Relatório de mestrado: o papel do enfermeiro especialista na fase pré-analítica do exame microbiológico

Relatório de Trabalho de Projeto apresentado para cumprimento dos requisitos necessários à obtenção do grau de Mestre em Enfermagem Médico- Cirúrgicapresente Relatório de Mestrado aborda a temática da Fase Pré-Analítica do Exame Microbiológico e o Papel do Enfermeiro Especialista em Enfermagem em Pessoa em Situação Crítica na mesma. Nele relata-se os dois projetos que suportam a aquisição das competências presentes nos perfis de Mestre em Enfermagem Médico-Cirúrgica e de Enfermeiro Especialista em Enfermagem em Pessoa em Situação Crítica. Na introdução é apresentada de forma sucinta a estrutura do relatório e realizada uma breve descrição da metodologia selecionada para a obtenção das competências necessárias para os perfis já referidos, no Enquadramento conceptual, é apresentado o Modelo Teórico de Enfermagem selecionado – Definição de Enfermagem de Virgínia Henderson – e o Modelo de Desenvolvimento de Competências de Patrícia Benner, utilizado em complementaridade com a Definição de Enfermagem de Virgínia Henderson. É feito o enquadramento dos Padrões de Qualidade dos Cuidados de Enfermagem da Ordem dos Enfermeiros, no que concerne à responsabilidade dos Enfermeiros na condução de práticas seguras e na elaboração de guias orientadores de boas práticas. É feita a descrição o Projeto de Intervenção em Serviço de acordo com as suas fases, nomeadamente o diagnóstico de situação, o planeamento e a avaliação do realizado. No decurso da realização deste projeto salientam-se como principais resultados: a elaboração de 6 Normas de Orientação Clínica relativas à colheita e envio de produtos para o Laboratório de Microbiologia; e o aumento do "Awareness" da equipa de Enfermagem relativamente à temática em estudo. As aprendizagens deste projeto inserem-se nas competências específicas K1 – Cuida da pessoa a vivenciar processos complexos de doença crítica e ou falência orgânica e K3 – Maximiza a intervenção na prevenção e controlo da infeção perante a pessoa em situação crítica e ou falência multiorgânica, face à complexidade da situação e à necessidade de repostas em tempo útil e adequadas, do perfil do Enfermeiro Especialista em Enfermagem em Pessoa em Situação Crítica. Seguidamente é feita a descrição do Projeto de Aprendizagem Clínica de acordo com as suas fases, nomeadamente o diagnóstico de situação, o planeamento e a avaliação do realizado. Durante a implementação deste projeto salienta-se como principal resultado a elaboração de um documento orientador para a formalização de uma mala de transporte de doentes críticos e a sua posterior criação, implementação e formação da equipa de enfermagem. As aprendizagens deste projeto inserem-se nas competências específica K2 – Dinamiza a resposta a situações de catástrofe ou emergência multi-vítima, da conceção à ação, do perfil do Enfermeiro Especialista em Enfermagem em Pessoa em Situação Crítica.No capítulo 4 é feita uma avalização do realizado à luz das competências do Enfermeiro Especialista em Enfermagem em Pessoa em Situação Crítica, abordando as aprendizagens relativas às competências comuns e específicas do Enfermeiro Especialista, segue-se a avaliação do realizado à luz das competências do Mestre em Enfermagem Médico-Cirúrgica. Nas considerações finais é feita uma avaliação global dos dois projetos e da forma como foram atingidas todas as competências dos perfis de Enfermeiro Especialista em Enfermagem em Pessoa em Situação Crítica e de Mestre em Enfermagem Médico-Cirúrgica.Abstract: This Masters Degree report approaches the subject of the pre-analytical phase of the microbiological analysis, and the inherent role of the Specialist Nurse in Critical Care Situations. It describes the two projects that support the acquisition of the skills patent in the profiles of Master of Science in Medical-Surgical Nursing and Specialist Nurse in Critical Care Situations. The introduction is presented in a concise form, consisting in the structure of the report and a brief description of the selected methodology to the acquisition of the necessary skills of the previously mentioned profiles. In the Literature Review we have presented Virginia Henderson’s Definition of Nursing and Patricia Benner’s Model of Skill acquisition in Nursing which is used in complementarity with presented Virginia Henderson’s Definition of Nursing. An approach to the Quality Standards of the Portuguese Order of Nurses (equivalent to the American Nurses Association) is made regarding the nurses responsibility in conducing safe practices and in the creation of nursing practice guidelines. The description of the Service Intervention Project is made in accordance to three phases, namely, situational assessment, planning and performance evaluation. From this project stands out as primary outcomes: the creation of 6 Guidelines regarding the collection and forwarding of samples to the Microbiology Laboratory; and the increased awareness of the nursing staff about this subject. The lessons from this project insert themselves in the specific skills K1 – Taking care of the person going through complex critical illness situations and or organic failure, and K3 – Maximizes the intervention in the prevention and control of Health Care Associated Infections in person with critical illness or multi organic failure, in spite of the complexity of the situation and the need for timely and adequate responses, from the profile of the Specialist Nurse in Critical Care Situations. Then an approach was made to the Clinical Learning Project in accordance to three phases, namely situational assessment, planning and performance evaluation. Throughout the completion of this project stands out as its main outcome, the creation of a guideline to the formalization of a Critical Patients Transportation Case and its posterior concretization, divulgation and inherent nursing staff training. The lessons from this project insert themselves in the specific skills K2 – Streamlines the response in catastrophe or multi-victim emergencies, from the conception to action, from the profile of the Specialist Nurse in Critical Care Situations.In Chapter 4 a performance assessment is made in light of the Skills of the Specialist Nurse in Critical Care Situations profile, regarding the common and specific skill of the Specialist Nurse and afterwards in observance of the profile of the Master of Science in Medical-Surgical Nursing. The Conclusion and global assessment of both projects is made, and a specification of how all of the necessary skills were achieved, regarding the profiles of the Master of Science in Medical-Surgical Nursing and Specialist Nurse in Critical Care Situations

Consensus must be found on intravenous fluid therapy management in trauma patients

Introduction: Trauma is an important cause of death among young people and 30-40% of this mortality rate is due to hypovolemic shock, intensified by trauma's lethal triad: Hypothermia, Acidosis, and Coagulopathy. Nurses are responsible for managing fluid therapy administration in trauma victims. The purpose of this study is to analyse the reasons why intravenous fluid therapy is recommended for trauma patients' hemodynamic stabilization. Methods: This narrative literature review included published and unpublished studies in English, Spanish or Portuguese between 1994 and January 2019. The search results were analyzed by two independent reviewers. Inclusion criteria encompasses quantitative studies involving trauma victims aged over 18 who underwent fluid therapy in a prehospital assessment context. Results&Discussion: 11 quantitative studies were included. 9 involved the use of fluid therapy for hypotension treatment and 2 of the studies analyzed involved the use of warmed fluid therapy for hypothermia treatment. The analysis performed reveals that the administration of aggressive fluid therapy seems to be responsible for the worsening of the lethal triad. In the presence of traumatic brain injury, permissive hypotension is not allowed due to the negative impact on cerebral perfusion pressure. Used as warming measure, warmed fluid therapy does not seem to have a significant impact on body temperature. Conclusions: There is no consensus regarding the administration of fluid therapy to trauma patients. This conclusion clearly supports the need to develop more randomized controlled trials in order to understand the effectiveness of such measure when it comes to control hypovolemia and hypothermia.info:eu-repo/semantics/publishedVersio

A framework for quality assessment of ROS repositories

Robots are being increasingly used in safety-critical contexts, such as transportation and health. The need for flexible behavior in these contexts, due to human interaction factors or unstructured operating environments, led to a transition from hardware-to software-based safety mechanisms in robotic systems, whose reliability and quality is imperative to guarantee. Source code static analysis is a key component in formal software verification. It consists on inspecting code, often using automated tools, to determine a set of relevant properties that are known to influence the occurrence of defects in the final product. This paper presents HAROS, a generic, plug-in-driven, framework to evaluate code quality, through static analysis, in the context of the Robot Operating System (ROS), one of the most widely used robotic middleware. This tool (equipped with plug-ins for computing metrics and conformance to coding standards) was applied to several publicly available ROS repositories, whose results are also reported in the paper, thus providing a first overview of the internal quality of the software being developed in this community.This work is financed by the ERDF - European Regional Development Fund through the Operational Programme for Competitiveness and Internationalisation - COMPETE 2020 Programme within project "POCI-01-0145-FEDER-006961", and by National Funds through the FCT - Fundacao para a Ciencia e a Tecnologia (Portuguese Foundation for Science and Technology) as part of project UID/EEA/50014/2013.info:eu-repo/semantics/publishedVersio

Mining the usage patterns of ROS primitives

The Robot Operating System (ROS) is nowadays one of the most popular frameworks for developing robotic applications. To ensure the (much needed) dependability and safety of such applications we forecast an increasing demand for ROS-specific coding standards, static analyzers, and tools alike. Unfortunately, the development of such standards and tools can be hampered by ROS modularity and configurability, namely the substantial number of primitives (and respective variants) that must, in principle, be considered. To quantify the severity of this problem, we have mined a large number of existing ROS packages to understand how its primitives are used in practice, and to determine which combinations of primitives are most popular. This paper presents and discusses the results of this study, and hopefully provides some guidance for future standardization efforts and tool developers.FCT -Fundação para a Ciência e a Tecnologia(UID/EEA/50014/2013)info:eu-repo/semantics/publishedVersio

Desenvolvimento de uma ferramenta de apoio a auditorias energéticas no âmbito das empresas de serviços de energia

Dissertação para obtenção do Grau de Mestre em Energias Renováveis – Conversão Elétrica e Utilização Sustentáveis, pela Universidade Nova de Lisboa, Faculdade de Ciências e TecnologiaEm plena crise financeira Mundial, a eficiência energética e a utilização racional da energia ganham cada vez maior significado, potenciando modelos de negócio como o preconizado pelas Empresas de Serviços de Energia (ESE). Estas identificam e fornecem soluções energeticamente mais eficientes que as detidas por clientes, sendo remuneradas de acordo com as poupanças energéticas conseguidas ao longo do período de contrato, que pode variar entre seis e vinte anos. Em Portugal o programa ECO.AP (Programa de eficiência energética na administração pública) encontra-se em fase inicial. Lançado através da Resolução de Conselho de Ministros n.º 2/2011, tem como objetivo alcançar uma redução energética na ordem dos 30% até 2020, nos organismos e serviços da Administração Pública. Nesta dissertação é desenvolvida uma ferramenta de apoio a auditorias energéticas para utilização, quer no âmbito do programa ECO.AP, quer num plano de racionalização energético. Para demonstração de todas as funcionalidades da ferramenta estudada, foi feita uma aplicação a um caso real, recorrendo ao programa ECO.AP e tendo como modelo o protocolo internacional de medição e verificação de desempenho, embora tenha sido aplicado no setor privado. É necessário ter em conta que neste sector é dada maior atenção à redução da fatura energética. Mesmo assim, e tendo em conta que anteriormente já tinham sido aplicadas outras medidas de eficiência energética, foi obtido para o edifício em estudo, uma poupança garantida de 13%, não considerando todavia a liberalização do mercado da eletricidade. Foi ainda garantido também um período de retorno do investimento de treze anos e onze meses

Prehospital interventions to reduce discomfort caused by immobilization in adult trauma victims: a scoping review protocol

Objective: The objective of this review is to identify the level of discomfort caused by immobilization as reported by trauma victims, and to map all the interventions in the prehospital context where they have been implemented and evaluated in order to reduce discomfort in adult victims of trauma. Introduction: Immobilization is a cause of discomfort for trauma victims, which has important implications for the deterioration of vital signs and quality of life. However, discomfort caused by immobilization remains an underexplored topic by the scientific community. Inclusion criteria: This scoping review will consider studies of adult victims of trauma, aged 18 years or over, in prehospital emergency care. Studies that focus on interventions designed to reduce immobilization discomfort, implemented and evaluated by health professionals, of any form, duration, frequency, and dose will be considered. Methods: An initial search of PubMed and CINAHL will be undertaken, followed by a second search for published and unpublished studies without time restrictions, in major health care–related electronic databases. Studies in English, French, Spanish, and Portuguese will be included. Data extraction will be performed independently by 2 reviewers in a tabular format and will include details about the level of discomfort, interventions, populations, study methods, and outcomes of interest. A narrative synthesis will accompany the results and will describe how they relate to the review objectives.info:eu-repo/semantics/publishedVersio

Management of bleeding in trauma victims by Portuguese nurses in prehospital setting

Introduction: External bleeding is the leading preventable cause of death from traumatic injuries. Implementation of guidelines for its control have been associated with a significant reduction in mortality. The objectives of this study were to provide a characterisation of trauma patients with external bleeding and to compare the outcomes from specific autonomous interventions applied by nurses in prehospital care.Methods: A non-randomised prospective study was conducted in the Immediate Life Support Ambulances in Portugal, from 1 March 2019 to 30 April 2020. Patients were divided into two groups according to whether external bleeding was controlled or not on their arrival at the emergency room.Results: A total of 189 patients were included in this study (73.0% men; mean age of 53.6 years). Among these patients, 140 (74.1%) had their external bleeding controlled by prehospital nurse’s intervention. The average time of assistance at the incident site was 31.5 min. Patients with uncontrolled bleeding had a higher average rescue time (30.8 ±15.2 vs 33.7 ±13.0). Cryotherapy was administered to 15.9% of all patients and 93.3% of these patients arrived at the emergency room with controlled bleeding (p=0.01).Discussion: Despite the substantial reduction in the number of patients who keep bleeding after prehospital care, it was observed that one fifth of patients have external bleeding on arrival at the emergency room. Cryotherapy has been shown to be effective in controlling external bleeding. Failure to use haemostatic agents may explain the ineffective control of more complex external bleeding.Contribution to Emergency Nursing Practice: The current literature on management of bleeding in trauma patients is scarce and contradictory, especially in terms of interventions provided by AUTHORSMAURO AL MOTA PhD, RN1,2,3,4,5MARGARIDA REIS SANTOS PhD, RN6,7EDUARDO JF SANTOS PhD, RN2,3ANDREA FIGUEIREDO MSN, RN5FILIPE MELO MSN, RN5,8,9SARA ALBUQUERQUE MSc, MD10MADALENA CUNHA PhD, RN2,31. Abel Salazar Institute of Biomedical Sciences, University of Porto, Porto, Portugal2. Health School of the Polytechnic Institute of Viseu, Portugal3. Health Sciences Research Unit: Nursing (UICISA: E), Nursing School of Coimbra (ESEnfC), Portugal4. Hospital Nossa Senhora da Assunção, Local Health Unit of Guarda, Seia, Portugal5. INEM – National Institute of Medical Emergency. Portugal6. Nursing School of Porto, Porto, Portugal7. CINTESIS – Center for Health Technology and Services Research, University of Porto, Porto, Portugal8. Hospital de Faro. University Hospital Center of Algarve. Faro, Portugal9. ABC – Algarve Biomedical Centre. Faro, Portugal10. Group of Health Centers – Greater Porto VII – Gaia, USF Nova Salus, Gaia, PortugalRESEARCH ARTICLESManagement of bleeding in trauma victims by Portuguese nurses in prehospital setting rehospital teams led by a registered nurse. In addition, interventions vary from country to country.This article increases awareness of autonomous interventions implemented by prehospital nurses to manage external bleeding.Key implications for emergency nursing practice identified in this study suggest greater fluid therapy appears harmful while cryotherapy achieved the best results (control of the bleeding on emergency room arrival). This may contribute to the review of institutional algorithms and training in this area.info:eu-repo/semantics/publishedVersio