Care Practices Research Articles

Simulation for Systems Integration: A Win-Win to Achieve Your Education, Quality, and Safety Goals.

Health care education is a cornerstone of clinical excellence, ensuring the highest level of readiness to achieve high-quality and safe care. Integrating simulation into health care systems can provide a modality to address educational, quality, and safety goals. Simulation is a methodology used to immerse individuals, teams, and medical systems into clinical scenarios or environments. Through facilitation and debriefing, the immersive experience can be used to provide vital education, develop optimal health care practices, and identify prospects for improvement. Simulation provides an opportunity to blend the needs of continuing multiprofessional education while addressing quality and safety goals, and ultimately, promoting a positive safety culture. Applied comprehensively, simulation for systems integration can both promote the transformation of the health care system into a learning organization, as well as translate to improved health care outcomes. [Pediatr Ann. 2024;53(11):e408-e413.].

‘Making vulnerability’ while negotiating family care practices: evidence from multigenerational living

ABSTRACT The article draws upon in-depth interviews conducted in Czech multigenerational living with representatives of three generations. The repeated interviews took place in 2018–2019 and then in spring 2020 during the Covid-19 pandemic. The analysis focused on caring practices and dynamics of care between three generations and how these had been impacted by pandemic in 2020. We were interested in how the pandemic affected the daily lives of multigenerationally living family members and how through their caring practices they redefine what family in the era of super-diversity is. In order to do so, we particularly focus on how vulnerability has been constructed through the caring practices as a response to Covid-19. We followed the scholarship on vulnerability which emphasises its social character and sees it as a social construct. We put forward this discussion and aim at developing the concept of ‘making vulnerability’ – processes through which people make themselves and others vulnerable through daily taken-for-granted routines and rituals – as an essential part of family care practices.

Gambaran Praktik Pengasuhan Anak Kembar di Kabupaten Gayo Lues

The purpose of this study is to know the image of the practice of child care in gayo lues district. This study uses qualitative methods with a descriptive approach. Number of participants in the study are three subjects. The data is analyzed using thematic analysis techniques. The findings suggest that there are 7 themes illustrating the practice of foster care in gayo lues district, of which 7 include the following sub themes. Parenting stress that covers the subtheme of financial demands, the lack of time for yourself. Support system that includes sub themes of extended family help, husband support, local government assistance. Coping strategies that include the subtheme manage time through other work, not managing emotions in a healthy way. Teaching that includes sub themes that enhance understanding, direction and example. The culture that includes the sub theme educating children firmly, the high tone of voice and educating children independently. The vaforitism consists of the sub theme divide and contrast.

Effectively Addressing Hospital-Acquired Pressure Injuries With a Multidisciplinary Approach.

Hospital-acquired pressure injuries (HAPIs) result in patient harm, discomfort, and even death, with an estimated 2.5 million HAPIs occurring annually in the United States. These pressure injuries from prolonged pressure on the skin and deeper tissues cause reduced blood flow and the breakdown of skin and tissues, resulting in wounds. Additionally, these injuries contribute to longer hospital stays and increased health care costs. Hospitals have programs aimed at reducing HAPIs as well as ongoing surveillance to identify new trends early on. This ongoing monitoring revealed a trend early at our institution that HAPIs were 66% higher than the national HAPI rate of 3.5% of observed patients. In rapid response, a multidisciplinary team was formed to address and improve the HAPI rate via a quality improvement project. To achieve the goal of decreased pressure injuries or ulcers, a team of nurses, patient care technicians, nutritionists, infectious disease specialists, radiologists, surgeons, vascular technicians, supply chain administrators, case management and social workers, hyperbaric medicine specialists, and wound care experts was created. The team completed a gap analysis and discovered inconsistencies in documentation and care practices that led to HAPI rates above the national average. The team then standardized a policy, standardized documentation of wounds, and provided staff education. Measures were implemented to proactively prevent pressure injuries. There was a 4.2 percentage point decrease in HAPIs from the beginning of the project (5.76%) to the last survey (1.59%). However, this difference was not statistically significant (P = .07). Overall, there were 6 fewer patients (8 vs 2 patients) with hospital-onset observed injury. Additionally, the length of stay decreased by 46%. Documentation of skin assessments within 24 hours of admission improved to 100%. We implemented a quality improvement program across 10 service lines, monitoring pressure injuries, HAPI incidence, and length of stay in 480 patients over 2 years. Although the reduction in HAPI was not statistically significant (P = .07), our program positively impacted the hospital's response to pressure injuries and warrants further replication.

Validity And Reliability Of Digital Health Education On Diabetic Foot Care Based On Health Belief Model Among Type Ii Diabetic Patients

The study aims to evaluate the effectiveness of digital health education on diabetic foot care among type II diabetic patients using the Health Belief Model (HBM). A total of 30 participants were recruited from local diabetes clinics to receive digital health education focused on diabetic foot care practices. To ensure the validity and reliability of the assessment tools, we employed multiple methods. Content validity was established through expert reviews, while construct validity was examined using Exploratory Factor Analysis (EFA) and Confirmatory Factor Analysis (CFA), which confirmed a good factor structure aligned with the HBM constructs. Reliability was assessed using Cronbach’s alpha for internal consistency, which showed acceptable values ranging from 0.67 to 0.84, and test-retest reliability with Intraclass Correlation Coefficients (ICC) ranging from 0.74 to 0.78. The results indicate that the digital health education program significantly improved the participants' understanding and practices related to diabetic foot care. These findings underscore the potential of digital education interventions for chronic disease management, particularly for enhancing self-care behaviors in diabetic patients. Future studies should consider larger sample sizes to further validate these tools and results. Overall, this study provides evidence supporting the effectiveness of digital health education for diabetic foot care and validates the reliability and validity of the instruments used.

Analysis of Risk Factors for the Occurrence of Diabetic Foot Ulcers in Patients with Type II Diabetes Mellitus

Background: Diabetes Mellitus (DM) has become a prevalent disease, imposing a significant burden on public health due to its widespread occurrence and association with numerous disabilities and fatalities. Uncontrolled DM can lead to severe metabolic complications and long-term vascular issues, including microangiopathy and macroangiopathy. Additionally, individuals with DM are highly susceptible to foot infections, which can escalate into gangrene if not properly managed. Purpose: This study aimed to determine the risk factors for diabetic foot ulcers in patients with Type II Diabetes Mellitus at the Hospital Infatil e Maternidade Jardim Amalia Methods: The research employed an analytical survey method with a case-control study design. Purposive sampling was utilized to select a total of 134 participants, comprising 67 individuals in the case group (those with diabetic foot ulcers) and 67 in the control group (those without diabetic foot ulcers). Data collection was conducted using a structured questionnaire, and the results were analyzed using the Odds Ratio (OR) test to identify significant risk factors. Findings: The findings of the study indicated that age is a risk factor for developing diabetic foot ulcers in patients with Type II DM, with an OR of 3.15 (95% CI: 0.43-17.216). The duration of diabetes also emerged as a significant risk factor, with an OR of 3.13 (95% CI: 0.62-14.12). Furthermore, foot care practices were identified as a crucial risk factor, with an OR of 4.13 (95% CI: 0.72-12.45). Conclusion: this study demonstrates that age, the length of time a patient has had diabetes, and their foot care routines are significant risk factors for the development of diabetic foot ulcers in patients with Type II Diabetes Mellitus at Hospital Infatil e Maternidade Jardim Amalia. These findings underscore the importance of early intervention and targeted patient education to mitigate these risks and improve patient outcome

Korean nurses' knowledge, opinions and current practice of trauma-informed pediatric nursing care in South Korea: a descriptive study.

This study aimed to investigate the knowledge, opinions, competence, and barriers of nurses providing trauma-informed care (TIC) to children in hospitals. Data were collected from 198 nurses nationwide using the TIC Provider Survey developed by the Center for Pediatric Traumatic Stress in July, 2024. Descriptive statistics, t tests, and one-way ANOVA were conducted using the IBM SPSS Statistics software (ver. 23.0, IBM Corp.). Of the 13 items assessing knowledge of TIC, seven had a correct response rate of over 90%. However, the correct response rate for these three items were less than 30%. Regarding opinions on the TIC, more than 90% of participants agreed with five of the seven items. In self-rated competence in providing TIC, they were not competent in responding to a child's (or parent's) questions about whether the child is going to die or understanding how traumatic stress may present differently according to developmental stages. The major barriers to providing TIC were time constraints, lack of training, and organizational support. Items with relatively low performance rates were 'teach parents what to say to their child after a difficult/sick/scary experience, and teach child or parents the specific ways to cope with unpleasant experiences'. This study suggests that it can contribute to the development of specific guidelines for nurses to effectively apply TIC in pediatric and family nursing practice, emphasizing the need for educational programs to support this implementation.

Effects of nurse's knowledge and self-efficacy on nursing performance in pediatric intravenous fluid management in South Korea: a descriptive study.

This study aimed to identify the effects of nurse's knowledge and self-efficacy on nursing performance in pediatric intravenous fluid management and provide the primary data necessary for the efficient intravenous injection management of hospitalized children. This study was a descriptive study design with 141 nurses who perform pediatric intravenous therapy care at eight hospitals in the S, C, D, and S regions. Data were collected from September 1, 2023, to September 30, 2023. Nursing performance of pediatric intravenous injection management was significantly positively correlated with knowledge (r=.44, p<.001) and self-efficacy (r=.19, p=.022). Nurses' knowledge (β=.42, p<.001) and self-efficacy (β=.22, p=.004) of pediatric intravenous injection management and care were identified as significant predictors of nursing performance thereof, with these two factors explaining 21.9% of the variance. This study found that knowledge and self-efficacy of pediatric intravenous injection management are significant predictors of the practice of intravenous care among pediatric nurses. Therefore, considering these factors, education and intervention programs should be developed to enhance pediatric nurses' knowledge and self-efficacy regarding intravenous injection management.

Encounters of Care: Technological Kin and Nonhuman Care

Practices of care are not easily categorized. They are often embedded in encounters and interactions but are impossible to frame simply according to species boundaries or the supposedly positive or negative feelings they might elicit. This fluidity of care is also characterized by dualities and contradictions, forcing a reflection on who the participants in this caring network of ontologies are, and what the expected and often unexpected results of these interactions can be. This article explores possibilities of care beyond human agency. In a world in which the human is increasingly entangled with technology, practices of care are no longer only a human prerogative. Caring encounters between the technological other and the human become spaces for the redefinition of cross-species collaborations that defy anthropocentrism and human exceptionalism. Technological practices of care towards the human emphasize the emergence of symbiotic existences that disrupts the logic of a human centered approach to the nonhuman, challenging dominant ideas of merely gentle and positive care. Kawakami Hiromi’s Don’t Get Carried Away by Big Birds (2016) and Kazuo Ishiguro’s Klara and the Sun (2021) subvert the logic of anthropocentrism by describing practices of care enacted by technological others towards the human. In their awareness of the inherent complexities and contradictions embedded in nonhuman-human practices of care, they exemplify Elena Pulcini’s notion that fear for the world means an actual care for the world. The disruptive kinships between technology and the human epitomize the non-romanticized character of technological care. By choosing to avoid both technophobia and technophilia, the two novels express the awareness that human existence is always affected by contradictory but unavoidable encounters with the nonhuman other.

Knowledge And Practice Regarding Prehospital Care After Road Traffic Accidents Among Three-Wheel Drivers and Associated Factors in Selected Police Areas in Colombo District, Sri Lanka

Introduction: Road traffic injuries are an increasingly significant public health issue worldwide. Knowledge and practice of prehospital care is a crucial responsibility of every citizen of the country. Pre-hospital care is delivered by a civilian first responder, who is usually another driver. The study aims to describe the knowledge and practice of prehospital care after a road traffic injury among three-wheel drivers and associated factors in selected police areas in the Colombo District. Methods: A communitybased descriptive cross-sectional study was carried out in three Colombo Municipality police areas. A sample of 384 full-time three-wheel drivers above the age of 18 years, registered in these police areas were recruited using a simple random sampling method. A structured pre-tested intervieweradministered questionnaire was used for data collection. Descriptive analysis was used to determine the level of knowledge and practices regarding prehospital care. SPSS version 25 was used for data entry and analysis. Significance was taken as p&lt;0.05. Results: Mean age of three-wheel drivers was 40.98 (SD±11.01). Only 31.5% of the drivers had first aid training. The majority (52.9%) of the drivers had good knowledge and 65.2% had poor practice towards prehospital care. Advanced age (&gt;45 years) and having first aid training were significantly associated with good knowledge (p&lt;0.05). Drivers with previous training within the last ten years (p=0.031) and having less hires per day (&lt;10) were significantly associated with better first aid practice (p=0.001). Conclusion: Although knowledge regarding prehospital care was adequate, practice of prehospital care was inadequate. Findings of the study call for ongoing first-aid training for all three-wheel drivers.Keywords: Prehospital care, First aid, Knowledge, Practice, Road traffic accidents

A Real-Life Laboratory Setting for Clinical Practice, Education, and Research in Family Systems Care: Protocol for a Transformational Action Research Study.

Burdening health and illness issues such as physical or mental illnesses, accidents, disabilities, and life events such as birth or death influence the health and functioning of families and contribute to the complexity of care and health care costs. Considerable research has confirmed the benefits of a family systems-centered care approach for patients, family caregivers, families, and health care professionals. However, health care professionals face barriers in working with families, such as feeling unprepared. Family systems-centered therapeutic conversations support families' day-to-day coping, resilience, and health. A family systems care unit (FSCU) was recently established as a real-life laboratory at one of the Swiss Universities of Applied Sciences. In this unit, health care professionals offer therapeutic conversations to families and individual family members to support daily symptom management and functioning, soften suffering, and increase health and well-being. These conversations are observed in real time through a 1-way window by other health care professionals, students, and trainees and are recorded with video for research and education. Little is known about how therapeutic conversations contribute to meaningful changes in burdened families and the benefits of vicarious learning in a real-life laboratory setting for family systems care. In this research program, we aim to deepen our understanding of how therapeutic conversations support families and individuals experiencing burdening health and illness issues and how the FSCU laboratory setting supports the learning of students, clinical trainees, and health care professionals. Here we apply a transformational action research design, including parallel and subsequent substudies, to advance knowledge and practice in family systems care. Qualitative multiple-case study designs will be used to explore the benefits of therapeutic conversations by analyzing recordings of the therapeutic conversations. The learning processes of students, trainees, and professionals will be investigated with descriptive qualitative study designs based on single and focus group interviews. The data will be analyzed with established coding methods. Therapeutic conversations have been investigated in 3 single-case studies, each involving a sequence of 3 therapeutic conversation units. Data collection regarding the second research question is planned. Preliminary results confirm the therapeutic conversations to support families' coping. This renders the FSCU a setting for ethically sensitive research. This program will not only support the health and well-being of families, but also contribute to relieving the financial and workforce burdens in the health and social care system. DERR1-10.2196/53090.

Knowledge, attitudes, practices of cancer palliative care and their associated factors among nursing officers in Apeksha Hospital, Maharagama

Introduction: Nursing officers, having a good knowledge, favourable attitudes, and correct practices in cancer palliative care uplift patient’s quality of life. Objectives: To describe the level of knowledge, attitudes, practices of cancer palliative care and associated factors among the nursing officers in Apeksha Hospital, Maharagama. Methods: A descriptive cross-sectional study was carried out among 252 participants with more than one year of work experience at Apeksha Hospital, Maharagama. Stratified sampling technique was adopted to select the nursing officers from different wards. Data were collected using a validated self-administered questionnaire. Sum of points of each participant and the percentage was calculated. Depending on the mean score they were categorized into groups accordingly. Data were analysed initially by a descriptive analysis and then by Chi square test using SPSS software version 26. P&lt;0.05 was the significance level. Results: Response rate was 70. %. The mean age of the study participants was 32.9 (SD=6.55) years. The majority (59.5%) had good knowledge, 53.2% had favourable attitudes and 54% engaged in correct practices. Mean knowledge score was 26.4 (SD=3.44). Nurses above 30 years of age, married and having more than 10 years’ experience had significant association with knowledge (p&lt;0.05). Most of the participants who had good knowledge had correct practices (p&lt;0.001). Most of the participants those who had favourable attitude had correct practices (p&lt;0.001). Association of level of knowledge and attitude was not found to be statistically significant (p=0.109). Conclusion: The majority of the nurses had a good knowledge, favourable attitudes and were engaged in correct practices in palliative care. There is a significant association between the year of experience and the nurses’ knowledge on palliative care. Having a good knowledge and favourable attitude on palliative care were positive factors for correct practices.Keywords: Knowledge, Attitude, Practices, Cancer palliative care, Nurses

“When you provide abortion services, you are looked upon as a bad guy”: experiences of abortion stigma by health providers in Nigeria

ABSTRACT Background Abortion stigma as reported globally has been inadequately documented empirically in Nigeria, Africa’s most populous country with a restrictive abortion law and a high rate of unsafe abortions. Objective The objectives of this study were to investigate the ways in which abortion stigma is experienced by Nigerian health professionals and how such experiences influence health professionals’ practice of safe abortion and post-abortion care. Methods The study utilized qualitative research consisting of in-depth interviews with 10 abortion providers. We elicited information with an open-ended interview guide that investigated the understanding of participants’ experiences of abortion stigma in Nigeria. The data were analysed qualitatively and thematically using Atlas.ti. Results The themes centred on perceptions and experiences of stigma among the providers interviewed. Participants’ experiences of abortion stigma included the following: being treated differently to other health professionals; experiencing disapproval and disrespect; name-calling and societal judgement; tagging and profiling of clinics by anti-abortionists; and social isolation. Participants attributed stigma to cultural and religious beliefs, the restrictive national abortion law, and pointed to hypocrisy. Some reported effects of stigma on providers included a feeling of insecurity, social exclusion, secrecy, and insincerity in clinical practice, discouragement, and guilt feelings. Despite the negative impacts, many respondents reported a sense of satisfaction stemming from their views that they were saving lives. Conclusion Systematic efforts to address these adverse factors could reduce the level of stigma experienced by providers, with a potential follow-through effect of improving women’s access to safe abortion care in Nigeria.

Effectiveness of a Need-based Interventional Tracheostomy Care Protocol on Knowledge and Practice of Tracheostomy Care among Nurses

Effectiveness of a Need-based Interventional Tracheostomy Care Protocol on Knowledge and Practice of Tracheostomy Care among Nurses

Pedagogies to “hold on to life”: practices of body-territory care in the midst of the armed conflict in Buenaventura, Colombia

En este artículo analizo las prácticas de defensa del cuerpo-territorio que realizan maestras que trabajan en escuelas afectadas por el conflicto armado en la ciudad de Buenaventura, en el Pacífico colombiano. A partir de un trabajo etnográfico, pongo en evidencia cómo el conflicto armado y la depredación capitalista del territorio étnico de Buenaventura han afectado a las escuelas y la reproducción de la vida de las comunidades negras que allí habitan. Ante las prácticas de terror, despojo y desterritorialización agenciadas por los actores armados, las maestras negras bonaverenses han respondido con “pedagogías para agarrase a la vida”. Estas pedagogías articulan estrategias de enseñanza, relaciones de cuidado y conocimientos ancestrales que permiten sostener los cuerpos y los territorios escolares en medio de la desesperanza. Se concluye que el cuidado es una forma de agencia político-pedagógica para recuperar y sanar el territorio, pero también se trata de una práctica ambivalente, poblada de dolores, desigualdades y contradicciones. En este sentido, se destaca el cuidado como una clave analítica central para comprender las relaciones posibles entre educación, resistencia y defensa de los territorios ancestrales afrocolombianos.

On-time childhood vaccination before and during the COVID-19 pandemic in seven communities: Findings from the New Vaccine Surveillance Network

BackgroundThe COVID-19 pandemic raised unprecedented challenges to vaccinating children. This multi-center study aimed to compare on-time vaccination of children before and during the COVID-19 pandemic and identify key factors associated with on-time vaccination. MethodsThis study was conducted among children aged 0–6 years enrolled in the New Vaccine Surveillance Network at seven geographically diverse U.S. academic medical centers. Children with acute respiratory illness or acute gastroenteritis were enrolled from emergency department and inpatient settings; healthy control subjects were enrolled from primary care practices. Vaccination data were collected and verified from patient medical records, immunization information systems, and/or provider documentation. On-time vaccination according to Advisory Committee on Immunization Practices recommendations was compared between pre-pandemic (December 2018–February 2020) and pandemic (March 2020–August 2021) periods using bivariate and multivariable analyses, adjusting for key demographic, clinical, and study characteristics. ResultsA total of 24,713 children were included in the analytic sample (non-Hispanic 73.4 %; White 51.0 %; publicly insured 69.0 %). On-time vaccination declined between the pre-pandemic (67.3 %) and pandemic (65.4 %) periods (Adjusted Odds Ratio 0.89, 95 % CI 0.84–0.95). The largest declines were observed among children who were < 12 months, male, Black, publicly insured, or whose mothers had a high school-equivalent education or less. The pandemic impact also varied by vaccine type and study site. ConclusionsThis multi-center study revealed a relatively modest overall reduction in on-time vaccination, which may reflect multilevel efforts to address pandemic-associated challenges. However, some patient subgroups and sites experienced greater reductions in on-time vaccination, highlighting the importance of tailoring interventions to increase equitable vaccine delivery, access, and acceptance across populations and communities.

EXaminaTion of cRitical cAre PHArmacist pRoductivity MetricS (EXTRA‐PHARMS): The clinical pharmacist's perspective

AbstractBackgroundCritical care pharmacists are well‐established, valuable members of the intensive care unit interprofessional team with unique skills to perform comprehensive medication management in complex critically ill patients. However, standardized and consequential productivity metrics for critical care pharmacists have not been established.ObjectiveTo characterize the utilization and perception of contemporary critical care pharmacy productivity metrics utilized among individual institutions.Design, Setting, and ParticipantsAn electronic survey was distributed to critical care pharmacist members of the Society of Critical Care Medicine Clinical Pharmacy and Pharmacology Section and the American College of Clinical Pharmacy Critical Care Practice and Research Network.Main Outcomes and MeasuresThe survey included 23 questions to assess institution demographics, individual respondent demographics, institution practices, and individual respondent perceptions about the value of critical care pharmacist productivity metrics.ResultsA total of 204 critical care pharmacists, largely from the United States, responded to the survey between July and November 2022. Institutional metrics captured by more than 50% of the respondents' institutions included order verification rate/number of orders verified (60%), number of clinical interventions (57%), and intravenous to enteral product interchanges (52%). Of these metrics, critical care pharmacists only agreed with the value of the number of clinical interventions, were indifferent to the value of intravenous to oral product interchanges, and disagreed with the value of order verification rate/number of orders verified.ConclusionsSignificant discrepancies exist between institutional productivity metric practices and their perceived value and utility among critical care pharmacists.

Exploring Belief Systems in Kinship Fostering Practice in Igbo Indigenous Communities of Southeast Nigeria

ABSTRACTKinship fostering in Igbo indigenous communities is an enduring alternative child care practice that promotes collective responsibility for child care in a family environment. The practice is believed to be fundamental for family and community continuity. Weakening extended family ties and a lack of social work support services in this care arrangement have cast doubt on the continual viability of this alternative child care practice This is an exploratory study using grounded theory. In‐depth interviews with six community leaders and six senior public social welfare officers provided insight on belief systems promoting kinship fostering in Igbo indigenous communities. Findings were thematically analysed to show continuity of lineage, preservation of family name and challenges associated with kinship fostering. Belief systems on kinship fostering provides insights on how children are viewed in Igbo culture, which can help policymakers design intervention programme that are culturally relevant in child‐care formation in Nigeria given challenges in kinship fostering. The study promotes indigenous knowledge that is vital for social work education and practice in Nigeria. Further study suggests exploring the belief of foster children and their experiences in kinship fostering.

Low-Value Clinical Practices in Pediatric Trauma Care

Reducing low-value care has the potential to improve patient experiences and outcomes and decrease the unnecessary use of health care resources. Research suggests that low-value practices (ie, the potential for harm exceeds the potential for benefit) in adult trauma care are frequent and subject to interhospital variation; evidence on low-value practices in pediatric trauma care is lacking. To estimate the incidence of low-value practices in pediatric trauma care and evaluate interhospital practice variation. A retrospective multicenter cohort study in a Canadian provincial trauma system was conducted. Children younger than 16 years admitted to any of the 59 provincial trauma centers from April 1, 2016, to March 31, 2022, were included. Low-value practices were identified from systematic reviews of clinical practice guidelines on pediatric trauma. The frequencies of low-value practices were evaluated by estimating incidence proportions and cases per 1000 admissions (low if ≤10% and ≤10 cases, moderate if >10% or >10 cases, and high if >10% and >10 cases) were identified. Interhospital variation with intraclass correlation coefficients (ICCs) were assessed (low if <5%, moderate if 5%-20%, and high if >20%). A total of 10 711 children were included (mean [SD] age, 7.4 [4.9] years; 6645 [62%] boys). Nineteen low-value practices on imaging, fluid resuscitation, hospital/intensive care unit admission, specialist consultation, deep vein thrombosis prophylaxis, and surgical management of solid organ injuries were identified. Of these, 14 (74%) could be evaluated using trauma registry data. Five practices had moderate to high frequencies and interhospital variation: head computed tomography in low-risk children (7.1%; 33 per 1000 admissions; ICC, 8.6%), pretransfer computed tomography in children with a clear indication for transfer (67.6%; 4 per 1000 admissions; ICC, 5.7%), neurosurgical consultation in children without clinically important intracranial lesions (11.6%; 13 per 1000 admissions; ICC, 15.8%), hospital admission in isolated mild traumatic brain injury (38.8%; 98 per 1000 admissions; ICC, 12.4%), and hospital admission in isolated minor blunt abdominal trauma (10%; 5 per 1000 admissions; ICC, 31%). In this cohort study, low-value practices appeared to be frequent and subject to interhospital variation. These practices may represent priority targets for deimplementation interventions, particularly as they can be measured using routinely collected data.

MULTIDISCIPLINARY APPROACH IN THE CARE OF PSYCHIATRIC OUTBREAKS IN URGENCY AND EMERGENCY SETTINGS: A LITERATURE REVIEW

Introduction: patients diagnosed with psychiatric disorders, before the psychiatric reform, were isolated from society and admitted to asylums, in a coercive manner, without ethical and human support from the multidisciplinary treatment team. Objective: to contribute to reflection on care practices and improvement of care for individuals experiencing a psychiatric outbreak directed to the urgent and emergency care network. Method: a theoretical, descriptive, exploratory literature review was carried out in the Virtual Health Library (BVS). The inclusion criteria were articles published between 2019 and 2023, complete, available online, free of charge in national or international journals, in the Portuguese language. Results: seven articles responded to the proposed methodological compliances and criteria and encouraged discussion on the research topic. Conclusion: patients in a psychiatric outbreak were directed to the Emergency Care Units (UPA), but the reception according to law 10.216/2011 is not done with mastery, given that there is a lack of professional qualifications in the multidisciplinary team and difficulties related to the physical structure from the emergency room to specific reception.