O presente estudo objetivou determinar um protocolo para sedação de veados-mateiros (Mazama americana) que permitisse procedimentos comumente utilizados no manejo dessa espécie em cativeiro. Foram utilizados seis animais adultos, pesando 38,4 ± 5 Kg, pertencentes ao Núcleo de Pesquisa e Conservação de Cervídeos (UNESP - Jaboticabal). Os animais foram submetidos a dois tratamentos, com um intervalo mínimo de 30 dias entre eles, a saber: AX-0,5 - associação de 1 mg/kg de azaperone e 0,5 mg/kg de xilazina via intramuscular (IM) e AX-1,0 - associação de 1 mg/kg de azaperone e 1 mg/kg de xilazina (IM). A partir da administração do tratamento (0 minuto) foram avaliados os tempos para latência da sedação, para decúbito esternal, para a manipulação segura e para a manipulação sem segurança. Ainda, foram avaliados a qualidade da contenção química por meio da somatória de pontos obtida com a utilização de uma escala descritiva adaptada, a cada 10 minutos, por até 90 minutos, parâmetros fisiológicos (FC, fR, PAM e To) a cada 10 minutos, durante 60 minutos, perfil ácido-base e eletrolítico (pH, PaCO2, PaO2, HCO3-, EB, SaO2, Na+ e K+) aos 10, 30 e 60 minutos e lactato sérico aos 30 e 60 minutos pós-tratamentos. As diferenças foram consideradas significantes quando P < 0,05. O período de latência da sedação e período para os animais apresentarem decúbito esternal foram maiores em AX-0,5 (7 ± 6,6 e 12 ± 9,7 minutos, respectivamente) em relação a AX-1,0 (5 ± 2,0 e 6 ± 3,1 minutos respectivamente), porém não houve diferenças entre os grupos para os demais tempos avaliados. A qualidade da contenção química diferiu entre os grupos a partir de 60 minutos, observando-se possibilidade de manipulação sem segurança a partir de 60 minutos para AX-0,5 e de 90 minutos para AX-1,0. Não houve diferenças entre FC, fR, PAM e To e o lactato sérico entre os momentos nem entre os grupos. Em relação ao perfil ácido-base e eletrólitico, AX-0,5 apresentou diferenças em pH, HCO3-,, EB e K+, com valores aos 60 minutos superiores aos valores em 10 minutos, e AX-1,0 apresentou diferenças apenas para EB também com valores aos 60 minutos superiores aos 10 minutos. Diante dos resultados conclui-se que os dois protocolos promoveram sedação adequada e que a escolha entre eles deve ser pautada pela índole do animal. Embora não tenham ocorrido alterações fisiológicas consideráveis em nenhum dos grupos, sugere-se a suplementação de oxigênio nos primeiros 30 minutos de contenção química. / The aim of this study was to determine a sedation protocol for red brockets (Mazama Americana) that allows common handling procedures for captive individuals of this species. Six adult animals, weighing 38.4 ± 5 kg, from Núcleo de Pesquisa e Conservação de Cervídeos (UNESP - Jaboticabal) were used in the study. They underwent two treatments with a 30 days washout period: AX-0.5 with 1 mg/kg azaperone and 0.5 mg/kg xylazine, intramuscularly (IM), and AX-1.0 with 1 mg/kg azaperone and 1 mg/kg xylazine, IM. From the moment of drug administration (0 minute) latency periods for sedation, sternal recumbency, safe handling and unsafe handling were recorded. The quality of chemical restraint was quantified every 10 minutes, for up to 90 minutes, through a descriptive scale, and the physiological variables (FC, fR, PAM and To) every 10 minutes, up to 60 minutes. Acid base status and blood electrolytes (pH, PaCO2, PaO2, HCO3-, EB, SaO2, Na+ e K+) were assessed at 10, 30 and 60 minutes, while blood lactate was assessed at 30 and 60 minutes after treatment. Differences were considered significant when P < 0.05. Sedation latency periods and period for sternal recumbency were longer in AX-0.5 (7 ± 6,6 e 12 ± 9,7 minutes, respectively) in comparison to (AX-1.0 5 ± 2,0 e 6 ± 3,1 minutes respectively), however no other significant differences in periods between groups were observed. Quality of chemical restraint was significantly different between treatments after 60 minutes, when safe handling of the animals was no longer possible in AX-0.5, but only after 90 minutes in AX-1.0. No differences between FC, fR, PAM, To and blood lactate levels were observed between groups or between moments. Regarding the acid base status and blood electrolytes, animals from AX-0,5 showed significant differences in pH, HCO3-,, BE and K+ between 10 and 60 minutes, being values at 10 minutes higher. Same tendency was also observed in AX-1.0, however only for BE. In conclusion, both protocols led to adequate sedation and predilection between them should be based on the animal\'s behavior. Even though no alterations in physiological parameters were detected in any of the experimental groups, oxygen therapy is recommended for the first 30 minutes of chemical restraint in all animals.

O presente estudo objetivou determinar um protocolo para sedação de veados-mateiros (Mazama americana) que permitisse procedimentos comumente utilizados no manejo dessa espécie em cativeiro. Foram utilizados seis animais adultos, pesando 38,4 ± 5 Kg, pertencentes ao Núcleo de Pesquisa e Conservação de Cervídeos (UNESP - Jaboticabal). Os animais foram submetidos a dois tratamentos, com um intervalo mínimo de 30 dias entre eles, a saber: AX-0,5 - associação de 1 mg/kg de azaperone e 0,5 mg/kg de xilazina via intramuscular (IM) e AX-1,0 - associação de 1 mg/kg de azaperone e 1 mg/kg de xilazina (IM). A partir da administração do tratamento (0 minuto) foram avaliados os tempos para latência da sedação, para decúbito esternal, para a manipulação segura e para a manipulação sem segurança. Ainda, foram avaliados a qualidade da contenção química por meio da somatória de pontos obtida com a utilização de uma escala descritiva adaptada, a cada 10 minutos, por até 90 minutos, parâmetros fisiológicos (FC, fR, PAM e To) a cada 10 minutos, durante 60 minutos, perfil ácido-base e eletrolítico (pH, PaCO2, PaO2, HCO3-, EB, SaO2, Na+ e K+) aos 10, 30 e 60 minutos e lactato sérico aos 30 e 60 minutos pós-tratamentos. As diferenças foram consideradas significantes quando P < 0,05. O período de latência da sedação e período para os animais apresentarem decúbito esternal foram maiores em AX-0,5 (7 ± 6,6 e 12 ± 9,7 minutos, respectivamente) em relação a AX-1,0 (5 ± 2,0 e 6 ± 3,1 minutos respectivamente), porém não houve diferenças entre os grupos para os demais tempos avaliados. A qualidade da contenção química diferiu entre os grupos a partir de 60 minutos, observando-se possibilidade de manipulação sem segurança a partir de 60 minutos para AX-0,5 e de 90 minutos para AX-1,0. Não houve diferenças entre FC, fR, PAM e To e o lactato sérico entre os momentos nem entre os grupos. Em relação ao perfil ácido-base e eletrólitico, AX-0,5 apresentou diferenças em pH, HCO3-,, EB e K+, com valores aos 60 minutos superiores aos valores em 10 minutos, e AX-1,0 apresentou diferenças apenas para EB também com valores aos 60 minutos superiores aos 10 minutos. Diante dos resultados conclui-se que os dois protocolos promoveram sedação adequada e que a escolha entre eles deve ser pautada pela índole do animal. Embora não tenham ocorrido alterações fisiológicas consideráveis em nenhum dos grupos, sugere-se a suplementação de oxigênio nos primeiros 30 minutos de contenção química. / The aim of this study was to determine a sedation protocol for red brockets (Mazama Americana) that allows common handling procedures for captive individuals of this species. Six adult animals, weighing 38.4 ± 5 kg, from Núcleo de Pesquisa e Conservação de Cervídeos (UNESP - Jaboticabal) were used in the study. They underwent two treatments with a 30 days washout period: AX-0.5 with 1 mg/kg azaperone and 0.5 mg/kg xylazine, intramuscularly (IM), and AX-1.0 with 1 mg/kg azaperone and 1 mg/kg xylazine, IM. From the moment of drug administration (0 minute) latency periods for sedation, sternal recumbency, safe handling and unsafe handling were recorded. The quality of chemical restraint was quantified every 10 minutes, for up to 90 minutes, through a descriptive scale, and the physiological variables (FC, fR, PAM and To) every 10 minutes, up to 60 minutes. Acid base status and blood electrolytes (pH, PaCO2, PaO2, HCO3-, EB, SaO2, Na+ e K+) were assessed at 10, 30 and 60 minutes, while blood lactate was assessed at 30 and 60 minutes after treatment. Differences were considered significant when P < 0.05. Sedation latency periods and period for sternal recumbency were longer in AX-0.5 (7 ± 6,6 e 12 ± 9,7 minutes, respectively) in comparison to (AX-1.0 5 ± 2,0 e 6 ± 3,1 minutes respectively), however no other significant differences in periods between groups were observed. Quality of chemical restraint was significantly different between treatments after 60 minutes, when safe handling of the animals was no longer possible in AX-0.5, but only after 90 minutes in AX-1.0. No differences between FC, fR, PAM, To and blood lactate levels were observed between groups or between moments. Regarding the acid base status and blood electrolytes, animals from AX-0,5 showed significant differences in pH, HCO3-,, BE and K+ between 10 and 60 minutes, being values at 10 minutes higher. Same tendency was also observed in AX-1.0, however only for BE. In conclusion, both protocols led to adequate sedation and predilection between them should be based on the animal\'s behavior. Even though no alterations in physiological parameters were detected in any of the experimental groups, oxygen therapy is recommended for the first 30 minutes of chemical restraint in all animals.

No description available.

Problème. L'administration de médicaments aux propriétés sédatives pour la gestion des symptômes comportementaux, aussi appelée contention chimique, est une intervention complexe dont les finalités de contrôle, de protection, de traitement et d'alternative à d'autres coercitions entrent en conflit et sèment le désaccord chez les acteurs en établissements de santé. Tous s'entendent toutefois sur la nécessité d'en mesurer l'usage et d'évaluer la conformité des pratiques des soignants aux normes de qualité applicable. Or, à l'heure actuelle, aucune définition opérationnelle de la contention chimique, aucun outil ni indicateur de qualité des soins valide ne permet d'évaluer l'usage des contentions chimiques. But. Cette étude métrologique a pour but de développer et de valider un outil d'évaluation réflexive de la qualité des soins en matière de contention chimique de la perspective de l'infirmière. Méthodologie. Quatre questions de recherche rassemblées en deux grandes phases de l'étude ont permis de poursuivre ce but, lors desquelles des méthodes qualitatives et quantitatives ont été utilisées. La phase de développement de l'outil d'évaluation réflexive impliquait la conduite d'une revue réaliste pour rassembler, à l'intérieur d'un modèle théorique, un inventaire d'items potentiels. Cette méthode systématique de synthèse des connaissances suggère une étape préliminaire destinée à clarifier la nature et les contextes de déploiement de l'intervention d'intérêt, ici l'usage des contentions chimiques. Pour ce faire, un examen de la portée a été réalisé. Puis, une technique Delphi a permis la validation du contenu des items recensés, lesquels ont ensuite été intégrés dans une plateforme virtuelle d'évaluation réflexive qui permet de mesurer les perceptions des professionnelles en charge de la décision d'administrer la contention chimique, soit les infirmières. L'outil d'évaluation au format innovant, appelé E-value-action, a ensuite été pré-testé pour une appréciation de la validité apparente (face validity) auprès de futurs- utilisateurs d'un Centre intégré universitaire de santé et de services sociaux (CIUSSS) du Québec, Canada, lesquels ont offert une rétroaction qualitative suite à une simulation d'évaluation. Résultats. L'examen de la portée basé sur 33 articles de provenance internationale a fait ressortir la nécessité d'élargir le concept à définir et à mesurer pour aborder la contention chimique comme une notion synonyme à la sédation des symptômes comportementaux. Ensuite, par le biais de la revue réaliste, 28 normes de pratique répertoriées dans 45 articles scientifiques ou textes de lignes directrices ont pu être insérées au modèle théorique puis libellés sous forme d'items à intégrer à l'outil d'évaluation. Ces normes, appuyées d'exemples concrets, reflètent la qualité des soins infirmiers en trois contextes principaux : les soins en santé mentale, les soins aigus à l'adulte et les soins de longue durée à la clientèle âgée. Au niveau de la validité de contenu, les items de l'outil ont présenté un degré d'accord sur la clarté des items de 90% et de 95% sur la pertinence, témoignant d'un consensus (>70%) chez le panel d'experts chercheurs, gestionnaires et cliniciens (n = 20) de différentes régions administratives du Québec, Canada. L'adéquation de la plateforme virtuelle d'évaluation et l'intérêt pour son implantation en contextes cliniques ressortent de l'analyse des données de la validité apparente auprès d'infirmières en soins directs (n = 7) d'un CIUSSS québécois. Discussion. L'usage de cet outil d'évaluation réflexive devrait favoriser l'intégration des normes de pratique en soins infirmiers en plus de promouvoir une culture de réduction des mesures de contrôle favorable à des soins plus sécuritaires, efficaces et centrés sur la personne. Une validation ultérieure à plus grande échelle et la traduction du contenu d'E-value-action avec validations transculturelles sont recommandées pour soutenir les nombreux états/provinces et pays anglophones qui possèdent, comme le Québec, une règlementation sur la réduction ou l'usage d'exception des mesures de contrôle dont la substance chimique. / Background. The administration of sedative agents for the management of behavioral symptoms, also called chemical restraint, is a complex intervention of which the various goals of control, protection, treatment and alternative to other coercion inspire vigorous debate among professionals within the health care field. There is general consensus, however, on the necessity to reduce the application and to evaluate professional practices against relevant quality standards. Despite this clear recommendation, there is currently no operational definition of chemical restraint, and there is no valid measurement tool or indicator available for the evaluation of chemical restraint interventions in healthcare. Aim. This metrological study aims to develop and validate an instrument to assess the quality of chemical restraint practices from the perspective of nurses. Methods. This goal has been pursued through the formulation of four research questions organized into two large phases of study, involving both qualitative and quantitative methods. The development phase was based on a realist review of existing quality standards in order to gather, within a theoretical model, an inventory of potential items. This systematic method of knowledge synthesis requires, as a preliminary step, the clarification of the nature and various contexts of the intervention of interest, in this case, chemical restraint. This was accomplished through a scoping review. Following this, the Delphi method enabled the content validation of the identified items, which were then integrated into a virtual reflexive assessment tool within which the perceptions of the nurses in charge of administering chemical restraints could be measured. In order to gain an appreciation of the face validity of this innovative assessment tool, called E-value- action, it was then pre-tested among future users at one of Quebec's Integrated University Health and Social Services Centers (CIUSSS), Canada. After completing this simulated evaluation, participants were invited to provide a qualitative description of their experience. Results. The scoping review, based on 33 internationally sourced articles, highlighted the necessity to expand the concept being defined and measured to include chemical restraint or behavioral sedation. The realist review method was then used to identify 28 quality standards, inventoried within 45 scientific articles or practical guidelines, which were then integrated into the theoretical model and itemized to facilitate their inclusion within the quality assessment tool. These items, supported by concrete examples, reflect nursing practices in three principal contexts: mental health care, acute care for adults and long- term elder care. As concerns the content validity, the items within the theoretical model presented an agreement of 90% for the clarity, and of 95% for the relevance, demonstrating a consensus (>70%) among the panel of expert researchers, managers and clinicians (n = 20) from different administrative regions of Quebec, Canada. The alignment between the virtual self-evaluation platform and the interest for its implementation within clinical contexts is palpable from the analysis of the face validity data gathered from direct care nurses (n = 7) in the Quebec CIUSSS. Discussion. The application of this reflexive self-evaluation tool should engender a deeper integration of nursing standards in addition to promoting a diminished utilization of coercive measures leading to care that is more secure, effective and patient-centered. A subsequent large-scale pilot testing of the E-value-action platform is recommended, including the translation and adaptation for cross-cultural analysis, in order to support the numerous English-speaking jurisdictions which, like Quebec, have developed regulations concerning the reduction or exceptional application of coercive measures such as pharmacological agents.

L’utilisation des mesures de contrôle pour la gestion des comportements violents constitue une préoccupation majeure pour les infirmières qui pratiquent dans les unités de soins de santé mentale adulte. Le recours à ces mesures engendre des conséquences physiques et des traumatismes psychologiques chez les patients et tout le personnel soignant. Par conséquent, la prévention et la réduction de leur utilisation deviennent une priorité. De par l’aspect multifactoriel de cette problématique, la connaissance des facteurs qui influencent l’utilisation de ces mesures est primordiale pour cibler les interventions qui permettent de les prévenir ou les réduire. Les facteurs reliés aux caractéristiques cliniques des patients et au personnel soignant sont bien décrits dans la littérature. Toutefois, les facteurs reliés à l’environnement du patient ne sont pas attribués à l’ensemble des dimensions qui le constituent. Ceci est dû à la rareté des modèles conceptuels qui donnent une représentation structurée et globale de cet environnement. L’absence de cette représentation laisse les facteurs associés à l’environnement circonscrits seulement dans sa dimension physique, alors que d’autres facteurs reliés à ses autres dimensions sont rapportés dans la littérature sans être définis comme des facteurs environnementaux. Le but de cette revue de la portée a donc été d’explorer l’étendue des connaissances et d’identifier les facteurs de l’environnement qui sont associés à l’utilisation des mesures de contrôle chez les patients atteints de troubles mentaux. Afin d'intégrer une représentation globale de l’environnement, le cadre de référence du modèle de l’environnement thérapeutique optimal a été retenu (Optimal healing environment, ETO) (Jonas et al. , 2014). Les étapes de la revue de la portée selon Peters et al. (2020) ont été suivis, ce qui a donné lieu à l'inclusion de 35 écrits. L’analyse thématique des données extraites a permis d'identifier deux dimensions, à savoir l’environnement interpersonnel et l’environnement externe du patient. L’environnement interpersonnel décrit le développement et le maintien d’une relation thérapeutique à travers l’amélioration des compétences de communication du personnel soignant, l’utilisation des stratégies de prévention de crise d’agressivité, l’implication du patient, le retour post-évènement d’isolement et/ou contention et le sentiment d’appartenance à la communauté de l’unité de soins. Il décrit également la création d’organisations thérapeutiques via l’exercice du leadership organisationnel, les initiatives d’améliorations de l’organisation des soins, et la gestion des ressources humaines et technologiques. Pour sa part, l’environnement externe décrit la conception architecturale et le design intérieur des unités de soins où le patient est hospitalisé. Finalement, on pourrait conclure que des trois dimensions de l’ETO qui ont été incluses dans ce travail, les dimensions de l’environnement interpersonnel et l’environnement externe sont les plus représentées dans la littérature des cinq dernières années. De plus, les interventions de prévention de crise d’agressivité et le leadership organisationnel se sont montrés des facteurs clés d'un environnement thérapeutique favorisant la réduction de l’utilisation des mesures de contrôle. / The use of coercive measures (seclusion and restraints) to manage violent behaviors is a major preoccupation for adult mental health nurses. The use of these measures results in physical consequences and psychological trauma for patients and all caregivers. Therefore, prevention and reduction of their use becomes a priority. Due to the multifactorial aspect of this problem, understanding of the factors influencing this measures use is essential in order to target interventions to reduce them. Factors related to the clinical characteristics of patients and caregivers are well described in the literature. However, factors related to the patient's environment are not attributed to all of its dimensions. This is due to the scarcity of conceptual models that provide a structured, global representation of this environment. The absence of such a representation leaves the factors associated with the environment circumscribed only within its physical dimension, while other factors related to its other dimensions are reported in the literature without being defined as environmental factors. The aim of this scope review was therefore to explore the extent of knowledge and identify the environmental factors associated with reduced use of coercive measures in patients with mental disorders. In order to incorporate a holistic representation of the environment, the framework of the Optimal healing environment (ETO) model was selected (Jonas et al., 2014). The scope review steps according to Peters et al. (2020) were followed, resulting in the inclusion of 35 literatures. Thematic analysis of the extracted data identified two dimensions, namely the patient's interpersonal environment and external environment. The interpersonal environment describes the development and maintenance of a therapeutic relationship through the improvement of caregivers' communication skills, the use of aggressive crisis prevention strategies, patient involvement, the post-event return from isolation and/or restraint, and the sense of belonging to the care community. It also describes the creation of therapeutic organizations through the exercise of organizational leadership, initiatives to improve the organization of care, and the management of human and technological resources. For its part, the external environment describes the architectural and interior design of the care units where the patient is hospitalized. Finally, we may conclude that of the ETO three dimensions included in this work, interpersonal environment and external environment are the most represented in the literature of the last five years. In addition, aggression crisis prevention interventions and organizational leadership have been shown to be key factors in a therapeutic environment conducive to reducing the use of coercive measures.