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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
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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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
Metodologia 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 -
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 -
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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Symbolic effects capitalized by nurses from the National Institute of Cancer in Brazil (1980 – 1990)
Revista Brasileira de Enfermagem. 2015;68(2):284-290
Abstract
Symbolic effects capitalized by nurses from the National Institute of Cancer in Brazil (1980 – 1990)
Revista Brasileira de Enfermagem. 2015;68(2):284-290
DOI 10.1590/0034-7167.2015680214i
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Objective:
to describe the strategies of nurses in the National Institute of Cancer to disseminate its scientifi c capital and discuss the symbolic effects capitalized in the fi eld of oncology in the 1980s.
Method:
historical social studies, with primary sources consisting of written documents and oral reports, and as secondary sources, articles and books on the subject, based on the French sociologist Pierre Bourdieu’s concepts of scientifi c capital and habitus.
Results:
it revealed the effective performance of nurses in this Institute on policies of cancer prevention and control and strategies used in the teaching of oncology nursing at the undergraduate level. In conclusion, nursing stands out in this context, through the dissemination of its scientifi c knowledge, as a participant in the construction of a scientifi c fi eld of oncology nursing in Brazil, highlighting the occupation of important social areas.
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Perception of nursing undergraduate students on self-aging
Revista Brasileira de Enfermagem. 2015;68(2):278-283
Abstract
Perception of nursing undergraduate students on self-aging
Revista Brasileira de Enfermagem. 2015;68(2):278-283
DOI 10.1590/0034-7167.2015680213i
Views1See moreABSTRACT
Objective:
to analyze the perceptions of nursing undergraduate students on their self-aging process.
Method:
qualitative study carried out between August and September, 2011 with 18 nursing undergraduate students of a public university in Salvador, Bahia. The interviews were analyzed by means of the Content Analysis method.
Results:
the following thematic concept was apprehended: Perceptions of nursing undergraduates on their self-aging, which generated two subcategories: A) The “don’t think about it” process; B) The context infl uencing the process.
Conclusion:
undergraduates reveal that the aging process is an intrinsic factor to human development. Family ties, spirituality and physical activity would be key mechanisms toward active aging. However, students also reported that their accelerated and stressed social lifestyles led to inadequate habits, such as the consumption of fast food and alcohol, which become negative infl uences in their aging process.
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Non-conventional technologies for data collection in Brazilian dissertations and theses
Revista Brasileira de Enfermagem. 2015;68(2):269-277
Abstract
Non-conventional technologies for data collection in Brazilian dissertations and theses
Revista Brasileira de Enfermagem. 2015;68(2):269-277
DOI 10.1590/0034-7167.2015680212i
Views0See moreABSTRACT
Objective:
to characterize non-conventional technologies used for data collection of dissertations and theses available in the Catalog of Theses and Dissertations (CEPEn) of the Brazilian Nursing Association (ABEn).
Method:
this is a documentary research, whose data were collected in the catalogs of theses and dissertations available at the ABEn website, from Volumes XIX to XXI. The indicators collected were: academic level; educational institution; year; qualification of the author; setting; non-conventional technology used; type of technology; association with conventional techniques; methodological design; benefi ts and methodological limitations.
Results:
from a total of 6346 studies, only 121 (1.91%) used non-conventional technologies for data collection, representing the fi nal sample of the study.
Conclusion:
it is concluded that Brazilian Nursing researches still need methodological innovations for data collection.
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Content analysis of a technology to the nursing diagnostic reasoning
Revista Brasileira de Enfermagem. 2015;68(2):261-268
Abstract
Content analysis of a technology to the nursing diagnostic reasoning
Revista Brasileira de Enfermagem. 2015;68(2):261-268
DOI 10.1590/0034-7167.2015680211i
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Objective:
to undergo a content analysis of a metacognitive strategy of indirect assessment in the pre-encounter with the client.
Method:
methodological study. Agreement and inter-rater reliability index for the criteria: relevance, adequacy, clarity, conciseness and accuracy of a technology to the nursing diagnosis reasoning for novices through an electronic form. The sample consisted of 13 raters. Data were analyzed using descriptive statistics.
Results:
high agreement and inter-rater reliability for 85 items related to data collection stage and the strategy description. Only fi ve items did not reach the validation criteria and must be rewritten.
Conclusion:
indirect assessment of the pre-encounter is relevant to the diagnostic reasoning process, being possible to develop competencies and diagnostic skills in the novice through strategies, proposals on innovative technology in the form of a diagram.
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Manual for monitoring the quality of nursing home care records
Revista Brasileira de Enfermagem. 2015;68(2):253-260
Abstract
Manual for monitoring the quality of nursing home care records
Revista Brasileira de Enfermagem. 2015;68(2):253-260
DOI 10.1590/0034-7167.2015680210i
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Objective:
to build and validate an instrument aimed at monitoring the quality of nursing records in the Home Care Program (HCP) of a university hospital.
Method:
methodological study involving the elaboration of a manual, whose content was later submitted to six experts for validation, reaching a ≥ 80% consensus. The data collection process was carried out in 2012 by means of a questionnaire comprised of the following issues: nursing evolution, nursing diagnosis, and nursing prescription, and standards for the nursing team recommended by the Regional Nursing Council of São Paulo and by the assessed institution. Manual items were judged according to the following variables: relevance, pertinence, clarity and simplicity.
Results:
of the 39 propositions, 100% achieved ≥ 80% agreement in the relevance, pertinence and clarity variables; 92.3% in the simplicity variable. Sleep/rest, Mobility and Check-out variables did not reach a favorable minimum consensus in the prescribed activities and were improved following suggestions from the experts.
Conclusion:
we believe that the instrument will enable the improvement of the HCP’s work process.
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Vulnerability of families of elderly citizens cared for by the Family Health Strategy
Revista Brasileira de Enfermagem. 2015;68(2):244-252
Abstract
Vulnerability of families of elderly citizens cared for by the Family Health Strategy
Revista Brasileira de Enfermagem. 2015;68(2):244-252
DOI 10.1590/0034-7167.2015680209i
Views0See moreABSTRACT
Objective:
the present descriptive, exploratory, cross-sectional study aimed to identify the vulnerability of families of elderly citizens cared for by the Family Health Strategy (FHS).
Method:
the research employed home interviews and was developed with a sample of 500 families of aged people cared for by 32 FHS teams in the city of Dourados, MS, Brazil. The Family Development Index (FDI) was adapted in order to classify the families according to their degree of vulnerability.
Results:
the results revealed the presence of multigenerational families with low educational levels among individuals over the age of 20 and high illiteracy rates among elderly citizens. There were 403 families whose vulnerability was acceptable, 95 in severe vulnerability, and two families in a condition of very severe vulnerability. The most critical dimensions of the FDI were the access to knowledge and to work.
Conclusion:
the study identifi ed that there is still a need for further investments that can assist these aged people and their families in the Primary Health Care.
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The work in prison: reflections on the health of prison officers
Revista Brasileira de Enfermagem. 2015;68(2):235-243
Abstract
The work in prison: reflections on the health of prison officers
Revista Brasileira de Enfermagem. 2015;68(2):235-243
DOI 10.1590/0034-7167.2015680208i
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Objective:
to understand the working conditions of prison offi cers and the repercutions of labor activity on their health.
Method:
qualitative and descriptive research. Data were collected through open interviews with the prison offi cers of a regional prision and the speeches were submitted to content analysis.
Results:
the results showed unsatisfactory working conditions due to poor material resources and neglect of governmental regarding rehabilitation of convicts, resulting in workers’ exposure to psychosocial risks, dissatisfaction, and emotional distress.
Conclusion:
investments on the security of workers may contribute to their health promotion.
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Mother recognition in the Neonatal Intensive Care Unit
Revista Brasileira de Enfermagem. 2015;68(2):228-234
Abstract
Mother recognition in the Neonatal Intensive Care Unit
Revista Brasileira de Enfermagem. 2015;68(2):228-234
DOI 10.1590/0034-7167.2015680207i
Views0ABSTRACT
Objective:
analyze the maternal experience in a neonatal intensive care unit, focusing on relations of recognition.
Method:
a qualitative study, built on the perspective of Gadamer’s hermeneutics, based on Honneth’s concept of recognition. In-depth interviews were conducted with 10 mothers of children admitted to a neonatal intensive care unit.
Results:
failures were reported in the process of mother recognition in the unit, with consequent feelings of insecurity and obligation to child care, resulting in fragility of self-esteem.
Conclusion:
interactions with health professionals in the NICU and its standards and protocols cause vulnerabilities and affect maternal recognition and autonomy.
Keywords:Humanization of AssistanceIntegrality in HealthIntensive CareNeonatalProfessional-Family RelationsSee more
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Perceptions of adolescent students about drugs
Revista Brasileira de Enfermagem. 2015;68(3):517-523
Abstract
Perceptions of adolescent students about drugs
Revista Brasileira de Enfermagem. 2015;68(3):517-523
DOI 10.1590/0034-7167.2015680320i
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Objective:
To analyze the perceptions of adolescent public school students about drugs.
Method:
Qualitative approach of focus groups with 16 adolescent students. The data collected were analyzed by means of content analysis, leading to the following categories: meaning of drugs; living with drug use; opinions, beliefs and attitudes toward drug use; and preventing drug abuse in adolescence.
Results:
The adolescent students know about some drugs, and associate their use with delinquent and criminal behavior. The students identifi ed factors that lead to drug abuse, such as easy access, use by family and friends, idleness, dropping out of school and the characteristic vulnerability of adolescence.
Conclusion:
the results point to the need for educational activities in the context of where the adolescents live, including school, community and family environments, to support and to minimize their vulnerability.
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Cognitive stimulation for older people with Alzheimer’s disease performed by the caregiver
Revista Brasileira de Enfermagem. 2015;68(3):510-516
Abstract
Cognitive stimulation for older people with Alzheimer’s disease performed by the caregiver
Revista Brasileira de Enfermagem. 2015;68(3):510-516
DOI 10.1590/0034-7167.2015680319i
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Objective:
to learn the infl uence of cognitive therapy at home, conducted by the caregivers of older people with Alzheimer’s Disease.
Method:
a case study was developed with fi ve older people with Alzheimer’s Disease and their caregivers. The stages of research development were: orientation with the caregivers; selection of older people and caregivers; approach of the study subjects at home; weekly meetings and reapplication of tests to follow up the cognitive function of the participants.
Results:
in three months it was possible to identify improved cognition, verifi ed by the result of the Mini-Mental State Examination (MMSE). The scores of the other tests (KATZ, LAWTON, CLOCK TEST and VFT) remained the same.
Conclusion:
this strategy can be considered a light technology of nursing care for older people with dementia. When providing this care with the support of a nurse, caregivers re feel less anxious and understand the disease better.
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Anxiety and spirituality in university students: a cross-sectional study
Revista Brasileira de Enfermagem. 2015;68(3):504-509
Abstract
Anxiety and spirituality in university students: a cross-sectional study
Revista Brasileira de Enfermagem. 2015;68(3):504-509
DOI 10.1590/0034-7167.2015680318i
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Objective:
to study anxiety and spirituality and the relationship between them in university students.
Method:
the State-Trait-Anxiety Inventory (STAI) and Pinto and Pais-Ribeiro Spirituality Scales were used for data collection.
Results:
six hundred and sixty-nine students participated in the study, of whom 91.5% had moderate and high levels of trait anxiety and 92.9% of state anxiety; 93.8% had high spirituality scores. The multiple linear regression test showed a signifi cant relationship between anxiety and the presence of physical discomfort, unusual body movements, and the need for treatment. Furthermore, higher levels of anxiety were associated with the female gender, the lack of leisure activities, and low levels of optimism in the spirituality scale.
Conclusion:
it is important to develop strategies for coping with anxiety, which in turn can be oriented toward protective factors such as spirituality.
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Nursing guidance on bed baths to reduce anxiety
Revista Brasileira de Enfermagem. 2015;68(3):497-503
Abstract
Nursing guidance on bed baths to reduce anxiety
Revista Brasileira de Enfermagem. 2015;68(3):497-503
DOI 10.1590/0034-7167.2015680317i
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Objective:
to evaluate the effectiveness of a nursing guidance protocol to reduce the anxiety of patients with acute coronary syndrome undergoing bed bath, and the correlation of vital signs with state-anxiety.
Method:
randomized clinical trial study. The sample consisted of 120 patients. The intervention group received a nursing guidance protocol about bed bath and the control group received the unit’s routine information. The STAI-State scale was used to assess anxiety, and data were collected at three times: immediately after informing the patients about the bed bath; immediately after interventions; and immediately after the bath.
Results:
the intervention group presented signifi cantly lower state-anxiety compared to the control group (p<0.001) after the intervention.
Conclusion:
the nursing orientation was effective to reduce anxiety in patients with acute coronary syndrome undergoing bed bath.
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Body language in health care: a contribution to nursing communication
Revista Brasileira de Enfermagem. 2015;68(3):490-496
Abstract
Body language in health care: a contribution to nursing communication
Revista Brasileira de Enfermagem. 2015;68(3):490-496
DOI 10.1590/0034-7167.2015680316i
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Objective:
to classify body language used in nursing care, and propose “Body language in nursing care” as an analytical category for nursing communication.
Method:
quantitative research with the systematic observation of 21:43 care situations, with 21 members representing the nursing teams of two hospitals. Empirical categories: sound, facial, eye and body expressions.
Results:
sound expressions emphasized laughter. Facial expressions communicated satisfaction and happiness. Eye contact with members stood out in visual expressions. The most frequent body expressions were head movements and indistinct touches.
Conclusion:
nursing care team members use body language to establish rapport with patients, clarify their needs and plan care. The study classifi ed body language characteristics of humanized care, which involves, in addition to technical, non-technical issues arising from nursing communication.
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Health promotion in supplementary health care: outsourcing, microregulation and implications for care
Revista Brasileira de Enfermagem. 2015;68(3):482-489
Abstract
Health promotion in supplementary health care: outsourcing, microregulation and implications for care
Revista Brasileira de Enfermagem. 2015;68(3):482-489
DOI 10.1590/0034-7167.2015680315i
Views0See moreABSTRACT
Objective:
to analyze health promotion programs in the supplementary health care.
Methods:
This was a multiple case study with a qualitative approach whose data were obtained from interviews with coordinators of providers contracted by the corporations of health insurance plans in Belo Horizonte, Minas Gerais. The data were submitted to Critical Discourse Analysis.
Results:
Home care has been described as the main action in the fi eld of health promotion transferred to the providers, followed by management of patients and cases, and the health education.groups. The existence of health promotion principles is questionable in all programs. Outsourcing is marked by a process with a division between cost and care management. Implications of this process occur within admission and interventions on the needs of the benefi ciaries.
Conclusions:
Statements revealed rationalization of cost, restructuring of work, and reproduction of the dominant logic of capital accumulation by the health insurance companies.
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Gateway to the diagnosis of tuberculosis among elders in Brazilian municipalities
Revista Brasileira de Enfermagem. 2015;68(3):467-473
Abstract
Gateway to the diagnosis of tuberculosis among elders in Brazilian municipalities
Revista Brasileira de Enfermagem. 2015;68(3):467-473
DOI 10.1590/0034-7167.2015680313i
Views0See moreABSTRACT
Objective:
to analyze the factors associated with the gateway of the health systems of Brazilian municipalities for the diagnosis of tuberculosis in older people.
Method:
survey study type, with a sample of 91 elders, in a population with 706 cases of tuberculosis. Data were collected by means of an instrument based on the Primary Care Assessment Tool (PCAT) adapted for tuberculosis care, emphasizing the gateway variable. Variables were categorized and compared between primary health care (PHC) and specialized care (SC) services. Bivariate analysis and the Chi-square association test were used.
Results:
a statistically signifi cant association (p = 0.0001) was found between the fi rst health service sought and the unit that diagnosed tuberculosis, showing better performance of specialized care services in the diagnosis.
Conclusion:
it is necessary to improve primary health care services to tackle delayed diagnosis of tuberculosis in older people.
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