Teaching-Learning Programs to Prevent and Control Infections Related to Long-Term Central Venous Access Device in Cancer Patients: A Systematic Review

OBJECTIVES

To evaluate the effectiveness of teaching-learning programs for cancer patients and/or their caregivers or family in preventing and controlling infections associated with long-term central venous access devices.

DATA SOURCES

This systematic review used the CINAHL, Cochrane Library, EMBASE, LILACS, and MEDLINE via PubMed portal, Scopus, and Web of Science. Google Scholar was used for the gray literature search. The included studies were analyzed, and the obtained data were qualitatively synthesized. The risk of bias was assessed using Cochrane tools: RoB 2 and ROBINS-I. The certainty of the evidence was evaluated using the GRADE. The review protocol was registered in PROSPERO (CRD42021267530).

CONCLUSION

The teaching-learning programs were implemented through theoretical-practical and theoretical dimensions in five and two studies, respectively. The risk of bias in the studies was low, moderate, severe, and high in one, three, two, and one of them, respectively. The certainty was very low. Teaching-learning programs on central venous access devices care for cancer patients and/or their caregivers or families could be effective in reducing infection rates.

IMPLICATIONS FOR NURSING PRACTICE

This systematic review addressed the teaching-learning programs for preventing and controlling infections associated with long-term central venous access devices. We identified that the most programs were effective in reducing the infection rates. The results may influence the clinical practice of oncology nurses, and consequently, the educational strategies and methods provided not only to these patients but for caregivers and families.

Effectiveness of co-debriefing to develop clinical skills in basic life support: randomized pilot study

ABSTRACT Objective To compare the effectiveness of co-debriefing with debriefing with a facilitator in the development of clinical competences in nursing students in the simulated care of cardiac arrest. Method Randomized pilot study, carried out at a university in Minas Gerais, Brazil, in August 2021, with 17 students, to compare debriefing with a facilitator (control n=8) with co-debriefing (intervention n=9). Pre- and post-test, Objective Structured Clinical Examination and scales were used to assess behavioral skills. Wilcoxon and Mann-Whitney nonparametric comparison tests were used for analysis. Results The intervention group performed better than the control for knowledge about basic life support (control=17.00±2.39 and intervention=19.22 ± 0.66, p=0.021) and psychomotor skills (control=8.12±0.13 and intervention=8.50 ± 0.001, p<0.001). There were no significant differences for behavioral skills. Conclusion Co-debriefing appears to be more effective than debriefing with a facilitator to develop clinical skills in basic life support in nursing.

Efetividade do co-debriefieng para desenvolver competências clínicas no suporte básico de vida: estudo piloto randomizado

RESUMO Objetivo Comparar a efetividade entre co-debriefing com debriefing com facilitador no desenvolvimento de competências clínicas em estudantes de enfermagem no atendimento simulado da parada cardiorrespiratória. Método Estudo-piloto randomizado, realizado em uma universidade de Minas Gerais, Brasil, em agosto de 2021 com 17 estudantes, para comparar o debriefing com um facilitador (controle n=8) e com o co-debriefing (intervenção n=9). Utilizaram-se pré e pós-teste, Exame Clínico Objetivo Estruturado e escalas para avaliar as habilidades comportamentais. Adotaram-se testes de comparação não paramétricos Wilcoxon e Mann-whitney para análise. Resultados O grupo intervenção obteve desempenho superior ao controle para o conhecimento sobre o suporte básico de vida (controle=17,00±2,39 e intervenção=19,22 ± 0,66, p=0,021) e habilidades psicomotoras (controle=8,12±0,13 e intervenção=8,50 ± 0,001, p<0,001). Não houve diferenças significativas para as habilidades comportamentais. Conclusão O co-debriefing parece ser mais efetivo do que o debriefing como um facilitador para desenvolver competências clínicas no suporte básico de vida em enfermagem.

Blended learning program for the development of skills in the aspiration of artificial airways

Objective:

to develop and validate a blended learning program, of the inverted classroom type, on the aspiration of artificial airways.

Method:

applied and methodological research that involved technological production for teaching a Nursing Intervention, based on Vygotsky’s theoretical frameworks and on the Nursing Process. For elaboration and validation, a classic instructional design model was followed. The general and pedagogical requirements were validated, as well as those for videos and interface. For the analysis, the Content Validity Index and the First-order agreement coefficient were used.

Results:

34 experts participated, 27 of whom were nurses and seven were professionals in Information Technology. In the nurses’ opinion, the general and pedagogical requirements obtained a Content Validity Index of 0.99 and 0.98 was obtained for the videos and for the interface. The interface for the IT professionals was 0.94. All requirements showed almost perfect agreement.

Conclusion:

the teaching program was elaborated and validated by experts and constitutes an innovative proposal to train nurses. The mediation of teaching by means of duly validated technologies can favor learning and reaching positive results in the development of skills in the practice of aspiration of artificial airways.

Debriefing methods and techniques used in nursing simulation

OBJECTIVE

To identify in the literature methods and techniques of debriefing used in teaching and learning in nursing simulation.

METHODS

Integrative review of PubMed/MEDLINE®, LILACS, Scopus and CINAHL® databases, with the descriptors "nursing", "nursing education", respective terms in English and Spanish, and the keyword "debriefing". Twelve primary studies, in Portuguese, English and Spanish, from January 2008 to December 2018 were included. Qualitative analysis was used to categorize the domains.

RESULTS

The identified meaningful learning methods were based on principles of transfer of learning; model of clinical reasoning, interprofessional, with good judgment and structured and self-debriefing techniques, oral, eye-tracking, video-assisted and written debriefing.

CONCLUSIONS

The structured method and the oral technique with video were outstanding. One method was not superior to the other but effective for a particular proposal. No national studies have been found. Research should be conducted on the effectiveness of nursing debriefing methods and techniques.

Hand hygiene: knowledge and skill of caregivers in the hematopoietic stem cell transplantation

OBJECTIVE

to identify the knowledge and ability of caregivers on hand hygiene in hematopoietic stem cell transplantation.

METHOD

a prospective cross-sectional study. A questionnaire was used to identify the knowledge and it was observed the hygiene technique performance. Data were collected in two units (autologous and allogeneic transplant).

RESULTS

the 37 participants recognized the importance of hand hygiene and 95.5% related to removal of dirt or infection prevention. 91.9% stated that it was important to clean their hands with soap and water when entering and leaving the room, and 64.9% understood that it was necessary to apply alcoholic solution after washing. On average, the caregivers scored 6.16 steps, when demonstrating the washing technique and 3.91 steps in the friction with alcoholic solution.

CONCLUSION

although they recognize the importance of the procedure, there are deficits related to the moment and the correct way of doing it, evidencing the need for strategies aimed at improving this process.

Virtual learning object in hematopoietic stem cell transplantation for autoimmune diseases

ABSTRACT Objective: describe the development of a virtual learning object to provide information about autologous transplantation of hematopoietic stem cells to autoimmune diseases. Methods: methodological study of a website development, using the instructional design model that includes Analysis, Design, Development and Implementation. Results: the virtual object, available at http://www.transplantardai.com.br, was developed in a web platform, in the Hypertext Markup Language, using the software WebAcappella - Responsive Website Creator (Intuisphere, France 2016). The content was structured in the modules: History, Transplant, Autoimmune Diseases, Links, Guidelines, Speech Team and Doubts. The icons and menus were created in order to attract the user, facilitating the search for information and allowing maximum use of the resources available on the website. Conclusion: the methodology used allowed the development of the virtual learning object, which can be used as a tool to guide and disseminate knowledge about this treatment.

Competências de enfermeiros nos cuidados críticos de crianças submetidas a transplante de células-tronco hematopoéticas

Estudo descritivo, com análise qualitativa dos dados, a fim de identificar e analisar experiências e competências necessárias ao enfermeiro no atendimento à criança transplantada que demanda cuidados críticos. Foram entrevistados nove enfermeiros. Os dados foram analisados segundo os procedimentos para análise qualitativa de conteúdo e, em seguida, elaboraram-se os temas: Cuidados críticos à criança transplantada: duplo desafio para o enfermeiro; Competências do enfermeiro para assistência à criança grave submetida a transplante de células-tronco hematopoéticas (TCTH). As competências identificadas fundamentaram-se em conhecimento científico, habilidades e aptidões e estão relacionadas ao conhecimento específico sobre TCTH pediátrico; habilidades técnico-científicas, interacionais e de comunicação; gerenciamento de recursos materiais e equipamentos; controle emocional, empatia e liderança. Tais competências auxiliam na construção de um perfil específico para o cuidado oferecido a esta clientela, com vistas ao sucesso terapêutico.

Anxiety and performance of nursing students in regard to assessment via clinical simulations in the classroom versus filmed assessments

OBJECTIVE

To compare the level of anxiety and performance of nursing students when performing a clinical simulation through the traditional method of assessment with the presence of an evaluator and through a filmed assessment without the presence of an evaluator.

METHODOLOGY

Controlled trial with the participation of Brazilian public university 20 students who were randomly assigned to one of two groups: a) assessment through the traditional method with the presence of an evaluator; or b) filmed assessment. The level of anxiety was assessed using the Zung test and performance was measured based on the number of correct answers.

RESULTS

Averages of 32 and 27 were obtained on the anxiety scale by the group assessed through the traditional method before and after the simulation, respectively, while the filmed group obtained averages of 33 and 26; the final scores correspond to mild anxiety. Even though there was a statistically significant reduction in the intra-groups scores before and after the simulation, there was no difference between the groups. As for the performance assessments in the clinical simulation, the groups obtained similar percentages of correct answers (83% in the traditional assessment and 84% in the filmed assessment) without statistically significant differences.

CONCLUSION

Filming can be used and encouraged as a strategy to assess nursing undergraduate students.

Permanência do Cateter de Hickman em Pacientes Submetidos a Transplante de Células-Tronco Hematopoéticas Alogênico: Estudo Retrospectivo

Introdução: O uso do cateter de Hickman e fundamental para viabilizar terapêuticas complexas, no entanto, sua permanência segura requer o conhecimento dos profissionais que o manuseiam sobre as principais complicações que levam a sua retirada. Objetivo: Analisar a permanência do cateter de Hickman em pacientes submetidos ao transplante de células-tronco hematopoiéticas alogênico. Método: Estudo descritivo do tipo transversal, com coleta de dados retrospectiva. Foram identificados 73 prontuários de pacientes no período de interesse do estudo, dos quais três foram excluídos por possuírem informações incompletas. Os dados foram analisados por meio de estatística descritiva. Resultados: Foram implantados 78 cateteres em 70 pacientes, sendo o tempo médio de permanência dos dispositivos de 41 dias (DP=26,78). A média do tempo transcorrido entre o implante do cateter e o início do regime de condicionamento foi quatro dias (DP=4,6). Em 26 (33,4%) casos, a indicação de retirada do dispositivo ocorreu por suspeita de infecções relacionadas ao cateter e, em outros 24 (30,8%) casos, a retirada ocorreu após seguimento ambulatorial, sem complicação documentada no prontuário. Conclusão: O cateter de Hickman geralmente causa complicações, entre elas, a infecção, o que leva a um curto tempo de permanência do dispositivo in situ, contrariando sua proposta de longa permanência; além de muitas vezes ser retirado sem registro do critério adotado, antes do termino da terapia. Esta pesquisa contribui com o enfermeiro da pratica clinica ao identificar os principais motivos de retirada do cateter e ao fornecer dados que podem subsidiar propostas de intervenções para minimiza-los.

Central catheter dressing in a simulator: the effects of tutor's assistance or self-learning tutorial

AIMS

to compare the performance of undergraduate students concerning semi-implanted central venous catheter dressing in a simulator, with the assistance of a tutor or of a self-learning tutorial.

METHOD

Randomized controlled trial. The sample consisted of 35 undergraduate nursing students, who were divided into two groups after attending an open dialogue presentation class and watching a video. One group undertook the procedure practice with a tutor and the other with the assistance of a self-learning tutorial.

RESULTS

in relation to cognitive knowledge, the two groups had lower performance in the pre-test than in the post-test. The group that received assistance from a tutor performed better in the practical assessment.

CONCLUSION

the simulation undertaken with the assistance of a tutor showed to be the most effective learning strategy when compared to the simulation using a self-learning tutorial. Advances in nursing simulation technology are of upmost importance and the role of the tutor in the learning process should be highlighted, taking into consideration the role this professional plays in knowledge acquisition and in the development of critical-reflexive thoughts and attitudes. (ClinicalTrials.gov Identifier: NCT 01614314).

Motivo de retirada do cateter de Hickman em pacientes submetidos ao transplante de células-tronco hematopoéticas

OBJETIVO: Identificar os motivos da retirada do primeiro cateter de Hickman implantado em pacientes submetidos ao transplante de células-tronco hematopoéticas alogênico, os micro-organismos envolvidos na ocorrência de infecção e o tempo de permanência do cateter in situ. MÉTODOS: Estudo transversal retrospectivo. A amostra foi constituída por 57 prontuários de pacientes transplantados. Para a obtenção dos dados, elaborou-se um instrumento contendo variáveis relativas à identificação do paciente, tempo de permanência do cateter, motivo de retirada e micro-organismo isolado. RESULTADOS: Dentre os motivos de retirada do cateter, destacou-se como o mais frequente a infecção (49%). O Stenotrophomonas maltophilia (25%) foi o micro-organismo identificado com maior frequência. CONCLUSÕES: Diante da elevada incidência de complicações infecciosas que levam à retirada do cateter de Hickman, faz-se necessária uma padronização de cuidados relacionados a esse cateter, tanto para a equipe de saúde como ao paciente e seu cuidador.

O uso de simulador no ensino de avaliação clínica em enfermagem

OBJETIVO: avaliar o uso de simulador no ensino da avaliação clínica dos olhos. MATERIAL E MÉTODO: estudo experimental, randomizado, controlado com 31 alunos do 2º ano de Graduação em Enfermagem de uma escola do interior paulista. A coleta dedados ocorreu de setembro a outubro de 2009, com dois instrumentos previamente validados, após autorização do Comitê de Ética. Os sujeitos foram divididos em Grupo 1 (ensino tradicional e o uso do simulador de baixa fidelidade) e Grupo 2 (ensino tradicional) para a avaliação dos olhos. RESULTADOS: houve aumento de acertos pelos sujeitos nas questões teóricas após a aula expositiva dialogada. Na avaliação prática clínica dos olhos a média percentual de acertos foi de 76±7 (Grupo 1) e 21±11 (Grupo 2) (p < 0,01). CONCLUSÃO: o uso do simulador mostrou ser estratégia facilitadora no processo ensino-aprendizagem

The Use Of Polyurethane Transparent Film In Indwelling Central Venous Catheter

Dressing is an intervention aimed to prevent infection in central venous catheter. This study aimed to analyze the frequency of catheter-related infection and skin toxicity in the use of transparent film in Hickman’s catheter in patients who underwent allogeneic hematopoietic stem cell transplantation. A case series with 10 cases was carried out. Due to the presence of exudate on the average for 12 days, sterile gauze dressing was used for 12.9 days (average). Transparent film was used, on average, for 15.1 days. Catheters were precociously removed due to infection in four cases. The highest degree of skin toxicity occurred in a case that used gauze dressing and in three cases with film. The transparent film permitted visualization of the exit site of the catheter and changes with longer intervals.