Repositório RCAAP

ABSTRACT Objectives: to analyze the understanding of the Therapeutic Itinerary of people affected by stroke in the Unified Health System context of a medium-sized city in the state of São Paulo. Methods: this is a clinical-qualitative, using in-depth semi-structured interviews, conducted in 2019 with 6 patients, a number determined by theoretical saturation. Results: qualitative content analysis allowed the construction of four categories that emerged from the data: a) You are having a stroke! - Identifying the problem; b) Anguish and expectations in waiting for assistance; c) Helplessness and guidance for rehabilitation after hospital discharge; d) Spirituality in rehabilitation after stroke. Final Considerations: the affected people expressed feelings and meanings, such as fear, anguish, sadness, beliefs and uncertainties, in order to shed light on the complexity inherent to the experiences of Therapeutic Itinerary of stroke.

ABSTRACT Objectives: to analyze the Ethical Conciliation Hearings held by the Regional Nursing Council of São Paulo. Methods: this is a retrospective study, of a quantitative approach, with documentary analysis. To obtain the data, documents related to ethical processes were analyzed. The time frame established for the study was from January 1, 2011 to December 31, 2017. Results: 513 Ethical Conciliation Hearings were held and ratified. Nurses represent the category that most denunciate and are most accused. The highest percentages of ethical conciliations were in events related to public and hospital institutions. The Conduct Adjustment Term was the modality with the highest number of agreements. The main reason of conciliation failure was the non-attendance of at least one of the parties. Conclusions: the Ethical Conciliation Hearings represent an effective alternative instrument for the resolution of ethical-disciplinary processes in nursing.

ABSTRACT Objectives: to analyze the burden and the social support of the informal caregivers of people undergoing kidney dialysis. Methods: mixed study, based on the Theory of Stress and Overload, using instruments of sociodemographic characterization, the Social Support Survey from the Medical Outcomes Study, Zarit’s Burden Scale, and guiding questions. Analysis of data used statistical and thematic inferences. Results: 55 caregivers were evaluated, most were women, from 31 to 50 years old, married, and having worked in care for more than three years. A high level of affective and material support was observed, with a light overload on the caregiver. The central theme of the discourses was: “Experiences of the caregiver: between the burden of responsibility and the search for meaning”. Conclusions: a small overload was found in the participants, with a high median in the dimensions of affective and emotional support, in the relations between positive social interactions and the burden of the caregivers, in addition to the duality or responsibility and the meaning of care.

ABSTRACT Objectives: to propose quality indicators for clinical nursing documentation Methods: methodological study in which literature review guided the composition of an instrument for evaluating nursing documentation. Two independent professionals evaluated 204 medical records of adult patients. The analysis of this assessment generated quality indicators for clinical nursing documentation. Inter-rater agreement was analyzed by Cohen’s kappa. Results: the bibliographic review, analysis by experts and pre-test resulted in 88 evaluation items distributed in seven topics; in 88.5% of the items, inter-rater agreement between strong and almost perfect (k=0.61-1.0) was observed. Analysis of the evaluations generated a global indicator and seven partial indicators of documentation quality. Compliance in the two services ranged between 62.3% and 93.4%. The global indicator showed a 2.1% difference between services. Conclusions: seven quality indicators of clinical nursing documentation and their method of application in hospital records have been proposed.

ABSTRACT Objective: Identify the theoretical concepts that have been used in the context of nursing care for hospitalized children. Methods: Scoping review was carried out according to the PRISMA-ScR methodology. The research limitations included: primary studies dealing with the use of theoretical concepts of nursing in the provision of care to hospitalized children, access in full text, in Portuguese or English and published between 2000 and 2019. Research was carried out on grassroots platforms (EBSCOhost, PubMed, SciELO and Web of Science), gray literature and in the bibliography of selected articles. Results: 21 studies were found and 10 theoretical conceptions of nursing were identified, with family-centered care being the most used. Final considerations: The variability of the identified theoretical conceptions is emphasized, with no evidence to support the use of one in detriment of the other. A more integrative theoretical conception, which adds care centered both on the family and the child, emerges as a research trend.

ABSTRACT Objectives: to analyze the microbiological profile of leg ulcers of patients treated at outpatient clinics and hospitals regarding the type of microorganism, microbiological selection of antibiotics, and techniques for the collection of culture material. Methods: literature review performed on LILACS, IBECS, MEDLINE, and CINAHL databases, resulting in a descriptive analysis of 27 studies. Results: 35.7% of the studies occurred in an outpatient care scenario; and 64.2% in hospitals. There was a predominance of swab (100%) in outpatient care and biopsy (55.5%) in the hospital. Escherichia coli, Pseudomonas aeruginosa, and Staphylococcus aureus were more common at both levels of assistance. Methicillin-resistant Staphylococcus aureus was isolated in both. Conclusions: the microbiological profile of infections was similar, with the presence of resistant bacteria in both environments. This fact causes concern and raises the need for research to elucidate it. The studies did not compare the effectiveness between biopsy and swab.

ABSTRACT Objectives: to analyze the impact of social protection programs on adults diagnosed with Tuberculosis. Methods: systematic review conducted by PRISMA, with registration PROSPERO CRD42019130884. The studies were identified in the VHL, PubMed, Scielo, CINAHL and Scopus databases, using the descriptors “Social Protection” and “Tuberculosis”, in combination with keywords combined with Boolean operators AND and OR. Observational and interventional studies published until October 23, 2019, in Portuguese, English and Spanish, were included. Results: social protection programs improve the treatment of tuberculosis, cure rates, adherence to treatment, the provision of services for the control of TB and reduce poverty. Conclusions: social protection programs have a positive impact on the treatment and control of people diagnosed with Tuberculosis.

ABSTRACT Objectives: to identify vulnerabilities of nurses who work in an intensive care unit. Methods: an integrative review was held from 2006 to 2019, with searches on the platforms/databases LILACS, BDENF, SciELO, MEDLINE, Scopus, CINAHL, and Web of Science. The theoretical framework of ergology, by Schwartz, was used and the guiding question “What are the main vulnerabilities of nurses who work in an intensive care unit”? Results: eleven articles were included. Five topics of vulnerabilities emerged: physical, emotional, communication process, care process, and organizational. We observed that the organizational vulnerability was kept as a common and intersection factor in developing the other four. Conclusions: vulnerabilities found have a relationship to the physical, emotional, communication, care process, and institution organization elements. The organization aspect intersected with the others, configuring itself as the core in this context.

ABSTRACT Objectives: to analyze evidence on the quality of life of people with tuberculosis/HIV coinfection. Methods: review that followed steps of the Cochrane Collaboration, with the search of publications in the bases Embase, LILACS, PubMed, and Cochrane, through the descriptors “HIV,” “Tuberculosis,” and “Quality of Life,” without a temporal cut. Results: the results include 15 studies, published between 2009 and 2019, with the level of evidence V, in its majority. It was observed that there is no uniformity in the instrument used. Psychological support to this group and strengthening of actions to manage both infections are necessary. This segment’s quality of life is associated with social factors and scientific production on the subject concentrated in underdeveloped countries. Conclusions: the articles found have a low level of scientific evidence and indicate that people who experience coinfection have a more compromised quality of life when compared to those who experience tuberculosis or HIV separately.

ABSTRACT Objectives: to identify the factors related to the use of religious coping in informal caregivers. Methods: integrative literature review carried out through a search in the databases LILACS, PubMed, Scopus, Web of Science, and CINAHL, in addition to the Virtual Health Library and SciELO. The study selected primary articles in English, Portuguese, and Spanish, using the descriptors Coping Behavior, Caregivers, Spirituality, and Religion, which were combined with each other and with synonyms. There was no time limit for the publications. Results: nine articles were selected. Factors related to the use of religious coping in informal caregivers included: having an advanced age, experiencing traumatic situations, being under overload, being a spouse or mother, caring for hospitalized individuals, or for those with chronic diseases and high degrees of dependence. Conclusions: the factors related to the use of religious coping are multifaceted and involve physical, psychological, psychosocial, and situational aspects.

ABSTRACT Objectives: to analyze the available evidence on the nursing care provided to patients after hematopoietic stem cell transplantation. Methods: integrative review with the search for primary studies in four databases and a virtual health library. A broad search strategy was used, including research published in English, Brazilian Portuguese, or Spanish, between 2008 and 2018, totaling a sample of 42 studies. Results: the studies were grouped into three categories: multiple nursing care (n=19), first-line care (n=18), and self-management of care (n=5). Conclusions: nursing care is critical, comprising patients’ physical, psychological and social aspects. It occurs in hospital and home contexts, mainly involving technical actions and health guidance. The evidence identified provide subsidies for decision-making; however, most studies are of the non-experimental type, indicating the need for conducting intervention research.

ABSTRACT Objectives: to analyze care strategies for breast cancer screening in Primary Health Care in Brazil. Methods: this is a systematic review following the Cochrane Collaboration recommendations. Results: among 355 manuscripts, five were eligible. The patient navigation program by Community Health Agent stood out with the best result, among the strategies: flexibility of goals considering viability; community engagement; team training; active search of the target population by Community Health Agent; request for mammography by physicians; actions integrated to women’s health; monitoring of mammography results, absent users, and population coverage by physician and nurse; and assessment of criteria for requesting screening mammography by means of an information system. The population coverage rate in the program ranged from 23% to 88%. Conclusions: Primary Health Care in Brazil presents devices with potential to induce the production of care for breast cancer screening.

ABSTRACT Objectives: to describe the available evidence on indications, complications, care and alternative strategies in the use of physical restraint in adult patients in Intensive Care Units. Methods: an integrative review conducted in the LILACS, Nursing Database, Índice Bibliográfico Español en Ciencias de la Salud, Scopus and CINAHL databases and the PubMed portal, in the period from June to August 2018. Results: the final selection was of 19 articles, from which the indications, complications, care and alternative strategies were extracted. The studies were conducted between the years 2003 and 2018, with a predominance of the United States; they were mostly classified (58%) in level 6 evidence, being performed by nurses, with multi-professional participation of psychologists, pharmacists, physicians, and nurses. Conclusions: the most common practices regarding physical restriction were described, and the need for the elaboration and implementation of protocols on intervention to support decision making was observed.

ABSTRACT Objectives: to identify publications about the applicability of the Symptom Management Theory in nursing care to pediatric, adolescent, adult and elderly patients. Methods: scoping review following the steps: definition of the objective, research question and inclusion criteria; search, selection and analysis of publications; synthesis of results. The search occurred in the VHL, SciELO, CAPES and PubMed Journals Portal bases, contemplating publications between 1994 and July 2020. Results: out of 3,286 studies, ten were selected, published between 2008 and 2019. They described the relationships between the participants and the domains (person, environment, health and disease), components (symptom experience, management strategies, results) and presented strategies for symptom management. Conclusions: the Symptom Management Theory was considered applicable to the participants of the studies and to nursing care. It was concluded that understanding the interaction of these elements is essential to plan actions aimed at controlling symptoms effectively.

ABSTRACT Objectives: to analyze ethically, aesthetically and politically the cine-debate of the movie “Human”, reflecting on training of researchers in qualitative research. Methods: the debate about moral questions as the essence of humanity was based on Narrative Bioethics; the comprehensive, relational and reflective character of qualitative methods; and the ethical and social sense of qualitative researches. Results: the narratives of the experiences of morality, loaded with facts and valuations, highlighting the importance of reflexivity in all phases of the qualitative research process, from thinking about themes and research questions to fieldwork, from data analysis to the production of reports, fostering the researcher’s responsibility both in the intervention for understanding and narrating the world, and in its possible transformation. Final Considerations: cinematographic art becomes an instrument of reflexivity capable of affecting and mobilizing students, in a fusion of horizons of understanding of different universes that dialogue.

ABSTRACT Objectives: to analyze the process of permanent professional training of Primary Health Care nurse managers from the perspective of reflective practice theory, built by Donald Schön. Methods: this is a theoretical-reflective study. Results: the findings apply to nurse managers’ practice to deal with the dilemmas that present themselves in the professional routine according to their knowledge, skills and attitudes, anchored in the reflection-in-action movement, which unites the process of permanent and practical training reflective, favoring the development of skills relevant to management. Final Considerations: nursing health managers, during their ongoing training process, can develop skills to act effectively in Primary Care, reflecting in practice and on practice, deciding on the need to remain in training to address the issues arising from that same practice.

ABSTRACT Objective: To reflect on autonomy in health care, its perspective on the lives of the elderly, and its meaning for the practice of nursing care. Methods: Theoretical essay on the practice of nursing care to promote autonomy and self-care for the elderly. Results: It is necessary to qualify the practice of nursing care to consider the aging process and maintain the autonomy of the elderly. Three parts emerged: “The autonomy of the elderly and the care plan”, “Nursing in the self-care process”, and “Challenges to the practice of caring for the elderly in nursing”. Final considerations: There is still a deficiency in promoting autonomy for the elderly due to the need for a review of the practice of nursing care, which, considering aging in Brazil, needs to undertake new actions in order to encourage self-care and autonomy in this population.

ABSTRACT Objectives: to report the experience using ludic strategies for the teaching-learning in the elaboration of the genogram and ecomap; and the use of these instruments by Nursing students in the Primary Health Care services. Methods: an experience report of the discipline Integrity of Care I (Integralidade do Cuidado I), of the Nursing School of Ribeirao Preto. Problems scenarios were created to approach the genogram and ecomap, comprising different family arrangements, represented by pedagogic puppets. Results: students actively participated, held collective discussions, elaborated genogram, and ecomap, identified the type of family, and the stages of the vital cycle, providing increased dynamics and interactivity. Subsequently, in supervised activities in Primary Health Care services, students elaborated the genogram and ecomap to monitor a family. Final Considerations: the use of ludic strategies propitiates the teamwork, active interaction of the group, and the creativity. The articulation between theory and practice resulted in a significant learning.

ABSTRACT Objective: to describe characteristics of pregnant women at risk and analyze the relationship with type of delivery and complications during pregnancy and puerperium. Methods: a retrospective study with secondary data of 1,574 at-risk pregnant women followed up in an educational intervention by telemedicine. Results: pregnant women with an average age of 35 years and high educational level participated. Preference for normal delivery was 43.1%, but only 17.3% had normal delivery. During pregnancy, 43.5% sought emergency care. In the postpartum period, 2.0% needed an ICU. Emergency room search was associated with age and contacts with the intervention. Cesarean delivery was associated with age, physical inactivity and overweight/obesity. ICU admission was associated with age and BMI. Conclusion: pregnant women were of high age and education, the younger and who had more contacts with the intervention sought more the emergency room. Older age, physical inactivity and overweight/obesity were factors associated with cesarean delivery.

ABSTRACT Objective: Evaluate the association between early pregnant hospitalization and the use of obstetric interventions and cesarean delivery route. Methods: Cross-sectional study, with 758 women selected at the time of childbirth. It was assumed as early hospitalization when the woman was admitted to the hospital having less than 6 cm of cervical dilation. Logistic regression models were constructed in order to estimate the odds ratio for each obstetric intervention, adjusted by sociodemographic and obstetric variables. Results: 73.22% of women were early hospitalized. On average, they had 1.97 times the chance to undergo Kristeller’s maneuver, 2.59 and 1.80 times the chance to receive oxytocin infusion and analgesia, respectively, and 8 times more chances to having their children by cesarean delivery when compared to women that had timely hospitalization. Conclusion: Early hospitalized women were submitted to a higher number of obstetric intervention and had increased chances of undergoing cesarean sections.