Quality of nursing care and satisfaction of patients attended at a teaching hospital

Objectives

assess the quality of nursing care, the patients'' satisfaction and the correlation between both.

Method

cross-sectional study, involving 275 patients hospitalized at a teaching hospital in the Central-West of Brazil. The data were collected through the simultaneous application of three instruments. Next, they were included in an electronic database and analyzed in function of the positivity, median value and Spearman''s correlation coefficients.

Results

among the nursing care assessed, only two were considered safe - hygiene and physical comfort; nutrition and hydration - while the remainder were classified as poor. Nevertheless, the patients were satisfied with the care received in the domains assessed: technical-professional, confidence and educational. This can be justified by the weak to moderate correlation that was observed among these variables.

Conclusion

Despite the quality deficit, the patients'' satisfaction level with the nursing care received was high. These results indicate that the institution needs to center its objectives on a continuing evaluation system of the care quality, aiming to attend to the patients'' expectations.     

Factors associated with the patient safety climate at a teaching hospital

Objectives:

to investigate the association between the scores of the patient safety climate and socio-demographic and professional variables.

Methods:

an observational, sectional and quantitative study, conducted at a large public teaching hospital. The Safety Attitudes Questionnaire was used, translated and validated for Brazil. Data analysis used the software Statistical Package for Social Sciences. In the bivariate analysis, we used Student''s t-test, analysis of variance and Spearman''s correlation of (α=0.05). To identify predictors for the safety climate scores, multiple linear regression was used, having the safety climate domain as the main outcome (α=0.01).

Results:

most participants were women, nursing staff, who worked in direct care to adult patients in critical areas, without a graduate degree and without any other employment. The average and median total score of the instrument corresponded to 61.8 (SD=13.7) and 63.3, respectively. The variable professional performance was found as a factor associated with the safety environment for the domain perception of service management and hospital management (p=0.01).

Conclusion:

the identification of factors associated with the safety environment permits the construction of strategies for safe practices in the hospitals.     

Patient safety culture at neonatal intensive care units: perspectives of the nursing and medical team

OBJECTIVE:

to verify the assessment of the patient safety culture according to the function and length of experience of the nursing and medical teams at Neonatal Intensive Care Units.

METHOD:

quantitative survey undertaken at four Neonatal Intensive Care Units in Florianópolis, Brazil. The sample totaled 141 subjects. The data were collected between February and April 2013 through the application of the Hospital Survey on Patient Safety Culture. For analysis, the Kruskal-Wallis and Chi-Square tests and Cronbach''s Alpha coefficient were used. Approval for the research project was obtained from the Ethics Committee, CAAE: 05274612.7.0000.0121.

RESULTS:

differences in the number of positive answers to the Hospital Survey on Patient Safety Culture, the safety grade and the number of reported events were found according to the professional characteristics. A significant association was found between a shorter Length of work at the hospital and Length of work at the unit and a larger number of positive answers; longer length of experience in the profession represented higher grades and less reported events. The physicians and nursing technicians assessed the patient safety culture more positively. Cronbach''s alpha demonstrated the reliability of the instrument.

CONCLUSION:

the differences found reveal a possible relation between the assessment of the safety culture and the subjects'' professional characteristics at the Neonatal Intensive Care Units.     

某医院住院病人满意度调查及其影响因素分析

目的了解医院住院及出院病人的满意度情况，为提高医疗服务质量提供参考。方法采用自制的调查表，分别调查医院的住院及出院病人满意度。结果本调查表测得克朗巴哈的α信度系数为0．98．调查表总分与各项目分的相关系数绝大部分大于0.5。绝大部分病人的满意度评分在8分以上。行风情况得分最高，医护人员（包括医生、护士和其它医务人员）次之，出入院处理和工作效率及辅助检查位居第3，后勤管理是第4位，收费情况得分最低。住院病人与出院病人对医院的评价没有统计学差异。影响病人总评分的关键因素是护士的技术水平、等候手术时问、经治医生检查是否认真负责、病房的整洁安静程度和是否有乱收费现象等指标。病人的建议集中在后勤管理方面。结论①本调查表的信度和效度较高，可尝试作为量表使用；②病人对该医院的总体评价较高，但对后勤管理和收费方面的评价相对较低并要求改进；③出院病人和住院病人对医院的评价没有差别；④提高病人满意度应该从技术、服务、效率和费用等方面入手。     

Adverse drug events in hospital: pilot study with trigger tool

OBJECTIVE

To estimate the frequency of and to characterize the adverse drug events at a terciary care hospital.

METHODS

A retrospective review was carried out of 128 medical records from a hospital in Rio de Janeiro in 2007, representing 2,092 patients. The instrument used was a list of triggers, such as antidotes, abnormal laboratory analysis results and sudden suspension of treatment, among others. A simple random sample of patients aged 15 and over was extracted. Oncologic and obstetric patients were excluded as were those hospitalized for less than 48 hours or in the emergency room. Social and demographic characteristics and those of the disease of patients who underwent adverse events were compared with those of patients who did not in order to test for differences between the groups.

RESULTS

Around 70.0% of the medical records assessed showed at least one trigger. Adverse drug events triggers had an overall positive predictive value of 14.4%. The incidence of adverse drug events was 26.6 per 100 patients and 15.6% patients suffered one or more event. The median length of stay for patients suffering an adverse drug event was 35.2 days as against 10.7 days for those who did not (p < 0.01). The pharmacological classes most commonly associated with an adverse drug event were related to the cardiovascular system, nervous system and alimentary tract and metabolism. The most common active substances associated with an adverse drug event were tramadol, dypirone, glibenclamide and furosemide. Over 80.0% of events provoked or contributed to temporary harm to the patient and required intervention and 6.0% may have contributed to the death of the patient. It was estimated that in the hospital, 131 events involving drowsiness or fainting 33 involving falls, and 33 episodes of hemorrhage related to adverse drug effects occur annually.

CONCLUSIONS

Almost one-sixth of in-patients (16,0%) suffered an adverse drug event. The instrument used may prove useful as a technique for monitoring and evaluating patient care results. Psycothropic therapy should be critically appraised given the frequency of associated events, such as excessive sedation, lethargy, and hypotension.     

Treatment adherence in heart failure patients followed up by nurses in two specialized clinics

Objectives:

to analyze treatment adherence in heart failure (HF) patients followed up by the nursing staff at specialized clinics and its association with patients'' characteristics such as number of previous appointments, family structure, and comorbidities.

Methods:

a cross-sectional study was conducted at two reference clinics for the treatment of HF patients (center 1 and center 2). Data were obtained using a 10-item questionnaire with scores ranging from 0 to 26 points; adherence was considered adequate if the score was ≥ 18 points, or 70% of adherence.

Results:

a total of 340 patients were included. Mean adherence score was 16 (±4) points. Additionally, 124 (36.5%) patients showed an adherence rate ≥ 70%. It was demonstrated that patients who lived with their family had higher adherence scores, that three or more previous nursing appointments was significantly associated with higher adherence (p<0.001), and that hypertension was associated with low adherence (p=0.023).

Conclusions:

treatment adherence was considered satisfactory in less than a half of the patients followed up at the two clinics specialized in HF. Living with the family and attending to a great number of nursing appointments improved adherence, while the presence of hypertension led to worse adherence.     

Software development to support decision making in the selection of nursing diagnoses and interventions for children and adolescents

Objective:

to report the development of a software to support decision-making for the selection of nursing diagnoses and interventions for children and adolescents, based on the nomenclature of nursing diagnoses, outcomes and interventions of a university hospital in Paraiba.

Method:

a methodological applied study based on software engineering, as proposed by Pressman, developed in three cycles, namely: flow chart construction, development of the navigation interface, and construction of functional expressions and programming development.

Result:

the software consists of administrative and nursing process screens. The assessment is automatically selected according to age group, the nursing diagnoses are suggested by the system after information is inserted, and can be indicated by the nurse. The interventions for the chosen diagnosis are selected by structuring the care plan.

Conclusion:

the development of this tool used to document the nursing actions will contribute to decision-making and quality of care.     

Clinical factors predicting risk for aspiration and respiratory aspiration among patients with Stroke

Objective:

to investigate the association of risk factors with the Risk for aspiration nursing diagnosis and respiratory aspiration.

Method:

cross-sectional study assessing 105 patients with stroke. The instrument used to collect data addressing sociodemographic information, clinical variables and risk factors for Risk for aspiration. The clinical judgments of three expert RNs were used to establish the diagnosis. The relationship between variables and strength of association using Odds Ratio (OR) was verified both in regard to Risk for aspiration and respiratory aspiration.

Results:

risk for aspiration was present in 34.3% of the patients and aspiration in 30.5%. The following stood out among the risk factors: Dysphagia, Impaired or absent gag reflex, Neurological disorders, and Impaired physical mobility, all of which were statistically associated with Risk for aspiration. Note that patients who develop such a diagnosis were seven times more likely to develop respiratory aspiration.

Conclusion:

dysphagia, Impaired or absent gag reflex were the best predictors both for Risk for aspiration and respiratory aspiration.     

Validation of the Adherence Determinants Questionnaire scale among women with breast and cervical cancer

Objectives:

the aim was to translate and culturally adapt the Adherence Determinants Questionnaire scale for the Portuguese language in the Brazilian context, and to check its reliability and validity to analyze the elements of the adherence of patients to the clinical treatment for breast and cervical cancer.

Method:

this was a methodological study, carried out in two oncology reference centers. The sample consisted of 198 participants, with 152 being treated for breast cancer and 46 being treated for cervical cancer. The content validation was performed by a committee of experts. The construct validation was demonstrated through factor analysis and the reliability was analyzed using Cronbach''s alpha.

Results:

the committee of experts made the necessary adjustments so that the scale was adapted to the Brazilian context. The factor analysis suggested a reduction from seven to five factors and the maintenance of 38 items similar to those of the original scale. The reliability, investigated through Cronbach''s alpha, was .829, showing high internal consistency.

Conclusion:

it was concluded that the Brazilian version of the Adherence Determinants Questionnaire scale is a valid and reliable instrument that is able to measure the elements of adherence to the treatment for breast and cervical cancer.     

移动临床信息系统在病人安全管理中的应用

目的:讨论移动临床信息系统在病人安全管理中的应用及意义.方法:在影响病人安全因素及传统医疗质量管理局限性简要讨论的基础上,分析无线移动临床信息系统在病人安全管理中的应用实践.结果:在实现连贯可及的信息贯穿医疗全流程的同时,移动临床信息系统重点加强病人安全管理的应用,在完善病人身份识别,严格执行查对制度,提高用药安全,加强医务人员责任意识,提高效率等方面取得成效.结论:移动临床信息系统的应用有效促进病人安全管理水平的提高.     

Adherence to treatment for diabetes mellitus: validation of instruments for oral antidiabetics and insulin

Objectives

to verify the face validity, criterion-related validity and the reliability of two distinct forms of presentation of the instrument Measurement of Adherence to Treatment, one being for ascertaining the adherence to the use of oral antidiabetics and the other for adherence to the use of insulin, as well as to assess differences in adherence between these two modes of drug therapy.

Method

a methodological study undertaken with 90 adults with Type 2 Diabetes Mellitus. The criterion-related validity was verified using the Receiver Operating Characteristic curves; and for the reliability, the researchers calculated the Cronbach alpha coefficient, the item-total correlation, and the Pearson correlation coefficient.

Results

the oral antidiabetics and the other showed sensitivity of 0.84, specificity of 0.35 and a Cronbach correlation coefficient of 0.84. For the adherence to the use of insulin, the values found were, respectively, 0.60, 0.21 and 0.68. A statistically significant difference was found between the final scores of the two forms of the instrument, indicating greater adherence to the use of insulin than to oral antidiabetics.

Conclusion

it is concluded that the two forms of the Measurement of Adherence to Treatment instrument are reliable and should be used to evaluate adherence to drug treatment among people with diabetes mellitus.