Reducing costs and improving patient recovery through a nurse-driven centralized spinal orthoses program on a post-surgical unit: A quality improvement initiative.

Background: An external vendor providing off-the-shelf spinal orthoses to inpatients created significant costs and barriers to quality care for spinal surgery patients. A nursing leadership team initiated a quality improvement project to reduce the cost of providing off-the-shelf spinal orthoses and improve the care provided to spinal patients. Objective: To develop and evaluate a nursing-led process for providing off-the-shelf orthoses to spinal surgery patients and eliminate high costs. Design: Quality improvement project evaluated as a retrospective interrupted time-series. Setting: Post Surgery Inpatient Unit Level II Trauma Center in a United States hospital located in Florida. Participants: Vendor Program: 134 patients; Centralized Program: 155 patients. Methods: The nursing leadership team developed a centralized spinal orthoses program where the bedside nurse fitted the patient with a spinal orthosis, eliminating the need for an external orthotist. The study quantifies changes in study metrics by comparing patients identified through chart review who received care in the vendor program to those who received care in the centralized program utilizing nonparametric statistical techniques. Results: The centralized nursing-led spinal orthosis program allowed the unit to mobilize patients more quickly than patients managed under the vendor program (3.85 hr. [95 % CI: 1.27 to 7.26 hrs] reduction; p = 0.004). The overall length of stay was reduced by 0.78 days ([1.34 - 0.02 days]; p = 0.063) or 18.72 h. While the statistical test did not indicate significance, the 18.72-hour reduction in length of stay represents a potential clinically relevant finding. Evaluating patients that suffered a primary spinal injury and no complications (vendor program: 54 patients; centralized program: 86 patients) showed a similar reduction in time to mobilization (4.5 hr reduction [0.53 to 12.93 hrs]; p = 0.025), but the length of stay reduction increased to 1.02 days [0.12 to 1.97 days], a difference determined to be statistically significant (p = 0.014). Centralizing the process for providing off-the-shelf spinal orthoses reduced the cost of a thoracic-lumbar sacral orthosis by $1,483 and the price of a lumbar-sacral orthosis by $1,327. Throughout the study, the new program reduced the cost of providing spinal orthoses by $175,319. Conclusions: The results demonstrate that the nursing-led centralized spinal orthosis program positively impacted the quality of care provided to our patients while also reducing the cost of delivering the orthoses. Tweetable abstract: A nursing-led centralized spinal orthosis program reduces the cost of care while reducing time to mobilization and length of stay.

Characterizing nursing time with patients using computer vision.

BACKGROUND: Compared to other providers, nurses spend more time with patients, but the exact quantity and nature of those interactions remain largely unknown. The purpose of this study was to characterize the interactions of nurses at the bedside using continuous surveillance over a year long period. METHODS: Nurses' time and activity at the bedside were characterized using a device that integrates the use of obfuscated computer vision in combination with a Bluetooth beacon on the nurses' identification badge to track nurses' activities at the bedside. The surveillance device (AUGi) was installed over 37 patient beds in two medical/surgical units in a major urban hospital. Forty-nine nurse users were tracked using the beacon. Data were collected 4/15/19-3/15/20. Statistics were performed to describe nurses' time and activity at the bedside. RESULTS: A total of n = 408,588 interactions were analyzed over 670 shifts, with >1.5 times more interactions during day shifts (n = 247,273) compared to night shifts (n = 161,315); the mean interaction time was 3.34 s longer during nights than days (p < 0.0001). Each nurse had an average of 7.86 (standard deviation [SD] = 10.13) interactions per bed each shift and a mean total interaction time per bed of 9.39 min (SD = 14.16). On average, nurses covered 7.43 beds (SD = 4.03) per shift (day: mean = 7.80 beds/nurse/shift, SD = 3.87; night: mean = 7.07/nurse/shift, SD = 4.17). The mean time per hourly rounding (HR) was 69.5 s (SD = 98.07) and 50.1 s (SD = 56.58) for bedside shift report. DISCUSSION: As far as we are aware, this is the first study to provide continuous surveillance of nurse activities at the bedside over a year long period, 24 h/day, 7 days/week. We detected that nurses spend less than 1 min giving report at the bedside, and this is only completed 20.7% of the time. Additionally, hourly rounding was completed only 52.9% of the time and nurses spent only 9 min total with each patient per shift. Further study is needed to detect whether there is an optimal timing or duration of interactions to improve patient outcomes. CLINICAL RELEVANCE: Nursing time with the patient has been shown to improve patient outcomes but precise information about how much time nurses spend with patients has been heretofore unknown. By understanding minute-by-minute activities at the bedside over a full year, we provide a full picture of nursing activity; this can be used in the future to determine how these activities affect patient outcomes.

Acesso vascular intraósseo: atitudes e práticas dos enfermeiros do serviço de urgência / Intraosseous vascular access: attitudes and practices of emergency department nurses

O Estágio de Natureza Profissional é um período fundamental do segundo ciclo de estudos pois visa completar a formação académica da componente de especialização, onde o estudante, integrado num contexto profissional, imerge em ambiente e situações clínicas complexas, desenvolvendo atividades que lhe permitam adquirir e aprimorar competências comuns e específicas do Enfermeiro Especialista em Enfermagem Médico-Cirúrgica. Pretende-se com este relatório evidenciar as oportunidades de aprendizagem e atividades realizadas no âmbito deste espaço e tempo formativo, no serviço de urgência de um hospital do norte do país, compreendendo a importância e apropriando a intervenção do Enfermeiro Especialista em Enfermagem Médico-Cirúrgica na área da Pessoa em Situação Crítica e as suas competências para gerir cuidados de enfermagem, intervir na formação de equipas de saúde e prestar cuidados altamente qualificados à pessoa doente e família. A investigação que integra este relatório assenta num estudo descritivo-correlacional com o objetivo de analisar as atitudes e práticas dos enfermeiros do serviço de urgência, de um hospital do norte de Portugal, na utilização do acesso vascular intraósseo. Utilizou-se o questionário como instrumento de recolha de dados a uma amostra de 76 enfermeiros, distribuído e preenchido via on-line, entre 4 e 15 de maio de 2023. Os resultados evidenciaram que 97,4% dos participantes reconhecem o acesso intraósseo como importante no contexto do serviço de urgência, embora 85,5% nunca o utilizassem, sendo o acesso por veia central privilegiado por 90,8%, como alternativa à falha da inserção da veia periférica. A insatisfação com os conhecimentos sobre cateterização intraóssea é de 89,5%. Fatores como a falta de treino/formação na realização do procedimento são considerados pela maioria, como os mais condicionantes à realização do procedimento. A principal conclusão é que os enfermeiros do serviço de urgência reconhecem a importância do acesso intraósseo, no entanto, afirmam que é necessário mais formação e treino para que o número de cateterizações intraósseas possa aumentar nas situações que se justifiquem. Deste percurso formativo, destaca-se a importância da intervenção diferenciada do Enfermeiro Especialista na melhoria contínua da qualidade de cuidados, num contexto complexo como é o serviço de urgência. Salienta-se, a nível pessoal, o desenvolvimento de competências especializadas comuns e específicas, na interação com o ambiente clínico envolvente.

The Professional Internship is a fundamental period of the second cycle of studies because it aims to complete the academic training of the specialisation component, where the student, integrated in a professional context, immerses himself in complex clinical environment and diferent situations, developing activities that allow him to acquire and improve common and specific skills of the Specialist Nurse in Medical-Surgical Nursing. This report aims to highlight the learning opportunities and the activities carried out within this space and time training, in the emergency service of a hospital in the north of the country, understanding the importance and appropriate intervention of the Nurse Specialist in Medical-Surgical Nursing in the area of the Person in a Critical Situation and their skills to manage nursing care, intervene in the training of health care teams and provide highly qualified care to the sick person and their families. The research that integrates this report is based on a descriptive-correlational study with the objective of analysing the attitudes and practises of nurses in the emergency service, of a hospital in the north of Portugal, in the use of intraosseous vascular access. The questionnaire was used as a data collection tool for a sample of 76 nurses, distributed and completed online, between May 4 and 15, 2023. The results showed that 97.4% of the participants recognise intraosseous access as important in the context of the emergency service, although 85.5% never used it, and access by central vein was privileged by 90.8%, as an alternative to the failure of the insertion of the peripheral vein. Dissatisfaction with the knowledge of intraosseous catheterisation is 89.5%. Factors such as the lack of training in the realisation of the procedure are considered by most, as the most conditioning to the realisation of the procedure. The main conclusion is that the nurses of the emergency service recognise the importance of intraosseous access, however, they say that more training is necessary so that the number of intraosseous catheterisations can increase in situations that are justified. From this training path, the importance of the differentiated intervention of the Specialist Nurse in the continuous improvement of the quality of care is highlighted, in a complex context such as the emergency service. It is noteworthy, at a personal level, the development of common and specific specialised skills in the interaction with the surrounding clinical environment.

General ward nurses detection and response to clinical deterioration in three hospitals at the Kenyan coast: a convergent parallel mixed methods study.

BACKGROUND: In low and middle-income countries like Kenya, critical care facilities are limited, meaning acutely ill patients are managed in the general wards. Nurses in these wards are expected to detect and respond to patient deterioration to prevent cardiac arrest or death. This study examined nurses' vital signs documentation practices during clinical deterioration and explored factors influencing their ability to detect and respond to deterioration. METHODS: This convergent parallel mixed methods study was conducted in the general medical and surgical wards of three hospitals in Kenya's coastal region. Quantitative data on the extent to which the nurses monitored and documented the vital signs 24 h before a cardiac arrest (death) occurred was retrieved from patients' medical records. In-depth, semi-structured interviews were conducted with twenty-four purposefully drawn registered nurses working in the three hospitals' adult medical and surgical wards. RESULTS: This study reviewed 405 patient records and found most of the documentation of the vital signs was done in the nursing notes and not the vital signs observation chart. During the 24 h prior to death, respiratory rate was documented the least in only 1.2% of the records. Only a very small percentage of patients had any vital event documented for all six-time points, i.e. four hourly. Thematic analysis of the interview data identified five broad themes related to detecting and responding promptly to deterioration. These were insufficient monitoring of vital signs linked to limited availability of equipment and supplies, staffing conditions and workload, lack of training and guidelines, and communication and teamwork constraints among healthcare workers. CONCLUSION: The study showed that nurses did not consistently monitor and record vital signs in the general wards. They also worked in suboptimal ward environments that do not support their ability to promptly detect and respond to clinical deterioration. The findings illustrate the importance of implementation of standardised systems for patient assessment and alert mechanisms for deterioration response. Furthermore, creating a supportive work environment is imperative in empowering nurses to identify and respond to patient deterioration. Addressing these issues is not only beneficial for the nurses but, more importantly, for the well-being of the patients they serve.

Combining the Nurse Intuition Patient Deterioration Scale with the National Early Warning Score provides more Net Benefit in predicting serious adverse events: A prospective cohort study in medical, surgical, and geriatric wards.

OBJECTIVES: This prospective cohort study aimed to assess the predictive value of the Nurse Intuition Patient Deterioration Scale (NIPDS) combined with the National Early Warning Score (NEWS) for identifying serious adverse events in patients admitted to diverse hospital wards. RESEARCH METHODOLOGY/DESIGN: Data was collected between December 2020 and February 2021 in a 350-bed acute hospital near Brussels, Belgium. The study followed a prospective cohort design, employing NIPDS alongside NEWS for risk assessment. Patients were monitored for 24 h post-registration, with outcomes recorded. SETTING: The study was conducted in a hospital with a Rapid Response System (RRS) and electronic patient record wherein NEWS was routinely collected. Patients admitted to two medical, two surgical, and two geriatric wards were included. MAIN OUTCOME MEASURES: The primary outcome included death, urgent code calls, or unplanned ICU transfers within 24 h after NIPDS registration. The secondary outcome comprised rapid response team activations or changes in Do-Not-Resuscitate codes. RESULTS: In a cohort of 313 patients, 10/313 and 31/313 patients reached the primary and secondary outcome respectively. For the primary outcome, NIPDS had a sensitivity of 0.900 and specificity of 0.927, while NEWS had a sensitivity of 0.300 and specificity of 0.974. Decision Curve Analysis demonstrated that NIPDS provided more Net Benefit across various Threshold Probabilities. Combining NIPDS and NEWS showed potential for optimizing rapid response systems. Especially in resource-constrained settings, NIPDS could be used as a calling criterion. CONCLUSION: The NIPDS displayed strong predictive capabilities for adverse events. Integrating NIPDS into existing rapid response systems can objectify nurse intuition, enhancing patient safety. IMPLICATIONS FOR CLINICAL PRACTICE: The Nurse Intuition Patient Deterioration Scale (NIPDS) is a valuable tool for detecting patient deterioration. Implementing NIPDS alongside traditional scores such as NEWS can improve patient care and safety. The optimal NIPDS threshold to activate rapid response is ≥5.

Partnership-based nursing practice framework for patients with advanced chronic obstructive pulmonary disease and their families-A discursive paper.

AIM: The increase in the number of people with chronic obstructive pulmonary disease (COPD) and the disease burden, has prompted concerted efforts to improve healthcare, particularly outpatient services. In line with these attempts the Partnership-Based Nursing Practice Theoretical Framework for People with COPD was developed to guide outpatient nursing care. The principal approach of the framework is a 'Dialogue' with the patients, which has four components: 'Establishing family involvement', 'Assisting living with symptoms' and 'Facilitating access to healthcare', with the primary goal being 'Enhancement of the health experience'. With new knowledge, research on the framework, and extensive experience in using it, a need arose to modify the framework to maximize its clinical utility. DESIGN: Discursive paper. METHODS: A narrative review and critical reflection was conducted to revise the nursing practice framework via selected literature search from 2012 to 2022, research on the framework, and the authors' reflections on the clinical experience of using the framework. RESULTS: The nursing practice framework highlights capacities and possibilities that lie in the nurse-patient relationship. The overarching dialogue in the revised framework includes both patients and families. The action-related component 'Assisting living with the disease' was added to the framework to underscore the significance of attempting to understand what may lie ahead for patients and families. The other action-related components are as follows: 'Assisting living with symptoms' and 'Facilitating access to healthcare'. The primary goal remains unchanged: enhancing the 'Health experience'. CONCLUSION: Using the revised nursing practice framework in outpatient care may help to enhance the lives of people with COPD and their families, particularly at advanced stages of the disease. It may have transferability to other groups of people living with progressive diseases dealing with complicated health problems, and to reduce the usage of costly healthcare resources such as hospital care. IMPLICATIONS FOR THE PROFESSION AND/OR PATIENT CARE: The partnership-based nursing practice framework assumes an extension of conventional specialized respiratory service and embraces a comprehensive account for that which may influence the patient's health problems. This guidance, which holistically attends to patient-family needs of living with complicated and progressive health predicaments, is fundamental. It contributes to strengthening the disciplinary focus of nursing, interdisciplinary collaboration, person-family-centred quality nursing care and inspires research initiatives. Critical reflections and updates on nursing practice frameworks, such as this revision, are essential to advance nursing and healthcare. PATIENT OR PUBLIC CONTRIBUTION: There is no direct patient- or public contribution.

Post-operative nursing activities to prevent wound complications in patients undergoing colorectal surgeries: A scoping review.

AIMS: To identify postoperative interventions and quality improvement initiatives used to prevent wound complications in patients undergoing colorectal surgeries, the types of activities nurses undertake in these interventions/initiatives and how these activities align with nurses' scope of practice. DESIGN: A scoping review. DATA SOURCES: Three health databases were searched, and backward and forward citation searching occurred in April 2022. Research and quality improvement initiatives included focussed on adult patients undergoing colorectal surgery, from 2010 onwards. Data were extracted about study characteristics, nursing activities and outcomes. The 'Dimensions of the scope of nursing practice' framework was used to classify nursing activities and then the Patterns, Advances, Gaps, Evidence for practice and Research recommendations framework was used to synthesise the review findings. RESULTS: Thirty-seven studies were included. These studies often reported negative wound pressure therapy and surgical site infection bundle interventions/initiatives. Nurses' scope of practice was most frequently 'Technical procedure and delegated medical care' meaning nurses frequently acted under doctors' orders, with the most common delegated activity being dressing removal. CONCLUSION: The full extent of possible interventions nurses could undertake independently in the postoperative period requires further exploration to improve wound outcomes and capitalise on nurses' professional role. IMPACT STATEMENT: Nurses' role in preventing postoperative wound complications is unclear, which may inhibit their ability to influence postoperative outcomes. In the postoperative period, nurses undertake technical activities, under doctors' orders to prevent wound infections. For practice, nurses need to upkeep and audit their technical skills. New avenues for researchers include exploration of independent activities for postoperative nurses and the outcomes of these activities. IMPLICATIONS FOR THE PROFESSION AND/OR PATIENT CARE: There may be opportunities to broaden nurses' scope of practice to act more autonomously to prevent wound complication. REPORTING METHOD: Scoping Reviews (PRISMA-ScR) checklist. PATIENT OR PUBLIC CONTRIBUTION: A health consumer interpreted the data and prepared the manuscript.

Adesão dos enfermeiros aos equipamentos de proteção individual numa Unidade de Cuidados Intensivos: um imperativo em cuidados especializados / Nurses' adherence to personal protective equipment in an intensive care unit: an imperative in specialised care

As Unidades de Cuidados Intensivos assumem-se como um local qualificado para a prestação de cuidados integrais à pessoa com falência múltipla de órgãos. Estas unidades disponibilizam meios diferenciados de monitorização e protocolos terapêuticos ao doente crítico. Um dos seus desafios é o desenvolvimento de cuidados seguros, dado que são os serviços hospitalares com maior prevalência de Infeções Associadas aos Cuidados de Saúde. Fortalecer as práticas de prevenção e controle de infeção e implementar a gestão antimicrobiana são medidas essenciais para a sua diminuição, bem como evitar a disseminação de resistência antimicrobiana. Preocupações com estas questões, aliadas ao facto de exercer funções em cuidados intensivos há longa data, nortearam as decisões quanto à continuidade do processo de ensino/aprendizagem. Assim, optou-se por realizar um estágio de natureza profissional numa unidade de cuidados intensivos de um hospital do norte de Portugal, com o objetivo de desenvolver competências especializadas em enfermagem médico-cirúrgica na área de enfermagem à pessoa em situação crítica. A execução do relatório assenta na apresentação de uma reflexão crítica e analítica do processo de aquisição das competências. Para tal, foram mobilizadas metodologias ativas, participativas, sustentadas nos referenciais teóricos e na melhor evidência disponível. No âmbito das inúmeras atividades desenvolvidas, realizou-se um estudo relativo à adesão dos enfermeiros ao uso de equipamento de proteção individual face à tipologia de isolamento, estabelecido na referida unidade. Tratou-se de um estudo descritivo correlacional com uma amostra de 41 enfermeiros. Os principais resultados mostram que a adesão dos enfermeiros aos equipamentos de proteção individual variou conforme a tipologia de isolamento. Relativamente ao isolamento de proteção a adesão foi de 100%, ao isolamento aéreo foi de 95,3% e ao isolamento de contacto foi de 68.8%. Assim, conclui-se que é imperativo que as instituições continuem a investir em estratégias de adesão ao uso destes equipamentos. No que concerne ao desenvolvimento de competências, destacam-se as da área de enfermagem à pessoa em situação crítica. Não descurando nenhuma, deu-se especial relevo à prevenção e controlo da infeção e resistência a antimicrobianos, perante a complexidade da situação e imperatividade de respostas adequadas e atempadas. Em suma, o enfermeiro especialista em médico-cirúrgica é detentor de competências que lhe permite uma intervenção técnico-científica, ética e humana.

Intensive Care Units are considered a qualified place to provide integral healthcare to people suffering from multiple organ failure. These specialised units supply different types of monitoring and protocols to critical patients. One of the main challenges is the development of safe care, given that they're the hospital services with the highest prevalence of healthcare associated infections. Strengthening prevention and infection control practices as well as implementing antimicrobial protocols are essential measures for decreasing and also to avoid the spread of antimicrobial resistance. Concerning with these questions and associated to the years of experience with critical care patients, it was decided to follow this theme regarding the continuity of my learning process. This being said, it was opted to do a clinical pratice, as a subject of my master degree, in an intensive care unit in a hospital in the north of Portugal, with the goal of developing specialized skills in medical-surgical nursing for people in critical situations. The execution of this report lays on presenting a critical and analytical reflection of the competences skills acquire. To do this, active and participative methods were deployed, sustained in theoretical references and in the best evidence possible. Within the scope of the multiple activities developed, a study about the adherence of nurses to the use of individual protective equipment given the type of isolation established in that unit was accomplished. It consisted on a descriptive and correctional study with a sample size of 41 nurses. The main results showed that the adherence of the nurses to the individual protective equipment varied considering the type of isolation. Relatively to protective isolation, the adherence was 100%, in the respiratory isolation was 95.3% and contact isolation was 68.8%. With this information, it was conclude that it's imperative that institutions continue to invest in strategies to endorse the adhesion to the use of this equipment. Regarding the development of competences, it was highlighted the areas focused in the care to people in critical condition. While not neglecting any of them, the prevention and infection control as also as the antimicrobial resistance before the complexity of the situation and the imperativeness to adequate and timely response, were enphasised in this essay. In conclusion, a nurse specialized in medical-surgical nursing is the holder of many skills that allows to have a technical-scientifical, ethical and humane approach.

Reprocessamento em endoscopia digestiva: contributo para a prevenção da infeção associada aos cuidados de saúde / Reprocessing in digestive endoscopy: a contribution to healthcare-associated infection prevention

O presente relatório surge como a etapa final do Estágio de Natureza Profissional, inserido no Mestrado em Enfermagem Médico-Cirúrgica da Escola Superior de Saúde do Instituto Politécnico de Viana do Castelo, que decorreu de 3 de outubro de 2022 a 31 de março de 2023. A elaboração deste relatório visa uma análise crítico-reflexiva das experiências e atividades realizadas, bem como das competências desenvolvidas durante o estágio, que decorreu em dois contextos clínicos: Grupo de Coordenação Local do Programa de Prevenção e Controlo de Infeções e de Resistência aos Antimicrobianos e Unidade de Endoscopia Digestiva, de um hospital central. A realização deste estágio proporcionou a aquisição e o desenvolvimento de competências comuns e específicas do Enfermeiro Especialista em Enfermagem Médico-Cirúrgica. Este relatório tem também como objetivo descrever o desenvolvimento do estudo de investigação intitulado Reprocessamento em Endoscopia Digestiva - contributo para a prevenção da Infeção Associada aos Cuidados de Saúde. Sendo os endoscópios dispositivos reutilizáveis com uma estrutura muito complexa, o reprocessamento destes equipamentos inclui várias etapas, que devem ser rigorosamente cumpridas, de forma a se prevenir a infeção associada à endoscopia e com isso garantir a segurança dos utentes e profissionais envolvidos. Trata-se de um estudo de natureza quantitativa, do tipo exploratório e descritivo, sustentado pela descrição de práticas de 22 profissionais de saúde (13 enfermeiros e 9 assistentes operacionais), no reprocessamento de endoscópios altos e endoscópios baixos, com deteção das principais falhas, principais dificuldades sentidas e estratégias de melhoria apresentadas pelos mesmos. Para a recolha de dados utilizámos a observação estruturada e o inquérito por questionário. Os resultados obtidos evidenciaram que apesar de serem executadas a maioria das etapas de reprocessamento, existem vários desvios das boas práticas, comprometendo a adequada desinfeção dos dispositivos e consequentemente aumentando o risco de transmissão de infeção através dos equipamentos. O espaço físico desadequado ao reprocessamento e os rácios de assistentes operacionais baixos na sala de descontaminação foram os principais aspetos mencionados pelos profissionais como dificultadores do cumprimento das etapas de reprocessamento. A resolução destas situações, foi as principais sugestões de melhoria descritas pelos profissionais como forma de prevenir as infeções associadas ao reprocessamento de endoscópios. Podemos concluir que este estudo contribuiu para a melhoria das práticas associadas ao reprocessamento de endoscópios no respetivo contexto, tendo evidenciado a necessidade de formação teórica e prática, de forma a possibilitar aos profissionais envolvidos a aquisição de conhecimentos e a adoção de práticas seguras, maximizando a prevenção, intervenção e controlo da infeção.

This report emerges as the final stage of the Professional Internship, integrated into the Master's in Medical-Surgical Nursing at the School of Health of the Polytechnic Institute of Viana do Castelo, which took place from 3rd of October, 2022, to 31st of March 2023. The preparation of this report aims for a critical-reflexive analysis of the experiences and activities carried out, as well as the skills developed during the Professional Internship, which took place in two clinical contexts: the Local Coordination Group of the Infection Prevention and Control and Antimicrobial Resistance Program and the Digestive Endoscopy Unit of a central hospital. The completion of this internship provided the acquisition and development of common and specific competencies of a Nurse Specialist in Medical-Surgical Nursing. This report also aims to describe the development of the research study entitled Reprocessing in Digestive Endoscopy - contribution to the prevention of healthcare-associated infection. Since endoscopes are reusable devices with a highly complex structure, the reprocessing of these equipment involves several stages that must be rigorously followed to prevent infection associated with endoscopy and ensure the safety of patients and professionals involved. This is a quantitative, exploratory, and descriptive study, supported by the description of the practices of 22 healthcare professionals (13 nurses and 9 operational assistants) in the reprocessing of high and low endoscopes, with the detection of key failures, main difficulties experienced, and improvement strategies presented by them. To collect data, structured observation and questionnaire surveys were used. The results obtained showed that despite most of the reprocessing steps being carried out, there are several deviations from best practices, compromising the proper disinfection of devices and consequently increasing the risk of infection transmission through the equipment. Inadequate physical space for reprocessing and low operational assistant ratios in the decontamination room were the main aspects mentioned by professionals as hindrances to complying with the reprocessing steps. The resolution of these situations was the primary improvement suggestions described by professionals as a way to prevent infections associated with endoscope reprocessing. In conclusion this study contributed to the improvement of practices associated with the reprocessing of endoscopes in the respective context, having highlighted the need for theoretical and practical training, in order to enable the professionals involved to acquire knowledge and adopt safe practices, maximizing prevention, intervention and control of infection.

Competências não técnicas valorizadas pelos enfermeiros na sala de urgência / Non-technical skills valued by nurses in the emergency room

Os serviços de urgência têm como principal objetivo a prestação de cuidados de saúde às pessoas cuja situação se enquadre no conceito de urgência e emergência médica, conforme referido no Despacho Normativo n.º 11/ 2002. Nestes serviços, que se pretendem altamente diferenciados, desenvolvem-se as mais sofisticadas intervenções de carácter tecnológico, médico e de Enfermagem, no sentido de dar resposta a situações onde as pessoas em situação de vulnerabilidade, se encontram instáveis ou em estado crítico e com algum compromisso orgânico. Este contexto de grande imprevisibilidade e complexidade, exige equipas multiprofissionais, detentoras de competências técnicas altamente diferenciadas, a par do domínio de um conjunto de competências não técnicas, de forma a garantir uma resposta organizada, eficaz e rápida, em particular no que se reporta às situações de compromisso das funções vitais. Este relatório surge no âmbito da unidade curricular Estágio de Natureza Profissional do Mestrado em Enfermagem Médico-Cirúrgica, da Escola Superior de Saúde do Instituto Politécnico de Viana do Castelo, tendo decorrido no serviço de urgência do Hospital Santa Maria Maior Barcelos, EPE, de 3 de outubro de 2022 a 31 de março de 2023 e pretende analisar, de forma crítica, reflexiva e fundamentada, todo o processo de aquisição de competências comuns e específicas do Enfermeiro Especialista em Enfermagem Médico- Cirúrgica, mais concretamente na área de Enfermagem à Pessoa em Situação Crítica. O presente relatório pretende descrever o percurso efetuado e os contributos do estágio de natureza profissional para o desenvolvimento de competências especializadas na área da pessoa em situação crítica. A primeira parte aborda as oportunidades de aprendizagem ao longo de todo o percurso, descrevendo e analisando as atividades desenvolvidas e com impacto na aquisição de competências e práticas especializadas no cuidado à pessoa em situação crítica. A segunda parte descreve o percurso investigativo, com a realização de um estudo assente no paradigma qualitativo de cariz exploratório e descritivo. Partindo de uma problemática centrada nas competências não técnicas valorizadas pelos enfermeiros em contexto de sala de emergência, e com o objetivo de conhecer a perceção dos enfermeiros acerca desta problemática, recorremos à entrevista semiestruturada como instrumento de recolha de dados, efetuada a oito enfermeiros do contexto onde realizámos este estágio. A análise dos dados demonstrou que os enfermeiros valorizam as competências não técnicas em contexto de sala de emergência, das quais se destacam a comunicação, a liderança, a gestão de emoções, a consciência da situação e o trabalho em equipa. São apontados como barreiras para a sua operacionalização, fatores relacionados com os recursos humanos, nomeadamente a inexistência de equipas dedicadas e os diferentes níveis de formação dos próprios profissionais. Aspetos relacionados com a ineficácia da comunicação, e com a estrutura da sala de emergência emergiram como fatores que interferem na operacionalização das competências não técnicas. As estratégias valorizadas pelos enfermeiros para ultrapassar estes fatores relacionam-se, maioritariamente, com as questões associadas à liderança, nomeadamente a identificação atempada de um líder nas equipas de reanimação. Como sugestões para otimizar a operacionalização das competências não técnicas, destaca-se a realização regular de debriefing e formação contínua, preferencialmente utilizando a prática simulada como estratégia de formação.

The emergency services have as their main objective the provision of healthcare to individuals whose situation falls within the concept of medical urgency and emergency, as referred to in Dispatch Normative No. 11/2002. In these services, which are intended to be highly specialized, the most sophisticated technological, medical, and nursing interventions are developed to respond to situations where vulnerable individuals are unstable, in critical condition, and with some organic compromise. This context of great unpredictability and complexity requires multiprofessional teams with highly specialized technical skills, along with the mastery of a set of non-technical skills, in order to ensure an organized, effective, and rapid response, particularly regarding compromised vital functions. This report arises within the scope of the curricular unit Professional Nature Internship of the Master's Degree in Medical-Surgical Nursing, at the School of Health of the Polytechnic Institute of Viana do Castelo. It took place in the emergency department of Hospital Santa Maria Maior Barcelos, EPE, from October 3, 2022, to March 31, 2023, and aims to critically, reflectively, and substantively analyze the entire process of acquiring common and specific skills of the Specialist Nurse in Medical-Surgical Nursing, specifically in the area of Nursing for Individuals in Critical Situations. This report aims to describe the path taken and the contributions of the professional nature internship to the development of specialized skills in the area of individuals in critical situations. The first part addresses the learning opportunities throughout the entire journey, describing and analyzing the activities developed and their impact on the acquisition of specialized skills and practices in caring for individuals in critical situations. The second part describes the investigative journey, with the realization of a study based on the qualitative exploratory and descriptive paradigm. Starting from a problem focused on the non-technical skills valued by nurses in the emergency room context, and with the aim of understanding nurses' perceptions of this issue, we used semi-structured interviews as a data collection instrument, conducted with eight nurses in the context where we carried out this internship. The data analysis showed that nurses value non-technical skills in the emergency room context, with communication, leadership, emotion management, situation awareness, and teamwork standing out. Barriers to their operationalization are related to human resources, namely the lack of dedicated teams and the different levels of training of the professionals themselves. Aspects related to ineffective communication and the structure of the emergency room emerged as factors that interfere with the operationalization of non-technical skills. Strategies valued by nurses to overcome these factors are mainly related to leadership issues, particularly the timely identification of a leader in resuscitation teams. As suggestions to optimize the operationalization of non-technical skills, regular debriefing and continuous training are highlighted, preferably using simulated practice as a training strategy.

Cuidados à pessoa em fim de vida e família no serviço de medicina intensiva / End-of-life care and the family in the intensive care unit

A Medicina Intensiva apresenta um desenvolvimento marcante nas últimas décadas. Atualmente, vive-se mais tempo, sendo esta longevidade acompanhada de morbilidades que aumentam o número de internamentos hospitalares, particularmente em Serviço de Medicina Intensiva. Estes dois aspetos, além da natureza crítica da própria doença, levam a que os Serviços de Medicina Intensiva a nível mundial apresentem taxas de mortalidade elevadas. Os enfermeiros especialistas em Enfermagem Médico-cirúrgica, na área de Enfermagem à Pessoa em Situação Crítica procuram cuidar da pessoa/família a vivenciar processos complexos de doença crítica, nomeadamente nas perturbações emocionais daí resultantes, tais como a dignificação da morte e os processos de luto. No âmbito do VIII Curso de Mestrado em Enfermagem Médico-Cirúrgica, da Escola Superior de Saúde do Instituto Politécnico de Viana do Castelo, realizou-se o Estágio de Natureza Profissional no Serviço de Medicina Intensiva Polivalente do Centro Hospitalar de Entre o Douro e Vouga, no período compreendido entre 3 de outubro de 2022 e 31 de março de 2023. Este estágio revelou-se uma oportunidade para desenvolver diversas atividades, principalmente: no âmbito da prestação de cuidados à pessoa em situação crítica e família; da gestão e supervisão dos cuidados, adequação dos recursos humanos e materiais através do acompanhamento e colaboração do enfermeiro tutor; no diagnóstico de necessidades de formação e intervenção enquanto formador, através da elaboração de um póster sobre a (não) utilização de heparina na manutenção do cateter venoso central, contribuindo para a inovação da prática clínica; e no desenvolvimento de um estudo de investigação com base nas necessidades do serviço. O trabalho de investigação realizado procurou conhecer a opinião dos enfermeiros do serviço acerca dos cuidados prestados à pessoa em fim de vida no Serviço de Medicina Intensiva Polivalente. Para tal, realizou-se um estudo qualitativo descritivo e exploratório, com recurso à entrevista semiestruturada a 10 enfermeiros deste serviço, cuja análise de conteúdo foi realizada segundo o referencial de Bardin. O desenvolvimento deste trabalho permitiu efetuar um diagnóstico de situação e identificar as intervenções realizadas pelos enfermeiros neste contexto, aspetos facilitadores e dificultadores na prestação de cuidados à pessoa em fim de vida e família e identificar os contributos para a melhoria no atendimento. A prestação de cuidados de conforto, assente numa comunicação eficaz, controlo adequado de sintomas e trabalho em equipa, foram considerados fundamentais na prestação de cuidados à pessoa em fim de vida e família. Os enfermeiros consideraram ainda que a prestação de cuidados pode ser otimizada, com a implementação de várias medidas, nomeadamente a tomada de decisão em equipa, a abordagem da temática dos cuidados em fim de vida nas discussões de equipa, envolvimento do psicólogo na equipa multidisciplinar e formação na área. Assim, considera-se que este estudo pode servir como um ponto de partida para a melhoria progressiva da qualidade dos cuidados prestados à pessoa em fim de vida e família no Serviço de Medicina Intensiva. A realização do estágio permitiu o desenvolvimento de dois níveis de competências: Competências comuns, nomeadamente no domínio da responsabilidade profissional, ética e legal, no domínio da melhoria contínua da qualidade, no domínio da gestão dos cuidados e no domínio do desenvolvimento das aprendizagens profissionais; e Competências especificas no âmbito do cuidar da pessoa em situação crítica e família e na maximização da prevenção, intervenção e controlo de infeção. Todo este desenvolvimento foi sustentado na observação, na prática baseada na evidência mais recente, na partilha de experiências e no aperfeiçoar do pensamento crítico-reflexivo.

Intensive Care Medicine has undergone remarkable development in recent decades. Currently, people are living longer and this lifespan is accompanied by morbidities that increase the number of hospital admissions, particularly in Intensive Care Units. In addition to the critical nature of the disease, these two aspects lead to high mortality rates in Intensive Care Units worldwide. The specialist nurses in Medical-Surgical Nursing, in the area of Nursing the Person in Critical Condition, seek to care for the person/family experiencing complex processes of critical illness, namely in the resulting emotional disturbances, such as the dignification of death and mourning processes. Within the scope of the VIII Master's Degree Course in Medical-Surgical Nursing of the School of Health of the Polytechnic Institute of Viana do Castelo, a Professional Training Course was carried out at the Polyvalent Intensive Care Unit of the Entre o Douro e Vouga Hospital Centre between October 3, 2022 and March 31, 2023. This internship proved to be an opportunity to develop several activities, mainly: the provision of care to critically-ill patients and their families; the management and supervision of care, and the suitability of human and material resources through the monitoring and collaboration of the nurse tutor; the diagnosis of training needs and intervention in the role of trainer through the development of a poster on the (non-)use of heparin in the maintenance of the central venous catheter, thus contributing to the innovation of clinical practice; and the development of a research study based on the service needs. The research study aimed to identify the nurses' opinion about the care provided to the person at the end-of-life in the Polyvalent Intensive Care Unit. To this end, a qualitative descriptive and exploratory study was conducted using semi-structured interviews with 10 nurses of this service, whose content analysis was performed according to Bardin's framework. The development of this study allowed diagnosing the situation and identifying the interventions performed by nurses in this context, facilitating and hindering aspects in the provision of care to the person at the end-of-life and the family, as well as identifying the contributions to improved care. The provision of comfort care, supported on effective communication, adequate symptom control and teamwork were considered essential in the provision of care to the end-of-life person and family. Nurses also considered that the provision of care can be optimised with the implementation of various measures, namely team decision-making, addressing the topic of end-of-life care in team discussions, involving the psychologist in the multidisciplinary team, and training in this area. Therefore, it is considered that this study may serve as a starting point for the progressive improvement of the quality of care provided to the end-of-life patient and family in the Intensive Care Unit. Carrying out the internship allowed the development of two levels of skills: Common skills, namely in the field of professional, ethical and legal responsibility, in the field of continuous quality improvement, in the field of care management and in the field of developing professional learning; and Specific skills based on caring for people in critical situations and their families and maximizing prevention, intervention and infection control. All this development was based on observation, practice based on the latest evidence, sharing of experiences and improvement of critical-reflective thinking.

Use of immersive virtual reality to reduce anxiety during complex paediatric dressing changes.

In recent years, there has been an increasing interest in the practical applications of virtual reality (VR) in healthcare. One discussed application of this technology is to reduce anxiety during procedures for paediatric patients. Following skin loss in paediatric patients, careful management of the wound with appropriate dressings and frequent dressing changes is a key part of the treatment process. In children, continued dressing changes are often a source of anxiety, which complicates procedures causing distress to the child, their parents and staff members. VR systems have the potential to not only reduce anxiety but also pain in children requiring frequent dressing changes. Although our knowledge of this technology is improving, further research is needed to evaluate its full potential in this population and to establish guidelines to take advantage of the full potential of VR technology.

Stigma towards patients with mental illness: An online survey of United States nurses.

People with mental illness experience significant health disparities, including morbidity and premature mortality. Evidence suggests that stigma is a contributing factor to these observed inequities. The tripartite conceptualization of stigma proposes that three problems underlie stigma: problems of knowledge (ignorance), attitudes (prejudice) and behaviour (discrimination). There is limited prior research concerning stigma towards mental illness among nurses in the United States (US). The aims of this study were to assess stigma among US nurses towards patients with mental illness, compare the stigma expressed by nurses working in medical/surgical settings with mental health settings, and identify factors associated with stigma. Participants were recruited online from national professional nursing organizations in the US. We collected demographic data and administered measures of mental health stigma and stigma-related mental health knowledge. Mental health nurses demonstrated comparatively lower levels of stigma and higher levels of knowledge than the medical/surgical nurses. Nursing speciality and personal contact with mental illness were the most significant predictors of stigma and knowledge. Knowledge was found to partially mediate the relationship between nursing speciality and stigma. We found support for the 'contact hypothesis', that is, having a personal experience of mental illness or a friend or family member who has a mental illness is associated with lower stigma towards mental illness. These findings support the development of contact-based and educational anti-stigma interventions for nurses in order to reduce stigma towards mental illness.

Insuficiencia venosa periférica en personal de enfermería quirúrgica: importancia del autocuidado / Peripheral venous insufficiency in surgical nursing personnel: importance of self-care

Introducción: la insuficiencia venosa es una afectación en la cual las venas son incapaces de enviar sangre desde las extremidades inferiores al corazón. La gravedad de esta enfermedad radica en sus complicaciones, el grado más leve produce escozor, dolor, pesadez, cansancio y quemazón en la planta de los pies; al complicarse puede presentar edema, calambres en pantorrillas, prurito intenso y coloración oscura de la piel. Objetivo: describir el nivel de conocimiento y cumplimiento del personal de enfermería de área quirúrgica respecto al autocuidado relacionado a la insuficiencia venosa de miembros inferiores. Material y métodos: se trata de un estudio descriptivo, trasversal, prolectivo y observacional; el universo es de 24 profesionales en enfermería y la muestra estuvo conformada por 22 colaboradores adscritos al área quirúrgica de un hospital público de segundo nivel de atención; se utilizaron dos instrumentos: 1) conocimiento y 2) cuestionario para evaluar el autocuidado. Se analizaron los datos mediante estadística descriptiva y prueba exacta de Fisher. Resultados: el 100 % de los participantes en el estudio no cumple con el autocuidado, el criterio para determinar el cumplimiento fue que, al observar las acciones preventivas conocidas como autocuidado, se obtuviera una calificación de 6 ítems completos, lo cual no sucede. Conclusión: existe un factor de riesgo para la insuficiencia venosa en miembros inferiores, donde la antigüedad laboral es la variable que evidencia diferencias significativas con respecto al conocimiento y cumplimiento.

Introduction: venous insufficiency is an affection in which the veins are unable to send blood from the lower extremities to the heart. The seriousness of this disease lies in its complications, the mildest degree produces itching, pain, heaviness, tiredness and burning on the soles of the feet, when complicated it can present edema, calf cramps, intense itching, and dark coloration of the skin. Objective: the knowledge and compliance of nursing staff in the surgical area with respect to self-care related to venous insufficiency of the lower limbs is described. Material and methods: This are a descriptive, cross-sectional, prolective and observational study. The universe is made up of 24 nursing professionals and the sample was made up of 22 collaborators assigned to the surgical area of a second-level public hospital; 2 instruments were used: 1) knowledge and 2) questionnaire to assess self- care. Data were analyzed using descriptive statistics and Fisher's exact test. Results: 100% of the study participants do not comply with self-care, the criterion to determine compliance was that when observing the preventive actions known as self-care, a score of 6 complete items was obtained, which does not happen. Conclusion: there is a risk factor for venous insufficiency in the lower limbs, when the seniority is the variable that shows significant differences with respect to knowledge and compliance.

Leadership Competencies of the Medical-Surgical Nursing Specialist Nurse / Competencias de liderazgo del Enfermero Especialista en Enfermería Médico-Quirúrgica / Competências de Liderança do Enfermeiro Especialista em Enfermagem Médico-Cirúrgica

ABSTRACT Objective: To identify the leadership competencies of Medical-Surgical Nursing Specialist Nurses. Methods: A quantitative, descriptive study using the Leadership Competencies Questionnaire. 311 Portuguese Medical-Surgical Nursing Specialist Nurses participated. Data analysis involved descriptive and inferential statistical analysis using the Statistical Package for Social Sciences (SPSS), version 22.0. Results: Study participants had an above-average self-perception on the scale (mean = 3.5) in all leadership roles, recognizing their leadership competencies. The leadership competencies of Medical-Surgical Nursing Specialist Nurses are balanced across all roles: Mentor (5.80 ± 1.02); Coordinator (5.53 ± 0.86); Facilitator (5.38 ± 1.04); Innovator (5.34 ± 0.88); Director (5.31 ± 1.10); Producer (5.30 ± 0.98); Monitor (5.15 ± 1.00); Corrector (4.79 ± 1.29) Conclusions: Specialized nursing practice enhances nurses' self-perceived leadership competencies. Nurses see themselves as leaders focused on internal support and facilitation of collective effort and opportunities for skill development.

RESUMEN Objetivo: Identificar las competencias de liderazgo de los Enfermeros Especialistas en Enfermería Médico-Quirúrgica. Métodos: Estudio cuantitativo, descriptivo, utilizando el Cuestionario de Competencias de Liderazgo. Participaron 311 Enfermeros Especialistas en Enfermería Médico-Quirúrgica portugueses. En el análisis de datos, se utilizó el análisis estadístico descriptivo e inferencial a través del programa Statistical Package for Social Sciences (SPSS), versión 22.0. Resultados: Los participantes en el estudio tienen una autoevaluación por encima del promedio en la escala (media=3,5) en todos los roles de liderazgo, reconociendo sus competencias de liderazgo. Las competencias de liderazgo de los Enfermeros Especialistas en Enfermería Médico-Quirúrgica están equilibradas en todos los roles: Mentor (5,80±1,02), Coordinador (5,53±0,86), Facilitador (5,38±1,04), Innovador (5,34±0,88), Director (5,31±1,10), Productor (5,30±0,98), Monitor (5,15±1,00), Corrector (4,79±1,29). Conclusiones: La práctica de la enfermería especializada aumenta la percepción de las competencias de liderazgo del enfermero sobre sí mismo. Los Enfermeros se ven a sí mismos como líderes orientados hacia una orientación interna de apoyo al esfuerzo colectivo y facilitadores de oportunidades y desarrollo de competencias.

RESUMO Objetivo: Identificar as competências de liderança dos Enfermeiros Especialistas em Enfermagem Médico-Cirúrgica. Métodos: Estudo quantitativo, descritivo, utilizando o Questionário de Competências de Liderança. Participaram 311 Enfermeiros Especialistas em Enfermagem Médico-Cirúrgica portugueses. Na análise de dados, recorreu-se à análise estatística descritiva e inferencial através do programa Statistical Package for Social Sciences (SPSS), versão 22.0. Resultados: Os participantes do estudo têm uma autopercepção acima da média da escala (média=3,5) em todos os papéis de liderança, reconhecendo suas competências de liderança. As competências de liderança dos Enfermeiros Especialistas em Enfermagem Médico-Cirúrgica estão equilibradas entre todos os papéis: Mentor (5,80±1,02), Coordenador (5,53±0,86), Facilitador (5,38±1,04), Inovador (5,34±0,88), Diretor (5,31±1,10), Produtor (5,30±0,98), Monitor (5,15±1,00), Corretor (4,79±1,29). Conclusões: A prática de uma enfermagem especializada aumenta a percepção das competências de liderança do enfermeiro sobre si próprio. Os Enfermeiros veem-se assim como líderes voltados para uma orientação interna de apoio do esforço coletivo e facilitador de oportunidades e desenvolvimento de competências.

Medical-surgical nurses' EBP beliefs and competencies.

BACKGROUND: The lack of evidence-based practice (EBP) knowledge and inability to implement EBP among nurses is a major barrier to quality nursing care. The literature shows that nurses highly value the use of EBP, however, they lack necessary EBP competencies. Although medical-surgical nurses were included in studies examining cross-sections of the nursing workforce, no studies exist specifically investigating their EBP beliefs and EBP competencies. AIMS: The purpose of this study was to describe medical-surgical nurses' self-reported EBP beliefs and competencies. METHOD: A descriptive, cross-sectional design employing survey methodology was used. RESULTS: A total of 1,709 medical-surgical nurses participated for a response rate of 13%. The findings revealed that medical-surgical nurses had positive beliefs about EBP. However, they rated themselves competent in only 2 EBP competencies of 24. Medical-surgical nurses working in units or organizations that had a special designation such as Academy of Medical-Surgical Nurses Premier Recognition in the Specialty of Med-Surg (AMSN PRISM; p = .001) or Pathway to Excellence (p = .006) reported greater EBP competency scores. Also, nurses educated at the master's level or higher had better EBP competency scores (p < .0001). LINKING EVIDENCE TO ACTION: Medical-surgical nurses need support at the personal and organizational levels to improve their EBP competence and increase uptake of EBP in their practice. Therefore, individual nurses must reflect on their EBP competence level and pursue opportunities to develop these essential attributes. Leaders must also create practice environments where EBP is valued, and barriers to EBP implementation are eliminated. Faculty in prelicensure and graduate programs should integrate EBP into their curricula and assess students' EBP competencies.

Estresse e burnout em trabalhadores de enfermagem de Unidade de Cirurgia Geral / Estrés y burnout en los trabajadores de enfermería de una unidad de cirugía general / Stress and burnout in nursing workers at a General Surgery Unit

Objetivo: avaliar os níveis de estresse e burnout dos trabalhadores de enfermagem de clínica cirúrgica antes e após a participação em grupo de apoio. Materiais e método: estudo quase-experimental, realizado em um hospital público com 16 trabalhadores. Os dados foram coletados entre maio e junho de 2015, e no mesmo período em 2016, por meio de instrumento de características biossociais e laborais, da Escala de Estresse no Trabalho e do Inventário Maslach de Burnout. Resultados: antes da participação no grupo de apoio em 2015, houve predomínio de médio nível de estresse (50 %). Quanto ao burnout, evidenciaram-se níveis de baixo desgaste emocional (43,8 %), baixa despersonalização (56,3 %), baixa realização profissional (43,8 %) e nenhum caso de burnout. Em 2016, após a participação no grupo de apoio, o nível médio de estresse manteve-se prevalente (56,6 %). Para o burnout, houve aumento dos níveis de desgaste emocional e despersonalização, e diminuição da realização profissional. Apesar disso, também não foram identificados casos da síndrome. Conclusões: a participação no grupo de apoio mobilizou o aumento do alto nível de estresse, apesar da manutenção da prevalência de nível médio. Quanto ao burnout, notaram-se piora na avaliação do desgaste emocional, despersonalização e, consequentemente, diminuição da realização profissional. Situação que sinaliza atenção, pois mostra condição favorável para o surgimento de casos da síndrome. Contudo, ainda são necessárias intervenções com foco no enfrentamento desses estressores ocupacionais.

Objetivo: evaluar los niveles de estrés y burnout de los trabajadores de enfermería de una clínica quirúrgica antes y después de participar en un grupo de apoyo. Materiales y método: estudio cuasiexperimental realizado en un hospital público sobre una muestra de 16 trabajadores. Los datos fueron recopilados entre mayo y junio de 2015, y durante el mismo periodo de 2016, a través de un instrumento de características biosociales y laborales, la Escala de Estrés Laboral y el Inventario de Burnout de Maslach. Resultados: antes de la participación en el grupo de apoyo, en 2015, los participantes reportaron un nivel medio de estrés (50 %). En cuanto al burnout, se evidenciaron niveles de baja angustia emocional (43,8 %), baja despersonalización (56,3 %), baja realización profesional (43,8 %) y ningún caso específico de burnout. En 2016, tras la participación en el grupo de apoyo, el nivel medio de estrés siguió siendo prevalente (56,6 %). En el caso del burnout, se observó un aumento de los niveles de malestar emocional y despersonalización, así como una disminución de los logros profesionales. A pesar de eso, tampoco fueron identificados casos del síndrome. Conclusiones: la participación en el grupo de apoyo generó un aumento del nivel alto de estrés, a pesar de que se mantuvo la prevalencia del nivel medio. En cuanto al burnout, se evidenció un incremento en la evaluación del malestar emocional, la despersonalización y, en consecuencia, una disminución en la realización profesional. Esta situación llama la atención, puesto que muestra una condición favorable para la aparición de casos del síndrome. Por lo anterior, las intervenciones centradas en el afrontamiento de estos factores de estrés laboral continúan siendo necesarias.

Objective: To evaluate the levels of stress and burnout among nursing workers at a surgical clinic before and after their participation in a support group. Materials and method: Quasi-experimental study conducted in a public hospital over a sample of 16 workers. Data were collected between May and June 2015 and in the same period of 2016, through a biosocial and work characteristics instrument, the Work Stress Scale, and the Maslach Burnout Inventory. Results: Prior to participation in the support group, in 2015, there was a predominance of medium level of stress (50 %). As for burnout, low emotional distress (43.8 %), low depersonalization (56.3 %), low professional fulfillment (43.8 %), and no cases of burnout were observed. In 2016, after participating in the support group, the average level of stress among individuals remained stable (56.6 %). Regarding burnout, there was an increase in the levels of emotional distress and depersonalization, as well as decreased professional achievement. Despite this, no cases of the burnout syndrome were identified. Conclusions: Participating in the support group mobilized an increase in the high level of stress, despite the steady prevalence of the medium level. As for burnout, we noticed a worsening in the evaluation of emotional distress, depersonalization, and, consequently, a decrease in professional fulfillment. This situation is particularly important, since it shows favorable conditions for the emergence of cases of the syndrome. Therefore, interventions focused on coping with these occupational stressors are still necessary.

Prevalence of Psychiatric Diagnoses and Psychiatric Consultation Service Utilization on Inpatient Medical Units.

OBJECTIVE: This practice improvement project sought to determine the prevalence of psychiatric diagnoses among patients admitted to a community hospital's inpatient medical units and which diagnoses were serviced by the hospital's psychiatric consultation service. METHOD: Electronic medical record data on adult patients of five medical units admitted with a psychiatric condition between October 1, 2019, and December 31, 2019, were used. Psychiatric ICD-10 (International Classification of Diseases, 10th Revision) codes and diagnosis names extracted were categorized into seven major diagnostic groups. A total of 687 adult patients with 82 psychiatric ICD-10 codes were analyzed using descriptive statistics. RESULTS: Substance-related and addictive disorders were the most prevalent psychiatric diagnoses. Ninety-six percent (n = 658) of patients residing on medical floors with psychiatric disorders were hospitalized for a principal medical problem. Seventy-three cases received psychiatric consultations during their stay. Sixty percent (n = 44) of those cases had psychiatric disorders from two or more diagnostic categories. CONCLUSIONS: Multidisciplinary, team-based health care delivery models that include a psychiatric nurse can provide an effective approach to treat patients in community hospitals with multiple psychiatric and medical comorbidities. Hospitals could take a significant role in providing substance use disorder treatment and equipping medical nurses with training to competently care for patients with psychiatric disorders on medical units. Further research into the prevalence and impact of patients with co-occurring and multiple psychiatric diagnoses in community hospitals is needed to implement effective health care delivery models and provide appropriate treatment options in the community.

Infecções de sítio cirúrgico: reabordagem cirúrgica e infecção em cirurgias limpas e potencialmente contaminadas / Surgical site infections: surgical reoperation and infection in clean and potentially contaminated surgeries / Infecciones del sitio quirúrgico: reoperación quirúrgica e infección en cirugías limpias y potencialmente contaminadas

Objetivo: verificar a associação entre a ocorrência de infecção de sítio cirúrgico (ISC) e a necessidade de reabordagem em pacientes submetidos a cirurgias limpas e potencialmente contaminadas. Método: estudo longitudinal, envolvendo 75 pacientes com infecção; a coleta de dados foi em formulário de pesquisa avaliando aspectos sociodemográficos e clínicos. A associação foi avaliada pela razão de chances e seus intervalos de confiança (IC95%). Resultados: pacientes internados por causas externas têm chance quatro vezes maior de reabordar cirurgicamente (p=0,011), na especialidade ortopédica a razão foi cinco vezes maior (p=0,003), reinternações, têm 10 vezes mais chances de reabordagem (p=0,000), leucocitose (p=0,002) e alteração no valor de proteína c-reativa (p=0,016) mostraram-se associados à necessidade de realização de nova cirurgia. A cultura positiva (p=0,001) e antibiótico terapêutico (p=0,04) demonstraram-se fatores protetores para a reabordagem. Conclusão: os dados demonstram a presença de ISC como forte influenciador à reabordagem cirúrgica, norteando hospitais com o mesmo perfil.

Objective: to verify the association between the occurrences of surgical site infection (SSI) and the need for re-approach in patients undergoing clean and potentially contaminated surgeries. Method: longitudinal study, involving 75 patients with infection; data collection was carried out using a survey form evaluating sociodemographic and clinical aspects. The association was assessed by the odds ratio and its confidence intervals (95%CI). Results: patients hospitalized for external causes are four times more likely to be surgically re-approached (p=0.011), in the orthopedic specialty the reason was five times greater (p=0.003), readmissions are 10 times more likely to be re-approached (p=0.000), leukocytosis (p=0.002) and alteration in the value of c-reactive protein (p=0.016) were associated with the need for a new surgery. Positive culture (p=0.001) and therapeutic antibiotic (p=0.04) proved to be protective factors for re-approach. Conclusion: the data demonstrate the presence of SSI as a strong influencer in surgical reoperation, guiding hospitals with the same profile.

Objetivo: verificar la asociación entre la ocurrencia de infecciones del sitio quirúrgico (ISQ) y la necesidad de reoperación en pacientes sometidos a cirugías limpias y potencialmente contaminadas. Método: estudio longitudinal, involucrando 75 pacientes con infección; la recogida de datos tuvo lugar en un formulario de investigación que evaluaba aspectos sociodemográficos y clínicos. La asociación se evaluó mediante odds ratio y sus intervalos de confianza (IC95%). Resultados: los pacientes hospitalizados por causas externas tienen cuatro veces más posibilidades de reoperación (p=0,011); en la especialidad de ortopedia, la proporción fue cinco veces mayor (p=0,003); los reingresos tienen 10 veces más posibilidades de reoperación (p=0,000); la leucocitosis (p=0,002) y la alteración en el valor de la proteína c-reactiva (p=0,016) se asociaron con la necesidad de nueva cirugía. La cultura positiva (p=0,001) y el antibiótico terapéutico (p=0,04) demostraron ser factores protectores para la reoperación. Conclusión: los datos demuestran la presencia de ISQ como una fuerte influencia en la reoperación quirúrgica, guiando a los hospitales con el mismo perfil.