O cuidado intensivo oferecido ao paciente no ambiente de Unidade de Terapia Intensiva

A conceptual framework of clinical nursing care in intensive care

Objective:

to propose a conceptual framework for clinical nursing care in intensive care.

Method:

descriptive and qualitative field research, carried out with 21 nurses from an intensive care unit of a federal public hospital. We conducted semi-structured interviews and thematic and lexical content analysis, supported by Alceste software.

Results:

the characteristics of clinical intensive care emerge from the specialized knowledge of the interaction, the work context, types of patients and nurses characteristic of the intensive care and care frameworks.

Conclusion:

the conceptual framework of the clinic's intensive care articulates elements characteristic of the dynamics of this scenario: objective elements regarding technology and attention to equipment and subjective elements related to human interaction, specific of nursing care, countering criticism based on dehumanization.

Comprehensiveness and humanization of nursing care management in the Intensive Care Unit

OBJECTIVE

Identifying the elements that promote comprehensiveness and humanization of nursing care management in the Intensive Care Unit, with an ecosystemic approach.

METHOD

A documentary qualitative study. The method of documentary analysis was used for data analysis.

RESULTS

Four pre-established categories were identified - Technical; Organizational; Technological; and Humanizing Dimensions. Data resulted in forming two sub-categories that integrate the humanizing dimension category, namely 'Comprehensiveness in healthcare actions' and 'Integrating processes and promoters of humanization,' bringing forth implications and challenges in forms of managing health work processes, enabling organizational, structural and managerial changes to the provided healthcare.

CONCLUSION

It was considered that all structural elements in managing nursing care with a focus on the needs of users should be in line with public policies and the principles of comprehensiveness and humanization, thus possessing strong potential for transforming health practices.

OBJETIVO

Identificar os elementos capazes de promover a integralidade e a humanização na gestão do cuidado de enfermagem na Unidade de Terapia Intensiva, com enfoque ecossistêmico.

MÉTODO

Pesquisa documental, de natureza qualitativa. Para a análise dos dados utilizou-se do método da análise documental.

RESULTADO

SForam identificadas quatro categorias preestabelecidas ‒ Dimensões: Técnica; Organizacional; Tecnológica e Humanizadora. Os dados resultantes das duas subcategorias que integraram a categoria Dimensão Humanizadora, Integralidade nas ações do cuidado e Processos integradores e promotores de humanização, trazem implicações e desafios nos modos de gerir os processos de trabalho em saúde, o que possibilita transformações organizacionais, estruturais e gerenciais na produção do cuidado.

CONCLUSÃO

Considera-se que na gestão do cuidado de enfermagem todos os elementos estruturantes, com enfoque nas necessidades dos usuários, devem estar em consonância com as políticas públicas e os princípios da integralidade e da humanização e possuir forte potencial para a transformação das práticas em saúde.

Intensive care nurses' practice related to experience and shift worked

OBJECTIVE

To analyse the social representations of nurses about intensive care practices comparing the variables 1) time since graduation and 2) shift worked.

METHOD

Qualitative field research using social representation theory. Individual interviews were conducted and lexical analysis was applied.

STUDY SETTING

Intensive Care Unit of a federal hospital with 21 clinical nurses.

FINDINGS

Day shift nurses are more pragmatic and operationally oriented because they deal directly with the general functioning of the unit. Less experienced nurses face difficulties dealing with intensive care contexts, but have a critical view of their practices, while more experienced nurses apply practical knowledge in their decision-making and actions.

CONCLUSION

The relationship of proximity or distance from patients, mediated by technology, is related to the domains of knowledge that are required to manage technology and to the role technology plays in intensive care.

Knowledge of nurses about delirium in critical patients: collective subject discourse

This is an exploratory, descriptive and qualitative study with the aim of analyzing the knowledge of nurses in an intensive care unit about delirium in critically ill patients. Study participants were fourteen ICU nurses from a public hospital. Data were collected through semi-structured interviews and analyzed using the Collective Subject Discourse technique. Five features were identified after data analysis: signs and symptoms, use of sedatives, physical restraint, environment and lack of professional preparation. It was found that nurses have doubts concerning delirium, its management in intensive care, the use of scales and nursing interventions. This study points to the need for education on the subject and further research on the management of delirium in nursing.

[Cross-Mapping: diagnostic labels formulated according to the ICNP® versus diagnosis of NANDA International]

This descriptive study aimed at elaborating nursing diagnostic labels according to ICNP®; conducting a cross-mapping between the diagnostic formulations and the diagnostic labels of NANDA-I; identifying the diagnostic labels thus obtained that were also listed in the NANDA-I; and mapping them according to Basic Human Needs. The workshop technique was applied to 32 intensive care nurses, the cross-mapping and validation based on agreement with experts. The workshop produced 1665 diagnostic labels which were further refined into 120 labels. They were then submitted to a cross-mapping process with both NANDA-I diagnostic labels and the Basic Human Needs. The mapping results underwent content validation by two expert nurses leading to concordance rates of 92% and 100%. It was found that 63 labels were listed in NANDA-I and 47 were not.