Thesis (MHSc--Health Science) -- Auckland University of Technology, 2004. / Also held in print (114 leaves, 30 cm.) in North Shore Theses Collection (T 610.730690993 MCC).

FundaÃÃo Cearense de Apoio ao Desenvolvimento Cientifico e TecnolÃgico / Trata-se de uma revisÃo integrativa da literatura, que teve como objetivo buscar e avaliar as evidÃncias disponÃveis na literatura sobre o cuidado no perÃodo perioperatÃrio prestado à paciente submetida à mastectomia. Para a seleÃÃo dos estudos, foram consultadas as bases de dados PUBMED, LILACS e CINAHL. A amostra constituiu-se de sete estudos. NÃo foi identificado nenhum estudo nas bases de dados LILACS e CINAHL, sete estudos foram provenientes do PUBMED. Houve uma prevalÃncia de seis estudos (86%) com nÃvel de evidÃncia 2 e um estudo (14%) com nÃvel de evidÃncia 3. ApÃs a anÃlise dos aspectos abordados nestes artigos, reuniu-se em uma categoria temÃtica: o manejo da dor, contendo os sete estudos. O primeiro estudo concluiu que uma dose de 600 mg de gabapentina administrada uma hora antes da cirurgia produz analgesia pÃs-operatÃria significativa apÃs a mastectomia total. O segundo estudo demonstrou que o uso do EMLA em pacientes mastectomizadas reduziu a solicitaÃÃo de analgÃsicos no pÃs-operatÃrio e uma reduÃÃo da incidÃncia e a intensidade da dor crÃnica. No terceiro estudo nÃo foram encontradas diferenÃas no manejo da dor pÃs-operatÃria entre 3,75 mg / ml de ropivacaÃna e infiltraÃÃo da ferida com soluÃÃo salina antes da mastectomia. O quarto estudo concluiu que a administraÃÃo preventiva com cetoprofeno por via endovenosa (100 mg) produz maior alÃvio da dor pÃs-operatÃria em pacientes submetidas à mastectomia. O quinto estudo evidenciou que a administraÃÃo de 8 mg de dexametasona diminui efetivamente o uso de analgÃsicos em mulheres submetidas à anestesia geral para a mastectomia. O sexto estudo nÃo demonstrou associaÃÃo entre o Ãndice de Ãxido nÃtrico e o desenvolvimento de dor crÃnica pÃs-operatÃria. O sÃtimo estudo concluiu que a administraÃÃo perioperatÃria de venlafaxina reduz significativamente a incidÃncia de sÃndrome da dor pÃs-mastectomia. O estudo apresentou como limitaÃÃes o fato de que ao longo dos 10 anos pesquisados, o Ãnico cuidado perioperatÃrio da cirurgia de mastectomia encontrado na literatura foi relacionado ao manejo farmacolÃgico da dor, ademais os estudos analisados nÃo mostraram uma associaÃÃo entre si, visto que em cada um foi avaliado uma droga diferente, dificultando o consenso e a recomendaÃÃo relacionada ao uso de fÃrmacos para o controle/minimizaÃÃo da dor. A evidÃncia nÃo apresentou um consenso para o cuidado perioperatÃrio de mastectomia, pois encontrou-se uma diversidade de uso de fÃrmacos para o controle da dor e em grande parte dos estudos existiu divergÃncias e divisÃo de opiniÃes. Contudo, observou-se a preocupaÃÃo por parte dos profissionais em minimizar/prevenir a dor prÃ, intra e pÃs-operatÃria. Desse modo, a enfermagem deve estar atenta, tanto à atualizaÃÃo dos tratamentos farmacolÃgicos no manejo da dor quanto ao desenvolvimento de futuras pesquisas relacionadas ao cuidado de enfermagem no perÃodo perioperatÃrio de mastectomia. / It is an integrative literature review, which aimed to search and evaluate the available evidence in the literature on perioperative care provided to patients undergoing mastectomy. To select the studies were consulted the databases PUBMED, LILACS and CINAHL and the sample consisted of seven studies. No study has been identified in the databases LILACS and CINAHL, and all seven studies were from the PUBMED. There was a prevalence of 6 studies (86%) with level of evidence 2 and 1 study (14%) with level of evidence 3. After analyzing the issues addressed in these articles, gathered in atopical category: pain management, containing the seven studies. The first study found that a dose of 600 mg of gabapentin administered 1 h before surgery produces significant postoperative analgesia after total mastectomy. The second study showed that use of EMLA in mastectomy patientsreduced the request of analgesics postoperatively and a reductionin the incidence and intensity of chronic pain. In the study 03 found no differences in the management of postoperative pain between 3.75 mg / ml and ropivacaine wound infiltration with saline prior to mastectomy. The fourth study found that preventive administration of ketoprofen intravenously (100 mg) produces greater relief of postoperative pain in patients undergoing mastectomy. The fifth study showed that administration of dexamethasone 8 mgeffectively decreases the use of analgesics in women undergoinggeneral anesthesia for mastectomy. The sixth study showed no association between the index of nitric oxide and the development of chronic postoperative pain. The seventh study found that perioperative administration of venlafaxine significantly reduces the incidence of pain syndromeafter mastectomy. The study had limitations the fact that over the 10 years studied, the only perioperative care of the mastectomy surgery in the literature was related to the pharmacological management of pain and the studies analyzed did not show an association between them, since in each was assessed a different drug, hindering consensus and recommendation regarding the use of drugs to control / minimize the pain. The evidence did not show a consensus for the perioperative care of mastectomy, because we found a diversity of use of drugs for pain control and in most studies there were differences and division of opinion. However, we noted the concern on the part of professionals to minimize / prevent pain before, during and after surgery, and nursing must be attentive to both the update of pharmacological treatments in pain management, for the development of future research related to the care of perioperative nursing.

No description available.

Introdução: A hipotermia inadvertida perioperatória é um evento frequente e atinge cerca de 70% dos pacientes cirúrgicos, levando a complicações importantes, como alterações cardiovasculares, infecção do sitio cirúrgico, desconforto ao paciente, aumento do tempo de hospitalização, entre outros. Por oferecer inúmeros riscos ao paciente cirúrgico, a ocorrência da hipotermia não intencional perioperatória tem ganhado espaço na literatura atual. A manutenção da temperatura perioperatória vem sendo sugerida pela literatura com a implementação de métodos passivos e ativos de aquecimento como o aumento da temperatura da sala cirúrgica, uso de cobertor de algodão, uso de cobertor térmico, uso de dispositivos de ar forçado, infusão de fluidos aquecidos, entre outros. No entanto, não há no Brasil nenhum estudo publicado onde se investigue a atuação das equipes que atuam no bloco cirúrgico realizam a prevenção da hipotermia perioperatória nos hospitais. Objetivos: Verificar como se dá o monitoramento da temperatura e a prevenção de hipotermia inadvertida perioperatória em pacientes cirúrgicos internados em hospitais brasileiros. Material e método: Estudo transversal, realizado na cidade de São Paulo através de questionário preenchido pelos enfermeiros participantes do 12° Congresso Brasileiro de Enfermagem em Centro Cirúrgico, Recuperação Anestésica e Centro de Material e Esterilização. Os dados foram analisados descritivamente e demonstrados em foram de tabelas. Resultados: O monitoramento da temperatura no período perioperatório ainda não é realizado sistematicamente por todos os profissionais de centro cirúrgico, porem a realização dessa pratica foi relatada por 92,4% no período pré-operatório, 83,8% no período intraoperatório e 94,9% no período pós-operatório. A prevenção da hipotermia inadvertida no perioperatório é uma pratica exercida pela grande maioria dos participantes (96%), com predomínio nos métodos passivos de manutenção da normotermia nos períodos pré-operatório (51%) e associação de métodos passivos e ativos nos períodos pós (64,6%) e intraoperatório (45,5%) de manutenção da normotermia ao paciente cirúrgico. Os principais profissionais envolvidos para a monitorização da temperatura e a prevenção da hipotermia perioperatória inadvertida são a equipe de enfermagem e os anestesiologistas. Apesar de um número grande de profissionais não informarem a taxa de ocorrência de hipotermia inadvertida perioperatória, nota-se que para a maioria dos respondentes a ocorrência desse evento é baixa. Conclusão: a realização de praticas para a manutenção da normotermia operatória é realidade para a equipe de enfermagem. A monitorização da temperatura ainda não é realizada de maneira constante em todo período perioperatório. A prevenção da hipotermia inadvertida no período perioperatório é pratica bastante frequente entre os procedimentos cirúrgicos. / Introduction: Perioperative inadvertent hypothermia is a frequent event and affects about 70% of surgical patients, leading to important complications, such as cardiovascular alterations, surgical site infection, patient discomfort, hospitalization time, and others. Because it offers innumerable risks to the surgical patient, the occurrence of perioperative unintentional hypothermia has gained space in the current literature. Perioperative temperature maintenance has been suggested in the literature with the implementation of passive and active heating methods such as increased operating room temperature, use of cotton blanket, use of thermal blanket, use of forced air devices, infusion of fluids heated, among others. However, there is no published study in Brazil to investigate the performance of the teams that work in the surgical block, and to prevent perioperative hypothermia in hospitals. Objectives: To verify how temperature monitoring and the prevention of perioperative inadvertent hypothermia occur in surgical patients hospitalized in Brazilian hospitals. Material and method: A cross-sectional study was carried out in the city of São Paulo through a questionnaire filled out by nurses participating in the 12th Brazilian Congress of Nursing in Surgical Center, Anesthetic Recovery and Material and Sterilization Center. The data were analyzed descriptively and demonstrated in the tables. Results: Temperature monitoring in the perioperative period has not been systematically performed by all surgical center professionals, but the practice of this practice was reported by 92.4% in the preoperative period, 83.8% in the intraoperative period and 94, 9% in the postoperative period. The prevention of inadvertent perioperative hypothermia is a practice practiced by the vast majority of participants (96%), with predominance in passive methods of maintaining normothermia in the preoperative periods (51%) and association of passive and active methods in the post- 64.6%) and intraoperative (45.5%) maintenance of normothermia in the surgical patient. The main professionals involved in temperature monitoring and the prevention of inadvertent perioperative hypothermia are the nursing team and anesthesiologists. Although a large number of professionals do not report the occurrence rate of inadvertent perioperative hypothermia, it is noted that for most of the respondents the occurrence of this event is low. Conclusion: the practice of practices for the maintenance of operative normothermia is reality for the nursing team. Temperature monitoring is not yet performed consistently throughout the perioperative period. The prevention of inadvertent hypothermia in the perioperative period is a very frequent practice among surgical procedures.

There are a number of factors recognised as significant for nursing staff retention. These include, a lack of organisational care, bullying (commonly referred to as horizontal violence), and high workload acuity. However, there does not appear to be any indication that these factors influence the retention of nurses within the speciality of acute perioperative nursing. A descriptive study using postpositivist methodology and triangulation of methods was designed to answer the question: What are the critical factors that influence staff retention in an acute perioperative environment? Forty-eight (n = 48) perioperative nurses answered a questionnaire in relation to individual needs, provision of nursing care and administration and management. Four (n = 4) nurses subsequently participated in a focus group interview that explored in more depth, the survey data related to the following characteristics: Educational opportunities; Level of workload acuity; Rostering flexibility; Management; Established policies/Quality assurance; Graduate orientation programs and Professional relationships in an acute perioperative setting. Data analysis revealed that > 90% of respondents agreed that these characteristics are important for job satisfaction and influence staff retention in an acute perioperative environment. A sense of belonging appears to be the most important theme that emerged from the qualitative data. Job satisfaction and staff retention are attained when nurses have a sense of belonging in the workplace. To achieve these, nurses need to identify barriers, develop their communication and leadership skills and determine the ideal professional practice model. The themes (Figure 5), "Finding time" and increased "sick leave", in relation to workload acuity are new findings that provide a platform for future research.

There are a number of factors recognised as significant for nursing staff retention. These include, a lack of organisational care, bullying (commonly referred to as horizontal violence), and high workload acuity. However, there does not appear to be any indication that these factors influence the retention of nurses within the speciality of acute perioperative nursing. A descriptive study using postpositivist methodology and triangulation of methods was designed to answer the question: What are the critical factors that influence staff retention in an acute perioperative environment? Forty-eight (n = 48) perioperative nurses answered a questionnaire in relation to individual needs, provision of nursing care and administration and management. Four (n = 4) nurses subsequently participated in a focus group interview that explored in more depth, the survey data related to the following characteristics: Educational opportunities; Level of workload acuity; Rostering flexibility; Management; Established policies/Quality assurance; Graduate orientation programs and Professional relationships in an acute perioperative setting. Data analysis revealed that > 90% of respondents agreed that these characteristics are important for job satisfaction and influence staff retention in an acute perioperative environment. A sense of belonging appears to be the most important theme that emerged from the qualitative data. Job satisfaction and staff retention are attained when nurses have a sense of belonging in the workplace. To achieve these, nurses need to identify barriers, develop their communication and leadership skills and determine the ideal professional practice model. The themes (Figure 5), "Finding time" and increased "sick leave", in relation to workload acuity are new findings that provide a platform for future research.

Thesis (M.Sc. (Nursing)--Mahidol University, 1979.

Introdução: A hipotermia inadvertida perioperatória é um evento frequente e atinge cerca de 70% dos pacientes cirúrgicos, levando a complicações importantes, como alterações cardiovasculares, infecção do sitio cirúrgico, desconforto ao paciente, aumento do tempo de hospitalização, entre outros. Por oferecer inúmeros riscos ao paciente cirúrgico, a ocorrência da hipotermia não intencional perioperatória tem ganhado espaço na literatura atual. A manutenção da temperatura perioperatória vem sendo sugerida pela literatura com a implementação de métodos passivos e ativos de aquecimento como o aumento da temperatura da sala cirúrgica, uso de cobertor de algodão, uso de cobertor térmico, uso de dispositivos de ar forçado, infusão de fluidos aquecidos, entre outros. No entanto, não há no Brasil nenhum estudo publicado onde se investigue a atuação das equipes que atuam no bloco cirúrgico realizam a prevenção da hipotermia perioperatória nos hospitais. Objetivos: Verificar como se dá o monitoramento da temperatura e a prevenção de hipotermia inadvertida perioperatória em pacientes cirúrgicos internados em hospitais brasileiros. Material e método: Estudo transversal, realizado na cidade de São Paulo através de questionário preenchido pelos enfermeiros participantes do 12° Congresso Brasileiro de Enfermagem em Centro Cirúrgico, Recuperação Anestésica e Centro de Material e Esterilização. Os dados foram analisados descritivamente e demonstrados em foram de tabelas. Resultados: O monitoramento da temperatura no período perioperatório ainda não é realizado sistematicamente por todos os profissionais de centro cirúrgico, porem a realização dessa pratica foi relatada por 92,4% no período pré-operatório, 83,8% no período intraoperatório e 94,9% no período pós-operatório. A prevenção da hipotermia inadvertida no perioperatório é uma pratica exercida pela grande maioria dos participantes (96%), com predomínio nos métodos passivos de manutenção da normotermia nos períodos pré-operatório (51%) e associação de métodos passivos e ativos nos períodos pós (64,6%) e intraoperatório (45,5%) de manutenção da normotermia ao paciente cirúrgico. Os principais profissionais envolvidos para a monitorização da temperatura e a prevenção da hipotermia perioperatória inadvertida são a equipe de enfermagem e os anestesiologistas. Apesar de um número grande de profissionais não informarem a taxa de ocorrência de hipotermia inadvertida perioperatória, nota-se que para a maioria dos respondentes a ocorrência desse evento é baixa. Conclusão: a realização de praticas para a manutenção da normotermia operatória é realidade para a equipe de enfermagem. A monitorização da temperatura ainda não é realizada de maneira constante em todo período perioperatório. A prevenção da hipotermia inadvertida no período perioperatório é pratica bastante frequente entre os procedimentos cirúrgicos. / Introduction: Perioperative inadvertent hypothermia is a frequent event and affects about 70% of surgical patients, leading to important complications, such as cardiovascular alterations, surgical site infection, patient discomfort, hospitalization time, and others. Because it offers innumerable risks to the surgical patient, the occurrence of perioperative unintentional hypothermia has gained space in the current literature. Perioperative temperature maintenance has been suggested in the literature with the implementation of passive and active heating methods such as increased operating room temperature, use of cotton blanket, use of thermal blanket, use of forced air devices, infusion of fluids heated, among others. However, there is no published study in Brazil to investigate the performance of the teams that work in the surgical block, and to prevent perioperative hypothermia in hospitals. Objectives: To verify how temperature monitoring and the prevention of perioperative inadvertent hypothermia occur in surgical patients hospitalized in Brazilian hospitals. Material and method: A cross-sectional study was carried out in the city of São Paulo through a questionnaire filled out by nurses participating in the 12th Brazilian Congress of Nursing in Surgical Center, Anesthetic Recovery and Material and Sterilization Center. The data were analyzed descriptively and demonstrated in the tables. Results: Temperature monitoring in the perioperative period has not been systematically performed by all surgical center professionals, but the practice of this practice was reported by 92.4% in the preoperative period, 83.8% in the intraoperative period and 94, 9% in the postoperative period. The prevention of inadvertent perioperative hypothermia is a practice practiced by the vast majority of participants (96%), with predominance in passive methods of maintaining normothermia in the preoperative periods (51%) and association of passive and active methods in the post- 64.6%) and intraoperative (45.5%) maintenance of normothermia in the surgical patient. The main professionals involved in temperature monitoring and the prevention of inadvertent perioperative hypothermia are the nursing team and anesthesiologists. Although a large number of professionals do not report the occurrence rate of inadvertent perioperative hypothermia, it is noted that for most of the respondents the occurrence of this event is low. Conclusion: the practice of practices for the maintenance of operative normothermia is reality for the nursing team. Temperature monitoring is not yet performed consistently throughout the perioperative period. The prevention of inadvertent hypothermia in the perioperative period is a very frequent practice among surgical procedures.

Orientador: Gloria Maria Braga Poterio, Ilka de Fatima S. Ferreira Boin / Dissertação (mestrado) - Universidade Estadual de Campinas, Faculdade de Ciencias Medicas / Made available in DSpace on 2018-08-12T04:48:43Z (GMT). No. of bitstreams: 1 Santos_ReginaMariadaSilvaFeu_M.pdf: 2522967 bytes, checksum: 7189a57f4af010fc0ae8d017adcf0e5d (MD5) Previous issue date: 2008 / Resumo: A elaboração da Sistematização da Assistência de Enfermagem é um dos meios de que o enfermeiro dispõe para aplicar seus conhecimentos técnico-científicos e humanos na assistência ao paciente e caracterizar sua prática profissional, colaborando na definição do seu papel. O objetivo do presente estudo, foi contribuir para diminuir o risco de acidentes alérgicos, durante o período perioperatório, quando do atendimento a pacientes alérgicos ao látex, identificando antecedentes de risco e transmitindo-lhes informações sobre a alergia ao látex. Trata-se de um estudo prospectivo, de caráter descritivo e exploratório realizado com pacientes cirúrgicos eletivos, com história pregressa de reação comprovada a produtos que continham látex. Como resultados, foram identificados produtos que continham látex e produtos isentos de látex, para atendimento perioperatório. Por meio da visita pré-operatória, foram identificados fatores que pudessem expor o paciente a riscos. A proposta da confecção de um protocolo perioperatório para atendimento de pacientes alérgicos ao látex foi particularmente importante e encontra-se em fase de pré-teste. É importante destacar que é função do enfermeiro do centro cirúrgico proporcionar estrutura física, recursos humanos e materiais para que o ato anestésico-cirúrgico seja realizado em condições ideais, visando à assistência integral ao paciente, principalmente utilizando dados previamente coletados por meio da Vpré-OE. Dos resultados obtidos nas condições adotadas neste estudo nos permitiram concluir que os fatores de risco detectados, alimentares ou não, coincidem com os citados na literatura, mas diferem quanto à freqüência. Dentre as alergias às frutas, as mais freqüentes, em ordem decrescente, foram maracujá, banana e nozes; e em menor e igual percentual, tomate, abacate, kiwi, abacaxi e laranja. / Abstract: The elaboration of the Systematization of Nursing Assistance is one of the means that the nurse applies his/her technical-scientific and human knowledge on the assistance to the patient and characterizes his professional practice, collaborating on the definition of his/her role. The main objective is to reduce the risk of allergic accidents during the Peroperative period, of attending allergic patients to latex by identifying previous risk patients and providing knowledge concerning latex allergy. It is a prospective descriptive and exploratory study accomplished with surgical chosen patients with former proven history of reaction to products that contained latex. As results, products that contained latex were identified and products exempt from latex for preoperative assistance, as well as by means of a pre-surgical visit, factors that could put the patient at risk were identified. The proposal of making a Peroperative protocol for assisting patients allergic to latex was particularly important and is in phase of pre-testing. It is worth pointing out that due to the CC nurse providing physical structure, human resources and materials for the anesthetic/surgical procedure to be performed in ideal conditions, in view of the complete assistance to the patient, specially using data previously collected by the (Vpré-OE). The results obtained with the conditions adopted in this study allow us to conclude: The risk factors detected, related to nourishment or not, correspond to the ones mentioned in literature, but differ with regards to its frequency. Amongst the allergies to fruits, the most frequent ones in decreasing order were: passion fruit, banana and nuts and in less or similar percentage, tomato, avocado, kiwi, pineapple and orange. / Mestrado / Pesquisa Experimental / Mestre em Cirurgia

This experimental study was designed to determine the effectiveness of a structured preoperative teaching programme for the adult surgical patient as measured by several indicators. The major questions asked in this study were: What are the effects of a structured preoperative teaching programme upon the adult surgical patient's length of hospital stay, postoperative complications, number of analgesics administered postoperatively, recall of knowledge explained preoperatively, and satisfaction with his preoperative teaching. This study was conducted over a four month period, on one surgical ward of a large general hospital. A total of forty subjects met the criteria of the study, and their informed consent was obtained. The first twenty subjects were assigned to the control group, and received the unstructured, pre-existing preoperative instruction from the staff nurses. The second twenty subjects made up the experimental group and received structured preoperative teaching in small groups conducted by the investigator, with the aid of a slide-taped programme developed specifically for the study. Prior to discharge, each subject was given two questionnaires to complete, and data were collected by means of a patient profile sheet. The two groups of subjects were found to be similar when compared on selected characteristics. The alternative hypotheses of the study were analyzed by means of a t-test, and chi square test at the .05 level of significance. The results revealed no significant effect of the structured preoperative teaching programme upon the adult surgical patient's length of hospital stay, postoperative complications, number of analgesics administered postoperatively, or the degree of satisfaction attained from the preoperative teaching he received. However, statistical significance was found for the patient's ability to recall knowledge explained preoperatively. Implications of this study and recommendations for future research were also suggested. / Applied Science, Faculty of / Nursing, School of / Graduate