Browsing by Author "Silva, Raquel Marques"
Now showing 1 - 4 of 4
Results Per Page
Sort Options
- Algoritmos clínicos de apoio à tomada de decisão em enfermagem no cuidado à pessoa com ferida complexaPublication . Silva, Raquel Marques; Alves, Paulo Jorge Pereira; Lopes, MarcosIntroduction: The impact of wounds significantly affects the quality of life and places a substantial burden on healthcare systems. Clinical algorithms are believed to aid clinical reasoning and decision-making by nurses, thereby improving care for individuals with wounds. Objective: To develop and evaluate computerized clinical algorithms to support nursing decision-making in the care of adults with complex wounds. Methods: This mixed-methods study, comprising both qualitative and quantitative approaches, was structured in three phases. In the first phase, preliminary studies were conducted to design clinical algorithms, including a scoping review (according to JBI), a descriptive study using two online focus groups (13 participants, thematic analysis), and a prospective cohort study [data collection performed by nurses through mobile application (app), for six months, in nine Portugal health units, during the follow-up period for up to five weeks with six assessments and the healing time was the main outcome]. In the second phase focused on constructing clinical algorithms based on a deductive knowledge model using "if-then" logic and the Outcome-Present State-Test model, and achieving a consensus among experts and a consensus of judges developed to evaluate the content created through online questionnaires submitted to 105 participants. In the third phase, the constructed clinical algorithms were implemented in an app through a prospective cohort study (data collection performed by nurses through an app, for six months, in seven Portugal health units, during the follow-up period for up to four weeks, with three assessments. Up to three health ethics commissions approved the studies. Results: The scoping review and cohort study revealed primarily that local factors related to wound characteristics have a greater impact on healing than systemic or demographic factors. Features to be incorporated into an app for wound care should include image capture, professional communication, decision support, and action safety promotion. Clinical algorithms were created to support wound type diagnosis and therapeutic planning for intermediate and comprehensive wound monitoring, based on clinical reasoning with an emphasis on outcomes and the analysis of multiple conditions. Thirteen logical conditions for wound type, 40 informational alerts, 10 general recommendations, and 32 specific recommendations were successfully validated, with no items eliminated, and all achieved content evaluation indices statistically equal to or greater than 0.8 or within confidence intervals. In implementation, the overall agreement between the nurse's diagnosis and the algorithm-suggested diagnosis was moderate at 0.406 (CI 0.243-0.569). For therapeutic plan support algorithms, 85.3% and 90.3% of nurses followed the recommendations for comprehensive and intermediate monitoring, respectively. Alerts issued were evaluated with means of 4.34 (SD=0.82) for comprehensive monitoring and 4.33 (SD=0.97) for intermediate monitoring, on a scale of 1 to 5. Conclusion: The identified evidence on prognostic factors for delayed healing and the developed assessment tool allow nurses to improve reliability in characterizing individuals with wounds, anticipate complications, and individualize interventions. The successful implementation of clinical algorithms has practical applicability to improve care quality, reduce subjectivity in clinical reasoning and decision, and enhance action safety by incorporating updated evidence and innovative technology.
- Custos associados à prevenção das úlceras por pressão em adultos – revisão sistemática da literaturaPublication . Silva, Raquel Marques; Simões, Nuno A. F.
- Fatores que contribuem para a tomada de decisão dos enfermeiros no cuidado à pessoa adulta com ferida crónicaPublication . Silva, Raquel Marques; Deodato, SérgioIntrodução: A tomada de decisão é um tema importante para os enfermeiros e para a qualidade dos cuidados. Assim, considerámos pertinente estudar a decisão de enfermagem no contexto específico, pouco investigado, do cuidado à pessoa adulta com ferida crónica. Metodologia: O estudo parte da questão, “Que fatores contribuem para tomada de decisão dos enfermeiros no cuidado à pessoa adulta com ferida crónica?”. Definiu-se como objetivos específicos, identificar a tomada de decisão como autónoma ou interdependente no processo de cuidado à pessoa adulta com ferida crónica, identificar os fatores que contribuem para a tomada de decisão dos enfermeiros no cuidado à pessoa adulta com ferida crónica, analisar de que modo os fatores identificados contribuem para a tomada de decisão dos enfermeiros no cuidado à pessoa adulta com ferida crónica e descrever o modo de decisão no cuidado à pessoa com ferida crónica. Optámos por uma investigação do tipo exploratório descritivo, seguindo uma abordagem qualitativa. Os dados foram recolhidos por entrevista semiestruturada, sendo aplicada aos enfermeiros que prestam cuidados a adultos com feridas crónicas, por uma técnica de amostragem não probabilística tipo bola de neve até à saturação dos mesmos. Na análise das narrativas, optámos pela análise de conteúdo segundo Bardin. Resultados: Verificámos que o enfermeiro considera a sua tomada de decisão como autónoma. Identificámos vários fatores que contribuem para a tomada de decisão, tais como: avaliação do enfermeiro, recursos disponíveis, mobilização do conhecimento, recurso a terceiros, opinião do cliente, resultados de enfermagem planeados, experiência clínica, tempo disponível e segurança científica. Obtivemos dois modos de decidir no cuidado à pessoa com ferida crónica. No primeiro os participantes utilizam o processo de enfermagem, mas acrescentam as fases de construção da decisão em equipa multidisciplinar, continuidade dos cuidados e incentivo ao autocuidado do cliente e família, enquanto que, no segundo não recorrem ao processo de enfermagem, fazem-no através de uma decisão não deliberada ou por orientação de outro profissional. Conclusão: A responsabilidade do tratamento e prevenção da pessoa com ferida crónica é atribuída ao enfermeiro, devendo este na sua tomada de decisão ter em conta vários fatores para a escolha da alternativa adequada. Todavia, pretende-se que seja um trabalho em equipa multidisciplinar, com uma visão abrangente e holística, procurandose abandonar o conceito “ferida da pessoa”, e dando-se visibilidade “à pessoa com a ferida”
- Wound Navigator profiling: scoping reviewPublication . Silva, Raquel Marques; Fernandes, Filipa Alexandra VeludoOBJECTIVE: Map specific skills of the Wound Navigator. METHODS: A scoping review of complete and free articles in the databases CINAHL®, Nursing & Allied Health Collection, Cochrane Plus Collection, MedicLatina, MEDLINE® and 12 specialist associations in tissue viability, references in Portuguese, English, Spanish and French, with no time limit. Realized by two researchers in August 2017, of the 746 articles found, 19 met the inclusion and exclusion criteria. RESULTS: Four competency domains were identified: care (prevention/treatment of wounds and advanced therapies, decision-making; empowerment and clinical supervision), quality (specialized training; peer qualification; research and audit), and leadership (change agent; teamwork and consultant) and management (material selection/cost control). CONCLUSIONS: With four areas of competences, the Wound Navigator in partnership focuses on redefining people's life plans in the presence of wounds.