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Resumo Objetivo Avaliar o desempenho do Escore Pediátrico de Alerta (EPA) no rastreio de casos de sepse em um contexto hospitalar. Métodos Estudo de teste diagnóstico guiado pelas recomendações do Standards for the Reporting of Diagnostic Accuracy Studies (STARD). A amostra foi de 190 crianças e adolescentes internados em um hospital do interior da Bahia, Brasil. A coleta foi realizada em banco de dados de um projeto guarda-chuva, em prontuários e sistema de registros do hospital. O processamento e análise foram realizados no SPSS® version 25.0 for Windows e MedCalc® version 20.00. O desempenho do EPA no rastreio da sepse quando comparado aos critérios do padrão de referência foi mensurado através da Sensibilidade, Especificidade, Valores Preditivos e curva ROC. Resultados Dentre os participantes, 53,2% eram do sexo masculino, com média da idade de 4,39 anos (DP: 4,28) e mediana 3 anos (IIQ: 1 – 8). A prevalência da sepse identificada pelo padrão de referência foi de 10% e pelo EPA 23.1%. A sensibilidade, especificidade e valores preditivos positivo e negativo do EPA no rastreio de sepse foram de 73,7%, 82,5%, 31,8% e 96,6%, respectivamente. A área sob a curva ROC foi de 0,794. Conclusão O estudo apresenta evidências sobre o desempenho do EPA no rastreio da sepse, demonstrando boa acurácia na discriminação de pacientes pediátricos com e sem sepse na amostra estudada.

ABSTRACT Objective: To construct and validate an instrument to assess events related to maintaining the sterility of processed healthcare products. Methods: This methodological study developed the instrument through analysis by a panel of experts, focusing on the integrity of commonly used packaging: spunbond-meltblown-spunbond and medical-grade paper. The instrument was analyzed using the Content Validity Index and Content Validity Ratio (≥ 0.80) and modified Kappa (≥ 0.74). The instrument underwent pre-testing. Results: Six experienced professionals participated in the expert panel. After two rounds, the final version of the instrument contained five dimensions. In the pre-test, 30 nursing professionals participated, of whom 86.67% considered the instrument good, and 90% found it understandable. Conclusion: The construction and validation followed literature recommendations. The instrument is available, aiding in the safe use of processed healthcare products.

ABSTRACT Objectives: to develop and validate an instrument for the classification of pregnant and postpartum women according to the demand for nursing care. Methods: a methodological study conducted in three stages: 1) construction of the instrument based on literature review; 2) content validation using the Delphi technique with 12 experts; and 3) Evaluation of the convergent construct validity through the correlation between the scores of the constructed instrument and the Fugulin instrument. Results: an instrument with ten indicators of specific care for pregnant and postpartum women was developed. A content validity index higher than 0.9 was obtained, requiring only one round of the Delphi technique. The Spearman coefficient was 0.64 between the instruments, indicating a strong correlation. Conclusions: the classification instrument specifically constructed for pregnant and postpartum women showed evidence of content validity and convergent construct validity with a widely used instrument in the national territory.

Objective: to evaluate the Nursing workload and its related factors in the assistance provided to hospitalized women with gynecological and breast cancers, according to the Nursing Activities Scores adapted for cancer patients. Method: a cross-sectional and epidemiological study. The participants were women with gynecological and/or breast cancer, over 18 years of age, and hospitalized for a minimum period of 24 hours. The following was collected from the medical records: sociodemographic and clinical data, Karnofsky Performance Status and workload, according to the adapted Nursing Activities Score. The factors related to workload were analyzed by means of multiple linear regression. Results: the mean Nursing Activities Scores was 29.3%, denoting seven hours of daily care per patient. The factors related to workload differed according to the breast or gynecological cancer diagnosis (β=-0.01; p

ABSTRACT Objective: To build and validate the content of an instrument to conduct medical record audits; to conduct a pre-test. Methods: Methodological study conducted from May/2020 to May/2021 in three stages: 1) development of the instrument by bibliographic survey and benchmarking; 2) content validation using the Delphi technique; 3) application of the instrument and descriptive analysis in a sample of 200 medical records. Results: An instrument was constructed with 11 domains containing sub-items that characterize the quality of care. Two stages of the Delphi technique were necessary to reach a content validity index higher than 0.90. For each domain, a graduated scale with a numerical value from 1 to 4 points was attributed, reflecting the quality of its completion. The average time of application was 35 minutes per record. Conclusions: The tool proved to be viable to support clinical audits to identify the level of excellence and reveal opportunities for improvement in care processes.

ABSTRACT Objectives: to adapt and validate an instrument for classifying adult patients that emphasizes the family support network in the demand for nursing care. Methods: methodological study, carried out in three phases: adaptation of an instrument considering the reality of adult patients; content validation with seven experts and assessment of measurement properties (construct validity and internal consistency) with 781 hospitalized patients. Results: in content validation, the indicators reached the values established for the Content Validity Index (0.85-1.00). In the confirmatory factor analysis, the 11 indicators were distributed in three domains and presented average variance extracted and factor loading greater than 0.5. Composite reliability was greater than 0.7. Conclusions: the present study adapted and made available, with evidence of validity and reliability, an instrument for classifying adult patients that considers the family support network in the demand for nursing care.

Objetivo: avaliar a carga de trabalho de enfermagem em uma unidade de internação neonatal e correlacionar com características clínicas dos pacientes. Método: estudo descritivo e transversal, com o Nursing Activities Score em uma unidade neonatal de hospital público de ensino. Foram incluídos pacientes hospitalizados por no mínimo 24 horas, no período de 60 dias. Os dados foram analisados segundo estatística descritiva e inferencial. Resultados: a amostra foi composta por 115 pacientes, com total de 1944 medidas. A média do Nursing Activities Score foi de 73%, obtendo-se média de 74% em leitos de cuidados intensivos e 64% em cuidados semi-intensivos. Conclusão: identificou-se uma alta carga de trabalho, com média de 17,5 horas de assistência a cada recém-nascido nas 24 horas, o que pode ter impacto na segurança da assistência. Peso de nascimento e idade gestacional podem representar incremento à carga de trabalho dos profissionais. ABSTRACT Objective: to evaluate the nursing workload at a neonatal unit and to correlate it to patient clinical characteristics. Method: this descriptive, cross-sectional study applied the Nursing Activities Score to assess nursing workload at a neonatal unit of a public teaching hospital. Patients included were those hospitalized for at least 24 hours over 60-day period. Data were analyzed using descriptive and inferential statistics. Results: the sample comprised 115 patients, yielding a total of 1944 measurements. The average Nursing Activities Score at the unit was 73%, an average of 74% for intensive care beds and 64% for semi-intensive ones. Conclusion: high workload was identified at the unit, averaging 17.5 hours of care every 24 hours for each newborn, which can impact the safety of care. Birth weight and gestational age may entail increased workload for nursing staff. RESUMEN Objetivo: evaluar la carga de trabajo de enfermería en una unidad de hospitalización neonatal y relacionarla con las características clínicas de los pacientes. Método: se trata de un estudio descriptivo y transversal, utilizando el Nursing Activities Score en una unidad neonatal, en un hospital universitario público. Se incluyeron pacientes hospitalizados durante al menos 24 horas, dentro del período de 60 días. Se analizaron los datos según estadística descriptiva e inferencial. Resultados: la muestra se compuso de 115 pacientes, totalizando 1944 mediciones. El puntaje promedio del Nursing Activities Score fue del 73%, siendo el promedio para la unidad de cuidados intensivos del 74% y para los cuidados semi intensivos del 64%. Conclusión: se identificó una alta carga de trabajo en la unidad, con un promedio de 17.5 horas de atención a cada neonato en 24 horas, lo que puede impactar la seguridad de la atención. El peso al nacer y la edad gestacional pueden representar un aumento en la carga de trabajo de los profesionales.

Objective: to compare the workload at a neonatal unit, according to Nursing Activities Score, and the dimensioning of nursing staff. Methods: cross-sectional study at a teaching unit with 30 beds. Data collection took place from October 6 to December 6, 2017, and data were analyzed according to descriptive statistics. Results: the sample of 115 neonates, totaling 1944 measurements. The average workload score was 73%. The unit has 107 nursing professionals, while should has 137. The proportion of registered nurses was lower than recommended (34%), whereas the proportion of nursing technicians was higher than recommended (66%). Conclusion: there was an imbalance between workload and number of professionals in nursing staff. Tools as Nursing Activities Score should be applied for supporting the staff dimensioning, since workload can impact the health outcomes and patient safety.

Objective: to compare the workload at a neonatal unit, according to Nursing Activities Score, and the dimensioning of nursing staff. Methods: cross-sectional study at a teaching unit with 30 beds. Data collection took place from October 6 to December 6, 2017, and data were analyzed according to descriptive statistics. Results: the sample of 115 neonates, totaling 1944 measurements. The average workload score was 73%. The unit has 107 nursing professionals, while should has 137. The proportion of registered nurses was lower than recommended (34%), whereas the proportion of nursing technicians was higher than recommended (66%). Conclusion: there was an imbalance between workload and number of professionals in nursing staff. Tools as Nursing Activities Score should be applied for supporting the staff dimensioning, since workload can impact the health outcomes and patient safety.

ABSTRACT Objective: To adapt and validate a patient classification instrument for neonatal units. Method: Methodological study, with adaptation of the Pediatric Patients Classification Instrument for neonatal patients. After content validation by judges, the instrument was tested for reliability, applied to 33 neonates by two nurses, simultaneously. To assess the agreement among nurses regarding the scores of each patient on the classification scale, an intraclass agreement coefficient was applied. To assess the agreement regarding the classification in care categories, the weighted Kappa coefficient was calculated. Results: The adapted instrument consisted of a total of nine indicators, with three care categories: high dependence on care, semi-intensive care and intensive care. The Content Validity Index varied between 0.85 and 0.92 for items of the instrument. The intraclass agreement was 0.87 and the weighted Kappa for care categories was 0.56. Conclusion: An instrument that allows neonatal patients to be classified into care categories, with satisfactory reliability was validated to support the dimensioning of the nursing team.

ABSTRACT Objective: To assess whether there are differences in psychological empowerment between different health professionals working in a teaching hospital. Method: A comparative, quantitative, and cross-sectional study carried out with 165 professionals selected at random and who worked in a teaching hospital in the inland of the state of São Paulo. The participants were divided into three groups: 1) nurses, 2) physicians, and 3) other professionals (physiotherapists, psychologists, pharmacists, speech therapists, social workers, and nutritionists). For data collection, a form was used to characterize the sample, as well as the Brazilian version of the Psychological Empowerment Instrument. To compare the scores between the three groups, the Kruskal-Wallis test was used, followed by Dunn' post-test. Results: Nurses, physicians, and other professionals scored 71.4; 69.3, and 71.1 points (p=0.5959), respectively, in the total score of the instrument Conclusion: There are no statistically significant differences in the perception of psychological empowerment of different health professionals. Conclusion: There are no statistically significant differences in the perception of psychological empowerment of different health professionals.

ABSTRACT Objectives: to construct and validate an instrument for the classification of mother-baby binomials that subsidizes personnel Staffing in in-rooming units. Method: methodological study. The construction was based on theoretical and legal references. Content validity was performed by experts through the content validity index measurement. Then, the instrument was applied to a sample of 122 binomials, and exploratory factor analysis was performed using the principal components analysis. Results: the instrument consisted of seven care indicators: Birth route; Maternal morbidity; Neonatal morbidity; Breastfeeding; Social aggravating factors; Care guidance; and interaction and bonding. All with content validity index of 1. The construct was composed of 3 domains, with Cronbach’s alpha of 0.62, 0.85 and 0.89. Conclusions: the classification instrument of mother-baby binomials allows the classification of mother-baby binomials and may support personnel Staffing in in-rooming units.

Objetivo: atualizar o conhecimento sobre a manutenção da permeabilidade dos Dispositivos de Acesso Vascular Central (DAVC) em paciente com câncer. Conteúdo: os pacientes que fazem uso de quimioterápicos muitas vezes necessitam de DAVC seguros e de longa permanência; a obstrução ocorre em 36% dos pacientes com DAVC inseridos no período de 2 anos, que pode ser classificada como mecânica, por precipitação de medicamento/minerais e pela formação de coágulos. A equipe de enfermagem é responsável por realizar os cuidados para manter a permeabilidade desses dispositivos através do Flushing e Locking. O uso de heparina demonstrou baixa evidência quando comparado ao Soro Fisiológico (SF), em relação a diminuição da obstrução. Conclusão: o uso de SF na manutenção dos DAVC mostra-se seguro, eficaz e com menor custo financeiro. ABSTRACT Objective: to update the knowledge on the maintenance of permeability of Central Vascular Access Devices (CVAD) in cancer patients. Content: Patients on chemotherapy often require safe, long-term CKD. Obstruction occurs in 36% of patients with CVAD inserted in a 2-year period, which can be classified as mechanical due to drug / mineral precipitation and clot formation. The nursing staff is responsible for taking care to maintain the permeability of these devices through Flushing and Locking. The use of heparin showed low evidence when compared to saline (SF), regarding the reduction of obstruction. Conclusion: the use of DES to maintain CVAD is safe, effective and has a lower financial cost. RESUMEN Objetivo: actualizar los conocimientos sobre el mantenimiento de la permeabilidad del dispositivo de acceso vascular central (DAVC) en pacientes con cáncer. Contenido: los pacientes que usan quimioterápicos a menudo necesitan DAVC seguros y de larga permanência. La obstrucción ocurre en el 36% de los pacientes con DAVC insertados en el período de 2 años y puede ocorir por precipitación de medicamento / minerales y por la formación de coágulos. El equipo de enfermería es responsable de realizar los cuidados para mantener la permeabilidad de estos dispositivos a través del Flushing y Locking. El uso de heparina demostró una baja evidencia en comparación con el Suero Fisiológico (SF), en relación con la disminución de la obstrucción. Conclusión: el uso de SF en el mantenimiento de los DAVC se muestra seguros, eficaz y con menor costo financiero.

Enquadramento: O quotidiano familiar de uma criança com doença crónica é modificado decorrente das exigências recorrentes da doença. Os irmãos destas crianças podem receber menos atenção, tanto dos pais, quanto da restante família, que podem interessar-se mais pela criança doente e não da mesma forma pelo irmão considerado saudável. Objetivos: Compilar perceções de irmãos de crianças hospitalizadas por doença crónica. Metodologia: Participaram do estudo irmãos de crianças diagnosticadas com doenças crónicas, com idades entre os 8 e os 16 anos. Utilizaram-se entrevistas abertas, que foram gravadas, transcritas e submetidas à análise. Resultados: Apenas 4 irmãos puderam ser entrevistados. Na análise das entrevistas, emergiram 4 categorias de resultados (Enfrentamento da doença do irmão; Reestruturação familiar, Experiências a partir da hospitalização do irmão, e Experiências de exclusão). Conclusão: Os irmãos das crianças com doenças crónicas estão em situação de vulnerabilidade e exclusão, demonstram dificuldades em lidar com as suas perceções e sentimentos, o que mostra a importância de integrar o irmão no processo de enfermagem.

RESUMO Objetivo Avaliar a percepção da equipe de enfermagem frente ao clima de segurança que permeia a assistência entre profissionais de instituições públicas e privadas. Método Estudo quantitativo, transversal, desenvolvido com 235 profissionais de enfermagem de um hospital privado e um público, da região de Campinas, entre outubro de 2014 e outubro de 2015. Para a coleta foi utilizado o Questionário Atitudes de Segurança – Short Form. Na análise, foram utilizadas estatísticas descritivas e inferenciais, com realização do teste de Mann Whitney, para comparar as instituições. Resultados A instituição privada apresentou médias superiores às da pública, com diferenças significantes nos domínios clima de segurança (p=0,00), gestão da unidade (p

Objective Improve the content validity of the instrument for classification of pediatric patients and evaluate its construct validity. Method A descriptive exploratory study in the measurement of the content validity index, and correlational design for construct validation through exploratory factor analysis. Results The content validity index for indicators was 0.99 and it was 0.97 for graded situations. Three domains were extracted in the construct validation, namely: patient, family and therapeutic procedures, with 74.97% of explained variance. The instrument showed evidences of content and construct validity. Conclusion The validation of the instrument occurred under the approach of family-centered care, and allowed incorporating some essential needs of childhood such as playing, interaction and affection in the content of the instrument.

OBJECTIVES: to assess the construct validity and reliability of the Pediatric Patient Classification Instrument.METHODS: correlation study developed at a teaching hospital. The classification involved 227 patients, using the pediatric patient classification instrument. The construct validity was assessed through the factor analysis approach and reliability through internal consistency.RESULTS: the Exploratory Factor Analysis identified three constructs with 67.5% of variance explanation and, in the reliability assessment, the following Cronbach's alpha coefficients were found: 0.92 for the instrument as a whole; 0.88 for the Patient domain; 0.81 for the Family domain; 0.44 for the Therapeutic procedures domain.CONCLUSIONS: the instrument evidenced its construct validity and reliability, and these analyses indicate the feasibility of the instrument. The validation of the Pediatric Patient Classification Instrument still represents a challenge, due to its relevance for a closer look at pediatric nursing care and management. Further research should be considered to explore its dimensionality and content validity.

A classificação de pacientes é essencial para o gerenciamento de uma unidade. Entretanto, a literatura não dispõe de conceituações de categorias de pacientes pediátricos. Os objetivos deste estudo foram definir e validar categorias de cuidado de pacientes pediátricos, de acordo com o grau de dependência da equipe de enfermagem. Utilizou-se revisão bibliográfica para definição das categorias de cuidado e a validação de conteúdo das categorias propostas foi realizada por um grupo de juízes envolvidos em assistência e gerência de unidades pediátricas e por juízes envolvidos em ensino e pesquisa de pediatria e construção de instrumentos de classificação de pacientes. Foram estabelecidas e validadas cinco categorias de cuidados: Mínimos, Intermediários, Alta dependência, Semi-intensivo e Intensivo. A validação das categorias de cuidado subsidiou a construção de um sistema de classificação de pacientes pediátricos que poderá contribuir para o processo de tomada de decisão do enfermeiro na prática gerencial e assistencial.

Objective: to identify the risk and prevalence of falls in the last year in chronic renal failure patients on hemodialysis; to associate the risk of falls with the fear of falling and socio-demographic-clinical variables. Method: association study. 131 individuals participated in the study. The Morse Falls Scale, the Fall Efficacy Scale and the Tilburg Frailty Indicator were used. The data were analyzed by linear regression, the level of significance adopted was 0.05. Results: 97.7% were at risk for falls and 37.4% had at least one fall per year, with a mean of 2.02. Extreme concern about falling was presented by women, patients with less education, amputees, and frail individuals. Diabetes, as a comorbidity, and people with difficulty or need for assistance for ambulance showed a significant increase in the occurrence of falls. Conclusion: high risk and high prevalence of falls were found in hemodialysis patients, greater in those with diabetes or mobility limitations. Fear of falling was identified especially in women and in people with less education. These findings challenge the role of preventing falls, both in hemodialysis sessions and in the adoption of strategies for activities of daily living that involve patients and their families.