Empowering Nursing Students to Adopt and Embody Strengths-Based Nursing and Healthcare

This paper presents an international academic partnership in teaching and research with two case studies. The cases explore the integration of Strengths-Based Nursing and Healthcare (SBNH) and SBNH-Leadership (SBNH-L) in nursing science programs. SBNH values and foundations were integrated within an undergraduate-level community health course in Canada and SBNH-L was introduced into a graduate-level program in Brazil. Both cases comprise active learning activities promoting the uptake of the values and foundations of SBNH and the capacity to identify strengths and innate capacities. This paper synthesizes the issues and provides recommendations to enhance teaching-learning strategies to support SBNH adoption by students to support the humanization of healthcare. International partnerships in education and research and facilitating factors are discussed.

Vulnerability analysis of Haitian adolescent girls before pregnancy: a qualitative study

OBJECTIVES

This article aims to analyze the vulnerabilities experienced by Haitian adolescent girls before their pregnancy.

METHODS

A qualitative research design was developed from Dewey's social survey. From October 2020 to January 2021, semi-structured interviews were conducted with 33 pregnant adolescents living in Haiti's North and North-East departments. Thematic data analysis was performed using the qualitative data analysis software QDA miner, 6.0.5.

RESULTS

The adolescent girls interviewed were between 14 and 19. The study showed that adolescent girls experienced economic and social hardship, gender issues, and barriers to contraceptive use before pregnancy. These girls have experienced restrictive conditions that make them vulnerable to risky sexual practices and unwanted pregnancy.

CONCLUSIONS

The results have indicated that Haitian adolescent girls' vulnerabilities before their pregnancy result from economic, social, and cultural injustices to which they are exposed from early childhood. These adolescent girls are also highly vulnerable to sexual exploitation and rape, as well as pregnancy. It is essential to address these issues when implementing programs aimed at improving the living conditions of adolescents in Haiti, including the prevention of early and unwanted pregnancy.

COMPLEX CLINICAL HOSPITAL MODEL OF DISCHARGE MANAGEMENT: CONCEPTION AND IMPLEMENTATION

Objective: to present the conception and implementation of the Discharge Management Model of the Clinics Hospital Complex of the Federal University of Paraná. Method: experience report occurred between 2017 and 2020, about the design and implementation of the Discharge Management model with support of the logic model. Results: continuity of care and case management are operationalized by a dedicated team of liaison nurses who manage and counter-reference care to primary care and other points in the health care network. Conclusion: discharge management has been consolidated as a managerial strategy that integrates the health care network, avoids discontinuities in care, promotes patient and family safety, and optimizes beds, and inserts complex patients into the primary care agenda. It contributes to the continuity of care and represents evidence of a new field of work for nurses.

MODELO COMPLEXO HOSPITAL DE CLÍNICAS DE GESTÃO DE ALTA: CONCEPÇÃO E IMPLANTAÇÃO

Objetivo: apresentar a concepção e implantação do Modelo de Gestão de Altas do Complexo Hospital de Clínicas da Universidade Federal do Paraná. Método: relato de experiência ocorrido entre 2017 e 2020, sobre a concepção e implantação do modelo de Gestão de Altas com apoio do modelo lógico. Resultados: continuidade do cuidado e gerenciamento de caso são operacionalizados por uma equipe exclusiva de enfermeiras de ligação que gerenciam e contrarreferenciam os cuidados para a atenção primária e outros pontos da rede de assistência à saúde. Conclusão: a gestão de altas se consolidou como uma estratégia gerencial que integra a rede de atenção à saúde, evita descontinuidades da assistência, promove segurança aos pacientes e familiares, além de otimização de leitos, e ainda insere na agenda da atenção primária os pacientes complexos. Contribui para a continuidade do cuidado e representa evidência de um novo campo de atuação do Enfermeiro.

MODELO CLÍNICO HOSPITALARIO DE GESTIÓN DEL ALTA: DISEÑO Y EJECUCIÓN

Objetivo: presentar la concepción e implementación del Modelo de Gestión de Alta del Complejo Hospitalario de Clínicas de la Universidad Federal de Paraná. Método: informe de experiencia ocurrida entre 2017 y 2020, sobre el diseño e implementación del modelo de Gestión del Alta con apoyo del modelo lógico. Resultados: la continuidad de los cuidados y la gestión de los casos son operados por un equipo exclusivo de enfermeras de enlace que gestionan y contra revierten los cuidados a la atención primaria y a otros puntos de la red sanitaria. Conclusión: la gestión de altas se consolida como una estrategia gerencial que integra la red de atención a la salud, evita las discontinuidades de la asistencia, promueve la seguridad de los pacientes y los familiares, además de la optimización de las camas, y aún inserta en la agenda de la atención primaria a los pacientes complejos. Contribuye a la continuidad de los cuidados y representa la evidencia de un nuevo campo de trabajo para las enfermeras.

Strengths-based Nursing and Healthcare in maternities: rethinking practices and continuity of care

OBJECTIVE

To identify elements of the Strengths-Based Nursing and Healthcare in the maternity nurses care practice in a perspective of continuity of care.

METHOD

Qualitative exploratory-descriptive study. A focus group was used for data collection, seven meetings were held with 18 nurses between August 2019 and January 2020, starting from a priori categories: "problem-based nursing care" and "strengths-based nursing and healthcare".

RESULTS

In the first category, nurses' care is centered on problems identified in women; they keep a hierarchical relationship and a prescriptive posture based on a biomedical model. In the second category, care is focused on singularity, empowerment, self-determination, learning, collaborative partnership, and promotion of women's health, based on a holistic nursing model.

CONCLUSION

Although nurses use the biomedical model in their care practice, many of them already use the framework elements empirically. Applying this theoretical framework allows nurses to shift the focus of their attention from the disease to the person/family, promoting health and the continuity of care in a holistic way.

STRENGTHS-BASED NURSING AND HEALTHCARE: PERCEPÇÃO DE MULHERES EM UMA MATERNIDADE DE RISCO HABITUAL

Objetivo: apresentar a percepção das mulheres hospitalizadas em uma maternidade em relação aos cuidados de enfermagem recebidos, tendo como respaldo referencial teórico Strengths-Based Nursing and Healthcare, de Laurie Gottlieb. Método: estudo exploratório de abordagem qualitativa. Foram entrevistadas 20 puérperas hospitalizadas no período de novembro a dezembro de 2019, em uma maternidade de risco habitual em Curitiba-PR, Brasil. Os dados foram transcritos e categorizados, utilizando software MaxQDA®2020, sendo realizada a análise de conteúdo, segundo os passos de Creswell. Resultados: foram estabelecidas duas categorias: “ausência de elementos do referencial teórico”; e “presença de elementos do referencial teórico”. Conclusão: o referencial teórico foi percebido pelas mulheres nos cuidados recebidos; estas se beneficiaram com este modelo, compreendendo o seu papel ativo no processo de parturição. Desenvolver este referencial teórico nas maternidades de risco habitual e em outras realidades assistenciais é uma janela de oportunidades para o desenvolvimento do trabalho dos enfermeiros.

Cuidados de transição: análise do conceito na gestão da alta hospitalar

RESUMO Objetivo analisar o conceito Cuidados de Transição no contexto da gestão da alta hospitalar. Método reflexão analítica utilizando-se a análise conceitual de Walker e Avant: seleção do conceito; definição do objetivo, identificação do uso do conceito (busca na literatura e dicionários entre setembro-dezembro/2019 nas bases de dados: PubMed, Biblioteca Virtual em Saúde e SCOPUS. Consideraram-se 77 artigos que contemplaram conceito e outros termos que corroboraram o estudo; para fins metodológicos, 12 estudos possibilitaram a análise); definição dos atributos; descrição de caso modelo; descrição de casos adicionais; definição de antecedentes e consequentes; definição de indicadores empíricos. Resultados os antecedentes cuidados fragmentados e reinternação são comuns ao conceito. Identificaram-se atributos cuidado integrado, colaboração profissional, coordenação, planejamento da alta, comunicação, integração profissional e gerenciamento de casos. Conclusão e implicações para a prática foi oportuno analisar o conceito em conjunto com termos relacionados ao contexto da alta hospitalar. Cuidados de Transição são práticas coordenadas e eficazes para a Continuidade dos Cuidados na transferência do usuário na alta hospitalar; nesse contexto, as Enfermeiras de Ligação são potenciais protagonistas para estar à frente nesse processo de Integração. As especificidades do conceito poderão favorecer a sua compreensão e a construção de conhecimentos que repercutam no cuidado coordenado e contínuo.

Liaison nurse competences at hospital discharge

OBJECTIVE

To identify the liaison nurse competences at hospital discharge in the light of Strengths-Based Nursing Care theoretical reference.

METHOD

Descriptive and qualitative study, developed at the province of Quebéc-Canada, with 23 liaison nurses. The data were collected from March to July 2016, by a semi-structured questionnaire via Survey Monkey® electronic platform and analyzed through the content analysis, supported by software Qualitativa Data Analysis Miner.

RESULTS

The categories that has emerged were: competences related to patient care, competences related to personal characteristics of the liaison nurse and managerial competences.

FINAL CONSIDERATIONS

Liaison nurses hold a set of competences from different dimensions, which provide the care centered in the person, in its potentialities, and assure the continuity of patient care with hospital discharge.

The role of nurses in the integration of care for people with chronic noncommunicable diseases

OBJECTIVE

To describe the role of nurses in the integration of care for people with chronic noncommunicable diseases.

METHOD

This was an integrated single-case study conducted with care coordinators and nurses, purposefully selected, with interviews, documentary analysis and computerized files as sources of evidence. Categorical analysis was used based on data organization using MAXQDA® software, version 2018.

RESULTS

Thirty-four professionals participated. Most of the professionals who held coordination positions were nurses. The categories clinical team integration and care integration and their subcategories increased understanding of the roles of nurses.

CONCLUSION

The role of nurses in integrating care for people with chronic noncommunicable diseases was mainly focused on coordination of care, which occurred because of the different roles that they play and that give them autonomy to make decisions and place them in the front line to contribute to situations that required assertive attitudes, such as directing users within the care network.

Care management in coping with COVID-19 at a teaching hospital

OBJECTIVE

to report the experience of implementing care management strategies in coping with the COVID-19 pandemic in a teaching hospital.

METHOD

this is an experience report of the managers who work at the largest public hospital in Paraná with functions as Head of the Care Management Division, Head of the Care Lines Management Sector, Head of the Infectiology Unit and support team.

RESULTS

care management strategies were structured based on the service dynamics; physical structure; human Resources; professional and user safety.

FINAL CONSIDERATIONS

preparing for a pandemic involves measures that include modifying infrastructure and processes, managing employees and users, infection prevention strategies, and clinical recommendations. These measures are necessary to optimize the quality of care provided to users with COVID-19 and to reduce the risk of viral transmission to other users or health professionals.

Integration strategies for caring for chronic noncommunicable diseases: a case study

OBJECTIVES

to identify the strategies for integrated care used regarding Chronic Noncommunicable Diseases in a Health District.

METHODS

a case study developed in a district of a municipality in southern Brazil, with 34 participants (coordinators and nursing assistants). Data were collected between August 2016 and June 2017, through interviews, documents and computerized files. To organize the data, the MAXQDA® software was used. Analysis took place using the Integrated Care Network model.

RESULTS

integration strategies were highlighted in the systemic, normative and functional dimensions, such as coordination, district organization, Annual Operating Plan, information system, and user management service.

FINAL CONSIDERATIONS

the district comprises a structure that enables interactions through various tools; among these, coordination represents an effective strategy to enhance care, boost cooperation among professionals and support and manage the district.

Performance of nurses in the bed management service of a teaching hospital

OBJECTIVES

to analyze the performance of nurses in the Bed Management service of a public teaching hospital.

METHODS

descriptive, qualitative research inspired by Dubois theoretical model. 32 participants from the bed management unit and care units of a public hospital were interviewed from February to May 2018. Observations and data records from the Bed Management service complemented data collection. Theme/Category-Based Content Analysis was used.

RESULTS

the performance of nurses was described in three analysis matrices, represented by the categories: acquisition, implementation and maintenance of nursing resources; transformation of nursing resources into nursing service and results of the work of the nurse in Bed Management. Final Considerations: understanding the performance of nurses in bed management contributes to the scenario of new practices and different roles that favor visibility and strengthening of the nurse's identity.

CONTINUITY OF HOSPITAL DISCHARGE CARE FOR PRIMARY HEALTH CARE: SPANISH PRACTICE

ABSTRACT Objective: to understand discharge plan and the facilities and difficulties for continuity of care in Primary Health Care. Method: a qualitative and exploratory study carried out in Madrid, Barcelona, Murcia, Seville and Granada, with 29 hospital liaison nurses working in university hospitals, between 2016 and 2018. For data collection, an online questionnaire was used with open and closed questions about the profile of nurses; work context; hospital discharge plan; communication between hospital nurses and primary care. All were analyzed based on Thematic Analysis. Results: hospital liaison nurses from Spain draw up a discharge plan at least 48 hours in advance. They offer a Continuity of Care Report, guide patients, families and caregivers to the necessary care after hospital discharge, coordinate consultations and referrals and carry out home visits. Communication with primary care occurs through the computerized system and telephone. Monitoring takes place using indicators and statistical reports. In cases of readmission, nurses are requested and contacted by nurses in primary care. Communication with primary care is among the facilities. Lack of liaison nurses is among the difficulties. Conclusion: hospital liaison nurses from Spain carry out a discharge plan and communicate with primary care. When patients are hospitalized, they are called when there is a need for continuity of care for primary care.

ACCESS VERSUS CARE CONTINUITY IN HEALTH NETWORK SERVICES: EXPERIENCING POSSIBILITIES AND CONTRADICTIONS

ABSTRACT Objective: to understand the meaning of access to health services with a view to care continuity in the care network for users and professionals. Method: qualitative research, which used the methodological steps of Grounded Theory, carried out from November 2015 to April 2017. The theoretical sampling was obtained with 33 participants from a hospital institution and a Family Health Strategy unit. The participants were organized into three sample groups according to circular and continuous orientation of data collection and Grounded Theory analysis. The analysis was conducted according to the guidelines of the methodological framework which was composed of the open, axial and integrative coding phases. Results: four central concepts emerged from the data that demonstrate how participants experience access with a view to care continuity. These range from the first contact with the health network, through limitations and alternatives found to achieve perspectives to the care continuity in health actions and services. Conclusion: possibilities and contradictions were identified in the experience of care, with regard to access to health services and actions for the continuity of care, understanding them as feasible in health services, but divergent from the ideal advocated by the literature on the theme, as well as by the norms and prerogatives in force in the Unified Health System.

Liaison nurse activities at hospital discharge: a strategy for continuity of care

Objective

to describe the activities developed by the liaison nurses for the continuity of care after hospital discharge.

Method

descriptive, qualitative study, based on the theoretical reference. Strength Based Care. The sample comprised 23 liaison nurses. The data was collected through a semi-structured questionnaire via Survey Monkey electronic platform and analyzed through the content analysis technique, with pre-defined categories.

Results

among the liaison nurses, nine (39.14%), between 35 and 44 years of age; 17 (73.91%) were female; 15 (65.22%) were working eleven years or more nurse and 11 (47.82%), were between six and ten years old as a liaison nurse. The professionals participate in the identification of the patients who need care after hospital discharge, coordinate the planning of the hospital discharge and transfer the patient’s information to an extra-hospital service.

Conclusion

the activities developed by the liaison nurses focus on the needs of the patient and the articulation with the extra-hospital services, and can be adapted to the Brazilian context as a strategy to minimize the discontinuity of care at the time of hospital discharge.

Indicadores de segurança do paciente

Objetivo: Elaborar um instrumento de coleta de indicadores de segurança informatizado para o gerenciamento do cuidado de enfermagem em unidade de terapia intensiva de um hospital universitário referência em trauma do estado do Paraná. Método: Pesquisa descritiva, exploratória, abordagem quanti-qualitativa, realizada nas UTIs adulto de um hospital referência em trauma do Paraná. Participaram 25 enfermeiros e os dados foram coletados do acervo documental das UTIs, da aplicação de questionário e de grupo focal, no período de setembro de 2016 a fevereiro de 2017. Resultados: A elaboração de um instrumento informatizado e específico para coleta de indicadores de segurança, a partir da organização de indicadores de segurança da Enfermagem das UTIs. Considerações finais: Com vistas a uniformizar a coleta de dados, de forma rápida, segura e fidedigna e pontuar algumas particularidades das categorias dos indicadores, o instrumento elaborado auxiliará no gerenciamento do cuidado e na formulação de estratégias que ajudem a melhorar a qualidade da assistência prestada ao paciente.

The continuity of hospital nursing care for Primary Health Care in Spain

OBJECTIVE

To learn the profile and activities carried out by the Hospital Nurse Liaison for the continuity of care in Primary Health Care in Spain.

METHOD

An exploratory study with a qualitative approach developed in five University Hospitals in Madrid and three in Barcelona, with Hospital Nurse Liaisons who work in Hospitals in Madrid (8) and Barcelona (11). An online questionnaire was applied with open and closed questions for data collection. The data were analyzed by the content analysis technique in the thematic modality.

RESULTS

Nineteen (19) Hospital Nurse Liaisons participated in the study. The liaisons' ages ranged from 26 to 64 years old, the majority were women (94.73%) with experience between 21 and 30 years (52.63%), and had worked in this job between 6 months and 26 years. The Nurse Liasion is required to perform a clinical assessment of the patient prior to discharge and to contact the Nurse in the patient's area of origin by telephone or e-mail. It is necessary to have experience as an educator, to work in a team and have motivation.

CONCLUSION

Nurses in Spain perform care continuity for Primary Health Care, in which their activities encompass the availability of resources and experience in managing the care of complex patients and their families.

GESTÃO DE ALTA PARA A CONTINUIDADE DO CUIDADO: EXPERIÊNCIA DAS ENFERMEIRAS DE LIGAÇÃO DE PORTUGAL

Objetivo: descrever as atividades de continuidade do cuidado desenvolvidas pelas enfermeiras de ligação nos serviçoshospitalar. Método: estudo descritivo, exploratório, realizado de setembro/2016 a março/2017, em 15 hospitais dePortugal, com 107 enfermeiras. Os dados foram coletados com um questionário semiestruturado e analisados pormeio das frequências absolutas. Resultados:51 (47,7%) dos pacientes que necessitam de cuidados continuados sãoidentificados por médicos e enfermeiras assistenciais, 69 (64,5%) utilizam critérios para a identificação dos riscospara a alta do paciente. Os elementos considerados no planejamento de alta são: reabilitação motora e funcional,54 (30,86%); e preparo do cuidador, 41 (23,43%). As transferências das informações para continuidade do cuidadoocorrem majoritariamente por correio eletrônico, 58 (25,55%). Conclusão: as atividades para a continuidade do cuidadonão são homogêneas entre os profissionais que realizam atividades de ligação, mas contribuem para estratégias maisconsolidadas para o enfrentamento da descontinuidade do cuidado.

CONTINUIDADE DO CUIDADO E O INTERACIONISMO SIMBÓLICO: UM ENTENDIMENTO POSSÍVEL

RESUMO Objetivo: buscar um entendimento pela consubstanciação entre o conceito de continuidade do cuidado ao referencial teórico do interacionismo simbólico, no sentido de agregar uma possibilidade de fortalecê-lo como conceito indispensável ao cuidado prestado aos usuários do sistema de saúde e provocar uma necessária reflexão sobre este. Método: estudo teórico-reflexivo, organizado em quatro seções, sobre a continuidade do Cuidado analisado sob a luz do referencial do interacionismo simbólico. Resultados: o interacionismo simbólico busca compreender a ação humana em grupo e acredita que os indivíduos ajam tendo como base os significados que as coisas têm para eles. Esta é uma construção social que se desenvolve na medida em que as pessoas agem e interagem consigo mesmas e com os outros. A continuidade do cuidado, trabalhada a partir das dimensões relacional, informacional e de gestão, coaduna com o proposto, por representar um produto social resultante das interações entre os envolvidos no cuidado, que se expressa segundo sua ação e reação, como uma constante para um conjunto de práticas de diferentes profissionais que buscam garantir o cuidado integral e coerente ao usuário. Conclusão: este trabalho possibilitou apresentar a continuidade do cuidado, dentro do contexto das interações sociais, não como algo concreto, mas como um objeto social decorrente do agir de cada um dos envolvidos com o cuidado, embora, ainda assim, se perceba a necessidade de sensibilizar profissionais e usuários a respeito de seu significado e intencionalidade no agir da cada um.

Nurse liaison: a strategy for counter-referral

ABSTRACT Objective: to identify the profile of the counter-referred patients by the “nurse liaison” and to describe the experience of the professionals who participated in the project. Method: intervention research, with twelve nursing nurses from a hospital and an Emergency Care Unit, and 26 nurses from Primary Health Care. Data were obtained through questionnaires and counter-referral forms. Results: Out of 43 counter-referred individuals, 62.8% are over sixty years, 53.5% are men with multi-pathologies. Among the positive aspects, the nurses highlighted the dialogue between health care services, agility in the acquisition of inputs for the continuity of care in primary care, benefiting patients after hospital discharge. The greatest challenge was the lack of time and the deficit of nurses to perform the function. Final considerations: the presence of the “nurse liaison” has proved to be an important strategy to improve integration between services and to promote continuity of care.

Clinical competences of nursing assistants: a strategy for people management

OBJECTIVE

to identify the clinical competences of nursing assistants in a hospital organization and to understand how professional acquired these competences.

METHOD

an exploratory study of a qualitative approach, performed at a private hospital in southern Brazil, through a semi-structured interview, in May and June 2013 with 20 nursing assistants.

RESULTS

the nursing assistantswho worked longer in the same work unit had a higher list of clinical competences. The acquisition of clinical competences occurred through interaction with other professionals; in daily nursing practice; in previous experiences and in formal learning.

FINAL CONSIDERATIONS

the identification of clinical competences and the way nursing assistants acquire these competences can be important resources for managing people, which can be used by nurse managers to better allocate these professionals and provide th e opportunity for their professional development.

LA COMUNICACIÓN DEL PERSONAL DE ENFERMERÍA CON EL EQUIPO QUIRÚRGICO

O objetivo desta pesquisa foi interpretar a comunicação de enfermeiras com a equipe cirúrgica. Estudo qualitativo, em que se utilizou a Etnometodologia, com base na teoria da comunicação humana de Watzlawick. As participantes do estudo foram 19 enfermeiras, durante a coleta de dados foram aplicados formulários de entrevista e observação, de fevereiro a maio de 2015, e o estudo foi realizado em uma hospital terciário do México. A teoria acima mencionada foi analisada com o método de análise de conteúdo, para sua discussão. As enfermeiras realizam a comunicação com previsão, confirmam a informação mais significativa, e observam a importância de garantir a segurança do paciente ao se comunicar. Conclui-se que o profissional de enfermagem promove comunicação assertiva dentro da equipe; no entanto, requer-se a participação ativa de todos para obter reciprocidade e sintonia na informação, e assim manter uma comunicação eficaz para evitar riscos durante os procedimentos cirúrgicos.

The home care teaching and learning process in undergraduate health care degree courses

Home care, one of the services provided by the health system, requires health practitioners who are capable of understanding its specificities. This study aimed to build a substantive theory that describes experiences of home care teaching and learning during undergraduate degree courses in nursing, pharmacy, medicine, nutrition, dentistry and occupational therapy. A qualitative analysis was performed using the grounded theory approach based on the results of 63 semistructured interviews conducted with final year students, professors who taught subjects related to home care, and recent graduates working with home care, all participants in the above courses. The data was analyzed in three stages - open coding, axial coding and selective coding - resulting in the phenomenon Experiences of home care teaching and learning during the undergraduate health care degree courses. Its causes were described in the category Articulating knowledge of home care, strategies in the category Experiencing the unique nature of home care, intervening conditions in the category Understanding the multidimensional characteristics of home care, consequences in the category Changing thinking about home care training, and context in the category Understanding home care in the health system. Home care contributes towards the decentralization of hospital care.

Integrality of care: challenges for the nurse practice

ABSTRACT Objective: to understand the role of the nurse in the collegiate management model of a teaching hospital, in the integrality of care perspective. Method: a single case study with multiple units of analysis, with the theoretical proposition "integrality of care is a result of the care offered to the user by multiple professionals, including the nurse". Data were obtained in a functional unit of a teaching hospital through interviews with 13 nurses in a non-participant observation and document analysis. Results: from the analytical categories emerged subcategories that allowed understanding that the nurse promotes integrality of care through nursing management, team work and integration of services. Final considerations: the theoretical proposition was confirmed and it was verified that the nursing management focus on attending to health care needs and is a strategy to provide integrality of care.

CARACTERÍSTIZACIÓN DE LA AUTORIDAD EJERCIDA POR ENFERMERAS GERENTES DE INSTITUCIONES DE SALUD EN MÉXICO-PORTUGAL

Foram objetivos do estudo analisar o significado da autoridade exercida pela enfermeira gerente em instituições de saúde e comparar o tipo de autoridade de dirigentes de enfermagem no México e em Portugal. Pesquisa qualitativa, descritiva e comparativa, da qual participaram 24 gerentes de enfermagem. O instrumento utilizado foi o de roteiro de entrevista, com base nas dimensões: significado e tipo de autoridade.Discutiu-se o significado de autoridade de acordo com a teoria do interacionismo simbólico. Os resultados possibilitaram refletir sobre o significado de autoridade, revelando-se que, para as gerentes mexicanas, é um valor moral do gestor e, para os portugueses, uma competência inerente à posição. No que concerne ao tipo de autoridade exercido, para as primeiras predominou justiça, compreensão e igualdade em relação aos demais. Para os segundos,esta deve ser democrática, participativa e de aceitação. Conclui-se que não há confluência sobre a autoridade entre gerentes de ambos os países e que sua divergência incide na perspectiva final de suas decisões.

[Managerial nursing competencies in the expansion of the Family Health Strategy]

OBJECTIVE

To relate the managerial competencies required of nurses with the process of change experienced in the expansion of the Family Health Strategy (FHS).

METHOD

A qualitative research conducted in primary health care in a southern Brazilian city, through interviews with 32 managerial and clinical nurses. The interviews were processed by IRAMUTEQ software. The resulting classes were examined under five managerial competencies to promote change.

RESULTS

The four classes obtained from data were: the Family Health Strategy expansion process; confrontations and potentialities; mobilization for the change; innovations in medical and nursing consultations. The classes were related to one or more competencies.

CONCLUSION

The expansion of the Family Health Strategy requires managerial competencies of implementing and sustaining change, negotiating agreements and commitments, using power and influence ethically and effectively, sponsoring and selling new ideas, and encouraging and promoting innovation.

Good practices in collecting umbilical cord and placental blood

Objective:

to identify the factors related to the quality of umbilical cord and placental blood specimens, and define best practices for their collection in a government bank of umbilical cord and placental blood.

Method:

this was a descriptive study, quantitative approach, performed at a government umbilical cord and placental blood bank, in two steps: 1) verification of the obstetric, neonatal and operational factors, using a specific tool for gathering data as non-participant observers; 2) definition of best practices by grouping non-conformities observed before, during and after blood collection. The data was analyzed using descriptive statistics and the following statistical software: Statistica^(r) and R^(r).

Results:

while there was a correlation with obstetrical and neonatal factors, there was a larger correlation with operational factors, resulting in the need to adjust the professional practices of the nursing staff and obstetrical team involved in collecting this type of blood. Based on these non-conformities we defined best practices for nurses before, during and after blood collection.

Conclusion:

the best practices defined in this study are an important management tool for the work of nurses in obtaining blood specimens of high cell quality.

EDUCAÇÃO À DISTÂNCIA E A VALORIZAÇÃO DA ENFERMAGEM

Editorial

HEALTHCARE MANAGEMENT OF TUBERCULOSIS: INTEGRATING A TEACHING HOSPITAL INTO PRIMARY HEALTH CARE

ABSTRACT Qualitative, exploratory and interventionist case study at a teaching hospital of Paraná, with the objective of proposing a Tuberculosis Healthcare Management model focused on the hospital discharge, with a view to comprehensive care for patients with tuberculosis. Interviews were conducted with key informants (17 subjects), using the Theory of Nursing Praxis Intervention in Collective Health as the theoretical and methodological framework, with its three interdependent dimensions used as analytical categories. Weakness was revealed in the protocols for hospitalized patient care, insufficient integration between levels of care and the need for direct communication between the hospital and primary care nurses. In view of this result, a Healthcare Management Model, expressed as a flow of care with matrix support, nursing consultation and phone contact between nurses. The implementation of this model will lead to greater integration between the levels of care, permitting improvements in patient monitoring with greater probability of treatment compliance.

THE NEGOTIATOR THAT WE HAVE AND THE NEGOTIATOR THAT WE WANT IN NURSING

ABSTRACT This study aimed to identify the negotiator profile of nurse managers of a public hospital. Data collection occurred between April and June of 2012, using a semi-structured questionnaire and a logical framework as a resource for planning the development of the action plan prepared by the nine nurses who participated in the study. In the data analysis, the following categories were identified: the negotiating process; the negotiator that we have in nursing; and the negotiator that we want, according to Bardin's content analysis technique. It was evident that the nurse negotiator profile was marked by the lack of autonomy and legitimacy. The conclusion shows that nurses are essential in the negotiating process when they understand the principles of conflict management, the establishment of rules and acceptable behavior, and the instrumentalization of the teamwork to develop healthy spaces in redefining the conflict as a situation that can contribute to organizational growth.

ATIVIDADES DESENVOLVIDAS POR ENFERMEIRAS NA CAPTAÇÃO DE DOADORES DE SANGUE

Introdução: A enfermeira, como profissional habilitada para a captação de doadores de sangue, deve desenvolver ações que enfoquem essa doação como um ato voluntário, de cidadania e solidariedade, enfatizando a ausência de um substituto para o sangue. Objetivo: Descrever as atividades desenvolvidas por enfermeiras na captação de doadores de sangue.  Casuística e Métodos: Pesquisa exploratória de abordagem qualitativa, desenvolvida com 12 enfermeiras que atuavam em cinco serviços de hemoterapia da cidade de Curitiba- PR. Os dados foram coletados em junho de 2012 por meio de uma entrevista semiestruturada, gravada e, posteriormente, transcrita na íntegra. Para o tratamento dos dados utilizou-se a análise de conteúdo. Resultados: Emergiram três categorias: recrutamento junto aos familiares de pacientes internados; uso dos meios de comunicação e palestras de incentivo à doação de sangue junto às empresas. Conclusão: As enfermeiras desenvolveram ações no seu espaço de trabalho, junto aos familiares dos pacientes que necessitavam da doação de sangue e com pessoas já cadastradas no serviço de hemoterapia, o que demonstra a importância de desenvolver ações focadas nas pessoas próximas aos serviços de hemoterapia e qualificar essa prática no cotidiano das enfermeiras. Externo ao seu âmbito de trabalho, as enfermeiras desenvolveram ações educativas nos espaços proporcionados pela mídia e pelas empresas, as quais revelaram atividades voltadas à captação de doadores de sangue além dos serviços de hemoterapia em que elas atuavam.  

NURSES AND THE WORKING PROCESS AT A TEACHING HOSPITAL: IMPLEMENTATION OF THE UNIFIED HEALTH SYSTEM

Study guided by Norberto Elias's theoretical, methodological background, which objectified to analyze the changes in nurses' work process at a Teaching Hospital since the implementation of the Unified Health System. Data were gathered by means of an interview applied to 12 nurses working in the studied setting since 1990, with further discourse analysis. Eight themes emerged as results (integrality, decentralization, hierarchization, regionalization, work process, health funding and social control), and 35 thematic statements, categorized from concepts of figuration, interdependence and tension balance, which enabled discussions on relational dynamics between society and individuals in order to apply Unified Health System principles, and tension production to carry out the work process. We concluded that Unified Health System implementation-ridden changes reflected on such professionals' work process even indirectly.

Análise de modelo de tomada de decisão de enfermeiros gerentes: uma reflexão coletiva

RESUMO Objetivo: analisar o modelo de tomada de decisão construído por enfermeiros na perspectiva das teorias da administração sobre processo decisório. Método: pesquisa qualitativa na modalidade pesquisa-ação, realizada de abril a junho de 2012 que, por meio de questionário semiestruturado e seminários, buscou explorar a compreensão de nove enfermeiros gerentes de um hospital público do sul do Brasil sobre processo decisório e a natureza da tomada de decisão. Os dados foram submetidos à análise de conteúdo. Resultados: emergiram duas categorias: Situação atual de tomada de decisão, que apresentou falta de sistematização; e Construção coletiva do processo decisório, que enfatiza a necessidade da construção de um modelo de tomada de decisão. Conclusão: o modelo de tomada de decisão elaborado é limitado, pois não considera importantes aspectos do processo decisório: os limites da racionalidade humana e o ambiente externo e interno das organizações que interferem e determinam as decisões.

The nurse in the management of materials in teaching hospitals

OBJECTIVETo present the nurse's integration within materials management of six teaching hospitals of Paraná - Brazil, and to describe the activities performed by nurses within this process.METHODA study of a qualitative approach and descriptive nature, conducted in teaching hospitals in Paraná, between June and August of 2013. The data collection was conducted through semi-structured interviews with eight nurses who worked in materials management; data were analyzed using content analysis.RESULTSThese showed that nurses perform ten categories of activities, distributed into four of the five steps of the materials management process.CONCLUSIONThe nurse, in performing of these activities, in addition to favoring the development of participative management, contributes to the organization, planning, and the standardization of the hospital supply process, giving greater credibility to the work with professionals who use the materials, and to the suppliers.

Secondary care clinic for chronic disease: protocol

Background

The complexity of chronic disease management activities and the associated financial burden have prompted the development of organizational models, based on the integration of care and services, which rely on primary care services. However, since the institutions providing these services are continually undergoing reorganization, the Centre hospitalier affilié universitaire de Québec wanted to innovate by adapting the Chronic Care Model to create a clinic for the integrated follow-up of chronic disease that relies on hospital-based specialty care.

Objective

The aim of the study is to follow the project in order to contribute to knowledge about the way in which professional and management practices are organized to ensure better care coordination and the successful integration of the various follow-ups implemented.

Methods

The research strategy adopted is based on the longitudinal comparative case study with embedded units of analysis. The case study uses a mixed research method.

Results

We are currently in the analysis phase of the project. The results will be available in 2015.

Conclusions

The project’s originality lies in its consideration of the macro, meso, and micro contexts structuring the creation of the clinic in order to ensure the integration process is successful and to allow a theoretical generalization of the reorganization of practices to be developed.

Nursing care in a hematopoietic stem cells transplantation unit

In hematopoietic stem cell transplantation units, nursing care is different from other services. The objective in this descriptive study with a qualitative approach was to identify the care activities of nurses at a transplantation unit, classified according to the framework of nurses' functions. The data were collected through systematic observation and treated through content analysis. Three functions were identified for nurses: clinical nurse, management nurse and visit nurse, the first having a wider range of care activities. The maintenance of life care is focused on patient and environmental hygiene; the general techniques involve basic techniques like instrument/drug handling and patient assessment; and the specialized care includes specific activities, such as bone marrow collection and infusion, central catheter care and care for blood transfusion and chemotherapy. It was concluded that the care is integral, specialized and based on knowledge gained through additional training and expertise.

The teaching and learning experience of home care in undergraduate nursing programs

The objectives of this research were interpreted as the teaching and learning home care is experienced by students and teachers at the Nursing Undergraduate Course, at the Federal University of Paraná and build a theoretical model that explain this experience. It is a qualitative research that used the Grounded Theory method. Semi-structured interviews were performed with eight of the last academic year of nursing undergraduate course and five professors of content related to the topic. The experience in home care occurs and grows out in contact with reality through interaction between practical and theoretical issues and stage with specific working hours. The student comes across various nuances of this type of assistance, which allows understanding the health system and knowledge expansion related to home care. This fact shows that this area of expertise should be part of nursing undergraduate course because it is in expanding process and requires trained professionals to perform it.

PERFIL DE PACIENTES SUBMETIDOS AO CATETERISMO CARDÍACO: SUBSÍDIO PARA PREVENÇÃO DE FATORES DE RISCO CARDIOVASCULAR

Este estudo descritivo, transversal e de abordagem quatitativa teve como objetivo identificar o perfil dos pacientes submetidos ao cateterismo cardíaco em serviço de hemodinâmica de hospital de ensino. Durante seis meses os procedimentos foram monitorados através de formulário tipo checklist e foram incluídos no estudo procedimentos agendados de pacientes internados no hospital e de procedência ambulatorial, e excluídos procedimentos de urgência/emergência. Os resultados apontaram a predominância de pacientes do sexo masculino, com idade entre 62-69 anos, hipertensão, dislipidemia e diabetes. A identificação do perfil contribui para o desenvolvimento de estratégias de prevenção de fatores de risco para doenças arteriais coronarianas e, nesse sentido, a atuação da equipe de enfermagem se torna decisiva.

FORMAÇÃO DE COMPETÊNCIAS PARA O GERENCIAMENTO EM ENFERMAGEM

O objetivo deste estudo exploratório-descritivo foi identificar os conhecimentos, habilidades e atitudes apreendidas por 22 egressos de um curso de graduação na temática de Gerenciamento em Enfermagem. O período de coleta de dados foi de fevereiro a abril de 2010; utilizou-se, para a análise dos dados, a técnica do Discurso do Sujeito Coletivo que tem como pressuposto a Teoria da Representação Social. Como resultados surgiram Discursos do Sujeito Coletivo referentes à utilização de instrumentos gerenciais nas ações gerenciais: conhecimentos sobre gerenciamento dos recursos humanos, materiais, físicos e ambientais e do cuidado de enfermagem; habilidades gerenciais como comunicação, educação permanente, tomada de decisão; resolução de problemas e liderança; atitude embasada pelo conhecimento e influenciada pelo papel institucional da Enfermagem. O ensino do gerenciamento na graduação destaca-se pela sustentação que este propicia para o desenvolvimento de conhecimentos, habilidades e atitudes que embasam a prática gerencial em enfermagem.

POLITICS IN NURSING: AN ESSENTIAL LEARNING FOR POSTGRADUATE STUDENTS

No Canadá, como em outros lugares, enfermeiros devem enfrentar muitos desafios caso queiram participar como umgrupo que influencia em organizações de cuidados em saúde. Contudo, existem alguns facilitadores, entre eles estão a habilidade deanalisar o contexto, assuntos e percurso correto de ações sob a perspectiva política. Este artigo compartilha o resultado de aprendizado de estudantes de pós-graduação durante um seminário em politicas relacionadas aos serviços de administração de enfermagem na Universidade Laval, Quebec, Canadá. O objetivo deste artigo é apresentar o aprendizado alcançado sobre temas e assuntos discutidos e introduzir ferramentas para análise política, úteis para descrever a atual posição de enfermagem no sistema de saúde. No final do seminário, o aprendizado permitiu aos estudantes compreender diferentes elementos que devem ser considerados para avaliar a atual situação no que diz respeito a assuntos importantes para a profissão, e considerar percursos de ação para influenciar seu desenvolvimento.

Transcultural adaptation and validation of the Conditions of Work Effectiveness-Questionnaire-II instrument

OBJECTIVE

This study aims at translating and validating the content of the instrument Conditions of Work Effectiveness-Questionnaire-II CWEQ-II), developed by Laschinger, Finegan, Shamian and Wilk, modified from the original CWEQ for the Brazilian culture.

METHOD

The methodological procedure consisted of the stages of translation of the instrument into the Portuguese language; back-translation; semantic, idiomatic and cultural equivalence and tests of the final version. The instrument in the Portuguese version was applied to a group of 40 nurses in two hospitals.

RESULTS

The data resulted in a Cronbach's Alpha of 0.86 for the first hospital and 0.88 for the second one. The results of the factorial analysis are considered sufficiently satisfactory.

CONCLUSION

It is to conclude that the instrument can be used in Brazil.

[Functions of nurses in hematopoietic stem cell transplantation units]

INTRODUCTION

nurses working at the hematopoietic stem cells transplantation (HSCT) unit execute very specialized activities since transplantation is more than just being complex but involves a set of procedural techniques.

OBJECTIVE

describe activities completed by nurses working at HSCT units and classify them according to the frame of reference of a Brazilian HSTC unit.

METHOD

A qualitative descriptive research was carried out in May 2011 with 12 nurses using systematic observation techniques of their daily activities for a total of 77 hours.

RESULTS

staff nurses principally carry out caregiving activities and education whereas those related to cooperation, coordination and supervision are mainly executed by the nurse manager and visiting nurses.

CONCLUSION

nurses carry out all functions. They take charge of all transplant patients treatments and services. In some way, nurses exceed the scope of the profession.

CARACTERÍSTICAS DA PRODUÇÃO CIENTÍFICA DE ENFERMAGEM ACERCA DE TRANSPLANTE DE CÉLULAS-TRONCO HEMATOPOIÉTICAS

Revisão integrativa da literatura cujo objetivo foi identificar e caracterizar a produção científica de Enfermagem sobre Transplante de Células-Tronco Hematopoiéticas, indexada na Base de Dados em Enfermagem, na Literatura Latino-Americana e do Caribe em Ciências da Saúde, e Scientific Electronic Library Online, utilizando-se os descritores enfermagem e transplante de medula óssea. Nos 29 artigos que resultaram da análise predominaram artigos originais de pesquisa das regiões Sudeste e Sul, advindos de Programas de Pós-graduação, e publicados por enfermeiros assistenciais, docentes e discentes de Pós-Graduação. As temáticas abordadas referem-se aos cuidados e à atuação da enfermagem ao paciente e seus familiares no processo de transplante, terapêutica, organização do serviço e produção do conhecimento de Enfermagem em transplantes. Verificou-se que a produção nesta área é incipiente, pois apesar de estar em ascensão, há temas ainda não foram explorados. 

ESTRATÉGIAS GERENCIAIS PARA O DESENVOLVIMENTO DE COMPETÊNCIAS EM ENFERMAGEM EM HOSPITAL DE ENSINO

Estudo de abordagem qualitativa buscou identificar as competências gerenciais utilizadas por enfermeiros que ocupam cargo de supervisores em unidades funcionais assistenciais, em um hospital de ensino na capital paranaense; levantar as competências esperadas pelos enfermeiros sob sua responsabilidade e apreender qual a sua contribuição para o desenvolvimento dessas competências. A amostra se constituiu de dez enfermeiros. A coleta de dados foi realizada em setembro de 2010 mediante entrevista semiestruturada associada à vinheta, análise temática foi utilizada para a compreensão dos discursos. As categorias encontradas foram trabalho em equipe, comunicação, planejamento, administração de conflitos, liderança, relacionamento interpessoal, técnica, tomada de decisão, compromisso, motivação, facilidades para o desenvolvimento pessoal e profissional. Verificou-se que as competências gerenciais identificadas são tradicionais e não confluentes com o modelo institucional, contudo, as estratégias para o desenvolvimento de competências necessitam ser reavaliadas e inovadas visando resultados positivos e consolidados.