A covid-19 como um analisador do sofrimento de enfermeiras: um ensaio teórico / Covid-19 as a suffering analyzer for female nurses: a theoretical essay / El covid-19 como analizador de sufrimiento de enfermeras: un ensayo teórico

Este ensaio propõe que a Covid-19 pode operar como um analisador, dentro da perspectiva da análise institucional, iluminando um determinado modo de organização social que promove profundas desigualdades e ameaça a vida em diversos níveis e revelando as condições sociais, institucionais e políticas de produção de sofrimento no corpo profissional de Enfermagem. A pandemia desvelou um conjunto de marcas relacionadas à profissão, agravadas pela crise sanitária, reforçando a naturalização das relações de cuidado atribuídas ao feminino, bem como um conjunto de clivagens e hierarquias internas à profissão a partir da sinergia de marcadores da diferença, como gênero, cor/raça, classe e geração. Além disso, este trabalho mostra a presença de uma necropolítica nas respostas à pandemia que banaliza a vida e permite morrer determinados grupos sociais. A ideia de "profissionais de linha de frente" é criticada em suas metáforas bélicas, mas tomada como figura de linguagem em sua potência para afirmar que existem corpos que, pelas marcas sociais e históricas e pela interdependência do cuidado, são mais presentes e exigidos e, portanto, mais vulneráveis à doença e ao sofrimento dela decorrente.(AU)

The essay proposes that Covid-19 can operate as an analyzer, within the perspective of institutional analysis, illuminating a certain mode of social organization that promotes profound inequalities and threatens life at various levels, revealing the social, institutional and political conditions for the production of suffering in the professional nursing body. The pandemic would unveil a set of marks related to the profession, aggravated by the sanitary crisis, reinforcing the naturalization of the care relations attributed to the feminine, as well as a set of cleavages and internal hierarchies to the profession from the synergy of markers of difference as gender, color/race, class and generation. The work shows the presence of necropolitics in responses to the pandemic, which trivializes life and allows certain social groups to die. The idea of "front-line professionals" is criticized in its war metaphors, but taken as a figure of speech in its potency to affirm that there are bodies that by social and historical marks, and by the interdependence of care, are more present and demanded, and therefore more vulnerable to disease and the resulting suffering.(AU)

El ensayo propone que el Covid-19 puede funcionar como analizador, desde la perspectiva del análisis institucional, revelando las condiciones sociales, institucionales y políticas de producción de sufrimiento de enfermeras. La pandemia revela algunas marcas relacionadas con la profesión, agravadas por la crisis de salud, reforzando la naturalización de la atribución del cuidado a lo femenino y un conjunto de jerarquías internas de la profesión. El trabajo también muestra la presencia de una necropolítica en las respuestas a la pandemia. La idea de "profesionales de primera línea" es criticada, pero tomada como una figura del lenguaje en su potencia para afirmar que hay cuerpos que, por las marcas sociales e históricas y por la interdependencia del cuidado, están más presentes y demandados, y por lo tanto más vulnerables a la enfermedad.(AU)

Critérios para acolhimento noturno, segundo a equipe de um centro de atenção psicossocial / Criterios de recepción nocturna según el equipo del centro de atención psicosocial / Criteria for night reception according to the psychosocial care center team

RESUMO. O acolhimento noturno configura-se como um dos recursos oferecidos pelos Centros de Atenção Psicossociais de tipo III no cuidado aos sujeitos em sofrimento psíquico grave. Este estudo teve como objetivo identificar as percepções de profissionais de um Centro de Atenção Psicossocial tipo III sobre os critérios para inserção e alta de usuários em acolhimento noturno. Trata-se de uma pesquisa qualitativa da qual participaram nove profissionais respondendo a um roteiro semiestruturado de entrevista sobre dados sociodemográficos e questões sobre o funcionamento e os critérios para o acolhimento noturno no referido serviço e realizada análise de conteúdo temática com os dados obtidos. A análise de conteúdo temática apontou que a estabilização da crise e a proteção à vida configuram-se como critérios centrais para a inserção no acolhimento noturno, o qual pode assumir tanto o sentido de vigilância sobre o comportamento do usuário quanto de oportunidade para desenvolver vínculo com a equipe. Diante disso, conclui-se que o acolhimento noturno tem função estratégica no manejo às situações de crise em saúde mental e que muitos são os desafios enfrentados pela equipe na interlocução dos diversos pontos da rede de atenção psicossocial no cuidado aos seus usuários.

RESUMEN. La recepción nocturna está configurada como uno de los recursos ofrecidos por los Centros de Atención Psicosocial Tipo III en la atención de sujetos con angustia psicológica severa. Este estudio tuvo como objetivo identificar las percepciones de los profesionales en un Centro de Atención Psicosocial tipo III sobre los criterios de inserción y alta de los usuarios en la atención nocturna. Es una investigación cualitativa en la que participaron nueve profesionales, que respondieron a un guión de entrevista semiestructurada sobre datos socidemográficos y preguntas sobre el funcionamiento y los criterios para la recepción nocturna en el servicio referido. El análisis del contenido temático se realizó con los datos obtenidos. El análisis de contenido temático de que la estabilización de la crisis y la protección de la vida son criterios centrales para la inserción en la recepción nocturna, que puede asumir tanto un sentido de vigilancia sobre el comportamiento del usuario como una oportunidad para desarrollar un vínculo con el paciente. equipo En vista de esto, se concluye que la atención nocturna tiene un papel estratégico en el manejo de situaciones de crisis en salud mental y que el equipo enfrenta muchos desafíos al hablar sobre los diferentes puntos de la red de atención psicosocial en el cuidado de sus usuarios.

ABSTRACT. Night care is one of the resources offered by Type III Psychosocial Care Centers in the care of subjects in severe psychological distress. This study aimed to identify the perceptions of professionals in a Psychosocial Care Center type III on the criteria for insertion and discharge of users in night care. It is a qualitative research in which nine professionals participated, responding to a semi-structured interview script about socidemographic data and questions about the functioning and criteria for night reception at the referred service. Thematic content analysis was performed with the data obtained. Thematic content analysis that the stabilization of the crisis and the protection of life are central criteria for insertion in the night reception, which can assume both a sense of vigilance about the user's behavior and an opportunity to develop a bond with the patient. team. In view of this, it is concluded that night care has a strategic role in managing crisis situations in mental health and that there are many challenges faced by the team when talking about the different points of the psychosocial care network in caring for its users.

Condicionantes de calidad de los cuidados enfermeros durante el turno de noche / Factors Influencing Quality of Nursing Care during the Night Shifts

Introducción: El turno nocturno provoca efectos físicos y psicológicos en las enfermeras. Fatiga, estrés, ansiedad, alteraciones del sueño y percepción negativa del entorno laboral pueden condicionar la calidad del cuidado. Objetivo: Identificar las condiciones relacionadas con la calidad de los cuidados enfermeros durante los turnos de noche en los hospitales. Métodos: Se realiza una revisión sistemática según criterios PRISMA. Se utilizó como estrategia común en las bases consultadas la combinación de las palabras clave y booleanos: ("Quality of Care") AND ("Nurse"OR"Nurses") AND ("Night shift"OR"Shift"). Se exploraron las bases de datos PubMed, Cinahl, Scopus y Cochrane. Se Incluyeron ensayos, estudios transversales, revisiones y estudios cualitativos entre 2009 y 2018. Se excluyeron los que no cumplieron requisitos de contenido y criterios de evaluación de calidad metodológica descritos a priori. Se incluyeron 20 trabajos. Conclusiones: Para la mayoría de autores la calidad de los cuidados nocturnos es menor que durante el día y puede estar condicionada por exceso de horas trabajadas, percepción de salud, fatiga, calidad del sueño, menor ratio enfermera-paciente, menor apoyo institucional y menor satisfacción profesional. Los indicadores de calidad más utilizados fueron incidencia de úlceras por presión, errores en identificación de pacientes, errores de medicación, errores de comunicación, cuidados sin realizar, desmotivación profesional, despersonalización y retención institucional. La heterogeneidad de los estudios hace que pueda aumentar el sesgo en los resultados. Muchos indicadores descritos son evaluados mediante percepciones, ocasionalmente por métodos objetivos. La identificación de condicionantes clave en la calidad de cuidados nocturnos permite iniciativas institucionales de gran impacto(AU)

Introduction: The night shift causes physical and psychological effects on nurses. Fatigue, stress, anxiety, sleep disturbances and negative perception of the work environment can affect the quality of care. Objective: To identify the conditions related to the quality of nursing care during night shifts in hospitals. Methods: A systematic review was carried out according to PRISMA criteria. As a common strategy in the consulted databases, the combination of the following keywords and Booleans was used: ("Quality of Care") AND ("Nurse "OR "Nurses") AND ("Night shift "OR "Shift"). The PubMed, Cinahl, Scopus and Cochrane databases were explored. Trials, cross-sectional studies, reviews and qualitative studies between 2009 and 2018 were included. Those that did not meet content requirements and methodological quality assessment criteria described a priori were excluded. Twenty papers were included. Conclusions: For most authors, the quality of night care is lower than during the day and may be affected by an excess of working hours, health perception, fatigue, sleep quality, lower nurse-patient ratio, lower institutional support and lower professional satisfaction. The most frequently used quality indicators were incidence of pressure ulcers, patient identification errors, medication errors, communication errors, unperformed care, professional demotivation, depersonalization and institutional retention. The heterogeneity of the studies may increase bias in the results. Many of the indicators described are assessed by perceptions, occasionally using objective methods. The identification of key determinants in the quality of night care allows for high-impact initiatives at the institutional level(AU)

Trabalho noturno e alterações de peso corporal autopercebidas pelos profissionais de enfermagem / Night work and self-perceived body weight changes among nursing professionals / Trabajo nocturno y alteraciones en el peso corporal según los trabajadores de enfermería

Objetivo: avaliar as alterações de peso corporal em trabalhadores de enfermagem do turno noturno. Metodologia: estudo quantitativo, exploratório, descritivo, realizado em um hospital federal de grande porte do Rio de Janeiro. Foram estudadas variáveis sóciodemográficas; influências do turno noturno sobre o organismo e índice de massa corporal, após aprovação do Comitê de Ética em Pesquisa da instituição. Resultados: os 89 trabalhadores de enfermagem apresentaram ganho de peso médio de aproximadamente 20Kg a partir da admissão no turno noturno, sendo que os enfermeiros referiram maior influência da ausência de sono sobre o organismo, e maior exaustão quando comparados aos dados das demais categorias. Conclusão: considerando as desordens hormonais e os impactos sociais do serviço noturno, é imprescindível a implementação de mudanças para uma cultura prevencionista, seja por programas institucionais ou pesquisas intervencionistas, capazes de desenvolver medidas que conduzam ao autorreconhecimento e à promoção do bem-estar físico, mental e social dos trabalhadores de enfermagem.

Objective: to evaluate body weight changes in nursing workers on the night shift. Methodology: this quantitative, exploratory, descriptive study, conducted at a large federal hospital in Rio de Janeiro, after approval of the institution's research ethics committee, considered socio-demographic variables, influence of the night work on the organism, and body mass index. Results: average weight gain among the 89 nursing workers was approximately 20kg since admission to night work, and nurses reported greater influence of lack of sleep on the body, and greater exhaustion as compared with data on the other categories. Conclusion: considering the hormonal disorders and social impacts of night work, it is essential to implement changes towards a culture of prevention, through either institutional programs or interventionist research able to develop measures that lead to self-recognition and promotion of nursing workers' physical, mental and social wellbeing.

Objetivo: evaluar las alteraciones de peso corporal en trabajadores de enfermería del turno nocturno. Metodología: estudio cuantitativo, exploratorio, descriptivo, realizado en un gran hospital federal en Río de Janeiro. Se estudiaron las variables sociodemográficas, la influencia reportada de la guardia nocturna en el organismo y el índice de masa corporal, tras la aprobación del Comité de Ética de Investigación de la Institución. Resultados: Los 89 trabajadores de enfermería tuvieron un aumento de peso promedio de aproximadamente 20 kg desde el ingreso en el turno nocturno, y los enfermeros informaron una mayor influencia de la falta de horas dormidas sobre el cuerpo y un mayor agotamiento en comparación con los datos de las otras categorías. Conclusión: Teniendo en cuenta los trastornos hormonales y los impactos sociales del servicio nocturno, es esencial implementar cambios hacia una cultura de prevención, ya sea a través de programas institucionales o de investigación intervencionista, capaces de desarrollar medidas que conduzcan al auto reconocimiento y a la promoción del bienestar físico, mentales y social de los trabajadores de enfermería.

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)

Acute myocardial infarction and primary percutaneous coronary intervention at night time / Infarto agudo do miocárdio e intervenção coronariana percutânea primária no período noturno

Background: Primary percutaneous coronary intervention is the preferred treatment in ST-elevation myocardial infarction. At night period, the delay until performing primary percutaneous coronary intervention may be determinant to prognosis worsening. Objective: To analyze the results of primary percutaneous coronary intervention performed at day and night periods. Methods: Cohort study that included patients admitted with ST-elevation myocardial infarction who underwent primary percutaneous coronary intervention from December 2013 until December 2016 in a ST-elevation myocardial infarction reference hospital of a metropolitan region in Brazil, followed from admission to hospital discharge or death, compared according to time of primary percutaneous coronary intervention (night or day). Statistical analysis comprehended the Chi-square test, the Fisher test, the Student's t-test and the analysis of variance, with significance level of 5%. Results: 446 patients were submitted to primary percutaneous coronary intervention, 159 (35.6%) at night time and 287 (64.4%) at day time. No differences were found between the two groups concerning clinical baseline characteristics. Door-to-balloon time (101 ± 81 minutes vs. 99 ± 78 minutes; p = 0,59) and onset-to-ballon time (294 ± 158 minutes vs. 278 ± 174 minutes; p = 0,32) did not differ between the groups. The incidence of combined major adverse cardiac events (15.1% vs. 14.3%; p = 0,58) and in-hospital mortality (9.4% vs. 8.0%; p = 0,61) were similar between the groups, as well as length of hospital stay (6.0 ± 4 days vs. 4.9 ± 4 days; p = 0,91). Conclusion: Primary percutaneous coronary intervention at night time showed similar results as the procedure performed at day time, without significant increase of in-hospital adverse events, length of stay or mortality

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.

Avaliação da presença de sintomas depressivos entre usuários de plantão noturno, em unidade de emergência / Assessment to the presence of depressive symptoms among users nightshift at emergency room / Evaluación de la presencia de síntomas depresivos entre usuarios de turno de noche en unidad de emergencia

Depressão é uma doença com agravos pessoais e sociais. Objetivou-se avaliar indicadores clínicos e contextuais entre usuários de plantão noturno, com sintomas depressivos, em unidade de emergência. Estudo descritivo, exploratório, transversal, realizado em 2008, em Campinas/SP, com 62 adultos em atendimento noturno. Aplicou-se questionário de identificação, contextualização e informações clínicas, bem como o Inventário de Depressão de Beck. Realizou-se análise estatística. Os resultados mostraram 62 sujeitos entre 18 e 56 anos, 75,8% mulheres, 71,8% brancas, 53,2% solteiros, todos com ocupação, nenhum analfabeto, 21% com nível superior. Apresentavam queixas digestivas e cefaleia (32,2%) e referiam problemas no trabalho (12,9%) e álcool e drogas na família (17,7%). Registraram-se sinais de depressão em 21% dos sujeitos. Encontrou-se relação significativa com fumo (p=0,021), insônia (p=0,005) e problemas econômicos (p<0,000). Conclui-se que os sintomas depressivos estavam aumentados, se comparados à amostra insuspeita, mas em acordo com os dados de depressão associada a doenças clínicas.

Depression is a disease with personal and social losses. We aimed to know the clinical and contextual factors related to the presence of depression in users of night-shift services, in a emergence unit. Descriptive, exploratory, cross-sectionalstudy conducted in 2008, Campinas/SP, with 62 adults who searched for care. A questionnaire with personal, psychosocial and clinical information and the Beck’s Depression Inventory (BID) were applied. Statistics analyses were carried out. The results showed 62 subjects were between 18 and 56 years old, 75.8% women, 71,8% white and 53,2% single, all subjects worked and none of them were illiterate, 21% had university studies; they had digestive complaints and headache (32.2%) and reported problems at work (12.9%) and alcohol and drug abuse in the family (17.7%). According to BID, 21% of the subjects were depressed. The test showed correlations for smoking (p=0.021), insomnia (p=0.005), economic problems (p<0.000). We concluded that compared to unsuspected samples, symptoms were high, but in accordance to disease-related depression.

La depresión es una enfermedad con pérdidas personales y sociales. El objetivo fue evaluar indicadores clínicosy contextuales relacionados a la presencia de síntomas depresivos entre usuarios de servicios de turno nocturno, en una unidad de emergencia. Estudio descriptivo, exploratorio y transversal, realizado en 2008, Campinas/SP-Brasil, con 62 adultos en atendimiento nocturno. Se aplicó un cuestionario de identificación, contextualización e informaciones clínicas, asi como elInventario de Depresión de Beck. Se realizó análisis estadístico. Los resultados indicaron 62 sujetos entre 18 y 56 años, 75,8% mujeres, 71,8% blancas y 53,2% solteros, todos trabajando, ninguno analfabeto, 21% con educación superior; tenían problemas digestivos y dolor de cabeza (32,2%) y reportaron problemas en el trabajo (12,9%) y abuso de alcohol y drogas en la familia (17,7%). Se registró depresión en 21% de los sujetos. Se encontró relación significativa con el tabaquismo (p=0,021), insomnio (p=0,005) y problemas económicos (p<0,000). La conclusión es que, si comparados a muestras insospechadas, los síntomas estaban aumentados, pero en acuerdo con la depresión asociada a enfermedades clínicas.

Nursing work at night in palliative oncology care / O trabalho noturno da enfermagem no cuidado paliativo oncológico / El trabajo nocturno de la enfermería en el cuidado paliativo oncológico

OBJECTIVE: to understand the meaning baccalaureate nurses and nursing technicians attribute to night work in the context of clinical palliative oncology nursing care services, as well as how nursing works to attend to clients and caregivers' needs in this period. METHOD: in this exploratory and qualitative study, grounded theory was used. Seven nurses and four nursing technicians were interviewed, who composed two sample groups. Nine categories were produced and, in their comparative content analysis, a knowledge emphasis was evidenced with implications for nighttime nursing work. In this study, these aspects were discussed in two of the categories, which are: to describe care practice in order to understand nursing care management and to point out the difficulties in care practice and nursing care management. RESULTS: The results evidence the complexity in the nighttime care context, considering the clients' clinical conditions and clients and caregivers' psychological demands, mainly because of the threat of death. CONCLUSION: The team attempts to respond to these needs through communication, but reveals a lack of assistential services and an overload. Interdisciplinarity is a palliative care premise, favoring holistic care delivery, and cannot be neglected at, which requires attention and investment to develop better practices. .

OBJETIVO: compreender o significado atribuído pelos enfermeiros e técnicos de enfermagem acerca do trabalho noturno, no contexto das enfermarias clínicas de cuidado paliativo oncológico, bem como o modo de trabalho da enfermagem em busca do atendimento das necessidades dos clientes e cuidadores, nesse período. MÉTODO: estudo exploratório, qualitativo, utilizando-se a Grounded Theory. Foram entrevistados sete enfermeiros e quatro técnicos de enfermagem, compondo dois grupos amostrais. Geraram-se nove categorias e na análise do conteúdo das mesmas, comparativamente, evidenciou-se conhecimento de destaque, com implicações no trabalho noturno da enfermagem. Tais aspectos foram discutidos no presente estudo em duas das categorias, a saber: descrevendo a prática para compreensão do gerenciamento do cuidado de enfermagem e apontando as dificuldades da prática e do gerenciamento do cuidado de enfermagem. RESULTADOS: evidenciam-se a complexidade do contexto no noturno, considerando o quadro clínico dos clientes e a demanda psicológica desses e dos seus cuidadores, principalmente pela ameaça da morte. CONCLUSÃO: a equipe busca atender tais necessidades a partir da comunicação, mas evidencia carência dos serviços assistenciais e sobrecarga. A interdisciplinaridade é uma premissa do cuidado paliativo, em prol da integralidade, e não pode ser negligenciada no trabalho noturno, o que requer atenção e investimento para o desenvolvimento de melhores práticas. .

OBJETIVO: comprender el significado atribuido por los enfermeros y técnicos de enfermería acerca del trabajo nocturno en el contexto de las enfermarías clínicas de cuidado paliativo oncológico, y también el modo de trabajo de la enfermería en el intento de atender a las necesidades de los clientes y cuidadores en este período. MÉTODO: estudio exploratorio, cualitativo, que utilizó la Grounded Theory (Teoría Fundamentada en los Datos). Fueron entrevistados siete enfermeros y cuatro técnicos de enfermería, incluidos en dos grupos de muestreo. Fueron generadas nueve categoría y, en el análisis de contenido de las mismas, comparativamente, fue evidenciado un conocimiento de destaque, con implicaciones en el trabajo nocturno de la enfermería. Tales aspectos fueron discutidos en el presente estudio en dos de las categorías, a saber: describiendo la práctica para comprensión de la gestión del cuidado de enfermería y indicando las dificultades de la práctica y gestión del cuidado de enfermería. RESULTADOS: los resultados evidencian la complejidad del contexto en el trabajo nocturno, considerando el cuadro clínico de los clientes y la demanda psicológica de estos y de sus cuidadores, principalmente debido a la amenaza de la muerte. CONCLUSÍON: el equipo busca atender a tales necesidades a partir de la comunicación, pero evidencia carencia de los servicios asistenciales y sobrecarga. La interdisciplinariedad es una premisa del cuidado paliativo, a favor de la integralidad, y no se la puede ignorar en el trabajo nocturno, lo que demanda atención e inversiones para el desarrollo de mejores prácticas. .

Validación de una escala de satisfacción con el cuidado nocturno de enfermería / Validation of a satisfaction scale for night nursing care

Con el objetivo de validar la escala The Night Nursing Care Instrument (NNCI) para la evaluación de la satisfacción con el cuidado enfermero nocturno en pacientes y enfermeros; entre enero y junio de 2011 se realizó en Medellín (Colombia) un estudio descriptivo de corte transversal con la participación de 194 pacientes hospitalizados en una institución de salud y de 34 enfermeros que tenían turnos nocturnos en el mismo hospital. Se utilizó la NNCI de 11 ítems, que evalúa en enfermeros y pacientes la satisfacción con los cuidados nocturnos de enfermería. Se hizo: a) traducción y retrotraducción del instrumento, b) validación semántica, c) validación de constructo con análisis de componentes principales, d) evaluación de la consistencia interna, y e) comparación de los ítems de la escala entre enfermeras y pacientes con un análisis de ANOVA de un factor. Los resultados mostraron en la validación factorial que la escala tiene tres dimensiones (intervenciones enfermeras, tratamiento médico y evaluación) en enfermeros y pacientes. La confiabilidad fue de 0,91 en enfermeros y 0,88 en pacientes. El 95,6 % de los pacientes y el 55,9 % de los enfermeros están satisfechos con el cuidado nocturno, diferencia que es estadísticamente significativa. La conclusión final de este estudio es que la escala NNCI es un instrumento con buena validez y confiabilidad y que puede ser utilizado en Colombia para evaluar la satisfacción de enfermeros y pacientes con el cuidado nocturno de enfermería(AU)

Aiming to validate The Night Nursing Care Instrument (NNCI) for evaluating satisfaction with night nursing care of patients and nurses, a cross sectional descriptive study, where 194 patients hospitalized in a health care institution and 34 nurses who had night shifts in the same hospital, was conducted between January and June 2011 in Medellin (Colombia). 11 items NNCI was used, it evaluates night nursing care satisfaction of nurses and patients. The instrument was: a) translated and retro-translated, b) semantically validated, c) construct validity with main component analysis was made, d) internal consistency was evaluated, and e) item comparison among nurses and patients with ANOVA analysis of a factor was made. Results showed in factorial validation, that the scale has three dimensions (Nurses interventions, medical treatment and evaluation) in nurses and patients. Reliability was 0,91 in nurses and 0,88 in patients. 95,6 % of patients and 55.9% of nurses were satisfied with nigh care, statistically significant difference. It was concluded that NNCI is an instrument with great validity and reliability and it can be used in Colombia to evaluate nurses' and patients' satisfaction with night nursing care(AU)

Aspectos do ciclo vigília-sono e estados emocionais em enfermeiros dos diferentes turnos de trabalho / Aspects of the sleep-wake cycle and mood states in nurses from different work shifts

Objetivo O objetivo principal deste estudo foi descrever o ciclo vigília-sono de enfermeiros em função de seus turnos de trabalho, identificar alterações no padrão de sono e seus estados emocionais durante o trabalho. Métodos Este estudo foi conduzido com 53 enfermeiros de diferentes turnos de um hospital universitário de Campinas (São Paulo, Brasil). Os horários de trabalho foram os seguintes: turno matutino das 6h55min às 13h10min e turno vespertino das 13h às 19h15min, ambos com jornada semanal de 30 horas; turno noturno das 19h05min às 7h05min, com turno de 12 horas de trabalho seguido de 60 horas de descanso. Os questionários utilizados foram: Avaliação do Ciclo Vigília-Sono e Lista de Estados Emocionais Presentes. Resultados Os resultados revelaram que os enfermeiros do período matutino acordavam mais cedo, porém não antecipavam o horário de dormir; o sono dos enfermeiros do período vespertino não sofria alterações; os enfermeiros do período noturno apresentavam sono diurno curto e fracionado; o perfil emocional dos enfermeiros sofria alterações no decorrer do turno. Conclusão Concluiu-se que o trabalho em turnos causou prejuízos à qualidade e duração do sono dos enfermeiros dos períodos matutino e noturno, e que as alterações dos estados emocionais podem estar relacionadas ao desgaste da atividade de prestar assistência.

Objective The main objective of this study were to describe the sleep-wake cycle of nurses as a function of their work shifts, identify changes in their sleep patterns, and identify their mood states during work. Methods This study included 53 nurses from a University Hospital in Campinas (São Paulo- Brazil) working different shifts. The 30-hour workweek shifts were as follows: mornings from 6h55 a.m. to 1h10 p.m. and afternoons from 1h p.m. to 7h15 p.m. The night shift was from 7h05 p.m. to 7h05 a.m. followed by 60 hours off duty. The following questionnaires were used: Evaluation of sleep-wake cycle and Present Mood States List. Results The results showed that morning-shift nurses woke up earlier than those of other shifts but they did not go to bed earlier. Sleep patterns of afternoon-shift nurses were not affected. Night-shift nurses slept less and woke up often during their daytime sleep. The emotional profile of the nurses changed over the work shift. Conclusion In conclusion, the morning and night shifts negatively affected the quality and duration of the nurses´ sleep and the changes in emotional states may be associated with the occupation itself.

Consultations de nuit aux urgences pediatriques du CHU de Brazzaville; Congo

"Le centre hospitalier et universitaire (CHU) est le seul hopital de Brazzaville ayant une unite d'urgences pediatriques (UP). Nous avons evalue de facon prospective sa frequentation nocturne en comparant du 1"" janvier au 31 decembre 2006 les enfants (nouveau-nes exclus) admis la nuit (de 19 a 7 heures) (groupe 1) a ceux admis entre 8 et 14 heures (groupe 2). Au total; 5 796 passages ont ete enregistres aux UP; dont 2 648 (45;7) entre 19 et 7 heures et 2209 enfants (38;1) entre 8 h et 14 h.). Le delai d'admission etait comparable dans les 2 groupes. Le taux de deces a l'admission etait significativement superieur dans le groupe 1 a celui du groupe 2 (84;6vs 15;4; p0;01). Le motif de consultation dans le groupe 1 etait domine par la fievre; 81;4; les troubles digestifs; 44;2; la toux; 35;7; et les convulsions; 13;9. Les taux d'hospitalisation (56;7vs 52;8) etaient identiques dans les deux groupes. Les causes les plus frequentes en etaient les gastroenterites aigues; 24;7; les infections broncho-pulmonaires; 18;9; le paludisme; 17;3; les sepsis severes; 9;3et les infections ORL; 8;1. L'age inferieur a 2 ans; l'heure d'arrivee avant minuit et la malnutrition en constituaient les facteurs favorisants. Au cours des 24 premieres heures qui suivaient l'hospitalisation; 23des enfants du groupe 1 et 11;5de ceux du groupe 2 sont decedes (p10-4). Le deces etait plus frequent chez les enfants admis avant minuit. La sollicitation des UP la nuit au CHU de Brazzaville demeure importante avec des taux d'hospitalisation et de mortalite encore eleves. Les affections febriles en constituent les causes les plus frequentes. L'amelioration de leur pronostic doit passer par l'education des parents (reduction du delai de consultation) et le renforcement des capacites hospitalieres d'accueil et d'intervention (personnel medical; plateau technique)."

The Tao of bao: a randomised controlled trial examining the effect of steamed bun consumption on night-call inpatient course and mortality

<p><b>BACKGROUND</b>Medical superstitions remain prevalent in today's stressful and technology driven healthcare environment. These irrational beliefs commonly involve night calls, which are periods of volatile workload. In Singapore and Hong Kong, it is commonly held that consumption of steamed buns ("bao") by on-call physicians is associated with increased patient admissions and mortality, due to a homonymous interpretation of the word "bao" in dialect.</p><p><b>MATERIALS AND METHODS</b>A prospective unblinded randomised controlled trial with a permuted block randomisation design was performed on weekdays over 6 weeks. Steamed buns or control food were offered to the internal medicine night-call team of a tertiary-care hospital on a nightly basis. Information on admissions and mortality was collected from the hospital electronic database. Data on sleep patterns and shift duration were obtained by interview.</p><p><b>RESULTS</b>There were no significant differences in the median number of hours slept on days on "bao" administration versus "control" intervention (2 +/- median absolute variation of 1.5 h vs 2 +/- 1.5 h, P = 0.30) or in the number of hours spent in the hospital (30.8 +/- 1.9 h vs 30.5 +/- 2.2 h, P = 0.09). There were no significant differences in the median number of general ward admissions per night (n = 73 +/- 6 versus 71 +/- 7 admissions, P = 0.35), monitored care unit admissions (4 +/- 1.5 vs 4 +/- 1.5 admissions, P = 0.65) or inpatient mortality (2 +/- 1.5 vs 2 +/- 1.5 deaths per night, P = 0.47).</p><p><b>CONCLUSION</b>The consumption of steamed buns ("bao") has no effect on inpatient admissions, mortality, or sleep duration on call. Regardless, our results indicate that the night call in Singapore remains a challenge in terms of workload and shift duration.</p>

Contribution of nocturnal nursing intervention to sleep disruption among intensive care units patients

Patient care nursing activities in the night shift in the intensive care units are the causes of sleep deprivation among critically ill patients, Sleep disturbance has long-term effects on health outcome. The present study aimed to determine the frequency and types of nursing interventions that lead to sleep disruption among critically ill patients in different intensive care units during night shift. The design is a retrospective descriptive research. This study was conducted in four critical care units the open heart surgery [OHS] intensive care unit at Mansoura Main University Hospital, the medical intensive care unit of the specialized medical hospital at Mansoura University the coronary care unit and general intensive care units of Mansoura International Hospital of the Ministry of Health Sample: The sample consisted of 80 adult patients of both sexes admitted to the four intensive care units, 20 patients from each unit. Patients were included if they stayed for at least 4 consecutive nights in a critical care unit. A tool consisting of two parts was used. Part I included the demographic data of the patients, while part II was an activity checklist that included nurse interventions between 8.00 PM and 7.00 AM. Data represented the nursing interventions leading to sleeping disruption during 240 nights. The mean number of sleep disturbing nursing interventions per night was 28.91 +/- 12.11. Interventions were most frequent at 8.00 PM and midnight and least frequent at 3.00 AM. Only 34 uninterrupted periods of two or more hours were available for sleep [14.66% of the studied nights]. Measuring vital signs and assessing intake/output were the most frequent type of nursing interventions. Significant differences were found between the four studied units concerning number, type and frequency of nursing interventions. Nocturnal nursing interventions leave patients few uninterrupted periods for sleep. Efforts should be made to expand these periods by clustering nursing intervention without affecting patients' health outcome

A Study on the Care Burden and Service Demand of the Poverty Families Caring for the Demented Elderly

The poverty families, who take care of the demented elderly, can suffer from the deficiency of social services for dementia and the condition and nature the families have. Therefore, This study examines the burden of the poverty caring for the demented elderly. This study focused on the three points : the level of care burden of the families, who take care of the demented elderly ; the needs of welfare services ; the differences of care burden and service demand on trait of the families and the demented elderly. In order to achieve them, the 250 families, who take care of the demented elderly at home, were sampled and the primary caregivers of family member interviewed. Then, the statistics of the 226 people were analyzed by SPSSWIN. The major findings of the study were as follows : First, the level of the care burden the families of the demented elderly have, participated in this research, is higher than 'a little yes'. In a type of the care burden, the social & personal restriction is higher than the other types, including physical restriction, economical restriction, and reciprocal restriction. Second, some families had used service and had a low satisfaction, because of no various and adequate services. It shows that the services for the demented elderly and their families is not enough to use, that the services is not various for the families having many problem related the demented elderly. Third, there are many services needed by the families caring for the demented elderly : residential care facilities for the demented elderly ; day care service center ; short-term care services ; family counseling service ; services at home ; nursing services at home ; night care services ; family meeting. Fourth, the most difficult thing of caring is the economic burden of the families. The families are willing to take care of the demented elderly at home, if the government supports economically them and serves proper services to them. Finally, the lower income of the families is, the more time of caring the demented elderly in a day is, the lower vital functions of the demented elderly are, and the lower level of academic achievement, the higher level of care burden of the families is. According to the result, the level of the care burden can be affected by the family's economic capacity, the vital function of the demented elderly, and the existence of service for the demented elderly. For the elderly welfare especially, the demented elderly and their poverty families, three opinions may be suggested. First, the service programs based on community should be developed to reduce the burdens-economic, psychological, medical burden, etc. - of the poverty families caring for the demented elderly. These programs may include preventive service, education programs of dementia, diagnosis services, family counseling, and medical service. Second, the national government and the local government must try to make policies to solve the temporary problems of the family having the demented elderly.

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.

Programa de atención pediátrica domiciliaria nocturna / Nocturnal domiciliary pediatric attention program

Informe estadístico de la actividad del programa, implementado en Abril de 2000 por la Secretaría de Salud de la Ciudad de Buenos Aires. Presenta promedio mensual de consultas diarias, evolución del programa por mes y a±o, porcentajes de atenciones según edad de los pacientes, variación de llamadas a lo largo del horario del programa, demora en la atención, resolución del pedido, y principales diagnósticos

Estudo de algumas condiçöes que dificultam a assistência de enfermagem no período noturno / Some conditions that difficult the nursing care during the night

Neste estudo exploratório de algumas condiçöes que dificultam a assistência de enfermagem no período noturno, verificamos que a razäo que leva os enfermeiros e auxiliares de enfermagem, componentes da amostra, a trabalhar a noite é, principalmente, a necessidade de exercer outra atividade durante o dia. As dificuldades encontradas se referem a insuficentes horas de repouso após o serviço, näo existência de pausa regulamentada para descanso durante o trabalho, precariedade de serviços de apoio, necessidade de executar atividades pertencentes a outras áreas, ou que deveriam ser executadas durante o dia. Mais da metade dos funcioários amostrados está insatisfeita com a assistência de enfermagem prestada durante o plantäo noturno