Emiliane Nogueira de Souza

Effectiveness of nursing interventions in heart failure patients in home care using NANDA-I, NIC, and NOC

OBJECTIVE The objective of the study is to evaluate the effectiveness of nursing interventions (NIC) using nursing outcomes (NOC) and based on NANDA-I nursing diagnoses in patients with heart failure in home care. METHOD In this longitudinal study, 23 patients with heart failure were followed for 6 months, in four home visits. During the visits, nursing diagnoses were established, outcomes assessed, and interventions implemented. RESULTS Of the 11 NIC interventions implemented, eight proved effective, that is, showed significant improvement between the first and the fourth visit, according to scores obtained for six outcomes: knowledge: treatment regimen, knowledge: medication, compliance behavior, symptom control, activity tolerance, and energy conservation. CONCLUSION NIC interventions health education, self-modification assistance, behavior modification, teaching: prescribed medication, teaching: disease process, nutritional counseling, telephone consultation, and energy conservation showed effective outcomes based on NOC scores, suggesting that the NANDA-I, NIC, and NOC linkage is useful in patients with heart failure in home care.

Home visit improves knowledge, self-care and adhesion in heart failure: randomized Clinical Trial HELEN-I

OBJETIVO: verificar o efeito de uma intervencao educativa de enfermagem combinada, caracterizada por visita domiciliar e contato telefonico, em pacientes com internacao recente por insuficiencia cardiaca descompensada, no conhecimento da doenca, nas habilidades para o autocuidado e na adesao ao tratamento, comparado ao acompanhamento convencional de pacientes no periodo de seis meses. METODOS: nsaio linico randomizado com pacientes que tiveram internacao recente por insuficiencia cardiaca descompensada. O grupo-intervencao recebeu quatro visitas domiciliares e quatro contatos telefonicos para reforco das orientacoes, em seis meses de acompanhamento; o grupo-controle recebeu acompanhamento convencional sem visitas e sem contatos telefonicos. RESULTADOS: duzentos pacientes foram randomizados (101: intervencao e 99: controle). Apos seis meses, observou-se melhora significativa no conhecimento e autocuidado para o grupo-intervencao (p=0,001 e p<0,001), respectivamente; a adesao ao tratamento, aferida no final entre os grupos, foi significativamente maior no grupo-intervencao (p<0,001). CONCLUSAO: a estrategia de visita domiciliar para pacientes que se internaram recentemente por insuficiencia cardiaca descompensada foi efetiva na melhora dos desfechos avaliados, e sua implementacao merece ser considerada no Brasil, visando-se evitar internacoes nao planejadas. NCT-01213862

Preditores de mudança na qualidade de vida após um evento coronariano agudo

BACKGROUND The assessment of quality of life (QOL), identifying functional capacity and frequency of angina and other cardiac symptoms, are key issues in the treatment of chronic patients or in those with disease instability. OBJECTIVE To identify predictors of quality of life (QOL) improvement in patients with non-ST segment elevation acute coronary syndrome (NSTEACS). METHODS Patients hospitalized in a cardiology reference hospital were assessed with the Seattle Angina Questionnaire (SAQ) at the time of admission and after 6 months. The analyzed outcome was the variation of the QOL score, resulting from the difference between the score after six months and the score at the time of admission. Differences between patients with or without 6-month QOL improvements regarding the demographic, clinical and therapeutic characteristics were assessed by univariate and multivariate analysis. RESULTS Hypertensive patients presented lower improvement in QOL scores when compared to non-hypertensive ones [8.3(0-25) vs. 16.6(0-33.3); P=0.05], as well as patients with dyslipidemia, when compared to non-dyslipidemic ones [8.3(0-25) vs. 16.6(0-33.3); P=0.02]. Patients with unstable angina presented greater improvements in QOL in relation to those with NSTE myocardial infarction [16.6(0-33.3) vs. 8.3(-8.3-25); P=0.03]. By multivariate analysis, myocardial revascularization in the first 30-days was associated with the greater improvement in the QOL score (8.47 points; P=0.005). On the other side, the presence of dyslipidemia at the baseline evaluation was an independent predictor of worse QOL scores (-7.2 points; P=0.01). CONCLUSION Myocardial revascularization was associated with improvement in the 6-month QOL scores, while dyslipidemia was associated with worse scores.

Cross-cultural adaptation and validation of the European Heart Failure Self-care Behavior Scale for Brazilian Portuguese

OBJECTIVE To adapt and validate a Brazilian Portuguese version of the European Heart Failure Self-Care Behavior Scale. METHODS The cross-cultural adaptation (translation, synthesis, back-translation, expert committee review, and pretesting) and validation (assessment of face validity, content validity, and internal consistency reliability) were carried out in accordance with the literature. The European Heart Failure Self-Care Behavior Scale assesses key components of self-care: recognition of the signs and symptoms of decompensated heart failure (HF) and decision-making when these signs and symptoms arise. It comprises 12 items (range 12-60, where lower scores indicate better self-care). RESULTS The sample comprised 124 HF patients with a mean age of 62.3 ± 12 years. The Cronbachs Alpha internal consistency was 0.70 and the intraclass correlation coefficient for reproducibility was 0.87. CONCLUSION Face and content validity, internal consistency and reproducibility have lended validity and reliability for the use of the instrument in Brazil.

Patients with acute myocardial infarction and interfering factors when seeking emergency care: implications for health education

Con el objetivo de estimar el tiempo transcurrido entre el inicio de las senales y sintomas del infarto hasta la llegada al sector de emergencia cardiologica (delta T) y los factores que influenciaron ese proceso, se estudiaron 112 pacientes, con diagnostico de infarto con elevacion del segmento ST. El delta T fue en promedio de 3h59min ± 2h55min, siendo que 99(88%) de esos pacientes buscaron un servicio de emergencia una hora despues el inicio del evento. Pacientes solteros presentaron un delta T menor en relacion a los demas (P=0,006), asi como aquellos que reconocieron los sintomas como un evento cardiaco; dolor toracico con ardor fue relatado por 25(24%) pacientes, siendo que la primera actitud tomada ante esos sintomas fue la automedicacion 37(33%). Se concluyo que el reconocimiento de las senales y de los sintomas de IMA por el paciente es un factor determinante en la busqueda de atencion especializada.With the objective of estimating the time elapsed between the beginning of the signs and symptoms of a heart attack until the arrival at the cardiology emergency service (Delta T) and the factors that influence in this process, 112 patients were studied, with an infarction diagnosis with supraunleveling ST segment. The delta T was on average of 3h59+/-2h55min; 99(88%) of those patients sought out an emergency service within 1h after the beginning of the event. Unmarried patients presented a delta T smaller in relation to the others (P=0,006), as well as those that recognized the symptoms as a heart event; thoracic pain with burning symptoms, were described by 25 (24%) of patients, and the first attitude taken, in view those symptoms, was self-medication 37(33%). The recognition of the signs and symptoms of Acute Myocardium Infarction, is a decisive factor for the seeking of a specialized service.

Implantação do diagnóstico de enfermagem em unidade de terapia intensiva: uma análise periódica

Knowledge about the prevalence of nursing diagnosis (ND) helps to provide the necessary care and to guide continuing education programs. This cross-sectional study aimed to identify the main nursing diagnosis (ND) prescribed in intensive care units (ICU) and to compare them with medical and surgical patients. Data analysis was performed according to the North American Nursing Diagnoses Association (NANDA) Taxonomy II. In the 150 medical records evaluated were found 195 nursing diagnoses, with an average of 1.3 per patient, mainly in the protection and security domain (39.5%). The most common ND were: impaired tissue integrity (22%), impaired gas exchange (22%), ineffective cerebral tissue perfusion (8.7%), impaired skin integrity (7.7%), decreased cardiac output (6.7%) and ineffective tissue perfusion cardiopulmonary (6.1%). The most prevalent nursing diagnoses revealed the physiological needs as the most common in our sample.

Avaliação dos registros de enfermagem quanto ao exame físico

The nursing records are essential to generate benefits to individualized care planning, once data collection is the first step of the Nursing Process. The purpose of this study is to analyze the records made by nurses during each physical patient examination in critical care units (CCU) and hospitalization units (HU). This is a transverse and retrospective study, in which forms and records from both public and private hospitals were analyzed. From the 69 records considered, we observed a greater quality and frequency in records from CCUs, while records from HUs were mostly about intercurrences that happened during the shift. The research shows a deficit in physical examination records of patients, which complicates the individual assistance focused on the real needs of the patient, since many changes in patients condition might not be recorded.Os registros de enfermagem geram subsidios essenciais ao planejamento do cuidado individualizado, sendo a coleta de dados a primeira etapa do Processo de Enfermagem. O objetivo deste estudo foi avaliar os registros realizados pelos enfermeiros quanto ao exame fisico do cliente na unidade de tratamento intensivo (UTI) e na unidade de internacao clinica (UIC). O estudo e transversal-retrospectivo, no qual foram avaliados 69 prontuarios de clientes internados em UTI e transferidos para UIC de um hospital publico e outro privado. Constatou-se que os registros realizados pelos enfermeiros, mais frequentes e com melhor qualidade acerca do exame fisico, foram os da UTI, enquanto na UIC eram mais frequentes os registros de intercorrencias clinicas ocorridas durante o plantao. Evidenciou-se um deficit nos registros acerca do exame fisico, o que pode dificultar a assistencia individualizada com enfoque nas reais necessidades do cliente, uma vez que muitas alteracoes podem ser deixadas de serem registradas.

Adesão medicamentosa e não medicamentosa de pacientes com doença arterial coronariana

OBJETIVOS: Verificar a adesao a terapeutica farmacologica e nao farmacologica de pacientes atendidos por uma equipe multidisciplinar, em um ambulatorio de prevencao secundaria da doenca arterial coronariana, bem como identificar fatores que possam interferir na adesao. METODOS: Estudo transversal que avaliou a adesao farmacologica atraves do teste de Morisky e a nao farmacologica, atraves das modificacoes no estilo de vida em pacientes apos primeiro infarto. RESULTADOS: Dos 92 pacientes avaliados, 64,1% eram homens e a media de idade foi de 56,4±10,9 anos. Adesao a terapeutica farmacologica foi verificada em 56,5% e adesao a nao farmacologica, em 40,2% dos pacientes. CONCLUSAO: Os resultados demonstraram pacientes com baixa aderencia a terapeutica de prevencao secundaria da doenca arterial coronariana.

Consenso de diagnósticos, resultados e intervenções de enfermagem para pacientes com insuficiência cardíaca em domicílio

Estudo de consenso realizado entre seis enfermeiras especialistas da area de cardiologia, com o objetivo de selecionar diagnosticos, intervencoes e resultados de enfermagem descritos pela NANDA Internacional (NANDA-I), Nursing Outcomes Classification (NOC), Nursing Intervention Classification (NIC), para pacientes com insuficiencia cardiaca em cuidado domiciliar. Inicialmente, foram pre-selecionados oito diagnosticos de enfermagem, conforme a NANDA-I e, a partir deles, realizado um consenso, em tres etapas, para a selecao das intervencoes/atividades NIC e os resultados/ indicadores NOC. Consideraram-se selecionados os que obtiveram entre 70% e 100% de consenso. Os resultados apontaram seis diagnosticos de enfermagem selecionados, 11 intervencoes de um total de 96 e sete resultados de um total de 71. O consenso entre os enfermeiros especialistas permitiu identificar e selecionar diagnosticos, intervencoes e resultados de enfermagem para aplicacao na pratica clinica, com vistas a subsidiar o processo de cuidado e o conhecimento das taxonomias de enfermagem.This was a consensus study with six cardiology nurses with the objective of selecting nursing diagnoses, outcomes and interventions described by NANDA International (NANDA-I), Nursing Outcomes Classification (NOC), Nursing Intervention Classification (NIC), for home care of patients with heart failure (HF). Eight nursing diagnoses (NDs) were pre-selected and a consensus was achieved in three stages, during which interventions/activities and outcomes/indicators of each NDs were validated and those considered valid obtained 70% to 100% consensus. From the eight pre-selected NDs, two were excluded due to the lack of consensus on appropriate interventions for the clinical home care scenario. Eleven interventions were selected from a total of 96 pre-selected ones and seven outcomes were validated out of 71. The practice of consensus among expert nurses provides assistance to the qualifications of the care process and deepens the knowledge about the use of tazonomies in nursing clinical practice.

Influência da Curva de Aprendizado nos Procedimentos Percutâneos por Via Transradial

ABSTRACT Influence of the Learning Curve inPercutaneous Procedures by Transradial Approach Background: The learning curve is one of the limitations ofthe transradial technique. The aim of this study was toevaluate the influence of the learning curve in the outcomesof procedures using the radial approach. Methods: Pros-pective cohort study in patients undergoing cardiac cathe-terization allocated to Group A (interventions performedby operators with > 500 procedures by radial approach)and Group B (interventions performed by operators with 0.99), but valve disease was more prevalent in GroupA (24.1% vs. 3.2%; P = 0.001). The crossover rate for thefemoral technique was similar (1.7% vs. 1.6%; P > 0.99).The more experienced operators performed the procedureswith shorter puncture, fluoroscopy and total procedure time(13.2 + 5.2 minutes vs. 16.3 + 4.8 minutes; P = 0.001).There were no major complications. No differences wereobserved for the presence of type I (12% vs. 3.2%), type II(1.7% vs. 1.7%) and type III (0 vs. 1.7%) hematoma. OnDoppler evaluation, pulse flow and radial artery occlusionwere similar between groups.