Validación clínica de la propuesta diagnóstica de enfermería de sed perioperatoria / Clinical validation of the nursing diagnostic proposition perioperative thirst / Validação clínica da proposição diagnóstica de enfermagem sede perioperatória

Objetivo: verificar la validez clínica de la proposición de un nuevo diagnóstico de enfermería denominado sed perioperatoria, basado en la precisión diagnóstica de sus indicadores clínicos, incluyendo la magnitud del efecto de sus factores etiológicos. Método: estudio de validación clínica diagnóstica con 150 pacientes quirúrgicos en un hospital universitario. Se recogieron variables sociodemográficas e indicadores clínicos relacionados con la sed. Se utilizó la técnica de análisis de clases latentes. Resultados: se propusieron dos modelos de clases latentes para las características definitorias. El modelo ajustado en el preoperatorio incluía: labios resecos, saliva espesa, lengua espesa, ganas de beber agua, informe del cuidador, garganta seca y deglución constante de saliva. En el postoperatorio: sequedad de garganta, saliva espesa, lengua espesa, constante deglución de saliva, ganas de beber agua, mal gusto en la boca. Los factores relacionados "temperatura ambiente elevada" y "sequedad de boca" se asocian a la presencia de sed, así como las condiciones asociadas "uso de anticolinérgicos" e "intubación". La prevalencia de sed fue del 62,6% en el preoperatorio y del 50,2% en el postoperatorio inmediato. Conclusión: la proposición diagnóstica de la sed perioperatoria mostró buenos parámetros de precisión de sus indicadores clínicos y efectos etiológicos. Esta propuesta en una taxonomía de enfermería permitirá una mayor visibilidad, apreciación y tratamiento de este síntoma.

Objective: to verify the clinical validity of the proposition of a new nursing diagnosis called perioperative thirst, based on the diagnostic accuracy of its clinical indicators, including the magnitude of effect of its etiological factors. Method: clinical diagnostic validation study with a total of 150 surgical patients at a university hospital. Sociodemographic variables and clinical indicators related to thirst were collected. The latent class analysis technique was used. Results: two models of latent classes were proposed for the defining characteristics. The model adjusted preoperatively included: dry lips, thick saliva, thick tongue, desire to drink water, caregiver report, dry throat and constant swallowing of saliva. In the postoperative period: dry throat, thick saliva, thick tongue, constant swallowing of saliva, desire to drink water, bad taste in the mouth. The factors related to "high ambient temperature" and "dry mouth" are associated with the presence of thirst, as well as the associated conditions "use of anticholinergics" and "intubation". The prevalence of thirst was 62.6% in the pre and 50.2% in the immediate postoperative period. Conclusion: the diagnostic proposition of perioperative thirst showed good accuracy parameters for its clinical indicators and etiological effects. This proposition in a nursing taxonomy will allow greater visibility, appreciation and treatment of this symptom.

Objetivo: verificar a validade clínica da proposição de um novo diagnóstico de enfermagem denominado sede perioperatória, com base na acurácia diagnóstica de seus indicadores clínicos, incluindo a magnitude de efeito de seus fatores etiológicos. Método: estudo de validação clínica diagnóstica com 150 pacientes cirúrgicos em um hospital universitário. Foram coletadas variáveis sociodemográficas e indicadores clínicos relacionados à sede. Empregou-se a técnica de análise de classe latente. Resultados: dois modelos de classes latentes foram propostos para as características definidoras. O modelo ajustado no pré-operatório incluiu: lábios ressecados, saliva grossa, língua grossa, vontade de beber água, relato do cuidador, garganta seca e constante deglutição de saliva. No pós-operatório: garganta seca, saliva grossa, língua grossa, constante deglutição de saliva, vontade de beber água, gosto ruim na boca. Os fatores relacionados Temperatura do ambiente elevada e Boca seca estão associados à presença de sede, assim como as condições associadas Utilização de anticolinérgicos e Intubação. A prevalência de sede foi de 62,6% no pré-operatório e 50,2% no pós-operatório imediato. Conclusão: a proposição diagnóstica de sede perioperatória apresentou bons parâmetros de acurácia de seus indicadores clínicos e efeitos etiológicos. Essa proposição em uma taxonomia de enfermagem permitirá maior visibilidade, valorização e tratamento desse sintoma.

Clinical validation of the nursing diagnostic proposition perioperative thirst. / Validación clínica de la propuesta diagnóstica de enfermería de sed perioperatoria.

OBJECTIVE: to verify the clinical validity of the proposition of a new nursing diagnosis called perioperative thirst, based on the diagnostic accuracy of its clinical indicators, including the magnitude of effect of its etiological factors. METHOD: clinical diagnostic validation study with a total of 150 surgical patients at a university hospital. Sociodemographic variables and clinical indicators related to thirst were collected. The latent class analysis technique was used. RESULTS: two models of latent classes were proposed for the defining characteristics. The model adjusted preoperatively included: dry lips, thick saliva, thick tongue, desire to drink water, caregiver report, dry throat and constant swallowing of saliva. In the postoperative period: dry throat, thick saliva, thick tongue, constant swallowing of saliva, desire to drink water, bad taste in the mouth. The factors related to "high ambient temperature" and "dry mouth" are associated with the presence of thirst, as well as the associated conditions "use of anticholinergics" and "intubation". The prevalence of thirst was 62.6% in the pre and 50.2% in the immediate postoperative period. CONCLUSION: the diagnostic proposition of perioperative thirst showed good accuracy parameters for its clinical indicators and etiological effects. This proposition in a nursing taxonomy will allow greater visibility, appreciation and treatment of this symptom.(1) Evaluates the accuracy of the proposition of the nursing diagnosis perioperative thirst; (2) Allows refined diagnosis for use in clinical practice, teaching and research; (3) Strengthens the systematization of perioperative nursing care; (4) Highlights thirst management as part of care, considering its high prevalence and discomfort; (5) Presents a structure with good accuracy parameters which are representative of thirst.

Implementation of the thirst management model in the burn unit guided by knowledge translation.

OBJECTIVE: To implement the preoperative Thirst Management Model, measuring its adoption, coverage, acceptability, feasibility and fidelity by nursing in a burn unit. METHOD: Quasi-experimental, pre- and post-test intervention study. Sample of 59 patients at pre-implementation and 40 post-implementation and 36 nursing professionals participating in the implementation in a burn unit from August (2019) to March (2020). Statistical analysis used Mann-Whitney and Chi-square. RESULTS: Adoption of management ranged from 0.0% to 72.5% post-implementation. The capacity coverage was 87.5% of nurses and 87.9% of nursing technicians. There was acceptability and feasibility of thirst management by professionals. In the plan-do-study-act cycles, three pillars of the Model reached the goals, showing fidelity. CONCLUSION: The implantation of the Preoperative Thirst Management Model had acceptability and feasibility by the nursing team, showing fidelity in achieving the proposed goals, in addition to the adoption of evidence in clinical practice after high coverage professional training.

Process of implementing thirst management in surgical burned patients, based on knowledge translation / Proceso de implementación del manejo de la sed en pacientes quirúrgicos con quemaduras, sobre la base de knowledge translation / Processo de implantação do manejo da sede no paciente queimado cirúrgico embasado no knowledge translation

ABSTRACT Objective: to report the path taken to implement the Thirst Management Model using the Knowledge Translation Evidence-based Practice for Improving Quality intervention in a Burn unit. Method: an experience report on the implementation, which took place in two stages: Preparation; and Implementation/Change, both requiring a sequence of steps. Results: the implementation was performed in four cycles of the PDSA improvement tool. All had the same indicator collected, with increasing goals to be attained. Considering the barriers identified, multiple combined Knowledge Translation strategies were used, namely: posters; theoretical and practical training sessions, individual or in group; videos; dynamics; music; logo development for implementation visibility; audit and feedback; and didactic and illustrated clinical protocols. Conclusion: the report of the entire implementation process using the Evidence-based Practice for Improving Quality intervention, pointing out its weaknesses and strengths, proves to be useful, necessary and innovative. This study may assist in future evidence-based implementations that choose to use multifaceted interventions.

RESUMEN Objetivo: informar el camino recorrido para implementar el Modelo de Manejo de la Sed recurriendo a la intervención Knowledge Translation llamada Evidence-based Practice for Improving Quality (Práctica Basada en Evidencia para Mejorar la Calidad) en una unidad especializada en Quemaduras. Método: informe de experiencia sobre la implementación, que tuvo lugar en dos etapas: Preparación e Implantación/cambio, ambas obedeciendo una secuencia de pasos para su realización. Resultados: la implementación se realizó en cuatro ciclos de la herramienta de mejoras PDSA. En todos los ciclos se recolectó el mismo indicador, con metas crecientes por alcanzar. Considerando las barreras identificadas, se utilizaron múltiples estrategias combinadas de Knowledge Translation, a saber: posters; sesiones de capacitación teóricas y prácticas, individuales o en grupo, videos, dinámicas, música, desarrollo de un logotipo para conferir visibilidad a la implementación; auditoría y feedback; y protocolos clínicos didácticos e ilustrados. Conclusión: el informe de la totalidad del proceso de implementación recurriendo a la intervención Evidence-based Practice for Improving Quality, incluso señalando sus debilidades y puntos fuertes, demuestra que es útil, necesaria e innovadora. Este estudio pode auxiliar futuras implementaciones de evidencias que decidan utilizar intervenciones multifacéticas.

RESUMO Objetivo: Relatar o caminho percorrido para a implantação do Modelo de Manejo da Sede com o uso da intervenção de Knowledge Translation Evidence-based Practice for Improving Quality (Prática Baseada em Evidência para a Melhoria do Processo de Qualidade) em uma unidade de queimados. Método: Relato de experiência sobre a implantação que ocorreu em duas etapas: Preparação e Implantação/ mudança, ambas obedecendo uma sequência de passos para sua realização. Resultados: A implementação foi realizada em quatro ciclos da ferramenta de melhoria PDSA. Todos tiveram o mesmo indicador coletado, com metas crescentes a serem alcançadas. Considerando as barreiras identificadas, utilizaram-se múltiplas estratégias combinadas de Knowledge Translation: cartazes, capacitações teóricas e práticas, individuais ou em grupo, vídeos, dinâmicas, músicas, desenvolvimento de logo para visibilidade da implantação, auditoria e feedback, protocolos clínicos didáticos e ilustrados. Conclusão: O relato de todo o processo de implantação com o uso da intervenção Evidence-based Practice for Improving Quality, apontando suas fragilidades e fortalezas, mostra-se útil, necessária e inovador. Este estudo pode auxiliar futuras implantações de evidências que escolham utilizar intervenções multifacetadas.

Prevalência das características definidoras da proposição diagnóstica de enfermagem de sede perioperatória / Prevalence of defining characteristics of the proposed nursing diagnosis of perioperative thirst / Prevalencia de características definitorias de la propuesta diagnóstica de enfermería de sed perioperatoria

Objetivo: avaliar a prevalência das características definidoras da proposição diagnóstica sede perioperatória, comparando-as no período pré e pós-operatório imediato. Método: estudo quantitativo realizado em um hospital universitário de grande porte no norte do Paraná, no período de dezembro de 2019 à janeiro de 2020, com 150 pacientes. Resultados: A média do tempo de jejum foi de 13 horas (±5:11). Apresentaram sede no pré-operatório 69,3% dos pacientes e 81,3% no pós-operatório; intensidade média de 4,62 (±3,6) e 5,67 (±3,53). A característica definidora mais relatada nos dois períodos foi boca seca (75,3%-86,7%), seguida por lábios ressecados (71,3%-82,7%); vontade de beber água (64%-72,7%); constante deglutição de saliva (62,7%-70%); garganta seca (58%-72%); saliva grossa (48,7%-53,4%); língua grossa (46%-54,7%); gosto ruim na boca (41%-46%); relato do cuidador (0,7%-0%). Conclusão: houve alta prevalência e intensidade da sede em ambos os períodos avaliados; cinco das nove características definidoras apresentaram diferença significativa entre os dois momentos avaliados.

Objective: to evaluate the prevalence of defining characteristics of the proposed diagnosis perioperative thirst, as compared between the pre- and immediate postoperative period. Method: this quantitative study was conducted with 150 patients at a large university hospital in northern Paraná, from December 2019 to January 2020. Results: mean fasting time was 13 hours (±5:11). 69.3% of the patients presented thirst preoperatively and 81.3%, in the postoperative period; mean intensity was 4.62 (±3.6) and 5.67 (±3.53). The most frequently reported defining characteristic in both periods was dry mouth (75.3%- 86.7%), followed by dry lips (71.3%-82.7%); desire to drink water (64%-72.7%); constant swallowing of saliva (62.7%-70%); dry throat (58%-72%); thick saliva (48.7%-53.4%); thick tongue (46%-54.7%); bad taste in the mouth (41%-46%); caregiver's report (0.7%-0%). Conclusion: prevalence and intensity of thirst were high in both periods evaluated; five of the nine defining characteristics differed significantly between the periods.

Objetivo: evaluar la prevalencia de las características definitorias de la propuesta diagnóstica sed perioperatoria, comparándolas en el periodo pre y postoperatorio inmediato. Método: estudio cuantitativo realizado em un hospital universitario de gran porte en el norte de Paraná, de diciembre de 2019 a enero de 2020 junto a 150 pacientes. Resultados: el tiempo medio de ayunas fue de 13 horas (±5:11). El 69,3% de los pacientes presentó sed en el preoperatorio y el 81,3% en el postoperatorio; la intensidad media fue de 4,62 (±3,6) y 55,67 (±3,53). La característica definitoria notificada con mayor frecuencia en ambos períodos fue boca seca (75,3%-86,7%), seguida de labios resecos (71,3% - 82,7%); deseo de tomar agua (64% - 72,7%); deglución constante de saliva (62,7%-70%); garganta seca (58%-72%); saliva espesa (48,7%-53,4%); lengua gruesa (46%-54,7%); sabor desagradable en la boca (41%-46%); informe del cuidador (0,7%-0%) Conclusión: hubo alta prevalencia e intensidad de sed en ambos periodos evaluados; cinco de las nueve características definitorias mostraron una diferencia significativa entre los dos momentos evaluados.

Beyond the Centrality of Shame: How Self-Concealment and Fear of Receiving Compassion From Others Impact Psychological Suffering in Transgender Adults.

Shame-based social interactions are a minority social stressor commonly experienced by transgender individuals. However, few studies have explored the centrality of shame experiences in transgender identity and mental health. Also, the ability to receive care and soothing support may be influenced by intrapersonal shame- and fear-related factors, which may hinder openness, and support and care seeking, thus contributing to psychological distress. This study aims to examine the relationship between central shame experiences, fear of receiving compassion from others, self-concealment, and psychological distress (depression, anxiety, and stress symptoms) in a sample of Portuguese transgender adults. Following a cross-sectional design, data from a convenience sample of 70 self-identified transgender individuals undergoing gender-affirming medical interventions (GAMIs) were analyzed, using SPSS PROCESS, to determine whether the relationship between central shame experiences and psychological suffering occurred indirectly through fear of receiving compassion from others, and self-concealment. Results suggest that fear of receiving compassion from others, but not self-concealment, was the underlying factor between central shame experiences, and depression and anxiety. Results suggest that the centrality of shame experiences and stress symptomatology associate sequentially through fear of compassion and, in turn, through self-concealment. Clinical implications for mental health interventions with transgender individuals undergoing GAMI are discussed.

Effects of carbohydrate use on preoperative thirst: a randomized clinical trial.

OBJECTIVES: to evaluate the effectiveness of carbohydrate popsicles, carbohydrate solution, and usual care (fasting) on the intensity and discomfort of preoperative thirst. METHODS: a randomized clinical trial with 60 preoperative patients aged between 18 and 60 years, randomized into three groups: control (fasting), carbohydrate solution (100 ml), and carbohydrate popsicle (100 ml). The outcomes were thirst intensity and discomfort. RESULTS: there was a difference between groups for final thirst intensity (p = 0.01) and final thirst discomfort (p = 0.001). The effect size for both the Solution Group and the Popsicle Group was robust: 0.99 and 1.14, respectively. CONCLUSIONS: the groups that received the carbohydrate fasting abbreviation showed a reduction in thirst discomfort compared to the control group. The carbohydrate popsicle proved more effective in reducing the intensity of thirst. NCT: 3.209.283.

Jejum pós-operatório prolongado: um problema negligenciado / Ayuno postoperatorio prolongado: un problema negligenciado / Prolonged postoperative fasting: a neglected problem

RESUMO Objetivo: analisar o tempo de jejum e tipo de dieta prescrita para reintrodução alimentar no pós-operatório de diferentes especialidades cirúrgicas. Método: estudo quantitativo, retrospectivo, documental e descritivo dos prontuários de pacientes cirúrgicos, com amostra randomizada e estratificada de 464 pacientes, realizado em hospital universitário público de grande porte no Paraná. Realizou-se análise estatística descritiva, apresentando medidas de tendência central e seus intervalos de confiança. Resultados: a média de jejum pós-operatório foi de 9:54h (DP: 6:89), variando de 8 a 30 horas. As clínicas que apresentaram maior tempo de jejum foram cirurgia cardíaca, cirurgia torácica e neurocirurgia, com médias de 18:25h, 14:45h e 12:22h, respectivamente. Quanto à prescrição de dieta no pós-operatório imediato, 51,3% dos pacientes receberam dieta geral, 15,3% dieta leve e 11,9% mantiveram jejum nas primeiras 24 horas após o procedimento cirúrgico. Conclusão: o tempo de jejum encontrado nessa instituição excede as atuais recomendações de protocolos nacionais e internacionais, o que implica aumento de desconfortos para o paciente cirúrgico, como sede, fome e estresse, além da insatisfação com o serviço prestado pela equipe de saúde.

RESUMEN Objetivo: analizar el tiempo de ayuno y tipo de dieta prescrita para la reintroducción alimentaria postoperatoria de diferentes especialidades quirúrgicas. Método: estudio cuantitativo, retrospectivo, documental y descriptivo de historias clínicas de pacientes quirúrgicos, con una muestra aleatorizada y estratificada de 464 pacientes, realizada en un gran hospital universitario público de Paraná. Se realizó análisis estadístico descriptivo, presentando medidas de tendencia central y sus intervalos de confianza. Resultados: el ayuno postoperatorio medio fue de 9: 54h (DP: 6:89), con un rango de 8 a 30 horas. Las clínicas que mostraron mayor tiempo de ayuno fueron cirugía cardíaca, cirugía torácica y neurocirugía, con medias de 18: 25h, 14: 45h y 12: 22h, respectivamente. En cuanto a la prescripción de dieta en el postoperatorio inmediato, el 51,3% de los pacientes recibió dieta general, el 15,3% dieta ligera y el 11,9% ayuno durante las primeras 24 horas posteriores al procedimiento quirúrgico. Conclusión: el tiempo de ayuno encontrado en esta institución supera las recomendaciones vigentes de los protocolos nacionales e internacionales, lo que implica un aumento de las molestias para el paciente quirúrgico, como sed, hambre y estrés, además de insatisfacción con el servicio brindado por el equipo de salud.

ABSTRACT Objective: to analyze the fasting time and type of the diet prescribed for the food reintroduction during the postoperative period of different surgical specialties. Method: this is a quantitative, retrospective, documentary, and descriptive study with medical records of surgical patients. The study had a randomized and stratified sample with 464 patients carried out in a large public university hospital in Paraná. We performed a descriptive statistical analysis, presenting measures of central tendency and their confidence intervals. Results: the mean post-operative fasting was 9:54 hours (SD: 6:89), ranging from 8 to 30 hours. The cardiac surgery, thoracic surgery, and neurosurgery were the clinics that presented the longest fasting time with averages of 18:25, 14:45, and 12:22 hours, respectively. Regarding the diet prescription in the immediate postoperative period, 51.3% of the patients received a general diet, 15.3% a light diet, and 11.9% fasted for the first 24 hours after the surgical procedure. Conclusion: the fasting time found in this institution exceeds the current recommendations of national and international protocols, showing an increase in discomfort for the surgical patient such as thirst, hunger, and stress, in addition to dissatisfaction with the service provided by the health team.

Manejo da sede: perspectiva do paciente cirúrgico queimado / Thirst management: perspective of burnt surgical patient

Objetivo: explorar a percepção de um paciente cirúrgico queimado em relação à sede e seu manejo no período pré-operatório e pós-operatório imediato. Relato de caso: trata-se de um estudo com abordagem qualitativa, exploratória, do tipo estudo de caso. Os critérios de inclusão foram: paciente estar internado no centro de tratamento de queimados, ser submetido a procedimento cirúrgico ou balneoterapia, ter experenciado a sede no período pré-operatório ou pós-operatório e ter recebido o manejo da sede. Para a coleta de dados utilizou-se entrevista semiestruturada, gravada e transcrita. Paciente do sexo feminino, de 32 anos, admitida com queimaduras de segundo grau em extensão de tórax, membros superiores e pescoço por tentativa de autoextermínio com álcool. Passou por seis procedimentos e esteve internada por 15 dias até o momento da coleta. Experienciou o desconforto sede durante o jejum pré-operatório e pós-operatório, considerado intenso e muito estressante durante sua internação. Conclusão: a partir da identificação do desconforto sede, utilizou-se como estratégia o picolé de gelo, que fez diferença em seu tratamento. O modelo de manejo da sede é pioneiro no cuidado ao paciente queimado e apresenta benefícios para minorar a sede.

Objective: explore thirst perception of a burnt surgical patient and its management in the preoperative and immediate postoperative period. Case report: study with a qualitative and exploratory approach, named as case study. Inclusion criteria were: inpatient at burnt treatment unit, undergone surgical procedure or balneotherapy, experienced thirst in the preoperative or postoperative period and received thirst management. For data collection, semi-structured interviews were performed, recorded and transcribed. Female patient, 32 years old, admitted with second degree burns in extension of thorax, upper limbs and neck due to attempted self-extermination with alcohol. Underwent six procedures and was hospitalized for 15 days until the data collection. Experienced thirst discomfort during preoperative and postoperative fasting, which was considered intense and very stressful during his hospitalization. Conclusion: since the identification of thirst discomfort, the ice popsicle was used as a strategy, which made difference in her treatment. The thirst management model is pioneer in care of burnt patients and has benefits to alleviate thirst.

Effects of carbohydrate use on preoperative thirst: a randomized clinical trial / Efectos de la utilización del carbohidrato sobre la sed en el preoperatorio: ensayo clínico randomizado / Efeitos da utilização do carboidrato sobre a sede no pré-operatório: ensaio clínico randomizado

ABSTRACT Objectives: to evaluate the effectiveness of carbohydrate popsicles, carbohydrate solution, and usual care (fasting) on the intensity and discomfort of preoperative thirst. Methods: a randomized clinical trial with 60 preoperative patients aged between 18 and 60 years, randomized into three groups: control (fasting), carbohydrate solution (100 ml), and carbohydrate popsicle (100 ml). The outcomes were thirst intensity and discomfort. Results: there was a difference between groups for final thirst intensity (p = 0.01) and final thirst discomfort (p = 0.001). The effect size for both the Solution Group and the Popsicle Group was robust: 0.99 and 1.14, respectively. Conclusions: the groups that received the carbohydrate fasting abbreviation showed a reduction in thirst discomfort compared to the control group. The carbohydrate popsicle proved more effective in reducing the intensity of thirst. NCT: 3.209.283

RESUMEN Objetivos: evaluar efectividad del polo de carbohidrato, solución de carbohidrato y cuidado usual (ayuno) sobre la intensidad e incomodidad de sed en el preoperatorio. Métodos: ensayo clínico randomizado, con 60 pacientes en el preoperatorio, edad entre 18 y 60 años, randomizados en tres grupos: control (ayuno); solución de carbohidrato (100 ml); polo de carbohidrato (100 ml). Los desfechos fueron la intensidad e incomodidad de sed. Resultados: hubo diferencia entre los grupos cuanto a la intensidad final de sed (p = 0,01) e incomodidad final de sed (p = 0,001). El tamaño del efecto tanto para el Grupo Solución cuanto para el Grupo Polo fue fuerte: 0,99 y 1,14, respectivamente. Conclusiones: los grupos que recibieron la abreviación del ayuno con carbohidrato presentaron reducción en la incomodidad de sed cuando comparados al grupo-control. El polo de carbohidrato se mostró más efectivo en la reducción de la intensidad de la sed. NCT: 3.209.283

RESUMO Objetivos: avaliar a efetividade do picolé de carboidrato, solução de carboidrato e cuidado usual (jejum) sobre a intensidade e desconforto da sede no pré-operatório. Métodos: ensaio clínico randomizado, com 60 pacientes no pré-operatório, idade entre 18 e 60 anos, aleatorizados em três grupos: controle (jejum); solução de carboidrato (100 ml); picolé de carboidrato (100 ml). Os desfechos foram a intensidade e o desconforto da sede. Resultados: houve diferença entre os grupos quanto à intensidade final da sede (p = 0,01) e ao desconforto final da sede (p = 0,001). O tamanho do efeito tanto para o Grupo Solução quanto para o Grupo Picolé foi forte: 0,99 e 1,14, respectivamente. Conclusões: os grupos que receberam a abreviação do jejum com carboidrato apresentaram redução no desconforto da sede quando comparados ao grupo-controle. O picolé de carboidrato mostrou-se mais efetivo na redução da intensidade da sede. NCT: 3.209.283

Prevalência e intensidade da sede de crianças no pós-operatório imediato / Prevalencia e intensidad de la sed de niños en el posoperatorio inmediato / Prevalence and thirst intensity in children in the immediate postoperative period

Resumo Objetivo Identificar a prevalência e intensidade da sede de crianças no pós-operatório imediato e seus fatores associados. Métodos Estudo transversal e analítico. A amostra consistiu-se de 78 crianças de quatro a doze anos em sala de recuperação anestésica no pós-operatório imediato. A presença de sede, bem como seus atributos e sinais foi identificada por questionamento da pesquisadora e/ou autorrelato da criança e seu cuidador. A intensidade de sede foi mensurada por meio da escala de faces. As variáveis desfecho foram presença e intensidade da sede. A razão de prevalência foi calculada por regressão de Poisson, com variância robusta. Resultados A prevalência de sede foi de 88,5% sendo que 39,7% referiram sede no pós-operatório e 48,7% desde o pré-operatório. Quanto à intensidade, 20,5% referiram sede forte e 37,2 % sede intensa. Adicionalmente, mais da metade das crianças (59%) a verbalizou de forma espontânea. Os fatores associados à maior intensidade da sede foram: sexo feminino (RP=1,27); queixa espontânea (RP=1,29); referir sensação de boca seca (RP=1,93) e de saliva grossa (RP=1,43); a idade apresentou associação inversa com a intensidade da sede, ou seja, quanto menor a idade, maior a intensidade da sede (beta= -0,053; p=0,01). Conclusão A sede na criança cirúrgica apresenta elevada prevalência e intensidade. A criança é capaz de identificar os sinais relacionados à sede e a verbaliza espontaneamente. Sexo, queixa espontânea, idade, boca seca e saliva grossa apresentaram associação com a intensidade. Estes resultados sinalizam a necessidade de intervenções intencionais para reduzir a sede da criança na prática clínica.

Resumen Objetivo Identificar la prevalencia e intensidad de la sed de niños en el posoperatorio inmediato y los factores asociados. Métodos Estudio transversal y analítico. La muestra fue formada por 78 niños de 4 a 12 años en sala de recuperación anestésica en el posoperatorio inmediato. La presencia de sed, así como sus atributos y señales, fue identificada mediante cuestionario de la investigadora o autorrelato del niño y su cuidador. La intensidad de la sed fue medida mediante escala de expresiones faciales. Las variables de resultado fueron presencia e intensidad de la sed. La razón de prevalencia fue calculada por regresión de Poisson, con varianza robusta. Resultados La prevalencia de sed fue del 88,5 %, de los cuales el 39,7 % relató sed en el posoperatorio y el 48,7 % desde el preoperatorio. Con relación a la intensidad, el 20,5 % relató sed fuerte y el 37,2 % sed intensa. Además, más de la mitad de los niños (59 %) la verbalizó de forma espontánea. Los factores asociados con una mayor intensidad de sed fueron: sexo femenino (RP=1,27), queja espontánea (RP=1,29), relatar sensación de boca seca (RP=1,93) y de saliva espesa (RP=1,43), la edad presentó asociación inversa respecto a la intensidad de la sed, es decir, cuanto menor la edad, mayor la intensidad de la sed (beta= -0,053; p=0,01). Conclusión La sed en niños quirúrgicos presenta una elevada prevalencia e intensidad. Los niños son capaces de identificar las señales relacionadas con la sed y la verbalizan espontáneamente. Sexo, queja espontánea, edad, boca seca y saliva espesa presentan asociación con la intensidad. Estos resultados indican la necesidad de intervenciones intencionales para reducir la sed de los niños en la práctica clínica.

Abstract Objective To identify the prevalence and thirst intensity in children in the immediate postoperative period and its associated factors. Methods This is a cross-sectional and analytical study. The sample consisted of 78 children aged four to twelve years in the post-anesthesia care unit in the immediate postoperative period. Thirst presence, as well as its attributes and signs, were identified by questioning by the researcher and/or self-report of children and their caregivers. Thirst intensity was measured using the face scale. The outcome variables were thirst presence and intensity. Prevalence ratio was calculated by Poisson regression, with robust variance. Results The prevalence of thirst was 88.5%, with 39.7% reporting thirst in the postoperative period and 48.7% since the preoperative period. As for the intensity, 20.5% reported strong thirst and 37.2% intense thirst. Additionally, more than half of the children (59%) reported it spontaneously. The factors associated with greater thirst intensity were: female sex (PR=1.27); spontaneous complaint (PR=1.29); reporting feeling of dry mouth (PR=1.93) and thick saliva (PR=1.43); age was inversely associated with thirst intensity, i.e., the younger the age, the greater the thirst intensity (beta= -0.053; p=0.01). Conclusion Thirst in surgical children has a high prevalence and intensity. Children are able to identify the signs related to thirst and spontaneously reports it. Sex, spontaneous complaints, age, dry mouth and thick saliva were associated with intensity. These results signal the need for intentional interventions to reduce child thirst in clinical practice.

Implementation of the thirst management model in the burn unit guided by knowledge translation / Implementación del modelo de gestión de la sed en la unidad de quemados guiada por laknowledge translation / Implantação do modelo de manejo da sede na unidade de queimados norteada pelo knowledge translation

ABSTRACT Objective: To implement the preoperative Thirst Management Model, measuring its adoption, coverage, acceptability, feasibility and fidelity by nursing in a burn unit. Method: Quasi-experimental, pre- and post-test intervention study. Sample of 59 patients at pre-implementation and 40 post-implementation and 36 nursing professionals participating in the implementation in a burn unit from August (2019) to March (2020). Statistical analysis used Mann-Whitney and Chi-square. Results: Adoption of management ranged from 0.0% to 72.5% post-implementation. The capacity coverage was 87.5% of nurses and 87.9% of nursing technicians. There was acceptability and feasibility of thirst management by professionals. In the plan-do-study-act cycles, three pillars of the Model reached the goals, showing fidelity. Conclusion: The implantation of the Preoperative Thirst Management Model had acceptability and feasibility by the nursing team, showing fidelity in achieving the proposed goals, in addition to the adoption of evidence in clinical practice after high coverage professional training.

RESUMEN Objetivo: Implementar el Modelo de Gestión de la Sed Preoperatoria, midiendo su adopción, cobertura, aceptabilidad, factibilidad y fidelidad por parte de enfermería en una unidad de quemados. Método: Estudio de intervención cuasi-experimental, pre- y post-test. Muestra de 59 pacientes en la pre-implementación y 40 en la post-implementación y 36 profesionales de enfermería participantes en la implementación en un centro de quemados desde agosto (2019) hasta marzo (2020). El análisis estadístico utilizó Mann-Whitney y Chi-cuadrado. Resultados: La adopción de la gestión osciló entre el 0,0% y el 72,5% después de la aplicación. La cobertura de la formación fue del 87,5% de los enfermeros y del 87,9% de los técnicos. Hubo aceptación y viabilidad de lagestión por parte de los profesionales. En los ciclos planear-hacer-estudiar-actuar tres de cuatro pilares del Modelo alcanzaron las metas, evidenciando fidelidad. Conclusión: La implantación del Modelo de Gestión de la Sed Preoperatoria fue aceptable y viable por el equipo de enfermería, demostrando fidelidad a la consecución de los objetivos propuestos, además de la adopción de evidencias en la práctica clínica tras alta cobertura de formación profesional.

RESUMO Objetivo: Implantar o Modelo de Manejo da Sede no pré-operatório mensurando a sua adoção, cobertura, aceitabilidade, viabilidade e fidelidade pela enfermagem em uma unidade de queimados. Método: Estudo de intervenção quase-experimental, pré e pós-teste. Amostra de 59 pacientes na pré-implantação e 40 pós-implantação e 36 profissionais de enfermagem participantes da implantação em um centro de queimados de agosto (2019) à março (2020). Análise estatística utilizou Mann-Whitney e Chi-quadrado. Resultados: Adoção do manejo variou de 0,0% para 72,5% pós-implantação. Cobertura da capacitação de 87,5% das enfermeiras e 87,9% dos técnicos de enfermagem. Houve aceitabilidade e viabilidade do manejo da sede pelos profissionais. Nos ciclos planejar-fazer-estudar-agir três dos quatro pilares do Modelo alcançaram as metas, evidenciando fidelidade. Conclusão: A implantação do Modelo de Manejo da Sede no pré-operatório teve aceitabilidade e viabilidade pela equipe de enfermagem, apresentando fidelidade pelo alcance das metas propostas, além da adoção da evidência na prática clínica após alta cobertura das capacitações dos profissionais.

Barriers and facilitators in the management of preoperative thirst of the burned patient in the light of Knowledge Translation. / Barreiras e facilitadores no manejo da sede pré-operatória do paciente queimado à luz do Knowledge Translation.

OBJECTIVE: To explore the perception of health care professionals about barriers and facilitators, and coping strategies for the implementation of the Thirst Management Model in the preoperative period of the burned patient. METHOD: This is a qualitative study, anchored in the conceptual framework Knowledge Translation. The focus group technique was chosen for data collection, composed by eight key professionals, to identify barriers and facilitators in evidence implementation and to point out coping strategies for the critical nodes found. Thematic Content Analysis technique was used to evaluate the data. RESULTS: Five categories emerged: Physical structure, environment and supplies; Particularities of the burned patient; Human Resources; Team attitude; Team training and education. Coping strategies were raised for each barrier identified. CONCLUSION: The main barriers identified were found in the Human Resources and Team Attitude categories. The main facilitators were Particularities of the burned patient and Team training and education. The identification allowed planning coping strategies for critical nodes, providing support for scientific evidence in clinical practice.

Development and validation of a new nursing diagnosis: Perioperative thirst.

PURPOSE: To develop and validate the content of the nursing diagnosis proposal for perioperative thirst. METHODS: A content analysis by 34 judges. An online Delphi panel was used in one round, evaluating criteria of relevance, clarity and precision. Wilcoxon's one-tailed test was used and the content validity index to maintain the item was set to 0.80. FINDINGS: The content validity index in relation to the evaluated items reached levels between 0.87-1.00. The final components of the diagnosis proposal included the following items as defining characteristics: dry mouth, dry throat, dry lips, thick saliva, thick tongue, constant swallowing of saliva, desire to drink water, bad taste in the mouth, and caregiver's report. Related factors are as follows: pre- and postoperative fasting, oral breathing, dehydration, hypovolemia, insensitive loss of hydration by breathing, dry mouth, habit of drinking water, high room temperature. Associated conditions: intubation, use of muscarinic and nicotinic anticholinergics and water restriction. CONCLUSIONS: All components of the nursing diagnosis were validated in relation to relevance, clarity, and accuracy, demonstrating high levels of agreement between experts. Qualitative observations were found to be fundamental for both combining and excluding some items. IMPLICATIONS FOR NURSING PRACTICE: Improvement of refinement and clarity levels of this nursing diagnosis proposal aiding its inclusion in the NANDA International taxonomy and thus enabling greater understanding of the phenomenon of thirst in surgical patients. This study helps to explain and facilitate the identification of defining characteristics, related factors, and associated conditions for nurses, nursing students, and researchers on this subject.

Content and usability validation of the Retire with Health web software.

OBJECTIVES: to validate the content and usability of the Retire with Health web software. METHODS: a methodological study. The content validation was carried out by seven experts in the aging subject, using an instrument that evaluated the objectives, contents, relevance, and the environment of the web software. Usability was validated by seven experts in software development, referring to ergonomics, functionality, usability, and efficiency. The data were submitted to statistical analysis, described by calculating the Content Validity Index. RESULTS: the global Content Validity Index found 0.97 for the usability aspects and 1.00 for the content. After incorporating all the experts' suggestions, the Retire with Health web software was made available on the internet (www.aposentarsecomsaude.com.br). CONCLUSIONS: content validation and usability showed that the web software meets the objective of supporting reflection on retirement, with a high level of agreement among experts.

Concept analysis of Perioperative Thirst for the development of a new nursing diagnosis.

OBJECTIVES: to analyze the perioperative thirst concept for the development of a new diagnostic structure according to NANDA International. METHODS: a concept analysis study based on the framework proposed by Walker and Avant, instrumentalized through an integrative literature review based on SCOPUS, CINAHL, PUBMED, LILACS, and WOS. The elaboration of the diagnostic structure followed NANDA International guidelines. RESULTS: 41 studies were analyzed revealing that perioperative thirst is prevalent and intense, having visceral and behavioral attributes as the core of the concept. Antecedents indicate that surgical patients are vulnerable to thirst; and consequents 16 signs and symptoms were organized and model cases were developed. A diagnostic structure has been developed for perioperative thirst. FINAL CONSIDERATIONS: concept analysis allowed language standardization that describes thirsty patients, helping the identification, planning of actions and communication of perioperative nursing care.

Effects of the ice popsicle on vasopressin, osmolality, thirst intensity, and thirst discomfort.

OBJECTIVE: To analyze the effects of the ice popsicle on vasopressin, osmolality, thirst intensity, and thirst discomfort. METHOD: This is a quasi-experimental, pre- and post-test study conducted in a laboratory. The sample consisted of nine healthy male volunteers, who received 2% hypertonic saline solution. RESULTS: Popsicle intake did not result in a statistically significant reduction in vasopressin levels (F=0.876 and p=0.428). However, there was a reduction in the hormonal physiological profile of vasopressin from 7.1 pg/ml to 5.8 pg/ml after the first two interventions. Osmolality concentration changed from 270.65 to 286.51 mOsm/kg, with no statistical difference (F=2.207; p=0.09). Ice popsicles significantly reduced thirst intensity (F=10.00; p=0.001) and thirst discomfort (F=10.528; p <0.001). CONCLUSION: There was a reduction in thirst intensity and discomfort after the use of the 20 ml ice popsicle. There was no statistical difference for vasopressin and osmolality. However, there was a reduction in the hormonal physiological profile of vasopressin during 30 minutes of intervention.

Use of Mentholated Popsicle in the Management of the Elderly Patient's Thirst in the Immediate Postoperative Period: A Randomized Controlled Trial.

PURPOSE: This study aimed to compare a mentholated popsicle with usual care (absolute fasting) in the change in thirst intensity and discomfort in elderly patients in the immediate postoperative period (IPP). DESIGN: A randomized controlled trial. METHODS: The sample consisted of 50 elderly patients (60 years or older) in the IPP who were randomly assigned to two groups: experimental group (20 mL mentholated popsicle) and control group (usual care). The outcomes, thirst intensity and discomfort, were assessed at baseline and 20 minutes after the intervention. FINDINGS: The mentholated popsicle presented a statistically significant (P < .001) decrease in thirst intensity and discomfort by 5.0 in the median and a Cohen's r large effect size for both outcomes. There were no adverse events or side effects. CONCLUSIONS: The use of a mentholated popsicle decreased the intensity and discomfort of the elderly patient's thirst in the IPP.

Concept analysis of Perioperative Thirst for the development of a new nursing diagnosis / Análisis conceptual de la Sede Perioperatoria para el desarrollo de un nuevo diagnóstico de enfermería / Análise de conceito da Sede Perioperatória para o desenvolvimento de um novo diagnóstico de enfermagem

ABSTRACT Objectives: to analyze the perioperative thirst concept for the development of a new diagnostic structure according to NANDA International. Methods: a concept analysis study based on the framework proposed by Walker and Avant, instrumentalized through an integrative literature review based on SCOPUS, CINAHL, PUBMED, LILACS, and WOS. The elaboration of the diagnostic structure followed NANDA International guidelines. Results: 41 studies were analyzed revealing that perioperative thirst is prevalent and intense, having visceral and behavioral attributes as the core of the concept. Antecedents indicate that surgical patients are vulnerable to thirst; and consequents 16 signs and symptoms were organized and model cases were developed. A diagnostic structure has been developed for perioperative thirst. Final Considerations: concept analysis allowed language standardization that describes thirsty patients, helping the identification, planning of actions and communication of perioperative nursing care.

RESUMEN Objetivo: analizar el concepto de asiento perioperatorio para el desarrollo de una nueva estructura diagnóstica según NANDA International. Método: estudio de análisis de conceptos basado en el marco propuesto por Walker y Avant, instrumentalizado a través de una revisión integradora de la literatura basada en SCOPUS, CINAHL, PUBMED, LILACS y WOS. La elaboración de la estructura de diagnóstico siguió los lineamientos de NANDA International. Resultados: Se analizaron 41 estudios que revelaron que la sed perioperatoria es prevalente e intensa, teniendo atributos viscerales y conductuales como núcleo del concepto. Los antecedentes indican que el paciente quirúrgico es vulnerable a la sed y como consecuencia, se organizaron 16 signos y síntomas y se desarrollaron casos modelo. Se ha desarrollado una estructura de diagnóstico para el asiento perioperatorio. Consideraciones finales: el análisis de concepto permitió estandarizar el lenguaje que describe al paciente sediento, ayudando a la identificación, planificación de acciones y comunicación de los cuidados perioperatorios de enfermería.

RESUMO Objetivos: analisar o conceito de sede perioperatória para o desenvolvimento de uma nova estrutura diagnóstica segundo a NANDA Internacional. Métodos: estudo de análise de conceito baseado no referencial proposto por Walker e Avant, instrumentalizada por meio de uma revisão integrativa da literatura nas bases SCOPUS, CINAHL, PUBMED, LILACS e WOS. A elaboração da estrutura diagnóstica seguiu as diretrizes da NANDA Internacional. Resultados: foram analisados 41 estudos revelando que a sede perioperatória é prevalente e intensa, tendo como núcleo do conceito atributos viscerais e comportamentais. Antecedentes indicam que o paciente cirúrgico é vulnerável à sede, e como consequentes, 16 sinais e sintomas foram organizados e casos modelo foram desenvolvidos. Foi desenvolvido uma estrutura diagnóstica para a sede perioperatória. Considerações Finais: a análise de conceito permitiu a padronização da linguagem que descreve o paciente com sede, auxiliando a identificação, planejamento de ações e comunicação da assistência de enfermagem perioperatória.

Content and usability validation of the Retire with Health web software / Validación de contenido y usabilidad del web software Jubilarse con Salud / Validação de conteúdo e usabilidade do web software Aposentar-se com Saúde

ABSTRACT Objectives: to validate the content and usability of the Retire with Health web software. Methods: a methodological study. The content validation was carried out by seven experts in the aging subject, using an instrument that evaluated the objectives, contents, relevance, and the environment of the web software. Usability was validated by seven experts in software development, referring to ergonomics, functionality, usability, and efficiency. The data were submitted to statistical analysis, described by calculating the Content Validity Index. Results: the global Content Validity Index found 0.97 for the usability aspects and 1.00 for the content. After incorporating all the experts' suggestions, the Retire with Health web software was made available on the internet (www.aposentarsecomsaude.com.br). Conclusions: content validation and usability showed that the web software meets the objective of supporting reflection on retirement, with a high level of agreement among experts.

RESUMEN Objetivos: validar el contenido y usabilidad del web software Jubilarse con Salud. Métodos: estudio metodológico. La validación de contenido fue realizada por siete especialistas del área de envejecimiento mediante instrumento que evaluó objetivos, contenidos, relevancia y ambiente del web software. La usabilidad fue validada por siete especialistas en desarrollo de software, que observaron ergonomía, funcionalidad, usabilidad y eficiencia. Datos sometidos a análisis estadístico, descriptos mediante cálculo del Índice de Validez de Contenido. Resultados: el Índice de Validez de Contenido global fue de 0,97 para los aspectos de usabilidad y de 1,00 para el contenido. Agregadas todas las sugerencias de los especialistas, el web software Jubilarse con Salud fue puesto a disposición en Internet (www.aposentarsecomsaude.com.br). Conclusiones: la validación de contenido y de usabilidad demostró que el web software satisface el objetivo de apoyar la reflexión sobre la jubilación, con elevado nivel de concordancia entre los especialistas.

RESUMO Objetivos: validar o conteúdo e a usabilidade do web software Aposentar-se com Saúde. Métodos: estudo metodológico. A validação de conteúdo foi realizada por sete experts da área de envelhecimento, por meio de instrumento que avaliou os objetivos, conteúdos, relevância e o ambiente do web software. A usabilidade foi validada por sete experts em desenvolvimento de software, quanto à ergonomia, funcionalidade, usabilidade e eficiência. Os dados foram submetidos à análise estatística, descritos por meio do cálculo do Índice de Validade de Conteúdo. Resultados: o Índice de Validade de Conteúdo global foi de 0,97 para os aspectos de usabilidade e de 1,00 para o conteúdo. Após incorporar todas as sugestões dos experts, o web software Aposentar-se com Saúde foi disponibilizado na internet (www.aposentarsecomsaude.com.br). Conclusões: Validação de conteúdo e usabilidade demonstraram que o web software atende ao objetivo de apoiar a reflexão sobre a aposentadoria, com elevado nível de concordância entre os experts.