Daniele Alcalá Pompeo

Anxiety, depression, resilience and self-esteem in individuals with cardiovascular diseases

Objetivos: analisar as relacoes entre os sintomas ansiosos e depressivos, resiliencia e autoestima com as caracteristicas sociodemograficas e clinicas; correlacionar resiliencia e autoestima com a idade e o tempo da doenca; analisar associacoes entre ansiedade e depressao com as medidas de resiliencia e autoestima em individuos com doencas cardiovasculares. Metodo: estudo correlacional, realizado em Hospital de Ensino de grande porte do interior do Estado de Sao Paulo. A populacao era constituida por pacientes adultos internados com doencas cardiovasculares. Uma amostra consecutiva e nao probabilistica foi constituida por 120 pacientes. As variaveis de interesse foram avaliadas pela Escala Hospitalar de Ansiedade e Depressao, Escala de Resiliencia e Escala de Autoestima de Rosenberg. Resultados: os sintomas de ansiedade e depressao estavam presentes em 32,5% e 17,5% dos pacientes, respectivamente e foram associados ao sexo feminino (p = 0,002; p = 0,022). As manifestacoes de depressao foram associadas a presenca de comorbidades (p = 0,020). Pacientes mais resilientes nao apresentaram sintomas depressivos (p < 0,001) e, as mulheres ansiosas, foram menos resilientes (p = 0,042). Os maiores escores de autoestima estiveram presentes em pacientes com ansiedade e depressao. Os homens apresentaram maior resiliencia e menor autoestima quando comparados as mulheres. Conclusao: pacientes com ansiedade e depressao foram menos resilientes e apresentaram maior autoestima.ABSTRACT Objectives: to analyze the relationship between anxiety and depression symptoms, resilience and self-esteem with sociodemographic and clinical characteristics; correlate resilience and self-esteem with age and duration of the disease; check associations between anxiety and depression with measures of resilience and self-esteem among individuals with cardiovascular diseases. Method: correlational study conducted in a large university hospital in the interior of the state of São Paulo, Brazil. The population was composed of adult inpatients with cardiovascular diseases. A non-probabilistic consecutive sample was composed of 120 patients. Variables of interest were assessed using the Hospital Anxiety and Depression Scale, Resilience Scale, and Rosenberg Self-Esteem Scale. Results: anxiety and depression symptoms were present in 32.5% and 17.5% of the patients, respectively, and were associated with the female sex (p = 0.002; p = 0.022). Manifestations of depression were associated with the presence of comorbidities (p = 0.020). More resilient patients did not present depression symptoms (p < 0.001) and anxious women were more resilient (p = 0.042). The highest scores regarding self-esteem were present in patients with anxiety and depression. Men presented higher resilience and lower self-esteem compared to women. Conclusion: patients with anxiety and depression were less resilient but presented higher self-esteem.

Estratégias de enfrentamento dos enfermeiros em serviço hospitalar de emergência

Objective: To identify the coping strategies of nurses in hospital emergency services, and relate them to sociodemographic and professional variables. Methods: Cross-sectional study with 89 nurses. Research instruments included a form to characterize the research subjects and the Ways of Coping Questionnaire by Folkman and Lazarus. Results: The most commonly used coping strategies were problem solving and positive reappraisal, whereas the least used was confrontation. The strategies of confrontation, positive reappraisal and escape-avoidance were associated with the male sex, not having a partner and working night shifts, respectively. Conclusion: Coping strategies can be aided by listening, monitoring, educational programs and creation of a space for discussion of work-related difficulties.

Strategies for coping with family members of patients with mental disorders

Objetivo: identificar as estrategias de enfrentamento de familiares de pacientes com transtornos mentais e relaciona-las com as variaveis sociodemograficas do familiar e clinicas do paciente. Metodo: estudo descritivo, desenvolvido em hospital psiquiatrico do interior do estado de Sao Paulo, com 40 familiares de pacientes internados, maiores de 18 anos e que acompanhavam o paciente antes e durante a internacao. Foram utilizados instrumentos para caracterizacao dos sujeitos e o Inventario de Estrategias de Enfrentamento de Folkman e Lazarus. Resultados: as estrategias de enfrentamento mais utilizadas pelos familiares foram suporte social e resolucao de problemas. Pais e maes utilizaram mais estrategias funcionais (autocontrole p=0,037; reavaliacao positiva p=0,037; suporte social p=0,021). Nao foram evidenciadas diferencas significativas entre as estrategias e as demais variaveis estudadas. Conclusao: apesar do sofrimento causado pelo impacto do adoecimento do seu ente querido, os familiares utilizam mais estrategias funcionais, permitindo-lhes enfrentar as adversidades de forma mais ajustada.ABSTRACT Objective: to identify the coping strategies of family members of patients with mental disorders and relate them to family member sociodemographic variables and to the patients clinical variables. Method: this was a descriptive study conducted at a psychiatric hospital in the interior of the state of São Paulo, with 40 family members of hospitalized patients over the age of 18, and who followed the patient before and during hospitalization. We used tools to characterize the subjects and the Folkman and Lazarus Inventory of Coping Strategies. Results: the coping strategies most often used by family members were social support and problem solving. Mothers and fathers used more functional strategies (self-control p=0.037, positive reappraisal p=0.037, and social support p=0,021). We found no significant differences between the strategies and other variables examined. Conclusion: despite the suffering resulting from the illness of a dear one, family members make more use of functional strategies, allowing them to cope with adversities in a more well-adjusted way.

Relationship between anxiety, depressive symptoms and compulsive overeating disorder in patients with cardiovascular diseases

ABSTRACT Objectives: to identify the presence of compulsive overeating disorder in patients with cardiovascular diseases and to verify its relation with sociodemographic, clinical variables and the presence of anxiety and depressive symptoms. Method: cross-sectional, correlational study with a sample of 111 patients with cardiovascular diseases. The presence of anxiety and depressive symptoms was assessed by the Hospital Anxiety and Depression Scale instrument and compulsive overeating disorder was assessed through a likert instrument called the Periodic Eating Disorder Scale (Binge Eating Scale). Results: there was a predominance of patients without compulsive overeating disorder (n=91, 82%), followed by moderated compulsive overeating (n=15, 13.5%) and severe (n=5, 4.5%) associating to high levels of body mass index (p=0.010) and the presence of anxiety (p=0.017). Conclusion: Compulsive overeating disorder was present in 18% of the patients, being associated with body mass index and anxiety, suggesting that health professionals should pay attention to the comprehensive evaluation of patients with cardiovascular diseases. Important results emerged from this study, emphasizing the need to implement programs to improve the patients’ mental and physical health in both primary and specialized care services.

DIAGNÓSTICOS DE ENFERMAGEM EM PACIENTES COM DOENÇAS CARDIOVASCULARES: APLICAÇÃO DO MODELO OUTCOME-PRESENT STATE-TEST

A enfermagem contemporânea e focada em resultados e na analise complexa das multiplas condicoes do paciente. Um modelo de raciocinio diagnostico denominado Outcome-Present State-Test (OPT) e apontado como ferramenta para auxiliar o raciocinio clinico e, consequentemente, incentivar novas habilidades cognitivas. Assim, a contribuicao dessa investigacao esta alicercada na utilizacao de um metodo inovador e transformador para a execucao do diagnostico de enfermagem no Brasil, ja que a forma tradicional vem apresentando falhas e gerando inquietacoes. Objetivo: Identificar a concordância e a discordância entre os enunciados dos diagnosticos de enfermagem de pacientes com doencas cardiovasculares elaborados por pesquisadores e os registrados em prontuario eletronico por enfermeiros da pratica clinica e verificar a presenca de associacao entre os diagnosticos medicos e os diagnosticos de enfermagem dos pacientes com doencas cardiovasculares. Metodo: Estudo descritivo, realizado em uma amostra nao probabilistica constituida por 50 pacientes adultos, internados por algum tipo de doenca cardiovascular em um hospital publico. Os dados foram coletados por meio de um formulario, aplicado simultaneamente por duas pesquisadoras, composto por dados de identificacao, caracterizacao sociodemografica e dados clinicos. Apos a avaliacao do paciente, as pesquisadoras formulavam os diagnosticos de enfermagem da NANDA-I por meio do modelo OPT. As informacoes coletadas sobre o paciente eram transcritas na forma de caso clinico e, os diagnosticos de enfermagem pertinentes aquele caso, eram elencados, para facilitar o processo de validacao de conteudo, realizada por seis expertos. Posteriormente, o prontuario eletronico era acessado para coletar os diagnosticos documentados naquele dia pelos enfermeiros da Unidade de Cardiologia. Diagnosticos com alta pontuacao pelos expertos foram comparados aos diagnosticos elaborados pelos enfermeiros clinicos, para verificacao da concordância, por meio do mapeamento cruzado. Resultados: A insuficiencia cardiaca congestiva foi o diagnostico medico de 44% dos pacientes, seguida de coronariopatias (36%), arritmias (12%) e endocardite (8%). De acordo com os pesquisadores e os expertos, 14 diferentes diagnosticos de enfermagem estiveram presentes (±3,3), mas apenas tres obtiveram frequencia maior que 50%: Risco de sangramento, Debito cardiaco diminuido e Conhecimento deficiente. Os enfermeiros da pratica clinica registraram 15 diferentes diagnosticos de enfermagem (±3,3), sendo Risco de infeccao e Risco de quedas os dois enunciados com frequencia maior que 50%. De 307 titulos diagnosticos, distribuidos entre os 50 participantes, apenas dois diagnosticos de enfermagem (0,7%) foram concordantes e 305 (99,3%) discordantes. Conclusoes: A concordância de diagnosticos de enfermagem entre pesquisadores e enfermeiros clinicos foi baixa. Os diagnosticos elencados pelos pesquisadores foram voltados as respostas cardiovasculares e os enfermeiros clinicos se preocuparam mais com as questoes de seguranca do paciente. O raciocinio clinico realizado pelo OPT e uma importante ferramenta para a assistencia aos pacientes em situacoes complexas, como aqueles com doencas cardiovasculares, bem como um recurso valioso para o processo de ensino-aprendizagem, que impulsionara o processo de raciocinio clinico dos estudantes.

GRUPOS EDUCATIVOS PARA O CONTROLE DE HIPERTENSÃO E DIABETES MELLITUS: REVISÃO INTEGRATIVA DE LITERATURA

Introduction: Diabetes Mellitus and Hypertension are among the main risk factors for cardiovascular disease. Both can be reduced taking preventive measures and delivering treatment. Educational support programs targeted to diabetic and hypertensive patients can be an effective way to motivate self-care. Thus, these programs minimize the modifiable risk factors. Objective: Seek scientific evidence on the effectiveness of the educational groups’ strategy in clinical practice in order to control hypertension and diabetes mellitus. Material and Methods: We performed an integrative review of the literature on Lilacs and PubMed databases from 2008 to 2013. Results: We found 12-English written articles. Two studies were conducted in Brazil, and 10 of them were efficacious. Conclusion: This study showed the importance of health education in educational groups over the control of diseases such as diabetes and hypertension. These actions require planning, teamwork, and attitudes focused upon the development and strengthening of the link between users and professional, and the longitudinality of assistance. Descriptors: Health Promotion; Diabetes Mellitus; Health Education; Hypertension; Nursing.

Aplicação do modelo outcome present state test em paciente com insuficiência cardíaca congestiva

Trata-se de estudo de caso de paciente idosa, internada em unidade medico-cirurgica por insuficiencia cardiaca descompensada, que teve como objetivo identificar, por meio do modelo de raciocinio clinico Outcome Present State Test (OPT), os diagnosticos, resultados e intervencoes de enfermagem. A coleta de dados foi realizada por meio de instrumento previamente validado e direcionado as condicoes cardiologicas. Os diagnosticos, resultados e intervencoes foram realizados com o uso de sistemas padronizados de linguagem NANDA-I Inc., Nursing Outcomes Classification e Nursing Interventions Classification. O diagnostico central foi debito cardiaco diminuido. Os resultados e as intervencoes escolhidos foram relacionados aos estados cardiacos e respiratorios, sobrecarga hidrica, ansiedade, fadiga, perfusao tissular periferica, conhecimento e autocontrole da insuficiencia cardiaca, sinais vitais e melhora do sono. A terceira geracao do processo de enfermagem, representada pelo OPT, auxiliou na identificacao das principais necessidades do paciente e direcionou o planejamento da assistencia com base nas prioridades do cuidado.(AU)This is a case study of an old female patient admitted in a medical-surgical unit due to decompensated heart failure. It aimed to identify, through the Outcome-Present State-Test (OPT) Model, a clinical reasoning model, the diagnosis, outcomes and nursing interventions. Data were collected using previously validated instrument and directed to cardiological conditions. Diagnoses, outcomes, and interventions were carried out with the use of the standardized nursing language of NANDA-I Inc., Nursing Outcomes Classification, and Nursing Intervention Classification. The main diagnosis was decreased cardiac output. The results and chosen interventions were related to cardiac and respiratory conditions, fluid overload, anxiety, fatigue, peripheral tissue perfusion, knowledge, and self-control of heart failure, vital signs, and improved sleep. The third generation of the Nursing process represented by the OPT helped to identify the patient́ s main needs and directed the planning of care based on the care priorities.

GRUPOS DE PESQUISA NA ENFERMAGEM BRASILEIRA EM SAÚDE MENTAL E PSIQUIATRIA

Introduction: Mental health is inserted in society since ancient times. Its constant association with physical and social health means that there is a growing interest in the production of knowledge and technical-scientific discoveries in this area. Objective: Identify and characterize the nursing research groups in Mental Health and Psychiatry in Brazil. Material and Methods: This is a documentary, descriptive, and exploratory study. We searched the current database of the Directory of Research Groups of the Brazilian National Council for Scientific and Technological Development (CNPq), using the terms “mental health” and “psychiatry.” Research groups were analyzed, and the information was input on an instrument designed by the researcher. Data analysis was performed using descriptive statistics. Results: We have identified 25 research groups. Most of these groups are linked to public higher education institutions (n=23; 92%) and located mainly in the southeast (n=12; 48%) and Northeast regions of Brazil (n=7; 28 %). There was an increase of research groups registered in CNPq between 2006 and 2014 (n=20; 80%). We have identified 189 researchers and 237 students in the study groups, with an average of 17.04 members per group. Conclusion: There was an increase of research groups in mental health and psychiatry nursing in Brazil. However, the quantity of the groups is still reduced. Strategies that strengthen the development of research may lead to further consolidation, visibility, and advancement of science on this issue.

Readmissões por acidentes de trânsito em um hospital geral

Objetivo: verificar la ocurrencia y las causas de reinternaciones hasta un ano despues del alta de hospitalaria, debido a accidentes de trafico. Metodos: fueron incluidas victimas de traumas multiples, por accidentes de trafico, admitidas en una Unidad de Terapia Intensiva. Fueron recolectados de las fichas medicas de los pacientes: datos sociodemograficos, circunstancias del accidente, regiones corporeas afectados y causa de la readmision. Resultados: de las 109 victimas de accidentes de trafico, la mayoria eran hombres jovenes y adultos. El mayor numero de internaciones por accidentes se relaciono con motociclistas (56,9%). Las causas de retorno al hospital fueron: necesidad de continuar el tratamiento quirurgico (63,2%), infeccion de sitio quirurgico (26,3%) y caida relacionada a las secuelas fisicas del trauma (10,5%), siendo la tasa de reinternacion de 174/1.000 personas/ano. Conclusion: la tasa de readmision hospitalaria en la poblacion estudiada es semejante a las encontradas en otros estudios. Victimas de traumas graves de extremidades necesitan de multiples procedimientos quirurgicos, mayor tiempo de internacion hospitalaria y rehabilitacion prolongadaAbstract Objective: to verify the occurrence and the causes of hospital readmissions within a year after discharge from hospitalizations due to traffic accidents. Methods: victims of multiple traumas due to traffic accidents were included, who were admitted to an Intensive Care Unit. Sociodemographic data, accident circumstances, body regions affected and cause of readmission were collected from the patient histories. Results: among the 109 victims of traffic accidents, the majority were young and adult men. Most hospitalizations due to accidents involved motorcycle drivers (56.9%). The causes of the return to the hospital were: need to continue the surgical treatment (63.2%), surgical site infection (26.3%) and fall related to the physical sequelae of the trauma (10.5%). The rehospitalization rate corresponded to 174/1,000 people/year. Conclusion: the hospital readmission rate in the study population is similar to the rates found in other studies. Victims of severe limb traumas need multiple surgical procedures, lengthier hospitalizations and extended rehabilitation.

Readmissions due to traffic accidents at a general hospital.

Objetivo: verificar la ocurrencia y las causas de reinternaciones hasta un ano despues del alta de hospitalaria, debido a accidentes de trafico. Metodos: fueron incluidas victimas de traumas multiples, por accidentes de trafico, admitidas en una Unidad de Terapia Intensiva. Fueron recolectados de las fichas medicas de los pacientes: datos sociodemograficos, circunstancias del accidente, regiones corporeas afectados y causa de la readmision. Resultados: de las 109 victimas de accidentes de trafico, la mayoria eran hombres jovenes y adultos. El mayor numero de internaciones por accidentes se relaciono con motociclistas (56,9%). Las causas de retorno al hospital fueron: necesidad de continuar el tratamiento quirurgico (63,2%), infeccion de sitio quirurgico (26,3%) y caida relacionada a las secuelas fisicas del trauma (10,5%), siendo la tasa de reinternacion de 174/1.000 personas/ano. Conclusion: la tasa de readmision hospitalaria en la poblacion estudiada es semejante a las encontradas en otros estudios. Victimas de traumas graves de extremidades necesitan de multiples procedimientos quirurgicos, mayor tiempo de internacion hospitalaria y rehabilitacion prolongadaAbstract Objective: to verify the occurrence and the causes of hospital readmissions within a year after discharge from hospitalizations due to traffic accidents. Methods: victims of multiple traumas due to traffic accidents were included, who were admitted to an Intensive Care Unit. Sociodemographic data, accident circumstances, body regions affected and cause of readmission were collected from the patient histories. Results: among the 109 victims of traffic accidents, the majority were young and adult men. Most hospitalizations due to accidents involved motorcycle drivers (56.9%). The causes of the return to the hospital were: need to continue the surgical treatment (63.2%), surgical site infection (26.3%) and fall related to the physical sequelae of the trauma (10.5%). The rehospitalization rate corresponded to 174/1,000 people/year. Conclusion: the hospital readmission rate in the study population is similar to the rates found in other studies. Victims of severe limb traumas need multiple surgical procedures, lengthier hospitalizations and extended rehabilitation.