Ruth Natalia Teresa Turrini

Resolutividade dos serviços de saúde por inquérito domiciliar: percepção do usuário

The objective of this study was to identify the case-resolving capacity of health care services used by individuals who reported a health problem within two weeks prior to the interview and to unveil their respective perceptions of the solution to the problem. Data were obtained from a household morbidity survey including 10,199 interviewees, performed in the southwestern area of the city of Sao Paulo, Brazil, in 1989/1990. Some health problem was reported by 31.3% of interviewees, and 47.7% sought help to solve their problem. Primary health services were the main gateway into the health system (35.7%), followed by hospitals (25.4%), and outpatient clinics (24.3%). The case-resolving capacity in the medical services was greater than 90%; 44.5% had their problem solved, 35.5% were under treatment, and 10.5% reported that their problem had not been solved. The largest proportion of problems solved belonged to respiratory and digestive system, infectious and parasitic diseases, and ill-defined symptoms, signs, and conditions. Due to the large proportion of individuals still in treatment, this study does not allow one to conclude that the health care services had a high case-resolving capacity, although they were capable of handling the patient demand.

Creating and Validating Educational Material for Patients Undergoing Orthognathic Surgery

PURPOSE To create and validate educational material for patients undergoing orthognathic surgery. METHODS The design included five phases: (a) a review of the literature regarding surgical complications; (b) gathering information on the needs of patients through blogs and virtual communities; (c) evaluating patient perceptions of the post-operative period through a focus group; (d) obtaining information through specialists using the Delphi technique and validation by judges; and (e) validation by patients in terms of understanding the exhibited material. RESULTS The first three phases of the study and the first round of the Delphi technique assisted in generating the perioperative patient booklet. The following rounds of the Delphi technique introduced modifications to improve the material, with the judges agreeing on the final material to be validated by patients. CONCLUSION Creating a booklet involves more than simply writing summarized ideas on a paper and handing it to the patient. One must understand the population, involve the relevant professionals, and obtain high-quality graphic aids for this type of educational material.

Attitudes of nursing staff related to the nursing process

The aims of the study were to describe nurses’ positions on nursing process and their perception of power; and to analyse asso ciations between positions on nursing process, power perception and selected variables. One thousand six hundred and five nurses (86.9% female, mean age=44.12 years, SD=9.55) participated in the study. Mean score on the Positions on Nursing Process (PNP) tool was 112.37 (SD=22.28); and on the Power as Knowing Participation in Change Tool – Brazilian Version (PKPCT) was 281.12 (SD=38.72). Baccalaureate nurses had statistically higher scores on PNP and PKPCT than auxiliary nurses. There was positive and moderate correlation between PNP and PKPCT scores. Auxiliary nurses’ scores on PNP were associated with sex and post-graduation; auxiliary nurses’ scores on PKPCT were associated with sex. For baccalaureate nurses there was association between PKPCT and admi nistrative position. More studies should be developed in order to identify variables po tentially associated with the use of nursing process in clinical practice.

Applying validated quality indicators to surgical antibiotic prophylaxis in a Brazilian hospital: Learning what should be learned

BACKGROUND Compliance with the best surgical antibiotic prophylaxis practice is usually low despite many published guidelines. OBJECTIVE This study investigated compliance with the Hospital Infection Control Committee guideline for antibiotic prophylaxis in a Brazilian hospital using quality indicators. METHODS A retrospective study was carried out from November 2009 to March 2010. Medical records from adult inpatients undergoing cardiac, neurologic, and orthopedic clean surgeries were included. The full compliance index was considered 100% when the antibiotic prophylaxis showed adequacy in all evaluated attributes. Analyses were conducted with 5% significance. RESULTS Medical records from 101 cardiac, 128 neurologic, and 519 orthopedic surgical patients were evaluated. The compliance index was 4.9%, and the compliance index according to specialty was 5.8%, 3.1%, and 3.0%, respectively, for orthopedic, neurologic, and cardiac surgeries. The attribute route of administration produced the best outcomes, whereas the attribute duration of antibiotic prophylaxis produced the worst. No association was identified between compliance to the attributes and patient characteristics. CONCLUSION This study showed a low level of adherence to Hospital Infection Control Committee guidelines for antibiotic prophylaxis. This suggests that different strategies should be implemented to promote the best possible practice in the field of antibiotic prophylaxis with greater surgeon engagement.

Percepção das enfermeiras sobre fatores de risco para a infecção hospitalar

Realizou-se estudo num hospital publico pediatrico com o intuito de avaliar o conhecimento das enfemeiras-chefes sobre possiveis fatores de risco envolvidos na ocorrencia de infeccoes hospitalares. Entrevistou-se as enfermeiras responsaveis pelos servicos de cuidados semi-intensivos, intensivos e emergencias. Atraves da analise de conteudo dos discursos, identificou-se os seguintes fatores de risco: ausencia de rotinas pre-estabelecidas, inadequacao de planta fisica e instalacoes, falta de material e equipamentos, desproporcao entre o numero de profissionais e o numero de leitos ocupados, falta de treinamento e orientacao dos funcionarios e acompanhantes.A study was undertaken in a pediatric teaching hospital to evaluate the nurses understanding about risk factors for nosocomial infections. The data were obtained in interviews with nurses of the emergency room, intensive and semi-intensive units. The analysis of the meaning of the conversation permitted the identification of the following risk factors: inadequacy of the hospital design and construction, deficiency of care equipment and supplies, understaffing, lack of education and training to the healthcare workers and orientation to the patients family.

Atitudes dos profissionais de enfermagem relacionadas ao Processo de Enfermagem

The aims of the study were to describe nurses’ positions on nursing process and their perception of power; and to analyse asso ciations between positions on nursing process, power perception and selected variables. One thousand six hundred and five nurses (86.9% female, mean age=44.12 years, SD=9.55) participated in the study. Mean score on the Positions on Nursing Process (PNP) tool was 112.37 (SD=22.28); and on the Power as Knowing Participation in Change Tool – Brazilian Version (PKPCT) was 281.12 (SD=38.72). Baccalaureate nurses had statistically higher scores on PNP and PKPCT than auxiliary nurses. There was positive and moderate correlation between PNP and PKPCT scores. Auxiliary nurses’ scores on PNP were associated with sex and post-graduation; auxiliary nurses’ scores on PKPCT were associated with sex. For baccalaureate nurses there was association between PKPCT and admi nistrative position. More studies should be developed in order to identify variables po tentially associated with the use of nursing process in clinical practice.

fATORES RELACIONADOS À READMISSÃO DE PACIENTES EM SERVIÇO HOSPITALAR DE EMERGÊNCIA

RESUMO A elevada procura pelo Servico de Emergencia e consequente permanencia dos pacientes em repetidas admissoes torna-se uma situacao dificil para os enfermeiros responsaveis pelo gerenciamento desses servicos. Estudo transversal e descritivo realizado no Servico de Emergencia de um hospital de ensino de atencao terciaria a saude em Sao Paulo, que teve por objetivos identificar o perfil socio-demografico e morbidade dos pacientes readmitidos e identificar os fatores relacionados as readmissoes. A amostra foi composta por maiores de 14 anos internados no Servico de Emergencia, com mais de uma admissao nos seis meses anteriores ao dia da coleta de dados, realizada no mes de Maio de 2004. A incidencia de readmissoes foi 23,3%, com predominio de homens (61,9%), idade na faixa de 40 a 90 anos (85,9%) e baixa escolaridade (57,8%). A maioria dos pacientes (57,6%) foi readmitida com o mesmo diagnostico e 23,9% devido a complicacoes do diagnostico de base. Concluiu-se que a elevada incidencia de readmissoes pode ser atribuida a evolucao da doenca cronico-degenerativa, a avancada idade dos pacientes, as complicacoes pos-operatorias, a nao resolucao do problema anterior e ao baixo seguimento das orientacoes recebidas. Tais achados sugerem a necessidade de investir em melhorias na qualidade do atendimento hospitalar com maior atuacao do enfermeiro na assistencia direta ao paciente nos servicos de emergencia e na extensao do cuidado no domicilio.The high demand for attendance in Emergency Department and the resultant length of stay for the patients in repeated admissions have become hard to nurses responsible for the administration of this units deal with the situation. Transversal and descriptive study made at Emergency Department of a teaching hospital in São Paulo city whose objectives were to identify the social-demographic and morbidly profile of the readmitted patients and the factors associated with readmissions. The sample was constituted by patients over fourteen years old that became inpatient at the Emergency Department, with over than one admission until six months before the data collection during May 2004. The readmission incidence was 23.3%, the patients were predominantly males (61.9%), had 40 to 90 years old (85,9%) and low level education (57.8%). Most of patients (57.6%) were readmitted with the same diagnosis and 23.9% due to complications. It was conclude that the high readmission incidence can be attributed to the evolution of the chronic disease, advanced age, surgical complications, notresolution of the last health problem and non-adherence to the orientations. The findings suggest the need to invest on improvement of the attendance quality, with more nurse performance on direct assistance to patient on the Emergency Department, and continuity of the care at home.

Validação de constructo de tecnologia educativa para pacientes mediante aplicação da técnica Delphi

Objective: To describe the process of validation of an educational technology for patients undergoing orthognathic Surgery with Delphi technique. Method: Four maxillofacial surgeons, two nurses, two nutritionists and two speech therapists. These indicate issues to be addressed in the material in the first round of Delphi technique. After construction of the researcher, based on the literature, the ambulatory and Internet patient’s needed and results of the first phase, started the second and third phase of the validation technique and the relevance of information designed this educational technology. Results: In the second round achieved at least 90,0% agreement for all categories. In the third round a 12% increase for item content, language, an improvement of 6,7%, 12,5% in illustrations, layout 3,3%, 10% culture and motivation remained constant. Conclusion: The Delphi technique may be an important tool in the construction and validation of educational technology.Resumo Objetivo: Descrever o processo de validacao de uma tecnologia educativa para pacientes submetidos a cirurgia ortognatica, mediante a aplicacao da tecnica Delphi. Metodos: Participaram do estudo, dez juizes (quatro cirurgioes bucomaxilofaciais, duas enfermeiras, duas nutricionistas e duas fonoaudiologas) que indicaram os assuntos a serem abordados no material destinado a primeira fase da tecnica Delphi. Apos a construcao do material e a obtencao dos resultados da primeira fase, iniciou-se as segunda e terceira fases dessa tecnica com validacao da pertinencia das informacoes contidas nessa tecnologia educativa. Resultados: Na segunda rodada, obteve-se, pelo menos, 90,0% de concordância em todas as categorias. Na terceira, houve um aumento de 12% para o item conteudo, melhora de 6,7% em linguagem, de 12,5% em ilustracoes, de 3,3% no layout, de 10% em cultura, mantendo-se constante o item motivacao. Conclusao: A tecnica Delphi, pode ser uma importante ferramenta na construcao e validacao de tecnologias educativas. Descritores: Educacao em saude; Tecnica Delfos; Prospecto para educacao de pacientes; Estudos de validacao

Construct validation of educational technology for patients through the application of the Delphi technique

Objective: To describe the process of validation of an educational technology for patients undergoing orthognathic Surgery with Delphi technique. Method: Four maxillofacial surgeons, two nurses, two nutritionists and two speech therapists. These indicate issues to be addressed in the material in the first round of Delphi technique. After construction of the researcher, based on the literature, the ambulatory and Internet patient’s needed and results of the first phase, started the second and third phase of the validation technique and the relevance of information designed this educational technology. Results: In the second round achieved at least 90,0% agreement for all categories. In the third round a 12% increase for item content, language, an improvement of 6,7%, 12,5% in illustrations, layout 3,3%, 10% culture and motivation remained constant. Conclusion: The Delphi technique may be an important tool in the construction and validation of educational technology.Resumo Objetivo: Descrever o processo de validacao de uma tecnologia educativa para pacientes submetidos a cirurgia ortognatica, mediante a aplicacao da tecnica Delphi. Metodos: Participaram do estudo, dez juizes (quatro cirurgioes bucomaxilofaciais, duas enfermeiras, duas nutricionistas e duas fonoaudiologas) que indicaram os assuntos a serem abordados no material destinado a primeira fase da tecnica Delphi. Apos a construcao do material e a obtencao dos resultados da primeira fase, iniciou-se as segunda e terceira fases dessa tecnica com validacao da pertinencia das informacoes contidas nessa tecnologia educativa. Resultados: Na segunda rodada, obteve-se, pelo menos, 90,0% de concordância em todas as categorias. Na terceira, houve um aumento de 12% para o item conteudo, melhora de 6,7% em linguagem, de 12,5% em ilustracoes, de 3,3% no layout, de 10% em cultura, mantendo-se constante o item motivacao. Conclusao: A tecnica Delphi, pode ser uma importante ferramenta na construcao e validacao de tecnologias educativas. Descritores: Educacao em saude; Tecnica Delfos; Prospecto para educacao de pacientes; Estudos de validacao

Perception of orthognathic surgery patients on postoperative care

Patients anxiety and worry due to a lack of knowledge about the orthognathic surgery motivated the development of this study. The objective was to identify information needs of postoperative patient undergoing orthognathic surgery. Its an exploratory and qualitative research that used the focus group to collect the dada. Postoperative patients of orthognathic surgery from an oral and maxillofacial surgery and trauma ambulatory were invited to participate in the group. Through content analysis it was possible to identify the following problems related to the postoperative procedure: long recovery time, nutrition, oral hygiene, relief of postoperative signs and symptoms. Themes involving self-image and satisfaction levels related to the outcome of the surgery were also recognized pointing out the need of future studies to explore these issues.A ansiedade e a preocupacao dos pacientes decorrentes da obscuridade das informacoes relacionadas ao procedimento cirurgico ortognatico despertou o desenvolvimento deste estudo, que objetivou identificar as necessidades de informacao do paciente sobre o cuidado pos-operatorio da cirurgia ortognatica. Trata-se de pesquisa exploratoria qualitativa, que utilizou como metodo de coleta de dados o grupo focal com pacientes em pos-operatorio de cirurgia ortognatica de um ambulatorio de cirurgia e traumatologia bucomaxilofacial. Os dados foram submetidos a analise de conteudo para identificacao das falas significativas para o alcance do objetivo. Entre os assuntos mais abordados, destacaram-se o longo tempo de recuperacao e as dificuldades relacionadas a alimentacao, higienizacao e reducao dos sinais e sintomas pos-operatorios. Comentarios relacionados a autoimagem e a satisfacao com os resultados da cirurgia apontam para a necessidade de exploracao em futuros estudos.