Rosemary Silva da Silveira

Percepções e mudanças na qualidade de vida de pacientes submetidos à hemodiálise

Chronicle Renal Failure is considered a major problem in Public Health. The dyalitic treatment while waiting for the renal transplant means a boost on quality of life. This qualitative study, carried out in Rio Grande-RS, aimed at knowing the perceptions of patients with Chronicle Renal Failure, identifying the elements that influence their quality of life. The results highlighted that the initial feelings of indignation and denial change as they strengthen themselves to face the disease. Restrictions of fluid and eating habits, inability to perform or limitation in activities, professional and leisure, were the main difficulties identified. The support from family members and from health professionals may help to overcome these limitations and adaptation to a new lifestyle.A Insuficiencia Renal Cronica e um importante problema de Saude Publica. O tratamento dialitico, na espera pelo transplante renal, constitui-se numa expectativa de melhoria da qualidade de vida. Este estudo qualitativo, realizado em Rio Grande-RS, objetivou conhecer as percepcoes dos pacientes com Insuficiencia Renal Cronica acerca das mudancas ocorridas em sua rotina de vida, decorrentes do tratamento de hemodialise, identificando os elementos que influenciam a sua qualidade de vida. Os resultados evidenciaram que os sentimentos iniciais de indignacao e negacao se modificam, enquanto os pacientes se fortalecem para o enfrentamento da doenca. Restricoes dos habitos alimentares e hidricos, incapacidade ou limitacao das atividades fisicas, profissionais e de lazer foram as principais dificuldades identificadas. O apoio dos familiares e dos profissionais da saude pode contribuir para a superacao dessas limitacoes e adaptacao ao novo estilo de vida.La Insuficiencia Renal Cronica es un importante problema para la Salud Publica. El tratamiento dialitico, en la espera por el trasplante renal, se constituye en una expectativa de mejoria de la calidad de vida. Este estudio cualitativo, realizado en Rio Grande-RS, tuvo por objetivo conocer las percepciones de los enfermos con Insuficiencia Renal Cronica sobre los cambios ocurridos en su rutina de vida que derivan del tratamiento de hemodialisis, identificando los elementos que influencian su calidad de vida. Los resultados evidenciaron que los primeros sentimientos de indignacion y negacion se modifican a la medida que se fortalecen para enfrentar a la enfermedad. Restricciones de los habitos alimentares e hidricos, incapacidad o limitacion de las actividades fisicas, profesionales y de ocio fueran las principales dificultades identificadas. El apoyo de los parientes y de los profesionales de la salud puede contribuir para la superacion de esas limitaciones y adaptaciones al nuevo estilo de vida.

O cuidado de si como condição para o cuidado dos outros na prática de saúde

We need to take a critical look at our practices and the relationships we construct in our personal and professional life, with a view to leading a life guided by ethics. In this text, we discuss governability practices that are built in the relations between health and especially nursing professionals, with the health institutions, with the clients and with the nursing profession. We conclude that, for persons to deliver care and guide others, like nurses do in their practice, they first need to demonstrate that they can guide themselves, that they know the limits of their practice and can respect the other as someone different from themselves.We need to take a critical look at our practices and the relationships we construct in our personal and professional life, with a view to leading a life guided by ethics. In this text, we discuss governability practices that are built in the relations between health and especially nursing professionals, with the health institutions, with the clients and with the nursing profession. We conclude that, for persons to deliver care and guide others, like nurses do in their practice, they first need to demonstrate that they can guide themselves, that they know the limits of their practice and can respect the other as someone different from themselves.

Sofrimento moral e a dimensão ética no trabalho da enfermagem

Trabalhadores de enfermagem vivenciam problemas morais, dilemas morais e sofrimento moral, no seu cotidiano profissional. O sofrimento moral manifesta-se quando os trabalhadores apresentam dificuldades para executar situacoes moralmente adequadas, segundo suas consciencias. O texto tem como objetivo enfocar o sofrimento moral dos trabalhadores de enfermagem e sua relacao com problemas morais e dilemas morais, abordando conceitos, vivencias de sofrimento moral e possiveis estrategias a serem adotadas para o seu enfrentamento. Enfocar o sofrimento moral provocado pelo enfrentamento de problemas e dilemas morais no trabalho da enfermagem parece fundamental, nao apenas para desvelar um fenomeno ainda pouco conhecido, mesmo que vivenciado quase que diariamente, mas, tambem, para destacar a necessidade de problematizacao e valorizacao da dimensao etica do trabalho em saude.

Implicações do sofrimento moral para os(as) enfermeiros(as) e aproximações com o Burnout

This integrative review was performed with the objective to identify, in national and international scientific literature over the last ten years, the implication that moral distress has on nurses, the similarities between moral distress and burnout, and the coping strategies for moral distress. The surveys were conducted on CINAHL, MEDLINE and SAGE databases, using the keywords: moral distress, burnout, and nursing. Twenty-one articles were obtained for the four-stage analysis: data reduction, visualization and comparison, and the verification and draft of the conclusion. It was found that the moral distress experienced by the nurses is manifested in the personal dimension, by emotional and physical alterations, and in the professional dimension, by job dissatisfaction, burnout and abandonment of the profession. The coping strategies are used in three dimensions: educational, communicative, and organizational. In conclusion, this theme should be further explored in order to contribute with the prevention of moral distress.This integrative review was performed with the objective to identify, in national and international scientific literature over the last ten years, the implication that moral distress has on nurses, the similarities between moral distress and burnout, and the coping strategies for moral distress. The surveys were conducted on CINAHL, MEDLINE and SAGE databases, using the keywords: moral distress, burnout, and nursing. Twenty-one articles were obtained for the four-stage analysis: data reduction, visualization and comparison, and the verification and draft of the conclusion. It was found that the moral distress experienced by the nurses is manifested in the personal dimension, by emotional and physical alterations, and in the professional dimension, by job dissatisfaction, burnout and abandonment of the profession. The coping strategies are used in three dimensions: educational, communicative, and organizational. In conclusion, this theme should be further explored in order to contribute with the prevention of moral distress.

Diagnósticos de enfermagem em pacientes no período pós-operatório de cirurgias cardíacas

OBJETIVO: Identificar en conjunto con las enfermeras, de una Unidad de Tratamiento Intensivo Postoperatorio Cardiologico, los diagnosticos de enfermeria realizados en pacientes en el periodo postoperatorio de cirugias cardiacas, con la finalidad de, futuramente, implementar el proceso de enfermeria en esa unidad. METODOS: Se trata de un estudio cualitativo, basado en la investigacion convergente-asistencial. Los datos fueron obtenidos de los registros de enfermeria de 20 pacientes sometidos a cirugia cardiaca, en el mes de abril de 2008, acrecidos de la experiencia profesional de seis enfermeras participantes del grupo de convergencia que se reunio durante cinco encuentros. RESULTADOS: Fueron establecidos 15 diagnosticos, segun la Taxonomia II de la North American Nursing Diagnosis Association, corroborados por otros autores. CONCLUSION: La identificacion de diagnosticos estandar de enfermeria en pacientes en el postoperatorio de cirugias cardiacas permite orientar la asistencia de enfermeria y subsidiar el establecimiento de intervenciones que tiene solidas bases y son adecuadas a las necesidades individuales que tienen esos pacientes.OBJECTIVE: To identify - together with working nurses at a Postoperative Cardiac Intensive Care Unit - the nursing diagnoses of patients in the postoperative period of cardiac surgery, with the intention of, in the future, implement the nursing process on that unit. METHODS: This is a qualitative study based on convergent-care research. Data were obtained from nursing records of 20 patients who underwent surgery in April 2008, plus the professional experience of six participating nurses from the convergence group who met for five sessions. RESULTS: 15 diagnoses were established according to Taxonomy II of the North American Nursing Diagnosis Association, which were corroborated by other authors. CONCLUSION: The identification of standard nursing diagnoses, in postoperative cardiac surgery patients, can guide the nursing care and subsidize the development of interventions that have solid basis and are appropriate to individual needs that patients have.

Moral distress in everyday nursing: hidden traces of power and resistance

OBJETIVO: conocer las estrategias de resistencia adoptadas por los trabajadores de enfermeria, frente a las situaciones de sufrimiento moral, bajo una perspectiva etica. METODO: se realizo una investigacion cualitativa, por medio de entrevistas semiestructuradas con quince trabajadores de enfermeria de un hospital universitario en el extremo sur de Brasil, a traves del analisis textual-discursivo y de los referenciales teoricos de Foucault. RESULTADOS: se construyeron dos categorias: negacion de si mismo y del otro - donde se observa que los trabajadores de enfermeria pueden realizar acciones motivadas predominantemente por la inmovilidad y el conformismo, evitando enfrentamientos de quien representa el poder en las situaciones que les causan sufrimiento moral; posibilidad de cuidado de si mismo y del otro - en que los trabajadores de enfermeria, frente a situaciones que les causan sufrimiento moral, ejercen el poder y la resistencia. CONCLUSION: se percibe que algunos profesionales parecen utilizar estrategias de afrontamiento eticas, con el fin de garantizar y preservar los valores profesionales. Sin embargo, a menudo, la decision de algunos profesionales de enfermeria puede recaer en la inmovilidad y en la ausencia de construccion de estrategias de resistencia. Situacion esta que puede representar a su reducido ejercicio del poder y a una resistencia suficiente frente a los problemas eticos, contribuyendo a intensificar su invisibilidad en el area de la saludOBJECTIVE To know the strategies of resistance adopted by nursing staff, facing situations of moral distress, from an ethical perspective. METHOD The authors conducted qualitative research through semi-structured interviews, with fifteen nursing staff members of a university hospital in the extreme south of Brazil, using textual discourse analysis and the theoretical reference of Foucault. RESULTS Two categories were constructed: denial of oneself and the other - in which one perceives that the nursing staff can perform actions that are governed predominantly by immobility and conformism, avoiding confrontations with whoever represents power in situations that provoke moral distress in them; possibility to care for oneself and for the other - in which nursing workers in situations that provoke moral distress for them exercise power and endurance. CONCLUSION it was perceived that some professionals seem to use ethical coping strategies, in order to ensure and preserve their professional values. However, often the choice of some nursing professionals may be to relapse into immobility and the absence of building strategies of endurance. This situation may represent their reduced exercise of power and insufficient resistance in the face of ethical problems, contributing to the intensification of their invisibility in the area of health.

Moral distress and Burnout syndrome: are there relationships between these phenomena in nursing workers?

Objective to identify relationships between moral distress and Burnout in the professional performance from the perceptions of the experiences of nursing workers. Methods this is a survey type study with 375 nursing workers working in three different hospitals of southern Rio Grande do Sul, with the application of adaptations of the Moral Distress Scale and the Maslach Burnout Inventory, validated and standardized for use in Brazil. Data validation occurred through factor analysis and Cronbachs alpha. For the data analysis bivariate analysis using Pearsons correlation and multivariate analysis using multiple regression were performed. Results the existence of a weak correlation between moral distress and Burnout was verified. A possible positive correlation between Burnout and therapeutic obstinacy, and a negative correlation between professional fulfillment and moral distress were identified. Conclusion the need was identified for further studies that include mediating and moderating variables that may explain more clearly the models studied.Objetivo: identificar relacoes entre sofrimento moral e sindrome de Burnout nas percepcoes das vivencias de trabalhadores de enfermagem no seu desempenho profissional. Metodos: tratase de uma pesquisa survey com 375 trabalhadores de enfermagem, atuantes em tres distintas instituicoes hospitalares do sul do Rio Grande do Sul, atraves da aplicacao de uma adaptacao do Moral Distress Scale e do Maslach Burnout Inventory, validado e normatizado para uso no Brasil. A validacao dos dados ocorreu via analise fatorial e alfa de Cronbach. Para analise dos dados, procedeu-se a analise bivariada com utilizacao da correlacao de Pearson, e analise multivariada, atraves de regressao multipla. Resultados: verificou-se a existencia de uma correlacao baixa entre o sofrimento moral e a sindrome de Burnout. Identificou-se possivel correlacao positiva entre a obstinacao terapeutica e a sindrome de Burnout, e uma correlacao negativa entre realizacao profissional e sofrimento moral. Conclusao: identificou-se a necessidade de realizacao de novos estudos que incluam variaveis mediadoras e moderadoras que possam explicar mais claramente os modelos estudados.

Burnout syndrome among undergraduate nursing students at a public university

OBJECTIVE: to investigate the burnout syndrome and its relationship with demographic and academic variables among undergraduate nursing students at a public university in Southern Brazil. METHOD: a quantitative study with 168 students, by applying an adaptation of the Maslach Burnout Inventory - Student Survey, validated for this study. We used descriptive and variance analysis of the data analysis. RESULTS: we found that students do not have the burnout syndrome, manifesting high average scores in Emotional Exhaustion, low in Disbelief and high in Professional Effectiveness; that younger students who perform leisure activities have greater Professional Effectiveness, unlike students in early grades with no extracurricular activities; combining work and studies negatively influenced only the Professional Effectiveness factor, while the intention of giving up influenced negatively Disbelief and Professional Effectiveness factors. CONCLUSION: the situations that lead students to Emotional Exhaustion need to be recognized, considering the specificity of their study environments.OBJETIVO: investigar la sindrome de burnout y su relacion con variables sociodemograficas y academicas, entre estudiantes de pregrado en enfermeria de una universidad publica del Sur de Brasil.METODO: estudio cuantitativo, desarrollado con 168 estudiantes, mediante la aplicacion de una adaptacion del Maslach Burnout Inventory - Student Survey, validada para fines de ese estudio. Fueron utilizados los analisis descriptivo y de variancia para analizar los datos.RESULTADOS: se constato que los estudiantes no presentan la sindrome de burnout, manifestando altos promedios en Agotamiento Emocional, bajos en Descreencia y altos en Eficacia Profesional; que estudiantes mas jovenes y que practican actividades de ocio presentan mayor Eficacia Profesional, diferentemente de estudiantes de los anos iniciales sin actividades extracurriculares; conciliar trabajo y estudios influyo negativamente apenas el factor Eficacia Profesional, mientras la intencion de desistir del curso influyo negativamente los factores Descreencia y Eficacia Profesional.CONCLUSION: es necesario reconocer las situaciones que llevan a los estudiantes al Agotamiento Emocional, considerando la especificidad de sus ambientes de formacion.

Nursing diagnoses in patients in the postoperative period of cardiac surgery

OBJETIVO: Identificar en conjunto con las enfermeras, de una Unidad de Tratamiento Intensivo Postoperatorio Cardiologico, los diagnosticos de enfermeria realizados en pacientes en el periodo postoperatorio de cirugias cardiacas, con la finalidad de, futuramente, implementar el proceso de enfermeria en esa unidad. METODOS: Se trata de un estudio cualitativo, basado en la investigacion convergente-asistencial. Los datos fueron obtenidos de los registros de enfermeria de 20 pacientes sometidos a cirugia cardiaca, en el mes de abril de 2008, acrecidos de la experiencia profesional de seis enfermeras participantes del grupo de convergencia que se reunio durante cinco encuentros. RESULTADOS: Fueron establecidos 15 diagnosticos, segun la Taxonomia II de la North American Nursing Diagnosis Association, corroborados por otros autores. CONCLUSION: La identificacion de diagnosticos estandar de enfermeria en pacientes en el postoperatorio de cirugias cardiacas permite orientar la asistencia de enfermeria y subsidiar el establecimiento de intervenciones que tiene solidas bases y son adecuadas a las necesidades individuales que tienen esos pacientes.OBJECTIVE: To identify - together with working nurses at a Postoperative Cardiac Intensive Care Unit - the nursing diagnoses of patients in the postoperative period of cardiac surgery, with the intention of, in the future, implement the nursing process on that unit. METHODS: This is a qualitative study based on convergent-care research. Data were obtained from nursing records of 20 patients who underwent surgery in April 2008, plus the professional experience of six participating nurses from the convergence group who met for five sessions. RESULTS: 15 diagnoses were established according to Taxonomy II of the North American Nursing Diagnosis Association, which were corroborated by other authors. CONCLUSION: The identification of standard nursing diagnoses, in postoperative cardiac surgery patients, can guide the nursing care and subsidize the development of interventions that have solid basis and are appropriate to individual needs that patients have.

Moral distress in nursing personnel

OBJETIVO: analisar a frequencia e a intensidade de sofrimento moral vivenciado por trabalhadores de enfermagem do Sul do Brasil, contemplando elementos do seu cotidiano profissional. METODO: survey realizado em dois hospitais do Rio Grande do Sul, Brasil, com 247 profissionais de enfermagem. A coleta dos dados ocorreu mediante aplicacao da adaptacao do Moral Distress Scale. RESULTADOS: a percepcao de situacoes que conduzem ao sofrimento moral e intensificada em enfermeiros e em trabalhadores de enfermagem que atuam em instituicoes com maior abertura ao dialogo, realizam reunioes de equipe e tem menores jornadas de trabalho. Essa percepcao tambem e intensificada quando se observa maior relacao no numero de profissionais por pacientes. CONCLUSAO: compreender o sofrimento moral permite ir alem da resolucao dos problemas dos proprios trabalhadores, possibilitando a elaboracao de uma etica de sujeitos ativos e de amplas possibilidades, definidas principalmente pelas relacoes consigo mesmos.OBJECTIVE to analyze the frequency and intensity of moral distress experienced by nursing personnel in southern Brazil, covering elements of their professional practice. METHOD a survey was undertaken in two hospitals in Rio Grande do Sul, Brazil, with 247 nurses. Data was collected by means of the adapted Moral Distress Scale. RESULTS the perception of situations that lead to moral distress is enhanced in nurses and in nursing staff working in institutions with greater openness to dialogue, which hold team meetings, with fewer working hours and a greater ratio of professionals to patients. CONCLUSION understanding moral distress allows us to go beyond solving the problems of the workers themselves, enabling the development of an ethics of active individuals and wide opportunities, defined mainly by the relationship with oneself.