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Práticas de Enfermagem na Hemóstase da Artéria Radial após coronariografia: um problema de Supervisão Clínica?
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Abstract(s)
Introdução: A enfermagem contemporânea tem evoluído significativamente, tanto no âmbito científico como na sua representação social. O enfermeiro é hoje um profissional com crescente autonomia, capaz de tomar decisões fundamentadas em evidências científicas. A Supervisão Clínica em Enfermagem desempenha um papel crucial no desenvolvimento contínuo de competências, promovendo a qualidade e segurança dos cuidados prestados. No contexto da cardiologia de intervenção, uma gestão eficaz do local de acesso, nomeadamente da artéria radial, é essencial para prevenir complicações. Objetivos: Esta investigação tem como objetivos: a) Identificar as práticas de enfermagem relacionadas com a hemóstase da artéria radial após coronariografia; b) Avaliar as bases de conhecimento e as estratégias de supervisão clínica na formação inicial e contínua dos enfermeiros envolvidos neste contexto de cuidados. Metodologia: Seguiu-se um paradigma quantitativo e um desenho descritivo, utilizando um questionário distribuído entre enfermeiros de cinco hospitais terciários em Portugal. A amostragem foi realizada por método de bola de neve e a análise dos dados utilizou estatística descritiva. Foram analisados dados sociodemográficos, práticas de hemóstase e a influência da supervisão clínica. Previamente, foi realizada uma revisão scoping para mapear a evidência existente sobre os métodos de hemóstase utilizados após coronariografia via artéria radial. Resultados: A análise revelou que a maioria dos enfermeiros utiliza o dispositivo de compressão pneumática, sendo a TR Band o mais comum. Contudo, identificou-se uma variação significativa nos protocolos de desinsuflação, muitas vezes divergentes das práticas expostas. Menos de metade dos enfermeiros segue corretamente o protocolo de hemóstase permeável, indicando um conhecimento insuficiente sobre o conceito. Além disso, verificou-se que as estratégias de supervisão clínica mais frequentemente adotadas são a explicação e a demonstração, enquanto o uso da discussão, debate e feedback é menos recorrente. O tempo reduzido destinado à integração dos enfermeiros e a elevada rotatividade das funções dos profissionais, é aponte como barreira a uma integração que promova práticas seguras. Apesar dessas adversidades e da falta de formação específica em supervisão, os enfermeiros supervisores mostram-se empenhados nas suas responsabilidades. Conclusão: Esta investigação destaca a relevância da supervisão clínica em enfermagem na consolidação de práticas baseadas na evidência, especialmente no contexto da cardiologia de intervenção. A padronização de protocolos e o investimento na formação contínua são fundamentais para assegurar cuidados de qualidade e segurança. As variações observadas nas práticas em uso, face às melhores práticas descritas, reforçam a necessidade de maior uniformidade e adesão aos protocolos, bem como a necessidade de mais investigação.
Introduction: Contemporary nursing has evolved significantly, both scientifically and in its social representation. Nurses are currently professionals with increasing autonomy and are capable of making decisions based on scientific evidence. Clinical Supervision in Nursing plays a crucial role in the continuous development of skills and in promoting the quality and safety of the care provided. In the context of interventional cardiology, effective management of the access site, namely the radial artery, is essential to prevent complications. Objectives: This study aimed to: a) identify nursing practices related to radial artery haemostasis after coronary angiography, and b) evaluate the knowledge bases and clinical supervision strategies in the initial and continuing training of nurses involved in this care context. Methodology: A quantitative paradigm and descriptive design were followed, using a questionnaire distributed among nurses from five tertiary hospitals in Portugal. Sampling was carried out using the snowball method, and descriptive statistics were used for data analysis. Sociodemographic data, haemostasis practices, and the influence of clinical supervision were analysed. Previously, a scoping review was conducted to map the existing evidence on the haemostasis methods used after coronary angiography via the radial artery. Results: The analysis revealed that most nurses used pneumatic compression devices, with the TR Band being the most common. However, a significant variation in deflation protocols was identified, which often diverged from best practices. Less than half of the nurses correctly followed the permeable haemostasis protocol, indicating insufficient knowledge of the concept. Furthermore, it was found that the most frequently adopted clinical supervision strategies were explanation and demonstration, while the use of discussion, debate, and feedback was less recurrent. The reduced time allocated to the integration of nurses and the high turnover of professional roles are barriers to integration that promote safe practices. Despite these adversities and the lack of specific supervision training, nursing supervisors are committed to their responsibilities. Conclusion: This study highlights the relevance of clinical supervision in nursing in consolidating evidence-based practices, especially in the context of interventional cardiology. Standardisation of protocols and investment in continuing education are essential for guaranteeing quality and safety care. The observed variations in practices in use, given the best practices described, reinforce the need for greater uniformity and adherence to protocols as well as the need for further research.
Introduction: Contemporary nursing has evolved significantly, both scientifically and in its social representation. Nurses are currently professionals with increasing autonomy and are capable of making decisions based on scientific evidence. Clinical Supervision in Nursing plays a crucial role in the continuous development of skills and in promoting the quality and safety of the care provided. In the context of interventional cardiology, effective management of the access site, namely the radial artery, is essential to prevent complications. Objectives: This study aimed to: a) identify nursing practices related to radial artery haemostasis after coronary angiography, and b) evaluate the knowledge bases and clinical supervision strategies in the initial and continuing training of nurses involved in this care context. Methodology: A quantitative paradigm and descriptive design were followed, using a questionnaire distributed among nurses from five tertiary hospitals in Portugal. Sampling was carried out using the snowball method, and descriptive statistics were used for data analysis. Sociodemographic data, haemostasis practices, and the influence of clinical supervision were analysed. Previously, a scoping review was conducted to map the existing evidence on the haemostasis methods used after coronary angiography via the radial artery. Results: The analysis revealed that most nurses used pneumatic compression devices, with the TR Band being the most common. However, a significant variation in deflation protocols was identified, which often diverged from best practices. Less than half of the nurses correctly followed the permeable haemostasis protocol, indicating insufficient knowledge of the concept. Furthermore, it was found that the most frequently adopted clinical supervision strategies were explanation and demonstration, while the use of discussion, debate, and feedback was less recurrent. The reduced time allocated to the integration of nurses and the high turnover of professional roles are barriers to integration that promote safe practices. Despite these adversities and the lack of specific supervision training, nursing supervisors are committed to their responsibilities. Conclusion: This study highlights the relevance of clinical supervision in nursing in consolidating evidence-based practices, especially in the context of interventional cardiology. Standardisation of protocols and investment in continuing education are essential for guaranteeing quality and safety care. The observed variations in practices in use, given the best practices described, reinforce the need for greater uniformity and adherence to protocols as well as the need for further research.
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Keywords
cuidados de enfermagem supervisão clínica angiografia coronária hemóstase artéria radial