Objective: The aim of this study was to compare sleep pattern, tiredness sensation and quality of life between different chronotypes in train drivers from a Brazilian transportation company. Subjects and Methods: Ninety-one train drivers, working a rotary work schedule including night shift, were divided into three groups according to their chronotype (morning types, intermediate or evening types) and were assessed for their sleep and quality of life, as characterized by a subjective questionnaire and the Psychomotor Vigilance Task (PVT), applied before and immediately after the night shift. The pattern of activity and rest was measured for 10 days by actigraphy, and the chronotype was determined through the Morningness-Eveningness Questionnaire. Results: Forty-one (45.1%) individuals were classified as morning type, 44 (48.4%) were classified as intermediate and 6 (6.6%) as evening type. The evening types had a tendency to remain awake for a longer period of time before the night shift (p = 0.05) and scored worse overall for quality of life compared to morning types (p = 0.11). There was no significant difference between the groups regarding variability in the PVT performance, even when covaried by the period of waking time before the test. There was no significant difference either in feelings of fatigue before and after starting the shift. Conclusion: Although the evening type number was small, evening type individuals scored worse relative to sleep and quality of life than morning type individuals.

This theoretical and reflexive study analyzed the risks related to the maintenance of patency of the Peripherally Inserted Central Catheter with the use of saline solution in comparison with saline-filled syringes, through the application of the Healthcare Failure Mode and Effect Analysis - HFMEA. The process was mapped, detailing the failure modes of each step. For the calculation of the Risk Priority Number, the severity and probability of the failure modes were analyzed. This analysis gave rise to the severity and probability matrix. Finally, actions to reduce the failure modes in the maintenance of patency were proposed, considering the use of saline-filled syringes in comparison to the use of saline ampoules. It was verified that the use of saline ampoules is associated with a greater risk, since it requires four stages more than saline-filled syringe does not, increasing the risk of contamination and the level of three different risks, which would result in additional hospital costs. The use of the saline-filled syringe would avoid risks that could negatively affect the patient’s health, the nursing professional and the health institution.

Objective: To assess the MEWS association with the clinical outcomes (CO) of patients admitted to an internal medicine ward (IMW) at a Brazilian university hospital (UH). Introduction:It is important to quickly identify patients with clinical deterioration, especially in wards. The health team must recognize and act before the situation becomes an adverse event. In Brazil, nurses' work to overcome performance myths and the application of standardized predictive scales for patients in wards is still limited.Design: An observational cohort study designed and developed by a registered nurse that followed the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) checklist.Methods: Data were collected from the IMW of a UH located in the city of São Paulo, Brazil (2017). An ROC curve was calculated to strengthen the use of a MEWS of < or ≥ 4 as a cutoff. CO of the two subgroups were compared.Results: Three hundred patients completed the study; their vital signs were recorded consecutively throughout hospitalization in the IMW. The highest MEWS value each day was considered for analysis. Scores < 4 were significantly associated with a higher probability of hospital discharge, a lower chance of transfer to the ICU, a lower total number of days of hospitalization, and a lower risk of death. Score ≥ 4 had worse CO (orotracheal intubation and cardiac monitoring), transfer to the ICU, and increased risk of death. Conclusion: Scores < 4 were associated with positive outcomes, while scores ≥ 4 were associated with negative outcomes. MEWS can help prioritize interventions, increase certainty in decision-making, and improve patient safety, especially in a teaching IMW with medical teams undergoing professional development, thereby ensuring the central role of the nursing team in Brazil. Relevance for clinical practice: MEWS aid nurses in identifying and managing patients, prioritizing interventions through assertive decision-making.

Objectives: to analyze the mean direct cost and peripheral venous access length outcomes using devices over needle with and without extension. Methods: quantitative, exploratory-descriptive research. Venous punctures and length of the devices were followed. The mean direct cost was calculated by multiplying the time (timed) spent by nursing professionals by the unit cost of labor, adding to the cost of materials. Results: the total mean direct cost of using devices “with extension” (US$ 9.37) was 2.9 times the cost of using devices “without extension” (US$ 4.50), US$ 7.71 and US$ 2.66, respectively. Totaling 96 hours of stay, the “device over needle with extension” showed a lower occurrence of accidental loss. Conclusions: the use of the “device over needle with extension”, despite its higher mean direct cost, was more effective in favoring adequate length of peripheral venous access.

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