Nasogastric/nasoenteric tube-related adverse events: an integrative review

Objective: to analyze in the scientific literature the evidence on nasogastric/nasoenteric tube related adverse events in adult patients. Method: integrative literature review through the search of publications in journals indexed in PubMed/MEDLINE, CINAHL, LILACS, EMBASE and Scopus, and hand searching, was undertaken up to April 2017. Results: the sample consisted of 69 primary studies, mainly in English and published in the USA and UK. They were divided in two main categories and subcategories: the first category refers to Mechanical Adverse Events (respiratory complications; esophageal or pharyngeal complications; tube obstruction; intestinal perforation; intracranial perforation and unplanned tube removal) and the second alludes to Others (pressure injury related to fixation and misconnections). Death was reported in 16 articles. Conclusion: nasogastric/nasoenteric tube related adverse events are relatively common and the majority involved respiratory harm that resulted in increased hospitalization and/or death. The results may contribute to healthcare professionals, especially nurses, to develop an evidence-based guideline for insertion and correct positioning of bedside enteral tubes in adult patients.

Anxiety and its influence on maternal breastfeeding self-efficacy

Objective: to identify the levels of anxiety and breastfeeding self-efficacy in puerperal women at the intervals of 60, 120, and 180 days postpartum; and to verify the influence of anxiety on breastfeeding self-efficacy among these puerperal women. Method: an analytical, longitudinal and prospective study, conducted with 186 puerperal women, and which used a sociodemographic and obstetric characterization questionnaire, the State-Trait Anxiety Inventory, and the Breastfeeding Self-Efficacy Scale - Short Form. The analyses were performed by means of descriptive statistics, and Fisher’s Exact Test was used. Results: most of the puerperal women presented low levels of trait anxiety (55.4%) and of state anxiety (66.2% at 60 days, 72.8% at 120 days, and 75.5% at 180 days), and a high level of self-efficacy (77.3% at 60 days, 75.3% at 120 days, and 72.1% at 180 days of puerperium). Low levels of trait anxiety and state anxiety were associated with high self-efficacy at 60 days (p=0.0142 and p=0.0159, respectively). Conclusion: it is necessary to pay greater attention to the mental health of puerperal women, considering that those who presented low levels of anxiety had higher levels of self-efficacy, a situation that can result in longer exclusive breastfeeding.

Follow-up care for premature children: the repercussions of the COVID-19 pandemic

Objective: to analyze elements of the follow-up care provided to premature children amidst the COVID-19 pandemic. Method: qualitative study from the perspective of philosophical hermeneutics, interpreting experiences with childcare provided at home. Twelve mothers and 14 children aged two years old were interviewed online via a text messaging application. Data were analyzed by interpreting meanings. Results: weaknesses stood out in the follow-up care provided to children such as gaps of communication, lack of guidance and delayed immunizations, while care intended to meet health demands was interrupted. Vulnerability aspects affecting child development included: social isolation measures that impeded the children from socializing with their peers, increased screen time, the manifestation of demanding behaviors and irritation and the mothers experiencing an overload of responsibilities. The elements that strengthened maternal care included the mothers being attentive to contagion, enjoying greater experience and satisfaction with the maternal role, spending more time with their children, and recognizing respiratory signs and symptoms, especially fever. Conclusion: follow-up care provided to children in stressful situations implies implementing practices that support the wellbeing of children and families, decreasing the likelihood of children being exposed to development deficits, and detecting signs and symptoms timely. The use of nursing call centers can break the invisibility of longitudinal needs and promote health education actions at home.

Heparin solution in the prevention of occlusions in Hickman® catheters a randomized clinical trial

Objective: to evaluate the effectiveness of the 50 IU/mL heparin solution compared to the 0.9% isotonic saline solution in preventing occlusion of the double lumen Hickman® catheter, 7 and 9 French, in patients undergoing hematopoietic stem cell transplantation. Method: a triple-blind randomized clinical trial. 17 double-lumen catheters (heparin group: n=7 and 0.9% isotonic saline group: n=10) were analyzed in which the two catheter routes were evaluated separately, totaling 34 lumens. The outcome variables were occlusion without reflux and complete occlusion. Descriptive analyses were performed using the Chi-square test and, of survival, according to the Kaplan-Meier test. Results: the mean number of days until the occlusion outcome was 52 in the heparin group and 13.46 in the 0.9% isotonic saline group in the white catheter route (p<0.001). In the red route, the mean follow-up days in the heparin group were 35.29, with no occlusion and 22.30 in the 0.9% isotonic saline group until the first occlusion (p=0.030). Conclusion: blocking with 50 IU/mL heparin solution is more effective than 0.9% isotonic saline in preventing occlusion of the Hickman® catheter. Brazilian Registry of Clinical Trials: RBR-3ht499.

Quality of life and eating habits of patients with obesity during the COVID-19 pandemic

Objective: to verify the quality of life and eating habits of patients with obesity during the COVID-19 pandemic. Method: cross-sectional study with 68 outpatients, candidates for bariatric surgery, at university hospital in the Southern Brazil. Data collection was carried out by telephone, with questions about the profile of the participants and social distancing; questionnaires on quality of life and eating habits were also used. The data analysis, the logistic regression model, Spearman correlation, Mann-Whitney U and Student t-tests were used for independent samples. Results: the general quality of life was 57.03 points and the eating habit with the highest score was cognitive restraint (61.11 points). Most patients (72.1%) were socially distancing themselves and 27.9% had not changed their routine. The chance of isolation was 3.16 times greater for patients who were married. There is a positive correlation between the domains of the Quality of Life questionnaire and cognitive restraint from the questionnaire about eating habits. Conclusion: we found that the participants tended to have a better quality of life as cognitive restraint increased.

Cesarean childbirth: an institutional socio-clinical study of the professional practices and discourses

Objective: to analyze how the social, historical, economic and professional elements influence the institutionalization process of cesarean childbirth in Brazil and France. Method: a qualitative study grounded on the theoretical framework of the institutional socioclinic. The data were produced through focus groups and individual interviews, supported by semi-structured scripts, with health professionals, mothers and fathers and a research diary. The study had 83 participants. The analysis was based on the theoretical framework and thematic analysis. Cross analysis was developed between the different types of data, services and groups, as well as between countries. Results: the participants were characterized in terms of schooling, employment, level of training and workplace. The countries researched have their own peculiar health and educational structure and are marked by a social-historical-economic construction outlined by patriarchy. The New Public Management influences both contexts and makes health care precarious. The technical and organizational dimensions reinforce an intellectual and social division of work and knowledge in health. Conclusion: the institutionalization process of childbirth in the countries is marked by social, economic and professional aspects. Practices and speeches of the professionals in their work process influence the occurrence, or not, of cesarean sections.

Development of an integrative learning program for community dwelling old people with dementia

Objective: to develop an integrative learning program for people with dementia. Method: a methodological study was conducted using Delphi technique to develop the learning program, followed by a feasibility test. An expert panel was invited to develop the integrative learning program based on the neuroplasticity and learning framework. A feasibility test was conducted to evaluate the implementation of the program in two centers after the training of personnel who run the program. Verbatim transcripts of case conferences were coded, analyzed, and collapsed into themes and sub-themes by consensus. Results: there was no indication for content modification during the period of program implementation. Qualitatively, the participating older adults showed improvement in communications, emotions, connectedness with self and others, and well-being. Conclusion: the integrative learning program was uneventfully implemented with promising results. The program is ready for full-scale research on its efficacy in multiple centers to obtain more robust evidence.

Patient safety culture, missed Nursing care and its reasons in Obstetrics

Objective: to assess the correlations between the patient safety culture, the missed Nursing care, and the reasons for the omission in the obstetric area. Method: a cross-sectional study, conducted in 2019, with 62 Nursing professionals working in the obstetric area of a teaching hospital in southern Brazil. The MISSCARE-Brasil and Hospital Survey on Patient Safety Culture instruments were used. The data were analyzed using descriptive statistics, means comparison test and Spearman correlation. Results: the overall mean of positive answers for the safety culture was 34.9 (± 17.4). The care of assessing the vital signs and monitoring capillary blood glucose were the most prioritized, with airway aspiration and oral hygiene being the most overlooked. The main reasons for the omissions refer to labor resources and to inadequate staffing. A significant and inversely proportional correlation was found between the patient safety culture and overlooked nursing care (r=-0.393). Conclusion: the safety culture of the obstetric area was assessed as fragile by the Nursing professionals. The more the safety culture is strengthened and the greater investment in labor and human resources, the less care is overlooked.

Relationship of the type of breastfeeding in the sexual function of women

Objective: to relate the type of breastfeeding in the women’s sexual function. Method: a cross-sectional study conducted with 150 women in the postpartum period registered in the Family Health Strategy of a large Brazilian municipality. Two instruments were used: one for characterizing sociodemographic, obstetric and breastfeeding variables, and the Female Sexual Function Index for the sexual function. Descriptive data analysis was performed, comparing the variables of interest using the Analysis of Variance, Brown-Forsythe and Tukey tests. Results: there was statistical significance between the groups that practiced different types of breastfeeding in the vaginal lubrication domain (p = 0.015), with the mothers in mixed or partial breastfeeding presenting a higher score for this domain (3.8). Conclusion: there is a difference in the female sexual function between different types of breastfeeding. Women who presented better vaginal lubrication belonged to the mixed breastfeeding group.

Contributions of the Simplified Competency Management Model to a Municipal Health Secretariat

Objective: to present the contributions of the Simplified Competency Management Model in a municipal health secretariat. Method: research of integrated mixed methods of exploratory-descriptive type. The model was applied in a southern Brazilian city, in the following stages: documentary, questionnaire, mapping of gaps and educational proposal. Results: in the first stage, after documentary research, a total of 14 general core competences were described and a questionnaire with specific core competences was chosen, with confirmation of correlation among them; in the second stage, the importance and expression competence at work degrees were obtained, after the questionnaires were filled out by 74 municipal public health managers; in the third one, a formula was adopted for the training priority degree and its classification; the fourth stage presented an educational proposal for the development of one of the competences with the highest priority degree. Conclusion: the model brings contributions by describing general core competences, after documentary research; carrying out the correlation between a questionnaire, containing specific core competences with the general ones; by mapping gaps; and by the proposal of learning trails for the development of competences.