Predictors of death in an Intensive Care Unit: contribution to the palliative approach. / Fatores preditores de óbito em Unidade de Terapia Intensiva: contribuição para a abordagem paliativista.

OBJECTIVE: To identify predictors of death in the Intensive Care Unit and relate eligible patients to preferential palliative care. METHOD: A prospective cohort study that evaluated patients hospitalized for more than 24 hours, subdivided into G1 (patients who died) and G2 (patients who were discharged from hospital). For identifying the predictors for death outcome, the intensivist physician was asked the "surprise question" and clinical-demographic data were collected from the patients. Data were analyzed by descriptive/inferential statistics (p<0.05 significance). RESULTS: 170 patients were evaluated. The negative response to the "surprise question" was related to death outcome. A greater possibility of death (p<0.05) was observed among older and more frail patients with less functionality, chronic cardiac and/or renal insufficiencies or acute non-traumatic neurological insult, with multiorgan failure for more than 5 days, and hospitalized for longer. CONCLUSION: Predictors of death were related to a subjective evaluation by the physician, the clinical condition of the patient, underlying diseases, the severity of the acute disease and the evolution of the critical illness. It is suggested that patients with two or more predictive criteria receive preferential palliative care.

Intensive care unit team perception of palliative care: the discourse of the collective subject.

OBJECTIVE: To learn the perception of health professionals in an intensive care unit towards palliative care. METHOD: This was a descriptive and qualitative study based on the converging care approach conducted at an intensive care unit in the South of Brazil. Semi-structured interviews were used to investigate the understanding of the professionals about palliative care in this unit. The data were organized and analyzed using the discourse of the collective subject method with the help of Qualiquantisoft® software. RESULTS: Participants included 37 professionals (12 nurses, 11nursing technicians, 5 physical therapists and 9 doctors). The key ideas extracted from the interviews were: care in the end stage of life that avoids futile measures; comfort care; lack of standardized care and lack of team training. CONCLUSION: The professionals perceived palliative care as appropriate in the last stages of life, with no need for futile treatment or as comfort measures. However, they are aware of the lack of standardization and lack of capacity building in this area, which leads them to conceive palliative care as terminal care, and measures are recommended to break with this stigma. OBJETIVO: Conhecer a percepção dos profissionais de saúde de uma Unidade de Terapia Intensiva acerca do cuidado paliativo. MÉTODO: Pesquisa descritiva, qualitativa do tipo Convergente Assistencial realizada em uma Unidade de Terapia Intensiva da região sul do Brasil. Utilizou-se de entrevista semiestruturada que investigou o entendimento e a compreensão sobre cuidado paliativo nesta unidade. Os dados foram organizados e analisados pela técnica do discurso do sujeito coletivo com auxílio do software Qualiquantisoft®. RESULTADOS: Participaram do estudo 37 profissionais (12 enfermeiros, 11 técnicos de enfermagem, cinco fisioterapeutas e nove médicos). As ideias centrais extraídas dos relatos: cuidado na fase terminal da vida sem medidas fúteis; cuidados de conforto; falta uniformizar a assistência e falta capacitação para a equipe. CONCLUSÃO: Os profissionais percebem o cuidado paliativo apropriado na fase terminal da vida, sem necessidade de medidas fúteis de tratamento e promotoras de conforto. No entanto, estão conscientes da falta de uniformização e da sua capacitação nesta matéria, o que os leva a conceber o paliativismo como cuidado de terminalidade, pelo que se recomendam medidas para romper com este estigma.

Ethical conflicts and the process of reflection in undergraduate nursing students in Brazil.

BACKGROUND: Nursing students on clinical placements as part of their professional training are routinely faced with situations involving ethical conflicts. The initial act of perceiving a situation as causing an ethical dilemma is the result of both the students' personal values, drawn from their culture and families, and of the professional knowledge and values that they have acquired through training and experience. OBJECTIVES: Nursing students' experiences on clinical placements in primary care settings were investigated in order to identify situations that they perceived as involving ethical conflict and describe the elements they took into consideration during their decision-making processes in these situations. METHODS: The research design was qualitative descriptive case study. Around 50 students from three different intakes to a nursing degree answered a questionnaire and discussed it in focus groups. ETHICAL CONSIDERATIONS: The study was designed in accordance with the principles guiding research with human beings and was approved by the Human Research Ethics Committee. RESULTS: Synthesised into two principal axes: (a) ethical conflicts in primary care, linked with the domains of working processes, professional nursing ethics and human and social rights and (b) students' decision-making processes - realisation, reflection and intervention. CONCLUSION: The student nurses saw themselves both as actors and spectators in situations involving ethical problems and demanding moral deliberation, demonstrating the ability to base their arguments soundly. They tended to emphasise the possibilities offered by dialogue and that different ethical values must be respected to find fair solutions to ethical problems.

Low back pain self-management mobile applications: a systematic review on digital platforms.

OBJECTIVE: To identify and analyze the features and quality of self-management support of mobile applications available in Brazil for chronic low back pain in adults. METHOD: A systematic review on the Apple Store® and Google Play® digital platforms. The Self-Management Support Assessment Tool scale was used to assess self-management support and the Institute for Healthcare Informatics Functionality Score scale was used to assess functionality. RESULTS: Seventeen applications were selected, which included around seven self-management skills. The applications that met the majority of self-management support skills were Pathways, Branch, Pancea, Pain Navigator, and Curable. The Curable, Branch and MoovButh applications had the highest scores, with ten features on the functionality scale. CONCLUSION: Some applications have the potential to complement in-person treatment in terms of validity, acceptability and clinical usefulness in pain management. However, barriers such as lack of partnership between healthcare providers and patients, limited evidence-based content, social support, cultural relevance, cost, language, security and privacy can limit their sustained use. PROSPERO Registration: CRD42022382686.

Assistance to victims of violence in Emergency services from the Forensic Nursing perspective.

OBJECTIVE: to analyze nurses' role in collecting, identifying and preserving traces in Emergency care for victims of violence, from the perspective of these professionals. METHOD: a qualitative study with an exploratory and descriptive approach. It was developed through semi-structured interviews with 21 nurses from hospitals that are part of the intersectoral flow to assist victims of violence from two reference hospitals in this type of care, in a capital city from southern Brazil. Nurses that are members of the multiprofessional team working in the Emergency areas at the respective hospitals were included; in turn, the exclusion criteria corresponded to professionals relocated in Emergency areas during the pandemic. Data analysis was performed according to Thematic Content Analysis. RESULTS: the data were discussed in five categories: 1) Professional qualification; 2) Institutional protocol and materials; 3) The professionals' perceptions; 4) The professionals' actions; and 5) Team structure. CONCLUSION: Nursing professionals' skills in collecting, identifying and preserving traces in Emergency assistance provided to victims of violence need to be better organized, structured and standardized. The presence of Nursing professionals in the care of victims of violence in Emergency services is undeniable, but their importance is still underestimated and their potential contribution to the forensic approach is underused.

[Hospitalization by court order: ethical dilemmas experienced by nurses]. / Internação por ordem judicial: dilemas éticos vivenciados por enfermeiros.

A qualitative study aimed at describing the situations experienced and the ethical dilemmas of nurses in the process of referring and receiving hospitalized patients by court order who require admission to the Intensive Care Unit (ICU). A partially structured interview was conducted with 10 nurses who worked in the ICU and 10 who worked in the Emergency Room (ER) in public and private hospitals in the metropolitan area of Porto Alegre, Brazil. The data was analyzed following the Semantic Analysis. The results indicated that nurses experienced ethical dilemmas associated with problems of overcrowding in emergency rooms and ICUs, poor specialized technology and orientation as to the benefits provided by law. We concluded that it is essential for nurses to participate in discussions that allow the planning of the different instances that have been promoting this often chaotic situation.

Adaptation and Validation of a Moral Distress Instrument in Mental Health Nurses.

Background and Purpose: To adapt and validate the Brazilian Scale of Moral Distress in Nurses for the mental health field. Methods: A cross-sectional methodological study was carried out, adapted with the contribution of 34 specialists, and validated by 173 mental health nurses. Results: The validated scale consists of 37 items divided into seven factors, and they were responsible for 77.2% of variance-working conditions, advocacy for the values and rights, professional safety and autonomy, ethical violations, social conflicts, ethical-professional competence, and conflicts with the management, with Cronbach's alpha at .972 for the entire instrument, and ranging from .852 to .949 for the constructs. Conclusion: The results provide evidence that the adapted instrument is reliable, valid, and consistent in measuring moral distress in mental health nurses.

Actions of a cancer surveillance technical group based on the perspective of advocacy.

OBJECTIVE: To analyze epidemiological surveillance actions for people with cancer based on the perspective of advocacy. METHOD: Qualitative study, Convergent Care Research type, combined with the framework of health advocacy. It was carried out in the Epidemiological Surveillance of the Health Department of a municipality in the southern region of Brazil. RESULTS: Eleven health service professionals participated in the study, from June 2020 to July 2021, making up 14 group meetings. Two aspects were discussed: (1) problems involving the management of the work process in the network services, directly influencing user assistance; and (2) issues related to the training management of the professional who works at these services, where the lack of knowledge regarding the legislation leads to serious consequences for the users. CONCLUSION: The advocacy strengthened health defense concepts and ideas, mobilizing actions related to cancer, acting as a bridge between the members of the group and the sectors holding power to change circumstances that prevent compliance with public policies and current legislation.

Development of the Patient Advocacy Scale for Intensive Care Nurses.

Background and Purpose: To describe the process of developing and validating the content of the Patient Advocacy Scale for Nurses in Intensive Care (EAPEnf-UTI). Methods: Methodological research. To achieve the elaboration objective, five stages were developed: (a) definition of the theme, (b) generation of the number of items, (c) determination of the measurement format, (d) validation of face and content, and (e) content adjustment. Results: The instrument elaborated from a survey and integrative literature review, and the measurement format chosen was the 5-point Likert scale. The validation of face and content was performed by expert judges and by pretest. The final instrument had 57 items. Conclusion: EAPEnf-UTI is a pioneering instrument built in the Brazilian context, whose future validation will allow the capturing of situations specific to intensive care units and the professional practice of intensive care nurses.

Hospital structure elements demarcating (in)visibilities of institutional violence against children.

OBJECTIVES: to analyze the hospital structure elements that demarcate (in)visibilities of institutional violence in hospitalized children. METHODS: this is a descriptive-exploratory qualitative study that used approaches with Foucault's thinking. Ten companions and 39 healthcare professionals from a university hospital in Salvador, Bahia participated. Data collection took place from November 2018 to June 2019 through semi-structured interviews. The discourse analysis method was used. The study was approved by the Institutional Review Board. RESULTS: institutional violence was understood in the violations and invisibilities of the structure of health services through the problems: in infrastructure (physical structure, lack of human and material resources, scrapping of equipment); administrative and management; pilgrimage. FINAL CONSIDERATIONS: it is necessary to realize the invisibilities of the infrastructure to act in confronting institutional violence to hospitalized children.

Challenges experienced by Portuguese professionals in humanitude care for institutionalized elderly people during the pandemic.

OBJECTIVE: To understand the challenges experienced by Portuguese workers in humanitude care for institutionalized elderly people during the pandemic. METHOD: This is a qualitative study, supported by reflections on the Humanitude Care Methodology, carried out with workers from different areas in a nursing home for elderly people in Portugal. Data collection took place between September and October 2020, from individual and online interviews. The categorization proposed by Bardin was adopted as the analysis technique. RESULTS: Three categories emerged: (1) self-protection and of the other with the subcategories fear of being contaminated and fear of contaminating the elderly; (2) maintenance of affective relationships, broken down into the subcategories absence of family members in the nursing home and personal protective equipment as a barrier to communication and approximation; and (3) confinement of the elderly who attended the Day Center, with the subcategories lack of family support/loneliness and change in the elderly's routine. CONCLUSION: The main challenges experienced by Portuguese workers are related to the necessary changes in the performance of care practices due to the use of personal protection that was not used before, limitations in affective relationships, and restrictions in interaction spaces.

Perception of family members and health professionals about institutional violence against hospitalized children.

OBJECTIVE: To understand the perception of family members and health professionals about institutional violence against hospitalized children. METHODS: Qualitative, exploratory-descriptive study, used approximations with Foucault's thinking, carried out in a pediatric unit of a large hospital in Salvador - Bahia. 10 mothers and 39 health professionals participated. Data collection took place between November/2018 and October/2019 through semi-structured interviews. Data content analysis was performed with the help of the NVIVO12 software. The study, approved by Ethics Committee, complied with resolution 466/2012. RESULTS: The Institutional Violence was understood by the participants evidenced in three categories: abusive care practices; problems in the relationships between professionals, child and family; precariousness of the hospital structure. CONCLUSION: The perception of family members and health professionals about the presence of Institutional Violence in children's hospital care demonstrates the need to establish actions in their confrontation to ensure the dignity of the child during hospitalization.

[Responsibility in health care: regarding the time we live as intensive care nurses]. / Responsabilidade no cuidar: do tempo que nos toca viver como enfermeiros/as intensivistas.

This qualitative investigation was supported by Foucault's analysis with emphasis on the notion of governability, and had the following objectives: to analyze the relationship between techno-biomedicine and bioethics as discourses of the contemporaneousness implied in the production of nurses' subjectivity within the context of the Intensive Care Unit (ICU); and approach the responsibility implied in health care as one of the unfolding strategies of technology of speech of bioethics and biotechnology, creating certain forms of the nurse understanding and intervening in the Intensive Care Unit (ICU). From the perspective of the multiple ways that can emerge when analyzing a critical reading of analyzed texts and interviews with nurses, responsibility in health care was unfolded into categories that expressed the responsibility in front of new languages and of nursing as a guardian of certain attributes in the Intensive Care Unit (ICU).

The use of selfbody in nurses work in hospital care: an ergology approach.

OBJECTIVE: to know how happens the nurse use of selfbody in the emergency room. METHODS: qualitative study, performed with 23 nurses in an adult emergency room at a university hospital in the South of Brazil. The data gathering was through documental research, systematic observation, and semi-structured interview. According to the thematic modality, the data analysis was carried out anchored in the theoretical reference of ergology. RESULTS: it was evidenced the use of selfbody in the work of the nurse, as much in the development of managerial activities as assistance, especially: in the organization of the environment, in the performance in intercurrences and definition of priorities of attendance, as well as in the conduction of the activities of each work shift, together with the nursing and multi-professional team. FINAL CONSIDERATIONS: the nurse makes use of selfbody at work in the emergency room, based on values, knowledge, and experience, considering the organization of the work process and better nursing assistance.

Reflecting rehabilitation nursing care: Theory of Recognition crossed by the Principle of Hope.

OBJECTIVE: The study seeks to reflect on rehabilitation nursing care, from the perspective of the Theory of Recognition and the Principle of Hope. STATE OF ART: Reflection study, based on Axel Honneth's Theory of Recognition crossed by Ernst Bloch's Principle of Hope, aiming to elucidate the theoretical and methodological potential of these references for future research in health, nursing and rehabilitation nursing. Rehabilitation nursing care is permeated by theoretical and philosophical influences little described in the literature. The study proposes a way of thinking and exercising care with the perspective of building rehabilitation nursing care, in which the nurse excels in trust, respect and mutual esteem, playing the role of agent of hopeful and realistic expectations. CONCLUSION: The study showed the main characteristics of each philosophical theoretical axis, permeating, separately, the relevant definitions to understand its implications in the concrete reality of living.

Neither angels nor heroes: nurse speeches during the COVID-19 pandemic from a Foucauldian perspective.

OBJECTIVE: to analyze the processes of meaning production, based on the speeches of nursing professionals, about how they feel about the titles of "angels and heroes" given by society during the pandemic of COVID-19. METHODS: a qualitative, documentary research. Data was collected in October and November 2020 and analyzed from the perspective of the Discourse Analysis proposed by Michel Foucault. RESULTS: they were organized into two thematic categories: "Angels and heroes? The (not) heroic reality of nursing during the pandemic" and "The search for recognition of the professional work of nursing: between what is said and what is not said". FINAL CONSIDERATIONS: the nurses' speeches enunciate the search for decent conditions for the execution of care, fair wages, and recognition of the professional work by society.

Biosafety measures to prevent COVID-19 in healthcare professionals: an integrative review.

OBJECTIVE: to identify the main biosafety measures for preventing COVID-19 in healthcare professionals. METHODS: this is an integrative literature review, with studies published between January and July 2020, on the MEDLINE/PubMed, Scopus, Embase, Web of Science, LILACS, SciELo, Wiley Online Library, Cochrane CINAHL databases. The selection of studies followed the PRISMA recommendations. RESULTS: among the 2,208 publications identified, 12 studies comprised the sample, which enabled the analysis in four thematic categories: The importance of using recommendations about the use of personal protective equipment; The restructuring of new operational and clinical routines and flows in the practice of services; Monitoring professionals, especially testing; Conducting training. CONCLUSIONS: the phenomena involved are innumerable, covering operational management and the training of teams to deal with highly infectious pathogens and disease outbreaks.

Iatrogenesis in intensive care units: dramatization of contemporary bio/ethical problems.

This qualitative investigation, based in Foucauldian analysis with approximations to the post-structuralism theoretical framework, explores iatrogenesis as one of the tensions in the nursing to do/to know which can be discursively articulated to bioethics and to technobiomedicine. The documentary sources and intensive interviews with nurses, permitted the activation of a reflection on the act of the nurse in a context permeated by the ever-present possibility of failure in both the procedure and in the conduct and, from this possibility, they should meet their obligation to correct this failure not so much or not only in knowledge, not so much or not only in law but in practice itself.

What is said and unspoken about the autonomy of a nurse: (dis) continuity in discourses.

OBJECTIVE: to know how autonomy is constituted in the nurse's professional practice in the hospital context. METHODS: Qualitative analytical study, based on Foucault's methodological theoretical framework. The empirical material consisted of articles published in the Revista Brasileira de Enfermagem and narrative interviews conducted with 18 nurses from a public hospital in southern Brazil. Data collection took place between December 2017 and May 2018, being analyzed through Foucauldian discourse analysis. RESULTS: Autonomy in the professional practice of nurses goes through the core of knowledge, the political positioning and the working conditions. These factors are revealed as power instruments in the construction of nurse governability. Final Considerations: It is believed that the investment focused on the debate of the nurse's autonomy interfaces could raise new attitudes about professional practice and favor the transformation of nursing practice.

Women in situations of sexual violence: potentialities and weaknesses of the intersectoral network.

OBJECTIVES: to identify potentialities and weaknesses of the intersectoral network for women in situations of sexual violence, from the perspective of Intervention Bioethics and the Universal Declaration on Bioethics and Human Rights. METHODS: qualitative study conducted with multidisciplinary team members who work in intersectoral care services for women subject to sexual violence. It was held in a municipality in southern Brazil. An intentional sample, totaling 30 professionals. Semi-structured interview was used from January to April 2016. Interviews were analyzed by Thematic Analysis. RESULTS: two categories emerged: potentialities and weaknesses related to the intersectoral network. Potentialities confirm the importance of the articulated intersectoral network; weaknesses such as lack of organized flow and disarticulation of services result in women revictimization and care fragmentation. Final Considerations: it is necessary to articulate services and qualify professionals. The Intervention Bioethics and the Universal Declaration on Bioethics and Human Rights foster discussions that contribute to how to organize and sustain the intersectoral network.