Thesis (M.S.)--University of Michigan, 1993.

Thesis (M.S.)--University of Michigan, 1993.

This thesis explores the role of the nurse on an Acute Medical Admissions Unit (AMAU). AMAUs provide a dedicated area for the assessment, treatment, and subsequent transfer or discharge of patients who are medical emergencies. Despite increasing numbers of AMAUs across the UK they are an under researched area and, in particular, there is limited research that has explored the role of the nurse in the AMAU setting. Data were generated through the use of ethnography that entailed participant observation over an eighteen-month period, semi-structured interviews with a purposive sample of doctors, nurses, paramedics, and patients (n= 19), and examination of documentary evidence. Drawing on the concept of communities of practice (Wenger 1998) and the demand-control-social support model of occupational stress (Baker et al., 1996) the key themes of the study were identified as: The AMAU nurse's role in co-ordinating patients ' transition; Professional skills and attributes o f the AMAU nurse; 7 love the buzz': the AMAU nurses' work place stresses and balances; and Organisational constraints and practice boundaries for AMA U nursing The findings from the study indicate that a key aspect of the AMAU nurse's role was the facilitation of rapid patient transition. In addition the study has identified the distinctive and locally negotiated working practices developed by the nurses to coordinate this transition. Another important claim arising from this study was the identification of this nursing role as an evolved construction within a community of practice. This study makes a significant contribution to the limited body of knowledge regarding AMAU nursing practice by aiding understanding of the complexity of this nursing role. Additionally, the application of the concept of community of practice provides a unique perspective and insight into this under explored role. Recommendations are offered for practice, education, management and future research.

Thesis (M.S.)--Boston University / The chronically ill patient in a general hospital designated for the treatment of the acutely ill presents serious problems to the medical team. With the advancements made in the medical profession, together with improved hospital facilities, more people today can benefit from hospitalization. Because of this fact, more people utilize hospital facilities today than in the past, with the results that hospitals are often overcrowded and cannot accommodate all who require treatment. Consequently, it is extremely important that the period of hospitalization be as short as possible, and consistent with the patient's condition, both for the chronically and the acutely ill if these services are to be available to all.

Bakgrund Det finns flera svårigheter vid en överförflyttning från intensivvårdsavdelning till en vårdavdelning. En av dessa är hur all den vård som utförts på intensivvårdsavdelningen ska sammanfattas till en relevant, överblickbar omvårdnadsepikris. Syfte och frågeställning Syftet med denna studie är att undersöka om sjuksköterskor som vårdar traumapatienter anser att omvårdnadsepikrisen innehåller den information som krävs för att omvårdnadens mål ska kunna uppnås. Utöver detta syftar studien till att undersöka vilken information  sjuksköterskorna anser att omvårdnadsepikrisen ska innehålla. Vidare undersöks huruvida åsikterna skiljer sig åt mellan de båda grupperna och vad de tror om införandet av en standardiserad omvårdnadsepikrismall för traumapatienter. Metod Uppsatsen har designen av en kvantitativ studie med ett stratifierat strategiskt urval. Sammanlagt 48 sjuksköterskor har deltagit i studien. Tjugotvå stycken från ett regionsjukhus och 26 stycken från ett länssjukhus. Enkäten bestod av nio frågor där sjuksköterskorna fick bland annat skatta hur pass hur ofta de skrev viss information och vilka av VIPS- sökord de ansåg mest relevanta för omvårdnadsepikrisen. Resultat Det finns skillnader i hur omvårdnadsepikrisen uppfattas av de olika urvalsgrupperna. Regionssjukhusgruppen ansåg att de fick med all relevant information när de sammanställde omvårdnadsepikrisen medan länssjukhusgruppen ansåg att informationen var bristfällig. Vidare visade studien att de båda urvalsgrupperna skattade likvärdigt på flertalet sökord. Slutsats Båda urvalsgrupperna var i stort överrens om vilka VIPS- sökord omvårdnadsepikrisen bör innehålla. Information som ofta saknades var rekommenderade åtgärder. / Background There are numerous difficulties associated with transferring a patient from an intensive care unit to a regular ward. One of these difficulties regards the patient discharge summaries (PDS). It is difficult to summarize a relevant PDS for patients that have been treated at an intensive care unit. Objective This study’s objective is to describe what information registered nurses (RN) that care for, or receives trauma patients’ sees as relevant to include in the PDS for trauma patients. Method The study was made with a quantitative method, using a stratified strategic sample. Forty-eight RNs participated, divided into two study groups (group 1 & 2). 22 RNs were sampled from a regional hospital and 26 RNs were sampled from a county hospital. The RNs assessed how frequent they documented specific information. They also assessed how important they felt specific keywords from the VIPS- documentation tool were to compile a relevant PDS. The two groups’ assessments were then compared. Results Differences were found in how the two groups perceived the amount of information in the PDS. Group 1 felt that they wrote enough information in the patient discharge summary. Group 2 felt that the information in the PDS was insufficient. The study also showed that the two groups assesses similarly on most of the VIPS- keywords Conclusion Both groups mostly agreed on what the PDS should contain. Both groups felt that information about recommended measures was missing.

Aproximadamente 24% dos pacientes graves na unidade de terapia intensiva (UTI) são submetidos à traqueostomia (TQT), e a diminuição do trabalho respiratório, o desmame ventilatório precoce e facilidade na higiene brônquica são os benefícios mais comuns neste procedimento, porém são descritos em pacientes heterogêneos. O período da TQT precoce permanece controverso, mesmo que este procedimento seja descrito há séculos, e entre os pacientes que frequentemente requerem ventilação mecânica prolongada (VMP) estão os neurocirúrgicos e são susceptíveis ao desenvolvimento de complicações sistêmicas e pulmonares. Além disso, há poucos estudos sobre os benefícios da TQT precoce em pacientes neurocirúrgicos com características homogêneas e esses são retrospectivos. Não há relatos sobre o custo indireto e o desfecho hospitalar desse pacientes, portanto, o objetivo desse estudo foi analisar o tempo de ventilação mecânica invasiva (VMI), tempo de estadia na UTI em dias, tempo de estadia hospitalar em dias, custo indireto, ocorrência de complicações e o desfecho hospitalar em pacientes neurocirúrgicos submetidos à TQT precoce e tardia. Estudo prospectivo observacional, realizado no Instituto Central do hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, entre o período de Dezembro de 2009 a Junho de 2011. Foram incluídos os pacientes neurocirúrgicos admitidos na UTI, e submetidos à TQT após a intubação traqueal. Eles foram divididos em Grupo TQT Precoce (GTP): <= 7 dias de VMI e Grupo TQT Tardio (GTT): > 7 dias. Nível significativo adotado foi p<= 0,05. Foram incluídos 72 pacientes, 21 pacientes no GTP e 51 no GTT. A idade (GTP= 48, GTT= 51, p=0,101), gênero masculino (GTP= 16, GTT= 35, p=0,521), Apache II (GTP= 15, GTT= 15, p=0,700), Escala de Coma de Glasgow (GTP= 7, GTT= 7, p= 0,716) não apresentaram diferença entre os grupos. O GTP apresentou menor tempo de VMI (p < 0,001), tempo de estadia na UTI (p=0,001), tempo estadia no hospital (p=0,001) e custo indireto (p =< 0,001). A infecção nosocomial (IN) foi a complicação identificada, a IN sistêmica (p=0,088), IN pulmonar (pneumonia associada à ventilação mecânica (p=0,314), sobrevida (p=0,244) e o desfecho hospitalar mais comum (transferência para hospital de longa permanência) (p=0,320), não apresentaram diferença significativa entre os grupos. Em pacientes neurocirúrgicos, a TQT precoce reduziu o tempo de VMI, tempo de estadia na UTI, tempo de hospitalização e custo indireto. Porém não houve diferença na ocorrência de complicações e no desfecho hospitalar entre os grupos / Nearly 24% of the critically ill patients in intensive care unit (ICU) are submitted to tracheostomy (TQT), and the decrease the work of breathing, early weaning and pulmonary toilet are the most common benefits in this procedure, however these benefits are described in heterogeneous patients. The period of early TQT remains controversial, even if this procedure is described for centuries, and between the patients often require prolonged mechanical ventilation (PMV) are the neurosurgical and are susceptible to the development of systemic and pulmonary complications. In addition, there are few studies about the benefits of early TQT in neurosurgical patients with homogeneous characteristics and these are retrospective. There are no reports on the overhead and the hospital outcome of patients, therefore, the aim of this study was to analyze the duration of mechanical ventilation (MV), ICU length of stay (LOS) days, hospital LOS days, indirects costs, occurrence of the complications and patients discharge in neurosurgical submitted to early and late tracheostomy. Prospective, observational study, at the Central Institute of the Clinics Hospital, Medical School, University of São Paulo, from December 2009 until June 2011. Neurosurgical patients admitted at the ICU were included, and submitted to TQT after tracheal intubation were included. They were categorized in Early Tracheostomy Group (ETG) <= 7 days MV and Late Tracheostomy Group (LTG) > 7 days. Statistical analysis significance p < 0.05. 72 patients were included, 21 patients in ETG and 51 in LTG. Age (ETG= 48, LTG= 51, p=0.101), male (ETG 48, GTT= 51, p=0.521), Apache II (ETG= 15, LTG= 15, p=0.700), Glasgow coma scale (ETG= 7, LTG= 7, p= 0.716) no significant different between the groups. The ETG had shorter length of VM (p < 0.001), ICU LOS (p=0.001), hospital LOS (p=0.001) and indirects costs (p < 0.001). Nosocomial Infection (NI) was identificated complication, systemic NI (p=0.088), pulmonary NI (ventilator associated pneumonia- PAV) (p= 0.314), survival (p=0.244) and the most common hospital outcome (transfer to long-term care hospital) (p= 0.320), there were no significant difference between the groups. In neurosurgical patients, the early tracheostomy reduced length of MV, ICU LOS, hospital LOS and the indirects costs. However, there were no difference in the occurrence of complications and patient discharge between the groups

O tratamento cirúrgico por câncer colorretal (CCR) traz consequências fisiológicas e psicossociais na vida dos pacientes e de seus familiares, cujos desafios estão vinculados ao estigma social do câncer e as repercussões mutilatórias. Este estudo teve por objetivos analisar a produção científica nacional e internacional sobre a assistência de enfermagem perioperatória para pacientes com câncer colorretal e estabelecer as recomendações para a sistematização da assistência perioperatória com vistas à alta hospitalar. Trata-se de uma Revisão Integrativa, fundamentada na Prática Baseada em Evidências, cuja pergunta formulada foi: Quais as evidências científicas sobre a alta hospitalar do paciente cirúrgico com câncer colorretal? Os descritores utilizados para as buscas foram Colorectal Neoplasms, Nursing, Discharge, nas bases de indexação eletrônica PubMed, Web of Sciences, Literatura Latino-Americana e do Caribe em Ciências da Saúde (Lilacs), Scopus, Cumulative Index of Nursing and Allied Health Literature (Cinahl) e BDEnf , mediante os critérios de inclusão: estudos primários que abordassem a alta hospitalar do paciente cirúrgico adulto ou idoso com câncer colorretal; publicados no período entre 2005 e 2015 em inglês, espanhol e português; obtidos na íntegra via Biblioteca Central do Campus de Ribeirão Preto da Universidade de São Paulo; e os critérios de exclusão que foram estudos de revisão de literatura e em formato de monografia, dissertação ou tese. Do total de 47 artigos científicos, resultantes das buscas, foram selecionados mediante os critérios de inclusão e exclusão, sete (7) estudos que constituíram a amostra final, sendo que todos foram publicados em inglês, com níveis de evidência pouco fortes (VI e VII) e cujos aspectos abordados foram categorizados em três temáticas: Conhecimentos necessários aos enfermeiros e habilidades requeridas para a sistematização da alta hospitalar; Estratégias para implementar alta hospitalar e Necessidades de pacientes com CCR e familiares. Na temática Conhecimentos e habilidades para o planejamento da alta hospitalar, evidenciou-se que aspectos como fisiopatologia, tratamentos e suas consequências, prognósticos e experiência clínica são importantes para oferecer o suporte profissional adequado às demandas de necessidades de pacientes com CCR e família no perioperatório e para prepará-los para o contexto domiciliário. Na temática Estratégias para implementar alta hospitalar foi enfatizado a utilização do Processo de Enfermagem, de materiais educativos e cuidados especializados, com focalização de conhecimentos sobre a fisiopatologia oncológica, tratamentos e suas consequências e aspectos clínicos para atender a demanda de cuidados especializados desta clientela no perioperatório. Na temática Necessidades de pacientes com CCR e seus familiares verificamos que a demanda de intervenções de enfermagem são para prevenção de infecção do sítio cirúrgico, melhoria do catabolismo e da aprendizagem sobre fisiopatologia oncológica, tratamentos e suas consequências, além do seguimento de controle oncológico, com inclusão da família. Acreditamos que os resultados deste estudo possam subsidiar o planejamento da assistência de enfermagem perioperatória aos pacientes com câncer colorretal para o atendimento da demanda de necessidades específicas do paciente e familiar, favorecendo a transição hospital domicílio / The surgical treatment for colorectal cancer (CRC) brings physiological and psychosocial consequences in patients and their relative\'s life, whose challenges are linked to social stigma of cancer and the repercussions of mutilation. This study aimed to analyze the national and international scientific production about the nursing perioperative assistance to patients with colorectal cancer and establish the recommendations to the systematization of the nursing perioperative assistance aiming the discharge. This is a Integrative Review, grounded in the Evidence Based Practice, whose question formulated was: Which scientific evidences about colorectal cancer patient discharge? The keywords used to search was Colorectal Neoplasms, Nursing, Discharge, at the electronic indexed databases PubMed, Web of Sciences, Literature in the Health Sciences in Latin America and the Caribbean (Lilacs), Scopus, Cumulative Index of Nursing and Allied Health Literature (Cinahl) and BDEnf, by the inclusion criteria: original research about the discharge of the adult or aged patient with colorectal cancer; published between 2005 and 2015 in English, Spanish and Portuguese; with full text by Central Library USP Ribeirão Preto; and the exclusion criteria was reviews, monographs, dissertations and theses. Of 47 scientific papers, result of search, were selected by inclusion and exclusion criteria, seven (7) papers that constituted the final sample, all in English, with little strong reviewed evidence (VI and VII) and whose aspects were categorized in three theme: Knowledge required to nurses and required skills to systematize the discharge; Strategies for implement the discharge and Needs of patients with colorectal cancer and relatives. At Knowledge required to nurses and required skills to systematize the discharge, it became clear that aspects like pathophysiology, treatments and their consequences, prognosis and clinical experience are important to offer professional support suitable for the demands of needs of patients with colorectal cancer and their family at perioperative and to prepare them to home context. At Strategies for implement the discharge it became clear that the utilization of Nursing Process, of specialized educational material, with focusing about the oncologic pathophysiology, treatments and their consequences and clinical aspects to meet the demand of specialized care this clientele at perioperative. At Needs of patients with CRC and relatives we checked that the demand of nursing interventions are to prevent the surgical site infections, to improve catabolism and about the learning of oncologic pathophysiology, treatments and their consequences, beyond to oncologic control, with family including. We believe that the results of this study can subsidize the planning of nursing perioperative care to patients with CRC to meet the demand of specific to patients and their relatives, favoring the transition to hospital for home

Introdução: Com as Reformas Sanitárias e Psiquiátrica, a promulgação das Leis 8.080 de 1990 e 10.2016 de 2001 (Lei Paulo Delgado), ocorreu a reformulação do modelo assistencial de saúde mental no Brasil. A criação da Rede de Atenção Psicossocial (RAPS), com objetivo de articular a Desinstitucionalização, vinculada ao princípio da Integralidade devem ser a práxis do trabalho multiprofissional para garantir os cuidados integrais dos pacientes com transtornos mentais. A Enfermagem, como prática social, pode contribuir fundamentalmente na construção do cuidado afim de sistematizar a alta e vincular pacientes e familiares à rede. Objetivos: Revisar a bibliografia acerca do processo de alta da internação dos pacientes com depressão; levantar os instrumentos ou estratégias de cuidado aplicados pelos enfermeiros; propor instrumento ou estratégias de sistematização do processo de alta. Métodos: Revisão Integrativa que buscou selecionar, organizar e sistematizar os artigos publicados no período de 2005 a 2015, afim de responder à pergunta elaborada pelo acrônimo PICO: quais os instrumentos ou estratégias de cuidados estão sendo utilizados pelos enfermeiros no planejamento da alta hospitalar de pacientes com depressão? A busca foi realizada nas bases de dados BDEnf, LiLACS, ScieLO, PubMed e Cochrane e os dados foram organizados pelo software End Note Web. Resultados: Foram encontrados 1630 artigos indexados nas bases de dados, e após triagem pelos critérios de inclusão/exclusão, obtivemos uma amostra de 14 trabalhos (n=14) que foram lidos integralmente e fichados. Os estudos trouxeram algumas estratégias, porém não foram encontrados instrumentos padronizados. A aplicação de check-list no momento da alta hospitalar e o enfermeiro de ligação, foram sugeridos como ponto de contato entre a rede de assistência, os profissionais, pacientes e seus familiares. Foi proposto um modelo de instrumento para sistematização da alta e vinculação formal com a Atenção Primária à Saúde. / Introduction: With the Sanitary and Psychiatric Reform, the enactment of Law 8080 of 1990 and 10.2016 2001 (Paulo Delgado Law), was the reformulation of the care model of mental health in Brazil. The creation of the Rede de Atenção Psicossocial (RAPS), in order to articulate the deinstitutionalization, linked to the principle of Completeness must be the practice of multi-professional work to ensure the comprehensive care of patients with mental disorders. Nursing, as social practice, can fundamentally contribute to the construction of care in order to systematize the high and link patients and families to the network. Objectives: To review the literature on the process of discharge from hospital of patients with depression; up instruments or care strategies applied by nurses; proposed instrument or systematic strategies of the discharge process. Methods: An Integrative Review that sought to select, organize and systematize the articles published from 2005 to 2015, in order to answer the question prepared by PICO: \"which instruments or care strategies are being used by nurses in hospital discharge planning patients with depression? The search was conducted in BDEnf databases, LiLACS, ScieLO, PubMed and Cochrane and data were organized by End Note Web software. Results: We found 1630 articles indexed in the databases, and after screening for inclusion / exclusion criteria, we obtained a sample of 14 studies (n = 14) were read in full and filed. The studies brought some strategies, but have not found standardized instruments. The application checklist at the time of hospital discharge and the connecting nurse, have been suggested as a contact point between the service network, professionals, patients and their families. An instrument model for systematizing the high and formal link with the Primary Health Care has been proposed.

Diss. (sammanfattning) Stockholm : Karol. inst., 2005. / Härtill 4 uppsatser.

Lic.-avh. (sammanfattning) Stockholm : Karol. inst., 2005. / Härtill 2 uppsatser.