Actions and interactions in clinical nursing practice in Primary Health Care. / Ações e interações na prática clínica do enfermeiro na Atenção Primária à Saúde.

OBJECTIVE: Understanding the actions and interactions required for developing clinical nursing practice in Primary Health Care. METHOD: A qualitative study anchored in the Grounded Theory. Data was collected between April and October 2016 with nurses divided into two sample groups. RESULTS: Eighteen (18) nurses participated in the study. The category "Recognizing the Systematization of Nursing Care as an essential element for clinical nursing practice" supports the "actions-interactions" component and it is composed of two subcategories: "Accomplishing clinical practice in nursing consultations", which presents the challenges encountered in performing clinical practice; and "Highlighting management tools for evidence-based clinical practice", which operates through strategies in response to the studied phenomenon. CONCLUSION: Care actions developed in clinical nursing practice are highlighted by the systematization of care in nursing consultations, a moment of direct interaction with the individual, thus contributing to improvement in the quality of care provided.

Meaning of nursing care to brain dead potential organ donors. / Significados do cuidado de enfermagem ao paciente em morte encefálica potencial doador.

OBJECTIVE: To understand the meanings of care to brain dead potential organ donors for nurses, and construct a theoretical model. METHOD: Qualitative study based on the Grounded Theory approach. Data were collected through open interviews with 12 nurses, distributed in three sample groups in a university hospital in northeastern Brazil, from December 2010 to June 2011. RESULTS: The phenomenon Unveiling multiple relationships and interactions of nurses in the complexity of patient care in brain dead potential donors is supported by the interrelationship of five categories and results from the need to organize care practices in the context of the intensive care unit, considering the factors involved in the relationship between nurses, staff and family and reveals challenges for nurses imposed by the complexity of the care process. CONCLUSIONS: The meaning of care to brain dead potential donors involves understanding the complexity of this patient who can save somebody's life through organ donation.

Brazilian research groups in nursing: comparison of 2006 and 2016 profiles. / Grupos de pesquisa em enfermagem no Brasil: comparação dos perfis de 2006 e 2016.

OBJECTIVE: To compare the profile of nursing research groups registered at the CNPq Research Groups Directory in 2006 and 2016. METHOD: Descriptive and documentary analysis, The data has been collected in 2006 and in 2016, with parameterized search with the term "nursing" at the CNPq Research Groups Directory. The selected variables have been organized in a Microsoft Office Exce spreadsheetl. RESULTS: The research groups have increased from 251 in 2006 to 617 in 2016, with important increase of the number of participants, among students and researchers. There was a decrease of the number of groups without students. However, 22% remain without undergraduate students' participation. CONCLUSIONS: It has been observed an important increase regarding the interest on research activities, when comparing both scenarios. The nursing research groups reflect structural and political advances in generation of science, technology and innovation, however, the undergraduate students' and the foreign researchers' participation should still be encouraged.

Care management and leadership according to nurses' perception in the hospital context of COVID-19.

OBJECTIVE: To understand how nursing care management occurred during the COVID-19 pandemic. METHOD: A qualitative study conducted at a university hospital in São Paulo, Brazil. The sample consisted of eight nurses who worked caring for patients who tested positive for COVID-19. Data collection was carried out through semi structured interviews about experiences in managing care in coping with the pandemic. Thematic analysis and interpretation based on psychodynamics of work were used in data analysis. RESULTS: The results allowed constructing three thematic categories: The invisible that limits: biosafety, distress, uncertainty and fear of the pandemic, protecting oneself and ensuring the protection of others; Management work process instruments: team training, staff sizing, materials management, creative practice in the face of insufficiency; The competencies involved with the team, teamwork and leadership. CONCLUSION: Care management in COVID-19 was permeated by objective and subjective conditions, with situations of distress, pleasure, fear, insecurity and creative adaptation. Teamwork and leadership competencies, when present, can alleviate the distress that occurs in nursing work.

Nursing leadership strategies in addressing COVID-19 in light of John Kotter's framework.

OBJECTIVE: To analyze the leadership strategies of nurses in university hospitals in response to care management changes during the COVID-19 pandemic, informed by John Kotter's insights. METHODS: This multicentric study utilized qualitative and analytical methods. It was conducted through semi-structured interviews with 139 lead nurses from 10 university hospitals in Brazil. Data analysis included Bardin's content analysis and the webQDA software. RESULTS: The primary category identified was "Nursing Leadership Strategies in the Battle Against COVID-19," encompassing five subcategories. This category underscored the importance of strategic vision in nursing leadership for combating COVID-19 within hospital settings, as well as the necessity of working collaboratively with their teams and other healthcare professionals. FINAL CONSIDERATIONS: The results highlight the strategies used by lead nurses in confronting COVID-19, which can be associated with John Kotter's theoretical framework and his model of change.

Barriers to Discharge of Hip Fracture Patients From An Academic Hospital: A Retrospective Data Analysis.

Introduction: Adherence to best practices for care of hip fracture patients is fundamental to decreasing morbidity and mortality in older adults. This includes timely transfer from the hospital to rehabilitation soon after their surgical care. Hospitals experience challenges in implementing several best practices. We examined the potential barriers associated with timely discharge for patients who underwent a hip fracture surgery in an academic hospital in Ontario, Canada. Methods: We conducted a retrospective cross-sectional review of a local database. We used descriptive statistics to characterize individuals according to the time of discharge after surgery. Multivariable binary logistic regression was used to evaluate factors associated with delayed discharge (>6 days post-surgery). Results: A total of 492 patients who underwent hip fracture surgery between September 2019 and August 2020 were included in the study. The odds of having a delayed discharge occurred when patients had a higher frailty score (odds ratios [OR] 1.19, 95% confidence interval [CI] 1.02;1.38), experienced an episode of delirium (OR 2.54, 95% CI 1.35;4.79), or were non-weightbearing (OR 3.00, 95% CI 1.07;8.43). Patients were less likely to have a delayed discharge when the surgery was on a weekend (OR .50, 95% CI .32;.79) compared to a weekday, patients had a total hip replacement (OR .28, 95% CI .10;.80) or dynamic hip screw fixation (OR .49, 95% CI .25;.98) compared to intramedullary nails, or patients who were discharged to long-term care (OR .05, 95% CI .02;.13), home (OR .26, 95% CI .15;.46), or transferred to another specialty in the hospital (OR .49, 95% CI .29;.84) compared to inpatient rehabilitation. Conclusions: Clinical and organizational factors can operate as potential barriers to timely discharge after hip fracture surgery. Further research is needed to understand how to overcome these barriers and implement strategies to improve best practice for post-surgery hip fracture care.

Quality of Care Transition for COVID-19 Patients in a University Hospital in Southern Brazil.

OBJECTIVE: To assess the quality of care transition from hospital to home for COVID-19 patients. METHOD: A cross-sectional study conducted at a University Hospital in Southern Brazil, involving 78 patients discharged after COVID-19 hospitalization. Data collection was performed via telephone using the Brazilian version of the Care Transitions Measure (CTM-15). Data were analyzed using descriptive and analytical statistics. RESULTS: The mean quality of care transition was 70.8 on a scale ranging from zero to 100, indicating moderate quality of care transition. The highest score was attributed to factor 1, "Preparation for self-management," and the lowest to factor 4, "Care Plan." CONCLUSIONS: It is important to enhance communication and support provided to patients during the transition process, especially regarding understanding prescribed medications and the development of clear care plans.

Nurses' perceptions of leadership in Brazilian hospitals during COVID-19 through Kotter's conception.

OBJECTIVE: to understand nurses' leadership perceptions during the COVID-19 pandemic in Brazilian university hospitals, through the lens of John Kotter's concepts and his eight-step change model. METHOD: a multicenter qualitative research with an analytical design. The sample comprised 139 nurses working in COVID-19 settings, interviewed using a semi-structured interview guide. Data were categorized through Bardin's content analysis based on John Kotter's concepts and his eight-step change model. RESULTS: the findings yielded significant insights into nurses' perceptions of leadership during the COVID-19 response, which exhibited characteristics consistent with Kotter's principles. There is evidence of leadership based on the pursuit of knowledge, grounded in polished communication, facilitating teamwork through a relationship of trust and respect. The recognition of the complexity and difficulty of exercising nursing leadership, particularly in crisis contexts, is apparent. CONCLUSION: nurses' perceptions reinforce essential elements for leadership practice, such as the importance of seeking diverse knowledge, polished communication, relationships based on trust and respect, and recognition of the complexity of leadership, thus presenting characteristics in line with Kotter's principles. HIGHLIGHTS: (1) Nurses' perceptions of leadership during COVID-19 were highlighted. (2) COVID-19 intensified the complexity in nurses' leadership roles. (3) Nurses' leadership was consolidated in knowledge, communication, trust. (4) Working in the COVID-19 response as a nurse-leader has become challenging. (5) Kotter's principles assist in reflections on nurses' leadership.

Continuity of care for children with chronic conditions: mixed methods research.

OBJECTIVE: To analyze the continuity of care for children with chronic conditions from the transition from hospital to home. METHOD: Parallel-convergent mixed-methods research, with a cross-sectional study and Grounded Theory. A characterization instrument and the Care Transitons Measure were applied to 201 legal guardians of children with chronic conditions, and semi-structured interviews were conducted with 35 participants (among professionals and guardians). Data were combined by integration. RESULTS: The efforts of the hospital team to promote continuity of care after discharge from the transition from hospital to home impact on the quality-of-care transition perceived by caregivers, with a mean of 89.5 (standard deviation = 12.5) points. However, the absence of formal mechanisms to guide the transition of care makes it difficult to achieve continuity of care in the health network. CONCLUSION: Continuity of care for children is hindered by barriers, against which hospital care professionals seek individual strategies to overcome them. It is essential to establish institutional actions and public policies aiming at the transition of care to promote continuity of care.

Quality of child and adolescent care transitions considering the presence of chronic disease.

OBJECTIVES: to analyze the quality of child and adolescent care transitions from hospital to home, considering the presence of chronic disease. METHODS: quantitative, cross-sectional study, carried out from February to September 2019 in two hospitals in the south of Brazil. We used an instrument to characterize participants and the Care Transitions Measure (CTM-15) for the legal tutors of children and adolescents that were discharged from the institutions. RESULTS: the general mean of the quality of transition of care was 87.9 (SD=13.4), in a scale from 0 to100). We found a significant difference in the quality of transition of care when comparing patients with and without chronic disease (90.0 and 84.3; p=0.001). CONCLUSIONS: we found the quality of the transition of care to be satisfactory, with better results for patients with chronic disease. This can help understand the most impactful aspects in the transition of care, especially in regard to children health.

[Meaning the process of living the coronary artery bypass graft surgery: changes in lifestyle]. / Significando o processo de viver a cirurgia de revascularização miocárdica: mudanças no estilo de vida.

The study aimed to understand how patients mean your experience process of living after surgical revascularization. Will be presented in this article, a category and seven subcategories that represent significant changes from that experience, that is, the "consequences" component of the paradigm model, according to Grounded Theory, method of study. Participated in data collection 23 subjects The interviews were semi-structured and took place from October 2010 to August 2011. Significant changes are related to aspects of social and sexual life, work diet physical activity and drug treatment. We conclude that surgical revascularization experience encourages the reflection and the (re) think the lifestyle, it has limitations and difficulties that challenge changes in daily habits of patients and families to live a healthier process.

Network professional interaction in the care of patients with stroke.

OBJECTIVE: to understand the professional interaction in the Emergency Care Network in the care of patients with acute ischemic stroke in the city of Salvador/Bahia. METHODS: the Grounded Theory methodological framework, Straussian strand, and the health networks theoretical framework were used. An in-depth interview was used, between October 2019 and October 2020, with 75 professionals from the Mobile Emergency Care Service, Emergency Care Units and reference hospital. RESULTS: 5 categories and 24 subcategories point to shared goals among professionals, but they show elements of fragmentation of connections between services, such as the absence of a single language and conduct, obstacles to professional relationships and lack of knowledge of the other's role. CONCLUSIONS: to improve network relationships and care of patients with stroke, there is a need for well-established connecting elements, such as flows and protocols, supported by continuing education actions.

Continuity of care for children with chronic conditions after discharge: a constructivist grounded theory.

OBJECTIVES: to understand the meaning of continuity of care for children with chronic conditions through transitional care from hospital to home. METHODS: this is a qualitative study, conducted from a Constructivist Grounded Theory perspective. Purposive and theoretical sampling were used to recruit 35 participants, including nurses, professionals from the interprofessional hospital team, and actors responsible for healthcare in the home context. The research was conducted at two large hospitals, between March and September 2019. Semi-structured interviews were conducted. Data analysis was carried out using initial and focused coding, according to constructivist grounded theory. RESULTS: the substantive theory that emerged from this study was named "Postponing the next hospitalization". Eight categories-concepts and 18 elements were derived from the data to support the substantive theory. FINAL CONSIDERATIONS: transitional care from hospital to home acts as a reminder for the resumption of continuity of care after discharge.

Management in the care of people with HIV in primary health care in times of the new coronavirus.

OBJECTIVE: To understand management practices in the care of people living with the human immunodeficiency virus (HIV) in primary health care in a Brazilian capital, in times of the new coronavirus (covid-19) pandemic. METHOD: Qualitative research, anchored in the methodological-analytical framework of the grounded theory, constructivist aspect. Data were collected by using intensive online interviews with nurses from health centers and managers of the municipal health department. Data collection and analysis occurred concomitantly in two phases of analysis: initial and focused coding. RESULTS: They point to the development of best care practices, with emphasis on initiatives for coordination of care, decentralization of clinical management for primary health care services, establishment of protocols and flows, agreement of intersectoral partnerships, use of groups and social networks, use of tools such as teleconsultation and health surveillance spreadsheet and formation of support networks. CONCLUSION: The Brazilian capital restructured its network of health services with the implementation of clinical and management protocols, seeking to maintain care for people living with HIV. We highlighted the incorporation of non-face-to-face care technologies and the facilitation of routines, as strategies for expanding access.

Quality of transitional care of children with chronic diseases: a cross-sectional study.

OBJECTIVE: To analyze which factors may be associated with the quality-of-care transition of children with chronic diseases from the hospital to their home. METHOD: A cross-sectional, quantitative study, carried out in two hospitals in Southern Brazil, from February to September 2019. Participants included 167 family members of children with chronic disease. Data collection took place through a demographic questionnaire, and the use of the Brazilian version of the Care Transitions Measure (CTM-15). RESULTS: The average score for the quality of care transition was 90.1 (sd = 19.5) (0-100). Factor 1, "Health management preparation", was the one with the highest self-perceived average, 92.3 (sd = 11.6), while Factor 4, "Care plan", had the lowest average, 86.3 (sd = 21.3). The quality of care transition was higher for patients living in municipalities belonging to health regions other than the hospital's. CONCLUSION: The quality of care transition for children with chronic diseases, perceived by the children's family members, in the discharge process from the hospital to home, was considered high. Living in a health region other than the hospital's region was associated with better perception of the quality of care transition.

Best leadership practices of nurses in hospital risk management: case study.

OBJECTIVE: To highlight the best leadership practices of nurses who contribute to hospital risk management. METHOD: Single case study with two integrated units of analysis, with a qualitative approach. Data collected from April to November 2018, through focused interviews with nurse managers, non-participant observation and documentary research. Analysis using the analytical technique to the explanation construction. RESULTS: Three thematic categories were evidenced, demonstrating that the best leadership practices involve technical and non-technical competencies anchored in behavioral development, scientific knowledge, guidelines for quality and patient safety and participatory management of the health team. CONCLUSION: The best leadership practices of nurses who contribute to hospital risk management pervade technical skills and/or formal positions, valuing each team professional in a unique way and emphasizing the importance of scientific knowledge and the professional reference model that the nurse exercises in hospitals.

Validation of an educational game about first aid for schoolchildren.

OBJECTIVES: to validate the content and appearance of an educational game about first aid for schoolchildren with experts in education and health. METHODS: this is a methodological, quantitative and descriptive research, carried out using the Delphi technique, using an online collection instrument, covering 55 items of the game. Content and appearance assessment was performed by 26 judges. The data were analyzed using Content Validity index. RESULTS: the final prototype is presented in a board format, composed of four buildable pawns and 117 cards between questions, alerts and challenges. Overall Content Validity index of 0.95 and greater than 0.8 was obtained for all items in two Delphi rounds. CONCLUSIONS: the educational game validated by experts is a pedagogical tool for teaching first aid to schoolchildren as an option to traditional educational practices.

Validation of nursing diagnosis for nursing consultation on home visit to adults.

OBJECTIVES: to identify and confirm the priority nursing diagnosis of International Classification for Nursing Practice® for home nursing consultation to adults in Primary Health Care. METHODS: qualitative study, of methodological and validation type. The 5-point Likert scale was used, with a minimum Content Validity Index of 80% consensus among judges., considering the answers "priority" or "very priority" for the list of nursing diagnoses presented. 23 expert judges participated in this survey. RESULTS: a hundred and eleven nursing diagnoses of prepared statements lists have been grouped by human systems and sociodemographic characteristics. were grouped by human systems and sociodemographic characteristics. Eighty-three of them (74.77%) had a Content Validity Index equal or higher to 0.8; and 27 (32.5%) had an index of 1.0 (100%) among judges. CONCLUSIONS: nursing diagnosis validated can be used to assist clients in home nursing consultations in Primary Health Care.

Professional interaction in management of the triad: Permanent Education in Health, patient safety and quality.

OBJECTIVE: to understand how professional interaction takes place in the hospital organizational structure for the management of Permanent Education in Health, to guarantee patient safety and the quality of nursing care. METHOD: this is a qualitative study, which used the structuralist aspect of the Grounded Theory as a methodological framework. 27 interviewers participated in the study, who made up four sample groups. RESULTS: six categories and 13 subcategories were presented, representing the studied phenomenon and highlighting particularities of the public health system and the influence of the manager's support and management priority, the disposition of the organizational structure, the institutional culture, the external encouragement to institution, and the nurses' initiative and leadership in the professional interaction for the management of the Permanent Education in Health, patient safety, and quality of care triad, revealing the need for cultural change through interdisciplinarity. CONCLUSION: the professional interaction in the hospital organizational structure requires the creation of new management models with an emphasis on more participative management, in order to improve the care processes in hospital institutions.

University educational management and clinical practice applied to nursing by the faculty of a public university.

OBJECTIVE: to emphasize university educational management actions and their articulation to develop clinical practice in nursing training, designed by its faculty. METHODS: a single-case study with qualitative approach. The sources were composed of documentary research, focused interview with key informant and direct non-participant observation. Data were organized with the help of NVivo®10. Analysis followed the explanation construction technique from the perspective of complex thinking. RESULTS: three categories emerged: Characterization of university educational management actions; Articulation of university educational management with clinical practice and its repercussion; and Spaces to develop university educational management and clinical practice. Final considerations: university educational management actions are associated with the work of professors, supporting teaching, research, and extension in order to improve clinical knowledge in the general nursing training.