Fernanda Titareli Merizio Martins Braga

Effect of a video on developing skills in undergraduate nursing students for the management of totally implantable central venous access ports

BACKGROUND Handling Totally Implantable Access Ports (TIAP) is a nursing procedure that requires skill and knowledge to avoid adverse events. No studies addressing this procedure with undergraduate students were identified prior to this study. Communication technologies, such as videos, have been increasingly adopted in the teaching of nursing and have contributed to the acquisition of competencies for clinical performance. OBJECTIVE To evaluate the effect of a video on the puncture and heparinization of TIAP in the development of cognitive and technical competencies of undergraduate nursing students. METHOD Quasi-experimental study with a pretest-posttest design. RESULTS 24 individuals participated in the study. Anxiety scores were kept at levels 1 and 2 in the pretest and posttest. In relation to cognitive knowledge concerning the procedure, the proportion of correct answers in the pretest was 0.14 (SD=0.12) and 0.90 in the posttest (SD=0.05). After watching the video, the average score obtained by the participants in the mock session was 27.20. CONCLUSION The use of an educational video with a simulation of puncture and heparinization of TIAP proved to be a strategy that increased both cognitive and technical knowledge. This strategy is viable in the teaching-learning process and is useful as a support tool for professors and for the development of undergraduate nursing students.

Use of Chamomilla recutita in the Prevention and Treatment of Oral Mucositis in Patients Undergoing Hematopoietic Stem Cell Transplantation: A Randomized, Controlled, Phase II Clinical Trial.

Background: Oral mucositis is a common inflammatory complication among patients undergoing hematopoietic stem cell transplantation (HSCT). Among its therapeutic properties, Chamomilla recutita has anti-inflammatory effects. Objective: The aim of this study was to identify the dosage of the liquid extract of C recutita in mouthwash that is needed to reduce the incidence and intensity of oral mucositis in adult patients undergoing allogenic HSCT. Methods: In a randomized phase II clinical trial, 40 patients were randomized to receive routine care plus mouthwash containing a liquid extract of C recutita at 0.5%, 1%, or 2% (experimental groups) or standard care alone (control group). Daily evaluation was performed using the measurement scale for oral toxicity defined by the World Health Organization. Statistical analysis was performed, in which the incidence, intensity, and duration of oral mucositis were compared between each experimental group and the control group. Results: The experimental group at the 1% dosage demonstrated reduced incidence, intensity, and duration of oral mucositis compared with the control group. The formulation was well tolerated by patients and was safe, as no moderate or severe adverse effects were identified. Conclusions: In this study, the use of mouthwash containing 1% C recutita extract can be associated with reduced incidence, intensity, and duration of mucositis in adults patients undergoing allogenic HSCT. Implications for Practice: The results of this investigation will help nurses and other professionals in selecting the C recutita dosage used to manage oral mucositis in patients undergoing HSCT.

Central catheter dressing in a simulator: the effects of tutor's assistance or self-learning tutorial

AIMS to compare the performance of undergraduate students concerning semi-implanted central venous catheter dressing in a simulator, with the assistance of a tutor or of a self-learning tutorial. METHOD Randomized controlled trial. The sample consisted of 35 undergraduate nursing students, who were divided into two groups after attending an open dialogue presentation class and watching a video. One group undertook the procedure practice with a tutor and the other with the assistance of a self-learning tutorial. RESULTS in relation to cognitive knowledge, the two groups had lower performance in the pre-test than in the post-test. The group that received assistance from a tutor performed better in the practical assessment. CONCLUSION the simulation undertaken with the assistance of a tutor showed to be the most effective learning strategy when compared to the simulation using a self-learning tutorial. Advances in nursing simulation technology are of upmost importance and the role of the tutor in the learning process should be highlighted, taking into consideration the role this professional plays in knowledge acquisition and in the development of critical-reflexive thoughts and attitudes. (ClinicalTrials.gov Identifier: NCT 01614314).Objetivo: comparar el desempeno de graduandos en la realizacion del parche del cateter venoso central semi-implantado, en simulador, con el auxilio del tutor o de un guia auto-instruccional. Metodo: estudio experimental controlado hecho aleatorio. La muestra fue compuesta por 35 alumnos de Graduacion en Enfermeria que fueron asignados en dos grupos despues de asistir a una clase expositiva dialogada y a un video. Un grupo realizo el entrenamiento del procedimiento con el tutor y el otro con el auxilio de un guia auto- instruccional. Resultados: con relacion al conocimiento cognoscitivo, los dos grupos presentaron desempeno menor en la pre-prueba comparada al pos-prueba. El grupo con presencia del tutor presento mejor desempeno en la evaluacion practica. Conclusion: la utilizacion de simulacion aliada a la presencia del tutor mostro ser una estrategia de ensenanza mas efectiva del que la simulacion dirigida por guia autoinstruccional. Avances en simulacion en el area de enfermeria son de extrema importancia y la figura del tutor merece destaque en el proceso enseno-aprendizaje, teniendo en vista el papel que este profesional desempena durante la adquisicion de conocimiento y en el desarrollo de pensamientos y actitudes criticos reflexivos. (ClinicalTrials.gov Identifier: NCT 01614314). Descriptores: Tutoria; Simulacion; Enfermeria; Cateteres.

The Use Of Polyurethane Transparent Film In Indwelling Central Venous Catheter

Dressing is an intervention aimed to prevent infection in central venous catheter. This study aimed to analyze the frequency of catheter-related infection and skin toxicity in the use of transparent film in Hickmans catheter in patients who underwent allogeneic hematopoietic stem cell transplantation. A case series with 10 cases was carried out. Due to the presence of exudate on the average for 12 days, sterile gauze dressing was used for 12.9 days (average). Transparent film was used, on average, for 15.1 days. Catheters were precociously removed due to infection in four cases. The highest degree of skin toxicity occurred in a case that used gauze dressing and in three cases with film. The transparent film permitted visualization of the exit site of the catheter and changes with longer intervals.O curativo e intervencao que visa a prevencao de infeccao no cateter venoso central. O estudo teve como objetivo analisar a frequencia de infeccao, relacionada ao cateter, e toxicidade cutânea, na utilizacao do curativo de poliuretano no cateter de Hickman, implantado em pacientes submetidos ao transplante de celulas-tronco hematopoeticas alogenico. Para tal, realizou-se uma serie de casos, constituida por 10 casos. O exsudato esteve presente em media por 12 dias, sendo necessario o uso do curativo de gaze esteril, com fita adesiva, por 12,9 dias (media). O curativo de poliuretano foi utilizado, em media, por 15,1 dias. A retirada precoce do cateter por infeccao ocorreu em quatro casos. O maior grau de toxicidade cutânea aconteceu em um caso que utilizou o curativo de gaze e em tres casos com filme. O filme transparente permitiu a visualizacao do sitio de saida do cateter e a troca com intervalos maiores.

O uso de simulador no ensino de avaliação clínica em enfermagem

OBJETIVO: evaluar el uso de simulador en la ensenanza de evaluacion clinica de los ojos. MATERIAL Y METODO: estudio experimental, aleatorizado y controlado, con 31 alumnos del segundo ano de Pregrado en Enfermeria de una escuela del interior del estado de Sao Paulo. La recoleccion de datos ocurrio entre septiembre y octubre de 2009, con dos instrumentos previamente validadosy con la autorizacion del Comite de Etica. Para la evaluacion de los ojos, los sujetos fueron divididos en: Grupo 1 (ensenanza tradicional y uso del simulador de baja fidelidad), y Grupo 2 (ensenanza tradicional) RESULTADOS: hubo aumento de aciertos por los sujetos en las cuestiones teoricas despues de la clase expositiva dialogada. En la evaluacion practica clinica de los ojos, el promedio porcentual de aciertos fue de 76±7 (Grupo 1) y 21±11 (Grupo 2) (p<0,01). CONCLUSION: El uso del simulador mostro ser estrategia facilitadora en el proceso de ensenanza-aprendizaje

Infection prevention measures used in hematopoietic stem cell transplantation: evidences for practice

This integrative review aimed to identify and assess evidence available about the use of high-efficiency air filters, protective isolation and masks for infection prevention in patients submitted to hematopoietic stem cell transplantation during hospitalization. LILACS, PUBMED, CINAHL, EMBASE and the Cochrane Library were used to select the articles. Of the 1023 identified publications, 15 were sampled. The use of HEPA filters is recommended for patients submitted to allogeneic transplantation during the neutropenia period. The level of evidence of protective isolation is weak (VI) and the studies evaluated did not recommend its use. No studies with strong evidence (I and II) were evaluated that justify the use of masks, while Centers for Disease Control and Prevention recommendations should be followed regarding the use of special respirators by immunocompromised patients. The evidenced data can support decision making with a view to nursing care.Esta revisao integrativa teve como objetivo identificar e avaliar as evidencias disponiveis em relacao ao uso de filtros de ar de alta eficiencia, isolamento protetor e mascaras para a prevencao de infeccao em pacientes submetidos ao transplante de celulas-tronco hematopoeticas, durante a internacao. Para a selecao dos artigos foram utilizadas as bases de dados LILACS, PubMed, CINAHL, EMBASE e a Biblioteca Cochrane. Das 1023 publicacoes identificadas, 15 foram incluidas na amostra. O uso dos filtros HEPA e recomendado para pacientes submetidos ao transplante alogenico, durante o periodo de neutropenia. O nivel das evidencias do isolamento protetor e fraco (VI) e os estudos avaliados nao recomendam o seu uso. Nao foram avaliados estudos com evidencias fortes (I e II) que justifiquem o uso de mascaras, sendo indicado que sejam seguidas as recomendacoes dos Centers for Disease Control and Prevention quanto ao uso de respiradores especiais pelos pacientes imunocomprometidos. Os dados evidenciados podem auxiliar na tomada de decisao para a assistencia de enfermagem.

Motivo de retirada do cateter de Hickman em pacientes submetidos ao transplante de células-tronco hematopoéticas

Objective: To identify rationale for removal of the first Hickman catheter implanted in patients undergoing allogeneic hematopoietic stem cell transplantation, the micro-organisms involved in the occurrence of infection, and the length of time the catheter was in situ. Methods: A cross sectional, retrospective study was conducted. The sample consisted of 57 transplant recipients. To conduct chart review, an instrument was developed containing variables related to patient identification, time of catheter use, reason for withdrawal, and isolated micro-organisms. Results: Among the reasons for catheter removal, frequent infection (49%) was the most common; the Stenotrophomonas maltophilia microorganism (25%) was the most frequently isolated. Conclusions: Due to the high incidence of infectious complications leading to Hickman catheter removal, it is essential to standardize catheter care for the health care team, patients and their caregivers.

Use of simulator in teaching nursing clinical evaluation

OBJETIVO: evaluar el uso de simulador en la ensenanza de evaluacion clinica de los ojos. MATERIAL Y METODO: estudio experimental, aleatorizado y controlado, con 31 alumnos del segundo ano de Pregrado en Enfermeria de una escuela del interior del estado de Sao Paulo. La recoleccion de datos ocurrio entre septiembre y octubre de 2009, con dos instrumentos previamente validadosy con la autorizacion del Comite de Etica. Para la evaluacion de los ojos, los sujetos fueron divididos en: Grupo 1 (ensenanza tradicional y uso del simulador de baja fidelidad), y Grupo 2 (ensenanza tradicional) RESULTADOS: hubo aumento de aciertos por los sujetos en las cuestiones teoricas despues de la clase expositiva dialogada. En la evaluacion practica clinica de los ojos, el promedio porcentual de aciertos fue de 76±7 (Grupo 1) y 21±11 (Grupo 2) (p<0,01). CONCLUSION: El uso del simulador mostro ser estrategia facilitadora en el proceso de ensenanza-aprendizaje

O uso do filme transparente de poliuretano no cateter venoso central de longa permanência

Dressing is an intervention aimed to prevent infection in central venous catheter. This study aimed to analyze the frequency of catheter-related infection and skin toxicity in the use of transparent film in Hickmans catheter in patients who underwent allogeneic hematopoietic stem cell transplantation. A case series with 10 cases was carried out. Due to the presence of exudate on the average for 12 days, sterile gauze dressing was used for 12.9 days (average). Transparent film was used, on average, for 15.1 days. Catheters were precociously removed due to infection in four cases. The highest degree of skin toxicity occurred in a case that used gauze dressing and in three cases with film. The transparent film permitted visualization of the exit site of the catheter and changes with longer intervals.O curativo e intervencao que visa a prevencao de infeccao no cateter venoso central. O estudo teve como objetivo analisar a frequencia de infeccao, relacionada ao cateter, e toxicidade cutânea, na utilizacao do curativo de poliuretano no cateter de Hickman, implantado em pacientes submetidos ao transplante de celulas-tronco hematopoeticas alogenico. Para tal, realizou-se uma serie de casos, constituida por 10 casos. O exsudato esteve presente em media por 12 dias, sendo necessario o uso do curativo de gaze esteril, com fita adesiva, por 12,9 dias (media). O curativo de poliuretano foi utilizado, em media, por 15,1 dias. A retirada precoce do cateter por infeccao ocorreu em quatro casos. O maior grau de toxicidade cutânea aconteceu em um caso que utilizou o curativo de gaze e em tres casos com filme. O filme transparente permitiu a visualizacao do sitio de saida do cateter e a troca com intervalos maiores.

Curativo de cateter central em simulador: efeito da presença do tutor ou da aprendizagem autoinstrucional

AIMS to compare the performance of undergraduate students concerning semi-implanted central venous catheter dressing in a simulator, with the assistance of a tutor or of a self-learning tutorial. METHOD Randomized controlled trial. The sample consisted of 35 undergraduate nursing students, who were divided into two groups after attending an open dialogue presentation class and watching a video. One group undertook the procedure practice with a tutor and the other with the assistance of a self-learning tutorial. RESULTS in relation to cognitive knowledge, the two groups had lower performance in the pre-test than in the post-test. The group that received assistance from a tutor performed better in the practical assessment. CONCLUSION the simulation undertaken with the assistance of a tutor showed to be the most effective learning strategy when compared to the simulation using a self-learning tutorial. Advances in nursing simulation technology are of upmost importance and the role of the tutor in the learning process should be highlighted, taking into consideration the role this professional plays in knowledge acquisition and in the development of critical-reflexive thoughts and attitudes. (ClinicalTrials.gov Identifier: NCT 01614314).Objetivo: comparar el desempeno de graduandos en la realizacion del parche del cateter venoso central semi-implantado, en simulador, con el auxilio del tutor o de un guia auto-instruccional. Metodo: estudio experimental controlado hecho aleatorio. La muestra fue compuesta por 35 alumnos de Graduacion en Enfermeria que fueron asignados en dos grupos despues de asistir a una clase expositiva dialogada y a un video. Un grupo realizo el entrenamiento del procedimiento con el tutor y el otro con el auxilio de un guia auto- instruccional. Resultados: con relacion al conocimiento cognoscitivo, los dos grupos presentaron desempeno menor en la pre-prueba comparada al pos-prueba. El grupo con presencia del tutor presento mejor desempeno en la evaluacion practica. Conclusion: la utilizacion de simulacion aliada a la presencia del tutor mostro ser una estrategia de ensenanza mas efectiva del que la simulacion dirigida por guia autoinstruccional. Avances en simulacion en el area de enfermeria son de extrema importancia y la figura del tutor merece destaque en el proceso enseno-aprendizaje, teniendo en vista el papel que este profesional desempena durante la adquisicion de conocimiento y en el desarrollo de pensamientos y actitudes criticos reflexivos. (ClinicalTrials.gov Identifier: NCT 01614314). Descriptores: Tutoria; Simulacion; Enfermeria; Cateteres.