviços de qualidade pelo Supervisor/Planejador e pelo Aplicador de intervenções ABA. Os resultados mostraram que, a partir de diferentes critérios adotados pelas metanálises, a maioria das conclusões foi de que a magnitude dos efeito das intervenções baseadas em ABA eram moderada/média ou forte/grande. Os resultados do Estudo1 indicam que, apesar dos critérios de Baer, Wolf e Risley (1968) não serem considerados pelas metanálises para a avaliação das evidências, intervenções ABA continuam se mostrando eficazes e sendo consideradas como uma prática baseada em evidências para o tratamento de indivíduos com TEA. O Estudo 2 mostrou que existe pouca similaridade entre os documentos de recomendações sobre as competências dos dois tipos de profissionais que trabalham em intervenções ABA para TEA indicando que o repertório de ambos deve ser diferente. A partir da análise e síntese dos documentos, o presente estudo apresentou uma nova proposta sobre possíveis habilidades, competências, funções e conhecimentos que o Supervisor/Planejador e o Aplicador desse tipo de intervenção devem possuir. Diante de diversos desafios para ampliar os conhecimentos sobre a eficácia da intervenção e eficiência dos seus profissionais, futuros estudos devem ser realizados para ampliar o acesso e o reconhecimento desse tipo de informação para a comunidade científica de outras ciências biomédicas e para os consumidores da prestação de serviço em ABA para indivíduos com TEA

A prevenção de úlcera por pressão representa grande desafio no ambiente hospitalar, especialmente na Unidade de Terapia Intensiva, mediante a diversidade de fatores de risco apresentados pelos pacientes. A pesquisa teve como objetivo avaliar o efeito da construção e utilização de um protocolo embasado em evidências para prevenção de úlcera por pressão em Unidade de Terapia Intensiva, nas ações de enfermagem e na incidência do evento. Foi realizada na Unidade de Terapia Intensiva de hospital universitário, de João Pessoa, Paraíba, após aprovação do Comitê de Ética em Pesquisa. O percurso metodológico foi construído a partir das etapas do processo da adoção de uma inovação conforme Rogers, utilizando-se as abordagens quanti e qualitativa, em três fases: pré-intervenção, intervenção e pós- intervenção. Nas fases pré e pós-intervenção, por meio de dois estudos, investigou- se a realidade caracterizando-se as ações dos profissionais para prevenção durante a higiene corporal e a incidência de úlcera por pressão. A fase de intervenção possibilitou a construção e utilização do protocolo de prevenção de úlcera por pressão com a participação dos profissionais de saúde da Unidade de Terapia Intensiva, utilizando-se como estratégias o grupo focal, a avaliação da concordância pelos profissionais e o desenvolvimento de ações educativas, visando à persuasão para a adoção das recomendações. Os resultados das fases pré e pós-intervenção foram comparados utilizando testes estatísticos para verificar o impacto da utilização do protocolo. No estudo qualitativo, desenvolvido durante a fase de intervenção, a análise e interpretação dos depoimentos dos profissionais foram realizadas pela técnica de análise de conteúdo conforme Bardin. A comparação dos resultados dos estudos das fases pré e pós-intervenção evidenciou que a utilização do protocolo influenciou a prática clínica dos profissionais de enfermagem, observando-se mudanças significativas na adoção de medidas de prevenção como: avaliação do risco para úlcera por pressão utilizando a Escala de Braden durante a internação do paciente (p<0,001), incremento na utilização do hidratante corporal (p<0,001), inspeção da pele nas proeminências ósseas em todas as regiões corporais (p<0,001), aumento da utilização do lençol móvel para elevação do paciente do leito durante a movimentação (p<0,001), utilização de travesseiros para proteger as proeminências ósseas do joelho (p=0,015) e sob as panturrilhas para manter os calcâneos flutuantes (p<0,005). Observou-se ainda aumento na utilização de coberturas para proteção da pele nas áreas de proeminências ósseas (p=0,005). Quanto à incidência de úlcera por pressão observou-se diferença estatisticamente significante (p=0,0069) entre as duas fases da pesquisa com redução do índice de 35,7% (pré-intervenção) para 8,3% (pós-intervenção). Identificou-se que as variáveis associadas à ocorrência de úlcera por pressão foram: uso de antibióticos, vasoconstrictores, ventilação mecânica; tempo prolongado de internação; menores escores na Escala de Braden e de Glasgow. Os resultados denotam a importância da utilização do protocolo de prevenção de úlcera por pressão no serviço e ressaltam a necessidade do envolvimento da instituição na manutenção de um programa de educação permanente que envolva a equipe multiprofissional, no provimento de recursos humanos e materiais para garantir a continuidade na adoção das boas práticas para prevenção de úlcera por pressão e no monitoramento contínuo do problema / Preventing pressure ulcers poses a great challenge in the hospital context, especially in Intensive Care Unit, because of the range of risk factors the patients present. The objective in this research was to assess the effect of the construction and use of an evidence-based protocol to prevent pressure ulcers in Intensive Care Unit on nursing actions and on the incidence rates of the event. The study was undertaken at the Intensive Care Unit of a university hospital in João Pessoa/Paraíba, after receiving ethical clearance. The method was constructed based on Rogers\' steps in the innovation adoption process, using the quantitative and qualitative approaches, in three phases: pre-intervention, intervention and post-intervention. In the pre- and post-intervention phases, the reality was investigated through two studies, characterizing the professionals\' preventive actions during bodily hygiene and the incidence of pressure ulcers. The intervention phase permitted the construction and use of the pressure ulcers prevention protocol, involving health professionals from the Intensive Care Unit, through the adoption of the following strategies: focus group, assessment of the professionals\' agreement and development of educative actions to persuade the professionals to adopt the recommendations. The results of the pre and post-intervention phases were compared, using statistical tests to verify the impact of using the protocol. In the qualitative study, developed during the intervention phase, Bardin\'s content analysis technique was applied for the analysis and interpretation of the professionals\' statements. The comparison between the study results of the pre and post-intervention phases evidenced that the use of the protocol significantly influenced the nursing professionals\' clinical practice, revealing significant changes in the adoption of prevention measures, including: pressure ulcers risk assessment using the Braden scale during the patient\'s hospitalization (p<0.001), increased use of body hydrating lotion (p<0.001), skin inspection on bony prominences in all body regionso (p<0.001), increased use of blankets to raise the patient from the bed while moving (p<0.001); use of pillows to protect bony prominences on the knee (p=0.015) and under the calves to maintain the heels suspended (p<0.005). In addition, an increase was observed in the use of covers to protect areas of bony prominences (p=0.005). Concerning the incidence of pressure ulcers, a statistically significant difference (p=0.0069) was observed between the two research phases, with a reduction from 35.7 % (pre-intervention) to 8.3% (post-intervention). It was identified that the variables associated with the occurrence of pressure ulcers were: use of antibiotics, vasoconstrictors, mechanical ventilation; extended hospitalization time; lower scores on Braden and Glasgow Scale. The results indicate the importance of using the pressure ulcers prevention protocol in the service and highlight the need for the institution to engage in the maintenance of a continuing education program for the multiprofessional team, in the provision of human and material resources to guarantee continuity in the adoption of best practices for pressure ulcers prevention and in the continuous monitoring of the problem

Studiens syfte att få fördjupad kunskap om hur förskollärare upptäcker och praktiskt arbetar med normbrytande beteende hos barn, samt vilken kunskap de upplever att de har om risk- och skyddsfaktorer som en del i detta arbete. För att besvara studiens syfte tillämpades en kvalitativ metod där semistrukturerade djupintervjuer genomfördes med 13 förskollärare. Resultaten visade att förskollärare upplever sig ha kunskapen att upptäcka normbrytande beteende bland barn. Däremot upplever de inte att de besitter en kunskap om risk- och skyddsfaktorer, trots att författarna kan urskilja att förskollärarna i sitt arbetssätt arbetar med vad som i forskning menas med risk- och skyddsfaktorer. Vidare framgår det att de har tydliga handlingsplaner för hur de ska agera praktiskt när det upptäcker ett normbrytande beteende hos ett barn. Avslutningsvis upplever förskollärarna att det ingår i deras uppgift att upptäcka normbrytande beteende och arbeta med risk- och skyddsfaktorer hos dessa barn för att förhindra en negativ beteendeutveckling. / The aim of the present study is twofold. Firstly, the aim is to gain a deeper understanding of how preschool teachers discover and manage normbreaking behavior among children. Secondly, the aim is to understand how they experience their knowledge about risk- and protective factors for normbreaking behavior. The authors conducted semi-structured interviews with 13 preschool teachers. The result showed that preschool teachers have the knowledge to discover normbreaking behavior among children in preschool. The preschool teachers do not have knowledge regarding risk- and protective factors for normbreaking behavior, but the writers identify them to work according to the risk- and protective factors that are presented in earlier literature. Additionally, preschool teachers are well aware of the course of action to take whenever they discover a child with normbreaking behavior. Lastly, the preschool teachers believe it to be a part of their task to discover children with normbreaking behavior, and to work practically with risk- and protective factors to prevent these children from having a negative behavioral development.

We conducted a comprehensive review of the literature to establish the evidence base for using visual activity schedules (VAS) with individuals with intellectual disability. Literature published after 2005 was evaluated for quality using the criteria developed by Horner et al.; a total of 14 studies were included as acceptable. Findings suggest that VAS is an evidence-based practice for teaching a variety of daily living, navigation, vocational, recreation, and academic skills to adolescents and adults with intellectual disability. Results also show increases in independence and on-task behaviors. We conclude the article by discussing limitations and recommendations for future research.

No description available.

Background: Mixed-methods research (MMR) offers much to healthcare professions on clinical and research levels. Speech-language therapists and audiologists work in both educational and health settings where they deal with real-world problems. Through the nature of their work, they are confronted with multifaceted questions arising from their efforts to provide evidence-based services to individuals of all ages with communication disorders. MMR methods research is eminently suited to addressing such questions. Objective: The aim of this tutorial is to increase awareness of the value of MMR, especially for readers less familiar with this research approach. Method: A literature review was conducted to provide an overview of the key issues in MMR. The tutorial discusses the various issues to be considered in the critical appraisal of MMR, followed by an explanation of the process of conducting MMR. A critical review describes the strengths and challenges in MMR. Results: MMR is less commonly used or published in the fields of speech-language therapy and audiology. Conclusion: Researchers working in teams can draw on the strengths of different disciples and their research approaches. Such collaborative enterprises will contribute to capacity building. Researchers, SLTs and audiologists are encouraged to make use of MMR to address the complex research issues in the multicultural, multifaceted South African context. MMR makes an important contribution to the understanding of individuals with communication disorders, and in turn, researchers in the two disciplinary fields of speech-language therapy and audiology can contribute to the development of this research approach. MMR is well suited to the complexity of South African contexts and its populations, as it can provide multiple perspectives of a topic.

Falls with or without injuries among the elderly have become a public health concern, with falls among adults age 65 years and older increasing every year. Nurses play a role in ensuring patient safety by following fall prevention guidelines. The purpose of this evidence-based study was to implement the RE-AIM evaluation tool to determine the impact of the Safe Five program on staff compliance with the program; patients' awareness of the need for falls prevention; and falls among older adults, ages 65 years and older, admitted to an acute care nursing unit. The literature supports implementing a falls prevention program with multifactorial and interdisciplinary components, and an evaluation plan to help decrease falls in acute care settings. The Safe Five falls prevention program was implemented on the acute care nursing unit in an effort to decrease the inpatient falls rate on the unit. The inpatient falls data were collected retrospectively, 2 years pre implementation of the Safe Five program, and 8 to 10 months post implementation. Data were collected from the Safe Five checklists, recorded inpatient fall rates, and high fall risk chart audits provided by staff and nurse manager; they were then analyzed using the RE-AIM evaluation tool. The long-term effects of the Safe Five program include an 18% increase in patients' awareness of the importance of preventing falls, an 18% increase in staff compliance with the program, and a 14% decrease in inpatient fall rate on the unit. It is projected that the decrease in inpatient falls will result in decreased healthcare costs and improved patient satisfaction with the healthcare system, communication among the interdisciplinary team, and health outcomes for the patients.

Syftet med denna studie var att undersöka skolkuratorers erfarenheter av hur en problematisk skolgång identifieras, hur de bemöter denna problematik samt hur de kvalitetssäkrar arbetet. För att besvara studiens syfte genomfördes en kvalitativ intervjustudie med fem skolkuratorer på grundskolor i Mellansverige. Empirin analyserades utifrån teori kring problematisk skolgång, systematiskt kvalitetsarbete samt evidensbaserad praktik. Resultatet visade att problematisk skolgång innebär att måluppfyllelse inte nås eller att skolgången blir avbruten, viktiga faktorer i sammanhanget var frånvaro samt ökad psykisk ohälsa. Skolkuratorerna ansåg att en god relation mellan eleven och skolan samt samverkan var viktiga framgångsfaktorer för att tidigt upptäcka och kunna åtgärda problematiken. Systematiskt kvalitetsarbete framkom som en viktig faktor och i synnerhet genom kontroll av giltig och ogiltig frånvaro samt genom kartläggningar på olika nivåer. Att arbeta med evidens ansågs också vara viktigt men samtidigt fanns viss skepsis mot nya metoder och ofta användes bara valda delar av evidensbaserade metoder för att kunna individanpassa och att se helheten. / The purpose of this study is to examine how school counsellors, in their own practical experience, identify problematic schooling; how they approach these problems; and how they assure the quality of their work. To answer these questions, the authors have conducted a qualitative study, interviewing five school counsellors working in different schools in Central Sweden. The empirical study has been analyzed using the theoretical concepts of problematic schooling, systematic quality assurance, and evidence-based practice. The outcome of the study suggests that problematic schooling entails the failure to reach educational goals, or even the complete disruption of schooling. Important factors include pupil absence and impaired mental health. A successful pupil–school relationship, as well as a co-operative environment, are identified by the interview subjects as important factors for the successful detection and intervention of problematic schooling. Furthermore, systematic quality assurance is identified as a key factor, particularly in the shape of survey and verification by the school regarding the validity of pupil absence. Finally, the interview subjects generally consider an evidence-based approach to be important, but also tend to display some scepticism towards the implementation of new methods. The study thus shows that evidence-based methods are often only partially applied, in an attempt by school counsellors to make case-dependent adjustments to fit the wider picture.

More than 13,000 deaths and $340 million in health care costs are the result of catheter-associated urinary tract infections (CAUTIs) annually in the United States. CAUTIs can also result in acute patient discomfort and potentially preventable exposure to antibiotics. The hospital for which this quality improvement project was developed was above the National Healthcare Safety Network CAUTI bench mark. Framed within the Iowa model of evidence-based practice, a multidisciplinary team of 8 hospital stakeholders guided the project (n=8). The purpose of the project was to develop an indwelling urinary catheter maintenance checklist using evidence-based practice guidelines related to preexisting inappropriate risk factors for catheterization and appropriate indications for catheterization, as well as evidence-based maintenance practices for care of the indwelling catheter. Each piece of evidence to be included in the checklist was evaluated by 4 content experts using a 10 item 5 point Likert scale ranging from 'strongly disagree' to 'strongly agree'. Descriptive analysis showed an average of 4.8/5 for all items with 'agree' being voiced in two of the items rather than 'strongly agree'. The checklist was completed and presented to hospital senior leadership who recommended that the checklist be incorporated into the hospital CAUTI prevention plan. All project team members (n=8) completed an 8 item 5 point Likert scale summative evaluation of the purpose, goal, objectives, and my leadership which averaged as 5 or 'strongly agree' supporting the development of the project. Implications for social change include improved patient outcomes, mindful stewardship of healthcare dollars, and increased patient and family satisfaction.