De Cuidados Research Articles

A voz dos utilizadores dos cuidados de saúde primários da região de Lisboa e Vale do Tejo, Portugal

This article was the result of a study aimed at determining the degree of user satisfaction with the care provided in the 125 Family Health Units (Unidades de Saúde Familiar - USF) and in some of the 127 Personalized Health Care Units (Unidades de Cuidados de Saúde Personalizados - UCSP) of the Region of Lisbon and Tagus Valley (LVT). A total of 20,118 questionnaires were distributed and 16,965 received (89.0% response rate). The data collection instrument used was the Europep questionnaire, essentially measuring four dimensions: medical care, non-medical care, organization of care and quality of premises. 65.3% of the respondents were women, the average age was 50.8 years, 35% had a maximum of six years of schooling, and to 5.2% this had been their first contact. There was an overall average satisfaction of 77.4%, higher in what regards the care and attention provided by professionals. Women had slightly lower satisfaction than men, the same as for the younger compared to the older ones. Those with less literacy were the ones that presented better satisfaction rates. USF had always more satisfaction than the UCSP, and models B a satisfaction greater than models A. Users penalize units with more than 12 GP and there was a great regional disparity.

Cuidados Intensivos de Anestesia: recomendaciones de la Sección de Cuidados Intensivos de la Sociedad Española de Anestesiología

Los objetivos de la Sección de Cuidados Intensivos de la Sociedad Española de Anestesiología, Reanimación y Terapéutica del Dolor (SCI-SEDAR) con el presente trabajo son: establecer nuevas recomendaciones adaptando los estándares publicados por el Ministerio de Sanidad y Política Social, y alineadas con las principales guías internacionales, y desarrollar una herramienta de mejora de la calidad y la eficiencia.A lo largo de 2018, 3 miembros de la SCI-SEDAR definieron la metodología, desarrollaron las recomendaciones y seleccionaron al panel de expertos.Debido a la limitada evidencia de buena parte de las recomendaciones y a la importante variabilidad estructural de las unidades de cuidados intensivos de anestesia actuales, se optó por un abordaje Delphi modificado para determinar el grado de consenso.Un total de 24 expertos de 21 instituciones constituyeron el grupo de expertos del presente trabajo. Se establecieron 175 recomendaciones sobre 8 apartados, incluyendo 129 con consenso fuerte y 46 con consenso débil.La SCI-SEDAR estableció las recomendaciones estructurales de las unidades de cuidados intensivos de anestesia que deberán guiar la renovación o la creación de nuevas unidades.In this article, the Intensive Care Section of the Spanish Society of Anesthesiology (SCI-SEDAR) establishes new recommendations based on the standards published by the Ministry of Health, Consumer Affairs and Social Welfare and aligned with the principle international guidelines, and develops a tool to improve quality and efficiency.Over a 12-month period (2018), 3 members of the SCI-SEDAR defined the methodology, developed the recommendations and selected the panel of experts.Due to the limited evidence available for many of the recommendations and the significant structural differences between existing anesthesia intensive care units, we chose a modified Delphi approach to determine the degree of consensus.The panel consisted of 24 experts from 21 institutions. The group put forward 175 recommendations on 8 sections, including 129 with strong consensus and 46 with weak consensus.The SCI-SEDAR has established a series of structural recommendations that should be used when renovating or creating new anesthesia intensive care units.

Filosofía y formación como magisterio de interpelación. Un diálogo entre Jaeger y Foucault sobre la paideia, el cuidado de sí y la figura de Sócrates

El presente ensayo busca traer a cuenta la relevancia que tiene para nuestros días la pregunta acerca de la importancia de la práctica filosófica como un modo de interpelar y despertar del letargo a nuestro pensamiento, toda vez que se está en el escenario en el que impera una preocupación por la formación que no omita la reflexión, el análisis y la crítica, en tanto actividades de desarrollo del pensamiento y de la vida. Problematización que conlleva la cuestión por el tipo de práctica formativa que hace posible este modo de interpelación, justo donde la configuración de la escucha se torna preeminente. En este sentido, hemos expuesto, a modo de un diálogo en dos partes, las indagaciones que a propósito de la figura socrática, como figura de magisterio de interpelación, hicieran W. Jaeger y M. Foucault; uno a propósito de la exhortación socrática y la paideia, el otro a propósito del cuidado de sí. Diálogo a partir del cual nos damos finalmente a la tarea de replantear la pregunta por la pertinencia de esta práctica filosófica como práctica formativa y como replanteamiento de nuestra noción de educación en términos de libertad.

Efeito do canto materno na adaptação de prematuros à vida extrauterina

Introduction: Sounds are part of our life and are able to produce effects on physical and emotional balance of people. Objective: To evaluate the effects of mother’s singing on the preemie using as parameters the heart and respiratory frequency and blood oxygen concentration of preemies, and also the mother perception related to baby behavior during the exposition to her singing. Methods: It is an exploratory investigation with quantitative and qualitative analyzes. Twenty preemies babies were observed during three consecutive days. Each child was exposed to the mother singing during ten minutes for three periods. The data were collected before and immediately after the music exposition. The heart and respiratory frequency and blood oxygen concentration of the baby were registered in two moments: pre and post- music exposition; the two measures were analyzed and compared. In the third day, the mother was interviewed to know her perception related to baby behavior during the singing exposition. The assessment of data was performed from March to July 2015 in two public hospitals in Sorocaba, Sao Paulo, Brazil. For the statistical analysis, Wilcoxon, Mc Nemar and variance test of Friedman were applied. Results and Conclusion: Statistics showed no significant results, however the qualitative analyzes showed positive results from the mother’s speech, such as benefic changes on babies behavior, recognition of mother’s voice and in helping to consolidate the bond between mother and her baby. s positivos nos discursos obtidos das maes, tais como alteracoes comportamentais beneficas, reconhecimento da voz materna e auxilio na consolidacao do vinculo mae-bebe. Palavras-chave: musicoterapia; cuidados de enfermagem; prematuro; adaptacao fisiologica; humanizacao da assistencia.

Adesão ao Regime Terapêutico de Pessoas com Hipertensão Arterial em Cuidados de Saúde Primários

Background : Hypertension is a chronic disease and the leading risk factor for cardiovascular diseases, representing a major public health ...

Acceptability Study of "Ascenso": An Online Program for Monitoring and Supporting Patients with Depression in Chile.

Major depression is a highly prevalent and severe mental disease. Despite the effective treatment options available, the risk of relapse is high. Interventions based on information and communication technologies generate innovative opportunities to provide support to patients after they completed treatment for depression. This acceptability study evaluated the Internet-based program Apoyo, Seguimiento y Cuidado de Enfermedades a partir de Sistemas Operativos (ASCENSO) in terms of its feasibility and acceptability in a sample of 35 patients in Chile. The study reveals high rates of acceptance and satisfaction among patients who actively used the program. As obstacles, patients mentioned technical problems, a lack of contact with other participants, and an insufficient connection between the program and the health service professionals. ASCENSO appears to be a promising complement to regular care for depression. Following improvements of the program based on participants' feedback, future research should evaluate its efficacy and cost-effectiveness.

Enfermagem de Reabilitação Sensório-Motora em Unidades de Cuidados Intensivos Neonatais: Revisão Integrativa de Literatura

Theoretical framework: Sensorimotor stimulation is one of the interventions of Rehabilitation Nursing in Neonatal Intensive Care Units (NICU). However, the c...

Las actitudes de los enfermeros de atención primaria en el ciclo de envejecimiento de las familias

La importancia de la familia en el cuidado ha provocado que en Portugal se cree el perfil profesional del enfermero de la familia para asegurar una atención de calidad, ya que se presenta como el eje central de los equipos. Varios autores argumentan que los enfermeros que dan importancia a las familias en los cuidados son más propensos a interactuar con estas familias, aumentando el nivel de atención. Además, el centro de atención, en las intervenciones de enfermería, no debe ser solamente una respuesta de las familias, sino también las actitudes de los enfermeros. Con el objetivo de evaluar las actitudes de los enfermeros que se enfrentan a la familia, se realizó un estudio cuantitativo con la escala “A Importância das Famílias nos Cuidados de Enfermagem-Atitudes dos Enfermeiros(IFCE-AE)” a 871 enfermeros de Atención Primaria de Salud en el centro de Portugal. Se concluye que tienen mejores actitudes los enfermeros que: realizan intervención específica con las familias con los padres, abuelos y nietos (p<0.001); para consultar a los niños,llaman a sus abuelos también (p<0.001); integran a sus nietos en los cuidados de sus abuelos (p<0.001).

Perinatal outcomes after hypertensive disorders in pregnancy in a low resource setting.

The objective of this study was to evaluate perinatal outcomes of pregnancies complicated by hypertensive disorders in pregnancy in an urban sub-Saharan African setting. A prospective cohort study of 1010 women of less than 17 weeks of gestation was conducted at two antenatal clinics in Accra, Ghana, between July 2012 and March 2014. Information about hypertensive disorders was available for analysis on 789 pregnancies. The main outcomes were pre-term birth, birthweight, Apgar scores, small for gestational age and mortality. Relative risk (RR, 95% confidence interval (CI)) for the association between hypertensive disorders of pregnancy and perinatal outcomes was assessed using logistic regression adjusting for potential confounders. A total of 88.7% of women remained normotensive, 7.5% developed pregnancy-induced hypertension, 2.0% had chronic hypertension, and 1.7% developed (pre-)eclampsia. No adverse effects were observed in women with pregnancy-induced hypertension. Women with chronic hypertension were more likely to have a lower gestational age at delivery (38.0 ± 2.3 weeks vs. 39.0 ± 1.9 weeks, P = 0.04) and higher risk of pre-term delivery (aRR 4.63, 95% CI 1.35-15.91). Women with pre-eclampsia had emergency Caesarean section significantly more often (88.9% vs. 50%, P = 0.04), with a higher risk for low birthweight infants (aRR 7.95, 95% CI 1.41-44.80) and a higher risk of neonatal death (aRR 18.41, 95% CI 1.20-283.22). Comparable to high-income countries, in Accra hypertensive disorders during pregnancy were associated with increased risk of adverse perinatal outcomes necessitating maternal and newborn care.

Cuidados de higiene – banho: significados e perspetivas dos enfermeiros

Background: As direct care to the person, the bath, in its performance or supervision, is emphasised as a space/time of interaction and knowledge between ...

Utilization of maternal health services among adolescent women in Bangladesh: A scoping review of the literature.

To understand the health-seeking behaviour of adolescent women in Bangladesh with respect to the use of maternal health services. Literature review of seven electronic databases: PubMed, ISI Web of Knowledge, PsycINFO, Embase, CINAHL, POPLINE and Global Health. Studies published in English between 1990 and 2013 which describe Bangladeshi adolescent women's healthcare-seeking behaviour during pregnancy, delivery and post-partum were included. Twelve studies were included in this review. 11 used quantitative methods and one used a mixed-methods approach. All studies included married adolescent women only. Women with lower educational levels are less likely to seek skilled maternal health services than those with higher levels of education. Use of maternal health services is also less common among rural married adolescent women than women in urban areas. Being part of the richest bands of wealth, having had previous experiences of childbirth and higher women's autonomy positively influence the use of skilled maternal health services among married adolescent women in Bangladesh. Antenatal care is a key predictor of the use of skilled birth attendants for delivery and post-natal care. Maternal health-related programmes should be designed targeting rural and uneducated married adolescent women in Bangladesh. More qualitative investigations are required to broaden our understanding on maternal health-seeking behaviour of both married and unmarried adolescent women.

Profile of patients with indication of palliative care and admitted at the Júlia Kubitschek Hospital - FHEMIG

Introduction: Technological and therapeutic progress associated with improvements in general life conditions of the population led to the increased life expectancy of Brazilians. Aging is related to the emergence of chronic and disabling illnesses in which monitoring and care constitute the main goal to be accomplished. Objectives: To evaluate the profile of patients with indication of palliative care admitted in the internal medicine wards of the Julia Kubitschek Hospital (HJK); to identify the characteristics of these patients in relation to gender, age, illnesses, and general clinical picture. Methods: This was a cross-sectional study with data collection from reviewed medical records and questionnaire with information about clinical conditions during hospitalization. Results: 261 admissions were recorded between June 27 and September 27 of 2012. The percentages of 41% (96) and 44% (101) of patients had and did not have an indication of palliative care, respectively. Discussion: The indication of palliative care reaches expressive numbers observed in the current study and the literature used. Conclusions: There is a significant number of patients admitted in the internal medicine wards of HJK who need palliative care, which is also described in the literature, showing the needed for better assistance to these patients, Profile of patients with indication of palliative care and admitted at the Julia Kubitschek Hospital – FHEMIG Jucilene Aparecida Mendes de Faria1, Lourenco Goncalves Ferreira2, Marcos Antonio Batista Vieira2, Nathalia Novaes Cosenza2, Patricia Primo de Alvarenga2, Priscila Lisboa Figueiredo2 1 Medica Geriatra. Professora do Internato de Clinica Medica do Curso de Medicina da Universidade Jose do Rosario Vellano – UNIFENAS; Hospital Julia Kubistchek. Belo Horizonte, MG – Brasil. 2 Academico(a) do curso de Medicina da UNIFENAS. Belo Horizonte, MG – Brasil. Perfil dos pacientes com indicacao de cuidados paliativos internados no Hospital Julia Kubistchek – FHEMIG DOI: 10.5935/2238-3182.20150006

Design and Validation of a Health Questionnaire about Knowledge for Health and Back Care Related to the Practice of Physical Activity and Exercise for Adolescents: COSACUES-AEF

Background: Adolescents have a high prevalence of back problems. Some risk indicators are associated with sedentary lifestyle, the practice of inadequate physical activity, the physical contraindicated exercises, joint actions inadvisable, etc. For these reasons, there is a need to study the knowledge held by students about back health and sports to improve intervention programs and help them to improve their education and care of the back. Currently, there are no specific knowledge questionnaires on health and back care related to the practice of physical activity and exercise in adolescents. For these reasons, the aim of this study was to design and validate an assessment tool that measures such specific knowledge. Methods: For this, the test-retest design was used with an interval of time of two weeks between each passes. The sample consisted of 230 students with a mean age of 15.31 (SD=1.52). Results: The internal consistency of Cronbach’s alpha coefficient was 0.80. The intraclass correlation coefficient (ICC) for average measurements was 0.80 with a significance of p<0.001. The t test for paired samples showed no statistically significant differences between the values of the first and second pass. Conclusion: The COSACUES-AEF (in spanish cuestionario sobre “Conocimientos sobre la Salud y Cuidados de la Espalda relacionados con la Actividad y Ejercicio fisico”) is a valid and reliable tool to evaluate the level of specific knowledge about health and back care related to physical activity and exercise in adolescents. The tool will let to compare the specific knowledge with other variables like presence or absence of LBP.

Eventos adversos derivados del cuidado brindado en la Unidad de Cuidados Intensivos Adultos del Hospital Universidad del Norte. Barranquilla (Colombia)

Resumen Objetivo: Determinar los eventos adversos derivados del cuidado brindado en la Unidad de Cuidados Intensivos del Hospital Universidad del Norte (en Barranquilla) en el periodo enero-diciembre de 2012. Materiales y metodos: Estudio descriptivo transversal retrospectivo. La muestra se obtuvo mediante un muestreo sistematico, a partir de un listado ordenado de todas las personas ingresadas al Hospital Universidad del Norte ( HUN ) en los servicios de Urgencias, Hos-pitalizacion, Cirugia, UCI Adultos, UCI Neonatal, Gineco-Obstetricia, Consulta Externa, Radiologia y Laboratorio que hubieran sufrido algun evento adverso ocurrido entre enero a diciembre de 2012. La informacion se obtuvo mediante la base de datos del Hospital Uni-versidad del Norte. Para el analisis se utilizo Microsoft Excel 2010. Resultados: Durante 2012 se presentaron 130 (25 %) casos de eventos adversos; siendo el segundo servicio con mayor numero de eventos, despues de Hospitalizacion. Las tres pri-meras causas de eventos adversos fueron: la infeccion nosocomial, con un 25 %; las ulceras por presion, con en un 18 %, y la neumonia asociada a ventilacion mecanica, con un 16 %.

Design and validation of the INICIARE instrument, for the assessment of dependency level in acutely ill hospitalised patients.

The aim of this study was to establish the validity and reliability of an instrument (Inventario del NIvel de Cuidados mediante IndicAdores de clasificación de Resultados de Enfermería) used to assess the dependency level in acutely hospitalised patients. This instrument is novel, and it is based on the Nursing Outcomes Classification. Multiple existing instruments for needs assessment have been poorly validated and based predominately on interventions. Standardised Nursing Languages offer an ideal framework to develop nursing sensitive instruments. A cross-sectional validation study in two acute care hospitals in Spain. This study was implemented in two phases. First, the research team developed the instrument to be validated. In the second phase, the validation process was performed by experts, and the data analysis was conducted to establish the psychometric properties of the instrument. Seven hundred and sixty-one patient ratings performed by nurses were collected during the course of the research study. Data analysis yielded a Cronbach's alpha of 0·91. An exploratory factorial analysis identified three factors (Physiological, Instrumental and Cognitive-behavioural), which explained 74% of the variance. Inventario del NIvel de Cuidados mediante IndicAdores de clasificación de Resultados de Enfermería was demonstrated to be a valid and reliable instrument based on its use in acutely hospitalised patients to assess the level of dependency. Inventario del NIvel de Cuidados mediante IndicAdores de clasificación de Resultados de Enfermería can be used as an assessment tool in hospitalised patients during the nursing process throughout the entire hospitalisation period. It contributes information to support decisions on nursing diagnoses, interventions and outcomes. It also enables data codification in large databases.

Assessing the quality of care in a new nation: South Sudan's first national health facility assessment.

We adapted a rapid quality of care monitoring method to a fragile state with two aims: to assess the delivery of child health services in South Sudan at the time of independence and to strengthen local capacity to perform regular rapid health facility assessments. Using a two-stage lot quality assurance sampling (LQAS) design, we conducted a national cross-sectional survey among 156 randomly selected health facilities in 10 states. In each of these facilities, we obtained information on a range of access, input, process and performance indicators during structured interviews and observations. Quality of care was poor with all states failing to achieve the 80% target for 14 of 19 indicators. For example, only 12% of facilities were classified as acceptable for their adequate utilisation by the population for sick-child consultations, 16% for staffing, 3% for having infection control supplies available and 0% for having all child care guidelines. Health worker performance was categorised as acceptable in only 6% of cases related to sick-child assessments, 38% related to medical treatment for the given diagnosis and 33% related to patient counselling on how to administer the prescribed drugs. Best performance was recorded for availability of in-service training and supervision, for seven and ten states, respectively. Despite ongoing instability, the Ministry of Health developed capacity to use LQAS for measuring quality of care nationally and state-by-state, which will support efficient and equitable resource allocation. Overall, our data revealed a desperate need for improving the quality of care in all states.

Integration of care systems in Portugal: anatomy of recent reforms.

Integrated care is increasingly present in the agenda of policy-makers, health professionals and researchers as a way to improve care services in relation to access, quality, user satisfaction and efficiency. These are overarching objectives of most sectoral reforms. However, health care and social care services and systems are more and more dependent on the performance of each other, imposing the logic of network. Demographic, epidemiologic and cultural changes result in pressure to increase efficiency and efficacy of services and organisations in both sectors and that is why integrated care has become so relevant in the last years. We first used concept maps to organise and systematise information that we had gathered through deep literature review in order to set a framework where to base the subsequent work. Then, we interviewed informants at several levels of the health and social care systems and we built a list of major recent reforms addressing integrated care in Portugal. In a third step, we conducted two independent focus groups where those reforms were discussed and evaluated within the context of the concepts and frameworks identified from the literature. Results were confronted and reconciled, giving place to a list of requisites and guidelines that oriented further search for documentation on those reforms. Several important health reforms are in course in primary and hospital care in Portugal, while a so-called third level of care has been introduced with the launch of the National Network of Long-Term Integrated Care (RNCCI - Rede Nacional de Cuidados Continuados Integrados). The social care sector has itself been a subject of alternative models springing from opposite political orientations. All these changes are having repercussions on the way the systems work with each other as they are leading to ongoing and ill-evaluated reformulations on the way they are governed, financed, structured and operated. Care integration is not absent from policy-making and implementation endeavour in Portugal. However, recurrent issues seem to be consistently hampering the efforts regarding the integration of care in the country. It is urgent to assess current situation as experienced by those closely involved and directly affected.

Decrease in Mortality in Severe Community-Acquired Pneumococcal Pneumonia: Impact of Improving Antibiotic Strategies (2000-2013)

The objective of the present study was to compare antibiotic prescribing practices and survival in the ICU for patients with pneumococcal severe community-acquired pneumonia (SCAP) between 2000 and 2013. This was a matched case-control study of two prospectively recorded cohorts in Europe. Eighty patients from the Community-Acquired Pneumonia en la Unidad de Cuidados Intensivos (CAPUCI) II study (case group) were matched with 80 patients from CAPUCI I (control group) based on the following: shock at admission, need of mechanical ventilation, COPD, immunosuppression, and age. Demographic data were comparable in the two groups. Combined antibiotic therapy increased from 66.2% to 87.5% (P < .01), and the percentage of patients receiving the first dose of antibiotic within 3 h increased from 27.5% to 70.0% (P < .01). ICU mortality was significantly lower (OR, 0.82; 95% CI, 0.68-0.98) in cases, both in the whole population and in the subgroups of patients with shock (OR, 0.67; 95% CI, 0.50-0.89) or receiving mechanical ventilation (OR, 0.73; 95% CI, 0.55-0.96). In the multivariate analysis, ICU mortality increased in patients requiring mechanical ventilation (OR, 5.23; 95% CI, 1.60-17.17) and decreased in patients receiving early antibiotic treatment (OR, 0.36; 95% CI, 0.15-0.87) and combined therapy (OR, 0.19; 95% CI, 0.07-0.51). In pneumococcal SCAP, early antibiotic prescription and use of combination therapy increased. Both were associated with improved survival.

Contributo para a classificação da funcionalidade dos utentes da Rede Nacional de Cuidados Continuados Integrados segundo a Classificação Internacional de Funcionalidade

PurposeIdentify the categories of the “International Classification of Functioning, Disability and Health” (CIF) for the classification of functionality to users of the Rede Nacional de Cuidados Continuados Integrados (RNCCI). ObjectiveIdentify ICF categories to classify the population with the characteristics of RNCCI users. MethodologyResearch was conducted at EBSCO through CINAHL Plus with Full Text and MEDLINE with Full Text. Scientific articles published in Full Text (March 2012) between 01/01/2000 and 03/31/2012 were selected, using the PI [C]O method. Were selected 15 items of 23 matches. Results248 categories were identified which characterize the functionality of the population with the features of RNCCI users. It was found that from these, 86 have a frequency description of less than 50% and are divided by four ICF components. ConclusionsThe identified categories are distributed as follows: 26 categories of the component Body Functions (32.56%) in 15 articles, 5 categories of the component Body Structures (5.81%) in 13 articles, 35 categories of the component Activities and Participation (40.70%) in 15 articles, 18 categories of the component Environmental Factors (20.93%) in 14 articles. This systematic review can begin the process of characterizing the functionality of users RNCCI according to ICF.

The attitudes of primary care nurses in the families’ aging cycle

In Portugal, due to the importance of the family in care, the professional profile of the family nurse was created to ensure quality care, since they are considered to be at the core of the teams. Several authors argue that nurses who assign importance to the families in health care are more likely to interact with these families, increasing the level of care. In addition, the center of attention in nursing interventions should not only be the families’ responses, but also the nurses’ attitudes. With the aim of assessing nurses’ attitudes about the family care, a quantitative study was carried out in which the scale “A Importância das Famílias nos Cuidados de Enfermagem-Atitudes dos Enfermeiros (IFCE-AE)” was applied to 871 Primary Health Care nurses in the center region of Portugal. It was concluded that nurses who perform a specific intervention with parents, grandparents and grandchildren (p&lt;0.001); request the presence of grandchildren when consulting the grandparents (p&lt;0.001); and integrate grandchildren in the care for their grandparents (p&lt;0.001) have better attitudes.