Brazilian Nursing Research Articles

The Roles and Functions of Occupational Health Nurses in Brazil and in the United States

Cross-sectional exploratory research developed to outline the roles and functions of occupational health nurses (OHNs) in Brazil and compare them with those in the United States. The sample consisted of 154 Brazilian occupational health nurses. First, the instrument Job Analysis Survey of Occupational Health Nursing Practice was translated into Portuguese, followed by data collection and data analysis, comparing the results of the proposed study in Brazil with the findings of a job delineation study conducted in the United States. It was found that most were women, white, between 41 and 50 years of age and working primarily at hospitals or medical centers as clinicians and managers/administrators. Besides, it was found that most Brazilian OHNs spend more time in managerial roles, followed by consultant and educator responsibilities while, in the United States, OHNs spend significantly more time in education/advisory roles.

The search for excellence in Brazilian Nursing knowledge dissemination

Nursing is a knowledge area whose representations are occupying different spaces in Brazilian and international institutions. These representations are based on the advancement of the profession in terms of the quality of its scientific production, excellence in human resource training and defense of the population’s human rights. Research development, especially in recent decades, highlights Nursing, as illustrated by the excellence of its graduate programs, projects funded by support agencies, the quality of its research products and results, besides representations in Brazilian and international entities, among others.New challenges have been included in the Nursing agenda though. The analysis of knowledge production shows that existing studies, in line with scientific development stages, are predominantly descriptive, which allowed researchers to get to know phenomena of interest to the profession. The growth of Brazilian graduate programs and advances achieved in terms of knowledge production have also made Nursing researchers explore other factors related to the phenomena nurses research on.Current trends in Nursing research are increasingly oriented towards the explanation, forecasting and control phases of phenomena, seeking strong scientific evidence to support care actions. These challenges can partially explain the difficulties researchers are facing to have their manuscripts accepted in high-impact journals. Bottlenecks include problems related to sample representativeness, instruments validated for the culture of the country of origin, mastery of the language the manuscript will be published in, among others. On the other hand, themes of national or regional interest, of high social relevance, are accepted in Brazilian journals only. Thus, Brazilian researchers are facing difficulties to disseminate knowledge through publication in high-impact journals.In that sense, the expand research excellence in Brazilian Nursing, investments are needed in internationalization as one route for researchers’ complementary education at foreign colleges, in the increased qualified demand for projects submitted to funding agencies to get resources for research development, in the insertion of undergraduate Nursing students into scientific initiation programs, so as to identify potential talent for academic work, in permanent research training through collaborative work with researchers from other Brazilian researchers and abroad, and in graduate programs that offer the tools needed for scientific and technological knowledge development, significantly contributing to the country’s development

Caring with difficulty: Brazilian nurses' experiences of gynaecological surgery care

This study was made by a qualitative approach based on symbolic interactionism and grounded theory. The subject was defined as what mutilation means for nurses who take care of women submitted to gynaecological surgery. The aim was to identify the interaction relationship of nurses as female with the phenomenon of mutilation in gynaecological surgeries and how it affects their relationship with female patients in this situation. Data were obtained by interviews with 16 nurses who work in gynaecology units. The findings present two core categories: speaking as a professional and speaking as female. When they spoke as professional nurses they defined mutilation technically. As females they verbalized their conflict and difficulty in working with mutilation and redefined it as being the loss of something very important for themselves. We conclude that female nurses when confronting female surgery distances themselves behind the professional nurse and performs nursing care as a daily routine. It means that these nurses live a personal conflict that influences directly on how they supply care. They care for, but do not care about; the ethos of biomedicine leads carers on to a technical path from which it is difficult to get off.

Pesquisa na enfermagem brasileira: esse é o momento para mudanças?

Sou uma enfermeira brasileira e tenho trabalhado como professora e pesquisadora nos Estados Unidos da América (EUA) nos últimos nove anos. Minha linha de pesquisa está focada na Saúde Mental e sua relação com a cultura, mais especificamente a depressão entre mães e crianças de origem latina e de baixa renda que vivem em áreas rurais do estado da Flórida. O foco desta pesquisa é consistente com a redução das disparidades em saúde em minorias de baixa renda, uma meta do programa “Healthy People – 2010”(1). Os resultados da minha pesquisa devem contribuir com os dados de Saúde Mental apresentados nos Principais Indicadores de Saúde 2010(1). Em concordância com a abordagem da Pesquisa Ação, a minha pesquisa busca envolver a participação ativa dos membros da comunidade (professores, pessoas ligadas a igrejas, profissionais do departamento de saúde pública e mães da comunidade onde atuamos) em todas as etapas do projeto. Além disso, dois outros pesquisadores também fazem parte do meu grupo de pesquisa; sendo uma psicóloga infantil e uma professora especializada em ensino bilíngue.O processo de transição para a vida nos EUA tem sido desafiador, uma vez que meu coração permanece no Brasil. A tecnologia, entretanto, permite-me o privilégio de manter frequentes contatos e colaboração com colegas brasileiros que trabalham na universidade e na área assistencial. Meu objetivo neste editorial é destacar tópicos atuais de pesquisa que merecem atenção e promover a discussão entre enfermeiros.Obviamente os enfermeiros brasileiros têm enfrentado as complexidades do cuidado à saúde do século XXI e trabalhado na geração de professionais com pensamento mais crítico e na formação de pesquisadores que continuarão nesta trajetória. Um estudo recente sobre a pesquisa da enfermagem Latino-Americana apontou que os enfermeiros brasileiros são os mais produtivos na publicação de artigos em periódicos de enfermagem Latino-Americanos(2). Em 2007, ao participar do Congresso Brasileiro de Enfermagem (CBEn – Brasília), fiquei impressionada ao ver a participação maciça de alunos (graduação e pós graduação) apresentando seus trabalhos. Segundo Mancia et al(3) desde 2001 mais de 50% dos participantes do CEBEn são estudantes. Isto mostra claramente que a cultura da pesquisa está se iniciando precocemente no processo educacional e tem uma sólida fundamentação na enfermagem profissional. Estes são avanços positivos e interessantes.Acredito que a discussão dos três temas seguintes poderá contribuir para o avanço de nossa missão profissional: 1) pesquisa focada no cliente, 2) agenda formal de pesquisa em enfermagem, e 3) estímulo a pesquisas interdisciplinares. Evidências obtidas a partir de pesquisas de intervenções inovadoras, focadas no cliente, podem incrementar substancialmente a contribuição para a prática baseada em evidências. Sequencialmente, pergunto: qual a estratégia atual para a construção de uma agenda formal de pesquisa em enfermagem para as diferentes regiões do Brasil? Tal agenda pode servir como uma ferramenta importante para orientar a pesquisa em enfermagem e sua aplicação, reconhecendo as diferenças sociais, econômicas e culturais em um país nas dimensões do Brasil. Uma agenda formal pode também gerar mudanças positivas no campo político e social da profissão. Finalmente, parece que a maior parte das pesquisas em enfermagem e das publicações no Brasil são produtos de colaboração entre colegas enfermeiros e estudantes de enfermagem, apesar do importante papel da colaboração interdisciplinar como parte de nosso modelo teórico de enfermagem. Minha experiência em pesquisa continua a me ensinar o valor da colaboração interdisciplinar. Ao longo do tempo, entretanto, aprendi que para promover a sustentabilidade dos programas de saúde e a transformação social da comunidade, o trabalho colaborativo com os clientes é de valor inestimável considerando que eles são os verdadeiros agentes de mudança.Como sabemos, as mudanças em qualquer profissão exigem uma profunda discussão, planejamento e ação. Espero que os temas aqui apresentados possam ser úteis para fortalecer este processo. REFERÊNCIAS1. Healthy People 2010 [Internet]. Washington, DC: US Department of Health and Human Services (USA) [cited 05 out 2009]. Available from: http://www.healthypeople.gov.2. Mendoza-Parra S, Paravic-Klijn T, Muñoz-Muñoz AM, Barriga OA, Jiménez- Contreras E. Visibility of Latin American nursing research (1959–2005). J Nurs Scholarsh. 2009;41(1):54–63.3. Mancia JR, Padilha MICS, Ramos FRS, Cordova FP, Amaral NV. Congresso Brasileiro de Enfermagem: sessenta anos de história. Rev Bras Enferm. 2009;62(3):471-9.

Maria Lucia Pimentel de Assis Moura " liderança da enfermagem frente ao conselho regional de enfermagem de São Paulo

Com este estudo objetivamos desvelar a historicidade de uma enfermeira paulista, na presidência do Conselho Regional de Enfermagem de São Paulo, por quatro gestões. Trata-se de uma Pesquisa histórica documental, que teve como fonte de dados os Relatórios de Atividades anuais do Conselho Regional de Enfermagem de São Paulo deste período. Após análise dos dados foi possível identificar o perfil de liderança desta enfermeira frente às questões contemporâneas relevantes para a enfermagem brasileira: a Regulamentação do Exercício Profissional de Enfermagem, o Código de Ética dos Profissionais de Enfermagem, a Sistematização da Assistência de Enfermagem e principalmente, as atribuições deste Órgão de Fiscalização do Exercício Profissional para atender as novas demandas dos Sistemas de Saúde e Educação. Os achados possibilitam inferir que a enfermeira Maria Lucia Pimentel de Assis Moura foi um baluarte na enfermagem paulista e brasileira pela sua brilhante contribuição.

ENFERMAGEM FORENSE: UMA ESPECIALIDADE A CONHECER

O objetivo é relatar como ocorre a atuação da enfermagem forense nos Estados Unidos da América. Estaespecialidade é amplamente debatida pelas enfermeiras norte americanas, porém ainda é pouco conhecida por enfermeirasbrasileiras. A atuação de enfermagem forense ocorre em locais os mais diversos, desde hospitais a tribunais de justiça, emserviços hospitalares e/ou na comunidade. Contribui em comitês de ética de serviços de saúde, nas atividades educativaspara indivíduos ou grupos com comportamentos de risco, abuso de álcool e drogas e em organização de campanhas contraa violência. A ênfase na educação preventiva permite que a enfermeira se destaque dentre os demais profissionaisenvolvidos, em especial, por sua atuação junto à vítima, como responsável em realizar exames minuciosos e coletas deevidências sem contaminação, fatores indispensáveis para sucesso da investigação forense. A atuação das enfermeirasforenses facilita a aproximação com as vítimas e estabelece relações de confiança entre os que atuam nas áreas da justiça,facilitando a cooperação com o exame forense.

Uso das intervenções de enfermagem na prática clínica no Brasil

Há um desafio mundial de universalizar a linguagem e evidenciar a prática de enfermagem. A Nursing Interventions Classification (NIC) está sendo desenvolvida por pesquisadores do College of Nursing – The University of Iowa, EUA, com esse propósito. Este estudo teve por objetivo identificar o uso das intervenções de enfermagem da NIC no Brasil, por meio de levantamento da freqüência de utilização das 486 intervenções da NIC nas diversas especialidades clínicas dos enfermeiros brasileiros. Trata-se de estudo descritivo, realizado no período de março a julho de 2006, com amostra de 222 enfermeiros. Para a coleta de dados foi utilizado um instrumento aplicado pelo grupo de pesquisadores de Iowa. Para a análise dos dados foi utilizado um pacote estatístico. Um grau de concordância de 70% foi considerado aceitável e as intervenções centrais, consideradas como utilizadas diariamente ou semanalmente pelos enfermeiros foram identificadas. Os resultados mostraram que 77,7% das intervenções NIC foram identificadas como essenciais por enfermeiros de diferentes especialidades. As intervenções mais freqüentes mostram a essência da prática clínica da enfermagem no Brasil e a aplicabilidade das intervenções NIC à nossa realidade.

The psychometric properties of demand-control and effort–reward imbalance scales among Brazilian nurses

To compare the psychometric adequacy of the demand-control-support (DCS) and the effort-reward imbalance (ERI) questionnaires in relation to their respective theoretical models among workers within the same psychosocial work environment. A self-report questionnaire was administered to 1,509 nursing personnel at two Brazilian hospitals. Analyses were based on internal consistency, corrected item-total correlation, and confirmatory factor analysis models for ordinal data (conducted with Mplus software) to test the fit of each model. Internal consistency was satisfactory (>0.70) for most scales of the DCS and ERI questionnaires, except for the job decision latitude scale (alpha = 0.50). With reference to corrected item-total correlations, adequate performance was observed for most items of both questionnaires. The item 'Do you have to do same thing over and over again' had a very low corrected item-total correlation (-0.09) and the removal of this item increased the internal consistency of the skill discretion subscale. Overall, fit indices (of factorial validity) for the DCS and the ERI questionnaires were adequate. However, a low correlation between subscales of the decision latitude scale (-0.164) was observed. For the psychological job demands and overcommitment scales, the best adjustment of the model was obtained when correlated errors between items were considered. Strengths and limitations were observed in both the DCS and the ERI scales. The questionnaires could be improved by the revision of some items.

A divulgação da competência técnica em socorro das enfermeiras da cruz vermelha (SP) nas circunstâncias da Primeira Guerra Mundial (1917-1918)

Social-Historical study which aim is to describe the circumstances of the Brazil’s entrance in the 1st World War and to describe and analyze the photographic content about the Brazilian nurses prepare to participate at the Brazilian Red Cross services in the 1st World War. Periodic delimitation was in the year of 1917, when it occurs the spreading of Brazil’s participation in 1st World War and 1918 the spreading of the departure of a Brazilian medical commission for attendance to the wounded in the War. Documental study grounded in Bordieu conceptual frame, based on written and photographic documents refereeing that time, and with a special detach to the analysis of four pictures published in The Week Magazine. The I World War agitated the written and illustrated press. The Brazilian Red Cross, through the School of Nurses of São Paulo, presented to the society the nurses technical competences for aid care assistance with the habitus formation and school status acquired, but because adverse reasons it did not get real visibility in the institutional report. But, in the illustrated press we find vestiges of the Brazilian nurses participation in a hospital in Paris.

Infusions failures in the use of peripheral venous catheters in children: integrative review

During the time of maintenance of the therapy in peripheral vein, many problems, called as imperfections of the infusion, hinder that the therapy has continuity in a venous vase. Looking for to contribute and to add efforts for the improvement of the assistance of given nursing the child in use of intravenous therapy, considered it present inquiry with the objective to identify the available evidences in literature on the main infusionais imperfections related to the use of peripheral the venous catheter in pediatrics and to consider strategies for the reduction of the same ones. In the present research, she selected herself as method one of the resources of the practical one based in you evidence, that is, the integrative revision of the literature, which makes possible the synthesis it analyzes and it of the produced scientific knowledge already on the investigated subject. She proved herself that the main infusional imperfection is the flebit. In what it concerns to the time of permanence of the peripheral venous catheter in the venous access the average time is of 72 hours. Front the results pointed in the enclosed material in this integrative revision, is understood to be necessary to intensify efforts for the development of research with delineation that produces evidences relative forts to the investigated subject, mainly in the reality of the practical one of the Brazilian pediatric nursing.

The Emergence of Family Nursing in Brazil

A family perspective has been influencing Brazilian nursing practice and research, in particular in the past decade. Despite this development, there is evidence from research and from nurses' narratives that nurses still experience serious challenges in providing nursing care to families in Brazil. These challenges are analyzed and strategies are offered to support nurses in Brazil to "think family" and stimulate advanced practice in family nursing.

A Validation Study of the Nursing Diagnosis Anxiety in Brazil

This study aims to validate the nursing diagnosis of anxiety among expert Brazilian nurses and clinicians using NANDA International defining characteristics and to compare the clinical judgments of the experts and the clinicians. A semistructured questionnaire was completed by a convenience sample of 120 nurses. NANDA International defining characteristics of the Brazilian Portuguese version were used. The analysis of the ratings was based on the framework of the Diagnostic Content Validation model. Brazilian nurses considered the anxiety definition established by NANDA International to be appropriate and experts' and clinicians' judgments were similar for both groups of nurses. The results showed that among the 71 characteristics of anxiety, 8 were identified as critical defining characteristics of anxiety (score >or= 0, 80) by the expert nurses. Brazilian nurses accepted the NANDA International definition for nursing diagnosis of anxiety although some defining characteristics might differ due to cultural differences. Future research could address the limitations of the study and examine validations by both the experts and the clinicians. The adequate preparation of undergraduate and postgraduate nurses in nursing diagnosis is important in improving the quality of care given to patients.

Opposition to the American leadership by Brazilian nurses (1934-1938)

A historical social descriptive study whose objective is to describe the circumstances where Bertha Pullen assumes as the dean of Anna Nery Nursing School, to assess the strategies undertaken by Pullen to assure her position of power and prestige in the space of the school and Brazilian nursing; and to discuss about the resistance to the presence and authority of the American dean for the nurses and students, in the struggle for a national identity. Corpus analysis was made by putting photographs into context based on written documents and secondary sources. The second management of Pullen was the reiteration of the American presence in the leadership of the School, despite the resistance of the nurses and students. Thus, we may assume that the second tenure of Pullen did not represent a real need that was felt by the school.

Analysis about production of nursing knowledge on health education and aging

This study is exploratory, of qualitative nature and has the objective to identify the bibliographical production of nursing related to the aging, to the education in health and the methodological strategies, in Brazilian publications, from 2000 to 2006. Online database BDENF was used to search the articles and the keywords were: health education, aged, aging, behavior and nursing. Eight articles had been identified and five were chosen which are in the following publications: Revista Brasileira de Enfermagem (two), Revista Latino-Americana de Enfermagem (two) and Cogitare Enfermagem (one). The discussion of the selected articles was based on the technique of content analysis. The results had demonstrated that the subjects education in health and aged people have little space in researches by Brazilian nursing, in this period and at the database consulted, and group activity was distinguished as predominant methodological strategy of education in health. In such activity, the promotional actions of the autonomy of aged individuals had been valued. It is recommendable that the subject of the study could take part in new inquiries because population aging is a reality tending to expansion. The increment of studies in this area is needed; therefore the education in health is relevant for the process of human aging with quality.

Social insertion of nursing graduate programs

Since the dissemination of preliminary results of the triennial evaluation of Graduate (GP) courses in Brazil, performed by the Coordination for the Improvement of Higher Education Personnel (CAPES), much has been discussed on the theme among academics. The evaluation system values aspects related to the quality of programs focused on the education of human resources and the generation of knowledge produced, which are scored according to the following requirements: quality of the program proposal, faculty members, students, theses and dissertations, intellectual production and social insertion. Considering that the latter aims to identify how these master’s and doctoral graduates, as well as their research and advisors, act in terms of decisive challenges for society, and that each knowledge area is autonomous to define and understand social insertion within its particularities, in this editorial, we tried to present elements to support reflection on the GP’s social insertion in Brazilian Nursing. Since the creation of the first master’s (1972) and doctoral (1981) programs, the mission of Nursing graduate programs in Brazil has been to contribute to the education of critical, ethical and considerate master’s and doctoral graduates, capable of building new knowledge to the benefit of society. The number of master’s and doctoral programs in nursing, accredited by CAPES, has increased in recent last years by 69%, from 16 programs in the triennium 1998-2000 to 27 in 2004-2006. A total of 2,102 master’s and 653 doctoral graduates in Nursing, from different Brazilian states, Latin American and Portuguesespeaking African countries, graduated in the period between 2001 and 2006. Currently, there are 32 graduate programs, approximately 700 undergraduate courses in Nursing and 200,000 graduated nurses. The academia plays a central role in the generation of knowledge and graduate programs are responsible for the larger part of scientific production in Brazilian nursing. This production has gained increased visibility worldwide, though still far from the more traditional areas such as Medicine, both in number of articles and in the percentage of citation and journal impact number. However, it is perceived that, like in other knowledge areas, there is difficulty in applying the knowledge produced in practice and in the production of products. It is understood that, to expand GP, it is necessary to discuss their future, not only regarding the increase in publications in international journals of impact, but also in terms of the social insertion of its academic production and its contribution to the country’s social and economic development. Thus, publication of research results in high-quality national periodicals and in the popular media is also necessary, so that society perceives research results with consequent reflection on people’s lives. It is known that the contributions of scientific research to the society are mediated by broad political, cultural and social processes (1) . However, some elements can be considered indicators of what these contributions are. In the exact sciences, for instance, these indicators can be the generation of technical results, such as processes, patents conceded, and innovative software. In the health area, the results are focused on the quality of care delivered to users, productivity and service efficiency, diminished morbidity and mortality indicators and increased longevity, among others. The GP’s social insertion, on the other hand, is broader because it includes aspects of knowledge production and human resource education that are evaluated by CAPES through the following indicators: Insertion and regional and (or) national impact: evaluated by the educational impact (contribution to the improvement of primary, secondary, undergraduate, technical/professional education), social impact (education of human resources qualified for public administration or civil society, able to contribute to the improvement of public management and the reduction of social debt or training groups that use science resources or knowledge);

Brazilian nursing and professionalization at technical level: a retrospective analysis

This article presents a retrospective analysis of the Brazilian Nursing concerning the professionalization of workers at technical level. It also provides some indication about the trends of professional education. There is a clear indication of increased intellectual and conceptual accumulation in the four decades the professional education in nursing at technical level has been part of the public policy agenda. This experience serves as reference for the formulation of new actions directed to other professionals of technical level who deliver direct care to the population. The study shows that there was reformulation of the nursing professional qualification issue, including in the discussion the need to improve the quality of educational processes and extensive supply of continuous education to workers already inserted in the process, in order to keep the constant changes in the Brazilian Health system.

Errors in the administration of intravenous medication in Brazilian hospitals

To verify the frequency of errors in the preparation and administration of intravenous medication in three Brazilian hospitals in the State of Bahia. The administration of intravenous medications constitutes a central activity in Brazilian nursing. Errors in performing this activity may result in irreparable damage to patients and may compromise the quality of care. Cross-sectional study, conducted in three hospitals in the State of Bahia, Brazil. Direct observation of the nursing staff (nurse technicians, auxiliary nurses and nurse attendants), preparing and administering intravenous medication. When preparing medication, wrong patient error did not occur in any of the three hospitals, whereas omission dose was the most frequent error in all study sites. When administering medication, the most frequent errors in the three hospitals were wrong dose and omission dose. The rates of error found are considered low compared with similar studies. The most frequent types of errors were wrong dose and omission dose. The hospitals studied showed different results with the smallest rates of errors occurring in hospital 1 that presented the best working conditions. Relevance to clinical practice. Studies such as this one have the potential to improve the quality of care.

Spirituality in brazilian nursing: a historical retrospect

Spirituality is a subject present in nursing literature since Florence Nightingale. In Brazil, the first scientific publicationappeared in 1947 and is now represented by the Revista Brasileira de Enfermagem [Brazilian Journal of Nursing]. This periodic reflectsthe trends of thinking about nursing in the country, for it publishes the better evaluated works presented in the Congresso Brasileiro deEnfermagem [Brazilian Congress of Nursing], a yearly event of Associacao Brasileira de Enfermagem [Brazilian Association of Nursing]that happens since then. We did a historical survey of Brazilian nursing thought about spirituality from an active search of articlespublished by the said Journal from the decade of 1950 to the year 1999. 57 articles about the subject were found, and classified in 9categories, namely: spirituality as part of the character and morality of the individual that chooses to study nursing; spirituality as aphilosophy of work of nurses; spirituality as part of the curriculum and education of nurses; spirituality in patient assistance as a basichuman necessity; the meaning of spirituality for those who are taken care of (patient/client); the meaning of spirituality for thosewho take care of; spirituality and humanization; spirituality, death and dying; and spirituality according to Ethics and Bioethics. Oneconcluded that the thought of nurses in through these decades passed to variations in number and categories that reflect the evolutionof science and the questions this generates.

Poverty, health iniquities, and human development are global Issues

The Online Brazilian Journal of Nursing joinned this international collaboration with journals from developed and developing countries to raise awareness in Brazilian nurses about the health iniquities and poverty and to point out the necessity of developing research to bring solutions, wellbeing, and health for all regardless, race/colour, age, gender, etc. So, Online Brazilian Journal of Nursing created a new section: Poverty, Health Iniquities, and Human Development to point ou these issues.

Cultura dos cuidados: mulheres negras e formação da enfermagem profissional brasileira

This paper intends to analyze the exclusion of black women process from the origins of the Brazilian professional nursing. Based on the proposition of the anthropology of care, this study shows that black women cared sick people before the nursing professionalization in Brazil. Results of this process have created a professional identity for Brazilian nursing essentially characterized by white woman, daughter of elite. A reflection allows us to suppose that black representations in Brazil have reiterated stereotypes that has prevented from inclusion of blacks into modern nursing, while the black representation within Brazil has projected black women as morally disqualified, characterizing them as inappropriate for practicing the art and science of caring.