Mestrado Profissional em Enfermagem
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- ItemDesenvolvimento de protocolo para atendimento e registro da parada cardiorrespiratória intra-hospitalar(Universidade Federal do Espírito Santo, 2025-03-08) Nunes, Anna Luiza Zandonadi Falchetto; Bringuente, Maria Edla de Oliveira; https://orcid.org/0000-0002-5151-5368; http://lattes.cnpq.br/5786594324498349; Batista, Karla de Melo; https://orcid.org/0000-0001-9560-6627; http://lattes.cnpq.br/7477446640175505; https://orcid.org/0009-0002-2587-089X; http://lattes.cnpq.br/5861067769600702; Mattos, Tânia Mara Cappi; Smiderle, Fabiana Rosa Neves; Fiorin, Bruno Henrique; Simonetti, Sérgio HenriqueIntroduction: Cardiorespiratory arrest remains one of the most prevalent emergencies with high morbidity and mortality rates in Brazil. The quality of cardiopulmonary resuscitation and the standardization of care are essential for the success of treatment. Additionally, the standardization of records enhances the quality of care and generates data for defining institutional strategies and cost analysis related to this care. The Utstein Style is recommended for the standardization of these records and the improvement of epidemiological analyses. Objective: To develop an assistive technology for the standardization of in-hospital cardiorespiratory arrest management and documentation. Method: This is a methodological study involving the development of a technological product, conducted in a university hospital and structured in three stages: Stage 1: Analysis of documented records of in-hospital cardiorespiratory arrest within the institution. Stage 2: Literature review to identify content for protocol development. Stage 3: Development of an assistive technology in the form of a protocol. Results: In stage 1, 1,181 medical records were analyzed between October 2023 and February 2024, identifying 87 occurrences of in-hospital cardiorespiratory arrest. The document analysis provided insight into the institutional reality regarding the recording of cardiorespiratory arrest and highlighted weaknesses in the systematization of records. Additionally, it enabled the identification of the profile of cases attended and the procedures performed. In stage 2, the literature review revealed the following categories: Development and improvement of the response system to cardiorespiratory arrest. Education and the science of cardiopulmonary resuscitation. Evidence and recommendations for the management of cardiorespiratory arrest. In stage 3, the protocol includes interventions for the multidisciplinary management of cardiorespiratory arrest, standardized documentation based on the Utstein Style, and performance indicators. Products: The in-hospital cardiorespiratory arrest management and documentation protocol consists of 21 topics, including team responsibilities, competencies, and duties by professional category, medical history and physical examination, indicated treatment and therapeutic plan, basic life support, advanced life support, medication administration, and post-cardiac arrest care. Additionally, it includes standardized documentation forms based on the Utstein Style. Final Considerations: The establishment of a protocol for in-hospital cardiorespiratory arrest management and documentation can provide greater safety for the healthcare team, improve the quality of care provided, enhance patient outcomes and quality of life, reduce costs, and minimize legal concerns. Furthermore, it generates data that allow for a better understanding of the reality and impact of this care, supporting in-service education and research activities.
- ItemImplementação de um programa de navegação na especialidade de cirurgia cardiovascular(Universidade Federal do Espírito Santo, 2025-04-15) Fonseca, Marcio Vilaça da; Fioresi, Mirian; https://orcid.org/0000-0002-8560-4385; https://orcid.org/0000-0003-4955-6715; Filetti, Filipe Martinuzo; Fiorin, Bruno Henrique; Pautasso, Fernanda Felipe; Furieri, Lorena BarrosIntroduction: Patient navigation, introduced in 1990 by Harold Freeman, aims to facilitate access to healthcare, with a focus on chronic diseases. When conducted by a nurse, it is described as an intervention to reduce delays in accessing healthcare services and to provide personalized care throughout the treatment journey. It is an expanding model, contributing to the patient journey. Although little studied in cardiology, some studies have shown benefits in care, as evidenced by a 2017 study in the USA, which reported a reduction in 30-day readmission rates after discharge of patients with heart failure through a patient-centered approach. This raises the question: what are the main components for building a patient navigation program for individuals undergoing cardiovascular surgery? Objectives: To implement a navigation program in the cardiovascular surgery specialty, targeting patients undergoing myocardial revascularization and valve replacement. Methodology: This is a participatory action research study, structured into four main phases: problem identification, planning, action, and evaluation. Results: Of the 46 patients who participated in the study, 71% had comorbidities, 67% had a family history of heart disease, and 87% had not undergone previous surgical interventions. All patients (100%) were assessed and classified as needing navigation through the implemented program. As part of the proposed interventions, four Standard Operating Procedures were developed and validated, in addition to three informational flyers, which aimed to support the standardization and qualification of the care provided. Patient satisfaction with the program was 94.5%, and a significant reduction in preoperative waiting time was observed, decreasing from 10 to 2 days. Conclusion: The patient navigation program in the cardiovascular surgery specialty was able to reduce preoperative time and showed a high satisfaction rate among patients.
- ItemExercício da responsabilidade técnica em enfermagem : uma proposta de tecnologia educacional(Universidade Federal do Espírito Santo, 2025-03-24) Oliveira, Andressa Barcellos de; Massaroni, Leila ; https://orcid.org/0000-0001-7327-887X; http://lattes.cnpq.br/1280356644652701; Bringuente, Maria Edla de Oliveira; https://orcid.org/0000-0002-5151-5368; http://lattes.cnpq.br/5786594324498349; https://orcid.org/0000-0002-3720-6198; http://lattes.cnpq.br/5742762785651498; Silva, Rita Inês Casagrande da ; https://orcid.org/0000-0001-8289-9117; http://lattes.cnpq.br/8602876967833382; Pontes, Mônica Barros de ; https://orcid.org/0000-0003-3629-236X; http://lattes.cnpq.br/2027806297684753; Fiorin, Bruno Henrique; https://orcid.org/0000-0002-1629-9233; http://lattes.cnpq.br/9684030018018529; Vilela, António Carlos Lopes; https://orcid.org/0000-0002-7072-0359; http://lattes.cnpq.br/7521723809237664Introduction: Care management requires the improvement of professional practices, and the organization of the work process. However, technically responsible nurses need professional development to manage nursing services, since their academic training is insufficient for this function, which involves exclusive technical and ethical duties. However, the managerial skills of technically responsible nurses are not yet adequately addressed in undergraduate courses. Objective: To propose an educational technology to train nurses in the exercise of technical responsibility. Method: This is a methodological study, with a quantitative-qualitative approach, divided into three stages: (1) scoping review mapped publications on the managerial skills necessary for the exercise of technical responsibility by nurses; (2) empirical study, which used an online questionnaire with closed and open questions as a data production instrument, whose quantitative data were analyzed in SPSS and the qualitative data followed Bardin's content analysis, with support from IRaMuTeQ; (3), Proposal of an educational technology for technical responsible nurses, based on the first and second stages. Results: The scoping review revealed gaps in the literature on the subject. The empirical study highlighted limitations in the organization of nursing services, related to the lack of management training in undergraduate courses and the need for institutional support. The proposal consists of a self-instructional Massive Open Online Course, addressing legal foundations, planning, organization, service evaluation, continuing education and document management. Discussion: The research highlighted a mismatch between academic training and the demands of professional practice, especially regarding care management. In response to this gap, the proposal for an educational technology emerges as a product based on the scope review and empirical study, configuring itself as a training strategy capable of offering targeted, practical learning aligned with current regulations, strengthening the qualified exercise of Technical Responsibility in nursing. Final Considerations: The implementation of educational technology contributes to the managerial training of nurses, strengthening care management, promoting patient safety and qualifying services. The initiative represents a viable way to address training deficiencies and empower nurses in professional practice
- ItemMedidas de prevenção de infecção para cirurgia cardíaca: estudo de implementação(Universidade Federal do Espírito Santo, 2024-11-04) Barbieri, Bruna Moraes; Fiorin, Bruno Henrique ; https://orcid.org/0000-0002-1629-9233; http://lattes.cnpq.br/9684030018018529; https://orcid.org/0000-0001-7470-2118; http://lattes.cnpq.br/2448133242936971; Lima, Eliane de Fátima Almeida; https://orcid.org/0000-0001-5128-3715; http://lattes.cnpq.br/4640538188376728; Fioresi, Mirian; https://orcid.org/0000-0002-8560-4385; http://lattes.cnpq.br/2275021494677338; Rozetti, Cindy Medici Toscano; https://orcid.org/0000-0001-9865-6208; http://lattes.cnpq.br/9543458093185280Introduction: Surgical site infections are among the three most frequent types of infection in hospitalized patients, and are particularly worrying in cardiovascular surgeries with sternotomy, due to the risk of deep infections that increase mortality, making it essential to take a managerial look at the processes related to this adverse event. This study is carried out within the research line Organization and evaluation of health care systems. This study is one of the outcomes supported by funding from the CAPES/COFEN Cooperation Agreement, under Call for Proposals No. 08/2021. Objectives: To develop and implement a manual for the prevention and control of surgical site infections in the intraoperative period of cardiovascular surgery. Method: This is participatory research with a quantitative and qualitative approach, based on the theoretical framework of implementation science, carried out in the operating room of a university hospital in the state of Espírito Santo. The nursing and medical teams involved in intraoperative cardiovascular surgery took part in the study. The research followed five activities using the Plan-Do-Check-Act cycle: situational diagnosis, creation of a working group to draw up the manual, awareness-raising workshop, post implementation audit with assessment of barriers and facilitators, and planning of sustainability actions. Results and Products: Four new technical products were developed to meet an institutional need; a manual on measures to prevent and control surgical site infections during cardiac surgery, an infographic on antibiotic prophylaxis in cardiovascular surgery, and two scientific articles. To this end, a group was set up made up of employees responsible for caring for cardiac patients and a representative of the institution's infection control committee, which generated discussions based on scientific evidence, resulting in innovative technical products. After implementing the manual, some improvements were observed in the audit, such as: the rate of SSI in cardiovascular surgeries with sternotomy fell from 17.55% to 10.77%; adequacy in the indication of prophylactic antibiotics increased from 74.47% to 85.90%; and adherence to recording the time of administration of the antimicrobial and the surgical incision reached compliance in 42.2% of cases. There was also a significant increase in the collection of intraoperative blood glucose, from 28.72% to 87.5%. The recording of the validity of surgical instruments rose from 54.79% to 82.8%, with low rates of proof of sterilization through integrators being maintained. In addition, 95% compliance with preoperative cleaning of the operating room was recorded, a result similar to the adequacy of surgical gowns. Antisepsis of the patient's skin showed compliance in 97% of cases. Surgical instruments were considered adequate in 94% of the observations, and the procedure for cleaning instruments during surgery took place in 97% of the cases. There was 19% of misinformation about sterile dressing techniques. Conclusion: The Manual was published by the institution’s Quality sector and incorporated into the institution's work processes, favoring changes in practice, as well as maintaining evidence-based care. This research is relevant due to its potential to be extended nationally, as it systematically describes an innovative method with the steps and resources needed to implement good practices for the control and prevention of surgical wound infection.
- ItemConhecimento, atitude e prática de pacientes submetidos ao cateterismo cardíaco e à intervenção coronária percutânea(Universidade Federal do Espírito Santo, 2024-10-23) Souza Netto, Priscilla Gabriel de; Lima, Eliane de Fátima Almeida; Fioresi, Mirian; https://orcid.org/0000-0002-8560-4385; Sipolatti, Walckíria Garcia Romero; Pedraza, Leticia Lópes; Furieri, Lorena Barros; Filetti, Filipe MartinuzoIntroduction: Within the context of interventional cardiology, the nurse plays a crucial role in providing care, not only during the hemodynamic procedure but also as an educator. The guidance provided by this professional is fundamental to ensuring patient safety and preventing misconceptions that could pose risks in the pre- procedure, during, and post-procedure phases. Analyzing the knowledge, attitudes, and practices (KAP) of elective patients who will undergo cardiac catheterization and percutaneous coronary intervention (PCI) will provide support for the development of educational actions that can enhance accuracy and safety in the preparation and execution of these procedures. This will, therefore, contribute to the management planning of actions aimed at this target population, promoting optimal handling and reducing the risk of complications. General Objective: To evaluate the knowledge, attitudes, and practices (KAP) of patients undergoing cardiac catheterization and percutaneous coronary intervention. Methodology: This dissertation consists of two interdependent studies conducted in Vitória, Espírito Santo: 1) a methodological study for the construction and validation of a KAP questionnaire, conducted between August 2023 and June 2024; 2) a cross-sectional study aimed at evaluating the knowledge, attitudes, and practices of elective patients undergoing cardiac catheterization and percutaneous coronary intervention, with data collection from June to July 2024. The methodological study was conducted in two phases: a) identification of the domains and preparation of the KAP survey questions; b) validation of the KAP survey. The cross-sectional phase involved the application of the KAP survey to 49 patients admitted for cardiac catheterization or percutaneous coronary intervention at a university hospital in the Southeast Region. Data analysis was based on the responses regarding patients' knowledge, attitudes, and practices about cardiac catheterization and percutaneous coronary intervention. Descriptive and inferential statistics were used for data analysis. Results: All domains of the KAP survey demonstrated content validity (CVC greater than 0.8) and nearly perfect internal consistency, with Cronbach's alpha values exceeding 0.80. The final questionnaire included the following domains: (1) Sociodemographic characteristics, with 22 items; (2) Pre-procedure knowledge, comprising 13 items related to cardiac catheterization and 5 items related to percutaneous coronary intervention, totaling 18 items. The overall evaluation of pre-procedure knowledge revealed that only 3 patients (6.1%) had "good" knowledge. In contrast, 34 patients (69.4%) displayed positive attitudes, and 42 (85.7%) demonstrated good practices. The post-procedure evaluation of the KAP survey showed that only 14 (28.6%) patients had "good" knowledge, while 44 (89.8%) and 46 (93.4%) patients exhibited positive attitudes and practices, respectively. Variables associated with higher knowledge, positive attitudes, and proactive practices concerning CAT and PCI included patients’ desire for information about the procedures, owning a mobile phone, and education level, particularly those with at least a high school diploma compared to illiterate individuals. Conclusion: This dissertation produced a KAP survey for elective patients undergoing cardiac catheterization (CAT) and percutaneous coronary intervention (PCI), which is freely available online for use throughout Brazil. The cross-sectional study provided insights into these patients' knowledge, attitudes, and practices, including their preparation for the procedure, self-care management, and recognition of complications. It is anticipated that these findings will assist in the development and implementation of educational programs aimed at imroving the self-management practices of these patients.