Daily work variability in falls prevention of hospitalized patients: nursing team's perception.

BACKGROUND: The identification of safety incidents and establishment of systematic methodologies in health services to reduce risks and provide quality care was implemented by The World Health Organization. These safety incidents allowed the visualization of a vast panorama, ranging from preventable incidents to adverse events with catastrophic outcomes. In this scenario, the issue of fall(s) is inserted, which, despite being a preventable event, can lead to several consequences for the patient, family, and the healthcare system, being the second cause of death by accidental injury worldwide, this study aims to identify the variability inherent in the daily work in fall prevention, the strategies used by professionals to deal with it and the opportunities for improvement of the management of work-as-imagined. METHOD: A mixed method approach was conducted, through process modeling and semi-structured interviews. The study was conducted in a public university hospital in southern Brazil. Study steps: modeling of the prescribed work, identification of falls, modeling of the daily work, and reflections on the gap between work-as-done and work-as-imagined. Medical records, management reports, notification records, protocols, and care procedures were consulted for modeling the work process, and semi-structured interviews were conducted with 21 Nursing professionals. The study was conducted between March 2019 and December 2020. RESULTS: From July 2018 to July 2019, 447 falls occurred, 2.7% with moderate to severe injury. The variability occurred in the orientation of the companion and the assurance of the accompanied patient's de-ambulation. The professionals identified individual strategies to prevent falls, the importance of multi-professional work, learning with the work team, and the colleague's expertise, as well as suggesting improvements in the physical environment. CONCLUSION: This study addressed the need for fall prevention in the hospital setting as one of the main adverse events that affect patients. Identifying the variability inherent to the work allows professionals to identify opportunities for improvement, understand the risks to which patients are subjected, and develop the perception of fall risk as a way to reduce the gap between work-as-imagined and work-as-done.

Evaluation of patient safety culture in a private general hospital: a case study in Brazil.

PURPOSE: The purpose is to assess the patient safety culture perceived by healthcare and administrative staff in a Brazilian hospital and examine whether education and experience are related to positive perceptions. DESIGN/METHODOLOGY/APPROACH: A descriptive-analytical case study was carried out at Ernesto Dornelles Hospital, a private Brazilian institution. The Brazilian version of the Hospital Survey on Patient Safety Culture was used to assess the perceptions of 618 participants, of whom 315 worked in healthcare assistance and 303 in administrative services. The main outcome was the percentage of positive responses, and the independent variables included the type of work, schooling and length of experience. FINDINGS: None of the twelve dimensions was strengthened. The percentage of positive responses was the highest for "Hospital management support for patient safety" (67.5%), and the lowest was for "Nonpunitive response to error" (29%). The healthcare staff had a slightly higher average than the administrative staff. The percentage of positive responses from professionals with undergraduate or graduate degrees was higher for the eight dimensions of safety culture. The length of hospital experience was not associated with any dimensions. ORIGINALITY/VALUE: This study explored the influence of education and professional experience on the perception of patient safety in healthcare and administrative staff from a private institution. These approaches allow to know with greater depth and clarity factors that are related to the patient safety culture and, thus, have more consistent evidence to support interventions in specific needs.

Coping strategies of the nursing team acting in a burn treatment center. / Estratégias de coping da equipe de enfermagem atuante em centro de tratamento ao queimado.

OBJECTIVE To know the strategies of coping reported by the nursing team that works at a burn center. METHOD This is a qualitative, descriptive and exploratory study carried out with four nurses and six practical nurses at a burn center in southern Brazil. The data was collected from September to November 2013 through semi-structured interviews, and it was analyzed through the content analysis technique, which happened with the software Atlas.ti 7.0. RESULTS Two themes have emerged: coping focused on the problem, and coping focused on the emotion. Among the main strategies of coping focused on the problem, decision-making and re-evaluation actions should be highlighted; and in the coping focused on the emotion, actions centered on resigned acceptance and emotional extravasation stand out. CONCLUSIONS As the professionals interviewed opted for objective and practical strategies, compatible with coping based on the problem, it is believed that the elaboration is influenced by the workers' individual, collective and institutional contexts.

Nursing performance in COVID-19 and non-COVID-19 units: Implications for occupational health.

OBJECTIVE: to analyze the implications of the pandemic on the Nursing team's occupational health according to its performance in COVID-19 and non-COVID-19 units. METHOD: a multicenter and mixed-methods study, with a sequential explanatory strategy. A total of 845 professionals took part in the first stage, answering an electronic form which contained sociodemographic and work-related variables, as well as about the pandemic and their health, in addition to the Self-Reporting Questionnaire. 19 professionals were interviewed in the second stage. The quantitative data were submitted to statistical analysis and the qualitative ones to thematic content analysis, with integration by connection. RESULTS: the pandemic exerted impacts on the professionals' health, both in the COVID-19 and non-COVID-19 areas. However, composition of the teams presented different characteristics between the areas, as well as the risk perceptions and the work demands. CONCLUSION: the professionals working in areas COVID-19 and non-COVID-19 areas are equally affected, although with different work exposure regarding the requirements at work in the COVID-19 units and the fear of contamination in non-COVID-19 units.

Burnout and resilience in intensive care Nursing professionals in the face of COVID-19: A multicenter study. / Burnout e resiliência em profissionais de enfermagem de terapia intensiva frente à COVID-19: estudo multicêntrico.

OBJECTIVE: to analyze the relationship between the Burnout dimensions and the work resilience of intensive care Nursing professionals in the COVID-19 pandemic in four hospitals from southern Brazil. METHOD: this is a multicenter and cross-sectional study, composed of 153 nurses and nursing technicians of the Intensive Care Units. Sociodemographic, health and work-related questions were collected, and the Maslach Burnout Inventory and Resilience at Work Scale 20 instruments were applied. The data were submitted to descriptive analysis and to bivariate and partial correlations (network analysis). RESULTS: work resilience presented an inverse correlation to emotional exhaustion (r=-0.545; p=0.01) and depersonalization (r=-0.419; p=0.01) and a direct one to professional achievement (r=0.680; p=0.01). The variable with the greatest influence on the correlation network was the perception of the impact of the pandemic on mental health. CONCLUSION: resilience interferes in the emotional exhaustion and low professional achievement domains of Burnout. Emotional exhaustion is conducted through minor psychological disorders, with an impact on the workers' physical and mental health variables. The development of institutional resilience should be encouraged in order to moderate the illness.

Modeling of adult patient falls and the repercussions to Nursing as a second victim. / Modelagem de quedas de pacientes adultos e as repercussões à Enfermagem como segunda vítima.

OBJECTIVE: analyze the falls of adult hospitalized patients and their repercussions on the Nursing worker as the second victim. METHOD: an exploratory, descriptive and qualitative study conducted in two stages - identification of falls with moderate to severe damage and the modeling of falls using the software Functional Resonance Analysis Method; and analysis of the repercussions on the worker as the second victim by means of semi-structured interviews submitted to Content Analysis, with 21 Nursing workers. RESULTS: a total of 447 falls of adult patients were identified, 12 of which with moderate to severe damage, occurred in the absence of the companion, while using sleep inducing, hypotensive or muscle strength altering medications. The modeling identified 22 functions related to the Standard Operating Procedure, to the fall prevention protocol and to the post-event actions. Of these, eight presented variability in their execution. In the second step, the categories "The complexity of care to prevent falls" and "Feelings of the second victim" emerged. CONCLUSION: falls are complex phenomena and prevention requires involvement of the patient, family and multi-professional team. The professionals involved are second victims and experience feelings of guilt, fear, anguish and helplessness. This study can contribute to the multi-professional spirit and to the early approach to second victims.

Nursing practice environment in intensive care unit and professional burnout.

OBJECTIVE: To evaluate and compare the nursing practice environments in Intensive Care Units of a public and private hospital and the prevalence of burnout among nursing professionals. METHOD: Cross-sectional, descriptive study with a quantitative approach to the data. The data collection took place between October 2018 and March 2019, and it was carried out through a questionnaire with socio-occupational variables and with metrics of intensity. The practice environment was assessed through the Nursing Work Index Revised (NWI-R); and the burnout was assessed by the Maslach Burnout Inventory (IBM). We included professionals with, at least, six months of employment, and those who were on leave or on a fixed-term employment contract were excluded. RESULTS: The sample consisted of 296 professionals. We found Favorable environments in both institutions, however, low results in the subscales autonomy, control and organizational support in the private hospital. The prevalence of burnout among nurses was 2.5% in the public hospital and 9.1% in the private hospital, and among nursing technicians, it was 9.5% and 8.5%, respectively. CONCLUSION: The control of the environment, autonomy and support were considered critical points, referring to the importance of assessing institutions factors, that can improve the working conditions for the nursing team.

Nursing assessment: the elaboration and development of a massive open online course.

OBJECTIVE: Describing the stages of elaboration and development of a massive open online course on "Nursing Assessment". METHOD: Experience report of the construction of a free course, developed between 2015 and 2016 with the partnership of the School of Nursing and the Nucleus of Support to Distance Learning. The course was hosted on the Lúmina platform. RESULTS: The construction of the course began in 2015 and the first edition was made available in September 2016, with 693 participants. The aim of the choice and elaboration of the material was to design an attractive and quality course for the community. The stages observed in its elaboration were choice of theme, course production, preliminary assessment and launching the first edition. CONCLUSIONS: The course has been shown to be a support for in-class teaching, as well as for the continuing education of health professionals.

Quality of life, health conditions and life style of civil police officers.

OBJECTIVES: Evaluate the relation between quality of life, health conditions and life style of Civil Police Officers in Porto Alegre/RS. METHOD: Transversal study with 237 police officers that answered a questionnaire containing socio-occupational information, life style, health conditions and the instrument World Health Quality of Life (WHOQOL-bref). The data was collected in 2018 and submitted to statistical analysis. RESULTS: Broad domain of quality of life showed higher rates in non-hypertensive subjects (p=0,002), without cardiovascular alterations (p=0,001), non-smokers (p=0,003), no alcohol ingestion (p=0,036), regular physical activity (p<0,001), healthy eating (p<0,001), no use of medication (p=0,028), able to have time to rest (p=0,049). Correlated with sleeping, weight, abdominal and hip circumference (p<0.01). CONCLUSION: Chronic diseases, use of medication and unhealthy lifestyle are related to worsening health-related quality of life.

Work under urgency and emergency and its relation with the health of nursing professionals.

The study aimed at understanding work under urgent and emergency conditions and its connection with the health of nursing professionals, who work at an urgency and emergency state service. Descriptive qualitative case study carried out at a state service in Porto Alegre, RS. The collection of data included the analysis of documents from the Institution, the observation of the work dynamics, and the performance of semi-structured interviews with the nursing professionals. The data were submitted to content analysis. One could understand that the health of the nursing professionals is constituted from a working dynamics which is sometimes harmful because it results from an organizational context that carries marks of a state health system with many gaps, however, that allows the meaning of work to be an essential element for the ability to keep the balance and not getting sick in view of the work demands.

Burnout em lideranças de enfermagem durante a pandemia da COVID-19 / Burnout in nursing leaderships during the COVID-19 pandemic / Burnout en líderes de enfermería durante la pandemia de COVID-19

Objetivo: analisar a relação entre o contexto de trabalho das lideranças de enfermagem na pandemia da COVID-19 e o Burnout. Método: estudo de método misto, com uma amostra quantitativa de 64 líderes de enfermagem, de todos os setores de quatro hospitais gaúchos. A coleta de dados ocorreu de agosto a outubro de 2020, após aprovação do Comitê Nacional de Ética em Pesquisa. Foi realizada a análise inferencial dos dados quantitativos (n=64), aplicados os testes de Mann-Whitney e correlações bivariadas de Spearman, considerando diferenças estatisticamente significativas "p" bicaudal menor que 0,05. Realizaram-se entrevistas qualitativas (n=12) acerca dos impactos da pandemia. Resultados: identificou-se 6,3% de prevalência de Síndrome de Burnout. Houve associação entre os domínios Desgaste Emocional e Despersonalização e as variáveis medo, aumento do consumo de álcool e impacto na saúde (p<0,05). Evidenciaram-se mudanças no contexto laboral, aumento do nível de exigência e da carga de trabalho e impactos na saúde. Conclusão: conclui-se que há associação entre o contexto de trabalho na pandemia e o Burnout. O aumento da sobrecarga de trabalho repercutiu em prejuízos na saúde mental(AU)

Objective: to analyze the relationship between the work context of nursing leaders in the COVID-19 pandemic and Burnout. Method: mixed method study, with a quantitative sample of 64 nursing leaders, from all sectors of four hospitals in Rio Grande do Sul. Data collection carried out from August to October 2020, after approval by the National Research Ethics Committee. Inferential analysis of quantitative data (n=64) was performed, applying Mann-Whitney tests and bivariate Spearman correlations, considering statistically significant two-tailed "p" differences less than 0.05. Qualitative interviews (n=12) were carried out about the impacts of the pandemic. Results: a 6.3% prevalence of Burnout Syndrome was identified. There was an association between the Emotional Exhaustion and Depersonalization domains and the variables fear, increased alcohol consumption and impact on health (p<0.05). There were changes in the work context, an increase in the level of demand and workload, and impacts on health. Conclusion: it is concluded that there is an association between the work context in the pandemic and Burnout. The increase in work overload had negative effects on mental health(AU)

Objetivo: analizar la relación entre el contexto de trabajo de los líderes de enfermería en la pandemia de COVID-19 y el Burnout. Método: estudio de método mixto, con muestra cuantitativa de 64 líderes de enfermería, de todos los sectores de cuatro hospitales de Rio Grande do Sul. La recolección de datos tuvo lugar de agosto a octubre de 2020, previa aprobación del Comité Nacional de Ética en Investigación. Se realizó el análisis inferencial de datos cuantitativos (n=64), se aplicaron pruebas de Mann-Whitney y correlaciones bivariadas de Spearman, considerando diferencias estadísticamente significativas "p" de dos colas menor a 0,05. Se realizaron entrevistas cualitativas (n=12) sobre los impactos de la pandemia. Resultados: se identificó una prevalencia del Síndrome de Burnout del 6,3%. Hubo asociación entre los dominios Cansancio Emocional y Despersonalización y las variables miedo, aumento del consumo de alcohol e impacto en la salud (p<0,05). Se han producido cambios en el contexto laboral, aumento en el nivel de exigencia y en la carga de trabajo e impactos en la salud. Conclusión: se concluye que existe asociación entre el contexto laboral en la pandemia y el Burnout. El aumento de la sobrecarga de trabajo tuvo efectos negativos sobre la salud mental(AU)

Nursing performance in COVID-19 and non-COVID-19 units: Implications for occupational health / Atuação da enfermagem em unidades dedicadas e não dedicadas à COVID-19: implicações na saúde ocupacional / Trabajo de enfermería en unidades dedicadas y no dedicadas al COVID-19: consecuencias para la salud ocupacional

Abstract Objective: to analyze the implications of the pandemic on the Nursing team's occupational health according to its performance in COVID-19 and non-COVID-19 units. Method: a multicenter and mixed-methods study, with a sequential explanatory strategy. A total of 845 professionals took part in the first stage, answering an electronic form which contained sociodemographic and work-related variables, as well as about the pandemic and their health, in addition to the Self-Reporting Questionnaire. 19 professionals were interviewed in the second stage. The quantitative data were submitted to statistical analysis and the qualitative ones to thematic content analysis, with integration by connection. Results: the pandemic exerted impacts on the professionals' health, both in the COVID-19 and non-COVID-19 areas. However, composition of the teams presented different characteristics between the areas, as well as the risk perceptions and the work demands. Conclusion: the professionals working in areas COVID-19 and non-COVID-19 areas are equally affected, although with different work exposure regarding the requirements at work in the COVID-19 units and the fear of contamination in non-COVID-19 units.

Resumo Objetivo: analisar as implicações da pandemia sobre a saúde ocupacional da equipe de enfermagem conforme a atuação em unidades dedicadas e não dedicadas à COVID-19. Método: estudo multicêntrico, de método misto, estratégia explanatória sequencial. Participaram 845 profissionais na primeira etapa, respondendo a um formulário eletrônico contendo variáveis sociodemográficas, laborais, sobre a pandemia e sua saúde e o Self-Reporting Questionnaire. Na segunda etapa, 19 profissionais foram entrevistados. Os dados quantitativos foram submetidos à estatística analítica e os qualitativos à análise temática de conteúdo, sendo integrados por conexão. Resultados: os impactos da pandemia sobre a saúde dos profissionais ocorreram tanto nas áreas dedicadas como nas não dedicadas à COVID-19. Contudo, a composição das equipes apresentou características distintas entre as áreas, bem como as percepções de risco e das exigências no trabalho. Conclusão: os profissionais que atuam em áreas dedicadas e não dedicadas à COVID-19 estão igualmente adoecidos, mas com exposição laboral distinta quanto às exigências no trabalho nas unidades dedicadas e o medo da contaminação nas unidades não dedicadas.

Resumen Objetivo: analizar las consecuencias que tuvo la pandemia en la salud ocupacional de los enfermeros según si se desempeñaban en unidades dedicadas y no dedicadas al COVID-19. Método: estudio multicéntrico, método mixto, estrategia explicativa secuencial. En la primera etapa participaron en total 845 profesionales que respondieron un formulario electrónico que contenía variables sociodemográficas, ocupacionales, sobre la pandemia y la salud y el Self-Reporting Questionnaire. En la segunda etapa, fueron entrevistados 19 profesionales. Los datos cuantitativos fueron sometidos a estadística analítica y los datos cualitativos al análisis de contenido temático, posteriormente, ambos fueron integrados por conexión. Resultados: los impactos de la pandemia en la salud de los profesionales se produjeron tanto en las áreas dedicadas como en las no dedicadas al COVID-19. Sin embargo, la composición de los equipos presentó distintas características entre las áreas, así como también diferentes percepciones de riesgo y exigencias en el trabajo. Conclusión: los profesionales que trabajan en áreas dedicadas y no dedicadas al COVID-19 se enfermaron por igual, pero tuvieron diferente exposición ocupacional debido a las exigencias que presentaba el trabajo en las unidades dedicadas y al miedo al contagio en las unidades no dedicadas.

[Virtual discussion groups: a proposal for nursing teaching]. / Grupos de discussão virtual: uma proposta para o ensino em enfermagem.

This paper describes a teaching experience aimed at providing interactivity to the technique of field diary by using a virtual learning environment. The educational proposal derives from the Federal University of Rio Grande do Sul (UFRGS)'s Teaching Training Program of the Stricto Sensu Post-Graduation Program in Nursing, in which the author, a Master's degree candidate, oriented by her advisor, proposed forming virtual discussion groups in order to write the field diary for an undergraduate discipline in Nursing, with the aim of providing an opportunity for a joint discussion of academic experiences in the realm of practice. The instructors of the discipline in which the proposal was developed also participated in the activities. The virtual technology gave new dynamism to the technique of field diary, making possible an exchange of experiences among the students, the instructor and the author, as well as moments of reflection and discussion regarding the themes faced in the Nursing practice.

Prazer-sofrimento de profissionais de um serviço de tratamento para usuários de drogas no contexto de pandemia / Placer-sufrimiento de profesionales de un servicio de tratamiento para usuarios de drogas en el contexto de pandemia / Pleasure-suffering of professionals working in drug users' treatment in the pandemic context

RESUMO Objetivo: descrever fatores que geram prazer e sofrimento no trabalho de profissionais de um serviço em adição para usuários de drogas durante a pandemia de COVID-19. Método: duas vertentes metodológicas, uma quantitativa e outra qualitativa, foram realizadas com 39 trabalhadores da equipe multiprofissional do serviço em adição (internação e ambulatório). A coleta dos dados ocorreu no período de outubro a dezembro de 2020, e foi realizada com aplicação da Escala de Avaliação do Contexto do Trabalho, Escala de Indicadores de Prazer e Sofrimento no Trabalho e grupos de discussão. Os dados quantitativos foram submetidos à estatística descritiva e analítica, e os qualitativos, à análise do núcleo de sentido. Resultados: identificou-se avaliação crítica para organização do trabalho, condições de trabalho e esgotamento profissional. O sofrimento foi manifestado pela falta de reconhecimento e pelo esgotamento profissional, associados às consequências clínicas e psicológicas com a pandemia. O prazer no trabalho esteve presente na oportunidade de aprendizado, nas novas relações e atividades de ensino. Conclusão: o sofrimento no trabalho foi evidenciado diante das exigências impostas pela pandemia, porém vivências de prazer e estratégia defensivas foram vislumbradas como fontes de proteção aos trabalhadores do serviço.

RESUMEN Objetivo: describir factores que generan placer y sufrimiento en el trabajo de profesionales de un servicio de enfermería en adicción para usuarios de drogas durante la pandemia de COVID-19. Método: dos vertientes metodológicas, una cuantitativa y otra cualitativa, fueron realizadas con 39 trabajadores del equipo multiprofesional del servicio de enfermería en adicción (internación y ambulatorio). La recolección de datos ocurrió entre octubre y diciembre de 2020, y se llevó a cabo con la aplicación de la Escala de Evaluación del Contexto del Trabajo, Escala de Indicadores de Placer y Sufrimiento en el Trabajo y grupos de discusión. Los datos cuantitativos fueron sometidos a la estadística descriptiva y analítica, y los cualitativos, al análisis del núcleo de sentido. Resultados: se identificó evaluación crítica para organización del trabajo, condiciones de trabajo y agotamiento profesional. El sufrimiento fue manifestado por la falta de reconocimiento y por el agotamiento profesional, asociados a las consecuencias clínicas y psicológicas con la pandemia. El placer en el trabajo estuvo presente en la oportunidad de aprendizaje, en las nuevas relaciones y actividades de enseñanza. Conclusión: el sufrimiento en el trabajo fue evidenciado ante las exigencias impuestas por la pandemia, pero vivencias de placer y estrategia defensivas fueron señaladas como fuentes de protección a los trabajadores del servicio.

ABSTRACT Objective: to describe factors that generate pleasure and suffering in the work of professionals in a drug addiction service during the COVID-19 pandemic. Method: two methodological approaches, quantitative and qualitative, were carried out with a total of 39 workers from the multidisciplinary team of a drug addiction service (inpatient and outpatient). Data collection took place from October to December 2020, and was conducted using the Work Context Assessment Scale, the Pleasure and Suffering Indicator Scale at Work and discussion groups. Quantitative data were submitted to descriptive and analytical statistics, and qualitative data to thematic analysis. Results: critical assessment was identified for work organization, working conditions and professional burnout. Suffering was manifested by the lack of recognition and professional burnout, associated with the clinical and psychological consequences of the pandemic. Pleasure at work was present in the learning opportunity, in new relationships and teaching activities. Conclusion: suffering at work was evidenced in the face of the demands imposed by the pandemic, but experiences of pleasure and defensive strategies were seen as sources of protection for service workers.

Falls Suffered by Hospitalized Adult Patients: Support to the Nursing Team as the Second Victim / Caidas de pacientes adultos hospitalizados: soporte al equipo de enfermería como segunda víctima / Quedas de pacientes adultos hospitalizados: suporte à equipe de enfermagem como segunda vítima

Abstract Objective: To describe the support received by the second victim in falls suffered by hospitalized adult patients from the nursing team's perspective. Materials and Methods: This is an exploratory and descriptive study with a qualitative approach, conducted in a large general hospital in the southern region of Brazil. Data collection was carried out through semi-structured interviews with 21 nursing professionals (seven nurses and fourteen nursing technicians) selected by random sampling, who worked in the inpatient units where falls occurred with a level of harm ranging from moderate to severe during March and May of 2020. The data were submitted to content analysis from July to August of the same year. Results: On the one hand, from the nursing team's perspective, support for the second victim was considered incipient by the hospital institution. On the other, participants highlighted the support received by their families and peers in the work environment. The study followed the guidelines of the Consolidated Criteria for Reporting Qualitative Research (COREQ) . Conclusions: An institutional flow of support for the second victim needs to be formalized to mitigate the repercussions on staff.

Resumen Objetivo: describir el soporte recibido por la segunda víctima en las caídas de pacientes adultos hospitalizados desde la perspectiva del equipo de enfermería. Materiales y método: estudio exploratorio y descriptivo, con enfoque cualitativo, realizado en hospital general de gran tamaño en la región sur de Brasil. Se realizó la recolección de dados por medio de entrevista semiestructurada con 21 trabajadores de enfermería (siete enfermeros y 14 técnicos de enfermería) seleccionados por muestra aleatoria y que trabajaban en las unidades de hospitalización en que ocurrieron caídas con grado de daño comprendido de moderado a grave, de marzo a mayo de 2020. Se sometieron los datos al análisis de contenido, de julio a agosto de dicho año. Resultados: por una parte, desde la percepción del equipo de enfermería, el soporte a la segunda víctima se consideró incipiente por la institución hospitalaria. Por otra, los participantes destacan el apoyo recibido por sus familiares y pares en el entorno laboral. El estudio siguió las directrices del Consolidated Criteria for Reporting Qualitative Research (Coreq). Conclusiones: hay necesidad de formalizar un flujo institucional de soporte a la segunda víctima con el fin de mitigar las implicaciones a los trabajadores.

Resumo Objetivo: descrever o suporte recebido pela segunda vítima nas quedas de pacientes adultos hospitalizados sob a perspectiva da equipe de enfermagem. Materiais e método: estudo exploratório e descritivo, de abordagem qualitativa, realizado em hospital geral de grande porte na região sul do Brasil. A coleta de dados foi realizada por meio de entrevista semiestruturada com 21 trabalhadores de enfermagem (sete enfermeiros e 14 técnicos de enfermagem) selecionados por amostragem aleatória e que trabalhavam nas unidades de internação em que aconteceram quedas com grau de dano compreendido de moderado a grave, de março a maio de 2020. Os dados foram submetidos à análise de conteúdo, de julho a agosto do mesmo ano. Resultados: por um lado, na percepção da equipe de enfermagem, o suporte à segunda vítima foi considerado incipiente pela instituição hospitalar. Por outro, os participantes destacam o apoio recebido pelos seus familiares e por pares no ambiente de trabalho. O estudo seguiu as diretrizes do Consolidated Criteria for Reporting Qualitative Research (Coreq). Conclusões: há necessidade de formalizar um fluxo institucional de suporte à segunda vítima a fim de mitigar as repercussões sobre os trabalhadores.

Burnout e resiliência em profissionais de enfermagem de terapia intensiva frente à COVID-19: estudo multicêntrico / Burnout and resilience in intensive care Nursing professionals in the face of COVID-19: A multicenter study / Burnout y resiliencia en profesionales de enfermería de cuidados intensivos ante el COVID-19: estudio multicéntrico

Resumo Objetivo: analisar a relação entre as dimensões do Burnout e a resiliência no trabalho dos profissionais de enfermagem de terapia intensiva na pandemia de COVID-19, em quatro hospitais do Sul do Brasil. Método: trata-se de um estudo multicêntrico, de delineamento transversal, composto por 153 enfermeiros e técnicos de enfermagem das Unidades de Terapia Intensiva. Foram coletadas questões sociodemográficas, de saúde e laborais e aplicados os instrumentos Maslach Burnout Inventory e Resilience at Work Scale 20. Os dados foram submetidos à análise descritiva e a correlações bivariadas e parciais (análise de rede). Resultados: a resiliência no trabalho apresentou correlação inversa ao desgaste emocional (r= -0,545; p=0,01) e à despersonalização (r= -0,419; p=0,01) e direta à realização profissional (r= 0,680; p=0,01). A variável com maior influência sobre a rede de correlações foi a percepção do impacto da pandemia sobre a saúde mental. Conclusão: a resiliência interfere nos domínios desgaste emocional e baixa realização profissional do Burnout. O desgaste emocional é conduzido por meio dos distúrbios psíquicos menores, com impacto sobre as variáveis de saúde física e mental dos trabalhadores. Deve-se fomentar o desenvolvimento da resiliência no âmbito institucional, a fim de moderar o adoecimento.

Abstract Objective: to analyze the relationship between the Burnout dimensions and the work resilience of intensive care Nursing professionals in the COVID-19 pandemic in four hospitals from southern Brazil. Method: this is a multicenter and cross-sectional study, composed of 153 nurses and nursing technicians of the Intensive Care Units. Sociodemographic, health and work-related questions were collected, and the Maslach Burnout Inventory and Resilience at Work Scale 20 instruments were applied. The data were submitted to descriptive analysis and to bivariate and partial correlations (network analysis). Results: work resilience presented an inverse correlation to emotional exhaustion (r=-0.545; p=0.01) and depersonalization (r=-0.419; p=0.01) and a direct one to professional achievement (r=0.680; p=0.01). The variable with the greatest influence on the correlation network was the perception of the impact of the pandemic on mental health. Conclusion: resilience interferes in the emotional exhaustion and low professional achievement domains of Burnout. Emotional exhaustion is conducted through minor psychological disorders, with an impact on the workers' physical and mental health variables. The development of institutional resilience should be encouraged in order to moderate the illness.

Resumen Objetivo: analizar la relación entre las dimensiones del Burnout y la resiliencia en el trabajo de los profesionales de enfermería de cuidados intensivos durante la pandemia de COVID-19, en cuatro hospitales del sur de Brasil. Método: se trata de un estudio multicéntrico, transversal, compuesto por 153 enfermeros y técnicos en enfermería de las Unidades de Cuidados Intensivos. Se recolectaron datos sociodemográficos, de salud y laborales y se aplicaron los instrumentos Maslach Burnout Inventory y Resilience at Work Scale 20. Los datos fueron sometidos a análisis descriptivo y a correlaciones bivariadas y parciales (análisis de redes). Resultados: la resiliencia en el trabajo tiene una correlación inversa con el agotamiento emocional (r= -0,545; p=0,01) y la despersonalización (r= -0,419; p=0,01) y directa con la realización profesional (r= 0,680; p=0,01). La variable con mayor influencia en la red de correlaciones fue la percepción del impacto de la pandemia en la salud mental. Conclusión: la resiliencia afecta los dominios agotamiento emocional y baja realización profesional del Burnout. El agotamiento emocional se manifiesta a través de trastornos psíquicos menores e impacta en las variables de salud física y mental de los trabajadores. Se debe fomentar el desarrollo de la resiliencia a nivel institucional para moderar la enfermedad.

Implicações da pandemia da COVID-19 sobre a Atenção Primária à Saúde: revisão integrativa / Implications of the COVID-19 pandemic on Primary Health Care: an integrative review

Objetivo: Identificar na literatura as implicações da pandemia da Coronavirus disease de 2019 sobre a Atenção Primária à Saúde (APS). Método: Revisão integrativa da literatura realizada em abril de 2021, utilizando-se os descritores indexados "Primary Health Care", "Coronavirus" e "Pandemics", a partir dos Descritores em Ciências da Saúde e Medical Subject Headings. Foram incluídos artigos na íntegra, sem recorte temporal. Excluíram-se estudos duplicados, relatos de caso, reflexões, manuais, recomendações, revisões e estudos de outras temáticas. Resultados: Foram selecionados 25 estudos de 768 publicações. Apontam-se para mudanças nas demandas de trabalho relacionadas a materiais, logística, padrão de atendimento, distanciamento social e estratégias de vigilância e monitoramento da atenção à saúde utilizadas na APS na pandemia da Coronavirus disease de 2019. Conclusões: Revelam-se iniciativas voltadas à criação de estratégias de vigilância e monitoramento na Atenção Primária à Saúde no enfrentamento da pandemia da Coronavirus disease de 2019.

Objective: To identify in the literature the implications of the 2019 Corona Virus Disease pandemic on Primary Health Care. Method: Integrative literature review performed in April 2021 using the indexed descriptors "Primary Health Care", "Coronavirus" and "Pandemics", from Health Sciences Descriptors and Medical Subject Headings. Articles in full with no time frame were included. Duplicate studies, case reports, reflections, manuals, recommendations, reviews and studies on other topics were excluded. Results: Twenty-five studies out of 768 publications were selected. They point to changes in work demands related to materials, logistics, standard of care, social distancing and healthcare surveillance and monitoring strategies used in Primary Health Care in the 2019 Coronavirus Disease pandemic. Conclusions: Initiatives aimed at creating surveillance and monitoring strategies in Primary Health Care for coping with the 2019 Coronavirus Disease pandemic are shown

Impacto do comanejo multidisciplinar em desfechos de pacientes com fratura de quadril / Impacto del manejo conjunto multidisciplinario en desenlaces de pacientes con fractura de cadera / Impact of multidisciplinary co-management on outcomes of patients with hip fracture

Resumo Objetivo Avaliar o impacto do programa de comanejo multidisciplinar nos desfechos de pacientes com fratura de quadril hospitalizados. Métodos Estudo observacional, do tipo antes e depois, retrospectivo. Foram coletados dados dos pacientes hospitalizados por fratura de quadril entre 2015 e 2019, em hospital universitário com serviço referência para ortopedia. A intervenção analisada foi o programa de comanejo multidisciplinar, que iniciou em 2017. Resultados O número de lesões por pressão adquiridas na internação diminuiu significativamente (p<0,005) após a implementação do comanejo. Da mesma forma, o tempo de internação até a cirurgia reduziu (p<0,046), sendo cumpridas as diretrizes nacionais e internacionais de correção da fratura em até 48 horas. Infecções, reinternações e óbitos não tiveram seu impacto confirmado. Conclusão O comanejo multidisciplinar teve impacto positivo nos desfechos dos pacientes hospitalizados por fratura de quadril, resultando em redução do número de lesões por pressão e do tempo de espera para realizar a cirurgia. Através deste estudo, foram identificadas evidências preliminares que suportam a implementação desse tipo de programa.

Resumen Objetivo Evaluar el impacto del programa de manejo conjunto multidisciplinario en los desenlaces de pacientes con fractura de cadera hospitalizados. Métodos Estudio observacional, tipo antes y después, retrospectivo. Se recopilaron datos de pacientes hospitalizados por fractura de cadera entre 2015 y 2019, en un hospital universitario con servicio de ortopedia de referencia. La intervención analizada fue el programa de manejo conjunto multidisciplinario, que comenzó en 2017. Resultados El número de úlceras por presión adquiridas en la internación se redujo significativamente (p<0,005) luego de la implementación del manejo conjunto. De la misma forma, el tiempo de internación hasta la cirugía se redujo (p<0,046), cumpliendo las directrices nacionales e internacionales de corrección de la fractura en 48 horas como máximo. No se confirmó el impacto de infecciones, reinternaciones y fallecimientos. Conclusión El manejo conjunto multidisciplinario tuvo un impacto positivo en los desenlaces de los pacientes hospitalizados por fractura de cadera, lo que redujo el número de úlceras por presión y el tiempo de espera para realizar la cirugía. A través de este estudio, se identificaron evidencias preliminares que respaldan la implementación de este tipo de programa.

Abstract Objective To assess the impact of the multidisciplinary co-management program on the outcomes of hospitalized patients with hip fractures. Methods This is an observational, before-and-after, retrospective study. Data were collected from patients hospitalized for hip fracture between 2015 and 2019, at a university hospital with a referral service for orthopedics. The intervention analyzed was the multidisciplinary co-management program, which started in 2017. Results The number of pressure injuries acquired during hospitalization decreased significantly (p<0.005) after the implementation of co-management. Likewise, the length of hospital stay until surgery was reduced (p<0.046), and national and international guidelines for fracture correction within 48 hours were complied with. Infections, readmissions and deaths have not had their impact confirmed. Conclusion The multidisciplinary co-management had a positive impact on the outcomes of patients hospitalized for hip fracture, resulting in a reduction in the number of pressure injuries and in the waiting time for surgery. Through this study, preliminary evidence was identified to support the implementation of this type of program.

Modelagem de quedas de pacientes adultos e as repercussões à Enfermagem como segunda vítima / Modeling of adult patient falls and the repercussions to Nursing as a second victim / Modelaje de caídas de pacientes adultos y las repercusiones en la Enfermería como segunda víctima

Resumo Objetivo: analisar as quedas de pacientes adultos hospitalizados e suas repercussões no trabalhador de Enfermagem como segunda vítima. Método: estudo exploratório, descritivo e qualitativo realizado em duas etapas - identificação das quedas com dano moderado ao grave e a modelagem das quedas com uso do software Functional Resonance Analysis Method e análise das repercussões no trabalhador como segunda vítima por meio de entrevistas semiestruturadas submetidas à Análise de Conteúdo, com 21 trabalhadores de Enfermagem. Resultados: identificadas 447 quedas de pacientes adultos, sendo 12 com dano moderado ao grave, ocorridas na ausência do acompanhante, no uso de medicamentos indutores do sono, hipotensores ou que alteram a força muscular. A modelagem identificou 22 funções relacionadas ao Procedimento Operacional Padrão, ao protocolo de prevenção de quedas e às ações pós-evento. Dessas, oito apresentaram variabilidade em sua execução. Na segunda etapa, emergiram as categorias "A complexidade dos cuidados para prevenir as quedas" e "Sentimentos da segunda vítima". Conclusão: as quedas são fenômenos complexos e a prevenção exige envolvimento do paciente, família e equipe multiprofissional. Os profissionais envolvidos são segundas vítimas e experimentam sentimentos de culpa, medo, angústia e impotência. Este estudo pode contribuir com a multiprofissionalidade e na abordagem precoce às segundas vítimas.

Abstract Objective: analyze the falls of adult hospitalized patients and their repercussions on the Nursing worker as the second victim. Method: an exploratory, descriptive and qualitative study conducted in two stages - identification of falls with moderate to severe damage and the modeling of falls using the software Functional Resonance Analysis Method; and analysis of the repercussions on the worker as the second victim by means of semi-structured interviews submitted to Content Analysis, with 21 Nursing workers. Results: a total of 447 falls of adult patients were identified, 12 of which with moderate to severe damage, occurred in the absence of the companion, while using sleep inducing, hypotensive or muscle strength altering medications. The modeling identified 22 functions related to the Standard Operating Procedure, to the fall prevention protocol and to the post-event actions. Of these, eight presented variability in their execution. In the second step, the categories "The complexity of care to prevent falls" and "Feelings of the second victim" emerged. Conclusion: falls are complex phenomena and prevention requires involvement of the patient, family and multi-professional team. The professionals involved are second victims and experience feelings of guilt, fear, anguish and helplessness. This study can contribute to the multi-professional spirit and to the early approach to second victims.

Resumen Objetivo: analizar las caídas de pacientes adultos hospitalizados y sus repercusiones en el trabajador de Enfermería como segunda víctima. Método: estudio exploratorio, descriptivo y cualitativo realizado en dos etapas - Identificación de las caídas con daño moderado a grave y el modelaje de las caídas utilizando el software Functional Resonance Analysis Method y Análisis de las repercusiones en el trabajador como segunda víctima por medio de entrevistas semiestructuradas posteriormente sometidas al Análisis de Contenido, en 21 trabajadores de Enfermería. Resultados: fueron identificadas 447 caídas de pacientes adultos, siendo 12 con daño moderado a grave, ocurridas en la ausencia del acompañante, al usar medicamentos inductores de sueño, hipotensores y/o los que alteran la fuerza muscular. El modelaje identificó 22 funciones relacionadas al Procedimiento Operacional Estándar, es decir el protocolo de prevención de caídas y las acciones seguidas después del evento. Entre estas, ocho presentaron variabilidad en su ejecución. En la segunda etapa, surgieron las categorías "La complejidad de los cuidados para prevenir las caídas" y "Sentimientos de la segunda víctima". Conclusión: las caídas son fenómenos complejos y la prevención exige la participación del paciente, familia y equipo multiprofesional. Los profesionales involucrados son segundas víctimas y experimentan sentimientos de culpa, miedo, angustia e impotencia. Este estudio puede contribuir con la multiprofesionalidad y el abordaje precoz a las segundas víctimas.