Navegando por Palavras-chave "Emergency nursing"
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- ItemAcesso aberto (Open Access)Ausências dos colaboradores de enfermagem do pronto-socorro de um hospital universitário(Escola Paulista de Enfermagem, Universidade Federal de São Paulo (UNIFESP), 2012-01-01) Fakih, Flávio Trevisani [UNIFESP]; Tanaka, Luiza Hiromi [UNIFESP]; Carmagnani, Maria Isabel Sampaio [UNIFESP]; Universidade Federal de São Paulo (UNIFESP)OBJECTIVE: To verify and analyze absences of nursing staff of the adult emergency room (AER) of a university hospital. METHODS: A study using a quantitative approach, observational and prospective, conducted between January and December, 2009, involving the nursing staff of a AER. RESULTS: The AER had, on average, 96.8 employees per month. Expected absences corresponded to 30.1% of working days. The absenteeism rate was 11.7%. There was a greater incidence of unplanned absences during the periods of May (15.3%) and August (13.3%). CONCLUSION: There was a correlation between the variables: professional category, employment contract and shift work, and the distribution of expected and unexpected absences. Absenteeism was considered high and motivated, mainly, by allowances for health care greater than 15 days. The monthly deficit of staff also contributed to the work overload of the team.
- ItemAcesso aberto (Open Access)Avaliação do conhecimento da equipe de enfermagem sobre erros de medicação e terapêutica medicamentosa utilizada em um pronto-socorro infantil(Universidade Federal de São Paulo (UNIFESP), 2014-06-25) Macedo, Giselle Pinto de Oliveira Sa [UNIFESP]; D'Innocenzo, Maria D'Innocenzo [UNIFESP]; Bohomol, Elena [UNIFESP]; http://lattes.cnpq.br/0048156985550471; http://lattes.cnpq.br/8539986249567784; http://lattes.cnpq.br/0862271250121926; Universidade Federal de São Paulo (UNIFESP)Erros de Medicação estão presentes no cotidiano dos profissionais de saúde e acarretam graves consequências ao paciente, incremento no custo das internações, além de problemas no âmbito da organização hospitalar. A administração de medicamentos é um processo dinâmico e complexo, com várias etapas que contempla uma série de decisões específicas e ações inter-relacionadas, capazes de envolver profissionais de toda uma equipe multidisciplinar bem como o próprio paciente. Na faixa etária pediátrica, erros de medicação geram importantes complicações e têm sido relacionados a um maior risco para a ocorrência de iatrogenia. Objetivo: Analisar o grau de conhecimento da equipe de enfermagem sobre o conceito de erros de medicação e terapêutica medicamentosa de acordo com idade, tempo de formação, tempo de trabalho na instituição, categoria profissional, esquema de atuação, turno e regime de contrato. Método: Realizou-se um estudo exploratório e descritivo, no Pronto-Socorro Infantil (PSI) de um hospital universitário, no município de São Paulo. A coleta de dados foi realizada por um período de 60 dias, durante os meses de agosto e setembro de 2012, entre os profissionais de enfermagem do PSI, após a aprovação do projeto pelo Comitê de Ética em Pesquisa, autorização do Setor de Ensino e Pesquisa e submissão dos instrumentos de coleta para avaliação. Para a realização da avaliação do conteúdo dos instrumentos foi solicitada a participação de um comitê de consultores externos constituída por enfermeiros e professores universitários. Os dados foram armazenados em banco de dados do programa SPSS (Statistical Package for the Social Sciences). Para a comparação das variáveis quantitativas o teste utilizado foi o não paramétrico de Mann-Whitney e para a comparação das variáveis qualitativas foi utilizado o teste do Qui-Quadrado ou o Exato de Fisher. Considerou-se estatisticamente significante valores de p<00,5. Resultados: Os participantes da pesquisa constituíram-se por 37 profissionais de enfermagem, nove (24,3%) enfermeiros, nove (24,3%) técnicos de enfermagem e 19 (51,4%) de auxiliares de enfermagem. Destes participantes 91,9% eram do sexo feminino, 59,5% deles trabalhavam apenas na instituição da pesquisa e eram contratados em regime celetista, com média de idade de 38 anos, tempo médio de formação profissional de 11,3 anos e tempo médio de trabalho na instituição pesquisada de 7,2 anos. Pode-se evidenciar que os participantes da pesquisa demonstraram conhecimento uniforme e linear sobre o conceito erros de medicação. O quinto item do questionário registrou que 26 (72,9%) dos participantes discordaram e/ou discordaram completamente que atrasos superiores a uma hora correspondem a erro de medicação. Não foi possível observar diferença estatisticamente significativa entre profissionais de nível técnico e de nível superior com relação a esse tipo de erro de medicação. Quanto aos cenários elaborados, pode-se verificar que os participantes apresentam entendimento nivelado e uniforme sobre terapêutica medicamentosa. No entanto, no cenário 3 referente à administração de adrenalina e de outros fármacos, via cânula orotraqueal, devido à ausência de rede venosa, observou-se que houve diferença estatisticamente significante (p<0,05) segundo o teste do Qui-Quadrado, com relação a proporção de acertos entre os participantes da pesquisa e os diferentes esquema de atuação. O grupo de profissionais de enfermagem que trabalham na instituição da pesquisa e que estudam apresentou menor percentual de acertos (42,9%) da resposta esperada do que os demais grupos com diferente esquema de trabalho. Conclusões: A equipe de enfermagem do PSI apresentou maior conhecimento sobre erros de medicação do que terapêutica medicamentosa em situações de urgência. Porém, torna-se necessário a implantação de programas de treinamento e capacitação por parte da educação continuada das instituições, em unidades pediátricas, com o propósito de ampliar o conhecimento dos profissionais de enfermagem sobre o processo de medicação e assim, garantir a qualidade de assistência e segurança junto aos pacientes pediátricos.
- ItemAcesso aberto (Open Access)Avaliação do website educacional em Primeiros Socorros(Universidade de São Paulo, Escola de Enfermagem, 2013-08-01) Mori, Satomi; Whitaker, Iveth Yamaguchi [UNIFESP]; Marin, Heimar de Fatima [UNIFESP]; Universidade Federal de São Paulo (UNIFESP)The aim of this study was to evaluate the structure, quality of information and usability of a website on First Aid. The evaluation was performed by information technology (IT) and health care professionals and by students, using specific and validated instruments. The kappa method was used to evaluate the agreement of the answers, and Cronbach’s α coefficient was used to assess the reliability of the instrument. There was no agreement (0.047) among the answers obtained from the IT professionals, indicating that the structure of the website must be reviewed. There was also no agreement in the evaluation by the health care professionals (-0.062); however, the overall positive scores suggest that the quality of the information of the website is adequate. The assessment of reliability of the instrument to evaluate the navigability rendered a value of α=0.974. Although improvement of the website structure is recommended, the quality of the information is good, and its use has contributed to the apprenticeship of students.
- ItemAcesso aberto (Open Access)Classificação de risco no serviço de emergência: associação entre as suas categorias e os desfechos do paciente(Universidade Federal de São Paulo (UNIFESP), 2014-05-25) Becker, Juliana Barros [UNIFESP]; Batista, Ruth Ester Assayag [UNIFESP]; Barbosa, Dulce Aparecida [UNIFESP]; http://lattes.cnpq.br/1924137485244907; http://lattes.cnpq.br/7232913011589777; http://lattes.cnpq.br/7975003037777468; Universidade Federal de São Paulo (UNIFESP)O problema da superlotação dos serviços de emergência (SE) é uma realidade mundial, principalmente em países em desenvolvimento, traduzindo um baixo desempenho dos sistemas de saúde. Mundialmente há recomendação para a implantação da triagem de pacientes nos Serviços de Emergência com o objetivo de melhorar a assistência prestada. Seguindo estas diretrizes o Hospital Universitário da Universidade Federal de São Paulo (UNIFESP) desenvolveu e implantou um protocolo que utiliza a classificação em cinco níveis de gravidade, este definido pela queixa principal do paciente. O objetivo deste estudo foi avaliar se as categorias do protocolo de classificação de risco (CR) estão associadas à morte, internação hospitalar e alta. Métodos: Estudo observacional, tipo coorte retrospectivo, realizado no SE do Hospital São Paulo (HSP), UNIFESP, com pacientes maiores de 18 anos submetidos ao protocolo de CR no mês de agosto de 2012. Resultados: O maior número de pacientes submetidos ao protocolo de CR do SE foi classificado como baixa prioridade. A proporção de óbitos foi maior no grupo de pacientes classificados como alta prioridade. Os homens apresentaram maior taxa de internação hospitalar e óbito em relação às mulheres (?²=13,58; p=0,0011). Pacientes classificados como alta prioridade apresentaram taxa de internação cinco vezes maior e a taxa de óbitos 10,6 vezes maior em relação aos pacientes classificados como baixa prioridade (?²= 214,99; p <0,0001). Observou-se predominância das especialidades clínicas no grupo de maior prioridade (?²= 48.47; p< 0,0001), uma maior taxa de internação e óbito (?²= 20.04; p <0,0001) e um maior tempo de internação hospitalar (ANOVA F = 13.0; p=0,0004) quando comparados às especialidade cirúrgicas. Conclusão: O grupo de maior prioridade associou-se a maiores taxas de internação e óbitos. O protocolo foi capaz de detectar pacientes com condições mais urgentes e identificar fatores de risco para internação hospitalar e óbito. Os resultados encontrados demonstram que desenvolvimento de protocolos próprios, pode ser uma alternativa a protocolos internacionais em Instituições de Saúde com recursos financeiros limitados.
- ItemAcesso aberto (Open Access)Competência profissional do enfermeiro de urgência e emergência: desenvolvimento do processo de avaliação(Universidade Federal de São Paulo (UNIFESP), 2016-05-25) Holanda, Flavia Lilalva de [UNIFESP]; Cunha, Isabel Cristina Kowal Olm Cunha [UNIFESP]; http://lattes.cnpq.br/8695765272291430; http://lattes.cnpq.br/4048315298523475; Universidade Federal de São Paulo (UNIFESP)Objectives: To develop a process to create an instrument to evaluate the professional competencies of nurses in emergencies and to evaluate the evidence of validity and internal consistency of the proposed competencies. Method: Quantitative study with a non-experimental, descriptive and methodological design, carried out from 2011 to 2016, in a public university in the city of São Paulo, Brazil, based on the psychometric benchmark. In order to meet the criteria of the types of research and the use of this reference in the elaboration of an instrument to measure human behavior, the study was developed in stages, according to Pasquali. These steps were carried out in different and consecutive ways in the necessary Theorical, Empirical and Analytical Procedures to direct the investigation to its final objective. As for the theorists, the objective was to base the construction to scientifically support the instrument to be elaborated with necessary actions to the competent practice of the nurse in emergencies. It was dedicated to the survey of the literature and to the Construction of a Professional Competency Matrix of the nurse in emergency services. In this construction, it is considered empirical to evidence already obtained knowledge and experience of the researchers to establish the quantitative and nominal aspects, as well as the constitutive and operational definitions of the process. The Matrix was composed of Basic and Associated Competences and from it a Professional competency profile of nurses working in emergency services was proposed, aligned with the market trends, the particularities of Nursing in emergencies, the existing studies and the opinion of experts who considered the ownership of the actions to the performance Nurses in this area necessary for the definition of the construct. The Competence Assessment Instrument was organized into five parts: a spreadsheet with measurable actions at five levels of competence; Scale of evaluation of the degree of professional competence of nurses in emergencies; Personal and professional characterization data of the research subject and three fictitious cases. In Empirics, the sample, the application of the pilot instrument and the data collection were calculated and defined, and the psychometric quality of the instrument was evaluated. The Analytics were descriptive and inferential. Results: From the eight Basic Competences and the 32 Associated Competencies indicated in the Matrix, there were 56 attitudes / behaviors represented by actions named Identifying Issues generating the Competence Profile. After verifying the evidence of validity based on the content of the Identification Questions by nurse experts in the subject, we searched for evidence of validity of the item of the construct proposed in the instrument. 448 nurses participated in this process, with 407 self-assessments and 41 managers responding to 407 hetero-evaluations, making a total of 814 instruments applied in hospitals, Emergency Care Units 24h (AMA) and Mobile Medical Emergency Services (SAMU). The exploratory factorial analysis of the 81 items indicated the existence of seven factors that, after excluding three of these items, explained 66.5% of the total data variance. Alpha Cronbach ranged from 0.79 to 0.98. The evaluation of the scores by characteristics verified different means by gender, institutions, specialists and nurses with different courses inherent in emergencies. Conclusion: A process was developed for the creation of an Instrument for the Evaluation of Professional Competences of nurses in emergencies with evaluation of validity evidences throughout the study.
- ItemAcesso aberto (Open Access)Construção da Matriz de Competência Profissional do enfermeiro em emergências(Escola Paulista de Enfermagem, Universidade Federal de São Paulo (UNIFESP), 2014-08-01) Holanda, Flávia Lilalva de; Marra, Celina Castagnari; Cunha, Isabel Cristina Kowal Olm [UNIFESP]; Universidade Federal de São Paulo (UNIFESP)Objective:To propose a Professional Competency Matrix for the nurse working in emergency services. Methods:This is a descriptive study that details quantitative, nominal and conceptual aspects of the proposed competencies. The creation of the Competency Matrix was based on the professional experience of the researchers, empirical evidence, and specialized literature. Results:The proposed Professional Competency Matrix was composed of eight basic competencies, with 31 associated competencies attributed to them. Conclusion:The proposed matrix directs nursing practice toward a level of excellence, facing the quality assumptions and access to care for emergency patients.
- ItemAcesso aberto (Open Access)Hospital morbidity of injured motorcyclists: factors associated with length of stay(Univ Fed Sao Paulo, Dept Enfermagen, 2016) de Araujo, Giane Leandro; Whitaker, Iveth Yamaguchi [UNIFESP]Objective: Identify factors of injured motorcyclists associated with hospital length of stay. Methods: A retrospective cross-sectional study of motorcyclists with acute traumatic injury admitted to three reference trauma hospitals in Sao Paulo. Medical records of patients and necropsy reports were analyzed to extract variables that could be associated with length of stay, followed by an analysis by multiple linear regression to verify associated factors. Results: One analysis of 91 motorcyclists showed that the following were associated with long length of stay (p<0.05): increased severity of trauma and infectious complications, pressure ulcers, rhabdomyolysis, and acute respiratory distress syndrome. Pressure ulcers and surgical site infections were predictors of long length of stay and death was a predictor of reduced length of stay. Conclusion: The factors associated with length of stay resulted from both traumatic injury and the care provided to injured motorcyclists.
- ItemAcesso aberto (Open Access)Measuring trauma severity using the 1998 and 2005 revisions of the Abbreviated Injury Scale(Universidade de São Paulo, Escola de Enfermagem, 2014-08-01) Lopes, Maria Carolina Barbosa Teixeira; Whitaker, Iveth Yamaguchi [UNIFESP]; Universidade Federal de São Paulo (UNIFESP)Objetivo: Comparar a gravidade das lesões e do trauma mensurada pelas versões da Abbreviated Injury Scale 1998 e 2005 e verificar a mortalidade nos escores Injury Severity Score e New Injury Severity Score nas duas versões.Método: Estudo transversal e retrospectivo analisou lesões de pacientes de trauma, de três hospitais universitários do município de São Paulo, Brasil. Cada lesão foi codificada com Abbreviated Injury Scale 1998 e 2005. Os testes estatísticos aplicados foram Wilcoxon, McNemar-Bowker, Kappa e teste Z.Resultados: A comparação das duas versões resultou em discordância significante de escores em algumas regiões corpóreas. Com a versão 2005 os níveis de gravidade da lesão e do trauma foram significantemente reduzidos e a mortalidade foi mais elevada em escores mais baixos. Conclusão: Houve redução da gravidade da lesão e do trauma e alteração no percentual de mortalidade com o uso da Abbreviated Injury Scale 2005.
- ItemSomente MetadadadosMorbidade hospitalar decorrente de lesões traumáticas: análise dos fatores de risco relacionados às complicações(Universidade Federal de São Paulo (UNIFESP), 2014-10-29) Aguiar Junior, Wagner de [UNIFESP]; Whitaker, Iveth Yamaguchi [UNIFESP]; http://lattes.cnpq.br/4954772252354513; Universidade Federal de São Paulo (UNIFESP)Complications that arise during treatment of traumatic injuries are major causes of morbidity and mortality. Objective: To identify the complications and risk factors related to complications in trauma patients during hospitalization. Method: Retrospective observational study based on secondary data, conducted in a university hospital in São Paulo. The sample consisted of trauma patients treated in the emergency room and hospitalized in 2011, whose medical records were available for consultation. In the data analysis the complications were considered as the dependent variable and using the chi-square or Fisher's exact, Student t test or Mann-Whitney test, Mantel-Haenszel and logistic regression were applied. Results: The sample consisted of 407 patients and 194 (47.66%) had records of 500 complications, the most frequent infectious (41.80%), renal and metabolic (12.20%) and lung (10,00%). The occurrence of complications was statistically significant with increasing age (p = 0.037) in patients with burns (p <0.001) and those who died (p <0.001), and when two or more operations were performed (p <0.001). Patients with complications remained hospitalized twice the time and the higher the severity of the trauma greater number of patients with complications (p <0.001). The final model of logistic regression indicated age (OR = 1.02), length of hospital stay (OR = 1.02), burns (OR = 3.91) and falls (OR = 3.09) with scores < 8 on the Glasgow Coma Scale (OR = 4.25) and ISS scores between 25 and 40 (OR 8.58) and between 16 and 24 (OR = 2.46) as risk factors for posttraumatic complications factors during period of hospitalization. Conclusion: Infectious complications were the most frequent and before the identified risk factors, underscores the importance of surveillance and preventive measures in reducing complications in hospitalized trauma patients.
- ItemAcesso aberto (Open Access)Reinternação e adesão ao tratamento de pacientes com insuficiência cardíaca após orientação de alta e contato telefônico de enfermagem(Universidade Federal de São Paulo (UNIFESP), 2017-12-20) Oscalices, Monica Isabelle Lopes [UNIFESP]; Batista, Ruth Ester Assayag [UNIFESP]; Campanharo, Cássia Regina Vancini [UNIFESP]; http://lattes.cnpq.br/1796718487677796; http://lattes.cnpq.br/7232913011589777; http://lattes.cnpq.br/2749068884606714; Universidade Federal de São Paulo (UNIFESP)Adherence to treatment is a challenge for patients with chronic diseases, mainly heart failure, because most patients do not recognize the signs and symptoms, end up not participating or adhere properly to the treatment. The knowledge of Heath Literacy in patients with heart failure is shown as an important tool about the complexity of the disease’s treatment, and can be improved through health education. Telephone follow-up is an extension of the discharge orientation and is considered an important tool in nursing education, which has proved to be effective in increasing adherence to the treatment of patients with heart failure, but its efficacy is not widely evaluated studied. Objectives: To compare the effectiveness of the nursing intervention in adherence to treatment, rehospitalization and mortality in patients with heart failure, and to associate the level of Heath Literacy with drug adherence, barriers to nonadherence, and rehospitalization and mortality rates of these patients. Methods: A randomized, non-blinding clinical study included 201 patients admitted to the emergency room with a diagnosis of heart failure. On discharge, patients were divided into Control Group and Intervention Group, with specific Intervention Group discharge orientation and, after 90 days, treatment adherence was evaluated through the Morisky-Green, Brief Medical Questionnaire and non-drug adherence tests. In Intervention Group, the Heath Literacy level was evaluated through the Newest Vital Sign test, and contacts were made for reorientation by telephone calls at two moments. The generalized estimating equation model (p<0.05%) was used for statistical analysis. Results: 101 patients were allocated to Control Group and 100 to Intervention Group, with a mean age of 62.6±15.2. After 90 days, Intervention Group showed greater adherence to the treatment in relation to the Control Group (p<0.001). There was a higher incidence of readmissions and death in the Control Group when purchased from the Intervention Group (p<0.01). Patients with low Heath Literacy had worse drug adherence and presence of more barriers to adherence, in addition to a higher incidence of rehospitalization and death. Conclusions: High-quality follow-up with telephone follow-up resulted in greater adherence to treatment, reduction of rehospitalizations and deaths, consideration should be given to assessing patients' Heath Literacy to direct effective health education at each level, considering that low Heath Literacy has worse outcomes, bringing the importance of the interventions performed in the adherence and mortality of patients.