Rafaela Schaefer

Construção e validação do instrumento "Inventário de problemas éticos na atenção primária em saúde"

Identificar los conflictos eticos contribuye para mejorar la calidad de la atencion. Este estudio tuvo como objetivo evaluar la validez de constructo y la consistencia interna del Inventario de Problemas Eticos en la Atencion Primaria de la Salud. El instrumento, un cuestionario estructurado y cerrado, es resultado de una decada de investigaciones sobre bioetica en la atencion primaria. El articulo enfoca la ultima etapa de validacion. En el inicio de esta etapa, el instrumento contenia 41 elementos. Se lo ha aplicado a 237 profesionales de 12 centros de salud del Grupo Hospitalar Conceicao (Porto Alegre/RS). Tras el analisis factorial exploratorio de las puntuaciones, se encontro seis dimensiones centrales con alto grado de fiabilidad y consistencia (KMO = 0,831, Bartlett p < 0,001, alpha 0,876), explicando el 61,4 % de la varianza. La version validada del instrumento quedo con 6 factores y 24 items. El instrumento contribuira para las investigaciones en bioetica, pues posibilita estudios cuantitativos en grandes muestras para llevar a reconocerse los problemas eticos mas frecuentes en atencion primaria.

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.

Identification of risk factors for moral distress in nurses: basis for the development of a new assessment tool

This article proposes to identify risk factors for moral distress from the literature, validate them through expert analysis and provide the basis for a new tool to assess the risk of moral distress among nurses. Moral distress is related to the psychological, emotional and physiological aspects of nursing. It arises from constraints caused by various circumstances and can lead to significant negative consequences. A scoping review and validation through expert analysis were used. The research question guiding this study was as follows: What is known about risk factors for moral distress in nursing? The research was conducted using multiple sources including electronic databases and lists of references from relevant literature. The final sample consisted of 38 studies. A validation analysis was conducted by experts during December 2014 and June 2015. To exclude a risk factor item, at least 80% of the experts had to agree with the exclusion. In total, 53 risk factors for moral distress were identified, reviewed by the experts and grouped to form a new instrument that may help to identify risk for moral distress and to address its consequences.

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.

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.

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.

Nurses' practices in the context of primary healthcare in Portugal

Aim The aim of this study was to identify and categorise the nursing practices of Portuguese nurses in the context of primary healthcare services. Methods A scoping review was undertaken using the Latin American and Caribbean Health Sciences literature database; Spanish Bibliographic Index of Health Sciences; Medical Literature Analysis and Retrieval System Online; Cochrane Library; Scientific Electronic Library Online; El Banco de Datos de Enfermería nursing database; and Cumulative Index to Nursing and Allied Health Literature databases. The search strategy included articles of original research, which involved nurses or nursing practices in the context of Portugal’s primary healthcare, published in Portuguese, Spanish and/or English. The review involved the analysis of 11 studies published in Latin American, Brazilian and Portuguese journals, therefore all were available in Portuguese, published between 2007 and 2013. Results From the analysis it was possible to establish four categories of primary healthcare nurses’ work: technical procedures, health promotion, independent actions, and management and training practices. Conclusions Primary healthcare nursing in Portugal is challenged in the context of making more effective use of its own competences, investing more in actions of health promotion and disease prevention and less in technical curative procedures, thus contributing to better performance in the Portuguese National Health System.

Psychometric evaluation of the Moral Distress Risk Scale: A methodological study

Background: Moral distress is a kind of suffering that nurses may experience when they act in ways that are considered inconsistent with moral values, leading to a perceived compromise of moral integrity. Consequences are mostly negative and include physical and psychological symptoms, in addition to organizational implications. Objective: To psychometrically test the Moral Distress Risk Scale. Research design: A methodological study was realized. Data were submitted to exploratory factorial analysis through the SPSS statistical program. Participants and research context: In total, 268 nurses from hospitals and primary healthcare settings participated in this research during the period of March to June of 2016. Ethical considerations: This research has ethics committee approval. Findings: The Moral Distress Risk Scale is composed of 7 factors and 30 items; it shows evidence of acceptable reliability and validity with a Cronbach’s α = 0.913, a total variance explained of 59%, a Kaiser–Meyer–Olkin = 0.896, and a significant Bartlett <0.001. Discussion: Concerns about moral distress should be beyond acute care settings, and a tool to help clarify critical points in other healthcare contexts may add value to moral distress speech. Conclusion: Psychometric results reveal that the Moral Distress Risk Scale can be applied in different healthcare contexts.

Validación de la comprensibilidad de un instrumento sobre problemas éticos en la atención primaria

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.