Use of ultrasonography in the evaluation of urinary retention in critically ill patients

OBJECTIVE

to measure urinary volume through bladder ultrasound, performed by a nurse in critically ill patients, after removal of the indwelling urinary catheter and to verify the related factors on urinary retention.

METHOD

quantitative, observational and cross-sectional study, carried out with 37 critically ill patients of both sexes, over 18 years of age, with removal of indwelling urinary catheter in the last 48 hours. A questionnaire containing sociodemographic and clinical variables and an ultrasound examination were used. Data were presented through frequency distribution, centrality and variability measures, association using Fisher`s exact test and, for analysis multiple binomial logistic regression analysis.

RESULTS

the 37 patients were mostly male, with a mean age of 54.9 years. The measurement of urinary volume by ultrasound ranged from 332.3 to 950 ml, and 40.54% of patients had urinary retention. Urinary retention was significantly associated with the occurrence of urinary tract infection, intestinal constipation and spontaneous overflow diuresis. Patients with urinary tract infection were 7.4 times more likely to have urinary retention.

CONCLUSION

bladder ultrasonography was effective in measuring urinary volume after removal of the indwelling urinary catheter and and may contribute to the detection of urinary retention. (1) Ultrasonography of the bladder showed an advantage for a better nursing diagnosis. (2) Critical patients had urinary retention after removal of urinary catheter. (3) Overflow incontinence was detected after removal of the urinary catheter. (4) Patients with urinary tract infection were 7.4 times more likely to have retention.

Cateter venoso central de curta permanência: produção de vídeos educativos para a equipe de enfermagem

RESUMO Objetivo construir e validar roteiros e storyboards para a produção de vídeos educativos, em formato digital, sobre os cuidados e manutenção do cateter venoso central em pacientes adultos. Método estudo metodológico, descritivo, sobre construção e validação dos roteiros e storyboards para a produção de vídeos educativos, ocorrido em duas etapas metodológicas: de pré-produção e de produção. A etapa de pré-produção baseou-se em três fases: construção dos roteiros dos vídeos, elaboração dos storyboards e validação por peritos. A validação dos roteiros e storyboards foi realizada por nove juízes especialistas na temática e dois técnicos especialistas em vídeo. Calculou-se o Índice de Validação de Conteúdo (IVC), considerando-se como aceitável o índice mínimo de 0,80 para cada item dos instrumentos. Resultados produziram-se três vídeos educativos com as seguintes temáticas: cobertura, manutenção e troca e remoção do cateter venoso central. A respeito da validação pelos juízes especialistas na temática e pelos técnicos especialistas em vídeo, todos os itens avaliados resultaram na concordância em IVC de 100,0. Conclusão e implicações para a prática os vídeos educativos foram produzidos, validados e adequados para serem disponibilizados. A participação dos juízes na validação desse material foi fundamental para garantir a relevância teórica e prática do resultado.

Short-term central venous catheter: Production of educational videos for the Nursing team

ABSTRACT Objective to prepare and validate scripts and storyboards for the production of educational videos, in digital format, about the care and maintenance of the central venous catheters in adult patients. Method a methodological and descriptive study about the elaboration and validation of scripts and storyboards for the production of educational videos that was conducted in two methodological stages: pre-production and production. The pre-production stage was based on three phases: preparation of the video scripts, elaboration of the storyboards, and validation by experts. Validation of the scripts and storyboards was in charge of 9 specialist judges in the subject matter and 2 technical experts in video; the Content Validation Index (CVI) was calculated considering as acceptable a minimum index of 0.80 for each item of the instruments. Results three educational videos were created with the following themes: dressing, maintenance and exchange and removal of the central venous catheter. Concerning the validation by expert judges in the subject matter and expert video technicians, all items evaluated resulted in agreement with a CVI of 100.0. Conclusion and implications for the practice the educational videos were elaborated, validated and suitable to be made available; the judges' participation in the validation of this material was essential to ensure the theoretical and practical relevance of the result.

Validação de cenários simulados para estudantes de enfermagem: avaliação e tratamento de Lesão por Pressão

Objetivo: validar cenários simulados para ensino e aprendizagem de estudantes de enfermagem sobre avaliação e tratamento de Lesão por Pressão. Método: estudo metodológico, com cenários construídos por meio do referencial de Fabri e normas de práticas recomendadas da International Nursing Association for Clinical Simulation and Learning. A seleção dos juízes seguiu os critérios de Fehring e snowball technique, a coleta de dados ocorreu em duas etapas conforme Delphi. A análise dos resultados considerou o nível de concordância 0,80. Resultados: dois cenários foram validados resultando o Scale-Level Content Validity Index global maior que 0,80; ambos compõem itens sobre o conhecimento prévio do aprendiz, objetivo geral e específicos de aprendizagem, fundamentação teórica, responsáveis, complexidade, documentação, Briefing, tema, recursos humanos e materiais, público-alvo, treino da equipe, Debriefing eavaliação. Conclusões: cenários simulados foram validados para o ensino-aprendizagem de estudantes de enfermagem, para avaliar e tratar Lesão por Pressão no contexto hospitalar e domiciliar.

Self-confidence in the care of critically ill patients: before and after a simulated intervention

OBJECTIVE

To evaluate the self-confidence of nurses in the care of critically ill patients, before and after a simulated intervention.

METHOD

A quasi-experimental study was carried out with 103 nurses who participated in a workshop on the care of critically ill patients in the first semester of 2016. A clinical simulation pedagogical instrument was used throughout the event, and self-confidence was assessed by the Portuguese version of the Self-confidence Scale (SCSvp).

RESULTS

Most participants reported not being prepared to provide first care to critically ill patients, which was carried out during care practice. The participants presented a significant increase in self-confidence after the simulated intervention (p<0.001) in the cardiac, neurological, and respiratory dimensions.

CONCLUSION

Simulation has proved to be an effective strategy for the development of individuals' self-confidence, which contributes to the improvement of skills required for professional practice.

Social Determinants of Health in the lives of urinary catheter users

OBJECTIVE

To identify the influence of social determinants of health on the life conditions of patients who use intermittent urinary catheters.

METHOD

This was a descriptive study conducted in a rehabilitation center with 243 neurogenic bladder patients who used clear intermittent urinary catheters. The study was carried out between March 2012 and October 2015, using interviews based on semi-structured instruments, and data analysis using descriptive statistics.

RESULTS

Most of the patients were men, between 16 and 64 years old, single, with an elementary education level, and a monthly household income of 2 to 3 minimum wages. The results show that the social determinants of health were related to socioeconomic, demographic, and health factors.

CONCLUSION

The findings indicate a complex relationship between social determinants of health and the life conditions of patients who use clean intermittent urinary catheters, presenting greater vulnerability related to some aspects of health conditions.

Trends in Research on Simulation in the Teaching of Nursing: An Integrative Review

AIM

The aim of the study was to identify and reflect on evidence regarding the use of simulation in nursing education.

BACKGROUND

The use of simulation as a teaching strategy in nursing is expanding. It is important to check the evidence deriving from research.

METHOD

Departing from a guiding question, an international literature search was undertaken between January 2008 and March 2014 in Portuguese, English, and Spanish.

RESULTS

Out of 160 articles, 68.1 percent used simulated teaching to develop clinical reasoning; 31.9 percent used it to train skills. Most (about 91.8 percent) discussed positive aspects related to the use of simulation, including support for the teaching process and increased self-efficacy and self-confidence.

CONCLUSION

The studies indicate that appropriate tools are needed to measure the true impact of the strategy on the teaching of nursing care and the training needed to use simulation as a teaching strategy.

Validation to Portuguese of the Debriefing Experience Scale

OBJECTIVE

to translate and validate to Portuguese the Debriefing Experience Scale jointly with individuals that used high-fidelity simulation in learning.

METHOD

methodological and exploratory study for an instrument translation and validation. For the validation process, the event "III Workshop Brazil - Portugal: Care Delivery to Critical Patients" was created.

RESULTS

103 nurses attended. Validity and reliability of the scale, the correlation pattern among variables, the sampling adequacy test, and the sphericity test showed good results. Since there was no relationship among the groups established in the exploratory factor analysis, the option was to follow the division established by the original version.

CONCLUSION

the version of the instrument was called Escala de Experiência com o Debriefing. The results showed good psychometric properties and a good potential for use. However, further studies will contribute to consolidate the validity of the scale and strengthen its potential use.

Validation of self - confidence scale for clean urinary intermittent self - catheterization for patients and health - caregivers

Objective

To validate a measurement instrument for clean intermittent self-catheterization for patients and health-caregivers.

Material and Methods

Methodological study of instrument validation performed at a Rehabilitation Center in a University hospital for patients submitted to clean intermittent self-catheterization and their health-caregivers. Following ethical criteria, data were collected during interview with nurse staff using a Likert question form containing 16 items with 5 points each: “no confidence”=1, “little confidence”=2, “confident”=3, “very confident”=4 and “completely confident”=5. Questionnaire called “Self-Confident Scale for Clean Intermittent Self-catheterization” (SCSCISC) was constructed based on literature and previously validated (appearance and content).

Results

The instrument was validated by 122 patients and 119 health-caregivers, in a proportion of 15:1. It was observed a good linear association and sample adequacy KMO 0.931 and X2=2881.63, p<0.001. Anti-image matrix showed high values at diagonal suggesting inclusion of all factors. Screen plot analysis showed a suggestion of items maintenance in a single set. It was observed high correlation of all items with the total, alpha-Cronbach 0.944. The same results were obtained in subsamples of patients and health-caregivers.

Conclusion

The instrument showed good psychometric adequacy corroborating its use for evaluation of self-confidence during clean intermittent self-catheterization.

Urinary retention: implications of low-fidelity simulation training on the self-confidence of nurses

METHOD

This was a quasi-experimental study carried out among nurses stationed in municipal care units in the interior of São Paulo State. Data were collected during the course of a pedagogical workshop that used low-fidelity simulation training.

RESULTS

The study included 42 nurses, mostly female with over 15 years of experience. After low-fidelity simulation training, nurses showed a significant increase (p<0.05) in confidence related to nursing care in urinary retention. The lowest self-attributed scores during the activity were related to the objective assessment of urinary retention.

CONCLUSION

Low-fidelity simulated training is an effective resource for the development of nurses with respect to nursing care in urinary retention.

OBJETIVO

Avaliar o nível de autoconfiança de enfermeiros na assistência de enfermagem na retenção urinária antes e após atividade simulada de baixa fidelidade.

MÉTODO

Estudo quase-experimental realizado junto aos enfermeiros lotados nas unidades de atendimento de município do interior do estado de São Paulo. Os dados foram coletados durante a realização de uma oficina pedagógica que contou com atividade simulada de baixa fidelidade.

RESULTADOS

Participaram do estudo 42 enfermeiros, a maioria do sexo feminino e com mais de 15 anos de atuação. Após o treino simulado de baixa fidelidade os enfermeiros demonstraram aumento significativo (p < 0,05) na autoconfiança relacionada à assistência de enfermagem na retenção urinária. Os menores escores autoatribuídos durante a atividade foram relacionados à avaliação objetiva da retenção urinária.

CONCLUSÃO

A simulação de baixa fidelidade é um recurso efetivo no aprimoramento de enfermeiros no que diz respeito à assistência de enfermagem na retenção urinária.

Validation of the self-confidence scale of nursing care in urinary retention

Objective:

to validate an instrument to measure self-confidence of nursing care in urinary retention.

Methods:

methodological research study, carried out after ethical approval. A Likert-like scale of 32 items related to nursing care in urinary retention was applied to students of the graduate nursing course. For instrument validation, analysis of the sample adequacy and main components, Varimax orthogonal rotation and internal consistency analyses were developed.

Results:

in a sample of 305 students, there was high correlation of all items with the total scale and Cronbach's alpha of 0.949. The scale items were divided into five factors with internal consistency: Factor 1 (0.890), Factor 2 (0.874), Factor 3 (0.868), Factor 4 (0.814) and Factor 5 (0.773), respectively.

Conclusion:

the scale meets the validity requirements, demonstrating potential for use in evaluation and research.

Consequências do uso de fraldas descartáveis em pacientes adultos: implicações para a assistência de enfermagem

Objetivo: verificar as consequências do uso de fraldas descartáveis em pacientes adultos e discutir suas implicações para a assistência de enfermagem. Método: estudo de análise de sobrevivência realizado por observação direta e sistematizada. Seguidos os preceitos éticos, durante um período de 30 dias, foram observados 43 pacientes maiores de 18 anos, usuários de fraldas descartáveis, na unidade de clínica médica de um hospital de grande porte do estado de São Paulo. Resultados: dentre os 43 (100 %) pacientes da amostra, todos apresentaram evento subsequente ao uso de fraldas descartáveis. Os eventos observados foram uso de coletor urinário, uso do cateter urinário de demora, presença de infecção de trato urinário (ITU), presença de dermatite e úlcera por pressão (UPP), alterações do estado de consciência e do estado de orientação. Conclusão: observou-se uma relação entre o uso de fraldas de maneira indiscriminada com a qualidade do cuidado e segurança do paciente. A observação das implicações do uso de fraldas descartáveis na assistência de enfermagem ao paciente é recente e necessita novos estudos.