Noemi Marisa Brunet Rogenski

Estudo sobre a incidência de úlceras por pressão em um hospital universitário

Este estudo objetivou identificar a incidencia de ulceras de pressao (UP) no Hospital Universitario da USP e analisar as associacoes com as caracteristicas sociodemograficas e clinicas da clientela. Apos coleta de dados realizada durante 3 meses consecutivos, em que foram acompanhados 211 pacientes de risco, obteve-se indice de 39,8%. Correlacoes estatisticamente significativas (p<0,05) foram obtidas entre a incidencia e a idade e area das UP e entre a idade e umidade, tempo de internacao e nutricao, area das UP e nutricao. Os resultados indicam a urgente necessidade da implantacao de programa de prevencao e tratamento de UP na instituicao, bem como contribuem, metodologicamente, para que outros servicos possam estabelecer tal tipo de investigacao.

The incidence of pressure ulcers after the implementation of a prevention protocol

Even in the present, pressure ulcers still represent a severe health problem, particularly in Intensive Care Units (ICU). This study assesses the implementation of a protocol to prevent pressure ulcers in ICU inpatients. This prospective, descriptive and exploratory study verifies the incidence of pressure ulcers following the implementation of a prevention protocol. Data were collected from April 17th to July 15th 2009. The incidence observed in this study (23.1%) was below that reported in a similar study developed in the same institution (41.02%) before the implementation of the protocols to assess risk and prevent pressure ulcers. The prevention protocols are essential tools that have an impact on controlling the incidence of pressure ulcers, when used consistently.Even in the present, pressure ulcers still represent a severe health problem, particularly in Intensive Care Units (ICU). This study assesses the implementation of a protocol to prevent pressure ulcers in ICU inpatients. This prospective, descriptive and exploratory study verifies the incidence of pressure ulcers following the implementation of a prevention protocol. Data were collected from April 17th to July 15th 2009. The incidence observed in this study (23.1%) was below that reported in a similar study developed in the same institution (41.02%) before the implementation of the protocols to assess risk and prevent pressure ulcers. The prevention protocols are essential tools that have an impact on controlling the incidence of pressure ulcers, when used consistently.

Proposta educacional on-line sobre úlcera por pressão para alunos e profissionais de enfermagem

Objective: To develop an educational proposal to teach a pressure ulcer management course online to students and nursing professionals using a virtual learning environment. Methods: This was an applied technological research production technology. Steps of design, planning, and development characterized by a set of procedures, documentation, information technology, and digital images were used. Interactive educational software included the Cybertutor and the Virtual Man. Results: The educational proposal to teach pressure ulcer management online was divided into modules composed of list of discussions, case studies, and other didactic resources such as photos and utilization of the Virtual Man. Conclusion: The new educational course using online technology can promote effective knowledge on the management of pressure ulcer for undergraduate nursing students and practicing nurses. This has significance for clinical practice since the management of pressure ulcer continues to be a challenge for health care professionals and health services.OBJECTIVE: To develop an educational proposal to teach a pressure ulcer management course online to students and nursing professionals using a virtual learning environment. METHODS: This was an applied technological research production technology. Steps of design, planning, and development characterized by a set of procedures, documentation, information technology, and digital images were used. Interactive educational software included the Cybertutor and the Virtual Man. RESULTS: The educational proposal to teach pressure ulcer management online was divided into modules composed of list of discussions, case studies, and other didactic resources such as photos and utilization of the Virtual Man. CONCLUSION: The new educational course using online technology can promote effective knowledge on the management of pressure ulcer for undergraduate nursing students and practicing nurses. This has significance for clinical practice since the management of pressure ulcer continues to be a challenge for health care professionals and health services.

Evaluation of the pressure ulcers risk scales with critically ill patients: a prospective cohort study

AIMS: to evaluate the accuracy of the Braden and Waterlow risk assessment scales in critically ill inpatients. METHOD: this prospective cohort study, with 55 patients in intensive care units, was performed through evaluation of sociodemographic and clinical variables, through the application of the scales (Braden and Waterlow) upon admission and every 48 hours; and through the evaluation and classification of the ulcers into categories. RESULTS: the pressure ulcer incidence was 30.9%, with the Braden and Waterlow scales presenting high sensitivity (41% and 71%) and low specificity (21% and 47%) respectively in the three evaluations. The cut off scores found in the first, second and third evaluations were 12, 12 and 11 in the Braden scale, and 16, 15 and 14 in the Waterlow scale. CONCLUSION: the Braden scale was shown to be a good screening instrument, and the Waterlow scale proved to have better predictive power.AIMS: to evaluate the accuracy of the Braden and Waterlow risk assessment scales in critically ill inpatients. METHOD: this prospective cohort study, with 55 patients in intensive care units, was performed through evaluation of sociodemographic and clinical variables, through the application of the scales (Braden and Waterlow) upon admission and every 48 hours; and through the evaluation and classification of the ulcers into categories. RESULTS: the pressure ulcer incidence was 30.9%, with the Braden and Waterlow scales presenting high sensitivity (41% and 71%) and low specificity (21% and 47%) respectively in the three evaluations. The cut off scores found in the first, second and third evaluations were 12, 12 and 11 in the Braden scale, and 16, 15 and 14 in the Waterlow scale. CONCLUSION: the Braden scale was shown to be a good screening instrument, and the Waterlow scale proved to have better predictive power.

Patient classification system: a proposal to complement the instrument by Fugulin et al.

El analisis de los instrumentos de clasificacion de pacientes, disponibles en la literatura, demuestra que aspectos relevantes de la atencion a pacientes portadores de herida dejan de ser discutidos, dejando evidente la importancia de elaborar criterios que posibiliten evaluar estos pacientes. Este estudio propone la elaboracion de criterios que posibiliten evaluar estos pacientes, y tambien la elaboracion de areas de cuidados de manera a complementar el instrumento de Fugulin et al., validado por el Consejo Federal de Enfermeria (COFEN), que no contempla este aspecto. La construccion de las areas de cuidados para evaluacion de heridas se fundamento en un levantamiento bibliografico sobre los modelos operacionales del Sistema de Clasificacion de Pacientes (SCP), bien como sobre los distintos instrumentos de clasificacion de heridas. Fueron configuradas como nuevas areas de cuidado: el comprometimiento del tejido, el numero de cambios del curativo y el tiempo utilizado para su realizacion. Aun fueron redefinidos los valores que indican la categoria asistencial del paciente. La complementacion del instrumento Fugulin et al., propuesta en este estudio, favorece la aplicacion del instrumento a un grupo mas diversificado, por agregar un aspecto relevante de atencion que es la cuestion de los curativos.Analysis of patient classification instruments available in the literature shows that many significant aspects related to the assistance to patients with wounds are not approached, evidencing the importance to elaborate criteria to assess these patients. This study proposes the development of new of areas of care to complement the Fugulin et al. instrument, validated by the Federal Nursing Council (COFEN). The construction of new areas to evaluate wounds was based on a bibliographic search on the operational models of the Patient Classification System (PCS), as well as on several instruments of wound classification. New areas of care were established, as follows: tissue impairment, number of dressing changes and time taken to their preparation. Values were also redefined indicating the patients assistance category. The complementation of the Fugulin et al. instrument, proposed here, favors the application of this instrument in a more diversified group of patients since it adds a relevant assistance aspect, as the dressing issue.

Tempo de assistência de enfermagem em instituição hospitalar de ensino

This is a quantitative exploratory, descriptive study performed with the objective to identify and analyze the performance of the average time of nursing care delivered to patients of the Inpatient Units of the University Hospital at University of São Paulo (UH-USP), from 2001 to 2005. The average nursing care time delivered to patients of the referred units was identified by applying of a mathematical equation proposed in the literature, after surveying data from the Medical and Statistical Service and based on the monthly working shifts of the nursing professionals. Data analysis was performed using descriptive statistics. The average nursing care time observed in most units, despite some variations, remained stable during the analyzed period. Based on this observed stability, it is concluded that the nursing staff in the referred HU-USP units has been continuously evaluated with the purposes of maintaining the average time of assistance and, thus, the quality of the care being delivered.

Sistema de classificação de pacientes: proposta de complementação do instrumento de Fugulin et al.

El analisis de los instrumentos de clasificacion de pacientes, disponibles en la literatura, demuestra que aspectos relevantes de la atencion a pacientes portadores de herida dejan de ser discutidos, dejando evidente la importancia de elaborar criterios que posibiliten evaluar estos pacientes. Este estudio propone la elaboracion de criterios que posibiliten evaluar estos pacientes, y tambien la elaboracion de areas de cuidados de manera a complementar el instrumento de Fugulin et al., validado por el Consejo Federal de Enfermeria (COFEN), que no contempla este aspecto. La construccion de las areas de cuidados para evaluacion de heridas se fundamento en un levantamiento bibliografico sobre los modelos operacionales del Sistema de Clasificacion de Pacientes (SCP), bien como sobre los distintos instrumentos de clasificacion de heridas. Fueron configuradas como nuevas areas de cuidado: el comprometimiento del tejido, el numero de cambios del curativo y el tiempo utilizado para su realizacion. Aun fueron redefinidos los valores que indican la categoria asistencial del paciente. La complementacion del instrumento Fugulin et al., propuesta en este estudio, favorece la aplicacion del instrumento a un grupo mas diversificado, por agregar un aspecto relevante de atencion que es la cuestion de los curativos.Analysis of patient classification instruments available in the literature shows that many significant aspects related to the assistance to patients with wounds are not approached, evidencing the importance to elaborate criteria to assess these patients. This study proposes the development of new of areas of care to complement the Fugulin et al. instrument, validated by the Federal Nursing Council (COFEN). The construction of new areas to evaluate wounds was based on a bibliographic search on the operational models of the Patient Classification System (PCS), as well as on several instruments of wound classification. New areas of care were established, as follows: tissue impairment, number of dressing changes and time taken to their preparation. Values were also redefined indicating the patients assistance category. The complementation of the Fugulin et al. instrument, proposed here, favors the application of this instrument in a more diversified group of patients since it adds a relevant assistance aspect, as the dressing issue.

Incidence of pressure ulcers at a university hospital

Este estudo objetivou identificar a incidencia de ulceras de pressao (UP) no Hospital Universitario da USP e analisar as associacoes com as caracteristicas sociodemograficas e clinicas da clientela. Apos coleta de dados realizada durante 3 meses consecutivos, em que foram acompanhados 211 pacientes de risco, obteve-se indice de 39,8%. Correlacoes estatisticamente significativas (p<0,05) foram obtidas entre a incidencia e a idade e area das UP e entre a idade e umidade, tempo de internacao e nutricao, area das UP e nutricao. Os resultados indicam a urgente necessidade da implantacao de programa de prevencao e tratamento de UP na instituicao, bem como contribuem, metodologicamente, para que outros servicos possam estabelecer tal tipo de investigacao.

Incidência de úlceras por pressão após a implementação de um protocolo de prevenção

Even in the present, pressure ulcers still represent a severe health problem, particularly in Intensive Care Units (ICU). This study assesses the implementation of a protocol to prevent pressure ulcers in ICU inpatients. This prospective, descriptive and exploratory study verifies the incidence of pressure ulcers following the implementation of a prevention protocol. Data were collected from April 17th to July 15th 2009. The incidence observed in this study (23.1%) was below that reported in a similar study developed in the same institution (41.02%) before the implementation of the protocols to assess risk and prevent pressure ulcers. The prevention protocols are essential tools that have an impact on controlling the incidence of pressure ulcers, when used consistently.Even in the present, pressure ulcers still represent a severe health problem, particularly in Intensive Care Units (ICU). This study assesses the implementation of a protocol to prevent pressure ulcers in ICU inpatients. This prospective, descriptive and exploratory study verifies the incidence of pressure ulcers following the implementation of a prevention protocol. Data were collected from April 17th to July 15th 2009. The incidence observed in this study (23.1%) was below that reported in a similar study developed in the same institution (41.02%) before the implementation of the protocols to assess risk and prevent pressure ulcers. The prevention protocols are essential tools that have an impact on controlling the incidence of pressure ulcers, when used consistently.

Avaliação da concordância na aplicação da Escala de Braden interobservadores

Objectives: To verify pressure ulcer prevalence in hospital units of adult patients in the University Hospital of the University of Sao Paulo (HU-USP), and to verify interrater reliability in risk assessment, using the Braden Scale. Methods: A quantitative, exploratory study. Data were collected by six trained collaborators who conducted physical exams and risk assessment in 87 patients, an evaluation that is considered the “gold standard”. Data from the assessments performed by the nurses, of those same patients, were collected from the patient records. Results: We verified the pressure ulcer prevalence within the hospital was 19.5%, with 63.6% prevalence in the intensive care unit, 15.6% in the surgical clinic, 13.9% in the medical clinic, and 0% in the semi-intensive [step-down] unit. Regarding interrater reliability in the clinical evaluation of the patients, there was strong agreement in the subscores of: sensory perception, activity, mobility, friction/shear. Moisture and nutrition showed lower agreement, suggesting that these subscores require discussion to verify the causes of the discrepancies. Conclusion: Pressure ulcer prevalence studies provide the possibility to verify the extent of the problem and provide input for the construction of strategies and prevention programs.