ABSTRACT
RESUMO O acompanhamento dos pacientes que recebem alta das unidades de terapia intensiva segue fluxos distintos nas diferentes partes do mundo. Os ambulatórios ou clínicas pós-unidades de terapia intensiva representam uma das formas de realização deste acompanhamento, já com mais de 20 anos de experiência em alguns países do mundo. Estudos qualitativos que acompanharam pacientes nestes ambulatórios sugerem resultados mais animadores do que os estudos quantitativos, demonstrando melhora em desfechos intermediários, como satisfação do paciente e dos familiares. Resultados mais importantes, como mortalidade e melhora da qualidade de vida de pacientes e familiares, ainda não foram demonstrados. Além disto, quais pacientes devem ser indicados para estes ambulatórios? Por quanto tempo eles devem ser acompanhados? Podemos esperar melhora de desfechos clínicos nestes pacientes acompanhados? Os ambulatórios são custo-efetivos? Estas são somente algumas das dúvidas que esta forma de seguimento dos sobreviventes das unidades de terapia intensiva nos oferece. Este artigo visa revisar todos os aspectos referentes à organização e à realização dos ambulatórios pós-alta da unidade de terapia intensiva, bem como um apanhado dos estudos que avaliaram desfechos clínicos relacionados a esta prática.
ABSTRACT The follow-up of patients who are discharged from intensive care units follows distinct flows in different parts of the world. Outpatient clinics or post-intensive care clinics represent one of the forms of follow-up, with more than 20 years of experience in some countries. Qualitative studies that followed up patients in these outpatient clinics suggest more encouraging results than quantitative studies, demonstrating improvements in intermediate outcomes, such as patient and family satisfaction. More important results, such as mortality and improvement in the quality of life of patients and their families, have not yet been demonstrated. In addition, which patients should be indicated for these outpatient clinics? How long should they be followed up? Can we expect an improvement of clinical outcomes in these followed-up patients? Are outpatient clinics cost-effective? These are only some of the questions that arise from this form of follow-up of the survivors of intensive care units. This article aims to review all aspects relating to the organization and performance of post-intensive care outpatient clinics and to provide an overview of studies that evaluated clinical outcomes related to this practice.
Subject(s)
Humans , Ambulatory Care Facilities/organization & administration , Intensive Care Units , Patient Discharge , Quality of Life , Outcome Assessment, Health Care , Survivors , Aftercare/organization & administration , Critical CareABSTRACT
Esta pesquisa objetivou conhecer a atuação do enfermeiro no processo de alta hospitalar de crianças na articulação entre Atenção Hospitalar e Básica, na perspectiva da integralidade do cuidado. A proposta metodológica teve uma abordagem qualitativa-exploratória-descritiva, utilizando entrevistas semi-estruturadas com sete enfermeiros da atenção hospitalar e seis da atenção básica, coletadas entre dezembro de 2008 e janeiro de 2009, em seus locais de trabalho. Constatou-se uma lacuna no processo de trabalho de enfermagem no pós-alta hospitalar da criança, por praticamente não existir a articulação da atenção hospitalar e básica. A atuação do enfermeiro da atenção básica não acontece com freqüência, pois, dificilmente consegue identificar a criança em alta hospitalar. O agir integral de cada enfermeiro nem sempre consegue ultrapassar seu espaço de trabalho, sendo que os profissionais envolvidos reconhecem que existem limitações em sua atuação nessa articulação, as quais remetem à necessidade de reorganização do seu processo de trabalho.
Esta investigación tuvo como objetivo conocer, desde la perspectiva de la integralidad del cuidado, la labor del enfermero en el proceso de alta hospitalaria del niño, en el articulación entre Atención Hospitalaria y la Básica. La propuesta metodológica tuvo un abordaje cualitativo y exploratorio y descriptivo, utilizando entrevistas semiestructuradas con 7 enfermeros de la atención hospitalaria y 6 de la atención básica, recogidos entre diciembre de 2008 y enero de 2009, en sus propios lugares de trabajo. El resultado ostró un vacío en el proceso del trabajo de enfermería en el post-alta hospitalaria del niño, debido a que prácticamente no existe una articulación entre la atención hospitalaria y la básica. En ese proceso, la labor del enfermero de la atención básica no acontece con frecuencia, por lo que difícilmente consigue identificar al niño en el alta hospitalaria. La labor integral de cada enfermero no siempre ultrapasa su espacio de trabajo. Los propios profesionales reconocen que en esa articulación existen limitaciones en su labor que hacen necesaria la reorganización el proceso de trabajo.
This study had as an objectived to know the actuation of the nursing in the discharge process of the child from the hospital, in the articulation Hospital Attention and Attention Basic, in the perspective of the comprehensive of care. The methodology proposal has the qualitative exploratory-descriptive character approach, utilizing semi-structured interviews with 07 nurses of hospital attention and 06 of basic attention, collected from December 2008 to January 2009, in their own workplaces. In the result it was noted the gap in the work process of nursing in the post discharge of the child from the hospital, because practically it does not exist the articulation of the basic hospital attention. The performance of the basic nursing attention in this process does not happens with frequency, where it is difficult to identify the child that is discharge from the hospital. The integral actuation of each nurse does not always overtake his work space. The proper professionals involved admits that limitations exists in their actuation in this articulation, this remits the necessity of reorganization of your work process.
Subject(s)
Adult , Child , Humans , Aftercare/organization & administration , Child, Hospitalized , Continuity of Patient Care/organization & administration , Nurse's Role , Patient Discharge , Pediatric Nursing , Primary Care Nursing , Brazil , Hospitals, Public , Hospitals, University , Interprofessional Relations , Nurse-Patient Relations , Nursing Staff, Hospital , Qualitative ResearchABSTRACT
PURPOSE: A quasi-experimental study was performed to investigate the effects of a home visiting discharge education program on the maternal self-esteem, attachment, postpartum depression and family function in 35 mothers of neonatal intensive care unit (NICU) infants. METHODS: Twenty-three mothers in the intervention group received the home visiting discharge education while 12 mothers in the control group received the routine, hospital discharge education. Baseline data was collected in both groups one day after delivery. The intervention group received the home visiting discharge education while the control group did the routine hospital-based discharge education. The questionnaire including the data on maternal self-esteem, attachment, postpartum depression and family function were collected within 1week after the discharge by mail. RESULTS: The scores of maternal self-esteem, and attachment were significantly increased, and the postpartum depression and the family function score were decreased after the home visiting discharge education in intervention group. There were no changes in these variables before and after the routine hospital-based discharge education in control group. CONCLUSION: These results support the beneficial effects of home visiting discharge education on the maternal role adaptation and family function of the mothers of NICU infants.
Subject(s)
Adult , Female , Humans , Infant, Newborn , Male , Adaptation, Psychological , Aftercare/organization & administration , Attitude to Health , Depression, Postpartum/diagnosis , Family Health , Home Care Services/organization & administration , Intensive Care Units, Neonatal , Korea , Mother-Child Relations , Mothers/education , Nursing Evaluation Research , Patient Discharge , Postnatal Care/organization & administration , Program Evaluation , Public Health Nursing/organization & administration , Surveys and Questionnaires , Self ConceptABSTRACT
To improve treatment compliance, follow-up and attendance of STD patients and their contacts, a programme, based on domiciliary visits was attempted. The programme was limited to male defaulters not responding to written and telephone calls. House visits to 79 out of 169 defaulters were made. Approximately half the number of houses were found locked. Fourteen defaulting patients reported for completion of their treatment and follow-up. Of these 11 were directly interviewed. None of the 14 patients agreed to disclose the addresses of their extramarital partners. During the study period 51 female sex contacts reported for treatment as compared to 27 in the control group. Though the numbers were small the study revealed that direct contact with the patient yielded the best results. It is suggested that to make the system cost-effective the health workers should spend time with STD patients in the clinic to mark out the correct location and time for meeting the patient either in the work place or at home in case of a follow-up.
Subject(s)
Aftercare/organization & administration , Contact Tracing , Counseling/organization & administration , Female , Home Care Services/organization & administration , Humans , Male , Patient Dropouts/psychology , Program Evaluation , Surveys and Questionnaires , Sexually Transmitted Diseases/prevention & controlABSTRACT
Trata-se do relato de experiencia junto a Associacao Catarinense de Ostomizados - ACO, descrevendo a participacao do enfermeiro enquanto intelectual organico, segundo Antonio Gramsci, cujo referencial teorico foi utilizado na analise e nas reflexoes.