Nursing care adverse events at an intensive care unit Eventos adversos na assistência de enfermagem em uma unidade de terapia intensiva
Objective: To evaluate the relationship between presence/absence of Pressure Ulcer, socio-demographic factors and hospitalization. Method: Case-control study, performed through multiple logistic regression based on information from the adverse event reporting system and the hospital information system, between September/2014 and August/2015. Results: Among the risk factors, after adjustment, age greater than or equal to 60 years, hospitalization due to infectious, parasitic and neoplastic diseases, periods of hospitalization longer than seven days and being hospitalized in ICU other than ICU covenant were highlighted. Most of ulcers were reported with mild damage degree and Stage II classification. Conclusion: Age and days of hospitalization presented a dose-response effect, the longer the age or the number of days of hospitalization, the greater the chances of Pressure Ulcer. There was a significant association among higher occurrences of death in patients with ulcer.
ResumoIntrodução: A taxa de mortalidade hospitalar é indicador de resultados para avaliação da qualidade da assistência em unidade coronária. Objetivos: Caracterizar os pacientes submetidos à cirurgia cardíaca, identificar os tipos de cirurgia e as principais complicações nos primeiros 30 dias pós-cirurgia. Material e Métodos: Estudo retrospectivo, longitudinal, quantitativo envolvendo pacientes submetidos a cirurgia cardíaca em um hospital de ensino, de janeiro de 2003 a abril de 2012. Resultados: Foram avaliados 2.648 pacientes, 61% do sexo masculino e 39% do feminino, com idade entre 49 a 66 anos, com média de Índice de Massa Corpórea de 26. As doenças de base mais comuns foram Diabetes Mellitus e Doença Renal Crônica. Realizaram revascularização do miocárdio 1.641 pacientes (62%) e cirurgia valvar 1.007 (38%). As principais complicações pós-operatórias foram lesão renal aguda até 7º dia pós-operatório (32%), disfunção de ventrículo esquerdo moderada/grave (20%), reintubação por complicações pulmonares (11%), fibrilação atrial (8,6%) e lesão neurológica (4,3%). O tempo médio de permanência na Unidade Coronária foi de 6,8 dias e a maioria necessitou de circulação extracorpórea. Dos 22% de pacientes com história pregressa de diabetes, 25% morreram. Conclusões: A maioria submeteu-se à revascularização do miocárdio; 65% desenvolveram lesão renal aguda e 44% foram reintubados por complicações pulmonares e associação significativa com óbito. Dos 190 pacientes que morreram nos primeiros 30 dias, as complicações de maior prevalência foram afecções cardíacas, infecção hospitalar, distúrbio de coagulação, complicações neurológicas e pulmonares. Descritores:Complicações; Óbito; Pós-operatório; Cirurgia Cardíaca. Abstract Introduction: Hospital mortality rate is an indicator of outcomes to evaluate the quality of health care in a coronary care unit. Objectives: The aims of the present study are to characterize patients undergoing cardiac surgery, as well as to identify the types of surgery and its main complications in the first 30 postoperative days. Material and Methods: We carried out a retrospective longitudinal study using a quantitative approach involving patients who underwent cardiac surgery at a teaching hospital from January 2003 to April 2012. Results: We evaluated 2,648 patients, 61% males, and 39% females, with a mean age ranging from 49 to 66 years. Patients mean Body Mean Index was 26. The most common underlying diseases were diabetes mellitus and chronic renal insufficiency. We performed Coronary Artery Bypass Grafting in 1,641 patients (62%) and heart valve surgery in 1,007 (38%). The main postoperative complications were acute kidney injury on the 7 th postoperative day 7 (32%), moderate to severe left ventricular dysfunction (20%), reintubation due to pulmonary complications (11%), atrial fibrillation (8.6%), and neurological lesions (4.3%). The mean length of stay in Coronary Care Unit was 6.8 days. The majority of the patients required cardiopulmonary bypass. Of the 22% of patients with a prior histo...
Guerrero GP, Beccaria LM, Trevizan MA. Standard operating procedure: use in nursing care in hospital services.Rev Latino-am Enfermagem 2008 novembro-dezembro; 16(6)
Objective: To observe the quality of life of patients with implantable cardioverter-defibrillator (ICD).Methods: This is a descriptive research with a quantitative approach. Data collection was done through an interview. The Questionnaire SF-36 was used to analyze data, which has been collected in a cardiovascular outpatient service. Fifty patients with this device took part in the study during their medical follow-up from January to December.Results: Of the 50 patients, 19 (38%) were female and 31 (62%) male. The mean age of the patients was 58.4 years, with ages ranging from 21 to 75 years. It was observed two domains regarding limitations by physical and emotional profiles below score 50. The domain social profiles presented the higher score 80.5. Most of the patients reported that their health was a little better compared with a year ago. Conclusion:The results showed a loss in the patients' quality of life, with lower scores in the physical and emotional profiles. There was no correlation between quality of life with the variables age, sex, marital status and education level. However, patients feel relieved and secure with the benefits provided by ICD in maintaining their lives by protecting them from sudden death. Descriptors 239CESARINO, CB ET AL -Quality of life of patients with implantable cardioverter-defibrillator: the usage of SF-36 Questionnaire Rev Bras Cir Cardiovasc 2011; 26(2):238-43
Esta pesquisa investigou a experiência do profissional da enfermagem no cuidado ao paciente oncológico fora de possibilidade de cura; trata-se de um estudo de abordagem qualitativa, com participação de 13 profissionais da equipe de enfermagem de um hospital de ensino do interior paulista. Os dados foram coletados entre agosto e outubro/2009, por meio de entrevista. A análise de conteúdo de Bardin possibilitou a categorização dos dados em: O cotidiano da enfermagem com o paciente oncológico fora de possibilidade de cura; O enfrentamento do trabalho com paciente em fase terminal; e Dificuldades no trabalho com o paciente fora de possibilidade de cura. Os resultados apontaram que a assistência aos pacientes restringiu-se aos cuidados físicos e o enfrentamento se deu com estratégias individuais, podendo colocar em risco a segurança do paciente. O despreparo dos profissionais para o cuidado emocional foi a principal dificuldade relatada, com evidências de necessidade de sua capacitação.
After discharge from ICU, sepsis survivors of sepsis had a higher mortality rate than critically ill patients without sepsis. Older patients with sepsis had more moderate and severe problems in all five quality of life dimensions evaluated.
Objective: To investigate good nursing care practices for patient safety in an intensive care unit. Methods: Descriptive study using a checklist with 19 items on hygiene/comfort, patient identification/falls and hospital infection. Four hundred fifty records were analyzed through G test of independence with Williams correction. Results: Altogether, good care practices are delivered with an index above 90%, exception for position changing, limb restraints kept clean, and ventilator circuit. Conclusion: Good nursing care practices for patient safety were performed differently based on work shifts. ResumoObjetivo: Verificar as boas práticas assistenciais de enfermagem para segurança do paciente em unidade de terapia intensiva. Métodos: Pesquisa descritiva, utilizando um checklist com 19 itens sobre higiene/conforto, identificação do paciente/queda e infecção hospitalar. Foram analisadas 450 verificações por meio do Teste G de independência com a correção de Williams. Resultados: Em conjunto, as boas práticas estão sendo realizadas com índice acima de 90%, com exceção da mudança de decúbito, restrições de membros limpas e circuito do ventilador. Conclusão: As boas práticas assistenciais de enfermagem para a segurança do paciente foram realizadas, com diversidade conforme o turno de trabalho.
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