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- Family transitions to homelessness: a qualitative approachPublication . Figueiredo, Amélia Simões; Ferrito, Cândida; Santos, Alexandra Sarreira; Deodato, Sérgio; Seabra, Paulo; Vidal, Teresa; Figueiredo, HenriquetaObjectives: to characterize the homeless families who use a Public Shower Room; identify significant life events/phenomena for the family’s transition to homelessness; understand the relationship between significant life events; identify future expectations of respondents. Methods: an exploratory, descriptive study using the interview and thematic content analysis. Sample consisted of public shower room users. Results: mental illness, social, personal and family factors justify the transition of subjects to homelessness. The total absence of hopelessness alternates with expectations for the future based on resilience and hope. Final Considerations: we highlight in the study the self-determination expressed in small expressions of the narrative, on the one hand, as well as aspects related to the evolution of family relationships, on the other.
- Users of the Public Bathhouse of Alcântara: health profile diagnosisPublication . Figueiredo, Amélia Simões; Resende, Ana; Ferrito, Cândida; Rabiais, Isabel; Caldeira, SílviaBackground: The community outreach project of the Universidade Católica Portuguesa, which involves the public bathhouse of Alcântara, started out of the need to identify its users. Objectives: To characterize the users’ socio-demographic and health profile and describe their use of social and health resources. Methodology: A cross-sectional descriptive study, of quantitative nature, was conducted with the application of a questionnaire to a sample of 145 participants. Results: The typical user is male, single, aged 25-35 years and lives alone (21%). This user goes to the public bathhouse two to three times per week. Most of the users (58.3%) have no bathroom, 29.7% are homeless, 35.2% are not registered in any health care center, and 24.8% have mental disorders. Conclusion: The typical bathhouse user is of working age, was born in Lisbon and in the Portuguese-speaking African Countries, and has no source of income. The main reasons leading to the use of the public bathhouse are the economic difficulties, the homeless condition, and the lack of sanitary conditions.
- A informação transmitida na consulta de enfermagem pré-operatória: perceção do clientePublication . Mendes, Diana Isabel Arvelos; Ferrito, Cândida Rosa de Almeida Clemente; Gonçalves, Maria Isabel RodriguesIntrodução: A consulta de enfermagem pré-operatória pode ser entendida como um momento privilegiado para a transmissão de informação ao cliente visando melhor prepará-lo para a cirurgia e promovendo a sua colaboração nos cuidados pós-operatórios. Para que esta seja uma intervenção eficaz e valorizada pelo cliente deverá ter em conta as suas necessidades de informação e por isso torna-se relevante conhecer a sua perspetiva sobre este tema. Objetivo: Identificar a importância da informação transmitida na consulta para o cliente e identificar o contributo da informação para a colaboração do cliente na recuperação. Materiais e Métodos: Estudo descritivo de abordagem quantitativa. Consistiu na avaliação da consulta de enfermagem pré-operatória na ótima do cliente em relação à informação transmitida e à influência da mesma na colaboração do cliente nos cuidados pós-operatório. Foi elaborado e aplicado um questionário entre junho e dezembro de 2018. Amostra selecionada por conveniência, incluídos clientes com consulta de enfermagem pré-operatória integrados num programa de cuidados peri-operatórios multidisciplinar – Enhanced Recovery After Surgery, que estivessem conscientes, orientados e alfabetizados. Resultados: A amostra foi constituída por 45 clientes. Salienta-se que 91,1% (n=41) dos clientes classificaram a informação como “muito importante/importante”. Verificou-se que 91,1% (n=41) dos clientes respondeu “concordo inteiramente/concordo” que a informação recebida contribuiu para a sua responsabilização no processo de recuperação. Cerca de 88,9% (n=40) respondeu “concordo inteiramente/concordo” que a informação transmitida ajudou a que colaborasse mais nos cuidados pós-operatórios. Conclusão: Os clientes consideraram muito importante a informação transmitida durante a consulta de enfermagem pré-operatória. Os resultados sugerem que clientes mais informados percebem melhor a sua responsabilidade na recuperação e colaboram mais nos cuidados pós-operatórios o que favorece o processo cirúrgico e a melhoria os outcomes.
- Recommendations for the prevention of adverse events in endotracheal suctioning – integrative reviewPublication . Sousa, Ana Sabrina; Ferrito, Candida; Paiva, José ArturIntroduction: The use of endotracheal suctioning is a common procedure in intensive care units, which implies various risks, namely hypoxemia, atelectasis, arterial hypertension, microbial colonization, etc. Nevertheless, healthcare professionals can adopt certain strategies to prevent these adverse events. Aim: To describe good practice relating to endotracheal suctioning in patients undergoing invasive ventilation. Materials and Methods: Integrative literature review. The research occurred in December 2015, using the databases B-on, PUBMED and RCAAP and 534 documents were found. After inclusion/exclusion and quality criteria evaluation, four studies were accepted for inclusion in this review. Results: Recommendations encountered were: suction only when necessary, pre-oxygenate, use a suction catheter with half the diameter of the endotracheal tube, avoid saline instillation, employ a closed aspiration system when FiO2 or positive end-expiratory pressure is elevated, limit the procedural duration to under 15 seconds and monitor the patient. Conclusion: The review demonstrates that some conclusions are not consensual, which represents a limitation of this study, since more experimental studies are needed, which represents a limitation of this study, since more experimental studies are needed. However, the stimulation of open debate, reflection, as well as the adoption of preventative measures, can lead to safer practice.
- Augmentative and alternative communication in ventilated patients: a scoping reviewPublication . Pina, Sara; Canellas, Madalena; Prazeres, Rita; Lopes, José; Marcelino, Tânia; Reis, Duarte; Ferrito, CândidaOBJECTIVES: to map the benefits of Augmentative and Alternative Communication in ventilated adults in Intensive Care Unit and identify strategies used. METHODS: a Scoping Review was carried out according to the Joanna Brigs Institute Protocol. The research question was: "In adult patients ventilated in Intensive Care Units, what are the benefits of Augmentative and Alternative Communication?". An article research was carried out at PubMed, EBSCOhost and B-On databases. It was held between October and November 2018, from 2013 to 2018, in Portuguese and in English. RESULTS: 61 references were obtained. After selection according to the inclusion criteria, 7 articles were analyzed. CONCLUSIONS: studies enunciate Augmentative and Alternative Communication as a strategy to enhance communication, describing methods and tools. There is no agreement on the most effective tool.
- Intervenções de enfermagem na transição de cuidados em adultos com acidente vascular cerebral: uma scoping reviewPublication . Sousa, Marisa; Cabrita, Rita; Mamadhussen, Suraiya Mansurali; Ferrito, Cândida; Figueiredo, Amélia SimõesIntrodução: O Acidente Vascular Cerebral (AVC) é um evento que, de modo súbito, muda a vida das pessoas e dos seus familiares. A evidência científica aponta para a necessidade de que os sistemas de saúde estabeleçam intervenções que possam favorecer a continuidade de cuidados após a fase aguda com ênfase no período de reabilitação e reinserção social e comunitária. Tendo em conta a intervenção fundamental do enfermeiro na transição de cuidados, torna-se pertinente a realização desta scoping review. Objetivo: Identificar as intervenções de enfermagem na transição de cuidados, particularmente, em adultos com diagnóstico de AVC que usualmente apresentam limitações após a alta hospitalar. Materiais e Métodos: A revisão foi realizada segundo o protocolo de Joanna Briggs Institute. Resultados: De acordo com os critérios definidos foram incluídos na análise 5 artigos. Os processos de transição de cuidados analisados nos artigos foram maioritariamente desenvolvidos ou geridos por enfermeiros ou por equipas multidisciplinares nas quais o enfermeiro assumiu um papel primordial. Conclusão: Identificaram-se intervenções de enfermagem que se mostraram eficazes na transição de cuidados da pessoa com diagnóstico de AVC, que devem ser desenvolvidas em momentos chave, nomeadamente, na preparação da alta, no momento da alta e no acompanhamento nas semanas seguintes à alta hospitalar.
- Application of a ventilator associated pneumonia prevention guideline and outcomes: a quasi-experimental studyPublication . Sousa, Ana Sabrina; Ferrito, Cândida; Paiva, José ArturObjective: Ventilator associated pneumonia is the most frequent health-care-associated infection in Intensive Care Units, causing increased antibiotic consumption and resistance, length of stay, plus multiple health and economic costs. The aim of the study was to assess whether a customised guideline implementation would improve ventilator-associated pneumonia incidence and associated intensive care outcomes. Design: This was a quasi-experimental, before-after study consisting of pre-intervention, intervention and post-intervention periods. Setting: Three intensive care units at a well-known Portuguese hospital centre. Intervention: A set of eight recommendations was implemented after a guideline adaptation process. Patients: Adult patients admitted to the intensive care units over the study periods, aged 18 years or older and under invasive ventilation through an endotracheal tube or tracheostomy cannula. Measurements and main results: Data related to patient characterisation, guideline compliance and health outcomes were analysed. From a population of 1970 patients, a study sample of 828 was studied. Compliance with the recommendations was high. We identified a significant reduction in the incidence of ventilator-associated pneumonia in two of the units (p = 0.020 and p = 0.001) and a reduction in duration of invasive ventilation, intensive care unit length of stay and mortality in all the three units. We found associations between some recommendations and the implementation of the set of recommendations and intensive care unit length of stay, duration of invasive ventilation and mortality. Conclusion: The implementation of an evidence-based, locally customised guideline may improve ventilator associated pneumonia incidence and several outcomes.
- Prevention of ventilator associated pneumonia - evidence in oral carePublication . Sousa, Ana; Ferrito, CândidaBackground: Ventilator-associated pneumonia (VAP) is the most important noso- comial infection in intensive care units (ICUs), with an estimated inci- dence rate of 50% and the major cause of mortality and morbidity in ICUs [1,2]. Inadequate oral care develops an important role in this setting allowing various organisms to flourish in oral cavity and cause infections [1]. Many VAP prevention guidelines include oral care, but they don’t specify its demandings. Objective: The aim of this study is to describe evidence-based VAP prevention oral care in ICU, in terms of products, frequency and technique. Methods Integrative review. Research was conducted on B-on, PUBMED, and RCAAP between 24 and 28 December 2015, including guide- lines and original articles from the last 5 years. We found 256 documents and after analysing their abstract and methodological quality, nine documents were selected. Data were compiled in a chart in terms of grade of evidence, acceptance and applicability. Results: We found inconsistent results regarding the use of an antiseptic solution in oral care, though there were meta-analysis which indi- cated the benefit of chlorhexidine mostly in cardio-thoracic surgi- cal patients [2-4]. We also found evidence that tooth brushing reduces oral bacterial colonization and may reduce VAP when used with chlorhexidine [5,6]. There is no consensus regarding the adequate concentration of chlorhexidine. Some studies, thought, find an association with the use of chlorhexidine 2% and the incidence of Acute Respiratory Distress Syndrome [7]. Because of this potential risk, we do not recommend the use of this type of concentration, as more randomized controlled trials are needed. We found evidence in VAP prevention oral care compris- ing suctioning, tooth and gums wash and rising with 15 mL chlorhexidine 0.12%. This procedure should be performed at least 2 times a day. Secretions removal and moisturization should occur between 2 to 4 times a day [1-9]. Conclusions: This review allowed us to describe the adequate oral care in ICUs in order to potentially reduce VAP. As limitation of this study, we can find the lack of high grade of evidence concerning most recommen- dations. More randomized controlled trials are needed to support the impact of each intervention separately.
- Nursing interventions in the enhanced recovery after surgery®: scoping reviewPublication . Mendes, Diana Isabel Arvelos; Ferrito, Candida Rosa de Almeida Clemente; Gonçalves, Maria Isabel RodriguesOBJECTIVE: To identify the Nursing interventions, described in literature, in the ERAS® program. METHOD: We defined a scoping review based on the recommendations of The Institute Joanna Brigs (JBI) and on research in electronic databases. We chose the studies through flow diagrams "Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA)" and presented them in a chart. RESULTS: We found 306 articles published between 2010 and 2018 and included 14 of them. The main results were: the crucial role nurses play throughout the surgical process, which begins at the preoperative nursing consultation; goes to post-operative care, such as early giving food to patients, effective management of pain or early mobilization; and ends in telephone follow-up. CONCLUSION: The introduction of the surgical program ERAS® may be an opportunity for nurses to play a more influential role in the surgical path, directly involving with their clients' results.
- Intubation-associated pneumonia: an integrative reviewPublication . Sousa, Ana Sabrina; Ferrito, Cândida; Paiva, José ArturObjective: This article aims to characterise intubation-associated pneumonia regarding its diagnosis, causes, risk factors, consequences and incidence. Research methodology: Integrative literature review using database Pubmed and B-on and webpages of organisations dedicated to this area of study. Setting: The research took place between May and July 2015. After selection of the articles, according to established criteria, their quality was assessed and 17 documents were included. Results: Evidence has demonstrated that intubation associated pneumonia has a multifactorial aetiology and one of its main causes is micro-aspiration of gastric and oropharynx contents. Risk factors can be internal or external. The diagnostic criteria are based on clinical, radiological and microbiological data, established by several organisations, including the European Centres for Disease Control and Prevention, which are, however, still not accurate. In recent years, there has been a downward trend in the incidence in Europe. Nevertheless, it continues to have significant economic impact, as well as affecting health and human lives. Conclusions: Several European countries are committed to addressing this phenomenon through infection control and microbial resistance programmes; however there is a much to be done in order to minimise its effects. The lack of consensus in the literature regarding diagnosis criteria, risk factors and incidence rates is a limitation of this study.