Este estudo transversal teve como objetivos: caracterizar os erros de medicação relatados por profissionais de enfermagem que atuam em UTI; comparar os dados sócio-demográficos, do trabalho e da qualidade de vida relacionada à saúde (QVRS) dos profissionais envolvidos e não envolvidos com erros de medicação em UTI; verificar se os domínios da QVRS são fatores independentes associados aos erros de medicação em UTI. Foram pesquisados 94 profissionais de enfermagem de três UTIs (duas de adultos e uma pediátrica) de um hospital privado do município de São Paulo, sendo 39 enfermeiros (41,5%) e 55 técnicos de enfermagem (58,5%). Os dados socio-demográficos, do trabalho e os relacionados aos erros de medicação foram registrados em instrumentos próprios. A QVRS foi avaliada com a versão em português do instrumento SF-36. Os profissionais foram comparados em dois grupos, segundo o relato de terem ou não cometido erros de medicação nas quatro semanas anteriores à pesquisa. Regressão logística univariada e múltipla foram utilizadas para análise da relação entre as variáveis. A maioria dos profissionais era do sexo feminino (79,8%), com idade média de 33 anos (dp=6,45), casada ou com companheiro (52,1%). A renda familiar per capita foi de R$ 2.024,95 (dp=1.625,00); 52,1% tinham apenas um vínculo empregatício. Entre os 18 profissionais que mencionaram ter cometido erro, seis eram enfermeiros e 12, técnicos de enfermagem. Houve notificação do erro em 61,1% dos casos. Os erros mais freqüentes foram os da fase de administração (67,8%). Entre os profissionais que cometeram erros, todos os escores do SF-36 foram significativamente menores. Na análise múltipla, o domínio Aspectos Emocionais e os turnos de trabalho da tarde e da noite mostraram associação significativa com erro de medicação, como fatores de proteção. Os resultados deste estudo trazem subsídios para a adoção de medidas institucionais especificamente direcionadas às necessidades dos profissionais de enfermagem, contribuindo, desta forma, para uma assistência mais segura aos pacientes / This cross-sectional study aimed to characterize the medication errors reported by the nursing professionals who work in ICU; to compare the socio-demographic data of the labor and the health-related quality of life (HRQL) of professionals involved and not involved with medication errors in ICU; and to check whether the domains of HRQL are independent factors associated with medication errors in ICUs. We studied 94 nursing professionals in three ICUs (two adult and one pediatric) in a private hospital in the city of Sao Paulo, with 39 nurses (41.5%) and 55 nursing technicians (58.5%). Socio-demographic data of the labor and the ones related to medication errors were recorded in separate instruments. The HRQL was assessed with the Portuguese version of the SF-36 instrument. The professionals were compared in two groups, according to the report of having committed or not medication errors in the four weeks preceding the survey. Univariable and multiple logistic regressions were used to analyze the relationship between the variables. Most practitioners were female (79.8%) with average age of 33 years (SD = 6.45), married or with partner (52.1%). The per capita income was R$ 2024.95 (SD = 1625.00), 52.1% had only one job. Among the 18 practitioners who reported having committed error, six were nurses and 12 were nursing technicians. There was notification of the error in 61.1% of the cases. The most frequent errors were the ones of the administration stage (67.8%). Among those who committed errors, all of the SF-36 scores were significantly lower. In multiple analysis, the domain Emotional Aspects and the work shifts of the afternoon and night showed significant association with medication errors as factors of protection. The results of this study provide subsidies for the adoption of institutional measures specifically targeted to the needs of nursing professionals, thus contributing to a safer care of patients

Submitted by Silvana Teresinha Dornelles Studzinski (sstudzinski) on 2016-11-18T14:26:17Z No. of bitstreams: 1 Ariele Priebe Reisdorfer_.pdf: 1985228 bytes, checksum: 076794974edc775959e935820eee2c49 (MD5) / Made available in DSpace on 2016-11-18T14:26:17Z (GMT). No. of bitstreams: 1 Ariele Priebe Reisdorfer_.pdf: 1985228 bytes, checksum: 076794974edc775959e935820eee2c49 (MD5) Previous issue date: 2016-10-14 / Nenhuma / A cirurgia cardíaca é indicada como tratamento para doenças cardiovasculares. A realização desse procedimento é complexa e exige que todo o cuidado do pós-operatório imediato e parte do mediato sejam realizados na Unidade de Terapia Intensiva (UTI). Nesse sentido, o serviço prestado pela equipe de enfermagem contribui para garantir a recuperação do indivíduo submetido à cirurgia cardíaca. O objetivo desta pesquisa é elaborar um programa de Educação Permanente em Saúde para a equipe de enfermagem da UTI Adulto do Hospital Geral de Caxias do Sul/RS acerca do cuidado ao paciente no pós-operatório de cirurgia cardíaca. Esta pesquisa, de caráter qualitativo, contou com a participação de vinte e sete integrantes da equipe de enfermagem (enfermeiros e técnicos) que prestam cuidado ao paciente no pós-operatório do hospital em estudo. A coleta de dados ocorreu por meio de uma entrevista semiestruturada. Para o tratamento dos dados, foi utilizada a análise temática, da qual emergiram quatro categorias: desafios da equipe em relação aos cuidados específicos ao paciente no pós-operatório de cirurgia cardíaca; o medo da admissão na UTI de paciente no pós-operatório de cirurgia cardíaca; relações multiprofissionais; e necessidade de educação permanente em saúde. Os resultados apontaram que os profissionais que iniciaram suas atividades nesse cenário há pouco tempo sentem dificuldade na prestação de cuidados ao paciente, enquanto os mais antigos percebem a fragilidade dos novos colegas e relembram das suas quando iniciaram. Além disso, todos sentem a necessidade de qualificar a prática profissional. Nesse contexto, as propostas de intervenção deste estudo foram a elaboração do Programa de Educação Permanente em Saúde, uma cartilha de orientação sobre os cuidados no pós-operatório de cirurgia cardíaca e um checklist para guiar a passagem do plantão do bloco cirúrgico para a UTI. / The cardiac surgery is indicated as a treatment for cardiovascular diseases. This procedure is complex and its recuperation on the immediate postoperative and a part of the mediate postoperative is realized on the Intensive Care Unit (ICU). The nursing assistance contributes for the patient recovery after cardiac surgery. The objective of this search is to prepare a Health Permanent Education Program for the nursing team that work at the ICU Adult of this hospital, about the assistance to the patient that realized cardiac surgery. The study is qualitative and twenty-seven people from the nursing team that care of this patient participated of the search. It was utilized a semi structured interview to collect data. The analysis of the data were realized through the thematic analysis. Four categories emerged from the study: team challenges for specifically providing care on the postoperative of cardiac surgery; the fear of the patient admission on the ICU; multi professional relationships and necessity of health permanent education. This study indicated that the new professionals face difficulties to care of the patient that realized this surgery. The professionals that work for longer at this place observe the fragilities on the new coworkers and also remember their difficulties when they started to work. All of them related that is necessary to qualify their professional practice. Therefore, the proposal of this study were the elaboration of the Health Permanent Education Program; a guidance booklet about the care on the postoperative of cardiac surgery; and a checklist to guide the shift change from the surgical ward to the ICU.

INTRODUÇÃO: A ventilação não invasiva (VNI) tem sido amplamente utilizada na prática clínica para o tratamento de insuficiência respiratória aguda (IRpA) e crônica. OBJETIVO: Observar longitudinalmente a rotina da utilização da VNI e estimar o seu impacto sobre os desfechos dos pacientes internados em UTI. METODOS: Estudo de coorte prospectivo de pacientes admitidos consecutivamente em 10 UTIs de um grande hospital público universitário. Durante 9 meses, foram estudados todos os pacientes com idade >= 18 anos, submetidos a VNI durante a permanência na UTI. RESULTADOS: Um total de 392 pacientes foram incluídos. A média (DP) de idade foi 56 (19) anos e 55% eram do sexo masculino. A média (DP) escore SAPS II foi de 36 (14). As indicações de VNI foram: pós-extubação (44%), IRpA (27%), fisioterapia respiratória(18%). A média do IPAP e do EPAP no último dia da VNI foi de 14 cmH2O e 8,8 cmH2O, respectivamente. A máscara facial foi utilizada em 93% dos casos e a máscara facial total em apenas 6%. A incidência de pneumonia foi de 5%. No desfecho do estudo, foi observado falência da VNI em 35% dos casos, taxa de mortalidade em 25% e o tempo de internação na UTI com uma mediana de 10 dias. CONCLUSÕES: A VNI pode ser bem sucedida se usada em pacientes selecionados. Muitos fatores foram associadas ao fracasso NIV: idade, SAPS II, IPAP, EPAP e valores FiO2 no último dia da VNI e presença de tosse e da necessidade de aspiração traqueal. A taxa de mortalidade e tempo de UTI foi maior no grupo que fracassou na VNI. / CONTEXT: Noninvasive ventilation (NIV) has been widely used in clinical practice in order to treat acute or chronic respiratory failure. OBJECTIVE: To observe the routine use of NIV and estimate the outcomes of this population. METHODS: A prospective cohort study of consecutively admitted patients in 10 ICUs of a large public university affiliated hospital. Over a 9 months period, we studied all patients with age >= 18 years, submitted to NIV during ICU stay. RESULTS: A total of 392 patients were included in this study. The mean (SD) age was 56(19) years, and 55% were males. The mean (SD) SAPS II Score was 36 (14). NIV indications were: post extubation (44%), acute respiratory failure (ARF)(27%), and chest physiotherapy (18%). The mean IPAP and EPAP at the last day of NIV was 14 cmH2O and 8.8 cmH2O respectively. The full face mask was used in 93% of cases, only 6% used total face mask. The incidence of pneumonia was 5%. The NIV failure rate was 35%, ICU mortality rate 25% and the median ICU stay 10 days. CONCLUSIONS: NIV can be successful in selected patients. Many factors were associated to NIV failure: age, and SAPS II, IPAP, EPAP and FiO2 values at the last day of NIV and presence of cough and the need for tracheal aspiration. Mortality rate and ICU length of stay were higher in NIV failure group.

The concept of a missing nursing care in a nursing practice is a phenomenon that could endanger patients' safety in all cultures. This global deficit of a superior and comprehensive nursing care occurs in various departments of healthcare facilities. The theoretical part of this thesis deals with problematic aspects of the concept of a missing nursing care based on theoretical findings. Furthemore it summarises strategies used for ensuring that quality, safety and kompetence in a nursing care is met in relation to latest findings and the legislation. The research part presents outcomes of a conducted qualitative survey research focusing on nurses working in an Intensive Care Unit where a nursing care is directed towards the population of adult patients. Research Metodology: The data collection in the study is based on a semi-structured interview conducted on an actively working group of nine Intensive Care Unit nurses. Aim of the Study: The main objective of the thesis is to describe and analyse problematic aspects of the concept of a missing nursing care in an Intensive Care Unit, as well as to identify factors that affect occurrence of the given concept limited to the nursing staff in the Intensive Care Units. Research Results: The study analyses six categories in total, of which five categories...

Even though initiation of breastfeeding among term and preterm infants has increased, the incidence and duration among preterm infants continues to lag because of the unique challenges of breastfeeding preterm infants. African American mothers have the lowest rates of breastfeeding initiation and duration, and their preterm infants are less likely to receive breast milk while in the neonatal intensive care unit. The objective of this cross-€sectional quantitative study was to evaluate the relationship between breastfeeding and maternal sociodemographic factors as well as medical and obstetrical conditions for infants born between 32-€37 weeks gestational age in South Carolina from 2009 to 2011. The health belief model provided the framework for this study. Secondary data from the South Carolina Pregnancy Risk Assessment Monitoring System included 1,752 preterm pregnancies. Results of binary logistic regression and multivariate logistic regression analysis indicated that mothers who were African American and those who had lower income, no Medicaid, and lower education level breastfed less frequently. Findings may be used to decrease neonatal, postnatal, and infant morbidity and mortality, and to increase breastfeeding knowledge and support to ensure successful breastfeeding of preterm infants beyond the hospital.

Cleft lip with or without cleft palate (CLP) is an ongoing public health issue across the globe, and in the United States. The estimated number of babies born each year in the United States with cleft palate (CP) is about 2,650, while CLP affects approximately 4,440 babies. The purpose of this quantitative cross-sectional study was to determine if there is a relationship between CLP and maternal characteristics such as reproductive history (advanced maternal age, maternal obesity, prenatal visits, month prenatal care began, number of pregnancies, gestational age at birth, assisted reproductive technology used, gestational diabetes, and hypertension), socioeconomic status of the mother (marital status, education, mother's race, payment source for delivery, and place where birth occurred), and admission to the Neonatal Intensive Care Unit (NICU) in U.S. hospitals from January 2016 to December 2016. The epidemiological triad theory served as the study's framework. A secondary dataset from the National Vital Statistics System was used for this study. Logistic regression was used to test the hypothesized associations. Results indicated that many maternal characteristics such as mother's age (p = .000), maternal obesity (p = .020), number of prenatal visits (p = .001), total birth order (p = .001), gestational age at birth (p = .000), gestational diabetes (p = .002), and gestational hypertension (p = .032), mother's education (p = .000), marital status (p = .018), race (p = .000), and admission to NICU (p = .000) were significantly associated with CLP. Results of this study may help health care professionals identify the determinants of the risk of CLP so as to design and implement effective CLP preventive measures among United States populations that are disproportionately affected by this condition.

Purpose. To systematically develop and field test an intervention to engage families and healthcare teams in the decision-making process about life support for critically ill patients in the Intensive Care Unit (ICU). Setting. Adult medical-surgical ICU at a Canadian academic teaching hospital. Methods. The International Patient Decision Aid Standards (IPDAS) criteria and the Interprofessional Shared Decision Making (SDM) model guided the study of families facing decisions about life support for their relative in ICU that involved:1) systematic review; 2) qualitative descriptive study; 3) mixed methods field test of a novel patient decision aid (DA). Systematic review findings. Of 3162 citations, four trials evaluated interventions to improve communication between health professionals and patients/families. One intervention met eight of nine criteria for SDM but did not evaluate its effect on the benefit to communication. Qualitative study findings. Six family members and nine health professionals identified two options (life support or comfort care) and values associated with these options. Values included maintaining quality of life, surviving critical illness, minimizing pain and suffering, not being attached to machines, giving the family enough time to adapt emotionally to the patient’s health situation, and the judicious use of healthcare resources. Families were unlikely to become engaged without healthcare professionals making the decision explicit and minimizing other barriers across the decision-making process. Field test findings. Family members and health professionals for eight patients indicated that the DA was feasible to use, acceptable to users, had the potential to do what was intended, and did not seem to present adverse consequences to users. An enhanced delivery strategy is needed for future evaluation of its effect on facilitating patient/family involvement in decisions. Conclusions. Limited involvement of families in the process of decision-making about life support in the ICU reinforced the need for effective interventions to facilitate SDM. These studies validated the operationalization of the IPDAS criteria, as part of a systematic process for developing and field testing DAs. However, IPDAS criteria stop short of elements necessary to consider when implementing the DA in the processes of care.

Bakgrund: I en rapport från socialstyrelsen framgår det att akutmottagningarna runt omi landet har ca 2,5 miljoner patientfall, därtill kommer ännu fler anhöriga ochnärstående. Patientnämnden, som är det organ som hanterar klagomål från patienter ochanhöriga, uppger att det varje år kommer ungefär 4000 anmälningar där patienter ochanhöriga har känt sig kränkta och dåligt bemötta i sjukvården. Syfte: Syftet var attbeskriva hur vuxna anhöriga upplever bemötandet av sjuksköterskan vid akutasjukdomstillstånd inom somatisk vård. Metod: Arbetet skrevs som en allmänlitteraturstudie, enligt metod för kvalitativ manifestinnehållsanalys. Resultat:Anhörigas upplevelser i bemötandet från sjuksköterskorna kunde delas in i tre olikakategorier: trygghet-otrygghet, att bli sedd och bekräftad och sjuksköterskansmaktutövande. I det trygga och bekräftande bemötandet upplevde anhöriga känslor avtrygghet och betydelsefullhet, detta gav dem förutsättningar att skapa en handlingsplanför framtiden. När sjuksköterskan istället utövade sin maktställning upplevde anhörigakänslor av maktlöshet och att befinna sig i en beroendeställning. Detta gjorde attanhöriga fastnade i känslor av skuld och kunde inte ta sig vidare. / Background: A report from the National Board shows that emergency departmentsaround the country has about 2.5 million patient cases, which must be added even morefamily and friends. Patients Board, which is the body that handles complaints frompatients and relatives, said that each year, approximately 4000 notifications in whichpatients and families have felt insulted or badly treated in health care. Objective: Theaim was to describe how adult relatives are experiencing the hospitality of the nurse inacute illness in somatic care. Methods: This work was written as a general literaturestudy, by method of qualitative manifest content analysis. Results: Relatives'experiences of nurses' attitudes could be divided into three different categories:security-insecurity, to be seen and confirmed and nurses exercise of power. In the safeand confirmatory hospitality experienced relatives feelings of security and greatness,this gave them the ability to create an action plan for the future. When the nurse insteadexercised their position of power experienced relatives feelings of powerlessness andbeing in a position of dependence. This meant that families got stuck in feelings of guiltand could not get on.

Total quality management (TQM) approach is often used to carry out company-wide continuous quality improvement plans in manufacturing and service industries. Similarly, TQM can also play a critical role for quality management in health care. Aiming to improve health care quality, experiences showed that major problems of non-patient care, patient records and vital signs monitoring are encountered. In this study, we aim to introduce TQM for quality improvement for intensive care unit (ICU) operations, including some solutions and the prototype of quality management. And vital signs monitoring at ICU is taken as an example of process. For quality improvement of non-patient care, Health Care Quality Development Life Cycle, including (1) quality requirement analysis, (2) quality specification review, (3) quality design, (4) quality implementation, (5) quality testing, (6) quality maintaining, and (7) quality validation, is discussed. The prototype of the first three phases for quality improvement at ICU is explored. Through quality requirement analysis, non-patient care quality at ICU is defined in areas of administration, facility and environment. For quality improvement of patient records maintaining, firstly, scope of health care information systems is categorized as administrative operational system, decision support system, clinical information system, and medical information system. According to this categorization and experience, some interesting result is found. For instance, the current applications of information systems for teaching hospitals in southern Taiwan surveyed are that most applications are administrative and clinical. And the essential information of patient records used in each information system is not complete or not easily accessed. Model of the patient record maintaining is introduced and the prototype design of patient records is recommended for quality improvement of patient records maintaining at ICU. To improve quality of vital signs monitoring is one essential requirement and specification for ICU quality improvement. Effective outcome measures of vital signs monitoring and early detecting of abnormal vital signs is considered important. For quality improvement of vital signs monitoring at ICU, heart rate graphs are taken as examples in our study through the heart rate graphs monitoring. Health professionals can understand the interactions of human autonomic nervous system. By use of digitizer, the computable heart rate data is acquired from each graph and grouped into mortality and near-to-normal cases. Then spectrum form of heart rate data, describing more about heart function, is used for statistical analysis. Several control chart methods have been experimented to detect small heart rate shifts from target, cumulative sum control chart (Cusum) is adopted in our study. The observable variable is the patient¡¦s heart rate, the purpose is to check the alarms pointed out by Cusum that could be partially be ascribed to changes of heart rate trend over time, and to a shift in the monitoring process mean. From summaries of nonconformities in the Cusum charts, mortality cases obviously have more nonconformities. It is obvious that Cusum control charts of mortality cases provide diagnostic information for vital signs monitoring process. In addition, Cusum charts may also inform ICU professionals that there is a small shift of patient heart rate, a continuously increasing or decreasing heart rate, and the adjustment of sympathetic nerve and parasympathetic nerve. In those cases, some special care is needed.

This dissertation introduces a new problem in the delivery of healthcare, which could result in lower cost and a higher quality of medical care as compared to the current healthcare practice. In particular, a framework is developed for sedation and cardiopulmonary management for patients in the intensive care unit. A method is introduced to automatically detect pain and agitation in nonverbal patients, specifically in sedated patients in the intensive care unit, using their facial expressions. Furthermore, deterministic as well as probabilistic expert systems are developed to suggest the appropriate drug dose based on patient sedation level. This framework can be used to automatically control the level of sedation in the intensive care unit patients via a closed-loop control system. Specifically, video and other physiological variables of a patient can be constantly monitored by a computer and used as a feedback signal in a closed-loop control architecture. In addition, the expert system selects the appropriate drug dose based on the patient's sedation level. In clinical intensive care unit practice sedative/analgesic agents are titrated to achieve a specific level of sedation. The level of sedation is currently based on clinical scoring systems. In general, the goal of the clinician is to find the drug dose that maintains the patient at a sedation score corresponding to a moderately sedated state. This is typically done empirically, administering a drug dose that usually is in the effective range for most patients, observing the patient's response, and then adjusting the dose accordingly. However, the response of patients to any drug dose is a reflection of the pharmacokinetic and pharmacodynamic properties of the drug and the specific patient. In this research, we use pharmacokinetic and pharmacodynamic modeling to find an optimal drug dosing control policy to drive the patient to a desired sedation score.