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Este relatório surgiu no âmbito do Curso de Mestrado de Enfermagem Médico-Cirúrgica na área de Enfermagem à Pessoa em Situação Crítica e está organizado em duas partes. A primeira parte tem como objetivo o aperfeiçoamento das competências gerais e específicas relacionadas com a Enfermagem Médico-Cirúrgica na área da de pessoa em situação crítica. Na segunda parte reporta-se à prática especializada baseada na evidência: projeto de investigação.
O estudo tem como objetivo geral avaliar os conhecimentos/práticas dos enfermeiros na prevenção da Infeção Urinária Associada a Cateter Vesical na pessoa em situação crítica, num serviço de medicina intensiva da região norte de Portugal. Estabeleceram-se como como objetivos específicos: caracterizar o perfil sociodemográfico e profissional da amostra; identificar os conhecimentos/práticas da amostra relativamente à prevenção da infeção urinária associada a cateter vesical na pessoa em situação crítica; analisar as características sociodemográficas e profissionais dos enfermeiros significativamente associadas à menor frequência de conhecimentos/práticas.
Optou-se por um estudo analítico, transversal de cariz quantitativo, com a utilização de um questionário a enfermeiros que exercem funções no serviço de medicina intensiva, de uma Unidade Local de Saúde da região do Norte de Portugal.
A amostra foi constituída por 40 profissionais que acordaram em participar no estudo de forma voluntária, utilizando um método de amostragem não probabilística, em que constatou-se uma maior predominância: no sexo feminino (82,5%); na idade entre os 31 e 45 anos (77,5%); ao nível dos enfermeiros generalistas (65%); no tempo de serviço na medicina intensiva de pelo menos 10
anos (37,5%); no horário rotativo (95%), na formação na área de prevenção da IUACV (67,5%) e no conhecimento da norma sobre a prevenção de IUACV (100%).
Nas questões “Considera alternativas à cateterização vesical?” e “Verifica diariamente a necessidade de manter o cateter vesical, removendo-o o mais precocemente possível?”, a maioria da amostra referiu que o fazem sempre (respetivamente, 55,5% e 52,5%). Os enfermeiros revelam 100% na componente “procedimento da inserção do cateter vesical utiliza sempre a técnica assética” e de 90% “procedimento de cateterismo vesical e de conexão ao sistema de drenagem cumpre a técnica assética.
Os enfermeiros especialistas em relação ao “manter o CV fixo de modo a não permitir tração ou deslocação, prevenindo os movimentos do cateter” apresentam 52,9% e no parâmetro “o saco coletor é esvaziado quando atinge 2/3 da sua capacidade” (70,6%). No entanto as menores percentagens estão relacionadas aos enfermeiros generalistas no parâmetro “Verifica diariamente a necessidade de manter o cateter vesical, removendo-o o mais precocemente possível?” (30,4%) e no parâmetro “manter o CV fixo de modo a não permitir tração ou deslocação, prevenindo os movimentos do cateter” (21,7%). De modo geral, os enfermeiros em estudo apresentam conhecimentos/práticas na prevenção da infeção urinária associada a cateter vesical na pessoa crítica, num serviço de medicina intensiva. A categoria profissional, a realização de formação e a participação em projetos sobre a prevenção de infeção estão estatisticamente associados aos conhecimentos/práticas. Os enfermeiros especialistas com formação na área associam-se a pontuações mais elevadas.
This report was developed within the scope of the Master's Degree in Medical-Surgical Nursing in the area of Nursing for Critically Ill Patients and is organized into two parts. The first part aims to improve general and specific skills related to Medical-Surgical Nursing in the area of critically ill patients. The second part reports on specialized evidence-based practice: research project. The study's general objective is to evaluate the knowledge/practice of nurses in the prevention of urinary tract infection associated with bladder catheters in critically ill patients, in an intensive care unit in the northern region of São Paulo. The specific objectives were established: to characterize the sociodemographic and professional profile of the sample; to identify the knowledge/practice of the sample regarding the prevention of urinary tract infection associated with bladder catheters in critically ill patients; to analyze the sociodemographic and professional characteristics of nurses significantly associated with the lower frequency of knowledge/practices. An analytical, cross-sectional, quantitative study was chosen, using a questionnaire to nurses working in the intensive care unit of a Local Health Unit in the North of Portugal. The sample consisted of 40 professionals who agreed to participate in the study voluntarily, using a non-probabilistic sampling method, in which a greater predominance was found: in the female sex (82.5%); in the age range between 31 and 45 years (77.5%); in the level of generalist nurses (65%); in the length of service in intensive care of at least 10 years (37.5%); in the rotation of schedules (95%), in training in the area of prevention of IUACV (67.5%) and in knowledge of the standard on prevention of IUACV (100%). The questions “Do you consider alternatives to bladder catheterization?” and “Do you check daily the need to maintain the urinary catheter, removing it as soon as possible?”, the majority of the sample reported that they always do so (respectively, 55.5% and 52.5%). Nurses revealed 100% in the component “procedure for inserting the urinary catheter always uses the aseptic technique” and 90% “procedure for catheterization and connection to the drainage system complies with the aseptic technique”. Specialist nurses in relation to “keeping the VC fixed so as not to allow traction or displacement, preventing catheter movements” show 52.9% and in the parameter “the collection bag is emptied when it reaches 2/3 of its capacity” (70.6%). However, the lowest percentages are related to generalist nurses in the parameter “Do you check daily the need to maintain the urinary catheter, removing it as soon as possible?” (30.4%) and in the parameter “keep the CV fixed so as not to allow traction or displacement, preventing catheter movements” (21.7%). In general, the nurses in the study have knowledge/practices in preventing urinary tract infections associated with bladder catheters in critically ill patients in an intensive care unit. Professional category, training, and participation in projects on infection prevention are statistically associated with knowledge/practices. Specialist nurses with training in the area are associated with higher scores. During the internship, it was possible to develop and consolidate a set of technical, scientific, and relational skills that are fundamental for safe, ethical, and evidence-based clinical practice. One of the areas that required special attention was the prevention of healthcare-associated infections, in particular urinary tract infections associated with bladder catheters, a frequent and potentially serious complication in critically ill patients.
This report was developed within the scope of the Master's Degree in Medical-Surgical Nursing in the area of Nursing for Critically Ill Patients and is organized into two parts. The first part aims to improve general and specific skills related to Medical-Surgical Nursing in the area of critically ill patients. The second part reports on specialized evidence-based practice: research project. The study's general objective is to evaluate the knowledge/practice of nurses in the prevention of urinary tract infection associated with bladder catheters in critically ill patients, in an intensive care unit in the northern region of São Paulo. The specific objectives were established: to characterize the sociodemographic and professional profile of the sample; to identify the knowledge/practice of the sample regarding the prevention of urinary tract infection associated with bladder catheters in critically ill patients; to analyze the sociodemographic and professional characteristics of nurses significantly associated with the lower frequency of knowledge/practices. An analytical, cross-sectional, quantitative study was chosen, using a questionnaire to nurses working in the intensive care unit of a Local Health Unit in the North of Portugal. The sample consisted of 40 professionals who agreed to participate in the study voluntarily, using a non-probabilistic sampling method, in which a greater predominance was found: in the female sex (82.5%); in the age range between 31 and 45 years (77.5%); in the level of generalist nurses (65%); in the length of service in intensive care of at least 10 years (37.5%); in the rotation of schedules (95%), in training in the area of prevention of IUACV (67.5%) and in knowledge of the standard on prevention of IUACV (100%). The questions “Do you consider alternatives to bladder catheterization?” and “Do you check daily the need to maintain the urinary catheter, removing it as soon as possible?”, the majority of the sample reported that they always do so (respectively, 55.5% and 52.5%). Nurses revealed 100% in the component “procedure for inserting the urinary catheter always uses the aseptic technique” and 90% “procedure for catheterization and connection to the drainage system complies with the aseptic technique”. Specialist nurses in relation to “keeping the VC fixed so as not to allow traction or displacement, preventing catheter movements” show 52.9% and in the parameter “the collection bag is emptied when it reaches 2/3 of its capacity” (70.6%). However, the lowest percentages are related to generalist nurses in the parameter “Do you check daily the need to maintain the urinary catheter, removing it as soon as possible?” (30.4%) and in the parameter “keep the CV fixed so as not to allow traction or displacement, preventing catheter movements” (21.7%). In general, the nurses in the study have knowledge/practices in preventing urinary tract infections associated with bladder catheters in critically ill patients in an intensive care unit. Professional category, training, and participation in projects on infection prevention are statistically associated with knowledge/practices. Specialist nurses with training in the area are associated with higher scores. During the internship, it was possible to develop and consolidate a set of technical, scientific, and relational skills that are fundamental for safe, ethical, and evidence-based clinical practice. One of the areas that required special attention was the prevention of healthcare-associated infections, in particular urinary tract infections associated with bladder catheters, a frequent and potentially serious complication in critically ill patients.
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Enfermeiros Melhoria da qualidade Cateterismo urinário