Celeste Bastos

Introdução: A comunicação clínica é uma competência central na formação em saúde, associada à qualidade dos cuidados e à segurança do doente. Em paralelo, a rápida incorporação de tecnologias de inteligência artificial (IA) em contextos educativos tem produzido resultados inconsistentes quanto a modelos pedagógicos, instrumentos de avaliação e desfechos reportados no treino de competências comunicacionais clínicas. Objetivo: Mapear a utilização de tecnologias educativas baseadas em IA no desenvolvimento de competências comunicacionais clínicas em estudantes pré-graduados da área da saúde. Material e Métodos: Será conduzida uma scoping review segundo a metodologia do Joanna Briggs Institute, com questão estruturada pelo modelo PCC e reporte PRISMA-ScR. Serão pesquisadas as bases MEDLINE, CINAHL, Scopus, Web of Science, ERIC e PsycINFO, complementadas por literatura cinzenta. A seleção dos estudos será realizada em duas fases (título/resumo e texto integral) por dois revisores independentes, com resolução de divergências por consenso ou por terceiro revisor. Resultados: Os dados serão sintetizados de forma descritiva e analítica, recorrendo a tabelas e matrizes de evidência que relacionem tecnologia, componentes pedagógicas e avaliação, sendo os desfechos organizados segundo a Pirâmide de Miller e, quando aplicável, segundo o nível 1 do modelo de Kirkpatrick. Discussão: A revisão permitirá caracterizar abordagens educativas, identificar lacunas e clarificar a natureza da evidência disponível. Conclusão: Espera-se contribuir para a sistematização do conhecimento e apoiar decisões curriculares e futuras investigações neste domínio.

Background: Catheter-associated urinary tract infection (CAUTI) is a frequent and preventable healthcare-associated infection. Nurses play a central role in CAUTI prevention, yet barriers to consistent implementation of evidence-based practices persist. In Portugal, few studies have explored nurses’ lived experiences in this area. This study aimed to explore Portuguese oncology nurses’ perceptions of barriers and facilitators to CAUTI prevention, and to identify suggestions for improving urinary catheter-related care. Methods: An exploratory qualitative study was conducted with a purposive sample of eight oncology nurses from a Portuguese oncology hospital. Data were collected through a 90-minute focus group, in February 2023, and analyzed using inductive thematic analysis. The Nursing Role Effectiveness Model informed data interpretation and theme organization. Results: Two main domains emerged: structural variables and process-related variables. Nurses identified facilitators such as continuing education, access to catheterization kits, and a positive team culture. Barriers included inconsistent material availability, gaps in supervision of delegated tasks, variability in catheterization practices, and challenges in interprofessional communication. Patient and family engagement was rarely mentioned, suggesting that CAUTI prevention was conceptualized primarily as a nurse-driven activity. Nurses valued opportunities for reflective practice and expressed interest in standardized protocols and improved documentation systems. Conclusions: Oncology nurses demonstrated strong engagement in CAUTI prevention, yet gaps remain in supervisory practices and patient involvement. Fostering reflective practice, enhancing supervisory skills, and broadening conceptions of nurse-sensitive outcomes may support more comprehensive and sustainable CAUTI prevention strategies in clinical practice. Clinical trial number: Not applicable.

Introduction: Nursing management of peripheral intravenous catheters remains suboptimal and often lacks integration with underpinning theory. Therefore, it is essential to reflect on the persistent gap between theory and practice to enhance patients’ outcomes in this area. Objectives: To conceptually evaluate the integration of Tanner's Clinical Judgment Model using Chinn and Kramer's criteria, and to explore the integration of these two complementary frameworks with Kramer's Ways of Knowing for peripheral intravenous catheter decision-making and patient outcomes improvement in the emergency department. Methods: A discussion paper, using Tanner's Clinical Judgment and Chinn & Kramer's Models, to bridge theory and practice, in peripheral intravenous catheter management in the emergency departments, done in October 2024, through consensus among authors, in interactive rounds. Results: According to Chinn and Kramer's model, which advocates evidence-informed and theory-based practice, the absence of theory in nursing education and practice is detrimental to the discipline. Tanner's model supports the integration of evidence into practice, and Chinn and Kramer's framework guides nurses in refining their decisions. In deciding whether to insert a peripheral intravenous catheter, emergency department nurses engage in cognitive and reflective processes, consult evidence-based guidelines, and integrate empirical evidence with personal and ethical considerations to ensure technically sound, empathetic, and ethically grounded patient care. Conclusions: This article analyses and promotes critical reflection on advanced practice nursing decision-making in the emergency department, exemplified by the holistic, evidence-informed processes that nurses use in peripheral intravenous catheter management. Future research is needed to evaluate the effectiveness of these models in education and clinical reasoning in specific emergent situations.

Background: Healthcare-associated infections surveillance is a cornerstone of infection prevention and control, essential for guiding effective program implementation. Timely and clear dissemination of surveillance data is critical to inform decision-making and improve clinical practice. However, traditional lengthy reports are often overlooked due to time constraints among healthcare professionals. To address this, a secondary hospital introduced infographics as a concise and visually engaging method to communicate healthcare-associated infections surveillance data, aiming to enhance feedback and promote more impactful communication. This study explores infection prevention and control link nurses’ perspectives on using infographics to disseminate healthcare-associated infections surveillance data. Methodology: A descriptive qualitative design was employed, using semi-structured individual interviews conducted with thirteen purposively selected participants. Narrative data were analyzed using Bardin’s content analysis methodology. Results: Three key themes emerged as follows: Data awareness; infographic use; and team engagement. Participants emphasized that infographics simplified complex data, improved accessibility, and fostered team engagement. When integrated into educational and clinical workflows, infographics were perceived as effective tools for promoting reflection and supporting a culture of continuous quality improvement. Conclusions: Our findings suggest that infographics offer a promising approach to enhance communication of surveillance data. Their use may support informed decision-making and contribute to improved infection prevention and control practices.

Antimicrobial resistance (AMR) is a pressing global health challenge, driving the need for effective antimicrobial stewardship (AMS) programmes. Despite nurses’ critical role in care delivery, their involvement in AMS remains under-recognized. Objectives: This mapping review aims to identify barriers and facilitators influencing nurses’ engagement in AMS programmes and examine nursing-sensitive outcomes associated with their participation, using Irvine’s Nursing Role Effectiveness Model (NREM) as a guiding framework. Methods: A systematic mapping review was conducted following Joanna Briggs Institute (JBI) guidance and reported using the PRISMA-ScR checklist. The protocol was registered on the Open Science Framework. Searches were conducted in MEDLINE, CI-NAHL, Scopus, LILACS, Scielo, and grey literature sources. Data were extracted and categorized according to the NREM domains: structure, process, and outcomes. Results: Thirty-two studies were included. Key barriers included limited AMS knowledge, role ambiguity, hierarchical dynamics, communication gaps, and lack of standardized nursing outcomes. Facilitators encompassed targeted AMS education, participation in multidisciplinary discussions, managerial support, and defined nursing roles. Nurse-led interventions showed potential to improve infection control and antibiotic administration, although standardized outcome reporting remains scarce. Conclusions: Framed by the NREM, this review underscores the essential contribution of nurses to AMS. Addressing structural barriers, enhancing role clarity, and fostering interdisciplinary collaboration are critical to enabling nurses’ full participation. Strengthening nursing engagement in AMS not only supports effective antimicrobial use and patient safety but also reinforces health system resilience and sustainability.

Introduction: Accurate assessment of body temperature is essential for clinical decision-making in the care of critically ill patients, and requires careful selection of measurement devices based on scientific and technical evidence. The aim of this study was to evaluate the sensitivity of different devices for measuring body temperature in critically ill patients, and to determine the accuracy of four non-invasive devices compared to the esophageal thermometer, which is considered the gold standard. Materials and Methods: A quantitative, descriptive-correlational study was carried out on patients admitted to the intensive care unit of a Portuguese hospital. Five devices were used to assess body temperature at each time point: esophageal, axillary, frontal, groin skin and tympanic thermometers. The study was submitted to and approved by the hospital’s Ethics Committee. Results: 65 body temperature assessments were carried out on a sample of 30 patients. Each patient underwent two or three measurements. Differences in sensitivity were observed between the five body temperature measuring devices. However, there mean temperatures obtained in the groin skin and the frontal region did not differ statistically significantly from the mean esophageal temperatures. Conclusion: The esophageal thermometer proved to be accurate in the continuous assessment of core temperature, confirming data previously described in the literature. On the other hand, peripheral temperature thermometers were less accurate and sensitive than the esophageal thermometer. However, it is essential to understand the causes of these differences and explore the implications for clinical practice.

Enquadramento: A pessoa em situação crítica no contexto da medicina intensiva apresenta maior vulnerabilidade para desenvolver úlceras por pressão (UPP). Objetivo: Identificar os fatores de risco no desenvolvimento de UPP nos doentes internados em cuidados intensivos. Metodologia: Estudo observacional, longitudinal, retrospetivo, de natureza quantitativa. Foram analisados 116 doentes, entre junho e dezembro de 2020, internados por mais de 10 dias numa unidade de cuidados intensivos, em três momentos distintos, o dia da admissão (DO), o 10º dia (D1O) e o momento da alta (DALTA). Nesta análise incluímos variáveis principais e secundárias. Resultados: Os 116 doentes apresentavam uma média de idades de 58,98 anos e 49,7% desenvolveram uma UPP. Houve uma associação estatisticamente significativa entre o desenvolvimento de UPP a presença de dispositivos (SNG, VMI, imobilização cervical e cateter vesical), nos doentes com alteração do estado de consciência, em ECMO com suporte de aminas. Conclusão: A vulnerabilidade é evidente perante os fatores identificados. O seu conhecimento permite a prescrição de intervenções de enfermagem que resultem na prevenção de UPP.

Blood culture is crucial for accurate and timely bacteremia diagnosis and guide antibiotic therapy. However, during culture sampling, contamination can occur, resulting in misdiagnosis, unnecessary antibiotic exposure, and prolonged hospitalization. This before-and-after intervention study aimed to evaluate the effectiveness of a multimodal intervention in preventing blood culture contamination. The study was conducted in a 170-bed hospital in Portugal and included a total of 23,566 blood cultures. Contamination rates were assessed in two phases: Phase 1 (before intervention, month 0) included 10,928 cultures, and Phase 2 (after intervention, month 6) included 12,638 cultures. During the study period, a multimodal intervention targeting the nursing staff was implemented, consisting of training actions, guideline updates, regular data monitoring and feedback, and introduction of a blood culture pack. Following the intervention, blood culture contamination decreased from 6.8% (Phase 1) to 3.9% (Phase 2). A comparative analysis revealed that the risk of contamination before the intervention was nearly four times higher in first culture, OR = 3.97 (CI 2.86–5.49). Our findings suggest that the multimodal intervention enhanced nurses’ adherence to recommended practices, resulting in a reduced risk of blood culture contamination, earlier identification of infectious agents, and improved accuracy of antibiotic therapy.

Enquadramento: a preparação de medicação injetável é um procedimento clínico realizado frequentemente pelos enfermeiros, sendo que a literatura salienta a baixa uniformização das práticas entre instituições e entre profissionais, bem como, desvios no que respeita aos princípios da segurança. Objetivos: conhecer a prática de preparação de medicação injetável realizada pelos enfermeiros; avaliar o grau de importância que os enfermeiros atribuem à preparação segura; analisar a associação entre a importância atribuída à preparação segura de injetáveis e as variáveis socioprofissionais. Metodologia: estudo observacional, descritivo e transversal. Foram observadas 45 situações de preparação de medicação injetável através de uma grelha de observação. Posteriormente, 20 enfermeiros responderam a um questionário sobre o grau de importância que atribuem à preparação segura de injetáveis. Resultados: verificou-se desvios às recomendações que garantem a segurança do procedimento. A higiene das mãos salientou-se positivamente (adesão de 95.6%). As respostas aos questionários traduzem uma discrepância entre a importância atribuída pelos participantes à segurança e as práticas observadas. Conclusão: os resultados permitem uma primeira análise dos pontos fortes e das fragilidades da preparação de medicação injetável realizada pelos enfermeiros, possibilitando a identificação de estratégias de intervenção que poderão contribuir para a melhoria das práticas em uso no contexto estudado.