Browsing by Author "Machado, Paulo Alexandre Puga"
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- Analyses of pressure ulcer incidence in inpatient setting in a Portuguese hospitalPublication . Sardo, Pedro Miguel Garcez; Simões, Cláudia Sofia Oliveira; Alvarelhão, José Joaquim Marques; Simões, João Filipe Fernandes Lindo; Machado, Paulo Alexandre Puga; Amado, Francisco Manuel Lemos; Amaro, António José Monteiro; Melo, Elsa Maria Oliveira Pinheiro deAim: To gain more insight into the magnitude of the problem of pressure ulcer incidence in general wards of a Portuguese hospital. Material and methods: Retrospective cohort analysis of electronic health record database from 7132 adult patients admitted to medical and surgical wards of Aveiro Hospital during 2012. The development of (at least) one pressure ulcer during the length of stay was associated with age, gender, type of admission, specialty units, first Braden Scale score, length of stay, patient discharge outcome and ICD-9 diagnosis. Results: An incidence of 3.4% participants with pressure ulcer category I-IV in inpatient setting during 2012. During the length of stay, 320 new pressure ulcers were developed, most of them category/stage II. The sacrum/coccyx and the trochanters were the most problematic areas. Conclusions: The major risk factor for the development of a new pressure ulcer during the length of stay was the presence of (at least) one pressure ulcer at the first skin assessment. The length of stay itself, age and lower Braden Scale scores of our participants also played an important role in the odds of developing a pressure ulcer. Infectious diseases, traumatism and fractures and respiratory diseases were the ICD-9 diagnoses with higher frequency of participants that developed (at least) one pressure ulcer during the length of stay. It's important to standardize procedures and documentation in all care settings. The documentation of nursing interventions is vital to evaluate the impact of evidence-based nursing.
- Atividades de vida diária como preditores do estado cognitivo em idosos institucionalizadosPublication . Imaginário, Cristina; Machado, Paulo Alexandre Puga; Rocha, Magda; Antunes, Cristina; Martins, TeresaCONTEXTO: Partimos do pressuposto que a preservação do desempenho das atividades básicas e instrumentais de vida diária em idosos institucionalizados contribui para a potenciação e conservação da função cognitiva. OBJETIVOS: Avaliar se a capacidade funcional para as atividades de vida diária prediz a função cognitiva dos idosos institucionalizados em Equipamentos Residenciais. MÉTODOS: Estudo transversal correlacional preditivo, com recurso a amostra aleatória simples constituída por 475 sujeitos. Instrumentos: Mini-Mental State Examination (Guerreiro et al., 1994); Índice de Barthel (Araújo, Ribeiro, Oliveira e Pinto, 2007) e Escala de Lawton & Brody (Araújo, Ribeiro, Oliveira, Pinto e Martins, 2008). RESULTADOS: Os idosos que residem nas instituições residenciais são maioritariamente do género feminino, com idades compreendidas entre 65 e 104 anos (M = 83,94, DP = 7,21), na maioria viúvos e analfabetos. O modelo de regressão múltipla sugere que as atividades básicas e instrumentais de vida diária explicam cerca de 49% da variância existente do estado mental dos idosos. Verificou-se que as atividades instrumentais de vida diária correspondem ao preditor com maior peso, embora a contribuição das atividades básicas de vida diária seja também, estatisticamente, significativa para o modelo. CONCLUSÕES: O modelo sugere que a manutenção da execução das atividades de vida diária beneficia o estado cognitivo nestes utentes. Através de intervenções de estimulação motora e social, os idosos poderão preservar a sua autonomia na realização de atividades de vida diária, que por sua vez potenciam uma maior saúde mental, melhor bem-estar e maior autoestima.
- Avaliação da dependência no autocuidado: estudo exploratório do fenómeno em contexto comunitárioPublication . Pereira, Soraia; Martins, Teresa; Machado, Paulo Alexandre PugaThe assessment of the dependent person’s self-care ability, through measurement instruments, and the assessment of the level and kind of dependency, may provide nurses a more assertive method for understand the nature of the problems that affect dependency and for establish an action plan tailored to the development of new practices centered on the dependent person, looking forward to promote autonomy. Within this context, and in order to develop nursing practice in self-care dependency context, this paper serves the goal of the characterization of dependent people in self-care in a community context and the analysis of the different domains of self-care according to sociodemographic and clinical variables. It was used the non-probabilistic sampling method, of the accidental type and for data collection was used the reduced version of the Self-Care Dependency Assessment Form. The results found show that women and the elderly are more dependent, and that the dependence settles mainly gradually. Regarding the level of dependence by self-care domain, the one that registered the highest level of dependence was self-care “taking medication”, followed by “dressing and undressing” and self-care “taking a bath”. The “global level of dependence” has an average of 2.64 and a standard deviation of 0.83, which reveals high degrees of dependence on self-care. With current demographic changes and consequent health needs and their implications for health policy preparation and planning, the measurement and evaluation of the dependent person and their caregiver is becoming increasingly essential, enabling a holistic and adjusted approach.
- Clinical Virtual Simulation in Nursing Education: Randomized Controlled TrialPublication . Padilha, José Miguel Santos Castro; Machado, Paulo Alexandre Puga; Ribeiro, Ana; Ramos, José; Costa, PatrícioIn the field of health care, knowledge and clinical reasoning are key with regard to quality and confidence in decision making. The development of knowledge and clinical reasoning is influenced not only by students' intrinsic factors but also by extrinsic factors such as satisfaction with taught content, pedagogic resources and pedagogic methods, and the nature of the objectives and challenges proposed. Nowadays, professors play the role of learning facilitators rather than simple "lecturers" and face students as active learners who are capable of attributing individual meanings to their personal goals, challenges, and experiences to build their own knowledge over time. Innovations in health simulation technologies have led to clinical virtual simulation. Clinical virtual simulation is the recreation of reality depicted on a computer screen and involves real people operating simulated systems. It is a type of simulation that places people in a central role through their exercising of motor control skills, decision skills, and communication skills using virtual patients in a variety of clinical settings. Clinical virtual simulation can provide a pedagogical strategy and can act as a facilitator of knowledge retention, clinical reasoning, improved satisfaction with learning, and finally, improved self-efficacy. However, little is known about its effectiveness with regard to satisfaction, self-efficacy, knowledge retention, and clinical reasoning.
- El cuidado de familiares adultos: ¿Cómo afecta a la salud y al bienestar del cuidador familiar?Publication . Araújo, F.; Peixoto, Maria José; Martins, Teresa; Lumini Landeiro, Maria José; Pinto Martins Salazar Almeida, Berta Maria; Machado, Paulo Alexandre Puga; Freire, R.M.A.Introducción. El cuidado de un miembrode la familia con dependencia para los cuidados personales es un procesocomplejo que afecta a la salud y al bienestar del cuidador familiar. Objetivos. Sistematizar la producción científica nacional sobre las implicacionesen la salud y bienestar de los que tienen a su cargo cuidar familiares com dependencia en el autocuidado. Método. Se llevó a cabo una revisión integradora, respaldada por el Repositório Científico de Acesso Aberto de Portugal entre los años 2000 y 2012, en la que se tuvieron en cuenta todos los documentos completos accesibles. Seutilizó el método PI(CO)D. Para el análisis de los datos se solicitó la intervenciónde dos revisores independientes. Se utilizaron los indicadores del Joanna Briggs Institute para analizar la calidad metodológica de los estudios. Resultados. Se seleccionaron doce estúdios principales. La mayoría de ellos se basaban en investigación observacional de tipo transversal/descriptivo, lo cual permite describir el perfil de los cuidadores familiares e identificar sus necesidades y los factores relacionados con la sobrecarga. Los resultados muestran una mayor sobrecarga/estrés en los cuidadores familiares de personas con demencia y con un nivel elevado de dependencia. La mayor sobrecarga está relacionada con una mala percepción del estado de salud, de la satisfacción y de la calidad de vida del cuidador familiar. Los niveles de sobrecarga asociada, depresión emocional y estrés son más elevados en las mujeres que en los hombres. Conclusiones. La naturaleza de los estúdios utilizados permite identificar el impacto que supone el cuidado de un familiar con dependencia para los cuidadores familiares. No obstante, es imposible analizar los resultados de manera dinámica a lo largo de un periodo de tiempo. Es importante centrarse en la investigación basándose en los mejores datos clínicos disponibles para potenciar la toma de decisiones en la práctica clínica.
- Functional capacity and self‐care profiles of older people in senior care homesPublication . Imaginário, Cristina; Rocha, Magda; Machado, Paulo Alexandre Puga; Antunes, Cristina; Martins, TeresaThe reduction of the functional capacity in older people is the result of physical, psychological and functional changes related to the ageing process, compromising the performance of daily life activities. Assessing their functional capacity and their self-care profile can facilitate the planning of targeted strategies related to stimulation, as well as cognitive and motor rehabilitation. This study aims to evaluate and analyse the functional capacity, as well as the level of dependence in self-care of older people in senior care centres. This is a transversal exploratory study, quantitative in nature. The sample was comprised of 313 participants, randomly selected from a set of senior care centres, with an average age of 83.41 (SD=7.14) years, recruited from the interior North of Portugal. The data collection instruments included the Barthel Index, the Lawton and Brody Scale, the Evaluation Form of Dependence in Self-care, the Self-care of Home Dwelling Elderly (self-care subscale profiles) and a questionnaire on demographic data. The elderly showed several levels of dependence on different self-care items. It was possible to observe that the staff often replaces the elderly in many of the tasks that could still be performed by them, and thus aggravates their levels of dependence. The link observed between functional capacity and self-care profiles highlights the need to focus on the notion of a healthy and active ageing process, especially in some profiles. The monitoring of the functional capacity and the self-care profile can provide knowledge concerning the potential for autonomy and individual needs, thus enabling targeted and more responsive interventions for the individual and the real needs of older people.
- Nonpharmacological Clinical Effective Interventions in Constipation: A Systematic ReviewPublication . Carvalho Pinto, Cristina; Oliveira, Palmira; Fernandes, Olga; Padilha, José Miguel Santos Castro; Machado, Paulo Alexandre Puga; Ribeiro, Ana; Ramos, JoséPurpose: To identify nonpharmacological clinically effective interventions for constipation in adults. Methods: A systematic review of experimental studies of nonpharmacological interventions addressing participants’ management of constipation using samples of adults over 18 years of age was conducted. In evaluating the methodological quality of the eligible studies, we used the assumptions of the Cochrane Collaboration, and for the reporting of items in the systematic review we used the Model of Preferential Reporting Items for Systematic Reviews and Meta-Analyses. The protocol of this review was recorded in the International Prospective Register of Systematic Reviews of the University of York under number 43693. Results: This review included 12 randomized controlled trials. Nonpharmacological effective interventions for the resolution of constipation were identified: individualized intervention based on the participant’s modifiable risk factors of constipation promoting literacy in health; educational measures in dietary modification and lifestyle; and abdominal massage. Conclusions: Specific nonpharmacological interventions are crucial for nurses’ clinical practice and of major importance for clients and families. Evidence on these interventions in resolving constipation is still scarce and fails to provide evidence-based data to support nursing clinical practice. Clinical Relevance: Personal lifestyles, comorbidities, medication, and sedentary habits are likely to be risk factors in constipation. Thus, it is important to invest in nonpharmacological interventions that promote changes in behavior regarding prevention or resolution of constipation. Moreover, nursing researchers worldwide should conduct research for clinical practice regarding the fundamentals of care.
- Pressure ulcer (risk) assessment: Recommendations to improve nursing practicePublication . Garcez Sardo, Pedro Miguel; Guedes, Jenifer Adriana; Machado, Paulo Alexandre Puga; Melo, Elsa MariaPressure ulcer (risk) assessment is complex and multifactorial. National and international guidelines give orientations about pressure ulcer (PU) management and provide important recommendations. However, it’s necessary to know our reality in order to improve Evidence-Based Nursing. The main aim of this study was to provide some recommendations to improve clinical practice, clinical research, clinical management and continuous education on PU domain. The study was designed as a retrospective cohort analysis of electronic health record database from adult patients admitted to general wards in a Portuguese hospital during one year. The study had a sample of 8147 participants where 34.4% had “high risk” of PU development at the #rst PU risk assessment, 7.9% had (at least) one PU at the #rst skin and tissue assessment and 3.4% developed (at least) one PU during the length of inpatient stay. (Im)“mobility” was the major risk factor assessed through Braden Scale for PU development. The systematic PU risk assessment: is sensitive to patient clinical changes; should be performed since the hospital admission; and should be used in combination with nursing clinical judgement. The systematic skin and tissue assessment: identi#es early changes in skin and tissue condition; should be performed since the hospital admission; and should identify wounds of di$erent aetiologies. The PU assessment could be improved with the implementation of a validated tool in order to standardised data record, to monitor PU/wounds characteristics and their evolution.
- Pressure ulcer incidence and Braden subscales: Retrospective cohort analysis in general wards of a Portuguese hospitalPublication . Sardo, Pedro Miguel Garcez; Guedes, Jenifer Adriana Domingues; Alvarelhão, José Joaquim Marques; Machado, Paulo Alexandre Puga; Melo, Elsa Maria Oliveira PinheiroAim: To study the influence of Braden subscales scores (at the first pressure ulcer risk assessment) on pressure ulcer incidence using a univariate and a multivariate time to event analysis. Materials and methods: Retrospective cohort analysis of electronic health record database from adult patients admitted without pressure ulcer(s) to medical and surgical wards of a Portuguese hospital during 2012. The hazard ratio of developing a pressure ulcer during the length of inpatient stay was calculated by univariate Cox regression for each variable of interest and by multivariate Cox regression for the Braden subscales that were statistically significant. Results: This study included a sample of 6552 participants. During the length of stay, 153 participants developed (at least) one pressure ulcer, giving a pressure ulcer incidence of 2.3%. The univariate time to event analysis showed that all Braden subscales, except “nutrition”, were associated with the development of pressure ulcer. By multivariate analysis the scores for “mobility” and “activity” were independently predictive of the development of pressure ulcer(s) for all participants. Conclusion: (Im)“mobility” (the lack of ability to change and control body position) and (in)“activity” (the limited degree of physical activity) were the major risk factors assessed by Braden Scale for pressure ulcer development during the length of inpatient stay. Thus, the greatest efforts in managing pressure ulcer risk should be on “mobility” and “activity”, independently of the total Braden Scale score.
- Self-care profiles of the elderly institutionalized in Elderly Care CentresPublication . Imaginário, Cristina; Rocha, Magda; Machado, Paulo Alexandre Puga; Antunes, Cristina; Martins, TeresaThe concept of self-care in the elderly has been frequently associated with autonomy, independence and personal accountability. Self-care practices are a result of individual lifestyles and paths adapted to the circumstances and expectations of the elderly. Based on the model by Backman and Hentinen (1999), the present study attempts to categorically describe the types of self-care of the elderly. This is an exploratory study, transversal, of a quantitative nature. The sample was comprised of 313 participants, randomly selected among Elderly Care Centres in the interior North of Portugal. The Portuguese version of Self-care of Home Dwelling Elderly was used for data collection. The results call for a replication of the study, using the theoretical derivation of the four self-care profiles (responsible, formally guided, independent and abandoned).