Concordância entre enfermeiros quanto ao risco dos pacientes para úlcera por pressão

Abstract

Objectives: To evaluate the agreement between nurses regarding classification and assessment of patients' risk for developing pressure ulcer. Methods: A descriptive exploratory study conducted with 22 nurses in four intensive care units of Brazilian university hospitals. The Braden Scale was used for assessment and classification of the patients' risk for developing pressure ulcer. To assess agreement, we considered the score obtained by the researcher, nurse specialist, as gold standard parameter for comparison with scores punctuated by assisting nurses. Results: There was general agreement among nurses only in the assessment of the subscales Sensory Perception, Mobility, Friction & Shear. For classification into risk levels, there was agreement in only two units. Conclusion: There were differences of agreement between assisting nurses and difference in classification of patients into risk levels. ResumoObjetivos: Avaliar a concordância entre enfermeiros quanto à avaliação e classificação de risco dos pacientes para desenvolvimento da Úlcera por Pressão. Métodos: Estudo descritivo exploratório realizado com 22 enfermeiros assistenciais em quatro Unidades de Terapia Intensiva de hospital universitário brasileiro. Utilizou-se a escala de Braden para avaliação e classificação do risco dos pacientes para Úlcera por Pressão. Para avaliação da concordância, considerou-se o escore obtido pela pesquisadora, enfermeira especialista, como parâmetro ouro para comparação com os escores pontuados pelos enfermeiros assistenciais. Resultados: Verificou-se concordância geral entre os enfermeiros somente na avaliação das subescalas Percepção Sensorial, Mobilidade, Fricção e Cisalhamento. Quanto à classificação em níveis de risco, houve concordância apenas em duas Unidades. Conclusão: Foram encontradas divergências de concordância entre os enfermeiros assistenciais e diferença na classificação dos pacientes em níveis de risco.

Knowledge of the nursing team on pressure ulcer prevention

“…Nursing technicians/aides, in turn, reached the maximum score in three questions (items 22, 27 and 39) and 96.4% of hits in other four (items 21, 26, 37 and 41) related to specific (cleanness, moisture, friction) and general (risk evaluation, guidance to family members, systematization of measures) measures of prevention. The lowest mean of hits (17.8%) was achieved by technicians/ aides in item 5, related to the massage on regions of bone prominence, whereas nurses presented the lowest mean of hits (33.3%) in four items (4,8,18 and 37), related to friction, use of warm water and relief of pressure for patients in sitting position.…”

“…In a study developed with nursing team members of a tertiary teaching hospital in a city of São Paulo (18) , the mean hits by professionals regarding the description of the PU classification was low (29.5%) as well, with negative interference in the process of clinical evaluation of patients. This also entails unfavorable consequences to the planning of proper interventions.…”

Práticas assistenciais para segurança do paciente em unidade de terapia intensiva

“…(9) Nursing work in the intensive care unit is described as stressful, wearing, fatiguing and overloading, especially regarding the working hours and the environment. (10,11) Patient safety is related to changes in the work process, i.e., the way humans produce and reproduce their existence, interfering with the way that nurses perform their daily work. (3,12) These professionals aim to organize nursing work and human resources, with the purpose of creating and implementing appropriate conditions for patient care.…”

Risco de integridade da pele prejudicada: avaliação e conduta de enfermagem frente às úlceras por pressão (UPP) em pacientes em terapia intensiva

“…2016 clínicas justifi carem e treinamento sistematizado de enfermeiros, diminuindo as diferenças interobservadores no momento de aplicação das escalas de avaliação (GO-MES et al, 2010;KURCGANT, 2012b;SI-MÃO;CALIRI;SANTOS, 2013).…”