Intervenção nas práticas dos enfermeiros na prevenção de flebites em pessoas portadoras de cateteres venosos periféricos : um estudo de investigação-ação

Tese de doutoramento, Enfermagem, Universidade de Lisboa, com a participação da Escola Superior de Enfermagem, 2014Nos contextos de saúde há um recurso constante a cateteres venosos periféricos, para diferentes fins, entre eles a administração de medicação intravenosa. O seu uso não é porém isento de riscos, sendo a flebite a complicação local mais frequente. Os enfermeiros no âmbito das suas intervenções são responsáveis pela punção e vigilância da pessoa portadora de cateter venoso periférico, realizando um conjunto de ações para a prevenção de complicações, embora por vezes não sigam o definido nas guidelines. Dado que a literatura científica evidencia a possibilidade de prevenir e reduzir a flebite em grande número de doentes, implementámos um estudo de investigação-ação num serviço de medicina, com os seguintes objetivos: compreender as práticas dos enfermeiros realizadas a doentes portadores de cateteres venosos periféricos; identificar fatores que influenciam a alteração dessas mesmas práticas e contribuir para a redução da taxa de incidência de flebites. Na fase de Planeamento foram identificados desvios às boas práticas, uma taxa de incidência de flebites de 68.9% e fatores de risco para a sua ocorrência. Para tal, recorremos à observação participante, entrevistas semiestruturadas, análise da documentação escrita realizada pelos enfermeiros, estudo observacional prospetivo e avaliação do clima organizacional. Após a fase de Ação, através de Oficinas de Trabalho com a equipa de enfermagem, identificámos na fase de Reflexão com recurso às mesmas técnicas de recolha de dados anteriormente descritas, alterações positivas nas práticas dos enfermeiros. Os resultados evidenciaram maior mobilização do conhecimento explícito, com um decréscimo de 26.5% na taxa de incidência de flebites. Em síntese, realçamos a importância que as práticas dos enfermeiros têm para os ganhos em saúde e que as mesmas resultam da interseção das dinâmicas da organização, enfermeiros, profissão e também do perfil dos doentes. Confirmámos ainda, a natureza multifatorial da ocorrência de flebites.In health care settings, the use of peripheral venous catheters is a common practice used for different purposes, such as the administration of intravenous medication. However, their use is not risk-free, with phlebitis being the most common local complication. One of nurses’ interventions is the insertion and maintenance of peripheral venous catheters. Nurses perform a set of procedures to prevent complications, although sometimes they do not comply with the recommended guidelines. Given that scientific literature highlights the possibility of preventing and reducing phlebitis in a large number of patients, we conducted an action research study in a medicine ward so as to: understand nurses’ interventions in patients with peripheral venous catheters; identify the factors that influence changes in those practices; and contribute to reduce the incidence of phlebitis. In the Planning stage, we identified good practice deviations, a phlebitis incidence of 68.9%, and phlebitis risk factors. To this end, we used the following methods: participant observation, semi-structured interviews, analysis of nurses’ written documentation, a prospective observational study, and evaluation of the organizational climate. After the Action stage, which was composed of workshops with the nursing team, we identified positive changes in nurses’ practices during the Reflection stage, using the same data collection methods as described above. The results showed higher mobilization of explicit knowledge, with a 26.5% decrease in the incidence of phlebitis. To sum up, we emphasize the importance of nurses’ practices in health gains, and the fact that these practices result from the intersection between the dynamics of the organization, the nurses, the profession and the patients’ profile. We also confirm the multifactorial nature of phlebitis.Fundação para a Ciência e a Tecnologia (FCT

Assessment of Job Satisfaction in Nurses: Contributions to Health Management

Background: Evidence reflects that job satisfaction is an indicator of the quality of health care. Health managers and decision-makers cannot neglect its importance and should promote organizational interventions for its assessment and improvement. Objective: This study aims to (i) compare the job satisfaction experienced by nurses with the one desired (ii) identify the lowest areas of current satisfaction and (iii) reflect in areas of lowest and higher job satisfaction. Method: A descriptive study carried out in September 2021 with thirty oncology nurses, who were asked to fill out an electronic questionnaire with the professional life wheel coaching tool. This coaching diagnostic tool assesses the current satisfaction level and the desired satisfaction level from 1 to 10. The inquired areas were: salary, career progression, relationships with managers, relationships with the team, relationships with patients/family, professional environment, feeling of institutional belonging, working conditions, appreciation/recognition, and professional fulfillment. Ethical assumptions were preserved. Results: The results suggest that oncology nurses have important levels of job dissatisfaction. The lowest values of experienced job satisfaction were related to career development, while the highest were related to team relationships. Regarding the desired job satisfaction, the salary was the area presenting the least need for correction. The relationship with patients and families was identified as the area with the greatest desire for improvement. There was a weak correlation between job satisfaction and age, and job satisfaction and professional experience. Discussion and Conclusion: The relationship with the team was one of the areas identified by nurses as significant for their levels of satisfaction, revealing the importance of promoting the development of healthful and effective relationships. Promoting relationships with patients and families is also important as this area was identified as a desire for greater professional development. Health care institutions and nurse managers aiming at the promotion of job satisfaction should plan interventions focusing on the areas of lower job satisfaction and towards younger nurses, who have less experience in clinical environments. Such an approach will likely allow the nurses to feel valued and will reduce the gap between experienced and desired job satisfaction.info:eu-repo/semantics/publishedVersio

Brief report on double-chamber syringes patents and implications for infusion therapy safety and efficiency

This review aimed to map the existing patents of double-chamber syringes that can be used for intravenous drug administration and catheter flush. A search was conducted in the Google patents database for records published prior to 28 October 2020, using several search terms related to double-chamber syringes (DCS). Study eligibility and data extraction were performed by two independent reviewers. Of the initial 26,110 patents found, 24 were included in this review. The 24 DCS that were found display two or more independent chambers that allow for the administration of multiple solutions. While some of the DCS have designated one of the chambers as the flushing chamber, most patents only allow for the sequential use of the flushing chamber after intravenous drug administration. Most DCS were developed for drug reconstitution, usually with a freeze-dried drug in one chamber. Some patents were designed for safety purposes, with a parallel post-injection safety sheath chamber for enclosing a sharpened needle tip. None of the DCS found allow for a preand post-intravenous drug administration flush. Given the current standards of care in infusion therapy, future devices must allow for the sequential use of the flushing chamber to promote a pre-administration patency assessment and a post-administration device flush.info:eu-repo/semantics/publishedVersio

Improving peripheral venous catheterization-related outcomes in oncology patients: an action research study in Portugal

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Short peripheral venous catheters contamination and the dangers of bloodstream infection in Portugal: an analytic study

Peripheral venous catheters (PVCs) are the most used vascular access devices in the world. However, failure rates remain considerably high, with complications such as PVC-related infections posing significant threats to patients’ well-being. In Portugal, studies evaluating the contamination of these vascular medical devices and characterizing the associated microorganisms are scarce and lack insight into potential virulence factors. To address this gap, we analyzed 110 PVC tips collected in a large tertiary hospital in Portugal. Experiments followed Maki et al.’s semi-quantitative method for microbiological diagnosis. Staphylococcus spp. were subsequently studied for the antimicrobial susceptibility profile by disc diffusion method and based on the cefoxitin phenotype, were further classified into strains resistant to methicillin. Screening for the mecA gene was also done by a polymerase chain reaction and minimum inhibitory concentration (MIC)-vancomycin as determined by E-test, proteolytic and hemolytic activity on skimmed milk 1% plate and blood agar, respectively. The biofilm formation was evaluated on microplate reading through iodonitrotetrazolium chloride 95% (INT). Overall, 30% of PVCs were contaminated, and the most prevalent genus was Staphylococcus spp., 48.8%. This genus presented resistance to penicillin (91%), erythromycin (82%), ciprofloxacin (64%), and cefoxitin (59%). Thus, 59% of strains were considered resistant to methicillin; however, we detected the mecA gene in 82% of the isolates tested. Regarding the virulence factors, 36.4% presented α-hemolysis and 22.7% β-hemolysis, 63.6% presented a positive result for the production of proteases, and 63.6% presented a biofilm formation capacity. Nearly 36.4% were simultaneously resistant to methicillin and showed expression of proteases and/or hemolysins, biofilm formation, and the MIC to vancomycin were greater than 2 µg/mL. Conclusion: PVCs were mainly contaminated with Staphylococcus spp., with high pathogenicity and resistance to antibiotics. The production of virulence factors strengthens the attachment and the permanence to the catheter’s lumen. Quality improvement initiatives are needed to mitigate such results and enhance the quality and safety of the care provided in this field.info:eu-repo/semantics/publishedVersio

Traducción, adaptación cultural y validación de la escala Venous International Assessment al portugués europeo

Background: A significant number of adult patients experience difficult peripheral intravenous ac-cess, leading to multiple puncture attempts and venous network depletion. The Venous International Assessment (VIA) Scale is referenced internationally as a reliable instrument that classifies patients’ peripheral intravenous accesses and determines the risk of related complications. Objectives: To translate, culturally adapt and validate the VIA Scale to European Portuguese. Methodology: Study of the translation, cultural adaptation, and evaluation of the psychometric prop-erties of the VIA Scale in a nonprobability sample with 100 patients in need of peripheral intravenous catheterization. Results: The Portuguese version of the VIA Scale (EARV) revealed moderate inter-rater reliability scores (k = 0.490; p < 0.0005). The criterion and construct validity of the EARV were assessed through predictive, convergent, and correlational analysis, with moderate to large magnitudes, and statistical significance. Conclusion: The EARV is a reliable and valid instrument that can assist Portuguese health professionals in determining and categorizing difficult peripheral intravenous access. Further studies are recommended to test the transversal applicability of the scale.Enquadramento: Um número significativo de pessoas adultas tem um acesso venoso periférico difícil, o que leva a múltiplas tentativas de punção e ao esgotamento da rede venosa. A escala Venous International Assessment (VIA) é considerada a nível internacional como um instrumento fiável que classifica as vias de acesso venoso periférico das pessoas e determina o risco de complicações associadas. Objetivos: Traduzir, adaptar culturalmente e validar a Escala VIA para português europeu. Metodologia: Estudo da tradução, adaptação cultural, e avaliação das propriedades psicométricas da escala VIA em amostra não probabilística de 100 pessoas doentes a precisar de cateterização venosa periférica. Resultados: A versão em português europeu da escala VIA (EARV) revelou valores moderados de fiabilidade inter-observadores (k = 0,490; p < 0,0005). As validades do critério e do constructo da EARV foram avaliadas através de análise preditiva, convergente e correlacional, com magnitudes moderadas a grandes e significância estatística. Conclusão: A EARV é um instrumento fiável e válido que pode ajudar os profissionais de saúde portugueses na determinação e categorização de acessos venosos periféricos difíceis. Contudo, recomenda-se a realização de mais estudos para testar a aplicabilidade transversal desta escala.Marco contextual: Un número significativo de adultos experimenta dificultades al ser sometido a un acceso venoso periférico, lo que provoca múltiples intentos de punción y el deterioro de la red venosa. La escala Venous International Assessment (VIA) está considerada internacionalmente como un instrumento fiable que clasifica los accesos venosos periféricos en las personas y determina el riesgo de complicaciones relacionadas. Objetivos: Traducir, adaptar culturalmente y validar la escala VIA al portugués europeo. Metodología: Estudio de traducción, adaptación cultural y evaluación de las propiedades psicométricas de la escala VIA en una muestra no probabilística con 100 personas que necesitan ser sometidos a un cateterismo venoso periférico. Resultados: La versión portuguesa desarrollada de la escala VIA (EARV) mostró puntuaciones de concordancia entre evaluadores moderadas (k = 0,490; p < 0,0005). La validez de criterio y de constructo de la EARV se evaluó mediante un análisis predictivo, convergente y correlacional, con magnitudes de moderadas a amplias y significación estadística. Conclusión: La EARV es un instrumento fiable y válido que puede ayudar a los profesionales sanitarios portugueses a determinar y categorizar la dificultad de un acceso venoso periférico. Se necesita realizar futuros estudios para comprobar la aplicabilidad transversal de la escala.info:eu-repo/semantics/publishedVersio

Referral to the national network of integrated care: the nurses’ perception

Objective: to understand the referral to the National Network of Integrated Continuous Care, from the perspective of nurses who work in this care context. Method: an exploratory and descriptive study with a qualitative approach, with data collection between July and September 2019 through interviews with 12 nurses who work in Integrated Continuous Care Teams, in Northern Portugal. The content analysis technique was used to analyze the statements. Results: the professionals revealed that there are difficulties and constraints in the process of referring users to the National Network of Integrated Continuous Care. The process is bureaucratic, complex, and time-consuming, conditioning user accessibility to timely care. Conclusion: the referral process is a very bureaucratic and time-consuming procedure, which not only conditions and delays users’ access to the National Network of Integrated Continuous Care network, contributing to the worsening of the clinical status of some patients. The number of professionals is insufficient, inducing the demand for services through urgency. The focus on primary care should seek to improve inequalities in access, compete for more equitable and accessible care, generating more quality in health care.Objetivo: compreender a referenciação para a Rede Nacional de Cuidados Continuados Integrados, a partir da perspetiva de enfermeiros que atuam nesse contexto assistencial. Método: estudo exploratório, descritivo com abordagem qualitativa, cujos dados foram coletados entre julho e setembro de 2019, por meio de entrevistas a 12 enfermeiros que trabalham em Equipes de Cuidados Continuados Integrados, do norte de Portugal. Para analisar as falas, utilizou-se a técnica de análise de conteúdo. Resultados: os profissionais revelaram que existem dificuldades e constrangimentos no processo de referenciação dos usuários para a Rede Nacional de Cuidados Continuados Integrados. O processo é burocrático, complexo e demorado, condicionando a acessibilidade dos usuários aos cuidados em tempo útil. Conclusão: o processo de referenciação é um procedimento muito burocratizado e demorado, que condiciona e atrasa o acesso dos usuários à Rede Nacional de Cuidados Continuados Integrados, contribuindo para o agravamento do estado clínico de alguns pacientes. O número de profissionais é insuficiente, induzindo à procura de serviços pela via da urgência. A aposta na atenção primária deverá procurar melhorar as desigualdades no acesso, concorrer para cuidados mais equitativos e acessíveis gerando mais qualidade nos cuidados de saúde.Objetivo: comprender la derivación a la Red Nacional de Cuidados Continuados Integrados, desde la perspectiva de los enfermeros que actúan en este contexto asistencial. Método: estudio exploratorio, descriptivo, con enfoque cualitativo, cuyos datos fueron recolectados entre julio y septiembre de 2019, a través de entrevistas con 12 enfermeros que trabajan en Equipos de Cuidados Continuados Integrados, del norte de Portugal. Para analizar las declaraciones, se utilizó la técnica de análisis de contenido. Resultados: los profesionales revelaron que existen dificultades y limitaciones en el proceso de derivación de usuarios a la Red Nacional de Cuidados Continuados Integrados. El proceso es burocrático, complejo y demorado, condicionando la accesibilidad del usuario a la atención en tiempo oportuno. Conclusión: el proceso de derivación es un procedimiento muy burocrático y demorado, que no solo condiciona y atrasa el acceso de los usuarios a la Red Nacional de Cuidados Continuados Integrados sino que además contribuye al agravamiento del estado clínico de algunos pacientes. El número de profesionales es insuficiente, lo que induce a la demanda de los servicios de la emergencia. La apuesta en la atención primaria debe orientarse a mejorar las desigualdades en el acceso, competir por una atención más equitativa y accesible y, así, brindar una mayor calidad en la atención de la salud.info:eu-repo/semantics/publishedVersio

Evidence-informed development of a bundle for peripheral intravenous catheterization in Portugal: a delphi consensus study

Contrary to many international settings, there are no clinical guidelines for peripheral intravenous catheter (PIVC) insertion and maintenance in Portugal. We sought to derive an international consensus on a PIVC bundle that could guide Portuguese nurses’ clinical decision-making in this scope. Methods: Two international vascular access specialist groups participated in an online Delphi panel. During the first round, specialists (n = 7) were sent a summary report from a previous observational study conducted in a surgical ward in Portugal. Based on the report findings, specialists were asked to provide five to eight PIVC insertion and maintenance interventions. Then, another set of specialists (n = 7) scored and revised the recommendations until a consensus was reached (≥70% agreement). The PIVC bundle was made available and discussed with the surgical ward’s nurses. Results: After three rounds, a consensus was achieved for five evidence-informed interventions: (i) involve the person and assess the peripheral venous network; (ii) maintain an aseptic no-touch technique; (iii) ensure proper catheter dressing and fixation; (iv) perform catheter flush & lock; (v) test the peripheral venous catheter’s functionality and performance at each shift. Conclusion: The final version of the PIVC bundle achieved consensus among international experts. Despite the positive feedback provided by the ward nurses, future studies are warranted to assess its effectiveness in standardizing PIVC care delivery and its potential implications for care outcomes in Portuguese clinical settings.info:eu-repo/semantics/publishedVersio

Cateterismo venoso periférico: compreensão e avaliação das práticas de enfermagem

Objective: to understand the nursing practices related to peripheral venipuncture and to analyze the incidence of complications in patients with venous catheters. Method: mixed design, involving: case study, sectional study, cohort study and focus group. The sample consisted of nurses and patients from a medical clinic in Portugal. Thematic analysis and descriptive statistics were performed. Results: stressors capable of influencing nursing practices were identified, including: the decisions of the medical team, the age and characteristics of the venous network of the patient, the availability of other catheters in the institution, the low level of knowledge of nurses regarding the care of patients in the insertion, maintenance and removal of the peripherally inserted central venous catheter. The following complications and their respective incidences were documented in patients with peripheral venous catheters: phlebitis (22.2%), obstruction (27.7%), fluid exiting through insertion site (36.1%), infiltration (38.8%) and accidental catheter removal (47.2%). Catheter obstruction with an incidence of 22.2% was only observed in those who used the peripherally inserted central venous catheter. The following benefits were observed with the use of the peripherally inserted central venous catheter: safe administration of drugs; pain reduction, number of venous punctures and complications. Conclusions: the peripherally inserted central venous catheter is presented as a valid and viable alternative that can improve the quality of nursing care and the safety and well-being of patients.Objetivo: compreender as práticas de enfermagem relacionadas com o cateterismo venoso periférico e analisar a incidência de complicações durante a permanência do cateter venoso no paciente. Método: delineamento misto, envolvendo: estudo de caso, estudo seccional, estudo de coorte e grupo focal. A amostra foi constituída por enfermeiros e pacientes de um serviço de clínica médica de Portugal. Efetuada análise temática e estatística descritiva. Resultados: identificou-se estressores capazes de influenciar as práticas de enfermagem, sendo eles: as decisões da equipe médica, a idade e as características da rede venosa do paciente, a disponibilização de outros cateteres pela instituição e o baixo nível de conhecimento dos enfermeiros sobre os cuidados aos pacientes na inserção, manutenção e remoção do cateter venoso central de inserção periférica. Nos pacientes portadores de cateter venoso periférico, documentou-se as seguintes complicações e suas respectivas incidências: flebite (22,2%), obstrução (27,7%), saída de fluido pela inserção (36,1%), infiltração (38,8%) e remoção acidental do cateter (47,2%). Naqueles que usaram o cateter venoso central de inserção periférica, identificou-se apenas a obstrução desse cateter, com incidência de 22,2%. Verificou-se os seguintes benefícios com a utilização do cateter venoso central de inserção periférica: administração segura de medicamentos e redução da dor, do número de punções venosas e de complicações. Conclusão: o cateter venoso central de inserção periférica apresenta-se como alternativa válida e viável para melhorar a qualidade da assistência de enfermagem, a segurança e o bem-estar dos pacientes

Nurse-led interventions to promote hospitalized patients’ adherence to hand hygiene: narrative review

Background: during the hospital admission, nurses play a fundamental role in the adherence to hand hygiene (HH) measures by patients and their families, enhancing the quality and safety of care. Objective: synthesize the latest scientific evidence regarding nurse-led interventions focused on hospitalized patients’ adherence to HH and its impact on preventing Healthcare-Associated Infections (HAIs). Methodology: following the PICOD mnemonic, a narrative review was conducted in MEDLINE (via PubMed), CINAHL (via EBSCO), and Cochrane Library. Two independent reviewers analyzed the relevance of the studies, extracted and synthesized data. Results: seven studies were included for review, published between 2016 and 2018. Three central themes emerged: i) nurse-led interventions that promote patients’ adherence to HH; ii) patients’ HH adherence and HAIs prevention; iii) the importance of person-centered nursing care in this scope. Conclusion: isolated interventions do not lead to adequate behavioural changes. Although educational interventions are the most common actions used by nurses, visual cues, distribution of informational material, provision of HH material, and creation of specific moments for HH are complementary strategies that enhance the efficiency and quality of the intervention