Stress and Coping in Emergency Nurses Following Trauma Patient Care: A Qualitative Grounded Theory Approach.

BACKGROUND: Experiencing symptoms of traumatic stress may be the cost of caring for trauma patients. Emergency nurses caring for trauma patients are at risk for traumatic stress reactions. OBJECTIVE: This study explored the stress and coping behaviors experienced by emergency nurses who provide trauma care. METHODS: Focus groups were held at three urban trauma centers in the Midwestern United States: a Level I pediatric trauma center, a Level I adult trauma center, and a Level III adult trauma center. Data were collected between December 2009 and March 2010. Data analysis was guided by the principles of grounded theory. Line-by-line coding and constant comparative analysis techniques were used to identify recurring constructs. RESULTS: A total of 48 emergency nurses participated. Recurring constructs emerged in the data analysis and coding, revealing four major themes: care of the trauma patient, professional practice, personal life, and support. CONCLUSIONS: Nurse job engagement, burnout, and professional and personal relationships are influenced by trauma patient care. The study's resulting themes of care of the trauma patient, professional practice, personal life, and support resulted in the development of the "trauma nursing is a continual experience theory" that can be used as a framework to address these effects. Intentional support and timely interventions based on this new theory can help mitigate the effects of traumatic stress experienced by trauma nurses.

Exploring Nursing Students' First Experiences Providing Wound and Ostomy Care to Patients: A Qualitative Study.

BACKGROUND: Undergraduate nursing students experience significant differences between practice with models, manikins, or simulation applications and real patients in a clinical setting. Students' experiences applying their theoretical knowledge to real patient-care practices are little understood. OBJECTIVE: To determine the experiences of nursing students in providing skin, chronic wound, and ostomy care to real patients for the first time in a clinical setting within the content of the Ostomy and Wound Care Nursing Track Program (OWCNTP) and to define factors affecting this program. METHODS: The research was conducted qualitatively using the individual critical incident technique, and 17 senior undergraduate nursing students enrolled in the Nursing OWCNTP were selected using a simple random sampling method. In the classroom setting, individual face-to-face interviews were conducted using the critical incident technique. Data were analyzed with inductive content analysis. RESULTS: The research found that students experience genuine caregiving in putting their experiences from the Track Program into practice with real patients in a clinical setting. Three main themes were identified: experiencing real patient care in a clinical setting, being a competent student, and being a novice student. CONCLUSIONS: The study found that nursing students enrolled in the OWCNTP could apply their theoretical knowledge to care for real patients in clinical settings. Therefore, it is recommended that these programs be integrated into nursing curricula.

Theory-Guided Care of Intimate Partner Violence Trauma Patients in the Acute Care Setting Using the Vulnerable Populations Conceptual Model.

Background and Purpose: Vulnerable populations are social groups at increased risk for poor health outcomes. According to the vulnerable populations conceptual model (VPCM) nursing theory, vulnerable groups such as survivors of intimate partner violence (IPV) are at risk for disease, morbidity, and mortality due to limited resources. The purpose of this article is to propose the VPCM as an organizing theoretical framework in the acute care setting of trauma patients suffering from IPV by outlining the factors affecting the care of this vulnerable population. Results: This synthesis of the literature outlines the decreased resource availability and increased relative risk encountered by IPV survivors, which results in poor health, which supports the application of the VPCM as a guiding theory. The VPCM provides a structure for understanding IPV patients and equips nursing with a framework for taking action through engagement, assessment, intervention, and evaluation of practice when caring for this vulnerable trauma population in the acute care setting. Implications for Practice: Using a theory-based model provides a framework for clinical practice interventions. Further research in the application of the VPCM as a theoretical basis for caring for trauma patients who are survivors of IPV is needed.

Education for Health Care Providers on Implementation of Trauma-Informed Care in Practice.

BACKGROUND: Traumatic experiences can adversely affect a child's health. These effects often continue into adulthood, especially when trauma is not addressed. Although the evidence shows benefits with addressing trauma earlier in life, trauma-informed care of children is underused in primary care. Health care providers (nurses, nurse practitioners, physicians) report gaps in knowledge of trauma-informed care and in their comfort level addressing trauma in primary care. METHOD: This project investigated the use of continuing education sessions to increase health care providers' knowledge and readiness to implement trauma-informed care into their practice. RESULTS: The education sessions improved health care providers' knowledge and comfort with trauma-informed care. CONCLUSION: This intervention improved providers' readiness to implement trauma-informed care into their primary care practice. [J Contin Educ Nurs. 2024;55(5):246-252.].

Current practices and challenges in application of trauma-informed care for accidentally injured patients: An exploratory qualitative study.

AIM: To explore the Chinese nurses' current practices and challenges to trauma-informed care (TIC) for accidentally injured patients, which can provide the way forward of improvement in the future. DESIGN: A qualitative study. METHODS: Sixteen Chinese nurses who had experience working with accidentally injured patients were invited into the semi-structured interviews. Following each interview, the dialogue was transcribed verbatim. Subsequently, we analysed the data in accordance with the principles of thematic analysis. RESULTS: Four common themes emerged from the analysis: (a) Awareness of patients' psychological trauma; (b) Recognition of psychological trauma; (c) Response to psychological trauma; (d) Perceived barriers to implementing TIC. This research indicated an urgent need for interventions in the future, such as TIC education and training, time constraints, heavy workload, emotional exhaustion and mood self-regulation, giving policy incentives, strengthening leadership support and internal cooperation. Identifying those factors of TIC practice among accidentally injured patients helps promote TIC development in hospitals.

Percepciones de las enfermeras sobre el cuidado de pacientes con lesiones cutáneas relacionadas con la dependencia y otras heridas crónicas en la comunidad / Perceptions of nurses regarding the care of patients with dependency-related skin injuries and other chronic wounds in the community

Objetivos: Explorar las percepciones de las enfermeras de atención primaria en relación con los cuidados de los pacientes con lesiones cutáneas relacionadas con la dependencia y otras heridas crónicas en el ámbito comunitario. Metodología: Diseño cualitativo que empleó la técnica de grupo focal con una muestra de 8 participantes seleccionados mediante muestreo teórico. Para el análisis de los datos se utilizaron técnicas de análisis de contenido cualitativo. Resultados: Emergen 15 categorías que se presentan bajo los 4 conceptos del metaparadigma enfermero. Destacan la intervención de las enfermeras en el cuidado de heridas, los conocimientos profesionales insuficientes, la meta de los cuidados enfermeros, la vivencia única de cada paciente y la gran influencia del entorno. Conclusiones: El cuidado de pacientes con heridas en la comunidad es complejo e incluye un gran número de actividades de enfermería que, a menudo, se basan en la experiencia y no en la evidencia. Las heridas impactan profundamente en la calidad de vida de las personas provocando experiencias únicas y multifactoriales. El entorno que rodea a la persona, tanto la familia, los cuidadores, el domicilio como el nivel socioeconómico, político y cultural, influye enormemente en los cuidados.(AU)

Objectives: Exploring primary care nurses’ perceptions of caring for patients with dependency-related skin injuries and other chronic wounds in the community setting. Methodology: Qualitative design that employed the focus group technique with a sample of 8 participants selected through theoretical sampling. Qualitative content analysis techniques were used for data analysis. Results: A total of 15 categories emerge that are presented under the 4 concepts of the nursing metaparadigm. They highlight the intervention of nurses in wound care, insufficient professional knowledge, the goal of nursing care, the unique experience of each patient, and the great influence of the environment. Conclusions: The care of patients with wounds in the community is complex and involves a large number of nursing activities that often rely on experience rather than evidence. Wounds profoundly impact the quality of life of individuals, leading to unique and multifactorial experiences. The environment surrounding the individual, including family, caregivers, home, as well as socioeconomic, political, and cultural factors, greatly influences care.(AU)

La trilogía del enfermerode práctica avanzada paramejorar la efectividaden las heridas crónicas en elDistrito Sanitario Almería / The trilogy of the advanced practice nurse to improve the effectiveness in chronic wounds in Almeria Health District

Objetivos: Analizar el concepto coste-efectividad sobre el registro de heridas, así como acerca del consumo de apósitos prescritos desde la aplicación informática Diraya tras la formación realizada en heridas durante el año 2022 por el enfermero de práctica avanzada en heridas crónicas complejas (EPA-HCC) en el Distrito Sanitario Almería (DSA). Metodología: Estudio descriptivo, retrospectivo desde el 1 de enero al 31 de diciembre del año 2022, analizando en 2 semestres los costes económicos en consumo de apósitos. Resultados: En el año 2022 se formaron un total de 604 enfermeras en heridas, de las cuales 579 fueron formadas por el EPA-HCC del DSA en el segundo semestre. Tras esta formación se realizó un total de 15.648 registros, por lo que en el registro se produjo un incremento del porcentaje del 18,08% durante el segundo semestre y se obtuvo un ahorro económico de 63.049 € (–24,73%) entre los años 2021 y 2022, mientras que la estimación durante el segundo semestre fue de –73.982 €. Conclusiones: La formación realizada por el EPA-HCC mejora los conocimientos de los profesionales, incrementa los registros y consigue una optimización de los recursos.(AU)

Objectives: To analyze the cost-effectiveness concept of wound registry, as well as the consumption of dressings prescribed from the Diraya computer application after the training carried out in wounds during the year 2022 by the advanced practice nurse in complex chronic wounds (EPA-HCC) in Distrito Sanitario Almería (DSA). Methodology: Retrospective descriptive study from January 1 to December 31, 2022, analyzing in two semesters the economic costs in dressing consumption. Results: A total of 604 wound nurses were trained in 2022, of which 579 were trained by the EPA-HCC of DSA in the second semester. After this training, a total of 15,648 registrations were made, resulting in a percentage increase in registration in the second semester of 18.08%, obtaining an economic saving of 63,049 € (–24.73%) obtained between the years 2021 and 2022, while the estimate saving in the second semester was –73,982 €. Conclusions: The training carried out by the EPA-HCC improves the knowledge of professionals, increases registrations and achieves an optimization of resources.(AU)

Fatores associados à prevalência de cicatrização de feridas crônicas em uma unidade de saúde da família / Factors associated with the prevalence of chronic wound healing in a family health unit / Factores asociados a la prevalencia de cicatrización de heridas crónicas en una unidad de salud familiar

Objetivo: analisar os fatores associados à prevalência de cicatrização em pacientes com feridas crônicas. Método: estudo transversal, em pacientes com feridas crônicas de uma Unidade de Saúde da Família, em Salvador, Bahia. Os dados foram coletados de fontes secundárias disponíveis na planilha de acompanhamento dos pacientes, analisando como desfecho os níveis de cicatrização das feridas crônicas. Resultados: foram verificadas diferenças estatisticamente significantes nas variáveis faixa etária e dor, em que a proporção de apresentar os piores índices de cicatrização foi 77,78% maior entre os pacientes adultos quando comparada aos idosos; e a proporção de apresentar os piores índices de cicatrização entre os pacientes com dor intensa/muito intensa foi 80% maior quando comparada aos pacientes sem dor. Conclusão: ficou evidente a importância de desenvolver estratégias voltadas ao estilo de vida, adesão ao tratamento, manejo da dor, bem como utilização de instrumentos qualitativos para avaliação dos fatores que possam interferir na cicatrização.

Objective: to analyze the factors associated with the prevalence of healing in patients with chronic wounds. Method: cross-sectional study, in patients with chronic wounds at a Family Health Unit, in Salvador, Bahia. Data were collected from secondary sources available in the patient monitoring spreadsheet, analyzing the healing levels of chronic wounds as the outcome. Results: statistically significant differences were found in the variable age group and pain, in which the proportion of those presenting the worst healing rates was 77.78% higher among adult patients when compared to the elderly; and the proportion of patients with intense/very intense pain presenting the worst healing rates was 80% higher when compared to patients without pain. Conclusion: the importance of developing strategies focused on lifestyle, adherence to treatment, pain management, as well as the use of qualitative instruments to evaluate factors that may interfere with healing.

Objetivos:analizar los factores asociados a la prevalencia de curación en pacientes con heridas crónicas. Método: estudio transversal, en pacientes con heridas crónicas en una Unidad de Salud de la Familia, en Salvador, Bahía. Los datos se recopilaron de fuentes secundarias disponibles en la hoja de seguimiento de pacientes, analizando como resultado los niveles de curación de las heridas crónicas. Resultados: se observaron diferencias estadísticamente significativas en las variables grupo de edad y dolor, siendo la proporción de quienes tuvieron peores tasas de curación 77,78% mayor entre los pacientes adultos en comparación con los ancianos; y la proporción de pacientes con dolor intenso/muy intenso que presentaron peores tasas de curación fue un 80% mayor en comparación con los pacientes sin dolor. Conclusión: se evidenció la importancia de desarrollar estrategias enfocadas en el estilo de vida, la adherencia al tratamiento, el manejo del dolor, así como el uso de instrumentos cualitativos para evaluar factores que puedan interferir en la curación.

Construção e validação de cartilha educativa sobre suporte básico de vida para estudantes do ensino médio / Construction and validation of an educational booklet on basic life support for high school students / Construcción y validación de carpeta educativa sobre soporte vital básico para estudiantes de secundaria

O objetivo deste estudo é construir e validar uma cartilha educativa para estudantes do ensino médio sobre Suporte Básico de Vida nas escolas. Trata-se de uma pesquisa metodológica, realizada em três etapas. Na primeira etapa foi realizada revisão bibliográfica, na segunda etapa procedeu-se a elaboração da cartilha educativa e por fim, a validação do material por especialistas. Entre os resultados destaca-se que a cartilha aborda as principais recomendações acerca da segurança do socorrista e suporte básico de vida no adulto e possui 14 páginas. Conclui-se que todos os itens da cartilha educativa obtiveram índice de validade de conteúdo maior que 0,82 conseguindo a validação.

The objective of this study is to build and validate an educational booklet for high school students about Basic Life Support in schools. This is a methodological research, carried out in three stages. In the first stage, a bibliographic review was carried out, in the second stage, the educational booklet was elaborated and, finally, the material was validated by specialists in the subject. Among the results, it is highlighted that the booklet addresses the main recommendations regarding rescuer safety and basic adult life support and has 14 pages. It was concluded that all items in the educational booklet had a content validity index greater than 0.82, achieving validation.

El objetivo de este estudio es construir y validar una cartilla educativa para estudiantes de secundaria sobre Soporte Vital Básico en las escuelas. Se trata de una investigación metodológica, realizada en tres etapas. En la primera etapa se realizó una revisión bibliográfica, en la segunda etapa se elaboró la cartilla educativa y, finalmente, el material fue validado por especialistas en el tema. Entre los resultados, se destaca que la cartilla aborda las principales recomendaciones sobre seguridad del reanimador y soporte vital básico del adulto y tiene 14 páginas. Se concluyó que todos los ítems de la cartilla educativa tuvieron un índice de validez de contenido superior a 0,82, lográndose la validación.

Validade e Confiabilidade do Instrumento Resultados Esperados da Avaliação da Cicatrização de Feridas Crônicas (Resvech 2.0) / Validity and Reliability of the Expected Results of the Evaluation of Chronic Wound Healing (Resvech 2.0) / Validez y Fiabilidad de los Resultados Esperados de la Evaluación de la Cicatrización Crónica de Heridas (Resvech 2.0)

Introdução:As feridas de difícil cicatrização incidem em uma problemática de saúde devido a sua elevada prevalência e etiologias multifatoriais. O tratamento se inicia na prescrição do agente terapêutico apropriado, sucedido do uso de instrumentos que permitam ao profissional documentar as avaliações da ferida. Objetivo: O estudo tem como objetivo avaliar a confiabilidade e validade da versão brasileira do instrumento RESVECH 2.0 no contexto das feridas de difícil cicatrização. Método: Realizou-se um estudo metodológico. Inicialmente, foi aplicada uma entrevista nos participantes com o intuito de estabelecer um perfil; após, foram realizadas as avaliações das feridas de difícil cicatrização de qualquer etiologia (n = 179) com os instrumentos RESVECH 2.0 e Pressure Ulcer Scale for Healing 3.0 (PUSH 3.0). Resultado: As propriedades psicométricas avaliadas foram a validade do construto convergente, confiabilidade interobservadores e consistência interna. A confiabilidade de consistência interna apresentou os valores de 0,561 e 0,535. A confiabilidade interobservadores apresentou um valor Kappa que varia entre 0,14 e 0,76 e um coeficiente de correlação intraclasse (ICC) de 0,87. Para a validade de construto convergente, foi aplicado o coeficiente de correlação de Spearman para os dados dos escores dos instrumentos RESVECH 2.0 e PUSH 3.0 (n = 150), coeficiente obtido foi igual a 0,717. Conclusão: Conclui-se que o instrumento demonstrou evidências de confiabilidade e validade.

Introduction:Wounds that are difficult to heal are a health problem due to their high prevalence and multifactorial etiologies. Treatment begins with the prescription of the appropriate therapeutic agent, followed by the use of instruments that allow the professional to document wound assessments. Objective: The study aims to evaluate the reliability and validity of the Brazilian version of the RESVECH 2.0 instrument in the context of difficult-to-heal wounds. Methods: A methodological study was carried out. Initially, participants were interviewed in order to establish a profile; then evaluations of difficult-to-heal wounds of any etiology (n = 179) were performed with RESVECH 2.0 and Pressure Ulcer Scale for Healing 3.0 (PUSH 3.0) instruments. Results: The psychometric properties evaluated were convergent construct validity, interobserver reliability and internal consistency. Internal consistency reliability showed the values of 0.561 and 0.535. Interobserver reliability showed a Kappa value ranging from 0.14 to 0.76 and an intraclass correlation coefficient (ICC) of 0.87. For convergent construct validity, Spearman's correlation coefficient was applied to RESVECH 2.0 and PUSH 3.0 scores (n = 150); the coefficient obtained was 0.717. Conclusion: It is concluded that the instrument showed evidence of reliability and validity.

Introducción:Las heridas de difícil cicatrización constituyen un problema de salud por su alta prevalencia y etiologías multifactoriales. El tratamiento comienza con la prescripción del agente terapéutico adecuado, seguido por el uso de instrumentos que permiten al profesional documentar la evaluación de la herida. Objetivo: El estudio pretende evaluar la fiabilidad y validez de la versión brasileña del instrumento RESVECH 2.0 en el contexto de heridas de difícil cicatrización. Método: Se realizó un estudio metodológico. Inicialmente, se aplicó una entrevista a los participantes para establecer un perfil; a continuación, se realizaron las evaluaciones de las heridas de difícil cicatrización de cualquier etiología (n = 179) con los instrumentos RESVECH 2.0 y Pressure Ulcer Scale for Healing 3.0 (PUSH 3.0). Resultados: Las propiedades psicométricas evaluadas fueron la validez de constructo convergente, la fiabilidad interobservador y la consistencia interna. La fiabilidad de la consistencia interna presentó los valores de 0,561 y 0,535. La fiabilidad interobservador presentó un valor Kappa que osciló entre 0,14 y 0,76 y un coeficiente de correlación intraclase (CCI) de 0,87. Para la validez de constructo convergente, se aplicó el coeficiente de correlación de Spearman a los datos de las puntuaciones de los instrumentos RESVECH 2.0 y PUSH 3.0 (n = 150); el coeficiente obtenido fue de 0,717. Conclusión: Se concluye que el instrumento mostró indicios de fiabilidad y validez.

Evidence-Based Pearls: How the Healthy Work Environment Effects Multidisciplinary Trauma Teams.

Trauma remains a leading cause of death among adults. Care of the trauma patient requires highly skilled trauma teams. Trauma care begins in the field, then presents to the emergency room, proceeds to intensive care in many cases, and finally reaches recovery and rehabilitation. For patients, it can be a long road. To be effective, multidisciplinary trauma teams must expertly drill and practice skills, communicate among team members in closed loops, make split decisions affecting patient outcomes, and see the care through to the end. Many disruptions during the course of providing trauma care can alter safe outcomes for patients. The American Association of Critical Care Nurses Six Essentials of the Healthy Work Environment are presented as a framework to provide excellence in trauma care, both for the patient and team members. The six essentials of a healthy work environment include skilled communication, true collaboration, effective decision-making, appropriate staffing, meaningful recognition, and authentic leadership.

Cuide, movimente, evite lesão por pressão no seu paciente: um relato de experiência / Care, move, avoid pressure injury in your patient: an experience report / Cuidar, mover, evitar lesiones por presión en su paciente: informe de una experiencia

Introdução: As lesões por pressão (LPP) correspondem a danos na pele ou em tecidos moles encobertos, geralmente em áreas de proeminências ósseas, ou associado ao uso de dispositivo médico ou outro tipo de artefato. Diante disso, a enfermeira deve desenvolver sua prática, baseada em evidências científicas e priorizar a prevenção da formação das lesões na pele. Objetivo: Relatar a experiência de estudantes de Enfermagem sobre o desenvolvimento de ações de promoção do cuidado seguro relacionado à prevenção de LPP em pacientes internados em um hospital público pediátrico na Bahia. Metodologia: Trata-se de um estudo de caráter descritivo, do tipo relato de experiência, realizado por seis estudantes de Enfermagem em um hospital estadual pediátrico localizado no estado da Bahia, no período de novembro 2022. Principais resultados: Percebeu-se que existem profissionais de enfermagem que possuem interesse em obter mais conhecimento sobre o assunto, porém ainda há lacunas de conhecimento por parte da equipe sobre alguns assuntos abordados, tais como a escala de Braden e a utilização do colchão caixa de ovo para todas as faixas etárias. Foi possível perceber que os passos para prevenir a lesão por pressão não são cumpridos por parte da equipe e isso pode dificultar a prevenção das lesões de forma efetiva. Conclusão: Recomenda-se, portanto, que as unidades assistenciais, juntamente com suas respectivas coordenadoras, realizem ações contínuas de educação permanente, a fim de contribuir para uma melhor qualificação profissional, promovendo, acima de tudo, a segurança do paciente.

Introduction: Pressure lesions (PPL) correspond to damage to the skin or covert soft tissue, usually in areas of bony prominence, or associated with the use of a medical device or other type of artifact. Therefore, nurses should develop their practice, based on scientific evidence and prioritize the prevention of skin lesion formation. Objective: To report the experience of nursing students on the development of actions to promote safe care related to the prevention of PPL in patients admitted to a pediatric public hospital in Bahia. Methodology: This is a descriptive study, of the type of experience report, conducted by six nursing students in a pediatric state hospital located in the state of Bahia, in the period of November 2022. Main results: It was noticed that there are nursing professionals who have an interest in obtaining more knowledge about the subject, but there are still gaps in knowledge on the part of the team on some subjects addressed, such as the Braden scale and the use of the egg box mattress for all age groups. It was possible to notice that the steps to prevent pressure injury are not met by the team and this can hinder the prevention of injuries effectively. Conclusion: It is recommended, therefore, that the care units, together with their respective coordinators, carry out continuous actions of continuing education, in order to contribute to a better professional qualification, promoting, above all, patient safety.

Introducción: Las lesiones por presión (LPP) corresponden a lesiones en la piel o tejidos blandos encubiertos, generalmente en zonas de prominencia ósea, o asociadas al uso de un dispositivo médico u otro tipo de artefacto. Por ello, el personal de enfermería debe desarrollar su práctica, basándose en la evidencia científica y priorizando la prevención de la formación de lesiones cutáneas. Objetivo: Relatar la experiencia de estudiantes de enfermería sobre el desarrollo de acciones para promover cuidados seguros relacionados a la prevención de PPL en pacientes internados en un hospital público pediátrico de Bahía. Metodología: Se trata de un estudio descriptivo, del tipo relato de experiencia, realizado por seis estudiantes de enfermería en un hospital público pediátrico localizado en el estado de Bahía, en el período de noviembre de 2022. Principales resultados: Se observó que hay profesionales de enfermería que tienen interés en obtener más conocimientos sobre el tema, pero todavía hay lagunas de conocimiento por parte del equipo en algunos temas abordados, como la escala de Braden y el uso del colchón caja de huevos para todos los grupos de edad. Se pudo notar que los pasos para prevenir lesiones por presión no son cumplidos por el equipo y esto puede dificultar la prevención de lesiones de forma efectiva. Conclusiones: Se recomienda, por lo tanto, que las unidades asistenciales, junto con sus respectivos coordinadores, realicen acciones continuas de formación continuada, con el fin de contribuir a una mejor cualificación profesional, promoviendo, sobre todo, la seguridad del paciente.

A segurança da pessoa em situação crítica vítima de trauma: intervenção de enfermagem especializada / The safety of people in critical situations who are victims of trauma: specialized nursing intervention

As lesões traumáticas acarretam graves consequências pessoais, familiares e sociais. A pessoa vê-se confrontada com mudanças significativas, e por vezes definitivas, da imagem corporal, da cognição, da mobilidade e da autonomia. É frequente alguns elementos da família alterarem o quotidiano e interromper a atividade laboral para cuidar da pessoa vítima de trauma. A sociedade vê-se privada de jovens e adultos em idades produtivas, pois é uma das principais causas de morte e incapacidade, o que implica custos muito significativos. Cuidar da pessoa em situação crítica vítima de trauma é desafiante e exige do enfermeiro a mobilização de conhecimentos e competências específicos nos diversos contextos. Ao longo deste percurso, o enfermeiro mestre em enfermagem na área de especialização à pessoa em situação crítica coloca à disposição da pessoa vítima de trauma, as suas capacidades de vigilância, de monitorização e de juízo e raciocínio clínico, respondendo aos apelos de cuidados manifestados que podem ser realizados de forma direta (manifestações verbais e/ou corporais) ou de forma indireta, através da monitorização, da vigilância e do suporte vital (alterações hemodinâmicas, entre outras). A segurança na prestação de cuidados de enfermagem especializados à pessoa em situação crítica vítima de trauma é determinante, pois a implementação de medidas e processos que visem a mitigação de eventos adversos trazem ganhos em saúde para a pessoa e família. A escolha desta temática teve na sua génese motivações pessoais e profissionais, constituindo-se uma estratégia para a aquisição e desenvolvimento de competências especializadas de enfermagem na área da pessoa em situação crítica. Foi escolhido o modelo de Dreyfus de aquisição de competências e seguida a linha de pensamento de Benner para a prática de enfermagem, pois realça a importância e a necessidade da experiência e do domínio das capacidades, tendo como objetivo a melhoria da prestação de cuidados. Foi determinante a realização de estágios em contexto de urgência e cuidados intensivos, para o desenvolvimento de diversas atividades com vista ao cumprimento dos objetivos propostos e a concretização das metas definidas pela Escola Superior de Enfermagem de Lisboa para este curso de mestrado, das metas enunciadas nos descritores de Dublin para o 2º ciclo de estudos e a aquisição das competências comuns e específicas de enfermeiro especialista na área da pessoa em situação crítica, definidas legalmente pela Ordem dos Enfermeiros.

Traumatic injuries have serious personal, family and social consequences. The person is faced with significant and sometimes definitive changes in body image, cognition, mobility and autonomy. It is common for some family members to change their daily lives and interrupt their work activities to take care of the trauma victim. Society is deprived of young people and adults of productive ages, as it is one of the main causes of death and disability, which implies very significant costs. Caring for a person in a critical situation who is a victim of trauma is challenging and requires nurses to mobilize specific knowledge and skills in different contexts. Along this path, the nurse with a master's degree in nursing in the area of specialization for the person in a critical situation makes available to the person who is a victim of trauma, their surveillance, monitoring and judgment and clinical reasoning skills, responding to the manifested care calls that they can be performed directly (verbal and/or bodily manifestations) or indirectly, through monitoring, surveillance and vital support (hemodynamic changes, among others). Safety in the provision of specialized nursing care to the person in a critical situation who is a victim of trauma is crucial, as the implementation of measures and processes aimed at mitigating adverse events bring health gains to the person and family. The choice of this theme had in its genesis personal and professional motivations, constituting a strategy for the acquisition and development of specialized nursing skills in the area of the person in critical situation. The Dreyfus model of skills acquisition was chosen and Benner's line of thought for nursing practice was followed, as it emphasizes the importance and need for experience and mastery of skills, with the objective of improving care delivery. It was crucial to carry out internships in an emergency and intensive care context, for the development of various activities with a view to fulfilling the proposed objectives and achieving the goals defined by Lisbon Higher School of Nursing for this master's course, the goals set out in the Dublin descriptors for the 2nd cycle of studies and the acquisition of common and specific skills of a specialist nurse in the area of the person in critical situation, legally defined by the Ordem dos Enfermeiros.

Modelo de aprendizaje basado en problemas (ABP-2×3): decisiones con evidencia en cuidados de heridas complejas / Problem-based learning (PBL-2x3) model: evidence based decision making in complex wound care

Introducción: El modelo ABP-2×3 integra técnicas de aprendizaje basado en problemas, uso de pensamiento crítico y práctica basada en evidencias, determinando un modelo de práctica óptimo para la toma de decisiones. Objetivos: a) Establecer un modelo de entrenamiento aprendizaje que permita orientar a las enfermeras hacia el análisis causal y clínico de cada problema o situación (pensamiento crítico), para facilitar la toma de decisiones basadas en la evidencia en el abordaje de heridas complejas; b) sentar las bases de actuación para que las enfermeras puedan trasladar esa sistemática metodológica a cualquier otra situación clínica en su ejercicio profesional, y c) determinar el nivel de satisfacción de los alumnos al utilizar este nuevo modelo formativo. Metodología: El desarrollo, implementación y evaluación del ABP-2×3 necesitó 4 fases: desarrollo de la situación clínica con preguntas clínicas para la toma de decisiones, organización metodológica, implementación (2 momentos/3 niveles) y evaluación (estudio de satisfacción cuantitativo-cualitativo). Resultados: Se impartió formación ABP-2×3 (virtual y presencial) a 1.112 enfermeras de toda España, obteniendo cuantitativamente Net Promoter Score de 80,25 (modalidad virtual) y 88,48 (presencial), y cualitativamente emergieron categorías relacionadas con metodología, pensamiento crítico, práctica basada en evidencias y conocimientos específicos. Conclusiones: El ABP-2×3, aplicado al cuidado de personas con heridas complejas, orienta la toma de decisiones basadas en evidencia, con alto grado de satisfacción de las enfermeras. Promueve el pensamiento crítico, la toma de decisiones basadas en evidencia y el desarrollo de competencias transversales, posibilitando que los participantes sean protagonistas de su propio aprendizaje. En definitiva, “aprendiendo a aprender” (AU)

Introduction: The ABP-2×3 model integrates problem-based learning techniques, use of critical thinking and evidence-based practice, resulting in an optimal Practice Decision-Making model. Objectives: a) establish a training-learning model to guide nurses towards causal and clinical case analysis of each problem or situation (critical thinking) to facilitate evidence based decision making in the management of complex wounds; b) lay the foundations for nurses to be able to transfer this systematic methodology to any other clinical situation in their professional practice; and c) determine the level of satisfaction of the students when using this new training model. Methodology: The development, implementation and evaluation of the ABP 2×3 required 4 phases: development of the clinical situation with clinical decision-making questions, methodological organization, implementation (2 moments/3 levels) and evaluation (quantitative qualitative satisfaction survey). Results: ABP-2×3 training (virtual and face-to-face) was provided to 1,112 nurses from all over Spain, with the following outcomes, quantitatively Net Promoter Score of 80.25 (virtual modality) and 88.48 (face-to-face), and qualitatively categories emerged related to methodology, critical thinking, evidence-based practice and specific knowledge. Conclusions: The ABP-2×3 applied to the care of people with complex wounds, guides evidence-based decision making, with a high degree of satisfaction among nurses. It promotes critical thinking, evidence based decision making and the development of transversal competencies, enabling participants to be the protagonists of their own learning. In essence, “learning how to learn” (AU)

Ozonioterapia como opção ao tratamento de lesões cutâneas em humanos: revisão integrativa da literatura / Ozone therapy as an option for the treatment of skin lesions in humans: an integrative literature review / La ozonoterapia como opción para el tratamiento de lesiones cutáneas en humanos: revisión bibliográfica integradora

Este trabalho teve como objetivo realizar uma revisão integrativa sobre a Ozonioterapia como prática complementar no tratamento de lesões em seres humanos. Efetuou-se busca sistematizada nos portais: Biblioteca virtual em saúde (BVS), Biblioteca virtual em saúde de medicinas tradicionais complementares e integrativas (BVS MTCI) e Business source complete (EBSCO) nas seguintes bases de dados: Literatura latino-americana e do caribe em ciências da saúde (LILACS), Base de dados de Enfermagem (BDENF) e Medical literature analysis and retrievel system Online (MEDLINE), com cruzamento dos descritores: ozônio; ferimentos; lesões; cicatrização de feridas. Após os critérios de inclusão serem aplicados, observou-se que dez artigos atingiram todos os critérios previamente definidos. Os estudos apontam que a Ozonioterapia apresenta resultados positivos como opção na terapêutica complementar de lesões. Porém, é um recurso terapêutico com baixa adesão. Faz se necessário maior empenho cientifico sobre a temática. PALAVRAS-CHAVE: Ozônio; Ferimentos; Lesões; Cicatrização de feridas.

Currently, there are several treatments as well as ozone therapy that aim to improve wounds. This work aimed to carry out an integrative review on Ozone Therapy as a complementary practice in the treatment of injuries in humans. A systematic search was conducted on the portals: Virtual Health Library (VHL), Virtual Health Library of Complementary and Integrative Traditional Medicines (VHL MTCI) and Business Source Complete (EBSCO) in the following databases: Latin American and Caribbean Literature in Health Science (LILACS) , Nursing Database (BDENF) and Online Medical Literature Review and Retrieval System (MEDLINE), by crossing descriptors: Ozone, Wounds and Injuries, Healing injuries. After the inclusion criteria were applied, it was observed that ten articles reached all the criteria previously defined. The studies indicate that Ozone therapy presents positive results as a complementary therapy option on wounds. However, it is a therapeutical resource with low adherence. It is necessary a greater scientific commitment on the theme.

Este trabajo tuvo como objetivo realizar una revisión integradora sobre la ozonoterapia como práctica complementaria en el tratamiento de lesiones en humanos. Se realizó una búsqueda sistemática en los siguientes portales: Biblioteca Virtual de Salud (BVS), Biblioteca Virtual de Salud de Medicinas Tradicionales, Complementarias e Integrativas (BVS MTCI) y Business Source Complete (EBSCO) en las siguientes bases de datos: Latin American and Caribbean Health Sciences Literature (LILACS), Nursing Database (BDENF) y Medical Literature Analysis and Retrieval System Online (MEDLINE), utilizando las palabras clave: ozono; heridas; lesiones; curación de heridas. Una vez aplicados los criterios de inclusión, se observó que diez artículos cumplían todos los criterios previamente definidos. Los estudios demostraron que la ozonoterapia tiene resultados positivos como opción terapéutica complementaria para las lesiones. Sin embargo, es un recurso terapéutico con un bajo cumplimiento. Es necesario un mayor esfuerzo científico sobre el tema.

Efecto de una asignatura optativa de heridas crónicas, en el grado de enfermería, sobre el conocimiento respecto a úlceras de etiología venosa. Proyecto de investigación / Effect of an optional subject about chronic wounds care in the nursing degree: evaluating knowledge regarding venous etiology ulcers. A research project

Objetivo: Evaluar la mejora del conocimiento respecto a úlceras de etiología venosa en estudiantes de grado de enfermería matriculados en una asignatura optativa específica sobre heridas crónicas. Metodología:Se realizará un estudio analítico cuasiexperimental. Asimismo, se efectuará un cuestionario ad hoc pre-post- postintervención con grupo control. La muestra estará compuesta por 365 estudiantes que hayan recibido la misma formación teórica y práctica de enfermería ajustada al curso en el que se encuentran. Como grupo control se encuentra el alumnado matriculado en el grado de enfermería de las sedes Donostia, Leioa y Vitoria de la Universidad del País Vasco/Euskal Herriko Unibertsitatea no matriculado en una asignatura específica en heridas crónicas. Como grupo intervención se encuentra el alumnado que esté matriculado en una asignatura optativa específica de heridas crónicas que incluye, entre sus contenidos teoricoprácticos, úlceras de etiología venosa. Se realizará un análisis descriptivo de las variables sociodemográficas, asociándolas mediante c2. Para valorar las diferencias observadas en el nivel de conocimientos se utilizará la prueba ANOVA de medidas repetidas si la variable tiene distribución normal, y el test de Friedman en caso contrario tras ser contrastada mediante la prueba Kolmogórov-Smirnov. Resultados: El diseño de este plan de investigación como trabajo fin de máster tiene su continuidad con la matriculación en un programa de doctorado en ciencias de la salud en la Universidad de Alicante (AU)

Objective: To evaluate the improvement of knowledge regarding ulcers of venous etiology in nursing students enrolled in an optional subject specific to chronic wound care. Methods:A quasi-experimental analytical study will be carried out. An ad hoc pre-post-post intervention questionnaire with a control group will be carried out. The sample will be made up of 365 students who have received the same theoretical and practical nursing training adjusted to the course they are in. The control group is made up of students enrolled in the nursing degree at the Donostia, Leioa and Vitoria campuses of the University of the Basque Country who are not enrolled in a specific subject on chronic wounds. The intervention group includes students enrolled in a specific elective course on chronic wounds that includes among its theoretical and practical content, venous leg ulcers. A descriptive analysis of the socio-demographic variables will be carried out, associating them by means of c2. To assess the differences observed in the level of knowledge, the repeated measures ANOVA test will be used if the variable has a normal distribution and the Friedman test otherwise after being contrasted by the Kolmogórov-Smirnov test (K-S). Results: The design of this research plan as a final master's degree project has its continuity with the enrolment in a doctoral programme in health sciences at the University of Alicante (AU)

Screening complications in the postoperative period of orthopedic surgeries by video arthroscopy

To analyze the prevalence and characteristics of late postoperative complications of orthopedic surgeries by video arthroscopy.This was a descriptive cross-sectional study that evaluated, through its own instrument, local and systemic postoperative complications of patients undergoing orthopedic surgeries by video arthroscopy. The study included 270 patients, who were evaluated on days 30(without prosthesis) and 90(with prosthesis placement) of the postoperative period, by telephone service. The selection of participants occurred sequentially and population-based, within the data collection period, from February to July 2020, in a large hospital for medium and high complexity surgeries. Of the 270 procedures performed in the period, 4.4% (n = 12) presented late postoperative infection. The most frequent complications were erythema (83%), edema (75%) and secretion (67%) in the surgical wound. Most used antibiotic therapy (92%) and anti-inflammatory drugs (67%). Hospital readmission was not necessary concerning the complications. Only 50% required medical evaluation before the scheduled time.The need for practices that ensure the quality of perioperative care and improve the active search to assess surgical outcomes is reinforced.

Efetividade da biocelulose na cicatrização de úlceras venosas / Effectiveness of biocellulosis in healing venous ulcers / Efectividad de la biocelulosis en la curación de las úlceras venosas

Introdução: Mais frequentes em pessoas do sexo masculino úlceras venosas, são um relevante problema de saúde pública e caracterizam-se por processo inflamatório decorrente de insuficiência venosa por estase, têm alta incidência e podem tornar-se crônicas exigindo curativos tecnológicos específicos e monitoramento inicial da lesão. O tratamento desses agravos requer curativos altamente tecnológicos, indicados para o leito de feridas crônicas. Objetivo: Avaliar o processo cicatricial de lesões por úlceras venosas a partir do uso da biocelulose, bem como o quadro de dor em pacientes com úlceras venosas, utilizando o instrumento Pressure Ulcer Scale for Healing (PUSH) e a Classificação dos Resultados de Enfermagem (NOC). Material e Método: Estudo descritivo, exploratório, observacional, prospectivo, quantitativo, obtido de pacientes com úlceras venosas, usuários de Unidades Básicas de Saúde. Os dados foram coletados semanalmente, de maio a agosto de 2021 e analisados através de instrumentos específicos para avaliação do processo cicatricial, contendo também as características sociográficas, o estado de saúde e a doença dos participantes. Resultados: Constatou-se a eficácia da biocelulose no processo de cicatrização das úlceras venosas pelos escores obtidos na escala de PUSH e na Classificação dos Resultados de Enfermagem (NOC). Conclusão: Os resultados destacam a importância do processo de enfermagem no estudo, realizado em sala especializada para feridas, permitindo assistência direcionada as necessidades dos clientes, além da ação de películas porosas que promoveram a diminuição da exsudação, inibição da dor, levando ao surgimento de novos tecidos de granulação e início da epitelização.(AU)

Introduction: Venous ulcers are more frequent in males, are a relevant public health problem and are characterized by an inflammatory process resulting from venous insufficiency by stasis, have a high incidence and can become chronic, requiring specific technological dressings and initial monitoring of the lesion. The treatment of these diseases requires highly technological dressings, indicated for the bed of chronic wounds. Objective: To evaluate the healing process of lesions caused by venous ulcers using biocellulose, as well as the pain in patients with venous ulcers, using the Pressure Ulcer Scale for Healing (PUSH) instrument and the Nursing Outcomes Classification (NOC). Material and Method: Descriptive, exploratory, observational, prospective, quantitative study, obtained from patients with venous ulcers, users of Basic Health Units. Data were collected weekly, from May to August 2021 and analyzed using specific instruments to assess the healing process, also containing the sociographic characteristics, health status and disease of the participants. Results: The effectiveness of biocellulose in the healing process of venous ulcers was verified by the scores obtained in the PUSH scale and in the Nursing Outcomes Classification (NOC). Conclusion: The results highlight the importance of the nursing process in the study, carried out in a specialized room for wounds, allowing assistance directed to the needs of clients, in addition to the action of porous films that promoted the reduction of exudation, inhibition of pain, leading to the emergence of new granulation tissues and beginning of epithelialization.(AU)

Introducción: Más frecuentes en el sexo masculino, las úlceras venosas constituyen un problema de salud pública relevante y se caracterizan por un proceso inflamatorio derivado de la insuficiencia venosa por estasis, tienen una alta incidencia y pueden cronificarse requiriendo apósitos tecnológicos específicos y seguimiento de la lesión inicial. El tratamiento de estas condiciones requiere apósitos de alta tecnología, indicados para el lecho de heridas crónicas. Objetivo: Evaluar el proceso de curación de las lesiones causadas por úlceras venosas utilizando biocelulosa, así como el dolor en pacientes con úlceras venosas, utilizando el instrumento Pressure Ulcer Scale for Healing (PUSH) y la Clasificación de Resultados de Enfermería (NOC). Material y Método: Estudio descriptivo, exploratorio, observacional, prospectivo, cuantitativo, obtenido de pacientes con úlcera venosa, usuarios de Unidades Básicas de Salud. Los datos fueron recolectados semanalmente, de mayo a agosto de 2021 y analizados utilizando instrumentos específicos para evaluar el proceso de cicatrización, conteniendo además las características sociográficas, estado de salud y enfermedad de los participantesResultados: Se constató la efectividad de la biocelulosa en el proceso de cicatrización de úlceras...(AU)