Calidad de los cuidados de enfermería: un estudio en hospitales portugueses

Background: In a constant pursuit for professional excellence, nurses are required to comply with the quality standards of nursing care. Thus, it is essential to understand this phenomenon in the hospital setting. Objectives: To analyze nurses’ perception of the implementation of quality standards in nursing care. Methodology: A quantitative, descriptive-exploratory study was conducted in 36 public hospital institutions located in mainland Portugal, involving a total of 3.451 nurses. Data were collected using a questionnaire. Results: Most nurses often or always performed activities that enhance the quality of nursing care. This analysis showed that nurses perceive activities related to Health Promotion, Well-being and Self-care, and Functional Readaptation as less implemented. On the other hand, activities related to Responsibility and Rigor and Prevention of Complications are implemented most often. Conclusion: The findings suggest that nursing practices should be redesigned and adjusted based on the activities that are less often implemented.Enquadramento: Numa procura permanente da excelência no exercício profissional, é exigido aos enfermeiros uma atuação congruente com os padrões de qualidade dos cuidados de enfermagem, sendo pertinente perceber o fenómeno no contexto hospitalar. Objetivos: Analisar a perceção dos enfermeiros relativamente à concretização dos padrões de qualidade dos cuidados de enfermagem. Metodologia: Estudo exploratório-descritivo, de carácter quantitativo, realizado em 36 instituições hospitalares EPE de Portugal continental, com a participação de 3,451 enfermeiros. Como instrumento de colheita de dados usámos o questionário. Resultados: A maioria dos enfermeiros concretiza às vezes ou sempre as atividades que contribuem para a qualidade dos cuidados de enfermagem. Decorrente da análise efetuada, as atividades inerentes às dimensões Promoção da saúde, Bem-estar e autocuidado e Readaptação funcional, são aquelas que os enfermeiros percecionam como menos executadas. Por outro lado, as atividades mais frequentemente concretizadas, reportam-se às dimensões Responsabilidade e rigor e Prevenção de complicações. Conclusão: Os dados sugerem a necessidade de se repensarem as práticas, no sentido de uma atuação congruente com os enunciados descritivos menos frequentemente concretizados.Marco contextual: En una búsqueda permanente de la excelencia en el ejercicio profesional, se exige que los enfermeros actúen de forma congruente con los patrones de calidad de los cuidados de enfermería, para lo cual es pertinente comprender el fenómeno en el contexto hospitalario. Objetivos: Analizar la percepción de los enfermeros en relación a la concretización de los patrones de calidad de los cuidados de enfermería. Metodología: Estudio exploratorio y descriptivo, de carácter cuantitativo, realizado en 36 instituciones hospitalarias EPE de Portugal continental, en el que se contó con la participación de 3.451 enfermeros. Como instrumento de recogida de datos se usó el cuestionario. Resultados: La mayoría de los enfermeros realiza a veces o siempre las actividades que contribuyen a la calidad de los cuidados de enfermería. A partir del análisis efectuado, las actividades inherentes a las dimensiones Promoción de la salud, Bienestar y autocuidado y Readaptación funcional son aquellas que los enfermeros perciben como menos ejecutadas. Por otro lado, las actividades que se realizan con más frecuencia se refieren a las dimensiones Responsabilidad y rigor y Prevención de complicaciones. Conclusión: Los datos sugieren que es necesario repensar las prácticas con el objetivo de realizar una actuación congruente con los enunciados descriptivos que se ponen en práctica con menos frecuencia.info:eu-repo/semantics/publishedVersio

Musculoskeletal symptoms of hospital nurses: contribution of rehabilitation nurses

Background: Nurses make up the major professional category in the National Health Service, and their work a"ects their musculoskeletal well-being. Objective: To determine the prevalence of musculoskeletal symptoms of nurses and identify their risk factors. Methodology: A quantitative, descriptive, and correlational study, conducted in a Portuguese hospital center, used a non-probabilistic sample by convenience of 260 nurses. A questionnaire was used as data collection instrument, divided into two parts (sociodemographic and professional data/Nordic Musculoskeletal Questionnaire). Results: #e majority of nurses (65.1%) manifests musculoskeletal symptoms, the lumbar spine being the most a"ected body segment. #e female gender, aging, body mass index, time of professional experience, and workload are related to the worsening of symptoms. Conclusion: #e results point out the need to raise awareness of the risk factors among nurses, as well as to promote the adoption of strategies, like workplace gymnastics, to minimize musculoskeletal symptoms.info:eu-repo/semantics/publishedVersio

Ejercicio profesional de los enfermeros sostenido en los referentes teóricos de la disciplina: realidad o utopía

Background: Supporting nursing practice on the discipline’s conceptions is currently one of the biggest challenges, which is why it is important to understand nurses’ views. Objective: Analyzing hospital nurses’ perception of the relevance of the theoretical framework for sustaining their professional practice. Methodology: A qualitative, exploratory and descriptive study carried out in 19 hospitals, involving 56 nurses. The tool used for collecting data was a semi-structured interview. Results: Data analysis resulted in the following categories: Relevance of the theoretical framework for professional practice in nursing; Theoretical framework guiding professional practice in nursing; Constraints to the integration of the theoretical nursing framework and Strategies for the integration of theoretical nursing framework. Conclusion: Nurses’ intention to adopt a practice based on the theoretical framework of the discipline has been negatively influenced by their practice environment and by the difficulty in understanding and integrating the theoretical framework, thus resulting in the need to adopt strategies.Enquadramento: Sustentar a prática de enfermagem nas conceções da disciplina constitui atualmente um dos maiores desafios, motivo pelo qual importa conhecer a perspetiva dos enfermeiros. Objetivo: Analisar a perceção dos enfermeiros que exercem funções em instituições hospitalares, sobre a pertinência dos referenciais teóricos para a sustentação da sua prática profissional. Metodologia: Estudo de abordagem qualitativa, exploratório e descritivo, realizado em 19 centros hospitalares, com a participação de 56 enfermeiros. Como instrumento de colheita de dados foi usada a entrevista semiestruturada. Resultados: Da análise dos dados emergiram como categorias: Relevância dos referenciais teóricos para a prática profissional dos enfermeiros; Referenciais teóricos orientadores da prática profissional dos enfermeiros; Constrangimentos à integração dos referenciais teóricos de enfermagem e Estratégias para a integração dos referenciais teóricos de enfermagem. Conclusão: A intenção dos enfermeiros em adotar uma prática sustentada nos referenciais teóricos da disciplina tem sido negativamente influenciada pelos ambientes da prática, bem como pela dificuldade em compreender e integrar os referenciais teóricos, de onde emerge a necessidade de se adotarem estratégias.Marco contextual: Sostener la práctica de la enfermería en las concepciones de la disciplina constituye actualmente uno de los mayores desafíos, motivo por el cual importa conocer la perspectiva de los enfermeros. Objetivo: Analizar la percepción de los enfermeros que ejercen funciones en instituciones hospitalarias sobre la pertinencia de los referentes teóricos para sostener su práctica profesional. Metodología: Estudio de enfoque cualitativo, exploratorio y descriptivo, realizado en 19 centros hospitalarios, con la participación de 56 enfermeros. Como instrumento de recogida de datos se usó la entrevista semiestructurada. Resultados: Del análisis de los datos surgieron como categorías: Relevancia de los referentes teóricos para la práctica profesional de los enfermeros; Referentes teóricos orientadores de la práctica profesional de los enfermeros; Limitaciones a la integración de los referentes teóricos de enfermería y Estrategias para la integración de los referentes teóricos de la enfermería. Conclusión: La intención de los enfermeros en adoptar una práctica sostenida en los referentes teóricos de la disciplina se ha visto influida negativamente por los ambientes de la práctica, así como por la dificultad de comprender e integrar los referentes teóricos, de donde surge la necesidad de que se adopten estrategias.info:eu-repo/semantics/publishedVersio

A 63-Year-Old Woman Presenting with a Synovial Sarcoma of the Hand: a Case Report

INTRODUCTION: Synovial sarcoma is a high-grade, soft-tissue sarcoma that most frequently is located in the vicinity of joints, tendons or bursae, although it can also be found in extra-articular locations. Most patients with synovial sarcoma of the hand are young and have a poor prognosis, as these tumors are locally aggressive and are associated with a relatively high metastasis rate. According to the literature, local recurrence and/or metastatic disease is found in nearly 80% of patients. Current therapy comprises surgery, systemic and limb perfusion chemotherapy, and radiotherapy. However, the 5-year survival rate is estimated to be only around 27% to 55%. Moreover, most authors agree that synovial sarcoma is one of the most commonly misdiagnosed malignancies of soft tissues because of their slow growing pattern, benign radiographic appearance, ability to change size, and the fact that they may elicit pain similar to that caused by common trauma. CASE PRESENTATION: We describe an unusual case of a large synovial sarcoma of the hand in a 63-year-old Caucasian woman followed for 12 years by a multidisciplinary team. In addition, a literature review of the most pertinent aspects of the epidemiology, diagnosis, treatment and prognosis of these patients is presented. CONCLUSION: Awareness of this rare tumor by anyone dealing with hand pathology can hasten diagnosis, and this, in turn, can potentially increase survival. Therefore, a high index of suspicion for this disease should be kept in mind, particularly when evaluating young people, as they are the most commonly affected group

Psychosocial Aspects Associated with Pain Perception in Individuals Undergoing Coronary Surgery

Objectivo: Identificar os factores psicossociais que influenciam a percepção da dor pós-operatória em doentes submetidos a cirurgia de revascularização do miocárdio (CRM). Material e Métodos: Estudo exploratório correlacional de 91 doentes (71 homens e 20 mulheres) submetidos a CRM (pontagem aortocoronária) por esternotomia. A idade média era de 63,8 ± 9,6 anos (entre 39 e 84). Foram utilizados os seguintes instrumentos: Escala Analógica Visual às 24, 48 e 96 horas do pós-operatório; Questionário de Caracterização Demográfica; Mental Health Inventory de 5 itens; Percepção de Saúde Geral (SF-36); Escala de Expectativas de Dor; Escala de Percepção de Apoio; Escala de Expectativas de Auto-eficácia; Satisfação com o tratamento, médicos e enfermeiros (American Pain Society Questionnaire) aplicados às 96 horas após a cirurgia. Resultados: Os doentes que apresentaram expectativas elevadas de dor, percepcionaram maior apoio, apresentaram níveis elevados de auto-eficácia para lidar com a dor ou, se pertenciam ao sexo masculino, sentiram menos dor. De igual modo, os doentes que apresentaram melhor saúde mental, percepcionaram a sua saúde como boa e os doentes que expressaram maior satisfação com o tratamento sentiram menos dor. A dor não foi influenciada pela idade, grau de escolaridade ou pela satisfação com a conduta de médicos e enfermeiros. Conclusão: Após as primeiras 48 horas do pós-operatório, a experiência de dor é influenciada por factores psicossociais, em particular pela expectativa de dor, expectativa de auto-eficácia, apoio percebido, percepção da saúde geral, percepção de saúde mental e satisfação com o tratamento para a dor. Perante os resultados, evidencia-se a necessidade de conjugar conhecimentos no sentido de dar respostas mais alargadas e de carácter multidisciplinar no tratamento da dor pós-operatória em CRM devendo, a par de outros aspectos, focar-se na gestão das expectativas dos doentes

Explanatory approach to the grounding of the professional nursing practice

INTRODUCTION. In the current health care environment, the needs of the population provided the perfect opportunity for nurses to (re)de$ne their practice and professional career. Within this framework, this study aimed thus at identifying the bases that are underlying the practice, as well as the factors that stimulate or jeopardise the quality of care and a practice that is consistent with the desired grounding. METHOD. Qualitative study with a phenomenological nature carried out in 19 public hospitals in mainland Portugal with the participation of 56 nurses. The tool used for collecting data was a semi-structured interview. RESULTS. Regarding the factors that stimulate or jeopardise the quality of care a practice that is consistent with the desired grounding, we could highlight features that were perfectly integrated in the triad structure, process and result. In relation to “structure”, we could point out the following: organizational resources, human and material resources, service organization, nursing sustainment practices and organization of nursing care. Concerning “process”, we could analyse: decision-making process, guiding principles for the professional practice, scienti$c methodology of health care service, health care documentation process, communication process, collaborative practice and management practice. In what concerns “result”, the features were less evident in the participants’ speech, and more stressed among clients and nurses. CONCLUSION. The explanatory approach to the grounding of the professional nursing practice, outlined in a three-dimensional perspective, makes clear the theoretical framework that grounds the practice, as well as the factors in hospital environment, that stimulate or jeopardise the quality of the nursing careinfo:eu-repo/semantics/publishedVersio

Relevance of Circulating Nucleosomes, HMGB1 and sRAGE for Prostate Cancer Diagnosis

Background/Aim: Evasion from cell death occurs in prostate cancer (PCa). We verified whether serum levels of cell death markers can have diagnostic value in PCa. Patients and Methods: A total of 233 men scheduled for prostate biopsy [prostate specific antigen (PSA) level: 2-10 ng/ml] were enrolled. Serum nucleosomes, nucleosomes containing the H3 histone (H3), high mobility group box 1 (HMGB1), and soluble receptor for advanced glycation end products (sRAGE) were analyzed by enzyme immunoassays. Results: There were no differences (p>0.05) in nucleosomes, H3, and sRAGE levels between patients with and without PCa or clinically significant PCa (csPCa). HMGB1 had lower levels in PCa patients (p=0.023) and was a predictor of PCa (p=0.047), but not of csPCa (p=0.180). Conclusion: In patients with critical PSA levels between 2-10 ng/ml, HMGB1 had some diagnostic value for overall PCa detection, but it was not predictive of csPCa. Nucleosomes, H3 and sRAGE did not discriminate between PCa or csPCa and controls.The Authors received no financial support for the research, authorship, and/or publication of this article

Comparison of Three Assays for Total and Free PSA Using Hybritech and WHO Calibrations

Background/Aim: Lack of interchangeability between prostate-specific antigen (PSA) assays could have a clinical impact. We compared PSA assays from different manufacturers and calibrations. Patients and Methods: A total of 233 men who underwent prostate biopsy (PSA: 2-10 ng/ml; Beckman Coulter Access® Hybritech® as reference) were enrolled. Total (tPSA) and free PSA (fPSA) were also measured using the Roche cobas® and the Abbott Architect® methods. Results: Roche tPSA values were ≈1% higher than Beckman, while Abbott values were ≈5% lower. Roche had the highest diagnostic sensitivity (92%) compared to Beckman Coulter (87%) and Abbott (85%). Roche fPSA was ≈3% lower and Abbott ≈17% higher than that of Beckman. For the percentage of fPSA, Roche had the highest sensitivity (98%). Conclusion: Roche cobas® and Beckman Coulter Access® Hybritech® tPSA were almost interchangeable. While the agreement was acceptable for tPSA, this did not happen with fPSA and greater efforts for harmonization are required

Assessing the impact of different penalty factors of the Bayesian reconstruction algorithm Q.Clear on in vivo low count kinetic analysis of [11C]PHNO brain PET-MR studies

Introduction: Q.Clear is a Bayesian penalised likelihood (BPL) reconstruction algorithm available on General Electric (GE) Positron Emission Tomography (PET)-Computed Tomography (CT) and PET-Magnetic Resonance (MR) scanners. This algorithm is regulated by a β value which acts as a noise penalisation factor and yields improvements in signal to noise ratio (SNR) in clinical scans, and in contrast recovery and spatial resolution in phantom studies. However, its performance in human brain imaging studies remains to be evaluated in depth. This pilot study aims to investigate the impact of Q.Clear reconstruction methods using different β value versus ordered subset expectation maximization (OSEM) on brain kinetic modelling analysis of low count brain images acquired in the PET-MR. Methods: Six [11C]PHNO PET-MR brain datasets were reconstructed with Q.Clear with β100–1000 (in increments of 100) and OSEM. The binding potential relative to non-displaceable volume (BPND) were obtained for the Substantia Nigra (SN), Striatum (St), Globus Pallidus (GP), Thalamus (Th), Caudate (Cd) and Putamen (Pt), using the MIAKAT™ software. Intraclass correlation coefficients (ICC), repeatability coefficients (RC), coefficients of variation (CV) and bias from Bland–Altman plots were reported. Statistical analysis was conducted using a 2-way ANOVA model with correction for multiple comparisons. Results: When comparing a standard OSEM reconstruction of 6 iterations/16 subsets and 5 mm filter with Q.Clear with different β values under low counts, the bias and RC were lower for Q.Clear with β100 for the SN (RC = 2.17), Th (RC = 0.08) and GP (RC = 0.22) and with β200 for the St (RC = 0.14), Cd (RC = 0.18)and Pt (RC = 0.10). The p-values in the 2-way ANOVA model corroborate these findings. ICC values obtained for Th, St, GP, Pt and Cd demonstrate good reliability (0.87, 0.99, 0.96, 0.99 and 0.96, respectively). For the SN, ICC values demonstrate poor reliability (0.43). Conclusion: BPND results obtained from quantitative low count brain PET studies using [11C]PHNO and reconstructed with Q.Clear with β < 400, which is the value used for clinical [18F]FDG whole-body studies, demonstrate the lowest bias versus the typical iterative reconstruction method OSEM

Modelos de exercício profissional usados pelos enfermeiros em hospitais portugueses

info:eu-repo/semantics/publishedVersio