Multiprofessional Actions Research Articles

Effect of Early Multiprofessional Mobilization on Quality Indicators of Intensive Care in a Less Economically Developed Country: An Action on “Rehabilitation 2030” in Brazil

ObjectiveTo investigate the effects of implementing early multiprofessional mobilization on quality indicators of intensive care in Brazil. DesignThis is a retrospective cohort study. SettingA Brazilian educational and research-intensive care unit (ICU). ParticipantsA total of 1047 patients were hospitalized from May 2016 to April 2018. InterventionsImplementation of early multiprofessional mobilization using the MobilizAÇÃO Program (MAP). Main Outcome MeasuresClinical, ventilation and safety quality indicators, and physical function before (preprogram period) and after (postprogram period) the MAP. ResultsThere was a reduction in sedation time (4 vs 1d), hospital stay (21 vs 14d) and ICU stay (14 vs 7d), mechanical ventilation (8 vs 4d), hospital death rate (46% vs 26%) (P<.001), and ICU readmission (21% vs 16%; P=.030) from pre to post MAP. Successful weaning (42% vs 55%) and discharge rate (50% vs 71%) (P<.001) increased after MAP. No differences were found to safety quality indicators between periods. After MAP, complex physical functions assessed using the Manchester Mobility Score (MMS) were more frequent. The in-bed intervention was a predictor for readmission (P=.009; R²=0.689) and death (P=.035; R²=0.217), while walking was a predictor for successful weaning (P=.030; R²=0.907) and discharge (P=.033; R²=0.373). The postprogram period was associated with the MMS at ICU discharge (P<.001; R²=0.40). ConclusionsEarly mobilization implementation through changes in low mobility culture and multiprofessional actions improved quality indicators, including clinical, ventilation, and physical functional quality, without compromising patient safety in the ICU.

Palliative Care for SARS-CoV-2 Patients in the Intensive Care Unit: A Comprehensive Study.

To comprehend the multiprofessional actions regarding palliative care for patients in the Intensive Care Unit affected by SARS-CoV-2. A comprehensive qualitative study conducted with 31 professionals from the Intensive Care Units of a university hospital, based on the Theory of Peaceful End of Life. The analysis of the discourse led to the identification of two categories: "Multidisciplinary actions to promote comfort at the end of life" and "Palliative care during the pandemic period and the promotion of emotional and spiritual comfort." It became evident that local administration needs to invest in measures that reduce barriers to the implementation of palliative care during times of crisis. Understanding the discourse highlighted that non-specialized professionals can provide basic palliative care appropriately, without diminishing the importance and necessity of the presence of palliative care specialists in various hospital areas.

Effects of a Multi-professional Intervention on Quality of Life of Women with Overweight or Obesity Post-Covid-19. A Pragmatic Trial

Obesity is a global Non-Communicable Chronic Disease (NCD) associated with various comorbidities and a high mortality rate. This scenario has increasingly affected the female population, leading to a rise in prevalence and related health issues. Therefore, the present study aimed to assess the health-related quality of life of women with overweight or obesity and symptoms of COVID-19 using a multi-professional intervention model. This research was conducted as a parallel group and repeated measures pragmatic trial, in which 28 participants aged between 25 and 65 were allocated into two groups: experimental (intervention group) and control (non-intervention participants). The Body Mass Index (BMI) was (30.5 ± 5.45 kg/m²) in the Experimental Group, and the Control Group was (31 ± 8.2 kg/m2). The 12-Item Health Survey (SF-12) questionnaire was applied to assess the quality of life in the physical and mental domains of COVID-19 survivors with different symptom severities (mild, moderate, severe) compared to the control group. At the end of the program, 28 participants finished the study (15 from the experimental group and 13 from the control group). The results indicated a significant improvement in the mental health domain only in the experimental group after the intervention period (p &lt; 0.05). However, no significant differences in physical health were observed between the experimental and control groups (p &gt; 0.05). Considering these findings, multi-professional actions emerge as a crucial component for enhancing the quality of life, particularly within mental health, during the 16-week intervention period.

Edentulismo e fragilidade em pessoas idosas domiciliadas: um estudo transversal

Abstract Objective To investigate the association between frailty and edentulism in community-dwelling older adults and determine the individual, sociodemographic, and clinical factors associated. Method A total of 333 older adults aged 65 years or more participated in this study; they responded to the Edmonton Frail Scale instrument (EFS). Data on socioeconomic factors, oral health, and use of and need for dentures were also collected. Those with cognitive difficulties were excluded. Hierarchical multivariable logistic regression models were performed using the stepwise and backward procedure, which tested the relationship of edentulism and covariates with EFS results. Variables with p&lt;0,20 in the unadjusted analyzes were included in the adjusted logistic regression. Results The prevalence of moderate to severe frailty was 12.3%. Edentulism was related to frailty (OR 3,45; IC 95%: 1,45 – 8,25; p=0,01), age (OR 2,19; IC 95%: 1,07 – 4.46; p=0,03), female sex (OR 2,75; IC 95%: 1,23 – 6,15; p=0,01), the need of lower dental prosthesis (OR 3,19; IC 95%: 1,27 – 8,05; p=0,01) and toothache perception (OR 2,74; IC 95%: 1,15 – 6,15; p=0,02). Conclusions Frailty was associated with edentulism, age, female sex, the need for lower dental prosthesis and toothache perception. These oral conditions are highly prevalent among older adults and can be prevented by multiprofessional actions supported by public policies. Oral examinations should be considered in pre-frail and frail patients’ assessments as oral health indicators were associated of older adults’ frailty.

ADENOCARCINOMA CERVICAL E ABANDONO TERAPÊUTICO: A ÓTICA DOS ENFERMEIROS EM UMA CIDADE DO EXTREMO NORTE BRASILEIRO

Objective: to describe, from the perspective of nurses, the causes of dropout of users in treatment for cervical adenocarcinoma and analyze the proposals to reduce this dropout. Method: the study is descriptive, qualitative, of narrative research type. Seven care nurses, working in a high complexity oncology unit in the city of Macapá, capital of the state of Amapá, Brazil, participated. The study was conducted in the period from December three to 20, 2019. Data were submitted to categorical thematic analysis. Results: two categories emerged: main causes of dropout of users in treatment for cervical adenocarcinoma and nurse strategies for the reduction of treatment dropout by users. Conclusion: to promote the rescue of the users, the participating nurses propose a Nursing consultation and a multi-professional action plan, respecting the singularities of each woman.

ADENOCARCINOMA CERVICAL Y ABANDONO TERAPÉUTICO: LA PERSPECTIVA DE LOS ENFERMEROS DE UNA CIUDAD DEL EXTREMO NORTE DE BRASIL

Objective: to describe, from the perspective of nurses, the causes of dropout of users in treatment for cervical adenocarcinoma and analyze the proposals to reduce this dropout. Method: the study is descriptive, qualitative, of narrative research type. Seven care nurses, working in a high complexity oncology unit in the city of Macapá, capital of the state of Amapá, Brazil, participated. The study was conducted in the period from December three to 20, 2019. Data were submitted to categorical thematic analysis. Results: two categories emerged: main causes of dropout of users in treatment for cervical adenocarcinoma and nurse strategies for the reduction of treatment dropout by users. Conclusion: to promote the rescue of the users, the participating nurses propose a Nursing consultation and a multi-professional action plan, respecting the singularities of each woman.

CERVICAL ADENOCARCINOMA AND THERAPEUTIC DROPOUTS: THE PERSPECTIVE OF NURSES IN A CITY IN THE EXTREME NORTH OF BRAZIL

Objective: to describe, from the perspective of nurses, the causes of dropout of users in treatment for cervical adenocarcinoma and analyze the proposals to reduce this dropout. Method: the study is descriptive, qualitative, of narrative research type. Seven care nurses, working in a high complexity oncology unit in the city of Macapá, capital of the state of Amapá, Brazil, participated. The study was conducted in the period from December three to 20, 2019. Data were submitted to categorical thematic analysis. Results: two categories emerged: main causes of dropout of users in treatment for cervical adenocarcinoma and nurse strategies for the reduction of treatment dropout by users. Conclusion: to promote the rescue of the users, the participating nurses propose a Nursing consultation and a multi-professional action plan, respecting the singularities of each woman.

Humanization of the hospital: participatory construction of knowledge and practices on care and ambience.

To identify and implement care and ambience strategies, with a view to hospital humanization. Action-research study, whose investigation process occurred between January and March 2019, with the participation of employees in strategic functions of a medium-sized hospital, through a focus group and strategic focal analysis. The implementation of care and ambience strategies started in May 2019 and remains in progress, with the responsible and multiplying participation of professionals and patients. 18 employees participated in the study. It was found that investigative processes accompanied by practical interventions, especially those related to the promotion of interactive, inclusive, care spaces and the creation of a ludic, attractive and interactive environment favor multi-professional actions, mobilize innovative knowledge and practices, and contribute to the (re)signification of the being and doing of the health professional. Care and ambience, with a view to hospital humanization, include the implementation of strategies designed with the responsible and multiplying participation of all actors (professionals and users) of the hospital. It is important that, in this process, everyone feels they are protagonists of new ways of being, living and doing in health.

Planejamento em saúde sobre práticas corporais e atividade física no Programa Academia da Saúde

O objetivo foi analisar o planejamento das práticas corporais e atividades físicas (PC/AF) dos profissionais de educação física concluintes do Curso de Aperfeiçoamento em Implementação da Política Nacional de Promoção da Saúde: Programa Academia da Saúde (PAS). Das ações analisadas (n = 149), 60,5% (n = 286) eram de PC/AF. A ginástica foi mais frequente (20,1%; n = 95) e 21,4% (n = 101) das práticas tinham a alimentação associada. Mais de 60% das ações não informaram instrumentos (n = 330), cronograma (n = 345), recursos financeiros (n = 366) e alcance dos usuários (n = 394). A atuação multiprofissional foi prevista em 61,7% (n = 292) das ações. Sendo assim, o planejamento em saúde carece de informações metodológicas, avaliação e público-alvo para implementação de ações.

AÇÕES MULTIPROFISSIONAIS NA ATENÇÃO À SAÚDE DO PROFESSOR: UM RELATO DE EXPERIÊNCIA

O Ministério da Saúde recomenda a criação de espaços e ambientes saudáveis nas escolas com o objetivo de integrar as ações de saúde na comunidade educativa. O trabalho de promoção da saúde com estudantes, e também com professores e funcionários, precisa corresponsabilizá-los pelo seu estado de saúde. Este trabalho tem como objetivo identificar as principais queixas dolorosas em docentes de uma Unidade de Educação Infantil da cidade de Mossoró-RN, por meio de um relato de experiência realizado no 2º semestre de 2015 com esses professores. Participaram dessa pesquisa sete docentes. Utilizou-se o Questionário Corllet, para identificar a intensidade e frequência de dores corporais, e uma avaliação sobre a Organização e o Posto de Trabalho. Após, traçou-se um programa de intervenção multiprofissional. Os resultados demonstram que 100% dos professores não consideram seu ambiente de trabalho confortável e 75% estão com excesso de peso. Todos os professores queixam-se de desconfortos ou dores em pelo menos uma região do corpo. A partir disso, considera-se que as ações multiprofissionais devem ser priorizadas para contribuir de forma efetiva para melhoria da saúde e da qualidade de vida das pessoas.

Prevenção do desmame precoce de lactentes na perspectiva interprofissional da Equipe Saúde da Famí­lia

Objetivo: conhecer as ações de prevenção do desmame precoce de lactentes na perspectiva interprofissional da equipe de saúde da famí­lia. Método: Estudo descritivo de abordagem qualitativa, utilizada a entrevista semi-estruturada de análise temática. Resultado: Este estudo mostrou desconhecimento da maior parte da equipe de saúde da famí­lia em relação ao conceito da interprofissionalidade. A falta de conhecimento pode interferir na organização do processo trabalho, afetando a qualidade do atendimento a criança e a mulher na atenção básica. Em relação ao desmame precoce a equipe desenvolve ações multiprofissionais para a prevenção de forma individual e coletiva nos cenários como unidade de saúde da famí­lia, no consultório, nas escolas, nas visitas domiciliares e nas igrejas, enfatizando a importância do aleitamento materno. Conclusão: Dessa forma, é necessário que a equipe aprenda sobre a importância de fazer junto o planejamento e a execução das ações de prevenção ao desmame precoce, compreendendo a atuação interprofissional.

Promoção do Vínculo Afetivo entre Mãe e Recém-Nascido Pré-Termo: Percepções e Ações de uma Equipe Multiprofissional

The initial relationship between the newborn and the parents are the prototype of all future social relationships. The Norm of Humanized Attention to the Low Weight Newborn – Kangaroo Method support that the health team should prioritize the approximation between the newborn and the parents, minimizing the impacts of separation, and favoring the formation and strengthening of affective bonds. The objective was to investigate the perception and actions of the multiprofessional team in the promotion of affective bonding between mother and preterm newborn in a neonatal intensive care unit. This is a qualitative, descriptive, and exploratory research, in which we used a semi-structured interview conducted with 8 professionals from different areas of a multiprofessional team. The interviews were recorded, transcribed, and analyzed according to Bardin’s thematic content analysis. The multiprofessional team has direct participation in the affective bonding between mother and the preterm newborn. The actions guided by the Kangaroo Method, as: reception, maternal involvement in care, communication and qualification of care are configured as catalyst processes in the formation and strengthening of affective bonds. There is a need of a theoretical deepening beyond the preterm newborn initial physiological needs, that is, it is necessary to qualify the multiprofessional team actions and to stimulate interventions based on the formation and strengthening of the affective bonds, understanding the basis of the subject’s subjective constitution.

Multi-professional care for the patient affected by pemphigus vulgaris

Patients suffering from pemphigus vulgaris need specialized care. Thus, in their comprehensive care, multi-professional action is essential to meet the different technical challenges of the disease. The objective was to report a case of pemphigus vulgaris and multi-professional performance. This is a descriptive study of the case report of a patient seen at a referral hospital for pemphigus. The information necessary to describe the case was collected after approval by the Research Ethics Committee. The patient arrived at the hospital with diffuse crusty lesions with associated pruritus throughout the body for approximately two months. After clinical evaluation and laboratory examination, the histological examination found the presence of a supra-basal intraepidermal bubble, with the presence of acantholytic cells inside the bubble, concluding as pemphigus vulgaris. During hospitalization, the patient had several secondary infections, used corticosteroids, analgesics, polyantibiotic therapy, and immunoglobulin. At the end of 78 days of hospitalization, he developed complications and died. Early diagnosis and the start of rapid treatment delay the evolution of the disease, improving the appearance of the lesions, which reduces the length of hospital stay and the risk of infections occurring. Therefore, the performance of the multi-professional team contributes to solving the challenges related to the disease, such as improvement in physical, emotional, nutritional, and patient safety. We emphasize measures for the prevention and control of infections, such as, for example, hand hygiene by all professionals, the use of personal protective equipment in the management of the patient, and adequate hygiene of the environment.

A participação da extensão na resolução de caso de criança com Diabetes Mellitus Tipo 1

Introdução: Diabetes Mellitus (DM) representa um grupo de doenças caracterizadas por hiperglicemia. Objetivo: foi demonstrar a importância da extensão, da atuação interprossional e multiprofissional para a resolução de um caso clínico dentro de um Projeto de extensão interprofissional na perspectiva de clínica ampliada. Metodologia: foi realizado relato da atuação da extensão universitária em um caso de uma criança de 11 anos de idade com Diabetes mellitus tipo 1 (DMT1) não controlada, apresentando um quadro de hiperplasia gengival, além de fratura incisal no dente 21. Resultados: O protocolo de atendimento foi preventivo e terapêutico e incluiu: aferição da glicemia capilar, antibioticoterapia profilática, atendimento interprofissional e multiprofissional e controle do quadro de hipoglicemia. O apoio dos familiares foi fundamental para o sucesso do tratamento. Conclusão: Conclui-se que a atuação interprofissional e multiprofissional no planejamento e no desenvolvimento das atividades, favoreceram a interlocução de conhecimentos e experiências para ajudar na resolução das situações vivenciadas, promovendo, assim, melhores condições para o paciente lidar com sua saúde geral e bucal.

Potential risk of intracranial infection due to multiple odontogenic sinusitis

We report a clinical case that demonstrates the importance of multiprofessional action in the prevention of intracranial infection in a case of multiple sinusitis originating in the maxillary sinus after to dental procedure. Fifteen days after the extraction of the right upper third molar (tooth 18), a 19-year-old patient presented with symptoms of pulsatile pain at the surgical site, accompanied by oppressive headache, nasal obstruction, fetid mucopurulent rhinorrhea and posterior nasal discharge treated with antibiotics. There was persistence of intermittent headache and sinusitis remained chronic, with tomographic examination compatible with frontal, ethmoidal, sphenoidal and maxillary sinusopathy on the right side, with obliteration of the ipsilateral osteomeatal unit, small calcific foci at the right maxillary floor through areas of soft tissue density, evoking material of dental origin. A sinusotomy and new antibiotic therapy were performed, with a diagnosis of moderate/severe chronic sinusitis, evolving to absence of symptoms. In the presence of symptoms compatible with sinusitis and previous history of dental approach, it is widely necessary to have the attention of both dental surgeon and otolaryngologist to allow an assertive and early diagnosis of odontogenic sinusitis.

Educate and practice

The participation of our board review through evaluations of the articles submitted to our journal has been instrumental in the formation of the critical mass of foot and ankle surgeons centers.&#x0D; It becomes important in the process of academic refinement of this new generation of thinkers who should implement the technical, scientific, professional and ethical development of future surgeons in the foot and ankle area.&#x0D; One aspect that has stood is the need to plan the preparation of all forms of presentation of an article. Ideally, would be prospective projects with randomization, when pertinent and that would increase the position of the researcher and also our journal. It should be noted that it is available online, with easy access to all interested parties. Certainly, among our goals are the dissemination of our technical skills, our ability to create solutions, which vary point to point in our extensive territory. Efforts are made available to all medical classes. &#x0D; The characteristic of the foot heath care has demanded integrated multiprofessional actions, and this condition includes the treatment of diabetic feet. Nowadays, the orthopedic surgeon still acts late in these issues, however through the research and publication of papers they can act in a more close, intense andpreventive way, so that the health conditions of the individuals are evaluated, protected and understood as educational actions, basic citizenship. In this way We can control, prevent deformities and catastrophic situations that affect the individual and his social environment. The actions we are developing through stimulating science is one of the pillars of Brazilian Foot and Ankle Society.&#x0D; We have the opportunity to provide in this fourth number of volume 12, articles that refer us to the need to integrate the multi-professional care sectors, both in public and supplementary health for people with chronic diseases such as diabetes and degenerative and rheumatic diseases. It is time to think about integrated solutions that match our professional needs; to modern and effective best practices acting as a scientific association in line with the needs of the Brazilian citizen.&#x0D; The wind blows favourably. Have a great reading in this period of Christmas reflections.&#x0D; Jorge Mitsuo MizusakiEditor-in-chief

Possibilities and limits of multiprofessional attention in the care of psychiatric emergencies: analytical study

Goal: to analyze the possibilities and limits of multiprofessional care in the attention to psychiatric emergencies.&#x0D; Method: it is an analytical study of the type integrative review of the comprehensive literature. Searches were conducted in the Latin American and Caribbean Literature (LILACS) and Nursing Database (BDENF) databases and in the ScieLo Virtual Library, with the use of Descriptors in Health Sciences (DECs): “Emergency Services, Psychiatric”, “Forensic Psychiatry”, “Psychiatric Rehabilitation”, in the period from 2007 to 2017.&#x0D; Results: after data analysis, two thematic categories emerged: “Possibilities and limits in multiprofessional care for patients in crisis” and “The continuity of care to the patient in crisis by the multiprofessional team”. The studies point out fragility in the management of the multiprofessional team of care to the patients in psychiatric crisis. Therefore, in the substitutive services to the psychiatric hospital, it is necessary to strengthen the care and bonding tools for continuity of treatment after the cases of psychiatric emergency of these patients.&#x0D; Conclusion: this research provided a deepening of the knowledge regarding the challenges of the multiprofessional team in the care of analytical psychiatric emergencies and in relation to the patient in crisis, considering the main multiprofessional actions, understanding how this approach is done and patient follow-up.&#x0D; Descriptors: Emergency Services, Psychiatric. Forensic Psychiatry. Psychiatric Rehabilitation.

Causas de readmissão hospitalar após cirurgia cardíaca

Objetivou-se identificar o perfil e as causas de readmissão de pacientes submetidos à cirurgia cardíaca. Estudo retrospectivo, descritivo, realizado por meio de revisão de prontuários de pacientes submetidos à cirurgia de revascularização do miocárdio ou implante de prótese valvar com readmissão posterior. A amostra foi constituída por 62 pacientes. A taxa de readmissão foi de 5,9%. A infecção do sítio cirúrgico foi a principal causa de readmissão em 87,5% dos pacientes submetidos à revascularização do miocárdio e em 12,5% dos implantes de prótese valvar (p˂0,001) e esteve associada às variáveis obesidade (p=0,05) e dislipidemia (p=0,007). A identificação dos pacientes em risco para o desenvolvimento de infecção do sítio cirúrgico pode minimizar as taxas de readmissão e diminuir os custos associados ao cuidado, e, merece um planejamento diferenciado de ações multiprofissionais.

Why didn’t you say something? Effects of after-event reviews on voice behaviour and hierarchy beliefs in multi-professional action teams

ABSTRACTTeam decision-making can go wrong when individuals fear to voice suggestions or concerns to higher status team members. We investigate how after-event reviews (AERs) can be used to promote voice behaviour and hierarchy-attenuating beliefs in multi-professional action teams. We hypothesized that (1) lower status team members will speak up more following an assertiveness-specific AER (ASAER) as compared to a teamwork-generic AER (TGAER) and (2) that an ASAER leads to stronger endorsement of hierarchy-attenuating beliefs than the TGAER. To test these hypotheses, we implemented simulations of medical emergencies with 20 healthcare teams consisting of low (i.e., nurses) and high-status (i.e., physicians) professions. After participating in one of the two AERs, teams managed a simulation in which a higher status confederate engaged in potentially harmful actions. Behavioural coding of the videotaped simulations and assessment of team members’ hierarchy beliefs supported both hypotheses: nurses spoke up more following the ASAER than following the TGAER and both professional groups reported significantly higher levels of hierarchy-attenuating beliefs following the ASAER as compared to the TGAER. We discuss how AERs can affect upward voice and increase awareness for the potential downsides of status hierarchies in multi-professional teams.

Pain intensity assessment in chronic renal patients on hemodialysis

BACKGROUND AND OBJECTIVES: Chronic renal patients refer different types of pain, with variable intensity and location. So, this study aimed at assessing pain of chronic renal patients on hemodialysis. METHODS: This is a transversal and analytical study carried out with 88 patients on hemodialysis in a Nephrology Unit of the Northwest region of Rio Grande do Sul. Data were collected from May to July 2014, by means of a Socio-Demographic/ Clinic Characterization Form and McGill Questionnaire, short form, and were analyzed by means of the Statistical Package for the Social Sciences. RESULTS: From participants, 57.5% were males, 58.11% were married and 49.4% were elderly. As to pain intensity during session, 75% had no pain, followed by mild pain (17%), moderate (4%) and severe (3.4%) pain. At the end of the session, 58% remained without pain; however approximate percentages of mild or moderate pain (20.5% and 19.3%) and severe pain (2.3%) have shown increased pain intensity during the course of hemodialysis. CONCLUSION: Results are important as subsidies to qualify multiprofessional team actions toward attention to chronic renal patients and extensive to their families.