Lídia Aparecida Rossi

O significado cultural do cuidado humanizado em unidade de terapia intensiva: muito falado e pouco vivido

Este trabalho consistiu em um estudo etnografico, cujo objetivo foi compreender o significado cultural do cuidado humanizado, na perspectiva da equipe de enfermagem que atua na Unidade de Terapia Intensiva do Hospital das Clinicas da Universidade Federal de Goias. Para a coleta de dados, foram realizadas observacoes participantes e entrevistas semi-estruturadas com enfermeiros, tecnicos e auxiliares de enfermagem, em seu ambiente de trabalho. Com a analise dos dados, emergiram tres categorias principais que deram sentido ao significado do cuidado humanizado na UTI: cuidado Humanizado - amar ao proximo como a si mesmo; cuidado humanizado - nao esta presente como deveria estar; estresse e sofrimento: e preciso cuidar de quem cuida. O tema cultural foi o cuidado humanizado - muito falado e pouco vivido. Esse tema mostra a realidade do cuidar em terapia intensiva, envolvendo uma equipe de enfermagem que tem um conceito de humanizacao sintetizado na expressao: amar ao proximo como a si mesmo, mas que, na pratica, nao revela esse pensamento tao profundo.

CHILDHOOD BURN INJURIES: CIRCUMSTANCES OF OCCURRENCES AND THEIR PREVENTION IN RIBEIRAO PRETO, BRAZIL

The objectives of this study were to verify which circumstances are present in burn accidents of patients under 12 years of age and to gather information to ground strategies to prevent those accidents. Parents or guardians of 26 patients aged under 12 years, admitted to the burns unit of the Clinical Hospital of Ribeirão Preto Medical School, Brazil, were interviewed, from March 1996 to March 1997. Fifty percent of the injured children were under 3 years of age and had suffered a scald. The kitchen and the backyard were identified as the places where the majority of accidents (84.6%) happened. At least one parent was present in 80.7% of cases. The results speak for the necessity of implementation of programs to prevent burn accidents, focusing on the domestic setting, chiefly activities in the kitchen.

A prática baseada em evidências: considerações teóricas para sua implementação na enfermagem perioperatória

A pratica baseada em evidencias possibilita a melhoria da qualidade da assistencia de enfermagem prestada ao cliente/paciente. O presente artigo tem como objetivo oferecer subsidios que proporcionem reflexoes no cenario da enfermagem perioperatoria. Assim, fundamentadas na literatura, tecemos consideracoes acerca da pratica baseada em evidencias; conceitos gerais, importância e barreiras para sua implementacao na pratica profissional com a finalidade de incentivar o enfermeiro cirurgico a buscar conhecimento cientifico por meio do desenvolvimento de pesquisas e utilizacao de seus resultados.Evidence-based practice enables the quality improvement of the nursing care delivered to clients/patients. This work aimed at providing elements that will lead to reflections on the scenario concerning perioperative nursing. Accordingly, based on literature, authors have made considerations regarding evidence-based nursing practice, general concepts, its importance and the obstacles to its implementation in professional practice, aiming at encouraging surgical nurses to seek for scientific knowledge by developing research and applying its results.

Revisão integrativa: etapa inicial do processo de validação de diagnóstico de enfermagem*

Making nursing diagnoses is the second step of the nursing process. It is a source of nursing knowledge and essential for the planning and implementing of effective nursing interventions that promote quality nursing care. Integrative literature review is a research method that allows for gathering and synthesizing available evidence about a topic. Thus, the purpose of this review was to argue that integrative literature review is the initial step in the nursing diagnoses validation process. Important aspects in conducting integrative literature reviews are presented through an example, including their contributions to refine and validate nursing diagnoses proposed by the North American Nursing Diagnosis Association International’s (NANDA-I) Taxonomy II, which can guide the planning and implementation of quality nursing.

Diagnóstico de enfermagem de pacientes no período transoperatório de cirurgia cardíaca

O objetivo deste estudo foi identificar os diagnosticos de enfermagem de pacientes no periodo transoperatorio de cirurgia cardiaca. Para a coleta de dados, foi elaborado e validado um instrumento baseado no modelo conceitual de Horta. Foram avaliados 17 pacientes adultos, no periodo transoperatorio de cirurgia cardiaca, sendo nove homens e oito mulheres, com idade media de 58 anos. Os diagnosticos de enfermagem, identificados segundo a Taxonomia I da NANDA, com frequencia superior a 50,0%, foram: risco para infeccao (100%), risco para desequilibrio de volume de liquidos (100%), troca de gases prejudicada (100%), risco para aspiracao (100%), protecao alterada (100%), integridade da pele prejudicada (100%), risco para disfuncao neurovascular periferica (100%), risco para lesao perioperatoria de posicionamento (100%) e risco para temperatura corporal alterada (94,1%). Observamos uma predominância dos diagnosticos de enfermagem relacionados as necessidades fisiologicas.The purpose of this study was to identify nursing diagnoses of patients in the intra-operative period of cardiac surgery. One instrument was elaborated and validated for data collection. Such instrument was organized according to The Theory of Basic Human Needs. Seventeen adult patients in the intra-operative period of cardiac surgery were evaluated, of whom 09 were males and 08 were females with the average of 58 years old. Following data collection, the nursing diagnoses were identified based on NANDAs Taxonomy I. The nursing diagnoses identified with a higher frequency than 50% were: Risk for infection (100%), Risk for fluid volume imbalance (100%), Impaired gas exchange (100%), Risk for aspiration (100%), Altered protection (100%), Impaired skin integrity (100%), Risk for peripheral neurovascular dysfunction (100%), Risk for perioperative positioning injury (100%) and Risk for altered body temperature (94.1%). It was identified a predominance of the diagnoses related to psychobiological needs.

The cultural adaptation and validation of the "Burn Specific Health Scale-Revised" (BSHS-R): version for Brazilian burn victims.

BACKGROUND The Burns Specific Health Scale-Revised (BSHS-R) is of easy application, can be self-administered, and it is considered a good scale to evaluate various important life aspects of burn victims. OBJECTIVES To translate and culturally adapt the BSHS-R into the Brazilian-Portuguese language and to evaluate the internal consistency and convergent validity of the translated BSHS-R. METHODS The cultural adaptation of the BSHS-R included translation and back-translation, discussions with professionals and patients to ensure conceptual equivalence, semantic evaluation, and pre-test of the instrument. The Final Brazilian-Portuguese Version (FBPV) of the BSHS-R was tested on a group of 115 burn patients for internal consistency and validity of construct (using the Rosenberg Self-Esteem Scale (RSES) and the Beck Depression Inventory (BDI)). RESULTS All values of Cronbachs alpha were greater than .8, demonstrating that the internal consistency of the FBPV was very high. Self-esteem was highly correlated with affect and body image (r=.59, p<.001), and with interpersonal relationships (r=.51, p<.001). Correlations between the domains of the FBPV and the BDI were all negative but larger in magnitude than the correlations with RSES. Depression was highly correlated with affect and body image (r=-.77, p<.001), and with interpersonal relationships (r=-.67, p<.001). CONCLUSIONS The results showed that the adapted version of the BSHS-R into Brazilian-Portuguese fulfills the validity and reliability criteria required from an instrument of health status assessment for burn patients.

A dor da queimadura: terrível para quem sente, estressante para quem cuida

The goals of the study were to understand the cultural meaning that the nursing team and burn patients attribute to burn pain. Participant observations were carried out during one year at a Burn Unit. Semi-structured interviews with four nurses, five nursing auxiliaries and 12 patients were recorded. The burn pain is understood by nurses as physical and emotional pain. For professionals and patients, bath and dressing changes are stressful. For patients, burn pain is terrible and they can not explain it. However, they feel they should hold it up.The goals of the study were to understand the cultural meaning that the nursing team and burn patients attribute to burn pain. Participant observations were carried out during one year at a Burn Unit. Semi-structured interviews with four nurses, five nursing auxiliaries and 12 patients were recorded. The burn pain is understood by nurses as physical and emotional pain. For professionals and patients, bath and dressing changes are stressful. For patients, burn pain is terrible and they can not explain it. However, they feel they should hold it up.Os objetivos deste foram identificar os significados culturais atribuidos pela equipe de enfermagem as manifestacoes de dor apresentadas pelos pacientes portadores de queimaduras e identificar as percepcoes dos pacientes frente a dor provocada pela queimadura e a assistencia de enfermagem prestada nestas situacoes. Foram realizadas observacoes participantes e entrevistados quatro enfermeiros, cinco auxiliares e 12 pacientes, em uma unidade de queimados. A dor da queimadura foi compreendida pelos enfermeiros como: fisica e emocional. Para todos os profissionais o banho e curativo sao procedimentos estressantes. Para os pacientes a dor e terrivel e nao pode ser explicada, mas necessita ser suportada.

Prevenção de queimaduras: percepção de pacientes e de seus familiares

Os objetivos deste estudo foram investigar os meios de prevencao de queimaduras identificados por pacientes vitimas de queimaduras e por seus familiares. Os dados foram coletados na Unidade de Queimados do Hospital das Clinicas da Faculdade de Medicina de Ribeirao Preto, mediante a realizacao de entrevistas com pacientes e seus familiares. Os dados foram categorizados por quatro juizes. Para verificar a existencia de concordância entre os juizes, quanto a categorizacao, foi utilizada a medida nao parametrica de correlacao - Coeficiente de Contingencia. Foram entrevistados: 24 familiares de pacientes que sofreram queimaduras e 33 pacientes. Dos 33 pacientes entrevistados, 18 sofreram acidentes em ambiente domestico. Dos 57 entrevistados, 11 afirmaram que nao poderiam ter contribuido para evitar o acidente. Vinte pacientes e 12 familiares identificaram situacoes de risco no ambiente domestico ou no trabalho, e 13 pacientes e 12 familiares nao identificaram qualquer tipo de situacao de risco. Os familiares e pacientes apontaram como medidas preventivas de acidentes por queimaduras: estar atento as atividades realizadas e ter cuidado com o manuseio de produtos inflamaveis.

The meanings of quality of life: interpretative analysis based on experiences of people in burns rehabilitation

Con el objetivo de interpretar los significados para la calidad de vida, este estudio parte de la atribucion dada por personas que sufrieron quemaduras graves, sus experiencias y su contexto sociocultural. El metodo etnografico fue utilizado apoyado en la teoria hermeneutica moderna. Participaron del estudio 19 pacientes con secuelas de quemadura y sus familiares, atendidos en la Unidad de Quemados del Hospital de Clinicas de la Facultad de Medicina de Ribeirao Preto. Los sujetos pertenecian al sector popular, con edades entre 18 y 50 anos, participantes del programa de rehabilitacion por lo menos un ano. Los datos recolectados a traves de entrevistas semi-estructuradas y observacion directa; siendo su analisis realizado a traves de la identificacion de unidades de significados y construccion de nucleos tematicos. Los pacientes y sus familiares mencionaron cambios en su calidad de vida debidos a sus limitaciones fisicas y psiquicas por la quemadura. La calidad de vida asociada al desempeno de los roles sociales fue estructurada en base a los nucleos: familia, trabajo, autonomia, normalidad e integracion social.This research aimed to interpret the meanings of quality of life, taking into consideration the meanings attributed by those who have undergone serious burns, their experiences and social/cultural background. We used the ethnographic method based on modern hermeneutics. Nineteen patients with burn sequelae, already discharged from the Burns Unit of the Ribeirão Preto Medical School Clinical Hospital participated in this study, along with their relatives. Participants belong to the working class, are between 18 to 50 years old and have been in rehabilitation for at least a year. Data were collected by direct observation and semi-structured interviews. The analysis was processed through the identification of units of meanings and construction of thematic nucleuses. Patients and relatives reported that quality of life had changed because of physical and psychological limitations caused by the burns. The meanings of quality of life are associated with the performance of social roles and are guided by family, work, normality, autonomy and social integration.Com o objetivo de interpretar os significados de qualidade de vida, este estudo considera os sentidos atribuidos por pessoas que sofreram queimaduras graves, suas experiencias e contexto sociocultural. Utilizou-se o metodo etnografico com apoio teorico da hermeneutica moderna. Participaram 19 pacientes com sequelas de queimadura, atendidos pela Unidade de Queimados do Hospital das Clinicas da Faculdade de Medicina de Ribeirao Preto, e seus familiares. Pertencentes as classes populares, os sujeitos, com idade entre 18 e 50 anos, integram programa de reabilitacao ha um ano ou mais. A analise dos dados, coletados por entrevistas semi-estruturadas e observacao direta, processou-se pela identificacao de unidades de significados e construcao de nucleos tematicos. Pacientes e familiares relataram modificacoes da qualidade de vida introduzidas por limitacoes fisicas e psiquicas provocadas pela queimadura. Qualidade de vida, associada ao desempenho de papeis sociais, estrutura-se em torno dos nucleos: familia, trabalho, autonomia, normalidade e integracao social.

Curativo do paciente queimado: uma revisão de literatura

O objetivo deste estudo foi descrever, mediante revisao de literatura, os agentes topicos e tipos de cobertura que tem sido recomendados no tratamento de queimaduras e discutir as implicacoes do uso desses produtos. O estudo foi desenvolvido mediante levantamento bibliografico dos ultimos 12 anos, nas bases de dados Lilacs, Medline e Dedalus. As publicacoes encontradas foram organizadas como de pesquisa e de revisao e, posteriormente, categorizadas de acordo com a tematica: agentes topicos e substitutos temporarios de pele. Foram discutidos os possiveis efeitos colaterais, indicacoes e recomendacoes quanto a manipulacao.This study aimed at describing, by means of a literature review, the topical agents and bandage types which have been recommended in the treatment of burns and their implications in nursing care. This study was conducted by collected bibliographic data concerning the last 12 years from Lilacs, Medline and Dedalus databases. The articles found were organized as research and review articles and later categorized according to the theme: topical agents and temporarily skin dressing. We discussed the possible effects as well as the indications and recommendations as to the manipulation of the agents and bandage types which have been recommended in the treatment of burns.This study aimed at describing, by means of a literature review, the topical agents and bandage types which have been recommended in the treatment of burns and their implications in nursing care. This study was conducted by collected bibliographic data concerning the last 12 years from Lilacs, Medline and Dedalus databases. The articles found were organized as research and review articles and later categorized according to the theme: topical agents and temporarily skin dressing. We discussed the possible effects as well as the indications and recommendations as to the manipulation of the agents and bandage types which have been recommended in the treatment of burns.