Abstract The aim of the study was to investigate the amount and focus of rehabilitation nursing care practices and the association of these practices to quality outcomes. Additionally, the aim of the study was to describe the characteristics and leadership models of the functional level in long-term care units providing rehabilitation nursing care. The study consists of four articles. The data for the first three articles were derived from the National Institute for Health and Welfare Resident Assessment Instrument (RAI) database. The data for the first article (n = 5312) were collected using resident level data. The second article is based on unit level information (n = 256) and data from a questionnaire sent to the nursing leaders of the functional level (n = 189) in facilities which adopted RAI. For the third article the resident level data (n = 2037) were used from the study of Laine (2005). The statistical analyses were performed by SAS statistical software for Windows. The data were presented as mean scores and confidence intervals. Regression models were used to present the associations between variables. The qualitative data for the fourth article was collected by interviews with the nursing leaders at the functional level (n = 14). The data were analysed by content analysis. The results show that residents receiving rehabilitation nursing had more impaired cognitive and physical function. The amount of rehabilitation nursing practice was associated to the nurses' assessment of residents' rehabilitation potential. Daily provision of rehabilitation nursing activity was associated to better care quality. It decreased the prevalence of bedridden residents and residents with little or no activity. It increased the amount of nursing time spent on residents. The leadership of the rehabilitation units consisted of recognizing options, promoting guidelines, reminding nurses, upholding open communication, supporting the learning process and respecting. The characteristics of rehabilitation units involved characteristics of Magnet Hospitals. The measure of rehabilitation nursing that measured the amount of rehabilitation nursing activity was usable and distinctive. In this study, measurable information about the amount of rehabilitation nursing practice was acquired. Findings of this study are usable for evaluation of nursing care outcomes and for developing nursing management. / Tiivistelmä Tutkimuksen tarkoituksena oli analysoida kuntoutumista edistävän hoitajan toiminnan määrää, kohdentumista ja sen yhteyttä hoidon laadun tuloksiin. Lisäksi tarkoituksena oli kuvata kuntoutumista edistävien osastojen tunnuspiirteitä ja lähijohtamisen menetelmiä pitkäaikaisessa laitoshoidossa. Tutkimus koostuu neljästä osajulkaisusta, josta kolmessa on käytetty valmiita tutkimusaineistoja. Ensimmäisen (n = 5312) osajulkaisun asiakastason aineisto on kerätty tekemällä poimintoja Terveyden ja hyvinvoinnin laitoksen Resident Assement Instrument (RAI) -tutkimustietokannasta. Toisessa osajulkaisussa tutkimustietokannasta on kerätty osastotason aineisto (n = 256) ja tehty poimintoja RAI-järjestelmää käyttävien osastonhoitajien toimintatietokyselystä (n = 189). Kolmannessa osajulkaisussa on hyödynnetty asiakastason aikamittaus- ja RAI-arviointiaineistoa (n = 2037), jota Laine (2005) käytti väitöskirjassaan. Analyyseissä on käytetty SAS-tilasto-ohjelmistoa. Aineisto on kuvattu keskiarvoin ja luottamusvälein. Muuttujien yhteyksiä on kuvattu käyttämällä regressiomalleja. Neljättä osajulkaisua varten on koottu laadullinen aineisto osastonhoitajien teemahaastatteluista (n = 14), joka on analysoitu sisällön analyysillä. Tulosten mukaan hoitajan kuntoutumista edistävä toiminta kohdistui niihin asiakkaisiin, joilla oli keskivaikeasti alentunut fyysinen toimintakyky ja kognitio. Hoitajan toiminta oli yhteydessä hoitajan uskoon asiakkaan kuntoutumisen mahdollisuudesta. Osastotason tarkastelussa päivittäinen kuntoutumista edistävä toiminta oli yhteydessä hoidon laadun tuloksiin, sillä se vähensi vuodepotilaiden määrää ja lisäsi asiakkaiden sosiaalista osallistumista. Se lisäsi myös asiakaskohtaista välitöntä hoitoaikaa. Lähijohtamisen menetelminä korostuivat mahdollisuuksien näkeminen, linjassa pitäminen, mieleen palauttaminen, avoin kommunikointi sekä hoitajien osaamisen tukeminen ja arvostaminen. Kuntoutumista edistävien osastojen tunnuspiirteinä korostuivat magneettisairaaloiden vetovoimatekijät. Tutkimuksessa kehitetty kuntoutumista edistävän hoitajan toiminnan määrän mittaamiseen tarkoitettu mittari osoittautui käyttökelpoiseksi ja erottelevaksi mittariksi. Tutkimuksessa saatu tieto on hyödynnettävissä kuntoutumista edistävän hoitajan toiminnan mittaamisessa kuten myös hoidon tulosten arvioinnissa. Tutkimustuloksista on hyötyä hoitotyön johtamisessa. / Sammanfattning Syftet med undersökningen var att analysera mängden av rehabiliteringsfrämjande vårdinsatser, vem de riktades till och hur de relaterar till vårdkvalitet. Dessutom var avsikten att beskriva vad som kännetecknar rehabiliteringsfrämjande avdelningar och ledarskapsmodeller inom institutionsvården. Undersökningen består av fyra delpublikationer: i tre av dem användes existerande forskningsmaterial. Materialet på klientnivå (n = 5312) som användes i den första delpublikationen samlades in genom axplock ur forskningsdatabasen Resident Assessment Instrument (RAI) på Institutet för hälsa och välfärd (THL). Den andra delpublikationen består av material på avdelningsnivå (n = 256) och material ur en enkät om verksamhetsuppgifter (n = 189) riktad till de avdelningsskötare som använder RAI-systemet. Den tredje delpublikationen omfattar tidmätnings- och RAI-bedömningsmaterial (n = 2037) på klientnivå som Laine (2005) använde i sin doktorsavhandling. I analyserna har SAS-dataprogramvara använts. Materialet har beskrivits med medelvärden och konfidensintervaller. Variablernas förhållanden till varandra har illustrerats med regressionsmodeller. För den fjärde delpublikationen har ett kvalitativt material insamlats från temaintervjuer med avdelningsskötare (n = 14) och analyserats med innehållsanalys. Resultaten visar att vårdarens rehabiliteringsfrämjande vårdinsatser riktade sig på de klienter som hade medelsvårt nedsatt fysisk funktionsförmåga och kognition. Vårdinsatserna var sammankopplade med vårdarens uppfattning om klientens rehabiliteringsmöjligheter. I studien på avdelningsnivå relaterade den dagliga rehabiliteringsfrämjande vårdinsatsen till vårdkvalitet. Antalet sängliggande klienter minskade och det sociala deltagandet hos klienterna ökade, även den direkta vårdtiden per klient ökade. Bland de metoder som avdelningsskötarna använde för ledarskap framhävdes upptäckandet av möjligheter, linjehållning, påminnelser, öppen kommunikation samt stödandet och värdesättandet av vårdarnas kompetens. Särskilt kännetecknande för de rehabiliteringsfrämjande avdelningarna visade sig vara magnetsjukhusens dragningskraft. För att mäta mängden rehabiliteringsfrämjande vård som gavs, utvecklades en mätare, vilken visade sig vara användbar och urskiljande. De resultat som denna forskning gett kan tillämpas för att lyfta fram mätbarheten av rehabiliteringsfrämjande vårdinsatser såsom även till att utvärdera vårdresultaten. Forskningsresultaten kan också utnyttjas till att utveckla ledarskapet inom vårdarbetet.

Orientador: Marla Andréia Garcia de Avila / Resumo: Trata-se do levantamento de vídeos sobre o cateterismo intermitente limpo no YouTube e avaliação dos acessos de conteúdos voltados do website Cateterismo Digital nas redes sociais. Estudo metodológico dividido em duas etapas com abordagem quantitativa e descritiva para avaliar os conteúdos existentes no YouTube que abordam o cateterismo intermitente limpo e na segunda etapa avaliar os acessos de tecnologias educativas disponibilizadas em redes sociais acerca da temática. Na primeira etapa a amostra constituiu-se por 07 vídeos que descreviam a técnica do cateterismo intermitente limpo com disponibilização gratuita no YouTube. O material foi avaliado por enfermeiros baseado nas recomendações da Sociedade Brasileira de Urologia. A segunda etapa constituiu-se pela avaliação dos acessos das redes sociais Cateterismo Digital, sendo o YouTube a rede social com maior média de visitas ao perfil e impressão de conteúdos. De acordo a avaliação dos acessos das redes sociais Cateterismo Digital pode concluir que os perfis responderam positivamente às expectativas de divulgação dos conteúdos do website aos usuários. Nesse contexto, é importante considerar o potencial que as redes sociais desenvolvidas por profissionais de saúde apresentam como ferramentas tecnológicas educativas, podem ser utilizadas tanto pelos usuários quanto por demais profissionais para nortear a busca por informações seguras online colaborando com a promoção da saúde. / Abstract: This involves surveying videos about clean intermittent catheterization on YouTube and evaluating access to content on the Cateterismo Digital website on social networks. Methodological study divided into two stages with a quantitative and descriptive approach to evaluate the existing content on YouTube that address clean intermittent catheterization and in the second stage to assess the access of educational technologies available on social networks on the subject. In the first stage, the sample consisted of 07 videos that described the technique of clean intermittent catheterization with free availability on YouTube. The material was evaluated by nurses based on the recommendations of the Brazilian Society of Urology. The second stage consisted of assessing the accesses of the social networks Cateterismo Digital, with YouTube being the social network with the highest average number of visits to the profile and content printing. According to the evaluation of the accesses of the social networks Cateterismo Digital can conclude that the profiles responded positively to the expectations of disclosing the contents of the website to users. In this context, it is important to consider the potential that social networks developed by health professionals present as educational technological tools, which can be used by both users and other professionals to guide the search for safe information online, collaborating with health promotion. / Mestre

The study sought to gain an in-depth understanding of the knowledge and skills regarding rehabilitation of mental health care users of nurses who work at a psychiatric rehabilitation centre, in order to design a continuing professional development plan for registered and enrolled nurses. The researcher used a qualitative, exploratory descriptive design to explore the knowledge and skills of nurses who practise in a psychiatric rehabilitation centre dealing with the rehabilitation of mental health care users. Four themes emerged from the data that were collected from four focus groups: knowledge of the rehabilitation process; the need for continuing professional development; nursing skills required for the implementation of psychiatric rehabilitation and means of communication within psychiatric rehabilitation. The researcher devised a continuing professional development plan, including topics on the management of the mentally ill, the problems associated with mental illness and rehabilitation appropriate to the mental illness. / Health Studies / M. A. (Health Studies)

The study sought to gain an in-depth understanding of the knowledge and skills regarding rehabilitation of mental health care users of nurses who work at a psychiatric rehabilitation centre, in order to design a continuing professional development plan for registered and enrolled nurses. The researcher used a qualitative, exploratory descriptive design to explore the knowledge and skills of nurses who practise in a psychiatric rehabilitation centre dealing with the rehabilitation of mental health care users. Four themes emerged from the data that were collected from four focus groups: knowledge of the rehabilitation process; the need for continuing professional development; nursing skills required for the implementation of psychiatric rehabilitation and means of communication within psychiatric rehabilitation. The researcher devised a continuing professional development plan, including topics on the management of the mentally ill, the problems associated with mental illness and rehabilitation appropriate to the mental illness. / Health Studies / M. A. (Health Studies)

Submitted by Fabiana Gonçalves Pinto (benf@ndc.uff.br) on 2016-02-01T16:36:26Z No. of bitstreams: 1 Shirley Rangel Gomes.pdf: 961863 bytes, checksum: a33d3e20764fb1011595add663f1ac77 (MD5) / Made available in DSpace on 2016-02-01T16:36:26Z (GMT). No. of bitstreams: 1 Shirley Rangel Gomes.pdf: 961863 bytes, checksum: a33d3e20764fb1011595add663f1ac77 (MD5) Previous issue date: 2008 / Gomes e Rodrigues Comércio e Representações LTDA / Mestrado Profissional em Enfermagem Assistencial / O presente trabalho, com linha de pesquisa de pessoas e grupos humanos, visa identificar os fatores de risco aos quais a população está exposta. O Ministério da Saúde recomenda às equipes de saúde analisar o perfil da clientela atendida nos diferentes níveis de atenção com a finalidade de traçar ações preventivas, curativas e reabilitadoras. Considerando-se que as doenças cerebrovasculares têm apresentado grande impacto de morbidade e mortalidade na população, realizamos este estudo no campo de assistência, configurado como pesquisa descritiva, comparativa, de natureza aplicada, quantitativa e explicativa, com emprego do método observacional. O projeto de pesquisa foi submetido ao Comitê de Ética do Hospital Universitário Antonio Pedro, com aprovação no CEP em 01/09/2006 sob No do Parecer 155/06 conforme Resolução 196/1996. O estudo foi desenvolvido em unidade ambulatorial de reabilitação físico-motora de hospital municipal a fim de descrever o perfil fisiopatológico, socioeconômico e demográfico dos clientes com acidente vascular cerebral atendidos nessa unidade. Os dados foram colhidos em dois momentos: o primeiro pela análise de prontuários, e o segundo durante a Consulta de Enfermagem. O desenvolvimento da consulta seguiu as fases da Sistematização da Assistência de Enfermagem. Assim, foi possível caracterizar o perfil dos clientes, os graus de dependência dos cuidados de enfermagem e descrever as prescrições de enfermagem. Os resultados das condutas de enfermagem foram agrupados de acordo com diagnósticos de enfermagem baseados na Taxonomia II da North American Nursing Diagnosis Association – NANDA, conforme os domínios: 1- promoção da saúde; 2 - nutrição; 3 - eliminação e troca; 4 - atividade/repouso; 5 - percepção e cognição; 6 - autopercepção; 7 - relacionamentos de papel; 8 - sexualidade; 9 - enfrentamento/tolerância; 10 - princípios de vida; 11 - segurança/proteção; 12 - conforto. As condutas foram descritas com base nos achados e podem contribuir para os enfermeiros e acadêmicos de enfermagem que atuam na assistência aos clientes com dependência dos cuidados de enfermagem. A análise crítica da assistência foi realizada com base na legislação vigente que define as ações e direitos das pessoas com deficiências relacionadas à saúde, inclusão social, educação, autonomia, acessibilidade e todas as ações pertinentes às suas necessidades / This study, targeting people and human groups research, aims to identify risk factors to which the population is exposed. The Ministry of Health recommends that health teams analyze the profile of the clientele at different levels of care with the purpose of designing preventive, curative and rehabilitative actions. Considering that cerebrovascular diseases have shown a great impact on morbidity and mortality of people, we conducted this study in the field of assistance, as a descriptive, comparative and applied quantitative research through the observational method. The research project was submitted to the Ethics Committee of Antonio Pedro University Hospital, with CEP approval on 01/SEP/2006 under the Register 155/06 in accordance with Resolution 196/1996. The research was conducted in a physical rehabilitation area of a public hospital in order to describe the pathophysiological, socioeconomic and demographic profile of clients with stroke treated in this unit. Data were collected in two phases: the first by analysing charts, and the second during the Nursing Consultation. The proccess was performed according to the Nursing Care System standards. It was possible to map the customers profiles and the degree of dependence on nursing care, as well as describing the need for nursing. The results of nursing procedures were grouped according to nursing diagnoses based on the Taxonomy II of the North American Nursing Diagnosis Association - NANDA, as follows: 1 - health promotion; 2 - nutrition 3 - removal and exchange; 4 - activity / resting; 5 - perception and cognition, 6 – self-perception; 7 - role relationships, 8 - sexuality, 9 - facing / tolerance; 10 - life principles, 11 - safety / security; 12 - comfort. The procedures were described based on the findings and may contribute to nurses and nursing students who deal with customers with dependence on nursing care. The assistance review was based on current legislation which defines the actions and rights of people with needs related to health, social inclusion, education, autonomy and accessibility

De multiples auteurs de la discipline infirmière réclament la valeur inestimable de la relation de caring et de ses bienfaits pour la clientèle nécessitant des soins et services de réadaptation. En dépit de cette importance, la recherche concernant les bienfaits thérapeutiques de la relation de caring pour la clientèle de réadaptation demeure encore un domaine peu exploité. Actuellement, aucune étude scientifique québécoise, canadienne ou internationale, issue de la discipline infirmière, ne porte sur la compréhension de l’expérience d’« être avec » la personne soignée dans un contexte de réadaptation, aspect qui s’avère central à la relation de caring selon Watson. Au cœur même de la philosophie du Human Caring de Watson, la présente étude vise à explorer, par des entrevues qualitatives auprès de 17 infirmières oeuvrant en contexte de réadaptation, la signification de l’expérience d « être avec » la personne soignée, de même que leur perception de la contribution de cette expérience à la réadaptation de la personne soignée. Cinquante et une entrevues, c’est-à-dire trois entrevues réalisées pour chaque participant de recherche, ont été analysées à l’aide de la méthode phénoménologique intitulée « Relational Caring Inquiry » développée par Cara (1997). Le processus de recrutement des participants a impliqué la direction des soins infirmiers des deux centres de réadaptation ciblés par l’étude. Une attention particulière a été mise afin de favoriser une diversité de participants (par exemple : genre, niveau éducationnel, quart de travail, unité de soins). Le processus d’analyse des données a permis la découverte de cinq eidos-thèmes. Parmi ces eidos-thèmes, quatre se rapportent à la signification de l’expérience d’«être avec» la personne soignée (première question de recherche), à savoir : (a) l’importance des valeurs humanistes au centre du soin, (b) l’investissement de l’infirmière et de la personne soignée, (c) les dimensions réciproque et relationnelle du soin et, finalement, (d) l’expérience de soin irremplaçable d’une complexité contextuelle. De façon plus détaillée, le premier eidos-thème dévoile les fondements humanistes à la base de l’expérience d’« être avec » la personne soignée. Le deuxième manifeste l’implication substantielle de l’infirmière et de la personne soignée. Le troisième eidos-thème met en lumière la réciprocité et la dimension relationnelle comme étant des éléments centraux à l’expérience d’« être avec » la personne soignée. Le quatrième eidos-thème documente les natures fondamentale et complexe de cette expérience de soin unique, de même que les conditions contextuelles qui la facilitent et la contraignent. Le cinquième et dernier eidos-thème ayant émergé de la présente étude, « rehaussement de l’harmonie corps-âme-esprit chez la personne soignée et l’infirmière », illustre la perception des participantes quant à la contribution thérapeutique de l’expérience d’« être avec » la personne soignée à la réadaptation de cette dernière (deuxième question de recherche). Cette contribution se situe en termes de répondre aux besoins du patient, d’optimiser les progrès de réadaptation de la personne soignée, de promouvoir le niveau de bien-être de la personne soignée et de l’infirmière et, finalement, de hausser la croissance intérieure des personnes engagées dans cette expérience de soin extraordinaire. La reconnaissance des cinq eidos-thèmes a favorisé l’émergence de l’essence universelle du phénomène à l’étude qui s’intitule « la rencontre humaine profonde, thérapeutique et transformatrice ». La présente étude contribue de façon novatrice au développement des connaissances, notamment en permettant une meilleure compréhension de ce que signifie l’expérience d’« être avec » la personne soignée, pour des infirmières en réadaptation et en proposant une multitude de résultats probants pouvant servir de guide à la promulgation de soins infirmiers en contexte de réadaptation. En déterminant la signification ontologique de cette expérience de soin, la présente étude permet de préciser la place du phénomène d’« être avec » la personne soignée au centre de la théorie du caring. Ces résultats qui découlent de la deuxième question de recherche participent au développement initial d’un corpus de connaissances. Ces résultats probants serviront de guide au renouvellement de la pratique infirmière en contexte de réadaptation. De plus, en identifiant les bienfaits de cette expérience de soin, la présente étude reconnaît l’élément au cœur de la relation transpersonnelle de caring, qui contribue à rehausser l’harmonie corps-âme-esprit chez la personne soignée et l’infirmière. En plus de la clinique, des recommandations au niveau de la formation et de la recherche en sciences infirmières découlent de la présente étude. / Several nursing authors acknowledge the essential value of the caring relationship and its benefits for the rehabilitation clientele. In spite of this importance, the therapeutic benefits of the caring relationship for this clientele remain an unexamined area. Currently, no Quebec, Canadian or international scientific nursing study is concerned with understanding the experience to « be with » the person being cared for in a rehabilitation context, which is central to the caring relationship according to Watson. Inspired by Watson’s Human Caring philosophy, this study aims to investigate, by qualitative interviews with seventeen rehabilitation nurses, the meaning of the experience to « be with » the person being cared for, as well as their perception of the contribution of this experience to the person’s rehabilitation. Fifty one interviews, therefore three interviews for every research participant, were analyzed using the « phenomenological » method entitled « Relational Caring Inquiry » developed by Cara (1997). The process of participant recruitment involved the nursing management team of both rehabilitation centres targeted by the study. A variety of participants was favoured (e.g.: gender, educational level, shift worked, and patient care unit). The process of data analysis allowed the discovery of five eidos-themes. Among these eidos-themes, four refer to the meaning of the experience to « be with » the person cared for (first research question), namely: (a) the importance of humanistic values at the core of the care, (b) the investment of the nurse and the person cared for, (c) the reciprocal and relational care dimensions and finally, (d) the irreplaceable care experience of contextual complexity. In more detail, the first eidos-theme reveals the humanistic basis of the experience to « be with » the cared person. The second expresses the substantial implication of the nurse and the person cared for. The third eidos-theme clarifies the reciprocity and relational dimension as being central elements of the experience to « be with » the person cared for. The fourth eidos-theme documents fundamental and complex origins of this unique care experience, as well as the contextual conditions which facilitate and impede it. The fifth and last eidos-theme emerging from this study, « strengthening the mind-body-spirit harmony of the person cared for and the nurse », illustrates the participants’ perception regarding the therapeutic contribution of the experience to « be with » the person cared (second research question). This contribution meets the patient’s needs, optimizes the rehabilitation progress of the person cared for, promotes the level of well being of the person cared for and the nurse and finally, raises the inner growth of the people engaged in this extraordinary care experience. The recognition of these five eidos-themes supports the emergence of the universal essence of the phenomenon being studied which is entitled « the profound, therapeutic, and transformative human relationship ». The present study contributes, in an innovative way, to knowledge development, in particular by allowing a better understanding of the meaning of rehabilitation nurses’ experience to « be with » the patient, and advancing evidence-based results to be used as a guide for the development of nursing care in the context of rehabilitation. By determining the ontological meaning of this care experience, the present study makes it possible to specify the place of the phenomenon to « be with » the patient as being central to the caring theory. The results arising from the second research question contribute to the development of a body of knowledge. These evidence-based results will be used to guide the renewal of nursing practice in the context of rehabilitation. Moreover, by identifying the benefits of this care experience, the present study recognizes the element at the heart of transpersonal caring relationship, which contributes to mind-body-spirit harmony for both, the person cared for and the nurse. This study also proposes recommendations for education and research in nursing sciences.