Dissertations / Theses on the topic 'Nursing Nursing audit'

Recruitment and retention of professional nurses are crucial issues for hospital departments of nursing. Recognizing the necessity to bridge the gap that persists between nursing education and nursing services, hospitals have designed programs to assist new nurses make the transition to current nursing practice. By helping individuals make the transition to current nursing practice it is hoped that staff nurses will be retained.

The purpose of this thesis was to study different aspects of nursing content in patient records with special reference to nursing home care. The thesis focused on the content, comprehensiveness, accuracy and auditing of records, as well as the practice and perceptions of nurses in relation to recording. A national sample of nurses was asked to complete a questionnaire. The effects on recording and nurses' practice and perceptions in nursing homes following educational intervention were studied. Accuracy was examined through record reviews and interviews with nurses and patients. A literature review of record auditing methods was performed and findings from this search were applied in the assessment of a set of records.

The results indicate that the VIPS model, as a structure for nursing recording, is widespread and shows validity across various areas in Swedish health care. After the educational intervention program, documentation in nursing home care improved significantly in the study group concerning notes on nursing history, nursing status, nursing diagnoses, interventions and discharge notes. Systematic and comprehensive assessment grounded in research-based criteria were not used in the records. Accuracy varied considerably and was significantly better for some areas in the study group. After intervention, the nurses in the study group indicated that they recorded assessments of patients with greater frequency, showed greater satisfaction with their documentation and spent less time on oral reports. Procedures in auditing patient records were found to encompass four approaches: formal structure, process comprehensiveness, knowledge based and accuracy.

In conclusion, the evidence suggests that there are serious flaws in the nursing content of nursing home records though improvements can be achieved through educational means. Presently, there are serious limitations in using the patient record as the sole source of data for care delivery, quality assessment and evaluation of care.

The purpose of this study was to describe critical care nurses' perceptions of their experiences with nursing quality assurance activities. Using an exploratory, descriptive design, data were collected in a survey, utilizing a self-administered questionnaire. A convenience sample of critical care nurses, who are members of the Canadian Association of Critical Care Nurses, was used. The results showed that these particular nurses knew what comprised the components of a nursing quality assurance program, however, their participation in these activities was low. In addition, the majority identified that the primary purpose of nursing quality assurance activities was to meet the accreditation requirements of the hospital. Finally, the results also identified that all of this particular group of nurses felt that nursing quality assurance activities involved them, and the majority felt that these activities were part of their professional responsibilities.
Applied Science, Faculty of
Nursing, School of
Graduate

Thesis (MCur)--University of Stellenbosch, 2011.
ENGLISH ABSTRACT: Background: In her clinical practice as nursing manager the researcher was concerned about incomplete and inaccurate documentation of patients diagnosed with tuberculosis (TB) which were compromising the management of these patients. The primary care nurses endorsed these concerns. Goals and Objective: The goal of this study was to audit nursing documentation according to the phases of the nursing process and the discharge planning of patients diagnosed with TB discharged from TB hospitals in the Western Cape. The objectives for the study were to determine whether the patients were adequately assessed and diagnosed, whether nursing care plans were formulated based on the assessment and whether they were implemented and evaluated according to the nursing process - including the discharged planning. Ethics approval was obtained from the Committee of Human Research Science at Stellenbosch University and permission was also obtained from the respective institutions. Methodology: A descriptive design with a quantitative approach was applied for the purpose of this study. The total population for the study was N=1768. A systematic random sample of 12% from each hospital was drawn: n=214, hospital A (n=142) and hospital B (n=72). Criteria included:  all adult patients older than 18 years  patients who were discharged between 01 January 2007 and 31st December 2007  all discharged patients from the two hospitals specializing in patients diagnosed with TB. Instrumentation: An audit instrument based on the objectives of the study was approved as the data collection tool. Guided by the proposed study a 10% (n=21) of the number of discharged patient files were drawn for the purpose of a pilot study. Reliability and validity was ensured through the use of experts in the field of nursing, research methodology and statistics. A pilot study was also conducted to support the reliability and validity of the study. Data collection: The researcher collected the data personally with the support of five trained field workers who only assisted at hospital B and was reluctant to assist at the second hospital. Data analysis: Data was analysed with the support of a statistician and expressed in frequencies and tables. Results: All phases of the nursing process showed a low compliance. Results showed that only n=90(42%) of the registered professional nurses checked and signed the initial assessment, furthermore only n=53(34%) showed that a recording was made of all referral documentation to the patient’s follow-up clinic. Recommendations: Recommendations based on the scientific evidence obtained from the study include the implementation of a quality assurance programme namely standardisation, auditing, case management of patients, education and training, rewarding of staff and further research. Conclusion: In conclusion guided by the research question “Are the audited discharged patient files at hospitals specialising in the management of patients with TB in the WCDoH compliant?” The researcher concludes that the discharged patient files are not compliant.
AFRIKAANSE OPSOMMING: Agtergrond: In haar kliniese praktyk as verpleegbestuurder is die navorser besorgd oor die onvolledige en onakkurate dokumentasie van pasiënte wat met tuberkulose (TB) gediagnoseer is en wat dus die versorging van hierdie pasiënte in gevaar stel. Hierdie besorgdhede is deur die primêre sorg verpleegsters bevestig. Doel en Doelwitte: Die doel van die studie is om die verpleegdokumente te ouditeer volgens die fases van die vepleegproses, asook die ontslagbeplanning van die pasiënte gediagnoseer met TB van die hospitale in die Wes-Kaap. Die doelwitte is om te bepaal of die pasiënte korrek geassesseer en gediagnoseer is en of verpleegsorgplanne opgestel is, wat gebaseer is op die assessering en versorgingsplanne wat geïmplementeer en geëvalueer is volgens die verpleegproses, insluitende die ontslagbeplanning. Etiese goedgekeuring is toegestaan deur die Komitee vir Menslike Navorsingswetenskap van die Universiteit van Stellenbosch en toestemming is ook ontvang van die onderskeie instansies. Metodologie: ’n Beskrywende ontwerp met ’n kwantitatiewe benadering is toegepas vir die doel van die studie. Die totale bevolking vir die studie is N=1786. ’n Sistematiese ewekansige geselekteerde steekproef van 12% van elke hospitaal is geneem: n=214, hospitaal A (n=142) en hospitaal B (n=72). Die kriteria sluit in:  alle volwasse pasiënte ouer as 18 jaar  pasiënte wat gedurende die periode 01 Januarie 2007 tot 31 Desember 2007 ontslaan is  alle ontslag pasiënte van die twee hospitale wat spesialiseer in pasiënte wat gediagnoseer is met TB. Instrumentasie: ‘n Ouditinstrument gebaseer op die doelwitte is goedgekeur as die dataversamelingsinstrument. Na aanleiding van die voorgestelde studie is 10% (n=21) van die aantal ontslag pasiëntlêers getrek vir die doel van die loodsondersoek. Betroubaarheid en geldigheid is verseker deur gebruik te maak van deskundiges in die verplegingsveld, die navorsingsmetodologie en statistiek. Die loodsondersoek is ook uitgevoer om die betroubaarhied en geldigheid van die studie te rugsteun. Dataversameling: Die navorser het die data persoonlik gekollekteer met die bystand van vyf opgeleide veldwerkers wat slegs hulp verleen het by hospital B en wat teësinnig was om hulp te verleen by die tweede hospitaal. Data-analise: Data is geanaliseer met die hulp van ’n statistikus en is uitgedruk in frekwensies en tabelle. Resultate: Alle fases van die verpleegproses het nie voldoen aan die vereistes nie. Resultate dui daarop dat slegs n=90 (42%) van die geregistreerde professionele verpleegsters die aanvanklike assessering nagegaan en onderteken het, vervolgens het slegs n=53 (34%) getoon dat ’n opname gemaak was van alle verwysde dokumentasie van die pasiënt se opvolgbesoek aan die kliniek. Aanbevelings: Aanbevelings is gebaseer op die wetenskaplike bewys wat verkry is van die studie vir die implementering van ’n gehalte versekeringsprogram, naamlik standardisering, ouditering, gevallebestuur van pasiente, opvoeding en opleiding, erkenning aan die personeel, en voortgesette navorsing. Samevatting: Ter afsluiting gelei deur die navorsering’s vraag nl. “Is die geouditeerde verpleegdokumente in hospitale wat spesialiseer in die bestuur van pasiente gediagnoseer met TB in die Weskaap se Department van Gesondheid bygehou?” Die navorser bevestig dat die verpleegdokumente nie bygehou was nie.

Poor nursing documentation of patient care was identified in daily nurse visit notes in a health care setting. This problem affects effective communication of patient status with other clinicians, thereby jeopardizing clinical decision-making. The purpose of this evidence-based project was to determine the impact of a retraining program on the quality of documentation of patient care in nurses' notes in a home health agency in central Texas. A retrospective audit of quality of nursing documentation using the Nurse and Midwifery Content Audit Tool (NMCAT) was done. A pre- and posttest design was used. A convenience sample of de-identified nurses' notes (80 pre- and 80 post) was selected from active patient records in the agency (n = 160). Descriptive and inferential statistics from the project showed that there was improved quality for the 15 criteria representing quality nursing documentation. After the educational intervention, documentation of patient's status if changed or unchanged improved to 80%, and patient's response to treatment improved (57% to 85%), entries were written as incidents occurred improved (53% to 64%). The nurse refers to the patient by name improved (0% to 66%). These findings were an indication of practice change, validating the need for periodic audits of nurses' notes in the agency in order to demonstrate compliance with quality standards. Based on the project findings, a retraining program is recommended to improve structured nursing documentation in a home health agency. This project is likely to contribute to social change as it enhanced the information communicated to other health care providers, coordination of care, and patient outcomes.

Bakgrund: Kvaliteten på sjuksköterskans omvårdnadsjournal kan återspegla den vårdkvalitet som tillhandahålls patienter. Patienter med en höftfraktur har ofta ett omfattande vårdbehov där omvårdnadsjournalen har en viktig funktion att strukturera dokumentation av vårdinsatser genom patientens vårdförlopp. Patienter med höftfraktur har ofta en komplex sjukdomsbild, där omvårdnadsdokumentationens kvalitet kan bidra till en säkrare vård för patienten. Kvaliteten på dokumentationen ökar vid en strukturerad journal och framförallt när ett standardiserat språk används. Journalgranskning är ett sätt att göra kvalitetskontroll av dokumentation. Motiv: Att drabbas av en höftfraktur innebär stora hälsorisker för en ofta redan skör person. Omvårdnadsdokumentationens kvalitet vid höftfraktur kan bidra till att patienten får bättre förutsättningar för att undvika komplikationer och till kortare vårdtid. Syfte: Att undersöka kvaliteten av omvårdnadsdokumentation för patienter med höftfraktur.Metod: En retrospektiv, deskriptiv och jämförande design där granskning av omvårdnadsjournaler användes för att besvara studiens syfte. Ett konsekutivt urval har gjorts av omvårdnadsdokumentation från 40 vårdtillfällen med patienter över 60 år som vårdats för en höftfraktur på en akutortopedisk avdelning. För granskningen användes journalgranskningsinstrumentet Cat-ch-ing. Resultat: De granskade omvårdnadsjournalernas kvalitet var varierande; ingen av journalerna hade en komplett dokumentation. Dokumentation av vårdplan och resultat av omvårdnadsåtgärder saknades i en majoritet av journalerna. Dokumentationen var av bättre kvalitet i gruppen yngre äldre patienter vid jämförelse med gruppen äldre äldre patienter. Ingen skillnad av kvalitet i dokumentationen kunde urskiljas utifrån vårdtidens längd då patienter som vårdats mindre än sju dygn eller sju dygn eller mer jämfördes. Konklusion: Kvaliteten av omvårdnadsdokumentationen var inte komplett. Det krävs ytterligare kunskap om förbättringsåtgärder i den kliniskas verksamheten för att säkerställa en omvårdnadsdokumentation av god kvalitet där patienter med höftfraktur vårdas.
Background: The quality of the nursing record can reflect the quality of nursing care provided to patients. Patients with a hip fracture often have an extensive need for care. The nursing record has an important function of describing the nursing process, nursing diagnoses and interventions. Patients with hip fractures often have complex health care needs and the nursing documentation can contribute to patient safety. The quality of the documentation increases with a structured journal. Furthermore, it should be written in a standardized language. Audit of nursing documentation can contribute to quality of care. Motive: Great health risks is a fact when suffering from a hip fracture, especially an already fragile person. The quality of the nursing documentation can contribute to better outcome in patient safety and the length of stay. Aim: To explore the quality of nursing documentation for patients with hip fractures. Methods: A retrospective descriptive and comparative design where audit of nursing records was used to attain the study's aim. A consecutive sample was used, where 40 patients’ health care records of nursing documentation for patients over the age of 60 with a hip fracture in an emergency orthopedic ward were included. The audit instrument Cat-ch-Ing was used. Result: The result showed that the quality was variable; none of the records had a complete documentation. Documentation of care plans were missing in a majority of the records. The documentation was of better quality in the group of younger elderly patients compared to that of older elderly patients. No quality differences were seen based on the length of stay. Conclusion: None of the records had a complete documentation. Further knowledge of how good quality nursing documentation on hip fractur patients can be implement for a sustainable result in clinical activities.

Os registros no prontuário do paciente são ferramentas estratégicas para o gerenciamento da qualidade da assistência em saúde e enfermagem. A Lesão por Pressão caracteriza-se como um indicador de qualidade assistencial e gerencial, permitindo a implementação de ações preventivas, por meio da utilização de diretrizes e protocolos clínicos destinados a orientar os profissionais de saúde para o alcance de uma assistência livre de danos. O objetivo deste estudo foi analisar o conteúdo dos registros das ações de enfermagem relacionadas ao reposicionamento dos pacientes em uma unidade de terapia intensiva. Trata-se, portanto, de estudo quantitativo, longitudinal, correlacional e analítico. A coleta de dados foi conduzida após aprovação do Comitê de Ética em Pesquisa e a amostra foi composta por 37 pacientes que atenderam aos critérios de inclusão da pesquisa. Quanto às características sociodemográficas e clínicas, foi identificado como maioria, o sexo masculino (56,8%); brancos (78,4%), na faixa etária de 60 a 79 anos (48,6%) e o tempo médio de internação na unidade com predominância de até dez dias de permanência (57,9%). A maioria dos indivíduos (48,6%) apresentou risco elevado para a Lesão por Pressão, com média de 11,7%; escore médio de gravidade de 54% na admissão e 54% na alta. Do total, 35,1% apresentou Lesão por Pressão, notificada no sistema de informação hospitalar, e 43,2% evoluiu para óbito. Na análise dos escores de risco para Lesão por Pressão (Braden) e gravidade na entrada (APACHE-E) e na saída (APACHE-S) da UTI, segundo o sexo, LP notificada e evolução para óbito entre os participantes da pesquisa, foram identificados valores estatisticamente significantes, exceto, entre as variáveis Braden e Lesão por Pressão notificada. Na análise dos valores percentuais de registros de ações de reposicionamento dos pacientes, segundo Lesão por Pressão notificada e evolução para óbito, não foram identificados valores estatisticamente significantes. Foi identificada correlação negativa (-0,369) e significância estatística (p=0,024) entre o percentual de registros de ações de reposicionamento e o escore Braden, ou seja, os pacientes com maior risco para Lesão por Pressão apresentaram maior frequência de registros de ações de reposicionamento. Na análise do conteúdo dos registros realizados diariamente pela equipe de enfermagem no prontuário do paciente, foi verificada predominância de registros relacionados à descrição da posição do paciente no leito e reposicionamento do paciente sem especificar a posição adotada. Este estudo evidencia a importância das informações produzidas pela equipe de enfermagem para identificação de pacientes em risco de desenvolvimento de Lesão por Pressão e o estabelecimento de medidas preventivas que atendam às exigências contemporâneas de maior efetividade, qualidade e segurança na assistência hospitalar, em especial, na unidade de terapia intensiva. Finalmente, vale destacar a relevância da sistematização da assistência de enfermagem, pautada na adoção de linguagem padronizada e estruturada, em suporte de papel ou eletrônico, visando à disponibilização de informação precisa, oportuna, válida, comparável e compartilhável, fundamentada nos pressupostos éticos e legais, políticos e organizacionais que envolvem o processo de auditoria no gerenciamento da assistência em saúde e enfermagem
The records in the patient\'s chart are strategic tools for managing the quality of health and nursing assistance. The Pressure Injury is characterized as an indicator of welfare and management quality allowing the implementation of preventive actions, through the use of clinical protocols and guidelines intended to guide health professionals to achieve a damage-free assistance. The aim of this study was to analyze the contents of the records of nursing actions related to the repositioning of patients in an intensive care unit. It is a longitudinal, quantitative, correlational and analytical study. Data collection was conducted after approval by the Committee of ethics in research and the sample was comprised of 37 patients who met the inclusion criteria. With regard to socio-demographic and clinical characteristics, was identified most of the males (56.8%), whites (78.4%), aged 60 to 79 years (48.6%) and the average time of hospitalization in unit with up to ten days of stay (57.9%). The majority of individuals (48.6%) presented a high risk for Pressure Injury averaging 11.7%, average score for severity on admission of 54% and 54% on high. Of the total, 35.1% presented notified Pressure Injury in hospital information system and 43.2% evolved to death. In the analysis of the risk scores for Pressure Injury (Braden) and gravity at the entrance (APACHE-E) and outlet (APACHE-S) of the ICU second sex, notified PI and evolution to death among the participants of the survey, statistically significant values were identified, except between Braden and variables notified Pressure Injury. In the analysis the percentage values of stock records of repositioning of patients according to notified Pressure Injury and evolution to death were not identified statistically significant values. It was negative correlation (-0.369) and statistical significance (p = 0.024) between the percentage of stock records of repositioning and the Braden score, i.e., patients with increased risk for Pressure Injury presented a higher frequency of stock records of repositioning. In the analysis of the content of the records held daily by the nursing staff in patient records, was observed a predominance of records related to description of the position of the patient in the bed and repositioning of the patient without specifying the position adopted. This study highlights the importance of information produced by the nursing staff to identify patients at risk for developing Pressure Injury and the establishment of preventive measures that meet the contemporary requirements of greater effectiveness, quality and safety in the hospital, in particular, in the intensive care unit. Finally, it is worth highlighting the relevance of systematization of nursing care, based on the adoption of standardized and structured language, in paper or electronic support, aimed at the provision of accurate information, timely, valid, comparable and sharable, based on ethical and legal assumptions, organizational and political involving health assistance management and nursing

Background: To date, little attention has focused on what the factors are and how Best Practice Guidelines (BPGs) are sustained in acute care over time. Problem: For ten years, a multi-site acute care center supported the use of a Pain Assessment and Management Policy and Protocol (Pain P/P), placing the decision to use it with point of care nurses. Despite early implementation success, the nursing department identified an evidence-based gap on Medicine care units. Purpose: To (i) identify factors influencing nurses’ use (or not) of the Pain P/P over time, and ten years post-implementation; (ii) examine related knowledge translation interventions (KTIs) used over time, and ten years post-implementation; (iii) validate unit nurses’ use of the Pain P/P ten years post-implementation; and (iv) identify relevant sustainability frameworks/models/theories (F/M/Ts), constructs and factors for sustained use of BPGs in acute care. Methodology: A case study of an organization-wide nursing BPG was conducted ten years following initial implementation using mixed methods guided by the Dynamic Sustainability Framework (Chambers, 2013). The case study setting was a 1122 bed acute care center in Canada. I examined BPG sustainability at the (corporate) department and unit levels (two embedded subcases). Data sources included 19 informant interviews (3-corporate, 16-unit level), 200 chart audits (100/subcase), and 29 documents. I concurrently conducted a systematic review to identify sustainability concepts and factors for use in acute care to compare case study results. Results: I identified 7 constructs, 49 factors, and 29 KTIs influencing sustained use of evidence-base practices (EBPs) in acute care. Three factors and eight KTIs had a continuous influence during implementation and sustained use phases. Findings confirm the concept of sustainability is a dynamic ‘process’ or ‘ongoing phase’. Conclusions: This thesis provides a novel resource to support future practice and research aimed at sustaining EBPs to improve nursing practice and related patient outcomes. Attention to the level of application and changing conditions over time impacting factors that influence EBP use is required for sustainment. Use of a participatory approach to engage users in designing remedial plans and link KTIs to target behaviors that incrementally address low adherence rates promotes sustainability.

Introduction: A protocol for management of sedation and pain for mechanically ventilated patients at Flagstaff Medical Center (FMC) was implemented in August 2013. It was unknown whether the protocol is being adhered to or whether it has had an impact on patient outcomes. Objectives: To develop an audit and feedback mechanism to monitor adherence to sedation protocol at FMC and determine whether the protocol has impacted patient outcomes. Methods: A retrospective manual chart review was conducted including all mechanically ventilated adult patients for four, one-month periods: 1) pre-protocol; and 2) one month, 3) six months, and 4) 12 months post-protocol implementation. Results: 132 total patients were included (32 pre; 100 post-protocol). Mean weighted adherence score for post-protocol study groups were 5.0±0.6, 5.0±0.7, and 5.2±0.7 (p=0.926) out of ten. Time of mechanical ventilation (p=0.003) and hospital length of stay (LOS) (p=0.023) were reduced post (56±58h; 9.8±7.9days) vs. pre-protocol (90±67h; 13±7days). The adherence score was weakly correlated with hospital LOS but not time of mechanical ventilation. Conclusion: This project demonstrates improvements in patient outcomes from utilization of a sedation protocol. However, this project also highlights several challenges associated with the monitoring of protocol adherence. A lack of audit and feedback may be a factor in the observed unchanged adherence over time. Both research and monitoring activities are impaired by EHR systems that do not allow for the easy extraction of data. Ensuring that adequate audit and feedback strategies are designed and available prior to implementation of new protocols is an essential step in planning the implementation of a new protocol.

Orientador: Ana Silvia Sartori Barraviera Seabra Ferreira
Resumo: As deficiências relacionadas às Anotações de Enfermagem mostram a fragilidade da assistência prestada. Os erros cometidos nos registros de Enfermagem na assistência ao paciente causam impactos negativos para as instituições de saúde, tanto no cuidado direto ao paciente, como no setor financeiro. Essas ações levam as glosas hospitalares, que é o não pagamento das prestações de serviços realizados. O objetivo deste trabalho foi desenvolver um software-protótipo para o registro eletrônico das Anotações de Enfermagem. A metodologia utilizada aplicou a realização de uma revisão integrativa de literatura com o objeto de estudo, as Anotações de Enfermagem, e para desenvolvimento do protótipo se utilizou a engenharia de software, contemplando as fases de definição, desenvolvimento e avaliação. A construção do software ocorreu por meio do Microsoft Visual Studio®, que possui um ambiente de desenvolvimento integrado, com programação orientada a objetos, utilizando principalmente a linguagem de programação C# (C SHARP). O software construído foi norteado por deficiências identificadas acerca das inconformidades dos registros. Os resultados apresentados envolveram o desenvolvimento do programa, os layouts das telas do software contemplando as principais necessidades encontradas na literatura sobre déficits das Anotações de Enfermagem. O software-protótipo englobou a necessidade de ser um programa de fácil manipulação, intuitivo e que atendesse aos requisitos do Conselho de Classe, tendo ... (Resumo completo, clicar acesso eletrônico abaixo)
Abstract: The deficiencies related to the Nursing Notes show the fragility of the assistance provided. The errors made in the nursing records in patient care cause negative impacts for health institutions, both in direct patient care and in the financial sector. These actions lead to hospital disallowances, which is the non-payment of services rendered. The objective of this work was to develop a prototype software for the electronic registration of Nursing Notes. The methodology used applied an integrative literature review with the object of study, the Nursing Notes, and for the development of the prototype, software engineering was used, covering the phases of definition, development and evaluation. The software was built using Microsoft Visual Studio®, which has an integrated development environment, with object-oriented programming, using mainly the C # programming language (C SHARP). The software built was guided by deficiencies identified about the nonconformities of the records. The results presented involved the development of the program, the layouts of the software screens contemplating the main needs found in the literature on deficits in Nursing Notes. The prototype software encompassed the need to be a program that is easy to handle, intuitive and that meets the requirements of the Class Council, based on the Guide for recommendations for registering Nursing in the patient's record and other COFEN Nursing documents.
Mestre

This study was aimed at investigating the attitudes of nurse managers towards quality improvement programmes in the East London Hospital Complex. The research design comprised a qualitative, exploratory and descriptive approach. A purposive sample of 10 nurse managers participated in the study. The data were collected through interviews, using a semi-structured interview guide. Interviews were recorded using audiotape. Data were analysed manually and by using the computer software Atlas ti. Positive and negative themes were identified and ethical consideration was ensured by means of privacy, confidentiality and anonymity. The findings revealed that nurse managers in the East London Hospital Complex had overall positive attitudes towards quality improvement programmes. A few negative attitudes and their contributory factors were also identified. The limitations of the study and recommendations based on the findings of the study are presented

Stroke is one of the major causes of eating difficulties (EDs). It is one of the leading causes of death and disability and one of the most important factors contributing to health-care costs. There is a clear association between EDs after stroke and undernutrition, where studies have shown that structured screening of eating function among stroke patients can predict nutritional problems as well as need for subsequent institutional care. Reliable and valid instruments that can identify EDs exist, but there is lack of knowledge on how persons experience living with EDs after stroke. Stroke unit care is evidence-based and grounded in multidisciplinary collaboration and continuity of care. The overall aim of this thesis is to explore and describe EDs after stroke as represented by health care professionals in patient records (PRs) and transferred information, and as described by persons living with EDs after stroke. An additional aim is to explore methodological aspects related to the inclusion of persons with EDs and communication impairment in research studies. Both quantitative and qualitative methods were used. Two studies used descriptive designs (I, II), one an explorative design (III) and one applied a methodological discussion (IV). In one of the studies PR data were used (I), in another study data were derived from three sources: PRs, screening of patients and interviews with nurses (II). Persons with EDs after stroke participated in Study III while literature, empirical data and researchers' experiences served as the data in study IV. Data were analysed by categorisation of phrases (I), content analysis (II) and descriptive statistics (I, II), by qualitative analysis (III) and by processing of literature and empirical findings in two research groups (IV). The main findings from the studies on representation of stroke care in PRs (I, II) showed that, despite that >50% of patients in Study I and all patients in Study II had EDs, there were few signs of multidisciplinary collaboration dealing with this problem. Unsystematic screening for swallowing difficulties was routine, whereas screening for nutritional risk and EDs was lacking (I, II). Multidisciplinary discharge summaries proved to have low quality and entailed little information on patients' eating ability (I). The two EDs most frequently documented were swallowing and lack of energy to complete a meal (I,II). EDs were described in vague terms (I, II). In Study II, all patients had swallowing difficulties and most patients had lack of energy to complete a meal. The electronic information transfer tool held information on eating ability for most patients (II), but the nursing staff in residential home care perceived deficiencies in that information, even identifying several EDs not reported at discharge (II). Experiences from persons living with EDs after stroke were presented in one main theme: Striving to live a normal life, including three sub-themes: Abandoned to learn on one's own (little support from health care professionals to learn to handle eating), Experiencing losses (loss of eating functions and loss of valued activities) and Feeling dependent in mealtime situations (III). One major finding from the methodological exploration (IV) is that creative approaches and suitable methods for inclusion of participants with EDs and communication impairment into qualitative studies can be found in the fields of aphasiology and learning disabilities. Another major finding from Study IV is that researchers need good communication skills as well as knowledge in neuropsychology. A general conclusion is that screening for EDs should be routine in stroke care and that a multidisciplinary terminology to express EDs must be developed to provide accurate information transfer. Health care professionals need to enhance their knowledge in nutrition and provide support to stroke patients with EDs with the goal that they can eat and perform meal-related activities in accordance with their habits before the stroke. To gain access to the experiences of persons with EDs and communication impairment researchers need to test participatory approaches when planning for inclusion of those persons.

Syfte: Syftet med studien var att undersöka hur omvårdnaden dokumenteras i datoriserad patientjournal på en medicinavdelning i mellan Sverige, genom en journalgranskning med granskningsinstrumentet Cat-ch-Ing. Frågeställningarna var ”Vilka poäng ger Cat-ch-Ing instrumentet avseende kvantitet samt kvalitet?” och ”Kan omvårdnadsprocessen följas i omvårdnadsjournalen utifrån Cat-ch-Ing instrumentet?”

Metod: Studien är kvantitativ, deskriptiv och retrospektiv. En journalgranskning gjordes med hjälp av granskningsinstrumentet Cat-ch-Ing. Ett systematiskt urval av 100 journaler gjordes och därefter ett slumpmässigt urval av 30 journaler. Cat-ch-Ing instrumentet består av designade frågor som poängsätter sjuksköterskans dokumentation avseende kvantitet och kvalitet, samt hur omvårdnadsprocessen som helhet följs.

Resultat: Högst poäng avseende kvantiteten fick omvårdnadsepikrisen/slutanteckning och användandet av VIPS-sökord, medan omvårdnadsstatus uppdaterat under vårdtiden fick den lägsta poängen. Högst poäng avseende kvaliteten i dokumentationen fick användandet av VIPS-sökord och omvårdnadsstatus vid ankomst, medan vårdplanens omvårdnadsmål och omvårdnadsdiagnos fick de lägsta poängen. Resultatet visade att dokumentationen på medicinavdelningen följer omvårdnadsprocessens alla steg, då alla delar i omvårdnadsprocessen fick poäng avseende kvantitet i Cat-ch-Ing instrumentet.

Slutsats: Resultatet i den här studien tyder på att dokumentationen på medicinavdelningen generellt var bra, eftersom den har fått höga poäng i Cat-ch-Ing instrumentet. Omvårdnadsprocessens alla delar fanns med i dokumentationen. De brister som fanns förekom framförallt i vårdplanernas omvårdnadsdiagnoser, omvårdnadsmål samt i att uppdatera status. Kontinuerlig utbildning för all personal och uppföljning i form av journalgranskning behövs för att öka kvaliteten i omvårdnadsjournalen.

O enfermeiro tem sido cada vez mais requisitado para envolver-se nas decisões financeiras nas organizações de saúde. Sua participação no gerenciamento dos custos associado à assistência de enfermagem é importante para conhecer o quanto a enfermagem contribui para o faturamento de uma Unidade de Terapia Intensiva (UTI) e ao faturamento de um hospital e evidenciar, financeiramente, a relevância do trabalho desse profissional. No entanto, a literatura brasileira carece de estudos nesse aspecto. O objetivo deste estudo foi levantar o valor do faturamento gerado pelos procedimentos de enfermagem, mediante as prescrições médica e de enfermagem, identificar as atividades de enfermagem que são realizadas, mas não recebem pagamento pelas operadoras de saúde e estimar a perda monetária do hospital pela não taxação das atividades de enfermagem, em uma. Tratou-se de um estudo de caso exploratório, descritivo, com abordagem quantitativa. O estudo foi desenvolvido na UTI Cardiológica de um hospital geral filantrópico, com 319 leitos, na cidade de São Paulo. A amostra total calculada para 3 meses foi de 168 pacientes. O faturamento médio gerado pelas prescrições de enfermagem e médica foi de R$ 773,98, e R$ 333,06 corresponderam à prescrição de enfermagem e R$ 440,92, à prescrição médica. Em relação ao valor gerado pela prescrição de enfermagem (R$333,06), R$ 261,67 corresponderam ao pagamento de materiais de consumo e R$ 71,39, ao pagamento de taxas. Em relação ao valor gerado pela prescrição médica (R$ 440,92), R$ 322,51 corresponderam ao pagamento de materiais de consumo e R$ 118,41, ao pagamento de taxas. Os procedimentos da prescrição de enfermagem que mais contribuíram para o faturamento foram a troca de filtro bacteriano (R$ 10.342,80), a realização de punção venosa (R$ 8.062,99), o curativo de ferida operatória (R$ 5.315,26) e o curativo de traqueostomia (R$ 4.762,42). Os procedimentos provenientes da prescrição médica que mais geraram faturamento foram a realização de glicemia capilar (R$ 21.602,06), passagem de pressão arterial invasiva (R$ 14.220,56) e a passagem de sonda gástrica/enteral (R$ 20.239,00). A perda média estimada foi de R$ 480,65 por paciente da amostra. A estimativa média de perda para a amostra estudada foi de R$ 81.263,65. A projeção de perda média de faturamento, para o período dos 3 meses do estudo, para a amostra selecionada, foi de R$ 153.391,15. A extrapolação da estimativa de perda média para o período de um ano, para a amostra selecionada, foi de R$ 613.564,60. Do faturamento total da amostra selecionada, as atividades de enfermagem contribuíram com 1,7% do faturamento, e 0,65% corresponderam aos procedimentos executados mediante a prescrição de enfermagem e 1,05%, aos procedimentos provenientes da prescrição médica
Nurses have increasingly been asked to participate in financial decisions in healthcare organizations. Their participation in managing the costs of nursing care is important to know how nursing contributes to the turnover of an ICU and hospital billing, and, it shows, financially, the relevance of the work of these professionals. However, Brazilian literature lacks studies in this regard. The objective of this study was to raise the value of the revenue generated by nursing procedures by the medical and nursing requirements, to identify nursing activities that are performed but not paid by health insurance companies and to estimate the monetary loss of the hospital for not taxing nursing activities in an intensive care unit (ICU). It was an occurrence study, exploratory, descriptive in a quantitative approach. The study was conducted in the Cardiology ICU of a philantropic general hospital, with 319 beds in the city of Sao Paulo. The total sample calculated for three months was 168 patients. The sources of information were the medical and accounting records of selected patients. The average revenue generated by medical and nursing prescriptions was R$ 773,98 which R$ 333,06 corresponded to the nursing prescription and R$ 440,92, the medical one. In relation to the value generated by the nursing prescription (R$ 333,06), R$ 261,67 corresponded to the payment of consumables and R$ 71,39 to fees. For the value generated by the prescription (R$ 440,92), R $ 322,51 corresponded to the payment of consumables and R$ 118,41, the payment of fees. The procedures of nursing prescription which most contributed to revenue were the exchange of bacteria filter (R$ 10.342,80), performing venipuncture (R$ 8.062,99), the surgical wound dressing (R$ 5,315.26) and tracheostomy dressing (R$ 4.762,42). The procedures from prescription which most generated revenues were performing capillary blood glucose (R$ 21.602,06), passage of invasive blood pressure (R$ 14.220,56) and passage of nasogastric tube / enteral (R$ 20.239,00). The average loss was estimated at R$ 480,65 per patient sample. The average estimate of loss for the sample studied was R$ 81.263,65. The projected average loss of revenue for the period of three months of the study, for the sample selected, was R$ 153.391,15. The extrapolation of the estimated average loss for the period of one year, for the selected sample, was R$ 613.564,60. From the total revenue of the selected sample, nursing activities accounted for 1.7% of revenues, and 0.65% corresponded to the procedures performed by nursing prescription and 1.05% corresponded to the procedures from the doctors prescription

A auditoria tem sido uma ferramenta gerencial utilizada pelos profissionais da saúde, em especial os enfermeiros, com a finalidade de avaliar a qualidade da assistência de enfermagem e os custos decorrentes da prestação desta atividade. Embora essas duas vertentes de atuação sejam de grande importância, os estudos realizados até então demonstram que o foco da auditoria de enfermagem privilegia a sua dimensão contábil. A revisão da literatura também revela que o tema é pouco explorado evidenciando que não há clareza acerca de concepção, de método e da finalidade da auditoria de enfermagem, requerendo investimentos na produção de conhecimentos que possam sustentar a atuação dos profissionais nesta área. Desse modo, os objetivos desta pesquisa estão circunscritos a identificar e analisar opiniões de especialistas em auditoria que atuam no contexto da enfermagem brasileira e, sistematizar tendências de concepção, de método e de finalidade da auditoria de enfermagem, na atualidade e para os próximos cinco anos. Metodologicamente a investigação foi estruturada utilizando-se da técnica Delphi que trata de um tipo de avaliação prospectiva e consensual de tendências, por parte de especialistas no tema investigado. Assim foi elaborado um instrumento de coleta de opiniões contendo questões de tendências e de prioridades sobre auditoria de enfermagem. A coleta de dados foi realizada em duas rodadas conforme recomendado, na primeira etapa os especialistas tiveram acesso ao questionário e suas respostas foram organizadas e analisadas buscando identificar a convergência entre os participantes. Para a obtenção de consenso foi estabelecido um percentual mínimo de 70% de concordância; as questões que não alcançaram esse patamar foram reenviadas aos especialistas para uma segunda rodada de opiniões. Os resultados revelaram que a concepção atual da auditoria está enfocada na visão contábil e financeira tendo em vista a sustentação econômica do hospital e como ato de controladoria visando identificar pagamentos indevidos referentes à conta hospitalar; no futuro, à essa concepção referida será associada, a avaliação da qualidade da assistência, com envolvimento em outras áreas que interferem na assistência. Os métodos e finalidades que obtiveram consenso entre os participantes para a atualidade e futuro estão intimamente relacionados a concepção de tais períodos. Na atualidade o método da auditoria de enfermagem foi considerado de forma retrospectiva, do tipo interna, contemplando as etapas de coleta de dados e análise de contas hospitalares a fim de impor glosas ou diminuí-las, utilizando dados coletados dos prontuários dos pacientes, registros e manuais de enfermagem; no futuro, foram associados à esses métodos, a forma concorrente, o tipo externa, contemplando a análise da estrutura, processo e resultado, considerando visão integrada e ampliada e a definição de objetivos, coleta de dados acerca dos processos da assistência de enfermagem com elaboração de relatório técnico. A finalidade da auditoria de enfermagem na atualidade está restrita à comprovação de pagamento de contas hospitalares, revendo glosas, realizando negociações entre representantes do hospital e do convênio; no futuro, associado à primeira finalidade, apontar inadequações da assistência de enfermagem, reformulando suas práticas, indicando processos de educação em serviço e delineando ações corretivas. Com relação as prioridades a serem implementadas para a prática futura, foram pontuados a formação específica (especialização) e o planejamento e execução de forma sistemática pautada no conhecimento científico e técnico da profissão. Conclui-se que a auditoria de enfermagem cumpre uma finalidade institucional que na atualidade está pautada em um enfoque empresarial e mercadológico. Há uma tendência de mudança do enfoque de mercado voltado para o cliente, portanto pautado na qualidade do produto ou serviço, havendo a adequação das ações nesse sentido.
Auditing has become a managerial tool employed by healthcare professionals, in particular nurses, to evaluate the quality of nursing care and its cost. Although both these lines of action are highly important, studies carried out to date indicate that nursing care audits focus on its accounting dimension. A review of the literature also indicates that the theme is not explored much, which indicates that the notion, method and purpose of nursing audits are unclear and require investment in the production of knowledge capable of providing support for the professionals who work in this field. Thus, the objectives of this study center on identifying and analyzing the opinions of auditing experts who work within the context of Brazilian nursing and systematizing trends regarding the notion, methods and purposes of nursing audits at present and over the next five years. In terms of methodology, the study was structured using the Delphi technique, which consists of a type of prospective and consensual evaluation of trends, performed by experts on the theme under investigation. To do this, we developed a questionnaire for collecting opinions about the trends and priorities of nursing auditing. The data was collected in two rounds, as recommended. In the first stage, the experts responded to the questionnaire and their responses were organized and analyzed, an attempt being made to find points of convergence among the interviewees. Consensus was defined as having at least 70% in agreement. Questions whose responses failed to reach this level were sent back to the experts for a second round of opinions. Results showed that the current notion of nursing audits focuses on the accounting and financial elements, the financial maintenance of the hospital being kept in mind as well as the controlling activity of trying to identify incorrect hospital bills. In the future, however, the notion of auditing is expected to become associated with evaluating the quality of care, with the involvement of other areas that have an impact on it. The methods and objectives that were the object of a consensus among the respondents, in terms of both the present and the future, are intimately related with the notion of these periods. At present, the nursing auditing methods were seen in retrospect as being of an internal type, i.e., as taking into account the data collection stages and the analysis of hospital accounts in order to impose discounts or reduce cost, using information collected from patients\' medical files, records and nursing manuals. In the future, it is expected that the competing kind, i.e., the external type, will be associated with these methods, taking into account the structure, process and result, considering an integrated and expanded view as well as the definition of objectives and data collection regarding the processes of nursing care, with the preparation of technical reports. Currently, the purpose of nursing audits is limited to double checking that hospital bills are paid, carrying out negotiations between hospital representatives and healthcare plans; in the future, in association with the first purpose, there will be the intent to point out inadequate nursing care, reformulate its practices, propose service education processes and outline remedial actions. As for priorities to be implemented regarding future practices, the main elements mentioned were specific training (specialization) and planning plus systematic execution, based on scientific and technical knowledge of the profession. One concludes that nursing audits fulfill an institutional purpose that is currently based on a business and marketoriented focus. There is a trend toward this market focus changing and evolving into a stronger focus on the client, based more on the quality of the product or service, nursing audits being then adapted in this direction.

The aim of this study was to understand how evaluations are implemented and used in procured nursing homes for elderly. Our methodological approach consisted of a single-case study research. The case in this study was Växjö municipality. Three procured nursing homes for elderly were chosen in the municipality as examples of implementation and use of evaluation. The method for retrieving empirical data and the analyzing of it was based on triangulation. The empirical data was retrieved by semi-structured interviews with representatives from Växjö municipality and the suppliers. Empirical data was also retrieved from documents concerning the procurements and the evaluation process present in this study. The empirical data was analyzed on the basis of the neo-institutional theory and previous research that explain the implementation and use of evaluations. The result shows that evaluations are used as audit to control the suppliers and occur at three different levels in the municipality. The result also shows that the context and legitimacy of an organization affects the implementation and use of the evaluations. The result has made us question the use of evaluation at the overall level in view of the political debate at this level. The source of our doubts lies in that there are ideological differences in how politicians value procurement that may influence the use of evaluation. The ways the municipality implements and uses evaluations appear to be institutionalized.

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Objetivo: Propor uma padronização da gestão do processo de auditoria interna para a melhoria da qualidade dos serviços de um hospital privado na cidade de Santa Maria, no interior do Rio Grande do Sul. Método: Pesquisa transversal, cujos dados foram coletados de maneira prospectiva, por meio da análise de 200 prontuários, após a alta dos pacientes internados em uma das unidades de atendimento clínico-cirúrgicas, no período de agosto a outubro de 2016, a fim de identificar as glosas ocorridas no período. Resultados: Verificou-se que a categoria com maior quantidade de glosas é a de técnico em enfermagem, sendo o turno da tarde o de maior ocorrência delas. Os erros de prescrição médica foram prevalentes, totalizando 56,3% do total; entre eles, os medicamentos suspensos representaram 80,6%. Os erros de enfermagem mais frequentes são os de prescrição de cuidados realizados e não checados, representando 62,5% do total. As glosas mais encontradas das contas auditadas foram em relação aos custos dos procedimentos remunerados. Para minimizar as glosas, foram sugeridos: encontros semanais entre enfermeiros auditores e a equipe assistencial, criação de um checklist para o carro de emergência e dispensação de medicações por dose unitária. Conclusão: Fica clara a necessidade de implantar um processo de auditoria, atrelando qualidade assistencial e cobranças hospitalares ao cotidiano dos enfermeiros.
Objective: Propose a standardization of the internal audit process's management, to the improvement of services quality of a private hospital in the city of Santa Maria, a country side city of Rio Grande do Sul. Method: Transversal research, prospectively collected, through the analysis of 200 medical records, after the discharge of patients hospitalized in one of the clinic-surgical units from August to October 2016, in order to identify the glosses Occurred in the period. Results: It was verified that the category with more hospital gloss quantity is the nursing technician, being the afternoon the shift with more occurrences of it. The medical prescription errors were the prevalent, totalizing 56.3% of total; between them, the suspended medicines represented 80.6%. The most frequent nursing errors are the ones of prescriptions of realized care and not verified, representing 62.5% of total. The hospital gloss more found in the audited accounts were in relation to the costs of remunerated procedures. To minimize the hospital gloss, it was suggested: weekly meeting between the nurses’ auditors with the assistential team, creation of a checklist to the emergency car and the dispensation of medications per unit dose. Conclusion: It's clear the necessity of the implantation of an audit process, unifying assistential quality and hospital charges to the day by day of nurses.

Clinical documentation is an essential quality element that is often not adequately completed. Current data demonstrate that 32% of home health claims do not meet the requirements for federal reimbursement. Rogers's diffusion of innovation was used as a conceptual framework to guide this quality improvement project which determined whether home health nurses with education and chart audit experience demonstrate increased documentation compliance relative to nurses with education only. After completing a 1-hour education program on documentation, a convenience sample of home health nurses (n = 8) was divided between a chart-audit group (n = 4) and a no-chart-audit group (n = 4). Each nurse in the chart-audit group reviewed 4 charts for adequacy of documentation related to pain assessment, homebound status, and skilled nursing notes. Charts of all nurses who attended the education program were independently assessed for documentation compliance 3 weeks after they completed the chart audit session. Based on Fisher's exact test analysis, no significant difference in adequacy of documentation was noted between nurses who conducted chart audits and those who did not; however, all nurses in the audit group had adequate documentation compliance for pain, homebound status, and skilled nursing notes. Nurses with > 4 years in nursing charted more adequately than nurses with -?¤ 4 years in nursing, and nurses with -?¤ 4 years in homecare were found to chart more adequately than nurses with > 4 years in homecare. Staff participation in chart audits, as a quality improvement strategy, may improve compliance with documentation requirements.

A implementação de um sistema de avaliação organizacional por meio de indicadores é imprescindível para uma administração eficiente, na busca da melhoria da qualidade e segurança da assistência, otimização dos recursos, produtividade e satisfação do cliente. A utilização de medidas válidas e fidedignas, no entanto, é condição essencial, pois propicia monitorar a qualidade do cuidado dispensado, subsidia o planejamento de ações corretivas, além de direcionar estratégias e reajuste de metas por meio de ações educativas e de valorização profissional, princípios do Gerenciamento da Qualidade. O objetivo do estudo é testar a confiabilidade interavaliadores de indicadores de qualidade e utilizá-los na avaliação da assistência de enfermagem em hospital público de ensino. Foi desenvolvido em duas etapas: na primeira desenvolveu-se uma pesquisa quantitativa, metodológica, experimental e aplicada, em um hospital terciário público de ensino, que testou a confiabilidade interavaliadores de quinze indicadores de qualidade do cuidado de enfermagem. Na segunda etapa desenvolveu-se uma pesquisa aplicada, descritiva, exploratória, de abordagem quantitativa, do tipo estudo de caso, em duas unidades médico- cirúrgicas da instituição, com um total de 113 leitos, que avaliou a qualidade da assistência de enfermagem por meio da aplicação dos indicadores testados. Os resultados da primeira fase demonstram a fidedignidade dos indicadores, com resultados de Kappa para os indicadores de número 1 a 11 e 15 variando entre 0,956 e 1,000 e Coeficiente de Correlação Interclasse entre 0,951 e 0,992 para os indicadores 12, 13 e 14, o que caracteriza concordância/reprodutibilidade excelente, com p-value menor do que 0,001. Os resultados da aplicação dos indicadores na avaliação da qualidade da assistência mostram que na unidade feminina os menores percentuais de adequação ao padrão relacionam-se aos registros das ações de cuidados, no que tange às identificações (acesso venoso periférico - 44%, equipos - 66%, rótulos de soro - 60%, escala graduada - 33% e sonda gástrica - 58%) e checagens (prescrição de enfermagem - 52%, médica - 75% e registro de sinais vitais - 55%). Na unidade masculina os menores percentuais também se relacionam às identificações (acesso venoso periférico - 58% e sonda gástrica - 71%) e checagens (prescrição de enfermagem - 82%, médica - 86% e registro de sinais vitais - 88%). Com base nos resultados e a partir da aplicação do Ciclo PDCA para Solução de Problemas e ferramenta 5W1H para elaboração do Plano de Ação, a metodologia WebQuest foi proposta como estratégia educativa para enfrentamento dos problemas detectados. Conclui-se que os indicadores testados atendem ao requisito de fidedignidade da medida e os níveis de concordância e confiabilidade obtidos demonstram a relevância deste instrumento para a prática clínica, na avaliação da qualidade da assistência de enfermagem. Nas unidades avaliadas, o desempenho das equipes de enfermagem em relação aos indicadores avaliados se mostrou comprometido, principalmente no que se refere aos registros das ações de cuidados, caracterizando a necessidade de investimentos em capacitação, por meio de formas mais atraentes e estimulantes, que propiciem a busca ativa do conhecimento e que estimulem os servidores a participar das atividades educativas oferecidas pela instituição.
The implementation of an organizational assessment system by means of indicators is essential for an efficient administration in the pursuit of improving the quality and safety of care and optimizing resources, productivity and customer satisfaction. The use of valid and reliable measures, however, is a core condition because it allows for monitoring the quality of the provided care, subsidizes the planning of corrective actions, in addition to directing strategies and readjustment of goals through education and professional development, principles of Quality Management. Thus, this study aims to test the inter-rater reliability of quality indicators and use them in the evaluation of nursing care in a public school hospital. It was developed in two phases: firstly, an applied experimental quantitative methodological research was accomplished in a tertiary public school hospital, in which the inter-rater reliability of fifteen indicators of nursing care quality was tested. In the second phase, an applied descriptive exploratory quantitative research, kind of case study, was accomplished in two medical surgical units of the institution, with a total of 113 beds, which assessed the quality of nursing care through the application of the tested indicators. The results of the first phase show the reliability of the indicators, with Kappa results for the indicators number 1 to 11 and 15 ranging between 0.956 and 1.000 and Intraclass Correlation Coefficient between 0.951 and 0.992 for the indicators 12, 13 and 14, which characterizes excellent concordance/reproducibility, with p-value less than 0.001. The results of the application of the indicators in the assessment of quality care show that in the female unit the lowest percentages of adequacy to the standard relate to the records of care actions, with respect to identification (peripheral venous access - 44%, hoses - 66%, labels of serum - 60%, graduated scale - 33% and gastric hose - 58%) and verification (nursing prescription -52%, medical prescription - 75% and recording vital signs - 55%). In the male unit the lowest percentages also relate to identification (peripheral venous access - 58% and gastric hose - 71%) and verification (nursing prescription - 82%, medical prescription - 86% and recording vital signs - 88%). Based on the results as well as the implementation of the PDCA cycle for Troubleshooting and the 5W1H tool for preparation of the Action Plan, the Web Quest method was proposed as an educational strategy for coping with the problems detected. In conclusion, the indicators tested meet the requirement of reliability of the measures and the levels of agreement and reliability obtained demonstrate the relevance of this instrument in clinical practice for the evaluation of the quality of nursing care. As to the assessed units, the performance of nursing teams in relation to indicators shows insufficient, especially in relation to records of care actions, characterizing the need for investment in more attractive and stimulating training, encouraging the active search for knowledge and stimulating the servers to participate in the educational activities offered by the institution.

Den dokumentation som görs i patientjournaler får allt större betydelse för patientens säkerhet och delaktighet samt för uppföljning och utveckling av vårdens kvalitet. IT-stöd ökar informationens tillgänglighet, men studier visar på brister vad gäller struktur och innehåll.

Syftet med denna studie var att kartlägga i vilken omfattning dubbeldokumentation förekom i den tvärprofessionella, elektroniska patientjournalen, relaterat till sjuksköterskans dokumentation (delstudie I), samt att undersöka personals uppfattningar om dubbeldokumentation och värdet av att använda egen och annan professions dokumentation (delstudie II).

Studien genomfördes på ett länsdelssjukhus där datorjournaler använts i ca 10 år. Trettio strokepatienters journaler analyserades utifrån VIPS-modellens sökord och arbetsterapeuter, läkare, sjukgymnaster och sjuksköterskor (N = 111) besvarade en studiespecifik enkät.

Resultatet visade att 15 % av innehållet i omvårdnadsdokumentationen (exklusive epikris) också fanns dokumenterat på annan plats i journalen, en eller flera gånger. Av omvårdnadsanamnesernas innehåll var 43 % dubbeldokumenterat. Motsvarande andel för omvårdnadsstatus och omvårdnadsåtgärder var 6 % respektive 10 %. När det gäller omvårdnadsepikriserna var 41 % av innehållet även dokumenterat i annan professions epikris. Dubbeldokumentationer förekom oftare mellan sjuksköterska och läkare än mellan sjuksköterska och arbetsterapeut/sjukgymnast. Samtliga professioner ansåg det värdefullt att kunna ta del av varandras dokumentation. Läkarens dokumentation följdes i stor utsträckning av alla. Arbetsterapeuter, sjukgymnaster och sjuksköterskor följde varandras dokumentation i stor utsträckning. Det var vanligare att man sökte specifik information än läste dokumentationen för att skaffa sig en helhetsbild. Sjuksköterskor sökte också ofta information för att i sin tur lämna denna vidare. Dubbeldokumentation ansågs förekomma mest inom journalens anamnesdel. Tänkbara orsaker till dubbeldokumentation ansågs vara att man inte läser vad andra har dokumenterat, att man vill visa vad som gjorts samt att diktaten skrivs in för sent. Vid jämförelse mellan sjuksköterskor med äldre utbildning respektive de med utbildning enligt 1993 års studieordning visades att sjuksköterskor med äldre utbildning instämde i högre utsträckning till att dubbeldokumentation ofta förekommer mellan läkare och sjuksköterska.

För att undvika onödig dubbeldokumentation krävs, förutom att aktuell information finns tillgänglig, att roller och ansvarsförhållanden mellan professionerna tydliggjorts.

The documentation made in patients’ charts is becoming of greater importance for the safety and involvement of patients and for the follow up and development of the quality of care. IT support increases the accessibility of information, but studies even show deficits pertaining to structure and content. The aim for this study was to survey to what extent double documentation occurs in multiprofessional, electronic patient charts, related to the nurse’s documentation and to investigate staffs’ understanding of the value and usage of other professionals’ documentation.

The study was conducted at a county hospital where computer charts have been in use for about 10 years. Thirty stroke patients’ charts were analysed on the basis of the VIPS models key words and occupational therapists, physicians, physiotherapists, and nurses completed a study specific survey.

The results showed that 15% of the content in nursing care documentation (excluding epicrisis) was also documented in other places in the chart, one or more times. Of the content of the nursing anamnesis 43% were double documented. The corresponding share of the nursing status and nursing interventions were 6% respectively 10%. When it comes to nursing epicrisis 41% of the content was also documented in other professionals’ epicrisis. Double documentation occurs more often between nurses and physicians than between nurses and occupational therapists/physiotherapists.

All of the occupations considered that it is valuable to be able to take part in each others documentation. Physicians’ documentation was followed to a great extent by all. Occupational therapists, physiotherapists, and nurses followed each others documentation to a great extent. It was more common to seek specific information that to read the documentation in order to acquire an overall picture. Nurses sought also often information which in turn was given to others. Double documentation was considered to occur mostly in the section of the chart for anamnesis. Conceivable reasons for double documentation were considered to be caused by not reading what others had documented, to show what had been done, and that dictation was written in too late. At a comparison between nurses with an older education and those with an education according to the 1993 curriculum showed that nurses with an older education agreed to a greater extent that double documentation occurred between physicians and nurses.

Avoiding unnecessary double documentation demands, besides that current information is available, that the conditions of rolls and responsibilities between professionals are clarified.

The management and treatment of chronic diseases, such as end-stage renal disease, is often unproductive because of patients' poor adherence to treatment. The chronic care model toolkit is an Agency for Healthcare Research and Quality supported framework, associated with improved outcomes in patients living with chronic disease. The purpose of this project was to develop and plan an educational program using the chronic care model toolkit for the interdisciplinary clinical staff of a renal hemodialysis center. The goal of this project was to adapt team building between patients and their clinicians through the use of the chronic care model in order to improve patients' adherence to treatment. The educational program materials were developed, including a plan for future implementation over 6 weeks in 2-hour twice-weekly sessions. Program planning accounted for the mixed roles and responsibilities of the interdisciplinary clinical team members, who will share their knowledge among the team and act as patient advisors. The pretest and posttest materials were developed from the toolkit Team Health Audit Questionnaire, which can be used to evaluate staff learning after the program is delivered. Existing clinical metrics are tracked through a Quality Assessment Performance Improvement measure, which will be used to evaluate potential long term influences of the program on patient adherence and outcomes. The project may contribute to social change in practice by enhancing teamwork that has the potential to improve clinical outcomes. Future research should include longitudinal studies on team building using the chronic care model toolkit to determine if its adaption enhances team effort and contributes to a collaborative workforce that improves clinical outcomes.

O uso de Registros Eletrônicos de Saúde aliados aos sistemas de classificações, têm auxiliado na implementação do Processo de Enfermagem na prática clínica. Entretanto, possuir um sistema informatizado não garante a completude e qualidade de registros, necessitando de avaliações e aperfeiçoamento de forma sistemática. Essas avaliações têm sido realizadas por instituições que buscam a Acreditação Hospitalar. Considerando essa questão, durante todo o período de preparo para a Acreditação Hospitalar, a instituição campo de estudo desenvolveu intervenções com vistas a melhoria da qualidade assistencial, contemplando ações para a qualificação dos registros informatizados de enfermagem. Assim, este estudo teve por objetivo avaliar a qualidade dos registros informatizados de enfermagem de um hospital em dois momentos distintos, antes e após o preparo para a Acreditação Hospitalar. Trata-se de um estudo observacional de intervenções, retrospectivo de abordagem quantitativa realizado em um hospital universitário do sul do Brasil. A população do estudo foram os registros de enfermagem dos Serviços de Enfermagem Clínica e Cirúrgica, referentes ao período anterior e posterior a Acreditação Hospitalar, ou seja, os meses de outubro de 2009 e de 2013, respectivamente. Foram considerados critérios de inclusão prontuários de pacientes internados por pelo menos quatro dias em uma mesma unidade de internação, totalizando 224 prontuários. Não foram previstos critérios de exclusão. Os dados foram coletados por dois avaliadores entre os meses de dezembro de 2013 e janeiro de 2014. Para avaliação da qualidade dos registros, utilizou-se o instrumento Q-DIO - Versão brasileira, traduzido e validado para a língua portuguesa. Um segundo instrumento foi elaborado, concomitante a um manual de orientações, com critérios de qualidade específicos da Joint Commission International (JCI), não atendidos pelo primeiro. Foi realizado um teste piloto com 24 prontuários para estimar a concordância entre os dois avaliadores no preenchimento do Q-DIO – Versão brasileira e dos Critérios de qualidade específicos da JCI. Os dados foram analisados estatisticamente. Resultados: Houve melhora significativa da qualidade dos registros de enfermagem (p<0,001). Quando avaliado o escore total do instrumento Q-DIO – Versão brasileira houve melhora em 24 dos 29 itens (82,8%) e dos Critérios de qualidade específicos da JCI, em 9 de 12 itens (75%). Com base nestes resultados, conclui-se que houve empenho à mudança de cultura, por meio da inovação organizacional, de protocolos, de auditorias e, sobretudo, de atividades educativas, o que favoreceu o reconhecimento do campo de estudo como centro acadêmico de excelência em qualidade em saúde e segurança dos pacientes pela JCI em 2013. Espera-se que este trabalho incentive hospitais a estabelecerem metas de melhorias assistenciais e, consequentemente, de registros de enfermagem, a partir de intervenções educativas.
The use of Electronic Health Records allied to classification systems has supported the Nursing Process implementation into the clinical practice. However, owning a computerized system does not guarantee the completeness and quality of records, requiring reviews and improvement in a systematic way. These assessments have been undertaken by institutions seeking to Hospital Accreditation. The hospital audits can be used as a control tool for the work quality. Considering this issue, throughout the period of preparation for Hospital Accreditation, the institution field of study developed several strategies to improve quality of care, therefore, of computerized nursing records. With the aim of to assess changes in the computerized nursing records quality, this study proposes to evaluate the nursing records quality at two different times, before and after implementation for Hospital Accreditation. This is a retrospective observational study of interventions with a quantitative approach developed in a university hospital in southern Brazil. The study population was nursing records from the surgical and medical nursing services before and after the period of preparation for Hospital Accreditation, during the period of October 2009 and 2013, respectively. Inclusion criteria were inpatient medical records with stay of length of at least four days in the same inpatient unit, totaling 224 records. No exclusion criteria were previewed. Data collection was performed by two evaluators between the months of December 2013 and January 2014. To assess the records quality, we used the Q-DIO instrument - Brazilian version, translated and validated to the Portuguese language. A second instrument was built, concomitant with a guideline instructions, with specific quality requirements of Joint Commission International (JCI), which accessed missing information from the first one. A pilot test with 24 medical records was conducted to estimate the agreement between the two raters in applying the Q-DIO - Brazilian version and the specific quality criteria from the JCI. Data were statistically analyzed. Results: There was significant improvement in the nursing records quality (p <0.001). The total score of the Q-DIO instrument - Brazilian version improved in 24 of the 29 items (82.8%), and the specific quality criteria from the JCI out 9 of 12 items (75%). Upon these results, researchers believe that there was a commitment in the hospital cultural change through organizational innovation, protocols, audits and specifically, in educational activities. In addition, the process reinforced the recognition of the field of study as an academic center with excellence in health quality and patient safety by the JCI in 2013. This study may support other hospitals to set goals for care improvement, and consequently, the nursing records, from educational interventions.
El uso de registros electrónicos de salud aliados a los sistemas de clasificación, han favorecido la implementación del proceso de enfermería en la práctica clínica. Sin embargo; el contar con un sistema informatizado no garantiza la integridad y calidad de los registros, lo que requiere acciones sistematizadas para el crecimiento continuo, estas evaluaciones son realizadas por las instituciones hospitalarias que desean la Acreditación Internacional. Es viable utilizar entonces la auditoría hospitalaria como una herramienta para controlar la calidad del trabajo; en relación a ello, la institución estudiada desarrollo numerosas estrategias para mejorar la calidad de la atención, así como también sobre los registros de enfermería informatizados, con el fin de evaluar los cambios en la calidad de los registros de enfermería. El objetivo del presente estudio fue evaluar la calidad de los registros de enfermería en dos momentos diferentes, antes y después de la preparación para la Acreditación Hospitalaria. Se trata de un estudio observacional de intervenciones, cuantitativo y retrospectivo, realizado en un hospital universitario en el sur de Brasil. La población estuvo compuesta por las historias clínicas de pacientes hospitalizados en las Unidades Clínica y Quirúrgicas antes y después del período de preparación para la Acreditación Hospitalaria, realizado entre los meses de octubre de 2009 y 2013 respectivamente. Se incluyeron las historias clínicas de los pacientes que estuvieron hospitalizados por un mínimo cuatro días en la misma unidad, totalizando 224 historias. No se tuvo criterios de exclusión. Los datos fueron recolectados por dos evaluadores independientes entre los meses de diciembre de 2013 y enero de 2014. Para evaluar la calidad de los registros se utilizó dos instrumentos, el primero denominado Q-DIO-Versão brasileira traducido y validado para la lengua portuguesa. El segundo instrumento fue desarrollado concomitante con un manual de directrices, con lineamientos específicos de calidad de la Joint Commission International (JCI), no contempladas en el primer instrumento. Para estimar las concordancias interobservadores para los dos instrumentos, se realizó una prueba piloto con 24 historias clínicas. Los datos fueron analizados estadísticamente. Resultados: Hubo un progreso significativo en la calidad de los registros de enfermería después de las intervenciones (p<0,001). En la evaluación de la puntuación total del instrumento Q-DIO–Versão brasileira, se observó un variación en 24 (82,8%) de los 29 ítems, y en 9 (75%) de 12 criterios de calidad específicos de la JCI. Con base en estos resultados, es factible hablar de un compromiso de cambio en la cultura movida por la innovación organizativa, los protocolos, las auditorías y en particular, por las intervenciones educativas, que favoreció el reconocimiento del hospital como un centro académico de excelencia en la calidad la salud y la seguridad del paciente por la JCI, en el año de 2013. Se espera que este trabajo impulse a otras instituciones hospitalarias para que establezcan metas que lleven al progreso en la atención y en consecuencia a los registros de enfermería.

Bakgrund: Patienter med kronisk obstruktiv sjukdom (KOL) som behandlas med Non-invasiv ventilation (NIV) har risk för trycksår och malnutrition. Observation och övervakning av patienterna är viktigt för att kunna följa behandlingsförloppet och tidigt upptäcka en eventuell försämring samt förebygga komplikationer. Dokumentation av given omvårdnad måste kunna följas för att utvärdera och säkerställa kraven på en god och säker vård. Syfte: Syftet med studien var att granska omvårdnadsdokumentationen för patienter med KOL som behandlats med NIV på en medicinsk akutvårdsavdelning. Metod: Studien genomfördes som en retrospektiv systematisk journalgranskning i 75 journaler med en granskningsmall. Resultat: Omvårdnadsprocessens steg fanns inte dokumenterad i sin fullständighet för trycksår eller nutrition i någon journal. Dokumentationen av omvårdnadsprocessen för trycksår var oberoende av antal vårddygn, kön och ålder men beroende av antal dygn med NIV.  För nutrition var dokumentationen av omvårdnadsprocessen beroende av antal NIV- och vårddygn men oberoende av kön och ålder. Dokumentationen för omvårdnad och behandling med NIV var utspridd i journalen under olika rubriker. Slutsats: Studiens resultat visade att det fanns brister i omvårdnadsdokumentationen.

La césarienne est une intervention obstétricale majeure qui peut sauver la vie de la mère et de l’enfant. En Afrique sub-saharienne, il persiste une grande inégalité d’accès à la césarienne et une grande variation des pratiques autour des indications d’intervention. D’un côté, des barrières financières, géographiques, culturelles privent des femmes d’une intervention qui peut sauver leur vie. De l’autre, la pratique grandissante de césariennes sans indication médicale, dans un contexte de mauvaise qualité de soins, entraine une sur-morbidité et mortalité iatrogènes et évitables.

L’objectif de notre thèse est de contribuer à une meilleure connaissance des déterminants d’une césarienne de qualité et de montrer comment en situation réelle (cas d’un district urbain au Burkina Faso) on peut agir sur ces déterminants pour améliorer la qualité des césariennes.

Dans le cadre d’un projet multidisciplinaire (santé publique, mobilisation politique et sociale, anthropologie) d’Amélioration de la QUalité et de l’Accès aux Soins Obstétricaux d’Urgence - le projet AQUASOU (2003-2006) - nous avons pu mettre en œuvre des activités visant à améliorer l’accès à une césarienne de qualité dans le district du Secteur 30) à Ouagadougou, Burkina Faso. Nous avons mené une étude Avant-Après et utilisé des méthodes d’évaluation mixtes quantitatives et qualitatives pour comprendre dans quelle mesure et comment ce type d’approche globale améliore la qualité de la césarienne. Nous avons utilisé le cadre d’analyse de Dujardin et Delvaux (1998) qui présente les différents déterminants de la césarienne pour organiser et structurer nos résultats. Cette expérience s’étant déroulée dans le cadre d’un projet pilote nous avons également évalué le degré de pérennité du projet AQUASOU quatre ans après sa clôture officielle et analysé sa diffusion au niveau région et national.

Le cadre d’analyse de la césarienne de qualité avec ses quatre piliers (Accès, Diagnostic, Procédure, Soins postopératoires) a permis d’aller au-delà de la simple évaluation de la qualité technique de l’acte césarienne. Il a structuré l’analyse des différentes barrières à l’accès à la césarienne comme par exemple l’acceptabilité des services par la population et le coût de la prise en charge.

L’analyse des discours des femmes césarisées a mis en lumière le sentiment de culpabilité des femmes d’avoir eu une césarienne - ne pas avoir été « une bonne mère » capable d’accoucher normalement. Les questionnements sur la récurrence de la césarienne pour les prochaines grossesses, les dépenses élevées à la charge du ménage, la fatigue physique et les complications médicales possibles après l’opération mettent la femme dans une situation de vulnérabilités plurielles au sein de son couple et de sa famille.

L’évaluation du système de partage des coûts pour les urgences obstétricales mis en place en 2005 dans le district du Secteur 30 a montré qu’il était possible de mobiliser les collectivités locales de la ville et des communes rurales pour la santé des femmes. La levée des barrières financières a pu bénéficier à la fois aux femmes du milieu urbain et rural mais l’écart d’utilisation des services entre le milieu de résidence n’a pas été comblé et cela confirme l’importance des barrières géographiques (distance, route impraticable pendant la saison des pluies, manque de moyen de transport) et socioculturelles.

L’étude sur le rôle des audits cliniques ou revues de cas dans l’amélioration de la qualité des soins a montré que les soignants avaient une bonne connaissance du but de l'audit et qu’ils classaient l'audit comme le premier facteur de changement dans leur pratique, comparé aux staffs matinaux, aux formations et aux guides cliniques. Cependant, l’institutionnalisation des audits se révèle difficile dans un contexte de manque de ressources qui affecte les conditions de travail et dans un environnement peu favorable à la remise en question de sa pratique professionnelle.

L’évaluation de la pérennité du projet pilote quatre ans après la fin du soutien financier et technique montre que les bénéfices pour la population sont toujours là en terme d’accessibilité à la césarienne :coûts directs pour les ménages de 5000 FCFA (US $ 9.8), qualité des soins maintenue avec une diminution de la mortalité périnatale précoce pour les accouchements par césarienne de 3,6% en 2004 à 1,8% en 2008.

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Doctorat en Sciences de la santé publique
info:eu-repo/semantics/nonPublished

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Introduction: The search for Accreditation is a growing reality in hospitals and recently in Health Plan Operators (OPS), through the program established by Normative Resolution 277. The use of indicators is one of the most used forms of assessment quality in health services. Objectives: To build and measure quality indicators for nursing audit in the accreditation process. Propose actions to improve the network of hospitals and the audit service of the OPS. Compare the use of lancing technologies and securing peripheral intravenous catheter (CIP) and the length of time consumption and cost. Update and analyze the impact of equipo exchange protocol used in intravenous therapy based on best practices. Build and measure the quality indicator related to central venous catheter. Method: a descriptive exploratory study, quantitative and retrospective itself (2013), conducted in six hospitals linked to an OPS in which the data were obtained from the Nursing Audit service. They were constructed and validated care indicators and management by the audit team and quality OPS for compliance with the dimensions 1 and 2 of RN 277. Results: From the OPS Accreditation process indexes were created and performed protocol update. of service quality indicators, peripheral intravenous catheter time, care incidents related to central venous catheter and equipo exchange time protocol infusion based on scientific evidence, have been based in "second dimension" which It comes to the quality and dynamic performance of the hospital network that provides services to OPS. Quality indicators management were drawn from the "size 1" which evaluates the most common business processes and critical of the audit service. The equipo exchange protocol deployed in hospitals showed a reduction in consumption and cost, and improved safety to the customer. Subsequently, assistance with improvement proposals were presented to hospitals and management to OPS. Conclusion: This study showed the building, measuring six indicators of quality care, four in management and material consumption protocol update the audit nursing. In addition, proposals to hospitals focused on patient safety assurance and the audit service of the OPS to improve the processes and results were presented. There was a new performance audit of nursing through quality indicators in order to encourage continuous improvement of the assistance provided by hospitals and the management of the OPS audit service. It also contributes to the auditor nurse seek new practices, assuming his role as responsible for the pursuit of customer service quality.
Introdução: A busca pela Acreditação é uma realidade crescente em instituições hospitalares e, recentemente, em Operadoras de Planos de Saúde (OPS), por meio do programa instituído pela Resolução Normativa 277. A utilização de indicadores é uma das formas mais utilizada de avaliação da qualidade nos serviços de saúde. Objetivos: Construir e mensurar indicadores de qualidade pela auditoria de enfermagem no processo de acreditação. Propor ações de melhorias à rede de hospitais e ao serviço de auditoria da OPS. Comparar a utilização de tecnologias de punção e fixação de cateter intravenoso periférico (CIP) quanto ao tempo de permanência, consumo e custo. Atualizar e analisar o impacto do protocolo de troca de equipo utilizado na terapia intravenosa com base nas melhores práticas. Construir e mensurar o indicador de qualidade relacionado ao cateter venoso central. Método: Estudo exploratório-descritivo, quantitativo e retrospectivo propriamente dito (2013), realizado em seis hospitais vinculados a uma OPS, no qual os dados foram obtidos junto ao serviço de Auditoria de Enfermagem. Foram construídos e validados indicadores assistenciais e de gestão pela equipe de auditoria e qualidade da OPS para o cumprimento das dimensões 1 e 2 da RN 277. Resultados: A partir do processo de Acreditação da OPS foram construídos indicadores e realizada atualização de protocolo. Os indicadores de qualidade assistencial, tempo de permanência do cateter intravenoso periférico, incidentes assistenciais relacionados ao cateter venoso central e o protocolo de tempo de troca de equipo de infusão com base em evidência científica, foram elaborados com base no item “dimensão 2”, que trata da dinâmica da qualidade e desempenho da rede hospitalar que presta atendimento a OPS. Os indicadores de qualidade na gestão foram elaborados a partir da “dimensão 1”, que avalia os processos operacionais mais frequentes e críticos do serviço de auditoria. O protocolo de troca de equipo implantado nos hospitais apresentou uma redução no consumo e custo, e maior segurança ao cliente. Posteriormente, os assistenciais, com propostas de melhoria, foram apresentados aos hospitais e os de gestão à OPS. Conclusão: Este estudo mostrou a construção, mensuração de seis indicadores de qualidade assistencial, quatro em gestão e da atualização de protocolo de material de consumo pela auditoria de enfermagem. Além disso, foram apresentadas propostas aos hospitais voltadas a garantia da segurança do paciente e ao serviço de auditoria da OPS para a melhoria dos processos e resultados. Houve uma nova atuação da auditoria de enfermagem por meio de indicadores de qualidade com objetivo de incentivar a melhoria contínua da assistência realizada pelos hospitais e na gestão do serviço de auditoria da OPS. Também contribui para que o enfermeiro auditor busque novas práticas, assumindo seu papel como responsável pela busca da qualidade da assistência ao cliente.

CoordenaÃÃo de AperfeiÃoamento de Pessoal de NÃvel Superior
Conselho Nacional de Desenvolvimento CientÃfico e TecnolÃgico
A autoeficÃcia das mÃes em relaÃÃo à capacidade para cuidar de seus filhos à relevante para a promoÃÃo da saÃde, sendo considerada uma variÃvel modificÃvel. Diante dos elevados Ãndices de morbimortalidade por diarreia infantil no mundo, faz-se premente a elaboraÃÃo de estratÃgias que visem elevar a autoeficÃcia materna na prevenÃÃo da diarreia infantil. Objetivou-se construir e validar um vÃdeo educativo para promover a autoeficÃcia materna na prevenÃÃo da diarreia infantil. Tratou-se de um estudo multi-mÃtodos: estudo metodolÃgico e de desenvolvimento (elaboraÃÃo do vÃdeo educativo) e ensaio clÃnico randomizado (aplicaÃÃo do vÃdeo educativo). Na construÃÃo do vÃdeo foram seguidas trÃs etapas: prÃ-produÃÃo (sinopse, argumento, roteiro, storyboard), produÃÃo e pÃs-produÃÃo. Para a validaÃÃo do roteiro do vÃdeo, procedeu-se a avaliaÃÃo por 23 juÃzes, profissionais da saÃde e especialistas na Ãrea da diarreia infantil e saÃde da crianÃa; e por cinco juÃzes tÃcnicos especialistas na Ãrea de comunicaÃÃo. O vÃdeo editado passou pela validaÃÃo por 17 mÃes. Em seguida, o vÃdeo foi aplicado ao grupo intervenÃÃo, enquanto que o grupo controle nÃo recebeu nenhuma estratÃgia educativa para a prevenÃÃo da diarreia infantil. Ressalta-se que 90 mÃes de crianÃas menores de cinco anos compuseram cada grupo da investigaÃÃo. Esta fase foi realizada em uma Unidade de AtenÃÃo PrimÃria em SaÃde de Fortaleza-CE, sendo o primeiro contato na unidade de saÃde e o acompanhamento por trÃs meses realizado por contatos telefÃnicos. Os dados foram analisados no Statistical Package for the Social Sciences, versÃo 20.0. O estudo foi aprovado pelo Comità de Ãtica em Pesquisa da Universidade Federal do CearÃ. Verificou-se que nos quatro momentos de acompanhamento das mÃes no estudo, as mÃdias dos escores de autoeficÃcia materna para prevenir a diarreia infantil elevaram-se, individualmente em cada grupo, demonstrando significÃncia estatÃstica (p<0,0001). Com relaÃÃo à comparaÃÃo das mÃdias dos escores na Escala de AutoeficÃcia Materna para PrevenÃÃo da Diarreia Infantil entre os grupos e dentro dos momentos, pode-se verificar relaÃÃo estatisticamente significante no segundo mÃs de acompanhamento das mÃes (p=0,042). Houve uma mudanÃa considerÃvel na mÃdia dos escores de autoeficÃcia quando se comparou o momento inicial, no Centro de SaÃde da FamÃlia com os demais momentos em ambos os grupos. Os grupos assemelharam-se em todos os momentos com relaÃÃo à comparaÃÃo das mÃdias dos domÃnios da escala, com exceÃÃo do domÃnio de prÃticas alimentares/gerais, o qual no primeiro mÃs de acompanhamento apresentou p=0,036. No grupo intervenÃÃo, observou-se que trÃs meses apÃs as mÃes terem assistido ao vÃdeo educativo na unidade, a chance de crianÃas de mÃes com moderada autoeficÃcia na escala terem diarreia foi 2,36 maior do que os filhos daquelas com elevada autoeficÃcia para prevenir diarreia. Conclui-se que o uso de vÃdeo educativo âDiarreia Infantil: vocà à capaz de prevenirâ elevou a autoeficÃcia materna em prevenir diarreia infantil, bem como diminuiu as chances dessa enfermidade em filhos de mÃes que tinham elevada autoeficÃcia. Acredita-se que esta tecnologia educativa aliada a intervenÃÃes participativas e a orientaÃÃes do enfermeiro contribuirÃo para a obtenÃÃo de resultados ainda mais eficazes no que diz respeito à prevenÃÃo da diarreia infantil.
The maternal self-efficacy regarding the ability to care for their children is important for health promotion and consists of a modifiable variable. Given the high rates of morbidity and mortality from infant diarrhea worldwide, there is an urgent need to design strategies aimed at raising maternal self-efficacy in the prevention of infant diarrhea. This study aimed to develop and validate an educational video to promote maternal self-efficacy in the prevention of infant diarrhea. This was a multi-method study: methodological and development study (development of educational video) and randomized clinical trial (application of educational video). For developing the video, we followed three stages: pre-production (synopsis, plot, script, and storyboard), production, and post-production. To validate the video script, we conducted a review by 23 judges, health professionals and experts in the field of infant diarrhea and child health, as well as by five technical judges, experts in the field of communication. Seventeen mothers validated the edited video. After this validation, we applied the video in the intervention group, while the control group received no educational strategy for the prevention of infant diarrhea. It is worth mentioning that 90 mothers of children under five years composed the research group. This phase took place in a primary healthcare unit in Fortaleza-CE, Brazil, in which the first contact was in the health unit and the monitoring for three months happened via telephone. For data analysis, we used the Statistical Package for Social Sciences, version 20.0. The Research Ethics Committee of the Universidade Federal do Cearà approved the project. We verified that, in the four moments of monitoring the mothers in study, the mean scores of maternal self-efficacy for preventing infant diarrhea increased individually in each group, showing statistical significance (p<0.0001). As for the comparison of mean scores in the Maternal Self-Efficacy Scale for Preventing Childhood Diarrhea between groups and within moments, we identified a statistically significant association in the second month of monitoring the mothers (p=0.042). There was a considerable change in the mean self-efficacy scores when comparing the initial moment in the Family Health Center with other moments in both groups. The groups were similar at all moments as regards to the comparison of the mean domain scores of the scale, except for the domain of food/general practices, which in the first month of monitoring presented p=0.036. In the intervention group, we observed that three months after the mothers had watched the educational video at the unit, the chance of children of mothers with moderate self-efficacy having diarrhea was 2.36 higher than in the children of those with high self-efficacy for preventing diarrhea. Thus, we conclude that using the educational video âInfant Diarrhea: you can prevent itâ not only increased maternal self-efficacy in preventing infant diarrhea, but also decreased the chances of this disease in children of mothers who had high self-efficacy. We believe that this educational technology combined with participatory interventions and nursesâ guidance contributes to achieving effective results in the prevention of infant diarrhea.

CoordenaÃÃo de AperfeÃoamento de Pessoal de NÃvel Superior
Maternal self-efficacy in preventing childhood diarrhea is a modifiable variable, which measures the maternal confidence to adopt the necessary precautions to prevent illness in children, essential for the promotion of health. Considering that nurses should promote and support maternal self-efficacy in preventing childhood diarrhea, educational technologies have emerged in order to favor this practice. The objective was to analyze maternal self-efficacy to prevent childhood diarrhea before and after a combined educational intervention (educational video and dialogue wheel). It was a quasi-experimental study, before and after type, with single group composed by 58 mothers of children aged from zero to five years, developed in two health units belonging to the Regional Secretariat III and V, respectively. Data collection was performed from July to October 2014 in three stages: first, an interview was conducted with the mothers, individually, when it was applied Maternal Self-efficacy Scale for Prevention of Infant Diarrhea and the sociodemographic and diarrhea clinical form; the second stage corresponded to the educational group intervention with the application of educational video and the participation of women in dialogue wheel mediated by the researcher. The third stage corresponded to the telephone follow-up and the implementation of Maternal Self-efficacy Scale for Prevention of Infant Diarrhea and the reduced form of childhood diarrhea occurrence research every fortnight for two months. Data were analyzed using the Statistical Package for Social Sciences version 20.0. The study was approved by the Ethics Committee of the Federal University of CearÃ. Most participants were female from 20-29 years of age (56.9%), with partner (65.5%), with more than eight years of education (62.1%), housewives (74.5%), with monthly income of up to two minimum wages (91.4%). There was statistical significance between the sociodemographic variables health and the means of EAPDI scores in the four moments of follow-up (p <0.05): age, marital status, maternal education, occupation, per capita income, number of residents in the household , number of children and child sex. For sanitary variables: type of home, surface, garbage disposal, flies in the house, water source, origin of the water that the child drinks, treatment, soap near the tap, type of toilet, type of sewage, existence of refrigerator and presence of animal at home. There was no statistical significance relationship between the occurrence of diarrhea and self-efficacy, but it was observed the increase in self-efficacy scores and the reduction of cases of diarrhea over the follow-up times, indicating that the combined educational intervention influenced in reducing the chance of occurrence of childhood diarrhea. It is concluded that the combined educational intervention increased maternal self-efficacy in preventing childhood diarrhea and decreased the chances of occurrence childhood diarrhea in mothers of the study. The use of educational video combined with the guidelines of nurses in dialogue wheel can and should be done consistently for health education activities by health professionals, especially nurses.
A autoeficÃcia materna em prevenir a diarreia infantil à uma variÃvel modificÃvel, que mede a confianÃa materna em adotar os cuidados necessÃrios para prevenir a doenÃa na crianÃa, sendo essencial para a promoÃÃo da saÃde. Considerando que o enfermeiro deve promover e apoiar a autoeficÃcia materna na prevenÃÃo da diarreia infantil, as tecnologias educativas surgiram como favorecedoras dessa prÃtica. Objetivou-se analisar a autoeficÃcia materna para prevenir diarreia infantil antes apÃs uma intervenÃÃo educativa combinada (vÃdeo educativo e roda de conversa). Tratou-se de um estudo quase experimental, do tipo antes e depois, com grupo Ãnico composto por 58 mÃes de crianÃas com idade de zero a cinco anos, desenvolvido em duas unidades de saÃde pertencentes à Secretaria Regional III e V, respectivamente. A coleta de dados foi realizada, no perÃodo de julho a outubro de 2014, em trÃs etapas: na primeira, foi realizada uma entrevista com as mÃes, individualmente, onde se aplicou a Escala de AutoeficÃcia Materna para PrevenÃÃo da Diarreia Infantil e o formulÃrio sociodemogrÃfico e clÃnico da diarreia; a segunda etapa correspondeu à intervenÃÃo educativa grupal com a aplicaÃÃo do vÃdeo educativo e a participaÃÃo das mulheres na roda de conversa mediada pela pesquisadora. A terceira etapa correspondeu ao acompanhamento telefÃnico com a aplicaÃÃo da Escala de AutoeficÃcia Materna para PrevenÃÃo da Diarreia Infantil e o formulÃrio reduzido de investigaÃÃo da ocorrÃncia da diarreia infantil quinzenalmente por dois meses. Os dados foram analisados no Statistical Package for the Social Sciences, versÃo 20.0. O estudo foi aprovado pelo Comità de Ãtica em Pesquisa da Universidade Federal do CearÃ. Predominaram mulheres com 20 a 29 anos de idade (56,9%), com parceiro (65,5%), com mais de oito anos de estudos (62,1%), donas do lar (74,5%), com renda mensal de atà dois salÃrios mÃnimos (91,4%). Verificou-se significÃncia estatÃstica entre as variÃveis sociodemogrÃficas, sanitÃrias e as mÃdias dos escores da EAPDI nos quatro momentos de acompanhamento (p< 0,05): idade, estado civil, escolaridade materna, ocupaÃÃo, renda per capita, nÃmero de residentes no domicÃlio, nÃmero de filhos e sexo da crianÃa. Quanto Ãs variÃveis sanitÃrias: tipo de casa, tipo de piso, destino do lixo, moscas na casa, origem da Ãgua, procedÃncia da Ãgua que a crianÃa ingere, tratamento, sabÃo prÃximo das torneiras, tipo de sanitÃrio, tipo de esgoto, existÃncia de refrigerador e presenÃa de animal no domicÃlio. Observou-se, a partir do primeiro mÃs de acompanhamento, efeito positivo da intervenÃÃo combinada na ocorrÃncia da diarreia infantil e na autoeficÃcia materna, visto que houve reduÃÃo do percentil de crianÃas com diarreia e, tambÃm, elevaÃÃo na classificaÃÃo da autoeficÃcia materna de baixa para moderada e elevada. Conclui-se que a intervenÃÃo educativa combinada elevou a autoeficÃcia materna em prevenir a diarreia infantil, assim como diminuiu as chances ocorrÃncia da diarreia infantil nas mÃes do estudo. A utilizaÃÃo do vÃdeo educativo aliado Ãs orientaÃÃes dos enfermeiros em roda de conversa pode e deve ser realizada constantemente durante as atividades de educaÃÃo em saÃde pelos profissionais de saÃde, em especial o enfermeiro.

D.Cur.
During the last decade there has been a surge of interest in quality issues in education. This is largely due to spiralling costs of education and political demands for accountability in public institutions. In South Africa, higher education institutions are now required by law (Higher Education Act No. 101 of 1997 and the South African Qualifications Act No. 58 of 1995) to introduce quality management in an attempt to assure quality ofboth the programmes and the education providers. The Nursing Colleges in Gauteng provide nursing education to nearly 2000 nurses and, as such, make the major contribution to providing for the quality of the health care services. The colleges therefore have a double reason for introducing quality improvement measures, which start with a system for monitoring the quality of the colleges. In this study a quality audit system has been developed to address this need. There is no comprehensive internal audit system, which allows for quantitative measurement and acts as an empowerment strategy for institutional quality improvement in the nursing colleges in South Africa. The following research questions are relevant: • what should an auditing system for nursing colleges comprise? • what are the indicators of quality in a nursing college? • is the auditing system trustworthy? The overall aim of the study was to develop an audit system for the nursing colleges in Gauteng. This aim was supported by the following objectives: Phase one: to conduct a value clarification of quality within the nursing colleges in Gauteng, as perceived by the internal and external customers. Phase two: to explore and describe a conceptual framework for a quality audit system for nursing colleges in Gauteng. Phase three: a. to develop a quality audit system for the nursing colleges in Gauteng b. To pilot the audit system in one nursing college in Gauteng. A qualitative, exploratory, descriptive and contextual design was conducted within the nursing colleges of Gauteng in order to develop a contextual framework and a quality audit system for the nursing colleges. The content validity was tested by means of quantitative methods. The audit system that was developed included a tool for auditing the quality of nursing colleges as a means to identifY conformance to standards, criteria and indicators and to improve the quality of the structure, processes and results ofthe organization. The standards were developed on the basis of a value clarification of internal and external customers. Clusters ofindicators were developed for each of the standards. The value of this study is that a comprehensive audit system has been developed which empowers the staffand students ofthe college to improve the quality ofthe college. The same system can be used for purposes of accreditation, as an accountability mechanism and for institutional recognition.

M.Cur.
The occupational health nurse working degree of decision-making authority. deficiencies with regard to the health in industry. in industry has a certain It seems that there are decision-making process In a descriptive study by way of a literature study and empirical investigation the contribution of the occupational health nurse in the health decision-making process of an organisation was analysed. This study was conducted on the East Rand, 66 per cent (N=25) of the region's occupational health nurses being involved in the sample. The research design is embodied in the analysis and interpretation of the empirical data. Important conclusions culminating from this study include deficiencies with regard to: first level management skills of the occupational health nurse; authority structures which obstruct lines of communication; the decision-making authority of the occupational health nurse and the accountability of the occupational health nurse in respect of decision-making. Some recommendations were made in connection with improvement of practice, additional education and further research. These recommendations were made with a view to improving the first level management, communication and diagnostic skills of the occupational health nurse.

Yes
At present there is no established national minimum data set (MDS) for generic wound assessment in England, which has led to a lack of standardisation and variable assessment criteria being used across the country. This hampers the quality and monitoring of wound healing progress and treatment. The article aims to establish a generic wound assessment MDS to underpin clinical practice. The project comprised 1) a literature review to provide an overview of wound assessment best practice and identify potential assessment criteria for inclusion in the MDS and 2) a structured consensus study using an adapted Research and Development/University of California at Los Angeles Appropriateness method. This incorporated experts in the wound care field considering the evidence of a literature review and their experience to agree the assessment criteria to be included in the MDS. The literature review identified 24 papers that contained criteria which might be considered as part of generic wound assessment. From these papers 68 potential assessment items were identified and the expert group agreed that 37 (relating to general health information, baseline wound information, wound assessment parameters, wound symptoms and specialists) should be included in the MDS. Using a structured approach we have developed a generic wound assessment MDS to underpin wound assessment documentation and practice. It is anticipated that the MDS will facilitate a more consistent approach to generic wound assessment practice and support providers and commissioners of care to develop and re-focus services that promote improvements in wound care.
NHS England

The purpose of this study was to evaluate the quality of professional practice by the registered nurses midwives as reflected in clinical nursing care records for postlaparotomy patients in public central hospitals in Malawi. The set process standards by Nurses and Midwives Council of Malawi (NMCM) were addressed in relation to clinical care of post-laparotomy patients. The hypothesis for this study was that the quality of professional practice by the registered nurse midwives as reflected in clinical nursing care of post-laparotomy patients in public central hospitals in Malawi is inadequate and non-compliant with the process standards set by the NMCM. The researcher used quantitative, evaluative, descriptive, contextual survey and participatory observations to collect data. A three-point rating scale consisting of compliance (C) = 1, partial compliance (PC) = 0.5 and non-compliance (NC) = 0.0 was used to evaluate the state registered nurse midwives’ compliance with process standards. The results showed partial compliance with the set NMCM process standards by the state registered nurse midwives in public central hospitals in Malawi.
Health Studies
M.A. (Health Studies)

Administration and documentation are inseparable and obligatory parts of nurse's everyday work. Documentation in healthcare serves to communication of necessary patient information. Medical documentation is kept by physicians. Nursing documentation is conducted in parallel with medical documentation. Nursing documentation records facts of the nursing care provided to a particular patient. Duly kept nursing documentation is a quality indicator of qualified nurse's work. It has to comply with applicable legislation and reflect the latest research results. Documentation has to be brief, clear, concise and factual. It should definitely not be extensive, time consuming, complicated and it should not contain useless information and duplicities. Nurses should not be overloaded by document keeping and should not spend more time on it than with patients. The aims of the thesis: Aim 1: To map the approach to documentation among nurses at selected hospital departments. Aim 2: To map how nurses perceive document keeping in terms of time, how much time they really spend on documentation within their working hours. Aim 3: To analyse nursing documentation at selected hospital departments. Research questions: Research question 1: Do nurses feel overloaded by nursing documentation keeping? Research question 2: How much time do nurses have to spend on documentation within their working hours? Research question 3: Is the time spent on documentation used effectively? Research question 4: Would nurses welcome changes in nursing documentation? Applied methods: The research part of the thesis was based on qualitative research method applied at selected departments of a regional type hospital.The research results from the interviews, document analysis and working hours scanning will be provided to the examined hospital management. They may help the hospital management with better insight into their documentation and lead to improvement of the document keeping in general and particularly ease the work of nurses as they are overloaded anyway.

The name and the topic of my thesis is evaluation of the quality of given nursing care. The quality of nursing care as integral part of quality of medical care is gaining ground not only in medics but also in public. Words like quality, standard, audit are commonly used by every nurse but do they know meaning of separate words? Do they know how to ensure high-quality care and how to evaluate it? These and other questions must be answered in order to retrieve possible insufficiencies and thus, to ensure high-quality nursing care. That´s why I chose this topic for my thesis. Theoretical part first characterizes nursing, its aims and organization of nursing care. Extensive part is devoted to quality of nursing care, systems and models to ensure and evaluate the quality. Practical part is focused on research and its interpretation. There were two research units and were created by nurses from surgical wards of Hospital in České Budějovice and Hospital in Jihlava. In order to collect needed data I chose quantitative method, when the way of data collecting was questionnaire. The aim of the thesis was to chart nurses´ knowledge on evaluation of quality of given nursing care through two hypotheses. The hypothesis supposing that nurses working in Hospital České Budějovice know more about evaluation of quality of given nursing care than nurses working in Hospital Jihlava was confirmed. But it is evident from the results that both investigated units have certain reserves. The other hypothesis supposing that more than 80% nurses consider the audits helpful for improving the quality of nursing care was not confirmed. According to the results, for more than half of addressed nurses audit is only stressing matter when hospital management looks for faults in their work. I mean, this opinion results from insufficient knowledge or incorrect understanding of the audit sense. I would like to use the thesis and its results as a base for creating scientific lectures and subsequent presentation. The head nurse asked me to present my thesis and the results at the meeting of head nurses in autumn 2008. I was asked for the results by Jihlava Hospital management as well.

Nursing documentation became an important part of work of a general nurse / a midwife. The nursing documentation differs in individual hospitals. The clinic management is responsible for the documentation contents in given hospital and general nurses / midwives at least participate in its development. The nursing documentation serves as the work aid for the nursing staff, being the material providing important information for other medical staff and institutions. The documentation objectively informs the medical team members about the health conditions of the given individual. Recently, significant stress started to be put on education activities of a nurse and its documenting. New examination methods or therapeutic procedures are being introduced into practice, which should help in treatment of clients. Regardless modern progress, the number of chronically ill clients increases ? for example diabetes mellitus, chronic renal insufficiency, asthma bronchiale etc. That is why nurses in the positions of educators play very important rules. The graduation thesis / diploma work aims at nursing documentation in practice. The aim of the graduation thesis / diploma work was to map the efficiency of nursing documentation and to find out what an importance attach the nurses to nursing documentation keeping. Another aim was to find out whether education plans make a part of nursing documentation. My last aim was to find out whether an education nurse is a member of the nursing team. For the research part of this work, a combination of qualitative and quantitative research solution was used. A semi-structured interview was used s the data collection technique for the qualitative part, while there were interviewed the chief nurses working in a hospital in Plzeň region. A questionnaire was used as the data collection technique for the quantitative part and it was designed for general nurses working in the faculty, regional and district hospitals in Plzeň region, in standard department, intensive care unit and in consequent care unit. The aims of the work were reached. Four hypotheses were set for the quantitative research. 1. Nurses perceive the efficiency of nursing documentation in case of being kept by an appointed nurse. 2. The shift nurses consider nursing documentation keeping to be rather a stress instead of an expression of professional activities of a nurse. 3. A part of standard equipment of nursing documentation is reserved for education activities. 4. The system of nursing care provision in the hospital departments does not allow application of education process, even though its keeping in nursing documentation is required. The first two hypotheses were confirmed, the third and fourth hypotheses were not confirmed. Five chief nurses expressed their interest in results of our research and investigations. They are interested in results obtained in their departments. We continue our co-operation as the output of the work is a draft of documentation for education of a client, the education standard and a seminar or course of education activities of a nurse.

presente relatório surge no âmbito do Estágio de Enfermagem inerente ao Curso de Mestrado em Enfermagem, com Especialização em Enfermagem Médico-Cirúrgica, o qual é composto por três módulos: I - Serviço de Urgência; II - de Cuidados Intensivos/ Intermédios e o III - Opcional. Relativamente ao módulo Serviço de Urgência, estagiei no Hospital São Francisco Xavier, com o intuito de atingir os seguintes objetivos: desenvolver competências técnicas, científicas e relacionais na prestação de cuidados especializados, ao doente em estado crítico e sua família, onde foquei a minha intervenção no sentido de estabelecer prioridades nas necessidades identificadas, agindo em tempo útil no processo de tomada de decisão, e particularmente no desenvolvimento de competências comunicacionais; desenvolver competências na área da promoção da qualidade dos cuidados prestados, onde promovi a investigação em serviço ao participar num projeto relacionado com a “Campanha de Higienização das Mãos”. Paralelamente sensibilizei os profissionais para a importância desta temática, fomentando a qualidade dos cuidados, ao direcionar estratégias de atuação, evidenciando criatividade na interpretação e abordagem da temática, motivando os profissionais para a ideia basilar de que a prevenção e controlo de infeção são da responsabilidade de todos os profissionais. No que respeita ao módulo opcional, escolhi a Comissão de Controlo de Infeção Hospitalar, que decorreu no Hospital de São José, de modo a alcançar os seguintes objetivos de estágio: desenvolver competências científicas, técnicas e relacionais no âmbito das funções do enfermeiro da Comissão de Controlo de Infeção Hospitalar, tendo sido essencial para a perceção da transversalidade desta área, sendo notório a evolução no processo de aprendizagem na aquisição de competências, ao participar e refletir sobre as atividades desenvolvidas pela Comissão de Controlo de Infeção; desenvolver competências científicas, técnicas e relacionais no âmbito de auditoria de práticas clínicas na área de controlo de infeção associada aos cuidados de saúde, onde elaborei instrumentos de auditoria sobre a utilização de equipamento de proteção individual, especificamente: o uso de luvas, máscara, bata e avental. Estes instrumentos serão utilizados, no serviço onde exerço funções, como ferramenta de diagnóstico da situação. Em relação ao módulo de cuidados intensivos/ intermédios obtive creditação, relacionado com as competências que desenvolvi ao longo do meu percurso profissional, num serviço que integra uma Unidade de Cuidados Intermédios, das quais destaco: liderança; supervisão, gestão, formação e no processo de tomada de decisão.O relatório dá deste modo, ênfase ao desenvolvimento de competências no âmbito da assistência de enfermagem avançada ao doente em estado crítico, através da sua fundamentação pela análise reflexiva das atividades desenvolvidas e experiências vivenciadas ao longo do estágio, onde a qualidade dos cuidados constituiu o fio condutor no decorrer do mesmo, com posterior mobilização das competências para o contexto de trabalho.
This report comes under the Stage Medical-Surgical Nursing, inherent in the Master's Degree in Nursing with specialization in Medical-Surgical Nursing, which is composed of three modules: I - emergency service; II - intensive care / intermediate and III - Optional. For the module of urgency, an intern at the Hospital São Francisco Xavier, in order to achieve the objectives: to develop technical, scientific and relational in providing specialized care to patients in critical condition and his family, where I focused my remarks towards to prioritize the needs identified, acting in good time in the process of decision making, particularly in developing communication skills, developing skills in promoting quality of care, by raising awareness of health professionals in the prevention and hospital infection control, and encouraged the research service to participate in a project related to the "Hand Hygiene Campaign." Alongside the attention of the professionals of the importance of this issue, promoting the quality of care, the direct action strategies, demonstrating creativity in interpreting and discussing the issue, encouraging professionals to the basic idea that prevention and control of infection are the responsibility of all professionals. As regards the optional module, the Commission chose the Hospital Infection Control, held at Hospital S. José in order to achieve the following stage: developing scientific skills, techniques and relational functions within the Commission's nurse Hospital Infection control, was essential for the perception of mainstreaming in this area, with notable developments in the learning process in the acquisition of skills, to participate and reflect on the activities of the Infection control Committee, to develop scientific skills, techniques and relational context in audit of clinical practice in the area of Infection Control, audit tools which elaborated on the use of personal protective equipment, specifically: the use of gloves, mask, gown and apron. They will be used in the service where I exercise functions as a tool for diagnosis of the situation. In relation to the module intensive care / intermediate obtained accreditation, related to the skills I developed throughout my career, a service that integrates an Intermediate Care Unit, which highlight: leadership, supervision, management, training and process decision-making. The report thus emphasis on developing skills in advanced nursing care to patients in critical condition, through their foundation for reflective analysis of activities and experiences throughout the stage, where the quality of care was the wire over the same conductor, and subsequent mobilization of skills for the workplace.

Quality nursing care is today the essential goal of contemporary nursing. Therefore it is necessary to introduce in sanitary facilities a quality improvement program, whose part is tracking quality indicators of care provided. Within the practical part we set three goals. The first of them is to define tracked quality indicators of nursing care in Hospital České Budějovice, a.s. The second goal is to evaluate the selected quality indicators of nursing care in Hospital České Budějovice. The third goal is to inform nurses on quality indicators of nursing care in Hospital České Budějovice. Based on these goals we introduced six hypotheses. The first hypothesis says: Hospital České Budějovice, a.s. tracks at least 15 quality indicators of nursing care within the tracked period. The second hypothesis says: Hospital České Budějovice, a. s. realized at least four nursing care audits per year. The third hypothesis says: nurses of Hospital České Budějovice are satisfied with working conditions. The fourth hypothesis says: clients of Hospital České Budějovice, a.s. are satisfied with the provided nursing care. The fifth hypothesis says: Nurses of Hospital České Budějovice know at least four quality indicators of nursing care in Hospital České Budějovice being tracked in their wards. The sixth hypothesis says: Prevalence rate of decubitus in Hospital České Budějovice decreases. The research ran over under collaboration with staff nurse of Hospital České Budějovice, a.s.; one of forms of the research was also a nursing audit; further data collection method by means of questionnaires was used. The research file involved nurses and clients of Hospital České Budějovice, a.s. In the course of the research we fulfilled the set goals; the first, fourths and the fifth hypotheses were confirmed and the second, third, and the sixth hypotheses were not confirmed. The research results have been offered to the hospital top management as a data source concerning the nursing care quality. The work should also provide nurses with information on that monitoring and evaluating nursing care quality through specific indicators is at present a necessity and indispensable fact and that its goal is not individual disciplinary decisions of individual nurses, but it concerns finding out system errors, their assertion and resolution.

Great attention is paid to health care quality nowadays. Accreditation of a health care facility means "recognition that the facility is capable of providing quality health care and has developed The main goal of the research was to map whether nurses in the České Budějovice Hospital are duly prepared for the accreditation audit by the United Accreditation Board of the CR. Although the nurses succeeded attention has still to be paid to the individual partial topics contained in the UAB audits to eliminate possible mistakes or failure.

Dissertação de mestrado em Enfermagem da Pessoa em Situação Crítica
Os doentes internados na Unidade de Cuidados Intensivos (UCI) são os que têm mais complicações, pois são submetidos a procedimentos invasivos, sendo assim uma população de alto risco para Infeções Associadas aos Cuidados de Saúde (IACS). As infeções associadas a dispositivos, como Infeção do Trato Urinário (ITU), Cateter Venoso Central (CVC) e a Pneumonia Associada à Intubação (PAI), são as mais comuns na UCI, e por isso necessitam de medidas efetivas para a sua prevenção. Duas das medidas básicas de prevenção são a higiene das mãos e a aplicabilidade de Feixes de Intervenção, por parte dos enfermeiros, associada a cada tipo de infeção. O objetivo deste estudo foi identificar fatores relacionados com os Feixes de Intervenção aplicados pelos enfermeiros de uma UCI portuguesa. A metodologia do projeto foi suportada por um estudo descritivo-correlacional, transversal de abordagem quantitativa, realizado na UCI de um Centro Hospitalar situado na zona norte de Portugal, no período de maio a junho de 2019. Como instrumento de recolha de dados foi utilizado um inquérito por questionário. Os dados foram tratados com recurso ao Statistical Package for the Social Sciences (SPSS) versão 25.0. A amostra constituída por 44 enfermeiros, maioritariamente do sexo feminino (72,7%), pertencia ao grupo etário situado entre 38-50 anos (57%), e possuía como habilitação a licenciatura (95,5%). A maioria (61,4%) dos enfermeiros está situada entre 16-30 anos de tempo de exercício profissional, e situada entre 9-20 anos de tempo de exercício na UCI (59,2%). A maioria (80,0%) dos enfermeiros inquiridos respondeu ter necessidade de abordar os Feixes de Intervenção em formação contínua. Em relação aos procedimentos preventivos a totalidade (100%) dos enfermeiros considera que a higiene das mãos previne as infeções, sendo que a maioria (79,5%) refere que o uso de luvas previne a infeção. No que se refere aos Feixes de Intervenção estes profissionais de saúde demonstraram ter algum conhecimento sobre a aplicação dos mesmos pela experiência profissional. A auditoria interna tem a finalidade de avaliar a qualidade dos cuidados prestados, no entanto a maioria destes profissionais (86,4%) não executa auditorias para os três tipos de infeção ITU, CVC e PAI. Neste estudo conclui-se que os enfermeiros em geral aplicam os Feixes de Intervenção na ITU, CVC e PAI, preconizada pela Direção Geral de Saúde, cujos estão relacionados com os seguintes fatores: i) o tempo de exercício profissional; ii) o tempo de exercício na UCI; iii) as características sociodemográficas, iv) os procedimentos preventivos e, v) as auditorias.
Patients admitted to the Intensive Care Unit (ICU) are the ones that have more complications, they are submit to invasive procedures and have an increase of resistance to various drugs, being a high-risk population for Healthcare Associated Infections (HAI). Device-associated infections, such as Urinary Tract Infection (UTI), Central Venous Catheter (CVC) and Intubation-Associated Pneumonia (IAP) are the most common infections in the ICU, requiring effective measures for its prevention. One of the basic measures is hand hygiene and the other measure is the applicability, from nurses of Bundles associated with each type of infection. The aim of this study was to identify factors related to Bundles applied by nurses of a Portuguese ICU. The project methology was supported by descriptive correlational cross-sectional study of quantitative approach, realized in the ICU of a Hospital Center located in northern Portugal, from May to June 2019. As a data collection instrument, a questionnaire survey was use. Data were processed using SPSS version 25.0. The sample consisted of 44 nurses, mostly female (72.7%), belonged to the age group between 38-50 years (57%) and had a degree (95.5%). Most nurses (61.4%) are between 16-30 years of professional practice, and 9-20 years of ICU (59.2%). Most (80.0%) of the interviewed nurses answered that they needed to approach the Intervention Beams in continuous training. Regarding preventive procedures, all (100%) of nurses consider that hand hygiene prevents infections, and the majority (79.5%) report that the use of gloves prevents infection. Regarding Intervention Bundles, these health professionals demonstrated to have some knowledge about their application through professional experience. Internal audit is intended to evaluate the quality of care provided; however, most of those professionals (86.4%) do not perform audits for the three types of UTI, CVC and IPA infection. In this study, it is concluded that nurses in general apply the Bundles in the UTI, CVC and IAP, recommended by the Directorate General of Health, whose are related to the following factors: i) the time of professional practice; ii) the time of exercise at the ICU; iii) sociodemographic characteristics, iv) preventive procedures and, v) audits.