Peri-operative SARS-CoV-2 infection increases postoperative mortality. The aim of this study was to determine the optimal duration of planned delay before surgery in patients who have had SARS-CoV-2 infection. This international, multicentre, prospective cohort study included patients undergoing elective or emergency surgery during October 2020. Surgical patients with pre-operative SARS-CoV-2 infection were compared with those without previous SARS-CoV-2 infection. The primary outcome measure was 30-day postoperative mortality. Logistic regression models were used to calculate adjusted 30-day mortality rates stratified by time from diagnosis of SARS-CoV-2 infection to surgery. Among 140,231 patients (116 countries), 3127 patients (2.2%) had a pre-operative SARS-CoV-2 diagnosis. Adjusted 30-day mortality in patients without SARS-CoV-2 infection was 1.5% (95%CI 1.4-1.5). In patients with a pre-operative SARS-CoV-2 diagnosis, mortality was increased in patients having surgery within 0-2 weeks, 3-4 weeks and 5-6 weeks of the diagnosis (odds ratio (95%CI) 4.1 (3.3-4.8), 3.9 (2.6-5.1) and 3.6 (2.0-5.2), respectively). Surgery performed ≥ 7 weeks after SARS-CoV-2 diagnosis was associated with a similar mortality risk to baseline (odds ratio (95%CI) 1.5 (0.9-2.1)). After a ≥ 7 week delay in undertaking surgery following SARS-CoV-2 infection, patients with ongoing symptoms had a higher mortality than patients whose symptoms had resolved or who had been asymptomatic (6.0% (95%CI 3.2-8.7) vs. 2.4% (95%CI 1.4-3.4) vs. 1.3% (95%CI 0.6-2.0), respectively). Where possible, surgery should be delayed for at least 7 weeks following SARS-CoV-2 infection. Patients with ongoing symptoms ≥ 7 weeks from diagnosis may benefit from further delay.

Objective: The aim of this study was to analyze the potential association between nursing workload and patient safety in the medical and surgical inpatient units of a teaching hospital.Method: a mixed method strategy (sequential explanatory design). Results: the initial quantitative stage of the study suggest that increases in the number of patients assigned to each nursing team lead to increased rates of bed-related falls, central line-associated bloodstream infections, nursing staff turnover, and absenteeism. During the subsequent qualitative stage of the research, the nursing team stressed medication administration, bed baths, and patient transport as the aspects of care that have the greatest impact on workload and pose the greatest hazards to patient, provider, and environment safety. Conclusions: The findings demonstrated significant associations between nursing workload and patient safety. We observed that nursing staff with fewer patients presented best results of care-related and management-related patient safety indicators. In addition, the tenets of ecological and restorative thinking contributed to the understanding of some of the aspects in this intricate relationship from the standpoint of nursing providers. They also promoted a participatory approach in this study. Carga de trabajo de enfermería y seguridad de pacientes -estudio con método mixto y aproximación ecológica restaurativaEl estudio tuvo por objetivo analizar la carga de trabajo de enfermería y su potencial relación con la seguridad del paciente en unidades de internación de las áreas clínica y quirúrgica de un hospital universitario. Se adoptó un método mixto de investigación con diseño secuencial explicativo. Los resultados de la etapa cuantitativa indican que el aumento del número de pacientes atribuidos al equipo de enfermería implica en elevación de las tasas de caída de cama, infección relacionada a catéter vascular central, turnover y absentismo. En la etapa cualitativa, el equipo de enfermería destacó los cuidados relacionados con la administración de medicación, baño de cama y transporte de pacientes como aquellos que más repercuten en la carga de trabajo y representan riesgos para la seguridad de los pacientes, de los profesionales y del ambiente. Los resultados mostraron asociaciones significativas entre la carga de trabajo y la seguridad del paciente. La mejor dotación de personal mostró mejores resultados para el manejo y para el cuidado del paciente. Los principios del pensamiento ecológico y restaurativo contribuyeron a la comprensión de algunos de los aspectos involucrados en esta intricada relación, a partir de las miradas de los profesionales, con un enfoque participativo.

Objective:To describe the workload of the nursing team and relate it with patient safety outcomes in clinical and surgical inpatient units of a university hospital. Method: Crosssectional study, carried out from October 2013 to September 2015. The factor under study was the workload, expressed as the ratio between the mean number of patients and the number of nursing professionals in 24 hours and in the day shifts. Results: The sample consisted of 157,481 patients, 502 nursing professionals and 264 observations of safety outcomes. The ratios of patients per nurse and per nursing technician in day shifts indicate a mean estimate of 14-15 and 5-6 patients per professional, respectively. There was a significant association between the workloads in the inpatient units and average length of stay, urinary infection related to invasive procedure and the satisfaction of patients with nursing care. Conclusion: The increase in the workload of the nursing team had an impact on quality of care and safety for patients. An adequate staffing promotes a safer care environment.

RESUMOO presente ensaio tem como objetivo revisitar o conceito de tarefa à luz do referencial de Pichon-Rivière e discutir sua aplicação na pesquisa com grupos focais. Os grupos focais são entendidos como uma técnica de pesquisa que se propõe investigar um tema em profundidade, permitindo que se construam novas ideias e respostas sobre o tema em foco. Para ancorar a prática de pesquisa com grupos focais, utilizaram-se os pressupostos de grupos operativos, em que a noção de tarefa assume uma posição estratégica fundamental, que busca intervir no social através do diálogo e da construção coletiva, distinguindo-se da simples coleta de dados.Descritores: Grupos focais. Pesquisa qualitativa. Pesquisa em enfermagem. Estrutura de grupo. RESUMEN El presente ensayo busca revisitar el concepto de tarea bajo la teoría de Pichon-Rivière y discutir su aplicación en la investigación con grupos focales. Los grupos focales son entendidos como una técnica de investigación que se propone estudiar un tema con profundidad, permitiendo que sobre él se construyan nuevas ideas y respuestas. Para basar la práctica de la investigación con grupos focales se han utilizado los presupuestos de grupos operativos, donde la noción de tarea asume una posición estratégica fundamental que busca intervenir en lo social tras el diálogo y la construcción colectiva, siendo distinta de la simple recolección de datos. Descriptores: Grupos focales. Investigación cualitativa. Investigación en enfermería. Estructura de grupo. Título: La noción de tarea en los grupos focales. ABSTRACT The aim of this paper is to revisit the concept of task in light of Pichon-Riviére's referential and to discuss its application in research with focus groups. Focus groups are understood as a research technique which proposes to investigate a topic in depth, allowing the construction of new ideas and answers on the subject in focus.The presuppositions of operative groups were used to support the research practice with focus groups. In these, the notion of task has a key strategic position from which it seeks to intervene in society through dialogue and collective construction, unlike simple data collecting.

This study proposes an essay of issues involving human resources planning in nursing in the hospital sector in our current reality, discussing possible topics for future research. This is a retrospective of the evolution of research on determining the number of staff in Brazil, and the incorporation of new instruments to evaluate the work load based on the degree of dependency of the patients and actions in care. The impact of the quantity and quality of human resources on the results of care is discussed, and the role of leaders in adapting the staff composition, in order to supply safe, risk-free care to the patients and their families, seeking a management model for health practices from the perspective of complex care.

OBJECTIVE To identify and analyze available literature on care transition strategies in Latin American countries. METHODS Integrative literature review that included studies indexed in PubMed, LILACS, Web of Science Core Collection, CINAHL, SCOPUS databases, and the Scientific Electronic Library Online (SciELO), published in Portuguese, Spanish or English, between 2010 and 2017. RESULTS Eleven articles were selected and the strategies were grouped into components of care transition: discharge planning, advanced care planning, patient education and promotion of self-management, medication safety, complete communication of information, and outpatient follow-up. These strategies were carried out by multidisciplinary team members, in which nurses play a leading role in promoting safe care transitions. CONCLUSIONS Care transition activities are generally initiated very close to patient discharge, this differs from recommendations of care transition programs and models, which suggest implementing care transition strategies from the time of admission until discharge.

SARS-CoV-2 has been associated with an increased rate of venous thromboembolism in critically ill patients. Since surgical patients are already at higher risk of venous thromboembolism than general populations, this study aimed to determine if patients with peri-operative or prior SARS-CoV-2 were at further increased risk of venous thromboembolism. We conducted a planned sub-study and analysis from an international, multicentre, prospective cohort study of elective and emergency patients undergoing surgery during October 2020. Patients from all surgical specialties were included. The primary outcome measure was venous thromboembolism (pulmonary embolism or deep vein thrombosis) within 30 days of surgery. SARS-CoV-2 diagnosis was defined as peri-operative (7 days before to 30 days after surgery); recent (1-6 weeks before surgery); previous (≥7 weeks before surgery); or none. Information on prophylaxis regimens or pre-operative anti-coagulation for baseline comorbidities was not available. Postoperative venous thromboembolism rate was 0.5% (666/123,591) in patients without SARS-CoV-2; 2.2% (50/2317) in patients with peri-operative SARS-CoV-2; 1.6% (15/953) in patients with recent SARS-CoV-2; and 1.0% (11/1148) in patients with previous SARS-CoV-2. After adjustment for confounding factors, patients with peri-operative (adjusted odds ratio 1.5 (95%CI 1.1-2.0)) and recent SARS-CoV-2 (1.9 (95%CI 1.2-3.3)) remained at higher risk of venous thromboembolism, with a borderline finding in previous SARS-CoV-2 (1.7 (95%CI 0.9-3.0)). Overall, venous thromboembolism was independently associated with 30-day mortality ). In patients with SARS-CoV-2, mortality without venous thromboembolism was 7.4% (319/4342) and with venous thromboembolism was 40.8% (31/76). Patients undergoing surgery with peri-operative or recent SARS-CoV-2 appear to be at increased risk of postoperative venous thromboembolism compared with patients with no history of SARS-CoV-2 infection. Optimal venous thromboembolism prophylaxis and treatment are unknown in this cohort of patients, and these data should be interpreted accordingly.

Objective: to explain the research strategies/designs in mixed method studies proposed by Creswell, and to reflect on the applicability of the mixed approaches in scientific nursing research.Method: a reflexive theoretical essay based on Creswell as a conductor for reflections on mixed research. The reflection was organized in a guiding axis that relates the basic theoretical constructs of the mixed methods and their applicability in the area of nursing.Results: with the explanation of the six strategies of mixed research oriented by the author, including three in the sequential design and three in the concomitant, reflections emerged in the applicability of each of the strategies for scientific research in nursing, as well as practical examples of investigations on the use of scarce national and international literature available in the area.Conclusion: mixed methods seem to emerge as the third and new paradigm of scientific research and, once the complexity of the phenomena that can be researched by nursing is recognized, mixed research tends to favor deeper interpretations of its research subject. The researchers of the area must be dedicated to the mixed research project design, and Creswell's reference/design appears to be advantageous to its apprehension. DESCRIPTORS:Research design. Methods. Nursing research. Methodology. Nursing. MÉTODOS MISTOS NA PESQUISA EM ENFERMAGEM: POSSIBILIDADES DE APLICAÇÃO À LUZ DE CRESWELL RESUMOObjetivo: explanar sobre os desenhos/estratégias de pesquisa em métodos mistos propostos por Creswell, e refletir sobre a aplicabilidade das abordagens mistas de investigação científica na enfermagem.Método: ensaio-teórico reflexivo embasado essencialmente ao referencial de Creswell como condutor às reflexões sobre pesquisa mista. A reflexão foi organizada em um eixo condutor que relaciona os construtos teóricos básicos dos métodos mistos e sua aplicabilidade na área da enfermagem.Resultados: com a explanação das seis estratégias de pesquisa mista orientadas pelo autor, entre elas três no desenho sequencial e três no concomitante, foram tecidas reflexões sobre a aplicabilidade de cada uma das estratégias para a pesquisa científica na enfermagem, além de exemplificações práticas de investigações mistas ao uso da escassa literatura nacional e internacional disponível na área.Conclusão: os métodos mistos parecem emergir como o terceiro e novo paradigma da investigação científica e, uma vez reconhecida a complexidade dos fenômenos passíveis a serem pesquisados pela enfermagem, a pesquisa mista tende a favorecer interpretações mais aprofundadas sobre os seus objetos de estudo. Hánecessidade de franca dedicação dos pesquisadores da área no delineamento do projeto de pesquisa mista, e o referencial de Creswell parece ser profícuo à sua apreensão. DESCRITORES: MÉTODOS MISTOS EN LA INVESTIGACIÓN EN ENFERMERÍA: POSIBILIDADES DE APLICACIÓN A LA LUZ DE CRESWELL RESUMENObjetivo: explicar sobre los diseños/estrategias de investigación en métodos mixtos propuestos por Creswell, y reflexionar ...