Teresa Tonini

SIGN LANGUAGE: HOW THE NURSING STAFF INTERACTS TO TAKE CARE OF DEAF PATIENTS?

Objective: To identify how the professional nursing staff of a university hospital interacts to care for their deaf patients. Method: A descriptive, exploratory, and quanti-qualitative study performed in the second semester of 2012. Results: Twenty-one nurses (57%) reported never having provided care for deaf patients. Sixteen nurses (43%) have provided care for deaf patients and reported the following means of communication: 12 (46.15%) referred using mime; 4 (15.38%) mentioned using lip reading; 8 (30.77%) used writing; 1 (3.85%) used drawing and; 1 (3.85%) used an interpreter. Conclusion: It is necessary to take effective measures for nursing professionals to communicate appropriately with deaf patients starting with the offering of specific disciplines in all courses and education programs. Descriptors: Nursing care, Deafness, Accessibility, Sign language, Disabled persons. RESUMO Objetivo: Identificar como profissionais da equipe de enfermagem de um hospital universitário interagem para cuidar de seus clientes surdos. Método: Pesquisa descritiva, exploratória, quanti-qualitativa, realizada no segundo semestre de 2012. Resultados: 21 (57%) informaram nunca ter prestado cuidados a clientes surdos. 16 (43%) profissionais de enfermagem que já prestaram cuidados aos clientes surdos. 12 (46,15%) referências ao uso da mímica; 4 (15,38%) menções ao uso da leitura labial; 8 (30,77%) referências ao uso da escrita; 1 (3,85%) referência ao uso do desenho; e 1 (3,85%) menção à ajuda de intérprete para se comunicar com clientes surdos. Conclusão: Conclui-se que é preciso a tomada de providências efetivas para que profissionais de enfermagem se comuniquem adequadamente com os clientes surdos, a começar pela oferta regular de disciplinas específicas em todos os cursos e programas de ensino. Descritores: Cuidado de enfermagem, Surdez, Acessibilidade, Língua de sinais, Pessoas com deficiência. RESUMEN Objetivo: Identificar cómo el personal profesional de enfermería de un hospital universitario interactúa para atender a sus clientes sordos. Método: Estudio descriptivo, exploratorio, cuanti-cualitativo, celebrado en el segundo semestre de 2012. Resultados: 21 (57%) indicaron que nunca habían prestado atención a clientes sordos. 16 (43%) de los profesionales de enfermaría que habían atendido a los pacientes sordos.12 (46,15%) hicieran referencias a la utilización de la mímica; 4 (15,38%) mencionaran el uso de la lectura de labios; 8 (30,77%) dijeran respecto a la utilización de la escritura; 1 (3,85%) dijera respecto a la utilización del diseño y 1 (3,85%) mencionara un intérprete para comunicarse con clientes sordos. Conclusión: Se concluye que es necesario tomar medidas efectivas para los profesionales de enfermería comunicarse adecuadamente con los pacientes sordos, comenzando con el suministro regular de disciplinas específicas en todos los cursos y programas de educación. Descriptores: Cuidados de enfermería, La sordera, La accesibilidad, La lengua de signos, Personas con discapacidades. Nurse. PhD in Nursing Sciences by the Federal University of Rio de Janeiro – UFRJ. Professor and Academic Advisor at the Nursing Graduate School from the Federal University of Rio de Janeiro State – UNIRIO. Rua Silva Jardim, 5 – Centro – Três Rios, RJ. CEP 25805-160, Brazil. Telefone: (24) 22555840 wilmachado@uol.com.br. Nurse. Assistant Professor at the Fundamental Nursing Department from the Alfredo Pinto Nursing School. PhD student at the Graduate School of Nursing and Biosciences from the Federal University of Rio de Janeiro State – UNIRIO. Clinical Research Nurse at the D’Or Institute of Research and Teaching. daragao23@gmail.com. Nurse. Professor at the Fundamental Nursing Department at the Alfredo Pinto Nursing School from the Federal University of Rio de Janeiro State – UNIRIO. Professor and Academic Advisor at the Nursing Graduate School at the Alfredo Pinto Nursing School from the Federal University of Rio de Janeiro State, UNIRIO, RJ, Brazil. Email: nebia@unirio.gov.br. Nurse. Professor, PhD, Academic Advisor, and Coordinator of the Nursing Graduate School at the Alfredo Pinto Nursing School from the Federal University of Rio de Janeiro State, UNIRIO, RJ, Brazil. Email: ttonini@terra.com.br. Nurse. Graduate student at the Graduate School at the Alfredo Pinto Nursing School from the Federal University of Rio de Janeiro, UNIRIO, RJ, Brazil. Email: drigo_pan@yahoo.com.br. Undergraduate student at the Alfredo Pinto Nursing School from the Federal University of Rio de Janeiro State, UNIRIO, RJ, Brazil. Email: gabrielambo@gmail.com. RESEARCH ISSN 2175-5361 DOI: 10.9789/2175-5361.2013v5n3p283 Machado WCA, Machado DA, Figueiredo NMA et al. Sign language: how the... J. res.: fundam. care. online 2013. jul./set. 5(3):283-292 284 The planning of nursing assistance to people with hearing disabilities and specific care to this clientele represents an element of the frequent exposure of health care teams in their various contexts of practice. In this study, the unpreparedness of the members in the nursing team to interact with deaf people, in particular the lack of control of circumstances or knowledge in Brazilian Sign Language (Libras), leads to a substantially compromised image and social commitment of these professionals and reflect negatively on the results achieved by the nursing care provided to this segment of society. It is obvious that, in addition to communication barriers, the deaf still face difficulties that are inherent to the organization of the health care system, especially in the public services. The difficulties of effective communication with deaf people in the institutional environments of health care services, in this case, between members of the nursing staff in an university hospital, reiterates the dissonance between higher education institutional programs and legal precepts, which provide people with disabilities a complete social inclusion such as defined by the UN Convention on the Rights of persons with disabilities ratified by Decree No. 6.949 from August 25, 2009. Unfortunately, contrary to the great legal achievements that make Brazil a reference on the international scene, our deaf individuals have been narrated and defined exclusively from their physical reality of lack of hearing and, therefore, seen exclusively from that point of view in the eyes of the majority in the society without this disability. The effect of this is that deaf people and the languages that they use (LIBRAS and written/oral Portuguese) become canvases with blank spaces for the projection of cultural prejudice and discourses of standardisation. It is a fact that the sign language represents the first language for the deaf, which makes them recognized as social subjects, and therefore, the Portuguese language (in the case of Brazil) can turn the deaf into the enunciator of his own speech in a second language (in writing) and thus, become inserted as a subject in the Brazilian society. Although it is usual to find the use of the expression Brazilian Sign Language in the literature to designate ‘Libras’, it is worth mentioning that this is a language and not an alternative communication method. Thus, it is preferable to use the terminology ‘Brazilian Sign Language’ instead of ‘Brazilian language of signs’ for many reasons. One of the most important reasons is that the Sign Language is a unity that refers to a visual manual-articulatory linguistic modality and not a oroarticulatory-auditive modality. Thus, the Brazilian Sign Language was established because it is the sign language developed and used by the Brazilian deaf community. Therefore, it is clear that there is no Brazilian Language spoken or through signs. The interaction between the nursing professional and the deaf patient demonstrates the difficulty that the latter has to come across a language that is not his own and that is imposed as if it was his first language. Even if the professional try some forms of sign communication imagining to being equivalent to Libras, the difficulty for the deaf in understanding what is being requested is clear. The knowledge of the world refers to the conventional knowledge that people have about the things of the world; this knowledge is brought to the learning process and stored in the memory as blocks of information. That knowledge of the INTRODUCTION ISSN 2175-5361 DOI: 10.9789/2175-5361.2013v5n3p283 Machado WCA, Machado DA, Figueiredo NMA et al. Sign language: how the... J. res.: fundam. care. online 2013. jul./set. 5(3):283-292 285 world refers to experiments built throughout life for both the deaf or non-deaf person.

Evaluation of Primary Health Care Units in the Rio De Janeiro City According to the Results of PMAQ 2012

To assess the quality of the primary health care network, the Ministry of Health created the Program for Improving Access and Quality in Primary Care (PMAQ), a national evaluation of family health teams. Thus, this study aims to present the geolocation of PMAQ 2012 quality indicators in the city of Rio de Janeiro. The PMAQ data show that, in the city of Rio de Janeiro, 65% of the teams achieved the performances “good” or “excellent,” 34.7% “regular,” and 0.3% “unsatisfactory.” The results show a clear PMAQ polarization between teams units classified as optimal and regular in program areas 5 and 3, respectively.

Pós-operatório de transplante renal: avaliando o cuidado e o registro do cuidado de enfermagem

Objeto foi avaliacao do cuidado e do registro de enfermagem no pos-operatorio de transplante renal. Os objetivos foram identificar os cuidados de enfermagem registrados nos prontuarios de clientes no pos-operatorio de transplante renal; discutir as implicacoes dos registros para o cuidado de enfermagem e avaliar os cuidados de enfermagem. Trata-se de um estudo descritivo e observacional, realizado na Unidade de Transplante Renal de um hospital geral, localizado no Rio de Janeiro. Foi aprovado pelo Comite de Etica e Pesquisa, e tambem houve a autorizacao da instituicao pesquisada. Foram analisados 23 prontuarios no periodo de maio a julho de 2005. Utilizou-se como instrumento de coleta de dados: formulario e observacao sistematizada. Os resultados demonstram que o registro de enfermagem esteve presente nas 24 horas durante o periodo de internacao, porem contemplava apenas a dimensao biologica do cuidado. As acoes de cuidar ricas em subjetividade nao foram registradas, apesar de ofertadas

Post operation of renal transplant: evaluating the care and the nursing care record

Objeto foi avaliacao do cuidado e do registro de enfermagem no pos-operatorio de transplante renal. Os objetivos foram identificar os cuidados de enfermagem registrados nos prontuarios de clientes no pos-operatorio de transplante renal; discutir as implicacoes dos registros para o cuidado de enfermagem e avaliar os cuidados de enfermagem. Trata-se de um estudo descritivo e observacional, realizado na Unidade de Transplante Renal de um hospital geral, localizado no Rio de Janeiro. Foi aprovado pelo Comite de Etica e Pesquisa, e tambem houve a autorizacao da instituicao pesquisada. Foram analisados 23 prontuarios no periodo de maio a julho de 2005. Utilizou-se como instrumento de coleta de dados: formulario e observacao sistematizada. Os resultados demonstram que o registro de enfermagem esteve presente nas 24 horas durante o periodo de internacao, porem contemplava apenas a dimensao biologica do cuidado. As acoes de cuidar ricas em subjetividade nao foram registradas, apesar de ofertadas

Job satisfaction in an oncology nursing team

Objective: to identify the level of attributed, perceived and real job satisfaction of oncology nursing professionals and analyze the relationships between the levels of satisfaction among these workers. Method: a descriptive, quantitative cross-sectional study was conducted using the Index of Work Satisfaction (IWS) to evaluate the nursing team, nurses and technicians/auxiliaries. A total of 348 workers answered the questionnaire, of which 216 were fully completed and considered for the IWS calculation. Results: Autonomy was considered the most important item in attributed satisfaction for the nursing team and nurses. Salary was valorized most by the technicians/auxiliaries. For perceived satisfaction, Professional Status was the most important for all workers. Regarding real satisfaction, Interaction was the most important for the nursing team and technicians/auxiliaries; while the nurses valorized Autonomy. The nurses presented the greatest job satisfaction. Conclusion: a discrepancy was observed in job satisfaction among the oncology nurses, indicating the importance of further quantitative research. Objetivo: identificar o nível de satisfação profissional atribuído, percebido e o real no trabalho de profissionais de enfermagem oncológica e analisar as relações entre os níveis de satisfação desses trabalhadores. Método: estudo quantitativo, descritivo, transversal que utilizou o Índice de Satisfação Profissional (ISP) para avaliar a equipe de enfermagem, enfermeiros e técnicos/auxiliares. Dentre os profissionais, 348 destes responderam o questionário, dos quais 216 foram totalmente preenchidos e considerados para o cálculo do ISP. Resultados: Autonomia foi mais importante na satisfação atribuída para a equipe de enfermagem e enfermeiros, Remuneração foi mais valorizada pelos técnicos/auxiliares. Para a satisfação percebida, Status profissional foi mais importante para todos os profissionais. Sobre a real satisfação, Interação foi o mais importante para a equipe de enfermagem e técnicos/auxiliares; os enfermeiros valorizaram Autonomia. Os enfermeiros obtiveram maior satisfação profissional. Conclusão: Observou-se discrepância quanto à satisfação profissional dos trabalhadores de enfermagem oncológica, sendo importante maior aprofundamento qualitativo.

O Saber do Enfermeiro na Indicação de Coberturas no Cuidado ao Cliente com Feridas

Introducao: No cuidado ao cliente com ferida, a avaliacao do enfermeiro deve ser personalizada, exigindo que ele conheca as coberturas disponiveis no mercado e as suas indicacoes. Diante do exposto, objetiva-se analisar o saber do enfermeiro sobre a indicacao de coberturas para o curativo, quando realiza o cuidado direto ao individuo com ferida. Metodologia: Trata-se de um estudo quantitativo, descritivo, de analise univariada, realizado com 30 enfermeiros que participam do cuidado direto ao cliente com ferida internado em unidades de alta complexidade de um hospital universitario de referencia, no estado do Rio de Janeiro, de dezembro de 2013 a janeiro de 2014. Resultados: A media de idade dos participantes foi de 37,5 anos (DP=10,5); a maioria dos sujeitos do estudo era do sexo feminino (83,3%) e tinha entre 1 a 10 anos de graduado (60%). Apenas um nao possuia curso de pos-graduacao (3,3%) e 66,7% realizaram curso de capacitacao em feridas. As coberturas com maior indice de erro foram o hidrocoloide (100%). Em relacao ao conhecimento sobre a indicacao das coberturas por enfermeiro, 46,7% obtiveram entre 26 e 50% de acertos. A cobertura com maior numero de acertos foi o fi lme de poliuretano com 93,3%. Conclusao: A maioria dos enfermeiros nao sabe indicar a cobertura adequada. Tal fato indica a necessidade da formulacao de protocolos, algoritmos e acoes de educacao permanente, as quais modifiquem a atual realidade na unidade estudada.

Adverse events in the intensive care unit: impact on mortality and length of stay in a prospective study

This study sought to evaluate the occurrence of adverse events and their impacts on length of stay and mortality in an intensive care unit (ICU). This is a prospective study carried out in a teaching hospital in Rio de Janeiro, Brazil. The cohort included 355 patients over 18 years of age admitted to the ICU between August 1, 2011 and July 31, 2012. The process we used to identify adverse events was adapted from the method proposed by the Institute for Healthcare Improvement. We used a logistical regression to analyze the association between adverse event occurrence and death, adjusted by case severity. We confirmed 324 adverse events in 115 patients admitted over the year we followed. The incidence rate was 9.3 adverse events per 100 patientsday and adverse event occurrence impacted on an increase in length of stay (19 days) and in mortality (OR = 2.047; 95%CI: 1.172-3.570). This study highlights the serious problem of adverse events in intensive care and the risk factors associated with adverse event incidence.This study sought to evaluate the occurrence of adverse events and their impacts on length of stay and mortality in an intensive care unit (ICU). This is a prospective study carried out in a teaching hospital in Rio de Janeiro, Brazil. The cohort included 355 patients over 18 years of age admitted to the ICU between August 1, 2011 and July 31, 2012. The process we used to identify adverse events was adapted from the method proposed by the Institute for Healthcare Improvement. We used a logistical regression to analyze the association between adverse event occurrence and death, adjusted by case severity. We confirmed 324 adverse events in 115 patients admitted over the year we followed. The incidence rate was 9.3 adverse events per 100 patients-day and adverse event occurrence impacted on an increase in length of stay (19 days) and in mortality (OR = 2.047; 95%CI: 1.172-3.570). This study highlights the serious problem of adverse events in intensive care and the risk factors associated with adverse event incidence. Resumo: Este estudo teve como objetivo avaliar a ocorrência de eventos adversos e o impacto deles sobre o tempo de permanência e a mortalidade na unidade de terapia intensiva (UTI). Trata-se de um estudo prospectivo desenvolvido em um hospital de ensino do Rio de Janeiro, Brasil. A coorte foi formada por 355 pacientes maiores de 18 anos, admitidos na UTI, no período de 1º de agosto de 2011 a 31 de julho de 2012. O processo de identificação de eventos adversos baseou-se em uma adaptação do método proposto pelo Institute for Healthcare Improvement. A regressão logística foi utilizada para analisar a associação entre a ocorrência de evento adverso e o óbito, ajustado pela gravidade do paciente. Confirmados 324 eventos adversos em 115 pacientes internados ao longo de um ano de seguimento. A taxa de incidência foi de 9,3 eventos adversos por 100 pacientes-dia, e a ocorrência de evento adverso impactou no aumento do tempo de internação (19 dias) e na mortalidade (OR = 2,047; IC95%: 1,172-3,570). Este estudo destaca o sério problema dos eventos adversos na assistência à saúde prestada na terapia intensiva e os fatores de risco associados à incidência de eventos.

Eventos adversos na unidade de terapia intensiva: impacto na mortalidade e no tempo de internação em um estudo prospectivo

This study sought to evaluate the occurrence of adverse events and their impacts on length of stay and mortality in an intensive care unit (ICU). This is a prospective study carried out in a teaching hospital in Rio de Janeiro, Brazil. The cohort included 355 patients over 18 years of age admitted to the ICU between August 1, 2011 and July 31, 2012. The process we used to identify adverse events was adapted from the method proposed by the Institute for Healthcare Improvement. We used a logistical regression to analyze the association between adverse event occurrence and death, adjusted by case severity. We confirmed 324 adverse events in 115 patients admitted over the year we followed. The incidence rate was 9.3 adverse events per 100 patientsday and adverse event occurrence impacted on an increase in length of stay (19 days) and in mortality (OR = 2.047; 95%CI: 1.172-3.570). This study highlights the serious problem of adverse events in intensive care and the risk factors associated with adverse event incidence.This study sought to evaluate the occurrence of adverse events and their impacts on length of stay and mortality in an intensive care unit (ICU). This is a prospective study carried out in a teaching hospital in Rio de Janeiro, Brazil. The cohort included 355 patients over 18 years of age admitted to the ICU between August 1, 2011 and July 31, 2012. The process we used to identify adverse events was adapted from the method proposed by the Institute for Healthcare Improvement. We used a logistical regression to analyze the association between adverse event occurrence and death, adjusted by case severity. We confirmed 324 adverse events in 115 patients admitted over the year we followed. The incidence rate was 9.3 adverse events per 100 patients-day and adverse event occurrence impacted on an increase in length of stay (19 days) and in mortality (OR = 2.047; 95%CI: 1.172-3.570). This study highlights the serious problem of adverse events in intensive care and the risk factors associated with adverse event incidence. Resumo: Este estudo teve como objetivo avaliar a ocorrência de eventos adversos e o impacto deles sobre o tempo de permanência e a mortalidade na unidade de terapia intensiva (UTI). Trata-se de um estudo prospectivo desenvolvido em um hospital de ensino do Rio de Janeiro, Brasil. A coorte foi formada por 355 pacientes maiores de 18 anos, admitidos na UTI, no período de 1º de agosto de 2011 a 31 de julho de 2012. O processo de identificação de eventos adversos baseou-se em uma adaptação do método proposto pelo Institute for Healthcare Improvement. A regressão logística foi utilizada para analisar a associação entre a ocorrência de evento adverso e o óbito, ajustado pela gravidade do paciente. Confirmados 324 eventos adversos em 115 pacientes internados ao longo de um ano de seguimento. A taxa de incidência foi de 9,3 eventos adversos por 100 pacientes-dia, e a ocorrência de evento adverso impactou no aumento do tempo de internação (19 dias) e na mortalidade (OR = 2,047; IC95%: 1,172-3,570). Este estudo destaca o sério problema dos eventos adversos na assistência à saúde prestada na terapia intensiva e os fatores de risco associados à incidência de eventos.

Eventos adversos en una unidad de cuidados intensivos: impacto en la mortalidad y en el tiempo de internamiento en un estudio prospectivo

This study sought to evaluate the occurrence of adverse events and their impacts on length of stay and mortality in an intensive care unit (ICU). This is a prospective study carried out in a teaching hospital in Rio de Janeiro, Brazil. The cohort included 355 patients over 18 years of age admitted to the ICU between August 1, 2011 and July 31, 2012. The process we used to identify adverse events was adapted from the method proposed by the Institute for Healthcare Improvement. We used a logistical regression to analyze the association between adverse event occurrence and death, adjusted by case severity. We confirmed 324 adverse events in 115 patients admitted over the year we followed. The incidence rate was 9.3 adverse events per 100 patientsday and adverse event occurrence impacted on an increase in length of stay (19 days) and in mortality (OR = 2.047; 95%CI: 1.172-3.570). This study highlights the serious problem of adverse events in intensive care and the risk factors associated with adverse event incidence.This study sought to evaluate the occurrence of adverse events and their impacts on length of stay and mortality in an intensive care unit (ICU). This is a prospective study carried out in a teaching hospital in Rio de Janeiro, Brazil. The cohort included 355 patients over 18 years of age admitted to the ICU between August 1, 2011 and July 31, 2012. The process we used to identify adverse events was adapted from the method proposed by the Institute for Healthcare Improvement. We used a logistical regression to analyze the association between adverse event occurrence and death, adjusted by case severity. We confirmed 324 adverse events in 115 patients admitted over the year we followed. The incidence rate was 9.3 adverse events per 100 patients-day and adverse event occurrence impacted on an increase in length of stay (19 days) and in mortality (OR = 2.047; 95%CI: 1.172-3.570). This study highlights the serious problem of adverse events in intensive care and the risk factors associated with adverse event incidence. Resumo: Este estudo teve como objetivo avaliar a ocorrência de eventos adversos e o impacto deles sobre o tempo de permanência e a mortalidade na unidade de terapia intensiva (UTI). Trata-se de um estudo prospectivo desenvolvido em um hospital de ensino do Rio de Janeiro, Brasil. A coorte foi formada por 355 pacientes maiores de 18 anos, admitidos na UTI, no período de 1º de agosto de 2011 a 31 de julho de 2012. O processo de identificação de eventos adversos baseou-se em uma adaptação do método proposto pelo Institute for Healthcare Improvement. A regressão logística foi utilizada para analisar a associação entre a ocorrência de evento adverso e o óbito, ajustado pela gravidade do paciente. Confirmados 324 eventos adversos em 115 pacientes internados ao longo de um ano de seguimento. A taxa de incidência foi de 9,3 eventos adversos por 100 pacientes-dia, e a ocorrência de evento adverso impactou no aumento do tempo de internação (19 dias) e na mortalidade (OR = 2,047; IC95%: 1,172-3,570). Este estudo destaca o sério problema dos eventos adversos na assistência à saúde prestada na terapia intensiva e os fatores de risco associados à incidência de eventos.

Nursing care management of clients in intensive care: content analysis

Aims: To identify the management process of the nurse in directly caring for the hospitalized client in an intensive care unit; to characterize how the work process of the intensive care nurse guides the caring provided to the client and; to discuss the management process of direct care of the work performed by the intensive care nurse. Method: This is a descriptive study based on a qualitative approach, undertaken with 16 nurses. To collect the information, we used a semi-structured interview, non-participative observation and a field journal. The results were later categorized and submitted to content analysis based on Bardin’s principles.Results: The nurse has two guiding axes to his actions: the mind map and the real map. The designs done on the mind map start from a single point, with the information radiating from this central point. However, when implementing management processes that were planned mentally, nurses generate a real map based on which they know how to perform.Conclusion: In caring management, the nurse sees himself connected with the client, even though the professional does not get involved with direct care tasks.