COVID-19: Association of risk classification with the Modified Early Warning Score and hospital outcomes

OBJECTIVE

to evaluate the association of the risk classification categories with the Modified Early Warning Score and the outcomes of COVID-19 patients in the emergency service.

METHOD

a crosssectional study carried out with 372 patients hospitalized with a COVID-19 diagnosis and treated at the Risk Classification Welcoming area from the Emergency Room. In this study, the patients' Modified Early Warning Score was categorized into without and with clinical deterioration, from 0 to 4 and from 5 to 9, respectively. Clinical deterioration was considered to be acute respiratory failure, shock and cardiopulmonary arrest.

RESULTS

the mean Modified Early Warning Score was 3.34. In relation to the patients' clinical deterioration, it was observed that, in 43%, the time for deterioration was less than 24 hours and that 65.9% occurred in the Emergency Room. The most frequent deterioration was acute respiratory failure (69.9%) and the outcome was hospital discharge (70.3%).

CONCLUSION

COVID-19 patients who had a Modified Early Warning Scores > 4 were associated with the urgent, very urgent and emergency risk classification categories, had more clinical deterioration, such as respiratory failure and shock, and evolved more to death, which shows that the Risk Classification Protocol correctly prioritized patients at risk of life.

TRADUÇÃO, ADAPTAÇÃO E VALIDAÇÃO DA ESCALA FULL OUTLINE OF UNRESPONSIVENESS PARA O PORTUGUÊS DO BRASIL

RESUMO Objetivo: traduzir, adaptar culturalmente e validar a escala Full Outline of UnResponsiveness para o português do Brasil. Método: estudo metodológico realizado no Hospital de Clínicas da Universidade Federal do Triângulo Mineiro, Uberaba, Brasil, por meio das etapas: tradução, síntese, avaliação pelo comitê de especialistas, retrotradução, consenso, avaliação semântica e pré-teste. Alcançou-se uma amostra de 188 pacientes adultos. A coleta de dados ocorreu entre agosto e dezembro de 2020. Analisou-se a validade de critério concorrente comparando a escala Full Outline of UnResponsiveness com a Escala de Coma de Glasgow por meio dos coeficientes de correlação de Spearman e Pearson, e a validade preditiva com a Regressão de Cox, Sensibilidade e Especificidade e Área Sob a Curva Receiver Operating Characteristic. Adotaram-se, também, o alfa de Cronbach e os coeficientes Kappa ponderado e de Correlação Intraclasse para a confiabilidade interobservador. Resultados: o teste de Spearman para os itens resposta motora e ocular, respectivamente, resultou-se em 0,81 e 0,96, e o de Pearson para o escore total em 0,97. Obteve-se um risco relativo de 0,80, especificidade de 95,5%, sensibilidade de 51,6% e acurácia de 0,80 (IC95%: 0,688-0,905, p<0,001). O alfa de Cronbach foi de 0,94, o Kappa ponderado variou entre 0,89 e 1,0 e o ICC resultou em 0,99. Conclusão: a escala Full Outline of UnResponsiveness - versão brasileira, manteve quatro domínios e os 20 itens da escala original, tornando-se apropriada para utilização no Brasil e contribuindo para a avaliação do nível de consciência e prognóstico de pacientes adultos em condição grave.

TRANSLATION, ADAPTATION AND VALIDATION OF THE FULL OUTLINE OF UNRESPONSIVENESS SCALE INTO BRAZILIAN PORTUGUESE

ABSTRACT Objective: to translate, culturally adapt and validate the Full Outline of UnResponsiveness scale into Brazilian Portuguese. Method: a methodological study carried out at the Clinical Hospital of Universidade Federal do Triângulo Mineiro, Uberaba, Brazil, through the following stages: translation, synthesis, evaluation by the experts' committee, back-translation, consensus, semantic evaluation and pre-test. A sample of 188 adult patients was reached. Data collection took place between August and December 2020. Concurrent criterion validity was analyzed by comparing the Full Outline of UnResponsiveness scale with the Glasgow Coma Scale by means of Spearman's and Pearson's correlation coefficients; and predictive validity analysis was performed with Cox Regression, Sensitivity and Specificity and Area Under the Receiver Operating Characteristic Curve. The Cronbach's alpha, weighted Kappa and Intraclass Correlation coefficients were also adopted for interobserver reliability. Results: Spearman’s test for the motor and eye response items, respectively, resulted in 0.81 and 0.96, and Pearson's test for the total score was 0.97. A relative risk of 0.80, 95.5% specificity, 51.6% sensitivity and accuracy of 0.80 (95% CI: 0.688-0,905, p<0.001) were obtained. Cronbach's alpha was 0.94, weighted Kappa varied from 0.89 to 1.0, and ICC resulted in 0.99. Conclusion: the Full Outline of UnResponsiveness scale (Brazilian version), maintained four domains and the 20 items from the original scale, making it appropriate for use in Brazil and contributing to the assessment of the level of consciousness and prognosis of adult patients in severe conditions.

Urinary tract infection in patients with chronic kidney disease under conservative treatment

OBJECTIVES

to assess the prevalence and associated risk factors for urinary tract infection in patients with chronic kidney disease under conservative treatment and identify the microorganisms isolated in the urine of these patients and the staging of chronic kidney disease.

METHODS

a cross-sectional, analytical study carried out at the Conservative Treatment Outpatient Clinic of a university hospital in the city of São Paulo.

RESULTS

the prevalence of urinary tract infection is 22%. The risk factors Diabetes Mellitus, hypertension, heart disease, neoplasms and thyroid and autoimmune diseases stand out in the infected group (p < 0.001). Most of the microorganisms found in urine cultures (87.9%) were Gram-negative, being Escherichia coli (50.70%), followed by Klebsiella pneumoniae (23.1%) and Enterococcus spp. (9.7%).

CONCLUSIONS

the findings of this investigation reveal the intrinsic association between risk factors and microorganisms for the development of urinary tract infection.

Effectiveness of chest compressions skill training in the prone position: comparison of two methods

Introduction

The current pandemic caused by the new coronavirus (COVID-19), has become challenging for the health system.1 Pulmonary complication take patients to require ventilatory support and one of the interventions performed to improve then oxygenation is the prone position.2 In view of the current reality of patients with COVID-19 in a prone position, it is necessary to train cardiopulmonary resuscitation in this position.3 Purpose: To compare the effectiveness of two training methods, video and self-instructional guide, in the ability of chest compressions in prone position.

Methods

This is a randomized clinical trial. The sample consisted of nurses, nursing technicians, physiotherapists and residents of the intensive care and emergency unit of a public hospital. Randomization was performed in blocks of four using the Random @ system. Group 1 (G1) consisted of professionals who watched a validated video while practicing chest compression on a low-fidelity mannequin placed in the prone position. Group 2 (G2) consisted of professionals who practiced compression guided by a previously validated self-instructional guide. The study's outcome was the performance of chest compressions skills assessed before and after interventions, using a previously validated instrument. The study was approved by the Research Ethics Committee (no. 4.016.959).

Results

Ninety-one professionals participated in the study (45 from group 1 and 46 from group 2). It was observed that there was an improvement in hand positioning (G1 pre: 16 professionals correctly and post: 31 (p0.001); G2 pre: 20 correct and post: 20 (p0.781), of body positioning (G1 pre: 32 professionals hit and post: 41; G2 pre: 32 hit and post: 39) and the frequency of compressions G1 pre: 10 professionals hit and post: 19 (p0.017); G2 pre: 13 hit and post: 16 (p0.363)) after the interventions. Statistically, when applying the test within each group, a p-value of 0.0003 was obtained in G1 (video) and 0.512 in G2 (self-instructional guide). Thus, we can infer that only group 1 (video) had a change when we compared the two moments.

Conclusion

The video associated with simulation was more effective than the self-instructional guide and can be used as an attractive and dynamic teaching tool.

Funding Acknowledgement

Type of funding sources: Public Institution(s). Main funding source(s): Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES)

QUALIDADE DE VIDA E EXPERIÊNCIAS RELIGIOSAS/ ESPIRITUAIS DE PACIENTES COM CÂNCER EM UM SERVIÇO DE EMERGÊNCIA

Objetivo: avaliar qualidade de vida, experiências espirituais em pacientes com câncer e sua correlação.Método: estudo transversal, realizado na Emergência, de fevereiro a setembro de 2017. Utilizado o Medical Outcome Study 36 – Item Short-Form Health Survey para verificação da qualidade de vida, com oito dimensões, escore de 0 (pior estado) a 100 (melhor estado) e a Escala Diária de Experiência Espiritual, com 16 itens, pontuação entre 16 e 94 (menores pontuações refletem maior frequência de experiências). Utilizou-se o Coeficiente de Spearman para correlacionar qualidade de vida e espiritualidade.Resultados: 83 pacientes, média de idade 58 anos, predomínio masculino. A dimensão da qualidade de vida mais comprometida foi “aspecto físico”. A Escala de Experiência Espiritual apresentou média 51, com correlação negativa entre qualidade de vida e espiritualidade.Conclusão: a espiritualidade relaciona-se com qualidade de vida e deve ser considerada no atendimento a pacientes com câncer na emergência.

QUALITY OF LIFE AND BURDEN OF CAREGIVERS OF ELDERLY PEOPLE

ABSTRACT Objective: to assess caregivers’ quality of life and correlate it with elderly people’s quality of life, as well as assess the burden of caregivers of elderly people hospitalized in an Emergency Service and correlate it with their quality of life. Method: this is a cross-sectional and analytical study conducted with 250 caregivers of elderly patients admitted to the Emergency Service of Hospital São Paulo, Brazil, from December 2015 to January 2017. To assess caregivers’ quality of life, the generic Short-Form-36 questionnaire, item short-form health survey was used; burden was assessed using the Zarit Burden Interview. Results: the mean age was 48.36 years, with a predominance of females, most of whon were elderly people’s children. Caregivers showed mild to moderate burden, and in quality of life assessment, the most compromised domains were general health status, vitality, and social aspects. The Short-Form-36 dimensions that had a significant correlation with Zarit Burden Interview scores were physical aspect, general health status, vitality, social aspects, and emotional aspect. Conclusion: caregivers’ quality of live is associated with elderly people’s quality of life. Burden is related to the worsening quality of life of caregivers. It is necessary to identify the work demands and specific needs of caregivers of elderly people in order to develop care strategies involving this population.

Conhecimento da equipe de enfermagem sobre ressuscitação cardiopulmonar em um hospital universitário

Objetivou-se identificar o conhecimento teórico da equipe de enfermagem sobre as manobras de ressuscitação cardiopulmonar em suporte básico de vida, associando tal conhecimento às variáveis sociodemográficas, econômicas e de formação profissional. Trata-se de estudo transversal, descritivo e quantitativo, cujos dados foram obtidos de questionários aplicados a 351 funcionários de uma equipe de enfermagem de um serviço de emergência e de unidades de terapia intensiva. Houve declínio do conhecimento dos sujeitos sobre ressuscitação e parada cardiopulmonar com o passar do tempo. Fatores socioeconômicos e profissionais estiveram associados ao conhecimento dos profissionais de enfermagem. Sugere-se que treinamentos com menores intervalos aumentem o grau de retenção e o conhecimento da equipe de enfermagem.

Functional capacity and quality of life of hospitalized octogenarians

OBJECTIVE

To evaluate the ability to perform activities of daily living (ADL) and to correlate functional capacity with quality of life (QoL) of hospitalized octogenarians.

METHOD

A cross-sectional study with 128 patients using the quality of life instruments WHOQOL-OLD and WHOQOL-BREF and the Katz Scale.

RESULTS

The majority of patients was fully dependent; patients with higher schooling had less independence; older adults with partial dependence and independence had higher scores in perceived QoL; in the domains of autonomy, past, present and future activities; and better overall QoL than those with full dependence. Partially dependent patients had higher scores in the death and dying domain than independent patients.

CONCLUSION

Older adults' QoL is associated with the maintenance of autonomy and functional capacity. Older adults experience a health decline during the hospitalization process, due to the limitation in performing their ADL and lack of encouragement by the health team.

Good practices for preventing ventilator-associated pneumonia in the emergency department

OBJECTIVE

To evaluate the conformity of the set of good practices for preventing ventilator-associated pneumonia (VAP) in the emergency department of a university hospital.

METHOD

A cross-sectional analytical study with a quantitative approach, conducted in a university hospital in the city of São Paulo. The study sample consisted of opportunities for care observations that comprise the set of good practices for preventing ventilator-associated pneumonia provided to intubated patients hospitalized in the emergency department.

RESULTS

A total of 209 observations were performed in 42 patients. Of the hospitalized patients, 23.8% developed VAP, and 52.4% died. Of the five recommended measures for preventing VAP, only two presented compliance above 50%.

CONCLUSION

The care provided to patients is not in line with what is recommended in the literature, which demonstrates the need for periodic renewal of the team's educational practices and the development of auditing projects to ensure improvements in the care process.

QUALITY OF LIFE OF HOSPITALIZED OCTOGENARIANS

ABSTRACT Objective: to characterize socio-demographic and economic profiles, as well as to evaluate the quality of life of hospitalized octogenarians. Method: cross-sectional study with 128 hospitalized octogenarians. Instruments from the World Health Organization were used to evaluate the quality of life. Spearman correlation coefficient, student’s t-test and analysis of variance were used to correlate the studied variables with the quality of life of octogenarians. Results: the longer the hospitalization time, the higher the psychological score (p=0.0126), and the higher the scores in the past, present and future activity domain (p = 0.0485). The higher the age, the lower the score in the past, present, and future activity domain (p=0.0480). The higher the number of octogenarian morbidities, the lower the score in the social relation domain. Conclusion: it is highly important that care for the hospitalized elderly is planned and implemented, taking into account the factors that interfere in a positive and negative way in their quality of life.

Identification of warning signs for prevention of in-hospital cardiorespiratory arrest

Objective:

to identify the occurrence of warning signs and changes in vital signs in individuals who experienced in-hospital cardiorespiratory arrest and correlate them with the occurrence of this event.

Method:

this is a retrospective, analytical and quantitative study that included 218 medical records of patients who suffered in-hospital cardiorespiratory arrest and identified warning signs and alterations in vital signs. Mean, standard deviation, median, minimum and maximum values were calculated for the continuous variables, and frequency and percentage for the categorical variables. We compared the age and occurrence of cardiorespiratory arrest with the occurrence of warning signs using the Chi-Square Test and the Mann Whitney non-parametric test (p-value < 0.05).

Results:

62.1% of the patients presented signs and symptoms of shock, 44.9% of neurological alteration, 40.4% of malaise, 15.2% presented signs suggestive of acute coronary syndrome, and 25.9% presented mental confusion. In the last measurement of vital signs before cardiorespiratory arrest, the majority of patients had altered abnormal (32.6%) and severely abnormal (23.9%) heart rate, and abnormal (37.1%) and severely abnormal (27.0%) respiratory rate.

Conclusion:

the warning signs identified were: shock, neurological signs, malaise and acute coronary syndrome. The prevalent changes in vital signs were: heart rate, respiratory rate and O₂ saturation. Patients with severely abnormal systolic blood pressure were not discharged and those with abnormal respiratory rate did not survive 6 months after cardiorespiratory arrest.

Evaluation of delirium in aged patients assisted at emergency hospital service

ABSTRACT Objective: identify the occurrence of delirium in aged patients assisted in emergency services and verify its relationship with sociodemographic and clinical variables. Method: cross-sectional, prospective study with a quantitative approach. Two hundred aged hospitalized patients participated. The Confusion Assessment Method was used for data collection. For statistical analysis, chi-square tests, likelihood ratio and Fisher’s test were used, with a significance level of 5%. Results: male gender and mean age of 71.8 years were predominant. In the first 24 hours of hospitalization, 56 (28%) aged individuals presented delirium. An association of the disease with lack of physical activity, presence of a caregiver, hypertension, dyslipidemia and cerebrovascular diseases was identified. Conclusion: Delirium was associated with no physical activity, the need of a caregiver, and the presence of comorbidities. The importance of conducting other studies that may lead to early identification of the condition to prevent its complications is emphasized.

Pain in emergency units: correlation with risk classification categories

Objectives:

to correlate risk classification categories with the level of pain of patients in an emergency service.

Method:

cross-sectional study carried out in the Risk Classification of 611 patients. The variables studied were: age, gender, comorbidities, complaint duration, medical specialty, signs and symptoms, outcome, color attributed in the risk classification of and degree of pain. We used Analysis of Variance, a Chi-Square test and a Likelihood Ratio test.

Results:

the average age was 42.1 years (17.8); 59.9% were women; the green (58.9%) and yellow (22.7%) risk classification prevailed and hypertension (18.3%) was the most common Comorbidity. The most frequent pain intensity was moderate (25.9%). In the red category, patients presented a higher percentage of absence of pain; in the blue, mild pain; and in the green, yellow and orange categories, there was a greater percentage of intense pain (p < 0.0001).

Conclusion:

among the patients who presented pain, the majority reported moderate intensity. Regarding risk categories, most patients in the red category did not report pain. Those who were classified as green, yellow and orange, reported mostly intense pain. On the other hand, patients in the blue category reported predominantly mild pain.

Results of the implementation of integrated care after cardiorespiratory arrest in a university hospital

OBJECTIVES

to identify the care measures performed after cardiorespiratory arrest (CRA) and to relate them to the neurological status and survival at four moments: within the first 24 hours, at the discharge, six months after discharge, and one year after discharge.

METHOD

retrospective, analytical and quantitative study performed at the Emergency Department of a university hospital in São Paulo. Eighty-eight medical records of CRA patients who had a return of spontaneous circulation sustained for more than 20 minutes were included and the post-CRA care measures performed in the first 24 hours were identified, as well as its relationship with survival and neurological status.

RESULTS

the most frequent post-CRA care measures were use of advanced airway access techniques and indwelling bladder catheterization. Patients who had maintained good breathing and circulation, temperature control and who were transferred to intensive care unit had a better survival in the first 24 hours, after six months and one year after discharge. Good neurological status at six months and one year after discharge was associated with non-use of vasoactive drugs and investigation of the causes of the CRA.

CONCLUSION

the identification of good practices in post-CRA care may help to reduce the mortality of these individuals and to improve their quality of life.

Professional nursing practice in critical units: assessment of work environment characteristics

Objective

assess the autonomy, control over environment, and organizational support of nurses' work process and the relationships between physicians and nurses in critical care units.

Method

cross-sectional study conducted with 162 nurses working in the intensive care units and emergency service of a university hospital. The workers' satisfaction with their work environment was assessed using Brazilian Nursing Work Index - Revised, translated and adapted for the Brazilian culture.

Results

average age was 31.6 ± 3.9 years; 80.2% were women; 68.5% Caucasians and 71.6% worked in intensive care units. The nurses considered autonomy (2.38 ± 0.64) and their relationship with physicians (2.24 ± 0.62) to be characteristics of the work environment that favored professional practice. Control over environment (2.78 ± 0.62) and organizational support (2.51 ± 0.54), however, were considered to be unfavorable. No statistically significant differences were found between the units based on the scores obtained by the professionals on the Brazilian Nursing Work Index - Revised.

Conclusion

autonomy, relationship between physicians and nurses, and organizational support were considered by the units to be characteristics that favored nurses' professional practices. On the other hand, control over environment and organizational support were considered unfavorable.

The use of a metronome during cardiopulmonary resuscitation in the emergency room of a university hospital

Objective:

to compare the rate of return of spontaneous circulation (ROSC) and death after cardiac arrest, with and without the use of a metronome during cardiopulmonary resuscitation (CPR).

Method:

case-control study nested in a cohort study including 285 adults who experienced cardiac arrest and received CPR in an emergency service. Data were collected using In-hospital Utstein Style. The control group (n=60) was selected by matching patients considering their neurological condition before cardiac arrest, the immediate cause, initial arrest rhythm, whether epinephrine was used, and the duration of CPR. The case group (n=51) received conventional CPR guided by a metronome set at 110 beats/min. Chi-square and likelihood ratio were used to compare ROSC rates considering p≤0.05.

Results:

ROSC occurred in 57.7% of the cases, though 92.8% of these patients died in the following 24 hours. No statistically significant difference was found between groups in regard to ROSC (p=0.2017) or the occurrence of death (p=0.8112).

Conclusion:

the outcomes of patients after cardiac arrest with and without the use of a metronome during CPR were similar and no differences were found between groups in regard to survival rates and ROSC.

ADESÃO À HIGIENE DAS MÃOS: INTERVENÇÃO E AVALIAÇÃO

Trata-se de pesquisa quantitativa, com os objetivos de observar a adesão à higiene das mãos por profissionais de saúde de um Serviço de Emergência de Hospital Universitário, no estado de São Paulo, e verificar se houve modificação na adesão após a realização de intervenção educativa, entre julho de 2012 e dezembro de 2013. Foram observadas e registradas 5061 oportunidades de higiene das mãos em 120 horas de observação. O maior número de oportunidades foi de profissionais de enfermagem (70,05%), por ser a maior força de trabalho e tender predominantemente à assistência; seguiram-se a equipe médica (17,82%) e fisioterapeutas (12,13%). Observou-se adesão de 28,6% para 38,9% após as ações educativas. Na fase pós-intervenção, todos os profissionais apresentaram maior adesão à higiene das mãos quando comparado ao período pré-intervenção e a adesão foi significativamente maior após a realização de procedimentos assépticos. Conclui-se que a higienização das mãos esteve aquém do esperado e que estratégias educativas favoreceram a adesão.

Avaliação da qualidade do atendimento ao paciente com síndrome coronariana aguda no serviço de emergência

Estudo com objetivo de avaliar indicadores de qualidade no atendimento aos pacientes com suspeita de síndrome coronariana aguda (SCA) e associá-los a alta, óbito e tempo de internação hospitalar. Pesquisa transversal, analítica de 84 prontuários de pacientes com suspeita de SCA no Serviço de Emergência. Foi estudada a associação entre os fatores de risco e indicadores de qualidade no atendimento à SCA com: tempo de internação, óbito, recorrência de eventos isquêmicos e revascularização do miocárdio por meio da correlação de Spearman. O tempo de internação foi significativamente menor para pacientes com infarto sem supradesnivelamento de ST que tiveram menor intervalo entre admissão e tratamento. Para pacientes com infarto com supradesnivelamento de ST, o tempo de internação foi significativamente menor quando o intervalo entre classificação de risco e tratamento foi menor. Não houve associação dos indicadores de qualidade com recorrência de eventos isquêmicos, revascularização do miocárdio, tempo de internação e óbito.

[Advantages of a cohort study on cardiac arrest conducted by nurses]

OBJECTIVE

Identifying factors associated to survival after cardiac arrest.

METHOD

An experience report of a cohort study conducted in a university hospital, with a consecutive sample comprised of 285 patients. Data were collected for a year by trained nurses. The training strategy was conducted through an expository dialogue lecture. Collection monitoring was carried out by nurses via telephone calls, visits to the emergency room and by medical record searches. The neurological status of survivors was evaluated at discharge, after six months and one year.

RESULTS

Of the 285 patients, 16 survived until hospital discharge, and 13 remained alive after one year, making possible to identify factors associated with survival. There were no losses in the process.

CONCLUSION

Cohort studies help identify risks and disease outcomes. Considering cardiac arrest, they can subsidize public policies, encourage future studies and training programs for CPR, thereby improving the prognosis of patients.

AVALIAÇÃO DA FRAGILIDADE DE IDOSOS INTERNADOS EM SERVIÇO DE EMERGÊNCIA DE UM HOSPITAL UNIVERSITÁRIO

O objetivo do estudo foi avaliar a fragilidade de idosos internados no Serviço de Emergência de umhospital universitário do estado de São Paulo. O período da coleta de dados foi de março a junho de 2014.Estudo transversal com 101 idosos, por período igual ou superior a 24 horas. Análise realizada pela aplicaçãoda Edmonton Frail Scale. A média de idade foi 75 anos, 50,5% sexo feminino, 58,4% não terminou o ensinofundamental, 89,1% aposentados ou pensionistas e 84,2% acompanhados de cuidador. Antecedentes frequentesforam: hipertensão arterial (65,3%), diabetes mellitus (65,3%) e tabagismo (44,6%). Em relação à fragilidade, amédia do escore total foi 9,85, indicando fragilidade moderada. Os idosos com doenças neurológicas, demência,idade mais avançada e que tinham cuidador apresentaram maior fragilidade. O rastreamento da fragilidade propiciaplanejamento com vistas à prevenção de incapacidade e o agravamento das condições de saúde dos idosos.

DIAGNÓSTICOS DE ENFERMAGEM MAIS UTILIZADOS EM SERVIÇO DE EMERGÊNCIA

Objetivou-se identificar os principais diagnósticos de enfermagem utilizados por expertsem área de emergência. Estudo descritivo realizado em Serviço de Emergência, período de junho a novembro de 2011. Utilizouse a Técnica Delphi para a obtenção do consenso entre sete profissionais de diferentes instituições brasileiras, sobre os diagnósticos de enfermagem prevalentes em Ser viços de Urgência e Emergência. Os diagnósticos de enfermagem que tiveram consenso foram: Troca de gases prejudicada, Padrão respiratório ineficaz, Ventilação espontânea prejudicada, Risco de infecção, Risco de integridade da pele prejudicada, Integridade tissular prejudicada e Risco de quedas. Conclui-se que a Técnica Delphi mostrou-se como grande facilitadora para a obtenção de consenso, sobre os diagnósticos de enfermagem prevalentes em Ser viços de Emergência, relacionados aos domínios da Nor th American Nursing Diagnosis Association de “segurança e proteção”, “atividade e repouso” e “eliminação e troca”.

Nursing staff sizing in the emergency room of a university hospital

OBJECTIVE To verify the adequacy of the professional nursing staff in the emergency room of a university hospital and to evaluate the association between categories of risk classification triage with the Fugulin Patient Classification System. METHOD The classification of patients admitted into the emergency room was performed for 30 consecutive days through the methodology proposed by Gaidzinski for calculating nursing requirements. RESULTS The calculation determines the need for three registered nurses and four non-registered nursing for each six hour shift. However, only one registered nurse and four non-registered nurse were available per shift. There was no correlation between triage risk classification and classification of care by the Fugulin Patient Classification System. CONCLUSION A deficit in professional staff was identified in the emergency room. The specificity of this unit made it difficult to measure. To find the best strategy to do so, further studies should be performed.

Quality of life, socioeconomic profile, knowledge and attitude toward sexuality from the perspectives of individuals living with Human Immunodeficiency Virus

OBJECTIVES

to analyze the quality of life of "patients" with Human Immunodeficiency Virus and relate it to their socioeconomic profile, knowledge and attitudes toward sexuality.

METHOD

crosssectional and analytical study with 201 individuals who are 50 years old or older. The Targeted Quality of Life and Aging Sexual Knowledge and Attitudes Scales were applied during interviews. Multiple Linear Regression was used in data analysis.

RESULTS

dimensions of quality of life more strongly compromised were disclosure worries (39.0), sexual function (45.9), and financial worries (55.6). Scores concerning knowledge and attitudes toward sexuality were 31.7 and 14.8, respectively. There was significant correlation between attitudes and the domains of overall function, health worries, medication worries, and HIV mastery.

CONCLUSION

guidance concerning how the disease is transmitted, treated and how it progresses, in addition to providing social and psychological support, could minimize the negative effects of the disease on the quality of life of patients living with the Human Immunodeficiency Virus.

Avaliação das medidas de pressão arterial comparando o método tradicional e o padrão-ouro

OBJETIVO: Avaliar as medidas de pressão arterial comparando o método tradicional e o padrão-ouro em um serviço público de pronto atendimento. MÉTODOS: Estudo transversal no qual as medidas das pressões arteriais sistólica, diastólica, média e de pulso aferidas pelos profissionais da enfermagem pelo método tradicional foram comparadas com aquelas realizadas de acordo com o padrão-ouro. RESULTADOS: Foram incluídos 229 clientes, 69% do sexo feminino e a média de idade foi de 50 anos. A comparação entre os dois métodos mostrou que o valor médio das pressões sistólica, diastólica, média e de pulso foi maior utilizando-se a técnica padrão-ouro. CONCLUSÃO: Houve divergências entre as medidas realizadas pela técnica recomendada e pela classificação de risco.