Avaliação psicológica de pacientes após a alta da unidade de terapia intensiva / Psychological evaluation of patients after discharge from the intensive care unit / Evaluación psicológica de pacientes después de la alta de la unidad de terapia intensiva

A maioria dos pacientes sobrevive ao episódio de doença crítica, contudo, muitos deles podem desenvolver alterações psicológicas após a alta da UTI. Dada a natureza dos cuidados intensivos e as condições clínicas da maioria dos pacientes esta pesquisa tem como objetivo descrever os resultados da avaliação psicológica de pacientes três meses após a alta dos cuidados críticos. Foram avaliados 160 pacientes, destes 137 conseguiram responder à avaliação psicológica e os demais não foram avaliados em decorrência de algum comprometimento neurológico. Os instrumentos utilizados foram: planilha para coleta de dados do prontuário, instrumento de avaliação de memórias de UTI, Impact of Event Scale-Revised (IES-R) e Escala Hospitalar de Ansiedade e Depressão (HADS). Os resultados revelaram que a identificação precoce das complicações inerentes ao tratamento crítico poderá trazer benefícios para a prevenção de alterações emocionais/físicas crônicas subsequentes

Most patients survive the critical illness episode, however, many of them may develop psychological changes after discharge from the ICU. Given the nature of intensive care and the clinical conditions of most patients this study aims to describe the results of the psychological evaluation of patients three months after discharge from critical care. 160 patients were evaluated, of these 137 were able to respond to psychological assessment and the rest were not evaluated due to some neurological impairment. The instruments used were: Worksheet for collecting data from the medical record, ICU memory evaluation tool, Impact of Event Scale-Revised (IES-R) and Hospital Anxiety and Depression Scale (HADS). The results revealed that the early identification of the complications inherent to the critical treatment may bring benefits to the prevention of subsequent chronic emotional / physical changes

La mayoría de los pacientes sobrevive al episodio de enfermedad crítica, sin embargo, muchos de ellos pueden desarrollar alteraciones psicológicas después del alta de la UCI. Dada la naturaleza de los cuidados intensivos y las condiciones clínicas de la mayoría de los pacientes esta investigación tiene como objetivo describir los resultados de la evaluación psicológica de pacientes tres meses después del alta de los cuidados críticos. Se evaluaron 160 pacientes, de estos 137 pudieron responder a la evaluación psicológica y el resto no se evaluó debido a algún deterioro neurológico. Los instrumentos utilizados fueron: Planilla para la recolección de datos del prontuario, instrumento de evaluación de memorias de UTI, Impact of Event Scale-Revised (IES-R) y Escala Hospitalaria de Ansiedad y Depresión (HADS). Los resultados revelaron que la identificación precoz de las complicaciones inherentes al tratamiento crítico puede traer beneficios para la prevención de alteraciones emocionales / físicas crónicas subsiguientes

Characteristics and Outcomes of Intensive Care Unit Survivors: Experience of a Multidisciplinary Outpatient Clinic in a Teaching Hospital

OBJECTIVES: To describe the experience of an outpatient clinic with the multidisciplinary evaluation of intensive care unit survivors and to analyze their social, psychological, and physical characteristics in a low-income population and a developing country. METHODS: Retrospective cohort study. Adult survivors from a general intensive care unit were evaluated three months after discharge in a post-intensive care unit outpatient multidisciplinary clinic over a period of 6 years (2008-2014) in a University Hospital in southern Brazil. RESULTS: A total of 688 out of 1945 intensive care unit survivors received care at the clinic. Of these, 45.2% had psychological disorders (particularly depression), 49.0% had respiratory impairments (abnormal spirometry), and 24.6% had moderate to intense dyspnea during daily life activities. Patients experienced weight loss during hospitalization (mean=11.7%) but good recovery after discharge (mean gain=9.1%), and 94.6% were receiving nutrition orally. One-third of patients showed a reduction of peripheral muscular strength, and 5.7% had moderate to severe tetraparesis or tetraplegia. There was a significant impairment in quality of life (SF-36), particularly in the physical and emotional aspects and in functional capacity. The economic impacts on the affected families, which were mostly low-income families, were considerable. Most patients did not have full access to rehabilitation services, even though half of the families were receiving financial support from the government. CONCLUSIONS: A significant number of intensive care unit survivors evaluated 3 months after discharge had psychological, respiratory, motor, and socioeconomic problems; these findings highlight that strategies aimed to assist critically ill patients should be extended to the post-hospitalization period and that this problem is particularly important in low-income populations.

Sedação e memórias de pacientes submetidos à ventilação mecânica em unidade de terapia intensiva / Sedation and memories of patients subjected to mechanical ventilation in an intensive care unit

Objetivo: Investigar a relação entre sedação e as memórias relatadas por pacientes submetidos à ventilação mecânica após a alta da unidade de terapia intensiva. Métodos: Estudo de coorte prospectivo, observacional, realizado com pacientes submetidos à ventilação mecânica e que permaneceram por mais de 24 horas na unidade de terapia intensiva. Dados clínicos e de sedação foram pesquisados em prontuários, e os dados referentes às memórias do paciente foram coletados por meio de um instrumento validado para esse fim. As avaliações foram realizadas 3 meses após a alta da unidade de terapia intensiva. Resultados: Dos 128 pacientes avaliados, a maioria (84,4%) relatou lembranças do período de internação na unidade de terapia intensiva, prevalecendo uma combinação de eventos reais e ilusórios. Pacientes que permaneceram sedados (67,2%), com sedação profunda (RASS -4 e -5) durante um período maior do que 2 dias e que apresentaram agitação psicomotora (33,6%) foram mais suscetíveis a apresentarem memórias ilusórias (p>0,001). Conclusão: A probabilidade de os pacientes apresentarem memórias de ilusão foi maior naqueles com sedação profunda. A sedação, portanto, parece ser um fator adicional que contribuiu para o desenvolvimento de memórias ilusórias em pacientes gravemente enfermos e submetidos à ventilação mecânica. .

Objective: To investigate the relationship between sedation and the memories reported by patients subjected to mechanical ventilation following discharge from the intensive care unit. Methods: This prospective, observational, cohort study was conducted with individuals subjected to mechanical ventilation who remained in the intensive care unit for more than 24 hours. Clinical statistics and sedation records were extracted from the participants' clinical records; the data relative to the participants' memories were collected using a specific validated instrument. Assessment was performed three months after discharge from the intensive care unit. Results: A total of 128 individuals were assessed, most of whom (84.4%) reported recollections from their stay in the intensive care unit as predominantly a combination of real and illusory events. The participants subjected to sedation (67.2%) at deep levels (Richmond Agitation-Sedation Scale [RASS] -4 and -5) for more than two days and those with psychomotor agitation (33.6%) exhibited greater susceptibility to occurrence of illusory memories (p>0.001). Conclusion: The probability of the occurrence of illusory memories was greater among the participants who were subjected to deep sedation. Sedation seems to be an additional factor that contributed to the occurrence of illusory memories in severely ill individuals subjected to mechanical ventilation. .

Transtorno de estresse pós-traumático e a presença de recordações referentes à unidade de terapia intensiva / Posttraumatic stress disorder and the presence of recollections from an intensive care unit stay

OBJETIVO: Identificar a incidência de transtorno de estresse pós-traumático (TEPT) em pacientes submetidos à ventilação mecânica (VM) e analisar a sua relação com variáveis clínicas, demográficas e presença de recordações referentes à unidade de terapia intensiva (UTI). MÉTODO: Estudo prospectivo longitudinal realizado durante o período de um ano na UTI de um hospital-escola. A avaliação ocorreu três meses após a alta da UTI durante consulta ambulatorial. Os sujeitos foram avaliados utilizando-se um instrumento para avaliar memórias de UTI (IAM-TI) e o Impact of Event Scale-Revised (IES-R), para avaliar o TEPT. RESULTADOS: Do total de respondentes, 68,8% eram do sexo masculino, a idade variou entre 18 e 79 anos, com média de 43,5 anos ± 17,1. Quanto à avaliação dos pacientes, 14,5% apresentaram sintomas de TEPT, quando utilizado um ponto de corte > 20 pontos. Para uma melhor precisão diagnóstica, foi utilizado também o ponto de corte ≥ 33 pontos e, nesse caso, sete pacientes (5,1%) apresentaram o transtorno. CONCLUSÃO: Poucos pacientes preencheram todos os critérios para o diagnóstico de TEPT, indicando que a grande maioria deles apresentou apenas sintomatologia relacionada ao TEPT.

OBJECTIVE: Identify the incidence of post-traumatic stress disorder (PTSD), in patients submitted to MV and analyze its relation with clinical and demographical variables, and with the presence of memories regarding intensive care unit (ICU). METHOD: It is a longitudinal prospective study, carried out in one year at an ICU of a university hospital. Evaluation occurred three months after ICU discharge during patients follow up at the ambulatory. Subjects were evaluated using the ICU memories (ICU-AMI) and the Impact of Event Scale-Revised (IES-R) instruments. RESULTS: From the total of subjects, 68.8% were male from 18 to 79 years of age, 43.5 years old average ± 17.1. From the evaluated patients, 14.5% presented symptoms of PTSD when a cut-off score > 20 was used. For a diagnostic accuracy a ≥ 33 cut-off score was also used, and in this case, only seven patients (5.1%) showed signs of PTSD. CONCLUSION: A few patients met the criteria for the PTSD diagnosis indicating that the great majority of patients admitted at ICU show only symptomatology related to PTSD.

Sintomas depressivos em mulheres profissionais do sexo / Depressive symptoms in female sex workers los síntomas / Depresivos en mujeres trabajadoras del sexo

Este estudo descritivo, transversal, objetivou avaliar a presença de sintomas depressivos em mulheres profissionaisdo sexo de um município do Noroeste do Paraná e sua correlação com variáveis sociodemográficas e profissionais.Foram estudadas 18 mulheres profissionais do sexo, com idade variando entre 19 a 64 anos com média de38,11±11,55 anos. Do total 10 (55,6%) mulheres possuíam ensino fundamental incompleto e duas eram analfabetas.A maioria das mulheres (72,2%) pertencia à raça branca e não possuía companheiro (72,2%). Das mulheresavaliadas, todas apresentaram sintomas indicativos de depressão, distribuídos em mínimos (38,95%), leves (33,3%)e moderados (27,8%). Concluiu-se que a totalidade das mulheres profissionais do sexo avaliadas no municípioestudado apresenta sintomas depressivos.

This descriptive cross-sectional study evaluated the presence of depressive symptoms in female sex workers in a city ofnorthwest Paraná and its correlation with socio-demographic and professional. We studied 18 female sex workers,and ages ranged from 19 to 64 years with a mean of 38.11 ± 11.55 years. Total of 10 women had high school and twowere illiterate. Most women (72.2%) belonged to the white race and had no partner (72.2%). Of the women studied,all showed symptoms of depression, divided into minimal (38.95%), lightweight (33.3%) and moderate (27.8%). Itwas concluded that all sex workers women assessed in the city studied presented depressive symptoms.

Estudio de enfoque descriptivo, transversal que tuvo como objetivo evaluar la presencia de síntomas depresivosen mujeres trabajadoras del sexo de un municipio del noroeste de Paraná y su correlación con las variablessociodemográficas y profesionales. Se estudiaron 18 trabajadores del sexo con edades comprendidas entre los 19a 64 años, con una media de 38,11±11,55 años. De ese total, 10 mujeres (55,6%) poseían estudios primariosincompletos y dos eran analfabetas. La mayoría de las mujeres (72,2%) pertenecían a la raza blanca y (72,2%) notenían compañero. De las mujeres estudiadas, todas presentaron síntomas indicativos de depresión, distribuidos enun mínimo (38,95%), leve (33,3%) y moderado (27,8%). Se concluye que la totalidad de las mujeres profesionalesdel sexo, evaluadas en el municipio en estudio, presenta síntomas depresivos.

Estrutura e suporte familiar como fatores de risco de stress infantil / Family pillar and structure as risk factors to child stress

Este estudo investigou a relação entre a percepção acerca do suporte familiar e o stress infantil em 30 crianças, de ambos os sexos, de 7 a 12 anos de idade, participantes do Projeto Família em Ação, promovido pela Secretaria Municipal de Saúde do Município de Matelândia. Trata-se de um estudo descritivo exploratório, que utilizou como instrumento para coleta de dados o Inventário de Percepção do Suporte Familiar e a Escala de Estresse Infantil, aplicados individualmente. Os resultados indicaram que 60 por cento das crianças apresentaram baixo suporte familiar e stress ; dessas, 50 por cento moravam com suas famílias intactas. A sintomatologia de stress predominante é psicológica, com 50 por cento, indicando a vulnerabilidade da criança para a inadaptação psicossocial. Discute-se, dessa forma, a importância de trabalhos de prevenção e fortalecimento das redes de apoio social nas quais a família esteja inclusa, visando o bem-estar psicológico das crianças.

This study investigated the relationship between the perceptions concerning family support and child stress in 30 children of both sexes, between the ages of 7 and 12, who were participating in the "Family-in-Action Project "promoted by the Department of Health in the city of Matelândia, in the state of Paraná. It is a descriptive-exploratory study that used, as a data collection tool, the Inventory of Perception of Family Support and the Child-stress Scale, both applied individually. Results indicated that 60 percent of the children presented low family support and stress, and of these 50 percent lived in families that were still intact. The predominant symptoms of stress were psychological, affecting 50 percent, which indicates child vulnerability to psycho-social non-adaptation. Thus, the importance of preventive work and the strengthening of the social-support network is discussed, where families are inclusive, directed towards the psychological well-being of our children.

Estrés y recursos de enfrentamiento del cuidador en el contexto hospitalario / Stress and coping resources of the caretaker in the hospital environment

Hospital institutions, with their private work organization, are made of very peculiar environments characterized by tension, pain and suffering. This way the hospital sets rules, specific routines and determines the actions of the health team about the care service provided for the patients. In this context, it is possible to identify aspects in the professional actions that can set in stress symptoms, mainly due to the contact with emotionally intense situations, such as life, illness and death. Stress has been related to sensations of tension, anxiety, fear and discomfort, and there has been an increase in the number of people who define themselves as stressed. Therefore, stress is made up of psycho-physiological alterations that occur when an individual is forced to face situations beyond his/her coping abilities. Personal characteristics and the environment where the person is inserted are important factors in the occurrence and severity of the reactions to the stress process. Its development depends not only on the personality of the individual but also on his/her health state (mental and organic equilibrium) and because of it not everybody shows the same type of reaction to stressful events. Life style, past experiences, attitudes, beliefs, values, illness and genetic predisposition are important factors in the stress process development. From this relation (individual-environment) the individual uses coping resources to modify his/her relation with the environment, controlling or altering the stress-causing event. The coping, which is a response to the stress, corresponds to the cognitive and behavioral efforts oriented to deal with the internal or external demands, which are exceeding or overwhelming the individual resources. This way, the aim of the coping strategies is the reduction, elimination or stress handling according to the evaluation that the individual does of a certain event of his/her life. From the presupposition that the hospital and the provided care to the patient can be developers of stress symptoms, it is believed that studies which provide the evaluation of this event as well as the identification of stressing causes will be able to contribute to minimize and prevent the appearance of stress symptoms in health professionals working in the hospital environment. Objective The purpose of this study was to indentify the presence of stress symptoms in health-care professionals working in the hospital environment and know the main stressing causes at the working environment and the coping resources used by the professionals to deal with stressful situations. Material and methods It is a descriptive transversal study done with professionals who work at the University Hospital of the West of Parana (HUOP) and that provide direct assistance to the in-hospital patients. This hospital, which has 1 73 rooms, is a reference in high complexity in urgency and emergency assistance for the West and Southwest of Parana region and it provides assistance in various clinical specialties. The data was collected from October to December of 2007 together with professionals at the three working shifts. During the collection of the data period, the HUOP had 272 professionals who suited to the criteria to be included in this study, which was to provide direct assistance to the patient. In the definition of the sample size, it was adopted a 5% pattern error and prevalence of stress symptoms of 20%. Besides this, it was predicted a margin of 20% to the size of the sample to cover likely loss of subjects and/or information. Therefore, the calculated size sample was of 155 professionals. To define the professionals who would be included in this study, a stratification proportional to the total number of workers from each professional category was carried out. Moreover, when the number of workers of a certain category was very small (two or three at most), it was decided to include all of them. The research subjects were selected at random, and the two first workers to arrive in the sector at their working shift were invited to participate in this study. Sixteen professional, all technicians and auxiliary nurses, missed to fill the biggest part of the test as well the prepared questions and because of it they were excluded of the study, something which made the effective sample be made up of 139 professionals: 93 technicians and/or auxiliary nurses, 32 nurses, 6 doctors, 2 nutritionists, 2 physiotherapists, 1 sychologist, 1 phonoaudiologist, and 2 social assistance workers. The data was collected through a self-applicable questionnaire, to be filled individually and handed back the same day. The participants took an average of 20 minutes to answer the questionnaires. Two instruments were used; the first one was constituted of two parts, one approaching social-demographic and work related matters and the second with two discursive questions about stressful events in the working environment and the coping strategies used for dealing with them. The second instrument is the Inventory of Stress Symptoms for Adults -ISSL-, which allows us to identify, from the symptomatology shown by the subject, the presence or not of stress; the present type (somatic or psychological) and in which phase of stress the individual is. The data was kept in an Excel data bank, and we used the computer package Statistic 7.2 for the analysis of the variable, and for the calculus of the Fischer Exact Test we used the program SAS 9.1 (Statistical Analysis System). A significance level of 5% was established. For the analysis of the qualitative data, the answers to the discursive questions were grouped in four categories: intrinsic factors/ situations to work; working conditions; interpersonal relations and factors related to assistance. Results One hundred and thirty nine health professionals who provide direct assistance to the patient in hospital environment participated in this study, such as doctors, nurses, nurses technicians, physiotherapists, psychologist, phonoaudiologist, social assistants and nutritionist. The applied Inventory of Stress Symptoms revealed that from the 139 evaluated subjects 60.4% presented stress. From those, 5.7% were in the alert phase; 44.6% in the resistance phase; 7.2% at the close-to-exhaustion phase; and 2.9% in the exhaustion phase. From those who presented stress symptoms, there was a higher incidence of physical symptoms (36.7%), being followed by the physical/ psychological (16.5%) and psychological (7.2%) ones. It was observed a significant association between the presence of stress and the working sector (p = 0.0002) and the working period of time at the same institution (p = 0.0133). In relation to the stressful events, it was observed that the working conditions were pointed with more frequency as stress generators (31.1 %), followed by intrinsic working factors (26.6%), interpersonal relations (26.3%) and assistance related factors (16%). Many forms of coping were identified, and a great majority of the professionals (43.0%) uses as a strategy to deal with stress, alternatives out of the working environment, which means that they deal with the emotional response developed by the stressor event; a considerable part of the professionals (30.7%) uses as a strategy to relieve stress the focus in solving the problem - something that tries to modify the relation of the individual with the environment, promoting changes directly in the situation that causes stress; and, 26.3% did not show coping responses. Conclusions It was pointed an indicative of stress in professionals of various areas, with the prevalence of physical symptoms, in the resistance phase. The events considered as stressors by the professionals, in fact, led to the appearance of stress symptoms, being related to the working environment. Being aware of the stressors and understanding how the caretaker deal with these events support the more effective actions in order to reduce stress and improve the working conditions to these professionals. As it is extremely important that those professionals be in physical and psychological conditions which are favorable so that they can provide a better assistance as well as a proper one to the needs of the patient.

La institución hospitalaria con su organización particular constituye ambientes peculiares caracterizados por tensión, dolor y sufrimiento. En ese contexto es posible identificar en las acciones de los profesionales aspectos que pueden desencadenar síntomas de estrés, principalmente debido al contacto con situaciones emocionalmente intensas, tales como la vida, la enfermedad y la muerte. El estrés ha sido relacionado a sensaciones de tensión, ansiedad y miedo. Está compuesto de alteraciones psicofisiológicas que ocurren cuando el individuo es forzado a enfrentar situaciones que están más allá de sus habilidades de enfrentamiento. Características personales y el medio en que el sujeto está inserto son factores importantes en la ocurrencia y en la gravedad de las reacciones al proceso de estrés. Su desencadenamiento depende tanto de la personalidad del individuo como del estado de salud en que éste se encuentra (equilibrio orgánico y mental) y, por eso, no todas las personas demuestran el mismo tipo de reacción a eventos estresantes. A partir de esa relación el individuo echa mano de los recursos de enfrentamiento utilizados para modificar su relación con el ambiente, controlando o alterando el evento causante de estrés. Objetivos Identificar la presencia de síntomas de estrés en profesionales-cuidadores en el contexto hospitalario, y conocer los principales estresores del ambiente de trabajo y los recursos de enfrentamiento utilizados por los profesionales para lidiar con las situaciones de estrés. Material y métodos Estudio transversal descriptivo realizado con profesionales que actúan en el Hospital Universitario del Oeste de Paraná (HUOP), Brasil, y que prestan asistencia directa al paciente ingresado. Los datos fueron recolectados en el período de octubre a diciembre de 2007 junto a profesionales de los tres turnos de trabajo, seleccionados aleatoriamente, por medio de preguntas autoaplicables, contestadas individualmente y devueltas en el mismo día. Los participantes tomaron alrededor de 20 minutos para responder a las preguntas. Fueron utilizados dos instrumentos, el primero estuvo constituido por dos partes, una abordó preguntas sociodemográficas y relacionadas con el trabajo, y la segunda conteniendo dos preguntas subjetivas sobre eventos estresantes en el ambiente de trabajo y las estrategias de enfrentamiento utilizadas para lidiar con ellos. El segundo instrumento es el Inventario de Síntomas de Estrés para Adultos (ISSL), el cual permite identificar, a partir de la sintomatología presentada por el sujeto, la presencia o no de estrés, el modelo presente (somático o psicológico) y en cuál fase del estrés se encuentra el individuo. Resultados La aplicación del Inventario de Síntomas de Estrés reveló que de los 139 sujetos evaluados, 60.4% presentaban estrés. De esos, 5.7% estaban en la fase de alerta; 44.6%, en la fase de resistencia; 7.2%, en la fase de casi-agotamiento y 2.9% en la fase de agotamiento. Se observó asociación significativa entre la presencia de estrés y el sector de trabajo (p = 0.0002) y tiempo de trabajo en la referida institución (p = 0.0133). Con relación a los eventos estresantes se observó que las condiciones de trabajo fueron apuntadas con mayor frecuencia como generadoras de estrés (31.1%), seguida de factores intrínsecos del trabajo (26.6%), relaciones interpersonales (26.3%) y factores relacionados a la asistencia (16%). Se identificaron varias formas de enfrentamiento, siendo que la mayor parte de los profesionales (43.0%) utiliza como estrategia para lidiar con el estrés alternativas fuera del ambiente de trabajo, o sea, lidian con la respuesta emocional desencadenada por el evento estresor; una parte considerable de los profesionales (30.7%) utiliza como estrategia para alivio del estrés el enfoque en la resolución del problema - que busca modificar la relación de la persona con el ambiente, promoviendo cambios directamente en la situación generadora de estrés; y, por último, 26.3% no presentaron respuestas de enfrentamiento. Conclusiones Se constató indicativo de estrés en los profesionales de las diversas áreas, prevaleciendo síntomas físicos, de la fase de resistencia. Los eventos considerados como estresores por los profesionales han llevado, de hecho, al surgimiento de síntomas de estrés, estando éstos relacionados al ambiente de trabajo. Conocer los estresores y entender cómo el cuidador lidia con estos eventos favorece el emprendimiento más efectivo de acciones con el objetivo de reducir el estrés y mejorar las condiciones de trabajo de esos profesionales. Es primordial que éstos se encuentren en condiciones físicas y psicológicas favorables para que puedan prestar una asistencia mejor y adecuada a las necesidades del paciente.

Caracterização das internações psiquiátricas para desintoxicação de adolescentes dependentes químicos / Characterization of psychiatric admissions for detoxification of drug addicted adolescents / Caracterización de las admisiones psiquiátricas para desintoxicación de adolescentes adictos a las drogas

O objetivo desta pesquisa foi caracterizar as internações de adolescentes hospitalizados para desintoxicação em um hospital público do Oeste do Paraná e correlacionar as variáveis sócio-demográficas com o uso de drogas ilícitas. Trata-se de um estudo retrospectivo a partir de consultas em 81 protocolos de admissão dos adolescentes dependentes químicos internados no período de março de 2007 a abril de 2008. A maioria das internações foi de adolescentes do sexo masculino (79 por cento). As drogas consumidas com maior frequência foram o crack (87,6 por cento) e a maconha (85,2 por cento), sendo que, 79 por cento dos adolescentes usam tais drogas de forma concomitante. Identificaram-se fatores que levam ao consumo abusivo de drogas, como o acesso fácil, abandono escolar, o uso de drogas na família e a falta de motivação para o tratamento.

The purpose of this research was to characterize the profile of adolescents hospitalized for detoxification in a public hospital in the West of Paraná and correlate the socio-demographic variables with the use of street drugs. It is a retrospective study from the consultations in 81 protocols of admission of addicted adolescents hospitalized from March 2007 to April 2008. The largest admission was of male adolescents (79 percent).The most frequently used drugs by were crack (87.6 percent), followed by marijuana (85.2 percent), from these, 79 percent of these adolescents use these two drugs concomitantly. Most adolescents (55.6 percent) reported using drugs for more than three years, and 56.8 percent had already received some type of treatment before admission. Factors that lead to abusive consumption of drugs, such as easy access, leaving school, the use of drugs in the family and lack of motivation for treatment were identified.

El objetivo de esta investigación fue caracterizar las internaciones de adolescentes hospitalizados para desintoxicación en un hospital público del Oeste de Paraná y correlaceonar las variables sociodemográficas con el uso de drogas ilícitas. Se trata de un estudio retrospectivo apartir de consultas en 81 protocolos de admisión de los adolescentes internados en el periodo de marzo de 2007 hasta abril de 2008. La mayoría de las internaciones fue de adolescentes del sexo masculino (79 por ciento). Las drogas consumidas con más frecuencia fueron el crack (87,6 por ciento) y la marihuana (85,2 por ciento), siendo que, 79 por ciento de los adolescentes usan tales drogas de forma armônica. Se identificaron fatores que llevan al consumo abusivo de las drogas, como el acceso fácil, abandono escolar, el uso de drogas en la família y la falta de motivaciones para el tratamento.

Fatores estressantes para familiares de pacientes criticamente enfermos de uma unidade de terapia intensiva / Stressful factors for families of critically ill patients of the intensive care unit

OBJETIVO: Identificar os principais estressores ambientais, conforme a percepção de familiares de pacientes internados em uma UTI-G de adultos de um hospital público universitário. MÉTODO: Estudo transversal descritivo com familiares de pacientes gravemente enfermos internados na UTI de um hospital escola. Para a coleta de dados, utilizou-se uma escala contendo 25 itens relacionados a eventos da referida UTI. Para análise dos resultados, as respostas foram classificadas como estressores ambientais, referentes à equipe, ao paciente e à visita. RESULTADOS: Participaram 53 familiares, 67,9 por cento mulheres, com média de idade de 39,7 anos. Os fatores relacionados ao paciente foram mais estressantes do que aqueles referentes à equipe e ao ambiente (p < 0,005). Os eventos mais estressantes para os familiares estiveram relacionados à insegurança e ao medo quanto ao estado clínico do paciente, dentre esses, o motivo e o tempo de internação e ver o paciente em coma. CONCLUSÃO: A internação de um parente próximo na UTI foi considerada pelos familiares que efetivamente participaram desse processo um evento estressante. Todos os participantes indicaram pelo menos um evento causador de estresse capaz de provocar diferentes reações emocionais. Conhecer tais eventos pode facilitar as estratégias de humanização hospitalar, propiciando alternativas para reduzir os níveis de estresse e alterações psiquiátricas subsequentes.

OBJECTIVE:To identify main environment stressors according to the perception of relatives of patients hospitalized in an adult ICU in a university public hospital. METHOD: It is a transversal descriptive study involving family members of critically ill patients hospitalized in an ICU of a school hospital. To collect data we used a 25-item scale related to the referred ICU. For result analysis, answers were classified as environmental stressors concerning the team, patients, and visits. RESULTS: There were 53 family-member participants where 67.9 percent were women averaging 39.7 years of age. Factors related to patients were more stressing than those concerning the hospital team and the environment (p < 0.005). The most stressed events for the family members were related to uncertainty and fear of the clinical state of the patient, among them reason and length of hospital stay, and witness the patients in a coma. CONCLUSION: Hospital ICU stay of a relative was considered by the close to kin, who actually participated in the process, a stressful event. All participants indicated at least one event that causes stress as capable of provoking diverse emotional reactions. Knowing such events can favor hospital humanization strategies thus providing alternatives to reduce stress levels and subsequent psychiatrical disorder.

Avaliação do sofrimento psíquico da mãe acompanhante em alojamento conjunto pediátrico / Evaluation of the psychological suffering of the mother who rooms in with her child at a pediatric hospital

Este estudo objetivou apreender os sentimentos vividos pela mãe que acompanha um filho internado e identificar as estratégias de enfrentamento utilizadas para lidar com essa realidade. Tratou-se de uma pesquisa qualitativa que utilizou como técnica para coleta de dados o procedimento Desenho-Estória, aplicado junto a 17 mães que acompanhavam seus filhos em alojamento conjunto pediátrico de um hospital universitário. Realizou-se, na análise dos dados, a interpretação psicológica dos desenhos e análise do conteúdo das falas apresentadas na estória contada pela mãe a partir dos desenhos. Para tanto, utilizou-se na interpretação dos desenhos o referencial teórico proposto por van Kolck. Os dados com as falas dos sujeitos foram analisados nos moldes da análise de conteúdo proposto por Minayo. Observou-se a expressão do sofrimento psíquico a partir dos sentimentos de medo, preocupação, impotência e tristeza, geradores de ansiedade e angústia.

This study aimed to capture the feelings experienced by the mother who accompanies her child when admitted to hospital and also to identify the coping strategies used to deal with this situation. This is a qualitative study that used the Drawing-Story procedure as the data collection technique, applied to 17 mothers who roomed in with their children in a Pediatric Ward of a University Hospital. The psychological interpretation of the drawings was used in the analysis of the data, and also the analysis of the content of the language used in the story told by the mother, based on the drawings. For this purpose, the theoretical framework proposed by van Kolck was used to interpret the drawings. The data containing the words used by the individuals were analyzed along the lines of the content analysis proposed by Minayo. An expression of mental suffering was observed out of feelings of fear, concern, helplessness, sadness, leading to anxiety and anguish.

Elaboração e avaliação de um instrumento para identificar memórias referentes à Unidade de Terapia Intensiva / Development and evaluation of an instrument to identify memories on the Intensive Care Unit

OBJETIVO: Descrever o desenvolvimento de um instrumento para identificar as recordações de pacientes internados em Unidade de Terapia Intensiva (UTI) e verificar a validade de conteúdo e a aplicabilidade do instrumento. MÉTODO: Estudo de desenvolvimento metodológico, fundamentado na teoria de elaboração de escalas psicológicas de Pasquali (1998). Para elaboração do instrumento, foram percorridas três etapas, a construção dos itens, a análise da validade de conteúdo e aparência por um painel de experts e, por fim, a realização de um estudo-piloto para verificar a aplicabilidade do instrumento na população-alvo. RESULTADOS: Houve pouca discordância entre os experts na análise das questões de acordo com os domínios do construto. Os itens foram avaliados positivamente, recebendo uma pontuação acima de 80 por cento, valor este que obedece ao critério de validação do instrumento. Dessa forma, os itens foram considerados consistentes em relação aos domínios e ao construto, possibilitando identificar recordações das experiências vividas pelos pacientes durante sua permanência em UTI. CONCLUSÕES: Os itens propostos mostraram-se compreensíveis, claros e com uma adequada estrutura de apresentação. O instrumento apresenta validade de conteúdo atestada por um painel de experts, demonstrando possuir características teóricas para identificar memórias de pacientes internados em UTI a curto e longo prazo.

OBJECTIVE: Describe the development of an instrument to identify records of their stay at the intensive care unit, and verify content validation and the applicability of the instrument. METHOD: It is a methodological study, based in Pasquali's (1998) psychological scale elaboration theory. To elaborate the instrument, three stages were followed: the built of items; appearance and content validation analysis performed by a panel of experts; together with implementation of a pilot study to validation instrument applicability in the targeted population. RESULTS: There was little unconformity among the experts when analyzing the questions according to the domain of the constructor. The items were positively evaluated having a punctuation value above 80 percent, which abides the instrument validation criteria. Thus, the items were considered consistent in relation to the domain and constructor allowing identification of recollection of memories lived by the patients during their stay at the ICU. CONCLUSIONS: The proposed items demonstrated to be comprehensive, clear, and having an adequate presentation structure. The instrument shows validation to the content certified by a panel of experts, thus demonstrating to have theoretical characteristics to identify short and long term recollections of ICU patients.