Carlise Rigon Dalla Nora

Nursing practices in the primary health care context: a scoping review.

ABSTRACT Objective: to identify and categorize the practices performed by nurses working in Primary Health Care and Family Health Strategy Units in light of responsibilities established by the professions legal and programmatic frameworks and by the Brazilian Unified Health System. Method: a scoping review was conducted in the following databases: LILACS, IBECS, BDENF, CINAHL and MEDLINE, and the Cochrane and SciELO libraries. Original research papers written by nurses addressing nursing practices in the primary health care context were included. Results: the review comprised 30 studies published between 2005 and 2014. Three categories emerged from the analysis: practices in the service; practices in the community; and management and education practices. Conclusion: the challenges faced by nurses are complex, as care should be centered on the populations health needs, which requires actions at other levels of clinical and health responsibility. Brazilian nursing has achieved important advancements since the implementation of policies intended to reorganize work. There is, however, a need to shift work processes from being focused on individual procedures to being focused on patients so that an enlarged clinic is the ethical-political imperative guiding the organization of services and professional intervention.Objetivo: identificar y categorizar las practicas ejercidas por los enfermeros en las Unidades Basicas y los Equipos de Salud de la Familia, desde el punto de vista de las atribuciones previstas por los marcos legales y programaticos de la profesion y del Sistema Unico de la Salud. Metodo: se realizo una revision de la literatura con el metodo scoping review, en las bases LILACS, IBECS, BDENF, CINAHL y MEDLINE, y en las bibliotecas Cochrane y SciELO. Se incluyeron articulos de investigacion original, producidos con enfermeros, sobre las practicas de enfermeria en el contexto de los cuidados de salud primarios. Resultados: la revision abarco treinta estudios publicados entre 2005 y 2014. Del analisis, resultaron tres categorias: practicas en el servicio; practicas en la comunidad; y, practicas de administracion y formacion. Conclusion: los desafios de los enfermeros son complejos, ya que el cuidado debe estar centrado en las necesidades de salud de la poblacion, lo que conduce a la accion para otros niveles de responsabilidad clinica y sanitaria. La enfermeria brasilena muestra importantes avances a partir de la implantacion de las politicas de reorganizacion del trabajo. Necesita, entre tanto, avanzar en lo que se refiere al desplazamiento de los procesos de trabajo, enfocados en procedimientos individuales, para un proceso mas dirigido a los usuarios, en donde la clinica ampliada sea el imperativo etico politico de la organizacion de los servicios y de la intervencion profesional.

Deliberação ética em saúde: revisão integrativa da literatura

Trabalho em saude requer que profissionais dominem meios e instrumentos para resolucao de problemas eticos vivenciados. Este estudo analisa o uso da deliberacao etica na solucao dos problemas eticos vividos pela equipe de saude. Realizou-se revisao integrativa da literatura em bases de dados da saude. Incluiram-se artigos de pesquisa originais, relatos de experiencias, estudos teoricos, estudos de caso, editoriais, em ingles, espanhol e portugues, enfocando equipes de saude que contassem com enfermeiros. A revisao abrangeu 28 estudos, publicados entre 1999 e 2013. Da analise resultaram quatro categorias: conceito de deliberacao; estrategias de deliberacao; contribuicoes da deliberacao; facilitadores da implementacao do processo de deliberacao. Conclui-se que a deliberacao e estrategia util e relevante para equipes de saude na analise, avaliacao e indicacao do melhor curso de acao para solucao dos problemas. Tambem e instrumento de educacao permanente para profissionais, pela troca mutua de experiencias e dialogos sobre valores, crencas e principios.Working in the health field requires that professionals master means and tools for resolving the ethical dilemmas they face. We conducted an integrative review of the literature in health-related databases. We included original research articles, reports of experience, theoretical studies, case studies and editorials, in English, Spanish and Portuguese carried out with healthcare teams that included nurses. The review covered 28 studies, published between 1999 and 2013. The analysis yielded four categories: concept of deliberation; strategies of deliberation; contributions of deliberation, and facilitators of implemention of the deliberation process. We concluded that deliberation is a useful and relevant strategy for health teams in the analysis, assessment and indication of the best course of action in problem solving. It is also an instrument of continuing education for professionals through mutual exchange of experience and dialogue about values, beliefs and principles.

Ethical problems experienced by nurses in primary health care: integrative literature review

The aim of this study is to identify ethical problems experienced by nurses in primary health care and resources for coping based on publications on the subject. An integrative literature review was performed between the months of October and November 2013, using the databases: BDTD, CINAHL, LILACS, MEDLINE, Biblioteca Cochrane, PubMed, RCAAP and SciELO. Articles, dissertations and theses published in Portuguese, English and Spanish were included, totalling 31 studies published from 1992 to 2013. This analysis resulted in four categories: ethical problems in the relationship between team members, ethical problems in the relationship with the user, ethical problems in health services management and resources for coping with ethical problems. Results showed that nurses need to be prepared to face ethical problems, emphasizing the importance of ethics education during the education process before and during professional practice to enhance the development of ethical sensitivity and competence for problem resolution.

Problemas éticos vivenciados por enfermeiros na atenção primária à saúde: revisão integrativa da literatura

The aim of this study is to identify ethical problems experienced by nurses in primary health care and resources for coping based on publications on the subject. An integrative literature review was performed between the months of October and November 2013, using the databases: BDTD, CINAHL, LILACS, MEDLINE, Biblioteca Cochrane, PubMed, RCAAP and SciELO. Articles, dissertations and theses published in Portuguese, English and Spanish were included, totalling 31 studies published from 1992 to 2013. This analysis resulted in four categories: ethical problems in the relationship between team members, ethical problems in the relationship with the user, ethical problems in health services management and resources for coping with ethical problems. Results showed that nurses need to be prepared to face ethical problems, emphasizing the importance of ethics education during the education process before and during professional practice to enhance the development of ethical sensitivity and competence for problem resolution.

Validação da compreensibilidade de um instrumento sobre problemas Éticos na atenção primária

The study aimed to validate the comprehensiveness of an instrument on the occurrence of ethical problems in primary health care and discuss their results. This is a methodological research. The technique used was Delphi, which seeks to obtain a consensus on a subject by experts, using structured questionnaires that are modified to obtain consensus on the comprehensibility of content. The sample was composed by nine professionals with expertise in primary health care in São Leopoldo. Data collection was in March and April 2011. In the first round, the professional was asked to respond whether the described situation has represented an ethical problem, whether the statement was clear and whether there was any suggestion to rewriting the problem. Were presented thirty-six statements, and to twenty was suggested new rewrite. After the review and systematization the proposed amendments, has begun the second round to seek consensus among all the statements that its writing had changed. In the second round, the consensus required by the method was obtained. Using the method supported significantly to build the instrument in its initial stage, what makes it appropriated and comprehensive for the subsequent steps of the validation.

Moral sensitivity in Primary Health Care nurses

OBJECTIVE to characterize the profile and describe the moral sensitivity of primary health care nurses. METHOD this is a quantitative, transversal, exploratory, descriptive study. The data were collected through the Moral Sensitivity Questionnaire translated and adapted to Brazil. 100 primary health care nurses participated, from Rio Grande do Sul, Brazil. The data collection took place during the months of March and July 2016, in an online form. The analysis of the data occurred through descriptive statistical analysis. RESULTS the nurses had an average moral sensitivity of 4.5 (out of 7). The dimensions with the greatest moral sensitivity were: interpersonal orientation, professional knowledge, moral conflict and moral meaning. CONCLUSION the nurses of Rio Grande do Sul have a moderate moral sensitivity, which may contribute to a lower quality in Primary Health Care.

ELEMENTOS E ESTRATÉGIAS PARA A TOMADA DE DECISÃO ÉTICA EM ENFERMAGEM

Este estudo tem como objetivo identificar os elementos e as estrategias que facilitam a tomada de decisao etica dos enfermeiros frente aos problemas eticos, a partir de publicacoes sobre a tematica. Realizou-se uma revisao integrativa da literatura. A coleta de dados foi realizada entre os meses de abril e maio de 2014, nas bases: SciELO, CINAHL, LILACS e MEDLINE. Foram incluidos artigos de pesquisa empirica, estudos teoricos e estudos de caso, publicados em ingles, espanhol e portugues, com equipe de saude que incluisse enfermeiros. Foram selecionados 19 estudos, da analise resultaram tres categorias: fatores externos da tomada de decisao etica em enfermagem; fatores individuais da tomada de decisao etica em enfermagem; e, estrategias facilitadoras da tomada de decisao etica em enfermagem. Conclui-se que os enfermeiros precisam utilizar estrategias que desenvolvam a sensibilidade, habilidades e competencia etica para, assim, tomar decisoes eticas prudentes, contribuindo para a qualidade da atencao a saude.Este estudio tiene como objetivo identificar los elementos y estrategias que faciliten la toma de decision etica de las enfermeras frente a los problemas eticos, a partir de las publicaciones sobre el tema. Se realizo una revision integradora de literatura. La recoleccion de datos se llevo a cabo entre abril y mayo de 2014, en las bases de datos: SciELO, CINAHL, LILACS y MEDLINE. Se incluyeron articulos originales de investigacion, estudios teoricos y estudio de caso, publicadas en ingles, espanol y portugues, con el equipo de salud que incluye enfermeras. Se seleccionaron 19 estudios, el analisis resulto en tres categorias: factores externos de la toma de decisiones eticas en enfermeria, factores individuales de la toma de decisiones eticas en enfermeria y estrategias facilitadoras de la toma de decisiones eticas en la enfermeria. Se concluye que los enfermeros han de utilizar estrategias que desarrollan la sensibilidad, habilidades y competencia etica, para asi, tomar decisiones eticas prudentes, lo que contribuye a la calidad de la atencion a la salud.

Validation of the comprehensiveness of an instrument on ethical problems in primary care

The study aimed to validate the comprehensiveness of an instrument on the occurrence of ethical problems in primary health care and discuss their results. This is a methodological research. The technique used was Delphi, which seeks to obtain a consensus on a subject by experts, using structured questionnaires that are modified to obtain consensus on the comprehensibility of content. The sample was composed by nine professionals with expertise in primary health care in São Leopoldo. Data collection was in March and April 2011. In the first round, the professional was asked to respond whether the described situation has represented an ethical problem, whether the statement was clear and whether there was any suggestion to rewriting the problem. Were presented thirty-six statements, and to twenty was suggested new rewrite. After the review and systematization the proposed amendments, has begun the second round to seek consensus among all the statements that its writing had changed. In the second round, the consensus required by the method was obtained. Using the method supported significantly to build the instrument in its initial stage, what makes it appropriated and comprehensive for the subsequent steps of the validation.

Validação por peritos: importância na tradução e adaptação de instrumentos

Objetivo: Apresentar a validacao de conteudo por peritos, como etapa essencial da validacao, traducao e adaptacao cultural de instrumentos de psicometria, tendo como exemplo o processo de adaptacao realizado com o questionario de sensibilidade moral para Portugal e Brasil. Metodo: Trata-se de estudo metodologico, com um comite de 12 peritos, sete do Brasil e cinco de Portugal. A coleta e analise dos dados ocorreu em 2015, entre os meses de setembro e outubro, em Portugal e novembro e dezembro, no Brasil. Resultados: Dos 30 itens apresentados aos peritos, 20 tiveram sugestao de adaptacao. Algumas adaptacoes foram necessarias para que os itens ficassem claros e de facil compreensibilidade. A versao final permaneceu com 28 itens. Conclusao: A validacao de conteudo dos instrumentos de psicometria por um comite de peritos e essencial para pesquisadores e enfermeiros, cada vez mais preocupados em utilizar medidas confiaveis e apropriadas para pesquisas e avaliacao da assistencia. Palavras-chave: Inqueritos e questionarios. Estudos de validacao. Pesquisa em enfermagem. Revisao por pares.

Dupla titulação em enfermagem: potencialidades e desafios de uma experiência de internacionalização acadêmica discente

Objective To share the experience of a Double Nursing degree promoted between the Nursing School of the Universidade de São Paulo and the Health Sciences Institute of the Universidade Católica Portuguesa, reflecting on the potentialities and challenges of this opportunity for graduate students. Method This is an experience report presented in chronological order and of a descriptive nature. The double degree in Nursing was accomplished over a period of 6 months in a different institution from the institution of origin. Results Among the activities developed during the Double Degree are: participating in examining boards, congresses, seminars, courses, meetings, lectures, colloquium, classes, research groups and technical visits to health services. A table presents and describes the main benefits of the experience experienced by the authors. Conclusion When well-planned and well-developed, a double degree can promote personal, cultural and professional development of the students, favoring internationalization and contributing to the qualification of graduate programs.