BRADEN SCALE: THE RESPONSIBILITY OF NURSES IN THE PROMOTION OF PATIENT SAFETY 1

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1 BRADEN SCALE: THE RESPONSIBILITY OF NURSES IN THE PROMOTION OF PATIENT SAFETY 1 FERREIRA, Emanuelli Mancio 2 ; MAGNAGO, Tânia Solange Bosi de Souza 3 ; CERON, Marinez Diniz 4 ; PASA, Thiana Sebben 5 ; REIS, Thamiza Laureany da Rosa dos 6 ; BORDIGNON, Juliana Silveira 7 ; SOUTO, Valquiria Toledo 8. ABSTRACT The pressure ulcers (UP) are the bigger health problem in adult patients critical. The present study it is an experience report that aims to report the experience of graduate academics in nursing in the implementation of the Braden Scale as well as to discuss the nurses role in the context of promotion of the patient safety. As methodology it is used the theoretical referential obtained during a graduation complementary discipline (GCD) entitled "Work and Patient safety", the observations of nursing academic of a Federal University of the South of Brazil and the practical applications of the Braden Scale in adult patients admitted in a surgical unit during the training. As results were discussed the definition of PU, the of risk assessment Braden Scale, performed on the unit with basis in the "Clinical Protocol for the Prevention and Treatment of Pressure Ulcers", of the hospital where it was performed the observations, and the use of the same by the nurse as a tool to help in the prevention and promotion of patient safety. We conclude that there are gaps relating to this thematic and it is 1 Relato de experiência. Universidade Federal de Santa Maria (UFSM). 2 Presenter. Graduate Student in Nursing at the UFSM, Santa Maria, RS, Brazil. Integrant of the Research Group Work, Health, Education and Nursing at the UFSM/Brazil. Trainee PIBIC/CNPq Nursing Doctor. Teacher of the Nursing Department and of the Post-Graduate Program in Nursing at the UFSM, Santa Maria, RS, Brazil. Coordinator of the Research Group Work, Health, Education and Nursing at the UFSM/Brazil. 4 Nurse. Master Student of the Post-Graduate Program in Nursing at the UFSM. Integrant of the Research Group Work, Health, Education and Nursing at the UFSM/ Brazil. 5 Nurse. Master Student of the Post-Graduate Program in Nursing at the UFSM. Integrant of the Research Group Work, Health, Education and Nursing at the UFSM/ Brazil. 6 Graduate Student in Nursing at the UFSM, Santa Maria, RS, Brazil. Integrant of the Research Group Health care of people, family and society at the UFSM/Brazil. 7 Graduate Student in Nursing at the UFSM, Santa Maria, RS, Brazil. Integrant of the Research Group Work, Health, Education and Nursing at the UFSM/Brazil. Trainee FIEX/ Graduate Student in Nursing at the UFSM, Santa Maria, RS, Brazil. Integrant of the Research Group Health care of people, family and society at the UFSM/Brazil. 1

2 of extreme importance that are developed studies involving this thematic because these studies will be subsidies to invest in the qualifications of the professionals, ensuring more quality in the service and consequently more security to the patient. Keywords: Nursing; Pressure Ulcer; Patient Safety. 1. INTRODUÇÃO When the people become users of the health services, they put their trust in the health professionals to determine the diagnoses, treatments and care necessary for the health recovery, having the right to demand that the professionals assume the responsibility for the guaranty of their safety during the implementation of all aspects of service¹. Being the nursing professionals operate in greater numbers in the health institutions, it is the nurse that has as function to coordinate the nursing team, promoting the management of patient safety. This action happen through the planning, organization and systematization of the care provided, being necessary that the nurses develop a proactive attitude and of leadership in the context of the promotion of patient safety, constituting this premise, an essential competence of our praxis in to care². In the health institutions, in particular, in the hospital environment, the patients are exposed to various risks, among them the pressure ulcers (PU). Studies estimate that one in each seven hospitalized patients has a pressure ulcer and that many of them die as a consequence of their complications ³ -4. The most efficient way to prevent the PU is the identification of patients with risk as an assessment tool validated. There are several tools that can be used. In this study we will discuss the Braden Scale because it treats about various items that are directly linked to thedevelopment of PU 5, as well as it is an instrument recommended by the Brazilian Network in Nursing and Patient Safety (REBRAENSP). In this context it is important the nurses know about instruments that evaluate the potential risk for pressure ulcers, adapting them to the reality that it lives and contributing to improving of the well-being and recovery of the patient, satisfaction of the family, decrease of hospital expenditures, the period of hospitalization and, especially, valuing for the security of this pacient 6. 2

3 2. OBJETIVOS This study aimed to report the experience of nursing academics in application of the Braden Scale in an adult hospitalization unit in the supervision of nurses, in addition to discuss the nurse s role in the context of the promotion of patient safety. 3. METODOLOGIA It is an observational experience report based in experiences of nursing academics in a Federal University of the South of Brazil, relating the discussions arising during the classes and founded by theoretical contents of the graduation complementary discipline (GCD) of the Nursing course. The GCD is entitled "Work and Patient safety and is in walking this first semester of From the discussions made in class, the academics contextualize the content absorbed. In addition, this study account with practical applications of the Braden Scale during the training performed in the seventh semester, in an Adult Surgery Unit performed in the supervision of the nurse. The application of this scale in the unit occurs based on the "Clinical protocol for the prevention and treatment of pressure ulcers" developed by the Studies Group of Skin Lesions, which performs their studies in the hospital where it was performed the trainings. 4. RESULTADOS E DISCUSSÃO The pressure ulcers (PU) will remain as a serious health problem and may cause physical discomfort for the patient, increased of costs in the treatment, prolonged hospitalization, increased of risk for infections and mortality as well as the need of intensive care of nursing. They are defined as areas of cell necrosis that occur on bone protuberances exposed to pressure by a sufficient period of time to cause tissue ischemia 7. In relation to the development of the PU, it is multifactorial because is composed of factors related with the patient and with the external environment, being the immobile in the bed the main risk factor for the occurrence in hospitalized patients 8. The choice of the Surgery Clinical Unit in the preparation of this study is due to thefact of this unit 9 to attend adult patients in pre and post-surgical and patients from 3

4 Intensive Care Unit (ICU). In relation to the time of hospitalization of the patients, the academic perceived in the observed unit that it is relatively high and can vary from days to months. In this sense, studies show that the frequency of pressure ulcers is greater in populations of high risk, such as critical patients and chronic diseases, the elderly and between those groups that stay more of 10 days 8. The nurse as responsible for the management of the nursing team should promote the patient safety through the identification of risk factors for the development of PU in patients and planning of preventive actions aimed at improving the quality of care for hospitalized patients 9. As preventive actions for the emergence of PU there are protocols of prevention and treatment of pressure ulcers, as the Braden Scale, thematic of this study that offers subsidies for that the nurses may indicate more objectively which patients are with higher risk to develop them 10. The Braden Scale was developed by Bergstrom et al, in 1987, as a means to optimize prevention strategies and reduce the incidence of PU. She evaluates six risk factors in the patient: sensory perception, humidity (skin), activity, mobility, nutrition, friction and cisilhamenty. Five of these subscales are scored from 1 to 4, except friction and cisilhamenty that evaluates to 1 to With basis in the "Clinical protocol for the prevention and treatment of pressure ulcers", of the hospital where it was performed the observations, the risk assessment of the patient that developed PU will depend of the score of Braden Scale. Adding the scores obtained in six subscales, it is get a score of Total Risk that considers patients "without risk" with score 19 or more; "low risk" of 16 to 18 points; "moderate risk" of 13 to 15 points and "high risk" of 12 points or less. It is evident that the lower the score of Total Risk, greater risk of developing PU. The revaluation for the patients considered as "no risk" and "low risk" should occur in each 72 hours and for patients with "moderate and high risk" in each 24 hours 10. The use of this scale can become a great ally of the nurse to increase the quality of the service provided to the patient because it allows to know the profile of the patient and it directs its systematization of care, being the Nursing Care Systemization is private role of the nurse and fundamental in its care and care management². Thus, it is treat that for the use of the instrument to be effective the professional must be trained to perform the evaluation of the patient by means of diagnosis of the risk situations which it is exposed and it promotes actions that ensure the patient safety during their hospitalization 9. 4

5 5. CONSIDERAÇÕES FINAIS We conclude that the pressure ulcers can be prevented through the use of instruments that assist the nurse in the care systematization provided and the increase of the quality of this care. There is also the need for deepening and the development of complementary studies in this issue as well as studies that involve the other risks that the patients are exposed in the hospital environment and the form of prevention, elimination or reduction of these risks. That the nurses implement actions aimed the promotion of patient safety. REFERÊNCIAS 1 Van Der Castle B, et. al. Information technology and patient safety in nursing practice: an internacional perspective.intern J of Med Infor. 2004; 73: Harada MJCS, et. al. O erro humano e a segurança do paciente, 2.ed. São Paulo: Editora Atheneu Lyder CH. Pressure ulcer prevention and management. JAMA. 2003; 289: Reddy M, Gill SS, Rochon PA. Preventing pressure ulcers: a systematic review. JAMA. 2006; 296: Braden B, Bergstron N. A conceptual schema for the study of the etiology of pressure sore. Rehab Nurs ;12(1): Aguiar JM, Paiva SS. Escala de Braden: avaliação dos fatores de risco para úlcera de pressão em pacientes internados em uma Unidade de Terapia Intensiva. 1.ed. Maranhão: Rev. do Hospital Universitário/UFMA. 2003; 1(2): Fernandes MF, Caliri MHL. Uso da escala de Braden e de Glasgow para identificação dos risco para úlceras de pressão em pacientes internados em centro de terapia intensiva. São Paulo: Rev Latino-am Enfermagem. 2008; 16(6): Gomes FSL, Bastos MAR, Matozinhos FP, Temponi HR, Meléndez GV. Fatores associados à úlcera por pressão em pacientes internados nos Centros de Terapia Intensiva de Adultos. São Paulo: Rev Esc Enferm USP. 2010; 44(4):

6 9 Souza, CA; Santos, I; Silva, LD. Aplicando recomendações da Escala de Braden e prevenindo úlceras por pressão - evidências do cuidar em enfermagem. São Paulo: Rev Bras Enferm. 2006; 59(3): Universidade Federal de Santa Maria, Hospital Universitário de Santa Maria, Grupo de Estudos em Lesões de Pele (GELP). Protocolo assistencial de prevenção e tratamento de úlceras por pressão. Disponível em: <http://www.husm.ufsm.br/protocolos/protocolo_gelp.pdf> Acessado em: 14 de abril de

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