Orientador: Marla Andreia Garcia de Avila / Resumo: Introdução: A obrigatoriedade da implantação da sistematização da assistência de enfermagem em unidades atendimento de saúde que prestam assistência de enfermagem está estabelecida pela Resolução nº358 do COFEN. Sistematização da assistência de enfermagem é a representação metodológica do processo de trabalho de enfermagem, organizando o raciocínio clínico para conhecer e diagnosticar as necessidades, elencar prioridades e proporcionar intervenções adequadas no momento adequado. Objetivo: Elaborar um instrumento de Sistematização da Assistência de Enfermagem, pautado na teoria das Necessidades Humanas Básicas e utilizando Conjunto de Dados Mínimos de Enfermagem, específico para pacientes assistidos em sala de observação do pronto socorro, com viabilidade de aplicação. Método: estudo descritivo, metodológico em 4 etapas:1.Análise do perfil dos usuários atendidos na sala de observação do PSR; 2.Elaboração de um instrumento preliminar; 3.Construção participativa do instrumento de SAE; 4.Formatação final do instrumento de SAE.O levantamento de dados se deu por consultas aos prontuários eletrônicos dos pacientes admitidos na sala de observação nos meses de março, abril, agosto e setembro de 2018, o período foi escolhido considerando mudanças climáticas que poderiam inferir em sazonalidade. Resultados: Com a análise dos atendimentos realizados (3196 pacientes) foi possível tipificar as demandas de assistência, dividindo as especialidades clínicas (51,0%) destacando clínica médica g... (Resumo completo, clicar acesso eletrônico abaixo) / Abstract: The mandatory implementation of nursing care in health care units that attend nursing care is planned for COFEN. Nursing care counseling is a methodological examination of the nursing process, organization of clinical reasoning to know and diagnose how needs, list and maintain the function of light at the appropriate time. Objective: To elaborate a Nursing Care Systematization instrument, based on the theory of Basic Human Needs and using the Minimum Nursing Data Set, specific for patients assisted in the emergency room observation room, with feasibility of application. Method: descriptive, methodological study in 4 steps: 1. Analysis of the profile of the users served in the PSR observation room; 2. Elaboration of a preliminary instrument; 3. Participatory construction of the SAE instrument; 4. Final format of SAE instrument. Data collection was performed by means of records in patients' charts in the observation room during the months of April, April and September of 2018; inferred in seasonality. Results: With the analysis of the requests made (3196 patients) it was possible to classify as the assistance needs, dividing the medical specialties (51.0%) with the general medical attention and psychiatry; surgical (46.5%) general surgery and orthopedics; it was identified that the smallest part resulted in hospitalization (22.1%); Among the age groups, the greatest recurrence was between 19-59 years of age (55.6%), and the male sex (51.3%) was preceded by an instrument for the... (Complete abstract click electronic access below) / Mestre

<p>Background One of the main demands on Swedish and global health care in general is to meet the patient’s need for safety. By general health care law this also comprises district nurses’ field of responsibility. Although there are numerous studies describing the concept of safety and its different shapes, no research could be found exploring how safety is, or supposed to be, mediated by district nurses’ in a Swedish context. Research about this is therefore needed. Aim The aim of this qualitative study was to explore how district nurses’ mediate safety to their patients. Method Qualitative data were collected from seven district nurses’ by means of semi structured interviews. Thereafter, a concept analysis was carried out. Results Responses revealed that district nurses’ consider themselves mediate safety through a variety of ways. Five major categories emerged: (1) complaisance’s; (2) competence; (3) patient participation; (4) same caregiver; (5) personal characteristics. Conclusion District nurses’ mediate safety through a combination of general attitudes and concrete acts. Preconditions are bound to each district nurse’s individual ability to give a good complaisance, his/her competence and ability to involve patients in treatment and care. Other, less pronounced, are bound to the district nurse’s ability to create continuity in contact with patients’ and his/her personal characteristics.</p>

Background One of the main demands on Swedish and global health care in general is to meet the patient’s need for safety. By general health care law this also comprises district nurses’ field of responsibility. Although there are numerous studies describing the concept of safety and its different shapes, no research could be found exploring how safety is, or supposed to be, mediated by district nurses’ in a Swedish context. Research about this is therefore needed. Aim The aim of this qualitative study was to explore how district nurses’ mediate safety to their patients. Method Qualitative data were collected from seven district nurses’ by means of semi structured interviews. Thereafter, a concept analysis was carried out. Results Responses revealed that district nurses’ consider themselves mediate safety through a variety of ways. Five major categories emerged: (1) complaisance’s; (2) competence; (3) patient participation; (4) same caregiver; (5) personal characteristics. Conclusion District nurses’ mediate safety through a combination of general attitudes and concrete acts. Preconditions are bound to each district nurse’s individual ability to give a good complaisance, his/her competence and ability to involve patients in treatment and care. Other, less pronounced, are bound to the district nurse’s ability to create continuity in contact with patients’ and his/her personal characteristics.

The primary objective of this research was to evaluate the effectiveness of a checklist, compared to a smart pump and bar-code verification system, at detecting different categories of errors in intravenous medication administration. To address this objective, a medication administration safety checklist was first developed in an iterative user-centered design process. The resulting checklist design was then used in a high-fidelity simulation experiment comparing the effectiveness of interventions towards two classifications of error: execution and planning errors. Results showed the checklist provided no additional benefit for error detection over the control condition of current nursing practice. Relative to the checklist group, the smart pump and bar-coding intervention demonstrated increased effectiveness at detecting planning errors. Results of this work will this work will help guide the selection, implementation and design of appropriate interventions for error mitigation in medication administration.

The primary objective of this research was to evaluate the effectiveness of a checklist, compared to a smart pump and bar-code verification system, at detecting different categories of errors in intravenous medication administration. To address this objective, a medication administration safety checklist was first developed in an iterative user-centered design process. The resulting checklist design was then used in a high-fidelity simulation experiment comparing the effectiveness of interventions towards two classifications of error: execution and planning errors. Results showed the checklist provided no additional benefit for error detection over the control condition of current nursing practice. Relative to the checklist group, the smart pump and bar-coding intervention demonstrated increased effectiveness at detecting planning errors. Results of this work will this work will help guide the selection, implementation and design of appropriate interventions for error mitigation in medication administration.

Syftet med studien var att undersöka hur sköterskor som arbetar på en operationsavdelning där WHO´s Surgical Safety Checklist används, upplever kommunikation, samarbete och patientsäkerhet. Kort metodbeskrivning: Kvantitativ metod. Design: Deskriptiv, retrospektiv, icke-experimentell tvärsnittsstudie. Datainsamlingen genomfördes på en operationsavdelning som använt WHO´s Surgical Safety Checklist drygt ett år. Deltagarna fick anonymt besvara ett frågeformulär med strukturerade frågor, en översatt version av the Safety Attitudes Questionnaire (SAQ) anpassad till operationspersonal (OR). I studien undersöktes 3 av frågeformulärets 6 teman: säkerhetskultur, samarbetsklimat och stressidentifiering. Vidare undersöktes hur sköterskorna tyckte att kommunikationen på operationssalen fungerade; samt i vilken grad checklistan hade förbättrat kommunikationen, samarbetet och patientsäkerheten på operationssalen. Varje fråga besvarades genom en femgradig Likertskala. Huvudresultat: Fynden visar att man kan anta att sköterskorna upplevde att kvaliteten på kommunikationen och samarbetet på operationssalen var hög. Vidare ser det ut som om deltagarna ansåg att patientsäkerheten fungerade adekvat och att checklistan var viktig för patientsäkerheten. Resultaten visar också att sköterskorna tyckte att checklistan i hög grad har förbättrat kommunikationen, samarbetet och patientsäkerheten på operationssalen. Slutsats: Sköterskornas upplevelse av kommunikation, samarbete och patientsäkerhet på operationssalen antas huvudsakligen vara positiv 1 år efter att WHO´s Surgical Safety Checklist infördes. / The aim of the study was to examine the nurses´ experiences of communication, teamwork and patient safety in an operation ward where WHO´s Surgical Safety Checklist is used.  Quantitative method. Design: descriptive, retrospective, non-experimental cross-sectional study. The data collection was implemented in an operation theatre where WHO´s Surgical Safety Checklist had been applied for the last year. The participants responded to a structured questionnaire, a translated version of the Safety Attitudes Questionnaire (SAQ) adjusted for operating rooms (OR). In the study 3 of 6 themes of the questionnaire was examined: safety culture, teamwork climate and stress identity. The study examined the nurses´ experiences of communication in the operating room; and to what extent the checklist has improved the communication, teamwork and patient safety in the operating room. Each item was answered using a 5-point Likert scale. The findings reveal nurses´ experience of high quality of communication and collaboration in the operating room. Further it seems that the participants thought the patient safety was sufficient, and the checklist briefing was important for the patient safety. The results also show that nurses thought the checklist briefing has improved the communication, collaboration and patient safety in the operating room. The nurses´ experiences of communication, teamwork and patient safety in the operating room were assumed as mostly positive 1 year after the introduction of the WHO´s Surgical Safety Checklist.

A decade of heightened awareness concerning safety issues in healthcare since the Institute of Medicine’s awakening call has resulted in a string of counteroffensive measures. The pace of improvement has been slow and not altogether clear. Rates of patient harm are in general now measured by voluntary reporting and indicator measurements. The use of triggers or clues in random nurse-based reviews to enable identification of patient harm is a more effective method for measuring the overall rate of harm in a health care organisation. Measured actual overall rates of patient harm, their variations and patterns during delivery in the south-east health-care region of Sweden are not previously known. Measurement is important to patient safety improvement, as a foundation for accountability, effort selection and keeping track of results. The patient’s voice must also be much clearer in quality and safety improvement efforts in healthcare. The Institute of Healthcare Improvements Global Trigger Tool for measuring adverse events was used to review 1137 deliveries during 2011 in the seven departments (10% of all cases). Mother and new-born were both evaluated. Thirty eight patient harm events per 1000 patient days were identified, correlating to 13% of admissions. Presupposed rates among staff were double this value. Current patient safety indicators are half this value. One third of patient harm events at birth affected the new-born. Twenty different categories of harm were found. This study shows significantly higher rates of patient harm than previously reported. The nurse reviewers defined the method as valuable and a useful method for measuring harm at delivery. Limitations at this stage are no observed changes in health care delivery or clinical outcomes and that value assessment is based entirely on the judgement of the data-abstractors.

No description available.

De flesta vårdskador beror helt eller delvis på brister i kommunikation. Ett sätt att förbättra patientsäkerheten är att använda kommunikationsverktyg, där det vanligast förekommande kallas SBAR. En litteraturstudie gjordes där femton artiklar granskades med syftet att belysa hur SBAR påverkar patientsäkerheten. SBAR utövade sin påverkan på flera olika sätt. Kommunikationen mellan de olika professionerna gavs en enhetlig struktur där mindre information saknades. Sjuksköterskor och läkare upplevde en ökad trygghet i kommunikationssituationen. Teamsamarbetet påverkades positivt och vårdkulturen utvecklades mot en ökad problemfokusering och minskad personfokusering vid avvikelser. Sjuksköterskor upplevde en ökad säkerhetsmedvetenhet och fann att SBAR gav positiva bieffekter som utvecklade yrkesrollen. SBAR bidrog till att luckra upp hierarkierna i vården då alla i teamet tog ett jämbördigt ansvar för kommunikation. Mer forskning behövs från de europeiska länderna och inte minst Sverige. Det vore intressant att se vilken påverkan SBAR har på patientsäkerheten i ett land där teamarbete är mer vanligt förekommande än i många andra länder. Ett annat intressant forskningsområde är elektronisk användning av SBAR-verktyget. / Most health care damages are partially or totally caused by communication failures. One way to improve patient safety is to use a communication tool, of which the most common is called SBAR. A literature review was done where fifteen articles were reviewed with the aim to illuminate how SBAR influences patient safety. SBAR exerted its influence in several different ways. The communication between the different professions was given a standardized structure and less information was omitted. Both nurses and physicians experienced increased confidence in the communication situation. Teamwork was positively influenced and the care culture developed towards more problem focus and less of person focus at adverse events. Nurses experienced growing security awareness and found SBAR having positive side effects which developed the professional role. SBAR contributed to flattening of care hierarchies, by all team members assuming equal responsibility for communication. More research is needed from the European countries and not least Sweden. It would be interesting to learn what kind of influence SBAR has on patient safety in a country where teamwork is more common than in many other countries. Another interesting research topic is electronic uses of the SBAR tool.

Avvikelserapportering är grundläggande för att identifiera risker som kan leda till vårdskador. Trots detta väljer många sjuksköterskor att inte anmäla avvikelser. Syftet med studien var att beskriva faktorer som påverkar sjuksköterskans beslut att avstå från att anmäla avvikelser. Studien genomfördes som en litteraturstudie där 13 vetenskapliga artiklar utgjorde underlaget för resultatet. I resultatet angavs tidsbrist som ett hinder för att anmäla avvikelser. Även bristande kunskap och erfarenhet kring avvikelserapportering och brist på uppföljning av inlämnade avvikelser utgjorde ett hinder. Många sjuksköterskor upplevde rädsla för negativa konsekvenser då de begått ett misstag. De kände även dåligt samvete inför att anmäla en kollega som gjort fel. Arbetskultur och organisatoriska faktorer inverkade även på beslutet att anmäla avvikelser. Att diskutera avvikelsrapportering redan under sjuksköterskeutbildningen hade kunnat minska känslorna av skuld och inkompetens genom att sjuksköterskestudenterna tidigt förstår syftet med att anmäla avvikelser. Fortsatt forskning kring svenska förhållanden är nödvändig för att belysa sjuksköterskornas hantering av avvikelser för att kunna utveckla strategier för att öka patientsäkerheten. / Incident reporting is essential to identify risks that can lead to health damage. Despite this many nurses fail to report incidents. The aim of this study was to describe factors influencing nurse’s decision not to report incidents. The study was conducted as literature review in which 13 scientific articles were the basis for the result. The result indicated that time constraint were an impediment to incident reporting. Lack of knowledge and experience about incident reporting and lack of feedback are also reported as barriers to reporting incidents. Many nurses experienced fear of reprisals admitting to mistakes. They also felt guilty about writing an incident report on mistakes committed by a colleague. Work culture and organizational factors also affect the decision to make an incident report. Discussing incident reporting during nursing school might reduce feelings of guilt and incompetence by nursing students understanding the purpose of making incident reports. Research on Swedish conditions are necessary to highlight nurses attitudes on incident reporting as a mean to enhance patient safety.