Laís Helena Ramos

Medication errors in an intensive care unit

AIM This paper is a report of a study to investigating the incidence types and causes of medication errors (MEs) and the consequences for patients. Background. Medication errors are a common problem in hospitals around the world, including those in Brazil. METHOD An exploratory, quantitative survey design was used and 44 adult inpatients were studied over a 30-day period in 2006. Three different methods were employed: anonymous self-reports, staff interviews and review of patient prescriptions. FINDINGS A total of 305 MEs was observed. The mean (sd) number was 6.9 (6.8) per patient. The numbers of MEs per day differed statistically significantly between the two groups with length of stay in the intensive care unit of <1 week and more than 1 week, respectively, with mean (sd) of 0.4 (0.38) vs. 0.73 (0.39) The most frequent types were: omission (71.1%), wrong time of administration (11.5%), and prescribing errors (4.6%). The main causes were: medication not available in the hospital (41%); pharmacy stocking and delivery problems (16.3%); transcription errors (11%). No death was directly related to any ME. CONCLUSION There is a need to develop a culture of safety and quality in patient care. An understanding of the profile of ME types and frequencies in an institution is fundamental to raise awareness and implement measures to avoid them. Structural and procedural changes in hospital organization, with a focus on the efficacy, efficiency, and effectiveness of the medication system are needed to reduce MEs.

Diretrizes curriculares para o ensino da ética na graduação em enfermagem

This article discusses relevant philosophical, social, psychological, and pedagogical aspects that must guide the teaching of ethics/bioethics principles to undergraduate nursing students. There is a need to plan and use a systematic approach in teaching Ethics/Bioethics in the undergraduate nursing program in order to facilitate students’ critical thinking and decision making in a variety of situations. The article also proposes an outline for teaching on ethics/bioethics in undergraduate nursing programs. This outline consists of: ethics/bioethics as a transversal subject; values, virtue, and ethical attitudes that students must develop; fundamentals of ethics/bioethics consistent with qualified faculty members, the use of methods and strategies student-centered; and, participative process in the construction of transversal teaching of ethics/bioethics. Kewords: Ethics; Bioethics; Education, nursing, undergraduate nursing program; Guideline; Education; TeachingThis article discusses relevant philosophical, social, psychological, and pedagogical aspects that must guide the teaching of ethics/bioethics principles to undergraduate nursing students. There is a need to plan and use a systematic approach in teaching Ethics/Bioethics in the undergraduate nursing program in order to facilitate students’ critical thinking and decision making in a variety of situations. The article also proposes an outline for teaching on ethics/bioethics in undergraduate nursing programs. This outline consists of: ethics/bioethics as a transversal subject; values, virtue, and ethical attitudes that students must develop; fundamentals of ethics/bioethics consistent with qualified faculty members, the use of methods and strategies student-centered; and, participative process in the construction of transversal teaching of ethics/bioethics. Kewords: Ethics; Bioethics; Education, nursing, undergraduate nursing program; Guideline; Education; Teaching

Erro de medicação: importância da notificação no gerenciamento da segurança do paciente

Notifying medication errors is an important instrument in managing assistance quality and safety for the patient. The objective of this study was to verify with the nursing team their understanding that a medication error had been committed, and to observe how they notified responsible physicians of the event. To achieve this, researchers used a descriptive/exploratory survey with 89 professionals. The results demonstrate a lack of uniformity in understanding that medication errors had been committed, when these errors must be communicated to a physician, and when an event report must be filled out. The research shows the necessity to develop educational programs that shed light on exactly what constitutes a medication error, clarifying causes of the problem and providing solutions to solve it.Notifying medication errors is an important instrument in managing assistance quality and safety for the patient. The objective of this study was to verify with the nursing team their understanding that a medication error had been committed, and to observe how they notified responsible physicians of the event. To achieve this, researchers used a descriptive/exploratory survey with 89 professionals. The results demonstrate a lack of uniformity in understanding that medication errors had been committed, when these errors must be communicated to a physician, and when an event report must be filled out. The research shows the necessity to develop educational programs that shed light on exactly what constitutes a medication error, clarifying causes of the problem and providing solutions to solve it.

Liderança Coaching: um modelo de referência para o exercício do enfermeiro-líder no contexto hospitalar

The objectives of the present study was to evaluate the leadership of nurses by using the coaching strategy as a managerial tool, and identify, measure and analyze the acquisition of competencies from the view of nurse-coaches. This is a descriptive, cross-sectional, exploratory and field study that was performed using a quantitative approach. Situational Leadership was selected as the theoretical framework and the research instrument was submitted to statistical and content analyses and was applied on 11 nurse leaders of a large scale private general hospital located in Sao Paulo. The results showed that participants gained new knowledge, confirmed the Situational Leadership model as the recognized being a coach leader, with a style that is mainly aimed at tasks and people, according to the situation involved, and pointed out the following skills as determinant of coaches: communication, giving and receiving feedback, assigning and gaining power and having an influence. Finally, the attitudes reflected the practice of coaching.The objectives of the present study was to evaluate the leadership of nurses by using the coaching strategy as a managerial tool, and identify, measure and analyze the acquisition of competencies from the view of nurse-coaches. This is a descriptive, cross-sectional, exploratory and field study that was performed using a quantitative approach. Situational Leadership was selected as the theoretical framework and the research instrument was submitted to statistical and content analyses and was applied on 11 nurse leaders of a large scale private general hospital located in São Paulo. The results showed that participants gained new knowledge, confirmed the Situational Leadership model as the recognized being a coach leader, with a style that is mainly aimed at tasks and people, according to the situation involved, and pointed out the following skills as determinant of coaches: communication, giving and receiving feedback, assigning and gaining power and having an influence. Finally, the attitudes reflected the practice of coaching.

Capacitação de enfermeiros em atendimento pré-hospitalar

The performance of nurses in prehospital care (PHC) assumes acquiring specific competences. The objectives of the present study were to verify nurses’ opinion on theoretical knowledge and nursing skills necessary for the practice in pre-hospital setting and to analyze them according to their clinical practice. In this descriptive study, the opinion of nurses, from public pre-hospital care services of the City of Sao Paulo, was collected through a questionnaire and the data of the clinical practice using forms. Cardiopulmonary resuscitation was mentioned more often as basic knowledge (84%), and the most frequent procedure was oxygen therapy (15.5%). The analysis of nurses’ opinion indicated that the basic topics were related to situations that demanded making decisions, readiness and skill under stress or caring for a specific population, making training important in this area.A atuacao do enfermeiro na area de atendimento pre-hospitalar (APH) pressupoe a aquisicao de competencias especificas. Os objetivos deste estudo foram verificar a opiniao dos enfermeiros sobre conhecimentos teoricos e habilidades de enfermagem necessarios para o exercicio em APH e analisa-la de acordo com a pratica clinica. Neste estudo descritivo, a opiniao dos enfermeiros dos servicos publicos de APH do Municipio de Sao Paulo foi coletada por meio de questionario, e os dados da pratica clinica em formulario. A ressuscitacao cardiopulmonar foi mais citada como conhecimento basico (84%) e o procedimento mais frequente foi a oxigenoterapia (15,5%). A analise das opinioes dos enfermeiros revelou que os temas considerados basicos relacionaram-se as situacoes que exigem tomada de decisao, prontidao e destreza sob estresse, ou atendimento de uma populacao especifica, o que reforca a importância da capacitacao nessa area.

As dimensões da satisfação dos usuários do Programa Saúde da Família: confiabilidade e empatia

Objective: Describe users’ perceptions of teams from the Family Health Program (PSF) of the urban area of Montes Claros, Minas Gerais, regarding the dimensions of satisfaction related to trust and empathy; analyze the demographic profile of the population interviewed in relationship to their perceptions of trust and empathy. Methods: Quantitative descriptive survey; using SERVQUAL. 319 users were interviewed and the analysis was performed using descriptive statistics to identify statistically significant associations. Results: Most respondents were: female (80.6%), ages 18 to 30 years (38.2%), had completed high school (32.3%), had a family income of 1 to 3 times the minimum wage (76.8%), lived in the district for over 10 years (52.6%), and had good understanding of services as related to trust and empathy. Conclusion: We describe the aspects involving trust and empathy for users of the PSF, which must be considered when restructuring the processes of health care for the population.OBJETIVO: Describir la percepcion de los usuarios de los equipos del Programa Salud de la Familia (PSF) de la zona urbana de Montes Claros, Minas Gerais, sobre las dimensiones de la satisfaccion relacionadas a la Confiabilidad y la Empatia; analizar el perfil sociodemografico de la poblacion entrevistada frente a la Confiabilidad y a la Empatia. METODOS: Investigacion cuantitativa; descriptiva por medio del SERVQUAL. Fueron entrevistados 319 usuarios y el analisis fue realizado por meio da estadistica descriptiva y las asociaciones estadisticamente significativas. RESULTADOS: La mayoria de los entrevistados es del sexo feminino (80,6%), se encuentra en el grupo etareo de 18 a 30 anos (38,2%), posee secundaria completa (32,3%), ingreso familiar de 1 a 3 salarios minimos (76,8%), reside en los barrios hace mas de 10 anos (52,6%) y tiene buena percepcion de los servicios prestados en cuanto a la Confiabilidad y a la Empatia. CONCLUSION: Fue posible describir los aspectos que involucran a la Confiabilidad y la Empatia de los usuarios del PSF, que merecem ser considerados en la reestructuracion de los procesos de atencion a la salud de la poblacion.

Satisfação profissional de enfermeiros do Trabalho no Brasil

OBJECTIVE: To know if nurses working in Brazil are satisfied with the exercise of their practice and what factors are associated with it. METHODS: Exploratory cross-sectional study of 130 nursing professionals from the five Brazilian regions. We collected demographic data and administered the Job Satisfaction Scale of Occupational Stress Indicator (OSI), at three times during the period of August 2006 to March 2007. RESULTS: The five aspects of the OSI associated with job satisfaction were: relationship with others in the [...]Objective: To know if nurses working in Brazil are satisfied with the exercise of their practice and what factors are associated with it. Methods: Exploratory cross-sectional study of 130 nursing professionals from the five Brazilian regions. We collected demographic data and administered the Job Satisfaction Scale of Occupational Stress Indicator (OSI), at three times during the period of August 2006 to March 2007. Results: The five aspects of the OSI associated with job satisfaction were: relationship with others in the organization in which one works, the type (content) of the work performed, degree of motivation felt about one’s work, degree of job security and current level of flexibility and freedom one believes s/he has at work. Conclusion: Professional satisfaction presents in a significantly different manner between genders, referring to the fact that professionals have different perceptions of their work. In the women, the importance and degree of concern about job security was evident. In the men, the predominant motivation was participation in important decisions, and the flexibility and freedom at work.

Percepções sobre o erro de medicação: análise de respostas da equipe de enfermagem

Medication error is defined as any type of error in the prescription, transcription, dispensing and administration process which could bring about serious consequences or not. This descriptive and exploratory study assesses four scenarios showing situations from nursing practice. The study group was composed of 256 professionals and 89 questionnaires were analyzed. The answers given by the registered nurses were compared with those of licensed practical nurses and care aids. They should express their opinion if the situations represented a medication error or not, if it had to be communicated to the physician or an incident report had to be written. The two groups showed uniform answers. They expressed the same doubts to label the situation as an error and which measures should be taken, suggesting the need for further discussion on the matter within the institution.Medication error is defined as any type of error in the prescription, transcription, dispensing and administration process which could bring about serious consequences or not. This descriptive and exploratory study assesses four scenarios showing situations from nursing practice. The study group was composed of 256 professionals and 89 questionnaires were analyzed. The answers given by the registered nurses were compared with those of licensed practical nurses and care aids. They should express their opinion if the situations represented a medication error or not, if it had to be communicated to the physician or an incident report had to be written. The two groups showed uniform answers. They expressed the same doubts to label the situation as an error and which measures should be taken, suggesting the need for further discussion on the matter within the institution.

Perceptions about medication errors: analysis of answers by the nursing team

Medication error is defined as any type of error in the prescription, transcription, dispensing and administration process which could bring about serious consequences or not. This descriptive and exploratory study assesses four scenarios showing situations from nursing practice. The study group was composed of 256 professionals and 89 questionnaires were analyzed. The answers given by the registered nurses were compared with those of licensed practical nurses and care aids. They should express their opinion if the situations represented a medication error or not, if it had to be communicated to the physician or an incident report had to be written. The two groups showed uniform answers. They expressed the same doubts to label the situation as an error and which measures should be taken, suggesting the need for further discussion on the matter within the institution.Medication error is defined as any type of error in the prescription, transcription, dispensing and administration process which could bring about serious consequences or not. This descriptive and exploratory study assesses four scenarios showing situations from nursing practice. The study group was composed of 256 professionals and 89 questionnaires were analyzed. The answers given by the registered nurses were compared with those of licensed practical nurses and care aids. They should express their opinion if the situations represented a medication error or not, if it had to be communicated to the physician or an incident report had to be written. The two groups showed uniform answers. They expressed the same doubts to label the situation as an error and which measures should be taken, suggesting the need for further discussion on the matter within the institution.

Nurses' training in prehospital care

The performance of nurses in prehospital care (PHC) assumes acquiring specific competences. The objectives of the present study were to verify nurses’ opinion on theoretical knowledge and nursing skills necessary for the practice in pre-hospital setting and to analyze them according to their clinical practice. In this descriptive study, the opinion of nurses, from public pre-hospital care services of the City of Sao Paulo, was collected through a questionnaire and the data of the clinical practice using forms. Cardiopulmonary resuscitation was mentioned more often as basic knowledge (84%), and the most frequent procedure was oxygen therapy (15.5%). The analysis of nurses’ opinion indicated that the basic topics were related to situations that demanded making decisions, readiness and skill under stress or caring for a specific population, making training important in this area.A atuacao do enfermeiro na area de atendimento pre-hospitalar (APH) pressupoe a aquisicao de competencias especificas. Os objetivos deste estudo foram verificar a opiniao dos enfermeiros sobre conhecimentos teoricos e habilidades de enfermagem necessarios para o exercicio em APH e analisa-la de acordo com a pratica clinica. Neste estudo descritivo, a opiniao dos enfermeiros dos servicos publicos de APH do Municipio de Sao Paulo foi coletada por meio de questionario, e os dados da pratica clinica em formulario. A ressuscitacao cardiopulmonar foi mais citada como conhecimento basico (84%) e o procedimento mais frequente foi a oxigenoterapia (15,5%). A analise das opinioes dos enfermeiros revelou que os temas considerados basicos relacionaram-se as situacoes que exigem tomada de decisao, prontidao e destreza sob estresse, ou atendimento de uma populacao especifica, o que reforca a importância da capacitacao nessa area.