Navegando por Palavras-chave "Enfermagem Em Emergência"

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    Avaliação da classificação de risco em um serviço de emergência da Bahia
    (Universidade Federal de São Paulo (UNIFESP), 2020-06-25) Jesus, Ana Paula Santos De [UNIFESP]; Batista, Ruth Ester Assayag [UNIFESP]; Universidade Federal de São Paulo
    Objectives: To associate the risk classification categories with demographic profile, clinical aspects, comorbidities, times of care and patient outcomes in the emergency department, to assess the Manchester Screening System. Methods: Cross-sectional, analytical study. Patients aged 18 years or older were included in relation to the urgency of care under the Manchester Protocol in an emergency department. For statistical processing and analysis, the Statistical Package for Social Science (SPSS), version 23 was used. Descriptive analysis was performed using the calculations of mean, standard deviation, median, minimum and maximum. For categorical variables, frequency and percentage were calculated. Chi-square test, Student's t test, analysis of variance and generalized linear model were used, with a significance level of 5%. Comorbid load was calculated using the Charlson comorbidity index. Results: Data from 3,624 medical records were analyzed. Age ranged from 18 to 114 years, with a mean of 48.4 ± 18.7 years. There was a predominance of females (51.8%), brown skin (94.4%; n = 2,751), those from the household (88.1%), those classified in the yellow risk category (31.5%) and those with outcome of hospital discharge (42.9%). White individuals were older, and men had a higher percentage of red risk when compared to women (p = 0.0018). Patients classified in the high priority categories (red and orange) had a higher frequency of comorbidities, altered vital signs, cardiac complaints, external causes, two or more tests performed and death. The average waiting time to start the risk classification and the duration of the classification were longer than recommended, except the red category. The average waiting time for medical care in the red and orange categories was significantly longer than estimated. The death outcome was associated with the red category, which had shorter average waiting times for care and reduced stay in the emergency department. The average score on the age-adjusted comorbidity index was higher in patients in the red and white categories, with vascular and endocrine complaints, and those who underwent cranial tomography, with a high risk of mortality (p <0.0001). Hospital admission, transfer and death were associated with higher mean comorbidity scores (p <0.0001). Conclusion: The use of the Manchester Triage System was essential to prioritize severe cases, adequate use of diagnostic resources and the identification of a higher risk for hospitalization and death. There was a difference between the average waiting time for medical care and that recommended by the protocol. Despite the prioritization of urgent cases, improvements must be implemented to organize the flow of care, aiming at reducing waiting times, especially in high priority categories. The evaluation of comorbid load can be used to establish the clinical priority, defined by the Manchester Protocol, when it is desired to identify patients with the highest chances of progressing to death.
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    Método para análise das complicações decorrentes de trauma por acidentes de trânsito
    (Universidade Federal de São Paulo (UNIFESP), 2021) Lopes, Maria Carolina Barbosa Teixeira [UNIFESP]; Whitaker, Iveth Yamaguchi [UNIFESP]; Universidade Federal de São Paulo
    Background: Patients with injuries resulting from traffic accidents, who survive the severe traumatic condition, become vulnerable to the occurrence of complications during hospitalization. To improve patient outcomes and safety, complications need to be monitored and controlled. Objective: To develop a prediction model for in-hospital complication (POC) for patients with traffic accidents injuries; to verify the association between complications and independent variables; to identify risk factors associated with complications and to verify the predictive capacity of the proposed in-hospital POC model. Methods: These analysis from secondary data that sample was prospectively collected, from patients aged 14 years or older, with traumatic injuries from traffic accidents, from January 2015 to July 2016, in a municipal hospital in the city of São José dos Campos, São Paulo. To derive a POC model, the association and correlation of independent variables with complications was verified and the types of complications were analyzed according to length of stay and mortality using parametric and non-parametric statistical tests. Multivariate logistic regression was used to identify the predictive variables of the model and the adjustment was verified by the Hosmer-Lemeshow (HL) test. POC performance was assessed using the ROC and PR Curve curves. Results: The sample consisted of 327 patients and 82 (25.1%) had complications during hospitalization and infectious ones were the most frequent. The occurrence of complications was statistically associated with a higher average age, pedestrian accidents and the greater severity of trauma. The length of stay in the emergency room, the length of hospital stay (LOS), ICU stay (ICU-LOS), percentage of deaths and hospital readmission were higher in patients with complications. Were identified as independent risk factors for the occurrence of complications age, systolic blood pressure, Glasgow Coma Scale score, Revised Trauma Score, Injury Severity Score (ISS), New Injury Severity Score (NISS), ICU-LOS, LOS and readmission. The number of complications correlated with the severity of the trauma, ICU-LOS and mortality. The types of complications were associated with higher mortality. Cardiovascular and neurological complications were not associated with length of stay. The variables age and severity of trauma, measured by ISS and NISS, were identified as risk factors for the occurrence of complications in the final model of multivariate logistic regression, with HL of 0.84 and 1.0, respectively. The area under the ROC curve of the models with ISS and the NISS, reached 0.81 and 0.82, respectively, indicating excellent discrimination capacity and the area of the PR Curve for both models was compatible with those presented in the ROC curve. Conclusion: The in-hospital POC model of trauma patients resulting from traffic accidents included the independent variables age and ISS or NISS. The proposed model showed excellent predictive capacity. However, as it is an initial proposal, it requires application in a larger sample of multiple institutions to confirm the predictive capacity and enable its improvement.
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    Qualidade de vida de idosos internados no serviço de emergência e de seus cuidadores
    (Universidade Federal de São Paulo (UNIFESP), 2019-11-28) Costa, Andrea Fachini Da [UNIFESP]; Batista, Ruth Ester Assayag [UNIFESP]; Universidade Federal de São Paulo (UNIFESP)
    Introduction: In Brazil, the population is undergoing a rapid aging process due to demographic transition, with increasing prevalence of chronic diseases, growing need for care and increased demand for Emergency Services. In this scenario, the measurement of the Quality of Life and Functional Capacity of the elderly in these services, for the establishment and management of a comprehensive and individualized care plan is essential for the maintenance of autonomy and functional independence of this population. As well, they are tools for performing discharge guidance for the patient and caregiver, which can contribute to the reduction of readmissions in these services. The assessment of the caregiver's Quality of Life and Overload is important in order to identify their work demands and specific needs, to implement strategies that can contribute to improve their Quality of Life. Objectives: To evaluate the quality of life and functional capacity of the elderly and correlate them to the variables: age, occupation, marital status and home provider. Evaluate the quality of life of the caregiver and correlate it with the quality of life of the elderly. To evaluate the burden of caregiver of elderly hospitalized in the Emergency Service and correlate it with their Quality of Life. Methods: cross-sectional study with 250 elderly hospitalized in the Emergency Service of a university hospital and their caregivers. The Medical Outcome Study 36 - Item Short-Form Health Survey questionnaire was used to assess Quality of Life. Functional Capacity was assessed with the Independence in Daily Life Activities and Functional Independence Measure scales. Caregiver Overload was assessed using the Zarit Burden Interview scale. Results: The average age of the elderly was 71.9 years, mostly male, white-skinned, married, low education, low income, with comorbidities and home providers. The dimensions of Quality of Life with the highest average scores were: mental health, general health and pain. Functional Capacity was characterized by independence for basic activities of daily living and moderate dependence for instrumental activities of daily living. Regarding the profile of caregivers of the elderly, the average age of 48.36 years was found, predominantly female, with a filial relationship with the elderly. In assessing the quality of life of caregivers, the most compromised dimensions were: general health status, vitality and social aspects. The dimensions of Quality of Life that positively correlated with the Overload assessment scores were: physical aspect, general health status, vitality, social aspects and emotional aspect. The informal caregivers in this study had mild to moderate overload. The results showed that the more affected the quality of life of the elderly, the greater the burden of care and the worse the quality of life of the caregiver. Conclusion: The quality of life of older people with higher functional capacity and independence to perform instrumental and basic activities of daily living was better. As for the caregiver, it was identified that the more compromised the quality of life of the elderly, the greater the burden of care provided and the worse the quality of life of the caregiver. Given these findings we understand that assessments of the Functional Capacity of the elderly, the Quality of Life of the elderly and the caregiver, as well as the Caregiver Overload, may provide the implementation of specific interventions to the needs of this population, aiming to contribute to improve the quality of life of these individuals.
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    A simulação clínica na educação permanente do enfermeiro de pronto socorro: percepções e vivências
    (Universidade Federal de São Paulo (UNIFESP), 2021) Costa, Karina Aparecida Lopes Da [UNIFESP]; Figueiredo, Lucia Da Rocha Uchoa [UNIFESP]; Universidade Federal de São Paulo
    INTRODUCTION: clinical simulation is a strategy within active teaching methodologies, its application has been diversifying and expanding in the health area. Considering the importance of permanent nursing education, it presupposes professional engagement and participation, simulation is a relevant resource and tends to bring benefits. OBJECTIVES: to analyze clinical simulation as a pedagogical resource in the continuing education of emergency room nurses. And more specifically, identify the nurse's previous experience with clinical simulation and apprehend the nurse's perception of clinical simulation as a pedagogical resource for permanent education. METHOD: a quantitative, transversal, descriptive and exploratory approach. A questionnaire was constructed containing 24 items and agreement on four levels, which encompassed three dimensions of investigation - Clinical simulation: conceptions; Clinical simulation and the practice of emergency room nurses; Clinical simulation in the training of emergency room nurses: in undergraduate and permanent education. This was applied to a sample of 46 De acordo com os Descritores em Ciências da Saúde- DeCS da Biblioteca Virtual em Saúde - www.bvs.br nurses in the emergency department of Hospital São Paulo. For the analysis, the percentages of each agreement were considered and later, statistical treatment with calculation of Cronbach's alpha, the reference of 0.6 was adopted. This research was submitted and approved by the Comitê de Ética e Pesquisa under Opinion 3.619.061 and by Plataforma Brasil under CAEE n°. 20636019.1.0000.5505. RESULTS: regarding the dimension Clinical simulation and the practice of emergency room nurses, they recognized the modalities of clinical simulation and its possibilities while developing skills. And disagreement about the need to use high-fidelity simulation in emergency. In the second dimension Clinical simulation and the practice of emergency room nurses, it was considered important to use simulation as a strategy for professional improvement, including in a multidisciplinary team. On the other hand, nurses disagree on aspects such as debriefing and the stress of simulated care. And about the dimension Clinical simulation in the training of emergency room nurses: in undergraduate and permanent education, we obtained: recognition that the simulation increases the safety of nursing interventions, minimizing errors and discrepancies about the fact that the simulation limits the understanding of reality . CONSIDERATIONS: the nurses recognized the clinical simulation in a broad way and its models. Regarding the application of simulation in clinical practice, it was considered a training and improvement strategy, despite apparently not showing much experience with the method. And from the perspective of permanent education, simulation was understood to be beneficial and that contributes to increasing the security of care, including involving the multiprofessional team.