Systematization Of Nursing Care Research Articles

„Aber vielfach scheitert man dann an Besonderheiten“ – Pflegeberater über Gesetzesänderungen und die Herausforderungen ihrer Arbeit: Eine qualitative Untersuchung

IntroductionSince the implementation of long-term care insurance in 1995, various reforms have contributed to the development of the German nursing care system in order to meet the structural and financial needs of the growing number of people in need of care. The aim of this paper is to present an assessment of care consultants on past legislation, challenges encountered during their work and suggestions to improve the current care system. Methods14 semi-structured, face-to-face interviews were conducted with care consultants. All interviews were transcribed verbatim and a qualitative content analysis was performed. ResultsCare consultants perceived tangible improvements with regard to the scope of benefits as a direct result of recent legislation changes. The use of these benefits, however, is limited due to an insufficient growth of care infrastructure. Particularly frequent legislation changes, unclear responsibilities and dissimilar regulations between federal states were seen as challenges. Discussion and conclusionComplex dependencies within the German nursing care system were identified and the necessity for a public discourse on themes such as self-responsibility, equity and a comprehensive (nationwide) care supply was underlined. A central information platform was proposed in order to concretely improve information about services available locally.

Insertion of nursing in diagnostic technologies: innovations in secondary health care

Objectives: The study’s purpose has been to build Standard Operating Procedures (SOPs) for nursing care while performing diagnostic exams in secondary health care. Methods: A committee for Nursing Care Systematization (NCS) was then established, which assessed the sectors in which new diagnostic technologies were being implemented and raised the need for training of the technical team that performed these tests to standardize procedures, then reducing errors and failures in its realization. The SOPs were described through tables comprised by the following: definition of the diagnostic procedure, necessary material, nursing interventions and special care. Results: Four SOPs were elaborated, related to the exams of spirometry, polysomnography, retinography and hydrogen breath test. Conclusion: It was possible not only to know the execution of the exams, but also to understand the applicability of NCS with a focus on diagnostic technologies, besides providing subsidies for future implementation of NCS in the study institution.

Insertion of nursing in diagnostic technologies: innovations in secondary health care

Objectives: The study’s purpose has been to build Standard Operating Procedures (SOPs) for nursing care while performing diagnostic exams in secondary health care. Methods: A committee for Nursing Care Systematization (NCS) was then established, which assessed the sectors in which new diagnostic technologies were being implemented and raised the need for training of the technical team that performed these tests to standardize procedures, then reducing errors and failures in its realization. The SOPs were described through tables comprised by the following: definition of the diagnostic procedure, necessary material, nursing interventions and special care. Results: Four SOPs were elaborated, related to the exams of spirometry, polysomnography, retinography and hydrogen breath test. Conclusion: It was possible not only to know the execution of the exams, but also to understand the applicability of NCS with a focus on diagnostic technologies, besides providing subsidies for future implementation of NCS in the study institution.

Eliot Freidson’s sociology of professions: an interpretation for Health and Nursing

to analyze theoretical conceptions of Eliot Freidson's Sociology of Professions scoped on health and nursing professions. Eight nurses were interviewed, all involved in the development of the professional Council on the timeframe from 1975 to 1986. Documental resources were Laws, Ordinances, Resolutions, Reports, Meeting Minutes and Public Deeds. Information was organized as from literature and Eliot Freidson's conceptions, and thematic content analysis was carried out. the concepts authored by Eliot Freidson allowed for the development of a concept chart that portrays the nursing profession and that may be expanded for the other occupations in the health field, in consonance with professional organization in the country. Final Considerations: Eliot Freidson's framework, in interpretation for nursing, consolidates the profession with relative autonomy, expertise by Nursing Care Systematization and credentialism by professional normalizations.

Management tools in nursing care for children with pressure injury.

to develop and validate management tools for the systematization of nursing care for children with pressure injuries. methodological study in which the focus group technique was used for validation of tools in three different groups of 17 nurses. Conducted in April and May 2018 at a large pediatric hospital. two management tools were developed. The first was the Nursing care systematization instrument for children with pressure injury with three parts: a) risk factors; b) Psychobiological Basic Human Needs; c) signs of wound infection. The second was the Flowchart of pressure injury risk and prevention in pediatric patients with three categories: a) risk factors; b) Braden Q scale; c) nursing care. Final Considerations: the tools will support nurses in the care of children with pressure injuries by aiming at an individualized and systematized assessment based on a theoretical framework.

Validação de instrumento para registro da sistematização da assistência de enfermagem perioperatória

Objetivos: Construir e validar conteúdos de um instrumento para registro da sistematização da assistência de enfermagem perioperatória. Método: Estudo metodológico realizado em um hospital-escola do sul do Brasil que incluiu revisão de literatura, mapeamento cruzado entre observação não estruturada e taxonomias da North American Nursing Diagnosis Association para construção do instrumento e aplicação da técnica Delphi para validação, realizada entre novembro e dezembro de 2018. Disponibilizou-se formulário eletrônico a dez expertos para avaliação da objetividade, clareza/compreensão, aparência e exequibilidade dos conteúdos do instrumento, registrada em escala Likert. As respostas obtidas foram submetidas ao índice de validade de conteúdo (IVC), e escores ≥0,8 confirmaram a validação do conteúdo. Resultados: Os nove grupos de informações do instrumento foram avaliados por enfermeiros expertos. A média do IVC obtido entre todos os conteúdos foi de 0,92 na primeira rodada de validação. Os resultados demonstraram que a estratégia metodológica permitiu a construção de conteúdos que representam a necessidade clínica para os registros de enfermagem no período perioperatório. Conclusão: A implementação de instrumento validado contribui para uma prática de enfermagem mais segura e qualificada.

Nursing care systematization: perceptions and knowledge of the Brazilian nursing.

to present the perception and knowledge of Brazilian nursing nurses and academics regarding Nursing Care Systematization. a descriptive study, carried out in the first half of 2018. of the 596 respondents, 86% perceived Nursing Care Systematization as very important, but only 60.9% used it in their care practice. Its use was statistically associated with a higher level of training. Non-utilization was associated with the perception that it is irrelevant and with little knowledge on the Nursing Process, even in the face of recognition of its obligation. Among professionals who wish to learn more about the subject, understanding the application of the process, especially the planning step, is perceived as a necessity. the relevance perception of systematization and levels of knowledge of the professional/academic are directly related to the use or not of Nursing Care Systematization principles.

Nursing approach to tobacco users in primary health care.

to understand the experience of nurses in the approach to tobacco users in primary health care services. Qualitative, phenomenological research with 15 nurses who were interviewed between January and March 2017. Their speeches were analyzed and classified into categories. the approach by nurses to tobacco users is performed in an individual and unsystematic manner and in operative groups in accordance with the principles of the cognitive-behavioral therapy. This is a complex approach due to issues related to users themselves and to human, material, and structural resources. The expectations of nurses include supporting smoking cessation and expanding the tobacco use prevention work in educational environments. this study points out that nurses need to use the nursing care systematization in coordination with the recommendations of policies aimed at tobacco use control to perform their role in the promotion, control, and reduction of health complications in tobacco users.

Dificuldades na implementação da Sistematização da Assistência de Enfermagem na Unidade de Terapia Intensiva Adulto

Objetivo: Identificar as dificuldades na implementação da Sistematização da Assistência de Enfermagem na Unidade de Terapia Intensiva adulto no município de Porto Velho - RO. Métodos: Trata-se de uma pesquisa bibliográfica, de campo, descritiva, exploratória, de caráter qualitativa. A amostra da pesquisa foi constituída por 21 profissionais de enfermagem (5 enfermeiros e 16 técnicos de enfermagem), atuantes na Unidade de Terapia Intensiva adulto do Hospital e Pronto Socorro João Paulo II, utilizando-se um questionário com perguntas fechadas para caracterização profissional e seis (06) perguntas abertas focadas no tema central. A pesquisa foi aprovada pelo Comitê de Ética em Pesquisa com o Parecer de nº: 3.180.102. Resultados: Os resultados mostraram uma sobrecarga de trabalho por parte dos enfermeiros e conhecimento superficial da equipe de enfermagem a respeito da SAE. Conclusão: É preciso que as condições no ambiente de trabalho favoreçam a qualidade no serviço de enfermagem prestado, como o número de profissionais enfermeiros adequado frente às demandas de serviços assistenciais e burocráticos, além do conhecimento profundo do tema com discussões e capacitações em serviço através da educação permanente com os profissionais para que os enfermeiros e técnicos de enfermagem reconheçam seus papéis na sistematização.

Barriers and Facilitators for the Use of NURSING Bedside Handovers: Implications for Evidence-Based Practice.

Previous studies on bedside handovers have identified nurse-related barriers and facilitators for implementing bedside handovers, but have neglected the existing ward's nursing care system as an important influencing factor. To determine the association between the existing nursing care system (i.e., decentralized, two-tier, or centralized) on a ward and the barriers and facilitators of the bedside handover. Structured individual interviews (N=106) on 14 nursing wards in eight hospitals were performed before implementation of bedside handovers. The structured interview guide was based on a narrative review. Direct content analysis was used to determine the nursing care system of a ward and the degree to which barriers and facilitators were present. Pearson's Chi-square analysis was used to determine whether there were associations between the nursing care systems concerning the presence of barriers and facilitators for implementing bedside handovers. Twelve barriers and facilitators were identified, of which three are new to literature: the possible loss of opportunities for socializing, collegiality, and overview; head nurse's role; and role of colleagues. The extent to which barriers and facilitators were present differed across nursing care systems, with the exception of breach of confidentiality (barrier), and an existing structured handover (facilitator). Overall, nurses working in decentralized nursing care systems report fewer barriers against and more facilitators in favor of using bedside handovers than nurses in two-tier or centralized systems. Before implementing bedside handovers, the context of the nursing care system may be considered to determine the most effective process to implement change. Based on these study findings, implementing bedside handovers could be more challenging on wards with a two-tier or centralized care system.

Impact of the Japanese Disability Homecare System on ALS Patients’ Decision to Receive Tracheostomy with Invasive Ventilation

Research has documented the influence of ALS patients families’ attitudes on patients’ decision to accept or reject TIV (tracheostomy with invasive ventilation), a treatment that in many cases will allow them to live long enough to experience locked-in syndrome (LIS); under Japanese law the use of a ventilator cannot be terminated once it is essential to a patient’s survival, so to choose TIV means to choose the possibility of entering a locked-in state. Previous studies have not, however, elucidated the changes in family members’ attitudes that take place after they receive pertinent information about the social systems and services available to them. This study aims to fill this gap by collecting and analyzing patients’ and family members’ narratives. In Japan, about 30% of ALS patients utilize TIV. This rate is much higher than in most other developed countries. Patients’ narratives illuminate the psychological and especially the contextual factors of their decision-making. Many Japanese patients who currently use a ventilator say that their family members encouraged them to prolong their lives through ventilation. These family members have done so because patients are able to use long-term ventilation for only ¥1000 (around $11) per month, and can also access the latest communication devices and round the clock caregiver services in their homes at very low cost. Japanese caregivers who are supported by social systems and services including communication assistance (systems, training methods, funding), empowering factors such as patients’ associations, care provided by people outside the patient’s family, and a public nursing care system are able to encourage patients to decide to use longterm ventilation (provided that they are aware of the possibilities offered by these social systems and services).

Sistematização da assistência de enfermagem em pacientes com câncer de mama: a atuação do enfermeiro

Este estudo buscou identificar se há dificuldades encontradas pelos profissionais da enfermagem durante a realização da Sistematização da Assistência de Enfermagem a pacientes com Câncer de mama em uma Unidade de Internação e Setor Oncológico/Quimioterapia de um hospital do interior do estado do Rio Grande do Sul. Desta forma o presente estudo classifica-se como descritivo e exploratório que utilizou como procedimento técnico o levantamento de dados de forma transversal com abordagem qualitativa. Para tanto, foi aplicado uma entrevista a nove participantes da equipe de enfermagem do setor oncológico e de internação. Todos os participantes do estudo assinaram o Termo de Consentimento Livre e Esclarecido. As respostas foram transcritas e analisadas de acordo com aproximações com a Análise de Conteúdo de Bardin. Os resultados do presente estudo apontaram que o trabalho dos profissionais de enfermagem no setor oncológico é repetitivo e apresenta demandas diariamente, tornando inviável a realização da Sistematização durante os atendimentos, restringindo-a para a admissão no setor. O estudo serve de contribuição para entender como é realizada a Sistematização da Assistência de Enfermagem em pacientes diagnosticadas com Câncer de mama, por parte dos profissionais de enfermagem de um setor Oncológico e Clínico. Pode-se perceber que os impactos mais importantes relatados pela equipe de enfermagem são identificados quando uma paciente interna, a preocupação com a queda de cabelo e o medo de perder um ou ambos os seios que aparece na maioria dos casos.

Bibliometric analysis of discharge planning for patients with stroke in China

Objective To analyze the research levels and development dynamics of discharge planning for patients with stroke in China using the bibliometric method and to provide a reference for improving the system of continued nursing care for stroke. Methods The status quo of research into discharge planning for patients with stroke in China were explore using CNKI, Wanfang, VIP and CBM databases as the source of data. Bibliometric analysis was performed with Note Express. The external characteristics and keywords of the literature were analyzed. Results Totally 64 literatures were included in this study, with Jiangsu, Fujian, Guangdong and Shanghai ranking the top 3 in terms of the number of literatures. The authors of 64.06% of the literatures came from university affiliated hospitals and medical colleges and universities. The number of nursing journals accounted for 52.63% of the total number of literatures, and only 40.63% of the literatures were included in the key magazine of China technology. The number of experimental research and quasi trial accounted for 71.86% of the total number of the literatures. The themes of research were mainly rehabilitation, self-management, continuous/continued nursing care and models; and the specific content of discharge planning needed to be further improved. Conclusions There are not too many literatures on discharge planning for stroke. The development and intervention of discharge planning is not scientific or standardized yet, which should be improved based on the conditions of patients with stroke so as to establish a discharge planning model that conforms to China's national conditions. Key words: Stroke; Discharge planning; Continued nursing care; Bibliometrics

Sistematização da assistência de enfermagem: vantagens e dificuldades na sua aplicação sob a ótica de enfermeiros

Objetivos: Analisar a percepção do enfermeiro a respeito da Sistematização da Assistência de Enfermagem (SAE) no hospital em que trabalha, verificar se a SAE interfere na qualidade da assistência e identificar as principais dificuldades do enfermeiro para realiza-la. Metodologia: Estudo qualitativo, do tipo descritivo. Os dados foram coletados entre os meses de maio e junho de 2017, mediante entrevista com 30 enfermeiros de um hospital público de Teresina. Resultados: Houve predomínio de profissionais do sexo feminino 27 (90%), com idade entre 25 e 60 anos e tempo de serviço entre 1 e 27 anos. Além disso, 22 (73,33%) enfermeiros tiveram contato com a Sistematização da Assistência de Enfermagem durante a graduação. Os discursos dos enfermeiros permitiram a construção de três categorias temáticas: “A sistematização da assistência de enfermagem vista como processo que permite, aos profissionais, organizar e individualizar o cuidado”; “Percepção dos enfermeiros acerca das contribuições da sistematização da assistência de enfermagem para a melhoria do cuidado” e “Dificuldades vivenciadas por enfermeiros no processo de sistematização da assistência”. Conclusão: Constatou-se que a sistematização é um instrumento que possibilita o planejamento de cuidados individualizados, organiza o serviço e proporciona autonomia profissional. Todos os entrevistados acreditam que as ações sistematizadas contribuem para melhoria do serviço, ao passo que direciona o cuidado ao paciente e aproxima os profissionais de saúde, como equipe, bem como aumenta o vínculo profissional/paciente. Como barreiras e desafios, foram citados a sobrecarga de trabalho, o despreparo da equipe e a informatização desse instrumento.

Concept synthesis of dignity in care for elderly facility residents.

Protecting the dignity of elderly residents of facilities and providing dignified care can be difficult. Although attempts have been made from several aspects, dignity is considered an area in which less real impact has been made in both theory and practice. The objective of this study is to characterize the concept of dignity in care for elderly subjects in residential facilities from a practical perspective through concept synthesis. This study includes in-depth interviews with residents of elderly facilities and a literature review. A total of 12 residents of seven facilities in three prefectures in Japan were recruited via purposive sampling, and 27 interviews were conducted. Each digitally recorded interview was transcribed verbatim. The interview data were analyzed based on hermeneutic phenomenological research. The literature was searched using PubMed, CINAHL, and Web of Science with combinations of terms such as dignity, elderly, and residential facilities and then selected according to the predefined inclusion criteria. The descriptions about dignity in the included studies were divided into codes and compared with the results of the interviews. This study was approved by the institutional review board of Nagoya University's Graduate School of Medicine. There were 1728 data codes for the interviews from which four themes were generated. In the literature review, 3716 titles were searched, and 28 articles were selected. Combining these results, five following themes and a conceptual matrix were obtained: individual dignity not affected by others; dignified care in a narrow sense; elements of the staff side; dignity in relation to family members, friends, society, and other residents; and dignity in relation to nursing care facilities and the nursing care system. According to the established matrix, we must consider the role of the care system, facility, family, and society in providing care with dignity and the individual dignity to residents and dignity in daily care.

Stress and Burnout among Preretirement Employee in Hospital at 10th of Ramadan City

<em>Employees are at high risk for stress and burnout. The aim of this study was to assess job stressors and burnout among employees in hospital at Tenth of Ramadan city. Design: cross-sectional descriptive design. Setting: the National Health Insurance Hospital at 10<sup>th</sup> of Ramadan city. Samples: convenience sample consisted of 100 employees. Tools: a self-administered questionnaire including scales for job stress and strain, burnout, and coping strategies, in addition to socio-demographic data was used in data collection. Results: the majority of the nurses were younger than 30 years (78%), with diploma degree (93%), and insufficient income (69%). More nurses had high exposure to stressors (49%), than strains (19%), and 20% had high burnout. Conclusion: the coping strategy most commonly used was effective behavioral confrontation. Nurses’ stress, strain, and burnout are strongly correlated and are influenced by personal factors such as age, qualification, experience, and residence, as well as job factors such as work hours, income, and the use of ineffective coping. Recommendations: the hospital administration should deal with and periodic assess the job factors underlying nurses’ stress and burnout. Further research is proposed to investigate the effectiveness of changing work environment factors and nursing care system on nurses’ burnout.</em>

Meaningful inclusion of diverse voices: The case for culturally responsive teaching in nursing education.

Communication and diversity are essential features of safe and effective health care and of a safe and effective nursing workforce. Fostering diversity and meaningful inclusion of diverse perspectives in nursing school classrooms, labs and clinical learning environments are important steps toward building a stronger nursing workforce and health care system. This paper presents an argument for the importance of replacing the single, dominant voice in nursing education with culturally responsive teaching and offers strategies nurse educators can use to encourage students to share alternative perspectives and engage in alternative methods of discourse and communication. This essay reflects a review of the theoretical background to culturally responsive teaching and discusses how this method connects to nursing education. By engaging in culturally responsive teaching, nurse educators will prepare a nursing workforce that is ready to add multiple diverse voices to the health care team and contribute to the redesign of a safer and more effective health care system.

BEST PRACTICES IN NEONATAL NURSING CARE MANAGEMENT

ABSTRACT Objective: to build a theoretical matrix of care system/organization of Nursing in a Neonatal Intensive Care Unit based on the meanings attributed by the Nursing Team professionals and other involved actors in the relationships and interactions of care in dealing with the fragility of living/surviving newborn. Method: a qualitative study adopting the theoretical framework the Complexity Paradigm and the Grounded Theory as research design. The participants were 22 subjects divided into four sample groups. Data was obtained from interviews and analyzed through comparative analysis, performed from May to August 2012. Results: nursing care practices management is based on the experience of the relationships/interactions with the family members and other health team actors, aiming to incorporate best practices. Thus, nursing care practices management seeks to address the fragility that surrounds prematurity, minimizing the sequelae when seeking newborn’s survival. Conclusion: the organization of nursing care system in a Neonatal Intensive Care Unit is complex, dynamic, interactive and interdependent with other health systems, mobilized by a management process of care and/or good care management practices that enables pre-term and his family a care focused on the fragility and uncertainties of living/surviving in singular conditions of life. The nurse stands out with the fundamental role of articulation in the light of the relationships/interactions in the care and organizational daily routine.

Sequenciamento de infusão de antineoplásicos: contribuições para a prática de enfermagem oncológica baseada em evidência

Este estudo objetivou identificar as evidências científicas disponíveis acerca das interações medicamentosas entre antineoplásicos decorrentes da ordem de infusão para, então, descrever a melhor sequência de aplicação e discutir sua aplicabilidade na Sistematização da Assistência de Enfermagem (SAE). Revisão integrativa da literatura operacionalizada em 2018 nas bases MEDLINE, LILACS, CINAHL e BVS, a partir dos termos Neoplasms, Drug Therapy, Drug Interactions, Chemotherapy e Sequence Administration. Foram analisados 57 estudos que, em conjunto, estudaram 40 combinações de antineoplásicos, apontando as interações farmacocinéticas e farmacodinâmicas decorrentes da ordem de infusão, as quais subsidiaram a construção de um quadro determinando o melhor sequenciamento para cada uma dessas combinações. Um fluxograma também foi produzido para, junto com o quadro, apoiar a SAE na perspectiva da prática de enfermagem oncológica baseada em evidência. Selecionar as sequências de infusão de antineoplásicos combinados representa nova estratégia conceitual para enfermeiros que administram protocolos de poliquimioterapia.

Conhecimento de pacientes em hemodiálise quanto ao autocuidado com cateter venoso central

Objetivo: Analisar o conhecimento de pacientes em hemodiálise sobre o autocuidado com o cateter venoso central. Método: Estudo descritivo de abordagem qualitativa realizado com 9 pacientes matriculados no Serviço de Terapia Renal Substitutiva da Fundação Hospital de Clínicas Gaspar Vianna, no município de Belém do Pará. Utilizou-se um instrumento para a coleta dos dados que posteriormente foi analisado segundo o modelo proposto por Bardin. Resultados: Após as a análise e interpretação dos dados coletados dos 09 pacientes, os quais compuseram a amostra do estudo, emergiram 3 categorias: Conhecimento e significância da hemodiálise na vida dos pacientes renais crônicos; O autocuidado e o cotidiano do paciente renal crônico em hemodiálise; A autoestima e autoimagem do paciente renal crônico em hemodiálise. Percebeu-se que de maneira geral todos os pacientes possuem carência de conhecimento acerca de seu tratamento e sobre o autocuidado necessário à manutenção correta de seu cateter. Conclusão: Destaca-se a importância do enfermeiro no repasse de orientações para a promoção do autocuidado dos pacientes renais crônicos e, consequentemente, melhor qualidade de vida. Sugerimos a construção de tecnologias educativas para uso com estes pacientes, além da implementação da Sistematização da Assistência de Enfermagem, a qual poderá identificar as deficiências no autocuidado e implementar as intervenções de enfermagem minimizando tal problemática