Vivências de familiares do paciente internado em unidade de terapia intensiva: estudo fenomenológico

This study originated from my concerns as critical care nurse, regarding the lived experience of the family member of the patient that is hospitalized in the intensive care unit - ICU. The purpose of the study was to comprehend the experience of the family members while having a loved one interned in an ICU, and to identify the common elements of the phenomenon, based on the descriptions of their experiences. Considering that the object of study involves subjective and social questions, the study was conducted using some fundamental ideas of descriptive phenomenology as a referential and the situated phenomenon as suggested by Martins and Bicudo (1989). Ten (10) family members of patients that were interned in the ICU of private hospital in Natal, RN were interviewed using the following leading question: What is it like to have a member of your family interned in the ICU? Five thematic structural categories emerged from the comprehensive analysis of the interviews: Fear of the family member s death; Lack of humanization; Social isolation; Confidence in the ICU; and Overload to the personal life. The description of the phenomenon enabled a new look at how the care team relates to the family members of the patients interned in the ICU, providing some guidance on how to construct a humanized care that involves the family and that is based on affective human relations. This involves a rethinking of the care provided by team to the family and stimulates the reformulation of personal and social attitudes, and of hospital organizational norms

Avaliação da qualidade da assistência aos portadores de úlceras venosas atendidos no ambulatório de um hospital universitário em Natal/RN

Study descriptive that was designed to assess the quality of care for people with venous ulcers (VUs) tended at the ambulatory of a university hospital in Natal / RN. The target population of the study was composed by 40 users bearers of venous ulcers served in the ambulatory of angiology of a university hospital in the level of tertiary education. The study received assent of the Ethics Committee of the Federal University of Rio Grande do Norte (Protocol No. 169/06). The collect of data was performed using a form of interview and tour with collection of measures biophysiologic, for a team comprised by the researchers and an academic of nursing, in the period of three months. The data were analyzed in SPSS 14.0, using descriptive statistics and presented in the form of charts, tables and graphs. Identified a clientele of holders of VUs predominantly female, married, aged up to 59 years, low level of education and household income, from Natal, retirees or those exercising professions and occupations that require long periods standing or sitting. In relation to the characteristics of health, those surveyed had risk factors for venous disease and had UVs chronic, located in Zone 2, lost tissue in grade II and serous exudates on average quantity. The assistance to holders of UVs has been characterized by a lack of professional nurses and unavailability of products for the realization of the right curative in ambulatory and outside it; by the inadequacy of products used in VUs, for long periods of treatment without resolution, where the compressive therapy is not priority, by the lack of completeness in the levels of assistance; by monitoring the bearer of UVs only by doctors and the nurses, even with the other team of professionals in the health service; by the completion of guidelines by health professionals and the lack the standardization of conducting laboratory and specifics tests. The assistance was assessed as inadequate in aspects: reference and counter-reference (75.0%), number of consultations with angiologists last year (87.5%), documentation of the clinical findings (85.0%), use of compressive therapy in the past 30 days (77.5%), part of the team interdisciplinary (97.5%), completion of laboratory and specifics tests in the last year (100%), availability of products used in achieving the curative in ambulatory (80, 0%), and indication of products used in the conduct of dressing outside the clinic (70.0%) and appropriate in the guidelines made on the use of socks, lifting of the members and prescription of exercises regular (82.5%) and indication products used in achieving the curative in ambulatory (97.5%). We conclude that the assistance provided to holders of UV was inadequate in 80% of cases interviewed, becoming non-resolutive and assistematic

O processo de cuidar do enfermeiro em unidade de terapia intensiva: uma análise dos conhecimentos utilizados

Care has always been present in the history of humanity and in contemporary nursing it is considered to be a fundamental characteristic. In the Intensive Care Unit (ICU), care occurs within an environment that is known for its stressful factors, technological equipment, social isolation and discomfort. Whilst the reality of nursing practice in ICU demonstrates the lack of planned and systematized care, there is an indication that the professionals working in this setting utilize some type of knowledge. Based on that premise, in this study we aim to identify the knowledge that the nurses use in providing care in the ICU. We believe that the identification and characterization of this knowledge, and how it presents itself in practice, requires a reflective analysis process. Therefore, we utilized a qualitative perspective and Kim´s (1999) investigative methodology of reflective inquiry that is based on the precepts of Action Science proposed by Argyris et al. (1985). The study was conducted with 8 intensive care nurses of a public hospital. Data were collected by means of non-participative observation of the nursing care actions and a semi-structured interview conducted within the reflective mode that focused on the nurses practice in the ICU. The results enabled us no only to detect that the nurses utilized knowledge and patterns of knowledge acquired or constructed, but to identify them as: scientific, philosophic, religious, empirical, personal, ethical, and esthetic knowledge. The predominance of the scientific knowledge in the care process suggests that these nurses hold an acquired scientific substance that they utilize to provide specialized care directed toward critical treatment. The conception of this reality surpasses the theoretical limits, the techniques, and the known facts, and denotes the need for a reflective process in action to aide in the comprehension of the knowledge involved in the construction of excellent care

Uma intervenção educativa para profissionais de saúde na prevenção de pneumonia associada à ventilação mecânica

Quasi-experimental study, prospective with quantitative approach, performed at the Hospital do Coração in Natal, aimed at verified the existence of difference between the care given by health professionals to the patients under mechanical ventilation (MV) in the Intensive Care Unit, before and after an educative intervention. The population was of 31 professionals, with data collected between november 05 of 2007 to march 27 of 2008. The results show a yong population, female gender, middle level of education, nursing technique, working between 05 and 09 years on nursing profession, and 01 to 04 years on Intensive Care Unit; almost all, never had an kind of training over prevent pneumonia associated to mechanical ventilation; from those that had training, occur on the work place with duration from 12 to 24 hours. About endotracheal intubation, the cuff was tested with a sterilized syringe had a positive change after a educative intervention, increased from 75,0% to 100,0%; the sterile guide was used on 75,0% before and 100,0% after an educative intervention. Regarding endotracheal suction procedure, was not informed to the patient on 72,7% before, however was informed on 56,7% after; the hands was not previously washed 68,5% before, however was 63,3% after the procedure; mask was used on 74,2 % opportunities before and 76,7% after; the aspiration catheter had adequated size on 98,9% observation before and 100,0% after; the gaze was sterilized on 95,7% before and 100,0% after; the ventilator was connected to the patient during the aspiration intervals on 94,4% observation before and 100,0% after; the ambu bag was clean and protected on 76,1% before and 85,7% after; the aspiration catheter was discarded after be used on 98,9% before and 100,0% after; FIO2 was turned to the begging value on 32,9% observation before and 12,0% after; before the procedure 71,9% professions washed their hands and 73,3% after; before, notes of aspiration results were performed on 70,8% observation and 86,7% after. Regarding devices used on respiratory tract, aspirator flasks were not swapped on 84,6% observations before and 71,0% after; daily látex extention change was not performed on 93,6% observation before and 87,1% after; the ambu bag change was not performed on 50,0% observation before even if was duty or unprotected and on 75,8% opportunities was changed, after; nebulization was not prepared with sterile fluids or manipulated aseptically on 65,2% observation before, perhaps was on 71,7% after; before nebulizers were not changed on 65,2% observations, perhaps were on 60,9% after. Concerning ventilator breathing circuits, condense fluids cumulated on circuits were removed on 55,0% opportunities before, and 64,0% after; moisturizer was not filled with sterile water when already had small amount of liquid inside on 78,4% observations before, and 90,2% after; MV circuits were changed on 97,0% observations on presence of visible duty or when presents some kind of failure, before and 98,4% after. About body position, on 51,3% observations the decubitus position change were done before and 78,2% after; fowler position was maitened on 95,5% observations before and 98,2% after; Regarding respiratory physiotherapy, enteral diet was not interrupted before respiratory physiotherapy on 94,9% before and 90,0% after; respiratory physiotherapy devices were not disinfected or sterile on 69,6% observations before but they re on 60,0% after; before the cateter was not tested before introduction enteral diet or medications on 100,0% but after was done on 15,2%. About enteral feeding, intestine motility and measure of stomach contents were not done on 100,0% observations before, but was 15,2% after. We conclude that 05 of 07 valuated procedures in relation to MV, had a significant improvement on quality of care given after educative intervention, when compared before intervention

Avaliação da gravidade do trauma em condutores de motocicleta vítimas de acidentes de trânsito no Rio Grande do Norte

Descriptive exploratory study, prospective, with quantitative approach, performed on the Monsenhor Walfredo Gurgel Hospital Complex (MWGHC), in Natal/RN, aiming to identify injuries by body area and wound severity on drivers who suffered motorcycle accidents, evaluate the severity of injuries and trauma on these drivers and identify the existence of association between wound and trauma severity and some of the accident s characteristics. The population comprised 371 motorcycle drivers, with data collected between October and December 2007. We used as instruments the Abberviated Injury Scale (AIS), Injury Severity Score (ISS) and the Glasgow Coma Scale (GCE1). The results show that, concerning characterization, there was a predominance of the male gender (88.4%), aged between 18 and 24 years (39.90%), originating from the Natal metropolitan region (55.79%), with fundamental-level instruction (51.48%), catholic (75.78%), married (47.98%). 23.18% work on commerce-related activities and 75.20% have income of up to 2 minimum wages. As for the accident s characteristics, the predominant shift was the afternoon (46.36%), received up to one hour after the event (50.67%), transported by countryside ambulances colleagues and relatives (51.21%), 25.34% had the accident on Sunday; 53.91% suffered falls and vehicle rolls; among the collisions there was a predominance of the motorcycle-automoblie type (28.03%); 52,6% were licensed and among these 50.76% had up to one year of license; 65.50% declared not having suffered previous accidents; 65.77% declared waring helmets in the time of the accident; 57.41% said not to have used drugs, and among those who used, alcohol was the most consumed (98.10%). The lowest score evaluated by GCS1 (3 to 8) was linked to drivers who suffered accidents on Saturday (10.3%), those who were not wearing helmets (14.29%) and the victims of motorcycle-pedestrian/animal crashes (13.33%). The body areas most affected had AIS between 1 and 3 (95.76%) and were: external surface (39.90%) and head/neck (33.20%). As for trauma severity, the highest scores (ISS>25) belonged to those who consumed alcohol (30.73%), suffered falls or vehicle rolls (48.9%) and those attended to 3 hours or longer after the accident (50%). We conclude that for motorcycle drivers who suffered accidents, age, gender, weekday, type of accident, use of drugs and the absence of helmet use signal both to the risk of occurrence of these events, as well as for the greater severity of injuries and trauma.

Gritos de silêncio: na voz dos familiares cuidadores de portadores da doença de Alzheimer

This work is an investigation related to issues of those who take home care of people who suffer from Alzheimer disease (AD). Thus, it is justified by the need to acknowledge how these relatives perform this task and in which ways they do this. The study has is analytical and qualitative methodology with the use of a thematic oral history approach. The subjects of the research were nine relatives of those who suffer from AD that participate in the home care group in the Candelária neighborhood in the city of Natal in Rio Grande do Norte-Brazil. The data was collected using a semi-structured questionnaire and interview that was booked in advance and had full support from the care takers. After information collection, three thematic axles were defined. After this procedure, three analisys subcategories were also defined. The first thematic axle emphasizes the so called movement of rite of passage, when the relative becomes a care taker of a person with AD. The second category deals with the care takers strategies, either related to their own behalf or on their relative. It is possible to infer that amongst other forms of help, the care taker needs to rely on a support network, such as health services, groups composed by multiprofessionals that enable better articulation between family and collaborators. The dimension related to faith and spirituality was also observed and pointed out as an important aspect in the emotional support process for these relatives. In the third axle the perspectives of struggle, conquests of the right to health and life quality of those who suffer from AD as well as their relatives was observed. These also deal with dreams and hope

Caracterização do acidente de trânsito e gravidade do trauma: um estudo em vítimas de um hospital de emergência de Natal

Descriptive exploratory study, with quantitative approach and prospective data performed on the Monsenhor Walfredo Gurgel Hospital Complex (MWGH), in Natal/RN, aiming to classify the type of motor vehicle involved in the accident, the public roadway s user quality and the more frequent injuries; to evaluate the severity of trauma in traffic accident victims; characterized the severity of the injuries and the trauma, and the type of motor vehicle involved. The population comprises 605 traffic accident victims, with data collected between October and December 2007. We used as a support for the evaluation of severity of injuries and trauma the Glasgow Coma Scale (GCSl), the Condensed Abbreviated Injury Scale (CAIS) and the Injury Severity Score (ISS). The results show that 82.8% of the victims were male; 78.4% were aged 18 to 38; the victims originating from the State s Countryside prevailed (43.1%); 24.3% of the population had completed middle-level instruction; 23.1% worked on commerce and auxiliary activities; most (79.4%) was catholic; 48.8% were married/consensual union; 76.2% earned up to two monthly minimum wages; Sunday was the day with the most accidents (25.1%); 47.4% were attended to in under an hour after the event; the motorcycle on its own was responsible for 53.2% of the accidents; 42.3% were attended to by the SAMU; 61.8% were victims of crashes; over half (53.4%) used individual protection equipment (IPE); 49.4% were helmets and 4.0% the seatbelt; 61.3% were motorcycle drivers; 43.3% of the accidents took place in the afternoon shift; from 395 drivers, 55.2% were licensed, and 50.7% among those had been licensed for 1 to 5 years; 90.7% of the victims had GCS1 between 13 and 15 points at the time of evaluation; the body area most affected was the external surface (35.9%); 38.8% of the injuries were light or moderate (AIS=1 and AIS=2); 83.2% had light trauma (ISS between 1 and 15 points). In face of the results, we can conclude that there is a risk for the elevation of injury severity and trauma resulting from traffic accidents, when these events are related to certain variables such as gender, age, weekday, the interval between the accident and the first care, ingestion of drugs, type of accident, the public roadway s user quality, the use of IPE, day shift, body regions and the type of motor vehicle involved in the accident

O sofrimento do paciente na UTI : escutando a sua experiência

In tertiary care, the Intensive Care Unit (ICU) is nowadays one of the most complex settings in providing care to critically ill patients and could make the difference in favor of life. Nevertheless, the stigma of death which pervades the imagination when the ICU is mentioned and the excessive importance placed on machines rather than on the human being end up by causing distress to some extent. As the purpose of this investigation is to understand the distress caused to a patient in an ICU, it has been grounded on the following question: What kind of distress does a patient go through during his/her experience in an ICU? This study has, therefore, an analytical and reflexive character embedded in a qualitative dimension of a phenomenological approach based on narratives. To this purpose, five patients were interviewed from November to December 2008. Out of the empirical material gathered from these narratives we were able to identify several factors that cause distress to ICU patients. Among them were: the certainty that they are critically ill and fear death, a closed room, too much lighting, a typical loneliness arising from being isolated from family members and dear ones, lack of communication with the professional staff, and noise; besides having to undergo therapeutic procedures. In summary, although the ICU is seen as a place of distress, in many aspects and in accord with this research, such distress can and should be relieved. On the other hand, being near to death leads them to a redefinition of life, said the patients.

A morte a concepção de estudantes de enfermagem

Understanding the meaning of death for student nurses is the subject of this research. The motivation for the meeting place of my difficulties as a person and especially as a teacher in the face of nursing students in dealing with death on a day-to-day hospital during the undergraduate course. Death became known that this evil looms before men and destabilizing, causing often irreversible mental disorders when faced with family loss. Therefore, it is appropriate to study it the possibility of making us reflect on our way of living life and dealing with human beings from the perspective of finitude. Aimed to understand the meaning of death for nursing students. For this purpose, it was based on the following guiding question: What is the meaning of death for you as a nursing student? From this perspective, the study was developed within a qualitative dimension of the phenomenological approach. To perform ten students were interviewed during the month of July 2009. Emerged from these interviews a variety of feelings such as fear, anxiety, insecurity, failure, sadness, as the sensory experience of each. To understand the meaning units that emerged from the empirical data which constitute the essence of this research were fundamental studies dealing with Heidegger about the death in a phenomenological perspective, as well as authors Bicudo, D'Assunção, Dastur, Morin, Boff, Kübler-Ross, Boemer, among others. From the understanding of the phenomenon, we can say that death produces mixed feelings in these students that lead to selfprotection, understood, often as a departure from the other, at the approach of death. However, it proved to be sensitive and receptive to the approach of death in other dimensions, beyond the highly technical aspects, pointing to a paradigm shift that has the yeast's own willingness to change. In addition, the research highlights the weaknesses in the education of nurses regarding the understanding of the whole human death and the need to overcome them.