Nursing & Healthcare

Cris Renata Grou Volpe is currently teaching at the University of Brasilia -UNB, completed Master of Health Sciences University of Sao Paulo and a PhD in Nursing at the Graduate Nursing Program (UNB). She has experience in nursing, with emphasis on fundamental nursing, medical and gerontology acting on the following topics: nursing in adult health and elderly, medicine, nursing in public health, semiotics/semiotics and nursing process

Objective: To investigate the relationship between the prevalence of errors in medication process and interruptions in the nursing work in medical clinic inpatient units in two public hospitals in the Federal District, Brazil. Method: Observational, comparative and exploratory quantitative character. Data were collected from Jul’ 2012 to May’ 2014. The sample consisted of health professionals involved in the medication process, is 8 in the Hospital 1 and 18 in the Hospital 2. Results: In Hospital 1, were observed 484 doses and a total of 865 errors, of which 464 (56.3%) were directly related to work interruptions. In Hospital 2 were observed 415 doses and 583 medication errors, and these, 118 (24.4%) were associated with interruptions. Conclusions: work interruptions negatively influence the medication process, jeopardizing patient safety. Risk management measures should be implemented in order to reduce sources of interruptions in nursing work and reduce the chance of adverse medication events.

Marina Morato Stival has completed her Nursing from Health Sciences and Technologies Program of the University of Brasilia, Brazil. Currently, she conducts research on the subject of Human Aging and has published more than 30 papers in nationals and international journals.

Objective: To evaluate the nursing diagnosis of fragile elderly syndrome in the elderly with chronic diseases. Methodology: Quantitative, descriptive and cross-sectional study with 78 elderly patients with arterial hypertension and/or diabetes mellitus treated in primary care. We used a socio-demographic questionnaire, mini mental state examination, anthropometric data (weight and height), sarcopenia evaluation, body composition (bone densitometry), muscle strength (dynamometer) and functional performance evaluation (timed up and go-TUG). The nursing consultation was performed for the identification of the nursing diagnosis of the Fragile Elderly Syndrome of NANDA-I. The data were analysed in statistical software SPSS 20.0. Results: The majority of the elderly were female, with a mean age of 68.8±6.0 years and low schooling. The majority of the elderly had associated hypertension and diabetes mellitus (53.9%), 80.8% were overweight, 44.9% had cognitive deficits, 7.7% had sarcopenia and 3.8% had severe sarcopenia. The most prevalent related factors were: previous falls (79.5%), sedentary lifestyle (48.7%) and alteration in cognitive function (44.9%). The defining characteristics were identified: 93.6% with impaired memory; 93.6% impaired physical mobility; 82.1% fatigue; 76.9% impaired walking; 53.8% self-care deficit for dressing; 43.6% activity intolerance; 35.9% social isolation; 30.8% hopelessness; 29.5% self-care deficit for food; 29.5% for bath; 12.8% for intimate hygiene and 10.3% decreased cardiac output. Conclusion: Elderly individuals with risks for geriatric disabilities were identified. The identification of this diagnosis in the elderly in the primary care showed to be relevant when demonstrating a holistic approach of this elderly with chronic disease. This research is essential in view of the high prevalence observed mainly related to mobility and cognition. Nurses should be aware of the diversity of signs and symptoms involved in syndrome, as they may interfere with diagnostic accuracy and problems be judged in isolation rather than approaching a syndrome

Luciano Ramos de Lima has completed his Master in Nursing from Health Sciences and Technologies Program of the University of Brasilia, Brazil. Currently, he conducts research on the subject of Diabetes mellitus, Chronic pain and Quality of life. He has published more than 30 papers in journals nationals and internationals.

Objective: To analyse the quality of life (QoL) of individuals with diabetic mellitus type 2 (DM2) with neuropathy and pain treated in primary care in Brazil. Methodology: Transverse cohort study of quantitative approach conducted in two Basic Health Unit (UBS) users of the Unified Health System (SUS) of Brazil. The sample was 251 participants and we adopted instruments: demographic and socioeconomic profile, clinical, pain (Visual Analogue Scale). Diabetic neuropathy was investigated by the protective sensitivity loss (PSP) and by the Leeds Assessment of Neuropathic Symptoms and Signs (LANSS). QoL was evaluated using SF-6D (Short-Form 6 Dimensions-SF-6D). Results: The majority were 74.5% women, mean age 58.9±10.01 years, 68.5% with DM2 time less than 10 years. The neuropathic assessed by the LANSS was 16.3%, 97.1% had chronic pain, the neuropathic ones reported intense pain M=7.15±2.0 compared to non-neuropathic 6.4±2.3 (p=0.038), 51.2% had alteration in the monofilament test (p=0.001). The most mentioned pain descriptors were burn (p=0.004), tingling (p=0.002), and tuned and/or needling (p=0.003). The overall QOL was SF-6D averaged 0.78 points, patients with neuropathy had a lower score (mean=0.77) (p>0.05). In general, 91.2% of the QoLdor domain was the most affected among neuropathic patients, followed by mental health and vitality, and the domain less affected was social aspect, however, there was no difference between groups when compared between domains (p>0.05). Conclusion: QoL was affected in the neuropathic mainly in the domains of QoL pain, mental health and vitality. Most had chronic pain of moderate or severe intensity. Nurses should be attending to DM2 to recognize neuropathy and prevent further QoL promotion.

Miriam I Siebzehner Deputy Director and Senior Researcher Israeli Center for Technology Assessment in Health Care (ICTAHC ). She holds two MA's in Nursing from Tel Aviv University and in Public Administration from Harvard’s John F Kennedy School of Government. She received her PhD in Health Management from Ben-Gurion University. She is the Chief Nurse Officer of the Central Health District, Ministry of Health. She has published more than 30 articles in professional Israeli and international journals. She has lectured in professional educational programs in Tel-Aviv University. During 20 years, she is a Consultant to the Israeli Foreign Ministry, Division for International Cooperation on Health Issues for Latin America and selected African countries. She has received professional awards: The International Council of Nurses and 3M, Israel Award for outstanding professional achievements, the Ministry of Health Outstanding Employee Award in recognition of highest level of excellence, The Prime Minister Office Civil Service Commission Outstanding Governmental Employee Award.

In recent decades, efforts have been made by migrant workers from third world countries, to immigrate to developed countries in order to improve their wages and quality of life. This is often done in contravention of immigration laws of the destination country, especially when seeking a better life, such as infiltration of migrant workers to the United States from Mexico. This phenomenon also existed in Israel, especially from the Egypt border. The possibility of sick illegal immigrant`s access to health care institutions in most European countries is limited to emergency situations. In the United States, hospitals deal with the constant need to health expenditures, some are choosing "unlawful" deportations of illegal patients in order to save money. Utilitarianism states that the ends justify the means’ i.e. the value of an action is determined by its contribution to overall utility and happiness while minimizing the suffering. This doctrine argues that actions are morally correct, as they tend to increase happiness. This philosophy depends on consequentiality and is considered as a selfish approach, as it doesn’t take into account any kind of suffering which the society may face due to a particular action plan. In contrast, deontology is based on fairness and social justice. The moral value of the action lies in the act itself. There are things that are worth doing and there are things that we will do and no matter what will be the outcome. The presentation will highlight the questions that arise from the debate about the morality of deportation of sick illegal immigrants, the ethical approaches involved and conclusions regarding health coverage for illegal immigrants.