Orientador: Wilza Carla Spiri / Resumo: Introdução: o enfermeiro é responsável pela tomada de decisões em áreas administrativas e assistenciais de serviços de saúde. Algumas competências são necessárias para o desenvolvimento do seu trabalho, incluindo: liderança, visão estratégica, empreendedorismo, habilidades de comunicação e empoderamento da equipe. Entretanto, na literatura nacional são escassos os estudos que indicam qual o comportamento do enfermeiro, para o empoderamento de sua equipe. O presente estudo pretende contribuir para preencher essa lacuna ao considerar que é necessário utilizar instrumentos capazes de mensurar o comportamento empoderador do líder. Objetivo: Adaptar culturamente e validar o conteúdo da escala Leader Empowering Behaviour (LEB) para a cultura brasileira. Método: Trata-se de um estudo metodológico, desenvolvido em duas fases: a primeira constitui-se das etapas de tradução para a língua portuguesa; retro-tradução; avaliação por um grupo de juízes quanto às equivalências semântica, idiomática, conceitual e cultural dos 27 itens e pré-teste. A segunda fase contemplou a validação por meio de propriedades psicométricas, mediante validação do construto pela análise fatorial exploratória e a confiabilidade do instrumento pelo alfa de Cronbach. O instrumento foi aplicado a um grupo de 135 enfermeiros. Resultados: as avaliações das equivalências pelo grupo de juízes apresentou Índice de Validade de Conteúdo de 89%. A análise fatorial exploratória resultou em uma escala com quatro fatores e 21... (Resumo completo, clicar acesso eletrônico abaixo) / Abstract: Introduction: Nurses are accountable to decision-making in administrative and health care areas. Some skills are necessary to professional performance, including leadership, strategic view, entrepeneurship, communication, and empowering staff. However, there are few studies in Brazilian literature that indicates the behavior of nurse which have develop leadership to the staff empowering. This present search intends to fill this gap by considering necessary use tools to measure the leader empowering behaviour. Objective: Do the transcultural adaptation and validation of Leader Empowering Behaviour scale to Brazilian culture. Method: This is a study with methodological emphasis, of adaptation and validation of a instrument. At first methodological procedure steps were: translation to portuguese; back translation, evaluation by a judges committee regarding semantics, idiomatic, conceptual and cultural equivalences of 27 items and pretesting, followed by validation of psychometric properties, instrument construct validation was done through by factorial exploratory analysis and reliability through Cronbach´s alpha. The scale was applied to 135 nurses group. Results: Judges equivalences evaluation presented total agreement of 89%. The exploratory factor analysis resulted in a four factors and 21 items scale and the reliability coefficient, measures by Cronbach´s alpha for the four domains ranged from 0,82 to 0,87. Conclusions: Findings resulted good psychometric properties and pot... (Complete abstract click electronic access below) / Mestre

The characteristics of nurses acting as organizational champions, as well as the ways that clinical leaders systematically harness the energy of these champions in support of innovation, were explored in this qualitative descriptive study. The specific aims were guided by prior empirical evidence and identified research needs. Semi-structured interviews were conducted with 14 formal nursing leaders (e.g. managers, educators, administration) in an academic medical center. This study, including the interview guide, was informed by Kouzes and Posner’s (2007) Five Practices of Exemplary Leadership. Two models were developed to describe the data. Overall, participants echoed prior empirical findings identifying a need for organizational champions’ support of innovation and explained how some nurses seem to have “innate” characteristics that make them champions. Participants identified the champion as the “go to” person who can see the bigger picture and who seems to “own their own practice”. They described the importance of being truly present on the unit in order to harness the energy of these champions. Once champions are identified, leaders match the champions’ talents to the innovation planned, secure buy in from the champions, and actively work to support champions and get a culture of innovation “in the drinking water.” This work enhances the leader’s experience and makes him/her feel inspired and engaged. The two models developed based on the participants’ description of their experience working with staff nurses acting as organizational champions provide a framework for clinical leaders to identify and engage organizational champions in their clinical areas in support of innovation.

Este estudo teve como objetivo identificar a percepção do grau de competência gerencial alcançado por graduandos em enfermagem de uma universidade privada frente ao elenco de competências previsto nas disciplinas da área de administração que permeiam o currículo do curso desta instituição. Também, se procurou identificar possíveis relações de associação entre as variáveis independentes do estudo e os resultados encontrados. Este estudo tem caráter quantitativo descritivo que se utiliza de comparações ora transversalmente entre - sujeitos, ora longitudinalmente nos - sujeitos, sendo a população de estudo constituída por graduandos das disciplinas da área de administração do curso de graduação da Faculdade de Enfermagem da PUC-Campinas do período integral e noturno. Para tal, este estudo foi pautado em recursos da análise quantitativa e se utilizou da técnica de coleta de dados por meio de questionários estruturados com uma escala de respostas que permitiu a aplicação de processos estatísticos para obtenção de representações simplificadas. Os questionários foram estruturados em duas partes: uma composta pela caracterização dos respondentes envolvendo as variáveis sexo, idade, tipo e local de atividade profissional, e outra envolvendo as competências previstas nas disciplinas da área de administração. A definição das competências das disciplinas constituiu um trabalho a partir da análise dos objetivos e conteúdos programáticos das disciplinas e passou por um processo de validação de juízes. Os resultados mostraram uma população de 488 respondentes distribuídos em função da disciplina que estavam cursando e do período de realização do curso, sendo identificada uma predominância de indivíduos do sexo feminino, idade mediana de 24 anos, a maioria foi composta por graduandos trabalhadores distribuídos em 19 diferentes tipos de atividade profissional com grande incidência de trabalhadores de nível médio de enfermagem. Os resultados relativos ao alcance das competências mostraram que aproximadamente ¾ das respostas se situaram entre o grau parcial e o grau integral da escala de intensidade, sendo que das 125 questões em que se constituíram os quatro questionários aplicados, em apenas 14 delas foi identificada uma diferenciação nas respostas entre os grupos analisados. A análise dos resultados e a comparação dos resultados fase á fase do conjunto de respostas dos respondentes em relação a sua percepção do grau de competência alcançado permite concluir que o grupo alcançou em sua maioria o grau de competência integral e, preservados os limites da análise transversal, alcançaram um grau de competência crescente conforme cursaram as disciplinas. É preciso uma avaliação da contribuição das disciplinas para o desenvolvimento de competências previstas no projeto político pedagógico de forma a atender ao perfil do egresso desejado pelo curso. E, além disto, primordialmente avaliar a contribuição que estas disciplinas podem dar ao curso no sentido de buscar a formação do Enfermeiro capaz de uma ação transformadora de sociedade em que atua e vive / This studys objective was to identify the perception degree of management competency reached by undergraduates in nursing of a private university relative to subjects that administrative field forecasts. Also, was to identify possible relations of association between the independent variables contained in the paper and the results found. This study has quantitative descriptive character which uses comparisons times transversally with subjects, times longitudinal in subjects, being the study population made of undergraduates of administration disciplines of the Nursing course from the Faculdade de Enfermagem da PUC-Campinas, both integral and night shifts. For that, this study was ruled by quantitative analysis resources and has used the data collection by questioning method, those structured by an answer scale that allowed the application of statistic processes leading to simplified representations. The question forms were structured by two parts: the first was composed by the characterization of the interviewed containing variables as gender, age, type and local of professional activity, the second touching the subjects of forecast in the administrative graduation field. The definition of subjects competencies constituted a work of developing the analysis of the objectives and programmatic contents and went through a process of validation by judges. The results shown a population of 448 repliers distributed by the subject they were coursing and the period they were in, being identified predominance of female individuals, medium age of 24, most of them worker undergraduates distributed in 19 different groups of professional activity and great incidence of workers on nursing basic levels. The results related to range of the competences have shown approximately ¾ of the answers situated between the partial and integral level of the intensity scale, being that from 125 questions which built the forms, in only 14 of them were identified a differentiation of the answers by the analyzed groups. The analysis of the results and the comparisons of the them phase by phase allows to conclude that the group reached in its majority the integral degree of competence and, preserved the limits of transversal analysis, reached an increasing degree of competence as they attended the disciplines. An evaluation of the subjects contribution is needed for the development of competences forecast in the politic pedagogic project as to reach the expected egress profile of the course. And, besides that, first mostly evaluate the contribution that those subjects may give to the course in sense of seeking the development of the Nurse capable of transformation action on the society in which he acts and lives

Esta pesquisa teve como objetivo geral analisar o processo de trabalho gerencial do enfermeiro; como objetivos específicos, identificar e analisar a existência de cisão ou de articulações entre as atividades gerenciais e assistenciais do enfermeiro, analisar a finalidade do processo de trabalho gerencial do enfermeiro e identificar sua(s) prioridade(s). Utilizou-se uma abordagem qualitativa com o referencial teórico dos estudos sobre trabalho em saúde e enfermagem. O estudo foi realizado em um hospital privado localizado na região central da cidade de São Paulo e a coleta de dados foi feita através de entrevista semi-estruturada com dez enfermeiros que atuam em unidade de internação. A análise do material empírico utilizou a técnica de análise de conteúdo de Bardin. Os resultados mostram o predomínio de atividades de controle de materiais e equipamentos no processo de trabalho gerencial, mostram também a possibilidade de articulação entre as atividades gerenciais e assistenciais do enfermeiro, ora subentendida nos relatos sem referência às conexões existentes, ora explicitada, o que expressa a prática de gerenciamento do cuidado; e a inexistência de cisão entre os dois processos de trabalho. / The general purpose of this research was to analyze the nurse management work process. The specific goals were to identify and analyze the existence of separation or articulation on the management and assistance activities of a nurse, to analyze the goals of the management work process of a nurse, and to identify their priorities. A qualitative approach was used, and health and nursing work-studies were referenced. The research took placed at a private hospital located in a central region of São Paulo. The data was collected from semi-structured interviews with ten nurses who work in an inpatient care unit. The empirical analysis used Bardin\'s technique for content analysis. The results show that supplies and equipment control are the prevailing activities of the management work process. The research also shows the possibility of articulation between the management and assistance activities of a nurse, sometimes implied on the reports with no reference to the existing connections, sometimes explicit, which explains the care management practice. At least shows the inexistence of separation between the two processes of work.

As Novas Tecnologias da Informação e Comunicação são uma realidade na sociedade atual e também no ensino. Na busca da utilização do ensino mediado pelo computador, ambientes virtuais de aprendizagem são utilizados visando atender às necessidades educacionais e culturais de determinados grupos. O objetivo deste trabalho é desenvolver e avaliar um ambiente virtual de aprendizagem sobre tomada de decisão em enfermagem. Para tanto, a metodologia utilizada consistiu em três fases: Concepção e Planejamento, Desenvolvimento e Avaliação. O ambiente virtual de aprendizagem sobre tomada de decisão em enfermagem desenvolvido é composto por materiais educacionais com ênfase no conteúdo (Guia de Orientação do Aluno, bibliografia, hipertexto), nas atividades (hipertexto com exercícios lúdicos, histórias em quadrinhos digitais, editor de texto coletivo, elaboração de perfil) e na interação (chat e fórum). A avaliação do ambiente foi realizada por onze especialistas das áreas de informática na educação, administração em enfermagem e informática. Os itens avaliados foram referentes aos aspectos pedagógicos (conteúdo, atividades e interação) e aos aspectos técnicos (tempo de resposta e qualidade da interface). Na maioria dos itens os especialistas avaliaram que as características foram atendidas ou parcialmente atendidas, sugerindo algumas modificações. Concluiu-se que a metodologia de desenvolvimento do ambiente virtual de aprendizagem foi um dos pontos determinantes para o sucesso do projeto. A utilização de ambientes virtuais de aprendizagem no ensino de enfermagem, ainda é uma estratégia que precisa ser amplamente pesquisada e divulgada visando à criação e a inovação de estratégias específicas para o ensino de enfermagem. / New Information and Communication Technologies are a reality in contemporary society and also in education. In the search of using computer mediated teaching, virtual teaching environments are used aiming to answer educational and cultural needs of certain groups. The objective of this study is to develop and evaluate a learning virtual environment on decision making in the Nursing field. For that, the methodology consisted in three stages: Conception and Planning, Development and Evaluation. The developed learning virtual environment on decision making in Nursing is composed by educational material with emphasis on content (Student Orientation Guide, bibliography, hypertexts), on content itself and on activities (hypertexts with playful exercises, digital frames stories, collective texts editors, profile elaboration) and on interaction (chat and forums). The evaluation of the environment was carried on by eleven specialists of areas such as Informatics in education, Administration in Nursing and to Informatics. The evaluated items referred to pedagogic aspects (content, activities and interaction) and to technical aspects (answering time and interface quality). For the most part of items, the specialists evaluated the characteristics as completely or partially satisfying, suggesting some modifications. It concluded that the development of the virtual environment methodology on learning was one of the determinative points to the project’s success. The utilization of virtual learning environment in Nursing education is still a strategy that needs to be broadly researched and divulged aiming to create specific strategies innovation to Nursing teaching.

Introdução: A associação entre tempo médio de assistência de enfermagem dispensado aos pacientes e indicadores de qualidade assistencial tem sido considerada uma importante ferramenta gerencial, possibilitando demonstrar a relevância da adequação quantitativa e qualitativa de profissionais para a promoção de cuidados de excelência aos usuários dos serviços de saúde. Objetivo: Analisar a correlação entre tempo médio de assistência de enfermagem e indicadores de qualidade assistencial em unidade de terapia intensiva pediátrica e neonatal. Método: Pesquisa de abordagem quantitativa, documental, correlacional, realizada na Unidade de Terapia Intensiva Pediátrica e Neonatal (UTIPN) do Hospital Universitário da Universidade de São Paulo (HU-USP), compreendendo o período de 01 de janeiro de 2008 a 31 de julho de 2013. Os dados foram coletados dos instrumentos gerenciais utilizados pela chefia de enfermagem da Unidade. A análise correlacional foi realizada mediante a utilização do coeficiente de correlação de Spearman para as variáveis que não seguiam distribuição normal e do coeficiente de correlação de Pearson, para as variáveis com distribuição normal. Resultados: O tempo médio de assistência de enfermagem dispensado aos pacientes, no período analisado, correspondeu a 15,23 horas, das quais 32% foram disponibilizadas por enfermeiras e 68% por técnicos-auxiliares de enfermagem. A análise correlacional entre o tempo de assistência de enfermagem e o indicador saída não planejada de sonda oro/nasogastroenteral (SOG) evidenciou coeficiente de correlação de Spearman de (r = 0,433 - 0,485), com valor de p 0,001, indicando que a disponibilidade de tempo influencia as notificações ou subnotificações desses eventos. Os resultados encontrados permitiram verificar que o tempo médio de cuidado dispensado aos pacientes da UTIPN corresponde ao preconizado pelo COFEN, porém o percentual de enfermeiras disponível para assistir o paciente crítico é menor que o indicado por esse Órgão. Conclusão: Os resultados desta pesquisa não evidenciaram alteração nos índices dos indicadores de qualidade em função do tempo médio de cuidado dispensado aos pacientes internados na UTIPN, mas sugerem que os valores encontrados podem estar relacionados ao tempo de experiência profissional e à capacitação da equipe de enfermagem, bem como à implementação de ações educativas que buscam a melhoria contínua dos processos assistenciais. Desse modo, é necessária a realização de novas investigações que contemplem outros cenários e variáveis, além dos indicadores assistenciais e do tempo de assistência de enfermagem, subsidiando o processo de tomada de decisão referente ao quantitativo e qualitativo de profissionais de enfermagem, visando melhorar a qualidade e a segurança dos pacientes pediátricos. / Introduction: Introduction: The association between the mean time of nursing care given to the patients and the indicators of quality care have been considered an important management tool, enabling to demonstrate the relevance of quantitative and qualitative adequacy of the professionals to promote excellence of care to the health service users. Goal: To analyze the correlation between the mean time of the nursing care and indicators of quality care in a pediatric and neonatal intensive care unit. Method: Research of quantitative, documentary, and correlational approach, held in the Pediatric and Neonatal Intensive Care Unit (UTIPN) at the University Hospital of the University of São Paulo (HU-USP), between January 01, 2008 and July 31, 2013. All the data were collected from management instruments used by the Unit\'s Nursing Director. The correlational analysis was done upon use of Spearman Correlation Coefficient for the variables that did not follow normal distribution and Pearson correlation coefficient for the variables with normal distribution. Results: The mean time of nursing care given to the patients, in the above mentioned period, was 15,23 hours, of which 32% were from Licensed Nurses and 68% from Certified Nursing Assistants. The correlational analysis between the nursing care time and the non planned output of the nasogastric tube indicator highlighted a Spearman correlation coefficient of (r = 0,433 - 0,485), with p < 0,001value, indicating that the availability of time influences the notification or sub notifications of these events. The results allowed to verify that the mean time of the care given to the UTIPN patients matches the one recommended by the COFEN, however the percentage of Licensed Nurses available to assist the acute patient is less than the indicated by this Agency. Conclusion: The results of this research did not highlight alteration of the quality indicators index regarding the mean time of care given to the UTIPN patients, but they suggest that the values found could be related to the professional experience and continued education of the nursing team, as well as the implementation of education actions that will keep improving the care plan. This way, it is necessary that new investigations that contemplate other scenarios and variables, in addition to the assistance and time indicators of the nursing care, subsidizing the decision making process regarding the quantitative and qualitative of the nursing professionals, aiming to improve the quality and security of the pediatric patients.

The objective of this study is to evaluate the impact of the Diabetes Nurse Care Manager on an at-risk diabetic population using a Primary Group Visit Model in Outlying Medical Offices within the Kaiser-Permanente Health Care System upon the process and outcome of care in this population.

In the 1990s, dedicated education units transformed undergraduate preceptorships, but graduate preceptorships remain static. The dyadic nurse practitioner preceptorship model supports an environment where faculty, students, and preceptors may overlook nuances that affect the teaching-learning process. This article describes an innovative clinical education model, Student and Preceptor Advancement in a Dedicated Education Site, designed to improve preceptorships for advanced practice nurses. The focus is on adaptations made to facilitate use in advanced practice nursing programs.

Trauma informed care nursing education is crucial. Trauma informed care is a method of providing health care which understands the likelihood of past and present traumatic events in patients and families. The experience of past or present trauma often led to chronic diseases, substance abuse disorder, fragmented health care, fears surrounding health care, chronic stress, and other negative health consequences. The purpose of this project is to increase licensed nurses’ awareness and ability to practice trauma informed care in clinical practice, as well as promote policy initiation within the health care facilities. Method planning integrated the Knowledge to Action Cycle. A two hour, Delphi reviewed, evidenced based educational session was developed for licensed nurses in two health care facilities. After the educational session is completed, an anonymous survey will be distributed to determine the licensed nurses’ awareness of trauma informed care. A second anonymous survey will be sent four weeks later to assess changes in clinical practice based on trauma informed care education. One educational session for eleven licensed nurses working in a psychiatric facility has been completed. Two preliminary themes emerged from the first survey. The first theme was more intentional focus on integrating trauma informed care principles into practice. The second theme was an increased need for self-care. Two more educational sessions are planned for licensed nurses in an acute care hospital. Keywords: trauma informed care, nursing, education, KTA Cycle, health care, policy

Several issues have impacted on district nursing practice and education within the UK, which can be conceptualised within four main areas: national policy; local organisational structures and practice; professional and disciplinary theory; and practice of individuals (Bergen and While 2005). However, there has been a lack of direction in district nursing in recent years within the UK, with a decline in the number of district nurses being educated (Queen’s Nursing Institute 2014a) and the educational standards supporting district nurse education being over 20 years out of date (Nursing and Midwifery Council 2001). In addition to this, the standards of education for pre-registration nursing (Nursing and Midwifery Council 2010) have supported a graduate workforce with an increasing focus on nursing in the community. This was identified as a consideration for me as an educator when examining the future educational requirements of nurses beyond the point of registration in the community, and became the focus of this study. Knowing in practice is a key concept within this thesis, that is, the particular awareness that underpins the being and doing of a district nurse in practice (Chinn and Kramer 2008). This study explores the unique knowing of district nursing in practice, and how this professional knowing is developed. Understanding the knowing of district nurses and how this is developed will contribute to future educational frameworks and ways of supporting professional development within community nursing practice. A question that is often asked is what makes district nurse knowing different from nursing in inpatient settings, and this emerges in this thesis. A qualitative study using an interpretative approach within a case study design was adopted using three Health Boards within Scotland as the cases. Within each Health Board area, interviews were undertaken with key informants and also, group interviews with district nurses were undertaken using photo elicitation as a focussing exercise. The data were analysed using framework analysis (Spencer et al. 2003). This approach illuminated a depth and breadth of knowing in district nurse practice and how this knowing is developed. The study findings depict the complexity of knowing in district nursing, acknowledging the advancing role of district nursing practice, where the context of care is an essential consideration. The unique knowing can be described as a landscape that the district nurse must travel: crossing a variety of socio-economic areas; entering the private space of individuals, and the public space of communities; as well as acknowledging professional practice; navigating the policy agenda while maintaining clinical person-centred care; and leading others across the terrain of interprofessional working. The unique knowing in practice that characterises the expertise of district nurses is a matrix of elements that incorporates different aspects of knowing that contribute to leadership, as suggested by Jackson et al. (2009). The participants in this study recognised that due to the complexity of the district nurse role, and its continuing advancements, that district nurse education needs to move to a Master's level preparation and it needs to continue to be supported by a suitably qualified practice teacher. Furthermore, the findings within this study demonstrate that the development of the unique knowing in district nurses does not happen in isolation and it is very complex. It consists of networks, conversations, engagement with policy, understanding of professional contexts, adhering to organisational boundaries, and interaction with complex and challenging situations. Theory and practice are mutually dependent on each other; change is inevitable and is unpredictable; and practices change by having experiences, therefore change is integral to practice. Consequently, it was concluded that the interdependent elements, which interact, develop the unique knowing of district nurses in practice. Finally this thesis makes recommendations and discusses future implications for policy, practice and research.