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- The COVID-19 Pandemic and Professional Nursing Practice in the Context of HospitalsPublication . Ribeiro, Olga; Trindade, Letícia de Lima; Pinto Novo, André Filipe Morais Pinto; da Rocha, Carla Gomes da; Sousa, Clemente Neves; Cabral Teles, Paulo João Figueiredo Cabral; Reis, Ana Catarina Rodrigues da Silva; Perondi, Alessandro Rodrigues; Andrigue, Karen Cristina Kades; Pereira, Soraia Cristina de Abreu; Leite, Paula Cristina da Silva; Ventura-Silva, João Miguel AlmeidaThe COVID-19 pandemic has imposed challenges to health systems and institutions, which had to quickly create conditions to meet the growing health needs of the population. Thus, this study aimed to assess the impact of COVID-19 on professional nursing practice environments and to identify the variables that affected their quality. Quantitative, observational study, conducted in 16 Portuguese hospitals, with 1575 nurses. Data were collected using a questionnaire and participants responded to two different moments in time: the pre-pandemic period and after the fourth critical period of COVID-19. The pandemic had a positive impact on the Structure and Outcome components, and a negative trend in the Process component. The variables associated with the qualification of the components and their dimensions were predominantly: work context, the exercise of functions in areas of assistance to COVID-19 patients, length of professional experience and length of experience in the service. The investment in professional practice environments impacted the improvement of organizational factors, supporting the development of nurses’ work towards the quality of care. However, it is necessary to invest in nurses’ participation, involvement and professional qualifications, which are aspects strongly dependent on the institutions’ management strategies
- Radio‐cephalic fistula recovered with drainage to median basilic vein by straightening of the forearm cephalic vein: A case reportPublication . Costa, Luísa Lemos; Matos, António Norton; Almeida, Paulo; Teles, Paulo; Loureiro, Luís; Campos, Luís; Delgado, Elisabete; Oliveira, Debora; Campos, Tiago; Inácio, Marta; Fernandes, Filipa; Coutinho, Sara; Ventura, Ana; Pereira, Susana; Castro, Ana; Xavier, Eva; Sousa, Clemente NevesThe distal arteriovenous fistula (AVF) has less complications and better patency than the proximal fistula, when it works properly. The complications of outflow of the fistula are complex, and it is necessary to analyze all solutions to solve the problem. We introduce a novel approach to solve outflow problems of a radio-cephalic AVF by straightening of the forearm cephalic vein with drainage into the median basilic vein.
- Haemodialysis for children under the age of two yearsPublication . Sousa, Clemente Neves; Gama, Madalena; Andrade, Melanie; Faria, M. Sameiro; Pereira, EloiLess than 10% of children under 2 years old with end-stage renal failure in Europe and in the United States of America are treated with haemodialysis. For small children, peritoneal dialysis is often the preferred treatment. Haemodialysis is chosen for a very small number of children, and is only used in some selected centres because of its highly complex technique, the difficulties related to vascular access, and the need to have a skilled and experienced nursing and medical team. With the technological development of recent years, the quality of dialysis treatment offered to paediatric patients has improved considerably and haemodialysis is presently considered to be a safe and efficient treatment for acute or chronic paediatric renal impairment. However, because a successful renal transplant continues to be linked to a better quality of life for children with terminal chronic renal impairment, dialysis ought to be regarded as a temporary treatment method, while waiting for a renal transplant.
- Impact of COVID‐19 on professional nursing practice environments and patient safety culturePublication . Ribeiro, Olga; de Lima Trindade, Letícia; Silva Fassarella, Cintia; de Abreu Pereira, Soraia Cristina; Figueiredo Cabral Teles, Paulo João; Gomes da Rocha, Carla; da Silva Leite, Paula Cristina; Almeida Ventura‐Silva, João Miguel; Sousa, Clemente NevesAim: To analyse the impact of COVID-19 on professional nursing practice environments and patient safety culture. Background: The relationship between work environments and patient safety has been internationally recognized. In 2020, the pandemic imposed enormous challenges, yet the impact on these variables remains unknown. Method: This is a quantitative observational study, conducted in a Portuguese hospital, with 403 registered nurses. A self-completion questionnaire was used. Results: The impact on the Structure and Outcome components of nursing professional practice environments was positive. Although the Process component remained favourable to quality of care, a negative trend was confirmed in almost all dimensions. The results regarding safety culture showed weaknesses; ‘teamwork within units’ was the only dimension that maintained a positive culture. Conclusion: Positive responses regarding patient safety were significantly associated with the quality of the nursing professional practice environment. The need to invest in all dimensions of safety culture emerges to promote positive professional environments. Implications for nursing management: Improving professional nursing practice environments can be achieved through managers’ investment in the participation and involvement of nurses in the policies and functioning of institutions, as well as promoting an open, fair and participatory safety culture that encourages reporting events and provides adequate support for professionals.
- Interventions to promote self-care of people with arteriovenous fistulaPublication . Sousa, Clemente Neves; Apóstolo, João Luís; Figueiredo, Maria; Martins, MM; Dias, Vanessa FThe literature shows many self-care behaviours related to people with end-stage renal disease (ESRD). Our aim is to identify interventions within the 'teaching' that promote self-care (behaviour) with arteriovenous fistula (AVF).
- Physical examination of arteriovenous fistula: The influence of professional experience in the detection of complicationsPublication . Sousa, Clemente Neves; Teles, Paulo; Dias, Vanessa Filipa Ferreira; Apóstolo, João Luís Alves; Figueiredo, Maria; Martins, MMVascular access is one of the leading causes of mobilization of financial resources in health systems for people with chronic kidney disease on hemodialysis. Physical examination of the arteriovenous fistula (AVF) has demonstrated its effectiveness in identifying complications. We decided to evaluate the influence of nurses' professional experience in the detection of complications of the AVF (venous stenosis and steal syndrome). The study took place in eight hemodialysis centers between May and September of 2011 in the north of Portugal. Sample was constituted by registered nurses. The nurses involved in the experiment were divided in two groups: those who had more than 5 years of experience and those who had less than 5 years of experience. Ninety-two nurses participated in the study: 34 nurses had less than 5 years of professional experience and 58 had more than 5 years of professional experience. In the practices considered by nurses in the detection of venous stenosis, there were no differences observed between the groups (P > 0.05). In steal syndrome, there were no differences observed between the groups in the practices of the nurses in the detection of this complication of the AVF (P > 0.05). We concluded that professional experience does not influence the detection of venous stenosis and steal syndrome.
- Radio-cephalic fistula recovered with drainage to forearm basilic veinPublication . Norton de Matos, António; Sousa, Clemente Neves; Almeida, Paulo; Teles, Paulo; Loureiro, Luís; Teixeira, Gabriela; Rego, Duarte; Teixeira, SérgioDysfunction problems with vascular access are a concern to patients and dialysis units. The vascular surgeon should analyse such dysfunction and perform a careful assessment of the vascular network in order to find new fistula layouts. We introduce and discuss the case of creation of a radio-cephalic fistula with outflow into the forearm basilic vein through rotation of the forearm basilic vein toward the cephalic vein in the forearm of an 88-year-old hemodialysis male patient. This technique enables extending fistula patency and improves cost efficiency.
- Effect of Dialysis Day on Intradialytic Hypotension RiskPublication . Rocha, Ana; Sousa, Clemente Neves; Teles, Paulo; Coelho, Augusto; Xavier, EvaBackground/Aims: Intradialytic hypotension (IDH) is a serious and frequent complication of hemodialysis (HD). Thus far, data are scarcely available to assess the impact of first versus subsequent HD sessions of the week in IDH. Therefore, the purpose of this work was to evaluate IDH risk in patients on thrice-weekly HD. Methods: We conducted an analysis of all blood pressure (BP) measurements obtained during 492 HD treatments given to 41 prevalent adult patients over a one month period. A logistic regression model for repeated binary observations was used to determine the association between hypotension and patient and dialysis factors. Results: The incidence of IDH was 32.5%. First dialysis session of the week was associated with a 9% higher risk of hypotension relatively to the second one. The risk was even higher from the first to the third session of the week (60%) and from the second to the third (50%). A higher hypotension odds ratio was also associated with age (1.03, 90%CI: 1.01-1.06), higher predialysis BP (1.04, 90%CI: 1.03-1.05) and higher phosphorus level (1.38, 90%CI: 1.07-1.76). The risk decreased 24.4% for each additional antihypertensive drug taken by the patient. Conclusions: The odds of hypotension occurrence decrease throughout dialysis sessions of the week. Minimizing modifiable risk factors may decrease IDH episodes.
- Two-Stage Basilic Vein Transposition: Second Stage ResultsPublication . Rego, Duarte; Nogueira, Clara; Matos, António; Almeida, Paulo; Queirós, José; Silva, Fernanda; Sousa, Clemente Neves; Almeida, RuiThe increasing survival of hemodialysis patients results in the depletion of superficial venous capital justifying the use of the basilic vein. Many groups still prefer an arteriovenous graft due to transposition complexity and the time needed to achieve maturation. In this work we review the results of our series of basilic vein transpositions (BVT). BVTs were performed in two stages: first, creation of the fistula; second, transposition of the vein using three small incisions in the arm. All patients had to have direct arterialization of the basilic vein, therefore, patients with previous ipsilateral wrist fistulas also followed a two-stage protocol. Data were retrospectively revised from all transposition procedures made between September 2005 and November 2012. Patency and complication rates were the primary outcomes evaluated. A total of 276 basilic veins were transposed. Usage rate was 82.2%. 8% (N = 22) of the fistulas were never used due to thrombosis. Secondary patency rates at 1 and 2 years were, respectively, 84% and 66.3%. Complications occurred in 61.6% (N = 170) of fistulas and 65.9% (N = 112) of which had to undergo surgical or endovascular revision. The most frequent complication was vein stenosis (39.7% of late complications, N = 92). Albeit its greater technical complexity, the transposed basilic vein represents a hemodialysis access with good patency rates. Complication rates, although high, are less than those of CVC or prosthetic grafts. These results support the use of the transposed basilic vein as hemodialysis access after the brachiocephalic fistula.
- Vulnerabilidade mental em estudantes de enfermagem no ensino superior: estudo exploratórioPublication . Sequeira, Carlos; Carvalho, José Carlos; Borges, Elisabete; Sousa, Clemente NevesRESUMO Objetivos: avaliar os consumos de substâncias psicoativas, a morbilidade psiquiátrica e analisar as variáveis que estão associadas a maior risco de adoecer dos estudantes de enfermagem. Métodos: estudo transversal, exploratório e descritivo de cariz quantitativo. Amostra constituída por 980 estudantes do Curso de Licenciatura em Enfermagem em que foi aplicada o Mental Health Inventory (MHI). Foram respeitados os princípios éticos expressos na Declaração de Helsínquia. Resultados: os resultados sugerem níveis preocupantes de morbilidade essencialmente em termos de, solidão (48.5%), nervosismo e apreensão (48.2%), tensão e irritabilidade (68.6%). Sentem tristeza (59.3%), ansiedade, preocupação (65%) e depressão (61.4%). Conclusão: os dados apontam, para a existência de tristeza, tensão, ansiedade, nervosismo e depressão, evidenciando a necessidade de implementação de programas de promoção da saúde mental nos estudantes de enfermagem.