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Simulação clínica como estratégia de ensino da transferência segura do leito para a cadeira de rodas em terapia ocupacional

Tue, 27 May 2025 00:00:00 GMT

Título: Simulação clínica como estratégia de ensino da transferência segura do leito para a cadeira de rodas em terapia ocupacional Abstract: Introduction: Simulation has emerged as an effective educational strategy in the health field, as it helps students develop essential skills for their training. To achieve the expected teaching and learning outcomes, simulation-based experiences require a structured design, and a predefined sequence aligned with the proposed objectives. In the context of the manual transfer of patients from bed to wheelchair, occupational therapy students and professionals need to develop skills related to the management of manipulation and the possible consequences of this procedure. Objective: To evaluate the effect of clinical simulation on teaching and learning for occupational therapy students regarding safe patient transfer from the bed to the wheelchair. Methods: The study was conducted in two stages: Stage 1 was a methodological study for the construction and content validation of the Design for the planning and implementation of Clinical Simulation in the Teaching and Learning of Safe Care in the Transfer of Adult Patients from Bed to Wheelchair, the Knowledge Assessment and the Skills Checklist on the subject. The analysis was based on the Content Validity Index (CVI), considering a CVI ≥ 80% in terms of the pertinence and clarity of the items. The design and evaluations were sent to nurses and occupational therapists who specialize in simulation and/or patient safety in wheelchair transfers. The Stage 2 was a quasi-experimental, before-and-after study was carried out, with the experimental group as its own control, to analyze the performance of knowledge, skills, satisfaction and self-confidence in learning, and the perception of the participants about the simulation design previously validated. The research was conducted with students in the final year of the occupational therapy course at a Brazilian federal university, selected for convenience. Data collection collected from April to May 2024 at a rehabilitation center linked to the same institution. A pre-test was carried out, in which the Knowledge Assessment and Skills Checklist were applied, which were also used in the post-test. After the simulated activity and the debriefing, the participants completed the Student Satisfaction and Self-Confidence in Learning Scale and the Simulation Design Scale in the post-test. Descriptive statistics and the paired Student's t-test were used to analyze the data. Cohen's d was used to calculate the effect size of the intervention. Results: In Stage 1, the simulation design was constructed based on the conceptual components of the International Nursing Association for Clinical Simulation and Learning (INACSL) Healthcare Simulation Standards of Best Practice, on a theoretical-practical protocol for simulated clinical activities and aligned with the principles of Bloom's Taxonomy. The theoretical references for the learning theme, as well as for the knowledge and skills assessments, were based on the theoretical framework related to safe care in the transfer of patients from beds to wheelchairs. Ten experts participated in the content validation, including nurses and occupational therapists. There was a high level of agreement among experts regarding the clarity and relevance of the items, indicating the validity of the instrument. In Stage 2, referring to the experimental study, 32 students participated, the majority of whom were female (87.5%), with a mean age of 24.28 years. The majority had no experience of occupational therapy involving patient transfer maneuvers (78.1%) and had never done simulated clinical activities (62.5%). Simulation was considered a highly important resource for developing clinical skills by 96.9% of the students. There was a statistically significant difference in knowledge (p= 0.007), with a moderate effect size (Cohen's d= 0.50). Regarding transfer skills, a statistically significant effect (p< 0.001) of large size (Cohen's d = 3.61) was observed. The Student Satisfaction and Self-Confidence in Learning Scale presented a total mean of 4.65 (SD = 0.28), with the Satisfaction dimension (4.79; SD= 0.31) presenting a higher mean than the Self-Confidence (4.53; SD= 0.33). The Simulation Design Scale obtained a mean of 4.82 (SD= 0.15), standing out in the dimensions Support (4.96; SD= 0.11) and Objectives and Information (4.91; SD= 0.19). Conclusion: The simulation design demonstrated validity in terms of relevance and clarity, reinforcing its use in research and teaching in occupational therapy, and being an important tool for the implementation of clinical simulation of patient transfer from bed to wheelchair. Clinical simulation proved to be an effective educational strategy for teaching and learning, promoting significant gains in knowledge and skills of bed-to-wheelchair transfers, in addition to increasing the satisfaction and self-confidence of occupational therapy students.; Introducción: La simulación se ha revelado como una estrategia educativa eficaz en el ámbito de la salud, ya que permite a los estudiantes desarrollar competencias esenciales para su formación. Para alcanzar los resultados de enseñanza y aprendizaje esperados, las experiencias basadas en la simulación requieren un planteamiento estructurado y una secuencia bien definida y alineada con los objetivos propuestos. En el contexto de la transferencia manual de pacientes de la cama a la silla de ruedas, los estudiantes y profesionales de terapia ocupacional necesitan desarrollar competencias relacionadas con el manejo de la manipulación y las posibles consecuencias de este procedimiento. Objetivo: Evaluar el efecto de la simulación clínica en la enseñanza y el aprendizaje de los estudiantes universitarios de terapia ocupacional sobre los cuidados seguros al transferir pacientes de la cama a la silla de ruedas. Métodos: El estudio se ha realizado en dos etapas: La Etapa 1 fue tratado un estudio metodológico para la construcción y validación del contenido del Diseño para la planificación e implementación de la Simulación Clínica en la Enseñanza y Aprendizaje de Cuidados Seguros en la Transferencia de Pacientes Adultos de la Cama a la Silla de Ruedas, la Evaluación de Conocimientos y la Lista de Verificación de Habilidades sobre el tema. El diseño y las evaluaciones se enviaron a enfermeros y terapeutas ocupacionales especializados en simulación y/o seguridad del paciente en las transferencias en silla de ruedas. El análisis se basó en el Índice de Validez de Contenido (IVC), considerando IVC ≥ 80% en cuanto a la pertinencia y claridad de los ítems. Em la Etapa 2 se desarrolló un estudio estudio cuasiexperimental, antes y después, con el grupo experimental como control propio, para analizar el rendimiento de los conocimientos, las habilidades, la satisfacción y la autoconfianza en el aprendizaje, así como la percepción de los participantes sobre el diseño de la simulación previamente validado. La investigación se realizó con estudiantes del último año del curso de terapia ocupacional de una universidad federal brasileña, seleccionados por conveniencia. La recolección de datos se realizó entre abril y mayo de 2024 en un centro de rehabilitación vinculado a la misma institución. Se realizó un pre-test, en el que se aplicaron la Evaluación de Conocimientos y la Lista de Verificación de Habilidades, que también se utilizaron en el post-test. Tras la actividad simulada y el debriefing, los participantes completaron la Student Satisfaction and Self-Confidence in Learning Scale y la Simulation Design Scale en el post-test. Para analizar los datos se utilizaron estadísticas descriptivas y la prueba t de Student emparejada. El tamaño del efecto de la intervención se calculó mediante la d de Cohen. Resultados: En la Etapa 1, el diseño de la simulación, se desarrolló en base a los componentes conceptuales de los International Nursing Association for Clinical Simulation and Learning (INACSL) Healthcare Simulation Standards of Best Practice, en un protocolo teórico-práctico para actividades clínicas simuladas y alineado con los principios de la Taxonomía de Bloom. Las referencias teóricas para el tema de aprendizaje, así como para las evaluaciones de conocimientos y habilidades, se basaron en el marco teórico relacionado con los cuidados seguros en el transferir pacientes de la cama a la silla de ruedas. Diez especialistas participaron en la validación del contenido, incluidos enfermeros y terapeutas ocupacionales. Se observó una alta concordancia entre los especialistas en cuanto a la claridad y pertinencia de los ítems, lo que indica la validez del instrumento. En la Etapa 2, referida al estudio experimental, participaron 32 estudiantes, en su mayoría mujeres (87,5%), con una edad media de 24,28 años. La mayoría no tenía experiencia en terapia ocupacional con maniobras de transferencia de pacientes (78,1%) y nunca había participado en actividades clínicas simuladas (62,5%). La simulación fue considerada un recurso muy importante para el aprendizaje de habilidades clínicas por el 96,9% de los estudiantes. Se observó una diferencia estadísticamente significativa en los conocimientos (p= 0,007), con un tamaño del efecto moderado (d de Cohen= 0,50). En cuanto a las habilidades de transferencia, hubo un gran tamaño del efecto estadísticamente significativo (p<0,001) (d de Cohen = 3,61). La Student Satisfaction and Self-Confidence in Learning Scale obtuvo una media total de 4,65 (Desviación Estándar = 0,28), siendo la dimensión Satisfacción (4,79; DE = 0,31) la que obtuvo una media más alta que la dimensión Autoconfianza (4,53; DE = 0,33). La Simulation Design Scale obtuvo una media de 4,82 (DE=0,15), destacando las dimensiones de Apoyo (4,96; DE=0,11) y Objetivos e Información (4,91; DE=0,19). Conclusión: El diseño de simulación demostró validez en términos de relevancia y claridad, reforzando su uso en la investigación y la docencia en terapia ocupacional, siendo una herramienta importante para la implementación de la simulación clínica de transferencia de pacientes de cama a silla de ruedas. La simulación clínica ha demostrado ser una estrategia educativa eficaz para la enseñanza y el aprendizaje, promoviendo ganancias significativas en el conocimiento y las habilidades de transferencias de la cama a la silla de ruedas, además de aumentar la satisfacción y la autoconfianza de los estudiantes de terapia ocupacional. Tipo: Tese

Efeitos da estimulação elétrica nervosa transcutânea de baixa e alta frequência em pacientes com dor oncológica sob cuidados paliativos que fazem uso crônico de morfina: ensaio clínico randomizado

Thu, 27 Feb 2025 00:00:00 GMT

Título: Efeitos da estimulação elétrica nervosa transcutânea de baixa e alta frequência em pacientes com dor oncológica sob cuidados paliativos que fazem uso crônico de morfina: ensaio clínico randomizado Abstract: Introduction: The treatment of cancer patients aims not only to reduce tumors but also to improve their quality of life, both during treatment and for individuals in Palliative Care (PC). One of the most common symptoms in individuals with cancer is cancer pain, which is present in 50% to 70% of patients at the beginning of treatment and in up to 90% of those in advanced stages, directly impacting their quality of life. Given its subjective and multifaceted nature, cancer pain is the result of physical, cognitive, psychological and social aspects, making its assessment complex and its control and treatment challenging. Electrotherapy, through Transcutaneous Electrical Nerve Stimulation (TENS), is a non-invasive, simple, safe and low-cost physiotherapeutic resource that is highly effective in reducing pain and analgesic consumption. Objective: evaluate the effect of high-frequency and low-frequency TENS in controlling cancer pain in PC patients using morphine specifically. Methodology: This is a planned clinical trial, which involves data collection at four moments: pre-intervention, immediately after, one hour after and 24 hours after intervention. Participants were divided into two groups: GALTA, which received high-frequency TENS and GBAIXA, which received low-frequency TENS. Results: A total of 43 participants were included in the study, 21 from the high-frequency TENS group and 22 from the low-frequency TENS groupThe results showed a prevalence of females, with a mean age of 51 years. Regarding pain intensity scores, it was observed that GALTA presented lower pain intensities when compared to GBAIXA. Regarding the Brief Pain Inventory domains, both GALTA and Gbaixa presented statistical significance in the domain of pain intensity at the precise moment of assessment and in the pain relief domain, while in the pain impact domain, GALTA presented significance in the items relationship with other people, sleep and pleasure of living. While GBAIXA presented significance only in the item relationship with other people. The morphine dosage was quantified before and after 24 hours of the intervention in both groups, and it was observed that the patients who presented a reduction in the morphine dosage were in GALTA. Regarding the analysis of the prescription of adjuvant medications, it was observed the maintenance, addition or withdrawal of the prescribed medications, before and after the intervention and no evidence was observed of an association between these two variables. Similarly, the analysis of the number of morphine rescues/day in the pre- and post-intervention periods showed no significant difference in either group. Conclusion: Thus, TENS proved to be effective both for controlling pain intensity and for improving the perception of pain interference in its various aspects, highlighting the clear superiority of high-frequency TENS for patients on chronic morphine use. Tipo: Tese

Empreendedorismo na Enfermagem obstétrica brasileira: um estudo na perspectiva da representação social

Fri, 12 Apr 2024 00:00:00 GMT

Título: Empreendedorismo na Enfermagem obstétrica brasileira: um estudo na perspectiva da representação social Abstract: Entrepreneurship, understood as the ability to conceive, coordinate, and carry out innovative projects, is an interdisciplinary field that has been studied for centuries. In the context of Brazilian obstetric nursing, it manifests itself as an instrument of both transformation and innovation, enabling the development of distinctive management practices and the creation of services that meet the needs of women and families during the pregnancy and postpartum cycle. In conjunction with this phenomenon, Serge Moscovici's Theory of Social Representations offers a theoretical framework for understanding how collective meanings and knowledge shape perceptions, attitudes, and behaviors regarding entrepreneurship in this professional field. The study aimed to analyze social representations of entrepreneurship in the context of Brazilian obstetric nursing. Exploratory in nature and qualitative in approach, Oral History was used as the research method. The research was conducted at the Federal University of Triângulo Mineiro (UFTM), in Uberaba-MG, between August and October 2023. Ten obstetric nurses from the five regions of the country participated, selected by non-probabilistic snowball sampling. The online interviews were guided by a script validated by experts and analyzed using Bardin's Content Analysis technique, complemented by automated textual analysis by IRAMUTEQ®. The participants were between 26 and 50 years old and had experience in obstetric nursing ranging from two to 22 years. Data analysis revealed five central categories: motivations for entrepreneurship, advantages, challenges faced, influence of academic training, and future prospects. The main motivations for entrepreneurship were related to the desire to balance motherhood and career, the search for professional autonomy, dissatisfaction with the traditional model of obstetric care, and the desire for innovation. The advantages highlighted included increased job satisfaction, financial gains, recognition, independence, and work-life balance. Challenges included the difficulty of balancing personal and professional life, legal bureaucracy, facing prejudice, the complexity of managing one's own business, and financial insecurity. Regarding their academic background, participants reported a lack of entrepreneurship-focused content in nursing curricula. Learning about management and business was informal and self-taught, through personal experiences and guidance from close associates. Regarding future prospects, the obstetric nurses demonstrated a desire to continue training, expand their businesses, achieve greater professional recognition, and strengthen the debate on entrepreneurship in healthcare. They also expressed interest in occupying leadership positions and contributing to the transformation of obstetric care through education. The analysis revealed differences between the results obtained manually and those generated by IRAMUTEQ®, attributed to the subjectivity of the human analysis and the statistical precision of the software. However, the integration of both provided a broader understanding of the phenomenon. It can be concluded that entrepreneurship in obstetric nursing is a complex process, fraught with challenges, but also a promising field for innovation and professional transformation. It represents a new paradigm in healthcare, reaffirming the potential of entrepreneurship as a driving force for the advancement and recognition of these professionals in the context of women's healthcare in Brazil. Tipo: Tese

Construção e validação de um instrumento que avalia a percepção da imagem corporal em pacientes com câncer de pele

Tue, 30 Apr 2024 00:00:00 GMT

Título: Construção e validação de um instrumento que avalia a percepção da imagem corporal em pacientes com câncer de pele Abstract: Introduction: Physical appearance influences almost all aspects of human life, influencing the way people are evaluated and treated by others. Therefore, the use of validated tools can help understand the perception of body image of people with skin cancer. Currently, there is a shortage and/or nonexistence of publications on body image and self-image related to skin cancer. Thus, research on the perception of body image and self-image needs to be expanded to different types of cancer. It is known that non-melanoma skin cancer is the most common type of cancer worldwide and in Brazil, and that malignant melanoma, despite being less incident, is the most aggressive and lethal type of skin cancer. Objective: to build and validate an instrument that assesses the perception of body image and self-esteem of patients with skin cancer. Methodology: Methodological study that sought to develop the conceptual framework of CI, structure the semantics that make up the perception of CI of people affected by skin cancer for the development of the construct. This research was developed in five stages: conceptual definition of body image (Stage I); development of the instrument (Stage II); definition of items in categories and dimensions of the instrument (Stage III); apparent and content validation (Stage IV); semantic evaluation of the instrument (Stage V). The analysis of the judges' responses followed the following criteria: simplicity, clarity, objectivity, simplicity, precision, credibility, variety, and relevance. The study was carried out with 22 participants diagnosed with skin cancer, who were undergoing treatment at a hospital in Minas Gerais, in the time axis between January 2023 and November 2023. The data obtained in the study were entered and organized in the Microsoft® Office Excel® 2007 program with double entry, followed by verification to confirm consistency and consolidation followed by statistical analyses in the Statistical Package for Social Sciences version 22.0 program. Results: Through a narrative review of the literature, the conceptual framework that was used in the study was found through the selected articles; The body image perception scale for people with skin cancer was constructed, containing 12 questions with subsequent analysis by seven judges and content validation; the distribution of the judges' responses was organized, who evaluated the construction of the instrument, with the final preparation of the instrument containing 11 questions with four answer options for each question. Regarding the clinical and work profile data in relative frequency, with a predominance of males (63.3%), elderly (81.1%) and fair skin (100%), higher incidence of basal cell carcinoma (63.6%), high prevalence of chronic disease and drug treatment in addition to cancer in the sample (63.3%), and high professional performance in the agricultural sector (68.2%); the instrument that assesses the perception of body image in patients with skin cancer was applied to 22 participants with a predominance of changes in the perception of body image in the general appearance and psychological domains. In the semantic evaluation, no participant had difficulty understanding the questions. Conclusion: It was concluded that it was possible to develop and validate an instrument that assesses the perception of body image in people with skin cancer.; Introducción: La apariencia física influye en casi todos los aspectos de la vida humana, influyendo en la forma en que las personas son evaluadas y tratadas por los demás. Por tanto, el uso de herramientas validadas puede ayudar a comprender la percepción de la imagen corporal de las personas con cáncer de piel. Actualmente existe escasez y/o inexistencia de publicaciones sobre imagen corporal y autoimagen relacionadas con el cáncer de piel. Por tanto, es necesario ampliar la investigación sobre la percepción de la imagen corporal y la autoimagen a los diferentes tipos de cáncer. Se sabe que el cáncer de piel no melanoma es el tipo de cáncer más común en el mundo y en Brasil y que el melanoma maligno, a pesar de ser menos común, es el tipo de cáncer de piel más agresivo y letal. Objetivo: construir y validar un instrumento que evalúa la percepción de la imagen corporal y la autoestima de pacientes con cáncer de piel. Metodología: Estudio metodológico que buscó desarrollar el marco conceptual del CI, estructurar la semántica que compone la percepción del CI en personas afectadas por cáncer de piel para desarrollar el constructo. Esta investigación se desarrolló en cinco etapas: definición conceptual de imagen corporal (Etapa I); la elaboración del instrumento (Etapa II); definición de ítems en categorías y dimensiones del instrumento (Paso III); validación facial y de contenido (Etapa IV); Evaluación semántica del instrumento (Etapa V). El análisis de las respuestas de los jueces siguió los criterios: sencillez, claridad, objetividad, sencillez, precisión, credibilidad, variedad, relevancia. El estudio fue realizado con 22 participantes diagnosticados con cáncer de piel, que estaban en tratamiento en un hospital de Minas Gerais, en el eje temporal entre enero de 2023 y noviembre de 2023. Los datos obtenidos en el estudio fueron ingresados y organizados en el programa Microsoft® Office Excel® 2007 con doble entrada, seguido de verificación para confirmar consistencia y consolidación seguido de análisis estadísticos en el Paquete Estadístico para Ciencias Sociales versión 22.0. Resultados: A través de una revisión narrativa de la literatura se encontró a través de los artículos seleccionados el marco conceptual que se utilizó en el estudio; se construyó la escala de percepción de la imagen corporal en personas con cáncer de piel, que contiene 12 preguntas con posterior análisis por parte de los siete jueces y validación de contenido; Se organizó la distribución de las respuestas de los jueces, quienes evaluaron la construcción del instrumento, siendo la creación final del instrumento conteniendo 11 preguntas con cuatro opciones de respuesta para cada pregunta. En cuanto a los datos del perfil clínico y laboral en frecuencia relativa con predominio de personas del sexo masculino en la muestra (63,3%), personas de edad avanzada (81,1%) y de piel clara (100%), mayor incidencia de carcinoma basocelular (63,6%), alta prevalencia de enfermedades crónicas y tratamientos farmacológicos además del cáncer en la muestra (63,3%), alta actividad profesional en el sector agrícola (68,2%); El instrumento que evalúa la percepción de la imagen corporal en pacientes con cáncer de piel se aplicó a 22 participantes con predominio de cambios en la percepción de la imagen corporal en los dominios apariencia general y psicológico. En la evaluación semántica ningún participante tuvo dificultades para comprender las preguntas. Conclusión: Se concluye que fue posible desarrollar y validar un instrumento que evalúa la percepción de la imagen corporal en personas con cáncer de piel. Tipo: Tese