NURSING PROTOCOL FOR REMOTE MONITORING OF WOMEN WITH EXCESSIVE WEIGHT

ABSTRACT Objective: to describe the construction and implementation of the nursing protocol for remote monitoring of overweight women. Method: report of experience with 50 women who participated in an intervention study developed in a reference outpatient clinic for obesity in Salvador, Brazil. The steps involved in the development of the protocol consisted of structuring the theoretical content and defining the form of operationalization. Results: the definition of the theoretical content of the protocol was guided by the main guides and guidelines of the Ministry of Health and Scientific Societies and discussion with specialists. A thematic weekly script was developed for phone calls, including content on obesity, its causes and complications, feeding and practicing physical activity for weight control. The protocol was performed in ten weeks, with scheduled weekly connections and duration of five minutes. To guide the team in the operation of telephone calls, a Telephone Call Guide was developed. The information was offered in a flexible way, providing moments for the participant to clarify doubts and to add information, being observed the understanding of the contents. Women noted that monitoring, as well as guiding how they could take better care of themselves, helped to avoid giving up treatment and solving problems with health consultations and procedures. Conclusion: the use of remote nursing monitoring focused on educational actions, has proved to be a tool to support the care of overweight women.

Cross-cultural adaptation of the General Comfort Questionnaire to Brazilian patients with myocardial infarction

OBJECTIVE

Describe the first stages of the cross-cultural adaptation process of the General Comfort Questionnaire for myocardial infarction patients in intensive care units.

METHOD

This is a study of qualitative and quantitative research and analysis techniques. Conceptual, item, semantic and operational equivalence was performed. Fifteen items were added to the original instrument to better represent the comfort experienced by myocardial infarction patients in intensive care units. The content validity index was applied to analyze the answers of the experts; it was considered adequate above 0.78.

RESULTS

Some changes suggested by the experts for better understanding were adopted. All items were kept, obtaining a scale of sixty-three items. In the pre-test conducted with 30 subjects, the instrument was considered adequate to the target audience.

CONCLUSION

The adapted version of the General Comfort Questionnaire for people with myocardial infarction is adequate to the target audience.

Short version of the "instrument for assessment of stress in nursing students" in the Brazilian reality

Goal:

validate a short version of the Instrument for assessment of stress in nursing students in the Brazilian reality.

Method:

Methodological study conducted with 1047 nursing students from five Brazilian institutions, who answered the 30 items initially distributed in eight domains. Data were analyzed in the R Statistical Package and in the latent variable analysis, using exploratory and confirmatory factor analyses, Cronbach’s alpha and item-total correlation.

Results:

The short version of the instrument had 19 items distributed into four domains: Environment, Professional Training, Theoretical Activities and Performance of Practical Activities. The confirmatory analysis showed absolute and parsimony fit to the proposed model with satisfactory residual levels. Alpha values ​​per factor ranged from 0.736 (Environment) to 0.842 (Performance of Practical Activities).

Conclusion:

The short version of the instrument has construct validity and reliability for application to Brazilian nursing undergraduates at any stage of the course.

Validation of the Comfort scale for relatives of people in critical states of health

OBJECTIVE

this methodological study aims to present the construct validity of the Comfort scale for family members of people in a critical state of health (ECONF).

METHOD

this is a methodological study. The sample was made up of 274 family members of adults receiving inpatient treatment in six Intensive Care Units (ICU) in the State of Bahía responded to 62 items distributed in 7 dimensions. The validation procedures adopted were based on the techniques of the Classical Test Theory.

RESULTS

the analysis of dimensionality was undertaken through principal components analysis, a scale being obtained with 55 items distributed in four factors: Safety, Support, Family member-relative interaction and Integration with oneself and the everyday. The analysis of the items' , discriminative power, undertaken by the item-total correlation-coefficient showed a good relationship of the items with their respective factors. From the ECONF's reliability test, from the analysis of internal consistency, a raised Alpha Cronbach coefficient was obtained for the 4 factors and the general measurement.

CONCLUSION

the comfort scale presented satisfactory psychometric parameters, thus constituting the first valid instrument for evaluating the comfort of family members of people in a critical state of health. The advance made by the study lies in its theoretical framework on comfort, and provides the health team with a scale based on empirical evidence.

Construction and validation of nursing diagnoses for people in palliative care

Objective:

to construct and validate nursing diagnoses for people in palliative care based on the Dignity-Conserving Care Model and the International Classification for Nursing Practice.

Method:

a two-stage methodological study: 1) construction of the database of clinically and culturally relevant terms for the nursing care for people in palliative care and 2) construction of nursing diagnoses from the database of terms, based on the guidelines of the International Council of Nurses.

Results:

the 262 terms validated constituted a database of terms from which 56 nursing diagnoses were developed. Of these, 33 were validated by a group of 26 experts, and classified in the three categories of the Dignity-Conserving Care Model: illness-related concerns (21); dignity-conserving repertoire (9); and social dignity inventory (3).

Conclusion:

of the 33 validated diagnoses, 18 of them could be included in the update of the Catalog of the International Classification for Nursing Practice - palliative care for a dignified death. The study contributes to support the clinical reasoning and decision making of the nurse.

Cumulative sitting time as discriminator of overweight, obesity, abdominal obesity and lipid disorders in nursing university

DOI: http://dx.doi.org/10.5007/1980-0037.2017v19n1p40 There is evidence demonstrating that prolonged sitting time is relevant risk factors for metabolic and cardiovascular disorders. The aim of this study was to identify the discriminatory power and propose cumulative sitting time cutoff points for overweight, obesity, abdominal obesity and lipid disorders in nursing university students. A cross-sectional study of 137 women, nursing students from a public university in Salvador, Bahia, Brazil. Data were obtained by applying specific forms, laboratory and anthropometric measurements. The predictive power and cutoff points of sitting time for the outcomes of interest were identified by receiver operating characteristic curves (ROC). A 95% confidence interval was established. Sitting time for a day of the week was a good discriminator of abdominal obesity: area under the ROC curve (AUC) = 0.66 (0.57-0.75). No AUC with statistical significance were found to discriminate overweight and total obesity. Sitting time over the weekend showed no discriminatory power for overweight, obesity or abdominal obesity. Sitting time during the week or weekend did not discriminate lipid abnormalities. Sitting time for 8 hours or more a day during the week discriminates the presence of abdominal obesity. The sitting time during the week of 8 hours accumulated per day discriminates abdominal obesity in undergraduate nursing. It is suggested that educational institutions establish measures to encourage a reduction in this sedentary behavior.

Fatores relacionados à inatividade física no lazer em mulheres obesas

Resumo Objetivo Verificar os fatores relacionados à inatividade física (IF) no lazer em mulheres com excesso de peso. Métodos Estudo transversal, recorte de um projeto matriz denominado “Monitoramento remoto de enfermagem de mulheres com excesso de peso”, desenvolvido em ambulatório de referência para obesidade, em Salvador, Bahia, Brasil, no qual uma equipe multidisciplinar cerca de 300 usuários do Sistema Único de Saúde, sendo 91% mulheres, razão pela qual foram selecionadas para o estudo. Mediante consulta aos prontuários 174 mulheres foram recrutadas atendendo aos critérios de inclusão para o projeto matriz: ter excesso de peso (IMC ≥25 kg/m2), idade superior a 18 anos, comparecido a consulta médica nos últimos doze meses e telefone fixo e/ou celular. Foram critérios de exclusão: ausência de condições físicas para medidas antropométricas e cognitivas para responder aos instrumentos da pesquisa, distúrbios psiquiátricos, uso de drogas para perda de peso e realização de cirurgia bariátrica. Obedeceu-se as orientações do processamento e de análise dos dados do IPAQ. Resultados Houve alta prevalência de IF (85,2%) e associação significante entre IF e índice de massa corporal, autoeficácia para atividade física, percepção do ambiente, dependentes no domicílio, estado de saúde percebido e número de comorbidades. Na regressão, a IF associou-se ao número de comorbidades (RP:1,31; IC 95% 1,06;1,64); a autopercepção de saúde ruim (RP: 1,28; 1,01;1,61); a baixa autoeficácia (RP:1,27; 1,06; 1,51) e a percepção do ambiente ruim (RP:1,27; IC 95% 1,01;1,60). Conclusão A IF no lazer associou-se a variáveis individuais e ambientais.

Tempos de acesso a serviços de saúde face ao infarto do miocárdio

Resumo Objetivo Analisar os tempos relacionados ao acesso de homens e mulheres com infarto do miocárdio a hospitais referência em cardiologia e a correlação entre eles. Métodos Pesquisa transversal, com 100 pessoas com infarto entrevistadas em hospitais referência em cardiologia. Dados analisados por estatística descritiva e inferencial, adotando-se significância estatística. Resultados Os tempos foram elevados (decisão para atendimento, chegada ao primeiro serviço de saúde, permanência na rede de atenção e admissão em hospitais referência em cardiologia), exceto o de transporte, sobretudo para mulheres. Houve maior contribuição do tempo de decisão na composição do tempo de chegada ao primeiro serviço de saúde e do tempo de permanência na rede na composição do tempo de chegada aos hospitais referência em cardiologia. Conclusão A longa espera por atenção especializada reflete a falta de estrutura dos serviços de saúde, e o tempo de decisão elevado reflete a falta do não reconhecimento do infarto pelos participantes.

Fatores associados ao descontrole da pressão arterial em homens

Resumo Objetivo Verificar os fatores associados ao descontrole da pressão arterial em homens. Métodos Estudo exploratório, de corte transversal, realizado em centro de referência para doenças cardiovasculares, em Salvador-BA, lócus para o núcleo de referência do programa de saúde do homem do Ministério da Saúde. Amostra foi selecionada por conveniência totalizando 130 homens atendidos em centro de saúde, submetidos a entrevista, avaliação clínica e antropométrica. Na análise bivariada empregou-se o Qui-quadrado de Pearson ou Exato de Fisher realizando-se posteriormente análise de regressão logística múltipla sendo a OR corrigida pelo modelo de Poisson. Adotou-se significância estatística de 5%. Resultados Constatou-se alta prevalência de descontrole da pressão arterial (65,4%), de hábitos de vida inadequados e de excesso de peso. Não houve associação estatisticamente significante entre descontrole dos níveis pressóricos e variáveis sociodemográficas, hábitos de vida e medidas antropométricas. Na regressão, o descontrole da pressão arterial associou-se ao uso inadequado da medicação (RP: 1,35, IC 95%: 1,03; 1,76). Conclusão O uso inadequado da medicação foi reforçado como importante fator associado ao descontrole. Medidas efetivas para mudança deste panorama são emergenciais e desafiam profissionais e autoridades públicas.

Consumo de bebidas alcóolicas entre estudantes de enfermagem

Objetivo Comparar o consumo de bebida alcóolica entre estudantes de Enfermagem ingressantes e concluintes do curso. Métodos Estudo transversal, com 154 estudantes de enfermagem. O instrumento de pesquisa foi um questionário com dados sociodemográficos e da vida acadêmica, e o Alcohol Use Disorders Identification Test (AUDIT). Na análise dos dados, empregaram-se estatísticas descritivas, teste Qui-quadrado de Pearson, exato de Fischer e de tendência linear. Adotou-se significância estatística de 5%. Resultados Predominaram mulheres, na faixa etária de 20 a 24 anos, solteiros, da raça negra e classe socioeconômica C. Consumiam bebida alcoólica 57,1% da amostra. Constatou-se maior frequência de consumo e de doses de bebida alcoólica para estudantes concluintes e maior proporção destes nas Zonas AUDIT II, III e IV. Não houve diferença estatisticamente significante na análise entre zonas e ano em curso. Conclusão Estudantes concluintes apresentaram maior consumo prejudicial de bebidas alcoólicas.

Pre-hospital delay in acute myocardial infarction: judgement of symptoms and resistance to pain

OBJECTIVE

To estimate the time of decision (TD) to look for medical care and the time of arrival (TA) at the health service for men (M) and women (W) suffering from acute myocardial infarction and to analyze the influence of the interpretation of pain and pain resistance behaviors during these times.

METHODS

This is an exploratory research, performed at the university hospital in Salvador/Bahia. 43 W and 54 M were interviewed. To study the dependence among sociodemographic and gender variables, the Fisher Exact Test was used. To analyze times, a geometric mean (GM) was used. In order to verify the association between the GM of TD and TA and the judgment of pain, and between the GM of TD and TA and the behavior of resistance to pain, as well as to test the time of interaction between the gender variable and other variables of interest, the robust regression model was used. The statistical significance adopted was 5%.

RESULTS

The GM of the TD for M was 1.13 h; for W, 0.74 h. The GM of the TA was 1.74 h for M and 1.47 h for W. Those who did not recognize the symptoms of AMI and presented behavior of resistance to pain had higher TD and TA, being the associations significant. Gender did not change the associations of interest.

CONCLUSION

The findings demonstrate the importance of health education aiming at the benefits of early treatment.

Sociodemographic and clinical factors associated with the decision time for seeking care in acute myocardial infarction

OBJECTIVE

this study aimed to analyze the interaction of gender in the association between decision time for seeking healthcare services and the sociodemographic and clinical variables.

METHOD

this exploratory, cross-sectional study was performed with 100 individuals interviewed in hospitals in Salvador, Bahia. The chi-square test or Fisher's exact test and the robust linear regression model were used in the analysis. A statistical significance of 5% was adopted.

RESULTS

men and women presented long decision times. The decision time was less for smokers and those with constant and/or severe pain. There was an interaction between gender and smoking and between gender and pain radiating to the neck or jaw for the decision time outcome.

CONCLUSION

decision times were long and were influenced by clinical and gender variables. The study provides support for nursing care practices focused on the specificity of these factors and of the genders aiming to reduce the decision time.

Social representations of adolescents on quality of life: structurally-based study

This study sought to conduct a comparatively analysis and describe the contents of the structure of the social representations of adolescents on quality of life. It involves descriptive, quantitative research, with the benchmark of a structural approach to social representations. The informants included 316 adolescents from three public schools in Jequié in the State of Bahia. The Spontaneous Word-Choice Eliciting Technique using the key expression "Quality of Life" was used for data collection. The responses were processed using Evoc 2003 software, which generated the Four-House Chart. The results reveal the core nucleus of the terms: healthy eating; physical activity; money; and sex. In the 1st outer circle, the words absence of disease, condoms, liberty, marijuana, housing, work and living well are featured. In the 2nd outer circle, there appeared the words difficulty, family, peace and power, and the contrasting elements of well-being and soccer. The overall consensus is that adolescents associate quality of life with sports and other healthy behavior activities, and are influenced by the desires and curiosities of adolescence.

[Environmental factors associated with the decision time for seeking care in myocardial infarction]

The purpose was to estimate the decision time (DT) for searching for attendance for men and women suffering from acute myocardial infarction (AMI); and to analyze the influence of surrounding variables in the DT. Transversal study, involving one hundred patients interviewed in hospitals of Salvador-BA, Brazil. For data analysis, it was used the chi-squared or Fisher's exact test, and the Robust Linear Regression Model. AMI at the home predominated, with family members and patients receiving mistaken actions. A high DT was observed both, for women (0.9h) and men (1.4h). Those at home during the initial symptoms had higher DT, compared to those at work; and lower in relation to those in public spaces (p=0.047). Statistically significant interaction occurred among gender and the fact of living with company; and among gender and having a companion and children, for the outcome of the DT. Nursing care focused on the specificity of surrounding factors and gender can optimize early attendance.

Acesso de usuários com infarto do miocárdio a hospitais referência em cardiologia

Objetivo Caracterizar o acesso de usuários com infarto do miocárdio a hospitais referência em cardiologia. Métodos Estudo transversal, realizado em dois hospitais referência em cardiologia. A amostra de 100 usuários, com diagnóstico de infarto, foi entrevistada empregando-se instrumento específico. Na análise utilizou-se médias, desvio padrão e percentuais. Resultados Predominaram homens, raça negra; casados; baixo nível socioeconômico, idade média de 56,4 anos. Prevaleceu início dos sintomas no domicílio, uso de meios de deslocamento inadequados, procura de serviço de emergência como primeiro local de atendimento, admissão nos hospitais referência em cardiologia até o terceiro atendimento. Dos 67 usuários com infarto com supradesnível do segmento ST, 12% receberam terapias de reperfusão miocárdica. A insuficiência de recursos foi a principal razão para a peregrinação na rede de saúde. Conclusão Constatou-se uso de meios de transporte inapropriados, baixa proporção de reperfusão miocárdica e falta de estrutura da rede para atendimento ao infarto.

[SCIENTIFIC PRODUCTION ON THANATOLOGY IN NURSING JOURNALS: SYSTEMATIC REVIEW]

OBJECTIVE

Analyze the scientific production on Thanatology published in nursing journals.

METHODOLOGY

Systematic review, with quantitative approach, that aimed the characterization of the articles with regard to the year and journal of publication, and its Qualis CAPES, thematic approach, methodological focus, description of training area and qualification of authors.

RESULTS

According to the selection criteria of the sample, 36 articles whose publication period was between the years 1986 and 2011 were extracted for analysis. It was noted the predominance of studies published in journals with high quality strata (A1 and A2), use of qualitative method and nurses educators as authors. The focus of the studies encompassed six central themes, and the prevailing ones were: "Thanatology in the academic training" and "The nurse in face of the dying process of patients and families under their cares".

CONCLUSION

It is clear that the issue still presents itself in a timid manner, requiring an increased production on the subject.

[Comfort of the patient's family in an Intensive Care Unit related to welcoming]

This study aimed to identify the level of comfort of families of patients in a critical health condition related to the welcoming practices performed by the hospital staff. Interviews were conducted with 250 relatives in hospitals of the state Bahia, using a Likert scale. Data were analyzed as percentages and quartiles. For nine of the 12 statements of the scale, most relatives scored their comfort level between very and totally comfortable, median of 4,revealing kindness, tranquility and friendly communication with family members. More than half of the sample scored its level as not at all to more or less comfortable, median of 3, for statements about demonstration of interest towards the relative by the staff and flexible visiting of the patient. The necessity of greater interest of the team in the condition and needs of the family was observed. Promoting comfort from the dimension of welcoming demands interdisciplinary actions grounded in humanistic philosophy, in which the nurse has an important role to play.

[Factors associated with the decision to seek health care in myocardial infarction: gender differences]

Analyze cognitive and emotional variables between genders in terms of the decision time (DT) to seek care when experiencing symptoms of myocardial infarction. One hundred adults were interviewed at two hospitals in Salvador-BA. The analysis used percentage means, the chi-square test, and a robust linear regression model. Most participants were male, with a mean age of 58.78 years and a low socioeconomic status. The geometrical mean of the sample was 1.1h (0.9h for men, and 1.4h for women). A shorter decision time was found for those who considered their symptoms to be severe, and a longer decision time for those who expected symptoms to improve and took something to feel better, with statistically significant associations. An interaction was observed between gender and the following variables: waiting for symptoms to improve (p=0.014), concealing symptoms (p=0.016) and asking for help (p=0.050), thus an association was observed between the variables of interest and DT. The decision times were long and were affected by cognitive, emotional and gender variables. Nursing care may promote early assistance.

Prática de atividade física entre estudantes de graduação em enfermagem

OBJETIVO: Comparar a prática de atividade física entre estudantes de graduação em enfermagem ingressantes e concluintes. MÉTODOS: Estudo transversal desenvolvido com amostra de 154 estudantes. Os instrumentos de pesquisa foram um questionário com dados sociodemográficos e da vida acadêmica e para os dados sobre a prática de atividade física utilizou-se o questionário internacional sobre atividade física. Para a análise dos dados empregou-se estatísticas descritivas e para as análises bivariadas o teste de Qui-quadrado de Pearson, Exato de Fischer. RESULTADOS: Identificou-se predomínio de ingressantes do sexo feminino com idade entre 20 a 24 anos, solteiros. Houve predominância do padrão sedentário. Houve diferença estatisticamente significante para tempo gasto sentado e ano em curso (p=0,010). CONCLUSÃO: O padrão sedentário mostrou-se predominante para os grupos de estudantes ingressantes e concluintes do curso. Houve diferença estatisticamente significante para tempo gasto sentado e ano em curso, com maior percentual para ingressantes.

Desconfortos vividos no cotidiano de familiares de pessoas internadas na UTI

Trata-se de uma pesquisa qualitativa que objetivou conhecer os desconfortos vividos no cotidiano de familiares de pessoas internadas na unidade de terapia intensiva (UTI). Foi realizada na UTI geral de um hospital público, em Salvador-BA, no segundo semestre de 2009. Nove familiares de pessoas internadas foram entrevistados. Empregou-se a técnica de análise da Teoria Fundamentada em Dados. Os resultados mostraram que a interação das famílias com a ameaça à vida de um de seus membros na UTI produziu, como desconforto central, a descontinuidade da vida cotidiana, a qual foi caracterizada por quatro categorias: vivendo a angústia da possibilidade de perda, vivendo uma cisão na vida familiar, sofrendo mudanças na vida social e profissional, tendo dificuldade para cuidar de si. Tais desconfortos podem ser minimizados com abordagem multiprofissional sensível às demandas das famílias e apoio de sua rede social.

Crenças e comportamentos de pessoas com doença arterial coronária

O estudo descreveu crenças e comportamentos sobre causas e medidas de controle da doença arterial coronária (DAC). Cem adultos foram entrevistados em ambulatório público, em Salvador (BA). Os resultados foram analisados em percentuais, médias e por técnica de análise de dados qualitativos. Predominaram homens, idade < 60 anos, cor negra, baixas escolaridade e renda, casados e sem ocupação. A média de crenças para a causa da DAC foi de 1,53 por participante incluindo fatores comportamentais, biológicos, relacionais e religiosos e representaram sobretudo acúmulo de excessos quanto às tensões cotidianas e alimentação. A maioria dos participantes não considerou a enfermidade de caráter crônico acreditando que o tratamento não duraria a vida toda e na cura da doença. A média de crenças para medidas de controle foi de 1,45 prevalecendo seguimento do regime alimentar e uso das medicações. Predominou sedentarismo, redução do tabagismo e consumo de bebida alcoólica, preparo de alimentos com menos sal e gordura saturada, maior consumo de carnes brancas, alimentos cozidos e industrializados. Apenas 66% cumpriam a receita médica. O entendimento insatisfatório sobre causas e medidas de controle da DAC torna essencial a implementação de cuidados contemplando as distintas condições de vida e saúde e projetos para o cuidar de si.