Larissa Bertacchini de Oliveira

Avaliação da carga de trabalho no pós-operatório de cirurgia cardíaca segundo o Nursing Activities Score

Objetivo Identificar los factores asociados con la carga de trabajo de enfermeria en el cuidado de los pacientes despues de la cirugia cardiaca. Metodo Estudio prospectivo de cohorte, realizado con 187 pacientes de la Unidad Quirurgica de Cuidados Intensivos (UCI) del Instituto do Coracao. Los datos fueron recogidos en las primeras 24 y 72 horas el paciente en la UCI. La variable dependiente fue la carga de trabajo calculada por el Nursing Activities Score (NAS) y eran independientes de la naturaleza y de mortalidad puntajes demograficas y clinicas. Para el analisis de los datos se utilizo la prueba de Wilcoxon-Mann-Whitney y Spearman correlacion y de regresion lineal con el modelo de efectos mixtos. Resultados La mayoria de los pacientes eran varones (59,4%) con una edad media de 61 anos (±12,7) y 43,9% desarrollaron algun tipo de complicacion en el postoperatorio. Dentro de 24 horas, la carga de trabajo fue 82,4% (±3,4) y 58,1% (±3,4) en 72 horas. Los factores asociados con el aumento de NAS fueron: longitud del paciente de la estancia en la UCI (p=0,036) y la presencia de complicaciones (p<0,001). Conclusion La gravedad de la paciente dentro de 24 horas, a diferencia de numerosos estudios, no afecto a la mayor carga de trabajo, que se asocio a la duracion de la estancia y complicaciones.

Assessment of workload in the postoperative period of cardiac surgery according to the Nursing Activities Score

Objetivo Identificar los factores asociados con la carga de trabajo de enfermeria en el cuidado de los pacientes despues de la cirugia cardiaca. Metodo Estudio prospectivo de cohorte, realizado con 187 pacientes de la Unidad Quirurgica de Cuidados Intensivos (UCI) del Instituto do Coracao. Los datos fueron recogidos en las primeras 24 y 72 horas el paciente en la UCI. La variable dependiente fue la carga de trabajo calculada por el Nursing Activities Score (NAS) y eran independientes de la naturaleza y de mortalidad puntajes demograficas y clinicas. Para el analisis de los datos se utilizo la prueba de Wilcoxon-Mann-Whitney y Spearman correlacion y de regresion lineal con el modelo de efectos mixtos. Resultados La mayoria de los pacientes eran varones (59,4%) con una edad media de 61 anos (±12,7) y 43,9% desarrollaron algun tipo de complicacion en el postoperatorio. Dentro de 24 horas, la carga de trabajo fue 82,4% (±3,4) y 58,1% (±3,4) en 72 horas. Los factores asociados con el aumento de NAS fueron: longitud del paciente de la estancia en la UCI (p=0,036) y la presencia de complicaciones (p<0,001). Conclusion La gravedad de la paciente dentro de 24 horas, a diferencia de numerosos estudios, no afecto a la mayor carga de trabajo, que se asocio a la duracion de la estancia y complicaciones.

Critical thinking: concept analysis from the perspective of Rodger's evolutionary method of concept analysis.

Objetivo: analisar o conceito de pensamento critico (PC), na perspectiva evolucionista de Rodgers. Metodo: pesquisa documental realizada nas bases de dados Cinahl, Lilacs, Bdenf e Dedalus, utilizando-se as palavras-chave pensamento critico e Enfermagem, sem delimitacao de ano de publicacao. Os dados foram analisados conforme etapas do modelo conceitual de Rodgers. Incluiram-se livros e artigos na integra, publicados em portugues, ingles ou espanhol que abordavam o PC no ensino e pratica de Enfermagem, excluindo-se estudos que nao abordassem aspectos relacionados ao conceito do PC. Resultados: a amostra foi constituida por 42 trabalhos. Como termo substituto, destacou-se pensamento analitico e, como fator relacionado, tomada de decisao. Pela ordem, os atributos, antecedentes e consequentes mais frequentes, foram: capacidade de analise, formacao do estudante de enfermagem e tomada de decisao clinica. Como implicacao do PC, destaca-se o alcance de resultados efetivos na assistencia ao paciente, familia e comunidade. Conclusao: o PC e uma habilidade cognitiva que envolve analise, raciocinio logico e julgamento clinico, orientado para resolucao de problemas e destacando-se na formacao e pratica do enfermeiro com vistas a tomada de decisao clinica acurada e alcance de resultados efetivos.

Effectiveness of teaching strategies on the development of critical thinking in undergraduate nursing students: a meta-analysis

OBJECTIVE To evaluate the effectiveness of teaching strategies used for development of critical thinking (CT) in undergraduate nursing students. METHOD Systematic review with meta-analysis based on the recommendations of the Joanna Briggs Institute . Searches were conducted in the following databases: PubMed, CINAHL, EMBASE, Web of Science, SCOPUS, LILACS, Cochrane CENTRAL, PsycINFO, ERIC, and a database of theses from four continents. The initial selection and evaluation of studies and assessment of methodological quality was performed by two reviewers independently. RESULTS Twelve randomized clinical trials were included in the study. In the meta-analysis of the four studies included that evaluated the strategy of problem-based learning (PBL), compared to lectures, the effectiveness of PBL was demonstrated with statistical significance (SMD = 0.21 and 95% CI = 0.01 to 0.42; p = 0.0434) for the development of CT in undergraduate nursing students, and the studies were homogeneous (chi-square = 6.10, p = 0.106). CONCLUSION The effectiveness of PBL was demonstrated in the increase of overall CT scores. Further studies need to be conducted in order to develop, implement and evaluate teaching strategies that are guided in high methodological rigor, and supported in theoretical models of teaching and learning. OBJETIVO Avaliar a efetividade das estratégias de ensino utilizadas para o desenvolvimento do pensamento crítico (PC) em estudantes de graduação em Enfermagem. MÉTODO Revisão sistemática com metanálise baseada nas recomendações do Joanna Briggs Institute. A busca foi realizada nas bases de dados PubMed, CINAHL, EMBASE, Web of Science, SCOPUS, LILACS, Cochrane CENTRAL, PsycINFO e ERIC e de banco de teses dos quatro continentes. A seleção e avaliação inicial dos estudos e a avaliação da qualidade metodológica foi realizada por dois revisores de forma independente. RESULTADOS Incluídos 12 ensaios clínico randomizados. Na metanálise, dos quatro estudos incluídos que avaliaram a estratégia do Problem Based Learning (PBL), comparada a palestras, foi demonstrada a efetividade do PBL, estatisticamente significativa (SMD=0,21 e 95% IC=0,01-0,42; p=0,0434) para o desenvolvimento do PC em estudantes de graduação em Enfermagem e os estudos eram homogêneos (Qui-quadrado=6,10, p=0,106). CONCLUSÃO Foi demonstrada a efetividade do PBL no aumento dos escores de PC global. Novos estudos precisam ser feitos com o objetivo de desenvolver, implementar e avaliar estratégias de ensino, que sejam pautadas em alto rigor metodológico e amparadas em modelos teóricos de ensino-aprendizagem.Objective: To evaluate the effectiveness of teaching strategies used for development of critical thinking (CT) in undergraduate nursing students. Method: Systematic review with meta-analysis based on the recommendations of the Joanna Briggs Institute. Searches were conducted in the following databases: PubMed, CINAHL, EMBASE, Web of Science, SCOPUS, LILACS, Cochrane CENTRAL, PsycINFO, ERIC, and a database of theses from four continents. The initial selection and evaluation of studies and assessment of methodological quality was performed by two reviewers independently. Results: Twelve randomized clinical trials were included in the study. In the metaanalysis of the four studies included that evaluated the strategy of problem-based learning (PBL), compared to lectures, the effectiveness of PBL was demonstrated with statistical significance (SMD = 0.21 and 95% CI = 0.01 to 0.42; p = 0.0434) for the development of CT in undergraduate nursing students, and the studies were homogeneous (chisquare = 6.10, p = 0.106). Conclusion: The effectiveness of PBL was demonstrated in the increase of overall CT scores. Further studies need to be conducted in order to develop, implement and evaluate teaching strategies that are guided in high methodological rigor, and supported in theoretical models of teaching and learning.OBJETIVO Evaluar la efectividad de las estrategias de ensenanza utilizadas para el desarrollo del pensamiento critico (PC) de estudiantes de pregrado de Enfermeria. METODO Revision sistematica con metaanalisis basado en las recomendaciones del Joanna Briggs Institute. La busqueda fue realizada en las bases de datos PubMed, CINAHL, EMBASE, Web of Science, SCOPUS, LILACS, Cochrane CENTRAL, PsycINFO y ERIC, y de banco de tesis de los cuatro continentes. La seleccion y evaluacion inicial de los estudios y la evaluacion de la calidad metodologica las llevo a cabo dos revisores de modo independiente. RESULTADOS Incluidos 12 ensayos clinicos randomizados. En el metaanalisis, de los cuatro estudios incluidos que evaluaron la estrategia del Problem Based Learning (PBL), comparada con conferencias, fue demostrada la efectividad del PBL, estadisticamente significativa (SMD=0,21 y el 95% IC=0,01-0,42; p=0,0434) para el desarrollo del PC en estudiantes de pregrado en Enfermeria, y los estudios eran homogeneos (Chi cuadrado=6,10, p=0,106). CONCLUSION Fue demostrada la efectividad del PBL en el incremento de los puntajes de PC global. Se necesitan hacer nuevos estudios con el fin de desarrollar, implantar y evaluar estrategias de ensenanza que se pauten en un alto rigor metodologico y se amparen en modelos teoricos de ensenanza-aprendizaje.

Long-Term Follow-Up Evaluation of Renal Function in Patients with Chronic Kidney Disease Undergoing Cardiac Surgery.

Background. Acute kidney injury (AKI) is a common complication of cardiac surgery but its long-term consequences, in patients with chronic kidney disease (CKD), are not known. Methods. We compared the long-term prognoses of CKD patients who developed (n = 23) and did not develop (n = 35) AKI during the period of hospitalization after undergoing coronary artery bypass graft (CABG). Fifty-eight patients who survived (69.6 ± 8.4 years old, 72% males, 83% Whites, 52% diabetics, baseline GFR: 46 ± 16 mL/min) were followed up for 47.8 ± 16.4 months and treated for secondary prevention of events. Results. There were 6 deaths, 4 in the AKI+ and 2 in the AKI− group (Log-rank = 0.218), two attributed to CV causes. At the end of the study, renal function was similar in the two groups. One AKI− patient was started on dialysis. Only 4 patients had an increase in serum creatinine ≥ 0.5 mg/dL during follow-up. Conclusion. CKD patients developing AKI that survived the early perioperative period of coronary intervention present good renal and nonrenal long-term prognosis, compared to patients who did not develop AKI.

Estratégias de prevenção da lesão renal aguda em cirurgia cardíaca: revisão integrativa

Acute kidney injury is a common complication after cardiac surgery and is associated with increased morbidity and mortality and increased length of stay in the intensive care unit. Considering the high prevalence of acute kidney injury and its association with worsened prognosis, the development of strategies for renal protection in hospitals is essential to reduce the associated high morbidity and mortality, especially for patients at high risk of developing acute kidney injury, such as patients who undergo cardiac surgery. This integrative review sought to assess the evidence available in the literature regarding the most effective interventions for the prevention of acute kidney injury in patients undergoing cardiac surgery. To select the articles, we used the CINAHL and MedLine databases. The sample of this review consisted of 16 articles. After analyzing the articles included in the review, the results of the studies showed that only hydration with saline has noteworthy results in the prevention of acute kidney injury. The other strategies are controversial and require further research to prove their effectiveness.

TEACHING CRITICAL THINKING SKILLS THROUGH PROBLEM BASED LEARNING

Objective: to comparatively analyze the perception of nursing students from two class groups, regarding the implicit teaching of critical thinking in a Basic Life Support course. Method: educational intervention with a qualitative approach based on historical-cultural theory. A total of 102 students participated in the study, 52 in the intervention group, who were taught using Problem Based Learning methodology associated with guiding questions, and 50 in the control group, taught only using Problem Based Learning. Data were collected from November 12 to 30 in 2015 at the Federal University of Viçosa, through a sociodemographic questionnaire, an evaluation instrument and semi-structured interviews. The evaluative tool and interviews were explored using Bardin’s content analysis. Results: the course stimulated critical thinking skills in students from both groups. However, the intervention group portrayed more perceptions about the characteristics of a critical thinker. The students in the control group, to which only the Problem Based Learning methodology was applied to, mentioned the acquisition of technical skills. In the intervention group, to which the Problem Based Learning methodology associated with the guiding questions was applied to, the students reported the skills of a critical thinker in addition to the technical skills. Conclusion: the comparative analysis allows us to conclude that teaching methodologies that stimulate critical thinking become mediators in the development and improvement of higher mental functions in teaching, encompassing cognitive and metacognitive capacities. The study represents contribution and advancement in the scope of nursing teaching, considering that the questions add to the technologies of health education. DESCRIPTORS: Nursing. Nursing education. Nursing students. Problem-based learning. Teaching ENSINO DAS HABILIDADES DO PENSAMENTO CRÍTICO POR MEIO DE PROBLEM BASED LEARNING

Effectiveness of teaching strategies to improve critical thinking in nurses in clinical practice: a systematic review protocol

OBJECTIVES The aim of this review is to identify and synthesize the best available evidence on the effectiveness of teaching strategies aimed at improving critical thinking (CT) in registered nurses who provide direct patient care. Specifically, the research question is: What are the best teaching strategies to improve CT skills in registered nurses who provide direct patient care?

Pensamento crítico: análise do conceito sob a ótica evolucionista de Rodgers

Objetivo: analisar o conceito de pensamento critico (PC), na perspectiva evolucionista de Rodgers. Metodo: pesquisa documental realizada nas bases de dados Cinahl, Lilacs, Bdenf e Dedalus, utilizando-se as palavras-chave pensamento critico e Enfermagem, sem delimitacao de ano de publicacao. Os dados foram analisados conforme etapas do modelo conceitual de Rodgers. Incluiram-se livros e artigos na integra, publicados em portugues, ingles ou espanhol que abordavam o PC no ensino e pratica de Enfermagem, excluindo-se estudos que nao abordassem aspectos relacionados ao conceito do PC. Resultados: a amostra foi constituida por 42 trabalhos. Como termo substituto, destacou-se pensamento analitico e, como fator relacionado, tomada de decisao. Pela ordem, os atributos, antecedentes e consequentes mais frequentes, foram: capacidade de analise, formacao do estudante de enfermagem e tomada de decisao clinica. Como implicacao do PC, destaca-se o alcance de resultados efetivos na assistencia ao paciente, familia e comunidade. Conclusao: o PC e uma habilidade cognitiva que envolve analise, raciocinio logico e julgamento clinico, orientado para resolucao de problemas e destacando-se na formacao e pratica do enfermeiro com vistas a tomada de decisao clinica acurada e alcance de resultados efetivos.

Pensamiento crítico: análisis del concepto bajo la óptica evolucionista de Rodgers

Objetivo: analisar o conceito de pensamento critico (PC), na perspectiva evolucionista de Rodgers. Metodo: pesquisa documental realizada nas bases de dados Cinahl, Lilacs, Bdenf e Dedalus, utilizando-se as palavras-chave pensamento critico e Enfermagem, sem delimitacao de ano de publicacao. Os dados foram analisados conforme etapas do modelo conceitual de Rodgers. Incluiram-se livros e artigos na integra, publicados em portugues, ingles ou espanhol que abordavam o PC no ensino e pratica de Enfermagem, excluindo-se estudos que nao abordassem aspectos relacionados ao conceito do PC. Resultados: a amostra foi constituida por 42 trabalhos. Como termo substituto, destacou-se pensamento analitico e, como fator relacionado, tomada de decisao. Pela ordem, os atributos, antecedentes e consequentes mais frequentes, foram: capacidade de analise, formacao do estudante de enfermagem e tomada de decisao clinica. Como implicacao do PC, destaca-se o alcance de resultados efetivos na assistencia ao paciente, familia e comunidade. Conclusao: o PC e uma habilidade cognitiva que envolve analise, raciocinio logico e julgamento clinico, orientado para resolucao de problemas e destacando-se na formacao e pratica do enfermeiro com vistas a tomada de decisao clinica acurada e alcance de resultados efetivos.