Introduction: Fundamental Care are nursing actions based on the nurse-assisted relationship so that the essential needs of the person are guaranteed so as to ensure their physical and psychosocial well-being. The need elimination is part of the primary needs and its evaluation and management is a nursing competence. The use of absorbent devices should be reserved for those who have a real requirement decided on the basis of appropriateness criteria, because a lot of negative outcomes have been demonstrated in the literature including the risk of developing urinary incontinence. Within the AOU 'Ospedali Riuniti' of Ancona from 2013 to 2017 the expenditure of diapers doubled. Keyword: Fundamental Care, incontinence and diapers, absorbent device Aim: Encourage appropriate care interventions in the AOU 'Ospedali Riuniti' of Ancona, in a surgical setting, measuring the appropriateness of use of absorbent devices and subsequently improving the behaviors of healthcare professionals. Materials and Methods: A descriptive observational study was conducted from April to May 2019 at the AOU 'Ospedali Riuniti' in Ancona. The reference population corresponded to those ordinary hospitalized in surgical SOD for at least 12 hours. A non-probabilistic sampling with convenience methods was used (the sample that was interviewed and evaluated corresponds exclusively to the holders of absorbent device), through an ad hoc created tool with which the appropriateness of the absorbent device was defined for each case according to the criteria in the literature. For the improvement of the behaviors of the health professionals, general interventions were planned from March to April 2020, returning the results individually to every SOD and specific ones to the SOD which was the most critical for the number of patients observed and the percentage of inappropriate detected, through PBL meetings and subsequent data collection (with the same methodology and the same tools as the previous observational study to have comparable results) from June to July 2020 to observe any change in behavior. Results: 348 patients were observed: 20.6% of these were carriers of absorbent devices, representing the sample of the study. Absorbent device was not appropriate in 43% of the patients, 87% of whom had poor mobility. 51.6% of the patients with inappropriate absorbent device were female. In many cases, it emerged that the use of the absorbent device was required by the patients themselves. In the SOD, in which the PBL meetings and the subsequent data collection were planned, 84 patients were interviewed, the carriers of absorbent devices were 44%, of which 38% inappropriate. Discussion: The results obtained are superimposable to those present in the literature for the correlation between the inadequacy of the absorbent device and the female gender, the poor mobility and the request of the assisted. The emergency situation due to Covid-19 did not allow the implementation of the PBL meetings and the subsequent observation on the improvement of the behaviors of the health personnel, despite this it is assumed a positive outcome having previously performed the SWOT feasibility analysis of the total path. Conclusions: With a view to assistance based on fundamental care, the primary elimination need must be managed by placing the patient at the center and establishing an authentic relationship with him, in order to ensure appropriate care planning. The working group intends to complete the project once the emergency situation has ended.
Introduzione: Le Fundamental Care sono azioni infermieristiche basate sulla relazione infermiere-assistito affinchè vengano garantiti i bisogni essenziali della persona così da assicurarne il benessere fisico e psicosociale. Il bisogno di eliminazione è parte dei bisogni primari e la sua valutazione e gestione è competenza infermieristica. L’utilizzo di presidi assorbenti va riservato ai casi di effettiva necessità, in quanto sono dimostrati in letteratura numerosi esiti negativi tra cui il rischio di sviluppare incontinenza urinaria. All’interno dell’AOU ‘Ospedali Riuniti’ di Ancona dal 2013 al 2017 è raddoppiata la spesa dei pannoloni. Parole chiave: Fundamental Care, incontinence and diapers, absorbent device Obiettivo: Favorire interventi assistenziali appropriati nell’AOU ‘Ospedali Riuniti’ di Ancona, in un setting chirurgico, misurando l’appropriatezza d’uso dei dispositivi assorbenti e attuando strategie di miglioramento dei comportamenti dei professionisti sanitari. Materiali e Metodi: È stato condotto uno studio osservazionale descrittivo da Aprile a Maggio 2019 presso l’AOU ‘Ospedali Riuniti’ di Ancona. La popolazione di riferimento corrispondeva ai ricoverati nelle SOD chirurgiche da almeno 12 ore in regime ordinario. È stato utilizzato un campionamento non probabilistico con modalità di convenienza (il campione che è stato intervistato e valutato corrisponde esclusivamente ai portatori di presidio assorbente), tramite uno strumento creato ad hoc col quale è stata definita l’appropriatezza del presidio assorbente per ogni caso secondo i criteri presenti in letteratura. Per il miglioramento dei comportamenti dei professionisti sanitari sono stati pianificati da Marzo ad Aprile 2020 interventi di tipo generale restituendo i risultati singolarmente a tutte le SOD e di tipo specifico alla SOD che risultava maggiormente critica per numero di assistiti osservati e percentuale di inappropriatezza rilevata, attraverso incontri di PBL e successiva raccolta dati (con la stessa metodologia e gli stessi strumenti del precedente studio osservazionale per rendere i risultati comparabili) da Giugno a Luglio 2020 per osservare la modifica attesa dell’esito, e quindi dei comportamenti. Risultati: Sono stati osservati 348 assistiti di cui il 20,6% era portatore di presidio assorbente, rappresentando il campione dello studio. Il presidio assorbente non era appropriato nel 43% degli assistiti, di questi l’87% presentava scarsa mobilità. Nei portatori di presidio assorbente inappropriato il 51,6% era di genere femminile. In molti casi è emerso come l’utilizzo del presidio assorbente fosse richiesto dagli stessi assistiti. Dal confronto con i singoli reparti è emerso un feedback positivo da parte dei Coordinatori di SOD e dei partecipanti. Nella SOD in cui sono stati pianificati gli incontri di PBL e la successiva raccolta dati sono stati intervistati 84 assistiti, i portatori di presidio assorbente erano il 44%, di cui il 38% inappropriato. Discussione: I risultati ottenuti sono sovrapponibili a quelli presenti in letteratura per la correlazione tra la non appropriatezza del presidio assorbente e il genere femminile, la scarsa mobilità e la richiesta dell’assistito. La situazione emergenziale dovuta al Covid-19 non ha permesso l’attuazione degli incontri di PBL e la successiva osservazione sul miglioramento dei comportamenti del personale sanitario, nonostante ciò si suppone un esito positivo avendo eseguito preventivamente l’analisi di fattibilità SWOT del percorso totale. Conclusioni: Nell’ottica di presa in carico basata sulle cure fondamentali, anche il bisogno primario di eliminazione va gestito ponendo al centro l’Assistito e instaurando una autentica relazione con esso, al fine di garantire un’appropriata pianificazione assistenziale. Il gruppo di lavoro si propone di completare il progetto una volta conclusa la situazione emergenziale.
Appropriatezza d'uso dei presidi assorbenti in setting chirurgico: studio osservazionale e metodologia PBL come strategia di miglioramento orientata alle Fundamental Care presso l'AOU "Ospedali Riuniti" di Ancona.
CINGOLANI, PAMELA
2019/2020
Abstract
Introduction: Fundamental Care are nursing actions based on the nurse-assisted relationship so that the essential needs of the person are guaranteed so as to ensure their physical and psychosocial well-being. The need elimination is part of the primary needs and its evaluation and management is a nursing competence. The use of absorbent devices should be reserved for those who have a real requirement decided on the basis of appropriateness criteria, because a lot of negative outcomes have been demonstrated in the literature including the risk of developing urinary incontinence. Within the AOU 'Ospedali Riuniti' of Ancona from 2013 to 2017 the expenditure of diapers doubled. Keyword: Fundamental Care, incontinence and diapers, absorbent device Aim: Encourage appropriate care interventions in the AOU 'Ospedali Riuniti' of Ancona, in a surgical setting, measuring the appropriateness of use of absorbent devices and subsequently improving the behaviors of healthcare professionals. Materials and Methods: A descriptive observational study was conducted from April to May 2019 at the AOU 'Ospedali Riuniti' in Ancona. The reference population corresponded to those ordinary hospitalized in surgical SOD for at least 12 hours. A non-probabilistic sampling with convenience methods was used (the sample that was interviewed and evaluated corresponds exclusively to the holders of absorbent device), through an ad hoc created tool with which the appropriateness of the absorbent device was defined for each case according to the criteria in the literature. For the improvement of the behaviors of the health professionals, general interventions were planned from March to April 2020, returning the results individually to every SOD and specific ones to the SOD which was the most critical for the number of patients observed and the percentage of inappropriate detected, through PBL meetings and subsequent data collection (with the same methodology and the same tools as the previous observational study to have comparable results) from June to July 2020 to observe any change in behavior. Results: 348 patients were observed: 20.6% of these were carriers of absorbent devices, representing the sample of the study. Absorbent device was not appropriate in 43% of the patients, 87% of whom had poor mobility. 51.6% of the patients with inappropriate absorbent device were female. In many cases, it emerged that the use of the absorbent device was required by the patients themselves. In the SOD, in which the PBL meetings and the subsequent data collection were planned, 84 patients were interviewed, the carriers of absorbent devices were 44%, of which 38% inappropriate. Discussion: The results obtained are superimposable to those present in the literature for the correlation between the inadequacy of the absorbent device and the female gender, the poor mobility and the request of the assisted. The emergency situation due to Covid-19 did not allow the implementation of the PBL meetings and the subsequent observation on the improvement of the behaviors of the health personnel, despite this it is assumed a positive outcome having previously performed the SWOT feasibility analysis of the total path. Conclusions: With a view to assistance based on fundamental care, the primary elimination need must be managed by placing the patient at the center and establishing an authentic relationship with him, in order to ensure appropriate care planning. The working group intends to complete the project once the emergency situation has ended.File | Dimensione | Formato | |
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Tesi di Laurea-Cingolani Pamela.pdf
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https://hdl.handle.net/20.500.12075/4597