Validación clínica del comportamiento de prevención de caídas en ambiente hospitalario

Araújo, Jéssica Naiara de Medeiros; Fernandes, Ana Paula Nunes de Lima; Silva, Amanda Barbosa da; Moura, Laísla Alves; Ferreira Júnior, Marcos Antonio; Vitor, Allyne Fortes

doi:10.1590/0034-7167-2017-0212

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Revista Brasileira de Enfermagem

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RESEARCH • Rev. Bras. Enferm. 71 (4) • Jul-Aug 2018 • https://doi.org/10.1590/0034-7167-2017-0212 copiar

Validación clínica del comportamiento de prevención de caídas en ambiente hospitalario

Autoría SCIMAGO INSTITUTIONS RANKINGS

RESUMEN

Objetivo:

Validar clínicamente el Resultado de Enfermería Comportamiento de prevención de caídas en pacientes hospitalizados en ambiente hospitalario.

Método:

Se trata de un estudio transversal desarrollado en un hospital universitario público, con una muestra de 45 pacientes. La recolección de datos ocurrió mediante evaluación de cuatro enfermeros, dado que un par utilizó el instrumento con las definiciones constitutivas y operativas de los indicadores y magnitudes del Resultado Comportamiento de prevención de caídas, mientas que otro par no utilizó estas definiciones.

Resultados:

Al aplicar el análisis de varianza no paramétrica por la prueba de Friedman, diez indicadores mostraron diferencias estadísticas entre las inferencias hechas por los evaluadores para cada paciente. En cuanto al coeficiente de correlación intraclase, intervalo de confianza y valor p asignado a cada indicador de la escala, la mayoría de los indicadores fue estadísticamente significativa.

Conclusiones:

El instrumento referente al Resultado Comportamiento de prevención de caídas fue considerado válido para la población estudiada.

Descriptores:
Estudios de Validación; Evaluación de Resultados (Cuidados de Salud); Accidentes por Caída; Procesos de Enfermería; Enfermería

Variables	n	%
Environmental risk factors
Environment with furniture and objects in excess	45	100.0
Absence of non-slip material	45	100.0
Absence of non-slip material in shower enclosure	45	100.0
Non-Family Room	16	35.6
Poor lighting	03	6.7
Climate conditions	02	4.4
Immobilization	02	4.4
Rug scattered on the floor	01	2.2
General risk factors
Age over 65 years	17	37.8
History of falls	05	11.1
Physiological risk factors
Postoperative Conditions	39	86.7
Visual impairments	17	37.8
Anemias	15	33.3
Foot problem	09	20.0
Lack of sleep	08	17.8
Impaired physical mobility	07	15.6
Difficulty walking	06	13.3
Decreased strength in the lower extremities	04	8.9
Orthostatic hypotension	03	6.7
Auditory difficulties	03	6.7
Impaired balance	02	4.4
Arthritis	02	4.4
Change in post-meal sugar	01	2.2
Vascular disease	01	2.2
Drug risk factors
ACE Inhibitors	11	24.4
Narcotics / opiates	11	24.4
Diuretics	10	22.2
Alcohol use	07	15.6
Antihypertensives	06	13.3
Anxiolytics	01	2.2

Indicator	With definitions		Without definitions		p value^* * Friedman Test.
	Evaluator		Evaluator
	1	2	1	2
Properly uses auxiliary mechanisms to wander	3.00	2.50	2.75	1.75	0.776
Asks for physical assistance for yourself	2.29	2.49	2.68	2.55	0.293
Uses barriers to prevent falls during bedtime	2.26	2.44	2.96	2.34	0.007
Uses handrails as needed	2.82	2.50	2.47	2.21	0.173
Keeps the environment free from accumulation of objects and obstacles and liquids on the floor	2.31	2.89	2.70	2.10	0.005
Properly uses stool and stairs	---	---	---	---	---
Uses adequate footwear to prevent falls	2.54	3.74	1.42	2.31	<0.001
Adapts the height of the toilet according to need	2.29	2.36	2.77	2.58	0.203
Uses chairs appropriately	1.66	2.51	3.19	2.64	<0.001
Uses bed properly	2.40	2.18	2.97	2.45	0.014
Uses rubber mats in the bathtub or shower box	2.64	2.45	2.45	2.45	0.112
Uses safety bars in the bathroom for hand support	2.44	2.49	2.67	2.40	0.630
Controls agitation and restlessness	1.87	3.08	2.44	2.61	<0.001
Takes precautions when taking medicines that increase the risk of falls	2.83	3.03	2.37	1.77	0.021
Appropriately uses vision correction features	2.65	2.38	2.48	2.48	0.771
Uses safe actions during transfer	1.91	2.09	3.17	2.83	<0.001
Correctly uses the alarm system	2.50	2.45	2.67	2.37	0.460
Manage urinary/intestinal urgency	2.63	2.75	2.92	1.71	<0.001
Wears appropriately sized clothes	1.88	2.85	2.64	2.63	<0.001
Correctly uses auditory correction features	3.50	3.00	1.75	1.75	0.284

Indicator	Instrument Evaluators with definitions				Instrument Evaluators without definitions
Indicator	n	ICC¹	CI	Value of p^* * Friedman Test; ICC – Intraclass Correlation Coefficient; CI – Confidence Interval.	n	ICC¹	CI	p value^* * Friedman Test; ICC – Intraclass Correlation Coefficient; CI – Confidence Interval.
Properly uses auxiliary mechanisms to wander	45	0.24	-0.38 ; 0.58	0.181	2	---	---	---
Asks for physical assistance for you	45	0.82	0.67 ; 0.90	<0.001	42	0.83	0.68 ; 0.91	<0.001
Use of barriers to prevent falls during bedtime	45	0.79	0.62 ; 0.89	<0.001	45	0.77	0.57 ; 0.87	<0.001
Uses handrails as needed	45	0.71	0.48 ; 0.84	<0.001	31	0.77	0.52 ; 0.89	<0.001
Keeps the environment free from accumulation of objects and obstacles and liquids on the floor	45	-1.46	-3.47 ; -0.35	0.998	44	0.80	0.63 ; 0.89	<0.001
Properly uses stool and stairs	9	---	---	---	17	0.67	0.09 ; 0.88	0.017
Uses adequate footwear to prevent falls	44	-0.38	-1.52 ; 0.25	0.851	43	-0.46	-1.70 ; 0.21	0.889
Adapts the height of the toilet according to need	45	0.19	-0.48 ; 0.55	0.248	42	0.70	0.44 ; 0.84	<0.001
Uses chairs appropriately	45	0.42	-0.06 ; 0.68	0.039	40	0.72	0.46 ; 0.85	<0.001
Uses bed properly	45	0.16	-0.52 ; 0.54	0.282	44	0.63	0.33 ; 0.80	0.001
Uses rubber mats in the bathtub or shower box	45	-0.06	-0.93 ; 0.42	0.575	43	-0.02	-0.88 ; 0.45	0.529
Uses safety bars in the bathroom for hand support	45	0.75	0.55 ; 0.86	<0.001	43	0.92	0.85 ; 0.96	<0.001
Controls agitation and restlessness	45	0.33	-0.22 ; 0.63	0.096	45	0.95	0.91 ; 0.97	<0.001
Takes precautions when taking medicines that increase the risk of falls	45	0.84	0.70 ; 0.91	<0.001	15	0.20	-1.37 ; 0.73	0.339
Appropriately uses vision correction features	45	0.71	0.47 ; 0.84	<0.001	13	0.73	0.45 ; 0.87	<0.001
Uses safe actions during transfer	45	-0.39	-1.54 ; 0.23	0.863	44	0.75	0.55 ; 0.86	<0.001
Correct use of the alarm system	45	0.92	0.86 ; 0.96	<0.001	43	0.72	0.48 ; 0.85	<0.001
Manages urinary/intestinal urgency	45	0.73	0.50 ; 0.85	<0.001	36	-1.06	-3.04 ; -0.05	0.982
Wears appropriately sized clothes	45	0.77	0.58 ; 0.87	<0.001	43	0.89	0.79 ; 0.94	<0.001
Correctly uses auditory correction features	45	0.76	0.57 ; 0.87	<0.001	2	---	---	---

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[1] CORRESPONDING AUTHOR: Jessica Naiara de Medeiros Araújo. E-mail: jessicanaiara_rn@hotmail.com