Hemodialysis vascular access coordinator: Three-level model for access management.

Management of vascular access is a challenge for the dialysis team, particularly to keep the arteriovenous access working. The vascular access coordinator can positively contribute to increase the number of arteriovenous fistulas and reduce central venous catheters. In this article, we introduce a new approach to vascular access management centered on (the results of setting up) the role of vascular access coordinator. We described the three-level model (3Level_M) for vascular access management organized in three levels: vascular access nurse manager, vascular access coordinator, and vascular access consultant. We defined the instrumental skills and training required to be developed by each element and clarify the articulation between the model and all members of the dialysis team related to vascular access.

From the first to the fourth critical period of COVID-19: what has changed in nursing practice environments in hospital settings?

BACKGROUND: The COVID-19 pandemic reinforced the need to invest in nursing practice environments and health institutions were led to implement several changes. In this sense, this study aimed to analyze the impact of the changes that occurred in nursing practice  environments between the first and fourth critical periods of the pandemic. METHODS: Quantitative, observational study, conducted in a University Hospital, with the participation of 713 registered nurses. Data were collected through a questionnaire with sociodemographic and professional characterization and the Scale for the Environments Evaluation of Professional Nursing Practice, applied at two different points in time: from 1 to 30 June 2020 and from 15 August to 15 September 2021. Data were processed using descriptive and inferential statistics. RESULTS: Overall, the pandemic had a positive impact on nursing practice environments. However, the Process component remained favourable to quality of care, while the Structure and Outcome components only moderately favourable. Nurses working in Medicine Department services showed lower scores in several dimensions of the Structure, Process and Outcome components. On the other hand, nurses working in areas caring for patients with COVID-19 showed higher scores in several dimensions of the Structure, Process and Outcome components. CONCLUSIONS: The pandemic had a positive impact on various dimensions of nursing practice environments, which denotes that regardless of the adversities and moments of crisis that may arise, investment in work environments will have positive repercussions. However, more investment is needed in Medicine Department services, which have historically been characterised by high workloads and structural conditions that make it difficult to promote positive and sustainable workplaces.

Scale for the Environment Evaluation of Professional Nursing Practice: Construct validation.

AIM: Testing the validity and reliability of the Scale for the Environments Evaluation of Professional Nursing Practice (SEE-Nursing Practice). BACKGROUND: The environment of professional nursing practice is key to achieve better results for clients, nurses and institutions. Therefore, instruments enabling the assessment of all its attributes are required. METHOD: Cross-sectional methodological study. The SEE-Nursing Practice, based on a previous qualitative study and literature review, was applied as a questionnaire. Exploratory and confirmatory factor analyses were used to assess construct validity. RESULTS: A total of 752 nurses participated in the study. Exploratory factor analysis of the SEE-Nursing Practice led to a factor solution with 93 items and three subscales. The Structure, Process and Outcome subscales, respectively, have 43, 37 and 13 items, loaded in 6 factors, 6 factors and 2 factors and explaining 62.6%, 59.2% and 67.4% of the total variance. Cronbach's alpha of the overall scale and of the 3 subscales was greater than 0.90. Confirmatory factor analysis showed a good fit. CONCLUSION: SEE-Nursing Practice is a good valid and reliable instrument. IMPLICATIONS FOR NURSING MANAGEMENT: The SEE-Nursing Practice enables assessing practice environments and is a tool for nursing managers in the definition of strategies ensuring favourable environments for nursing care quality.

Death and dying: contributions to a practice based on nursing theoretical frameworks. / A morte e o morrer: contributos para uma prática sustentada em referenciais teóricos de enfermagem.

OBJECTIVE: To identify nurses' agreement on nursing conceptions with the potential to support their practice in the death and dying process context. METHOD: An exploratory and descriptive study with a quantitative approach was carried out with 3,451 nurses from 36 hospitals in Portugal, from July 2015 to March 2016. Data collection was carried out with the use of questionnaires and data analysis was carried out by means of descriptive and inferential statistics. RESULTS: Among conceptions with the potential to support practice, nurses highlighted those from Virginia Henderson, Afaf Meleis, and Madeleine Leininger. The following variables influenced the degree of agreement: region, service, gender, professional training, and length of professional practice. CONCLUSION: Considering current challenges of a practice that is mostly based on meeting needs, the relevance of nursing practices' purposes emerges in order to facilitate experiencing death and the dying process in culturally significant ways.

Behavior of nursing managers and leaders when errors are disclosed in the media. / Posicionamento de gestores e lideranças de enfermagem diante dos erros divulgados na mídia.

OBJECTIVE: To analyze the behavior of nursing managers and leaders when nursing errors are disclosed in the media. METHODOLOGY: A qualitative, retrospective, documental study of the collection carried out in newspapers in Brazil and Portugal, between 2012 and 2016. Analysis performed at Atlas.ti, using a Ricoeur technique based on Habermas Theory of Communicative Action. RESULTS: Managers and caretakers focused on the workforce, continuing with the opening of internal syndication, removal of position and dismissal. How to lead the discipline process, carrying out inspections, requesting documents and questioning about the facts, as well as repudiating some disclosed notes. CONCLUSION: Leaderships in nursing played a crucial role in developing a complex problem strategy. However, this was not done efficiently.

The impact of nursing practice environments on patient safety culture in primary health care: a scoping review.

BACKGROUND: Patient safety has in recent decades become a global concern. It is a key priority area of healthcare organisations, and has a direct impact on patient health and wellbeing. Work environments can strongly impact nurses' wellbeing and may ultimately produce different outcomes for both professionals and patients. The adverse events occurrence is an example of how work environments influence outcomes, and there is evidence of this correlation in several studies conducted in recent years. AIM: To map the knowledge regarding the impact that nursing practice environments have on safety culture in primary healthcare settings, as primary health care concentrates a significant portion of the population's care. DESIGN & SETTING: This review was conducted following the methodology proposed by the Joanna Briggs Institute (JBI) for scoping reviews. METHOD: Study selection, data extraction, and synthesis were performed by two independent reviewers. Based on Population (or participants), Concept, and Context (PCC) framework, studies were considered that addressed nurses' practice environment and patient safety culture in primary health care. All studies published or unpublished from 2002 to the present were considered. RESULTS: Seven studies were included in this review; however, the existing evidence on the relation between nurses' practice environments and patient safety is still limited in primary healthcare settings. Although clear evidence was not found, several characteristics of nursing practice environments that may impact healthcare safety were found, such as leadership, communication, and organisational culture and policies. CONCLUSION: More research directed at primary healthcare nursing practice settings is needed and could be valuable in defining and implementing strategies that promote the safety of care.

The impact of nursing practice environments on patient safety culture in primary health care: a scoping review protocol.

BACKGROUND: Patient safety is a key priority for healthcare organisations. It impacts directly on patient health and wellbeing. The increasing complexity of current healthcare settings, which are associated with high work demands and increasingly stressful professional practice environments, contributes to an increased likelihood of errors and adverse events. Primary health care, given its comprehensiveness of care, makes up a large proportion of the care delivered to the population. AIM: To map the knowledge about the impact that nursing practice environments have on safety culture in the primary healthcare setting. This knowledge is essential for a more effective and appropriate understanding of this phenomenon and to enable the definition of strategies that can promote the provision of safer care to the population. DESIGN & SETTING: A scoping review will be conducted based on the method proposed by the JBI, and the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR) will be used. METHOD: Study selection, data extraction, and synthesis will be performed by two independent reviewers. Based on the Population (or participants), Concept, and Context (PCC) framework, this scoping review will consider studies that address nurses' practice environment and patient safety culture in primary health care. The review will consider all studies, published or unpublished, from 2002 to the present. CONCLUSION: The results from this scoping review are expected to provide an overview of the importance of the nursing practice environments on patient safety culture, which will be crucial to define an appropriate range of strategies to promote the delivery of the safest health care to the population.

Effect of the Active Aging-in-Place-Rehabilitation Nursing Program: A Randomized Controlled Trial.

(1) Background: It is of great importance to promote functional capacity and positive lifestyles, since they contribute to preventing the progression of frailty among the older adults. The aim of this study was to evaluate the effect of active aging-in-place−rehabilitation nursing program (AAP-RNP) on the functional capacity and lifestyles of frail older adults. (2) Methods: This was a single-blinded, two-group, randomized, controlled trial of 30 frail older people enrolled at a Health-care unit in Portugal between 2021 and 2022. The duration of the program was 12 weeks, and the sessions took place at the participants' homes. We used as instruments the Tilburg Frailty Indicator; Fried frailty phenotype; Senior Fitness Test battery; Barthel Index; Lawton Index; handgrip strength measurement; Tinetti Index; Individual lifestyle profile; and Borg's perception of effort. (3) Results: Post-program, there was an improvement in multidimensional and physical frailty, functional capacity, balance, and perceived exertion (p < 0.05) in the experimental group. Among the older adults' lifestyles, we observed significant improvements in physical activity habits, relational behavior, and stress management. (4) Conclusions: Rehabilitation nurses have a relevant role, and the AAP-RNP seems to be effective in improving functional capacity and lifestyles in frail older adults.

Nurses' Work Methods Assessment Scale: a study of content validation.

OBJECTIVE: To develop and validate the content of the Nurses' Work Methods Assessment Scale. METHODS: Methodological study conducted between January and February 2022, based on the Quality Standards for Nursing Care and Imogene King's framework. A literature review was previously undertaken to design the scale. The content validation was carried out by 23 experts. RESULTS: The initial version consisted of 40 items organized in four work methods identified in the literature. In the first dimension, from ten items, seven were considered, and one was reformulated. Seven of the initial ten items were considered in the second version. The third dimension consisted of seven items. In the fourth dimension, three items were reformulated, and three were excluded, leaving seven items. The final version ended with 28 items, whose Content Validity Index ranged between 0.83 and 1. CONCLUSIONS: The involvement of experts has become pivotal in the development and validation of the items, providing confidence to the continuity of psychometric procedures.

How to choose the appropriate cannulation technique for vascular access in hemodialysis patients.

The cannulation technique is important for the survival of the arteriovenous access. Choosing the appropriate technique is a complex decision. Such choice must be customized to patients, considering their characteristics, the type of arteriovenous access and the experience of the hemodialysis team. We describe seven items that can help nurses to identify the appropriate cannulation technique: type of arteriovenous access; drainage vein; hygienic self-care profile; experience of the nursing staff in the cannulation technique and nurse-to-patient ratio; hemodialysis treatment method; patient's condition; and patient's decision. Such items can help nurses in decision-making on the "ideal" cannulation technique for each patient.

Adaptation and Validation of the Individual Lifestyle Profile Scale of Portuguese Older Adults Living at Home.

(1) Background: Unadjusted lifestyles have been the main cause of risk for the loss of years of healthy life. However, currently valid and reliable instruments to assess the lifestyles of the elderly are quite long and difficult to interpret. For this reason, the objective of this study was to adapt and validate the 'Individual Lifestyle Profile' (ILP) scale in a sample of elderly people; (2) Methods: A methodological study was carried out and a sample of 300 older adults enrolled in a Health Unit located in the North of Portugal was used, who responded to the scale. We examined internal consistency, predictive validity, and discriminative ability; (3) Results: After the Exploratory Factorial analysis, a solution was found with four factors that explain a variance of 67.8%. The designation of the factors was changed from the original scale, with the exception of one dimension, and they were called Health Self-management, Social Participation and Group Interaction, Citizenship and Physical Activity. The total internal consistency (Cronbach's alpha) was 0.858, ranging from 0.666 to 0.860 in the mentioned factors; (4) Conclusions: The ILP scale proved to be easy to apply and presented a good reliability and validity index, based on internal consistency, AFE and AFC. The scale allows evaluating the lifestyle of older adults, and its use will be aimed at modifying behaviors associated with negative lifestyles of older adults and their individual needs.

Construction and validation of a rehabilitation nursing program for fragile elderly.

OBJECTIVE: To build a rehabilitation nursing program to be implemented in the homes of frail elderly people and validate it by rehabilitation nurses. METHODS: This is a qualitative, exploratory study, divided into two stages. The first corresponded to an integrative literature review that supported the construction of the program. The second consisted of the program content validity stage, through a focus group, in May 2021. RESULTS: Nine experts participated in the construction and content validation of the rehabilitation nursing program for frail elderly. Two focus groups were carried out, and the final version of the program included training in life activities and particularly self-care, strength, balance, coordination and joint mobility. FINAL CONSIDERATIONS: The program reached content validity, with a minimum set of characteristics that it must integrate, now requiring application in Primary Health Care for clinical validation.

Dying in the emergency service: nurses' attitudes before and after the first critical period of COVID-19.

BACKGROUND: Death is an increasingly frequent event in hospitals, and nurses are the health professionals who live with this reality the most. The pandemic caused by COVID-19 made this event more present, showing that nurses' attitudes toward death may influence the care provided to people at the end of life. The objective of this study was to analyze the attitudes of nurses in the emergency service toward death, before and after the first critical period of the pandemic by COVID-19 in Portugal. METHODS: A quantitative, comparative, and cross-sectional study was conducted in a hospital in Northern Portugal at 2 different moments: the first in February 2018 and the second in May 2020, after the first critical period of the pandemic by COVID-19. In both moments, data were collected using a self-completion questionnaire, which included the Death Attitude Profile Assessment Scale. RESULTS: The attitudes fear, avoidance, closeness, and escape did not show significant differences. In neutral/neutral acceptance, differences were found between the first and second moments of data collection (P = .01), with a lower mean after the critical period of the pandemic. CONCLUSIONS: The results obtained in 2018 and 2020 showed slight changes in attitudes toward death. The need to invest in the training and preparation of nurses who deal directly with death and the dying process was evident. Nurse managers should promote spaces for reflection and team training on death, aiming to reduce the professionals' suffering and anxiety.

Environments of professional nursing practice in the context of the COVID-19 pandemic.

BACKGROUND: Although COVID-19 attracted attention to the environments of professional nursing practice, triggering a series of responses to address some of the most pressing problems, it is important to identify the size and scope of other weaknesses that have emerged. METHODS: In an observational and cross-sectional study, using the Scale for the Evaluation of the Environment of Professional Nursing Practice, 752 nurses from a Portuguese university hospital, provided socio-demographic and professional data about the components structure, process and outcome of their professional nursing environment. Data collection took place from June 1-30, 2020, immediately after the first critical period of the COVID-19 pandemic in Portugal. RESULTS: In the analysed environment of professional nursing practice, Process factors were favourable to the quality of care, while the Structure and Outcome factors had a moderately favourable effect. Structure factors related to work contexts (P < .001) and nursing functions in patient care areas with COVID-19 (P = .001). Process factors related significantly to work contexts (P < .001). A significant association was found between Outcome factors and work contexts (P < .001) and nursing functions in patient care areas with COVID-19 (P = .005). CONCLUSION: The environments of professional nursing practice in the hospital under study are moderately favourable to the quality of care. However, the need to invest in nurses' participation, involvement and professional qualification is clear. Maintenance of a sustainable nursing workforce requires attention to be given to ensuring that practice environments are conducive to the quality of care and geared to promoting professional involvement and job satisfaction among nurses.

Violence against nursing workers: repercussions on patient access and safety.

OBJECTIVES: to analyze the repercussions of violence against nursing professionals, in the access and safety of patients in Family Health Strategy. METHODS: a mixed study, with 169 nursing professionals. We used a socio-labor questionnaire, Survey Questionnaire Workplace Violence in the Health Sector, a patient safety instrument and interviews. RESULTS: verbal aggression was related to support (p=0.048), respect (p=0.021), hours of care (p=0.047) and patient safety behaviors (p=0.033) among professionals. Suffering from bullying was related to fear of questioning when something is wrong (p=0.010) and lack of support from management (p=0.016). Victims of physical violence felt that their mistakes could be used against them. Mixed data converge and confirm that violence affects professional behavior and puts Primary Health Care attributes at risk. CONCLUSIONS: violence affects workers' behavior, interferes with the care provided, weakens the access and safety of patients.

Impact of COVID-19 on the Environments of Professional Nursing Practice and Nurses' Job Satisfaction.

(1) Background: The repercussions of work environments were widely studied before the pandemic. However, there are still many difficulties to be discovered considering the impact generated by it. Thus, this study aimed to analyse the impact of COVID-19 on nursing practice environments and nurses' job satisfaction. (2) Methods: A correlational study was conducted in a hospital in northern Portugal, with the participation of 416 registered nurses. Data were collected in June 2021 through questionnaires. The study was approved by the Institutional Ethics Committee. (3) Results: COVID-19 had a favourable impact on the structure component of the practice environments; the process component decreased compared to the pre-pandemic period; the outcome component remained moderately favourable to the quality of care. Nurses were not very satisfied or not at all satisfied with their valuation and remuneration; moderately satisfied with the leadership and staffing; and satisfied with the organisation and resources, co-workers and valuation by patients and families. In more favourable environments, nurses' job satisfactions were higher. (4) Conclusions: Identifying the dimensions with the best and worst scores allowed the institution's managers to concentrate efforts on where improvements were needed, thus preparing professional contexts for the recovery of care activities.

From Health Literacy to Self-Care: Contributions of the Specialist Nurse in Rehabilitation Nursing.

(1) Background: Initiatives aimed at assessing and intervening in health literacy have the potential to promote adherence to self-care behaviours, which is the main focus of intervention by rehabilitation nurses. Thus, the objectives were to analyse the level of health literacy of working-age citizens and identify priority areas for intervention by rehabilitation nurses. (2) Methods: Quantitative, correlational and cross-sectional study, conducted in a multinational company, with the participation of 161 workers. The data were collected between 14 April and 7 May 2021, using a self-completion questionnaire composed of sociodemographic and clinical characterization and the European Health Literacy Survey, following a favourable opinion from the Ethics Committee and the company's management. (3) Results: Overall, low to moderate literacy scores were predominant. Age and education were significantly associated with literacy scores. Workers with higher levels of health literacy had no diagnosed illnesses, took less medication, reported less sadness, fewer memory changes and less muscle and joint pain. (4) Conclusions: The fact that higher levels of health literacy trigger self-care behaviours and, consequently, fewer health problems reinforces the need for rehabilitation nurses to invest in this area.

Multidimensional Frailty and Lifestyles of Community-Dwelling Older Portuguese Adults.

(1) Background: Lifestyles are referred to as conditioning factors for the frailty of older adults. However, there are few studies that explore its association. The objective of the present study is to analyze the association between sociodemographic, clinical, and lifestyle factors of older adults people with multidimensional frailty. (2) Methods: Descriptive and correlational study carried out with older adults people registered in a Health Unit in Portugal. Data were collected through a sociodemographic and clinical questionnaire and application of the Individual Lifestyle Profile and Tilburg Frailty Index to assess the lifestyles and multidimensional frailty of older adults, respectively. This last instrument, being of a multidimensional nature, assesses not only physical, but also psychological and social frailty, with a cut-off point of 6. (3) Results: Of the 300 older adults who participated, most were female (60.3%) and had a mean age of 81.34 ± 6.75 years. Moreover, 60.3% of the sample were frail older adults. Gender, marital status, number of household members, number of chronic diseases, number of daily medications, self-perception of health status and lifestyle and use of a walking device were associated with multidimensional frailty (p ≤ 0.001). Healthy eating habits, physical activity, relational behaviour, preventive behaviour, and stress management were significantly associated with lower physical, psychological, and social frailty (p ≤ 0.001). (4) Conclusions: When community health workers are aware of multidimensional frailty predictors and their components, they can intervene early and, consequently, delay the onset and progression of frailty in older adults.

Effects of demographic and clinical character on differences in self-care behavior levels with arteriovenous fistula by hemodialysis patients: An ordinal logistic regression approach.

INTRODUCTION: Hemodialysis (HD) patients should be trained to develop self-care behaviors in order to prevent and preserve their arteriovenous fistula (AVF). The aim of this study was identifying the factors that affect the levels of self-care behavior with AVF by HD patients. METHODS: A cross-sectional study was conducted involving 89 patients. RESULTS: Self-care levels were negatively affected by patients' location (Azores) and positively affected by marital status, education, employment, AVF duration, and absence of complications with the AVF. Concerning the management of signs and symptoms, self-care levels were negatively affected by patients' location. Regarding prevention of complications, self-care levels were negatively affected by age and marital status and positively affected by marital status, employment, chronic kidney disease etiology, AVF duration, and previous AVF. CONCLUSION: Further studies are required in order to confirm whether the considered factors affect levels of self-care behaviors with AVF, or whether other factors are needed as well.

The voice of those who provide care during the pandemic - a lexicographic study in Brazil-Portugal.

OBJECTIVE: To analyze the most frequent words in interviews given by nurses during the coronavirus pandemic. METHOD: This is a qualitative, exploratory, descriptive study, carried out with 45 interviews granted by nurses to newspapers of great circulation in Brazil and Portugal. The data were processed using the ATLAS.ti® software and analyzed using the word cloud tool. RESULTS: The seven most frequent words were: "home" (respect for isolation), "nurses" (valuing of the profession and structural problems), "patients/diseased" and "care" (referring to the severity of the disease), "family" (missing her own family/emotional stress) and "fear" (fear of contamination of oneself and others). FINAL CONSIDERATIONS: The word cloud revealed how straining nurses' experiences have been and reinforced the urgent need to rethink nursing work and the risks faced. Reflections like this contribute to the construction of more valued nursing and public policies for the protection of nurses.