Jeanne Liliane Marlene Michel

Situações geradoras de ansiedade e estratégias para seu controle entre enfermeiras: estudo preliminar

Este estudo teve como objetivos: identificar situacoes que sao consideradas fontes geradoras de ansiedade, na atuacao cotidiana das enfermeiras, e identificar estrategias conscientes utilizadas pelas mesmas para diminuir os niveis de ansiedade. A amostra foi constituida de 54 enfermeiras de um hospital geral de ensino, de grande porte, que responderam a um questionario contendo perguntas abertas e fechadas. As respostas apontaram situacoes geradoras de ansiedade, inesperadas ou cotidianas, nas areas: assistencial, de gerenciamento e de ensino. Foram tambem apontados os mecanismos utilizados pelas enfermeiras para enfrentar a ansiedade, tanto nos momentos de crise como no seu cotidiano. Os resultados demonstram que, embora as profissionais estejam realmente sujeitas a situacoes ansiogenicas, elas tambem se utilizam de estrategias de enfrentamento adequadas.Verifica-se a necessidade de realizacao de outros estudos sobre o assunto, a fim de se proporem novas alternativas que possam melhorar a qualidade de vida das enfermeiras.

Difficulties and facilities pointed out by nurses of a university hospital when applying the nursing process

OBJETIVO: Identificar las dificultades y facilidades mencionadas por enfermeras del Hospital Sao Paulo en la ejecucion de las fases del proceso de enfermeria. METODOS: Fueron entrevistadas 83 enfermeras, que trabajaban en 20 unidades de internamiento que poseen el proceso de enfermeria implantado en el servicio, utilizandose cuestionarios estructurados. RESULTADOS: El diagnostico y evolucion de enfermeria fueron las fases que las enfermeras refirieron tener mayor dificultad para operacionalizar. El nucleo de las dificultades y facilidades esta relacionado con el nivel de conocimiento teorico y practico de las enfermeras para la ejecucion de las fases del proceso de enfermeria. CONCLUSION: La falta de conocimiento suficiente se vuelve una barrera para la adhesion de las enfermeras al metodo. Se sugiere la evaluacion de la ensenanza teorica y practica del proceso de enfermeria en el pregrado y la educacion permanente en los servicios hospitalarios.Objective: To identify the difficult and easy aspects of performing the different stages of the nursing process, according to the reports of nurses working at Hospital Sao Paulo. Methods: Eighty-three nurses from 20 different hospital units, where the nursing process was regularly implemented, answered structured research questionnaires. Results: Nursing diagnosis and evolution were the phases where nurses reported more difficulties. Most of the difficult and easy points reported are related to the nurses’ theoretical and practical knowledge to perform the phases of the process. Conclusion: Insufficient knowledge becomes an obstacle for the nurses’ compliance to the nursing process. An evaluation of theoretical and practical teaching of the nursing process during undergraduate courses is recommended, as well as continuous education in hospital settings.

Diagnósticos de enfermagem e proposta de intervenções para pacientes com lesão medular

Introduction: Spinal cord lesions constitute very serious events that occur mostly among young people. Providing care to these patients is a complex task because they are greatly dependent on nursing staff and require a very carefully designed plan of care. The purpose of this study was to contribute ways to design a quality plan of care to attend these patients. Objectives: To identify nursing diagnoses according to the NANDA for patients with spinal cord lesions from an Orthopedic and Trauma Unit, and to propose appropriate nursing interventions according to the NIC. Methods: This study used a descriptive and prospective research design. The sample consisted of 10 patients with spinal cord lesions. Data were colleted from January, 2000 to July, 2002 using a specific assessment tool. Data analysis led the researchers to propose nursing diagnoses which were validated by two clinical nursing specialists. Results: Fifteen prevalent nursing diagnoses were identified and 26 nursing interventions were proposed. Conclusion: The results can be used to assist nurse to provide quality care for patients with spinal cord lesions, so as to improve the patients independence.INTRODUCAO: As lesoes medulares constituem evento grave que acomete principalmente jovens, requerendo um planejamento cuidadoso da assistencia de enfermagem Este estudo tem a finalidade de contribuir nesse planejamento, oferecendo subsidios para melhorar a qualidade do cuidado desses pacientes. OBJETIVOS: Identificar os diagnosticos de enfermagem, segundo a NANDA, em portadores de lesao medular internados numa Unidade de Ortopedia e Traumatologia; e propor as intervencoes de enfermagem, conforme a NIC. METODOS: Estudo descritivo prospectivo, com 10 casos analisados no periodo de janeiro/2000 a julho/2002. Os dados foram coletados por meio de um instrumento criado para uso na unidade de estudo, identificando-se os diagnosticos de enfermagem. As intervencoes foram propostas pelas autoras e submetidas a avaliacao de duas especialistas. RESULTADOS: Foram identificados 15 diagnosticos de enfermagem prevalentes, para os quais foram propostas 26 intervencoes de enfermagem. CONCLUSAO: Os resultados poderao subsidiar as enfermeiras ao cuidado do paciente com lesao medular, auxiliando-o e contribuindo a sua autonomia, atraves das intervencoes propostas.

Pressure ulcers in surgery patients: incidence and associated factors

Pressure ulcers are an important perioperatory care quality indicator This is a longitudinal case series study, performed with the following objectives: to estimate the incidence of pressure ulcers in patients submitted to medium and large surgeries; rate them according to the stage and location; verify the association with the variables: gender, age, body mass index (BMI), co-morbidities, surgical position, duration of surgery, anesthesia type and use of positioning devices, with presence or absence of pressure ulcers. Data collection took place in 2007 in São Paulo, with 199 patients, 20.6% of which presented pressure ulcers, and most (98.6%) in stages I and II, and the main location was the trunk (35.1%). The variables: position, surgery time, general anesthesia, and device use had a statistically significant association. In conclusion, there is a high incidence of pressure ulcers among surgical patients, requiring actions aimed at reducing this type of injury.As ulceras por pressao constituem um dos principais indicadores da qualidade do cuidado na assistencia perioperatoria. Este e um estudo longitudinal, do tipo serie de casos, com o objetivo de estimar a incidencia de ulceras por pressao em pacientes submetidos a cirurgias de medio e grande portes; classifica-las segundo estagio e localizacao, verificar a associacao das variaveis sexo, idade, indice de massa corporea, comorbidades, posicao cirurgica, tempo cirurgico, anestesia e uso de dispositivos de posicionamento com a presenca ou ausencia de ulceras por pressao. Os dados foram coletados em 2007, em Sao Paulo, com 199 pacientes, dos quais 20,6% apresentaram ulceras por pressao, 98,6% nos estagios I e II, com localizacao predominante no tronco frontal (35,1%). As variaveis: posicao, tempo cirurgico, anestesia geral e uso de dispositivos apresentaram associacao estatistica significativa. Concluiu-se que a incidencia de ulceras por pressao em pacientes cirurgicos e elevada, demandando acoes que visem a reducao desse tipo de lesao.

Dificuldades e facilidades apontadas por enfermeiras de um hospital de ensino na execução do processo de enfermagem

OBJETIVO: Identificar las dificultades y facilidades mencionadas por enfermeras del Hospital Sao Paulo en la ejecucion de las fases del proceso de enfermeria. METODOS: Fueron entrevistadas 83 enfermeras, que trabajaban en 20 unidades de internamiento que poseen el proceso de enfermeria implantado en el servicio, utilizandose cuestionarios estructurados. RESULTADOS: El diagnostico y evolucion de enfermeria fueron las fases que las enfermeras refirieron tener mayor dificultad para operacionalizar. El nucleo de las dificultades y facilidades esta relacionado con el nivel de conocimiento teorico y practico de las enfermeras para la ejecucion de las fases del proceso de enfermeria. CONCLUSION: La falta de conocimiento suficiente se vuelve una barrera para la adhesion de las enfermeras al metodo. Se sugiere la evaluacion de la ensenanza teorica y practica del proceso de enfermeria en el pregrado y la educacion permanente en los servicios hospitalarios.Objective: To identify the difficult and easy aspects of performing the different stages of the nursing process, according to the reports of nurses working at Hospital Sao Paulo. Methods: Eighty-three nurses from 20 different hospital units, where the nursing process was regularly implemented, answered structured research questionnaires. Results: Nursing diagnosis and evolution were the phases where nurses reported more difficulties. Most of the difficult and easy points reported are related to the nurses’ theoretical and practical knowledge to perform the phases of the process. Conclusion: Insufficient knowledge becomes an obstacle for the nurses’ compliance to the nursing process. An evaluation of theoretical and practical teaching of the nursing process during undergraduate courses is recommended, as well as continuous education in hospital settings.

O uso do computador como ferramenta para a implementação do processo de enfermagem: a experiência do Hospital São Paulo/UNIFESP

Um grupo de enfermeiras do Hospital de Clinicas de Porto Alegre-RS, cientes de que o Processo de Enfermagem e um modelo teorico que proporciona uma estrutura logica e fundamenta as acoes de enfermagem, desenvolveu e implantou uma ferramenta para facilitar a implementacao das etapas do Processo de enfermagem. Esta ferramenta faz parte de um sistema corporativo de assistencia ao paciente, tem como foco os Diagnosticos e Intervencoes de Enfermagem .. O modelo esta baseado em tabelas com os seguintes conteudos, necessidades humanas basicas, sinais e sintomas, etiologias, diagnosticos e intervencoes de enfermagem. O acesso dos profissionais se da atraves de perfis e senhas. O sistema apresenta um desempenho positivo quanto ao aspecto agilizacao na determinacao dos diagnostico e prescricao das intervencoes de enfermagem permitindo que o enfermeiro possa estar mais junto ao paciente.

Úlcera por pressão em pacientes submetidos à cirurgia: incidência e fatores associados

Pressure ulcers are an important perioperatory care quality indicator This is a longitudinal case series study, performed with the following objectives: to estimate the incidence of pressure ulcers in patients submitted to medium and large surgeries; rate them according to the stage and location; verify the association with the variables: gender, age, body mass index (BMI), co-morbidities, surgical position, duration of surgery, anesthesia type and use of positioning devices, with presence or absence of pressure ulcers. Data collection took place in 2007 in São Paulo, with 199 patients, 20.6% of which presented pressure ulcers, and most (98.6%) in stages I and II, and the main location was the trunk (35.1%). The variables: position, surgery time, general anesthesia, and device use had a statistically significant association. In conclusion, there is a high incidence of pressure ulcers among surgical patients, requiring actions aimed at reducing this type of injury.As ulceras por pressao constituem um dos principais indicadores da qualidade do cuidado na assistencia perioperatoria. Este e um estudo longitudinal, do tipo serie de casos, com o objetivo de estimar a incidencia de ulceras por pressao em pacientes submetidos a cirurgias de medio e grande portes; classifica-las segundo estagio e localizacao, verificar a associacao das variaveis sexo, idade, indice de massa corporea, comorbidades, posicao cirurgica, tempo cirurgico, anestesia e uso de dispositivos de posicionamento com a presenca ou ausencia de ulceras por pressao. Os dados foram coletados em 2007, em Sao Paulo, com 199 pacientes, dos quais 20,6% apresentaram ulceras por pressao, 98,6% nos estagios I e II, com localizacao predominante no tronco frontal (35,1%). As variaveis: posicao, tempo cirurgico, anestesia geral e uso de dispositivos apresentaram associacao estatistica significativa. Concluiu-se que a incidencia de ulceras por pressao em pacientes cirurgicos e elevada, demandando acoes que visem a reducao desse tipo de lesao.

Identificação das características definidoras de medo e ansiedade em pacientes programadas para cirurgia ginecológica

OBJETIVOS: Identificar la presencia de las caracteristicas definidoras de Miedo y Ansiedad en el pre-operatorio inmediato de 50 pacientes sometidas a cirugia ginecologica, y verificar el Sindrome de Ansiedad Perioperatoria. METODOS: Este estudio de cohorte de caracter transversal tuvo como objetivo fue realizado en la Unidad de Ginecologia del Hospital Sao Paulo en mayo del 2007. RESULTADOS: Se confirmo la presencia de los diagnosticos de interes en 48 pacientes (96,0%) de un total de 50 mujeres (100,0%). El Sindrome de Ansiedad Perioperatoria fue identificada en 48 (96,0%) de las pacientes. CONCLUSION: Con la investigacion se comprobo la presencia de los diagnosticos Miedo y Ansiedad, debido a las manifestaciones clinicas, tambien contribuyentes para evidenciar el Sindrome de Ansiedad Perioperatoria.

Índices cienciométricos e a ciência de enfermagem brasileira

Scientific productivity constitutes a relevant aspect in the evaluation process for graduate programs. Therefore, scientific productivity has been the main criteria to evaluate the scientific performance of researchers worldwide. According to Spinak , since 1989 science is considered as an information production system, especially information published for permanent documents and available to the scientific community. Furthermore, according to Harqi and Yuhua , the evaluation of scientific productivity can be done in terms of bibliometric indicators of published work. Garrido and Rodrigues (3) stated that scientometry, known as quantitative research for scientific productivity, was intiated in the 1960’s, when the UNESCO (United Nations Educational, Scientific, and Cultural Organization) and the OECD (Organization for Economic Cooperation and Development) developed methodologies to evaluate scientific an technological activities. The scientometry applies bibliometric techniques to the evaluation of science. Scientometry examines the development of scientific politics, taking into consideration science not only as a discipline, but also as an economical activity. (3) Therefore, scientometry allows the development of indicators to subsidize the evaluation of human resources dedicated to science and technology. Such indicators allow the measurement of research activities and the interpretation of technological innovations for a specific area of science, such as nursing. In addition, measurement and interpretation of specific research productivities in nursing must consider the geographic area in which the productivities occurred. The development of Brazilian science occurs predominantly in the southeast region, and in graduate progams. In this context, nurse researchers have increased the number of scientific manuscripts published in journals indexed by the Institute for Scientific Information (ISI). According to Spinak , there is criticism regarding the criteria used to index scientific journals by international databases, because these criteria may not be appropriate to evaluate the productivity of science and technology for peripheric countries. Spinak (1) also noted that in any area of science, the published manuscripts concentrate in the same multidisciplinary journals with a high impact factor. These journals, approximately three thousand indexed in ISI, cover 90% of the literature considered to have high scientific rigor and value by the academic community. That is, still according to Spinak , an epistemiologic reason explicate by the historical process of the criteria used by ISI to index scientific journals. Other publications, specifically in nursing, addresses this same issue; for example, Broome (4) and Sousa, Cooksey-James, and Driessnack (5) have discussed the journal citation index (JRC), which contains the list of nursing journals indexed by ISI. These nurse authors recommended careful consideration in the use of the ISI criteria to evaluate nurse researchers because the number of nursing journals indexed in ISI are insufficient to accomodate quality scientific productivity of the national and international nursing community; other criteria must be considered as well when evaluating the productivity of nurse researchers. Because of these considerations, the writers of this editorial believe that nursing science in countries under development must create and maintain their own database to index nurse researchers productivity. The “II Conferencia Iberoamericana de Editores de Revistas de Enfermería” that will occur in November, in Mexico, will discuss these issues and propose strategies to strenghten the Iberoamerican journals of Nursing. The journal “Acta Paulista de Enfermagem”, through its editorial body is solidary and sensitive in the search for new strategies to facilitate the dissemination of Brazilian Nursing Science, in order to measure the impact factor of its productivity compared to countries with similar characteristics. Yet, this editorial body intends on using criteria not less significant than other countries with more resources. This is an important factor because countries with more resources for scientific productivity have a socio-economic perfil quite different than those countries known as “peripheric” nations.referem que a cienciometria, como e conhecida a pesquisa quantitativa da producaocientifica, foi iniciada na decada de 1960, quando a UNESCO e a OCDE (Organizacao para a Cooperacaoe Desenvolvimento Economico) desenvolveram metodologias para a avaliacao da atividade cientificae tecnologica.A cienciometria aplica as tecnicas bibliometricas a ciencia. Alem disso, a cienciometria examinao desenvolvimento das politicas cientificas, considerando a ciencia como Disciplina e tambemcomo atividade economica

Consensual Validation of the Nursing Diagnoses Fear and Anxiety Identified at the Immediate Preoperative Period in Patients Undergoing Elective Surgery

PURPOSE.  To identify the most frequent defining characteristics (DCs) for the diagnoses fear and anxiety in Brazilian patients in the immediate preoperative period following elective cardiac surgery; to develop conceptual and operational definitions for the DCs; to develop consensual validation. METHODS.  Clinical and observational, descriptive study developed in two phases. FINDINGS.  Forty DCs were identified for fear and 19 for anxiety. One expert judged it necessary to include “altered bowel motility” as a DC for fear. There was 100% agreement among the five experts in relation to the DCs. CONCLUSIONS.  To add “altered bowel motility” to the DCs for the nursing diagnosis fear. IMPLICATIONS FOR PRACTICE.  To enable nurses to more accurately assess patients for these diagnoses. OBJETIVOS.  Selecionar as caracteristicas definidoras mais frequentes dos diagnosticos de enfermagem de medo e ansiedade em pacientes brasileiros no pre-operatorio imediato submetidos a cirurgia cardiaca eletiva; formular definicoes conceituais e operacionais para as caracteristicas definidoras; realizar a validacao consensual. METODOS.  Estudo clinico e observacional desenvolvido em duas fases. RESULTADOS.  Foram identificadas 14 caracteristicas definidoras para medo e 19 para ansiedade. Inicialmente, um especialista julgou necessaria a inclusao de “mobilidade intestinal alterada” para medo. Posteriormente, foram atingidos 100% de concordância entre os cinco especialistas em relacao as caracteristicas definidoras. CONCLUSAO.  Acrescentar “mobilidade intestinal alterada” para o diagnostico de enfermagem de medo. IMPLICACOES PARA A PRATICA.  Fornecer subsidios para uma melhor avaliacao dos pacientes com tais diagnosticos.