Protocolo clínico para tratamento da sepse em adultos: uma proposta de capacitação

Abstract

This research aimed to identify the theoretical and operational gaps in applying the protocol by nurses, such as sepsis, specific objectives were formed to characterize structural conditions or other factors involved in the implementation of the sepsis protocol, and propose course in Education Distance Learning (ODL) to improve the effectiveness of the protocol by sepsis instensivistas nurses. Methods: This is a field research with quantitative, descriptive and exploratory approach. Study participants were 27 nurses in ICU specialists and related areas (urgency, emergency, cardiology and care of high complexity in nursing), cooperative Cooperative Intensivists Nurses (Coopenfint), headquartered in Manaus-AM / Brazil. Were established as inclusion criteria: being a nurse with at least one year of practice in adult ICU, ICU act, whether in care, supervision or teaching. The socio-demographic variables, the analysis of structural barriers, difficulties and doubts in adopting the protocol of sepsis and suggestions reported by nurses were presented using descriptive statistics. Regarding the responses of nurses related to the theoretical and practical difficulty, and difficulty concerning the points referred to sepsis in the work unit was used confidence intervals (95% CI) to assess the distribution and percentage of correct responses relative to the experience, degree of difficulty and intervening factors in the use of the sepsis protocol if the Fisher exact test (p-value> 0.05) was used. Results: With respect to sociodemographic characteristics of the "experts" surveyed 27 (100%), 26 (96.3%) of the nurses were female, compared to 11 marital status (40.7%) were married , as the time since graduation in years, the average was 20 years, 24 (89%) were clinical nurses of ICU and 3 (11.1%) were coordinators UTI.Com regarding the identification of self-reported experience of nurses as the use of Sepsis Protocol on Work Unit was observed that most of 14 (52%) had relative experience and little or. With respect to the sufficiency of the information nurses to implement the Protocol of Sepsis in the work unit was observed that 8 (29.6%) responded that the information / instructions are sufficient in most stages. Regarding the characterization of the degree of difficulty and as the theoretical and practical aspects of the nurses (27) in relation to the use of Sepsis Protocol on work unit it was found that adherence to protocol in the unit of work is the question that nurses attest more difficulties 12 (44.4%). Regarding the distribution of responses and confidence intervals of the nurses (27) in relation to the doubts persisted that it was found that the descriptively related question: "Realization of hand hygiene" there was no difficulty. Regarding the distribution of nurses (27) in relation to the degree of difficulty in the matters referred to sepsis in the work unit, it was found not to have significant statistical difference, although we note that with respect descriptively "Streamline results of clinical and laboratory "; "Having the material resources needed for appropriate care (space, equipment, devices, medications)," "Having human resources needed to care for sepsis patients in 24h", "Ability to modify behaviors in front of the timely evolution of the patient" , "Possibility of immediate implementation of changes in the prescription", showed very similar shapes between the degree of "hard and difficult" problems. From the data analyzed it is identified that there is difficulty in having mainly human resources in 24h. With respect to theoretical training and practical improvement of sepsis protocol, only 15 (55.5%) of nurses responded, so suggestions would be as follows: 8 (53%) suggested instituting sepsis protocol in the work units, followed by 02 (13.4%) of nurses to implement a specific protocol for nurses, however it is worth noting that only two (13.4%) of nurses cited antibiotics as a priority. Regarding the conditions of improvements, infrastructure and support services in the unit of work, it was found that the major concern (suggestions) indicated by 5 (33.3%) nurses was to prioritize agility of laboratory results and imaging for therapeutic purposes, quick decision making regarding clinical to be taken to the patient with sepsis pipelines. With respect to the degree of knowledge shown by the respondents nurses' questions regarding sepsis protocol was verified a significant percentage of accuracy regarding prevention (BOP) with 100% accuracy pipelines, and the same percentage for the use of handwashing. Analyzing the front of the hits on the knowledge demonstrated on test questions (culture collection, goals in the first 6h and sepsis due to an infection) sepsis protocol, there were issues separately and was found through the test questions Fisher's exact test (p-value> 0.05) that was not identified significant differences between questions. Analyzing the front of intervening factors regarding "membership of nurses" and the possibility of adjustments related to knowledge demonstrated on test questions (culture collection, goals in the first 6h and sepsis due to an infection) sepsis protocol issues, there was issues separately through the Fisher Exact Test (p value> 0.05) which also did not identify a statistically significant difference. After the research was proposed Training Course on Sepsis Protocol for Nurses "in ODL that characterize the structural conditions and involved in protocol implementation factors of sepsis according to the criteria of the Surviving Sepsis Campaign (SSC), Latin American Institute sepsis (ILAS) for best effectiveness in sepsis protocol for intensive care nurses, the course will be structured in two modules of 30 hrs, the first being called "Principle of learning to understand sepsis" and the second "Ensuring learning to start the protocol sepsis "the teaching contents are arranged in an organizational map and will support an institutional designer, preparing teaching videos with 30 minutes to 1 hour modules, each will be assembled according to the results obtained in that work. There will be production of learning objects in SCORM, producing tutorials navigation e-book: "Guide for students" and "Tutor Guide". Creating interactive objects in e-book for consultation and general questions on the Moodle platform for access. Conclusion: Therefore this work helped to clarify before the data presented that health education is needed to improve the ability of the professional nurse providing patient involved by the syndrome in question a more effective and early treatment of sepsis before the packages and ensuring the surviving sepsis campaign and essentially the opportunity to save lives which will be a proposal for an ODL course for nurses.