Construção de manual para visitantes de pacientes internados em terapia intensiva adulto: revisão integrativa e validação de conteúdo
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Data
2021-12-21
Autores
Calixto, Tereza Raquel Schorr
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Editor
Universidade Estadual Paulista (Unesp)
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Introdução: A UTI é uma unidade que oferece suporte tecnológico aos pacientes em estado grave por uma equipe multiprofissional especializada. Constitui-se em ambiente complexo, invasivo, com inúmeras situações e eventos emergenciais estressantes, para o paciente, família e equipe de saúde. A individualidade do paciente no planejamento da assistência pelos profissionais que atuam pode reduzir essa hostilidade. A humanização do cuidado pode ser alcançada com o cuidado centrado no paciente e na família, através do acolhimento das necessidades dos familiares do paciente crítico, que permite reduzir os sentimentos de angústia, medo e estresse. Assim é fundamental a utilização de estratégias de acolhimento para proporcionar melhoria da qualidade da assistência. A finalidade desse estudo foi construir um manual para os familiares e visitantes de pacientes internados em UTI. O referencial teórico utilizado foi o conteúdo da Política Nacional de Humanização do Brasil. Para a sua consecução foram propostos uma revisão integrativa de literatura para identificar as evidências científicas sobre o assunto, a construção do produto e a validação do seu conteúdo por enfermeiros especialistas em terapia intensiva. Objetivos: o objetivo geral foi construir um manual para os familiares e visitantes de pacientes internados em UTI de um hospital público de ensino; os objetivos específicos foram elaborar revisão integrativa de literatura para identificar as evidências científicas sobre o tema e validar o conteúdo do manual por enfermeiros especialistas em terapia intensiva. Métodos: o estudo foi aprovado pelo comitê de ética local, com parecer consubstanciado número 4.190.568. A elaboração do produto constituiu-se em três etapas: uma revisão integrativa de literatura; construção do manual e validação de conteúdo por especialistas. A revisão integrativa foi realizada em seis fases: identificação do tema e elaboração das perguntas norteadoras pela estratégia PICo; estabelecimento de critérios de inclusão e exclusão para a seleção dos artigos identificados; categorização e definição das informações do conteúdo dos textos dos artigos; análise crítica dos conteúdo de acordo com respostas às perguntas norteadoras da revisão; interpretação dos resultados e síntese do conhecimento. Para a busca de artigos para a revisão integrativa foram utilizados os Descritores em Ciências da Saúde em português, e em inglês os do Medical Subject Headings. Equações booleanas foram formuladas e inseridas nas bases de dados e nas plataformas on-line no período de janeiro de 2016 a junho de 2020, SCOPUS; PUBMED; EMBASE; Web of Science; CINHAL; Biblioteca Regional de Medicina que incluíram a LILACS, MEDLINE, BDENF e Scielo. Os artigos foram incluídos e excluídos de acordo com critérios e os conteúdos definidos pelas perguntas: “Como estão descritos na literatura branca (artigos científicos publicados em periódicos nacionais e internacionais) roteiros, protocolos, guias e ou quaisquer materiais educativos de acolhimento humanizado aos familiares que visitam seus entes na UTI Adulto?” e “Como se configura o acolhimento humanizado de familiares nas visitas aos pacientes internados em UTI Adulto com a pandemia da COVID 19?” As evidências científicas ofereceram subsídios para a construção do manual, e para o seu formato foi utilizado o software Adobe InDesign versão 16.3.2; as imagens foram copiadas do banco gratuito Freepik. Um painel de 16 enfermeiros especialistas em terapia intensiva foi composto, denominados de juízes, para a validação do conteúdo do manual. Os critérios de Fehring foram utilizados na composição do painel e a pontuação mínima de cinco pontos dos respectivos currículos lattes. Os juízes responderam a um questionário elaborado em formato Lime Survey e enviado por email pessoal e ou institucional. O questionário foi composto por 33 itens na primeira rodada e seis itens na segunda rodada, com valores para serem assinalados em escala tipo Likert. A concordância de no mínimo 80% para todos os itens foi considerada a partir da realização das rodadas de envio do material aos juízes. Resultados: identificaram-se na busca da literatura 1372 títulos de artigos nas bases nacionais e internacionais, e após os critérios de inclusão, exclusão e identificadas as respostas às duas perguntas norteadoras, foram incluídos 11 documentos na revisão. As evidências científicas demonstradas na síntese de conhecimento foram especificadas no manual. O manual foi enviado para a primeira rodada de validação de conteúdo pelos juízes, e obteve-se concordância mínima de 84,62% e máxima de 100% para a maioria dos itens, com exceção do item linguagem, que obteve 69,23% de concordância. O manual foi reformulado e enviado aos juízes para a segunda rodada e após o retorno, foi constatada uma concordância de 100% para a maioria das questões e 94,12% para a questão sobre o título do manual. A versão final do manual pode ser acessada pelo link: https://drive.google.com/file/d/1DDI6kKKblFTgAQAK49Jw_KAmmdI4Bvd8/view?usp=sharing. Conclusão: o manual elaborado em formato digital foi construído baseado nas evidências científicas demonstradas pela síntese de conhecimento da revisão integrativa de literatura; a validação do conteúdo pelos juízes foi obtida em duas rodadas com concordância maior que 80% em todo os itens avaliados. A aplicabilidade do manual possibilita o acolhimento humanizado aos visitantes; proporciona condições para orientações presenciais e virtuais pela equipe de saúde; colabora para a capacitação da equipe de saúde; e contribui com potencial de replicabilidade para ser utilizado em outras instituições.
Introduction: The ICU is a unit that offers technological support to critically ill patients by a specialized multidisciplinary team. It is a complex, invasive environment, with numerous stressful situations and emergency events for the patient, family, and health team. The individuality of the patient in the planning of care by the professionals who work can reduce this hostility. The humanization of care can be achieved with care centered on the patient and the family, by welcoming the needs of the critically ill patient's family members, which reduces feelings of anguish, fear and stress. Thus, it is essential to use reception strategies to improve the quality of care. The purpose of this study was to build a manual for family members and visitors of ICU patients. The theoretical framework used was the content of the National Humanization Policy in Brazil. For its achievement, an integrative literature review was proposed to identify the scientific evidence on the subject, the construction of the product and the validation of its content by nurses specialized in intensive care. Objectives: the general objective was to build a manual for family members and visitors of patients admitted to the ICU of a public teaching hospital; the specific objectives were to develop an integrative literature review to identify scientific evidence on the topic and validate the content of the manual by nurses specializing in intensive care. Methods: the study was approved by the local ethics committee, with opinion number 4,190,568. The elaboration of the product consisted of three stages: an integrative literature review; construction of the manual and content validation by experts. The integrative review was carried out in six phases: identification of the theme and elaboration of guiding questions by the PICo strategy; establishment of inclusion and exclusion criteria for the selection of identified articles; categorization and definition of information in the content of the articles' texts; critical analysis of the content according to the answers to the guiding questions of the review; interpretation of results and synthesis of knowledge. To search for articles for the integrative review, the Descriptors in Health Sciences in Portuguese were used, and in English, those from the Medical Subject Headings. Boolean equations were formulated and entered databases and online platforms from January 2016 to June 2020, SCOPUS; PUBMED; BASE; Web of Science; CINHAL; Regional Library of Medicine that included LILACS, MEDLINE, BDENF and Scielo. The articles were included and excluded according to criteria and the content defined by the questions: “How are scripts, protocols, guides and/or any educational materials of humanized reception for family members described in white literature (scientific articles published in national and international journals). visit their loved ones in the Adult ICU?” and “How is the humanized reception of family members configured in visits to patients hospitalized in Adult ICUs with the COVID 19 pandemic?” Scientific evidence provided subsidies for the construction of the manual, and the Adobe InDesign software version 16.3.2 was used for its format; the images were copied from the free bank Freepik. A panel of 16 nurses specialized in intensive care was composed, called judges, to validate the content of the manual. Fehring's criteria were used in the composition of the panel and the minimum score of five points from the respective curriculum lattes. The judges answered a questionnaire prepared in Lime Survey format and sent by personal and/or institutional email. The questionnaire consisted of 33 items in the first round and six items in the second round, with values to be marked on a Likert-type scale. The agreement of at least 80% for all items was considered from the completion of the rounds of sending the material to the judges. Results: the literature search identified 1372 article titles in national and international databases, and after the inclusion and exclusion criteria were identified and the answers to the two guiding questions were identified, 11 documents were included in the review. The scientific evidence demonstrated in the knowledge synthesis was specified in the manual. The manual was sent to the first round of content validation by the judges, and a minimum agreement of 84.62% and a maximum of 100% was obtained for most items, with the exception of the language item, which obtained 69.23% of agreement. The manual was reformulated and sent to the judges for the second round and after the return, a 100% agreement was found for most questions and 94.12% for the question about the title of the manual. The final version of the manual can be accessed via the link: https://drive.google.com/file/d/1DDI6kKKblFTgAQAK49Jw_KAmmdI4Bvd8/view?usp=sharing. Conclusion: the manual prepared in digital format was built based on scientific evidence demonstrated by the synthesis of knowledge of the integrative literature review; the content validation by the judges was obtained in two rounds with agreement greater than 80% in all the items evaluated. The applicability of the manual enables a humanized reception to visitors; provides conditions for face-to-face and virtual guidance by the health team; collaborates for the training of the health team; and contributes with replicability potential to be used in other institutions.
Introduction: The ICU is a unit that offers technological support to critically ill patients by a specialized multidisciplinary team. It is a complex, invasive environment, with numerous stressful situations and emergency events for the patient, family, and health team. The individuality of the patient in the planning of care by the professionals who work can reduce this hostility. The humanization of care can be achieved with care centered on the patient and the family, by welcoming the needs of the critically ill patient's family members, which reduces feelings of anguish, fear and stress. Thus, it is essential to use reception strategies to improve the quality of care. The purpose of this study was to build a manual for family members and visitors of ICU patients. The theoretical framework used was the content of the National Humanization Policy in Brazil. For its achievement, an integrative literature review was proposed to identify the scientific evidence on the subject, the construction of the product and the validation of its content by nurses specialized in intensive care. Objectives: the general objective was to build a manual for family members and visitors of patients admitted to the ICU of a public teaching hospital; the specific objectives were to develop an integrative literature review to identify scientific evidence on the topic and validate the content of the manual by nurses specializing in intensive care. Methods: the study was approved by the local ethics committee, with opinion number 4,190,568. The elaboration of the product consisted of three stages: an integrative literature review; construction of the manual and content validation by experts. The integrative review was carried out in six phases: identification of the theme and elaboration of guiding questions by the PICo strategy; establishment of inclusion and exclusion criteria for the selection of identified articles; categorization and definition of information in the content of the articles' texts; critical analysis of the content according to the answers to the guiding questions of the review; interpretation of results and synthesis of knowledge. To search for articles for the integrative review, the Descriptors in Health Sciences in Portuguese were used, and in English, those from the Medical Subject Headings. Boolean equations were formulated and entered databases and online platforms from January 2016 to June 2020, SCOPUS; PUBMED; BASE; Web of Science; CINHAL; Regional Library of Medicine that included LILACS, MEDLINE, BDENF and Scielo. The articles were included and excluded according to criteria and the content defined by the questions: “How are scripts, protocols, guides and/or any educational materials of humanized reception for family members described in white literature (scientific articles published in national and international journals). visit their loved ones in the Adult ICU?” and “How is the humanized reception of family members configured in visits to patients hospitalized in Adult ICUs with the COVID 19 pandemic?” Scientific evidence provided subsidies for the construction of the manual, and the Adobe InDesign software version 16.3.2 was used for its format; the images were copied from the free bank Freepik. A panel of 16 nurses specialized in intensive care was composed, called judges, to validate the content of the manual. Fehring's criteria were used in the composition of the panel and the minimum score of five points from the respective curriculum lattes. The judges answered a questionnaire prepared in Lime Survey format and sent by personal and/or institutional email. The questionnaire consisted of 33 items in the first round and six items in the second round, with values to be marked on a Likert-type scale. The agreement of at least 80% for all items was considered from the completion of the rounds of sending the material to the judges. Results: the literature search identified 1372 article titles in national and international databases, and after the inclusion and exclusion criteria were identified and the answers to the two guiding questions were identified, 11 documents were included in the review. The scientific evidence demonstrated in the knowledge synthesis was specified in the manual. The manual was sent to the first round of content validation by the judges, and a minimum agreement of 84.62% and a maximum of 100% was obtained for most items, with the exception of the language item, which obtained 69.23% of agreement. The manual was reformulated and sent to the judges for the second round and after the return, a 100% agreement was found for most questions and 94.12% for the question about the title of the manual. The final version of the manual can be accessed via the link: https://drive.google.com/file/d/1DDI6kKKblFTgAQAK49Jw_KAmmdI4Bvd8/view?usp=sharing. Conclusion: the manual prepared in digital format was built based on scientific evidence demonstrated by the synthesis of knowledge of the integrative literature review; the content validation by the judges was obtained in two rounds with agreement greater than 80% in all the items evaluated. The applicability of the manual enables a humanized reception to visitors; provides conditions for face-to-face and virtual guidance by the health team; collaborates for the training of the health team; and contributes with replicability potential to be used in other institutions.
Descrição
Palavras-chave
Humanização, Acolhimento, Famílias, Unidade de Terapia Intensiva, Pandemia, Covid-19, Humanization, Reception, Families, Intensive Care Unit, Pandemic