Submitted by Suzana Dias (suzana.dias@famerp.br) on 2018-10-31T23:24:12Z No. of bitstreams: 1 AlbertinaSilva_dissert.pdf: 1488903 bytes, checksum: 9add0f502a27d505b85c7f76253035a6 (MD5) / Made available in DSpace on 2018-10-31T23:24:12Z (GMT). No. of bitstreams: 1 AlbertinaSilva_dissert.pdf: 1488903 bytes, checksum: 9add0f502a27d505b85c7f76253035a6 (MD5) Previous issue date: 2018-06-11 / The engagement is a mental state of affective-cognitive achievement-positive motivational work-related, involving persistent sense of accomplishment, motivational and social in nature. Nurses with good levels of engagement will be more productive and can achieve greater resolution in the service to users of health services. Objective: To evaluate levels of engagement in nurses of primary health care units of municipality of São José do Rio Preto, São Paulo. Method: Cross-sectional study among nurses in primary health care units. Data collection were used two instruments: one prepared by the researchers, containing socio-demographic variables; and the Utrech Work Engagement Scale (UWES), composed of seventeen self-assessment items with three dimensions (force, dedication and absorption) and overall score. The calculation of scores of the dimensions of UWES proposed statistical model was used in Preliminary Manual UWES. Comparison of socio-demographic variables with the scores of the UWES occurred by the F test in analysis of variance (ANOVA), with a significance level of 95%. Results: 75 nurses participated, being 26 (34.7%) managers of units. There were female prevalence (94.7%), age between 29 and 39 years (52.0%), carry title of specialist (81.3%), married (57.3%), gazetted (68.0%), working 40 hours per week (98.7%), income six to 10 minimum wages (49.4%), acting on primary health care between three and 10 years (42.7%) satisfied with profession (92.0%), never thought of quitting profession (57.3%). The average scores of UWES ranged from 4.6 to 4.8 and engagement levels were high in all dimensions. Nurses who exercised the function of managers showed a very high level of Dedication (5.0; ± 1.4); professionals with 40 years or more showed very high levels in all dimensions [Dedication: 5.2 (± 0.9); Absorption: 5.0 (± 0.8); Force: 5.3 (± 0.8) and overall Score: 5.1 (± 0.8)]; professionals with over ten years of experience in the primary health care showed very high levels in all dimensions [Dedication: 5.0 (± 1.5); Absorption: 5.0 (± 1.5); Force: 5.0 (± 1.4) and overall Score: 5.0 (± 1.4)]. Conclusion: The study showed prevalence of female nurses, with less than 40 years old, married, with graduate course and satisfied with the work. Have formal link between three and 10 years of experience in the primary health care. The professionals showed high levels of engagement, which demonstrates that are excited and proud of activities engaged, energy and mood, concentration and effort, and persistence in adversity situations in environment laboral. The managers presented high involvement in carrying out its activities. The results show that primary health care system of municipality encourages engagement and ability to work of nurses, enhances the performance of team and promotes quality of care and effectiveness of assistance. / O engagement é um estado mental de realização afetivo-cognitivo-motivacional positivo relacionado ao trabalho, que implica sentimento de realização persistente, de natureza motivacional e social. Enfermeiros com bons níveis de engagement serão mais produtivos e poderão atingir maior resolutividade no atendimento aos usuários dos serviços de saúde. Objetivo: Avaliar os níveis de engagement em enfermeiros de unidades da atenção primária à saúde do município de São José do Rio Preto, São Paulo. Método: Estudo transversal entre enfermeiros de unidades da atenção primária à saúde. Para a coleta de dados foram utilizados dois instrumentos: um elaborado pelos pesquisadores, contendo variáveis sociodemográficas; e a Utrech Work Engagement Scale (UWES), composta por dezessete itens de autoavaliação com três dimensões (vigor, dedicação e absorção) e um escore geral. Para o cálculo dos escores das dimensões da UWES utilizouse modelo estatístico proposto no Manual Preliminar UWES. A comparação das variáveis sociodemográficas com os escores da UWES ocorreu pelo teste F na análise de variância (ANOVA), com nível de significância de 95%. Resultados: Participaram 75 enfermeiros, sendo 26 (34,7%) gerentes das unidades. Houve prevalência do sexo feminino (94,7%), idade entre 29 e 39 anos (52,0%), portadores do título de especialista (81,3%), casados (57,3%), concursados (68,0%), carga horária de trabalho de 40 horas semanais (98,7%), renda de seis a 10 salários mínimos (49,4%), atuando na Atenção Primária à Saúde entre três e 10 anos (42,7%), satisfeitos com a profissão (92,0%), nunca pensaram em desistir da profissão (57,3%). Os escores médios da UWES variaram de 4,6 a 4,8 e os níveis de engagement foram classificados como altos em todas as dimensões. Enfermeiros que exerciam a função de gerentes apresentaram nível muito alto de Dedicação (5,0;±1,4); profissionais com 40 anos ou mais apresentaram níveis muito altos em todas as dimensões [Dedicação: 5,2 (±0,9); Absorção: 5,0 (±0,8); Vigor: 5,3 (±0,8) e Escore geral: 5,1 (±0,8)]; profissionais com mais de dez anos de atuação na Atenção Primária à Saúde apresentaram níveis muito altos em todas as dimensões [Dedicação: 5,0 (±1,5); Absorção: 5,0 (±1,5); Vigor: 5,0 (±1,4) e Escore geral: 5,0 (±1,4)]. Conclusão: O estudo mostrou prevalência de enfermeiras, com menos de 40 anos, casadas, com curso de pós-graduação e satisfeitas com o trabalho. Possuem vínculo formal e entre três e 10 anos de atuação na Atenção Primária à Saúde. As profissionais apresentaram níveis altos de engagement, o que demonstra que são entusiasmadas e orgulhosas das atividades que exercem, apresentam energia e disposição, concentração e capacidade de esforço, e persistência frente às adversidades do ambiente laboral. As gerentes apresentaram alto envolvimento na realização de suas atividades. Os resultados evidenciam que o sistema de Atenção Primária à Saúde do município estimula o engagement e a capacidade de atuação dos enfermeiros, potencializa o desempenho da equipe e favorece a qualidade do atendimento e a eficácia da assistência prestada.

This diploma thesis deals with the role of the child nurse in the adaptation of the newborn after delivery.In the theoretical part we devote to the available scientific knowledge focused on the course of pregnancy, the way of giving birth (vaginal and operative), assessment of postnatal adaptation of the newborn, breastfeeding and its importance. The essential part is mapping the role of child nurse in newborn care using the NOC system to evaluate their postnatal adaptation. The Czech and foreign literary sources were used for the theoretical part of the diploma thesis. The first aim of the diploma thesis was a detailed mapping of the role of the child nurse in postnatal adaptation of the newborn after physiological and operative delivery. Two research questions have been selected for its solution. The first research question was, what Apgar values the newborns show after the physiological and operative delivery. The second research question was the success of the first application of the newborn to breastfeeding within 30 minutes after physiological and operative delivery. The second aim of this diploma thesis was to verify the classification of the NOC on the evaluation of the newborn adaptation. For the solution, a research question has been determined, what is the opinion of nurses on the use of the NOC classification system in postnatal adaptation. For the empirical part of the research we have chosen a qualitatively quantitative strategy. Observation, individual semi-structured interviews with nurses and written filling of NOC classification system forms were used for data collection. The first research group was 10 newborns after the physiological - vaginal delivery and 10 newborns after the operative delivery by Caesarean section. The second research group consisted of 2 child nurses working with neonates as part of postnatal adaptation in Hospital Jihlava. Analyzing and interpreting the obtained results, we found out that newborns born by vaginal delivery had an average Apgar score of 8.03 and newborns born by Caesarean section had an average Apgar score of 9.50. The average values of the indicators in the NOC classification system code 0118 The adaptation of the newborn showed slightly poorer results after vaginal deliveries. Two groups of newborns that we followed did not match the generally expected results. Newborns after the Caesarean section are threatened by risk factors, but due to careful nursing care and gentle childbirth, such a risk does not occur and the process of postnatal adaptation can be successful. In the NOC classification system code 1000 Beginning of breastfeeding child showed the indicators at vaginal deliveries, at least 8 feedings per day and infant satisfaction after feeding, better results. In the NOC classification system code 1001 Beginning of breastfeeding mother the average values of breast suction indicators and satisfaction with the breastfeeding process resulted better in favour of neonates born vaginally compared to neonates after Caesarean section. As regards the success of the first feeding of neonates to breastfeeding within 30 minutes after delivery, a clearly superior result was obtained for newborns born vaginally. The conclusions drawn from our research in relation to child breastfeeding by mother confirm the clear benefit of vaginal births for the successful adaptation of newborns. A child nurse undoubtedly plays an important role in the assessment of postnatal adaptation of the newborn. The research of the diploma thesis shows that the classification system NOC is very well sophisticated in the context of a newborn adaptation and it is even detailed in connection with the follow-up and subsequent provision of newborn care. Its full use in current practice in the established care system of particular healthcare facilities is not possible due to insufficient staffing of the department. The existing documentation system does not provide reserves

Even though it has been managed to concentrate deliveries of premature infants to the perinatal centres thanks to the ?in utero? (before-delivery) transports in recent years, there are still a certain number of newborn infants who are born outside the centres and, thus, it is required to transport them to the specialized departments. The transport of a newborn infant is characterized with special therapeutic procedures and it requires different equipment for providing intensive or resuscitation care and it is provided by transport service for newborn infants that is an integral part of the regional system of the differentiated care of newborn infants. The objective of the diploma thesis is: Objective 1: To characterize current provision of neonatal transport services. Objective 2: To map the role of nursing staff when providing neonatal transport service. Objective 3: To find out if nurses deliver care by nursing process when providing neonatal transport service. A hypothesis and research questions were defined on the basis of these results. Hypothesis 1: Presence of a nurse when providing neonatal transport service is important. Research question 1: What is the role of a nurse when providing neonatal transport service? Research question 2: How is the nursing process applied when providing neonatal transport service? The investigation proved the hypothesis and the research questions were answered. The goal of the thesis was met. The standard ?Nursing Care of Newborn Infants during Transport? is the result of the diploma thesis.

Bakgrund: Den palliativa vården blir allt viktigare för personer med icke-cancersjukdomarsom hjärtsvikt. Flera intresseorganisationer och internationella yrkesföreningar trycker påbehovet för tidigare information rörande prognos och integrering av palliativ vård för dessapatienter. Trots detta står denna patientgrupp ofta utan denna typ av vård och stöd även närpatienten närmar sig ett terminalt skede av livet. Syftet var att undersöka barriärer som fannsför initiering av palliativ vård hos vuxna patienter med hjärtsvikt Metoden var en ickesystematisk litteraturöversikt med ett systematiskt arbetssätt där totalt 17 artiklar valdes ut fördatagranskning. Resultatet visade på flera barriärer som kunde sammanfattas underrubrikerna Personalrelaterade barriärer, Patientrelaterade barriärer samt Organisatoriskabarriärer. Slutsatsen Resultatet identifierade flertalet komplexa barriärer som var patient,personal och organisatoriskt beroende. Dessa barriärer försvårade integrering av denpalliativa vården hos patienter med hjärtsvikt. Att möjliggöra för sjukvården att skapa godarelationer med proaktiv kommunikation är av stor vikt. Vidare behövs organisatoriskt stödmed tid för samtal, personalkontinuitet, utbildning och förbättrad kommunikationsförmåga.Detta tillsammans med tydligare riktlinjer och samarbete inom vården. / Background Palliative care is becoming increasingly important for patients with noncancerous diseases such as heart failure. Several interest groups and international professionalassociations emphasize the need for timely information regarding prognosis and integrationof palliative care for these patients. Despite this, this patient group is often without this typeof care and support even when the patient is approaching a terminal stage of life. Aim Wasto investigate barriers that existed for the initiation of palliative care in adult patients withheart failure. Method The method used was a non-systematic literature review with asystematic approach where a total of 17 articles were selected for data review. Result The results showed several barriers that could be summarized under the headings under theheadings Personnel-related barriers, Patient-related barriers and Organizational barriers. Conclusion The results identified several complex barriers that were patient, staff andorganizational dependent. These barriers made it more difficult to integrate palliative care forpatients with heart failure. Enabling the creation of good relationships with proactivecommunication in healthcare is of great importance. Furthermore, support from theorganization is needed which includes time for conversations, staff continuity, training andimproving communication skills. This together with clearer guidelines and cooperation inhealthcare.

Bakgrund: Kommunal hälso- och sjukvård för äldre personer sker genom teamarbete. För sjuksköterskan som teammedlem är det av intresse att förstå hur teammedlemmar från andra yrkeskategorier ser på sjuksköterskans roll. Syfte: Att beskriva förväntningar på sjuksköterskan i teamarbetet inom svensk kommunal hälso-och sjukvård för äldre personer.Metod: I denna kvalitativa studie bestod insamlade data av semistrukturerade intervjuer med arbetsterapeuter (n=4), fysioterapeuter (n=2) och undersköterskor (n=4) inom kommunal hälso- och sjukvård för äldre personer. Data analyserades genom induktiv manifest innehållsanalys. Resultat: I resultatet framkom två huvudkategorier.”Sjuksköterskan som enskild teammedlem och yrkesperson” med subkategorierna: ”Sjuksköterskans personliga egenskaper” och ”Sjuksköterskans ledarskap”. ”Sjuksköterskans ansvar i teamet” med subkategorierna: ”Samordning kring patienten”, ”Kommunikation” och ”Att tillvarata teamets kompetenser”. Slutsats: Examensarbetet ökar förståelsen av sjuksköterskans roll i teamet genom att beskriva de förväntningar ställs på sjuksköterskan. Dessa är att visa respekt och tillit, att vara vänlig och uppmuntrande samt att erbjuda trygghet och känslomässigt stöd. Det finns en tvetydighet i förväntningarna på sjuksköterskan när det gäller ledarskap i teamet. Genom fördjupad självkännedom hos sjuksköterskan kan patientsäkerhet och personcentrerad vård stärkas. Sjuksköterskan kan lyfta frågan om ledarskap i teamet för att öka kvaliteten i vården och förbättra samverkan i teamet. / Background: Community-based health care for older persons is provided through teamwork. For the nurse as a team member it is of interest to understand how team members from other professions perceive the role of the nurse. Aim. To describe expectations on the nurse in teamwork in Swedish community-based health care for older persons. Method: In this qualitative study the collected data consisted of semi structured interviews with occupational therapists (n=4), physiotherapists (n=2) and staff nurses (n=4) in communitybased health care for older persons. Data analysis was performed using an inductive manifest content analysis. Findings: Findings included two main categories: `The nurse as an individual team-member and professional person´ with the subcategories `Personal characteristics of the nurse´ and `Responsibilities of the nurse in the team´. The second category included three subcategories: `Coordination around the patient´, `Communication´ and `Making use of team competencies´. Conclusion: The thesis enhances the understanding of the nurse´s role in the team through describing the expectations on the nurse These are to show respect and trust, to be kind and encouraging and to offer a sense of security and emotional support. There is an ambiguity in the expectations on the nurse concerning leadership in the team. Patient safety and person-centered care can be improved through developed self-knowledge on the part of the nurse. By addressing the question of leadership in the team, the nurse an improve the quality of care and the collaboration in the team.

El rol educador de la enfermera, tiene como función la prevención y promoción de la salud en el entorno educativo. Asimismo, el profesional de enfermería tiene la responsabilidad de proporcionar de forma individualizada los cuidados que requiere el estudiante de forma directa e integral con el fin de mantener su salud. Además, la enfermera presta un servicio que permite aumentar la capacidad del estudiante y de la colectividad escolar, para prevenir, detectar y solucionar sus problemas de salud. Método: Investigación cualitativa, con abordaje descriptivo. Objetivo: Describir el rol educador de la enfermera sobre alimentación saludable en pandemia en adolescentes de una institución educativa privada de Chiclayo, 2022. Muestra: 15 adolescentes de la institución educativa privada Manuel Pardo, el muestreo fue no probabilístico por conveniencia y el tamaño de la muestra fue obtenida por saturación y redundancia de datos. Los datos serán recopilados mediante la entrevista semi estructurada validada por juicios de expertos y prueba piloto, posterior a la aprobación por el Comité de Ética. Se utilizó la técnica de análisis de contenido, se cumplió con criterios de rigor ético y científico. Resultados principales: (1) Promoviendo un cuidado autónomo y responsable en los adolescentes, (2) Comunicación asertiva y empática: enfermera - adolescente, (3) Recursos didácticos para un buen aprendizaje. Conclusión general: Este estudio demostró que, es evidente la importancia del rol educador de la enfermera en adolescentes porque fomenta el compromiso con su salud y los orienta a tomar acciones para mantener su bienestar.

The topic of my Dissertation is a role of a nurse in subsequent care at a patient after reimplantation of a total coxe endoprosthesis. The aim of this Dissertation is to find whether nurses provide patients with specific (medical) intervention (after reimplantation of a total coxe endoprosthesis) according to the diagnosis for care or in a standard way according to the performed act. Another aim was to find specific needs of patients (after reimplantation of total coxe endoprosthesis) and to create a plan of care, as possible. The last aim is to find whether patients after reimplantation of a total coxa endoprosthesis are provided with sufficient information about prevention of possible complications.To gain the necessary data, quantity research in combination with quality one was carried out. The hypothesis that nurses provide nursing intervention in a standard way, no matter if patients are after a primary implantation of a total coxa endoprosthesis or after a reimplantation of a total coxa endoprosthesis, was not proved. The other hypothesis, that nurses does not differ nursing care of clients after a reimplantation of a total coxa endoprosthesis from nursing care of clients after a primary implantation of a total coxa endoprosthesis, was not proved.

The aim of this diploma thesis was to assess a level of health literacy of patients with diabetes mellitus type 2, describe the nurse's competences in the field of patients' level of health literacy and map the occurrence of podiatric outpatient clinics in Czech Republic. In theoretical part, we were discussing the health literacy in nursing, what the health literacy means and why it is important to improve it. We mentioned the education and the role of nurse in nursing and how this role is related to health literacy. Then we focused on diabetes mellitus type 2, its characteristics, prevention, development of disease, treatment and the most common complications related to this disease. The lifestyle is closely related to this disease, therefore the rules of a healthy lifestyle are mentioned in the last section of theoretical part. Research part was divided into three areas. The first areas consisted of interviews with general nurses working in general practitioner's outpatient clinics. The second area consisted of two research groups. One group consisted of nurses working in inpatient wards and nurses working in specialized diabetological outpatient clinics. Second group consisted of patients with diabetes mellitus type 2. Third area was created with two interviews and participant observation. The research was conducted in cooperation Professor Kvapil and two nurse educators who are actively engaged in education of patients with diabetes mellitus and they are trained by Lilly Company. The research showed that increasing of health literacy depends by the greatest part on patient him-/herself, his/her interest, cooperation and attitude to change of his/her lifestyle. The most active nurses in the field of increasing health literacy were nurses working in specialized diabetological outpatient clinics, who are trying to increase the health literacy particularly by educational sessions with patients. Mapping the presence of podiatric outpatient clinics showed that these clinics are available in each region of Czech Republic. It is very important to improve the health literacy of patients with this disease thereby strengthening their health and reducing the risk of complications associated with this disease. The results of the research provide information about increasing the health literacy in relation to diabetes mellitus type 2.

The diploma thesis deals with a problematic of management of the nursing care by a patient with intracranial hemorrhage. Most of the patients who survive intracranial hemorrhage stay permanently reliant on the care from others. That is why it is so important for this care to be as qualitative as possible and to have a fluent continuity. The aim of the thesis was to find out what is the role of a nurse by the patient with intracranial hemorrhage, then also find out, if the nurses know the warning signs of a worsening state of such patient, how do they cooperate with his/her family and what are the possibilities of the following care. In the empirical part of the diploma thesis, qualitative-quantitative research was used. For a complex view on a management of nursing care, the chosen technique of research was semi-structured questionnaire with patients with intracranial hemorrhage and non-standardized questionnaire with nurses who take care of these patients. For the quantitative part of the research, two hypotheses to two aims of the diploma thesis were set. Both hypotheses weren't proven by statistical methods. For qualitative research, four research questions were set. The respondents described the role of a nurse, especially in helping the patient, in rehabilitation and in also her role in educating the patient. Addressed respondents agreed on appropriate and swift reactions of the nurses in case the state of the patient starts to worsen. The cooperation of nurses and families is according to the patients without problems. It showed in the interviews with respondents, that there is a problem with insufficient awareness of the patients about the existing possibilities of following care. The outcome of the diploma thesis is a coherent educational material about nursing care by a patient with intracranial hemorrhage, which can serve to either the students or the nurses taking care of these patients.

Requirements for changes in nursing care on the part of top management Abstract At present, nursing care has been experiencing a great progress. Implementation of the nursing process as a working method has been striven for. The educational system for non-medical workers has been changing. Nurses holding top managerial posts should have competence to lead and manage people effectively in the ever changing nursing environment. To acquire information necessary for achievement of the set goals, a quantitative research was employed. Within the framework of the quantitative research, the questioning method using a questionnaire was selected. The questionnaires concerned were sent to top managers among nurses and doctors working in medical centres all over the Czech Republic. The thesis had three objectives defined. First, to discover what prerequisites top managers miss to be able to implement the changes concerned in the area of nursing care. Second, to discover top managers´ opinions on the system of nursing care provision. Third, to identify differences between requirements for the nursing process method on the part of top managers {--} nurses and top managers {--} doctors. Based on these objectives, four hypotheses were formulated. The hypothesis no. I: The current situation does not allow top managers operating in health service to implement changes in nursing care in practice. This hypothesis has been confirmed. The hypothesis no. 2: Top managers do not require group nursing care as a prerequisite for the implementation of nursing care changes. This hypothesis has not been confirmed. The hypothesis no. III: Representatives of nurses in managerial posts promote the nursing process application as a prerequisite for changes concerning nursing care. This hypothesis has been confirmed. The hypothesis no. IV: Representatives of medicine doctors in managerial posts do not promote the nursing process application as a method of nurses´ work. This hypothesis has not been confirmed. As far as the results of this diploma thesis are concerned, we were trying to outline possible solutions of the issues concerning changes in nursing care. Top managers are recommended to stimulate critical thinking in their employees in the course of work in the nursing process. It is beneficial to improve communication on the managerial level in hospitals, and in addition, to obtain feedback from subordinates with respect to continuing education, to identify effectiveness and needs relating to education on the part of employees and to enable them to participate in the process of the respective changes implementation. To train function nurses in such changes management. To implement a programme aiming at continual quality improvement.