Assistência de enfermagem e o risco para úlceras de pressão medido pela Escala de Braden em unidade de terapia intensiva

The problem facing the incidence of pressure ulcers (UP) in the hospital environment especially in the intensive care unit (ICU), although it is an old and frequent event in our professional practice, it is not notified in the researches as much as it should be. We observed a tendency to invest in therapeutical and in studies about the production of sophisticated new bandages. Few, however, are the investments in research on preventive measures in order to prevent or at least slow down the development of lesions. In this sense, the study aimed to analyze the correlation between nursing care and the risk of developing UP measured by the Braden scale in ICU patients. This is a descriptive study of longitudinal quantitative approach. The project obtained a favourable opinion from the Ethics Committee of HUOL (no 486/10). Data collection was carried out in the Hospital of Unimed in Natal during six months in 2011. The sample was of 32 patients hospitalized in ICU for over four days. The results were processed in SPSS 15.0 for descriptive statistics and inferential statistics. We identified that, only 9.4% of our sample developed UP, being predominantly male, elderly people aged above 60 years, Caucasian, with diagnostic hypothesis at the time of hospitalization of sepsis, were clinical patients, who presented hemodynamic instability, using orotracheal tube (TOT), enteral probe (SNE), vesical probe delay (SVD) and had values of albumin and hemoglobin levels below normal. In addition, these patients had a longer hospital stay, longer usage of TOT, SNE, SVD, increased use of sedation and drain than those who did not develop UP and were all at risk for developing these injuries second Braden scores. 66.7% of the lesions developed were located in the sacral region, limiting the degree I and all patients that developed were considered serious, 100.0% of them have evolved since the death. Small were the differences between the averages of Braden scores between patients with and without UP, 11,9+2,4 against 12,4+2,6 with p = 0.627. The clinical aspects of the patients in the study were instrumental in the development of UP, once, these findings were statistically significant through the Mann-Whitney test, and appropriateness of nursing conduct was decisive for the prevention of pressure ulcers in critical patients, since many were those classified as at risk (28) and few who have developed lesions (03)

Integridade tissular de pacientes com úlceras venosas: um estudo baseado na Classificação dos Resultados de Enfermagem

The venous ulcer is an epidemiological problem of high prevalence, causing disability and dependence. Assess the tissue impairment level of patients with venous lesions, within a nursing referential, is relevant for the implementation of a directed assistance to specific clientele. Thus, this work aims to characterize the health status regarding the integrity the lower limbs skin of patients with venous ulcers, according to the of tissue integrity outcome indicators from the Nursing Outcomes Classification. A cross-sectional study conducted in a university hospital in Natal - Rio Grande do Norte. The sample consisted of 50 participants, selected through consecutive sampling. Data collection occurred through a interview and physical examination form and a operational definitions tool for indicators of the nursing Tissue Integrity outcome directed to patients with venous ulcer, applied from February to June 2012. Data analysis was done by descriptive statistics and nonparametric tests (Spearman, Kruskal-Wallis and Mann-Whitney tests). The project was approved by the Research Ethics Committee with protocol 608/11 and Presentation Certificate to Ethical Consideration No. 0038.0.294.000-11. The results were presented using three scientific articles derivatives of research. It was found that the indicators show moderate impairment, light and not impaired, as the median. The respondents had an average of 59.72 years, 66% female, 50% were retired, 60% with a partner, 44% had arterial hypertension, 26% allergies, 20% diabetes mellitus, 96% were sedentary, 14% drank alcohol and 6% were smokers. There was a statistically significant correlation of low intensity between age and hydration (p=0.032; rs=-0.304) and skin desquamation (p=0.026; rs=-0.316), family income and necrosis (p=0.012; rs=-0.353); Ankle Brachial Index and tissue perfusion (p=0,044; rs=-0,329); Diabetes Mellitus and texture (p=0.015) and tissue perfusion (p=0.026); allergy and texture (p=0.034), physical activity and hydration (p=0.034), smoking and thickness (p=0.018), and alcohol consumption and exudate (p=0.045). We conclude that the patients had light to moderate impairment, indicating a good state of health on the integrity of the skin of the lower limbs, according to the indicators of the outcome of tissue integrity Classification Nursing Outcomes valued in the present study. It is believed that the evaluation of impairment tissue using a self-nursing system and its relation with socioeconomic, clinical and risk factors are unique tools in the care planning and in the wound healing

A pessoa com tuberculose e o cuidado de si

Tuberculosis is a serious disease with high incidence and prevalence, and in many countries a priority public health problem, with persisting high epidemiological significance. Seeing the person with tuberculosis it is important to observe his/her self care, as well as the difficulties intertwined in this process, since it can be directly impacting the health/disease process. The aim of this study was to analyze the self care of people with tuberculosis. Descriptive study with qualitative approach, conducted in West Sanitary District of the city of Natal, RN. Data collection occurred through a semi-structured interview guided by questions concerning sociodemographic and about the disease, treatment, and self care, between the months of July to September 2012 and met the ethical precepts of research with human beings. To analyze the results we used the technique of thematic content analysis of Laurence Bardin, through the prism of the theoretical-philosophical self care discussed by Michel Foucault. From the analysis emerged two categories, the first being, Meaning of tuberculosis, with subcategories: tuberculosis as sadness and unhappiness and tuberculosis as a normal issue, and the second, Beware yourself to tuberculosis, which had subcategories: self care as attention to the health care of oneself as satisfaction of basic needs and difficulties to self care. Tuberculosis represents for some people, something really sad, causing psychological suffering, however the other presents as normal. Self care of persons with tuberculosis in this study are related in great part to seek health care and the satisfaction of basic needs. About the difficulties related to the practice of self-care, it is observed that these are tied to food, time for rest, slowness of health services for scheduling appointments and tests, as well as related habits and dependencies in the lives of these people. This study contributed to a reflection of the users with tuberculosis and self care, revealing aspects that healthcare professionals should pay attention to watch these people, being able to see everyday on the run, the need for a space and time for oneself

Atendimento Pré-hospitalar Móvel. Mapeando Riscos e Prevenindo Erros

The attention with safety of the patients is important in the quality of the nursing and health care. In the pre-hospital care, such care is essential on site with the purpose of avoiding possible consequences to the individual, ensuring a fast and appropriate care, with improvement of the morbidity and reduction of the mortality. This medical attention is equally associated with the significant risks of adverse events and serious mistakes, which can be reduced with the awareness of the professionals, organization and quality management. It is a descriptive, transversal research, of quantitative approach, with the objective of identifying the risks for the safety of the patient during the mobile pre-hospital care under the view of the nurses, in a city of the Brazilian Northeast. The sample was formed by 23 nurses. The inclusion criteria: to have at least two years of experience and accept to participate on the research. The data collection was done in two steps, first photo collection, through the adapted method of photographic analysis, and the second with the application of questionnaire, divide in two parts: socio-professional data and digital photo punctuation instrument of the patient s safety. The majority of the nurses had an average working time in the mobile pre-hospital care of six years and six months, in the age group of 38 to 53 years old (69,56%) and with Lato sensu specialization (73,91%), being (29,41%) emergency and (29,41%) in intensive care. The (74%) have the Advance Cardiac Life Support (ACLS) and (100%) have the Pre-Hospital Trauma Life Support (PHTLS); (91, 30%) know the thematic safety of the patient. On the pictures it was observed a bigger variability of the categories (risks) where 44% of variance emerged on the first picture of the research. The pictures 4 and 9 with the average below 5 were classified as very insecure, while pictures 7 and 3 with an average above 7, very secure. On the results of risks observed for the patient s safety in the mobile pre-hospital care five categories emerged: organization and packaging of the equipment and materials, routines and specificities in the mobile pre-hospital care, risks on the management of medications, for traumas and infections. Starting from the analysis of these risks, it was proposed ten steps for the safety in the mobile pre-hospital care: 1- Identify the patient; 2- Safety related to prevention of infection; 3- Safety in the management of medications; 4- Safety and standardization of the packaging of equipment and materials; 5- Attention to the specificities of the mobile pre-hospital care; 6- Incentive and value the participation of the patient and family; 7- Promote the communication with the central of regulation; 8- Prevention of traumas and falls; 9- Protect the skin from additional injuries; 10- Understand the benefit of all the equipment in the ambulance. The multiple risks and their emerged combinations on the research indicate a variety of actions to be developed and stimulated, like the use of steps for the patient s safety in the mobile pre-hospital care which contributes with the aid and management of risks, reduction of mistakes, disabilities and death

Ensino do processo de enfermagem: significados percepções docentes na formação do enfermeiro

The implementation of the nursing process should be experienced by all nurses during their formative years. However, the lack of implementation of the nursing process for care planning during the educational process and the existing disorder in the formation process prompted the following research questions: What is the meaning of teaching the nursing process to the nursing professors? Do nursing professors use strategies and methods that promote critical thinking in their students? The objective of the study was to analyze the meaning that teaching of the nursing process has for the nursing faculty of the bachalaureate nursing course. Qualitative descriptive study conducted with a sample of 30 faculty members that taught nursing care courses in the nursing program of the Federal University of Rio Grande do Norte (UFRN) in Natal, RN. Two instruments were used, a questionaire and an interview guide. The questionnaire was designed to obtain sociodemographic, educational and work information, of faculty activities and of the teaching of nursing care. The guide was composed of five open questions regarding the understanding and perceptions of the nursing process, its utilization in teaching, and the nursing care teaching strategies. Interview data were submitted to content analysis techniques and interpreted according to the principles of Symbolic Interactionism. Six categories related to the analytical themes were identified: the nursing process as the guide for the care actions; clinical rationality; use of the care activities; teaching relevance; teaching barreirs; teaching strategies with focus on the abilities and competencies of the clinical rationale. Faculty perceptions regarding the teaching of the nursing process; nursing care approach in the nurses‟ formation. The study indicates that the participants understand the relevance of the nursing process a work instrument and that the use of this method during the nurses‟ formation enhances the abilities and competencies for critical thinking that is essencial for care. The strategies for teaching of abilities and competencies were identified, however the nursing faculty should use codes, direction and the influence so that the students can Interact and therefore stimulate the use of the nursing process

Percepção do pai sobre sua presença no nascimento do filho

Coordenação de Aperfeiçoamento de Pessoal de Nível Superior

Segredos da alma: a dádiva da assistência de Enfermagem

The present study is an analysis of interpersonal relationships between the nursing staff and the patients under their care. Its objectives are to analyze ties/links that may possibly exist in such relationships and to describe, based on the experience of the patients, how they are received by the nursing staff, and what is the extent of their reliability on the nursing staff within the hospital. This investigation is analytical in nature and qualitative in approach, having as its leading thought Marcel Mauss s gift-exchange theory. The study involved eighteen in-patients, eight of them from government institutions, at a large hospital school and ten others from a private specialty hospital; both in the city of Natal, state of Rio Grande do Norte, Brazil. Data were collected between January and March 2006. Results point to ties being created between the nursing staff and patients irrespective of their social status, involving especially the development of friendship and reliability. We have noticed that in both services the interpersonal relationship is associated with the circulation of the symbolic goods mentioned in the patients discourse, such as attention, loving care and concern, among others, marking the formation of ties during hospital stay. Likewise, reliability is also present in close relationship with the technical competence of the professional. Patient hospitality is associated with the manner in which the patients were treated on being admitted to the hospital, although they also refer to hospitality at later moments, during the course of their treatment. Finally, we are in a position to say that there are ties/links between in-patients and nursing staff, irrespective of the patient s social status and class divide. It is thus evident that the antiutilitarian symbolism of gift to give, receive, give back -, which shapes the setting of social ties also takes place in today s utilitarian, individualistic and competitive societies. Thus, human beings whose existence is dependent on mutual relationships try to save their humanity, especially those who are fragile and dependent as is the case of the hospital in-patient

Relações interpessoais no ambiente de trabalho da equipe de enfermagem: uma ação comunicativa

The current study strives to address the interpersonal relationships of the nursing team from the perspective of the communicative action, by contributing to the health work process. It aims to analyze the interpersonal relationships of the nursing team in its work environment. This is a descriptive study with a qualitative approach. Data collection wal held from interviews, guided by a script with open questions. The study was conducted at a state hospital in the city of Natal/RN/Brazil. The research subjects were the workers of the nursing team, including nurses, nursing technicians and nursing assistants, totaling 16 subjects. The capture of information was performed in April 2012. The project was approved by the Ethics Research Committee, under CEP/UFRN protocol n. º 262/11 and Certificate of Presentation for Ethical Consideration n. º 0289.0.051.000-11. The analysis was performed from the categories that emerged from the research through a dialogue with the authors studied in the theoretical framework of the Theory of communicative action , by Jürgen Habermas, as well as The changing in the world of work, by Ricardo Antunes, and Characterization of the team , by Marina Peduzzi. The outocomes point out that the interpersonal relationship of the nursing team is very troubled, with no interaction among the individuals involved in this process, among themselves and with other health professionals. We have developed a particular concept about team, which is comprised of three essential elements: multiplicity of individuals, common objective and heterogeneity. In the studied environment, it was realized the existence of grouping teams. The interpersonal relationship of the nursing can be a facilitator or an obstacle in the workplace in such a way that causes positive or negative consequences, both to the health workers, and to the sicks. In this context, the interviewees have intensified their viewpoints with regard to the weaknesses that permeate the nursing relationship, by pointing them more frequently than the strengths. The work conditions have signaled a failing situation, which is evidenced by the constant improvisation process before the lack of human and material resources, low wages, deficit in recognizing the nursing worker, and physical and emotional wear, by creating a professional exhaustion. The devaluation of the worker also became a strong factor for this study, because it was characterized a reason of job dissatisfaction, due to the lack of valuation policies, which should be prepared by the institution or, even, they are unknown by the worker itself. The worker participation in the design of these policies has emerged as a relevant factor. The poor work conditions lead the worker to a process of professional demotivation and dissatisfaction, by causing the feeling of devaluation within its work environment. Hence, it was found in this research that the lack of communication leads to situations of inadequate interpersonal relationships, which are creators of an unsuitable environment for the performance of the nursing team

Em busca do conhecimento da equipe de enfermagem na sua prática assistencial às vítimas de traumatismo raquimedular

The great demand of accidents resulting in victims with rachi-medullar traumatism (RMT) and the need for indetifying how they are being assisted, led us to proceed with this investigation. It had as its goal to identify and analyze the knowledge of nurses and nurse assistents regarding the nursing assistance to these patients. It consists of a descriptive exploratory study, with a quantitative method and prospective data. For its execution, 193 subjects were interviewed, 37 of them nurses and 157 nurse assistents in 02 hospitals of the metropolitan zone of Natal. The results reveal that the subjects are not coherent when questioned whether they are prepared to assist victim of RMT and the content described by order of piority regarding the steps followed in the assistance of these victims, both in the pre-hospital and hospital care. Thus, we observe that only 06 nurses and 07 assistents, described correctly all the steps necessary to pre-hospital care and only 01 nurse and 02 assistents registered all the steps in the correct sequence regarding the hospital care. We conclude that, in face of the obtained results, we can urgently modify this reality, improving the nursing staff and giving them better work conditions

Estratégias de intervenção utilizadas por enfermeiros da ESF do município de Natal/RN no controle do câncer do colo de útero

Cancer of the cervix (cervical cancer) is the second most prevalent cancer among Brazilian women. The high rates of cervical cancer in Brazil justify the implementation of effective strategies to control this, which include actions to promote health, primary prevention, early detection, screening, treatment and palliative care. Despite the existence of the National Programme for Control of the CCU there was no reduction in the incidence and mortality of this disease in Brazil. The Family Health Strategy (FHS) has the potential to facilitate such control and, in this context, one should consider that nurses play a central role. The study aimed to know the general intervention strategies used by nurses FHS of Natal / RN in CCU control, and how specific: analyzing the knowledge of these nurses on the CCU, the actions developed in the ESF for the control of CCU and identify the difficulties faced by them to perform it. This is a descriptive exploratory quantitative developed through a structured interview guide with 106 nurses who have experience in controlling the CCU in FHS teams of Natal / RN. Data analysis was performed using descriptive statistic s. The results pointed to actions taken in the FHS to control the CCU, collection of cervical cancer screening, health education activities, nursing consultation, referral of suspected cases for medical monitoring and active women with abnormal test result . The actions that were not mentioned by the nurses included: forming groups of prevention and health promotion; expand coverage of exams and office hours of consultations, establishment of alternatives to end the pent-up demand in the health units, participation in treatment or rehabilitation process users with the CCU; interventions for pain management, alliances and partnerships with schools, in dustry and the use of protocols. This study can be seen that the practice nurses partially shares to the CCU in Natal / RN. The participants of this study, when asked about the CCU, specifically for signs and symptoms of disease and risk factors in general showed important gaps. Difficulties such as lack of materials for collection of Pap smear; inadequate physical space in the Health Units; pent-up demand in the service, delay in arrival of the test results; obstacles in the actions of referral and counter-referral and cultural factors make the CCU control is compromised. It is believed in this research contributed to a reflection on the importance of the role of nurses in the development of the ESF control actions CCU, pointing out the factors that affect these. It is important to involve all nurses who comprise the ESF as knowledgeable of the risk factors, signs and symptoms, and existing tools for the early detection of cervical cancer in the pursuit of quality improvement actions to promote women`s health, contributing in planning future interventions that may reduce mortality from this disease in Natal / RN.

Entre orquídeas e girassóis :o laboratório de Enfermagem na visão de estudantes

To study the teaching/learning process about the Nursing procedures carried out in the laboratory, and learn both the sapiens and the demens dimensions of such process, is the main purpose of this study. The objectives are to: identify the major laboratory contributions to the teaching/learning process from the point of view of undergraduate students and the feelings they express; describe the difficulties they have identified; and analyze the relevance of the laboratory to this process. As part of the inquiry procedure, four core group meetings were held with 26 undergraduate students who had completed the course on Semiology and Semiotics in Nursing, which is the course where the Nursing laboratory is most needed as a learning space. The analysis, based on a qualitative approach, had as fundamental theoretical support studies made by Friedlander and Hayashida, who deal with learning/teaching in the Nursing laboratory, and by authors who favor humanization in teaching such as, among others, Freire, Maturana, Morin, Assmann. Results point toward the relevance of the Nursing laboratory as a facilitator for the learning/teaching process. In their speech the students repeatedly state that the development of procedures in simulated situations enable them to become more self-assured and technically prepared for caring. In addition, they emphasize that feelings such as fear, lack of confidence, anxiety, anguish and panic become diminished at the time of their clinic experience when they have had previous learning in the laboratory. They have also acknowledged that some difficulties of structural nature have become obstacles to a high-quality learning development. In summary, in spite of the difficulties that have been pointed out by the students concerning the use of the Nursing laboratory in the learning/teaching process, they also recognize that this is the locus par excellence where they can develop their skills and appease their anxieties

Aumento da jornada de trabalho :qual a repercussão na vida dos trabalhadores da enfermagem?

The worker of the public service is loosing your acquisitive power by means of the politics of fiscal settlement. The ways out that were found in the health sector, especially in nursing, is being the increasing workday for beyond 40 or 20 hours established in the link of the work with the state. This survey has the object to identify the possible repercussion of the increasing workday in daily life workers from nursing in the public service of Rio Grande do Norte. The theory reference used was the work of Marx (1982) and Antunes (2000,2001) and the daily living in Heller (1991,1992). The methodology used was a qualitative survey in the exploration kind. The informations were gathered through interviews with open questions almost structured with workers of nursing, managers and representatives of entity. The analysis of informations were made through general categories, work, and daily life, using elements from dialetics-hermeneutics according to Minayo (1992,2002). In the analysis, it was identified that the ways that were found for the overcoming of the loss of acquisitive power were the many-employment; the extra scale of shift; the subletting of work posts and the substitution of friends in scales of work, and all of them being changed in increase. Other aspect realized was the move of rights, like vacation and medical license for the workers that act in extra scale. The tiredness, stress, and bad humor are influents factors in the development of work.. The reduction of free time makes in the workers ahguish because of the familiarity decreasement just as time to dedicate themselves to the technical-scientific improvement and for the cultivation of other aspects of subjectivity, as leisure, care and culture. The low salary and the non reajustment are the reasons for the adoption of part workers for the increasing workday, and government has been responsible for this situation. The conclusion was that the increasing workday has strong repercussions in the professional and personal daily life workers that made part of the survey

Trajetória de vida de mulheres mastectomizadas integrantes de um grupo de auto ajuda a luz da História Oral

Coordenação de Aperfeiçoamento de Pessoal de Nível Superior

Enfermagem na atenção primária em saúde no screening de adolescentes com excesso de peso

One of the Primary Health Care strategies for adolescent health is the growth and development follow-up and the early detection of overweight adolescents. Even though the School Health Program in Brazil proposes to evaluate the nutritional state of the school population in the corresponding community health units, not all cities have adhered to the Program and many nurses do not recognize overweight as a problem in their territory. The objective of the study was to identify the nurse´s participation in the screening of overweight adolescent students in their work territory. Cross sectional study conducted in eight state supported schools of the municipality of Natal/RN and in four Primary Health Units. The total student population was 27.277. A stratified sample was statistically calculated based on the student population of the four city geographical zones: 112 North , 74 West; 108 East; and 78 South, totalizing 372 adolescents. The students were selected by a probability process where eight schools were first selected, two per district, until the number per subsample in each district was reached. Four primary health nurses, responsible for the health units were included. Two instruments were used for data collection, a screening questionnaire and a semi-structured interview form for questioning of the nurses. The content of both instruments was validated. Anthropometric and health data were collected from the students and analyzed with descriptive and analytical statistics. Interview data were transcribed and submitted to content analysis. The nursing diagnosis of overweight was identified in 50 (13,5%) of the adolescents and its association with consumption of foods that have cardiovascular risk (canned foods, pasta and fried food). An association of the nursing diagnosis was identified with family history (diabetes, hypertension, obesity, and kidney disease). The nurses judged that care of overweight adolescents was important but noted difficulties because of the absence of this population in the health units, because of their work overload, and the lack of school articulation. The nurses do not have impacting actions with this population and delegate the responsibility to other professionals. It is concluded that overweight is a nutritional problem relevant to the adolescent school population in Natal/RN, with a 13,5% prevalence and that it is related to food consumption with cardiovascular risk and family health history. The nurses consider overweight as an important public health problem but do not envision ways to maintain linkage with adolescents and with the school to promote the needed care

Conquistas e desafios do processo de trabalho de enfermagem: o caso dos CAPS em Natal/RN

The Brazilian Psychiatric Reform proposes creating linkages / interactions of the mentally ill with civil society , through promoting citizenship and assistance to the mentally ill. The deinstitutionalization of mental health advocates from the guidelines decreased supply of hospital beds and consequently the creation of substitute services for psychosocial care, especially with regard to therapeutic practices emancipatory. From this scenario, the present study aims to investigate the relevance and challenges of the process of nursing work in CAPS III in Natal / RN. It is descriptive research with a qualitative and exploratory. The subjects are employees of the nursing team in CAPS III East of Natal / RN. This service has actions for the psychosocial care of the subjects treated with daily multidisciplinary care by behaving the length of treatment and follow-up activities, industrial and cultural activities. Employ the semi-structured interview as a tool for data collection. The data analysis was done by means of thematic analysis proposed by Bardin. Thus, this sought to bring to the discussion of how this process is consolidated in the daily service. Thus, purposed to contribute to the debate on deinstitutionalization in psychosocial care as a guideline in the process of mental health nursing work in a CAPSIII, Natal / RN