Experiencias del personal de enfermería acerca de los factores del entorno que intervienen durante el enlace de turno / Experiences of the nursing staff about the environmental factors that intervene during the shift change

Introduction: The shift change in the nursing care process, primarily located in hospital settings, is carried out through the transfer of verbal, written and gestural information from the interaction between nursing staff. The theoretical reference is from Elton Mayo's human relations. Objective: To understand and interpret the meaning of the nursing staff's experiences regarding the environmental factors involved during the shift change. Methodology: Qualitative study carried out with the phenomenological method. The information was obtained through non-participant observation and a semi-structured interview with operational nursing staff. Data saturation was reached with 32 interviews. Results: 7 categories were constructed: Verbal/language communication, Patient reception, Patient safety, Continuous care, Administrative documents, Shift change hours, and Work supplies. Conclusions: The findings show the various factors that interact and intervene between nursing staff during the shift change, which is an essential activity to provide continuity of care and guarantee safety in patient care.

Introducción: el enlace de turno en el proceso de atención de enfermería, primordialmente situado en escenarios hospitalarios, se lleva a cabo mediante la transferencia de información verbal, escrita y gestual a partir de la interacción entre personal de enfermería. El referente teórico es el de relaciones humanas de Elton Mayo. Objetivo: comprender e interpretar el significado de las experiencias del personal de enfermería acerca de los factores del entorno que intervienen durante el enlace de turno. Metodología: estudio cualitativo realizado con el método fenomenológico. La información se obtuvo mediante observación no participante y entrevista semiestructurada en personal de enfermería operativo. La saturación de datos se alcanzó con 32 entrevistas. Resultados: se construyeron 7 categorías: Comunicación verbal/lenguaje, Recepción del paciente, Seguridad del paciente, Cuidado continuo, Documentos administrativos, Horarios de enlace de turno e Insumos de trabajo. Conclusiones: los hallazgos permiten mostrar los diversos factores que interactúan e intervienen entre el personal de enfermería durante el enlace de turno, que es una actividad esencial para dar continuidad al cuidado y garantizar la seguridad en la atención de los pacientes.

Gerenciamento do tempo no processo de trabalho dos enfermeiros em Unidade de Terapia Intensiva / Gestión del tiempo en el proceso de trabajo de enfermeros de la unidad de cuidados intensivos / Time management in the work process of nurses in the intensive care unit

RESUMO Objetivo analisar o gerenciamento do tempo dispensado por enfermeiros em intervenções de cuidados diretos e indiretos, em atividades associadas ao trabalho e atividades pessoais. Método estudo quantitativo, transversal, realizado em Unidade de Terapia Intensiva de um hospital universitário no Rio de Janeiro em janeiro de 2017. Foram realizadas observações diretas das atividades realizadas pelos enfermeiros em 18 plantões, totalizando 216 horas. O "Instrumento para mensuração da carga de trabalho" foi utilizado para estruturar a observação. Resultados os resultados mostraram que 21,5% do tempo dos enfermeiros foram dedicados às intervenções de cuidados diretos 44,7% aos cuidados indiretos, 6,1% às atividades associadas e 27,7% às atividades pessoais. Conclusão os enfermeiros utilizam maior parte do tempo em atividades não relacionadas ao cuidado direto ao paciente. Os achados podem ser utilizados pelos gestores para revisão e adequação do dimensionamento de profissionais na assistência direta e indireta e do processo de trabalho na Unidade.

RESUMEN Objetivo analizar la gestión del tiempo que brindan los enfermeros en las intervenciones asistenciales directas e indirectas, en actividades asociadas al trabajo y actividades personales. Método estudio cuantitativo, transversal, realizado en la Unidad de Cuidados Intensivos de un hospital universitario de Rio de Janeiro en enero de 2017. Se realizaron observaciones directas de las actividades realizadas por enfermeras en 18 turnos, totalizando 216 horas. Se utilizó la "Herramienta de medición de la carga de trabajo" para estructurar la observación. Resultados los resultados mostraron que el 21,5% del tiempo de los enfermeros se dedicó a intervenciones de cuidados directos, el 44,7% a cuidados indirectos, el 6,1% a actividades asociadas y el 27,7% a actividades personales. Conclusión los enfermeros dedican la mayor parte de su tiempo a actividades no relacionadas con la atención directa al paciente. Los hallazgos pueden ser utilizados por los gestores para revisar y adecuar el dimensionamiento de profesionales en la atención directa e indirecta y el proceso de trabajo en la Unidad.

ABSTRACT Objective to analyze time management by nurses in direct and indirect care interventions, in work-related and personal activities. Method this quantitative, cross-sectional study was conducted in the Intensive Care Unit of a university hospital in Rio de Janeiro in January 2017. Direct observations were made of nurses' activities in 18 shifts, totaling 216 hours. Mello's "Workload Measuring Tool" was used to structure the observations. Results 21.5% of nurses' time was devoted to direct care, 44.7% to indirect care, 6.1% to work-related activities and 27.7% to personal activities. Conclusion nurses spend most of their time on activities unrelated to direct patient care. These findings can be useful to managers in reviewing and adjusting both staffing in direct and indirect care and the unit's work process.

More Nursing Home Staff Linked to More COVID-19 Cases.

According to this study: A higher number of nursing home staff members was associated with a higher number of COVID-19 cases, independent of the size of the facility.Decreasing the number of staff members but not the number of direct care hours could help improve patient safety.

Expert nurse response to workforce recommendations made by The Coronavirus Commission For Safety And Quality In Nursing Homes.

COVID-19 has exposed the longstanding internal problems in nursing homes and the weak structures and policies that are meant to protect residents. The Centers for Medicare and Medicaid Services convened the Coronavirus Commission for Safety and Quality in NHs in April, 2020 to address this situation by recommending steps to improve infection prevention and control, safety procedures, and the quality of life of residents in nursing homes. The authors of this paper respond to the Final Report of the Commission and put forth additional recommendations to federal policymakers for meaningful nursing home reform: 1) ensuring 24/7 registered nurse (RN) coverage and adequate compensation to maintain total staffing levels that are based on residents' care needs; 2) ensuring RNs have geriatric nursing and leadership competencies; 3) increasing efforts to recruit and retain the NH workforce, particularly RNs; and 4) supporting care delivery models that strengthen the role of the RN for quality resident-centered care.

[Novel Coronavirus: Applying Transformational Leadership to the Combat of COVID-19 in Nursing Practice].

Cases in the current novel coronavirus (COVID-19) pandemic continue to increase, bringing tremendous psychological pressures to frontline caregivers and threating the ability of existing medical care systems in many countries to cope with related demands. In this situation, nursing leaders have a heightened responsibility to assist nursing staff to remain at their jobs and feel secure, to strengthen safety systems, to provide adequate equipment and personnel training, and to proactively lead nursing staff. In this article, leadership strategies implemented under the COVID-19 pandemic are presented from the perspective of transformational leadership in nursing practice. This article is divided into the following five themes: 1. Leadership makes the vision more vivid; 2. Demonstrating charismatic leadership; 3. Leaders who stimulate intellectual potential; 4. Paying attention to spiritual inspiration; 5. Providing individualized sincere care. Leaders should promote the professional role of nursing staff and provide a safe and secure practice environment.

[Experimentation of a night shift nursing position in EHPAD]. / Expérimentation d'un poste infirmier de nuit en Ehpad.

The Nouvelle-Aquitaine Regional Health Agency is experimenting with a night nurse position shared between several accommodation facilities for dependent elderly.

Impact of a Public Policy Restricting Staff Mobility Between Nursing Homes in Ontario, Canada During the COVID-19 Pandemic.

OBJECTIVES: To assess changes in the mobility of staff between nursing homes in Ontario, Canada, before and after enactment of public policy restricting staff from working at multiple homes. DESIGN: Pre-post observational study. SETTING AND PARTICIPANTS: 623 nursing homes in Ontario, Canada, between March 2020 and June 2020. METHODS: We used GPS location data from mobile devices to approximate connectivity between all 623 nursing homes in Ontario during the 7 weeks before (March 1-April 21) and after (April 22-June 13) the policy restricting staff movement was implemented. We constructed a network diagram visualizing connectivity between nursing homes in Ontario and calculated the number of homes that had a connection with another nursing home and the average number of connections per home in each period. We calculated the relative difference in these mobility metrics between the 2 time periods and compared within-home changes using McNemar test and the Wilcoxon rank-sum test. RESULTS: In the period preceding restrictions, 266 (42.7%) nursing homes had a connection with at least 1 other home, compared with 79 (12.7%) homes during the period after restrictions, a drop of 70.3% (P < .001). Including all homes, the average number of connections in the before period was 3.90 compared to 0.77 in the after period, a drop of 80.3% (P < .001). In both periods, mobility between nursing homes was higher in homes located in larger communities, those with higher bed counts, and those part of a large chain. CONCLUSIONS AND IMPLICATIONS: Mobility between nursing homes in Ontario fell sharply after an emergency order by the Ontario government limiting long-term care staff to a single home, though some mobility persisted. Reducing this residual mobility should be a focus of efforts to reduce risk within the long-term care sector during the COVID-19 pandemic.

Experiencia cubana en planificación de los recursos humanos de enfermería en la epidemia por COVID-19 / Cuban experience in human resources planning for epidemic nursing COVID-19

Introducción: la pandemia por el virus SARS-CoV-2 ha provocado numerosas víctimas en el plano mundial. A partir de los primeros casos diagnosticados en Cuba, la máxima Dirección del Estado y el Ministerio de Salud Pública dispusieron el reordenamiento de los servicios del Sistema Nacional de Salud para garantizar la atención a los pacientes confirmados con la enfermedad y los programas priorizados con el aseguramiento de los recursos humanos de enfermería, además del desarrollo de acciones para garantizar la continuidad y calidad de las prestaciones proporcionadas. Desarrollo: se organizaron grupos de pesquisa diaria del 100% de la población en las viviendas para identificar a pacientes sintomáticos y se crearon centros para la vigilancia de acuerdo con la clasificación del paciente, ya fuera con- tacto, sospechoso o confirmado. En estos centros, el personal de enfermería mantiene una vigilancia para la detección oportuna de síntomas o agravamiento del estado de salud y efectúa el control de las pruebas diagnósticas por PCR evolutiva y el cumplimiento de los tratamientos médicos hasta su alta. En los hospitales se atienden los casos confirmados y sospechosos de alto riesgo de COVID-19. En estas instituciones se estableció un sistema de trabajo-vigilancia-descanso con el objetivo de garantizar la atención con el personal estrictamente necesario. Conclusiones: este trabajo permite compartir las experiencias vivenciales en la planificación del recurso humano de enfermería en cada una de las etapas y destaca la colaboración médica como muestra de solidaridad y humanismo que caracteriza a la sociedad. Los resultados obtenidos permitirán establecer líneas de trabajo con una clara visión de este fenómeno, con utilización óptima de los recursos materiales y humanos, además de contribuir a la preparación de los profesionales para el intercambio y la experiencia con otros países.

Introduction: The pandemic caused by the SARS-CoV-2 virus has hit numbers of victims worldwide, from the first cases diagnosed in Cuba, the highest state administration and the Ministry of Public Health provides the reorganization of the services of the National System of Health, guaranteeing care for patients confirmed with the disease and prioritized programs with the assurance of nursing human resources and the development of actions to guarantee the continuity and quality of the services provided for what the purpose is outlined. Development: Daily investigation groups of 100% of the population were organized in the homes to detect symptomatic patients, surveillance centers were created according to the classification of the patient as contact, suspect and confirmed, in these centers the nurse maintains a surveillance for the timely detection of symptoms or worsening of their health, controls the performance of the evolutionary PCR and compliance with medical treatments until discharge. In hospitals, confirmed and suspected high-risk cases of COVID-19 are treated. In these institutions, a work-surveillance-rest system was established in order to guarantee care with the strictly necessary personnel. Conclusions: In this article we share the experiential experiences in the planning of the nursing human resource in each of the stages and medical collaboration stands out as a sign of solidarity and humanism that characterizes our society. The results obtained will allow establishing lines of work with a clear vision of this phenomenon with optimal use of material and human resources, as well as contributing to the preparation of professionals with a view to exchange and experience with other countries.

A organização do trabalho, a carga de trabalho e o dimensionamento de pessoal de enfermagem em ambulatórios de quimioterapia em Minas Gerais / Work organization, workload and sizing of nursing staff in chemotherapy outpatient clinics in Minas Gerais

A organização do trabalho, a carga de trabalho e o dimensionamento de pessoal de enfermagem em ambulatórios de quimioterapia em Minas Gerais. 2021. 118 f. Dissertação (Mestrado em Enfermagem) ­ Escola de Enfermagem, Universidade Federal de Minas Gerais, Belo Horizonte, 2021. Introdução: O tratamento quimioterápico no nível ambulatorial é um desafio, pois o câncer como um problema de saúde pública, no Brasil e mundo, tem crescido em número e complexidade. Neste contexto, a enfermagem se destaca, não apenas por sua quantidade de profissionais, mas pela capacidade de gestão da unidade e de casos, atuando com primazia no cuidado. Contudo, cabe ao enfermeiro, responsável técnico, a garantia de um adequado quantitativo de profissionais para a realização dos cuidados de forma segura e com qualidade. O gerenciamento de recursos humanos se inicia com a previsão quanti-qualitativa de profissionais e se mantém com a avaliação contínua da carga de trabalho a fim de se adequar o quantitativo conforme demanda. No entanto, esse dimensionamento constitui-se como um desafio para o trabalho do enfermeiro gestor, por impactar tanto na qualidade quanto nos custos assistenciais. Destaca-se que na oncologia ambulatorial há uma carência de evidências científicas, legislações e recomendações que balizem as tomadas de decisão para esse dimensionamento. Objetivo: Analisar a organização do trabalho e as formas de mensuração da carga de trabalho e dimensionamento de pessoal de enfermagem utilizados em ambulatórios de quimioterapia do estado de Minas Gerais. Método: Pesquisa descritiva de abordagem quantitativa, desenvolvida com 20 enfermeiros gestores de ambulatórios oncológicos de Minas Gerais. Os dados foram coletados por meio de formulário online, composto pelo TCLE e 54 perguntas concernentes ao perfil dos respondentes, dos serviços, organização do trabalho e do dimensionamento de pessoal. Os dados foram submetidos a análise estatística descritiva e de correlação, por meio de software IBM SPSS versão 23. Foram obedecidos os requisitos éticos. O projeto foi aprovado pelo COEP-UFMG. Resultados: 75% dos enfermeiros possuem mais de 6 anos de experiência na oncologia ambulatorial e 75% a caracterizaram como alta complexidade. 60% dos ambulatórios estão localizados na região metropolitana de Belo Horizonte, sendo 40% em clínicas oncológicas. 55% dos serviços não possuem certificado/ acreditação. A mediana do número de profissionais enfermeiros é de 5,5 e de técnicos é de 3. Quanto ao perfil estrutural, o número de leitos/poltronas para infusão de quimioterapia variou entre 10 e 30, sendo o quantitativo de pacientes/dia atendidos pelos ambulatórios variado de 10 a 100. 50% funcionam de segunda a sexta-feira das 07:00 às 19:00 horas. Todos conhecem as Resoluções ANVISA nº 220/2004 e Cofen nº 569/2018, enquanto 90% conhecem a Resolução Cofen nº 543/2017 e 55% dizem conhecer o método de Sítio Funcional. Contudo, apenas 10% relataram ter recebido capacitação para dimensionar equipe. 55% dos enfermeiros relataram não utilizar nenhum instrumento para dimensionamento. 65% não utilizam nenhum instrumento para monitorar carga de trabalho. Destaca-se que 66,7% consideraram o quadro de pessoal adequado e 65% sentiam segurança para dimensionar. Conclusão: A organização do trabalho de enfermagem e a realidade operacional dos ambulatórios estudados são heterogêneos, mas demonstram fragilidade no domínio dos enfermeiros quanto a formas de monitorização da carga de trabalho e dimensionamento de pessoal. Os resultados deste estudo constituem- se como importante alerta quanto a necessidade de aprofundamento desse conhecimento junto aos enfermeiros para que se estabeleçam melhorias no processo de organização do trabalho para manutenção de uma assistência de qualidade e segura.

Work organization, workload and nursing staff dimensioning in chemotherapy outpatient clinics in Minas Gerais. 2021. 118 f. Dissertation (Master in Nursing) ­ School of Nursing, Federal University of Minas Gerais, Belo Horizonte, 2021. Introduction: Chemotherapy treatment at the outpatient level is a challenge because cancer is a public health problem in Brazil and worldwide that has grown in number and complexity. In this context, nursing stands out, not only for the number of professionals but also for their capacity to manage both the unit and the patient care path. However, it is up to the nurse, the technical manager, to ensure adequate professionals to provide safe and quality care. This management of human resources begins with the quantitative-qualitative prediction of professionals and continues with the continuous evaluation of the team's workload to adjust the quantity according to demand. However, this staff dimensioning constitutes a challenge for the nurse manager, as it impacts both the quality and costs of care. It is noteworthy that in outpatient units, there is a lack of scientific evidence, legislation, and recommendations for guiding the decision making about nursing staffing requirements. Objective: To analyze the organization of work and the methods of measuring workload and nursing staffing used in chemotherapy outpatient clinics in Minas Gerais. Method: Descriptive research with a quantitative approach, developed with 20 nurse managers of oncology outpatient clinics in Minas Gerais. Data were collected using an online survey form composed of the TCLE and 54 questions concerning the respondents' profile, services and work organization, and staff dimensioning. Data were submitted to descriptive statistical and correlational analysis, using IBM SPSS software version 23. Researchers followed the ethical requirements for the development of the project, which was approved by COEP UFMG. Results: 75% of the nurses had more than 6 years of experience in the outpatient oncology unit, and 75% characterized outpatient oncology as high complexity. 60% of the outpatient clinics are located in the metropolitan region of Belo Horizonte, being 40% in oncology clinics. 55% of the services do not have a certificate/accreditation. The median number of nursing professionals is 5.5, and of technicians is 3. Regarding the structural profile, the number of beds/seats for chemotherapy infusion was concentrated in units ranging from 10 to 30, while the number of patients/days attended by the outpatient clinics was 10 up to 100. 50% work from Monday to Friday from 07:00 to 19:00. All participants know Resolutions ANVISA No. 220/2004 and Cofen No. 569/2018, while 90% know Cofen No. 543/2017 and 55% said they know the Functional Site method. However, only 10% reported receiving training on team sizing. 55% of nurses reported not using any instrument to size a team. 65% of the nurses do not use any tool to monitor workload. It is noteworthy that 66.7% considered the staff adequate, and 65% felt safe to size. Conclusion: The organization of nursing work and the operational reality outpatient clinics studied are heterogeneous but demonstrate weaknesses in the nurses' domain regarding workload monitoring and staff requirements. The study results constitute an important alert to the need for improvements of this skill in these nurse groups to establish enhancements in organising the work and monitoring workload staff requirements to guarantee the quality and safety of nursing care.

Nurse Staffing and Coronavirus Infections in California Nursing Homes.

In the United States, 1.4 million nursing home residents have been severely impacted by the COVID-19 pandemic with at least 25,923 resident and 449 staff deaths reported from the virus by June 1, 2020. The majority of residents have chronic illnesses and conditions and are vulnerable to infections and many share rooms and have congregate meals. There was evidence of inadequate registered nurse (RN) staffing levels and infection control procedures in many nursing homes prior to the outbreak of the virus. The aim of this study was to examine the relationship of nurse staffing in California nursing homes and compare homes with and without COVID-19 residents. Study data were from both the California and Los Angeles Departments of Public Health and as well as news organizations on nursing homes reporting COVID-19 infections between March and May 4, 2020. Results indicate that nursing homes with total RN staffing levels under the recommended minimum standard (0.75 hours per resident day) had a two times greater probability of having COVID-19 resident infections. Nursing homes with lower Medicare five-star ratings on total nurse and RN staffing levels (adjusted for acuity), higher total health deficiencies, and more beds had a higher probability of having COVID-19 residents. Nursing homes with low RN and total staffing levels appear to leave residents vulnerable to COVID-19 infections. Establishing minimum staffing standards at the federal and state levels could prevent this in the future.

Implementation of the policy protocol for management of surgical and non-surgical wounds in selected public health facilities in Ghana: An analytic case study.

BACKGROUND: It is estimated that millions of patients are affected by healthcare associated infections (HAIs) each year. In Ghana, high prevalence of HAIs in relation to non-surgical (also called contaminated wounds) and surgical wounds (also called sterile wounds) is largely attributed to poor adherence to policy protocols for wound management by frontline clinical staff especially nurses. OBJECTIVE: Investigate the extent to which nursing staff adhere to the policy protocol for management of non-surgical and surgical wounds in selected public health facilities in Ghana. METHODOLOGY: This is an analytic case study among nursing staff (n = 140) in three government facilities in the Volta region of Ghana. Subjective and objective performance scores of staff on adherence proxies were compared using the Wilcoxon Signed-rank test, and univariate ordered logistic regression analysis used to predict staff likelihood of adherence to policy protocols on non-surgical and surgical wound management. FINDINGS: Overall, staff self-rated themselves higher on subjective performance proxies relative to their objective scores (p<0.05). Staff with more years of work experience did not translate into a higher likelihood of adhering to standard protocol on wound management (Coef. = -0.49, CI = -0.93-0.05, p = 0.036). Being a senior nursing officer relative to lower nursing ranks increased staff likelihood of complying particularly with standard policy protocol for management of non-surgical wounds (Coef. 5.27, CI = 0.59 9.95, p = 0.027). CONCLUSION: There is the need for accelerated in-service training for staff on standard protocols for wound management coupled with supportive supervisions. Staff adherence to standard quality care protocols should be a pre-requisite for licensing of health facilities by regulatory bodies like Health Facilities Regulatory Agency and National Health Insurance Authority.

Effective nurse leadership in times of crisis.

The emergence of coronavirus disease 2019 (COVID-19) has meant that nurse leaders need to respond rapidly and decisively to the demands and challenges of a pandemic in a context of increased staff shortages and limited resources. This article suggests essential leadership skills and characteristics that nurses can use to underpin effective leadership in a crisis, emphasising the importance of decision-making and emotional intelligence. It also addresses two important questions: 'what do leaders in a crisis need to do that differs from any other time?' and 'what does effective leadership look like in a crisis?'