The nursing process presented as routine care actions: building its meaning in clinical nurses' perspective

This qualitative study aimed to understand the meanings attributed to the nursing process by clinical nurses at a Mexican hospital. Data were collected through semi-structured interviews, participant observation and document research. Symbolic Interactionism and Grounded Theory were the theoretical and methodological frameworks for data analysis, which permitted understanding the experience and meaning nurses attributed to the nursing process in their daily care practice, which was unveiled as routine care actions, performed differently from what they had learned in school.Este estudio de naturaleza cualitativa tuvo como objetivo comprender los significados atribuidos al proceso de enfermería por enfermeras de una unidad clínica de un hospital de México. La recolección de datos fue realizada por medio de entrevistas semiestructuradas, complementada con la observación participante y la consulta documental. Los datos fueron analizados bajo el marco teórico y metodológico del Interaccionismo Simbólico y la Teoría Fundamentada en los Datos, que posibilitaron la comprensión de la experiencia y significado atribuido por las enfermeras, al proceso de enfermería en su práctica cotidiana asistencial, que se desvela como acciones de cuidado rutinario, aplicados de forma diferente a lo enseñado y aprendido en la escuela.Este estudo, de natureza qualitativa, teve como objetivo compreender os significados atribuídos ao processo de enfermagem por enfermeiras da unidade clínica em um hospital do México. A coleta dos dados foi realizada por meio de entrevistas semiestruturadas, complementada por observação participante e consulta documental. Os dados foram analisados tendo como referenciais teóricos e metodológicos o Interacionismo Simbólico e a Teoria Fundamentada nos Dados, possibilitando a compreensão da vivência e o significado atribuído pelas enfermeiras ao processo de enfermagem, na prática cotidiana assistencial, que se desvela como ações de cuidado rotineiro, aplicados de forma diferente daquilo que é ensinado e aprendido na escola

Factores que influyen en la actitud de los hombres ante la detección precoz del cáncer genital

Objective: describe the factors that contributes men behaviors due to the genital cancer test. Method: Scientific literature systematic review on PubMed, Scincedirect, Ebscohost, Scopus database and web sites, in which English, Portuguese and Spanish documents were included published between October 5th of 2006 and October 25th of 2016. Results: the incidence and prevalence of genital cancer in men is increasing; also, the behavior of men towards health and test of early detection is apathetic, results of the influence of social factors, role norms and masculinity and the attention processes. Conclusions: men actitud regard to early detection of cancer depends on social aspects and specific role norms; it is recommended to investigate, redirect the prevention of behavior associated with masculinity to improve men health.Objetivo: describir los factores que influyen en las conductas de los hombres ante las pruebas de detección precoz del cáncer genital. Método: revisión sistemática de literatura científica, en bases de datos PubMed, ScinceDirect, Ebscohost, Scopus; y sitios web, incluyo documentos en inglés, español y portugués, publicados del 10 de octubre de 2012. Resultados: La incidencia y prevalencia del cáncer genital en los hombres aumenta, además el comportamiento de los hombres hacia la salud y pruebas de detección precoz es de apatía, resultado de la influencia de factores sociales, normas de rol y masculinidad, así como de los procesos de la atención. Conclusiones: Las actitudes de los hombres para la detección precoz del cáncer, depende de aspectos sociales, las normas de rol específicas del contexto; se recomienda investigar y redirigir la prevención, a conductas asociadas a la masculinidad para mejorar la salud de los hombres

Global burden of 288 causes of death and life expectancy decomposition in 204 countries and territories and 811 subnational locations, 1990–2021: a systematic analysis for the Global Burden of Disease Study 2021

BACKGROUND Regular, detailed reporting on population health by underlying cause of death is fundamental for public health decision making. Cause-specific estimates of mortality and the subsequent effects on life expectancy worldwide are valuable metrics to gauge progress in reducing mortality rates. These estimates are particularly important following large-scale mortality spikes, such as the COVID-19 pandemic. When systematically analysed, mortality rates and life expectancy allow comparisons of the consequences of causes of death globally and over time, providing a nuanced understanding of the effect of these causes on global populations. METHODS The Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2021 cause-of-death analysis estimated mortality and years of life lost (YLLs) from 288 causes of death by age-sex-location-year in 204 countries and territories and 811 subnational locations for each year from 1990 until 2021. The analysis used 56 604 data sources, including data from vital registration and verbal autopsy as well as surveys, censuses, surveillance systems, and cancer registries, among others. As with previous GBD rounds, cause-specific death rates for most causes were estimated using the Cause of Death Ensemble model-a modelling tool developed for GBD to assess the out-of-sample predictive validity of different statistical models and covariate permutations and combine those results to produce cause-specific mortality estimates-with alternative strategies adapted to model causes with insufficient data, substantial changes in reporting over the study period, or unusual epidemiology. YLLs were computed as the product of the number of deaths for each cause-age-sex-location-year and the standard life expectancy at each age. As part of the modelling process, uncertainty intervals (UIs) were generated using the 2·5th and 97·5th percentiles from a 1000-draw distribution for each metric. We decomposed life expectancy by cause of death, location, and year to show cause-specific effects on life expectancy from 1990 to 2021. We also used the coefficient of variation and the fraction of population affected by 90% of deaths to highlight concentrations of mortality. Findings are reported in counts and age-standardised rates. Methodological improvements for cause-of-death estimates in GBD 2021 include the expansion of under-5-years age group to include four new age groups, enhanced methods to account for stochastic variation of sparse data, and the inclusion of COVID-19 and other pandemic-related mortality-which includes excess mortality associated with the pandemic, excluding COVID-19, lower respiratory infections, measles, malaria, and pertussis. For this analysis, 199 new country-years of vital registration cause-of-death data, 5 country-years of surveillance data, 21 country-years of verbal autopsy data, and 94 country-years of other data types were added to those used in previous GBD rounds. FINDINGS The leading causes of age-standardised deaths globally were the same in 2019 as they were in 1990; in descending order, these were, ischaemic heart disease, stroke, chronic obstructive pulmonary disease, and lower respiratory infections. In 2021, however, COVID-19 replaced stroke as the second-leading age-standardised cause of death, with 94·0 deaths (95% UI 89·2-100·0) per 100 000 population. The COVID-19 pandemic shifted the rankings of the leading five causes, lowering stroke to the third-leading and chronic obstructive pulmonary disease to the fourth-leading position. In 2021, the highest age-standardised death rates from COVID-19 occurred in sub-Saharan Africa (271·0 deaths [250·1-290·7] per 100 000 population) and Latin America and the Caribbean (195·4 deaths [182·1-211·4] per 100 000 population). The lowest age-standardised death rates from COVID-19 were in the high-income super-region (48·1 deaths [47·4-48·8] per 100 000 population) and southeast Asia, east Asia, and Oceania (23·2 deaths [16·3-37·2] per 100 000 population). Globally, life expectancy steadily improved between 1990 and 2019 for 18 of the 22 investigated causes. Decomposition of global and regional life expectancy showed the positive effect that reductions in deaths from enteric infections, lower respiratory infections, stroke, and neonatal deaths, among others have contributed to improved survival over the study period. However, a net reduction of 1·6 years occurred in global life expectancy between 2019 and 2021, primarily due to increased death rates from COVID-19 and other pandemic-related mortality. Life expectancy was highly variable between super-regions over the study period, with southeast Asia, east Asia, and Oceania gaining 8·3 years (6·7-9·9) overall, while having the smallest reduction in life expectancy due to COVID-19 (0·4 years). The largest reduction in life expectancy due to COVID-19 occurred in Latin America and the Caribbean (3·6 years). Additionally, 53 of the 288 causes of death were highly concentrated in locations with less than 50% of the global population as of 2021, and these causes of death became progressively more concentrated since 1990, when only 44 causes showed this pattern. The concentration phenomenon is discussed heuristically with respect to enteric and lower respiratory infections, malaria, HIV/AIDS, neonatal disorders, tuberculosis, and measles. INTERPRETATION Long-standing gains in life expectancy and reductions in many of the leading causes of death have been disrupted by the COVID-19 pandemic, the adverse effects of which were spread unevenly among populations. Despite the pandemic, there has been continued progress in combatting several notable causes of death, leading to improved global life expectancy over the study period. Each of the seven GBD super-regions showed an overall improvement from 1990 and 2021, obscuring the negative effect in the years of the pandemic. Additionally, our findings regarding regional variation in causes of death driving increases in life expectancy hold clear policy utility. Analyses of shifting mortality trends reveal that several causes, once widespread globally, are now increasingly concentrated geographically. These changes in mortality concentration, alongside further investigation of changing risks, interventions, and relevant policy, present an important opportunity to deepen our understanding of mortality-reduction strategies. Examining patterns in mortality concentration might reveal areas where successful public health interventions have been implemented. Translating these successes to locations where certain causes of death remain entrenched can inform policies that work to improve life expectancy for people everywhere. FUNDING Bill & Melinda Gates Foundation

The meaning attributed to the nursing process by nurses from a hospital in Mexico: Between routine actions and idealized thinking

Este estudo de natureza qualitativa teve como objetivo compreender os significados atribuídos ao processo de enfermagem por enfermeiras da unidade clínica num hospital do México. A coleta dos dados foi realizada por meio de entrevistas semiestruturadas com 16 enfermeiras, complementada com observação de sua atuação num período de trabalho, nos diferentes turnos, e consulta documental. Os dados foram analisados tendo como referenciais teórico e metodológico o Interacionismo Simbólico e a Teoria Fundamentada nos Dados, que possibilitaram a construção de categorias, subcategorias e suas inter-relações, utilizando o paradigma de codificação de Strauss e Corbin (2002). A comparação constante dos dados resultou na categoria central \"o processo de enfermagem no contexto hospitalar: entre o fazer rotineiro e o pensar idealizado\", que permitiu compreender o significado atribuído pelas enfermeiras ao processo de enfermagem na sua prática cotidiana assistencial, explicitado nas concepções, idealizações e ações de cuidado rotineiro, despercebido, aplicado de forma diferente ao aprendido na escola, e seguindo protocolos de atenção estabelecidos, como base de seu trabalho, uma maneira de fazer os cuidados e ajudar os pacientes a solucionar seus desconfortos, instrumento e metodologia que lhes permite direcionar suas atividades e assumir a prática profissional autônoma. O processo de enfermagem se mostra como dissociação entre o pensar e fazer, indicando haver distanciamento entre a teoria e a prática. As ações de cuidado das enfermeiras estão orientadas, principalmente, à realização de procedimentos, conforme rotinas e protocolos de atenção. Estas ações consistem em: recepção e entrega de turno, administração de medicamentos, mensuração de sinais vitais, registros clínicos de enfermagem e encaminhamento de pacientes, visando a dar conta da investigação de suas necessidades, planejamento e realização das ações, na perspectiva do cuidado individualizado e uso do processo de enfermagem. Nesse espaço de tomada de decisões, o enfermeiro estabelece relacionamento humanizado refletido na sua satisfação pelo cuidado realizado, evidenciando sua capacidade de lidar com as condições contextuais em que há delimitação de funções, sobrecarga de trabalho, bem como, costumes, crenças e valores pessoais e profissionais, expressos como limitantes na utilização do processo de enfermagem. Com este estudo foi possível compreender o processo social em que as enfermeiras atribuem significados ao processo de enfermagem no contexto hospitalar, captando a intersubjetividade de suas experiências e a participação ativa na construção de uma prática de enfermagem diferente, firmando a proximidade humana nas múltiplas interações do cotidiano hospitalar. Esta proximidade pode vir a ser resgatada e potencializada como objeto sensibilizador de uma prática que questione o caráter instrumental da rotina, avançando na perspectiva do cuidado humanizado.This qualitative study aimed to understand the meanings attributed to the nursing process by clinical unit nurses from a Mexican hospital. Data were collected through semistructured interviews with 16 nurses, in addition to observation of their activities during work hours, in different shifts, and consultation of documents. The theoretical and methodological frameworks for data analysis were Symbolic Interactionism and Grounded Theory, which permitted the construction of categories, subcategories and their interrelations, using the coding paradigm by Strauss and Corbin (2002). Constant data comparison resulted in the central category \"the nursing process in the hospital context: between routine actions and idealized thinking\", which permitted an understanding of the meaning nurses attributed to the nursing process in their daily care practice, expressed in conceptions, idealizations and routine care actions, unperceived, applied differently from what they had learned in school, and following established care protocols. This serves as the base of their work, as a way of delivering care and helping patients to solve their discomfort, as an instrument and methodology that allows them to direct their activities and assume an autonomous professional practice. The nursing process reveals itself as dissociation between thinking and doing, indicating a distance between theory and practice. The nurses\' care actions are mainly oriented towards the realization of procedures, according to routines and care protocols. These actions consist of: shift reception and transmission, medication administration, measurement of vital signs, clinical nursing records and patient referral, with a view to coping with needs assessment, action planning and performance, within the perspective of individualized care and use of the nursing process. In this decision making space, nurses establish humanized relations, reflected in their satisfaction with the delivered care, evidencing their capacity to deal with the contextual conditions of function delimitation, work overload, as well as personal and professional customs, beliefs and values, expressed as limiting factors in the use of the nursing process. This study allowed us to understanding the social process in which nurses attribute meanings to the nursing process in the hospital context, capturing the intersubjectivity of their experiences and their active participation in the construction of a different nursing practice, inscribing human proximity in the multiple interactions of daily hospital reality. This proximity can be recovered and potentialized as the sensitizing object of a practice that questions the instrumental nature of routine, advancing in the perspective of humanized care

Mercado Laboral de Enfermería en el Estado de Guanajuato Mercado Laboral de Enfermería en el Estado de Guanajuato

A descriptive, prospective and transversal type investigation was undertaken in order to identify the needs of the nursing labor market. The study shows the characteristics of the nursing labor market in the state of Guanajuato, referred to the potential and actual demands of this working force in the principal hiring institutions, their requirements on training skills and the potential working areas. The findings demonstrate a rising demand for the undergraduate nursing degree in the private health services institutions, civil associations, companies and educational services, it is worthwhile noting the demand for the specialization within the nursing field. The hiring perspectives in the studied institutions are focused towards general nurses and the undergraduate nursing degree. As far as the required profile by the DES-E of the University, the nursing graduates are up to the requirements.Con el objeto de identificar las necesidades del mercado laboral para Enfermería, se realizó una investigación de tipo descriptivo, prospectivo y transversal. El estudio muestra las características del Mercado Laboral de Enfermería en el Estado de Guanajuato, referidas a la demanda real y potencial de este personal en las principales instituciones empleadoras, sus requerimientos sobre la formación y las áreas actuales y potenciales de desempeño. Entrelos principales hallazgos resaltan el aumento de la demanda potencial para el nivel licenciatura en las instituciones de servicios de salud privados, asociaciones civiles, empresas productoras de bienes y de servicios educativos, haciéndose notoria la diversificación del campo de trabajo de la profesión de enfermería, tanto por tipo de institución como por servicios a atender. Las perspectivas de contratación en las instituciones estudiadas se enfocan hacia los niveles de formación de Enfermera General y Licenciada en Enfermería. En relación al perfil requerido, los egresados de la DES-E cubren estos requerimientos

Preoperative nasopharyngeal swab testing and postoperative pulmonary complications in patients undergoing elective surgery during the SARS-CoV-2 pandemic.

BACKGROUND: Surgical services are preparing to scale up in areas affected by COVID-19. This study aimed to evaluate the association between preoperative SARS-CoV-2 testing and postoperative pulmonary complications in patients undergoing elective cancer surgery. METHODS: This international cohort study included adult patients undergoing elective surgery for cancer in areas affected by SARS-CoV-2 up to 19 April 2020. Patients suspected of SARS-CoV-2 infection before operation were excluded. The primary outcome measure was postoperative pulmonary complications at 30 days after surgery. Preoperative testing strategies were adjusted for confounding using mixed-effects models. RESULTS: Of 8784 patients (432 hospitals, 53 countries), 2303 patients (26.2 per cent) underwent preoperative testing: 1458 (16.6 per cent) had a swab test, 521 (5.9 per cent) CT only, and 324 (3.7 per cent) swab and CT. Pulmonary complications occurred in 3.9 per cent, whereas SARS-CoV-2 infection was confirmed in 2.6 per cent. After risk adjustment, having at least one negative preoperative nasopharyngeal swab test (adjusted odds ratio 0.68, 95 per cent confidence interval 0.68 to 0.98; P = 0.040) was associated with a lower rate of pulmonary complications. Swab testing was beneficial before major surgery and in areas with a high 14-day SARS-CoV-2 case notification rate, but not before minor surgery or in low-risk areas. To prevent one pulmonary complication, the number needed to swab test before major or minor surgery was 18 and 48 respectively in high-risk areas, and 73 and 387 in low-risk areas. CONCLUSION: Preoperative nasopharyngeal swab testing was beneficial before major surgery and in high SARS-CoV-2 risk areas. There was no proven benefit of swab testing before minor surgery in low-risk areas

Global burden of 288 causes of death and life expectancy decomposition in 204 countries and territories and 811 subnational locations, 1990–2021: a systematic analysis for the Global Burden of Disease Study 2021

BackgroundRegular, detailed reporting on population health by underlying cause of death is fundamental for public health decision making. Cause-specific estimates of mortality and the subsequent effects on life expectancy worldwide are valuable metrics to gauge progress in reducing mortality rates. These estimates are particularly important following large-scale mortality spikes, such as the COVID-19 pandemic. When systematically analysed, mortality rates and life expectancy allow comparisons of the consequences of causes of death globally and over time, providing a nuanced understanding of the effect of these causes on global populations.MethodsThe Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2021 cause-of-death analysis estimated mortality and years of life lost (YLLs) from 288 causes of death by age-sex-location-year in 204 countries and territories and 811 subnational locations for each year from 1990 until 2021. The analysis used 56 604 data sources, including data from vital registration and verbal autopsy as well as surveys, censuses, surveillance systems, and cancer registries, among others. As with previous GBD rounds, cause-specific death rates for most causes were estimated using the Cause of Death Ensemble model—a modelling tool developed for GBD to assess the out-of-sample predictive validity of different statistical models and covariate permutations and combine those results to produce cause-specific mortality estimates—with alternative strategies adapted to model causes with insufficient data, substantial changes in reporting over the study period, or unusual epidemiology. YLLs were computed as the product of the number of deaths for each cause-age-sex-location-year and the standard life expectancy at each age. As part of the modelling process, uncertainty intervals (UIs) were generated using the 2·5th and 97·5th percentiles from a 1000-draw distribution for each metric. We decomposed life expectancy by cause of death, location, and year to show cause-specific effects on life expectancy from 1990 to 2021. We also used the coefficient of variation and the fraction of population affected by 90% of deaths to highlight concentrations of mortality. Findings are reported in counts and age-standardised rates. Methodological improvements for cause-of-death estimates in GBD 2021 include the expansion of under-5-years age group to include four new age groups, enhanced methods to account for stochastic variation of sparse data, and the inclusion of COVID-19 and other pandemic-related mortality—which includes excess mortality associated with the pandemic, excluding COVID-19, lower respiratory infections, measles, malaria, and pertussis. For this analysis, 199 new country-years of vital registration cause-of-death data, 5 country-years of surveillance data, 21 country-years of verbal autopsy data, and 94 country-years of other data types were added to those used in previous GBD rounds.FindingsThe leading causes of age-standardised deaths globally were the same in 2019 as they were in 1990; in descending order, these were, ischaemic heart disease, stroke, chronic obstructive pulmonary disease, and lower respiratory infections. In 2021, however, COVID-19 replaced stroke as the second-leading age-standardised cause of death, with 94·0 deaths (95% UI 89·2–100·0) per 100 000 population. The COVID-19 pandemic shifted the rankings of the leading five causes, lowering stroke to the third-leading and chronic obstructive pulmonary disease to the fourth-leading position. In 2021, the highest age-standardised death rates from COVID-19 occurred in sub-Saharan Africa (271·0 deaths [250·1–290·7] per 100 000 population) and Latin America and the Caribbean (195·4 deaths [182·1–211·4] per 100 000 population). The lowest age-standardised death rates from COVID-19 were in the high-income super-region (48·1 deaths [47·4–48·8] per 100 000 population) and southeast Asia, east Asia, and Oceania (23·2 deaths [16·3–37·2] per 100 000 population). Globally, life expectancy steadily improved between 1990 and 2019 for 18 of the 22 investigated causes. Decomposition of global and regional life expectancy showed the positive effect that reductions in deaths from enteric infections, lower respiratory infections, stroke, and neonatal deaths, among others have contributed to improved survival over the study period. However, a net reduction of 1·6 years occurred in global life expectancy between 2019 and 2021, primarily due to increased death rates from COVID-19 and other pandemic-related mortality. Life expectancy was highly variable between super-regions over the study period, with southeast Asia, east Asia, and Oceania gaining 8·3 years (6·7–9·9) overall, while having the smallest reduction in life expectancy due to COVID-19 (0·4 years). The largest reduction in life expectancy due to COVID-19 occurred in Latin America and the Caribbean (3·6 years). Additionally, 53 of the 288 causes of death were highly concentrated in locations with less than 50% of the global population as of 2021, and these causes of death became progressively more concentrated since 1990, when only 44 causes showed this pattern. The concentration phenomenon is discussed heuristically with respect to enteric and lower respiratory infections, malaria, HIV/AIDS, neonatal disorders, tuberculosis, and measles.InterpretationLong-standing gains in life expectancy and reductions in many of the leading causes of death have been disrupted by the COVID-19 pandemic, the adverse effects of which were spread unevenly among populations. Despite the pandemic, there has been continued progress in combatting several notable causes of death, leading to improved global life expectancy over the study period. Each of the seven GBD super-regions showed an overall improvement from 1990 and 2021, obscuring the negative effect in the years of the pandemic. Additionally, our findings regarding regional variation in causes of death driving increases in life expectancy hold clear policy utility. Analyses of shifting mortality trends reveal that several causes, once widespread globally, are now increasingly concentrated geographically. These changes in mortality concentration, alongside further investigation of changing risks, interventions, and relevant policy, present an important opportunity to deepen our understanding of mortality-reduction strategies. Examining patterns in mortality concentration might reveal areas where successful public health interventions have been implemented. Translating these successes to locations where certain causes of death remain entrenched can inform policies that work to improve life expectancy for people everywhere

Delaying surgery for patients with a previous SARS-CoV-2 infection

Not availabl