Objective: to identify the scientifi c publications about adverse events in nursing care in adult hospitalized patients and discuss the main adverse events in nursing care. Method: Integrative revision with a qualitative approach. The data were collected at LILACS, MEDLINE, BDENF and the library SCIELO and were submitted to thematic analysis. Results: three categories were developed: Adverse events in nursing care; The main causes of the adverse events in nursing care; Attitude of nursing professionals in face of errors. The main events were identifi ed in nursing care with emphasis on the medication error, the failure to perform dressings and falls of patients. The importance of instruments was emphasized for notifi cation of adverse events in the institutions. However the fear of punishment on professionals stimulates the underreporting of events. Conclusion: it is important to discuss effective prevention strategies that ensure patient safety in healthcare institutions.

Os objetivos deste estudo foram descrever as necessidades do paciente no pós-operatório de cirurgia cardíaca identificadas pelos enfermeiros e discutir o cuidado de enfermagem com base em tais necessidades. Trata-se de uma pesquisa descritivo-exploratória, de natureza qualitativa, desenvolvida na Unidade Cardiointensiva do Hospital Federal dos Servidores do Estado no Rio de Janeiro. Os dados foram coletados em 2008, por meio de entrevista e observação participante, e analisados mediante a análise de conteúdo. Os dados mostraram uma enfermagem preocupada com o cuidado técnico à beira do leito, porém, desprovida de maior interação com o paciente e sua família. Conclui-se que a adoção plena do processo de enfermagem como metodologia de trabalho contribuirá para uma assistência de melhor qualidade, pautada nas orientações necessárias para cada caso, e para uma melhor informação sobre cuidado envolvendo pacientes, familiares e equipe de enfermagem.

Objectives: to identify the errors in daily intensive nursing care and analyze them according to the theory of human error. Method: quantitative, descriptive and exploratory study, undertaken at the Intensive Care Center of a hospital in the Brazilian Sentinel Hospital Network. The participants were 36 professionals from the nursing team. The data were collected through semistructured interviews, observation and lexical analysis in the software ALCESTE(r). Results: human error in nursing care can be related to the approach of the system, through active faults and latent conditions. The active faults are represented by the errors in medication administration and not raising the bedside rails. The latent conditions can be related to the communication difficulties in the multiprofessional team, lack of standards and institutional routines and absence of material resources. Conclusion: the errors identified interfere in nursing care and the clients' recovery and can cause damage. Nevertheless, they are treated as common events inherent in daily practice. The need to acknowledge these events is emphasized, stimulating the safety culture at the institution.

Objective: To analyze the active failures and the latent conditions related to errors in intensive nursing care and to discuss the reactive and proactive measures mentioned by the nursing team. Method: Qualitative, descriptive, exploratory study conducted at the Intensive Care Unit of a general hospital. Data were collected through interviews, participant observation and submitted to lexical analysis in the ALCESTE® software and to ethnographic analysis. Results: 36 professionals of the nursing team participated in the study. The analysis originated three lexical classes: Error in intensive care nursing; Active failures and latent conditions related to errors in the intensive care nursing team; Reactive and proactive measures adopted by the nursing team regarding errors in intensive care. Conclusion: Reactive and proactive measures influenced the safety culture, in particular, the recognition of errors by professionals, contributing to their prevention, safety and quality care.

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Objective: To reflect on the safe care exercised by the pre-hospital care team by emergency ambulance in times of coronavirus infection. Method: A reflection and description of how to provide safe care to the patient and the professional during pre-hospital care in times of coronavirus infection. Results: To ensure the health of all those involved in the care, health professionals who work in pre-hospital care by emergency ambulance should use the recommended Personal Protective Equipment (PPE), such as the use of surgical masks and N95, N99, N100, PFF2 or PFF3, the use of an apron or overall, goggles and face shield, gloves and a hat. The entire team must receive training and demonstrate the ability to use PPE correctly and safely. Final considerations: The professional working in the pre-hospital care by ambulance is exposed to a series of occupational risks that need to be discussed and minimized through professional training.

Objectives: to identify the perception of nursing professionals on human errors in nursing care at a Neonatal Intensive Care Unit and to assess Best Practices strategies proposed by these professionals for patient safety in nursing care. Methods: this is a quantitative-qualitative, descriptive study. Setting: Neonatal Intensive Care Unit. Participants: 22 nursing professionals. Data collection was performed through interviews and sent to the thematic analysis. Results: human errors in nursing care, such as wasted catheters; errors in the medication process; causes for error in nursing care, with a focus on work overload; Best Practices for patient safety in nursing care, such as professional training and improved working conditions. Conclusions: it is of utmost importance to invest in Best Practices strategies for Patient Safety, aimed at consolidating the culture of organizational safety and encouraging an adequate environment to manage errors.

RESUMO: Objetivou-se identificar os erros na assistência de enfermagem em um Centro de Terapia Intensiva, de acordo com a equipe de enfermagem, e discutir os principais à luz da Teoria do Erro Humano. Estudo transversal cujo cenário foi um Centro de Terapia Intensiva de um hospital do estado do Rio de Janeiro -Brasil. Participaram 36 profissionais da equipe de enfermagem. Os dados foram coletados em entrevista estruturada, no período de julho a setembro de 2013, e analisados através EpiInfo™. Dentre os principais erros na assistência de enfermagem destacam-se: erros de medicação, não elevação das grades do leito, perda de catéteres, sondas e drenos, citados por 83% dos entrevistados; extubações acidentais (72%); e higienização inadequada das mãos (67%). A gravidade dos erros identificados comprometem a assistência e a recuperação da clientela. Enfatiza-se a necessidade de medidas de notificação e prevenção, estimulando-se a cultura de segurança e aumento da qualidade assistencial. DESCRITORES: Segurança do paciente; Erros médicos; Cuidados de enfermagem; Unidades de terapia intensiva. CARACTERIZAÇÃO DE ERROS ERROR CHARACTERIZATION IN INTENSIVE CARE NURSINGABSTRACT: This study aimed to identify errors in nursing care in an intensive care unit, according to the nursing staff, and discuss the main ones according to Human Error Theory. This was a cross-sectional study, and the scenario was an intensive care unit of a hospital in Rio de Janeiro state -Brazil. Participants were 36 professionals of the nursing team. Data were collected in structured interviews, from July to September 2013 and analyzed using Epi InfoTM. The major mistakes in nursing care included: medication error, not lifting the bed railings, loss of catheters, probes and drains (cited by 87% of respondents); accidental extubation (72%); and inadequate hand hygiene (67%). The severity of the errors identified involve the care and recovery of clientele. It emphasizes the need for notification and for prevention measures, contributing to the culture of safety and increasing care quality.