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Advisor(s)
Abstract(s)
Introdução: As quedas em contexto hospitalar são o incidente mais reportado e constituem um indicador relativo à segurança do doente sensível aos cuidados de enfermagem. A finalidade da presente investigação foi estudar os fatores de risco associados às quedas do doente, em contexto hospitalar com vista a contribuir para a sua prevenção, suportando-nos no modelo conceptual de Irvine, Sidani e Hall (1998), integrando evidências para a prática clínica de enfermagem, valorizando a informação disponível e a experiência dos profissionais que trabalham na área da gestão do risco.
Objetivos: Avaliar a dimensão e o impacto das quedas em adultos e identificar os fatores de risco associados às quedas em contexto hospitalar de cuidados agudos.
Metodologia: A investigação assenta no paradigma quantitativo, integrando um estudo principal e um estudo preliminar. A pesquisa preliminar corresponde a um estudo exploratório de análise de 260 notificações de queda, relativas a 229 doentes que tiveram episódios de queda documentados entre 1 de junho de 2008 e 31 de dezembro de 2010. Este estudo visou dar subsídios para um melhor estabelecimento do plano de investigação a desenvolver e averiguar a pertinência da informação disponível. O estudo principal tem um desenho do tipo de casos-controlos emparelhados. Os casos correspondem às notificações de queda relativas ao ano de 2012 e por cada caso foram selecionados de forma aleatória dois controlos. Neste período registaram-se 134 eventos de queda e o estudo incluiu 100 desses eventos. Numa primeira fase efetuou-se análise uni e bivariada dos dados com recurso a medidas de risco, nomeadamente o odds ratio (OR), com um intervalo de confiança de 95%. Posteriormente as variáveis com associação estatística foram analisadas através da regressão logística, utilizando o método Stepwise Forward.
Resultados: Os dados encontrados no estudo preliminar apontam que as quedas foram mais prevalentes no sexo masculino, em doentes com idade de 74 ou mais anos, com diagnóstico de doença oncológica ou neurodegenerativa. Os doentes caíram mais no período noturno e da cama. Estar medicado com fármacos do grupo terapêutico do sistema nervoso central mostrou ter uma associação mais significativa com as quedas. No estudo principal identificaram-se catorze variáveis associadas com as quedas (p<0,05), das quais quatro explicam o modelo final. As variáveis que explicam 71% dos resultados são, ter alto risco de queda avaliado através da Escala de Quedas de Morse, tendo estas pessoas três vezes mais risco de cair durante o internamento (ORa=3,10), assim como as que têm um estado psíquico deprimido (ORa=3,46). As pessoas que têm um estado psíquico confuso, têm duas vezes mais risco de cair (ORa=2,35). Por sua vez a utilização de uma cama baixa mostrou ser fator protetor, reduzindo a probabilidade de cair (ORa=0,47) em 53%.
Conclusão: Os dados corroboram as evidências da investigação nesta área. Deve ser feita uma avaliação multifacetada a todos os doentes com 65 ou mais anos de idade admitidos no hospital, que inclua a avaliação do risco de queda, da depressão e da confusão aguda, por serem fatores preditores de queda e alguns serem fatores reversíveis. É sobretudo neste tipo de fatores que os enfermeiros devem fazer incidir a sua avaliação e prescrever intervenções por forma a prevenirem as quedas e os danos associados.
Introduction: Patient falls are the most reported safety incident in the hospital setting and an indicator of patient safety, sensitive to nursing care. The purpose of this investigation was to study the risk factors associated with patient falls in the hospital setting in order to contribute to their prevention, supporting ourselves in the conceptual model of Irvine, Sidani and Hall (1998), integrating evidence into clinical nursing practice, valuing the available information and the experience of professionals working in the area of risk management. Objectives: Assess the dimension and impact of falls in adults and identify the risk factors associated with falls in patients hospitalized in an acute care setting. Methodology: The research is based on the quantitative paradigm, integrating one main study and a preliminary study. The preliminary research represents an exploratory analysis of 260 reports of falls of 229 patients who had documented episodes of falling, between the 1st of June of 2008, and 31st of December of 2010. This study aims to contribute to improve the establishment of a research plan to develop and evaluate the relevance of the available information. The main study as design of a matched case-control study. The cases correspond to the notifications of falls during the year of 2012, and for each case, two controls were randomly selected. In this period there were 134 events of fall, and the present study included 100 of these events. Initially we performed uni and bivariate data analysis using measures of risk, including the odds ratio (OR) with a confidence interval of 95%. Later variables with statistical associations were analyzed by logistic regression using the Stepwise Forward method. Results: The data found in the preliminary study showed that falls were more prevalent in men, in patients aged 74 years or older, with a diagnosis of cancer or neurodegenerative disease. Patients fell more during the night and from the bed. A significant association with falls was showed in patients being treated with the therapeutic group of central nervous system. In the main study were identified fourteen variables associated with falls (p<0,05), four of these variables explain the final model. The variables that explain 71% of the results are, high risk of falling assessed by Morse Falls Scale, and this patients are three times more likely to fall during the period of hospitalization (aOR=3,10), as well as those who have a depressed mental status (aOR= 3,45). Patients who have confused mental state, have twice the risk of falling (aOR = 2.35). On the other hand, the use of a very low bed proved to be a protective factor, reducing the likelihood of falling (aOR= 0,47) in 53%. Conclusion: The data support the evidence of research in this area. It should be made a multifaceted assessment to all patients aged 65 years and older admitted to the hospital, including the assessment of the risk of falling, depression and acute confusion, since they are predictors of fall and some are reversible factors. It is especially in this kind of factors that nurses should focus its evaluation and prescribe interventions in order to prevent falls and associated harm.
Introduction: Patient falls are the most reported safety incident in the hospital setting and an indicator of patient safety, sensitive to nursing care. The purpose of this investigation was to study the risk factors associated with patient falls in the hospital setting in order to contribute to their prevention, supporting ourselves in the conceptual model of Irvine, Sidani and Hall (1998), integrating evidence into clinical nursing practice, valuing the available information and the experience of professionals working in the area of risk management. Objectives: Assess the dimension and impact of falls in adults and identify the risk factors associated with falls in patients hospitalized in an acute care setting. Methodology: The research is based on the quantitative paradigm, integrating one main study and a preliminary study. The preliminary research represents an exploratory analysis of 260 reports of falls of 229 patients who had documented episodes of falling, between the 1st of June of 2008, and 31st of December of 2010. This study aims to contribute to improve the establishment of a research plan to develop and evaluate the relevance of the available information. The main study as design of a matched case-control study. The cases correspond to the notifications of falls during the year of 2012, and for each case, two controls were randomly selected. In this period there were 134 events of fall, and the present study included 100 of these events. Initially we performed uni and bivariate data analysis using measures of risk, including the odds ratio (OR) with a confidence interval of 95%. Later variables with statistical associations were analyzed by logistic regression using the Stepwise Forward method. Results: The data found in the preliminary study showed that falls were more prevalent in men, in patients aged 74 years or older, with a diagnosis of cancer or neurodegenerative disease. Patients fell more during the night and from the bed. A significant association with falls was showed in patients being treated with the therapeutic group of central nervous system. In the main study were identified fourteen variables associated with falls (p<0,05), four of these variables explain the final model. The variables that explain 71% of the results are, high risk of falling assessed by Morse Falls Scale, and this patients are three times more likely to fall during the period of hospitalization (aOR=3,10), as well as those who have a depressed mental status (aOR= 3,45). Patients who have confused mental state, have twice the risk of falling (aOR = 2.35). On the other hand, the use of a very low bed proved to be a protective factor, reducing the likelihood of falling (aOR= 0,47) in 53%. Conclusion: The data support the evidence of research in this area. It should be made a multifaceted assessment to all patients aged 65 years and older admitted to the hospital, including the assessment of the risk of falling, depression and acute confusion, since they are predictors of fall and some are reversible factors. It is especially in this kind of factors that nurses should focus its evaluation and prescribe interventions in order to prevent falls and associated harm.
Description
Keywords
Quedas Hospitais Adulto Fatores de risco Accidental falls Hospitals Adult Risk factors