Implementação de um protocolo de banho no leito para pacientes adultos criticamente enfermos em unidades de terapia intensiva

Abstract

The bed bathing practice is the moment of care that brings the caregiver closer to the individual being cared for. Hence, it may be considered as a ritualistic practice between the two, where various sensations are experienced, such as fear and anguish. To implement and validate a bath protocol in critically ill adult patients hospitalized in an Adult Intensive Care Unit (ICU) in the metropolitan area of POA, RS, Brazil. This was an implementation study. It is part of the project "Research and intervention in nursing: Systematization of Nursing Assistance to strengthen the Healthcare Network of São Leopoldo/RS". The implementation process was carried out using the PDSA tool (Plan, Do, Study and Act), which makes it possible to reevaluate the process at each phase. The implementation consisted of the following phases: Planning phase (P): technical visit to the unit, which helped with understanding the routines and procedures of the workplace. Composition of the work team (WT): multiprofessional team consisting of two nurses, one physician, one physiotherapist and two nursing technicians. Three meetings, lasting no more than two hours, were set up to present the proposal and the implementation process. Do phase: The bath protocol was analyzed and evaluated prior to its application by the AGREE II tool, which is composed of 25 items, two of which concerning overall assessment and 23 items organized into six quality domains, namely: Scope and Purpose; Involvement of interested parties; Rigor of development; Clarity of presentation; Applicability and editorial independence. Each item was assessed by the Likert scale with scores ranging from one (totally disagree) to seven (totally agree). The calculation for each domain was performed by summing all scores of individual items, and it was scaled as a percentage of the maximum possible score in the domain. Study Phase (S): The inconsistencies found in the protocol concerning the local reality were discussed, re-evaluated and corrected by the WT. All corrections and adaptations were based on the best scientific evidence available. Adaptation of the protocol followed the ADAPTE instrument, which consists of three phases: Configuration, Adaptation and Completion. All ADAPTE phases were followed; however, the items of each component were evaluated and, if necessary, removed, so that not to make it impracticable the adaptation of the bath protocol. After the elaboration and validation of the final protocol, the implementation process took place in the adult ICU of the hospital. Act Phase (A): The implementation was planned with the head of nursing and the nurses of the unit, starting with a pilot test in the afternoon shift, where all the team was trained. After an adaptation period, the protocol was implemented in the morning shift. Patients admitted to the ICU benefited from the implementation of an adapted and validated bath protocol. It is essential that nursing assistance in intensive care be based on scientific evidence, so that the best practices are utilized in the work process. Thus, bed bathing in critically ill adult patients should be a frequent topic of discussion as it comprises the central part of nursing care and, as such, should be practiced safely to minimize risks to patients.