Thesis advisor: Rosanna DeMarco / Abstract Testing the Efficacy of A Nurse-Led, Patient Self-Management Intervention to Decrease Rehospitalization in Older Adults Merrily Evdokimoff, Ph.D. Rosanna DeMarco, Ph.D., Committee Chair Rehospitalization rates of 20% within 30 days of hospital discharge and 27% within 60 days are one of the highest strains on the federal Medicare budget. The Center for Medicare and Medicaid Services (CMS) has responded by imposing financial disincentives in reimbursement regulations directed to those providers deemed responsible for preventable rehospitalizations. Identifying cost-effective interventions that are appropriate for individuals with chronic illnesses that may be provided within the current home health care system of reimbursement is critical. The purpose of this quasi-scientific intervention study was to test the efficacy of a cost-effective, nurse-led intervention to decrease rehospitalizations of community dwelling older adult Medicare beneficiaries receiving certified home health services following an acute care hospital admission. The intervention was based on Eric Coleman's Care Transition Intervention SM utilizing a personal health record, patient goal setting, and knowledge of "red flags" or changes in condition. Coaching by the home care nurses was added to Coleman's intervention to facilitate support of patient self-management. Three home care agencies, 60 clinicians and 87 patients participated in the study. Findings demonstrated a lower rate of readmission to the hospital in patients receiving the intervention. However, it was not statistically significant. Significant differences were noted between the intervention and the comparison groups including more married or partnered members and higher Case Mix Weight (CMW) or acuity score within the intervention group. Among the rehospitalized participants, provision of a greater number of skilled nursing visits was found. Future replication of the study should include a larger sample and greater time for education of the clinical staff. Inclusion of therapists and productivity adjustments for participating staff during initiation of study is also needed. Further examination of the role of depression in rehospitalization with a larger sample would provide greater understanding of the role depression plays in self-management and rehospitalization. / Thesis (PhD) — Boston College, 2012. / Submitted to: Boston College. Connell School of Nursing. / Discipline: Nursing.

A cobrança da sociedade pela melhoria da qualidade dos serviços de saúde implica na busca de ações pela enfermagem, para a implementação da Prática Baseada em Evidências (PBE), uma vez que a assistência, pautada em evidências geradas por meio de métodos científicos, pode contribuir para aumentar os resultados do cuidado de saúde. A utilização de resultados de pesquisas na prática clínica é um dos componentes da PBE, entretanto, ainda, é desafio para a enfermagem. Assim, dentre as ações que podem minimizar a lacuna entre o conhecimento produzido e sua aplicação, está a identificação de barreiras que impedem a interdependência entre pesquisa e prática. O presente estudo teve como objetivos gerais: realizar a adaptação cultural do instrumento The Barriers to Research Utilization Scale e analisar as propriedades métricas de validade e confiabilidade do instrumento The Barriers Scale, versão para o português brasileiro. Trata-se de pesquisa metodológica conduzida por meio das seguintes etapas: processo de adaptação cultural - tradução e retrotradução; validade de face e conteúdo - Comitê de Juízes; validade de construto - dimensionalidade e grupos conhecidos e análise de confiabilidade - teste-reteste. The Barriers Scale possui 29 itens distribuídos em quatro fatores, a saber: Fator 1 - Enfermeiro, Fator 2 - Organização, Fator 3 - Pesquisa e Fator 4 - Comunicação, com valores de respostas que variam de 1 (inexistente) a 4 (enorme), sendo que os valores maiores refletem maiores barreiras para utilização de resultados de pesquisas na prática. Os dados foram coletados em dois hospitais, por meio da aplicação de um instrumento para caracterização sociodemográfica e profissional dos enfermeiros e The Barriers Scale - versão para o português brasileiro, no período de outubro de 2014 a junho de 2015, com a participação de 335 enfermeiros. O nível de significância foi de 0,05. Os resultados evidenciaram que a maioria dos participantes era do sexo feminino (88,7%), com idade média de 33,9 anos, solteiros, mestres, com um único vínculo empregatício e em regime celetista. A maioria dos enfermeiros não havia realizado curso sobre a utilização de resultados de pesquisas, na prática clínica (85,1%), e desenvolvia ou já tinha conduzido pesquisas em enfermagem (68,4%). Na avaliação das propriedades métricas, a análise fatorial confirmatória demonstrou que a versão para o português brasileiro, composta por quatro fatores, está adequadamente ajustada à estrutura dimensional, originalmente proposta pela autora principal. A validade de construto foi determinada por grupos conhecidos, os resultados demonstraram diferenças estatisticamente significativas, sendo que os enfermeiros que atuavam em instituição, com cultura organizacional direcionada para a PBE, eram mestres ou doutores, tinham características favoráveis à PBE e identificaram menores barreiras para a implementação de resultados de pesquisas, na prática clínica. A confiabilidade, avaliada em intervalo de sete dias, indicou valores apropriados para o Coeficiente de Correlação Intraclasse, entre 0,75 e 0,84, e com diferença estatisticamente significativa. A avaliação da consistência interna demonstrou valor adequado para a versão para o português brasileiro de The Barriers Scale (? de Cronbach=0,92). Concluiu-se que The Barriers Scale, versão para o português brasileiro, é válida e confiável na amostra estudada / The society\'s demand to improve the quality of health services implies the search for nursing actions for the implementation of Evidence-Based Practice (EBP), since care guided by evidence generated through scientific methods can help increase health care results. The use of research results in clinical practice is one of the EBP components; however, it is still a challenge for the nursing team. Thus, one of the actions that can minimize the gap between the knowledge produced and its application is the identification of barriers that prevent the interdependence between research and practice. This study\'s overall objectives were: to perform the cultural adaptation of The Barriers to Research Utilization Scale and analyze the metric properties of validity and reliability of the instrument The Barriers Scale - Brazilian Portuguese version. A methodological study was conducted through the following steps: cultural adaptation process - translation and back-translation; face and content validity - expert committee; construct validity - dimensionality and known groups and reliability analysis - test-retest. The Barriers Scale consists of 29 items distributed into four factors, namely: Factor 1 - Nurse, Factor 2 - Organization, Factor 3 - Research, and Factor 4 - Communication. The response values range from 1 (nonexistent) to 4 (massive), wherein the highest values reflect greater barriers to using research results in practice. Data were collected at two hospitals, through the application of an instrument for sociodemographic and professional characteristics of the nurses and The Barriers Scale - Brazilian Portuguese version, from October 2014 to June 2015, with the participation of 335 nurses. Significance was set at 0.05. The results showed that most participants were women (88.7%), with a mean age of 33.9 years, bachelors, masters, with a single job and under the Consolidation of Brazilian Labor Laws (CLT regime). Most nurses had not taken a course on the use of research results in clinical practice (85.1%) and were developing or had already conducted studies in nursing (68.4%). In the evaluation of the metric properties, the confirmatory factor analysis demonstrated that the Brazilian Portuguese version of scale, consisting of four factors, is properly adjusted to the dimensional structure originally proposed by the main author. Construct validity was determined by known groups. Results showed statistically significant differences, and the nurses working in an institution with organizational culture directed to the EBP were either masters or doctors, had favorable characteristics to the EBP and identified lower barriers to the implementation of research results in clinical practice. The reliability, evaluated in seven-day intervals, indicated appropriate values for the intraclass correlation coefficient, between 0.75 and 0.84, with a statistically significant difference. The evaluation of the internal consistency demonstrated appropriate values for the Brazilian Portuguese version of The Barriers Scale (Cronbach\'s ? = 0.92). In conclusion, The Barriers Scale - Brazilian Portuguese version is valid and reliable as per the studied sample

A eletrocirurgia é uma tecnologia amplamente utilizada nas salas cirúrgicas. O período perioperatório oferece riscos para o paciente desde o momento da sua entrada no bloco operatório até o retorno para a unidade de origem e a eletrocirurgia constitui um destes riscos. A escassez de produção científica relacionada ao uso desta tecnologia nos motivou a elaborar este estudo. A implementação da prática baseada em evidências tem se tornado fundamental para a tomada de decisão do enfermeiro, sendo escolhida como o referencial teórico-metodológico adotado. O presente estudo é uma revisão integrativa da literatura, que teve como objetivo buscar e avaliar as evidências disponíveis na literatura sobre o conhecimento científico já produzido sobre os cuidados de enfermagem relacionados ao uso de eletrocirurgia no período intra-operatório. Para a seleção dos artigos utilizamos as bases de dados Medline e CINAHL, cuja amostra foi de 21 artigos científicos, os quais foram categorizados nas temáticas: complicações decorrentes do uso da eletrocirurgia (5 artigos); complicações decorrentes do uso da eletrocirurgia de alta potência (4 artigos); complicações decorrentes do uso da eletrocirurgia, outros equipamentos elétricos e agentes anti-sépticos (3 artigos); conhecimento dos enfermeiros sobre a unidade de eletrocirurgia (2 artigos) e recomendações práticas para o uso da eletrocirurgia (7 artigos). Os artigos publicados na área da enfermagem abordaram na sua maioria as recomendações práticas para o uso da eletrocirurgia (7 artigos); os relatos de casos (2 artigos) descreveram as queimaduras decorrentes do uso de eletrocirurgia com correntes de alta potência e 2 artigos avaliaram o conhecimento geral dos enfermeiros em eletrocirurgia. Na área médica todos os artigos eram relatos de casos (7 artigos), os quais descreveram as complicações (queimaduras) ocorridas devido a utilização desta tecnologia e as publicações consideradas de outras áreas (3 artigos) abordavam as queimaduras ocorridas no eletrodo dispersivo e em local alternativo. Os resultados deste estudo apontaram que é imperativo para o enfermeiro perioperatório o conhecimento técnico-científico sobre o uso da eletrocirurgia e as evidências encontradas fornecem subsídios para a implementação de políticas e procedimentos que garantam a segurança do paciente minimizando os riscos potenciais no uso desta tecnologia. / The electrosurgery is a technology largely used in surgical rooms. The perioperative period presents risks to patients from the moment they enter the surgical unit until they return to the unit of origin, and the electrosurgery constitutes one of these risks. The lack of scientific production related to the use of this technology motivated us to elaborate this study. The implementation of evidence-based practice has become fundamental to the nurse\'s decision process and was chosen as the theoreticalmethodological referential adopted. The present study is a literature integrative review that aimed to seek and evaluate the evidences available in the literature on the scientific knowledge produced on nursing care related to the use of electrosurgery in the period intra-surgical. For the selection of articles, the databases Medline e CINAHL were used and 21 scientific articles composed the sample, which were categorized in the themes: complications caused by the electrosurgery (five articles); complications caused by the use of high frequency electrosurgery (four articles); complications caused by the use of electrosurgery, other electrical equipments and anti-septic agents (three articles); nurse\'s knowledge about the electrosurgery unit (two articles) and practical recommendations for the use of the electrosurgery (seven articles). The articles published in the area of nursing approached, in their majority, practical recommendations for the use of electrosurgery (seven articles); the case reports (two articles) described burns caused by the use of electrosurgery with high frequency electric current and two articles evaluated nurse\'s general knowledge on electrosurgery. In the medical area all the articles were case reports (seven articles), which described the complications (burns) that occurred due to the use of this technology and the publications considered from other areas (three articles) approached burns that occurred in dispersive electron and in alternative site. The results of this study indicate that it is imperative for the perioperative nurse the technical-scientific knowledge about the use of the electrosurgery. The evidence found supports implementation of policies and procedures that assure the safety of the patient minimizing potential risks in the use of this technology.

Purpose: To describe occupational therapists experiences of development in occupational therapy at The Swedish Public Employment Service. Method: The study was conducted using qualitative interviews. Thirteen occupational therapists working at The Swedish Public Employment Service participated. The occupational therapists had a geographical spread throughout Sweden. Collected data was transcribed and analysed according to qualitative content analysis. Result: Data resulted in five categories as follows: To work with development of scientific methods, Importance of feasibility to competence development, Cooperation as a part of the improvement work, Preconditions to be person-centered and Importance of continual evaluation to improve actions. The occupational therapists describes in these categories various supportive and hindering factors at to what extent they had preconditions to carry out and develop occupational therapy at The Swedish Public Employment Service. Supporting factors were described as well-developed methods, a person-centered approach and intern cooperation. Obstructing factors were described as defective coordination between social actors in the community, insufficient evaluations, limited possibilities to competence development and implementation of research. Conclusion: This study contribute to knowledge of occupational therapists preconditions to development of methods and improvement work. The study shows that it is a lack of knowledge and a need of research is required to illustrate the role of occupational therapists within vocational rehabilitation at The Swedish Public Employment Service. / Syfte: Att beskriva arbetsterapeuters erfarenheter av utveckling inom arbetsterapi vid Arbetsförmedlingen i Sverige. Metod: Studien genomfördes med kvalitativa intervjuer. Tretton arbetsterapeuter med anställning vid Arbetsförmedlingen deltog. Arbetsterapeuterna hade en geografisk spridning över hela Sverige. Insamlad data transkriberades och analyserades enligt kvalitativ innehållsanalys. Resultat: Data resulterade i fem kategorier enligt följande: Att arbeta med utveckling av vetenskapliga metoder, Betydelsen av möjlighet till kompetensutveckling, Samverkan som en del i utvecklingsarbetet, Förutsättningar till personcentrering samt Betydelsen av ständig utvärdering för förbättrade åtgärder. Arbetsterapeuterna beskriver i dessa kategorier olika faktorer som stöttade och hindrade i vilken utsträckning som de hade förutsättningar att utföra och utveckla arbetsterapi vid Arbetsförmedlingen. Stödjande faktorer beskrevs bland annat som välutvecklade metoder, ett personcentrerat arbetssätt och interna samarbeten. Hindrande faktorer beskrevs som undermålig samverkan med samhällsaktörer, bristande utvärderingar samt begränsade möjligheter till kompetensutveckling och implementering av forskning. Slutsats: Studien bidrar till kunskap kring arbetsterapeuternas förutsättningar till utveckling av metoder och förbättrande arbetssätt. Studien visar på en kunskapslucka och behov av forskning kring ämnet är nödvändigt för att belysa arbetsterapeuters roll inom den arbetslivsinriktade rehabiliteringen vid Arbetsförmedlingen.

A Iniciativa Hospital Amigo da Criança (IHAC) é amplamente adotada nas maternidades brasileiras, porém não considera o contexto complexo e tecnológico das unidades neonatais e as dificuldades de amamentar o prematuro. As evidências científicas comprovam que leite materno é o melhor alimento, suficiente e indispensável para o prematuro, sabe-se que amamentalo não é tarefa fácil, pela imaturidade fisiológica, neurológica e condições clínicas. Para atuar no aleitamento materno (AM) do prematuro ampliou-se a proposta da IHAC com a adição dos Três Princípios Norteadores e adaptação dos Dez passos para o sucesso do AM em unidades neonatais: a IHAC-Neo. Incorporar as evidências científicas à prática dos profissionais de saúde nos diferentes cenários é um desafio. Modelos teóricos têm sido desenvolvidos para preencher essa lacuna, entre eles a knowledge translation (KT). O objetivo geral: descrever o processo de implementação IHAC-Neo, guiada pelo referencial da KT e avaliar a adesão e a manutenção das diretrizes e práticas da IHAC-Neo um mês e um ano após a implementação. Trata-se de um estudo de intervenção, prospectivo, quase-experimental, pré e pós-teste, realizado num Hospital Universitário. A coleta de dados foi realizada em três períodos: antes da intervenção (P1), um mês após a intervenção (P2) e um ano após a intervenção (P3). O instrumento utilizado para a coleta foi o Neo-BFHI Assessment Tool, traduzido e adaptado transculturalmente para a avaliação do nível de adesão aos Três Princípios Norteadores e Dez Passos da IHAC-Neo e ao Código Internacional para Comercialização dos Substitutos do Leite Materno. A implementação da IHAC-Neo foi guiada pelo modelo Promoting Actionon Research Implementation in Health Services da KT e pela estratégia Evidence-Based Practice Identification & Change. A análise deu-se pela triangulação de dados na perspectiva dos profissionais de saúde da unidade, das mães de prematuros e do avaliador externo com análise documental. No P1, a adesão geral dos Dez Passos foi de 32,7%, dos Três Princípios Norteadores (PN) de 13% e do Código, 56%. No P2 os PN 1 e 3, os Passos 1, 3, 8 e o Código apresentaram uma adesão maior que 80%, cumprindo os critérios considerados satisfatórios pela IHAC-Neo; a adesão geral dos Dez Passos foi de 67% e os Três Princípios Norteadores de 25,8%. No P3 os PN 1 e 3, os Passos 1, 2, 3, 8 e o Código apresentaram uma adesão maior que 80%; a adesão geral dos Dez Passos foi de 73,2% e os PN de 25,8%. As práticas relacionadas às diretrizes da IHAC-Neo apresentaram importante melhora com aumento da adesão global aos Dez Passos de 33% no P1, para 67% no P2 e 73% no P3; aos Três PN de 43% no P1 para 86% no P2 e P3; e ao Código de 56% no P1 para 81% no P2 e 88% no P3. Assim, conclui-se que a implementação da IHAC-Neo guiada pela KT aprimorou a prática clínica de promoção, proteção e apoio ao AM dos prematuros com potencial para se tornar uma política pública complementar a fim de minimizar os desafios complexos e multifatoriais de amamentar um prematuro / The Baby-Friendly Hospital Initiative (BFHI) is largely adopted in Brazilian maternity wards, but it does not consider the complex and technological context of neonatal units and the difficulties in breastfeeding premature babies. The scientific evidence proves that breast milk is the best food, sufficient and indispensable for the premature baby, but it is known that breastfeeding is not an easy task, due to the physiological and neurological immaturity of the baby, as well as the clinical conditions. In order to work in the breastfeeding (BF) of the premature baby, we expanded the BFHI proposal with the addition of the Three Guiding Principles and the adaptation of the Ten Steps to the success of BF in neonatal units: Neo-BFHI. Incorporating scientific evidence into the practice of health professionals in the different environments is a challenge. Theoretical models have been developed to fill this gap, among which the knowledge Translation (KT). The overall aim of this study was to describe the process of implementing Neo-BFHI, guided by the KT framework, and to assess adherence and maintenance of the Neo-BFHI guidelines and practices, one month and one year after its implementation. This is an interventional, quasiexperimental, pre and post-test and prospective study, which was performed in a University Hospital. Data collection took place in three periods: before the intervention (P1), one month after the intervention (P2) and one year after the intervention (P3). The instrument used for the collection was the Neo-BFHI Assessment Tool, which was transculturally translated and adapted for the assessment of the level of adherence to the Three Guiding Principles and Ten Steps of Neo-BFHI and to the International Code of Marketing of Breast-milk Substitutes. The implementation of Neo-BFHI was guided by the KT model named Promoting Action on Research Implementation in Health Services and by the strategy named Evidence-Based Practice Identification & Change. The analysis was conducted using triangulation of data from the perspective of the health professionals working in the surveyed unit, some mothers of premature babies and an external appraiser, with documental analysis. In P1, the general adherence was 32.7% to the Ten Steps, 13% to the Three Guiding Principles (GP) and 56% to the Code. In P2, the GP 1 and 3, the Steps 1, 3 and 8, as well as the Code, showed an adherence greater than 80%, thereby fulfilling the criteria considered satisfactory by Neo-BFHI; the general adherence to the Ten Steps was 67%; and to the Three Guiding Principles, it was 25.8%. In P3, the GP 1 and 3, the Steps 1, 2, 3 and 8, as well as the Code, showed an adherence greater than 80%; the general adherence to the Ten Steps was 73.2%; and to GP, it was 25.8%. The practices related to the Neo-BFHI guidelines showed a significant improvement, with increments in the overall adherence to the Ten Steps from 33% in P1 to 67% in P2 and 73% in P3; as for the Three GP, it was from 43% in P1 to 86% in P2 and P3; and for the Code, it was from 56% in P1 to 81% in P2 and 88% in P3. Thus, we can conclude that the implementation of the KT-guided Neo-BFHI has enhanced the clinical practice of promotion protection and support for the BF of premature babies and that this tool has a potential to become a complementary public policy aimed at minimizing the complex and multifactorial challenges concerning the breastfeeding of premature babies

Syfte: Syftet med studien var att beskriva arbetsterapeuters erfarenhet av att använda bedömningsinstrument. Metod: Studien genomfördes med en kvalitativ datainsamlingsmetod där tio yrkesverksamma arbetsterapeuter intervjuades. Vid intervjuerna användes en semistrukturerad intervjuguide. Analys av den insamlade datautfördes med en kvalitativ innehållsanalys. Resultat: Genom analysen uppstår våra fyra kategorier som beskriver arbetsterapeuters erfarenhet av att använda bedömningsinstrument. KategoriernaTid och kunskap, Klienters olika behov, Struktur och klinisk erfarenhet samt Bedömningsinstrument oförenliga med journalsystemenvisar ett resultat som indikerar på en hög arbetsbelastning inom yrket. Av studien framkommer ett nytt fynd som beskriver hur arbetsterapeuter också väljer bort bedömningsinstrument då de inte ser dem som kompatibla med journalsystemen, något som bidrar till att arbetsterapeuter upplever stora svårigheter att dokumentera sina bedömningar på ett strukturerat och tidseffektivt sätt. Slutsats:Av det resultat som presenteras i studien dras slutsatsen att arbetsterapeuter idag behöver få mer tid avsatt i sitt arbete för att få möjlighet till att använda sig mer av bedömningsinstrument. Detta för att kunna öka sin kunskap om bedömningsinstrument men också för att kunna administrera dem på avsett vis, då främst vad gäller dokumentation och journalföring. / Aim: The aim of the study was to describe occupational therapists’experience of using assessment tools. Method: The study was conducted with a qualitative data collection method where ten occupational therapists were interviewed. During the interviews, a semi-structured interview guide was used. When analyzing the collected data, a qualitative analysis was used. Result: Based on the analysis, four categories emerge that describe the occupational therapists' experience of using assessment tools. The categories Time and Knowledge, Clients'Different Needs, Structure and Clinical Experience, and Assessment Tools and the Incompatibility of the Journal Systems show a result that indicates a high workload within the profession. This study reveals a new finding that describes how occupational therapists also exclude assessment tools, since they do not see the assessment toolsas compatible with the medical record system, which contributes to the fact that occupational therapists experience great difficulties in documenting their assessments in a structured and time-efficient manner. Conclusion: From the results presented in the study, it is concluded that occupational therapists today need more time allocated in their work to enable the use of assessment tools. This is to be able to increase theirknowledge of assessment tools, but also to be able to administer them in the intended way, mainly regarding the documentation and medical record keeping

This thesis explored the concept of sport injury-related growth (SIRG). Specifically, the mechanisms through which growth occurs and how it may be promoted for injured athletes. Study 1 used a grounded theory methodology to develop a context-specific theory. Aligning with a Straussian approach, data was collected using semi-structured interviews and analysed using open, axial, and selected coding. Findings revealed that the mechanisms of (a) meta-cognition, (b) positive reappraisal, (c) positive emotions, and (d) facilitative responses are what enable SIRG. These mechanisms are influenced by a combination of internal (e.g., personality) and external (e.g., received social support) factors. These factors enable injured athletes to alter their perception of their injury into an opportunity for growth, and it is by drawing upon and mobilizing a variety of these resources that athletes are able to experience SIRG. Dimensions of growth were psychosocial, physiological, and behavioral. Although this study produced a theory that explains the SIRG process, it does not propose specific techniques or therapies that encourage the development of growth. To address this issue, Study 2 aimed to investigate and identify evidence-based interventions that promote growth after experiencing adversity. To achieve this aim, a systematic review was conducted on literature pertaining to the promotion of growth for populations who have undergone a stressful experience (e.g., medical illness). In total, 34 studies were located and obtained that met the preplanned inclusion criteria. Within these 37 studies, three types of interventions were identified: emotional processing, cognitive processing, and combined techniques. The authors of the studies who successfully demonstrated the promotion of growth either identified or suggested that growth occurs through the mechanisms of cognitive restructuring and/or reappraisal. Other important considerations that were identified through this review were the duration and timing of the intervention in relation to the adverse event, and the importance of the intervention meeting the needs of the participants. Although this study offers valuable insight into how growth may be more successfully nurtured, the studies included within this review did not specifically focus on promoting growth for injured athletes. Consequently, Study 3 sought to complement this study by examining the practice-based experiential knowledge of sport psychologists who have worked with injured athletes in an applied manner. In total, 10 sport psychologists were purposively sampled and interviewed. Data was collected using a semi-structured interview guide and analysed using content analysis. Findings revealed a fluid development framework that consisted of 5 phases: (a) reactionary phase, (b) preparation phase, (c) reflection phase, (d) application phase, and (e) monitoring phase. Within each phase a set of corresponding strategies, skills, and tools were identified that the sport psychologists would utilize to match the needs of the athletes. The sport psychologists also identified a number of personal and environmental factors that either promoted or hindered the development of SIRG. Altogether, this thesis supports and extends research regarding growth and sport injury, as well as offering applied practitioners useful information for promoting SIRG.

A cobrança da sociedade pela melhoria da qualidade dos serviços de saúde implica na busca de ações pela enfermagem, para a implementação da Prática Baseada em Evidências (PBE), uma vez que a assistência, pautada em evidências geradas por meio de métodos científicos, pode contribuir para aumentar os resultados do cuidado de saúde. A utilização de resultados de pesquisas na prática clínica é um dos componentes da PBE, entretanto, ainda, é desafio para a enfermagem. Assim, dentre as ações que podem minimizar a lacuna entre o conhecimento produzido e sua aplicação, está a identificação de barreiras que impedem a interdependência entre pesquisa e prática. O presente estudo teve como objetivos gerais: realizar a adaptação cultural do instrumento The Barriers to Research Utilization Scale e analisar as propriedades métricas de validade e confiabilidade do instrumento The Barriers Scale, versão para o português brasileiro. Trata-se de pesquisa metodológica conduzida por meio das seguintes etapas: processo de adaptação cultural - tradução e retrotradução; validade de face e conteúdo - Comitê de Juízes; validade de construto - dimensionalidade e grupos conhecidos e análise de confiabilidade - teste-reteste. The Barriers Scale possui 29 itens distribuídos em quatro fatores, a saber: Fator 1 - Enfermeiro, Fator 2 - Organização, Fator 3 - Pesquisa e Fator 4 - Comunicação, com valores de respostas que variam de 1 (inexistente) a 4 (enorme), sendo que os valores maiores refletem maiores barreiras para utilização de resultados de pesquisas na prática. Os dados foram coletados em dois hospitais, por meio da aplicação de um instrumento para caracterização sociodemográfica e profissional dos enfermeiros e The Barriers Scale - versão para o português brasileiro, no período de outubro de 2014 a junho de 2015, com a participação de 335 enfermeiros. O nível de significância foi de 0,05. Os resultados evidenciaram que a maioria dos participantes era do sexo feminino (88,7%), com idade média de 33,9 anos, solteiros, mestres, com um único vínculo empregatício e em regime celetista. A maioria dos enfermeiros não havia realizado curso sobre a utilização de resultados de pesquisas, na prática clínica (85,1%), e desenvolvia ou já tinha conduzido pesquisas em enfermagem (68,4%). Na avaliação das propriedades métricas, a análise fatorial confirmatória demonstrou que a versão para o português brasileiro, composta por quatro fatores, está adequadamente ajustada à estrutura dimensional, originalmente proposta pela autora principal. A validade de construto foi determinada por grupos conhecidos, os resultados demonstraram diferenças estatisticamente significativas, sendo que os enfermeiros que atuavam em instituição, com cultura organizacional direcionada para a PBE, eram mestres ou doutores, tinham características favoráveis à PBE e identificaram menores barreiras para a implementação de resultados de pesquisas, na prática clínica. A confiabilidade, avaliada em intervalo de sete dias, indicou valores apropriados para o Coeficiente de Correlação Intraclasse, entre 0,75 e 0,84, e com diferença estatisticamente significativa. A avaliação da consistência interna demonstrou valor adequado para a versão para o português brasileiro de The Barriers Scale (? de Cronbach=0,92). Concluiu-se que The Barriers Scale, versão para o português brasileiro, é válida e confiável na amostra estudada / The society\'s demand to improve the quality of health services implies the search for nursing actions for the implementation of Evidence-Based Practice (EBP), since care guided by evidence generated through scientific methods can help increase health care results. The use of research results in clinical practice is one of the EBP components; however, it is still a challenge for the nursing team. Thus, one of the actions that can minimize the gap between the knowledge produced and its application is the identification of barriers that prevent the interdependence between research and practice. This study\'s overall objectives were: to perform the cultural adaptation of The Barriers to Research Utilization Scale and analyze the metric properties of validity and reliability of the instrument The Barriers Scale - Brazilian Portuguese version. A methodological study was conducted through the following steps: cultural adaptation process - translation and back-translation; face and content validity - expert committee; construct validity - dimensionality and known groups and reliability analysis - test-retest. The Barriers Scale consists of 29 items distributed into four factors, namely: Factor 1 - Nurse, Factor 2 - Organization, Factor 3 - Research, and Factor 4 - Communication. The response values range from 1 (nonexistent) to 4 (massive), wherein the highest values reflect greater barriers to using research results in practice. Data were collected at two hospitals, through the application of an instrument for sociodemographic and professional characteristics of the nurses and The Barriers Scale - Brazilian Portuguese version, from October 2014 to June 2015, with the participation of 335 nurses. Significance was set at 0.05. The results showed that most participants were women (88.7%), with a mean age of 33.9 years, bachelors, masters, with a single job and under the Consolidation of Brazilian Labor Laws (CLT regime). Most nurses had not taken a course on the use of research results in clinical practice (85.1%) and were developing or had already conducted studies in nursing (68.4%). In the evaluation of the metric properties, the confirmatory factor analysis demonstrated that the Brazilian Portuguese version of scale, consisting of four factors, is properly adjusted to the dimensional structure originally proposed by the main author. Construct validity was determined by known groups. Results showed statistically significant differences, and the nurses working in an institution with organizational culture directed to the EBP were either masters or doctors, had favorable characteristics to the EBP and identified lower barriers to the implementation of research results in clinical practice. The reliability, evaluated in seven-day intervals, indicated appropriate values for the intraclass correlation coefficient, between 0.75 and 0.84, with a statistically significant difference. The evaluation of the internal consistency demonstrated appropriate values for the Brazilian Portuguese version of The Barriers Scale (Cronbach\'s ? = 0.92). In conclusion, The Barriers Scale - Brazilian Portuguese version is valid and reliable as per the studied sample

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The child welfare system in the state of Tennessee has faced many challenges, including accessing best practice mental health treatment, particularly for youth experiencing traumatic stress. In response, five state-funded groups, who were created to provide support and consultation to the Department of Children’s Services, initiated a project to train agencies serving the child welfare system in the use of evidence-based treatment. The result of this multi-disciplinary collaboration, which included individuals from the National Child Traumatic Stress Network, was a state-wide dissemination and implementation program on the use of Trauma-Focused Cognitive Behavioral Therapy. The presenter(s) will briefly outline the development of the project; discuss gaining support in both urban and rural underserved communities; and share important lessons learned.