CoordenaÃÃo de AperfeiÃoamento de Pessoal de NÃvel Superior / Conselho Nacional de Desenvolvimento CientÃfico e TecnolÃgico / O uso de bons indicadores clÃnicos possibilita uma atribuiÃÃo mais adequada dos diagnÃsticos de enfermagem, contribuindo com a eficÃcia do plano de cuidados. A acurÃcia determina a relaÃÃo direta entre as caracterÃsticas definidoras e a presenÃa ou ausÃncia de um determinado diagnÃstico de enfermagem. A necessidade de pesquisas voltadas para a determinaÃÃo da acurÃcia diagnÃstica motivou o desenvolvimento do estudo, com o objetivo principal de analisar a acurÃcia de indicadores clÃnicos de âDesobstruÃÃo ineficaz de vias aÃreasâ (DIVA) em pacientes no pÃs-operatÃrio cardÃaco. Estudo transversal desenvolvido na unidade pÃs-operatÃria de um hospital especializado em cardiologia do municÃpio de Fortaleza-CE. Uma amostra de 98 pacientes foi selecionada consecutivamente e constituiu-se de indivÃduos de ambos os sexos, com idade acima de 18 anos e que se encontravam em pÃs-operatÃrio imediato (atà 48 horas). A coleta de dados foi realizada no perÃodo de janeiro a abril/2010, mediante a utilizaÃÃo de um formulÃrio, submetido a um teste piloto e aplicado por participantes de um projeto de pesquisa voltado para terminologias de enfermagem, apÃs treinamento e avaliaÃÃes. Foram contemplados os elementos que compÃem o diagnÃstico DIVA de acordo com a Taxonomia II da NANDA-I. ApÃs a coleta, os dados foram sintetizados no formato de casos clÃnicos e encaminhados para cinco peritas que executaram as inferÃncias diagnÃsticas. Foram utilizados os softwares Excel e PASW para organizaÃÃo e anÃlise estatÃstica dos dados. O nÃvel de significÃncia adotado foi de 5%. Verificou-se uma proporÃÃo equilibrada de homens e mulheres, predominÃncia de pessoas com baixa renda e baixa escolaridade, mÃdia de 55,89 anos de idade e vÃnculo de uniÃo estÃvel na amostra. Os diagnÃsticos mÃdicos mais prevalentes foram angina e coronariopatias, levando a uma maior incidÃncia de cirurgias reconstrutoras. A incidÃncia elevada de tabagismo mostrou-se como um elemento desfavorÃvel, repercutindo em prejuÃzos no processo de limpeza das vias aÃreas. A prevalÃncia de DIVA foi de 33,7%. Do total de 13 caracterÃsticas definidoras, somente 4 apresentaram associaÃÃes significativas com o diagnÃstico: âdispnÃiaâ, âtosse ausenteâ, âruÃdos adventÃcios respiratÃriosâ e âtosse ineficazâ, sendo as duas Ãltimas as mais acuradas. Os fatores relacionados tambÃm se mostram mais especÃficos do que sensÃveis, destacando-se: âasmaâ, âhiperplasiaâ, âalergia respiratÃriaâ e âinfecÃÃoâ, sendo os dois Ãltimos os mais acurados. Os fatores relacionados âtabagismoâ, âsecreÃÃes retidasâ e âmuco excessivoâ mostraram relaÃÃo de risco. As peculiaridades do perÃodo pÃs-operatÃrio e a alta incidÃncia de tabagismo foram apontadas como elementos que se relacionaram à incidÃncia dos indicadores clÃnicos. SugestÃes a respeito da modificaÃÃo da nomenclatura dos indicadores e da inclusÃo de um fator relacionado referente ao pÃs-operatÃrio foram contribuiÃÃes deixadas pelas peritas. Foi demonstrada a existÃncia de diferenÃas de especificidades e sensibilidades, as quais sÃo influenciadas pelas caracterÃsticas populacionais estudadas. Ressalta-se a necessidade de desenvolver estudos neste tema contemplando outras populaÃÃes. As variaÃÃes de concordÃncia entre as peritas foram atribuÃdas Ãs diferenÃas de interpretaÃÃo destas frente aos dados levantados. O estudo forneceu direÃÃo para a eficiÃncia do uso dos indicadores clÃnicos avaliados, contribuindo com o aprimoramento da acurÃcia diagnÃstica. / The use of good clinical indicators contributes to the assignment of nursing diagnoses making the care plan more effective. Accuracy determines the direct relationship between defining characteristics and the presence or absence of a specific nursing diagnose. The need for research focused on diagnosesâ accuracy motivated the development of this study, whose purpose is to examine the accuracy of clinical indicators of "Ineffective airway clearance" (IAC) in patients in post-operative period of cardiac surgeries. Cross-sectional study developed in the post-operative unit of a specialized hospital of Fortaleza-CE. A sample of 98 patients was selected consecutively and it was composed by individuals of both sexes, age above 18 years old and evaluated in the immediate post-operative (up to 48 hours). The data collection occurred within the period of January to April/2010 from a form, which had been subjected to a pilot test and applied by research project participants, focused on nursing terminologies, after training and evaluations. The components of the nursing diagnose IAC were evaluated according to the NANDA-I Taxonomy. Clinical cases were formulated after the data collection and five specialists performed the diagnostic inference. For the organization and statistical analysis of data collected, the software Excel and PASW were used. The level of significance adopted in the study was 5%. The proportion of men and women was equal in the sample, with predominance of people with low income and low scholarship, with average of 55.89 years old and living with a partner. The clinical diagnosis angina and coronary diseases were more prevalent, increasing the incidence of reconstructive surgeries in the sample. The high incidence of smoking was showed as a favorable factor for dysfunction in the process of airway clearance. The prevalence of ICA was 33.7%. Four of thirteen defining characteristics have significant associations with the studied diagnosis: "dyspnea", "absence of cough", "adventitious breath sounds" and "ineffective cough", and the last two were accurate. Some of related factors were more specific that sensitive: "asthma", "hyperplasia", "allergic airways" and "infection", and the last two were the most accurate. The related factors: "smoking", "retained secretions" and "excessive mucus" increased the risk for IAC. Peculiarities of post-operative period and the high incidence of smoking were identified as elements linked to the incidence of clinical indicators. Contributions left by specialists were suggestions concerning the modification of the nomenclature and the inclusion of a related factor for post-operative period. The study demonstrated the existence of difference in the specificities and sensitivities, which are influenced by population characteristics. The need of further studies development in other contexts was emphasized. Changes in the trial of the specialists were attributed to differences in their interpretations. The study gave us a direction towards the diagnostic efficiency for some clinical indicators contributing to improve the accuracy of these elements.

CoordenaÃÃo de AperfeiÃoamento de Pessoal de NÃvel Superior / Verificamos a necessidade de construÃÃo e avaliaÃÃo de definiÃÃes constitutivas e operacionais para os resultados de enfermagem existentes, como no caso do Comportamento de PrevenÃÃo de Quedas, com o uso do devido rigor cientÃfico, com a finalidade de prover instrumentos cientificamente fundamentados, amplos e criteriosos para avaliaÃÃo do estado de saÃde. Observamos quanto a isto, que a avaliaÃÃo correta do risco de quedas no paciente fornece um substrato essencial e adequado ao melhor planejamento do cuidado preventivo. Portanto, torna-se imperativo desenvolver parÃmetros para a mensuraÃÃo do risco de quedas especificamente no Ãmbito hospitalar, visto ser um importante indicador sobre a qualidade da assistÃncia. Nossa hipÃtese fundamentou-se em que o resultado de enfermagem Comportamento de PrevenÃÃo de Quedas, pertencente a uma classificaÃÃo que se propÃe a ser de Ãmbito internacional como a NOC, ao ser destinado a um ambiente especÃfico como o hospital, poderia apresentar diferenÃa entre os indicadores sugeridos e aqueles encontrados na literatura e avaliados por especialistas, o que resultaria na reformulaÃÃo e identificaÃÃo de novos aspectos referentes ao estado de saÃde do paciente a serem avaliados e os quais poderÃo contribuir para a incorporaÃÃo de especificidades deste ambiente no cuidado ao indivÃduo. O objetivo geral foi revisar o resultado de enfermagem Comportamento de PrevenÃÃo de Quedas referente ao diagnÃstico de enfermagem Risco de Quedas, para pacientes no contexto de uma internaÃÃo hospitalar. Estudo metodolÃgico aprovado em Comità de Ãtica em Pesquisa e realizado no perÃodo de abril de 2009 a junho de 2010. As definiÃÃes constitutivas e operacionais foram anteriormente construÃdas mediante mÃtodo de pesquisa integrativa e anÃlise do conceito âquedasâ, realizada com base no modelo proposto por Walker e Avant e com o uso de sete critÃrios da psicometria: Comportamental, Simplicidade, Clareza, PrecisÃo, Tipicidade, Amplitude. Posteriormente, as definiÃÃes construÃdas foram submetidas à validaÃÃo por especialistas em duas fases, analisadas com uso dos sete critÃrios da psicometria. Os especialistas foram selecionados conforme os critÃrios de Fehring adaptados para o estudo. Submetemos 28 indicadores à validaÃÃo por especialistas, dos quais, 18 pertencem à Ãltima ediÃÃo da NOC, cinco indicadores novos, trÃs variÃveis confundidoras e dois indicadores de ediÃÃes anteriores. Consideramos o tÃtulo Comportamento de PrevenÃÃo de Quedas apropriado para avaliar as condutas do indivÃduo para prevenir quedas e, portanto, recomendamos sua manutenÃÃo como rÃtulo de resultado de enfermagem NOC; apreciamos como adequada sua inserÃÃo no DomÃnio 4/ Classe T. Dezessete dos 18 indicadores da Ãltima ediÃÃo da NOC foram considerados de conteÃdo vÃlido exceto, Prende pequenos tapetes e aqueles relativos Ãs variÃveis confundidoras os quais foram excluÃdos. A partir disso, 20 indicadores mostraram conteÃdo apropriado para avaliar as condutas preventivas de quedas no ambiente hospitalar. Consideramos que a hipÃtese apontada neste estudo foi confirmada, uma vez que identificamos diferenÃa entre os indicadores NOC e os levantados na literatura e entre estes e os apreciados pelos especialistas para a avaliaÃÃo do comportamento de prevenÃÃo de quedas no cenÃrio hospitalar. Referente ao produto final da proposta de revisÃo do resultado de enfermagem NOC Comportamento de PrevenÃÃo de Quedas, destacamos os benefÃcios de implementÃ-lo na prÃtica, para a gestÃo do risco de quedas no ambiente hospitalar de modo a evitar o desenvolvimento do agravo e de sua complicaÃÃes. / The construction and evaluation of constitutive and operational definitions for the nursing outcomes, such as the Behavior for Falls Prevention, by the use of scientific rigor, are increasingly required. The correct assessment of the risk of falls in the patient provides a suitable and essential substrate to improve the plan of preventive care. Therefore, the development of parameters to measure the risk of falls, specifically in the hospital setting is essential, because it is an important indicator of the quality of care. Our hypothesis was based on this: the nursing outcome Behavior for Falls Prevention, as a component of a international classification as the NOC, when destined for a specific environment such as the hospital, could present difference between its indicators and those suggested by the literature and evaluated by experts, resulting the reformulation and identification of new issues concerning the patientâs health status, which may contribute to the incorporation of specific properties of hospital to the care. The general objective was to review the nursing outcome Behavior for Falls Prevention, concerning the nursing diagnosis Risk of falls for patients within a hospital. Methodological study approved by the Ethics Committee on Research and developed from April 2009 to June 2010. The constitutive and operational definitions were previously constructed by integrative research method and analysis of the concept "falls", by Walker and Avant model and by the use of seven criteria of psychometrics: Behavioral, Simplicity, Clearness, Accuracy, Authenticity and Ampleness. Subsequently, the constructed definitions were evaluated by experts into two phases. Experts were selected according to Fehring criteria, adapted for the study. We were submit 28 indicators to the content validation, of which 18 belong to the latest issue of NOC, five were new indicators, three were confounding variables and two were indicators of previous editions. Thus, we consider the behavior under the Prevention of Falls appropriate to evaluate the individual conduct to prevent falls and, therefore, recommend its preserve as a label of the NOC result; we were appreciate its inclusion in the Domain 4 / Class T as appropriate. Seventeen of eighteen indicators of the latest NOC issue were considered valid about the content except, Holds small rugs and those related to confounding variables, which were excluded. Therefore, 20 indicators were presented appropriate content to evaluate the behaviors of prevention of falls in hospital. We believe that the hypothesis of this research was confirmed because we identify the difference between NOC indicators and those identified in the literature and between them and those assessed by experts. Referring to the final product of the proposed review of the NOC nursing outcome Behavior Prevention of Falls, we emphasize the benefits of its implementing in the nursing practice, to manage the risk of falls in hospitals, to prevent the development of this adverse event and its complications.

Submitted by Filipe dos Santos (fsantos@pucsp.br) on 2018-03-14T12:03:39Z No. of bitstreams: 1 Suely Rodrigues Thuler.pdf: 975463 bytes, checksum: a9cef63b3843b73cc4cdc67502af17bc (MD5) / Made available in DSpace on 2018-03-14T12:03:39Z (GMT). No. of bitstreams: 1 Suely Rodrigues Thuler.pdf: 975463 bytes, checksum: a9cef63b3843b73cc4cdc67502af17bc (MD5) Previous issue date: 2018-02-05 / SOBEST- Brazilian Association of Stomatherapy: stomas, wounds and incontinences, established in 2003, the title of TiSOBEST specialist in order to qualify stomatherapist nurses to practice the specialization, validate professional training and scientific-technical skills, by achievement of title awarding exams with pre-established criteria. The need felt by the Board to assess practical skills, prompted the present study. The study aims to propose an evaluation model that measures the skills in a wide range of this specialization. To reach these purposes, analysis include, the psychometric analysis of the level of difficulty; the discrimination and reliability coefficient of the items tested; the organization of Collection of Multiple Choice Items, after selection and adaptation, according to Criteria for Elaboration of Items, of the questions used in previous exams; reduction from one hundred items on the written exam, to eighty items and a presentation to the Board, proposal of addition of the Objective Structured Clinical Examination – OSCE to the two phases of the current exam, which nominated a commission to evaluate the cost, organization and operationalization of the reformulation of the title awarding exam / A SOBEST - Associação Brasileira de Estomaterapia: estomias, feridas e incontinências instituiu, em 2003, o título de especialista TiSOBEST com o objetivo de qualificar o enfermeiro estomaterapeuta para exercer a especialidade, validar sua capacitação profissional e competências técnico-científicas, por meio da realização de provas de título com critérios pré-estabelecidos. A necessidade de avaliar habilidades práticas, sentida pela diretoria, inspirou o presente estudo, que teve como objetivo propor um modelo de avaliação que mensure as competências nas áreas de abrangências da especialidade. Para alcançar esses propósitos, foi realizada a análise psicométrica do grau de dificuldade, discriminação e coeficiente de fidedignidade dos itens das provas realizadas; organizado um Acervo de Itens de Múltipla Escolha, após seleção e adequação, segundo os Critérios para Elaboração de Itens, das questões utilizadas em concursos anteriores; redução do número de cem itens da prova escrita, para oitenta itens e apresentação, à diretoria, proposta de acréscimo do exame clínico objetivo estruturado (Objetive Structured Clinical Examination - OSCE) às duas fases do exame atual, que nomeou uma comissão para avaliação de custos, organização e operacionalização da reformulação da prova de título

<p>The overall aim of the thesis was to study clinical decision making in nursing. This was performed by evaluation of the quality of nurses’ diagnostic statements and comparison of the concordance between nurses and patients’ perceptions of the patients’ nursing needs, as well as patient preferences for participation in clinical decision making. Further, predictors regarding patients’ active participation were investigated.</p><p>Quasi-experimental, comparative and cross-sectional descriptive study designs were used to collect data in acute care settings from randomly selected patient records (n = 140), nurse-patient dyads (n = 80), and patients discharged from hospital care (n = 428). Data were gathered using questionnaires and review of patient records.</p><p>The quality of nurses’ diagnostic statements improved by the means of education directed to nurses and implementation of new forms for recording supporting nursing care planning (I). Discrepancies were found concerning patients and nurses’ perceptions about what constitutes a problem for the patient as well as the severity and importance of acting on the problem (II). Further, nurses perceived that their patients preferred to be more active in clinical decision making compared with the patients’ own preferences for participation (III). Gender, education, living situation, and occupation were identified as predictors for preferring an active role in clinical decision making (IV).</p><p>The conclusions are that the accuracy of diagnostic statements needs to be addressed and validated further through systematic assessment of the patients’ perceptions and preferences concerning the health situation and preferences for participation in clinical decision making. Clinical implications are that nurses need to involve patients in identifying patient problems of relevance for nursing. Further, nurses also need to be aware of patients’ preferences for participation in clinical decision making in order that they can plan care in accordance with patient preferences and allow participation to the degree preferred by the patient.</p> / <p>Patientens delaktighet i kliniskt beslutsfattande i omvårdnad – ett gemensamt ansvar för patienter och sjuksköterskor</p><p>Bakgrund</p><p>Patienten har, med bas i lagstiftning och förordningar, en stark ställning inom svensk hälso- och sjukvård. Det grundas delvis på en samhällelig uppfattning om betydelsen av patientens delaktighet i såväl planering som genomförande av sin egen vård. I ett etiskt perspektiv har delaktigheten ett värde i sig själv, som en förutsättning för individens autonomi och integritet. Sjuksköterskan identifierar patientens behov och problem i syfte att kunna ge en individuellt anpassad omvårdnad. Sjuksköterskan har ofta djupgående professionell kunskap om patientens omvårdnadsproblem, medan patienten har preferenser och värderingar om vårdens genomförande. Om planeringen av omvårdnaden inte utgår från patientens preferenser så finns det stor risk att patientens perspektiv inte kommer med som bedömningsgrund. En samsyn mellan patient och sjuksköterska om patientens behov av omvårdnad och roll i beslutsfattandet kan öka möjligheten att optimera omvårdnadsinsatserna och främja en hög kvalitet på omvårdnaden. Kunskapen om kliniskt beslutsfattande inom omvårdnad är bristfällig, framförallt med fokus på patientens delaktighet och graden av samsyn mellan patienternas och sjuksköterskornas subjektiva perspektiv.</p><p>Syfte</p><p>Avhandlingens övergripande syfte var att undersöka kliniskt beslutsfattande inom omvårdnad med speciellt fokus på omvårdnadsdiagnosers kvalitet, patientens delaktighet i beslutsprocessen och överensstämmelsen mellan patienters och sjuksköterskors uppfattningar om behov och problem inom omvårdnad.</p><p>Specifika syften för respektive delarbeten var att I) undersöka effekten av utbildning i omvårdnadsdiagnostik riktad till sjuksköterskor och utveckling av journaldokument på omvårdnadsdiagnosers kvalitet; II) beskriva överensstämmelse i patienters och sjuksköterskors bedömningar av förekomst, svårighetsgrad och betydelse av problem inom omvårdnaden; III) beskriva samstämmighet mellan patienters och sjuksköterskors uppfattning om patientens preferenser för delaktighet i kliniskt beslutsfattande i omvårdnaden, samt samstämmighet mellan patienters preferenser och faktiska erfarenhet av delaktighet; och IV) identifiera prediktorer för patienters preferenser att delta i kliniskt beslutsfattande om den egna omvårdnaden.</p><p>Material och metod</p><p>Studier har genomförts med beskrivande, jämförande och kvasi-experimentell design på avdelningar inom somatisk sjukhusvård. Urvalet består av 140 patientjournaler (studie I), 80 patient-sjuksköterskepar (studie II och III), samt 428 patienter som nyligen blivit utskrivna från somatisk sjukhusvård (studie IV). Data har insamlats genom granskning av innehåll i patientjournaler samt genom enkäter till patienter och sjuksköterskor. Instrumenten CAT-CH-ING och Control Preference Scale har använts tillsammans med frågeformulär som utvecklats specifikt för studien.</p><p>Resultat</p><p>Delarbete I</p><p>Kvaliteten på omvårdnadsdiagnoserna förbättrades signifikant efter att sjuksköterskorna på experimentavdelningen genomgått en utbildning och nya journaldokument hade introducerats. Störst kvarvarande svårigheter var förknippade med hur etiologin i omvårdnadsdiagnosen formulerades. Omvårdnadsdiagnosernas kvalitet förbättrades inte på motsvarande sätt på kontrollavdelningarna.</p><p>Delarbete II</p><p>Sjuksköterskorna identifierade de omvårdnadsbehov och problem som patienterna uppfattade sig ha med en sensitivitet på 0.53 och ett prediktivt värde på 0.50. Det innebär att patienterna delvis identifierade andra problem än sjuksköterskorna, framför allt var det vanligt inom områdena nutrition, sömn, smärta och känslor/andlighet. Sjuksköterskorna underskattade problemens svårighetsgrad för 47 % av de behov och problem som hade identifierats gemensamt av patienter och sjuksköterskor. En gemensam uppfattning om betydelsen av att få stöd och hjälp med att lösa omvårdnadsproblemet fanns i knappt hälften av fallen.</p><p>Delarbete III</p><p>En majoritet av sjuksköterskorna uppfattade att patienterna föredrog att vara mer aktiva i det kliniska beslutsfattandet om omvårdnad än vad patienterna själv uppgav. Sammanlagt 61 % av patienterna föredrog en passiv roll i beslutsfattandet medan sjuksköterskorna angav att 24 % ville vara passiva. Preferenser om en aktiv roll i beslutsfattande angavs av 9 % av patienterna medan sjuksköterskorna hade uppfattat att 45 % av patienterna föredrog en aktiv roll. Totalt 71 % av patienterna upplevde att de inte hade varit delaktiga i den utsträckning de själva hade föredragit, 37 % hade varit mer passiva och 34 % mer aktiva. Patienterna uppgav att de intagit en mer passiv roll än vad de hade önskat i samband med behov och problem inom områdena kommunikation, andning och smärta, medan en mer aktiv roll än önskat förekom i samband med behov och problem inom områdena aktivitet och känslor/roller.</p><p>Delarbete IV</p><p>En majoritet av patienterna i sluten somatisk vård föredrog att inledningsvis under vårdperioden inta en passiv roll i kliniskt beslutsfattande om omvårdnad. Sammanlagt 22 % av patienterna föredrog en aktiv roll. Faktorer som predicerade preferenser för att inta en aktiv roll var kön (Odds ratio [OR] = 1.8), utbildning (OR = 2.2), levnadsförhållanden (OR = 1.8) och sysselsättning, d.v.s. om personen var yrkesarbetande eller pensionär (OR = 2.0). Sannolikheten var 53 % att en pensionerad högutbildad kvinna som levde ensam föredrog att vara aktiv i beslutsfattandet om sin egen omvårdnad. Sannolikheten för att en yrkesarbetande lågutbildad man som levde tillsammans med någon annan föredrog att vara aktiv var 8 %.</p><p>Slutsats</p><p>Kvaliteten på de omvårdnadsdiagnoser som sjuksköterskan ställer kan förbättras genom utbildning men orsakerna till omvårdnadsproblemet behöver identifieras på ett tydligare sätt. Det fanns en skillnad i hur patienter och sjuksköterskor uppfattade vad som utgjorde ett omvårdnadsbehov eller problem samt problemets svårighetsgrad och betydelse. Sjuksköterskan identifierade 53 % av de omvårdnadsproblem som patienten själv identifierade, samtidigt som sjuksköterskan identifierade andra omvårdnadsproblem som inte patienten uppfattade. Uppfattningarna skiljde sig också åt om vilken roll patienten föredrog att ha i det kliniska beslutsfattande om omvårdnad. Faktorer som kunde predicera patientens preferenser att ha en aktiv roll i kliniskt beslutsfattande var kön, utbildningsnivå, boendesituation och om personen yrkesarbetade eller var pensionär.</p><p>En slutsats av den påvisade diskrepansen i uppfattningar är att sjuksköterskor i högre grad behöver involvera patienterna i en diskussion om hälsotillståndet, behovet av omvårdnad och patientens önskan att delta i beslut om sin omvårdnad. Det är nödvändigt för att så långt det är möjligt kunna uppnå en samsyn som grund för planering och genomförande av omvårdnaden. Om sjuksköterskan validerar sina egna bedömningar om behovet av omvårdnad med patienten kan kvaliteten på bedömningarna förbättras. Patientens perspektiv blir en explicit del av beslutsunderlaget vid planering av omvårdnad vilket sannolikt också påverkar omvårdnadens innehåll och därmed även omvårdnadens kvalitet. Det bästa sättet att identifiera det individuella perspektivet är genom en systematisk bedömning i dialog mellan sjuksköterskan och den enskilde patienten. Mötet och dialogen mellan patienten och sjuksköterskan är en förutsättning för en god omvårdnad men är också en central del av själva omvårdnaden.</p>

Diss. (sammanfattning) Linköping : Univ., 2003. / Härtill 4 uppsatser.

Objetivo: Identificar as questões antiéticas, aéticas e iatrogênicas dos Profissionais da Enfermagem através da análise qualitativa dos processos ético-profissionais abertos junto ao COREN SP no período de 1º de janeiro de 2001 a 31 de dezembro de 2004. Quantificar o número de processos ético-profissionais abertos; identificar o perfil dos profissionais denunciados; relacionar as infrações éticas com os artigos elencados no Código de Ética dos Profissionais de Enfermagem; analisar os processos ético-profissionais, sistematizando os resultados de modo a obter os principais tipos de denúncia, seus locais de ocorrência e a identificação dos tipos de denunciantes; discutir a iatrogenia como fator predominante da infração ética. Método: Trata-se de uma pesquisa exploratória, documental e de corte qualitativo baseada na coleta de dados contidos nos autos dos processos ético-profissionais, no âmbito do COREN SP, no período de 1º de janeiro de 2001 a 31 de dezembro de 2004, por meio da utilização de um questionário, o questionário se encontra no Anexo 1. Do material coletado foram excluídos os processos ético-profissionais cujos dados não permitiram o preenchimento completo do questionário. Os dados obtidos foram submetidos à análise estatística. Resultados e Conclusões: Foram analisados 189 (cento e oitenta e nove) processos ético-profissionais no período de 1º de janeiro de 2001 até 31 de dezembro de 2004, período de 4 (quatro) anos. A coleta desses dados foi feita no Conselho Regional de Enfermagem de São Paulo - COREN SP, nos anos de 2010 e 2011. A maioria das ocorrências chega ao CORENSP por meio de denuncia feita pelas CEEs, com relação à distribuição do número de descritores agrupados em tipos de infrações éticas envolvidos na denúncia, dos Processos Ético- Profissionais analisados houve uma predominância da iatrogenia 38,83% dentre os descritores dos processos analisados. As denúncias são feitas em sua grande maioria dentro de hospitais públicos, as denúncias entre a cidade de São Paulo e cidades do interior do estado de São Paulo de acordo com a pessoa jurídica (CEE) como parte denunciante indicam um maior número de denúncias feitas pelas Comissões de Ética de Enfermagem - CEEs do interior do estado de São Paulo. As denúncias de pessoas físicas ocorreram no interior em 63,64% do estado de São Paulo e 36,36% na capital, indicando, portanto um maior número de denúncias feito por pessoa física no interior. Houve uma maior caracterização da parte denunciada como pessoa física na capital do que no interior do estado de São Paulo. As pessoas que denunciam 52% são pacientes, seguidos por acompanhantes 32%. A maioria das pessoas físicas como parte denunciada foram os auxiliares de enfermagem em 55,56%, enquanto enfermeiros foram denunciados 33,9%. Com relação à distribuição dos artigos infringidos do Código de Ética dos Profissionais de Enfermagem, segundo o número e a porcentagem em ordem decrescente o artigo mais infringido, artigo 16, aconteceu em 11,13%. Outras importantes variáveis foram estudadas e serão analisadas em trabalhos futuros / Objective: Identify the unethical, non-ethical and iatrogenic issues of the Nursing staff through qualitative analysis of the ethical legal proceedings taken at COREN SP during the period of January 1st 2001 to December 31st 2004. Quantify the number of ethical processes taken; identify the profile of the professionals accused; relate the ethical infractions with articles listed in the Code of Ethics of Professional Nursing; analyze the ethical and professional proceedings, systematizing the results in order to obtain the main types of complaint, their places of occurrence and identify the types of informers; discuss iatrogeny as a predominant factor of ethical offence. Method: This was an exploratory, documentary and qualitative research based on the collection of data in the record of proceedings within the ethical processes under COREN SP during the period January 1st 2001 to December 31st 2004, by use of a questionnaire, which is in Annex 1. Ethical processes whose data did not allow the complete filling out of the questionnaire were excluded. The data were subjected to statistical analysis. Results and Conclusions: One hundred and eighty-nine (189) ethical proceedings from the period of January 1st 2001 to December 31st 2004 were analyzed, a period of four (4) years. The collection was taken at the Regional Council of Nursing São Paulo - COREN SP, within the years 2010 and 2011. Most occurrences reach CORENSP through complaints made by the Nursing Ethics Committees (NEC). With respect to the distribution of the number of descriptors grouped into types of ethical violations involved in the complaint, there was a prevalence of 38.83% of iatrogenic descriptors in the analyzed processes. Complaints are mostly made within public hospitals. The complaints from the city of São Paulo and other cities in the state, in accordance with the legal person (NEC) indicate a greater number of complaints made by Ethics Committees in Nursing - in the state of São Paulo, not in the capital. Reports from individuals occurred in 63.64% within the state of São Paulo, while in the capital it were 36.36%, thus indicating a greater number of complaints made by individuals within the state of São Paulo. There was a greater characterization of the individual as reported in the capital than in the state of São Paulo. People who complain are 52% patients, followed by 32% companions. Most individuals reported were nursing assistants: 55.56%, while nurses were reported by 33.9%. The most violated article in the Code of Ethics of Professional Nursing was Article 16, which means 11.13%. Other important variables were studied and will be analyzed in a future research

Objetivo: Identificar as questões antiéticas, aéticas e iatrogênicas dos Profissionais da Enfermagem através da análise qualitativa dos processos ético-profissionais abertos junto ao COREN SP no período de 1º de janeiro de 2001 a 31 de dezembro de 2004. Quantificar o número de processos ético-profissionais abertos; identificar o perfil dos profissionais denunciados; relacionar as infrações éticas com os artigos elencados no Código de Ética dos Profissionais de Enfermagem; analisar os processos ético-profissionais, sistematizando os resultados de modo a obter os principais tipos de denúncia, seus locais de ocorrência e a identificação dos tipos de denunciantes; discutir a iatrogenia como fator predominante da infração ética. Método: Trata-se de uma pesquisa exploratória, documental e de corte qualitativo baseada na coleta de dados contidos nos autos dos processos ético-profissionais, no âmbito do COREN SP, no período de 1º de janeiro de 2001 a 31 de dezembro de 2004, por meio da utilização de um questionário, o questionário se encontra no Anexo 1. Do material coletado foram excluídos os processos ético-profissionais cujos dados não permitiram o preenchimento completo do questionário. Os dados obtidos foram submetidos à análise estatística. Resultados e Conclusões: Foram analisados 189 (cento e oitenta e nove) processos ético-profissionais no período de 1º de janeiro de 2001 até 31 de dezembro de 2004, período de 4 (quatro) anos. A coleta desses dados foi feita no Conselho Regional de Enfermagem de São Paulo - COREN SP, nos anos de 2010 e 2011. A maioria das ocorrências chega ao CORENSP por meio de denuncia feita pelas CEEs, com relação à distribuição do número de descritores agrupados em tipos de infrações éticas envolvidos na denúncia, dos Processos Ético- Profissionais analisados houve uma predominância da iatrogenia 38,83% dentre os descritores dos processos analisados. As denúncias são feitas em sua grande maioria dentro de hospitais públicos, as denúncias entre a cidade de São Paulo e cidades do interior do estado de São Paulo de acordo com a pessoa jurídica (CEE) como parte denunciante indicam um maior número de denúncias feitas pelas Comissões de Ética de Enfermagem - CEEs do interior do estado de São Paulo. As denúncias de pessoas físicas ocorreram no interior em 63,64% do estado de São Paulo e 36,36% na capital, indicando, portanto um maior número de denúncias feito por pessoa física no interior. Houve uma maior caracterização da parte denunciada como pessoa física na capital do que no interior do estado de São Paulo. As pessoas que denunciam 52% são pacientes, seguidos por acompanhantes 32%. A maioria das pessoas físicas como parte denunciada foram os auxiliares de enfermagem em 55,56%, enquanto enfermeiros foram denunciados 33,9%. Com relação à distribuição dos artigos infringidos do Código de Ética dos Profissionais de Enfermagem, segundo o número e a porcentagem em ordem decrescente o artigo mais infringido, artigo 16, aconteceu em 11,13%. Outras importantes variáveis foram estudadas e serão analisadas em trabalhos futuros / Objective: Identify the unethical, non-ethical and iatrogenic issues of the Nursing staff through qualitative analysis of the ethical legal proceedings taken at COREN SP during the period of January 1st 2001 to December 31st 2004. Quantify the number of ethical processes taken; identify the profile of the professionals accused; relate the ethical infractions with articles listed in the Code of Ethics of Professional Nursing; analyze the ethical and professional proceedings, systematizing the results in order to obtain the main types of complaint, their places of occurrence and identify the types of informers; discuss iatrogeny as a predominant factor of ethical offence. Method: This was an exploratory, documentary and qualitative research based on the collection of data in the record of proceedings within the ethical processes under COREN SP during the period January 1st 2001 to December 31st 2004, by use of a questionnaire, which is in Annex 1. Ethical processes whose data did not allow the complete filling out of the questionnaire were excluded. The data were subjected to statistical analysis. Results and Conclusions: One hundred and eighty-nine (189) ethical proceedings from the period of January 1st 2001 to December 31st 2004 were analyzed, a period of four (4) years. The collection was taken at the Regional Council of Nursing São Paulo - COREN SP, within the years 2010 and 2011. Most occurrences reach CORENSP through complaints made by the Nursing Ethics Committees (NEC). With respect to the distribution of the number of descriptors grouped into types of ethical violations involved in the complaint, there was a prevalence of 38.83% of iatrogenic descriptors in the analyzed processes. Complaints are mostly made within public hospitals. The complaints from the city of São Paulo and other cities in the state, in accordance with the legal person (NEC) indicate a greater number of complaints made by Ethics Committees in Nursing - in the state of São Paulo, not in the capital. Reports from individuals occurred in 63.64% within the state of São Paulo, while in the capital it were 36.36%, thus indicating a greater number of complaints made by individuals within the state of São Paulo. There was a greater characterization of the individual as reported in the capital than in the state of São Paulo. People who complain are 52% patients, followed by 32% companions. Most individuals reported were nursing assistants: 55.56%, while nurses were reported by 33.9%. The most violated article in the Code of Ethics of Professional Nursing was Article 16, which means 11.13%. Other important variables were studied and will be analyzed in a future research

The purpose of this quantitative, descriptive study was to describe how registered nurses utilise teachable moments to enhance students' learning in the clinical setting. The research questions were: What are the problems faced by registered nurses when they teach students in the clinical setting? and How do registered nurses utilise teachable moments to teach students? A pilot study was conducted in the clinical setting involving the respondents who had similar characteristics than the population. The sample consisted of 45 registered nurses who provided direct patient care in the clinical setting. A self­ administered, structured questionnaire was used to collect data. Data analysis was done by using descriptive statistical tests. The findings brought to light strengths and weaknesses with regard to the utilisation of teachable moments by registered nurses, and problems faced by registered nurses with regard to clinical accompaniment in general. Recommendations to improve clinical accompaniment by registered nurses through effective utilisation of teachable moments were made. Further research was recommended to explore some problematic areas that emerged from this study. / Health Studies / M.A. (Nursing Science)

In-patient deterioration is a global phenomena and timely recognition and action improves outcome. Intensive care facilities are scarce and expensive and therefore patient care must be optimal. A retrospective health record analysis was used for this study. The findings indicated that nursing personnel do not recognize patient deterioration timeuously. However, the implementation of an outreach team and clinical markers training program improved the recognition of patient deterioration in general wards with three hours and 40 minutes. It is recommended to implement a comprehensive hospital program that addresses the basic knowledge and skills of general ward personnel to observe, recognize, assess and intervene to patients with clinical deterioration. Together with an extensive training program, a basic physiological parameters guideline to activate a team of experts to the bedside, such as an Outreach team, assist nursing personnel to recognize and manage those patients timeuously and ensure treatment in an appropriate level of care. / Health Studies / M. A. (Health studies)

Depuis l’adoption de la Loi 90 en 2002, la Loi sur les infirmières et infirmiers (LII, article 36) confère une autonomie élargie aux infirmières en reconnaissant, notamment, leur compétence et leur responsabilité à l’égard de l’évaluation clinique qui est représentée dans cette loi comme l’assise de l’exercice infirmier (Pellerin, 2009; OIIQ, 2010). La collecte des données constitue une étape fondamentale du processus d’évaluation clinique (Dillon, 2007; Doyon, Brûlé & Cloutier, 2002; Pellerin, 2009; Weber & Kelley, 2007). L’infirmière d’urgence a une responsabilité majeure à l’égard de la collecte des données. En effet, elle œuvre auprès de clientèles de tous âges qui présentent des problèmes de santé variés, aigus et parfois urgents et doit souvent intervenir, sur la base de son évaluation clinique, avant qu’un diagnostic n’ait été établi ou que le patient n’ait été vu par le médecin (Newberry & Criddle, 2005). Or, malgré toute l’importance que revêtent dorénavant l’évaluation clinique et la collecte des données au sens de la loi, ce rôle de l’infirmière semble tarder à s’actualiser dans la pratique clinique. Le but de cette étude qualitative descriptive consiste à explorer les perceptions d’infirmières, de gestionnaires en soins infirmiers et d’infirmières ressources cliniques d’urgence relativement à la réalisation de la collecte des données. La norme clinique « collecte des données » (assessment) de l’Emergency Nurses Association (1999) constitue le cadre de référence de l’étude. Cinq entrevues individuelles semi-dirigées de 60 minutes ainsi qu’un groupe de discussion de 90 minutes ont été réalisés auprès d’infirmières d’urgence. Un deuxième groupe de discussion a également réuni deux gestionnaires en soins infirmiers et deux infirmières ressources cliniques de l’urgence. Les données recueillies ont été analysées selon l’approche proposée par Miles et Huberman (2003). Les résultats obtenus démontrent que les infirmières considèrent la collecte des données comme un aspect fondamental de leur pratique à l’urgence, qui contribue à améliorer la qualité et la sécurité des soins dispensés. Or, les résultats révèlent également que leur compréhension de la collecte des données est variable, que leur pratique est aléatoire et largement influencée par le modèle biomédical. Plusieurs facteurs influencent la pratique des infirmières relativement à la collecte des données notamment : la conception individuelle de la collecte des données et du rôle infirmier, les relations et l’interaction avec les membres de l’équipe des soins infirmiers et les autres professionnels ainsi que le soutien de l’organisation et des gestionnaires en soins infirmiers. Ce dernier facteur semble prépondérant dans le contexte de l’urgence et démontre que le soutien des gestionnaires et des infirmières ressources cliniques influence de façon importante la pratique dans les milieux cliniques. Cette étude propose des pistes de réflexion sur la formation académique, la formation continue, l’administration des soins infirmiers et la collaboration interprofessionnelle qui pourraient faciliter l’actualisation du rôle des infirmières à l’égard de la collecte des données et de l’évaluation clinique afin d’améliorer la qualité des soins dispensés à l’urgence. / Since the enactment of Bill 90 in 2002, the Nurses Act (section 36) gives nurses greater autonomy by recognizing their competency and responsibility in clinical assessment, featured in this Act as the corner stone of the nursing profession (Pellerin, 2009; OIIQ, 2010). Assessment constitutes a fundamental step in the clinical assessment process (Dillon, 2007; Doyon, Brûlé & Cloutier, 2002; Pellerin, 2009; Weber & Kelley, 2007). The emergency nurses have a major responsibility with regard to patient assessment. In fact, they work with patients of all ages that have various health problems that can be acute and sometimes urgent, and they must intervene, according to their clinical assessment, before a diagnosis has been established or the patient has seen a doctor (Newberry & Criddle, 2005). Yet, despite the importance now conferred by law on clinical assessment, this role has yet to be accepted as an integral part of clinical nursing. The aim of this qualitative descriptive study is to explore the perceptions of nurses, nursing managers and clinical resource nurses with regard to assessment. The clinical standard of the Emergency Nurses Association for patient assessment (1999) is the frame of reference for this study. Five 60-minute individual semi-structured interviews and a 90-minute discussion group were conducted with emergency nurses. A second discussion group included two nursing managers and two emergency clinical resource nurses. The data collected were analysed using the approach proposed by Miles and Huberman (2003). The results obtained show that nurses view patient assessment as a fundamental part of their emergency responsibilities that influences the improvement of the quality and security of the care given. However, the results also revealed that their understanding of assessment varies, and that this practice is random and largely influenced by the biomedical model. Several factors influence nursing practice regarding patient assessment, in particular: individual notions of assessment and the role of nurses, the relations and interactions between members of the nursing team and other professionals, as well as the support of the organisation and the nursing managers. This last is a leading factor in the context of the emergency department and shows that the support of the nursing managers and clinical resource nurses has an important impact on practice in clinical settings. This study proposes further areas of study focused on academic training, continuing professional education, nursing management and inter-professional collaboration that could facilitate the actualisation of nurses’ roles concerning patient assessment to improve the quality of care provided in the emergency department.