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Resumo Objetivo Relacionar variáveis sociodemográficas, econômicas, clínicas e ter ou não cuidador, risco de queda e percepção do risco de quedas com a capacidade funcional em pessoas idosas em um Serviço de Emergência. Métodos Estudo transversal e analítico, realizado entre setembro de 2019 e março de 2020, no Serviço de Emergência, com 197 pessoas idosas. Foi aplicado questionário com informações sociodemográficas, econômicas e clínicas; e os instrumentos: Falls Risk Awareness Questionnaire, Morse Falls Scale, Índice de Katz e Escala de Lawton. Para comparar o Índice de Katz e a Escala de Lawton; e associar a Morse Falls Scale com as variáveis contínuas foram utilizados, respectivamente, o teste de Kruskal Wallis e o coeficiente de correlação de Spearman. Para associar Falls Risk Awareness Questionnaire com as variáveis categóricas utilizou-se o teste de Mann-Whitney e o teste de Kruskal Wallis. Resultados Os nãos letrados (p

Objective: To identify factors related to burden and self-care for hypertension in family caregivers. Method: an online, cross-sectional survey of 68 family caregivers of elderly people, carried out between December 2021 and February 2022 in Brazil. Questionnaires on caregiver activity, the Informal Caregiver Burden Assessment Questionnaire and the Hypertension Self-Care Scale were applied. Descriptive and analytical analyses were carried out. Results: caregivers who lived with the elderly (p=0.0006) and had no rest day (p=0.0097) showed greater burden. The longer the time as a caregiver (p=0.0411), the lower the score in the domain of self-care management measures during blood pressure decompensation. Caregivers who received help from someone else (p=0.0379) had a higher score in the domain of the patient's degree of confidence in self-care related to hypertension. Conclusion: This study contributes to a better understanding of the variables relating to caregiver activity related to burden and self-care for hypertension among caregivers of elderly people.

Objetivo: identificar los factores relacionados con la carga y el autocuidado de la hipertensión en cuidadores familiares. Material y método: encuesta transversal online a 68 cuidadores familiares de ancianos, realizada entre diciembre de 2021 y febrero de 2022 en Brasil. Se aplicaron cuestionarios sobre la actividad del cuidador, el Cuestionario de Evaluación de la Carga del Cuidador Informal y la Escala de Autocuidado de la Hipertensión. Se realizaron análisis descriptivos y analíticos. Resultados: los cuidadores que vivían con el anciano (p=0,0006) y no tenían día de descanso (p=0,0097) mostraron mayor carga. Cuanto mayor era el tiempo como cuidador (p=0,0411), menor era la puntuación en el dominio de las medidas de gestión del autocuidado durante la descompensación por presión. Los cuidadores que recibían ayuda de otra persona (p=0,0379) tenían una puntuación más alta en el dominio del grado de confianza del paciente en el autocuidado relacionado con la hipertensión. Conclusión: Este estudio contribuye a una mayor comprensión de las variables relativas a la actividad del cuidador relacionadas con la carga y el autocuidado de la hipertensión de los cuidadores de personas mayores.

Objetivo: identificar os fatores relacionados à sobrecarga e ao autocuidado para hipertensão em cuidadores familiares. Método: pesquisa online e transversal, com 68 cuidadores familiares de pessoas idosas, realizada entre dezembro de 2021 e fevereiro de 2022, no Brasil. Foram aplicados questionários sobre atividade de cuidador, Questionário de Avaliação da Sobrecarga do Cuidador Informal e Escala Autocuidado de Hipertensão. Foram realizadas análises descritivas e analíticas. Resultados: cuidadores que residiam com idoso (p=0,0006) e sem dia de descanso (p=0,0097) apresentaram maior sobrecarga. Quanto maior o tempo como cuidador (p=0,0411), menor o escore do domínio medidas de manejo do autocuidado durante a descompensação pressórica. Cuidadores que recebiam auxílio de outra pessoa (p=0,0379) apresentaram maior escore no domínio grau de confiança do paciente para o autocuidado relacionado à hipertensão. Conclusão: este estudo contribui para maior compreensão das variáveis referentes à atividade de cuidador relacionada à sobrecarga e ao autocuidado para hipertensão de cuidadores de pessoas idosas.

Objetivo: evaluar la asociación entre las categorías de clasificación de riesgo y el Modified Early Warning Score y los resultados de los pacientes con COVID-19 en el servicio de emergencia Método: estudio transversal, realizado con 372 pacientes hospitalizados con diagnóstico de COVID-19 atendidos en la Recepción con Clasificación de Riesgo en Urgencias. En este estudio, el Modified Early Warning Score de los pacientes se clasificó como sin y con deterioro clínico, de 0 a 4 y de 5 a 9, respectivamente. Se consideró que había deterioro clínico cuando presentaban insuficiencia respiratoria aguda, shock y paro cardiorrespiratorio. Resultados: el Modified Early Warning Score promedio fue de 3,34. En cuanto al deterioro clínico de los pacientes, se observó que en el 43% de los casos el tiempo de deterioro fue menor a 24 horas y que el 65,9% ocurrió en urgencias. El deterioro más frecuente fue la insuficiencia respiratoria aguda (69,9%) y el resultado fue alta hospitalaria (70,3%). Conclusión: los pacientes con COVID-19 que presentaban Modified Early Warning Score 4 se asociaron a las categorías de clasificación de riesgo urgente, muy urgente y emergente y tuvieron más deterioro clínico, como insuficiencia respiratoria y shock, y murieron, lo que demuestra que el Protocolo de Clasificación de Riesgo priorizó correctamente a los pacientes con riesgo vital.

ABSTRACT Objectives: to identify the effect on satisfaction and self-confidence of undergraduate nursing students after using a validated bed bath video during the simulation. Methods: blinded parallel randomized clinical trial. Participants were allocated to the control group (simulation with tutor) or intervention (simulation with video). After the interventions, the Student Satisfaction and Self Confidence with Learning Scale was used to assess satisfaction and self-confidence. The study was approved by the Ethics Committee and Brazilian Registry of Clinical Trials. Mann Whitney, Fisher Exact and Student t statistical tests were used. A significance level of 5% was adopted. Results: fifty eight students (30, control; and 28, intervention) were evaluated. There was no significant difference between the groups regarding satisfaction (p=0.832) and self-confidence (p>0.999). Conclusions: satisfaction and self-confidence were similar between the groups, and the two strategies could be used in the simulated practice of bed bathing.

ABSTRACT Objective: To verify the factors associated with risk, perception, and knowledge of falls; and pain among older adults. Method: A cross-sectional study carried out in the Emergency Service of a teaching hospital in the city of São Paulo between September 2019 and March 2020. We selected 197 older adults aged 65 and over, who were not disoriented or confused, of both genders. The instruments Awareness Questionnaire on the Risk of Falls, Morse Fall Scale and Numerical Pain Scales were applied. Mann-Whitney and Kruskal-Wallis tests were used. Results: Interviewees with a high risk of falls in older adults (p = 0.0041); those with a support network had a lower perception and knowledge about the risk of falls (p = 0.0025) and lower percentage of severe pain (p = 0.0033). Conclusion: Factors associated with risk, perception and knowledge of falls and pain among older adults were age, family income, number of dependents, caregiver, support network, hypertension, impaired walking, antihypertensive medication, lipid-lowering medication, level of education, comorbidities and religion.

Abstract Objective: To exam the association of the age-adjusted Charlson comorbidity index with the categories of risk classification, the clinical aspects, and the patient outcomes in the emergency department. Method: Cross-sectional, analytical study that analyzed the medical records of 3,624 patients seen in the emergency department. Charlson index scores greater than 2 showed a high rate of comorbidity (mortality risk). T-test and analysis of variance were applied in the analyses. Results: There was a significant difference between the Charlson comorbidity index and the risk classification, with higher scores found in patients classified in the white (2.57) and red (2.06) categories. Patients with vascular, endocrine, neurological, cardiologic, or device problems, and those who underwent a head tomography had a high rate of comorbidity. In addition, those admitted, transferred, or who died in the emergency room had significantly higher index scores compared to those who were discharged from the hospital. Conclusion: The high rate of comorbidity was associated with the categories of risk classification, main and nonspecific complaints, performance of a head tomography, and patient outcomes in the emergency room.

ABSTRACT Objective: To evaluate the ability to perform activities of daily living (ADL) and to correlate functional capacity with quality of life (QoL) of hospitalized octogenarians. Method: A cross-sectional study with 128 patients using the quality of life instruments WHOQOL-OLD and WHOQOL-BREF and the Katz Scale. Results: The majority of patients was fully dependent; patients with higher schooling had less independence; older adults with partial dependence and independence had higher scores in perceived QoL; in the domains of autonomy, past, present and future activities; and better overall QoL than those with full dependence. Partially dependent patients had higher scores in the death and dying domain than independent patients. Conclusion: Older adults’ QoL is associated with the maintenance of autonomy and functional capacity. Older adults experience a health decline during the hospitalization process, due to the limitation in performing their ADL and lack of encouragement by the health team.

ABSTRACT Objective: to verify the conformity of the time interval between the end of the risk classification and the beginning of medical care with that recommended by the Manchester protocol and to relate the times of care and the risk categories with the outcome. Method: Cross-sectional, retrospective, and analytical study. The t test, the analysis of variance and the generalized linear model were used. Results: The average time for medical care in the red and orange categories was 3 and 39.5 minutes, respectively. Death outcome was associated with the red category, with an average time to start the classification of 5.5 minutes and an average length of stay of 2.3 hours. Conclusion: The waiting time for medical care in the high priority categories was longer than recommended, which suggests the need to continuously monitor the system. Shorter waiting times for classification and permanence were related to the red category and the outcome of death.

ABSTRACT Objective To build and validate the content of a clinical simulation scenario for teaching in-hospital transport of critically ill patients. Methods A descriptive study of construction and validation of a clinical simulation scenario for teaching in-hospital transport. A scenario based on the literature was built, followed by validation, using the Delphi technique, by five specialists, with an agreement of 80%. The experts were selected through snowball sampling. An instrument was developed containing 26 topics to be assessed for relevance, clarity, objectivity, feasibility, current content, vocabulary, and a field for observations. Results Two rounds were carried out by the specialists to reach a consensus of 80%. According to the experts´ recommendation, the initial scenario was written more clearly and objectively, and divided into two parts: patient preparation and patient transport. Conclusion In this study, the construction and validation of the scenario for teaching in-hospital transport were successfully performed. It may be applied in several services to evaluate the training of nursing undergraduate students, as well as for the professional improvement of those who work in the in-hospital transport service.

ABSTRACT Objectives: to analyze demographic data, clinical profile and outcomes of patients in emergency services according to Manchester Triage System’s priority level. Methods: a cross-sectional, analytical study, carried out with 3,624 medical records. For statistical analysis, the Chi-Square Test was used. Results: white individuals were more advanced in age. In the red and white categories, there was a higher percentage of men when compared to women (p=0.0018) and higher prevalence of personal history. Yellow priority patients had higher percentage of pain (p

ABSTRACT Objectives: to assess the implementation of a nurse-initiated pain management protocol for patients triaged as semi-urgent, and its impact in pain intensity, in the Emergency Department. Methods: a prospective cohort study for adult patients with pain who had been triaged as semi-urgent and admitted to the hospital’s Emergency Department. Patients who received the intervention (pain-management protocol with analgesic administration) were compared to those who were managed using the conventional approach (physician evaluation prior to analgesic administration). Results: of the 185 patients included, 55 (30%) received the intervention, and 130 (70%) were managed conventionally. Patients in the intervention group were more likely to have taken pain medication in the 4 hours prior to admission, and reported higher levels of pain at admission and more significant reductions in pain level. Conclusions: despite low protocol adherence, the intervention resulted in higher reported pain relief.

RESUMO Objetivo: Correlacionar a capacidade funcional e a qualidade de vida de pessoas idosas internadas no serviço de emergência. Método: Trata-se de um estudo transversal e analítico, realizado com idosos internados no serviço de emergência de um hospital universitário no município de São Paulo, entre dezembro de 2015 e janeiro de 2017. Os dados foram coletados por meio de entrevistas, utilizando questionário estruturado, o Medical Outcome Study 36, a Escala de Independência em Atividades de Vida Diária e a Medida de Independência Funcional. Resultados: Participaram 250 idosos com média de idade 71,9 anos, sexo masculino (56,8%), cor de pele branca (67,2%), casados (54,0%), baixa escolaridade (32,0%), baixa renda (58,0%), com comorbidades (81,2%) e provedores do lar (53,6%). As dimensões da qualidade de vida mais comprometidas foram aspecto físico (11,4%), aspecto emocional (21,6%) e capacidade funcional (25,2%). Sobre a capacidade funcional, caracterizou-se independência para as Atividades Básicas de Vida Diária, e dependência moderada, para as Atividades Instrumentais de Vida Diária. Quanto maior os escores da Medida de Independência Funcional maiores foram os escores de qualidade de vida. Conclusão: Quanto mais independente o idoso, melhor é sua qualidade de vida.

Resumo Objetivo Avaliar a prevalência e fatores associados à violência em idosos hospitalizados. Método Estudo transversal realizado com 100 idosos internados. Aplicaram-se os instrumentos: H-S/EAST, Escala de Estresse Percebido e Escala de Depressão Geriátrica. Utilizou-se análise descritiva para a caracterização sociodemográfica e clínica. Para associar a idade ao H-S/EAST foi utilizado o teste de Mann-Whitney; estresse percebido com o H-S/EAST foi utilizado o teste T, e sintomas depressivos com o H-S/EAST foi utilizado o teste da Razão Verossimilhança. Resultados A média de idade dos idosos foi 70,39 e 56,0%, houve risco aumentado para violação de direitos pessoais, características de vulnerabilidade e situações potencialmente abusivas. Os fatores associados ao risco aumentado para violação de direitos pessoais ou abuso direto nos idosos foram maior idade, apresentar estresse percebido e ter sintomas de depressão leve a severa. Conclusão e implicação para a prática Esses resultados mostram, portanto, a importância da observação atenta do idoso por parte do enfermeiro para permitir a identificação do risco para violência ou violação de direitos. O que possibilita estabelecer ações preventivas, coordenadas com a participação dos demais profissionais bem como o encaminhamento correto de cada situação, cumprimento do dever legal da profissão e do papel cidadão.

Objetivo: avaliar qualidade de vida, experiências espirituais em pacientes com câncer e sua correlação. Método: estudo transversal, realizado na Emergência, de fevereiro a setembro de 2017. Utilizado o Medical Outcome Study 36 – Item Short-Form Health Survey para verificação da qualidade de vida, com oito dimensões, escore de 0 (pior estado) a 100 (melhor estado) e a Escala Diária de Experiência Espiritual, com 16 itens, pontuação entre 16 e 94 (menores pontuações refletem maior frequência de experiências). Utilizou-se o Coeficiente de Spearman para correlacionar qualidade de vida e espiritualidade. Resultados: 83 pacientes, média de idade 58 anos, predomínio masculino. A dimensão da qualidade de vida mais comprometida foi “aspecto físico”. A Escala de Experiência Espiritual apresentou média 51, com correlação negativa entre qualidade de vida e espiritualidade. Conclusão: a espiritualidade relaciona-se com qualidade de vida e deve ser considerada no atendimento a pacientes com câncer na emergência.

Aim: to evaluate the quality of triage in an emergency service according to the perception of the nursing professionals. Method: a cross-sectional study carried out at the emergency service triage of the São Paulo Hospital, between March and July 2016. A hundred and thirty-three professionals who worked in the sector for at least three months participated in the study. A questionnaire was used with variables for sociodemographic characterization and, also, an instrument for triage quality evaluation. Results: mean age 36.2 years, the majority of females (77.4%) and graduated for more than 5 years (59.1%). The triage obtained the following scores: structure (23.0), process (22.0) and result (20.9). Conclusion: the triage quality was evaluated as precarious in the perception of the nursing professionals.

Objetivou-se identificar o conhecimento teo?rico da equipe de enfermagem sobre as manobras de ressuscitac?a?o cardiopulmonar em suporte ba?sico de vida, associando tal conhecimento a?s varia?veis sociodemogra?ficas, econo?micas e de formac?a?o profissional. Trata-se de estudo transversal, descritivo e quantitativo, cujos dados foram obtidos de questiona?rios aplicados a 351 funciona?rios de uma equipe de enfermagem de um servic?o de emerge?ncia e de unidades de terapia intensiva. Houve decli?nio do conhecimento dos sujeitos sobre ressuscitac?a?o e parada cardiopulmonar com o passar do tempo. Fatores socioecono?micos e profissionais estiveram associados ao conhecimento dos profissionais de enfermagem. Sugere-se que treinamentos com menores intervalos aumentem o grau de retenc?a?o e o conhecimento da equipe de enfermagem.

Objetivo associar a capacidade funcional com o risco de queda de idosos em serviço de emergência.Métodos estudo transversal e analítico, no qual foram incluídos 101 indivíduos, com idade igual ou superior a 60 anos, de ambos os sexos, internados no Serviço de Emergência. Para avaliar a capacidade funcional, utilizaram-se as escalas de Katz e Lawton/Brody; e, para o risco de queda, a escala de Downton. Para associar a capacidade funcional com o risco de queda, utilizou-se o teste de Fisher-Freeman-Halton.Resultados 32,7% dos idosos foram independentes em uma função e dependentes em cinco funções básicas de vida diária, 89,1% foram totalmente dependentes para atividades instrumentais e 64,4% obtiveram alto risco de queda. Não houve associação estatisticamente significativa entre as escalas de Katz, Lawton/Brody e Downton.Conclusão a capacidade funcional não se associou ao risco de queda na população estudada.

Objetivo: avaliar a estrutura e o processo do acolhimento com classificação de risco em uma unidade de emergência de acordo com as recomendações do Ministério da Saúde. Método: estudo descritivo e exploratório, realizado em uma unidade de emergência da Bahia. As técnicas de investigação foram a observação sistemática e a entrevista com enfermeiros. Para a análise foram feitas comparações e confrontações das avaliações das dimensões qualitativas de estrutura e processo. Resultados: os recursos disponíveis para o funcionamento da classificação de risco, quanto à estrutura física, recursos materiais e ao fluxo de atendimento contemplavam parcialmente o que é preconizado. Existiam lacunas, como sinalização dos espaços, ausência de alguns materiais na sala da classificação de risco, o não cumprimento do tempo de espera e ausência formal da referência/contrarreferência. Conclusão: a estrutura e o processo do acolhimento com classificação de risco em uma unidade de emergência precisavam de adequação do espaço físico e do suprimento total de recursos para cumprir o que é proposto pelo Ministério da Saúde. Descritores: Enfermagem. Acolhimento. Triagem. Serviços Médicos de Emergência.

Objective: to assess analgesia effectiveness and agreement between the Numerical and Faces scales in trauma patients in the emergency department. Method: a cross-sectional study with 173 patients performed from February 2013 to September 2014. Pain was assessed on admission and one hour after analgesia by using the Numerical and Faces scales. To compare pain before and after analgesia, the Spearman Correlation Coefficient was used and. To analyze agreement between the scales, Kappa Index was used. Results: on admission, most patients reported moderate and severe pain. There was pain relief, but 36.0% of patients remained with mild pain and 33.7% moderate pain, requiring analgesic supplementation. Agreement between the scales was considerable before analgesia (Kappa = 0.31, p-value

ABSTRACT Objective: to identify the occurrence of warning signs and changes in vital signs in individuals who experienced in-hospital cardiorespiratory arrest and correlate them with the occurrence of this event. Method: this is a retrospective, analytical and quantitative study that included 218 medical records of patients who suffered in-hospital cardiorespiratory arrest and identified warning signs and alterations in vital signs. Mean, standard deviation, median, minimum and maximum values were calculated for the continuous variables, and frequency and percentage for the categorical variables. We compared the age and occurrence of cardiorespiratory arrest with the occurrence of warning signs using the Chi-Square Test and the Mann Whitney non-parametric test (p-value < 0.05). Results: 62.1% of the patients presented signs and symptoms of shock, 44.9% of neurological alteration, 40.4% of malaise, 15.2% presented signs suggestive of acute coronary syndrome, and 25.9% presented mental confusion. In the last measurement of vital signs before cardiorespiratory arrest, the majority of patients had altered abnormal (32.6%) and severely abnormal (23.9%) heart rate, and abnormal (37.1%) and severely abnormal (27.0%) respiratory rate. Conclusion: the warning signs identified were: shock, neurological signs, malaise and acute coronary syndrome. The prevalent changes in vital signs were: heart rate, respiratory rate and O2 saturation. Patients with severely abnormal systolic blood pressure were not discharged and those with abnormal respiratory rate did not survive 6 months after cardiorespiratory arrest.

Quantitative study aimed to observe adherence to hand hygiene by health professionals of an Emergency Care Service of a Teaching Hospital, in the state of São Paulo, and assess whether an educational intervention conducted between July 2012 and December 2013 had impact on this practice. During 120 hours of observation, 5,061 opportunities of hand hygiene were observed and recorded. The greatest number of opportunities was observed among nursing professionals (70.05%), because they are most numerous health professionals and usually perform care functions; these were followed by the medical team (17.82%) and physiotherapists (12.13%). After the educational activities adherence increased from 28.6% to 38.9%.In the post-intervention moment, all the professionals showed higher adherence to hand hygiene compared to the pre-intervention moment, and adherence was significantly higher after the use of aseptic procedures. It is concluded that hand hygiene compliance was less than expected and educational strategies favored adhesion.

Aim: to identify if the time between the risk assessment and medical care for less severe patient was in accordance with institutional protocol. Method: cross-sectional descriptive study performed in the emergency department of a scholastic public hospital of high complexity, from March to June 2012. The sample consisted of 172 patients, aged starting from 12 years, ranked in colors: yellow, green and blue, according to protocol of the institution. Results: according to the institutional protocol 66.00% of patients were classified in the color green. It was observed that the average waiting time, measure in minutes, was within the recommended rating of the three colors: Yellow 40.68, green and blue 53.76 and 69.06. Conclusion: the average waiting time for medical care did not exceed that recommended by the emergency service protocol in any of the classification of colors

Objective: to identify the epidemiological profile of hypertension patients, how much they understand about the disease and the rate of adherence to treatment by these patients who had been hospitalized in the Brazilian emergency service. Methods: this cross-sectional study was performed with 116 patients, both male and female and aged over 18 years, who had been hospitalized in the Emergency Service of a University Hospital between March and June, 2013. The studied variables were data referring to socio-demographics, comorbidities, physical activity and knowledge regarding the disease. Patient adherence to treatment and the identification of the barriers were respectively evaluated using the Morisky test and the Brief Medication Questionnaire. Results: most of the patients involved in this study were women (55%), with white skin color (55%), married (51%), retirees or pensioners (64%) and with a low educational level (58%). Adherence to treatment, in most cases (55%), was moderate and the most prevalent adherence barrier was recall (67%). When medication was acquired at no cost to the patient, there was greater adherence to treatment. Conclusion: this study's patients had a moderate understanding about the disease. The high correlation between the number of drugs used and the recall barrier suggests that monotherapy is an option that can facilitate treatment adherence and reduce how often the patients forget to take their medication.

ABSTRACT Objectives: to correlate risk classification categories with the level of pain of patients in an emergency service. Method: cross-sectional study carried out in the Risk Classification of 611 patients. The variables studied were: age, gender, comorbidities, complaint duration, medical specialty, signs and symptoms, outcome, color attributed in the risk classification of and degree of pain. We used Analysis of Variance, a Chi-Square test and a Likelihood Ratio test. Results: the average age was 42.1 years (17.8); 59.9% were women; the green (58.9%) and yellow (22.7%) risk classification prevailed and hypertension (18.3%) was the most common Comorbidity. The most frequent pain intensity was moderate (25.9%). In the red category, patients presented a higher percentage of absence of pain; in the blue, mild pain; and in the green, yellow and orange categories, there was a greater percentage of intense pain (p < 0.0001). Conclusion: among the patients who presented pain, the majority reported moderate intensity. Regarding risk categories, most patients in the red category did not report pain. Those who were classified as green, yellow and orange, reported mostly intense pain. On the other hand, patients in the blue category reported predominantly mild pain.

ABSTRACT Objectives: to identify the care measures performed after cardiorespiratory arrest (CRA) and to relate them to the neurological status and survival at four moments: within the first 24 hours, at the discharge, six months after discharge, and one year after discharge. Method: retrospective, analytical and quantitative study performed at the Emergency Department of a university hospital in São Paulo. Eighty-eight medical records of CRA patients who had a return of spontaneous circulation sustained for more than 20 minutes were included and the post-CRA care measures performed in the first 24 hours were identified, as well as its relationship with survival and neurological status. Results: the most frequent post-CRA care measures were use of advanced airway access techniques and indwelling bladder catheterization. Patients who had maintained good breathing and circulation, temperature control and who were transferred to intensive care unit had a better survival in the first 24 hours, after six months and one year after discharge. Good neurological status at six months and one year after discharge was associated with non-use of vasoactive drugs and investigation of the causes of the CRA. Conclusion: the identification of good practices in post-CRA care may help to reduce the mortality of these individuals and to improve their quality of life.

RESUMO Objetivo: caracterizar o perfil e os atendimentos dos usuários frequentes de um serviço de emergência e associar as características sociodemográficas e clínicas dos usuários com as características de utilização do serviço. Método: estudo retrospectivo e analítico realizado no serviço de emergência de um hospital universitário localizado no município de São Paulo. Foram incluídos prontuários dos pacientes que procuraram o serviço de emergência no mínimo quatro vezes num período de 12 meses entre setembro de 2013 e agosto de 2014. Resultados: incluídos 480 prontuários (2.808 atendimentos). A média de atendimentos foi de 5,85, sendo que a amostra variou de quatro a 28 atendimentos. Foram classificados como verdes após a classificação de risco 44,4% dos pacientes; como laranja, 13,1%; e como vermelho 8,1%, sendo que a maioria desses atendimentos foi realizada às segundas-feiras; 69,1% tiveram como desfecho a alta hospitalar. Predominaram os atendimentos não urgentes. Conclusão: os serviços de emergência podem elaborar estratégias junto com as unidades básicas de saúde que facilitem o gerenciamento dos casos a fim de suprir integralmente as necessidades dos usuários no nível adequado de assistência, implementando um sistema de fluxo de referência e contrarreferência dos pacientes.

AbstractOBJECTIVEIdentifying factors associated to survival after cardiac arrest.METHODAn experience report of a cohort study conducted in a university hospital, with a consecutive sample comprised of 285 patients. Data were collected for a year by trained nurses. The training strategy was conducted through an expository dialogue lecture. Collection monitoring was carried out by nurses via telephone calls, visits to the emergency room and by medical record searches. The neurological status of survivors was evaluated at discharge, after six months and one year.RESULTSOf the 285 patients, 16 survived until hospital discharge, and 13 remained alive after one year, making possible to identify factors associated with survival. There were no losses in the process.CONCLUSIONCohort studies help identify risks and disease outcomes. Considering cardiac arrest, they can subsidize public policies, encourage future studies and training programs for CPR, thereby improving the prognosis of patients.

AbstractOBJECTIVEIdentify association between sociodemographic, clinical and triage categories with protocol outcomes developed at Hospital São Paulo (HSP).METHODSRetrospective cohort study conducted with patients older than 18 years submitted to the triage protocol in August 2012. Logistic regression was used to associate the risk categories to outcomes (p-value ≤0,05).RESULTSMen with older age and those treated in clinical specialties had higher rates of hospitalization and death. Patients in the high-priority group had hospitalization and mortality rates five and 10.6 times, respectively (p < 0.0001).CONCLUSIONThe high-priority group experienced higher hospitalization and mortality rates. The protocol was able to detect patients with more urgent conditions and to identify risk factors for hospitalization and death.

The objective in this study was to assess the frailty of elderly hospitalized at the Emergency Service of a university hospital in the State of São Paulo, Brazil. The data were collected between March and June 2014. Cross-sectional study involving 101 elderly, hospitalized for 24 hours or more. To develop the analysis, the Edmonton Frail Scale was applied. The mean age was 75 years, 50.5% female, 58.4% did not finish primary education, 89.1% retired or pensioner and 84.2% accompanied by a caregiver. Frequent antecedents were: arterial hypertension (65.3%), diabetes mellitus (65.3%) and smoking (44.6%). Concerning the frailty, the mean total score was 9.85, indicating moderate frailty. The elderly people with neurological diseases, dementia, more advanced age and who had a caregiver demonstrated higher levels of frailty. Frailty screening favors planning with a view to preventing disability and the worsening of the elderly people’s health conditions.

The objective was to identify the main nursing diagnoses used by experts in the emergency area. A descriptive study was undertaken at an emergency service between June and November 2011. The Delphi technique was used to reach a consensus among seven professionals from different Brazilian institutions about the prevailing nursing diagnoses at emergency care services. A consensus was reached on the following nursing diagnoses: Impaired gas exchange, Ineffective breathing pattern, Impaired spontaneous ventilation, Risk for infection, Risk for impaired skin integrity, Impaired tissue integrity and Risk for falls. In conclusion, the Delphi technique showed to be a great facilitator to reach a consensus about the prevailing nursing diagnoses at emergency care services related to the “safety and protection”, “activity and rest” and “elimination and exchange” domains of the North American Nursing Diagnosis Association.

OBJECTIVE To verify the adequacy of the professional nursing staff in the emergency room of a university hospital and to evaluate the association between categories of risk classification triage with the Fugulin Patient Classification System. METHOD The classification of patients admitted into the emergency room was performed for 30 consecutive days through the methodology proposed by Gaidzinski for calculating nursing requirements. RESULTS The calculation determines the need for three registered nurses and four non-registered nursing for each six hour shift. However, only one registered nurse and four non-registered nurse were available per shift. There was no correlation between triage risk classification and classification of care by the Fugulin Patient Classification System. CONCLUSION A deficit in professional staff was identified in the emergency room. The specificity of this unit made it difficult to measure. To find the best strategy to do so, further studies should be performed.

Objectives: to analyze the quality of life of "patients" with Human Immunodeficiency Virus and relate it to their socioeconomic profile, knowledge and attitudes toward sexuality. Method: crosssectional and analytical study with 201 individuals who are 50 years old or older. The Targeted Quality of Life and Aging Sexual Knowledge and Attitudes Scales were applied during interviews. Multiple Linear Regression was used in data analysis. Results: dimensions of quality of life more strongly compromised were disclosure worries (39.0), sexual function (45.9), and financial worries (55.6). Scores concerning knowledge and attitudes toward sexuality were 31.7 and 14.8, respectively. There was significant correlation between attitudes and the domains of overall function, health worries, medication worries, and HIV mastery. Conclusion: guidance concerning how the disease is transmitted, treated and how it progresses, in addition to providing social and psychological support, could minimize the negative effects of the disease on the quality of life of patients living with the Human Immunodeficiency Virus.

Methodological study to translate and culturally adapt the Jones Dependency Tool (JDT) to Portuguese. The translation and cultural adaptation method had four stages. First stage: translation of the original instrument from English to Portuguese. Second stage: content, cultural, semantic and conceptual equivalence in relation to the original instrument. Third stage: back-translation. Fourth stage: comparison of the translated and back-translated versions by a committee of specialists, resulting in the final version. In the Communication Domain, the original JDT measured pain using high, intermediate and low ranges, but the committee suggested replacing it with a visual analog scale. The translation and cultural adaptation of the JDT to Portuguese produced an instrument applicable to our reality. Studies need to be conducted to test the validity and reliability of the JDT in Brazilian Emergency Services. doi: 10.5216/ree.v16i4.22345.

O objetivo deste estudo foi identificar dados sobre atendimento à parada cardiorrespiratória na gestação. Foi realizada uma revisão integrativa de artigos publicados entre 2010 e 2015, em português, inglês e espanhol com a utilização dos seguintes descritores: “Parada Cardíaca”; “Ressuscitação Cardiopulmonar”; “Gestante” e “Gestação”, nas seguintes bases de dados: MEDLINE, LILACS, IBECS e CUMED. A idade gestacional variou de 10 a 41 semanas, as etiologias mais comuns da parada cardiorrespiratória foram embolia pulmonar e trauma, os ritmos foram fibrilação ventricular e atividade elétrica sem pulso e o tempo em parada cardiorrespiratória variou de 15 a 60 minutos. O tratamento foi ressuscitação cardiopulmonar, intubação, administração de epinefrina e cesárea de emergência. Os desfechos mais observados nas mães e recém-nascidos foram alta e bom estado neurológico. Conclui-se que protocolos de atendimento específicos podem respaldar e auxiliar a tomada de decisão da equipe durante a ressuscitação cardiopulmonar, aumentando a sobrevida e diminuindo o dano neurológico nestas pacientes.

OBJECTIVE: to verify the degree of agreement between the levels of priority given by baccalaureate nurses in care based on risk assessment and classification and the institutional protocol, and also among peers. METHOD: descriptive study, using a questionnaire with thirty fictitious clinical cases based on the institutional protocol, which is considered the gold standard, answered by twenty baccalaureate nurses. RESULTS: the agreement analysis through the Kappa Coefficient concluded that the agreement between baccalaureate nurses and the institutional protocol in relation to prioritizing the levels of severity was moderate. When the agreement among peers was evaluated, it was low, as represented by the colorimetric density in shades of light gray. CONCLUSION: in Brazil, some institutions have developed their own protocol, which makes it necessary to develop tools in order to evaluate the accuracy of professionals in relation to the protocols, highlighting the need for capable people to perform this activity, thus contributing to patient safety. OBJETIVO: verificar el grado de concordancia entre los niveles de prioridad atribuidos en el acogimiento con evaluación y clasificación de riesgo cuando efectuado por los enfermeros, en comparación con el protocolo institucional y entre los pares. MÉTODO: estudio descriptivo, utilizando un cuestionario con treinta casos clínicos ficticios, basado en el protocolo institucional, considerado la regla de oro, respondido por veinte enfermeros. RESULTADOS: el análisis de concordancia a través del Coeficiente Kappa concluyó que la concordancia entre la priorización de los niveles de gravedad entre los enfermeros y el protocolo institucional fue moderada. La concordancia entre los pares fue baja, representada por la densidad colorimétrica en las tonalidades de gris claro. CONCLUSIÓN: en Brasil, algunas instituciones desarrollaron protocolos propios, lo que hace fundamental el desarrollo de herramientas para evaluar la precisión de los profesionales respecto a los protocolos, evidenciando las necesidades de capacitación para esta actividad, contribuyendo a la seguridad del paciente. OBJETIVO: verificar o grau de concordância entre os níveis de prioridade atribuídos no acolhimento com avaliação e classificação de risco, realizado pelos enfermeiros, em relação ao protocolo institucional e entre os pares. MÉTODO: trata-se de estudo descritivo, utilizando um questionário com trinta casos clínicos fictícios com base no protocolo institucional, considerado padrão-ouro, respondido por vinte enfermeiros. RESULTADOS: pela análise de concordância pelo coeficiente Kappa, concluiu-se que a concordância entre a priorização dos níveis de gravidade entre os enfermeiros e o protocolo institucional foi moderada. Quando avaliada a concordância entre os pares, essa foi baixa, representada pela densidade colorimétrica nas tonalidades de cinza claro. CONCLUSÃO: no Brasil, algumas instituições desenvolveram protocolos próprios, o que torna fundamental o desenvolvimento de ferramentas para avaliar a acurácia dos profissionais em relação aos protocolos, evidenciando as necessidades de capacitação para essa atividade, contribuindo para a segurança do paciente.

OBJETIVO: identificar a ocorrência de potenciais interações medicamentosas em prescrições médicas de idosos internados no Serviço de Emergência. MÉTODOS: estudo transversal, amostra composta de 101 prescrições médicas das primeiras 24 horas de internação de idosos na sala de Emergências Clínicas do Pronto-Socorro. A análise das interações medicamentosas foi realizada pela base de dados Drugs.com, classificadas quanto ao potencial de interação em: grave, moderada e leve. RESULTADOS: o número de medicamentos das prescrições variou de duas a 14, com média de 5,8 por prescrição. Foram incluídos 587 medicamentos e identificaram-se 7% de interações graves, 26,8% moderadas e 7% leves; 11,3% grave/moderada, 21,1% moderada/leve e 26,8% grave/moderada/leve. CONCLUSÃO: este estudo identificou interações medicamentosas em prescrições médicas de idosos no Serviço de Emergência, classificadas, sobretudo, como moderadas. Ressalta-se a importância de os profissionais de saúde atentarem para as potenciais interações, aprazamento das prescrições, capacitação da equipe e monitoramento dos casos a fim de reduzir sua ocorrência.

A study aimed to assess quality indicators of the care for patients with suspicion of acute coronary syndrome (ACS) and associate them to discharge, death and, duration of hospitalization. A cross sectional, analytical study of 84 records of patients with ACS suspicion at the emergency service. The association between risk factors and quality indicators of ACS care as: duration of hospitalization, death, recurrence of ischemic events and myocardial revascularization were studied through Spearman’s correlations. The duration of hospitalization was significantly smaller for patients with myocardial infarction without ST segment elevation, with a shorter interval between admission and treatment. For patients with myocardial infarction with ST segment elevation, the hospitalization time was significantly shorter when the interval between the risk classification and treatment was shorter. There was no association of quality indicators as recurrence of ischemic events, myocardial revascularization, duration of hospitalization and death.

Objetivou-se relatar a experiência da construção de dois instrumentos para avaliar o desempenho de estudantes de um curso de graduação em Enfermagem de uma universidade pública, durante o estágio das Unidades Curriculares de Enfermagem em Cuidados Intensivos e Enfermagem em Emergência e apresentar os instrumentos construídos. A metodologia do trabalho consistiu em doze encontros presenciais e a distância, ocorridos no período de janeiro a março de 2014 entre a pedagoga da universidade e oito docentes da graduação de Enfermagem, quando se discutiu exaustivamente o tema avaliação, partindo de instrumentos existentes desde 2008. Concluiu-se que os instrumentos anteriores estavam inadequados em alguns aspectos e dois novos instrumentos de avaliação foram elaborados pelo grupo, com enfoque em competências e habilidades, com o objetivo de atender às necessidades de avaliação dos estudantes no momento, mas ambos os instrumentos são passíveis de reformulações futuras, condizentes com as necessidades que possam surgir.

O processo de envelhecimento vem acompanhado por diversos problemas de saúde que na maioria das vezes alteram a capacidade funcional e estão associados ao aumento da utilização dos serviços de saúde. Este estudo teve como objetivo identificar o perfil epidemiológico e avaliar a capacidade para desenvolver as atividades de vida diária dos idosos internados no Serviço de Emergência. Trata-se de um estudo transversal realizado com 200 indivíduos com idade igual ou superior a 60 anos, internados no Serviço de Emergência de um hospital universitário do município de São Paulo, Brasil. A avaliação da capacidade para realizar atividades de vida diária foi mensurada pela escala de Katz. Os testes estatísticos utilizados foram a análise de variância (ANOVA), correção de Bonferroni, teste qui-quadrado ou teste da razão de verossimilhança. A maioria dos idosos foi classificada como independente (65%). A idade mais avançada e o sexo feminino foram fatores relacionados ao maior grau de dependência, assim como a comorbidades e a fatores socioeconômicos, como baixa renda e escolaridade. As intervenções para essa população devem ser planejadas de modo a incentivar o autocuidado e a autonomia do idoso, considerando seus limites e grau de dependência.

OBJETIVO: Identificar a ocorrência de potenciais interações medicamentosas em prescrições médicas de pacientes adultos internados no Serviço de Emergência do Hospital São Paulo. MÉTODOS: Estudo de corte transversal e descritivo. A amostra foi composta por 200 prescrições médicas. A análise das interações medicamentosas foi realizada por meio da base de dados Drugs.com, onde são classificadas quanto à potencialidade de ação em interação grave, moderada, leve e sem interação. RESULTADOS: O número de medicamentos das prescrições variou de 2 a 19, e a média por prescrição foi de 4,97 medicamentos. Foram identificadas 526 potenciais interações medicamentosas em 159 prescrições (79,5%); destas, 109 foram interações graves, 354 moderadas, 63 leves e 41 não apresentaram interação. CONCLUSÃO: Este estudo demonstrou potencial interação medicamentosa em 79,5% das prescrições analisadas no Serviço de Emergência. As interações medicamentosas podem acontecer em todos os momentos da utilização dos fármacos e, nesse processo de trabalho, a equipe de enfermagem está envolvida em diversas etapas. Portanto, instrumentalizar o enfermeiro para o uso racional dos fármacos pode aumentar a segurança da assistência ao paciente.

ABSTRACT Objective: To identify which orientations were received by the patient about the medication prescription and which professional performed it; to evaluate the patients' knowledge about prescription drugs and to correlate it to socioeconomic variables, comorbidities, and the frequency with which the patient seeks emergency service; and to evaluate the knowledge about the medication prescribed after the health care. Method: This was a cross-sectional study on 304 patients that received emergency service's discharge along with medication prescription. Applied instruments: sociodemographic characterization and evaluation of the knowledge about the prescribed medication. We used a descriptive and inferential analysis. Results: Most subjects had no doubts about how or for how long to take the medication; and presented questions about adverse reactions and what to do in case of forgetting to take the medication doses. There was a significant association between age; educational level; comorbidity; the frequency of emergency service's use; and knowledge about medications. Conclusion: a total of 48% of the patients declared to need information about adverse effects and what to do if they forget to take the medication.

Resumo Consideradas a dinamicidade e complexidade dos serviços de emergência, bem como a recomendação de prática colaborativa interprofissional em saúde, este estudo foi desenvolvido para identificar as atribuições específicas e as compartilhadas dos fisioterapeutas que atuam nas equipes desses serviços. Foi realizada análise documental, para mapeamento das ações, e técnica Delphi, para consenso. Foram identificadas 26 atribuições, sendo cinco privativas do fisioterapeuta, 12 compartilhadas com médicos e enfermeiros e nove sem consenso. Isso mostra, de um lado, a ampliação do escopo de prática das profissões e a constituição de atribuições comuns entre os três profissionais, em especial entre fisioterapeutas e médicos. Por outro lado, também mostra que existem potenciais conflitos pela indefinição de um terço de atribuições. Há flexibilidade das fronteiras profissionais, o que pode contribuir para abordagem integral das necessidades dos pacientes e efetivo trabalho em equipe colaborativo.

Objective To assess knowledge of healthcare professionals about capture and reproduction of images of patients in a hospital setting. Methods A cross-sectional and observational study among 360 healthcare professionals (nursing staff, physical therapists, and physicians), working at a teaching hospital in the city of São Paulo (SP). A questionnaire with sociodemographic information was distributed and data were correlated to capture and reproduction of images at hospitals. Results Of the 360 respondents, 142 had captured images of patients in the last year, and 312 reported seeing other professionals taking photographs of patients. Of the participants who captured images, 61 said they used them for studies and presentation of clinical cases, and 168 professionals reported not knowing of any legislation in the Brazilian Penal Code regarding collection and use of images. Conclusion There is a gap in the training of healthcare professionals regarding the use of patient´s images. It is necessary to include subjects that address this theme in the syllabus of undergraduate courses, and the healthcare organizations should regulate this issue.

ABSTRACT Objective: To describe neurological status and associated factors of survivors after cardiac arrest, upon discharge, and at 6 and 12 month follow-up. Methods: A cohort, prospective, descriptive study conducted in an emergency room. Patients who suffered cardiac arrest and survived were included. A one-year consecutive sample, comprising 285 patients and survivors (n=16) followed up for one year after discharge. Neurological status was assessed by the Cerebral Performance Category before the cardiac arrest, upon discharge, and at 6 and 12 months after discharge. The following factors were investigated: comorbidities, presence of consciousness upon admission, previous cardiac arrest, witnessed cardiac arrest, location, cause and initial rhythm of cardiac arrest, number of cardiac arrests, interval between collapse and start of cardiopulmonary resuscitation, and between collapse and end of cardiopulmonary resuscitation, and duration of cardiopulmonary resuscitation. Results: Of the patients treated, 4.5% (n=13) survived after 6 and 12 months follow-up. Upon discharge, 50% of patients remained with previous Cerebral Performance Category of the cardiac arrest and 50% had worsening of Cerebral Performance Category. After 6 months, 53.8% remained in the same Cerebral Performance Category and 46.2% improved as compared to discharge. After 12 months, all patients remained in the same Cerebral Performance Category of the previous 6 months. There was no statistically significant association between neurological outcome during follow-up and the variables assessed. Conclusion: There was neurological worsening at discharge but improvement or stabilization in the course of a year. There was no association between Cerebral Performance Category and the variables assessed.

ABSTRACT Objective: To identify factors associated with not attempting resuscitation. Methods: A cross-sectional study conducted at the emergency department of a teaching hospital. The sample consisted of 285 patients; in that, 216 were submitted to cardiopulmonary resuscitation and 69 were not. The data were collected by means of the in-hospital Utstein Style. To compare resuscitation attempts with variables of interest we used the χ2 test, likelihood ratio, Fisher exact test, and analysis of variance (p

ABSTRACT Objective: To verify agreement between estimative of predicted resources using the adapted Emergency Severity Index and the real amount of resources used by patients. To analyze the variables number of years since graduation, years of work experience and years of experience in emergency services especially with accurate anticipation of resources need. Methods: This retrospective analytical study with a quantitative approach included 538 medical records of patients assisted by 11 triage nurses. Data collected were related to assistances carried out from December 2012 to February 2013. Results: There was no significant association between the adequacy of the number of resources used, based on Emergency Severity Index score, number of years since graduation, year of work experience or years of experience in emergency services. Kappa agreement coefficient (0.34) showed that agreement was low between predicted and real used number of resources. Conclusion: Nurses’ accuracy index to predict resources for patients care from emergency room using the adapted Emergency Severity Index was lower than results reported in the studies in the literature that used the original scale. There was low agreement of diagnostic exams predicted by nurses and those really performed. There was no association among correct prediction of resources needed, number of years since graduation, years of experience in emergency services and years of work experience in the unit where the study was done.

ABSTRACT Objective To assess knowledge of nurses of emergency services and intensive care units about Glasgow Coma Scale. Methods This cross-sectional analytical study included 127 nurses of critical units of an university hospital. We used structured interview with 12 questions to evaluate their knowledge about the scale. Association of Knowledge with professionals’ sociodemographic variables were verified by the Fisher-test, χ2 and likelihood ratio. Results Most of participants were women mean aged 31.1 years, they had graduated more than 5 years previously, and had 1 to 3 years of work experience. In the assessment of best score possible for Glasgow scale (question 3) nurses who had graduate more than 5 years ago presented a lower percentage success rate (p=0.0476). However, in the question 7, which evaluated what interval of the scale indicated moderate severity of brain trauma injury, those with more years of experience had higher percentage of correct answers (p=0.0251). In addition, nurses from emergency service had more correct answers than nurses from intensive care unit (p=0.0143) in the same question. Nurses graduated for more than 5 years ago had a lower percentage of correct answers in question 7 (p=0.0161). Nurses with more work experience had a better score (p=0.0119) to identify how assessment of motor response should be started. Conclusion Number of year since graduation, experience, and work at critical care units interfered in nurses’ knowledge about the scale, which indicates the need of training.