Pensamento Lean e cuidado do paciente em morte encefálica no processo de doação de órgãos

Interventions to Improve the Quality in the Organ and Tissue Donation Process

BACKGROUND

Map Interventions is capable of supporting the multidisciplinary team that works in organ and tissue donation to disseminate quality in this process.

METHODS

A scoping review study that was conducted through the steps proposed by the Joanna Briggs Institute.

RESULTS

Fifty-six studies made up the sample. 2018 (no. 07, 12.5%) had the highest number of publications. The country that published the most was the United States (no. 16, 28.56%). The database with the most publications was the Cumulative Index to Nursing and Allied Health Literature - CINAHL (no. 15, 26.78%). The most used interventions, which had the most significant impact on the improvement of results and quality, were the use of indicators in all stages of the organ and tissue donation process; the use of real goals that can be achieved; frequent audits, validation of instruments to track opportunities for improvement; as well as methodologies to implement quality and education among professionals who work in this process. Such interventions reveal important changes in the organ donation process, especially in the notification of potential and effective donors, as well as providing an opportunity for safety in the stages of the organ and tissue donation process.

CONCLUSION

The interventions tracked suggest the implementation of a set of actions formed by the continuous use of auditing, indicators, continuing education with the team that works in the process of organ and tissue donation, combined with the management of the results obtained through the indicators, where it is generated from these data, actions that have a direct impact on the weaknesses identified.

A Doação na Literatura Científica Nacional: Contribuições à Psicologia Moral

Resumo Conduziu-se uma revisão da literatura científica nacional publicada sobre doação com o objetivo de identificar temas para pesquisas no campo da Psicologia Moral. Os 49 artigos analisados abordaram doação de sangue, córneas, leite humano, medula óssea, gametas, órgãos e tecidos. O tratamento qualitativo sobre os artigos envolveu análise temática e o software NVivo. Sete temas resultaram da análise: por que doar, por que não doar, princípios e valores, sentimentos negativos, religião, mídia e esperança. Aspectos morais (compaixão, empatia, altruísmo, generosidade, gratidão) destacaram-se como antecedentes ou consequentes da doação. Evidenciou-se a ausência de artigos sobre doação de agasalhos, brinquedos, alimentos, livros - objetos com custo pessoal destacadamente menor do que os identificados na literatura. A compreensão das idiossincrasias de doadores e receptores, pelo estudo das virtudes, por exemplo, pode colaborar para a compreensão da doação e para aplicações sociais e educativas para promovê-la.

Lean thinking in health and nursing: an integrative literature review

Objectives:

to demonstrate the scientific knowledge developed on lean thinking in health, highlighting the impact and contributions in health care and nursing.

Method:

an integrative literature review in the PubMed, CINAHL, Scopus, Web of Science, Emerald, LILACS and SciELO electronic library databases, from 2006 to 2014, with syntax keywords for each data base, in which 47 articles were selected for analysis.

Results:

the categories were developed from the quality triad proposed by Donabedian: structure, process and outcome. Lean thinking is on the rise in health surveys, particularly internationally, especially in the USA and UK, improving the structure, process and outcome of care and management actions. However, it is an emerging theme in nursing.

Conclusion:

this study showed that the use of lean thinking in the context of health has a transforming effect on care and organizational aspects, promoting advantages in terms of quality, safety and efficiency of health care and nursing focused on the patient.

Prototype of a computerized scale for the active search for potential organ donors

Objective:

to develop a prototype of a computerized scale for the active search for potential organ and tissue donors.

Method:

methodological study, with the analysis of 377 electronic medical records of patients who died due to encephalic death or cardiorespiratory arrest in the intensive care units of a tertiary hospital. Among the deaths due to cardiorespiratory arrest, the study aimed to identify factors indicating underreported encephalic death cases. The Acute Physiology and Chronic Health Evaluation II and Sepsis Related Organ Failure Assessment severity indexes were applied in the protocols. Based on this, a scale was built and sent to five experts for assessment of the scale content, and subsequently, it was computerized by using a prototyping model.

Results:

34 underreported encephalic death cases were identified in the medical records of patients with cardiorespiratory arrest. Statistically significant differences were found in the Wilcoxon test between the scores of hospital admissions in the intensive care unit and the opening of the encephalic death protocol for both severity indexes.

Conclusion:

the prototype was effective for identifying potential organ donors, as well as for the identification of the degree of organ dysfunction in patients with encephalic death.