Night Admission at a Psychosocial Care Center III / Acogimineto Nocturno en um Centro de Atención Psicosocial III / Acolhimento noturno em um Centro de Atenção Psicossocial III

ABSTRACT Objective: to analyze night admission characteristics at a Psychosocial Care Center III (CAPS III - Centro de Atenção Psicossocial). Method: a qualitative research, whose data were collected with 15 nursing professionals from November to April 2016, through a semi-structured interview. Results: it was verified that night admission is provided by the nursing team in different dynamics from the day care. This team has strategies of care during crisis, avoiding search for other network services and maintaining the CAPS in its function within the psychosocial model. Final considerations: service operation depends on the nursing team for its permanence condition in all shifts, which leads to the need to think about the legislation reformulation that structures the CAPS III team, in order to guarantee the interdisciplinary care provided by the Brazilian Psychiatric Reform in this device, which should replace hospitalization in a specialized institution.

RESUMEN Objetivo: analizar las características de la recepción nocturna de un Centro de Atención Psicosocial III (CAPS III - Centro de Atenção Psicossocial). Método: investigación cualitativa, cuyos datos se recopilaron con 15 profesionales de enfermería, de noviembre a abril de 2016, a través de una entrevista semiestructurada. Resultados: Se verificó que el equipo de enfermería administra el host nocturno en una dinámica diferenciada del anfitrión diurno, y que este equipo tiene estrategias de asistencia durante la crisis, evitando la búsqueda de otros servicios de red y manteniendo el CAPS en su función dentro del modelo psicosocial. Consideraciones finales: el funcionamiento del servicio depende del equipo de enfermería por su condición de permanencia en todos los turnos, lo que lleva a la necesidad de pensar en la reformulación de la legislación que estructura al equipo mínimo de CAPS III, para garantizar la atención interdisciplinaria provista por la Reforma. Psiquiatra brasileño en este dispositivo, que debe reemplazar la hospitalización en una institución especializada.

RESUMO Objetivo: analisar as características do acolhimento noturno de um Centro de Atenção Psicossocial III (CAPS III). Método: pesquisa qualitativa, cujos dados foram coletados com 15 profissionais de enfermagem, de novembro a abril de 2016, por meio de entrevista semiestruturada. Resultados: verificou-se que o acolhimento noturno se dá pela equipe de enfermagem em dinâmica diferenciada do acolhimento diurno, e que esta equipe possui estratégias de atendimento durante a crise, evitando a busca por outros serviços da rede e mantendo o CAPS em sua função dentro do modelo psicossocial. Considerações finais: o funcionamento do serviço depende da equipe de enfermagem pela sua condição de permanência em todos os turnos, o que leva à necessidade de se pensar na reformulação da legislação que estrutura a equipe mínima do CAPS III, de forma a garantir o cuidado interdisciplinar previsto pela Reforma Psiquiátrica brasileira neste dispositivo, que deve substituir a internação em instituição especializada.

Eficacia de un plan de cuidados de enfermería específico para el paciente con delirio / Effectiveness of a Specific Nursing Care Plan for the Patient with Delirium

RESUMEN Introducción: El síndrome confusional agudo o delirio es un trastorno psiquiátrico severo frecuente en pacientes mayores ingresados, tiende a agravarse en las horas del final de la tarde y nocturnas, con un gran impacto en los cuidados nocturnos. Objetivos: Evaluar la eficacia de los cuidados de enfermería específicos ante el delirio nocturno en pacientes hospitalizados. Métodos: Ensayo clínico cuasi-experimental en dos unidades de hospitalización de Medicina Interna de un hospital de alta complejidad. Se identificaron un grupo control y un grupo experimental, mediante muestreo de conveniencia. En ambos grupos, se seleccionaron pacientes con delirio, mediante la escala validada Intensive Care Delirium Screening Checklist. Se expuso al grupo experimental a plan de cuidados específico basado en bibliografía y plan de cuidados estándar al grupo control. Sobre resultados de indicadores de delirio, pre y posaplicación de planes de cuidados en ambos grupos, se realizaron pruebas de contraste (ANOVA, t-Student y Chi2-test de Fisher). Resultados: Con incidencia de 12-15 por ciento, los grupos control y experimental mostraron resultados homogéneos en el test del delirio PRE (p > 0,05). La edad, motivo de ingreso, género, y número de interrupciones durante el sueño, no mostraron repercusión sobre los resultados de delirio. Tras la aplicación de los planes de cuidados, el grupo experimental mostró reducción significativa de los índices de delirio (p < 0,05), y no se obtuvieron cambios significativos en el grupo control (p > 0,05). Conclusiones: El plan de cuidados específico a pacientes con delirio demostró ser eficaz al mejorar los indicadores del test de delirio y evitar el empeoramiento del cuadro(AU)

ABSTRACT Introduction: Acute confusional syndrome or delirium is a severe psychiatric disorder of frequent presentation in hospitalized elderly patients. It worsens likely in the late afternoon and evening hours, with a great impact on night care. Objectives: To evaluate the effectiveness of specific nursing care for sundown delirium in hospitalized patients. Methods: Quasi-experimental clinical trial in two hospitalization units of internal medicine of a high-complexity hospital. A control group and an experimental group were identified by convenience sampling. In both groups, patients with delirium were selected, using the validated scale Intensive Care Delirium Screening Checklist. The experimental group was exposed to a specific care plan, considering the bibliography; and the control group was exposed to a standard care plan. Regarding the results of delirium indicators, before and after the application of the care plans in both groups, contrast tests were performed (ANOVA, t-Student and Fisher's Chi-square test). Results: With an incidence of 12-15 percent, the control and experimental groups showed homogeneous results in the delirium test PRE (p >0.05). Age, reason for admission, gender, and number of interruptions during sleep did not show repercussion on delirium results. After the application of the care plans, the experimental group showed a significant reduction in delirium rates (p < 0.05), and no significant changes were obtained in the control group (p >0.05). Conclusions: The specific care plan for patients with delirium was shown to be effective in improving the indicators of the delirium test and avoiding the worsening of the health status(AU)

Effect of nursing project management on the improvement of night nursing safety / 中国实用护理杂志

Objective To explore the effect of nursing project management on the improvement of night nursing safety quality. Methods Totally 332 cases of inpatients from department of cardiovascular medicine, in accordance with the fore-and-aft sequence of implementing nursing project management, divided into experimental group (160 cases) and control group (172 cases). Through the nursing project improvement management, analyzing the reason of high incidence of adverse events related with the nursing safety at night in control group. Formulating standardized solutions to improve the quality of nursing safety at night. To compare the incidence of night nursing safety incidents, nursing defects and the prevention of nursing defects of the two groups before and after intervention. Results Experimental night nursing safety of nursing adverse events, gaps and prevent nursing defects were occurred in the experimental group 8.75％ (14/160), 10.00％ (16/160), 3.12％ (5/160), the control group after the interventionwere 1.74％ (3/172), 2.33％ (4/172), 11.04％ (19/172), the difference was statistically significant (χ2=6.904, 9.981, 10.626,P< 0.01). After the intervention, patients' self-management ability was enhanced, the experimental group patient compliance, psychological emotion, safety consciousness, rational drug use rate was 56.25％(90/160),52.50％(84/160), 62.50％(100/160), 67.88％(107/160), the control group 86.63％(149/172), 74.41％(128/172), 91.28％(157/172), 88.37％(152/172), the difference was statistically significant (χ2= 4.656- 10.756, P<0.01 or 0.05). Conclusion Nursing project management can effectively improve the quality of night nursing safety and self-management of patients, reduce the occurrence of nursing defects, and improve the safety of nightcare.

After-hours care models in leading countries

After-hours care (AHC) provides medical care after the regular weekday work hours of clinics. In Korea, data from the National Emergency Department Information System showed that approximately 40% of the pediatric patients need AHC. To meet this need, many countries have different models of AHC. In this article, the authors tried to summarize and emphasize the advantages and disadvantages of AHC models in several leading countries. This article can be useful in designing AHC models in Korea because the proportions of potential patients requiring AHC are substantial, and the adoption of AHC models should be seriously considered.

Non-emergency department models for pediatric after-hours care

After-hours care (AHC) provides urgent primary care at nighttime, weekends, and holidays. In Korea, individual primary care physicians seldom participate in AHC and many parents have difficulty in receiving primary care during non-office hours without going to an emergency department (ED). The ED is currently the only place to access a full range of services at any time. However, the ED is not optimized for AHC, and using it for AHC is not an efficient use of resources. Therefore, many countries are seeking a safe, efficient non-ED AHC model which provides the best care considering the limitations. Different models for AHC exist worldwide, varying from family doctor-based to hospital-based models, and some countries use several different models including 24-hr telephone triage and advice services (TTA). Common problems of AHC include the inaccessibility to primary care, discontinuity of care, expensive healthcare costs, and work dissatisfaction among health care professionals. These are the major reasons for the recent changes made to the AHC system in many countries, such as the integration into one single national TTA in the United Kingdom, support for group practices in Canada, reorganization of small practice rotation groups into large scaled, general practitioner cooperatives in the Netherlands, and rapid expansion of the urgent care industry in the United States. This review presents a brief overview of the current AHC in Korea and the need for an effective non-ED AHC model. An effective AHC system will improve the quality of care, financial saving, and job satisfaction of the health care professionals.

Clinical Study of Hospital Mortality in Patients Visiting the Emergency Room at Nighttime in a City of Korea

PURPOSE: Attention has been focused recently on the impact of sleep deprivation, in-house staff, and overwork on patient outcome. The objective of this study was to determine whether any associations existed between the timing of a patient visit to an emergency setting and hospital mortality. METHOD: We analyzed retrospectively a series of consecutive visits to the emergency room of our hospital in 2003. Patients were divided according to the times of their visits to emergency room daytime (from 8:00 am to 6:00 pm) and nighttime (all others). We further divided nighttime visits into early nighttime (from 6:00 pm to 1:00 am) and late nighttime (from 1:00 am to 8:00 am) visits. The odds of death within 48 hours after visit for patients in the nighttime group were analyzed by using a multivariate logistic regression. The independent variable was visit to the emergency room during nighttime. RESULT: The patients visiting at night had a lower mortality (0.9% vs 1.6%, p=0.000), with an odd ratio for death within 48 hours, adjusted for severity of illness, of 1.265 (95% CI, 0.955-1.674). Severity of illness was the main contributor to the increased mortality rates of patients in the nighttime group. There was no significant difference in mortality rates between the early and the late nighttime subgroups. CONCLUSION: Nighttime visits to the emergency room are not associated with a higher mortality than daytime visits.