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ORIGINAL ARTICLE
Construction and validity of an educational video to prevent immunization errors
- Naiara Cristina Silva Simões
, - Laís Oliveira de Moraes Tavares ,
- Carlos Miguel Bolognani da Silva ,
- Samuel Barroso Rodrigues ,
- Stênio Henrique Oliveira , [ ... ],
- Valeria Conceição de Oliveira
10-09-2023
Resumo
ORIGINAL ARTICLEConstruction and validity of an educational video to prevent immunization errors
Revista Brasileira de Enfermagem. 2023;76(4):e20230010
10-09-2023DOI 10.1590/0034-7167-2023-0010
- Naiara Cristina Silva Simões ,
- Laís Oliveira de Moraes Tavares ,
- Carlos Miguel Bolognani da Silva ,
- Samuel Barroso Rodrigues ,
- Stênio Henrique Oliveira ,
- Eliete Albano de Azevedo Guimarães ,
- Valeria Conceição de Oliveira
Visualizações0Ver maisABSTRACT
Objective:
to construct and validate an orientation video, based on a low-fidelity clinical simulation scenario, to prevent immunization errors.
Methods:
a methodological study with video construction, validated in two stages by different audiences. Content was selected based on a realistic simulation scenario of the vaccine administration process to a patient-actor. Items with concordance greater than 0.8 and 0.6 were considered valid, verified using the Content Validity Index (CVI) and the Content Validity Ratio (CVR), respectively.
Results:
judges’ CVI had an average of 97.5%, and CVR, 0.9, and health professionals’ CVI, 95.4%, and CVR, 0.8. Successes in administering vaccines were addressed, such as careful reading of labels, double-checking the vaccine, distractions/interruptions and error reporting.
Conclusions:
the video was constructed and validated in terms of content, and can be used in training professionals working in vaccination.
Visualizações0
Resumo
ORIGINAL ARTICLEConstruction and validity of an educational video to prevent immunization errors
Revista Brasileira de Enfermagem. 2023;76(4):e20230010
10-09-2023DOI 10.1590/0034-7167-2023-0010
- Naiara Cristina Silva Simões ,
- Laís Oliveira de Moraes Tavares ,
- Carlos Miguel Bolognani da Silva ,
- Samuel Barroso Rodrigues ,
- Stênio Henrique Oliveira ,
- Eliete Albano de Azevedo Guimarães ,
- Valeria Conceição de Oliveira
Visualizações0Ver maisABSTRACT
Objective:
to construct and validate an orientation video, based on a low-fidelity clinical simulation scenario, to prevent immunization errors.
Methods:
a methodological study with video construction, validated in two stages by different audiences. Content was selected based on a realistic simulation scenario of the vaccine administration process to a patient-actor. Items with concordance greater than 0.8 and 0.6 were considered valid, verified using the Content Validity Index (CVI) and the Content Validity Ratio (CVR), respectively.
Results:
judges’ CVI had an average of 97.5%, and CVR, 0.9, and health professionals’ CVI, 95.4%, and CVR, 0.8. Successes in administering vaccines were addressed, such as careful reading of labels, double-checking the vaccine, distractions/interruptions and error reporting.
Conclusions:
the video was constructed and validated in terms of content, and can be used in training professionals working in vaccination.
- Naiara Cristina Silva Simões
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ORIGINAL ARTICLE
Occurrence and preventability of adverse events in hospitals: a retrospective study
- Antônio José de Lima Júnior ,
- Ariane Cristina Barboza Zanetti ,
- Bruna Moreno Dias ,
- Andrea Bernardes ,
- Francielly Marques Gastaldi , [ ... ],
- Carmen Silvia Gabriel
07-10-2023
Resumo
ORIGINAL ARTICLEOccurrence and preventability of adverse events in hospitals: a retrospective study
Revista Brasileira de Enfermagem. 2023;76(3):e20220025
07-10-2023DOI 10.1590/0034-7167-2022-0025
- Antônio José de Lima Júnior ,
- Ariane Cristina Barboza Zanetti ,
- Bruna Moreno Dias ,
- Andrea Bernardes ,
- Francielly Marques Gastaldi ,
- Carmen Silvia Gabriel
Visualizações0Ver maisABSTRACT
Objectives:
to analyze the incidence of preventable adverse events related to health care in adult patients admitted to public hospitals in Brazil.
Methods:
observational, analytical, retrospective study based on medical records review.
Results:
medical records from 370 patients were evaluated, 58 of whom had at least one adverse event. The incidence of adverse events corresponded to 15.7%. Adverse events were predominantly related to healthcare-related infection (47.1%) and procedures (24.5%). Regarding the adverse event severity, 13.7% were considered mild, 51.0% moderate, and 35.3% severe. 99% of adverse events were classified as preventable. Patients admitted to the emergency room had a 3.73 times higher risk for adverse events.
Conclusions:
this study’s results indicate a high incidence of avoidable adverse events and highlight the need for interventions in care practice.
Visualizações0Resumo
ORIGINAL ARTICLEOccurrence and preventability of adverse events in hospitals: a retrospective study
Revista Brasileira de Enfermagem. 2023;76(3):e20220025
07-10-2023DOI 10.1590/0034-7167-2022-0025
- Antônio José de Lima Júnior ,
- Ariane Cristina Barboza Zanetti ,
- Bruna Moreno Dias ,
- Andrea Bernardes ,
- Francielly Marques Gastaldi ,
- Carmen Silvia Gabriel
Visualizações0Ver maisABSTRACT
Objectives:
to analyze the incidence of preventable adverse events related to health care in adult patients admitted to public hospitals in Brazil.
Methods:
observational, analytical, retrospective study based on medical records review.
Results:
medical records from 370 patients were evaluated, 58 of whom had at least one adverse event. The incidence of adverse events corresponded to 15.7%. Adverse events were predominantly related to healthcare-related infection (47.1%) and procedures (24.5%). Regarding the adverse event severity, 13.7% were considered mild, 51.0% moderate, and 35.3% severe. 99% of adverse events were classified as preventable. Patients admitted to the emergency room had a 3.73 times higher risk for adverse events.
Conclusions:
this study’s results indicate a high incidence of avoidable adverse events and highlight the need for interventions in care practice.
- Antônio José de Lima Júnior
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ORIGINAL ARTICLE
Translation, cross-cultural adaptation and content validation of the Global Trigger Tool surgical module
- Francine Taporosky Alpendre ,
- Elaine Drehmer de Almeida Cruz ,
- Josemar Batista ,
- Eliane Cristina Sanches Maziero ,
- Marilise Borges Brandão
07-18-2022
Resumo
ORIGINAL ARTICLETranslation, cross-cultural adaptation and content validation of the Global Trigger Tool surgical module
Revista Brasileira de Enfermagem. 2022;75(6):e20210859
07-18-2022DOI 10.1590/0034-7167-2021-0859
- Francine Taporosky Alpendre ,
- Elaine Drehmer de Almeida Cruz ,
- Josemar Batista ,
- Eliane Cristina Sanches Maziero ,
- Marilise Borges Brandão
Visualizações0ABSTRACT
Objective:
to translate, cross-culturally adapt and validate the Global Trigger Tool surgical module content for Brazil.
Method:
this is methodological research, carried out between March/2018 and February/2019, following the steps of translation, synthesis, back-translation, validation by the Delphi technique, pre-test and presentation to developers. Two translators, two back-translators, six professionals participated in the expert committee. A pre-test was carried out with a retrospective analysis of 244 medical records of adult patients. The content validity index and Cronbach’s alpha were determined for data analysis.
Results:
the translation and cross-cultural adaptation allowed adjustments of items for use in Brazil. The mean Content Validity Index was 1.38, and the degree of agreement among experts was 92.4%. Cronbach’s alpha was 0.83 for the 11 surgical triggers and their guidelines.
Conclusion:
the module was translated, cross-culturally adapted for Brazil, with high reliability to identify surgical adverse events.
Palavras-chave: Health CareMedical ErrorsPatient SafetyQuality IndicatorsSurgicentersValidation StudyVer maisVisualizações0Resumo
ORIGINAL ARTICLETranslation, cross-cultural adaptation and content validation of the Global Trigger Tool surgical module
Revista Brasileira de Enfermagem. 2022;75(6):e20210859
07-18-2022DOI 10.1590/0034-7167-2021-0859
- Francine Taporosky Alpendre ,
- Elaine Drehmer de Almeida Cruz ,
- Josemar Batista ,
- Eliane Cristina Sanches Maziero ,
- Marilise Borges Brandão
Visualizações0ABSTRACT
Objective:
to translate, cross-culturally adapt and validate the Global Trigger Tool surgical module content for Brazil.
Method:
this is methodological research, carried out between March/2018 and February/2019, following the steps of translation, synthesis, back-translation, validation by the Delphi technique, pre-test and presentation to developers. Two translators, two back-translators, six professionals participated in the expert committee. A pre-test was carried out with a retrospective analysis of 244 medical records of adult patients. The content validity index and Cronbach’s alpha were determined for data analysis.
Results:
the translation and cross-cultural adaptation allowed adjustments of items for use in Brazil. The mean Content Validity Index was 1.38, and the degree of agreement among experts was 92.4%. Cronbach’s alpha was 0.83 for the 11 surgical triggers and their guidelines.
Conclusion:
the module was translated, cross-culturally adapted for Brazil, with high reliability to identify surgical adverse events.
Palavras-chave: Health CareMedical ErrorsPatient SafetyQuality IndicatorsSurgicentersValidation StudyVer mais
- Francine Taporosky Alpendre
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ORIGINAL ARTICLE
Supervisors’ perceptions on errors of nursing students in clinical clerkship: a qualitative research
- Ana Paula Sousa Santos ,
- Márcio Filipe Moniz Tavares ,
- Alberto Carlos Marques Duarte ,
- Fábio Alexandre Melo do Rego Sousa
05-28-2021
Resumo
ORIGINAL ARTICLESupervisors’ perceptions on errors of nursing students in clinical clerkship: a qualitative research
Revista Brasileira de Enfermagem. 2021;74(2):e20200675
05-28-2021DOI 10.1590/0034-7167-2020-0675
- Ana Paula Sousa Santos ,
- Márcio Filipe Moniz Tavares ,
- Alberto Carlos Marques Duarte ,
- Fábio Alexandre Melo do Rego Sousa
Visualizações0ABSTRACT
Objectives:
to compare pedagogical supervisors’ and clinical supervisors’ perceptions about the errors made by nursing students in clinical clerkship.
Methods:
a qualitative exploratory-descriptive study developed with 105 participants. Data collection was performed with a questionnaire with open-ended questions. Content analysis performed according to the conceptual model of student errors in clinical teaching.
Results:
pedagogical supervisors perceive, in descending order, errors in transversal competencies, in the execution of care and medication. Clinical supervisors perceive, in descending order, the execution of care, medication, and transversal competencies.
Final Considerations:
there was coincidence and complementarity in clinical supervisors’ and pedagogical supervisors’ perceptions, although not in the same order, regarding the errors made. This study presents contributions related to the existing knowledge in relation to medication errors, which are not the most perceived, and those of transversal competencies, which take on a prominent position.
Palavras-chave: Clinical ClerkshipEducation, NursingMedical ErrorsQualitative ResearchStudents NursingVer maisVisualizações0Resumo
ORIGINAL ARTICLESupervisors’ perceptions on errors of nursing students in clinical clerkship: a qualitative research
Revista Brasileira de Enfermagem. 2021;74(2):e20200675
05-28-2021DOI 10.1590/0034-7167-2020-0675
- Ana Paula Sousa Santos ,
- Márcio Filipe Moniz Tavares ,
- Alberto Carlos Marques Duarte ,
- Fábio Alexandre Melo do Rego Sousa
Visualizações0ABSTRACT
Objectives:
to compare pedagogical supervisors’ and clinical supervisors’ perceptions about the errors made by nursing students in clinical clerkship.
Methods:
a qualitative exploratory-descriptive study developed with 105 participants. Data collection was performed with a questionnaire with open-ended questions. Content analysis performed according to the conceptual model of student errors in clinical teaching.
Results:
pedagogical supervisors perceive, in descending order, errors in transversal competencies, in the execution of care and medication. Clinical supervisors perceive, in descending order, the execution of care, medication, and transversal competencies.
Final Considerations:
there was coincidence and complementarity in clinical supervisors’ and pedagogical supervisors’ perceptions, although not in the same order, regarding the errors made. This study presents contributions related to the existing knowledge in relation to medication errors, which are not the most perceived, and those of transversal competencies, which take on a prominent position.
Palavras-chave: Clinical ClerkshipEducation, NursingMedical ErrorsQualitative ResearchStudents NursingVer mais
- Ana Paula Sousa Santos
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EXPERIENCE REPORT
Safety Huddle methodology development in patient safety software: an experience report
- Lucas Rodrigo Garcia de Mello ,
- Barbara Pompeu Christovam ,
- Ana Paula Amorim Moreira ,
- Erica Brandão de Moraes
12-21-2020
Resumo
EXPERIENCE REPORTSafety Huddle methodology development in patient safety software: an experience report
Revista Brasileira de Enfermagem. 2020;73(suppl 6):e20190788
12-21-2020DOI 10.1590/0034-7167-2019-0788
- Lucas Rodrigo Garcia de Mello ,
- Barbara Pompeu Christovam ,
- Ana Paula Amorim Moreira ,
- Erica Brandão de Moraes
Visualizações0Ver maisABSTRACT
Objectives:
to report the development and implementation of a digital tool developed by a group of nurses and information technology professionals working in healthcare quality management.
Methods:
an experience report regarding the development of the Safety Huddle digital model, using the agile Scrum methodology.
Results:
the first stage was the development of the model proposed by the team of nurses and IT professionals, based on the demand of quality and patient safety leaders in Brazil, and the second phase was the software implementation.
Final Considerations:
the development and implementation of the Safety Huddle contributed to expedite the detection and distribution of actions, in addition to promoting integration among teams, accountability, and empowerment of professionals to foresee and identify issues related to patient safety and face them through action plans.
Visualizações0Resumo
EXPERIENCE REPORTSafety Huddle methodology development in patient safety software: an experience report
Revista Brasileira de Enfermagem. 2020;73(suppl 6):e20190788
12-21-2020DOI 10.1590/0034-7167-2019-0788
- Lucas Rodrigo Garcia de Mello ,
- Barbara Pompeu Christovam ,
- Ana Paula Amorim Moreira ,
- Erica Brandão de Moraes
Visualizações0Ver maisABSTRACT
Objectives:
to report the development and implementation of a digital tool developed by a group of nurses and information technology professionals working in healthcare quality management.
Methods:
an experience report regarding the development of the Safety Huddle digital model, using the agile Scrum methodology.
Results:
the first stage was the development of the model proposed by the team of nurses and IT professionals, based on the demand of quality and patient safety leaders in Brazil, and the second phase was the software implementation.
Final Considerations:
the development and implementation of the Safety Huddle contributed to expedite the detection and distribution of actions, in addition to promoting integration among teams, accountability, and empowerment of professionals to foresee and identify issues related to patient safety and face them through action plans.
- Lucas Rodrigo Garcia de Mello
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ORIGINAL ARTICLE
Best Safety Practices in nursing care in Neonatal Intensive Therapy
- Sabrina da Costa Machado Duarte ,
- Sílvia Schoenau de Azevedo ,
- Gabrielle da Costa de Muinck ,
- Tainara Ferreira da Costa ,
- Maria Manuela Vila Nova Cardoso , [ ... ],
- Juliana Rezende Montenegro Medeiros de Moraes
03-30-2020
Resumo
ORIGINAL ARTICLEBest Safety Practices in nursing care in Neonatal Intensive Therapy
Revista Brasileira de Enfermagem. 2020;73(2):e20180482
03-30-2020DOI 10.1590/0034-7167-2018-0482
- Sabrina da Costa Machado Duarte ,
- Sílvia Schoenau de Azevedo ,
- Gabrielle da Costa de Muinck ,
- Tainara Ferreira da Costa ,
- Maria Manuela Vila Nova Cardoso ,
- Juliana Rezende Montenegro Medeiros de Moraes
Visualizações0Ver maisABSTRACT
Objectives:
to identify the perception of nursing professionals on human errors in nursing care at a Neonatal Intensive Care Unit and to assess Best Practices strategies proposed by these professionals for patient safety in nursing care.
Methods:
this is a quantitative-qualitative, descriptive study. Setting: Neonatal Intensive Care Unit. Participants: 22 nursing professionals. Data collection was performed through interviews and sent to the thematic analysis.
Results:
human errors in nursing care, such as wasted catheters; errors in the medication process; causes for error in nursing care, with a focus on work overload; Best Practices for patient safety in nursing care, such as professional training and improved working conditions.
Conclusions:
it is of utmost importance to invest in Best Practices strategies for Patient Safety, aimed at consolidating the culture of organizational safety and encouraging an adequate environment to manage errors.
Visualizações0Resumo
ORIGINAL ARTICLEBest Safety Practices in nursing care in Neonatal Intensive Therapy
Revista Brasileira de Enfermagem. 2020;73(2):e20180482
03-30-2020DOI 10.1590/0034-7167-2018-0482
- Sabrina da Costa Machado Duarte ,
- Sílvia Schoenau de Azevedo ,
- Gabrielle da Costa de Muinck ,
- Tainara Ferreira da Costa ,
- Maria Manuela Vila Nova Cardoso ,
- Juliana Rezende Montenegro Medeiros de Moraes
Visualizações0Ver maisABSTRACT
Objectives:
to identify the perception of nursing professionals on human errors in nursing care at a Neonatal Intensive Care Unit and to assess Best Practices strategies proposed by these professionals for patient safety in nursing care.
Methods:
this is a quantitative-qualitative, descriptive study. Setting: Neonatal Intensive Care Unit. Participants: 22 nursing professionals. Data collection was performed through interviews and sent to the thematic analysis.
Results:
human errors in nursing care, such as wasted catheters; errors in the medication process; causes for error in nursing care, with a focus on work overload; Best Practices for patient safety in nursing care, such as professional training and improved working conditions.
Conclusions:
it is of utmost importance to invest in Best Practices strategies for Patient Safety, aimed at consolidating the culture of organizational safety and encouraging an adequate environment to manage errors.
- Sabrina da Costa Machado Duarte
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ORIGINAL ARTICLE
Nursing students’ errors in clinical learning. Qualitative outcomes in Mixed Methods Research
Revista Brasileira de Enfermagem. 2019;72(1):170-176
01-01-2019
Resumo
ORIGINAL ARTICLENursing students’ errors in clinical learning. Qualitative outcomes in Mixed Methods Research
Revista Brasileira de Enfermagem. 2019;72(1):170-176
01-01-2019DOI 10.1590/0034-7167-2018-0592
Visualizações0ABSTRACT
Objective:
to analyze factors associated with nursing students' errors during clinical learning, and their perceptions regarding these events and the opportunity for learning and development provided by them.
Method:
Convergent Mixed Method design according Creswell and Clark. Qualitative dimension included face to face and internet interviews. Data analysis followed Miles and Huberman method.
Results:
Nursing student's errors were revealed according to their perceptions. They occurred in all phases of the nursing process and in transversal skills. Errors were acknowledged as learning and developmental opportunities.
Final considerations:
Students acknowledged their errors and ascribe to themselves reasons and what could have prevented what happened. Mixed Method was a very adequate design to study phenomena. Qualitative dimension was essential to reveal and achieve the objectives. Suggestions founded on the findings are presented.
Palavras-chave: Education, NursingMedical ErrorsNursing ResearchQualitative ResearchStudents NursingVer maisVisualizações0Resumo
ORIGINAL ARTICLENursing students’ errors in clinical learning. Qualitative outcomes in Mixed Methods Research
Revista Brasileira de Enfermagem. 2019;72(1):170-176
01-01-2019DOI 10.1590/0034-7167-2018-0592
Visualizações0ABSTRACT
Objective:
to analyze factors associated with nursing students' errors during clinical learning, and their perceptions regarding these events and the opportunity for learning and development provided by them.
Method:
Convergent Mixed Method design according Creswell and Clark. Qualitative dimension included face to face and internet interviews. Data analysis followed Miles and Huberman method.
Results:
Nursing student's errors were revealed according to their perceptions. They occurred in all phases of the nursing process and in transversal skills. Errors were acknowledged as learning and developmental opportunities.
Final considerations:
Students acknowledged their errors and ascribe to themselves reasons and what could have prevented what happened. Mixed Method was a very adequate design to study phenomena. Qualitative dimension was essential to reveal and achieve the objectives. Suggestions founded on the findings are presented.
Palavras-chave: Education, NursingMedical ErrorsNursing ResearchQualitative ResearchStudents NursingVer mais
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RESEARCH
Error-producing conditions in nursing staff work
Revista Brasileira de Enfermagem. 2018;71(4):1858-1864
01-01-2018
Resumo
RESEARCHError-producing conditions in nursing staff work
Revista Brasileira de Enfermagem. 2018;71(4):1858-1864
01-01-2018DOI 10.1590/0034-7167-2017-0192
Visualizações0Ver maisABSTRACT
Objective:
To analyze the errors made by nursing staff workers who faced ethical-disciplinary actions.
Method:
Document, exploratory, quanti-qualitative research. The information was collected in 13 ethical-disciplinary actions of COREN BA, dated from 1995 to 2010, which had as object of complaint an error made by nursing staff workers. The quantitative data were analyzed using descriptive statistics and the qualitative data was analyzed using the Human Error Theory and Sociology of Work.
Results:
Nursing technicians and assistants held most actions. The health institution, through the nursing service coordination, was the predominant complainer and the most frequent shift was daytime.
Final considerations:
The errors made by nursing staff workers demonstrate that error-producing conditions are present in the context of their occurrence in all actions, and understaffing and intensity of work are the most recurrent circumstances.
Visualizações0Resumo
RESEARCHError-producing conditions in nursing staff work
Revista Brasileira de Enfermagem. 2018;71(4):1858-1864
01-01-2018DOI 10.1590/0034-7167-2017-0192
Visualizações0Ver maisABSTRACT
Objective:
To analyze the errors made by nursing staff workers who faced ethical-disciplinary actions.
Method:
Document, exploratory, quanti-qualitative research. The information was collected in 13 ethical-disciplinary actions of COREN BA, dated from 1995 to 2010, which had as object of complaint an error made by nursing staff workers. The quantitative data were analyzed using descriptive statistics and the qualitative data was analyzed using the Human Error Theory and Sociology of Work.
Results:
Nursing technicians and assistants held most actions. The health institution, through the nursing service coordination, was the predominant complainer and the most frequent shift was daytime.
Final considerations:
The errors made by nursing staff workers demonstrate that error-producing conditions are present in the context of their occurrence in all actions, and understaffing and intensity of work are the most recurrent circumstances.
Medical Errors Archives - Revista Brasileira de Enfermagem
