Eliane da Silva Grazziano

Fragilidade de idosos em vulnerabilidade social

Resumo Objetivo: Identificar a relacao entre fragilidade, caracteristicas sociodemograficos e vulnerabilidade social de idosos cadastrados em um servico de atendimento primario. Metodos: Trata-se de um estudo exploratorio, comparativo e transversal, com abordagem quantitativa de investigacao realizado com 247 idosos cadastrados em um servico de atendimento primario, em um municipio do interior paulista. Utilizou-se questionario para caracterizacao socio demografica dos participantes e Escala de Fragilidade de Edmonton, para avaliar a fragilidade. A vulnerabilidade foi classificada segundo Indice Paulista de Vulnerabilidade Social. [...]

Glycemic Control of Elderly Patients with Diabetes Mellitus Undergoing Surgery: A Mini Review

The elderly person presents a decline of the organic functions due to the organs and systems’ aging, which generates greater difficulty to maintain the homeostasis during functional overload caused by morbid processes, surgical interventions or emotional changes experienced. With aging, the need for surgical interventions increases, as well as the use of a large number of drugs (polypharmacy) to control morbidities [1]. Morbidites caused by chronic non-communicable diseases (NCDs) have been the main causes of death in the elderly population, following a worldwide trend. More than 50% of diabetic patients have a chance of undergoing surgery at least once in their lives. Diabetes mellitus(DM) is one of the main chronic diseases among the elderly, and the management of blood glucose during anesthesiasurgical procedure is necessary, mainly due to the metabolic disorders caused in this therapeutic procedure, among them the hyperglycemia and ketoacidosis. Perioperative hyperglycemia is aggravated when the patient is diabetic, requiring multi professional interventions for adequate glycemic control, avoiding the installation of ketoacidosis and hydro electrolytic imbalance [2]. Study identified hyperglycemia in 40% of patients admitted to hospitals, half of whom were not diabetic, corroborating the relationship between physical and emotional stress, use of corticosteroids and anti-inflammatories with hyperglycemia [3]. Evidence indicates that perioperative hyperglycemia significantly increases the risk for pneumonia, systemic blood infections, urinary tract infection, skin infections, and acute postoperative renal failure in adult patients undergoing general surgery. There is a positive association between blood glucose concentration and mortality rate, as well as the association between increased days of hospitalization and risk for complications and mortality in patients with glycemia> 150mg / dl, especially in non-diabetic patients [4]. The intra operative period presents a number of factors that affect blood glucose such as surgical stress and use of anesthetic drugs. Therefore, a protocol for the postoperative period may not be effective. For an algorithm to be really effective it would be necessary to use frequent measures of blood glucose for the patient or certain type of surgery and to be able to adapt its parameters to the various conditions during this period [5]. This integrative review (IR) aimed to identify and analyze protocols for the glycemic control of elderly patients with Diabetes Mellitus undergoing general surgery.

The Importance of Health Professionals Communication for Patient Safety: Narrative Review

Submit Manuscript | http://medcraveonline.com at the national and international levels, due to its importance for health systems and society [1,2]. These discussions about patient safety and communication are recent and for many years were seen as a utopia. The World Health Organization (WHO) defines patient safety as reducing the risk of unnecessary harm associated with health care to the least acceptable level [3]. The contributing human factor associated with the greatest number of adverse events is lack of communication. The communication failure can be between the professional and the patient; among professionals of the same professional category, as well as among professionals in a multiprofessional team. It is important to highlight the exhaustion factor (Burnout) that affects health professionals, especially nurses and [4]. Communication permeates all activities that integrate patient care. The more specialized the service, the greater the need for technical, specialized and accurate information. Ineffective communication is among the root causes of more than 70% of errors in health care. Interruptions in communication or lack of teamwork are factors that contribute to the occurrence of adverse events and unsatisfactory treatment outcomes. Among the consequences of communication failures are patient harm, increased hospitalization time, and inefficient use of resources [1,5]. In view of the above, this mini review aimed to identify the relationship between communication between health professionals and patient safety in a hospital environment.

Segurança no cuidado em cirurgias: onde estamos?

A temática sobre a segurança em cirurgia surgiu como meta do segundo desafio global lançado pela Aliança Mundial para a Segurança do Paciente, da Organização Mundial da Saúde (OMS), entre 2007 e 2008, tendo como marco a campanha “Cirurgia Segura Salva Vidas”. Tal campanha teve como objetivo estimular os gestores de instituições hospitalares, bem como os profissionais de saúde, a mobilizarem esforços no sentido de elencar um padrão de práticas que: promovesse a segurança em cirurgia, fosse aplicável em qualquer parte do mundo e em diferentes cenários cirúrgicos, permitisse a mensuração de indicadores visando a promoção de vigilância epidemiológica. Desses esforços surgiram protocolos assistenciais e listas de verificação cirúrgica aplicáveis no intraoperatório. A lista de verificação mais conhecida é o Time Out, e sua utilização é um dos requisitos de várias instituições acreditadoras, dentre elas a The Joint Commission, que criou o seu protocolo universal. Os resultados satisfatórios da aplicação do Time Out são inegáveis e a cada dia mais profissionais de saúde envolvidos com o cenário cirúrgico estão mudando de hábito e “parando” para responder ao checklist e confirmar se aquele paciente a ser submetido a uma cirurgia é o paciente certo, se o procedimento a ser realizado é o correto, se o sítio cirúrgico a ser abordado é o correto, dentre outras importantes informações. Porém, outras atividades relacionadas ao procedimento anestésico cirúrgico, mas que não ocorrem no momento de início da cirurgia, são de suma importância para a promoção da segurança do paciente e devem ser valoradas. Podemos citar o gerenciamento da limpeza ambiental, a gestão de custos, o adequado processamento dos artigos de assistência à saúde, o dimensionamento adequado de pessoal no bloco cirúrgico, a capacitação permanente da equipe de enfermagem diante das novas tecnologias, a assistência de enfermagem na recuperação anestésica e a comunicação entre as equipes. Embora o desafio global “Cirurgia Segura Salva Vidas” tenha sido lançado há oito anos, percebe-se que ainda há um longo caminho a percorrer na promoção da segurança em cirurgia e, mais do que o preenchimento do checklist, os profissionais envolvidos com o ato anestésico-cirúrgico devem resgatar as origens de sua formação humanística e ética. Essa é uma tarefa de todos os envolvidos no processo: profissionais, educadores, pesquisadores, pacientes e gestores. Sugiro um questionamento simples, para verificar o quanto estamos colaborando para esse processo: “caso eu necessite de um procedimento anestésico-cirúrgico, o quanto me sentiria seguro em ser submetido a uma cirurgia em meu próprio local de trabalho?”.

Efecto del relajamiento muscular progresivo como intervención de enfermería en el estrés de personas con esclerosis múltiple

Objetivo: avaliar o efeito do Relaxamento Muscular Progressivo, como intervencao de Enfermagem nos niveis de estresse em pessoas com Esclerose Multipla. Metodo: ensaio clinico randomizado conduzido em um ambulatorio de Neurologia de um Hospital Universitario. A amostra constituiu-se por 40 pacientes em acompanhamento ambulatorial (20 no grupo controle e 20 no experimental). Empregou-se a tecnica de Relaxamento Muscular Progressivo. As variaveis de controle foram coletadas pela tecnica de entrevista com registro em formulario e a Escala de Stress Percebido foi aplicada. Foram realizados cinco encontros quinzenais em um periodo de oito semanas. O grupo experimental foi orientado a realizar diariamente o Relaxamento Muscular Progressivo. Apos oito semanas de intervencao avaliou-se novamente os niveis de estresse. Para analise dos dados foi utilizado o pacote Estatistico para Ciencias Sociais-versao 19.0. Resultados: a aplicacao do Teste t demonstrou uma diminuicao significante dos escores da Escala de Stress Percebido no grupo experimental (p<0,001), evidenciando diminuicao nos niveis de estresse apos a pratica do relaxamento. Conclusao: a intervencao Relaxamento Muscular Progressivo contribui para reducao dos niveis de estresse em pessoas com Esclerose Multipla, podendo ser incluida como pratica na assistencia de enfermagem prestada a esses pacientes. Clinical Trials Identifier: NCT 02673827.ABSTRACT Objective: to evaluate the effect of progressive muscle relaxation as a nursing procedure on the levels of stress for sufferers of multiple sclerosis. Method: random clinical trials conducted at the Neurology outpatients unit at a University Hospital. The sample consisted of 40 patients who were being monitored as outpatients (20 in a control group and 20 in an experimental group). The Progressive Muscle Relaxation technique was used. The control variables were collected through interviews that were recorded on forms and on the Perceived Stress Scale that we used. Five meetings were held every fortnight covering a period of eight weeks. The experimental group was advised to carry out daily progressive muscle relaxation activities. After eight weeks of these activities, they were evaluated again to measure their levels of stress. In order to analyze the data used, the software package Statistics for Social Sciences version 19.0 was used. Results: the application of the t test showed a significant reduction in the Perceived Stress Scale scores in the experimental group (p<0.001), which in turn proved that there was a reduction in the levels of stress after the application of the relaxation practic-es. Conclusion: the progressive muscle relaxation activities contributed to the reduction in stress levels for multiple sclerosis suffers and thus can be used in nursing for patients. Clinical Trials Identifier: NCT 02673827.

Efeito do relaxamento muscular progressivo como intervenção de enfermagem no estresse de pessoas com esclerose múltipla

Objetivo: avaliar o efeito do Relaxamento Muscular Progressivo, como intervencao de Enfermagem nos niveis de estresse em pessoas com Esclerose Multipla. Metodo: ensaio clinico randomizado conduzido em um ambulatorio de Neurologia de um Hospital Universitario. A amostra constituiu-se por 40 pacientes em acompanhamento ambulatorial (20 no grupo controle e 20 no experimental). Empregou-se a tecnica de Relaxamento Muscular Progressivo. As variaveis de controle foram coletadas pela tecnica de entrevista com registro em formulario e a Escala de Stress Percebido foi aplicada. Foram realizados cinco encontros quinzenais em um periodo de oito semanas. O grupo experimental foi orientado a realizar diariamente o Relaxamento Muscular Progressivo. Apos oito semanas de intervencao avaliou-se novamente os niveis de estresse. Para analise dos dados foi utilizado o pacote Estatistico para Ciencias Sociais-versao 19.0. Resultados: a aplicacao do Teste t demonstrou uma diminuicao significante dos escores da Escala de Stress Percebido no grupo experimental (p<0,001), evidenciando diminuicao nos niveis de estresse apos a pratica do relaxamento. Conclusao: a intervencao Relaxamento Muscular Progressivo contribui para reducao dos niveis de estresse em pessoas com Esclerose Multipla, podendo ser incluida como pratica na assistencia de enfermagem prestada a esses pacientes. Clinical Trials Identifier: NCT 02673827.ABSTRACT Objective: to evaluate the effect of progressive muscle relaxation as a nursing procedure on the levels of stress for sufferers of multiple sclerosis. Method: random clinical trials conducted at the Neurology outpatients unit at a University Hospital. The sample consisted of 40 patients who were being monitored as outpatients (20 in a control group and 20 in an experimental group). The Progressive Muscle Relaxation technique was used. The control variables were collected through interviews that were recorded on forms and on the Perceived Stress Scale that we used. Five meetings were held every fortnight covering a period of eight weeks. The experimental group was advised to carry out daily progressive muscle relaxation activities. After eight weeks of these activities, they were evaluated again to measure their levels of stress. In order to analyze the data used, the software package Statistics for Social Sciences version 19.0 was used. Results: the application of the t test showed a significant reduction in the Perceived Stress Scale scores in the experimental group (p<0.001), which in turn proved that there was a reduction in the levels of stress after the application of the relaxation practic-es. Conclusion: the progressive muscle relaxation activities contributed to the reduction in stress levels for multiple sclerosis suffers and thus can be used in nursing for patients. Clinical Trials Identifier: NCT 02673827.

The effects of progressive muscular relaxation as a nursing procedure used for those who suffer from stress due to multiple sclerosis

Objetivo: avaliar o efeito do Relaxamento Muscular Progressivo, como intervencao de Enfermagem nos niveis de estresse em pessoas com Esclerose Multipla. Metodo: ensaio clinico randomizado conduzido em um ambulatorio de Neurologia de um Hospital Universitario. A amostra constituiu-se por 40 pacientes em acompanhamento ambulatorial (20 no grupo controle e 20 no experimental). Empregou-se a tecnica de Relaxamento Muscular Progressivo. As variaveis de controle foram coletadas pela tecnica de entrevista com registro em formulario e a Escala de Stress Percebido foi aplicada. Foram realizados cinco encontros quinzenais em um periodo de oito semanas. O grupo experimental foi orientado a realizar diariamente o Relaxamento Muscular Progressivo. Apos oito semanas de intervencao avaliou-se novamente os niveis de estresse. Para analise dos dados foi utilizado o pacote Estatistico para Ciencias Sociais-versao 19.0. Resultados: a aplicacao do Teste t demonstrou uma diminuicao significante dos escores da Escala de Stress Percebido no grupo experimental (p<0,001), evidenciando diminuicao nos niveis de estresse apos a pratica do relaxamento. Conclusao: a intervencao Relaxamento Muscular Progressivo contribui para reducao dos niveis de estresse em pessoas com Esclerose Multipla, podendo ser incluida como pratica na assistencia de enfermagem prestada a esses pacientes. Clinical Trials Identifier: NCT 02673827.ABSTRACT Objective: to evaluate the effect of progressive muscle relaxation as a nursing procedure on the levels of stress for sufferers of multiple sclerosis. Method: random clinical trials conducted at the Neurology outpatients unit at a University Hospital. The sample consisted of 40 patients who were being monitored as outpatients (20 in a control group and 20 in an experimental group). The Progressive Muscle Relaxation technique was used. The control variables were collected through interviews that were recorded on forms and on the Perceived Stress Scale that we used. Five meetings were held every fortnight covering a period of eight weeks. The experimental group was advised to carry out daily progressive muscle relaxation activities. After eight weeks of these activities, they were evaluated again to measure their levels of stress. In order to analyze the data used, the software package Statistics for Social Sciences version 19.0 was used. Results: the application of the t test showed a significant reduction in the Perceived Stress Scale scores in the experimental group (p<0.001), which in turn proved that there was a reduction in the levels of stress after the application of the relaxation practic-es. Conclusion: the progressive muscle relaxation activities contributed to the reduction in stress levels for multiple sclerosis suffers and thus can be used in nursing for patients. Clinical Trials Identifier: NCT 02673827.

Personalidade resistente nas equipes médica e de enfermagem em centro cirúrgico

Objective: To identify the presence of hardiness in health care professionals who work in operating rooms. Method: A descriptive, cross-sectional study with a quantitative approach, conducted with 58 professionals, from January to February 2013, using a closed biosocial questionnaire and the Hardiness Scale. Results: The majority (88%) of participants achieved high average on the dimensions commitment and control and, of these, seven (12%) presented a hardy personality, with high scores on the three dimensions of hardiness. Most of the subjects are women (71.4%), technical nurses (57.1%), who are married (83.3%), with 11 to 15 years working in the nursing profession (42.9%), and as operating room nurses (57.1%), besides having multiple employments (57.1%). Conclusion: We observed a small percentage of professionals that have characteristics of the hardy personality, but it was found that most of them have low scores on the control dimension of hardiness; therefore, there is a need for empowering them in their respective fields.

Eficacia de la Calatonia sobre los parametros clinicos en el periodo postoperatorio inmediato: estudio clinico

OBJETIVO: evaluar la eficacia de la tecnica de la Calatonia sobre los parametros clinicos y el dolor en el postoperatorio inmediato. METODO: fue realizado un estudio aleatorio, con 116 pacientes, sometidos a cirugia de colecistectomia por laparoscopica, divididos en dos grupos: experimental (58 pacientes) y placebo (58 pacientes). El grupo experimental recibio la tecnica de la Calatonia, y el placebo fue sometido apenas a toques no intencionales. RESULTADOS: el grupo placebo y experimental fueron considerados homogeneos en las variables: sexo, edad, Physical Status Clasification, tiempo de procedimiento quirurgico y de permanencia en la Sala de Recuperacion Postanestesica. Solamente la temperatura corporal axilar presento diferencia estadistica significativa. En lo que se refiere al dolor, el grupo experimental, presento resultados significativos, pudiendose deducir que el relajamiento proporcionado por la tecnica de Calatonia produjo el alivio del cuadro doloroso. CONCLUSION: la aplicacion de la Calatonia puede actuar como recurso complementario a la asistencia en el periodo postoperatorio inmediato. Registro Brasileno de Ensayos Clinicos: UTN U1111-1129-9629.OBJECTIVE To assess the efficiency of the Calatonia technique about clinical parameters and pain in the immediate post-surgical phase. METHOD A randomised study was carried out with 116 patients subjected to a cholecystectomy, by laparoscopy, divided into an experimental group (58 patients) and a placebo group (58 patients). The experimental group received the Calatonia technique, while the placebo was only subjected to non-intentional touches. RESULTS The placebo group and the experimental group were considered homogeneous in terms of the variables: sex, age, physical status classification, duration of surgical procedures and also the time spent recovering in the Post-Anaesthetic Recovery Room. The only variable to show a statistically significant difference was the axillary temperature of the body. In relation to pain, the experimental group showed significant results, and hence it is possible to deduce that the relaxation caused by the Calatonia technique brought some relief of the general situation of pain. CONCLUSION The application of Calatonia can take up the function of a resource complementary to assistance in the period immediately after surgery. Brazilian Register of Clinical Trials, UTN U1111-1129-9629.

Efficiency of Calatonia on clinical parameters in the immediate post-surgery period: a clinical study.

OBJETIVO: evaluar la eficacia de la tecnica de la Calatonia sobre los parametros clinicos y el dolor en el postoperatorio inmediato. METODO: fue realizado un estudio aleatorio, con 116 pacientes, sometidos a cirugia de colecistectomia por laparoscopica, divididos en dos grupos: experimental (58 pacientes) y placebo (58 pacientes). El grupo experimental recibio la tecnica de la Calatonia, y el placebo fue sometido apenas a toques no intencionales. RESULTADOS: el grupo placebo y experimental fueron considerados homogeneos en las variables: sexo, edad, Physical Status Clasification, tiempo de procedimiento quirurgico y de permanencia en la Sala de Recuperacion Postanestesica. Solamente la temperatura corporal axilar presento diferencia estadistica significativa. En lo que se refiere al dolor, el grupo experimental, presento resultados significativos, pudiendose deducir que el relajamiento proporcionado por la tecnica de Calatonia produjo el alivio del cuadro doloroso. CONCLUSION: la aplicacion de la Calatonia puede actuar como recurso complementario a la asistencia en el periodo postoperatorio inmediato. Registro Brasileno de Ensayos Clinicos: UTN U1111-1129-9629.OBJECTIVE To assess the efficiency of the Calatonia technique about clinical parameters and pain in the immediate post-surgical phase. METHOD A randomised study was carried out with 116 patients subjected to a cholecystectomy, by laparoscopy, divided into an experimental group (58 patients) and a placebo group (58 patients). The experimental group received the Calatonia technique, while the placebo was only subjected to non-intentional touches. RESULTS The placebo group and the experimental group were considered homogeneous in terms of the variables: sex, age, physical status classification, duration of surgical procedures and also the time spent recovering in the Post-Anaesthetic Recovery Room. The only variable to show a statistically significant difference was the axillary temperature of the body. In relation to pain, the experimental group showed significant results, and hence it is possible to deduce that the relaxation caused by the Calatonia technique brought some relief of the general situation of pain. CONCLUSION The application of Calatonia can take up the function of a resource complementary to assistance in the period immediately after surgery. Brazilian Register of Clinical Trials, UTN U1111-1129-9629.