Submitted by Fabiana Gonçalves Pinto (benf@ndc.uff.br) on 2016-05-18T20:10:49Z No. of bitstreams: 1 Allana Raphaela dos Santos Cardoso.pdf: 20267087 bytes, checksum: d5ccdc762ece6cf3585e610e83e44191 (MD5) / Made available in DSpace on 2016-05-18T20:10:49Z (GMT). No. of bitstreams: 1 Allana Raphaela dos Santos Cardoso.pdf: 20267087 bytes, checksum: d5ccdc762ece6cf3585e610e83e44191 (MD5) Previous issue date: 2016 / Mestrado Profissional em Enfermagem Assistencial / Objetivos: construir um instrumento para aplicação do processo de enfermagem para pacientes hospitalizados em unidades cardiológicas; treinar os enfermeiros destas unidades para o uso do instrumento e; avaliar a qualidade dos registros antes e após o treinamento por meio do Quality of Diagnosis, Interventions and Outcomes (Q-DIO). Métodos: Trata-se de um estudo quase-experimental que avaliou os registros de enfermagem de prontuários de pacientes de unidades cardiológicas, de um hospital universitário na cidade do Rio de Janeiro/RJ. Foi realizado em duas fases: a elaboração do instrumento para aplicação do processo de enfermagem para os pacientes com distúrbios cardiológicos hospitalizados, baseado na linguagem padronizada NANDA-I, NIC E NOC (NNN) baseada em uma revisão integrativa sobre registros de enfermagem para pacientes com doenças cardiovasculares e na sequência foi realizado um treinamento com enfermeiros das unidades cardiológicas sobre registro de enfermagem e uso do instrumento. O Q-DIO foi aplicado para avaliação da qualidade dos registros antes e após o treinamento. Resultados: O instrumento elaborado possibilitou o registro de enfermagem pautado nos domínios da NANDA-I e a seleção dos diagnósticos, intervenções e resultados foi de acordo com a literatura. O treinamento foi realizado com enfermeiros das unidades cardiológicas e proporcionou uma troca de experiências teórico-práticas positivas. Após o treinamento com os enfermeiros sobre o uso de linguagens padronizadas NNN e o uso do instrumento, o escore total do Q-DIO aumentou no momento pós-intervenção (14,8±5,7vs.29,0±10,5; p=0,003). Conclusão: A qualidade dos registros foi considerada satisfatória após treinamento e utilização do instrumento para aplicação do processo de enfermagem, no entanto, são necessárias mais pesquisas experimentais sobre o processo de enfermagem e sobre a qualidade do registro de enfermagem principalmente referente às intervenções de enfermagem. / Goals: to build an instrument for the application of the nursing process for hospitalized patients in cardiac units; to train nurse of these units for the use o the instrument and; to assess the quality of the records before and after the treatment through the Quality of Diagnosis, Interventions and Outcomes (Q-DIO). Methods: It is a quasi-experimental study that evaluated the nursing records of patients of cardiac units of an academic hospital in the city of Rio de Janeiro/RJ. It was performed in two phases: the elaboration of the instrument for the application of the nursing process for hospitalized patients with cardiac disorders based on a standardized language NANDA-I, NIC E NOC (NNN) based on a integrative revision about the nursing records for patients with cardiac diseases and in the sequence it was performed a training with nurses from cardiac units about the nursing records and the usage of the instrument. The Q-DIO was applied for the evaluation of the quality of the records before and after the training. Outcomes: The elaborated instrument enabled the nursing records based on NANDA-I domains and the diagnosis selection, interventions and results was according to the literature. The training was performed with nurses from cardiac units and provided a positive theoretical-practical exchange of experiences. After the training with the nurses about the use of the NNN standardized language and the use of the instrument, the total score of the Q-DIO increased in the post-intervention moment (14,8±5,7vs.29,0±10,5; p=0,003). Conclusion: The quality of the records was considered satisfactory, after training and the usage of the instrument for the application of the nursing process, however it is necessary to have more experimental research about the nursing process and about the quality of the nursing process mainly for the nursing interventions.

Submitted by Fabiana Gonçalves Pinto (benf@ndc.uff.br) on 2016-05-19T17:32:51Z No. of bitstreams: 1 Maria Cristina Freitas de Castro.pdf: 3328884 bytes, checksum: 9d8a08edc12f76187f8f59306e1490ac (MD5) / Made available in DSpace on 2016-05-19T17:32:51Z (GMT). No. of bitstreams: 1 Maria Cristina Freitas de Castro.pdf: 3328884 bytes, checksum: 9d8a08edc12f76187f8f59306e1490ac (MD5) Previous issue date: 2015 / Mestrado Profissional em Enfermagem Assistencial / O presente trabalho tem como objetivo o desenvolvimento e validação de subconjunto terminológico, utilizando a CIPE, para pacientes em cuidados paliativos, com feridas tumorais. No primeiro momento do estudo, foi realizada uma revisão integrativa da literatura em busca de evidências empíricas relacionadas às feridas tumorais e intervenções de enfermagem indicadas para o manejo dos sintomas. Para isso, foram empregados os descritores “ferimentos e lesões”, “cuidados paliativos”, “wounds and injuries” e “palliative care”, e as palavras-chaves “feridas neoplásicas”, “feridas tumorais”, “malignant wound”, “fungating wound” e “malignant fungating wound”. No segundo momento, a partir do cruzamento das evidências encontradas com os termos constantes na versão 2013 da CIPE® e tendo como base o Modelo de 7 Eixos, foram construídas 51 afirmativas de diagnósticos de enfermagem e 134 enunciados de intervenções de enfermagem. Após a construção das declarações de diagnósticos, estas foram distribuídas de acordo com as necessidades humanas básicas postuladas no referencial conceitual de Wanda Horta. No terceiro momento, o instrumento foi submetido à validação baseada na opinião de enfermeiros peritos e, no quarto momento, realizou-se a elaboração do catálogo, observando as etapas propostas pelo Guia para o Desenvolvimento de Catálogos CIPE®, do Conselho Internacional de Enfermeiros. Dos 51 diagnósticos apresentados, 43 (84,31%) alcançaram IC ≥ 0,8 e das 134 Intervenções de Enfermagem, 122 (91,04%) alcançaram IC ≥ 0,8, sendo, portanto, validadas. Considera-se que os objetivos do estudo foram alcançados, tendo como resultado a construção e validação do Subconjunto Terminológico CIPE para pacientes oncológicos, em cuidados paliativos, com feridas tumorais. Este instrumento servirá como um guia para os enfermeiros, propiciando um cuidado baseado em evidências, além do uso de uma linguagem unificada que facilite a documentação da prática de enfermagem. Espero que este trabalho possa gerar conhecimento, considerando a lacuna existente na literatura especializada de enfermagem e, assim, colaborar no fortalecimento da rede de cuidados ao paciente oncológico / The purpose of this study was to develop and validate an INCP terminological subset for patients with tumor wounds under palliative care. The first stage of the study consisted of an integrative literature review in search of empirical evidences related to tumor wounds and nursing interventions indicated for the handling of symptoms. The descriptors used were ‘wounds and injuries’ and ‘palliative care’; the key-words used were malignant wound, fungating wound, and malignant fungating wound. On the second stage, the correlation between the evidences found and the terms present in the 2013 Version of INCP®, based on the 7-Axes Model, led to the production of 51 nursing diagnoses and 134 nursing intervention statements. The diagnoses statements produced were distributed according to the basic human needs postulated in Wanda Horta’s theoretical references. On the third stage, the instrument was submitted to validation based on the opinion of specialized nurses; and on the fourth stage, a catalogue was generated following the steps proposed by the INCP® Guidelines for the Development of Catalogues, from the International Council of Nurses (ICN). Of the 51 diagnoses presented, 43 (84.31%) reached IC ≥ 0.8; and of the 134 nursing interventions, 122 (91.04%) reached IC ≥ 0.8, thus being validated. It has been considered that the purposes of this study have been achieved, resulting in the development and validation of an INCP® terminological subset for oncology patients under palliative care of tumor wounds. This instrument shall serve as a guide for nurses, providing evidence-based care, besides using a unified language that may facilitate the documentation of nursing practice. It is expected that this study may generate knowledge, considering the existing gap in the specialized nursing literature and therefore collaborate with the strengthening of the oncologic patient care network.

Problématique : L’avènement de la documentation infirmière des soins dans les dossiers cliniques informatisés (DCI) engendre des changements dans la pratique infirmière actuelle. Le personnel infirmier devra acquérir les habiletés et savoirs nécessaires pour documenter électroniquement la démarche de soins infirmiers. À cet effet, des chercheurs de l’Université de Sherbrooke, en collaboration avec une compagnie informatique, ont développé un logiciel de simulation nommé Environnement Virtuel d’Apprentissage (EVA). Ce dernier vise à permettre aux personnes étudiantes infirmières, au moyen d’un simulateur sur écran, de pratiquer, à partir d’histoires de cas, l’évaluation clinique, l’examen physique, de même que la documentation électronique de la démarche de soins infirmiers, tout en se familiarisant avec une terminologie infirmière standardisée. But : Cette étude visait à évaluer l’impact du système EVA sur le sentiment d’auto-efficacité d'étudiants et étudiantes en sciences infirmières concernant leur performance clinique associée à la documentation électronique de la démarche de soins infirmiers. Méthodologie : Un devis quasi-expérimental avant-après a permis de décrire le sentiment d’auto-efficacité du groupe témoin et expérimental. Une appréciation concernant les fonctionnalités d’EVA a aussi été documentée par le groupe expérimental. Analyses et résultats : L’échantillon était composé majoritairement de femmes entre 21 et 30 ans ayant moins d’un an d’expérience en soins infirmiers. Un total de 63 personnes étudiantes ont rempli le questionnaire d’enquête au pré-test. Les résultats sur le sentiment d’auto-efficacité initial étaient similaires chez les groupes témoin et expérimental. En raison d’une importante perte de sujets, les calculs en post-test et pour la comparaison des groupes dans le temps ne sont pas significatifs. Une présentation graphique et une comparaison descriptive des données de quatre sujets ont été possibles pour décrire l’évolution du sentiment d’auto-efficacité dans le temps. Conclusion : Malgré quelques embûches concernant la participation du groupe expérimental, nous avons décrit le sentiment d’auto-efficacité avant et après l’utilisation du logiciel, effectué des comparaisons inter et intra groupe et fourni une rétroaction au développeur du logiciel. / Abstract : Issue: The advent of nursing care documentation in computerized clinical records generates changes in the current nursing practice. Nurses will need to acquire the skills and knowledge required to electronically document the nursing process. To this end, researchers at the University of Sherbrooke, in collaboration with an IT company, have developed a simulation software called Environnement Virtuel d’Apprentissage (EVA). The purpose of this program is to enable nursing students, using a simulation software, to practice, from case histories, clinical assessment, physical examination, as well as electronic documentation of the nursing process while becoming familiar with the nursing terminology. Purpose: This study aimed to assess the impact of the software EVA on the self-efficacy of nursing students about their clinical performance associated with electronic documentation of the nursing process. Methods: A quasi-experimental design before and after allowed to describe the feeling of self- efficacy in the control and experimental sample. An appreciation regarding EVA’s features was described by the experimental sample. Findings: The sample was predominantly composed of females between 21 and 30 years of age with less than one year of experience in nursing. A total of 63 students completed the survey questionnaire in the pretest. The results for the initial self-efficacy measure were similar in for the control and experimental group. Due to a significant loss of participants, our calculations regarding the post-test and comparison of groups over time were not significant. A graphic presentation and a descriptive comparison of four subjects was possible to describe the evolution of self- efficacy over time. Conclusion: Despite some difficulties concerning the participation of the experimental sample, we described the feeling of self-efficacy before and after using the software, made inter and intra-group comparisons and provided feedback to the software developer.

INTRODUÇÃO: As vantagens da utilização do Cateter Central de Inserção Periférica (CCIP) no ambiente hospitalar faz com que esse cateter ocupe uma posição de destaque na terapia intravenosa dos pacientes com indicação de administração de drogas com características que danificam a rede venosa periférica. A possibilidade de inserção do cateter a beira do leito por enfermeiros capacitados conferem maior facilidade para a inserção deste dispositivo. Por ser um cateter seguro e de fácil manutenção possibilita ainda a desospitalização precoce dos pacientes em antibioticoterapia e quimioterapia. Este trabalho relata o uso do CCIP nos pacientes do Instituto de Ortopedia e Traumatologia do Hospital das Clinicas da Universidade de São Paulo (IOT-HC-FMUSP) nos últimos 10 anos. MÉTODOS: Foram analisados 1.057 prontuários de pacientes submetidos a inserção do CCIP por enfermeiros qualificados no Instituto de Ortopedia e Traumatologia do Hospital das Clinicas da Faculdade de Medicina da Universidade de São Paulo entre os anos de 2007 e 2017. Destes, 34 foram excluídos por não apresentar dados completos no prontuário para a análise posterior. Foram incluídos 1023 prontuários no total, onde foram analisados: idade, sexo dos pacientes, veia puncionada, diagnóstico, número de punções, tempo em que o paciente permaneceu com o cateter, motivo da retirada e posicionamento da ponta do CCIP. RESULTADOS: Um total de 1023 CCIPs inseridos durante o período de 10 anos cumpriram os critérios para inclusão neste estudo. Destes, 720 (70,4%) foram considerados adequadamente posicionados. O tempo médio de utilização do cateter foi de 34,3 dias. A veia basílica foi utilizada em 528 (51,6%) pacientes enquanto que a veia cefálica foi utilizada em 392 (38,3%) pacientes. Cento e cinquenta e sete (15,4%) cateteres foram removidos devido a complicações, sendo a oclusão a complicação mais frequentemente reportada, com 58 (5,7%) casos. Nenhum caso de trombose ou infecção relacionada ao cateter foi encontrado. Oitocentos e sessenta e seis (84,6%) pacientes completaram o tratamento. Destes, 791 (77,3%) completaram durante a hospitalização e 75 (7,3%) receberam alta com o dispositivo. A principal indicação do CCIP nos pacientes ortopédicos é a antibioticoterapia. CONCLUSÃO: Este estudo sugere que o CCIP é um dispositivo intravenoso seguro e pode ser utilizado para terapia intravenosa de média e longa duração em pacientes ortopédicos hospitalizados ou desospitalizados Benefits and risks of the peripherally inserted central catheter (PICC) / INTRODUCTION: The advantages of using a Peripherally Inserted Central Catheter (PICC) in hospitalized patients gives this dispositive great importance for the intravenous therapy, especially in patients with the indication of drugs that have a potential to damage peripheral veins. The possibility of inserting this catheter at bedside, procedure that should be realized by trained nurses, gives the use of this device an excellent choice for intravenous therapies. Also, for being a safe an easy maintain dispositive, it gives the patient the option of an early dismissal from the hospital to continue the intravenous therapy at home. This paper describes the uses of the Peripherally Inserted Central Catheter (PICC) in adult patients that used this device for intravenous therapy, and had complete information in the medical records between 2007 and 2016, at the Orthopedics and Traumatology Institute of the Clinics Hospital of the Medical School of the University of São Paulo. METHODS: This is a retrospective study in which we used 1.057 medical records from patients that receive intravenous therapy through a Peripherally Inserted Central Catheter (PICC). The procedure was carried out by trained nurses from the Orthopedics and Traumatology Institute of the Clinics Hospital of the Medical School of the University of São Paulo between 2007 and 2017. From the 1.057 medical records studied, 34 were excluded due to the lack of information or incomplete data at the time of the analyses. There were 1.023 medical files with complete information included in the study. We obtained the following information: age, gender, place of insertion, punctured vein, number of punctures, diagnosis, duration of the catheterization, complications of the catheter and positioning. RESULTS: A total of 1023 PICCs inserted during a 10 year period met eligibility criteria for this study. Of these, 720 (70.4%) were considered successfully positioned. Mean duration of catheterization was 34.3 days. The basilic vein was used in 528 (51.6%) patients, while the cephalic vein was used in 392 (38.3%) patients. One hundred and fifty seven (15.4%) catheters were removed due to complications. Of the complications, occlusion was reported in 58 (5.7%) patients. Incidence of catheter related thrombosis or infection was not found. Eight hundred and sixty six (84.6%) patients completed the treatment. Of these, 791 (77.3%) completed it during hospitalization and 75 (7.3%) were discharged with the catheter. PICCs in orthopedic patients are mainly used for antibiotic treatment. CONCLUSION: Our study suggests that PICC is a safe intravenous device that can be successfully utilized for medium and long lasting intravenous therapy in hospitalized and non-hospitalized orthopedic patients

A aplicação da tecnologia da informação na Saúde tem dado um suporte à prestação do cuidado ao paciente com mais qualidade e propiciado a adesão de processos mais lineares, eficientes e seguros. Apresenta-se, nesta Tese, o desenvolvimento e a avaliação de um módulo, denominado Sistematização da Assistência de Enfermagem (Módulo SAE) que, incorporado ao Sistema de Informação Hospitalar (SIH) do Instituto do Coração do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, seja capaz de automatizar as ações envolvidas no Processo de Enfermagem, identificando os benefícios e as limitações decorrentes da adoção de um sistema informatizado. A metodologia foi desenvolvida em duas etapas, uma para possibilitar o desenvolvimento e a implantação do Módulo SAE, outra para avaliar a contribuição para o enfermeiro e sua aplicabilidade no ponto de cuidado do paciente (PCP). A primeira etapa constou da organização das funcionalidades do Processo de Enfermagem no Módulo SAE. Como resultado, um conjunto de funcionalidades, estruturadas ou em texto livre, foi definido e compreende: coleta dos dados do paciente e exame físico, diagnóstico e evolução de enfermagem, intervenções e prescrição de enfermagem. O uso do Módulo SAE foi realizado em paralelo com a SAE manuscrita durante 6 meses e aprovado por 28 enfermeiros. Após esta fase, 50 outros enfermeiros foram treinados e utilizaram o Módulo SAE no seu trabalho diário, durante 15 meses, finalizando a primeira etapa com 78 enfermeiros treinados. A segunda etapa constou de uma pesquisa com os enfermeiros que responderam dois questionários para avaliar o uso do Módulo SAE, por meio de duas formas diferentes de acesso, uma delas por computador fixo no posto de enfermagem e a outra, um computador móvel desenvolvido no próprio hospital, para levar o sistema ao PCP. Para obter melhores resultados na pesquisa, as características pessoais desses enfermeiros foram analisadas e comparadas. Da homogeneidade dos resultados foram selecionados 42 profissionais aptos para usarem o computador móvel, dos quais, 25 participaram. Mediante os resultados analíticos e estatísticos, concluiu-se que o Módulo SAE incorporado no SIH contribuiu para o enfermeiro obter maior legibilidade e segurança no registro eletrônico, tanto por acesso fixo como por acesso móvel. A comparação entre as formas de acesso para a formulação do diagnóstico e da prescrição de enfermagem demonstrou resultado positivo a despeito das diferenças estatisticamente significantes (teste não paramétrico de Wilcoxon). Além disso, o registro eletrônico permitiu ao enfermeiro dispor de maior tempo para a assistência direta ao paciente (fixo 84% e móvel 60%). Quanto à facilidade do uso do computador móvel no PCP, as respostas positivas (84%) indicaram a diminuição do tempo gasto para a atualização da prescrição de enfermagem. / The application of information technology in health has given support to the patient care with more quality and provides more linear, efficient and safe processes. This thesis presents the development and evaluation of a module called Systematization of Nursing Care (SAE Module) that when incorporated into the Hospital Information System of the Heart Institute of the University of Sao Paulo Medical School is able to automate the actions involved in Nursing Process. The identification of the benefits and limitations resulting from the adoption of an information system are also described. The methodology was developed in two stages: the first involved the development and deployment of the SAE Module, and the second involved the assessment of the nursing computerized system to the nurse and its application at the point of patient care (PCP). The first step included the organization of the nursing process in the SAE Module. As a result, a set of features, structured or free texts were defined and comprised: collection of patient data and physical examination, nursing diagnosis and evolution, nursing interventions and prescription. The use of SAE Module was done in parallel with the SAE handwritten during 6 months and approved by 28 nurses. After this stage, 50 other nurses were trained and used it in their daily work for 15 months, finalizing the first step with 78 trained nurses. The second step involved the evaluation of nurses who replied two forms to evaluate SAE Module usage through two different ways of access, one using a fixed computer in the nursing counter and the other using a mobile computer, developed in the hospital in order to bring the system to the PCP. In order to obtain the best results from the evaluation, personal characteristics of these nurses were reviewed and compared. Fortytwo nurses were selected according to the homogeneity of the results, out of which 25 participated in the evaluation. The analytical and statistical results lead to the conclusion that the SAE Module incorporated into SIH contributed to the nurse to get more readability and security from patient electronic records for both fixed and mobile access. The comparison between the two forms of access to the formulation of nursing diagnosis and prescription has shown positive results despite statiscally significant differences (nonparametric Wilcoxon test). In addition, it was observed that the patient electronic record (fixed 84% and 60%) allowed an increase of the nurse´s time in the direct patient care. Regarding the use of a mobile computer in the PCP, the positive responses (84%) indicated a reduction in the time spent to update the nursing prescription.

Bakgrund: Kvaliteten på sjuksköterskans omvårdnadsjournal kan återspegla den vårdkvalitet som tillhandahålls patienter. Patienter med en höftfraktur har ofta ett omfattande vårdbehov där omvårdnadsjournalen har en viktig funktion att strukturera dokumentation av vårdinsatser genom patientens vårdförlopp. Patienter med höftfraktur har ofta en komplex sjukdomsbild, där omvårdnadsdokumentationens kvalitet kan bidra till en säkrare vård för patienten. Kvaliteten på dokumentationen ökar vid en strukturerad journal och framförallt när ett standardiserat språk används. Journalgranskning är ett sätt att göra kvalitetskontroll av dokumentation. Motiv: Att drabbas av en höftfraktur innebär stora hälsorisker för en ofta redan skör person. Omvårdnadsdokumentationens kvalitet vid höftfraktur kan bidra till att patienten får bättre förutsättningar för att undvika komplikationer och till kortare vårdtid. Syfte: Att undersöka kvaliteten av omvårdnadsdokumentation för patienter med höftfraktur.Metod: En retrospektiv, deskriptiv och jämförande design där granskning av omvårdnadsjournaler användes för att besvara studiens syfte. Ett konsekutivt urval har gjorts av omvårdnadsdokumentation från 40 vårdtillfällen med patienter över 60 år som vårdats för en höftfraktur på en akutortopedisk avdelning. För granskningen användes journalgranskningsinstrumentet Cat-ch-ing. Resultat: De granskade omvårdnadsjournalernas kvalitet var varierande; ingen av journalerna hade en komplett dokumentation. Dokumentation av vårdplan och resultat av omvårdnadsåtgärder saknades i en majoritet av journalerna. Dokumentationen var av bättre kvalitet i gruppen yngre äldre patienter vid jämförelse med gruppen äldre äldre patienter. Ingen skillnad av kvalitet i dokumentationen kunde urskiljas utifrån vårdtidens längd då patienter som vårdats mindre än sju dygn eller sju dygn eller mer jämfördes. Konklusion: Kvaliteten av omvårdnadsdokumentationen var inte komplett. Det krävs ytterligare kunskap om förbättringsåtgärder i den kliniskas verksamheten för att säkerställa en omvårdnadsdokumentation av god kvalitet där patienter med höftfraktur vårdas. / Background: The quality of the nursing record can reflect the quality of nursing care provided to patients. Patients with a hip fracture often have an extensive need for care. The nursing record has an important function of describing the nursing process, nursing diagnoses and interventions. Patients with hip fractures often have complex health care needs and the nursing documentation can contribute to patient safety. The quality of the documentation increases with a structured journal. Furthermore, it should be written in a standardized language. Audit of nursing documentation can contribute to quality of care. Motive: Great health risks is a fact when suffering from a hip fracture, especially an already fragile person. The quality of the nursing documentation can contribute to better outcome in patient safety and the length of stay. Aim: To explore the quality of nursing documentation for patients with hip fractures. Methods: A retrospective descriptive and comparative design where audit of nursing records was used to attain the study's aim. A consecutive sample was used, where 40 patients’ health care records of nursing documentation for patients over the age of 60 with a hip fracture in an emergency orthopedic ward were included. The audit instrument Cat-ch-Ing was used. Result: The result showed that the quality was variable; none of the records had a complete documentation. Documentation of care plans were missing in a majority of the records. The documentation was of better quality in the group of younger elderly patients compared to that of older elderly patients. No quality differences were seen based on the length of stay. Conclusion: None of the records had a complete documentation. Further knowledge of how good quality nursing documentation on hip fractur patients can be implement for a sustainable result in clinical activities.

Lecturers at three Nursing Colleges in the Gauteng Province in South Africa where this study was conducted raised their concern that a large proportion of learners reaching the senior phase have difficulty solving patient care problems and even making specific decisions regarding patient care. These learners are also unable to formulate nursing diagnoses and develop nursing care plans. This lack of essential critical thinking skills is evident during the assessment of their assignments, tests as well as clinical formative assessments. These skills can be developed within learners throughout their four-year training, if exposed to outcomes- based education (OBE) and problem-based teaching strategies especially starting on the first level of their training course. The current nursing education programme, at these Nursing Colleges where this study was conducted is an outcomes- and problem-based curriculum. It is important that teaching strategies utilized by nurse educators are appropriate for the specific curriculum implemented because they greatly differ from the traditional teaching strategies. The purpose of this study was to investigate the teaching and assessment strategies utilized in the facilitation of learning for the first year level students in the subject General Nursing Science (GNS I). The focus of the study was on the first year of training because it is expected that development of critical thinking be started at this level. A quantitative, contextual descriptive research method was utilised. The sample consisted of lecturers (N=23) and students (N=680). The lecturers from each of the three colleges were addressed during a personnel meeting regarding the study and a suitable date and time was set for the distribution of the questionnaires to the lecturers and to first year learners during the last block of the academic year. The questionnaires were distributed to the lecturers and the learners on the agreed date and time and the researcher was present to clarify any misunderstanding regarding the tool. The questionnaire consisted of appendix E, which was distributed to lecturers and appendix F, which was distributed to the learners. Respondents were requested not to give any identifiable information on the questionnaires and to place completed questionnaires in the box provided in each of the venues to ensure confidentiality and anonymity. Data from the study indicated that not all of the teaching strategies and assessment methods utilized by the educators are appropriate and conducive for the stimulation of critical thinking skills. The majority of the lecturers facilitate through a lecture method and assessments are mostly done through written tests and examinations. On the other hand teaching facilities at the colleges are inadequate, for instance small group facilities are not available. Recommendations are as follows: <ul> <li> More lecturers should be encouraged to obtain a Masters Degree qualification in Nursing.</li> <li> All lecturers should utilize the OBE educational strategies.</li> <li> In their facilitation of GNS I lecturers should accommodate older students, because they were never exposed to an OBE approach in their basic education.</li> <li> Lecturers should utilise a variety of teaching strategies that will ensure development of critical analytical thinking.</li> <li> Lecturers should utilize a variety of assessment methods.</li> <li> Students should be encouraged to seek information on their own, specifically regarding case studies because this actively involves them as they are solving problems, making decisions and draw conclusions in relation to GNS I.</li> </ul> Copyright / Dissertation (MCur)--University of Pretoria, 2011. / Nursing Science / unrestricted

Bakgrund: Sjuksköterskor ansvarar för att leda omvårdnadsarbetet, där omvårdnadsprocessen spelar en avgörande roll. Omvårdnadsprocessen säkerställer att sjuksköterskor ger högkvalitativ vård som är anpassad efter individens unika behov. Studier visar att nyutexaminerade sjuksköterskor har god teoretisk kunskap men saknar förmågan att tillämpa den i det kliniska arbetet. Syfte: Att beskriva nyutexaminerade sjuksköterskors upplevelser av att tillämpa omvårdnadsprocessen inom somatisk vård. Metod: En kvalitativ deskriptiv studie genomfördes med en induktiv ansats. Data samlades in genom tre semistrukturerade intervjuer och analyserades med Braun och Clarks tematiska analys. Resultat: Två teman identifierades: Arbetsmiljö och Omvårdnaden. Temana består av fyra underteman: arbetsmiljöns påverkan på omvårdnadsprocessen, samarbetets betydelse för omvårdnadsarbetet, från teori till praktik och prioritering av omvårdnaden. Slutsatser: Studien visar att tillämpningen av omvårdnadsprocessen kan vara utmanande för nyutexaminerade sjuksköterskor på grund av flera faktorer. Dessa faktorer är bland annat arbetsbelastning, tidsbrist, bristande samarbete och att inte tillåtas vara ny i professionen. För att säkerställa god tillämpning av omvårdnadsprocessen är det därför viktigt att förbättra arbetsmiljön, ge stöd under den första tiden som nyutexaminerad sjuksköterska och en ökad medvetenhet om vikten av att prioritera omvårdnadsarbete. / Background: Nurses are responsible for leading nursing work, where the nursing process plays a crucial role. The nursing process ensures that nurses provide high-quality care that is personalized to the individual's unique needs. Studies show that newly graduated nurses have good theoretical knowledge but lack the ability to apply this knowledge in their clinical work. Purpose: To describe newly graduated nurses' experiences of applying the nursing process in somatic care. Method: A qualitative descriptive study was conducted using an inductive approach. Data was collected through three semi-structured interviews and analyzed using Braun and Clark’s thematic analysis. Results: Two themes were identified: work environment and nursing care. The themes consist of four subthemes: the influence of the work environment on the nursing process, the cooperation’s significance for the nursing work, from theory to practice and prioritising of nursing care. Conclusions: The study shows that the application of the nursing process can be challenging for newly graduated nurses due to several factors. These factors include heavy workload, insufficient time, lack of cooperation, and not being allowed to be new in the profession. Therefore, to ensure the effective application of the nursing process, it is crucial to improve the work environment, provide support during the initial period as a newly graduated nurse, and increase awareness of the significance of prioritizing nursing work.

Submitted in fulfillment of the requirements of the degree of Master of Technology: Nursing, Durban University of Technology, Durban, South Africa, 2015. / Aim The aim of this study was to evaluate the use of nursing care plans in the management of patient care and to recommend guidelines for improving the quality of planned nursing care at a level 3 hospital in the Umgungundlovu district of KwaZulu-Natal. Method The case study was based on the conceptual model of care planning and employed both quantitative and qualitative research designs. The quantitative phase involved a retrospective audit of charts, using an itemised checklist to determine whether items relating to the phases of the nursing process were in evidence within the charts. The qualitative phase consisted of face-to-face interviews with registered nurses, who were asked about their understanding and use of the nursing process. Data derived were analysed using Nvivo 10 and presented as graphs, tables and written text extracts. Results The results show that the use of the standardised care plans at the study hospital had an impact on the understanding of the importance of the nursing process and the successful implementation of the care plans. Factors that had an impact on this included the registered nurses who failed to nurture the junior nurses, lack of understanding of the care plans and what was expected of the staff, staff attitudes and the heavy workload. Conclusion It was suggested that nurse leaders support the implementation and continued use of individualised care plans in order to improve critical thinking skills of nurses by implementing teaching and in-service programs, employing knowledgeable registered nurses, by developing and enforcing adherence to policies that favour care planning and nursing documentation.

A complexidade da atenção à saúde, como um reflexo da influência de uma diversidade de fatores sobre o processo saúde-doenças das pessoas, requer uma combinação de saberes e fazeres, com as devidas competências técnicas e relações peculiares a cada profissão de saúde, com o estabelecimento de habilidades interpessoais para a produção de relações colaborativas entre os profissionais, os usuários e as organizações de saúde. Nesse contexto, emerge o Cuidado Colaborativo que acontece quando, em uma ação coordenada na tentativa de buscar atingir maior aproximação com a integralidade da atenção de que um usuário precisa, profissionais de vários núcleos de competência e responsabilidade da saúde, diversas organizações de saúde, incluindo os usuários, trabalham juntos cotidianamente para conseguir um benefício compartilhado e obter um objetivo comum. Esse estudo teve como objetivo analisar o processo de organização para implantar o cuidado colaborativo integrante do processo de enfermagem, à adolescente com condições ginecobstétricas, a partir da atenção hospitalar, como dispositivo na contribuição da promoção da integralidade da atenção na rede de serviços do sistema de saúde. Foi desencadeada a realização de uma pesquisa-ação, organizada dentro da estrutura metodológica do processo de enfermagem, tomando por referência a implantação da Linha de Ação Teias do Adolescer, de um núcleo de extensão universitária, em colaboração com mais duas instituições, um hospital materno-infantil e de uma prefeitura, todos de um município do interior da Bahia, compondo o cenário de estudo. Teve como sujeitos do estudo em uma equipe de pesquisa-ação composta por representantes das três instituições do cenário de pesquisa. Os dados empíricos foram coletados por meio da técnica de grupos de discussão. A análise dos dados se deu pelo método de Análise Temática, tendo como apoio para isso o uso do software de tratamento de dados qualitativos NVivo 10, da QSR International. Do material empírico analisado emergiram três conjuntos temáticos: a) O cuidado colaborativo na atenção à saúde na perspectiva da equipe do Teias de Adolescer; b) A integralidade na atenção à saúde na perspectiva da equipe do Teias de Adolescer; e c) O Processo de Enfermagem no contexto do Teias de Adolescer. Os resultados analisados no processo que está, e estará, permanentemente em curso vêm apontando, mesmo de forma incipiente, que o cuidado colaborativo tem potencialidade para contribuir para o cuidado integral e servir como disparador para promoção da integralidade da atenção à saúde, seja por meio da colaboração intraorganizacional e/ou interorganizacional / Health care complexity, as a reflection of the influence of a variety of factors on people\'s health-disease process, requires a combination of knowledge and action, with the necessary technical skills and peculiar relations to each health profession, with the establishment of relational skills for the production of collaborative relationships among healthcare professionals, users and organizations. Within such context, Collaborative Care emerges when, in a coordinated attempt to seek to achieve closer ties with the comprehensive care that a user needs, accountability and specialization health professionals, health organizations, including users, work together on a daily basis to achieve shared goals and benefits. This study aimed to analyze the organization process to apply collaborative care, as constituent of the Nursing Process, to teenagers with gynecobstetric conditions, in the context of hospital care, as an approach to promoting comprehensive care in the service network of the health system. The conducted action research was organized within the methodological framework of the nursing process, with reference to the implementation of the project \"Teias do Adolescer\" (which is part of a university extension teenager health care program), in collaboration with two other institutions: a maternal and child hospital, and a city hall administration, all in a city in the interior of the State of Bahia, Brazil. As study subjects of the action research, representatives of the three mentioned institutions were involved. Empirical data were collected through discussion groups. Data analysis was made by the method of Thematic Analysis, supported by the NVivo 10 of QSR International software. The empirical material analyzed revealed three thematic clusters: a) The collaborative health care from the perspective of the \"Teias do Adolescer\" staff; b) The completeness in health care from the perspective of the \"Teias do Adolescer\" staff; and c) the nursing process in the context of the \"Teias do Adolescer\" project. The results analyzed in the ever-ongoing process have pointed out, even incipiently, that the collaborative care has the potential to contribute to a total care and serve as a trigger for the promotion of integral health care, either through intra-organizational or interorganizational collaboration