Orientador: Izilda Esmenia Muglia Araujo / Dissertação (mestrado) - Universidade Estadual de Campinas, Faculdade de Ciencias Medicas / Made available in DSpace on 2018-08-06T20:04:18Z (GMT). No. of bitstreams: 1 Bellan_MargareteConsorti_M.pdf: 1469477 bytes, checksum: 6b246d40e4df19b1a0571c088ab4f183 (MD5) Previous issue date: 2006 / Resumo: A equipe de enfermagem freqüentemente é quem testemunha a parada cardiorrespiratória (PCR). Portanto, deve possuir conhecimentos suficientes para realizar os primeiros atendimentos. O sucesso da reanimação cardiorrespiratória (RCR) depende do tempo entre a ocorrência e o início do tratamento, da harmonia e sincronismo da equipe e da capacitação dos profissionais. Foram objetivos do estudo: elaborar um programa de capacitação para enfermeiros na RCR, capacitar o enfermeiro para o atendimento da PCR, avaliar o conhecimento dos enfermeiros antes e após sua participação no programa e comparar a atuação dos enfermeiros submetidos ao programa com os do grupo controle. O estudo foi desenvolvido em um hospital universitário e contemplou três etapas: etapa-I, capacitação teóricoprática; etapa-II, avaliação recente do conhecimento teórico-prático; e etapa-III, avaliação tardia. A amostra foi composta por 21 enfermeiros no grupo-A (controle ¿ não participou do programa de capacitação) e 38 no grupo-B (experimental ¿ participou do programa). Os instrumentos teórico e prático foram submetidos à validação de conteúdo e pré-teste. Na avaliação dos juízes não houve discordância significativa quanto à organização (p=0,368), objetividade (p=1,000), exceto quanto à clareza (p=0,042) para o instrumento-I (teórico). Em relação ao instrumento-II (prático), não houve discordância em nenhum dos itens (p=0,05). Na análise de desempenho dos enfermeiros verificou-se que a média das notas da avaliação teórica no grupo-A variou de forma progressiva nas três etapas: 6,45, 6,66 e 7,10; e no grupo-B de forma oscilante: 6,48, 8,36 e 8,0, respectivamente, com diferença estatisticamente significativa entre os grupos nas etapas II e III (p<0,001). Em relação às atividades práticas do suporte básico de vida (SBV) e suporte avançado (SAV), no grupo-A as médias de notas foram 3,90 e 3,49 na etapa-II e 4,32 e 3,72 na etapa-III, respectivamente, enquanto no grupo-B obtiveram as médias de notas 6,92 e 5,66 na etapa-II e 7,08 e 4,99 na etapa-III, espectivamente. As diferenças entre os grupos nas duas etapas das duas atividades foram significativas (p<0,001). Conclui-se que os conteúdos abordados e os instrumentos utilizados subsidiaram de forma favorável a execução e avaliação do programa de capacitação elaborado e implementado para os enfermeiros no atendimento da PCR. Observou-se melhora no desempenho tanto nas atividades teóricas quanto nas práticas. O grupo-B foi superior em ambos os desempenhos em relação ao grupo-A. No entanto, o desempenho na atividade teórica do grupo-B após uma semana foi superior ao de três meses; já na atividade prática do SBV, o desempenho na etapa-III foi superior à etapa-II, enquanto no SAV o desempenho da etapa-III foi inferior ao da etapa-II. O comportamento do desempenho dos sujeitos do grupo-A diferiu tanto nas atividades teórica como na prática em relação ao grupo-B. Na avaliação teórica observou-se uma melhora progressiva nas três etapas, assim como nas duas etapas das atividades práticas de SBV e SAV. Diante destes resultados, acreditase que o programa de capacitação elaborado poderá ser amplamente utilizado na instituição estudada e também adaptado para utilização em outras / Abstract: Nursing team members are frequently cardiac arrest witness, and therefore must acquire knowledge to perform basic (BLS) and advanced cardiac life support (ACLS). Successful cardiopulmonary resuscitation (CPR) depends on the treatment starting time, team¿s harmony/synchrony and involved professionals¿ capability. The study¿s main objectives were: to elaborate a nursing capacitation program in CPR; to train nurses in performing CPR; to evaluate nurses¿ CPR-knowledge before and after their participation in the program; and to analyse, comparatively, the CPR-performance of nurses that took part or not in the program. The study was developed in an university-hospital and faced three stages: stage-I, theorical-practical capacitation; stage-II, recent evaluation of theorical-practical knowledge; and stage-III, delayed evaluation of theorical-practical knowledge. The time interval between stages I and II was one week and between II and III, three months. Nurses were divided into two groups [A ¿ control (n=21), did not participate; and B ¿ experimental (n=38), did participate on the capacitation program]. Theorical and practical instruments were submitted to content validation and to a pre-test. There were no disagreements amongst judges concerning organization (p=0,368) and objectivity (p=1,000), except for clearness (p=0,042) of the instrument-I (theorical). In relation to instrument-II (practical), there were no disagreement in any items (p=0,05). On the analysis of nurses¿ performance, it was verified that group-A average punctuation in theorical evaluation varied in a progressive way on the three stages (6.45, 6.66 and 7.10, respectively), and in group-B in a non-steady way (6.48, 8.36 and 8.0, respectively) [group-B better than group-A on stages II and III (p<0,001; Tukey-test)]. In relation to practical activities on BLS and ACLS in group-A, the average punctuations were 3.90 and 3.49 on stage-II, and 4.32 and 3.72 on stage-III, respectively, while group-B has got average punctuations of 6.92 and 5.66 on stage-II, and 7.08 and 4.99 on stage-III, respectively [group-B better than group-A on the two stages of two activities (p<0,001; Tukey-test)]. Based on these results, it can be concluded that the approached contents and the used instruments helped in a most favorable way the execution and evaluation of the capacitation program elaborated and implemented to improve nurses¿ CPR-performance. It was observed an improvement not only on theorical activities but also in practical ones. Group-B has shown superior performances than group-A. However, it could be verified that theorical activity performance of group-B, within a week (stage-II), was superior in relation to stage-III (after three months); on the BLS practical activity, subjects¿ performance on stage-III was superior to stage-II, while on the SAV, performance of stage-III was inferior to stage-II. Group-A performance behavior differed not only on theorical activity but also on practical one in relation to group-B. On the theorical evaluation, it was observed a progressive improvement in all three stages, and also on both stages of BLS and ACLS practical activities. Facing these results, it is believed that this elaborated capacitation program can be largely utilized in our own institution and possibly could be adapted and extended to other ones / Mestrado / Enfermagem e Trabalho / Mestre em Enfermagem

Orientador: Izilda Esmenia Muglia Araujo / Dissertação (mestrado) - Universidade Estadual de Campinas, Faculdade de Ciencias Medicas / Made available in DSpace on 2018-08-04T11:53:58Z (GMT). No. of bitstreams: 1 Boaventura_AnaPaula_M.pdf: 414108 bytes, checksum: faae3158a2586452ce01d7978f40b00b (MD5) Previous issue date: 2004 / Resumo: A situação encontrada na prática dos atendimentos da parada cardiorrespiratória é a de que os registros não são feitos adequadamente, ou são incompletos, relatando apenas o horário da PCR e o óbito, quando deveriam conter maior número de informações, como fármacos utilizados durante o atendimento, os ritmos cardíacos, o número de choques realizados, entre outros. Se forem analisados os prontuários médicos de pacientes hospitalizados que apresentaram parada cardiorrespiratória, possivelmente haverá dificuldades na realização de estudos retrospectivos de ressuscitação cardiorrespiratória, pela impossibilidade de coletar dados que poderiam colaborar no aprimoramento e na avaliação da atuação da equipe, como também, de estudos de sobrevida e prognóstico em ressuscitação cardiorrespiratória diante da escassez de dados que são registrados.O presente estudo teve por objetivo validar e aplicar um instrumento para o registro do atendimento da PCR/RCR no ambiente intra-hospitalar de uma instituição de ensino. A validação de um instrumento é etapa de fundamental importância antes da sua utilização pois verifica a qualidade dos dados. Sua aplicação em uma determinada população também permite perceber como se comporta o instrumento no ambiente em que se pretende implementá-lo, para isso, o instrumento adapatado foi submetido a validação de conteúdo e verificada também sua aplicabilidade. O instrumento foi validado por juízes, quanto ao seu conteúdo. Após, os instrumentos foram utilizados pelos enfermeiros das unidades: PS, UTI, EC/CT, Cardiologia e Moléstias Infecciosas para avaliação da aplicabilidade do instrumento. Na análise dos dados da avaliação dos juízes não houve discordância significativa quanto à clareza (p= 0,353), objetividade (p=0,333) e organização (p=0,107) (Teste de Cochran). Foram coletados 54 registros de atendimento da RCR e após o preenchimento os enfermeiros avaliaram o instrumento quanto a sua utilidade, praticidade e objetividade, obtendo-se mais que 90% de respostas positivas. Na análise dos preenchimentos constatou-se que a média de preenchimento dos dados de identificação do paciente foi de 92,7%; da PCR 72,18%; RCR 81,75%; pós-RCR 89,58%; equipe de atendimento 27,41% e anotações apenas 7,41%. Conclui-se que o instrumento adaptado para o registro dos atendimentos da PCR/RCR, no ambiente intra-hospitalar, foi validado e atende às necessidades da realidade desses atendimentos no hospital estudado. Dessa forma a utilização deste instrumento que apresenta menor complexidade poderia estimular a prática de registros do atendimento da PCR / RCR, orientar novos treinamentos, bem como, direcionar investimentos em recursos físicos e materiais adequados para as unidades destinadas ao cuidado de pacientes críticos e contribuir para a melhoria dos atendimentos / Abstract: Usually, during in-hospital cardiopulmonary resuscitation (CPR), there is a lack of comprehensive records about the whole procedure, or, more often, they are incomplete, reporting only the times of cardiac arrest (CA) and of death. OBJECTIVES: The objectives of the present study were to validate and to apply an instrument that was elaborated to record in-hospital CPR maneuvers in a teaching institution. The validation is the fundamental importance before utilization of an instrument, verifies your quality and the application of an instrument in a determined population also is going to perceive as behaves the instrument in environment that him implemented, for that, the instrument was submitted the validation of content and verified also its aplicability. METHODS: The instrument was previously validated by experts judges regarding its subject matter, and thereafter it was applied by registered nurses at the emergency room, adult intensive care unit, clinical and surgical emergency wards, during cardiac arrest events in order to evaluate its pratical applicability. RESULTS: Data analysis has shown that there was no disagreement among judges regarding the instrument¿s intelligibility (p=0,353), objectivity (p=0,333) and organization (p=0,107). (Cochran¿s test). Fifty- four records of in-hospital CPR have been done, and the nurses were argued to evaluate the instrument¿s utility, praticity and objectivity, within more than 90% of positive answers. Informations concerning patient¿s identification (92,7%), CA characterization (72,18%), CPR maneuvers (81,75%), post-CPR procedures (89,58%), team of attendance (27,41%) and general annotations (7,41%), were possible to be retrieved form the applied instrument. CONCLUSIONS: It was concluded that an adapted instrument for recording in-hospital CPR procedures could be validated and easily applied by nurses in a teaching hospital. The utilization of this instrument would be able to stimulate to practical of records, news training, direct investments and adequate in-hospital CPR maneuvers in the units destined to take care of critical patients and contribute for the improvement during in-hospital cardiopulmonary resuscitation / Mestrado / Enfermagem e Trabalho / Mestre em Enfermagem

Aim: Spanish-only speaking residents in the United States face barriers to receiving potentially life-saving 911 interventions such as Telephone-cardiopulmonary resuscitation (TCPR) instructions. Since 2015, 911 dispatchers have placed an increased emphasis on rapid identification of potential cardiac arrest. The purpose of this study was to describe the utilization and timing of the 911 system during suspected out-of-hospital cardiac arrest (OHCA) by Spanish-speaking callers in Metropolitan Phoenix, Arizona. Methods: The dataset consisted of suspected OHCA from 911 centers from October 10, 2010 through December 31, 2013. Review of audio TCPR process data included whether the need for CPR was recognized by telecommunicators, whether CPR instructions were provided, and the time elements from call receipt to initiation of compressions. Results: A total of 3398 calls were made to 911 for suspected OHCA where CPR was indicated. A total of 39 (1.2%) were determined to have a Spanish language barrier. This averages to 18 calls per year with a Spanish language barrier during the study period, compared with 286 OHCAs expected per year among this population. The average time until telecommunicators recognized CPR need was 87.4 s for the no language barrier group compared to 160.6 s for the Spanish-language barrier group (p < 0.001). Time to CPR instructions started was significantly different between these groups (144.4 s vs 231.3 s, respectively) (p < 0.001), as was time to first compression, (174.4 s vs. 290.9 s, respectively) (p < 0.001). Conclusions: Our study suggests that Hispanic callers under-utilize the 911 system, and when they do call 911, there are significant delays in initiating CPR. (C) 2017 Elsevier B.V. All rights reserved.

Background: Arterial cannulation and intra-arterial (IA) fluid and blood resuscitation in the patients with severe shock is an easier approach compared with the intravenous (IV) access if concerns regarding the efficiency and safety of this approach are addressed. Objectives: We hypothesized that IA fluid resuscitation is more effective than IV resuscitation in restoring cardiac contractions (CC) of cardiac-arrested mice following severe hemorrhagic shock. Methods: Mice (N = 22) were anesthetized using ketamine/xylazine. Arterial and venous systems accessed through cannulation of the carotid artery and the Jugular vein, respectively. As much blood as possible was aspirated from the carotid artery access. Mice were observed until the complete cessation of chest wall motions. Following 30 seconds delay, IV (N = 5) and IA access (N = 6) were used for fluid resuscitation using Ringer Lactate (RL) in a similar volume to the aspirated blood. Mice were observed for restoration of chest wall motions. In phase-II of the study, after cessation of chest motions, mice (N = 11) underwent a thoracotomy and CCs were observed. In three mice, IV RL Infusion after cardiac arrest failed to restore CCs and was followed by IA RL infusion. In eight mice, following cardiac arrest intermittent IA RL infusion was performed. Results: While IV RL Infusion failed to restore chest motion in mice (N = 5), IA RL infusion restored chest motion in all mice examined (N = 6) (P = 0.0067). In three mice, IV RL infusion after cardiac arrest showed no effect on CC. After failure of venous infusion, IA RL infusion was performed which resulted in restoration of CC for 13.33 +/- 1.76 minutes. In eight mice, intermittent IA infusion of RL after cardiac arrest, sustained CC for 31.43 +/- 10.9 minutes (P = 0.017). Conclusions: IA fluid resuscitation is superior to IV resuscitation in hemorrhagic shock induced cardiac arrest.

Background: For nurses in hospitals, the presence of close relatives in cardiopulmonary resuscitation (CPR) can be an uncertain experience. In 2015, 91 000 deaths occurred in Sweden, many of them in hospitals. Aim: This study aimed to explain nurses' experiences of relatives' presence at cardiopulmonary resuscitation in hospitals. Method: A literature review based on six qualitative and five quantitative articles was performed. Result: Two main themes, to invite and to not invite, constituted the result with four subthemes. The main theme to invite had two subthemes, good occupational experience and self-confidence. The main theme to not invite comprised likewise two subthemes, insecurity about absent guidelines and worry about relatives' reaction. Conclusion: A majority of the nurses believed that relatives should be present at CPR. Nurses believed that relatives easier could accept their relatives' death if they were able to touch their relative, share the last moments in life and say goodbye. Improvement of guidelines and development work is needed to maintain nurses' positive view of relatives' presence at CPR in hospital settings. To strengthen this, national guidelines are also necessary to assist local guidelines.

Background: Nurses experience both positive and negative experiences when dealing with patients relatives who are present during resuscitation. Factors that affect this include the current situation, past experiences and the nurses knowledge. Nurses percieve support as important for relatives that should be offered in form of a contact person. Problem: Relatives may be an important part of the patient's life but don’t always get the opportunity to participate in decision-making regarding their presence at the patient's resuscitation. Aim: To investigate the experiences of attending resuscitation in hospital from a relatives perspective. Method: Literature study with qualitative approach. Results: Relatives describe positive experiences when present such as ensuring that everything is done for the patient and to see how healthcare professionals act. The negative experiences are anxiety, fear and helplessness. Relatives may be in need of contact with the patient to support him/her and also with healthcare professionals to see their efforts. Conclusion: Relatives experience advantages when attending the resuscitation, which nurses should think about. To support relatives a contact person from the care team should be available. Guidelines concerning relatives presence in the hospital should be formed as a support for the nurses. / Bakgrund: Sjuksköterskor upplever både positiva och negativa erfarenheter i samband med närståendes närvaro vid återupplivning. Faktorer som påverkar är exempelvis den rådande situationen, tidigare erfarenheter och deras kunskap. Sjuksköterskor uppfattar stöd för närstående som viktigt under återupplivning på sjukhus, vilket kan erbjudas i form av en kontaktperson. Problem: Närstående kan vara en viktig del i patientens liv men får inte alltid delta i beslutsfattandet kring sin närvaro vid patientens återupplivning på sjukhus. Syfte: Syftet är att undersöka närståendes upplevelser av att närvara vid återupplivning på sjukhus. Metod: Litteraturstudie med kvalitativ ansats. Resultat: Närstående beskriver positiva upplevelser av att närvara som exempelvis att kunna se allt som genomförs på patienten och hur vårdpersonal agerar i situationen. De negativa upplevelserna är oro, rädsla och hjälplöshet. Närstående kan vara i behov av kontakt med patienten för att stödja denne och med vårdpersonal för att se insatserna som genomförs. Slutsats: Närstående upplever fördelar med att närvara vid återupplivning på sjukhus, vilket bör vara något som tas i åtanke av sjuksköterskor. För att lyckas stödja närstående så bör en kontaktperson från vårdteamet finnas lätttillgänglig. Riktlinjer vad gäller närståendes närvaro på sjukhus bör utformas som ett stöd vad gäller hanterandet.

Emergency department (ED) nurses exposed to pediatric resuscitations are at a high risk of developing posttraumatic stress (Adriaenssens et al., 2012; Lavoie et al., 2016). This may be especially true in community hospital EDs where nurses have less exposure to, knowledge about, and resources for managing these events (Gangadharan et al., 2018; Gilleland et al., 2014; Goldman et al., 2018). Interventions to proactively prevent nurse trauma in these contexts remain uninvestigated. To inform such interventions, this study aimed to understand the largely unknown lived experiences of these nurses. In-depth, semi-structured interviews were conducted with four registered nurses who experienced at least one pediatric resuscitation while working in a community hospital ED in Ontario. Data analyzed using Smith et al.’s (2009) interpretive phenomenological analysis revealed three superordinate themes (i.e., “Conceptualizing Pediatric Resuscitations,” “Seeing What I See,” and “Making Sense of What I Saw”) and nine corresponding subthemes. This study provides insight into the infrequent but profound experiences of nurses resuscitating children in community hospital EDs. Participants, who conceptualized these events as unnatural, emotional, and chaotic, were comforted by those who understood their experiences and distressed by those who could not see what they saw. To reconcile what they saw, the nurses reflected and ruminated on the event, ultimately restructuring their experiences of themselves, others, and the world to make room for a new reality where the safety of childhood is not certain. The findings of this study have implications for nursing practice, education, leadership, and research that may enhance nurse coping following these events.

Cardiac arrest is the leading cause of death in the United States. By reviewing and analyzing the successes and failures of resuscitation efforts, it has been possible to identify critical components which have come to be known as the “Chain of Survival:” Early Recognition, Early CPR, Early Defibrillation, Early ALS, and Early Post Resuscitative Care. A failure in any one of the five links will result in a failed resuscitation. Early Recognition is the beginning of the resuscitation effort and includes a number of related components. Witnessed cardiac arrests, those that are seen or heard to occur, have a significantly higher chance of survival than those which are unwitnessed. Properly identifying agonal gasps: irregular, forceful, reflexive breaths which can occur during cardiac arrest, is key to recognition of arrest and activation of the emergency response system. Emergency dispatchers trained to recognize cardiac arrest, as well as to initiate Early CPR via telephonic instruction, have been identified as key personnel in the resuscitation effort. Once professional rescuers have been dispatched, response delays due to distance and traffic can be costly. The use of new technologies like GPS and traffic signal preemption (as well as the use of Police, Fire and EMS in conjunction) has been shown to make it possible to get qualified persons to the scene of a cardiac arrest more safely and more quickly. Once on scene, early, high quality CPR has been shown to dramatically improve survival. After just 8 minutes without assistance, a victim of cardiac arrest has a near zero percent chance of survival. CPR of high quality has been shown to help maintain survivability until more definitive care can be obtained. Early Defibrillation is another key component to survival in many cardiac arrests. While CPR can sustain organ function briefly, cardiac arrest is rarely reversed without defibrillation. Increasingly widespread prevalence of public automated external defibrillators (AEDs) has made Early Defibrillation easier. Furthermore, increased use of AEDs by lay and professional rescuers has called into question the value of more traditional, higher risk interventions like intubation and medication administration. Early ALS interventions have been a staple of resuscitation for decades, but there is little data to support the use of these interventions during cardiac arrest. Early Post-Resuscitative Care, however, has been shown to be an area where invasive ALS interventions can and do make a difference in improved survival. By looking at the body of research for links in the Chain of Survival, opportunities for improvement of resuscitation were identified. Persons who spend significant time around an individual at high risk for heart disease should be educated on possible precipitating symptoms of a myocardial infarct or other early signs of potential cardiac arrest. Persons likely to encounter a cardiac arrest should likewise be trained not only in how to recognize cardiac arrest (through the combination of unresponsiveness and abnormal breathing) but also to initiate basic care via compressions-only CPR. Emergency dispatchers should be increasingly trained to recognize cardiac arrest, as well how to effectively provide dispatcher assisted CPR. The focus of these efforts should be high quality CPR and the early deployment of defibrillation. The use of AEDs by bystanders should be encouraged whenever possible. The emphasis on CPR and use of an AED should be paramount, with invasive ALS interventions eschewed for the simpler and more effective therapies. Once ROSC has been obtained, the use of ALS interventions in unstable patients has been shown not only to prevent death due to transient hemodynamic instability, but also to improve the likelihood of survival with little to no neurological deficit. By embracing the chain of survival, and identifying the critical areas in need of research and improvement, it is possible to provide recommendations that may lead to improved survival from cardiac arrest.

No description available.

Background: According to the ethical guidelines, family members of the patient should be allowed to be present during cardiopulmonary resuscitation (CPR). Nurses should be able to, besides performing CPR, decide if family presence is appropriate, support and explain the course of events to the family. Aim: The aim of this study was to illuminate nurses' experiences of family presence during resuscitation. Method: A literature study has been made of 11 qualitative studies, where differences and similarities were analysed. The studies were published between the years 2000 – 2015. Result: Two main themes were identified and five subthemes. The main themes were: "The nurse's experience of their work situation" and "The nurse's experience of the circumstances that affects the nursing". The findings showed that the nurses experienced a dilemma when they needed to decide if family presence was appropriate. The nurses experienced that a bond could be created with the families through the role of support person. They experienced that the family members could participate in the care but they could also be a distraction and a source of stress. Conclusion: Clear local guidelines would facilitate the decision if family presence is appropriate. A support person for the family would also facilitate the family's presence. More education and experience in this subject helps nurses overcome fears of difficulties often associated with family presence.