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ORIGINAL ARTICLE07-31-2023
Primary Health Care assessment in the COVID-19 pandemic from physicians’ and nurses’ perspective
Revista Brasileira de Enfermagem. 2023;76:e20220475
Abstract
ORIGINAL ARTICLEPrimary Health Care assessment in the COVID-19 pandemic from physicians’ and nurses’ perspective
Revista Brasileira de Enfermagem. 2023;76:e20220475
DOI 10.1590/0034-7167-2022-0475
Views0ABSTRACT
Objectives:
to assess the operationalization of Primary Health Care in the COVID-19 pandemic, according to Primary Care Assessment Tool: PCATool-Brasil attributes, from physicians’ and nurses’ perspective.
Methods:
a cross-sectional study, carried out with 99 physicians and nurses from Basic Health Units in a state in northeastern Brazil, with the aid of the adapted instrument PCATool-Brasil.
Results:
Essential Score was classified as high performance (6.6) and General Score as low performance (6.5). First Contact Access, Care Integration, and Community Guidance scores were <6.6. The best performances were attributed to the Longitudinality, Comprehensiveness and Family Guidance services (scores>6.6).
Conclusions:
the attributes of Primary Health Care, in general, showed values above or close to the cut-off point in the assessment. These data can support strategies for local and national managers to strengthen Primary Health Care in the COVID-19 pandemic and future public health emergencies.
Keywords:COVID-19Health Care Evaluation MechanismsHealth PersonnelHealth Services ResearchPrimary Health CareSee more -
ORIGINAL ARTICLE07-10-2023
Primary care in supplementary health: assessment of costs in the care of older adult patients with heart diseases
Revista Brasileira de Enfermagem. 2023;76(3):e20220486
Abstract
ORIGINAL ARTICLEPrimary care in supplementary health: assessment of costs in the care of older adult patients with heart diseases
Revista Brasileira de Enfermagem. 2023;76(3):e20220486
DOI 10.1590/0034-7167-2022-0486
Views0ABSTRACT
Objectives:
to identify whether implementing a supplementary Primary Health Care (PHC) system makes it possible to reduce care costs for older adults with heart diseases.
Methods:
a retrospective cohort of 223 patients with heart disease aged ≥ 60 years. Data were obtained from medical records and cost databases, assessed for a period of one year before and after PHC implementation. The results were expressed as mean absolute frequencies for number of hospitalizations and as average annual expenses expressed in dollars (US$) in relation to cost data.
Results:
there was a reduction in hospitalization expenses after implementing supplementary PHC (p=0.01) and a decrease in the frequency of hospitalizations for the entire sample (p=0.006). There was a reduction in the frequency of consultations at the Emergency Room among frail older adults (p=0.011).
Conclusions:
there was a reduction in hospitalization costs and frequency of visits to the Emergency Room after supplementary PHC.
Keywords:AgedCardiovascular DiseasesCosts and Cost AnalysisLearning Health SystemPrimary Health CareSee more -
ORIGINAL ARTICLE07-10-2023
Occurrence and preventability of adverse events in hospitals: a retrospective study
Revista Brasileira de Enfermagem. 2023;76(3):e20220025
Abstract
ORIGINAL ARTICLEOccurrence and preventability of adverse events in hospitals: a retrospective study
Revista Brasileira de Enfermagem. 2023;76(3):e20220025
DOI 10.1590/0034-7167-2022-0025
Views0See moreABSTRACT
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.
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ORIGINAL ARTICLE07-10-2023
Metodologia Lean Seis Sigma para melhoria do processo de alta em uma unidade de terapia intensiva
Revista Brasileira de Enfermagem. 2023;76(3):e20220538
Abstract
ORIGINAL ARTICLEMetodologia Lean Seis Sigma para melhoria do processo de alta em uma unidade de terapia intensiva
Revista Brasileira de Enfermagem. 2023;76(3):e20220538
DOI 10.1590/0034-7167-2022-0538
Views0RESUMEN
Objetivos:
describir el proceso de implementación de Lean Six Sigma para mejorar el proceso de alta en una unidad de cuidados intensivos brasileña.
Métodos:
estudio prospectivo siguiendo el método de desarrollo de proyectos denominado DMAIC (Define-Measure-Analyze-Improve-Control). Este método consta de cinco fases, a saber: definición del proyecto, medición del punto de partida y recolección de datos, análisis de resultados, mejora en los procesos y control estadístico.
Resultados:
la aplicación de la metodología Lean Six Sigma fue efectiva para mejorar el proceso de alta de la unidad de cuidados intensivos a la unidad de hospitalización. Esta mejora representó una reducción en el tiempo promedio de alta de 189 a 75 minutos, totalizando una mejora del 61%.
Conclusiones:
este artículo demuestra la efectividad de la aplicación de la metodología Lean Six Sigma para mejorar el flujo de descarga en una unidad crítica, lo que resulta en la reducción de tiempo y desperdicio.
Keywords:Administração em SaúdeFluxo de TrabalhoGestão da QualidadeMelhoria de QualidadeUnidades de Terapia IntensivaSee more -
ORIGINAL ARTICLE07-10-2023
Correlation between symptoms of depression, attitude, and self-care in elderly with type 2 diabetes
Revista Brasileira de Enfermagem. 2023;76(3):e20220741
Abstract
ORIGINAL ARTICLECorrelation between symptoms of depression, attitude, and self-care in elderly with type 2 diabetes
Revista Brasileira de Enfermagem. 2023;76(3):e20220741
DOI 10.1590/0034-7167-2022-0741
Views0See moreABSTRACT
Objectives:
to correlate depressive symptoms, attitude, and self-care of elderly people with type 2 diabetes.
Methods:
study developed with 144 elderly people with diabetes; carried out in Family Health Units. A semi-structured instrument was used to obtain data on the sociodemographic profile; the Geriatric Depression Scale (15 items), the Questionário de Atitudes Psicológicas do Diabetes [Psychological Attitudes of Diabetes Questionnaire], and the Diabetes Self-Care Activities Questionnaire (DSCA) were also used.
Results:
it was identified that 24.3% of the participants presented depressive symptoms, and 93.8% presented negative attitudes of coping. A greater adherence to self-care activities related to the practice of medication was observed. In the correlation between the scales, a negative and inversely proportional correspondence was noted between depressive symptomatology and physical activity (p=0.010) and foot care (p=0.006), likewise between attitude and foot care (p=0.009).
Conclusions:
self-care in elderly people with diabetes mellitus is influenced by depressive symptoms and negative coping attitudes.
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REVIEW07-10-2023
Lean Six Sigma methodology to improve the discharge process in a Brazilian intensive care unit
Revista Brasileira de Enfermagem. 2023;76(3):e20220538
Abstract
REVIEWLean Six Sigma methodology to improve the discharge process in a Brazilian intensive care unit
Revista Brasileira de Enfermagem. 2023;76(3):e20220538
DOI 10.1590/0034-7167-2022-0538
Views0ABSTRACT
Objectives:
to describe the Lean Six Sigma implementation process to improve the discharge process in a Brazilian health institution’s ICU.
Methods:
prospective study following the Define-Measure-Analyse-Improve-Control project development method. This method consists of five phases, namely: project definition, measurement of the starting point and data collection, analysis of results, improvement in processes, and statistical control.
Results:
applying Lean Six Sigma methodology following the Define-Measure-Analyse-Improve-Control in the discharge process from the intensive care unit to the inpatient unit was effective in improving processes. This improvement represented a reduction in the mean patient transfer time to the inpatient unit from 189 minutes to 75 minutes, representing a 61% improvement in discharge time.
Conclusions:
this article demonstrates the effectiveness of applying Lean Six Sigma methodology to improve the discharge flow in a critical unit, resulting in time and waste reduction.
Keywords:Health Services AdministrationIntensive Care UnitsPatient DischargeTotal Quality ManagementWorkflowSee more -
REVIEW06-26-2023
Barriers to Pre-Exposure Prophylaxis (PrEP) use for HIV: an integrative review
Revista Brasileira de Enfermagem. 2023;76(3):e20210963
Abstract
REVIEWBarriers to Pre-Exposure Prophylaxis (PrEP) use for HIV: an integrative review
Revista Brasileira de Enfermagem. 2023;76(3):e20210963
DOI 10.1590/0034-7167-2021-0963
Views0ABSTRACT
Objectives:
to identify and synthesize scientific evidence on the barriers and difficulties for Pre-exposure Prophylaxis (PrEP) use and compliance for HIV.
Methods:
an integrative literature review, using the MEDLINE/PubMed, Cumulative Index to Nursing and Allied Health Literature (CINAHL), Academic Search Premier and Scopus (Elsevier) databases.
Results:
all (100%) the articles included identified that PrEP users experience some type of structural barrier related to health services such as long distance from the units, suboptimal logistics for taking pills and professional resistance to prescribing PrEP. Furthermore, 63.21% identified social barriers, such as stigma about sexuality and HIV, in addition to individual barriers such as alcohol use, adverse effects, and concerns about long-term toxicity.
Conclusions:
the barriers to PrEP use are multifactorial. Effective interventions are needed to support PrEP users in accessing, complying with, and retaining health services.
Keywords:Access to Health ServicesAnti-HIV AgentsPre-Exposure ProphylaxisPrevention and ControlSexual HealthSee more
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Overview of clinical trial protocols for behavioral insomnia in infants
Revista Brasileira de Enfermagem. 2021;74:e20200769
Abstract
Overview of clinical trial protocols for behavioral insomnia in infants
Revista Brasileira de Enfermagem. 2021;74:e20200769
DOI 10.1590/0034-7167-2020-0769
Views1See moreABSTRACT
Objective:
to describe the overview of clinical trial protocols for behavioral insomnia in infants.
Methods:
an analytical study that reviewed protocols registered with the International Clinical Trials Registry Platform between August and September 2019, aiming to identify the interventions for behavioral insomnia in infants, the comparators, the main primary, secondary outcomes and their respective measurements.
Results:
eleven protocols registered between 2004 and 2018 were included. Nurses were the main coordinators of protocols (45.5%), with proposals using educational technologies, one-to-one and online follow-up consultations. The main outcome was improvement of infant and maternal sleep patterns. Secondary outcomes were anxiety, depression, and parental sexual satisfaction. To measure them, the following were used: sleep diary (54.5%), actigraphy (45.4%), and the Pittsburgh Sleep Quality Interview (36.3%) and Extended Brief Infant Sleep Questionnaire (27.2%) were used.
Conclusion:
the protocols proposed interventions for independent sleep, aiming at quality of sleep for the whole family.
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ORIGINAL ARTICLE07-30-2021
Curricular reforms in the transformation of nursing teaching in a federal university
Revista Brasileira de Enfermagem. 2021;74(4):e20201242
Abstract
ORIGINAL ARTICLECurricular reforms in the transformation of nursing teaching in a federal university
Revista Brasileira de Enfermagem. 2021;74(4):e20201242
DOI 10.1590/0034-7167-2020-1242
Views1See moreABSTRACT
Objectives:
to discuss the curricular reforms adopted for nursing teaching in Brazil, from 1969 to 2019.
Methods:
historical, qualitative approach using the thematic oral history and document research. 13 interviews were carried out with graduation nursing professors from a federal university in the South of Brazil. The document sources were the political-pedagogical projects of the course and their associated documents. Minayo’s thematic analysis was used.
Results:
nursing curricula delineates the profile of the professional that must be formed and are reviewed in order to be adapted to social and educational changes, showing the scientific and professional potential of the nurse. Curricular reforms consider the quality of nursing formation.
Final Considerations:
the structure of the curriculum and the reforms that took place emerged according to the historical, political, epidemiological and social context demanded from the profession, to attend to the demands of society and to the work market.
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REVIEW07-09-2021
Breast cancer screening in Primary Health Care in Brazil: a systematic review
Revista Brasileira de Enfermagem. 2021;74(3):e20200995
Abstract
REVIEWBreast cancer screening in Primary Health Care in Brazil: a systematic review
Revista Brasileira de Enfermagem. 2021;74(3):e20200995
DOI 10.1590/0034-7167-2020-0995
Views1See moreABSTRACT
Objectives:
to analyze care strategies for breast cancer screening in Primary Health Care in Brazil.
Methods:
this is a systematic review following the Cochrane Collaboration recommendations.
Results:
among 355 manuscripts, five were eligible. The patient navigation program by Community Health Agent stood out with the best result, among the strategies: flexibility of goals considering viability; community engagement; team training; active search of the target population by Community Health Agent; request for mammography by physicians; actions integrated to women’s health; monitoring of mammography results, absent users, and population coverage by physician and nurse; and assessment of criteria for requesting screening mammography by means of an information system. The population coverage rate in the program ranged from 23% to 88%.
Conclusions:
Primary Health Care in Brazil presents devices with potential to induce the production of care for breast cancer screening.
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ORIGINAL ARTICLE05-28-2021
Cultural adaptation and validation of an instrument about nursing critical thinking skills
Revista Brasileira de Enfermagem. 2021;74(2):e20200720
Abstract
ORIGINAL ARTICLECultural adaptation and validation of an instrument about nursing critical thinking skills
Revista Brasileira de Enfermagem. 2021;74(2):e20200720
DOI 10.1590/0034-7167-2020-0720
Views1See moreABSTRACT
Objectives:
to validate the Nursing Critical Thinking in Clinical Practice Questionnaire regarding cultural aspects and metric properties.
Methods:
a methodological research carried out through cross-cultural adaptation, face and content validity, dimensional construct and known groups validity, test-retest reliability and internal consistency. 511 nurses from four hospitals participated in the study, of which 54 participated in retest.
Results:
the instrument validation for Brazilian Portuguese maintained equivalences, according to the original version. The dimensional validity demonstrated adjustment to the tetrafactorial structure of the original version (GFI=0.69). There were statistically significant differences in critical thinking skills between nurses with graduate degrees and who undertook training, reading articles, developing research and working in an institution with a longer time implementation of the Nursing Process. The instrument showed temporal stability (ICC 073-0.84; p<0.001) and adequate internal consistency (α=0.97).
Conclusions:
the instrument proved to be valid and reliable for the studied population.
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ORIGINAL ARTICLE05-28-2021
Prevalence and severity levels of post-radical prostatectomy incontinence: different assessment instruments
Revista Brasileira de Enfermagem. 2021;74(2):e20200692
Abstract
ORIGINAL ARTICLEPrevalence and severity levels of post-radical prostatectomy incontinence: different assessment instruments
Revista Brasileira de Enfermagem. 2021;74(2):e20200692
DOI 10.1590/0034-7167-2020-0692
Views1See moreABSTRACT
Objectives:
to analyze urinary incontinence prevalence and severity in prostatectomized men assessed by three different instruments.
Methods:
a cross-sectional study was conducted with 152 men. The pad test, pad used, and International Consultation on Incontinence Questionnaire – Short Form (self-report) were considered. Data were analyzed using Spearman’s correlation, Kappa index, considering a significance level of 0.05.
Results:
urinary incontinence prevalence was 41.4%, 46.7% and 80.3% according to pad used, pad test and self-report. Positive correlations and moderate to poor agreement were found between the instruments. As for severity, most participants had mild incontinence. The largest number of cases of mild and severe incontinence was identified by self-report.
Conclusions:
the self-report showed higher values for prevalence of mild and severe severity levels. Through the identified differences, we propose that the objective assessment (pad used and pad test) be associated with individuals’ perception (self-report) to better estimate prevalence and severity.
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ORIGINAL ARTICLE05-28-2021
Managed clinical protocol: impact of implementation on sepsis treatment quality indicators
Revista Brasileira de Enfermagem. 2021;74(2):e20200282
Abstract
ORIGINAL ARTICLEManaged clinical protocol: impact of implementation on sepsis treatment quality indicators
Revista Brasileira de Enfermagem. 2021;74(2):e20200282
DOI 10.1590/0034-7167-2020-0282
Views1See moreABSTRACT
Objectives:
to assess the impact of the implementation of a managed sepsis protocol on quality indicators of treatment for septic patients in an emergency department of a university hospital.
Methods:
an observational epidemiological study involving septic patients. The study was divided into two phases, pre-intervention and intervention, resulting from the implementation of the managed sepsis protocol. The study variables included sepsis treatment quality indicators. The results were statistically analyzed using the program Epi InfoTM.
Results:
the study sample included 631 patients, 95 from pre-intervention phase and 536 from intervention phases. Implementing the protocol increased patients’ chances of receiving the recommended treatment by 14 times. Implementing the protocol reduced the hospitalization period by 6 days (p <0.001) and decreased mortality (p <0.001).
Conclusions:
this study showed that implementing the managed protocol had an impact on the improvement of sepsis treatment quality indicators.
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ORIGINAL ARTICLE12-21-2020
Development of an appearance validity instrument for educational technology in health
Revista Brasileira de Enfermagem. 2020;73:e20190559
Abstract
ORIGINAL ARTICLEDevelopment of an appearance validity instrument for educational technology in health
Revista Brasileira de Enfermagem. 2020;73:e20190559
DOI 10.1590/0034-7167-2019-0559
Views1ABSTRACT
Objectives:
to develop and evaluate the convergence of the instrument for the appearance validity of educational technologies in health.
Methods:
methodological study conducted in two steps. In step 1, the instrument items were developed, with subsequent content validity by nine specialists in the development of educational technologies in health. In step 2, the convergent validity between another instrument and the appearance instrument was performed. Correlation results above r> 0.3 and p <0.05 were considered as plausible convergent validity.
Results:
the ten items of the initial version of the appearance instrument were submitted to content validity that resulted in a final version with 12 items (Content Validity Index = 0.93). The correlation indexes were strong with the objective and appearance domains; moderate with motivation, organization and total; and weak with writing style.
Conclusions:
the appearance instrument demonstrated content validity and convergent validity, in addition to a strong correlation with the other instrument.
Keywords:Educational TechnologyHealth EducationMethodological Research in NursingTechnological DevelopmentValidation StudiesSee more -
REVIEW09-21-2020
Middle range theory for the nursing diagnosis Excess Fluid Volume in pregnant women
Revista Brasileira de Enfermagem. 2020;73:e20190334
Abstract
REVIEWMiddle range theory for the nursing diagnosis Excess Fluid Volume in pregnant women
Revista Brasileira de Enfermagem. 2020;73:e20190334
DOI 10.1590/0034-7167-2019-0334
Views1See moreABSTRACT
Objective:
To stablish a middle range theory for the understanding of the causal mechanisms and clinical consequentes of the nursing diagnosis Excess Fluid Volume (00026) among pregnant women.
Method:
The Middle Range Theory was constructed in five stages: defining of construction approach, establishing main concepts, elaborating propositions, developing a pictorial diagram, and establishing the causal relationships and evidence for practice of the Middle Range Theory.
Results:
We identified 14 clinical indicators and 6 causal factors of Excess Fluid Volume. A pictorial diagram was developed and relationships between Excess Fluid Volume elements were established with 6 propositions for them.
Conclusion:
The Middle Range Theory included both physiological and pathological conditions to explain Excess Fluid Volume. This Middle Range Theory might help in the better understanding of interactions between causal factors and clinical indicators of Excess Fluid Volume.
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