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ERRATUM01-13-2024
ERRATUM
Revista Brasileira de Enfermagem. 2024;77(6):e2024n6e08
Abstract
ERRATUMERRATUM
Revista Brasileira de Enfermagem. 2024;77(6):e2024n6e08
DOI 10.1590/0034-7167.20247706e08
Views0In the article “Brazilian nursing specific situation, middle and micro-range theories: a bibliometric study”, with DOI number: , published in Revista Brasileira de Enfermagem, 2024;77(4):e20230520, Chart 1: Where it read: […]See more -
ERRATUM01-13-2024
ERRATA
Revista Brasileira de Enfermagem. 2024;77(6):e2024n6e07
Abstract
ERRATUMERRATA
Revista Brasileira de Enfermagem. 2024;77(6):e2024n6e07
DOI 10.1590/0034-7167.20247706e06pt
Views0No artigo “Crenças e atitudes de pais ou responsáveis legais sobre a vacinação infantil: revisão de escopo”, com número DOI: , publicado no periódico Revista Brasileira de Enfermagem, 2024;77(4):e20240126, página 5:Onde se lia:[…]See more -
ORIGINAL ARTICLE01-13-2024
Indicators associated with severity and mortality in hospitalized people with HIV: A retrospective cohort
Revista Brasileira de Enfermagem. 2024;77(6):e20240204
Abstract
ORIGINAL ARTICLEIndicators associated with severity and mortality in hospitalized people with HIV: A retrospective cohort
Revista Brasileira de Enfermagem. 2024;77(6):e20240204
DOI 10.1590/0034-7167-2024-0204
Views0See moreABSTRACT
Objectives:
to compare the sociodemographic and clinical severity indicators of hospitalized people with HIV in relation to clinical outcomes and urgent hospital admission.
Methods:
a retrospective cohort study was conducted with 102 medical records of HIV-infected individuals hospitalized in a hospital in southern Brazil. In addition to descriptive analysis, Fisher’s exact test, Pearson’s Chi-square, and logistic regression were used.
Results:
the data showed a significant direct effect on severity indicators in the following variables: male sex (p=0.013), skin color (p=0.023), level of education (p=0.000), urgent admissions (p=0.000), late diagnosis (p=0.001), diabetes mellitus (p=0.001), hypertension (p=0.004), kidney disease (p=0.002), high viral load (p=0.006), CD4+ count below 200 (p=0.005), fever (p=0.016), weight loss (p=0.013), co-infection with hepatitis C (p=0.004), and mortality (p=0.007).
Conclusions:
three sociodemographic and thirteen clinical markers were identified as being associated with the risk of clinical deterioration in hospitalized people with HIV.
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ORIGINAL ARTICLE01-13-2024
Nurses’ perspectives on the use of telemonitoring in the management of people with diabetes and hypertension
Revista Brasileira de Enfermagem. 2024;77(6):e20230481
Abstract
ORIGINAL ARTICLENurses’ perspectives on the use of telemonitoring in the management of people with diabetes and hypertension
Revista Brasileira de Enfermagem. 2024;77(6):e20230481
DOI 10.1590/0034-7167-2023-0481
Views1See moreABSTRACT
Objectives:
to understand the perspective of nurses on the use of telemonitoring in the management of people with type 2 diabetes mellitus and arterial hypertension in primary care.
Methods:
this qualitative research involved sixteen nurses from eight municipalities in Paraná. Data were collected between November 2022 and January 2023 through inperson or remote interviews, which were audio-recorded and subjected to content analysis.
Results:
according to the nurses, telemonitoring enhances users’ knowledge about these conditions, communication and connection with the team, and productivity. However, the lack of electronic resources and equipment, high staff turnover, low user adherence, and the limited availability of professional time present significant challenges.
Final Considerations:
the effective implementation and operation of telemonitoring in the management of people with diabetes and hypertension involve both potential benefits and barriers. It is essential to have the availability of human and technological resources, managerial support, and the commitment of professionals and users.
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ORIGINAL ARTICLE01-13-2024
Knowledge, Attitudes, and Practices of nurses regarding blood culture collection
Revista Brasileira de Enfermagem. 2024;77(6):e20230424
Abstract
ORIGINAL ARTICLEKnowledge, Attitudes, and Practices of nurses regarding blood culture collection
Revista Brasileira de Enfermagem. 2024;77(6):e20230424
DOI 10.1590/0034-7167-2023-0424
Views0ABSTRACT
Objectives:
to investigate the knowledge, attitudes, and practices of nurses regarding blood culture collection.
Methods:
a cross-sectional study was conducted in five Brazilian public hospitals with 112 nurses. Data were collected using an adapted questionnaire and analyzed through descriptive and inferential statistics.
Results:
nurses who did not consider themselves capable of collecting blood cultures had a 72% lower chance of performing the collection at the recommended site and an 83% lower chance of using the same needle for blood inoculation into the vials. Nurses working in the emergency department had a 75% lower chance of knowing the international benchmark for blood culture contamination rates, and those with less than 5 years in the position decreased their chance of accuracy in this matter by 79%.
Conclusions:
there are gaps in the knowledge, attitudes, and practices of nurses regarding blood culture collection. Standardization of the technique, periodic education, supervision and guidance of the collection team, and process auditing are recommended coping strategies.
Keywords:Blood CultureBlood Specimen CollectionHealth Knowledge, Attitudes, PracticeNursing CareQuality of Health CareSee more -
ORIGINAL ARTICLE01-13-2024
Evaluation of care for people with HIV in Primary Health Care: construct validation
Revista Brasileira de Enfermagem. 2024;77(6):e20230190
Abstract
ORIGINAL ARTICLEEvaluation of care for people with HIV in Primary Health Care: construct validation
Revista Brasileira de Enfermagem. 2024;77(6):e20230190
DOI 10.1590/0034-7167-2023-0190
Views0ABSTRACT
Objectives:
to verify the construct validation of an instrument for evaluating care for people living with HIV in Primary Health Care.
Methods:
methodological study carried out in 2021 with 260 health professionals in Recife, PE. Validation based on the internal structure was carried out at this stage using exploratory and confirmatory factor analysis, and validity based on item response theory.
Results:
the validation determined the retention of five factors and 63 items. The instrument’s internal consistency and quality of fit was 0.90, the Tukey-Lewis index was 0.915 and the comparative fit index was 0.918 in the confirmatory factor analysis. The indication for the absolute majority of items is adequate fit.
Conclusions:
the instrument has construct validity, making it possible to use it to evaluate the decentralization process and care for People Living with HIV in Primary Health Care.
Keywords:Acquired Immunodeficiency SyndromeComprehensive Health CareHIVPrimary Health CareProgram EvaluationSee more -
ORIGINAL ARTICLE01-10-2024
Inventory of ethical problems in mobile pre-hospital care
Revista Brasileira de Enfermagem. 2024;77:e20230539
Abstract
ORIGINAL ARTICLEInventory of ethical problems in mobile pre-hospital care
Revista Brasileira de Enfermagem. 2024;77:e20230539
DOI 10.1590/0034-7167-2023-0539
Views0See moreABSTRACT
Objective:
to construct and validate the content of an inventory of ethical problems experienced by nurses in mobile pre-hospital care.
Method:
a psychometric approach study, developed with the following stages: (1) instrument construction through a theoretical matrix based on deliberative bioethics, scoping review and online qualitative research; (2) content validity by judges; (3) pre-testing with Mobile Emergency Care Service nurses in various Brazilian states. For content validity analysis, the Content Validity Ratio was calculated (CVR>0.45 for judges and CVR>0.35 for the target population).
Results:
the instrument had 44 items, distributed across four dimensions.
Final considerations:
the constructed instrument presented sources of evidence of content validity, providing good psychometric measurements and constituting a useful tool for nurses’ practice in the pre-hospital setting.
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Adverse events and safety in nursing care
Revista Brasileira de Enfermagem. 2015;68(1):144-154
Abstract
Adverse events and safety in nursing care
Revista Brasileira de Enfermagem. 2015;68(1):144-154
DOI 10.1590/0034-7167.2015680120i
Views0See moreObjective:
to identify the scientific publications about adverse events in nursing care in adult hospitalized patients and discuss the main adverse events in nursing care.
Method:
Integrative revision with a qualitative approach. The data were collected at LILACS, MEDLINE, BDENF and the library SCIELO and were submitted to thematic analysis.
Results:
three categories were developed: Adverse events in nursing care; The main causes of the adverse events in nursing care; Attitude of nursing professionals in face of errors. The main events were identified in nursing care with emphasis on the medication error, the failure to perform dressings and falls of patients. The importance of instruments was emphasized for notification of adverse events in the institutions. However the fear of punishment on professionals stimulates the underreporting of events.
Conclusion:
it is important to discuss effective prevention strategies that ensure patient safety in healthcare institutions.
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Staphylococcus aureus meticilino resistente adquirido na comunidade: um problema mundial
Revista Brasileira de Enfermagem. 2015;68(1):136-143
Abstract
Staphylococcus aureus meticilino resistente adquirido na comunidade: um problema mundial
Revista Brasileira de Enfermagem. 2015;68(1):136-143
DOI 10.1590/0034-7167.2015680119p
Views0Objetivo:
descrever a epidemiologia dos casos de CA-MRSA no Brasil de forma a compreender sua ocorrência, fatores de risco associados e formas de manejo em relação à situação mundial.
Método:
revisão integrativa e para seleção dos estudos utilizou-se as bases de dados: Scopus, Science direct, Isi Web of Knowledge, PUBMED e BVS.
Resultados:
foram identificados dez artigos nacionais que descreveram 21 casos de CA-MRSA principalmente em crianças, adolescentes e adultos com quadro de infecção de pele e tecidos moles evoluindo para infecções graves relacionados ao clone Oceania Southwest Pacific Clone (OSPC) que resultaram em hospitalização.
Conclusão:
apesar do CA-MRSA ser considerado um micro-organismo de relevância mundial verificou-se a escassez de dados publicados sobre sua epidemiologia no Brasil, o que dificultam o delineamento da realidade do país frente ao CA-MRSA.
Keywords:Controle de InfecçõesFarmacorresistência BacterianaInfecções Comunitárias AdquiridasStaphylococcus Aureus Resistente à MeticilinaSee more -
Prevention and non-pharmacological management of pain in newborns
Revista Brasileira de Enfermagem. 2015;68(1):131-135
Abstract
Prevention and non-pharmacological management of pain in newborns
Revista Brasileira de Enfermagem. 2015;68(1):131-135
DOI 10.1590/0034-7167.2015680118i
Views0See moreObjective:
to describe the main non-pharmacological interventions for pain relief in newborns available in Neonatal Intensive Care Unit.
Method:
an exploratory search of the MedLine, Lilacs and Scielo online databases was conducted to retrieve references of studies published from 2004 to 2013.
Results:
several non-pharmacological interventions were shown to be effective, to represent low risk for neonates and to have a low operational cost. The ones most often discussed in the literature were: oral administration of glucose/sucrose, non-nutritive sucking, breastfeeding, skin-to-skin contact, facilitated tucking and swaddling.
Conclusion:
healthcare teams should be familiar with these methods and use them more effectively in Neonatal Intensive Care Unit daily routines, so as to ensure that newborns receive qualified and more human care.
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BANFISA e (IN)DICA-SUS na graduação em saúde: o lúdico e a construção de aprendizados
Revista Brasileira de Enfermagem. 2015;68(1):124-130
Abstract
BANFISA e (IN)DICA-SUS na graduação em saúde: o lúdico e a construção de aprendizados
Revista Brasileira de Enfermagem. 2015;68(1):124-130
DOI 10.1590/0034-7167.2015680117i
Views0See moreObjectives:
to analyze the learning built during the matches of the games by students of the subject Gestão de Políticas Públicas em Saúde at the Universidade de Brasília.
Method:
exploratory, descriptive research, in a qualitative approach, with 26 students from various graduation courses in health, using a questionnaire and participant observation.
Results:
participants reinvented rules, related issues addressed in the games to the reality, interacted with colleagues and had fun throughout the match. Comparing the games in relation to ludicity, the BANFISA was more attractive than the (IN) DICA-SUS, although they are complementary.
Conclusions:
learning constructed by the students goes beyond the content of the subject; involve the active participation in group and creativity.
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Chinese auriculotherapy to improve quality of life of nursing team
Revista Brasileira de Enfermagem. 2015;68(1):117-123
Abstract
Chinese auriculotherapy to improve quality of life of nursing team
Revista Brasileira de Enfermagem. 2015;68(1):117-123
DOI 10.1590/0034-7167.2015680116p
Views0See moreObjective:
to evaluated the effi cacy of auriculotherapy for improving quality of life and reducing stress in nursing staff.
Method:
single-blind radomizad clinical trail envolving 175 subjects randomized in: Control (G1), Protocol Group (G2) and without Protocol Group (G3). They were evaluated by the Stress Symptoms List and SF36v2 at baseline, after 12 sessions and follow up (30 days), between January and July 2012.
Results:
both intervention groups reduced stress (p <0.05) with greater effect for G3 (d = 1.15). G3 was also higher for improving life quality especially the physical domain (p = 0.05).
Conclusion:
individualized auriculotherapy (G3) had greater effect compared to the protocol auriculotherapy (G2) for reducing stress and improving life quality.
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Adherence to foot self-care in diabetes mellitus patients
Revista Brasileira de Enfermagem. 2015;68(1):111-116
Abstract
Adherence to foot self-care in diabetes mellitus patients
Revista Brasileira de Enfermagem. 2015;68(1):111-116
DOI 10.1590/0034-7167.2015680115p
Views0See moreObjective:
to analyze the self-care of patients with type 2 diabetes mellitus in the Family Health Strategy in Teresina-PI.
Method:
search cross selected by simple random sampling, 331 people with diabetes mellitus. Data collection took place from August to December 2012 with the use of Self-Care Activities Questionnaire with Diabetes and structured instrument for recording information socioeconomic and guidance received by the professional nurse.
Results:
the data revealed that patients have poor adherence to blood glucose monitoring, the physical exercise and foot care, but with good adherence to the medication. Only 38.7% of the sample examined the feet of fi ve to seven days a week. Statistically signifi cant association between self-care activities with their feet and orientations of nurses (p < 0,05).
Conclusion:
that there is need to raise awareness with regard to the development of skills for self-care.
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Patients with disorders of consciousness: vital, facial and muscular responses to music or messages
Revista Brasileira de Enfermagem. 2015;68(1):102-110
Abstract
Patients with disorders of consciousness: vital, facial and muscular responses to music or messages
Revista Brasileira de Enfermagem. 2015;68(1):102-110
DOI 10.1590/0034-7167.2015680114p
Views1See morePurposes:
to compare vital signs, facial expression and basal electroneurographic signs with measures during stimuli music, message or “silence” in coma patients, vegetative status or sedated; and relating the score of Glasgow Results Scale with the intervention realized.
Method:
a Monoblind Transversal Controlled Clinical Trial to researcher. The distribution, among the three groups, was randomized (experiment with music, experiment with message or control). Two assessments (sessions) were performed with interval of 40 minutes on the same day.
Results:
most of the 76 patients were male, between 18 to 36 years old and hospitalized due to trauma. Statistically signifi cant changes were found in the variables referred to temperature, facial expression, electroneurography and Glasgow Results Scale; more frequent alterations in second session, in coma and vegetative patients, in frontal muscles and in experiment group.
Conclusions:
the facial expression and the electroneurography seem to be more trustworthy variables than vital signs to evaluate consciousness.
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Prevalence of minor psychiatric disorders in socio-educational agents in the state of Rio Grande do Sul
Revista Brasileira de Enfermagem. 2015;68(1):93-101
Abstract
Prevalence of minor psychiatric disorders in socio-educational agents in the state of Rio Grande do Sul
Revista Brasileira de Enfermagem. 2015;68(1):93-101
DOI 10.1590/0034-7167.2015680113p
Views0See moreObjective:
to determine the prevalence and factors associated with minor psychiatric disorders (MPD) in socio-educational agents.
Method:
it is a cross-sectional study with 381 socio-educational agents the Centers for Socio-Educational Services in the State of Rio Grande do Sul, Brazil. The Brazilian versions of the Scale of Demand-control-social support at work and the Self Reporting Questionnaire-20 have been applied.
Results:
the results showed a prevalence of suspicion MPD of 50.1%. They showed to be related to suspicion of MPD : being female (55.7%), having age up to 44 years old (58.5%), no physical activity (57.4%), do not have time for leisure (75%), make use of medication (61.4%), require medical attention (56.9%) and psychological counseling (72.7%), not being satisfied with the workplace (61.7%) and need for time off from work (65.6%).
Conclusion:
the study provides important data about the mental health of agents, showing the need for the involvement of managers and of the health service of worker’s health in planning actions to promote health of these workers.
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Environmental variables and errors in the preparation and administration of medicines
Revista Brasileira de Enfermagem. 2018;71(3):1046-1054
Abstract
Environmental variables and errors in the preparation and administration of medicines
Revista Brasileira de Enfermagem. 2018;71(3):1046-1054
DOI 10.1590/0034-7167-2016-0041
Views0See moreABSTRACT
Objective:
to identify the relationship between environmental factors and errors in the preparation and administration of antibacterial.
Method:
an observational, cross-sectional study conducted between August and December, 2014 in two clinical units. The sample consisted of 265 doses of medication, observed in different shifts that through a form had the environmental conditions of noise, illumination, humidity, temperature and physical space measured in the preparation and administration stages.
Results:
the physical dimension for the preparation was inadequate in one unit (3.8m2), and the items illumination, temperature and noise were extremely oscillating in the three shifts and in the two clinics, with averages generally higher than the recommended for the hospital environment, however, variations in illumination and noise were not statistically significant to cause dose errors or erroneous medicine choice (p> 0.05).
Conclusion:
the environmental variables analyzed may favor medication errors in both the preparation and administration stages.
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The use of gamification to teach in the nursing field
Revista Brasileira de Enfermagem. 2018;71(3):1038-1045
Abstract
The use of gamification to teach in the nursing field
Revista Brasileira de Enfermagem. 2018;71(3):1038-1045
DOI 10.1590/0034-7167-2017-0023
Views0ABSTRACT
Objectives:
To investigate whether the course offer with elements of gamification contributes to the formation of competences in Informatics in Nursing; and evaluate it based on teaching and learning criteria and content structure.
Method:
Exploratory, applied and technological innovation research, with a qualitative and quantitative approach, developed at a university in the southern region of the country between February and November 2016. Participants were professors (5) and nursing students (10).
Results:
The adoption of gamification was considered an interesting and innovative approach, as an alternative to traditional practices and applicable to Nursing teaching. In the quantitative analysis, it was observed that the course contemplates the set of evaluated criteria.
Final considerations:
Gamification contributes to the formation of competences among Nursing students for positively influencing the teaching-learning process. It can be understood as one more resource in the teaching work with a view to student motivation and meaningful learning.
Keywords:Competency-Based EducationComputer KnowledgeEducational TechnologyInformatics in NursingTeachingSee more -
Adherence of hypertension patients in the Brazil’s Family Health Strategy
Revista Brasileira de Enfermagem. 2018;71(3):1030-1037
Abstract
Adherence of hypertension patients in the Brazil’s Family Health Strategy
Revista Brasileira de Enfermagem. 2018;71(3):1030-1037
DOI 10.1590/0034-7167-2017-0297
Views0See moreABSTRACT
Objective:
to evaluate the adherence and associate it to blood pressure control and to follow-up observation of people with hypertension in the Brazil’s Family Health Strategy.
Method:
cross-sectional study, conducted with 417 people in treatment of hypertension, living in a municipality located in the Northwest region of the state of Paraná, Brazil. The data were collected in the first 2016 semester, using an instrument adapted and validated for the evaluation of satisfaction with the services offered by Primary Health Care. Analysis of variance and the logistic regression model were used for the treatment of variables.
Results:
it was evidenced that people with inadequate follow-up observation evaluate the relations between professional/user and the guidance to the medications used as unsatisfactory.
Conclusion:
weak guidelines and ineffective dialogue between health professionals and users might result in an inadequate follow-up observation of blood pressure control and of people with hypertension.
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Prevalence and factors associated with experience of intrafamilial violence by teenagers in school
Revista Brasileira de Enfermagem. 2018;71(3):1022-1029
Abstract
Prevalence and factors associated with experience of intrafamilial violence by teenagers in school
Revista Brasileira de Enfermagem. 2018;71(3):1022-1029
DOI 10.1590/0034-7167-2016-0546
Views0See moreABSTRACT
Objective:
To estimate prevalence of intrafamilial violence experience and its association with sociodemographic, sexual and use of alcohol/drugs variables in teenagers of a public school in Salvador, Bahia, Brazil.
Method:
Cross-sectional study with 239 teenagers. Data were collected through structured instrument, analyzed according to descriptive and inferential statistics, with multiple logistic regression.
Results:
Research pointed out a high prevalence of intrafamilial violence among teenagers (60.67%). Experience of this grievance was associated, with statistical significance, with the variables: higher age range (PR = 1.83 and 95%CI: 1.05 – 3.18) and regular use of condom (PR = 1.81 and 95%CI: 1.06 – 3.08). Violence was also associated with consumption of alcohol and marijuana.
Conclusion:
Regular use of condom and consumption of alcohol and/or marijuana represent risk behaviors to the experience of intrafamilial violence by teenagers in school, especially older than 15 years old.
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Estado nutricional y factores asociados en mayores de 75 años no institucionalizados
Revista Brasileira de Enfermagem. 2018;71(3):1007-1012
Abstract
Estado nutricional y factores asociados en mayores de 75 años no institucionalizados
Revista Brasileira de Enfermagem. 2018;71(3):1007-1012
DOI 10.1590/0034-7167-2017-0207
Views1See moreRESUMEN
Objetivo:
determinar los factores relacionados con el riesgo de desnutrición en la población de mayores de 75años no institucionalizada.
Método:
estudio transversal realizado mediante cuestionario en una muestra de 326 individuos mayores de 75 en Castellón (España), durante 2015. Seleccionados mediante muestreo intencionado.
Resultados:
Prevalencia de desnutrición 2,8%. El 26,9% de los individuos están en riesgo de desnutrición, las mujeres lo presentan en mayor proporción (31,5%). Las mujeres presentan una salud general buena en menor proporción que los hombres, el 55% frente a 69%. Tienen menor riesgo de desnutrición los individuos que tienen una percepción positiva y los que tienen una buena salud general. Los mayores frágiles presentan un mayor riesgo de desnutrición (57,5%) frente a los no frágiles (20,2%) p< 0.001.
Conclusión:
Se relacionan con mayor riesgo de desnutrición, mujeres fragilidad, percepción de la salud, salud global y utilización de Servicios sanitarios (consulta de la enfermería).
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Nutritional status and factors associated with non-institutionalized people over 75 years of age
Revista Brasileira de Enfermagem. 2018;71(3):1007-1012
Abstract
Nutritional status and factors associated with non-institutionalized people over 75 years of age
Revista Brasileira de Enfermagem. 2018;71(3):1007-1012
DOI 10.1590/0034-7167-2017-0207
Views0See moreABSTRACT
Objective:
to determine the factors related to the risk of malnutrition in a non-institutionalized population over 75 years of age.
Method:
a cross-sectional study was conducted using a questionnaire in a sample of 326 individuals over 75 years of age in Castellón (Spain), during 2015, and selected through intentional sampling.
Results:
Malnutrition prevalence was 2.8%. 26.9% of the individuals were at risk of malnutrition, whereas women presented a higher rate (31.5%). Women with a good overall health status showed a lower rate than men, 55% and 69%, respectively. Individuals that showed a lower risk of malnutrition are those with a positive perception than those who have a good overall health. Frail elderly people showed a higher risk of malnutrition (57.5%) compared to non-frail subjects (20.2%) p< 0.001.
Conclusion:
Frail women, self-assessed health, overall health, and use of health care services (nursing consultation) were related to a higher risk of malnutrition.
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Empowerment of the mothers of children in a pediatric intensive care unit
Revista Brasileira de Enfermagem. 2018;71(3):998-1006
Abstract
Empowerment of the mothers of children in a pediatric intensive care unit
Revista Brasileira de Enfermagem. 2018;71(3):998-1006
DOI 10.1590/0034-7167-2016-0689
Views0See moreABSTRACT
Objective:
to analyze the process of empowerment of the mothers of children hospitalized in a pediatric intensive care unit (PICU) according to Cheryl H. Gibson’s framework.
Method:
a qualitative study with a non-directive interview in groups was carried out with 14 mothers in the PICU of a pediatric teaching hospital in the state of Rio de Janeiro, whose data were submitted to thematic analysis.
Results:
all mothers underwent at least one phase of the process of empowerment. Some of them achieved the phase of participatory competence in the care for their children, being heard by the team and expressing their needs, opinions, and questions.
Final considerations:
attentive listening and information sharing with mothers is necessary, in order to provide essential support so that they undergo the process of empowerment, thus involving themselves in care and decision-making regarding their children.
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