Validity and reliability of a pediatric patient classification instrument

OBJECTIVES:

to assess the construct validity and reliability of the Pediatric Patient Classification Instrument.

METHODS:

correlation study developed at a teaching hospital. The classification involved 227 patients, using the pediatric patient classification instrument. The construct validity was assessed through the factor analysis approach and reliability through internal consistency.

RESULTS:

the Exploratory Factor Analysis identified three constructs with 67.5% of variance explanation and, in the reliability assessment, the following Cronbach''s alpha coefficients were found: 0.92 for the instrument as a whole; 0.88 for the Patient domain; 0.81 for the Family domain; 0.44 for the Therapeutic procedures domain.

CONCLUSIONS:

the instrument evidenced its construct validity and reliability, and these analyses indicate the feasibility of the instrument. The validation of the Pediatric Patient Classification Instrument still represents a challenge, due to its relevance for a closer look at pediatric nursing care and management. Further research should be considered to explore its dimensionality and content validity.     

Acute kidney injury after contrast-enhanced examination among elderly

OBJECTIVES:

to assess renal function in elderly patients undergoing contrast-enhanced computed tomography and identify the preventive measures of acute kidney injury in the period before and after the examination.

METHOD:

longitudinal cohort study conducted at the Federal University of São Paulo Hospital, from March 2011 to March 2013. All hospitalized elderly, of both sexes, aged 60 years and above, who performed the examination, were included (n=93). We collected sociodemographic data, data related to the examination and to the care provided, and creatinine values prior and post exam.

RESULTS:

an alteration in renal function was observed in 51 patients (54%) with a statistically significant increase of creatinine values (p<0.04), and two patients (4.0%) required hemodialysis.

CONCLUSION:

There is an urgent need for protocols prior to and post contrast-enhanced examination in the elderly, and other studies to verify the prognosis of this population.     

Epidemiological characteristics of cases of death from tuberculosis and vulnerable territories

Objective:

to characterize the differences in the clinical and epidemiological profile of cases of death that had tuberculosis as an immediate or associated cause, and to analyze the spatial distribution of the cases of death from tuberculosis within the territories of Ribeirão Preto, Brazil.

Method:

an ecological study, in which the population consisted of 114 cases of death from tuberculosis. Bivariate analysis was carried out, as well as point density analysis, defined with the Kernel estimate.

Results:

of the cases of death from tuberculosis, 50 were the immediate cause and 64 an associated cause. Age (p=.008) and sector responsible for the death certificate (p=.003) were the variables that presented statistically significant associations with the cause of death. The spatial distribution, in both events, did not occur randomly, forming clusters in areas of the municipality.

Conclusion:

the difference in the profiles of the cases of death from tuberculosis, as a basic cause and as an associated cause, was governed by the age and the sector responsible for the completion of the death certificate. The non-randomness of the spatial distribution of the cases suggests areas that are vulnerable to these events. Knowing these areas can contribute to the choice of disease control strategies.     

Nurses' workload and its relation with physiological stress reactions

OBJECTIVE:

to analyze the relation between the workload and the physiological stress reactions among nurses working at a hospital service.

METHODS:

cross-sectional, correlational, quantitative study, involving 95 nurses, in 2011 and 2012. Spearman''s bivariate Correlation Test was used.

RESULTS:

most subjects are female, between 23 and 61 years old and working between 21 and 78 hours per week. The most frequent physiological reactions were back pain, fatigue/exhaustion, stiff neck and stomach acidity, with 46.3% of the subjects presenting low and 42.1% moderate physiological stress responses. No correlation was found between the workload and the physiological stress responses.

CONCLUSION:

although most of the nurses work more than 36 hours/week, physiologically, they do not present high reaction levels in response to stress. These workers deal with conflicts in the vertical and horizontal relations between professionals, family members and patients. In that sense, taking care of professionals who offer health services can be a fundamental strategy, as good user care mainly depends on healthy teams.     

The treatment of childhood cancer: unveiling the experience of parents

Objective

to understand the experiences of parents of children and adolescents with cancer undergoing treatment.

Method

qualitative research, based on Heidegger''s existential phenomenology, in which 13 parents of eight patients under 19 years of age, assisted by a charity association, were interviewed.

Results

three topics resulted from the analysis: "Experiencing the unpleasantness of the treatment"; "Fearing the possibility of a frightening situation" and "Experiencing the carelessness of another person". It was showed that during and after the treatment, the parents experience the fear of the unknown and the uncertainty of the future of their children, especially as they witness the death of other children; they also experience the indifference of professionals working in the local healthcare units and feel helpless and insecure.

Conclusion

It is essential that the healthcare professionals, particularly the nurses, reflect about their care actions focused on the parents of children with cancer, recognizing their existential needs with the purpose of assisting them in their situation.     

Weaving meanings from the deliberative process of collegiate management in nursing

Objective

to understand the meanings of the collegiate deliberations attributed by its members on an undergraduate nursing course.

Method

Grounded Theory, interviews being held with 30 participants, making up 4 sample groups, between January and June 2012, in a public higher education institution.

Result

5 categories emerged, indicating the phenomenon and weaving the paradigmatic model: Understanding the experience of the complex relationships and interactions in the deliberations of collegiate management in nursing: intertwining divergences, convergences, dialogs, collectivities and diversities. This deliberative process presents various meanings involving discussion, and divergent, convergent and complementary positions, through dialog, commitment and negotiation.

Conclusion

the deliberations in the collegiate of nursing, intertwining dialogs, collectivities and diversities, mold the complex relational fabrics.     

Theoretical assumptions of Maffesoli's sensitivity and Problem-Based Learning in Nursing Education

Objective

understand the everyday and the imaginary of Nursing students in their knowledge socialization process through the Problem-Based Learning (PBL) strategy.

Method

Action Research, involving 86 students from the second year of an undergraduate Nursing program in Spain. A Critical Incident Questionnaire and Group interview were used. Thematic/categorical analysis, triangulation of researchers, subjects and techniques.

Results

the students signal the need to have a view from within, reinforcing the criticism against the schematic dualism; PBL allows one to learn how to be with the other, with his mechanical and organic solidarity; the feeling together, with its emphasis on learning to work in group and wanting to be close to the person taking care.

Conclusions

The great contradictions the protagonists of the process, that is, the students experience seem to express that group learning is not a form of gaining knowledge, as it makes them lose time to study. The daily, the execution time and the imaginary of how learning should be do not seem to have an intersection point in the use of Problem-Based Learning. The importance of focusing on the daily and the imaginary should be reinforced when we consider nursing education.     

Evaluation of perineal muscle strength in the first trimester of pregnancy

OBJECTIVES:

to analyze the Pelvic Floor Muscle Strength (PFMS) of pregnant women with one or more vaginal or cesarean deliveries; to compare the PFMS of these with pregnant women with the PFMS of primiparous women.

METHODS:

cross-sectional study with women up to 12 weeks pregnant, performed in Itapecerica da Serra, São Paulo state, from December 2012 to May 2013. The sample consisted of 110 pregnant women with one or more vaginal deliveries or cesarean sections and 110 primigravidae. The PFMS was evaluated by perineometry (Peritron(tm)) and vaginal digital palpation (modified Oxford scale).

RESULTS:

the average PFMS in pregnant women with a history of vaginal delivery or cesarean section was 33.4 (SD=21.2) cmH2O. From the Oxford scale, 75.4% of the pregnant women with previous vaginal or cesarean deliveries presented grade ≤ 2, and 5.5% grade ≥ 4; among the primiparae, 39.9% presented grade ≤ 2, and 50.9% grade ≥ 4, with a statistically significant difference (p<0.001). From the perineometry, there was no statistically significant difference between the PFMS and age, type of delivery, parity, body mass index, and genitourinary tract symptoms, however, there was a statistically significant difference between the pregnant women with and without a history of episiotomy (p=0.04). In the palpation, none of the variables showed a statistically significant difference.

CONCLUSION:

pregnancy and childbirth can reduce the PFMS.     

Telephone follow-up of patients after radical prostatectomy: a systematic review

Objective

to assess and summarize the best scientific evidence from randomized controlled clinical trials about telephone follow-up of patients after radical prostatectomy, based on information about how the phone calls are made and the clinical and psychological effects for the individuals who received this intervention.

Method

the search was undertaken in the electronic databases Medline, Web of Science, Embase, Cinahl, Lilacs and Cochrane. Among the 368 references found, five were selected.

Results

two studies tested interventions focused on psychological support and three tested interventions focused on the physical effects of treatment. The psychoeducative intervention to manage the uncertainty about the disease and the treatment revealed statistically significant evidences and reduced the level of uncertainty and anguish it causes.

Conclusion

the beneficial effects of telephone follow-up could be determined, as a useful tool for the monitoring of post-prostatectomy patients.     

Examining a Comprehensive Model of Disaster-Related Posttraumatic Stress Disorder in Systematically Studied Survivors of 10 Disasters

Objectives. Using a comprehensive disaster model, we examined predictors of posttraumatic stress disorder (PTSD) in combined data from 10 different disasters.Methods. The combined sample included data from 811 directly exposed survivors of 10 disasters between 1987 and 1995. We used consistent methods across all 10 disaster samples, including full diagnostic assessment.Results. In multivariate analyses, predictors of PTSD were female gender, younger age, Hispanic ethnicity, less education, ever-married status, predisaster psychopathology, disaster injury, and witnessing injury or death; exposure through death or injury to friends or family members and witnessing the disaster aftermath did not confer additional PTSD risk. Intentionally caused disasters associated with PTSD in bivariate analysis did not independently predict PTSD in multivariate analysis. Avoidance and numbing symptoms represented a PTSD marker.Conclusions. Despite confirming some previous research findings, we found no associations between PTSD and disaster typology. Prospective research is needed to determine whether early avoidance and numbing symptoms identify individuals likely to develop PTSD later. Our findings may help identify at-risk populations for treatment research.The frequency of major disasters in the United States alone is staggeringly high: once a week on average, a new disaster strikes somewhere in the United States.1 Considering the frequency and devastation caused by such events in the United States and worldwide, understanding the psychiatric sequelae of major disasters is a public health issue of paramount importance.A comprehensive model, developed by this research team, of the mental health outcomes of disaster provides a framework for understanding factors associated with mental health sequelae of disasters.2 This model includes domains of personal characteristics of survivors, characteristics of the disaster agent and individual exposures to it, characteristics of the disaster community, and secondary sequelae and other negative life events. Few studies, however, are designed to assess the relative contribution of these different factors, and comparison of the prevalence of psychiatric disorders among survivors of different disasters has been hampered by lack of diagnostic rigor and inconsistent methods across studies.A landmark review by Norris et al.3,4 compiled mental health outcome data across the domains of the comprehensive model in a careful synthesis of 20 years of disaster research. This review included 250 published articles on the combined experience of 61 396 disaster survivors from 102 disasters. The body of original research reviewed was conducted in separate studies of numerous disasters by many research teams using “a variety of designs, time frames, assessment strategies, and sampling methods.”3(p240) Although Norris’s group noted widely held assumptions that human-caused disasters result in more severe mental health sequelae compared with natural disasters, they urged further consideration of these relationships.4 They also identified a continuing need for research that is prospective and longitudinal and examines diverse populations whose exposure is sufficient to yield adverse mental health consequences.The inherently emergent and chaotic nature of the postdisaster setting presents barriers to methodological rigor in disaster research. These conditions hamper timely access to highly exposed survivors, impede systematic sampling, restrict sample sizes, and limit time and resources that are critical to conducting full diagnostic assessments, and they undoubtedly contribute to contradictory findings in disaster research. Comparison of disaster research findings is limited by the variability in types and severity of disasters (e.g., large-scale vs more limited, local disasters; terrorism vs natural disasters), diversity of research samples (e.g., highly exposed survivors vs people who were distant from the incident; general population members vs treatment samples), and breadth of research methods (e.g., full diagnostic assessment vs questionnaires and symptom scales) inherent in this body of research.To overcome these limitations in understanding the psychosocial effects of disasters, comprehensive studies are needed that examine a breadth of disasters and exposed populations and use consistent methods. In the largest cross-disaster study conducted to date using consistent methods (uniform assessments and time frames) with full diagnostic evaluation, we merged data from 811 directly exposed survivors of 10 disasters of various types, conducted by 1 disaster team, to provide systematic data on the prevalence of posttraumatic stress disorder (PTSD) and its predictors.     

Assessment and risk classification protocol for patients in emergency units

Objective

to develop, validate the contents and verify the reliability of a risk classification protocol for an Emergency Unit.

Method

the content validation was developed in a University Hospital in a country town located in the state of Sao Paulo and was carried out in two stages: the first with the individual assessment of specialists and the second with the meeting between the researchers and the specialists. The use of the protocol followed a specific guide. Concerning reliability, the concordance or equivalent method among observers was used.

Results

the protocol developed showed to have content validity and, after the suggested changes were made, there were excellent results concerning reliability.

Conclusion

the assistance flow chart was shown to be easy to use, and facilitate the search for the complaint in each assistance priority.     

Factors associated with satisfaction at work in Psychosocial Care Centers

OBJECTIVES:

to analyze the prevalence of satisfaction at work and identify associated factors in Psychosocial Care Centers.

METHOD:

cross-sectional study involving 546 workers from 40 Psychosocial Care Centers in the South of Brazil. The satisfaction was identified based on the Assessment Scale of Satisfaction in the Mental Health Team and a logistic regression model was used for the adjusted data analysis.

RESULTS:

the prevalence of satisfaction at work corresponded to 66.4%. Factors directly associated with satisfaction: higher-level function (except physicians and psychologists), work time of six months or less, making a larger number of home visits, good supervision by the team, possibility to make collective choices and take courses.

CONCLUSIONS:

the satisfaction is associated with the work organization and conditions and demonstrates the need to invest in team supervisions, in process that democratize the services and in the workers'' training.