Práticas seguras para o banho no leito em paciente crítico: elaboração e validação de uma lista de verificação

Abstract

Patient safety must be present in all interventions performed during hospitalization, as one of the goals of care is the recovery of health. In this context, body hygiene in bed, despite being a simple procedure when performed in stable patients, can become complex when it comes to critical patients. Due to the complexity of the critical patient, the nurse must carry out a careful assessment before the team starts the bathing procedure, making sure that the risks can be mitigated. The practice of bed baths in critically ill patients requires rigorous monitoring, in order to avoid adverse events, requiring prior planning and systematic actions. However, this intervention often becomes a technicist execution, which can cause harm to the patient. The lack of standardization of evidence-based procedures is related to the practice of unsafe acts during daily nursing care. Given the above, the aim of this study was to develop and validate a checklist for safe bathing in critically ill patients. This is a methodological study, with a quantitative approach, which was developed in two stages. In Step I, the instrument Checklist for Safe Bathing for Critical Patients was elaborated, followed by apparent and content validation by eleven judges, specialists in the subject, with a PhD degree, with experience in the subject area and the method of the research. Stage II was characterized by the performance of the pre-test and interobserver reliability. The pre-test was carried out with the observation of 10 bed bath procedures in critically ill patients, in order to estimate the collection time and applicability, as well as to assess the adequacy of the elaborated instrument. For the reliability analysis, the interobserver consistency assessment method was used, in which 54 bed bath procedures performed in critically ill patients were observed. The evaluation of the interobserver consistency was performed using the Kappa Coefficient and the Intraclass Correlation Coefficient. In the interobserver analysis, it was observed that most of the instrument items had an almost perfect strength of agreement, above 81%, minimum 72.22% and maximum 100%, demonstrating that the instrument items were understandable and reliable, when applied to the observed context. Kappa coefficient values ranged from moderate to almost perfect (0.462 to 0.962; p<0.001). It was also observed that the reliability of The Critical Patient Safe Bathing Checklist instrument was excellent (ICC=0.962), with a statistically significant correlation (p<0.001). The Critical Patient Safe Bathing Checklist version of the instrument is composed of 41 items divided into 3 parts referring to actions that must be performed before bathing, during bathing, and after bathing. The validated checklist makes it possible to measure adherence to safe practices for bed bathing in critically ill patients and also to assess the care provided to this patient during bathing, supporting interventions aimed at increasing the quality of care provided.