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Introducción: a través de la respiración profunda guiada y consciente, el biofeedback cardiovascular, una herramienta tecnológica innovadora, permite mejorar la coherencia cardiaca y la activación del sistema nervioso parasimpático, fundamentales para recuperar y mantener la homeostasis y la salud psicoemocional. Objetivo: analizar el efecto del biofeedback cardiovascular sobre los parámetros de variabilidad de la frecuencia cardiaca en profesionales de enfermería. Materiales y método: ensayo clínico aleatorizado con dos grupos ­biofeedback y placebo­ realizado con 115 profesionales de enfermería que trabajaban en unidades de hospitalización clínica y quirúrgica de un hospital universitario, que presentaban un nivel de estrés global superior a 1, según la Escala de Síntomas de Estrés. Los grupos participaron en nueve reuniones a lo largo de tres semanas. El desenlace se evaluó mediante parámetros de rMSSD y coherencia cardiaca al final de cada reunión, medidos con el EmWave Pro Plus®, que utiliza la fotopletismografía para cuantificar los datos fisiológicos relacionados con los latidos del corazón. El análisis se realizó mediante ecuaciones de estimación generalizada, considerando α = 5%. Resultados: se evidenció una interacción significativa tiempo-grupo en los parámetros de coherencia cardiaca; el grupo de intervención presentó un aumento de los parámetros medios de coherencia cardiaca en todos los momentos de medición en comparación con el grupo de control (p < 0,001; r > 0,98). No hubo una interacción significativa entre el tiempo y el grupo en los parámetros rMSSD en ninguno de los tiempos de medición (p = 0,432). Como terapia mente-cuerpo, el biofeedback cardiovascular demostró ser útil y prometedor, ya que al promover la activación parasimpática y la relajación es posible prevenir los efectos deletéreos asociados a los estresores ocupacionales. Conclusión: la intervención con biofeedback cardiovascular tuvo un efecto mayor que el placebo en la mejora de la coherencia cardiaca, lo que se tradujo en la recuperación de la homeostasis del organismo.

Introdução: a partir de uma respiração profunda guiada e consciente, o biofeedback cardiovascular, ferramenta tecnológica inovadora, possibilita melhorar a coerência cardíaca e a ativação do sistema nervoso parassimpático, fundamentais para a recuperação e manutenção da homeostase e da saúde psicoemocional. Objetivo: verificar o efeito do biofeedback cardiovascular sobre os parâmetros da variabilidade da frequência cardíaca dos profissionais da enfermagem. Materiais e método: ensaio clínico randomizado, com dois grupos ­ biofeedback e placebo ­, realizado com 115 profissionais de enfermagem atuantes em unidades de internação clínica e cirúrgica de um hospital universitário, que apresentaram nível geral de estresse maior que 1, conforme a Escala de Sintomas de Estresse. Os grupos participaram de nove encontros por três semanas. O desfecho foi avaliado pelos parâmetros rMSSD e pela coerência cardíaca, ao final de cada encontro, aferidos através do EmWave Pro Plus®, que utiliza fotopletismografia para a quantificação de dados fisiológicos relacionados ao batimento cardíaco. A análise foi feita por equações de estimação generalizadas, considerando α = 5 %. Resultados: evidenciou-se interação tempo-grupo significativa nos parâmetros da coerência cardíaca; o grupo intervenção teve aumento nas médias dos parâmetros da coerência cardíaca em todos os momentos de aferição quando comparado ao grupo controle (p < 0,001; r > 0,98). Não houve interação tempo-grupo significativa nos parâmetros da rMSSD em nenhum dos momentos de aferição (p = 0,432). Como terapia mente-corpo, o biofeedback cardiovascular mostrou-se útil e promissor, ao promover ativação parassimpática e relaxamento possibilita a prevenção de efeitos deletérios associados aos estressores ocupacionais. Conclusão: intervenção com biofeedback cardiovascular demonstrou efeito superior a placebo na melhora da coerência cardíaca, refletindo em recuperação da homeostase do organismo.

Introduction: Through guided and conscious deep breathing, cardiovascular biofeedback, an innovative technological tool that enables improved cardiac coherence and activation of the parasympathetic nervous system, which are vital for recovering and maintaining homeostasis and psycho-emotional health. Objective: To verify the effect of cardiovascular biofeedback on heart rate variability parameters in nursing professionals. Materials and Methods: This is a randomized clinical trial conducted in two groups ­ biofeedback and placebo ­ with 115 nursing professionals working in clinical and surgical inpatient units at a university hospital, who presented an overall stress level higher than 1, according to the Stress Symptom Scale. The groups participated in nine appointments over three weeks. The outcome was assessed by rMSSD parameters and cardiac coherence at the end of each appointment, which were measured using EmWave Pro Plus®, which uses photoplethysmography to quantify physiological data related to the heartbeat. The analysis was performed using generalized estimation equations, considering α = 5 %. Results: There was a significant time-group interaction in cardiac coherence parameters; the intervention group presented an increase in the mean cardiac coherence parameters at all measurement times, when compared to the control group (p < 0.001; r > 0.98). There was no significant time-group interaction in the rMSSD parameters at any of the measurement times (p = 0.432). As a mind-body therapy, cardiovascular biofeedback proved to be useful and promising. By promoting parasympathetic activation and relaxation, it is possible to prevent the deleterious effects associated with occupational stressors. Conclusion: The intervention with cardiovascular biofeedback proved to be superior to placebo in improving cardiac coherence, resulting in the recovery of the body's homeostasis.

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Resumo O objetivo foi analisar a percepção da equipe multiprofissional sobre as práticas de atenção integral à saúde da pessoa idosa, em situação de vulnerabilidade, que foram ofertadas na APS em tempos de Covid-19. Estudo descritivo exploratório, com abordagem qualitativa, desenvolvido com 14 profissionais de saúde, atuantes em uma unidade do Serviço de Saúde Comunitária do município de Porto Alegre. A coleta de dados ocorreu entre junho e novembro de 2020, por meio de entrevistas semiestruturadas sobre a temática. Destas emergiram as seguintes categorias: Conceito de vulnerabilidade da pessoa idosa na perspectiva dos profissionais de saúde; A saúde da pessoa idosa vulnerável no contexto pandêmico; Infraestrutura, acesso e acessibilidade da pessoa idosa; Prática de atenção à saúde da pessoa idosa vulnerável. Os resultados do estudo demonstraram que os profissionais da APS entendem o conceito de vulnerabilidade, oferecendo cuidados a partir dos princípios de equidade e integralidade, e organizando o processo de trabalho de forma interprofissional. Tais achados permitem o planejamento e gerenciamento de ações focadas nas necessidades da pessoa idosa, uma vez que identificam os nós críticos do cuidado a esta população, e favorecem a construção de possíveis estratégias que contribuam para uma assistência de qualidade a este público.

Abstract The objective was to analyze the perception of the multidisciplinary team about the practices of comprehensive health care for elderly people, in vulnerable situations, offered in PHC in times of Covid-19. Exploratory descriptive study, with a qualitative approach, developed with 14 health professionals, working in a Community Health Service unit in Porto Alegre, Brazil Data collection took place between June and November 2020, through semi-structured interviews. The following categories emerged from these: The concept of vulnerability of elderly people from the perspective of health professionals; The health of vulnerable elderly people in the pandemic context; Infrastructure, access, and accessibility for the elderly; Healthcare practice for vulnerable elderly people. The study results showed that PHC professionals understand the concept of vulnerability, offering care based on the principles of equity and comprehensiveness, and organizing the work process in an interprofessional manner. Such findings allow the planning and management of actions focused on the needs of elderly people, as they identify the critical nodes of care for this population and favor the construction of possible strategies that contribute to quality care for this population.

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OBJECTIVE: to assess the burden of spouse and non-spouse caregivers of older adults with stroke-induced-dependency after discharge from a university hospital's Specialized Care Stroke Unit in southern Brazil. METHODS: a longitudinal survey. The sample consisted of 48 consenting caregivers, among which 20 were spouse caregivers. Data were collected between May 2016 and July 2018. One week after discharge, caregivers completed a sociodemographic profile, the Functional Independence Measure, and the Caregiver Burden Scale. Burden was also measured two months after discharge. Data were analyzed using Multivariate Analyses of Variance. RESULTS: regarding time 1, non-spouse caregivers experienced greater burden with respect to social isolation (p = .01). Along with a persistently greater sense of isolation (p=.04), non-spouse caregivers felt far greater general strain (p =.01). CONCLUSION: statistically significant differences in burden over time highlight the importance of assessing caregiver burden after discharge and the need for a formal support program.

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Abstract Objective: to evaluate the effect of nursing home care interventions on the quality of life in family caregivers of aged stroke survivors. Method: a Randomized Clinical Trial, blinded for outcome evaluation. Forty-eighty family caregivers of aged stroke survivors participated in the study. The Intervention Group received three home visits by nurses one month after hospital discharge to provide stroke-related education (i.e., how to access health services and perform care activities) and emotional support. The Control Group received the usual guidance from the health services. Quality of life was assessed using the World Health Organization Quality of Life Assessment (WHOQOL-BREF) instrument and the Old Module(WHOQOL-OLD) 1 week, 2 months, and 1 year after discharge. Results: the caregivers were mainly women, children, or spouses. The caregivers in the Intervention Group and Control Group did not significantly differ in terms of their Overall Quality of Life at baseline. There was no interaction effect between group allocation and Overall Quality of Life(p=0.625) over time. However, there was an interaction effect for Social Relations(p=0.019) and Autonomy (p=0.004). Conclusion: the intervention exerted a statistically significant effect on the quality of life of family caregivers with respect to social relationships and autonomy. Trial registration: NCT02807012.

Resumo Objetivo: avaliar o efeito de intervenção educativa domiciliar de enfermagem na qualidade de vida de cuidadores familiares de idosos sobreviventes de acidente vascular cerebral (AVC). Método: Ensaio Clínico Randomizado, cego para avaliação de resultados. Quarenta e oito cuidadores familiares de idosos sobreviventes de AVC participaram do estudo. O Grupo de Intervenção recebeu três visitas domiciliares de enfermeiros, um mês após a alta hospitalar, para fornecer educação relacionada ao AVC (como acessar os serviços de saúde e realizar atividades de cuidado) e apoio emocional. O Grupo Controle recebeu as orientações habituais dos serviços de saúde. A qualidade de vida foi avaliada usando o instrumento Avaliação da Qualidade de Vida da Organização Mundial da Saúde (WHOQOL-BREF) e o Módulo Old (WHOQOL-OLD) em 1 semana, 2 meses e 1 ano após a alta. Resultados: os cuidadores eram principalmente mulheres, filhos ou cônjuges. Os cuidadores do Grupo Intervenção e do Grupo Controle não diferiram significativamente em termos de Qualidade de Vida Geral no início do estudo. Não houve efeito de interação entre a alocação do grupo e a Qualidade de Vida Geral (p=0,625) ao longo do tempo. No entanto, houve efeito de interação para Relações Sociais (p=0,019) e Autonomia (p=0,004). Conclusão: a intervenção apresentou efeito estatisticamente significativo na qualidade de vida dos cuidadores familiares no que diz respeito às relações sociais e autonomia. Registro do ensaio clínico: NCT02807012.

Resumen Objetivo: evaluar el efecto de intervenciones de atención domiciliaria de enfermería sobre la calidad de vida en cuidadores familiares de adultos mayores sobrevivientes de accidentes cerebrovasculares. Método: Ensayo Clínico Aleatorizado, cegado para la evaluación de los desenlaces. Los participantes del estudio fueron 48cuidadores familiares de adultos mayores sobrevivientes de accidentes cerebrovasculares (ACV). El Grupo Intervención recibió tres visitas domiciliarias a cargo de enfermeros un mes después del alta hospitalaria, en las que se les ofreció instrucción relacionada con ACV (es decir, cómo acceder a los servicios de salud y realizar las actividades inherentes a los cuidados) y apoyo emocional. Al Grupo Control se le brindó la orientación habitual de los servicios de salud. La calidad de vida se evaluó mediante el instrumento World Health Organization Quality of Life Assessment (WHOQOL-BREF) y el módulo Old(WHOQOL-OLD) 1semana, 2meses y 1año después del alta. Resultados: en su mayoría, los cuidadores fueron mujeres, hijos o cónyuges. Los cuidadores de los grupos Intervención y Control no presentaron diferencias significativas en términos de su Calidad de Vida general de base. La intervención no ejerció ningún efecto entre la asignación a los grupos y la Calidad de Vida general(p=0,625) con el transcurso del tiempo. Sin embargo, la intervención sí tuvo efecto sobre las Relaciones Sociales (p=0,019) y la Autonomía(p=0,004). Conclusión: la intervención ejerció un efecto estadísticamente significativo sobre la calidad de vida de los cuidadores familiares con respecto a las relaciones sociales y a la autonomía. Registro del ensayo: NCT02807012.

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OBJECTIVE: to evaluate the effect of nursing home care interventions on the quality of life in family caregivers of aged stroke survivors. METHOD: a Randomized Clinical Trial, blinded for outcome evaluation. Forty-eighty family caregivers of aged stroke survivors participated in the study. The Intervention Group received three home visits by nurses one month after hospital discharge to provide stroke-related education (i.e., how to access health services and perform care activities) and emotional support. The Control Group received the usual guidance from the health services. Quality of life was assessed using the World Health Organization Quality of Life Assessment (WHOQOL-BREF) instrument and the Old Module(WHOQOL-OLD) 1 week, 2 months, and 1 year after discharge. RESULTS: the caregivers were mainly women, children, or spouses. The caregivers in the Intervention Group and Control Group did not significantly differ in terms of their Overall Quality of Life at baseline. There was no interaction effect between group allocation and Overall Quality of Life(p=0.625) over time. However, there was an interaction effect for Social Relations(p=0.019) and Autonomy (p=0.004). CONCLUSION: the intervention exerted a statistically significant effect on the quality of life of family caregivers with respect to social relationships and autonomy. TRIAL REGISTRATION: NCT02807012.

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ABSTRACT Objective: to assess the burden of spouse and non-spouse caregivers of older adults with stroke-induced-dependency after discharge from a university hospital's Specialized Care Stroke Unit in southern Brazil. Methods: a longitudinal survey. The sample consisted of 48 consenting caregivers, among which 20 were spouse caregivers. Data were collected between May 2016 and July 2018. One week after discharge, caregivers completed a sociodemographic profile, the Functional Independence Measure, and the Caregiver Burden Scale. Burden was also measured two months after discharge. Data were analyzed using Multivariate Analyses of Variance. Results: regarding time 1, non-spouse caregivers experienced greater burden with respect to social isolation (p = .01). Along with a persistently greater sense of isolation (p=.04), non-spouse caregivers felt far greater general strain (p =.01). Conclusion: statistically significant differences in burden over time highlight the importance of assessing caregiver burden after discharge and the need for a formal support program.

RESUMO Objetivo: avaliar sobrecarga de cuidadores cônjuges e não cônjuges de idosos dependentes por AVC pós-alta da Unidade de Atendimento Especializado em AVC de um hospital do sul do Brasil. Método: pesquisa longitudinal. Amostra foi composta por 48 cuidadores, sendo 20 cuidadores cônjuges. Dados foram coletados entre maio/2016 e julho/2018. Uma semana pós-alta, verificou-se a capacidade funcional dos idosos pela Medida de Independência Funcional, o perfil sociodemográfico dos cuidadores e a sobrecarga com a Caregiver Burden Scale. A sobrecarga também foi medida dois meses pós-alta. Dados foram analisados por meio de Análise Multivariada de Variância. Resultados: no tempo 1, não cônjuges apresentaram maior sobrecarga em relação ao isolamento social (p=0,01). Juntamente com isolamento (p=0,04), não cônjuges sentiram tensão geral muito maior (p=0,01). Conclusão: diferenças estatisticamente significativas na sobrecarga ao longo do tempo destacam a importância de avaliar a sobrecarga do cuidador pós-alta e a necessidade de um programa formal de apoio.

RESUMEN Objetivo: evaluar la carga de los cuidadores conyugales y no conyugales de ancianos con dependencia inducida por ictus después del alta de la Unidad de Atención Especializada en Ictus de un hospital del sur de Brasil. Métodos: una encuesta longitudinal, con 48 cuidadores (20 cónyuges). Datos fueron recolectados entre mayo/2016 y julio/2018. Una semana después del alta, se aplicó la Medida de Independencia Funcional a los ancianos y la Caregiver Burden Scale a los cuidadores. Los datos se analizaron mediante análisis multivariado de varianza. Resultados: en tiempo 1, los cónyuges experimentaron mayor carga en relación al aislamiento social (p=0,01). Los cónyuges sintieron una tensión general y sensación de aislamiento mucho mayor (p=0,01; p=0,04). Conclusión: las diferencias estadísticamente significativas en la carga a lo largo del tiempo resaltan la importancia de evaluar la carga del cuidador después del alta y la necesidad de un programa de apoyo formal.

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OBJECTIVE: development and validation the content of a nursing care protocol with educational interventions for family caregivers of elderly people after stroke. METHODS: a methodological study conducted in three stages: (1) protocol development through literature review; (2) pretest with multidisciplinary team, analyzed with literature articulation; (3) protocol validation by the Delphi Technique. RESULTS: the protocol was structured in the following areas: Disease Guidelines; Emotional Support; Using the Health Care Network; Diet; Airways; Medications; Hygiene; Skin Care; Disposal; Dressing/Undressing; Positioning and Transfer; Fall Prevention. In the pretest, eight experts assessed protocol clarity and content. In validation, there were two rounds by the Delphi Technique. The validated protocol consisted of 12 domains, containing 42 items and 240 care guidelines. CONCLUSION: the protocol qualifies the transition of care after hospital discharge assisting nurses in home care practice.

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AIM: To analyze sociodemographic factors and aspects of care related to the burden of informal caregivers of dependent elderlies in the community. METHODS: A cross-sectional study with 125 caregivers. Data collection was carried out in municipalities of the Northwest of Rio Grande do Sul through a structured interview in 2017 and 2018. The Caregiver Burden Inventory was used. The Pearson or Spearman correlation coefficients and t-student test or Analysis of Variance (ANOVA) were done. For the multivariate analysis, Linear Regression was used. RESULTS: Most caregivers were female (73.6%), married (55.2%) and daughters (68.0%). The variables that showed a statistically significant relationship with burden were: caregiver age (p = 0.039), education (p = 0.001), time devoted to care (p = <0.001), kinship degree (p = 0.001), living with the elder (p <0.001), using their income (p = 0.001) and female gender (p = 0.017). CONCLUSION: Women caregivers, with less education, who spend more time in weekly care and lived with the elder presented higher burden.

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BACKGROUND AND PURPOSE: The Portuguese instrument for informal caregivers' skills providing care of aged people after a stroke (ECPICID-AVC) evaluates the capacities that informal caregivers must have for supporting aged stroke survivors. The purpose was to adapt and validate the ECPICID-AVC to be used in Brazil. METHODS: A methodological study was conducted. RESULTS: The terms with the lowest degree of comprehension were adapted. The factor analysis suggested the exclusion of three items and that the remaining be grouped into six domains. The factor loadings varied from 0.525 to 0.924. The internal intra-assessor consistency was satisfactory (ICC = 0.94, CI 95%). Total reliability was considered excellent (Cronbach's alpha = 0.914). CONCLUSIONS: The ECPICID-AVC is considered appropriate for using in Brazil.

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AIM: To verify the relation of a nursing home care educational intervention in the use of health services by elderly people post-stroke. METHODS: A randomized controlled trial conducted with 44 family caregivers of elderly people post-stroke. Data was collected between May/2016 and July/2018 in a hospital in the South of Brazil and at the participants' homes. The intervention group (IG=21) received home visits by nurses after hospital discharge. The control group (CG=23) had a conventional follow-up in a conventional health services. The Pearson's Chi-Square Test or the Fisher's Exact Test was performed for assessment of the outcome at 60 days and 1 year after discharge. Clinical Trial registration NCT02807012. RESULTS: There was a significant difference regarding the use of hospital outpatient service (IG=100%, CG=78.3%, p<0.050) 60 days after discharge. CONCLUSION: The great use of outpatient service by the IG demonstrates the effectiveness of nursing educational intervention focused on health care network after discharge.

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