Construção e validação de protocolo assistencial a idosos em Unidades de Pronto Atendimento / Construcción y validación de protocolo asistencial a adultos mayores en Unidades de Servicios de Emergencias / Construction and validity of care protocol for older adults in Emergency Care Units

Resumo Objetivo Construir e validar o conteúdo de um protocolo de assistência à idosos em Unidades de Pronto Atendimento. Métodos Pesquisa metodológica, desenvolvida mediante observação participante moderada, construção do protocolo e validação de conteúdo do instrumento. Para a construção do protocolo, realizaram-se 12 grupos focais com um total de 43 profissionais das Unidades de Pronto Atendimento de um município de médio porte do estado do Paraná. Posteriormente, o instrumento foi validado por sete especialistas da área. A validação de conteúdo foi estabelecida pelo Índice de Validade de Conteúdo maior que 0,80. Resultados O protocolo constitui 22 itens divididos em três partes, Acolhimento, Assistência e Alta, e seu conteúdo foi considerado válido pela obtenção do Índice de Validade de Conteúdo de 0,91. Conclusão O protocolo construído e validado pode ser utilizado no cuidado à população idosa nas Unidades de Pronto Atendimento, das quais se espera que qualifiquem a assistência e forneçam subsídios para o fortalecimento de políticas públicas voltadas a idosos.

Resumen Objetivo Construir y validar el contenido de un protocolo asistencial a adultos mayores en Unidades de Servicios de Emergencias. Métodos Investigación metodológica, desarrollada mediante observación participante moderada, construcción del protocolo y validación de contenido del instrumento. Para la construcción del protocolo, se realizaron 12 grupos focales con un total de 43 profesionales de las Unidades de Servicios de Emergencias de un municipio mediano del estado de Paraná. Luego, el instrumento fue validado por siete especialistas del área. La validación de contenido se estableció por el Índice de Validez de Contenido superior a 0,80. Resultados El protocolo constituye 22 ítems divididos en tres partes: Acogida, Atención y Alta, y su contenido fue considerado válido por la obtención del Índice de Validez de Contenido del 0,91. Conclusión El protocolo construido y validado se puede utilizar en el cuidado de la población de adultos mayores en las Unidades de Servicios de Emergencia, de las cuales se espera que califiquen la atención y ofrezcan subsidios para el fortalecimiento de políticas públicas dirigidas a adultos mayores.

Abstract Objective To construct and validate the content of a care protocol for older adults in Emergency Care Units. Methods This is methodological research, developed through moderate participant observation, protocol construction and instrument content validity. To construct the protocol, 12 focus groups were conducted with a total of 43 professionals from the Emergency Care Units of a medium-sized municipality in the state of Paraná. Subsequently, the instrument was validated by seven experts in the field. Content validity was established by the Content Validity Index greater than 0.80. Results The protocol consists of 22 items divided into three parts, reception, care and discharge, and its content was considered valid by obtaining the Content Validity Index of 0.91. Conclusion The constructed and validated protocol can be used in care of older adults in Emergency Care Units, which are expected to qualify care and provide subsidies for the strengthening of public policies aimed at older adults.

Validação de instrumento para investigação do conhecimento de enfermeiros sobre pé diabético / Validación del instrumento para la investigación del conocimiento de enfermeros sobre pie diabético / Validation of an instrument to investigate nurses' knowledge on diabetic foot

RESUMO Objetivo: construir e validar um instrumento para investigação do conhecimento de enfermeiros da Atenção Primária à Saúde sobre pé diabético. Método: estudo metodológico realizado de janeiro a junho de 2017, que seguiu o Modelo de Elaboração de Escalas Psicométricas de Pasquali, em três etapas: teórica, empírica e analítica. Para validação de conteúdo, adotou-sea técnica de Delphi em dois momentos, com a participação de 10 juízes. A validade de construto foi realizada por 73 enfermeiros que atuavam nos serviços de APS do município de Campina Grande-PB. Aos dados, aplicou-se o Índice de Validação de Conteúdo (IVC). Resultados: construiu-se o "Questionário de Investigação do Conhecimento do Enfermeiro sobre Pé Diabético (QICEPeD)" com 47 itens organizados em 12 domínios de conhecimentos sobre a temática. Após a segunda rodada de avaliação dos juízes, todos os itens atingiram escores máximos de concordância (IVC = 1,00). A análise da confiabilidade e da consistência interna total do instrumento foi considerada elevada (α=0,860). Conclusão: o instrumento QICEPeD foi considerado válido, quanto ao conteúdo e construto, podendo ser utilizado para avaliar o conhecimento de enfermeiros da Atenção Primária sobre pé diabético.

RESUMEN Objetivo: construir y validar un instrumento para la investigación del conocimiento de enfermeros de la Atención Primaria de la Salud (APS) sobre pie diabético. Método: estudio metodológico realizado de enero a junio de 2017, que siguió el Modelo de Elaboración de Propiedades Psicométricas de Pasquali, en tres etapas: teórica, empírica y analítica. Para la validación de contenido, se adoptó el método de Delphi en dos momentos, con la participación de 10 jueces. La validez del constructo fue realizada por 73 enfermeros que actuaban en los servicios de APS del municipio de Campina Grande-PB-Brasil. Para los datos, se aplicó el Índice de Validez de Contenido (IVC). Resultados: se construyó el "Cuestionario de Investigación del Conocimiento del Enfermero sobre Pie Diabético (CICEPeD)" con 47 ítems organizados en 12 dominios de conocimientos sobre la temática. Después de la segunda ronda de evaluación de los jueces, todos los elementos alcanzaron puntajes máximos de concordancia (IVC=1,00). El análisis de la confiabilidad y de la consistencia interna total del instrumento fue considerado alto (α=0,860). Conclusión: el instrumento CICEPeD fue considerado válido, en cuanto al contenido y constructo, pudiendo ser utilizado para evaluar el conocimiento de enfermeros de la Atención Primaria sobre pie diabético

ABSTRACT Objective: to construct and validate an instrument to investigate the knowledge of Primary Health Care nurseson diabetic foot. Method: methodological study carried out from January to June 2017, followed the Development Model for Psychometric Scales by Pasquali, in three stages: theoretical, empirical and analytical. In order to validate the content, the Delphi technique was adopted in two moments, with the participation of 10 judges. Construct validity was performed by 73 nurses who worked in PHC services in the municipality of Campina Grande-PB. The Content Validation Index (CVI) was applied to the data. Results: the "Questionnaire for Investigating Nurses' Knowledge on Diabetic Foot (QICEPeD, as per its Portuguese acronym)" was constructed with 47 elements organized into 12 domains of knowledge on the topic. After the second round of judges' assessment, all elements reached maximum agreement scores (CVI = 1.00). The analysis of the instrument's reliability and total internal consistency was considered high (α=0.860). Conclusion: the QICEPeD instrument was considered valid, in terms of content and construct, and can be used to assess the level of knowledge of Primary Care nurses on diabetic foot.

Visual Elicitation: Methods for Enhancing the Quality and Depth of Interview Data in Applied Qualitative Health Research.

Generating rich data from interviews for a qualitative study can be difficult to operationalize; especially when difficulties establishing rapport, power imbalances, and participant factors threaten the interview process and quality of data. The aim of this methods article is to (a) discuss the value of incorporating visual elicitation tools or tasks within semistructured or in-depth qualitative interviews to enhance the depth of data generated and (b) provide a specific example of how this is planned and executed within the context of an applied qualitative health research study.

Systematic review of the nature of nursing care described by using the Caring Behaviours Inventory.

AIM: To describe the nature of care received by patients measured through the Caring Behaviours Inventory. BACKGROUND: Professional nursing practice combines two dimensions of caring: instrumental care and expressive care. Instrumental care focuses on physical health needs, in terms of efficiency and employs interventions based on evidence. Expressive care is patient-centred and based on the interpersonal relationship. It requires caring attitudes that include respect, kindness, sensitivity and patience. The Caring Behaviours Inventory is a tool designed to assess the care expressed through the behaviours nurses perform, contextualised within the Jean Watson's Theory of Human Caring. METHODS: A systematic review following PRISMA recommendations. Scopus, PubMed and CINAHL databases were consulted using the keywords "Caring Behaviours Inventory" AND "Nursing". The Joanna Briggs Institute tool was used for the quality appraisal. A conceptual analysis and a thematic synthesis were performed for data extraction. RESULTS: 11 articles were selected. Three categories were identified: nature of caring, congruence between perceived care by patients and nurses, and factors associated with the expression of care. DISCUSSION: An emphasis on care of an instrumental nature was identified. The perception of patients differs from that of nurses, patients perceive a lower level of expressive caring than the one nurses believe to deliver. Caring behaviours are affected by the working environment, nurses' emotional intelligence and coping skills, and socio-demographic characteristics. CONCLUSION: This paper described the findings of previous research regarding the nature of care that is transmitted and received in clinical practice. Results highlight an emphasis on the instrumental aspect of the nursing care according to the patients' perception. RELEVANCE TO CLINICAL PRACTICE: Findings summarised in this review could contribute to a better understanding of the nursing care. Results reported in this paper could also help to improve the quality of care delivered by nurses as well as patient-centeredness.

Designing Interventions to Improve the Health of Women Using the ORBIT Model.

Researchers may find it difficult to transition from conducting descriptive, mechanistic, and associational studies to developing interventions based on those findings because little guidance is available. In this article, we present the Obesity-Related Behavioral Intervention Trials (ORBIT) model and describe its applicability in designing behaviorally oriented interventions for women. Adapted from drug development research on the translation of basic laboratory research to clinical practice, the ORBIT model emphasizes the pre-efficacy testing phases of intervention development. Phase I is focused on the definition and refinement of the intervention and incorporates various study designs, including experimental, observational, qualitative, and adaptive design. Phase II involves the use of single-group proof-of-concept, feasibility, and preliminary efficacy studies to show the feasibility and capacity of the intervention to produce change in an intermediate endpoint. Phase III involves the use of randomized controlled trials to test the efficacy of the intervention. We illustrate how the ORBIT model could be applied in a hypothetical intervention to increase a woman's sense of control of her life before behavioral weight loss efforts in the postpartum period.

A methodological review of qualitative longitudinal research in nursing.

Qualitative longitudinal research (QLR) provides temporal understanding of the human response to health, illness, and the life course. However, little guidance is available for conducting QLR in the nursing literature. The purpose of this review is to describe the methodological status of QLR in nursing. With the assistance of a medical librarian, we conducted a thorough search circumscribed to qualitative, longitudinal nursing studies of patients' and care-givers' experiences published between 2006 and 2016. The methodological quality of the 74 reviewed studies varied tremendously; many reports lacked sufficient detail in reporting on sampling and attrition, retention strategies, and data collection and analysis, making it difficult for readers to evaluate the credibility and transferability of study findings. Based on the strengths and limitations of the studies reviewed and findings in the literature, we provide recommendations for enhancing the reporting of the research process as a supplement to the standards for qualitative research more broadly. These recommendations are offered in the spirit of encouraging dialogue among colleagues and assisting journal reviewers and editors in their evaluation of QLR.

Data analysis: comparison between the different methodological perspectives of the Grounded Theory. / Análise de dados: comparação entre as diferentes perspectivas metodológicas da Teoria Fundamentada nos Dados.

Grounded Theory (GT) has undergone many transformations since its proposition as a research method in the 1960s. As a result of these changes, three different GT approaches have been outlined: classic, straussian and constructivist ground theory, each with its peculiarities, but mainly concerning data analysis. Thus, this study aimed to describe and compare the data analysis process adopted by the different methodological perspectives of GT. The text is organized into two topics. Firstly, we present the common and differentiating characteristics of the three methodological perspectives of GT. In sequence, the data analysis system adopted in each of the GT methodological perspectives is described and exemplified, varying between two and three stages, and may or may not include the use of the paradigmatic model. Thus, this study provides support for understanding the different data analysis systems adopted in GT, which may contribute to the rigor and scientific quality of nursing research adopting this method.

Habilidades investigativas en estudiantes de 2do año de Licenciatura en Enfermería: ocasión para su desarrollo / Researching skills in 2nd year students of the Bachelor in Nursing career: occasion for their development

Fundamento: la actividad científica debe ser asumida como componente esencial en la formación integral de los estudiantes de las ciencias médicas desde el pregrado. Objetivo: diagnosticar el desarrollo de las habilidades investigativas en los estudiantes de 2do año de Licenciatura en Enfermería, desde la asignatura Farmacología I. Métodos: se realizó un estudio descriptivo transversal en la Facultad de Ciencias Médicas de Cienfuegos durante el primer semestre del curso 2016-2017. Se utilizaron métodos del nivel teórico: analítico-sintético, inductivo-deductivo e histórico-lógico; del nivel empírico: el análisis documental y la observación, y matemático-estadísticos. Resultados: se constató que la mayoría de los estudiantes presentaron dificultades en la elaboración de los objetivos de investigación, la definición de las variables, la selección de métodos y técnicas y en el análisis de la información recolectada. Con menos dificultades resultaron la búsqueda bibliográfica, la redacción del informe escrito y la exposición oral. Conclusiones: se diagnosticaron las principales dificultades que presentaron los estudiantes de segundo año en cuanto a las habilidades investigativas, lo cual permite la retroalimentación de los docentes para ofrecer continuidad a su desarrollo a partir de nuevas estrategias.

Background: scientific activity must be assumed as an essential component in the comprehensive education of medical sciences students since the undergraduate level. Objective: to diagnose the development of researching abilities in the students of 2nd year of the Bachelor in Nursing career, through the subject Pharmacology I. Methods: a cross-sectional descriptive study was carried out in Cienfuegos Faculty of Medical Sciences during the first semester of the 2016-2017 academic year. Methods of the theoretical level were used: analytic-synthetic, inductive-deductive and historical-logical; of the empirical level: documentary analysis and observation, and mathematical-statistics. Results: it was found that most of the students presented difficulties in the elaboration of the research work objectives, the definition of the variables, the selection of methods and techniques and in the analysis of the information collected. The bibliographic search, the writing of the written report and the oral presentation were less difficult. Conclusions: the main difficulties that second-year students presented in terms of research skills were diagnosed, which allows feedback from teachers to offer continuity to their development based on new strategies.

Ethical considerations when conducting joint interviews with close relatives or family: an integrative review.

BACKGROUND: Researchers are obligated to do no harm to participants of research. Conflicts in relationships can cause negative well-being; therefore, insight is needed into the particular ethical considerations that arise when conducting joint interviews with close relatives or family members simultaneously in the healthcare setting. AIM: To collect and share knowledge related to ethical considerations conducting joint interviews. DESIGN AND METHODS: A literature review inspired by the integrative review method was performed. Data were retrieved through a structured search in PubMed, CINAHL and the Philosopher's Index and Academic Search Premier for articles published in English from 1980 to 2016 and included 18 articles, of a possible 2153. Article content was assessed line-by-line, and ethical considerations were extracted and organized in three subgroups regarding: Planning joint interviews; Conduction joint interviews and Reporting on joint interviews Findings: Participants should be offered the best terms for a constructive, on-going relationship after the joint interview has ended. This obligates the researcher to ensure a safe environment during the joint interview and create a delicate balance between the needs of the participants, using nonconfrontational techniques that foster equal and neutral but dedicated attention to all parties, before, during and after the joint interviews. CONCLUSION: Specific ethical considerations should be taken into account before, during and after joint interviewing. Further research is needed before a final conclusion can be drawn.

Diagnósticos, resultados e intervenções de enfermagem em pacientes com esclerose múltipla / Diagnósticos, resultados e intervenciones de enfermería en pacientes con esclerosis múltiple / Diagnostics, results and nursing interventions in patients with multiple sclerosis

RESUMO Introdução: a esclerose múltipla (EM) é uma Doença desmielinizante de etiologia autoimune, e está entre as principais causas de incapacidade neurológica não traumática nos adultos jovens. Objetivo: identificar os principais diagnósticos, resultados e intervenções de enfermagem e validar uma proposta de plano de cuidados para pacientes com Esclerose Múltipla. Métodos: estudo metodológico, realizado com 16 enfermeiros especialistas e 68 pacientes em uma unidade de Neurologia de um Hospital Escola, seguindo quatro etapas: elaboração dos Diagnósticos de Enfermagem; proposta inicial de resultados e intervenções de enfermagem; elaboração de um plano de cuidados; validação do plano por especialistas. Para a análise da concordância aplicou-se a escala do Coeficiente Kappa. Resultados: identificou-se quatro diagnósticos com frequência acima de 50 porcento, elencou-se quatro resultados de enfermagem e foram propostas 14 intervenções que alcançaram índice de concordância ≥ 0,8 entre os experts. Conclusão: o estudo permitiu identificar os diagnósticos, resultados e intervenções de enfermagem para aplicação na prática clínica, além de validar a proposta do plano de cuidados para pacientes com Esclerose Múltipla(AU)

RESUMEN Introducción: la esclerosis múltiple es una enfermedad desmielinizante de etiología autoinmune, y está entre las principales causas de incapacidad neurológica no traumática en los adultos jóvenes. Objetivo: identificar los principales diagnósticos, resultados e intervenciones de enfermería y validar una propuesta de plan de cuidados para pacientes con esclerosis múltiple. Métodos: estudio metodológico, realizado con 16 enfermeros especialistas y 68 pacientes en una unidad de Neurología de un Hospital Escuela, siguiendo cuatro etapas: elaboración de los Diagnósticos de Enfermería; Propuesta inicial de resultados e intervenciones de enfermería; Elaboración de un plan de cuidados; Validación del plan por expertos. Para el análisis de la concordancia se aplicó la escala del Coeficiente Kappa. Resultados: se identificaron cuatro diagnósticos con frecuencia por encima del 50 por ciento, se enumeraron cuatro resultados de enfermería y se propusieron 14 intervenciones que alcanzaron índice de concordancia ≥ 0,8 entre los expertos. Conclusión: el estudio permitió identificar los diagnósticos, resultados e intervenciones de enfermería para aplicación en la práctica clínica, además de validar la propuesta del plan de cuidados para pacientes con esclerosis múltiple(AU)

ABSTRACT Introduction: Multiple sclerosis (MS) is a demyelinating disease of autoimmune etiology and is one of the main causes of non-traumatic neurological disability in young adults. Objective: to identify the main nursing diagnoses, results and interventions and to validate a proposal for a care plan for patients with multiple sclerosis. Methods: a methodological study, carried out with 16 specialist nurses and 68 patients in a Neurology unit of a School Hospital, following four stages: elaboration of Nursing Diagnoses Initial proposal of results and nursing interventions; Preparation of a care plan; Validation of the plan by specialists. Kappa coefficient scale was used to analyze the agreement. Results: four diagnoses were identified with frequency above 50 percent, four nursing outcomes were listed and 14 interventions were proposed that reached a concordance index ≥ 0.8 among the experts. Conclusion: the study allowed to identify nursing diagnoses, results and interventions for application in clinical practice, in addition to validating the proposal of the care plan for patients with Multiple Sclerosis(AU)

Conflict between Family Caregivers and Staff in Nursing Homes: Feasibility of the Daily Diary Method.

OBJECTIVE: The purpose of this study was to investigate the daily diary method (DDM) for assessing family-staff conflicts in nursing homes, to provide descriptive information on conflict, and to examine the relationship between conflict and mood among family caregivers. METHODS: Participants were nine caregivers that experienced conflict with staff on an ongoing basis. They were contacted daily by telephone for 14 days and were asked (1) whether a conflict had occurred, (2) to describe the severity and type of conflict, and (3) to rate their positive and negative affect. RESULTS: Compliance was excellent with no attrition, and there were only 2 missing data points over 126 potential observations. Conflicts occurred on 22% of the days, were rated as moderately severe, and were related to poor resident care, lack of information, and staff attitudes. Participants reported significantly lower positive affect (p < .05) and higher negative affect (p < .001) on conflict versus no-conflict days. Exit interviews indicated positive attitudes towards the DDM. CONCLUSIONS: These results support the feasibility of the DDM for providing an in-depth understanding of family-staff conflict and its relationship to caregivers' mood. CLINICAL IMPLICATIONS: The DDM would ideally be used as an outcome measure in studies that assess interventions that target high-conflict family-staff relationships.

Methodological challenges in qualitative content analysis: A discussion paper.

This discussion paper is aimed to map content analysis in the qualitative paradigm and explore common methodological challenges. We discuss phenomenological descriptions of manifest content and hermeneutical interpretations of latent content. We demonstrate inductive, deductive, and abductive approaches to qualitative content analysis, and elaborate on the level of abstraction and degree of interpretation used in constructing categories, descriptive themes, and themes of meaning. With increased abstraction and interpretation comes an increased challenge to demonstrate the credibility and authenticity of the analysis. A key issue is to show the logic in how categories and themes are abstracted, interpreted, and connected to the aim and to each other. Qualitative content analysis is an autonomous method and can be used at varying levels of abstraction and interpretation.

Sensitive Interviewing in Qualitative Research.

In this paper we focus on important considerations when planning and conducting qualitative interviews on sensitive topics. Drawing on experiences of conducting interviews with dementia caregivers, a framework of essential elements in qualitative interviewing was developed to emphasize study participants' needs while also providing guidance for researchers. Starting with a definition of sensitive research, the framework includes preparing for interviews, interacting with gatekeepers of vulnerable groups, planning for interview timing, and location, building relationships and conducting therapeutic interactions, protecting ethically vulnerable participants, and planning for disengagement. This framework has the potential to improve the effectiveness of sensitive interviewing with vulnerable groups. © 2016 Wiley Periodicals, Inc.

Using observational methods in nursing research.

Observation is a research data-collection method used generally to capture the activities of participants as well as when and where things are happening in a given setting. It checks description of the phenomena against what the researcher perceives to be fact in a rich experiential context. The method's main strength is that it provides direct access to the social phenomena under consideration. It can be used quantitatively or qualitatively, depending on the research question. Challenges in using observation relate to adopting the role of participant or non-participant researcher as observer. This article discusses some of the complexities involved when nurse researchers seek to collect observational data on social processes in naturalistic settings using unstructured or structured observational methods in qualitative research methodology. A glossary of research terms is provided.

Addressing methodological issues in correctional health research: a case report.

This case study describes the experiences of a novice correctional nurse researcher's application of the recommended strategies from the correctional literature to improve the conduct of research in a correctional institution. An innovative booster intervention was implemented and evaluated as a pilot study in a state correctional institution. Correctional nurse researchers encounter many challenges when conducting research in a correctional facility. This case study shares challenges that persisted and concludes by recommending ways to strengthen and improve on learned strategies proposed by experienced correctional nurse researchers.

Grounded theory.

Grounded theory is a popular research approach in health care and the social sciences. This article provides a description of grounded theory methodology and its key components, using examples from published studies to demonstrate practical application. It aims to demystify grounded theory for novice nurse researchers, by explaining what it is, when to use it, why they would want to use it and how to use it. It should enable nurse researchers to decide if grounded theory is an appropriate approach for their research, and to determine the quality of any grounded theory research they read.

Maximizing Theoretical Contributions of Participant Observation While Managing Challenges.

Participant observation (PO) is an important method of data collection used in a variety of research methodologies. PO can inform theory development by providing understanding of participants' behaviors and the contexts that influence their behaviors. Because theory development is important in grounded theory studies, we emphasize theoretical contributions of PO while interrogating the challenges of using PO, in particular, attending to informed consent. We use the exemplar of a mid-range theory about nursing practice with hospitalized older adults to highlight contributions of PO to category development. While acknowledging theoretical contributions, we explore challenges entailed in observations where consenting participants interact with vulnerable patients and a changing cast of health care professionals in dynamic contexts. Reflexivity about interactions with vulnerable individuals, as well as other actions to avoid compromising voluntary consent, enhances contributions of PO.

Nursing researchers' modifications of Ricoeur's hermeneutic phenomenology.

Paul Ricoeur's hermeneutic phenomenology has proved to be very helpful in guiding nursing researchers' qualitative analysis of interview transcripts. Modifying Ricoeur's philosophy, a number of nursing researchers have developed their own interpretive methods and shared them, along with their experience, with research community. Major contributors who published papers directly presenting their modifications of Ricoeur's theory include Rene Geanellos (2000), Lena Wiklund, Lisbet Lindholm and Unni Å. Lindström (2002), Anders Lindseth and Astrid Norberg (2004) and Pia Sander Dreyer and Birthe D Pedersen (2009). The aim of this article was to delineate differences among these methods. Descriptive presentation of each method side by side makes clear the differences among them. In addition, Ricoeur's hermeneutic theory is portrayed and compared with the modifications. It is believed that differences that are found can stimulate further thoughts on how to apply Ricoeur's theory in qualitative research in nursing.