Transición del cuidado de pacientes con enfermedades crónicas y su relación con las características clínicas y sociodemográficas / Transition of care of patients with chronic diseases and its relation with clinical and sociodemographic characteristics / Transição do cuidado de pacientes com doenças crônicas e sua relação com as características clínicas e sociodemográficas

Objetivo: evaluar la transición del cuidado desde la perspectiva de las personas que viven con enfermedades crónicas e identificar su relación con las características clínicas y sociodemográficas. Método: estudio transversal, con 487 pacientes dados de alta de un hospital. Se utilizaron los instrumentos de caracterización clínica, sociodemográfica y Care Transitions Measure-15, que mide los factores Preparación para el automanejo, Preferencias aseguradas, Comprensión sobre medicamentos y Plan de cuidados. Análisis estadístico descriptivo e inferencial. Resultados: la transición del cuidado fue satisfactoria (76,8±10,4). Media de factores: Preparación para el automanejo (82,2±10,8), Preferencias aseguradas (84,7±14,3), Comprensión sobre medicamentos (75,7±13,7) y Plan de Cuidados (64,5±13,2). Pacientes del sexo femenino presentaron mayor promedio en el factor comprensión sobre medicamentos. Los blancos y los residentes en áreas urbanas calificaron mejor el Plan de cuidados. La media más alta se observó para el factor Preferencias aseguradas (84,7±14,3) y la más baja para el factor Plan de cuidados (64,5±13,2). En todos los factores se encontraron diferencias significativas en las variables (paciente quirúrgico, tener artefactos clínicos y no estar hospitalizado por COVID-19). Los pacientes internados hasta cinco días presentaron diferencia estadística en los factores Preparación para el automanejo y Comprensión sobre medicamentos. En los pacientes que no reingresaron dentro de los 30 días posteriores al alta, la preparación para el automanejo fue mejor. Cuanto mejor sea la preparación para el automanejo, menores serán las tasas de reingreso a los 30 días. Conclusión: en pacientes que viven con enfermedades crónicas, variables sociodemográficas y clínicas están asociadas a la transición del cuidado. Los pacientes que evaluaron mejor la preparación para el automanejo tuvieron menos reingresos dentro de los 30 días.

Objective: evaluate the transition of care from the perspective of people living with chronic diseases and identify its relation with clinical and sociodemographic characteristics. Method: cross-sectional study with 487 patients who were discharged from a hospital. Clinical and sociodemographic characterization instruments were used, as well as the Care Transitions Measure-15, which measures Preparation for self-management, Secured preferences, Understanding about medications and Care plan factors. Descriptive and inferential statistical analysis. Results: the transition of care was satisfactory (76.8±10.4). Average of the factors: Preparation for self-management (82.2±10.8), Secured preferences (84.7±14.3), Understanding about medications (75.7±13.7) and Care plan (64.5±13.2). Female patients had a higher average in the understanding about medications factor. Whites and residents in the urban area better evaluated the Care plan factor. The highest mean was observed for the Secured preferences factor (84.7±14.3) and the lowest for the Care plan factor (64.5±13.2). In all factors, significant differences were found in the variables (surgical patient, carrying clinical artifacts and not being hospitalized for COVID-19). Patients hospitalized for up to five days showed statistical difference in Preparation for self-management and Understanding about medications factors. In patients who were not readmitted within 30 days of discharge, Preparation for self-management was better. The better the Preparation for self-management, the lower the 30-day readmission rates. Conclusion: in patients living with chronic diseases, sociodemographic and clinical variables are associated with the transition of care. Patients who better evaluated preparation for self-management had fewer readmissions within 30 days.

Objetivo: avaliar a transição do cuidado na perspectiva de pessoas que vivem com doenças crônicas e identificar sua relação com as características clínicas e sociodemográficas. Método: estudo transversal, com 487 pacientes que receberam alta de um hospital. Foram utilizados instrumentos de caracterização clínica, sociodemográfica e Care Transitions Measure-15, que mensura os fatores Preparo para o autogerenciamento, Preferências asseguradas, Entendimento das medicações e Plano de cuidados. Análise estatística descritiva e inferencial. Resultados: a transição do cuidado foi satisfatória (76,8±10,4). Média dos fatores: preparo para o autogerenciamento (82,2±10,8), Preferências asseguradas (84,7±14,3), Entendimento das medicações (75,7±13,7) e Plano de Cuidados (64,5±13,2). Pacientes do sexo feminino apresentaram média superior no fator entendimento sobre medicações. Brancos e residentes na zona urbana avaliaram melhor o Plano de cuidados. Observou-se a maior média no fator Preferências asseguradas (84,7±14,3) e a menor no fator Plano de cuidados (64,5±13,2). Em todos os fatores, foram encontradas diferenças significativas nas variáveis (paciente cirúrgico, portar artefatos clínicos e não estar internado por COVID-19). Pacientes internados até cinco dias apresentaram diferença estatística nos fatores Preparação para o autogerenciamento e Entendimento das medicações. Em pacientes que não apresentaram reinternação em 30 dias após a alta, o Preparo para o autogerenciamento foi melhor. Quanto melhor o Preparo para o autogerenciamento, menores são os índices de reinternação em 30 dias. Conclusão: em pacientes que vivem com doenças crônicas, variáveis sociodemográficas e clínicas estão associadas à transição do cuidado. Pacientes que avaliaram melhor o preparo para autogerenciamento tiveram menos reinternações em 30 dias.

Sistematização do preparo a alta à pessoa adulta com agravos clínicos e cirúrgicos / Systematization of discharge preparation for adults with clinical and surgical problems

Objetivo: O objetivo desse trabalho é descrever a sistematização do preparo a alta à pessoa adulta com agravos clínicos e cirúrgicos. Metodologia: Trata-se de um relato de experiência através da aplicação da Sistematização da Assistência de Enfermagem (SAE), voltado para pessoas com alta no contexto hospitalar. Resultados e discussão: Foi aplicado a teoria da adaptação nas seis fases da Teoria de Calista Roy e foi elaborado diagnósticos de enfermagem para os quatro modos de adaptação: fisiológico, interdependência, autoconceito e função de papel. Considerações finais: Ao aplicar a SAE no indivíduo com alta hospitalar a equipe multidisciplinar deve realizá-lo em todas as suas etapas, e utilizar os protocolos para oferecer um cuidado holístico e integral, visando a promoção da saúde, prevenção de risco potencial e adaptação diante das necessidades em saúde.(AU)

Objective: The aim of this study is to describe the systematization of discharge preparation for adults with clinical and surgical conditions. Methodology: This is an experience report on the application of the Systematization of Nursing Care (SNC) to people being discharged from hospital. Results and discussion: The theory of adaptation was applied in the six phases of Calista Roy's theory and nursing diagnoses were drawn up for the four modes of adaptation: physiological, interdependence, self-concept and role function. Final considerations: When applying the SNC to individuals discharged from hospital, the multidisciplinary team must carry it out in all its stages, and use the protocols to offer holistic and comprehensive care, with a view to promoting health, preventing potential risks and adapting to health needs.(AU)

Objetivo: El objetivo de este estudio es describir la sistematización de la preparación al alta de adultos con patologías clínicas y quirúrgicas. Metodología: Se trata de un informe de experiencia sobre la aplicación de la Sistematización de los Cuidados de Enfermería (SNC) a personas en proceso de alta hospitalaria. Resultados y discusión: Se aplicó la teoría de la adaptación en las seis fases de la teoría de Calista Roy y se elaboraron diagnósticos de enfermería para los cuatro modos de adaptación: fisiológica, interdependencia, autoconcepto y función de rol. Consideraciones finales: Al aplicar el SNC a las personas con alta hospitalaria, el equipo multidisciplinar debe llevarlo a cabo en todas sus fases, y utilizar los protocolos para ofrecer una atención holística e integral, dirigida a la promoción de la salud, la prevención de riesgos potenciales y la adaptación a las necesidades de salud.(AU)

Promotion of self-efficacy in mothers with infants discharged from neonatal intensive care units.

INTRODUCTION: The mothers of newborns who are discharged from a neonatal intensive care unit (NICU) experience stress and anxiety due to the specialized care their child requires at home, affecting their perception of maternal self-efficacy. OBJECTIVE: To evaluate the effect of the nursing intervention called Hospital Discharge Plan (HDP) on the promotion of self-efficacy in mothers of newborns discharged from the NICU. METHOD: Quantitative study, quasi-experimental design with pre-test/post-test in a single group, using the Parental Evaluation Scale applied to a convenience sample of 72 mothers of high-risk newborns from a NICU located in the city of Villavicencio (Colombia). The first measurement was taken between days 3 and 4 before discharge and at 15 days' post-discharge. Data processing was carried out using the statistical program SPSS, version 21. The intervention was based on the four concepts of self-efficacy by Barbara Resnick. RESULTS: The perception of maternal self-efficacy before the intervention showed a median of 8.9 points (RI 7.6-9.5); after the intervention it showed a median of 9.6 points (RI of 10-8.7); a statistically significant p-value<0.001 was obtained before and after the intervention with the Wilcoxon rank test. CONCLUSIONS: Education and follow-up promoted the development of knowledge and skills in mothers for the care of high-risk newborns. This contributed to the experience of mastery and vicarious experience from the teaching-learning process and contact with the experience of other mothers, which contributes to the effective development of motherhood.

Menor mortalidad y reingreso en pacientes con pocas comorbilidades intervenidos de fractura de cadera y con alta precoz / Lower mortality and readmission in patients with few comorbidities who underwent hip fracture surgery and were discharged early

Introducción: El retraso preoperatorio en pacientes intervenidos de fractura de cadera (FC) se ha asociado a peores resultados; sin embargo, el momento óptimo del alta hospitalaria tras cirugía ha sido poco estudiado. El objetivo de este estudio fue determinar resultados de mortalidad y de reingreso en pacientes con FC con y sin alta hospitalaria precoz. Material y métodos: Se realizó un estudio observacional retrospectivo seleccionando a 607 pacientes mayores de 65años con FC intervenidos entre enero de 2015 y diciembre de 2019, de los que se incluyeron para el análisis 164 pacientes con menos comorbilidades y ASA ≤II y se dividieron según su estancia hospitalaria postoperatoria en alta precoz o estancia ≤4días (n=115) y alta no precoz o estancia postoperatoria >4días (n=49). Se registraron características demográficas; características relacionadas con la fractura y el tratamiento quirúrgico; tasas de mortalidad a los 30días y al año postoperatorio; tasa de reingreso hospitalario a los 30días postoperatorios, y causa médica o quirúrgica. Resultados: En el grupo alta precoz todos los resultados fueron mejores frente al grupo no alta precoz: menor tasa de mortalidad a los 30días postoperatorios (0,9% frente al 4,1%, p=0,16) y al año postoperatorio (4,3% frente al 16,3%, p=0,009), así como una menor tasa de reingreso hospitalario por razones médicas (7,8% frente al 16,3%, p=0,037). Conclusiones: En el presente estudio el grupo de alta precoz obtiene mejores resultados en indicadores de mortalidad a los 30días y al año postoperatorio, así como de reingreso por causas médicas.(AU)

Introduction: Preoperative delay in patients with hip fracture surgery (HF) has been associated with poorer outcomes; however, the optimal timing of discharge from hospital after surgery has been little studied. The aim of this study was to determine mortality and readmission outcomes in HF patients with and without early hospital discharge. Material and methods: A retrospective observational study was conducted selecting 607 patients over 65years of age with HF intervened between January 2015 and December 2019, from which 164 patients with fewer comorbidities and ASA ≤II were included for analysis and divided according to their postoperative hospital stay into early discharge or stay ≤4 days (n=115), and non-early or post-operative stay >4days (n=49). Demographic characteristics; fracture and surgical-related characteristics; 30-day and one-year postoperative mortality rates; 30-day postoperative hospital readmission rate; and medical or surgical cause were recorded. Results: In the early discharge group all outcomes were better compared to the non-early discharge group: lower 30-day (0.9% vs 4.1%, P=.16) and 1-year postoperative (4.3% vs 16.3%, P=.009) mortality rates, as well as a lower rate of hospital readmission for medical reasons (7.8% vs 16.3%, P=.037). Conclusions: In the present study, the early discharge group obtained better results 30-day and 1-year postoperative mortality indicators, as well as readmission for medical reasons.(AU)

[Translated article] Lower mortality and readmission in patients with few comorbidities who underwent hip fracture surgery and were discharged early / Menor mortalidad y reingreso en pacientes con pocas comorbilidades intervenidos de fractura de cadera y con alta precoz

Introducción: El retraso preoperatorio en pacientes intervenidos de fractura de cadera (FC) se ha asociado a peores resultados; sin embargo, el momento óptimo del alta hospitalaria tras cirugía ha sido poco estudiado. El objetivo de este estudio fue determinar resultados de mortalidad y de reingreso en pacientes con FC con y sin alta hospitalaria precoz. Material y métodos: Se realizó un estudio observacional retrospectivo seleccionando a 607 pacientes mayores de 65años con FC intervenidos entre enero de 2015 y diciembre de 2019, de los que se incluyeron para el análisis 164 pacientes con menos comorbilidades y ASA ≤II y se dividieron según su estancia hospitalaria postoperatoria en alta precoz o estancia ≤4días (n=115) y alta no precoz o estancia postoperatoria >4días (n=49). Se registraron características demográficas; características relacionadas con la fractura y el tratamiento quirúrgico; tasas de mortalidad a los 30días y al año postoperatorio; tasa de reingreso hospitalario a los 30días postoperatorios, y causa médica o quirúrgica. Resultados: En el grupo alta precoz todos los resultados fueron mejores frente al grupo no alta precoz: menor tasa de mortalidad a los 30días postoperatorios (0,9% frente al 4,1%, p=0,16) y al año postoperatorio (4,3% frente al 16,3%, p=0,009), así como una menor tasa de reingreso hospitalario por razones médicas (7,8% frente al 16,3%, p=0,037). Conclusiones: En el presente estudio el grupo de alta precoz obtiene mejores resultados en indicadores de mortalidad a los 30días y al año postoperatorio, así como de reingreso por causas médicas.(AU)

Introduction: Preoperative delay in patients with hip fracture surgery (HF) has been associated with poorer outcomes; however, the optimal timing of discharge from hospital after surgery has been little studied. The aim of this study was to determine mortality and readmission outcomes in HF patients with and without early hospital discharge. Material and methods: A retrospective observational study was conducted selecting 607 patients over 65years of age with HF intervened between January 2015 and December 2019, from which 164 patients with fewer comorbidities and ASA ≤II were included for analysis and divided according to their postoperative hospital stay into early discharge or stay ≤4 days (n=115), and non-early or post-operative stay >4days (n=49). Demographic characteristics; fracture and surgical-related characteristics; 30-day and one-year postoperative mortality rates; 30-day postoperative hospital readmission rate; and medical or surgical cause were recorded. Results: In the early discharge group all outcomes were better compared to the non-early discharge group: lower 30-day (0.9% vs 4.1%, P=.16) and 1-year postoperative (4.3% vs 16.3%, P=.009) mortality rates, as well as a lower rate of hospital readmission for medical reasons (7.8% vs 16.3%, P=.037). Conclusions: In the present study, the early discharge group obtained better results 30-day and 1-year postoperative mortality indicators, as well as readmission for medical reasons.(AU)

[Translated article] Lower mortality and readmission in patients with few comorbidities who underwent hip fracture surgery and were discharged early.

INTRODUCTION: Pre-operative delay in patients with hip fracture surgery (HF) has been associated with poorer outcomes; however, the optimal timing of discharge from hospital after surgery has been little studied. The aim of this study was to determine mortality and readmission outcomes in HF patients with and without early hospital discharge. MATERIAL AND METHODS: A retrospective observational study was conducted selecting 607 patients over 65years of age with HF intervened between January 2015 and December 2019, from which 164 patients with fewer comorbidities and ASA≤II were included for analysis and divided according to their post-operative hospital stay into early discharge or stay ≤4 days (n=115), and non-early or post-operative stay >4days (n=49). Demographic characteristics; fracture and surgical-related characteristics; 30-day and one-year post-operative mortality rates; 30-day post-operative hospital readmission rate; and medical or surgical cause were recorded. RESULTS: In the early discharge group all outcomes were better compared to the non-early discharge group: lower 30-day (0.9% versus 4.1%, p=.16) and 1-year post-operative (4.3% versus 16.3%, p=.009) mortality rates, as well as a lower rate of hospital readmission for medical reasons (7.8% versus 16.3%, p=.037). CONCLUSIONS: In the present study, the early discharge group obtained better results 30-day and 1-year post-operative mortality indicators, as well as readmission for medical reasons.

Lower mortality and readmission in patients with few comorbidities who underwent hip fracture surgery and were discharged early. / Menor mortalidad y reingreso en pacientes con pocas comorbilidades intervenidos de fractura de cadera y con alta precoz.

INTRODUCTION: Preoperative delay in patients with hip fracture surgery (HF) has been associated with poorer outcomes; however, the optimal timing of discharge from hospital after surgery has been little studied. The aim of this study was to determine mortality and readmission outcomes in HF patients with and without early hospital discharge. MATERIAL AND METHODS: A retrospective observational study was conducted selecting 607 patients over 65years of age with HF intervened between January 2015 and December 2019, from which 164 patients with fewer comorbidities and ASA ≤II were included for analysis and divided according to their postoperative hospital stay into early discharge or stay ≤4 days (n=115), and non-early or post-operative stay >4days (n=49). Demographic characteristics; fracture and surgical-related characteristics; 30-day and one-year postoperative mortality rates; 30-day postoperative hospital readmission rate; and medical or surgical cause were recorded. RESULTS: In the early discharge group all outcomes were better compared to the non-early discharge group: lower 30-day (0.9% vs 4.1%, P=.16) and 1-year postoperative (4.3% vs 16.3%, P=.009) mortality rates, as well as a lower rate of hospital readmission for medical reasons (7.8% vs 16.3%, P=.037). CONCLUSIONS: In the present study, the early discharge group obtained better results 30-day and 1-year postoperative mortality indicators, as well as readmission for medical reasons.

Validation of a checklist for responsible hospital discharge in a neonatal intensive care unit / Validación de una lista de verifiación para el alta hospitalaria responsable en una unidad de cuidados intensivos neonatales / Validação de um checklist para alta hospitalar responsável em unidade de terapia intensiva neonatal

ABSTRACT Objective: to create and validate a checklist for responsible hospital discharge processes in a neonatal intensive care unit. Method: a methodological study conducted from March to June 2022, in four phases: 1) Selection of topics relevant to the health of newborns discharged from the intensive care unit; 2) Elaboration of the first version of the checklist; 3) Content validation with expert judges by applying the Content Validity Index (CVI), accepting values > 0.8 per item; and 4) Correction and reformulation of the final version. The assessment instrument was structured by means of a Likert-type scale. The validation process was performed in electronic and printed means by approaching the evaluators within the neonatal unit, totaling 16 participants. Descriptive statistics was used for data analysis. Results: the checklist was validated with an overall Content Validity Index of 0.87. Analyzing the items individually, the following Content Validity Index values were found: 0.92 in the objectives, 0.89 for language, 0.84 for the content, 0.79 for relevance, 0.90 for layout, 0.94 for motivation and 0.88 for culture. Conclusion: the checklist presented favorable Content Validity Index values in the vast majority of the evaluation criteria, with the exception of relevance. However, it is noted that it can be implemented and tends to contribute to a responsible discharge process.

RESUMEN Objetivo: elaborar y validar una lista de verificación para el proceso de alta hospitalaria responsable en una unidad de cuidados intensivos neonatales. Método: estudio metodológico realizado de marzo a junio de 2022 en cuatro etapas: 1) Selección de temas relevantes a la salud de neonatos que reciben el alta de una unidad de cuidados intensivos; 2) Elaboración de la primera versión de la lista de verificación; 3) Validación del contenido con jueces especialistas aplicando el Índice de Validez de Contenido (IVC), aceptándose valores > 0,8 por ítem; y 4) Corrección y reformulación de la versión final. El instrumento para la evaluación se estructuró por medio de una escala tipo Likert. La validación se realizó por medios electrónico e impreso acercándose a los jueces dentro de la unidad neonatal, totalizando 16 participantes. Para el análisis de los datos se utilizó estadística descriptiva. Resultados: la lista de verificación se validó con un Índice de Validez de Contenido general de 0,87. Cuando se analizaron los ítems individualmente se encontraron los siguientes valores de IVC: 0,92 en los objetivos; 0,89 para el lenguaje; 0,84 para el contenido; 0,79 para la relevancia; 0,90 para el diseño; 0,94 para la motivación; y 0,88 para la cultura. Conclusión: la lista de verificación obtuvo un Índice de Validez de Contenido favorable en la amplia mayoría de los criterios de evaluación, con la única excepción del aspecto de la relevancia. Sin embargo, se destaca que puede ser implementado y tiende a contribuir a un proceso de alta hospitalaria responsable.

RESUMO Objetivo: construir e validar um checklist para o processo de alta hospitalar responsável em uma unidade de terapia intensiva neonatal. Método: estudo metodológico realizado no período de março a junho de 2022 em quatro etapas: 1) seleção de temas relevantes à saúde do neonato egresso da unidade de terapia intensiva; 2) construção da primeira versão do checklist; 3) validação de conteúdo com juízes especialistas mediante à aplicação do Índice de Validade de Conteúdo, aceitando-se o valor de > 0,8 por item; 4) correção e reformulação da versão final. O instrumento para avaliação foi estruturado por meio de uma escala, tipo Likert. A validação foi realizada por meio eletrônico e impresso com abordagem pelos juízes dentro da unidade neonatal, totalizando 16 participantes. Para análise dos dados utilizou-se a estatística descritiva. Resultados: o checklist foi validado com IVC geral de 0,87. Analisando-se os itens individualmente foi encontrado o Índice de Validade de Conteúdo de 0,92 nos objetivos, 0,89 para linguagem, 0,84 para o conteúdo, 0,79 para a relevância, 0,90 para o layout, 0,94 para a motivação e 0,88 para a cultura. Conclusão: o checklist apresentou Índice de Validade de Conteúdo favorável na grande maioria dos critérios de avaliação, com exceção apenas da relevância. Entretanto, destaca-se que o mesmo pode ser implementado e tende a contribuir para um processo de alta responsável.

Transição do cuidado à mulher no período puerperal na alta hospitalar / Transición de la atención a la mujer en el período puerperal al alta hospitalaria / Transition of care for women in the puerperal period at hospital discharge

Resumo Objetivo descrever as atividades dos enfermeiros na transição do cuidado à puérpera da atenção hospitalar para os demais serviços da Rede de Atenção à Saúde. Método pesquisa exploratório-descritiva, desenvolvida no alojamento conjunto de um hospital universitário federal na região Sul do Brasil. Os dados foram coletados remotamente, entre novembro e dezembro de 2020, por meio de um questionário semiestruturado via plataforma eletrônica SurveyMonkey com cinco enfermeiros e quatro enfermeiros residentes. A análise seguiu a estrutura de conteúdo de Bardin, com apoio do software Qualitativa Data Analysis Miner. Resultados as atividades desenvolvidas pelos enfermeiros na transição do cuidado à puérpera incluíram as orientações de alta e ações educativas às puérperas. Elementos como a falta de comunicação entre os profissionais do alojamento conjunto e dos demais serviços da Rede de Atenção à Saúde e a sobrecarga de trabalho dos enfermeiros foram considerados barreiras para a transição do cuidado à puérpera. Conclusão e implicações para a prática apesar de os enfermeiros empreenderem esforços na transição do cuidado à puérpera por meio de orientações e educação para a alta, é essencial o delineamento de estratégias gerenciais, a fim de implementar um conjunto de ações sistematizadas para assegurar a continuidade do cuidado à puérpera.

Resumen Objetivo describir las actividades de los enfermeros en la transición de la atención hospitalaria a los demás servicios de la Red de Atención a la Salud de la puérpera. Método investigación exploratoria-descriptiva, desarrollada en el alojamiento conjunto de un hospital universitario federal en la región sur de Brasil. Los datos se recolectaron de forma remota, entre noviembre y diciembre de 2020, a través de un cuestionario semiestructurado a través de la plataforma electrónica SurveyMonkey con cinco enfermeras y cuatro enfermeras residentes. El análisis siguió la estructura de contenido de Bardin, con el apoyo del software Qualitative Data AnalysisMiner. Resultados las actividades realizadas por los enfermeros en la transición del cuidado a la puérpera incluyeron orientaciones de alta y acciones educativas para la puérpera. Elementos como la falta de comunicación entre los profesionales del alojamiento conjunto y otros servicios de la Red de Atención a la Salud y la carga de trabajo de los enfermeros fueron considerados barreras para la transición del cuidado a la puérpera. Conclusión e implicaciones para la práctica si bien los enfermeros realizan esfuerzos en la transición del cuidado a la puérpera a través de la orientación y educación para el alta, es fundamental delinear estrategias de gestión para implementar un conjunto de acciones sistematizadas para garantizar la continuidad del cuidado posparto.

Abstract Objective to describe nurses' activities in transition of care for puerperal women from hospital care to other services in the health care network. Method exploratory-descriptive research, developed in the rooming-in of a federal university hospital in southern Brazil. Data were collected remotely, between November and December 2020, through a semi-structured questionnaire via the SurveyMonkey electronic platform with five nurses and four resident nurses. Analysis followed Bardin's content structure with the support of Qualitative Data Analysis Miner software. Results the activities carried out by nurses in transition of care for puerperal women included discharge guidelines and educational actions for puerperal women. Elements such as lack of communication between rooming-in professionals and other services in the Health Care Network and nurses' workload were considered barriers to transition of care to puerperal women. Conclusion and implications for practice although nurses undertake efforts in transition of care to puerperal women through guidance and education for discharge, it is essential to outline management strategies in order to implement a set of systematized actions to ensure continuity of care for puerperal women.

Conhecimento dos profissionais de enfermagem na alta hospitalar de crianças dependentes de tecnologia / Knowledge of nursing professionals in hospital discharge of technology-dependent children / Conocimientos de los profesionales de enfermería en el alta hospitalaria de niños dependientes de tecnología

Objetivo: analisar o conhecimento da equipe de enfermagem no preparo para alta hospitalar de crianças dependentes de tecnologias. Métodos: Trata-se de uma pesquisa de caráter descritivo e exploratório com abordagem qualitativa, realizado a partir do ponto de vista de profissionais de enfermagem atuam na clínica pediátrica de um Hos- pital Universitário, localizado no estado da Paraíba, Brasil. Resultados: As participantes eram todas do sexo feminino, sendo elas quatro enfermeiras e quatro técnicas de enfer- magem. Os dados foram organizados em categorias temáticas de acordo com Minayo. Elegeram-se duas categorias: conhecimento da equipe de enfermagem sobre a alta hospi- talar segura de crianças dependentes de tecnologias e ações de enfermagem na promoção à alta hospitalar segura de crianças dependentes de tecnologias. Conclusão: A inexistência de um fluxo ou protocolo assistencial dificulta o processo de orientações dos familiares no retorno ao domicílio, impossibilitando a capacitação adequada para a realização do cuidado.

Objective: to analyze the knowledge of the nursing team in preparation for hospital discharge of technology-dependent children. Methods: This is a descriptive and exploratory research with a qualitative approach, carried out from the point of view of nursing professionals working in the pediatric clinic of a University Hospital, located in the state of Paraíba, Brazil. Results: The participants were all female, four nurses and four nursing technicians. Data were organized into thematic categories according to Minayo. Two categories were chosen: knowledge of the nursing team about the safe hospital discharge of technology-dependent children and nursing actions to promote safe hospital discharge of technology-dependent children. Conclusion: The lack of a care flow or protocol makes it difficult for family members to guide them back home, making it impossible to provide adequate training to provide care.

Objetivo: analizar el conocimiento del equipo de enfermería en la preparación para el alta hospitalaria de niños dependientes de tecnología. Métodos: Se trata de una investigación descriptiva y exploratoria con enfoque cualitativo, realizada desde el punto de vista de los profesionales de enfermería que actúan en la clínica pediátrica de un Hospital Universitario, ubicado en el estado de Paraíba, Brasil. Resultados: Los participantes fueron todos del sexo femenino, cuatro enfermeros y cuatro técnicos de enfermería. Los datos fueron organizados en categorías temáticas según Minayo. Fueron elegidas dos categorías: conocimiento del equipo de enfermería sobre el alta hospitalaria segura de niños dependientes de tecnología y acciones de enfermería para promover el alta hospitalaria segura de niños dependientes de tecnología. Conclusión: La falta de un flujo o protocolo de atención dificulta que los familiares los guíen de regreso a casa, imposibilitando la capacitación adecuada para brindar el cuidado.

Plan de egreso: herramienta del cuidado - diada con enfermedad crónica / Discharge Plan: A Care Tool - Chronic Disease Dyad / Plano de saída: ferramenta de cuidados - diácono com doença crônica. Estudo pseudo-experimental

Introducción: La OMS reporta incremento de las enfermedades crónicas no trasmisibles, dada su complejidad, los pacientes presentan constantes hospitalizaciones, por lo cual es necesario fortalecer la competencia del cuidado de la enfermedad tanto del paciente como del cuidador en el hogar a través del programa plan de egreso. Objetivo: determinar el cambio en la competencia para el cuidado posterior a la implementación de herramienta plan de egreso para el cuidado en el hogar de la diada persona-cuidador familiar en situación de cronicidad en una institución de segundo nivel de atención. Materiales y métodos: Estudio de abordaje cuantitativo, seudo-experimental, con diseño de pruebas pre-test y pos-test, aplicando los instrumentos de "caracterización diada paciente-cuidador" y "Cuidar". La población correspondió a 62 diadas. Muestreo no probabilístico a conveniencia. Se calculó del delta pre-post y se utilizó t-Student pareada para comparar. Resultados: el programa plan de egreso aumentó en el paciente las dimensiones de Conocimiento con un delta de 3.2 y Unicidad de 3,0 y competencia de cuidado global en 10,3; mientras que las competencias del cuidador familiar mejoraron en las dimensiones de Conocimiento con un delta de 3.34, Unicidad con delta 1.5, la dimensión de Disfrute con 1.7 y la de Reciprocidad ­Relación con un delta de 1.61 para un total en la competencia de 9.2. Discusión y conclusiones: Estos hallazgos sugieren fortalecer el programa plan de egreso, durante la hospitalización y alta con el propósito de mejorar la competencia para cuidar en el hogar tanto del paciente como su cuidador familiar en situación de cronicidad.

Introduction: The WHO reports an increase in chronic non-communicable diseases. Given the complexity of these diseases, patients are constantly hospitalized; therefore, it is necessary to strengthen the competence of both patients and caregivers at home to take care of the disease using the program "discharge plan." Objective: To determine the change in care competency following the implementation of the tool "discharge plan" in a second-level care facility for in-home care of the chronically ill person and family caregiver dyad. Materials and Methods: Quantitative, quasi-experimental study, with pre-test and post-test design, using the "Characterization of the patient-caregiver dyad" form and the "CUIDAR" instrument. The population consisted of 62 dyads. Non-probabilistic convenience sampling was used. Pre- and post-delta was calculated, and paired Student t-test was used for comparison. Results: The "discharge plan" program increased the patients' dimensions of Knowledge by a delta of 3.2, Uniqueness by 3.0, and total care competency by 10.3. Family caregivers' competencies improved in the dimensions of Knowledge by a delta of 3.34, Uniqueness by 1.5, Enjoyment by 1.7, and Reciprocity-relationship by 1.61, for a total competency score of 9.2. Discussion and conclusions: These findings suggest that the discharge plan program must be strengthened during hospitalization and discharge to improve the homecare competency of chronically ill patients and their family caregivers.

Introdução: A OMS relata um aumento nas doenças crônicas não transmissíveis, dada sua complexidade, os pacientes apresentam hospitalizações constantes, razão pela qual é necessário reforçar a competência de atendimento tanto do paciente quanto do cuidador em casa através do programa do plano de alta. Objetivo: determinar a mudança na competência de prestação de cuidados após a implementação de uma ferramenta de plano de alta para o cuidado domiciliar da díade pessoa-família cuidadora em uma instituição de cuidados de segundo nível. Materiais e Métodos: Um estudo de abordagem quantitativa, pseudo-experimental, com um projeto pré-teste e pós-teste, aplicando os instrumentos "caracterização da díade paciente-cuidador" e "Cuidar". A população correspondia a 62 díades. Amostragem de conveniência não-probabilística. O delta pré-post foi calculado e foi utilizado o par t-Student para comparação. Resultados: o programa do plano de alta hospitalar aumentou as dimensões do Conhecimento do paciente com um delta de 3,2 e a exclusividade de 3,0 e a competência global de prestação de cuidados em 10,3; enquanto as competências dos cuidadores familiares melhoraram nas dimensões do Conhecimento com um delta de 3,34, a exclusividade com delta 1,5, a dimensão de prazer com 1,7 e a relação de reciprocidade com um delta de 1,61 para uma competência total de 9,2. Discussão e conclusões: Estas descobertas sugerem o fortalecimento do programa do plano de alta, durante a hospitalização e alta com o objetivo de melhorar a competência para cuidar em casa tanto do paciente quanto de seu cuidador familiar em uma situação de cronicidade.

Identificación de errores de medicación en pacientes con enfermedades crónicas no transmisibles en un hospital de Tungurahua, Ecuador / Identification of medication errors in patients with noncommunicable chronic diseases in a Tungurahua hospital, Ecuador

Los errores de medicación constituyen tema prioritario dentro de la estrategia de seguridad del paciente, por lo que es fundamental analizar discrepancias que ocurren entre los medicamentos que se administra el paciente antes de ingresar a la unidad de salud y la prescripción que se le indica durante su hospitalización y al alta. El objetivo del trabajo fue identificar los errores de medicación en pacientes con enfermedades crónicas no transmisibles (ECNT), en un hospital de Tungurahua, Ecuador. Se evaluaron, en un período de tres meses, las anamnesis presentes en historias clínicas de pacientes con ECNT, al ingreso al servicio de emergencia y durante la estancia, traslados intra hospitalarios y el alta; a fin de identificar y clasificar errores encontrados como discrepancias o errores de conciliación. Se encontraron que, de 154 historias clínicas analizadas, en 57 (34,1 %) no existía anamnesis, siendo ésta última realizada de manera correcta en 58 (42,5 %) y de manera incorrecta en 39(23,4 %). Se determinaron 327 discrepancias, 218 durante la estancia hospitalaria y 109 en el momento del alta de los pacientes, siendo la hipertensión arterial en ambos casos la ECNT, con mayor número de discrepancias. Fueron encontradas discrepancias justificadas y discrepancias que requirieron aclaración durante la estancia y alta hospitalaria, identificándose en las primeras una mayor prevalencia de gravedad tipo A, mientras que, las discrepancias de gravedad tipo D correspondieron a las de mayor presencia al momento del alta. (AU)

Medication errors are a priority issue within the strategy of patient safety, so it is essential to analyze discrepancies that occur between the medications administered by the patient before entering the health unit and the prescription that is indicated during their hospitalization and discharge. The objective of the work was to identify medication errors in patients with noncommunicable chronic diseases (NCD), in a hospital in Tungurahua, Ecuador. The anamnesis present in clinical histories of patients with NCD, on admission to the emergency service and during the stay, intrahospital transfers and discharge were evaluated over a period of three months; in order to identify and classify errors found as discrepancies or reconciliation errors. We found that out of 154 clinical histories analyzed, in 57 (34,1 %) there was no anamnesis, the latter being performed correctly in 58 (42,5 %) and incorrectly in 39 (23,4 %). 327 discrepancies were determined, 218 during the hospital stay and 109 at the time of discharge of the patients, with arterial hypertension in both cases being the ECNT, with the greatest number of discrepancies. We found justified discrepancies and discrepancies that required clarification during the hospital stay and discharge, identifying in the former a higher prevalence of type A severity, while the discrepancies of type D severity corresponded to those of greater presence at discharge. (AU)

Characteristics and management of patients with stroke and major hemorrhagic episodes with atrial fibrillation under vitamin K antagonist therapy. EVENTHO study

Introduction and objective: In Spain, vitamin K antagonists (VKA) remain the standard treatment for the prevention of thromboembolic and hemorrhagic complications in patients with atrial fibrillation (AF), despite the high risks of suffering adverse effects. The objective of this study was to characterize the profile of VKA-treated patients suffering from stroke/systemic embolism (SE) or major hemorrhagic episodes, their evolution and the actions taken after those episodes.Materials and methodsEVENTHO was an observational multicenter study conducted in 22 Anticoagulation Spanish Units. The study included patients ≥18 years with AF who suffered major hemorrhagic episodes (67.8%) or stroke/SE (32.1%) during 2016 whileon VKA treatment [acenocoumarol (98.2%) or warfarin (1.8%)]. Time in therapeutic range (TTR) was calculated according to the Rosendaal method based on the international normalized ratio (INR) values of the previous 6 months.ResultsThe study included 585 patients (median age [range] 82.3 [43.6–96.2] years; 51.1% men; mean [95% confidence interval, CI] CHA2DS2-VASc: 4.3 [4.2–4.4] and HAS-BLED: 2.2 [2.1–2.3]). Poor anticoagulation and VKA maintenance were higher in patients with major hemorrhagic episode (p<0.0001). The most common situations after hospital discharge were: functional dependence, neurological sequelae and death.ConclusionsIn the sample studied, half of the AF patients who suffered stroke/SE or major hemorrhagic episode had inadequate TTR and, despite this, after hospital discharge, they restarted treatment with VKA. These results highlight the need to evaluate safer and effective therapeutic alternatives in AF patients with poor TTR control after suffering a stroke/SE or major hemorrhagic episode. (AU)

Introducción y objetivo: En España, los antagonistas de la vitamina K (AVK) siguen siendo el tratamiento estándar para la prevención de las complicaciones tromboembólicas y hemorrágicas en pacientes con fibrilación auricular (FA), a pesar del alto riesgo de presentar efectos adversos. El objetivo de este estudio fue caracterizar el perfil de los pacientes tratados con AVK que experimentaron un ictus/embolia sistémica o hemorragia mayor, su evolución y las acciones realizadas tras esos episodios.Materiales y métodosEVENTHO fue un estudio multicéntrico observacional realizado en 22 unidades españolas de anticoagulación. Se incluyó en el estudio a pacientes≥18 años con FA que habían tenido hemorragia mayor (67,8%) o ictus/embolia sistémica (32,1%) durante 2016 y estaban en tratamiento con AVK (acenocumarol [98,2%] o warfarina [1,8%]). El tiempo en rango terapéutico (TRT) se calculó según el método de Rosendaal basado en los valores del índice internacional normalizado de los 6 meses previos.ResultadosEl estudio incluyó a 585 pacientes (edad mediana 82,3 [rango 43,6-96,2] años; 51,1% hombres; CHA2DS2-VASc medio 4,3 [IC 95% 4,2-4,4] y HAS-BLED medio 2,2 [IC 95% 2,1-2,3]). La mala anticoagulación y el mantenimiento de los AVK fueron mayores en los pacientes con hemorragia mayor (p<0,0001). Las situaciones más frecuentes tras el alta hospitalaria fueron: dependencia funcional, secuelas neurológicas y muerte.ConclusionesEn la muestra estudiada, la mitad de los pacientes con FA que tuvieron ictus/embolia sistémica o hemorragia mayor presentaban un TRT inadecuado y, a pesar de ello, tras el alta hospitalaria, reiniciaron el tratamiento con AVK. Estos resultados destacan la necesidad de evaluar alternativas terapéuticas más seguras y eficaces en pacientes con FA con mal control del TRT tras sufrir un ictus/embolia sistémica o hemorragia mayor. (AU)

Efectos de un programa de rehabilitación remota en atención primaria en salud, posterior al alta hospitalaria por COVID-19: estudio observacional / Effects of a remote rehabilitation program in primary health care, after hospital discharge due to COVID-19: observational study

Se ha reportado un importante daño sistémico de los pacientes afectados por COVID-19, y aún existen interrogantes sobre las secuelas a largo plazo. Surge ante esto la necesidad de plantear programas de rehabilitación de los sistemas primarios de atención, que respondan a estas necesidades. Se realizó un programa de 6 semanas de rehabilitación remota, con seguimiento y progreso semanal, posterior al alta hospitalaria por COVID-19 a 114 usuarios de 4 centros de atención primaria de la comuna de El Bosque, Santiago, R. Metropolitana. Se incluyó a pacientes de edades entre 21 y 93 años, combinando los principios del ejercicio terapéutico individualizado, una evaluación presencial previo y posterior a las 6 semanas de trabajo. Los indicadores evaluados fueron: Minimental Abreviado, 1 Minute Sit to Stand Test (1min STST), Timed Up and Go (TUG), índice de Barthel y FRAIL. Se hicieron análisis inferenciales y descriptivos y se encontraron mejoras favorables en los indicadores de condición física (TUG y 1'STST), Índice de Barthel y el Simple "FRAIL" Questionnaire Screening Tool (FRAIL). En conclusión, si bien la mayoría de los indicadores tuvieron resultados favorables, es necesario seguir estudiando herramientas de evaluación más sensibles e intervenciones específicas que se adapten a las necesidades de las personas.

Significant systemic damage has been reported in patients affected by COVID-19, and questions remain about long-term sequelae. Therefore, the need arises to propose rehabilitation programs for primary care systems that respond to these needs. A 6-week program of remote rehabilitation, with weekly follow-up and progress, after hospital discharge for COVID-19 was carried out on 114 users from 4 primary care centers in the commune of El Bosque, Santiago, Chile. The program included patients from 21 to 93 years-old, combining the principles of individualized therapeutic exercise, a face-to-face evaluation before and after 6 weeks of work. The indicators evaluated were: Abbreviated Minimental, 1 minute Sit to Stand Test (1 min STST), Timed Up and Go (TUG), Barthel index and the Simple "FRAIL" Questionnaire Screening Tool (FRAIL). Inferential and descriptive analyses were carried out and favorable improvements were found in the indicators of physical condition (TUG and 1min STST), Barthel Index and FRAIL. In conclusion, while most of the indicators had favorable results, it is required to further explore more sensitive assessment tools and targeted interventions that are tailored to people's needs.

Recuperación laboral clínica y funcional a 3 meses del alta en pacientes hospitalizados por neumonía por SARS-CoV-2: relación con la terapia recibida / Clinical and functional recovery and return to work 3 months after discharge in patients hospitalized for SARS-CoV-2 pneumonia: relationship with the therapy received

Resumen Introducción: La presentación clínica de neumonía por COVID-19 ha sido bien documentada; sin embargo, sus repercusiones a largo plazo son aún motivo de investigación. Objetivo: Evaluar la recuperación laboral, clínica y funcional respiratoria, a 3 meses del egreso de pacientes hospitalizados por neumonía por SARS-CoV-2, en relación con la terapia ventilatoria recibida. Pacientes y Métodos: Se analizó una cohorte prospectiva de 116 pacientes con neumonía por COVID-19 del Hospital Naval Almirante Nef de Viña del Mar, con seguimiento clínico y funcional respiratorio 3 meses después de su alta. Resultados: Mediana del seguimiento: 100 días. Constitución de la cohorte: 75 hombres, mediana de edad 60 años, 50% obesos, 34,5% fumadores y 13,8% con comorbilidad respiratoria. 16% recibió rehabilitación. Se reportó disnea en 48,3% y fatigabilidad en 33,6%. Solo 54,8% retornó al trabajo. El 65,2% que utilizó oxigenoterapia (O2) volvió a trabajar comparado con 44% que utilizó cánula nasal de alto flujo (CNAF) y 33,3% con ventilación mecánica invasiva (VMI). Mayoritariamente el grupo de O2 volvió a la vida normal en comparación con CNAF y VMI (71,4 versus 17,5% y 11,1% respectivamente). La función pulmonar fue normal en 39 pacientes (33,6%). La serie que volvió a vida normal tuvo mayor porcentaje de DLCO y test de caminata de 6 minutos normales. En comparación con la serie O2, la serie CNAF tuvo mayor frecuencia de alteración de DLCO (OR = 5) seguido por la serie VMI (OR = 3,6). Conclusión: A 3 meses de seguimiento, se evidenció ausentismo laboral, persistencia de síntomas y alteración funcional respiratoria (DLCO), especialmente en quienes recibieron soporte ventilatorio adicional a oxigenoterapia.

Introduction: The clinical presentation of COVID-19 pneumonia has been well documented; however, its long-term repercussions are still a matter of investigation. Objective: to evaluate the occupational, clinical and functional respiratory recovery, 3 months after the discharge of patients hospitalized for SARS-CoV-2 pneumonia, in relation to the ventilatory therapy received. Patients and Methods: A prospective cohort of 116 patients with COVID-19 pneumonia from Hospital Naval Almirante Nef (Viña del Mar, Chile) was analyzed, with clinical and functional respiratory follow-up at 3 months after being discharged. Results: Median follow-up: 100 days. Composition of the cohort: 75 men, median age 60 years-old, 50% obese, 34.5% smokers and 13.8% with respiratory comorbidity. 16% received rehabilitation. Dyspnea was reported in 48.3% and fatigue in 33.6%. Only 54.8% returned to work. 65.2% who used oxygen therapy (O2) returned to work compared to 44% who used high-flow nasal cannula (HFNC) and 33.3% with invasive mechanical ventilation (IMV). Mostly the O2 group returned to normal life compared to HFNC and VMI (71.4 versus 17.5% and 11.1% respectively). Lung function was normal in 39 patients (33.6%). The series that returned to normal life had higher percentage of normal DLCO and six-minute walk test. Compared to the O2 series, the CNAF series had a higher frequency of DLCO alteration (OR = 5) followed by the VMI series (OR = 3.6). Conclusion: At 3 months of follow-up, absenteeism from work, persistence of symptoms and respiratory functional alteration (DLCO) were evident, especially in those who received ventilatory support in addition to oxygen therapy.

Characteristics and management of patients with stroke and major hemorrhagic episodes with atrial fibrillation under vitamin K antagonist therapy. EVENTHO study.

INTRODUCTION AND OBJECTIVE: In Spain, vitamin K antagonists (VKA) remain the standard treatment for the prevention of thromboembolic and hemorrhagic complications in patients with atrial fibrillation (AF), despite the high risks of suffering adverse effects. The objective of this study was to characterize the profile of VKA-treated patients suffering from stroke/systemic embolism (SE) or major hemorrhagic episodes, their evolution and the actions taken after those episodes. MATERIALS AND METHODS: EVENTHO was an observational multicenter study conducted in 22 Anticoagulation Spanish Units. The study included patients ≥18 years with AF who suffered major hemorrhagic episodes (67.8%) or stroke/SE (32.1%) during 2016 whileon VKA treatment [acenocoumarol (98.2%) or warfarin (1.8%)]. Time in therapeutic range (TTR) was calculated according to the Rosendaal method based on the international normalized ratio (INR) values of the previous 6 months. RESULTS: The study included 585 patients (median age [range] 82.3 [43.6-96.2] years; 51.1% men; mean [95% confidence interval, CI] CHA2DS2-VASc: 4.3 [4.2-4.4] and HAS-BLED: 2.2 [2.1-2.3]). Poor anticoagulation and VKA maintenance were higher in patients with major hemorrhagic episode (p<0.0001). The most common situations after hospital discharge were: functional dependence, neurological sequelae and death. CONCLUSIONS: In the sample studied, half of the AF patients who suffered stroke/SE or major hemorrhagic episode had inadequate TTR and, despite this, after hospital discharge, they restarted treatment with VKA. These results highlight the need to evaluate safer and effective therapeutic alternatives in AF patients with poor TTR control after suffering a stroke/SE or major hemorrhagic episode.

Preparo para alta de crianças com doenças crônicas: olhar freiriano em aspectos influenciadores do cuidado no domicílio / Preparing for the discharge of children with chronic diseases from hospital: looking at aspects influencing home care through a Freirean lens / Preparación para alta de niños con enfermedades crónicas: mirada freiriana en aspectos que influyen en el cuidado a domicilio

Estudo qualitativo que analisou aspectos envolvidos no preparo para alta hospitalar de crianças com doenças crônicas que influenciam o cuidado no domicílio. Dados das entrevistas de 25 famílias foram interpretados segundo análise temática indutiva e referenciais freirianos. Identificaram-se aspectos do processo de hospitalização, como engajamento e postura dos profissionais no encontro com os familiares e atitude da família frente ao saber dos profissionais; da família, como tempo de diagnóstico da doença, conhecimento construído na hospitalização, literacia em saúde familiar, atitude para superar o medo inicial e envolvimento da criança no autocuidado; e da rede social familiar, que influenciaram a (re)moldagem do cuidado domiciliar. Compreende-se a necessidade de superar a visão bancária no preparo para alta hospitalar, para a família desenvolver seu potencial e transformar a realidade dos cuidados domiciliares dessas crianças.(AU)

This qualitative study analyzed aspects influencing home care involved in preparing for the discharge of children with chronic diseases from hospital. Data from interviews with 25 families were interpreted using inductive thematic analysis and a Freirean frame of reference. We identified aspects of the hospitalization process (staff engagement and posture with family members, family attitudes towards health professionals' knowledge) and the family (length of time to diagnosis, knowledge gained during hospitalization, family health literacy, attitudes to overcoming initial fear, and child involvement in self-care and his/her social network, which influence (re)shaping of home care). The findings reveal the need to overcome the "banking" vision in preparing for hospital discharge so that families can develop their potential and transform the reality of home care for these children.(AU)

Estudio cualitativo que analizó aspectos envueltos en la preparación para el alta hospitalaria de niños con enfermedades crónicas que influyen en el cuidado en el domicilio. Se interpretaron datos de las entrevistas con 25 familias según análisis temático inductivo y referenciales freirianos. Se identificaron los aspectos del proceso de hospitalización: el compromiso y la postura de los profesionales en el encuentro con los familiares y la actitud de la familia ante el saber de los profesionales; de la familia: tiempo de diagnóstico de la enfermedad, conocimiento construido en la hospitalización, alfabetización en salud familiar, actitud para superar el miedo inicial y el envolvimiento del niño en el autocuidado; así como de su red social que influyeron en el (re)moldeado del cuidado familiar. Se comprende la necesidad de superar la visión bancaria en la preparación para el alta hospitalaria, para que la familia desarrolle su potencial y transforme la realidad de los cuidados en domicilio de esos niños.(AU)

Efecto de una intervención de alta programada sobre los reingresos de pacientes con insuficiencia cardíaca: estudio APRICA / Effect of a planned discharge intervention on readmissions of patients with heart failure APRICA study / Efeito de uma intervenção de alta planejada nas readmissões de pacientes com insuficiência cardíaca estudo APRICA

Introducción. La insuficiencia cardíaca (IC) es una enfermedad con alta incidencia, prevalencia y mortalidad. Es primera causa de hospitalización en mayores de 65 años y 25% de los pacientes que reingresan antes de 30 días. La implementación de varios planes de transición al alta han mostrado beneficios respecto a los reingresos, no habiendo datos al respecto en Uruguay. Se diseñó un estudio para analizar el efecto de un Plan de Alta Programada sobre los reingresos en pacientes internados con IC en un Hospital. Material y métodos. Estudio prospectivo, controlado y randomizado, incluyendo pacientes ingresados en servicios de medicina del Hospital de Clínicas Dr. Manuel Quintela con diagnóstico de IC. Criterios de exclusión: negativa a participar, discapacidad cognitiva, hospitalización d"24 horas o muerte en internación. Se randomizaron dos grupos (intervención y control) con seguimiento a 18 meses. En el grupo intervención se aplicó un plan de alta programada y en el grupo control el criterio de médico tratante. Se registraron reingresos, muerte y calidad de vida a los 3, 6, 9, 12 y 18 meses. Se consideró significativo un valor de p<0,05. Se utilizó la prueba de T- student para muestras independientes. Resultados. Se incluyeron 149 pacientes, 78 en el grupo intervención. Se registraron 19 (24,4%) reingresos en el grupo intervención y 38 (53,5%) en el grupo control (RR 1,85 [IC 1,337-2,583] p<0,05). Ocurrieron 6 muertes en el grupo intervención y 7 en el grupo control (RR: 1,024 [IC 0,926-1,32] p=0,640). La calidad de vida por Test de Minnesota fue 50,98; 49,71 y 49,07 en el grupo intervención a los 3, 6 y 18 meses, respectivamente, y 55,04; 55,32 y 54,91 en el grupo control, con un valor de p no significativo. Conclusiones. La implementación de un Plan de Alta Programada reduce de manera significativa los reingresos por IC. Dado que parece ser una herramienta costo/efectiva para el sistema de salud la misma podría tener un impacto beneficioso en la calidad asistencial del paciente con IC.

Background. Heart failure (HF) is a disease with a high incidence, prevalence and mortality. It is the first cause of hospitalization in people over 65 years and 25% of patients are readmitted within 30 days. The implementation of various discharge transition plans has shown benefits with respect to readmissions, and there is no data in this regard in Uruguay. A study was designed to analyze the effect of a Scheduled Discharge Plan on readmissions in hospitalized patients with HF. Material and methods. Prospective, controlled and randomized study, including patients admitted to the medical services of the Hospital de Clínicas Dr. Manuel Quintela with a diagnosis of HF. Exclusion criteria: refusal to participate, cognitive disability, hospitalization d"24 hours or death in hospital. Two groups (intervention and control) were randomized with 18-month follow-up. In the intervention group, a planned discharge plan was applied and the criterion of treating physician was applied in control. Readmissions, death and quality of life were recorded at 3, 6, 9, 12 and 18 months. A value of p <0.05 was considered significant. The student s T-test was used for independent samples. Results. 149 patients were included, 78 in the intervention group. There were 19 (24.4%) readmissions in the intervention group and 38 (53.5%) in the control group (RR 1.85 [CI 1.337-2.583] p <0.05). There were 6 deaths in the intervention group and 7 in the control group, (RR: 1,024 [CI 0.926-1.32] p = 0.640). The quality of life by Minnesota Test was 50.98; 49.71 and 49.07 in intervention at 3, 6 and 18 months respectively and 55.04; 55.32 and 54.91 in the control group, with a non-significant p value. Conclusions. The implementation of a Scheduled Discharge Plan significantly reduces readmissions for HF. Given that it appears to be a cost/effective tool for the health system, it could have a beneficial impact on the quality of care for patients with HF.

Introdução. A insuficiência cardíaca (IC) é uma doença com alta incidência, prevalência e mortalidade. É a primeira causa de hospitalização em pessoas com mais de 65 anos e 25% dos pacientes são readmitidos em 30 dias. A implementação de vários planos de transição de alta mostrou benefícios no que diz respeito às readmissões, e não há dados a esse respeito no Uruguai. Um estudo foi desenhado para analisar o efeito de um Plano de Alta Planejado nas readmissões em pacientes hospitalizados com IC. Material e métodos. Estudo prospectivo, controlado e randomizado, incluindo pacientes internados nos serviços médicos do Hospital de Clínicas Dr. Manuel Quintela com diagnóstico de IC. Critérios de exclusão: recusa em participar, deficiência cognitiva, internação d"24 horas ou óbito no hospital. Dois grupos foram randomizados (intervenção e controle) com seguimento de 18 meses. No grupo de intervenção, um plano de alta planejado foi aplicado e o critério de médico assistente foi aplicado no controle. Readmissões, óbito e qualidade de vida foram registrados aos 3, 6, 9, 12 e 18 meses. Um valor de p<0,05 foi considerado significativo. O teste T do aluno foi usado para amostras independentes. Resultados. Foram incluídos 149 pacientes, 78 no grupo de intervenção. Houve 19 (24,4%) readmissões no grupo de intervenção e 38 (53,5%) no grupo de controle (RR 1,85 [IC 1,337-2,583] p <0,05). Houve 6 mortes no grupo de intervenção e 7 no grupo controle, (RR: 1,024 [IC 0,926-1,32] p=0,640). A qualidade de vida pelo teste de Minnesotafoi de 50,98; 49,71 e 49,07 na intervenção em 3, 6 e 18 meses, respectivamente, e 55,04; 55,32 e 54,91 no grupo controle, com um valor de p não significativo. Conclusões. A implementação de um Plano de Descarga Planejado reduz significativamente as readmissões para IC. Visto que parece ser uma ferramenta econômica para o sistema de saúde, pode ter um impacto benéfico na qualidade do atendimento aos pacientes com IC.

Implementación de un programa de corta estancia hospitalaria maternoinfantil / Early post-partum discharge program in a maternity unit

Objetivo: El objetivo del estudio fue analizar el perfil sociodemográfico y obstétrico, así como la incidencia de consultas y reingresos, de las mujeres acogidas a un programa de corta estancia puerperal en el hospital del estudio. Metodología: Se realizó un estudio descriptivo de las variables relativas al perfil sociodemográfico, el embarazo, el parto y el puerperio de las mujeres con parto vaginal y alta precoz antes de 48 horas en el Hospital del Mar (Barcelona), desde junio de 2017 a junio de 2019. Resultados: 188 mujeres (un 8,2% del total de partos vaginales) se acogieron a la corta estancia hospitalaria durante el periodo de estudio. El 53,7% (n= 101) eran de nacionalidad española, y el resto eran de 32 nacionalidades distintas más. El 74,5% (n= 140) habían tenido uno o más partos previos, y el 84,6% (159) eran gestantes sin riesgo. El 95,7% de las mujeres (n= 180) tuvieron partos eutócicos. Un 7% (n= 13) de mujeres tuvieron que consultar en el hospital durante la primera semana después del alta por diferentes motivos. Tuvieron que consultar e ingresar un 2,1% (n= 4) de los neonatos con alta precoz, todos ellos por ictericia. No hubo ningún reingreso materno. Conclusiones: El perfil de mujeres que se acogen al programa de alta precoz en el centro del estudio son gestantes de bajo riesgo y presentan menos complicaciones en el parto que el resto de la población. No hubo más complicaciones o readmisiones hospitalarias en las mujeres con alta precoz respecto al global de los partos del centro del estudio. La implementación de un programa de corta estancia puerperal en nuestra institución es un procedimiento seguro, pero aceptado por un perfil de mujeres específico. (AU)

Objective: The objective of the study is to analyze the different mothers and newborns profiles who attend this program, and to analyze the different readmission rates comparing to the overall population that come for the usual childbirth in the hospital. Methodology: A descriptive study was performed, analyzing socio-demographic, obstetrical and partum and post-partum outcomes in women who attended to an early post-partum discharge before 48h after a vaginal delivery in Hospital del Mar (Barcelona), from June 2017 to June 2019. Results: 188 women (8.2% of total of vaginal deliveries) had the early post-partum discharge, 53.7% (n= 101) were Spanish women, 74.5% (n= 140) of women had already children, and 84.6% (n= 159) had no obstetrical risk factors. 95.7% (n= 180) women had eutocic deliveries, 7% (n= 13) of mother had to readmission to the hospital after the early discharge during the first week. There was only a 2.1% (n= 4) of newborns with early discharge that need to readmission; all of them because of neonatal hyperbilirubinemia. Conclusions: Most of women who attend to an early post-partum discharge are low risk pregnancies and deliveries. There are no higher mother readmission rates respect to the overall population. The implementation of an early post-partum discharge in the maternity unit in the institution is a safe process, but still accepted by a specific maternal profile of women. (AU)

A atuação do assistente social na alta hospitalar do Hospital Universitário Regional dos Campos Gerais no contexto da humanização e integralidade em saúde / The role of the social worker at the discharge of the Hospital Universitário Regional dos Campos Gerais in the context of humanization and integrality in health / La actuación del asistente social en el alta hospitalaria del Hospital Universitario Regional dos Campos Gerais en el contexto de la humanización e integralidad en salud

O objetivo da pesquisa é compreender a atuação do Assistente Social na alta hospitalar do Hospital Universitário Regional dos Campos Gerais (HURCG). O estudo é exploratório e de natureza qualitativa, sendo utilizados o formulário de dados e o grupo focal como procedimentos metodológicos de coleta de dados e, para interpretar os dados adquiridos no grupo focal, a análise de conteúdo temática. Constatou-se que a atuação do Assistente Social no HURCG perpassa os casos emergenciais e os complexos, sendo o vínculo de confiança e a resolutividade dos problemas os fatores determinantes na relação dos Assistentes Sociais com outros profissionais e com os pacientes na alta hospitalar no HURCG. O Assistente Social é considerado um dos profissionais essenciais no planejamento da alta hospitalar. Além disso, a articulação com a rede de atendimento e os princípios de humanização e integralidade no atendimento mostraram-se imprescindíveis nesse processo.

The research aims to understand the role of the Social Worker at the hospital discharge of the Hospital Universitário Regional dos Campos Gerais (HURCG). The study has an exploratory and qualitative nature. The data form and the focus group were used as methodological procedures for data collection. To interpret the data acquired in the focus group, thematic content analysis was used. It was verified that the role of the Social Worker in the HURCG pervades the emergency and complex cases and problem solving are the determining factors in the relationship between Social Workers and other professionals and patients on discharge from HURCG. It was noted that the Social Worker is considered as one of the essential professionals in planning hospital discharge. In addition, the articulation with the service network and the principles of humanization and integrality in care were essential in this process.

La investigación tiene como objetivo comprender la actuación del Asistente Social en el alta hospitalaria del Hospital Universitario Regional dos Campos Gerais (HURCG). El estudio posee un marco exploratorio y una naturaleza cualitativa. Como procedimientos metodológicos de recolección de datos se utilizaron el formulario de datos y el grupo focal. Para interpretar los datos adquiridos en el grupo focal se utilizó el análisis de contenido temático. Se constató que la actuación del Asistente Social en el HURCG atravesaba los casos de emergencia y los complejos, siendo el vínculo de confianza y la resolución de los problemas los factores determinantes en la relación de los asistentes sociales con otros profesionales y con los pacientes en el alta hospitalaria en el HURCG. Se notó que el Asistente Social es considerado como uno de los profesionales esenciales en la planificación del alta hospitalaria. Además, la articulación con la red de atención y los principios de humanización e integralidad en la atención se mostraron imprescindibles en ese proceso.