Una mirada fenomenológica social al cotidiano de la gestión de la enfermera jefa de servicio / A Phenomenological Approach to the Daily Management Practice in the Head Nurse of the Service

Introducción: La inquietud surge como enfermera asistencial, percibiendo el trabajo diario de la enfermera jefa de servicio como sobrecargado y estresante. Está relacionado al quehacer cotidiano de la enfermera jefa, un área poco investigada. Objetivo: Comprender el cotidiano de la gestión de la enfermera jefa de servicio. Métodos: El abordaje teórico metodológico fue la fenomenología social de Alfred Schütz. El escenario, el Hospital Central de la Fuerza Aérea del Perú en el año 2018 a 2019. La muestra, conformada por diez enfermeras jefes de servicio, seleccionadas mediante saturación de discursos, utilizándose como técnica de recolección de datos la entrevista fenomenológica, como instrumento una guía de entrevista y para el análisis de los datos se utilizó el análisis temático. Resultados: Se generaron 2 categorías: "Asumiendo la responsabilidad y el liderazgo en la gestión del cotidiano de un servicio de Enfermería" y "Compartiendo intersubjetividades al interactuar con otros semejantes en el mundo de vida cotidiano". Conclusiones: La enfermera jefa de servicio en la gestión de su cotidiano tiene muy arraigado el sentido de responsabilidad atribuido al cargo, interactúa no solo con el equipo de enfermería, sino también con médicos y autoridades militares, encuentra muchas veces dificultades en hacerles entender las necesidades del servicio, sin embargo, en el cotidiano maneja estas intersubjetividades mediante su acervo de conocimientos(AU)

Introduction: The concern arises in the practice as a nurse, perceiving the daily work of the head nurse of the service as overloaded and stressful. It is associated with the daily work of the head nurse, an area little investigated. Objective: To understand the daily practice of the head nurse of the service. Methods: The theoretical-methodological approach was Alfred Schütz's social phenomenology. The setting was the Central Hospital of the Peruvian Air Force in the year 2018 to 2019. The sample was made up of ten service chief nurses, selected through saturation of speeches, using the phenomenological interview as a data collection technique; as an instrument, an interview guide was used and thematic analysis was used for data analysis. Results: Two categories were generated: "Assuming responsibility and leadership in the daily practice of a nursing service" and "Sharing intersubjectivities when interacting with other peers in the world of daily practice". Conclusions: The head nurse of the service, in the management of her daily practice, has a deep-rooted sense of responsibility attributed to the position. She interacts not only with the nursing team, but also with doctors and military authorities, often coming across difficulties in making them understand their needs. However, in everyday practice, the head nurse handles these intersubjectivities through her or his wealth of knowledge(AU)

Length of stay in pediatric intensive care unit: prediction model / Tempo de permanência em unidade de terapia intensiva pediátrica: modelo de predição

ABSTRACT Objective To propose a predictive model for the length of stay risk among children admitted to a pediatric intensive care unit based on demographic and clinical characteristics upon admission. Methods This was a retrospective cohort study conducted at a private and general hospital located in the municipality of Sao Paulo, Brazil. We used internal validation procedures and obtained an area under ROC curve for the to build of the predictive model. Results The mean hospital stay was 2 days. Predictive model resulted in a score that enabled the segmentation of hospital stay from 1 to 2 days, 3 to 4 days, and more than 4 days. The accuracy model from 3 to 4 days was 0.71 and model greater than 4 days was 0.69. The accuracy found for 3 to 4 days (65%) and greater than 4 days (66%) of hospital stay showed a chance of correctness, which was considering modest. Conclusion: Our results showed that low accuracy found in the predictive model did not enable the model to be exclusively adopted for decision-making or discharge planning. Predictive models of length of stay risk that consider variables of patients obtained only upon admission are limit, because they do not consider other characteristics present during hospitalization such as possible complications and adverse events, features that could impact negatively the accuracy of the proposed model.

RESUMO Objetivo Propor um modelo de predição de risco de permanência das crianças na unidade de terapia intensiva pediátrica, considerando-se as características demográficas e clínicas na admissão. Métodos Coorte retrospectiva realizada a partir da análise de 1.815 admissões na terapia intensiva pediátrica, em um hospital privado e geral, do município de São Paulo (SP). Foram utilizados procedimentos de validação interna e obtenção da área sob a curva ROC na construção do modelo preditor. Resultados A mediana do tempo de permanência foi de 2 dias. O modelo preditor produziu um escore que permitiu a segmentação do tempo de permanência de 1 a 2 dias, de 3 a 4 dias e maior que 4 dias. A acurácia do modelo de 3 a 4 dias foi de 0,71 e do modelo maior que 4 dias de 0,69. As acurácias encontradas para 3 a 4 dias e maior que 4 dias de permanência mostraram possibilidade de acerto, considerada modesta, de 65% e 66%, respectivamente. Conclusão A partir dos resultados encontrados, é possível verificar que a baixa acurácia encontrada no modelo preditor não permite que ele seja exclusivamente adotado para a tomada de decisão ou planejamento para a alta. Modelos de predição de risco do tempo de permanência que consideram variáveis do paciente obtidas somente durante a admissão têm limitações intrínsecas, já que não consideram outras características presentes durante a internação, como possíveis complicações e eventos adversos, e podem impactar negativamente na acurácia do modelo proposto.