Opinión de estudiantes de kinesiología relacionado con precauciones estándar, vista de enfermería / Opinion of kinesiology students related to standard precautions, nursing view

INTRODUCCIÓN: Las precauciones estándar corresponden a un grupo de prácticas de prevención de infecciones que se aplican en la atención a todos los pacientes, tiene como objetivo prevenir la transmisión cruzada de microorganismos entre pacientes. OBJETIVO: Develar la opinión de las/os estudiantes de Kinesiología de la Universidad Mayor-Temuco con relación a las Precauciones Estándar. METODOLOGÍA: Estudio cualitativo, descriptivo y exploratorio, estudio intrínseco de caso, la muestra no probabilística, intencionada: 12 sujetos estudiante de kinesiología 2018; criterio de inclusión: haber aprobado la asignatura de Cuidados Básicos del Enfermo; recogida de datos: entrevistas en profundidad, se utilizaron notas de campo y se manejó el método de comparación constante, además esquema de la reducción progresiva. RESULTADOS: Para la categoría de significado de precauciones estándar surge medida de protección y seguridad para usuario y tratante; para precauciones estándar utilizadas en prácticas clínicas emerge las subcategorías de elementos y técnicas de barrera en forma análoga nace como categoría aplicabilidad de precauciones estándar de ella se desprenden campos clínicos, eventos clínicos del usuario y técnicas y procedimientos; para la categoría factores facilitadores: docente y estudiantes; en tanto factores obstaculizadores: curriculum. CONCLUSIONES: En los estudiantes existe un conocimiento deficiente y conceptos aislados sobre PE, utilizan principalmente guantes y lavado de manos; menor grado uso de mascarilla y pechera. Destaca positivamente conocimiento docente; factores obstaculizadores: aspectos teóricos deficientes curriculares; considerar modificaciones curriculares en aspectos conceptuales y procedimentales.

BACKGROUND: the standard precautions correspond to a group of infection prevention practices that are applied in the care of all patients, it aims to prevent the cross-transmission of microoganisms between patiens. OBJETIVE: to reveal the opinion of Kinesiology students at the Universidad Mayor-Temuco regarding standard precautions. METHODOLOGY: Qualitative, descriptive, and exploratory study, intrinsic case study, non-probabilistic sample, intentional: 12 subjects, kinesiology student of the year 2018; For data collection, in-depth interviews were used, field notes and the constant comparison method were used, in addition to the progressive reduction scheme. RESULTS: 173 units of meaning emerge, for the category of meaning of standard precautions, protection and security measure for user and trafficker arises; For standard precautions used in clinical practices, the subcategories of barrier elements and techniques emerge, the most mentioned, in an analogous way, the applicability of standard precautions is born as a category of clinical fields, clinical events of the user and techniques and procedures; for the category facilitating factors: teacher and student are the least mentioned; as impeding factors: curriculum. CONCLUSIONS: There is a deficient knowledge and isolated concepts about SP, mainly use gloves and hand washing; less degree the use of masks and scrubs. It is positively highlighted teacher's knowledge, and some of the hindering factors are the lack of theoretical aspects of the curriculum and the consideration for curriculum modifications to compensate conceptual and procedural aspects.

Nurse staffing in large general hospitals in China: an observational study.

BACKGROUND: The appropriate staffing of nurses not only reflects the situation of nursing management of human resource, but also is related to the nursing quality in hospitals. This study investigated the staffing of nurses in large general hospitals in China. METHODS: In this study, a database established by the National Centre for Nursing Care Quality Control, which conducted a national survey of the staffing of nurses in China mainland in 2017, was analysed. The time-point survey data of 20 375 departments in 668 large general hospitals in China were obtained, including the information of nurses and patients during the day (10:00 am) and at night (10:00 pm). Then, the staffing of nurses was evaluated by calculating the nurse to patient ratio (the average number of patients assigned to a nurse, NTP ratio). The Kruskal-Wallis test was performed to compare the NTP ratios during the day and at night among different regions and departments. RESULTS: In large general hospitals, a nurse takes care of eight patients (NTP ratio = 1:8.0) during the day and 23 patients at night (NTP ratio = 1:23) on average. There were significant differences between day and night. In terms of different regions, a nurse in the hospitals in the western region takes care of 7.8 patients during the day (NTP ratio = 1:7.8) on average, and the nursing resource in the western region is more adequate than that in the eastern (1:8.0) and central (1:8.0) regions. At night, the eastern region has a higher level of NTP (1:23.0). In terms of departments, a nurse working in the ICU takes care of two patients during the day (NTP ratio = 1:2.0) and 2.9 patients at night (NTP ratio = 1:2.9). The level of NTP in the oncology department is relatively higher: 9.3 during the day and 34.0 at night. Other departments including internal medicine, surgery, obstetrics and gynaecology, paediatrics, and geriatrics have NTP ratios of 1:7-8 during the day and 1:18-25 at night. CONCLUSIONS: In China, the nurse staffing of large general hospitals has some regional and departmental patterns. The low level of nurse staffing at night may be a problem worthy of attention; the Chinese government needs to establish standards for different periods and departments to improve efficiency and quality of nursing.

Système de santé et de soins infirmiers en France / Health and nursing system in France

Résumé Cet article concerne le Système de Santé en France. Il souligne que dans ce pays il est essentiel de former des professionnels insérés dans un «savoir-faire¼, et également préparés aux mutations actuelles et à venir de la profession infirmière. Ainsi, une revue de la littérature a été réalisée à partir de la classification et de l'analyse des textes et des documents recherchés, nous avons essayé de comprendre le Système de Santé Français et de soins infirmiers. Cela a permis la construction de deux catégories thématiques. La première est le Service Sanitaire réalisé par les étudiants des formations en santé qui traduit la volonté du Gouvernement de placer la prévention au cœur de son action. Et la deuxième aborde la Formation des infirmiers qui est un référentiel basé sur la compétence. La démographie des infirmières en France est également abordée, ce qui met en évidence l'augmentation du nombre d'infirmières de 2010 à 2018.

Abstract This paper concerns the French Health Care System that revolutionized the rationale of the existing social protection. It emphasizes that, in this country, it is essential to train professionals integrated into a "know-how", and also prepared for the current and future changes in the nursing profession. A literature review was carried out based on the classification and analysis of the texts and documents researched, and we tried to understand the French Health and Nursing System. This allowed the construction of two thematic categories. The first one is the "Health Service" that addresses health training courses for prevention, while the second one deals with Nursing Education, which is a competency-based framework. The demography of nurses in France is also discussed, which highlights the increased number of nurses from 2010 to 2018.

Professional Autonomy as Centrality in Best Practices in Nursing / Autonomía Profesional como centralidad en Buenas Prácticas de Enfermería / Autonomia profissional como centralidade em Boas Práticas de Enfermagem

ABSTRACT Objectives: to reflect on professional, user and family autonomy as a centrality in Best Practices in nursing in Brazil. Methods: this is a theoretical-reflective study. Results: from a retrospective look at the creation and evolution of nursing autonomy in its knowledge and care practices, it exposes the use of autonomy in nursing care and foster the participation of the user and his family as the center of Best Practices in nursing. Final considerations: the text suggests the institutional commitment of health services to the formal postgraduate education of nurses and the prospect of more autonomy and quality for the expression of Best Practices in nursing.

RESUMEN Objetivos: reflexionar sobre la autonomía profesional, del usuario y de la familia como centralidad en Buenas Prácticas de Enfermería en Brasil. Métodos: estudio teórico-reflexivo. Resultados: a partir de una mirada retrospectiva a la creación y evolución de la autonomía en la enfermería en sus saberes y prácticas asistenciales, expone el uso de la autonomía en el cuidado de enfermería y el fomento a la participación del usuario y su familia como el centro de Buenas Prácticas de Enfermería. Consideraciones finales: el texto sugiere el compromiso institucional de los servicios de salud con la educación formal postgraduada de los enfermeros y la prospección de más autonomía y más calidad para la expresión de Buenas Prácticas de Enfermería.

RESUMO Objetivos: refletir sobre a autonomia profissional, do usuário e da família como centralidade em Boas Práticas de Enfermagem no Brasil. Métodos: estudo teórico-reflexivo. Resultados: a partir de um olhar retrospectivo à criação e evolução da autonomia na Enfermagem em seus saberes e práticas assistenciais, expõe o uso da autonomia no cuidado de enfermagem e o fomento à participação do usuário e sua família como o centro de Boas Práticas de Enfermagem. Considerações finais: o texto sugere o compromisso institucional dos serviços de saúde com a educação formal pós-graduada dos enfermeiros e a prospecção de mais autonomia e mais qualidade para a expressão de Boas Práticas de Enfermagem.

Clinical characteristics of COVID-19 patients and the main nursing diagnoses / Características clínicas dos pacientes COVID-19 e os principais diagnósticos de enfermagem

AIMS: to present a reflection on the clinic of patients infected by COVID-19 and to propose the main nursing diagnoses based on International Classification for Nursing Practice (ICNP©). METHOD: this is a reflection study, in which the selection criteria used were articles indexed in the MEDLINE, LILACS and BDENF databases published between December 2019 and April 2020, in English and Portuguese. RESULTS: 10 scientific articles were part of the study, which made it possible to know the symptomatologic profile of the disease, with emphasis on the classic triad of COVID-19, which is cough, shortness of breath and fever. It revealed that the basic human need most affected in this patient profile is oxygenation in view of hypoxemia being the main complication, for which the clinical outcome was negative, especially in elderly patients. CONCLUSION: there was a shortage and studies related to nursing in the face of this pandemic, but it was possible to conclude that ICNP© is one of the taxonomies that can be used to implement nursing diagnoses and intervention, the most frequent nursing diagnoses are related to the basic human and social need for oxygenation and vascular regulation.

OBJETIVO: apresentar uma reflexão sobre a clínica dos pacientes contaminados pela COVID-19 e propor os principais diagnósticos de enfermagem baseados na Classificação Internacional para a Prática de Enfermagem (CIPE®). MÉTODO: trata-se de um estudo de reflexão, na qual utilizaram-se como critérios de seleção, artigos indexados nas bases de dados MEDLINE, LILACS e BDENF publicados entre dezembro de 2019 a abril de 2020, no idioma inglês e português. RESULTADOS: fizeram parte do estudo 10 artigos científicos o que possibilitou conhecer o perfil sintomatológico da doença, com destaque para a tríade clássica da COVID-19 que é tosse, falta de ar e febre. Revelou que a necessidade humana básica mais afetada nesse perfil de paciente é a oxigenação tendo em vista hipoxemia ser a principal complicação, para as quais o desfecho clínico foi negativo, principalmente, em pacientes idosos. CONCLUSÃO: evidenciou-se a carência e estudos relativos à enfermagem frente a essa pandemia, porém foi possível concluir que a CIPE® é uma das taxonomias que pode ser utilizada para implementar os diagnósticos e intervenção de enfermagem, os diagnósticos de enfermagem mais frequentes estão relacionados a necessidade humana básica de oxigenação e regulação vascular.

Cultural adaptation and validation of the General Practice Nurse Satisfaction Scale / Adaptación cultural y validación de la General Practice Nurse Satisfaction Scale / Adaptação cultural e validação do General Practice Nurse Satisfaction Scale

ABSTRACT Objective: To culturally adapt and validate the General Practice Nurse Satisfaction Scale for the Brazilian context. Method: Methodological study performed according to guidelines provided in the international scientific literature and validation of the Australian instrument for the Brazilian context. The sample consisted of 199 patients admitted from August 2017 to January 2018 in a public university hospital in the south of Brazil. Data were analyzed using factor analysis and Cronbach's alpha. Results: According to factor analysis, 21 questions were validated and divided into four dimensions: interpersonal relationship and communication, confidence, credibility, and dedication. The instrument presented satisfactory internal consistency, with Cronbach's alpha equal to 0.93, and ranging between 0.87 and 0.66 for the dimensions. Conclusion: The instrument's Brazilian version is valid and reliable to assess the satisfaction of patients with nursing care.

RESUMEN Objetivo: Adaptar y validar culturalmente el instrumento de la General Practice Nurse Satisfaction Scale para el contexto brasileño. Método: Estudio metodológico, realizado a través de los pasos de traducción, síntesis, retrotraducción, evaluación por el comité de expertos, pre-prueba y revisión del proceso de adaptación por parte de los investigadores. La muestra consistió en 199 pacientes ingresados ​​desde agosto de 2017 hasta enero de 2018 en un hospital público y universitario en el sur de Brasil. El análisis de los datos se realizó mediante análisis factorial y alfa de Cronbach. Resultados: Del análisis factorial, 21 preguntas se dividieron en cuatro constructos: relación interpersonal y comunicación; confianza credibilidad y dedicación. El instrumento presentaba una consistencia interna satisfactoria, con alfa de Cronbach de 0,93 y entre 0,87 y 0,66 para las construcciones. Conclusión: La versión brasileña del instrumento tiene validez y confiabilidad para ser utilizada para evaluar la satisfacción del paciente con el servicio de enfermería.

RESUMO Objetivo: Adaptar culturalmente e validar o instrumento General Practice Nurse Satisfaction Scale para o contexto brasileiro. Método: Estudo metodológico, realizado segundo recomendações da literatura científica internacional e validação do instrumento australiano para sua utilização no contexto brasileiro. A amostra foi constituída de 199 pacientes internados no período de agosto de 2017 a janeiro de 2018 em um hospital público e universitário no sul do Brasil. A análise dos dados ocorreu por meio de análise fatorial exploratória e alfa de Cronbach. Resultados: A partir da análise fatorial exploratória, foram validadas 21 questões divididas em quatro dimensões: relacionamento interpessoal e comunicação; confiança; credibilidade e dedicação. O instrumento apresentou consistência interna satisfatória, com alfa de Cronbach 0,93 e variando entre 0,87 e 0,66 para as dimensões. Conclusão: A versão brasileira do instrumento tem validade e fidedignidade para ser utilizada

The human condition of the nursing worker from the perspective of Hannah Arendt / Condición humana del trabajador de enfermería desde la perspectiva de Hannah Arendt / Condição humana do trabalhador de enfermagem na perspectiva de Hannah Arendt

ABSTRACT Objective: This study intends to analyze how the human condition of the nurse is established in the context of Psychosocial Care Centers (Caps). Method: theoretical-reflexive study, anchored in three essential parts: 1) Theoretical and philosophical conception of the human condition from Hannah Arendt's perspective; 2) The nurse's work in the Caps; and 3) Human condition to think about the work of the nurse. Results: in the context of the Caps, the work can be represented by the psychic significations; the work, through the production of nurses' practice of care; and the action by the relations established between worker and institution, worker and user. Final considerations: the understanding of the vita activa allows to reflect on the human condition of the nurse in their work context and (re) considers a better understanding about the impact of the work on the life of these mental health workers in the contemporaneity.

RESUMEN Objetivo: evaluar cómo se establece la condición humana del enfermero en contexto de Centros de Atención Psicosocial (Caps). Método: estudio teórico y de reflexión a partir de tres partes esenciales: 1) Concepción teórica y filosófica de la condición humana desde la perspectiva de Hannah Arendt; 2) El trabajo del enfermero en los Caps; y 3) Condición humana para pensar el trabajo del enfermero. Resultados: el contexto de trabajo del Caps, la labor puede representarse por las significaciones psíquicas; obra por la producción de la práctica asistencial del enfermero; y la acción por las relaciones establecidas entre el trabajador y la institución, el trabajador y el usuario. Consideraciones finales: la comprensión de la vita activa permite reflexionar sobre la condición humana del enfermero en su contexto de trabajo y (re)considera en la contemporaneidad una mejor comprensión sobre el impacto del trabajo en la vida de esos trabajadores de la salud mental.

RESUMO Objetivo: analisar como se estabelece a condição humana do enfermeiro no contexto dos Centros de Atenção Psicossocial (Caps). Método: estudo teórico-reflexivo, ancorado em três partes essenciais: 1) Concepção teórica e filosófica da condição humana na perspectiva de Hannah Arendt; 2) O trabalho do enfermeiro nos Caps; e 3) Condição humana para pensar o trabalho do enfermeiro. Resultados: no contexto de trabalho do Caps, o labor pode ser representado pelas significações psíquicas; a obra, pela produção da prática assistencial do enfermeiro; e a ação pelas relações estabelecidas entre trabalhador e instituição, trabalhador e usuário. Considerações finais: a compreensão da vita activa permite refletir sobre a condição humana do enfermeiro em seu contexto de trabalho e (re)considera na contemporaneidade uma melhor compreensão sobre o impacto do trabalho na vida desses trabalhadores da saúde mental.

An interdisciplinary statement of scientific societies for the advancement of delirium care across Europe (EDA, EANS, EUGMS, COTEC, IPTOP/WCPT).

BACKGROUND: Delirium is a geriatric syndrome that presents in 1 out of 5 hospitalized older patients. It is also common in the community, in hospices, and in nursing homes. Delirium prevalence varies according to clinical setting, with rates of under 5% in minor elective surgery but up to 80% in intensive care unit patients. Delirium has severe adverse consequences, but despite this and its high prevalence, it remains undetected in the majority of cases. Optimal delirium care requires an interdisciplinary, multi-dimensional diagnostic and therapeutic approach involving doctors, nurses, physiotherapists, and occupational therapists. However, there are still important gaps in the knowledge and management of this syndrome. MAIN BODY: The objective of this paper is to promote the interdisciplinary approach in the prevention and management of delirium as endorsed by a delirium society (European Delirium Association, EDA), a geriatrics society (European Geriatric Medicine Society, EuGMS), a nursing society (European Academy of Nursing Science, EANS), an occupational therapy society (Council of Occupational Therapists for European Countries, COTEC), and a physiotherapy society (International Association of Physical Therapists working with Older People of the World Confederation for Physical Therapy, IPTOP/WCPT). SHORT CONCLUSION: In this paper we have strongly promoted and supported interdisciplinary collaboration underlying the necessity of increasing communication among scientific societies. We have also provided suggestions on how to fill the current gaps via improvements in undergraduate and postgraduate delirium education among European Countries.

Work process: a basis for understanding nursing errors. / Processo de trabalho: fundamentação para compreender os erros de enfermagem.

OBJECTIVE: To identify work process-related causes associated with nursing errors reported in newspapers. METHOD: This was a documentary and qualitative study based on the work process theory and hermeneutic analysis that examined 112 news articles published between 2012 and 2016 in 21 high-circulation Brazilian newspapers, organized and codified using Atlas.ti software. RESULTS: The causes associated with the reported errors were associated with workforce (lack of professionals and training, turnover, work overload, lack of information, recklessness, negligence, and distraction); work instruments (similar labels or packages, storage, lack of product identification and information, and medical prescriptions); and the object of nursing work (overcrowding and specific characteristics of patient). CONCLUSION: Analysis of the possible causes of reported errors identified the negative outcomes of nursing work, while also identifying elements of the work process that influenced these results. The findings emphasize the importance of understanding these errors so they can be avoided and of reviewing nursing work conditions to guarantee quality and safety of care.

Nursing errors in the media: patient safety in the window.

OBJECTIVE: To analyze the nursing errors reported by the journalistic media and interpret the main implications of this communication for the visibility of this problem. METHOD: Documental research, qualitative, descriptive and exploratory, with data collected in news reports from Brazil and Portugal, analyzed through hermeneutics with resources of Atlas Software. RESULTS: We analyzed 112 news items published between 2012 and 2016 that resulted in six categories: Year - highest occurrence in 2012; Age group of the patient - children; Professional category - nurses; Type of error - medication; Outcome - death; Possible attributed cause - occupational conditions. FINAL CONSIDERATIONS: Nursing mistakes are a challenge for the profession, and the way they are communicated by the media is not very explanatory, contributing to a negative visibility of the profession, and to making society insecure. Improving the way they are served in the media contributes to the visibility of the problem without affecting the professional image.

Nursing errors in the media: patient safety in the window / Errores de enfermería en los medios: la seguridad del paciente en la vitrina / Erros de enfermagem na mídia: a segurança do paciente na vitrine

ABSTRACT Objective: To analyze the nursing errors reported by the journalistic media and interpret the main implications of this communication for the visibility of this problem. Method: Documental research, qualitative, descriptive and exploratory, with data collected in news reports from Brazil and Portugal, analyzed through hermeneutics with resources of Atlas Software. Results: We analyzed 112 news items published between 2012 and 2016 that resulted in six categories: Year - highest occurrence in 2012; Age group of the patient - children; Professional category - nurses; Type of error - medication; Outcome - death; Possible attributed cause - occupational conditions. Final considerations: Nursing mistakes are a challenge for the profession, and the way they are communicated by the media is not very explanatory, contributing to a negative visibility of the profession, and to making society insecure. Improving the way they are served in the media contributes to the visibility of the problem without affecting the professional image.

RESUMEN Objetivo: Analizar los errores de enfermería noticiados por los medios periodísticos e interpretar las principales implicaciones de esa comunicación para la visibilidad de esta problemática. Método: Investigación documental, cualitativa, descriptiva y exploratoria, con los datos recogidos en los informes periódicos de Brasil y Portugal, analizó utilizando la hermenéutica con fondos de la Atlas.ti Software. Resultados: Se analizaron 112 noticias publicadas entre 2012 y 2016 que resultaron en seis categorías: Año - mayor ocurrencia en 2012; Edad del paciente - niños; Categoría profesional - enfermeros; Tipo de error - medicación; Descenso - muerte; y Posible causa atribuida - condiciones de trabajo. Consideraciónes finales: Los errores de enfermería constituyen un desafío para la profesión, y la forma en que son comunicados por los medios es poco explicativa, contribuyendo a una visibilidad negativa de la profesión, y para dejar a la sociedad insegura. Mejorar la forma en que se transmiten en los medios de comunicación contribuyen a la visibilidad del problema sin afectar la imagen profesional.

RESUMO Objetivo: Analisar os erros de enfermagem noticiados pela mídia jornalística e interpretar as principais implicações dessa comunicação para a visibilidade dessa problemática. Método: Pesquisa documental, qualitativa, descritiva e exploratória, com dados coletados em notícias de jornais do Brasil e Portugal, analisados por meio da hermenêutica com recursos do Software Atlas.ti. Resultados: Foram analisadas 112 notícias publicadas entre 2012 e 2016 que resultaram em seis categorias: Ano - maior ocorrência em 2012; Faixa etária do paciente - crianças; Categoria profissional - enfermeiros; Tipo de erro - medicação; Desfecho - morte; Possível causa atribuída - condições de trabalho. Considerações finais: Erros de enfermagem constituem um desafio para a profissão, e a forma como são comunicados pela mídia é pouco explicativa, contribuindo para uma visibilidade negativa da profissão, e para deixar a sociedade insegura. Melhorar a forma como são veiculados na mídia contribuem para a visibilidade do problema sem afetar a imagem profissional.

Performance indicators in colonoscopy after certification for independent practice: outcomes and predictors of competence.

BACKGROUND: Robust real-world performance data of newly independent colonoscopists are lacking. In the United Kingdom, provisional colonoscopy certification (PCC) marks the transition from training to newly independent practice. We aimed to assess changes in key performance indicators (KPIs) such as cecal intubation rate (CIR) in the periods pre- and post-PCC, particularly regarding rates and predictors of trainees exhibiting a drop in performance (DIP), defined as CIR <90% in the first 50 procedures post-PCC. METHODS: A prospective United Kingdom-wide observational study of Joint Advisory Group on Gastrointestinal Endoscopy Electronic Training System (JETS) e-portfolio colonoscopy entries (257,800) from trainees awarded PCC between July 2011 and 2016 was undertaken. Moving average analyses were used to study KPI trends relative to PCC. Pre-PCC trainee, trainer, and training environment factors were compared between DIP and non-DIP cohorts to identify predictors of DIP. RESULTS: Seven hundred thirty-three trainees from 180 centers were awarded PCC after a median of 265 procedures and 3.1 years. Throughout the early post-PCC period, average CIRs surpassed the national 90% standard. Despite this, not all trainees achieved this standard post-PCC, with DIP observed in 18.4%. DIP was not influenced by trainer presence and diminished after 100 additional procedures. On multivariable analysis, pre-PCC CIRs and trainer specialty were predictive of DIP. Trainees with DIP incurred higher post-PCC rates of moderate to severe discomfort despite requiring higher analgesic dosages and were more likely to require trainer assistance in failed procedures. CONCLUSIONS: The current PCC requirements are appropriate for diagnostic colonoscopy. It is possible to identify predictors of underperformance in trainees, which may be of value to training leads and could improve the patient experience.

Nursing resources and major immobility complications among bedridden patients: A multicenter descriptive study in China.

BACKGROUND: Being bedridden, which is a common clinical phenomenon, causes a series of complications related to immobilization. Effective management of immobility complications requires a reasonable allocation of nursing resources. Unit-level evidence about the relationship between nursing resources and immobility complications is lacking. OBJECTIVES: To gain insight into nursing resources in China and explore the relationship between nursing resources and the incidence of major immobility complications among bedridden patients. The major immobility complications included in our study were pressure ulcers, deep vein thrombosis, pneumonia and urinary tract infection. DESIGN: A nationwide, multicenter, cross-sectional survey. SETTING: From November 2015 to June 2016, 18 hospitals (six tertiary and 12 secondary) from six provinces and cities in different geographic regions (eastern, southern, western, northern and central) in China participated in our study. PARTICIPANT: Intensive care units, internal medicine and surgery wards with high proportions of bedridden patients were chosen as investigation sites. Of the total of 23,637 available patients in the selected wards, 19,530 were recruited. METHODS: Data on nursing resources and ward characteristics were collected mainly by questionnaire. The incidence of major immobility complications among bedridden patients was measured by trained investigators. Data on patient characteristics were collected from the patient record system of each hospital. Multilevel regression analysis was used to estimate the impact of nursing resources on the incidence of major immobility complications, adjusting for patient and ward characteristics. RESULTS: The study included 23,637 patients in 213 wards, and 19,530 were recruited. The incidence of the four complications was 0.77% (pressure ulcers), 0.82% (deep vein thrombosis), 3.39% (pneumonia) and 0.86% (urinary tract infection), and the overall incidence of major immobility complications was 5.41%. The incidence of major immobility complications was higher in wards not attaining the target bed-to-nurse ratios than in those that met these criteria (ß = 0.44, 95% confidence interval [CI]: 0.02-0.87; OR = 1.553, 95% CI: 1.002-2.387). The incidence of major immobility complications was negatively associated with the proportion of nurses with intermediate or senior job titles (ß = -2.12, 95% CI: -3.78 to -0.45; OR = 0.120, 95% CI: 0.023-0.638). However, the incidence of major immobility complications was unexpectedly positively associated with the proportion of nurses with a bachelor's degree or higher (ß = 1.06, 95% CI: 0.31-1.81; OR = 2.886, 95% CI: 1.363-6.110). CONCLUSIONS: Sufficient nurse staffing and higher professional titles of nurses might contribute to reducing the incidence of major immobility complications. Nurse experience was not related to the incidence of major immobility complications. However, the association between nurse education level and the incidence of major immobility complications requires further investigation. IMPLICATIONS FOR NURSING MANAGEMENT: More nurses,especially nurses with higher professional titles may reduce the incidence of major immobility complications.

La autorregulación: un avance hacia la autonomía de enfermería / Autorregulaçáo: um avanço em direção à autonomia da enfermagem / Self-regulation: a step towards nursing autonomy

RESUMEN La profesión de Enfermería en Chile se vio afectada por los hechos ocurridos en la sociedad chilena desde la Constitución de 1980 y la modificación del Código Sanitario en 1981, a través del Decreto Ley 3621. La construcción de la definición de Enfermería introducida al Código Sanitario chileno en el año 1997 proporcionó el respaldo legal a la función social de la enfermera, reconociendo a su vez a Enfermería como una profesión autónoma. Objetivo: Analizar cómo se gestó la construcción de la definición de Enfermería que se introdujo en el Código Sanitario chileno, en su artículo N° 113. Método: Estudio de abordaje socio-histórico, a través del testimonio de dos enfermeras que fueron actores relevantes en la construcción de la definición de Enfermería. Las entrevistas fueron analizadas a través del análisis de discurso. Resultados: Se expone una reflexión crítica realizada por enfermeras visionarias para lograr obtener una definición de Enfermería, que reconoce legalmente a la profesión en su función social, principalmente en el cuidado de la salud de las personas. Conclusión: Este hecho histórico que legitimó la función social de la enfermera significó un proceso reivindicativo al mandato social de la labor de la enfermera y constituyó un hito sociopolítico, sin embargo, a más de veinte años aparecen nuevos desafíos en el área de la salud y cuidado de las personas, cobrando valor continuar con la autorregulación para consolidar su autonomía e identidad profesional.

ABSTRACT The nursing profession in Chile was affected by events that occurred in the Chilean society since the Constitution of 1980 and the modification of the Health Code in 1981, through the DL 3621 (Executive order). The construction of the definition of nursing introduced to the Chilean Health Code in the year 1997 provided legal support to the social function of the nurse, recognizing nursing as an autonomous profession. Objective: To analyze how the construction of the definition of nursing that was introduced in the Chilean Health Code, in its article No. 113, was developed. Method: Socio-historical approach, through the testimony of two nurses who were relevant actors in the construction of the definition of nursing. The interviews were analyzed through discourse analysis. Results: We present a critical reflection made by visionary nurses to construct a definition of nursing, which legally recognizes the profession in its social function, mainly in people's health care. Conclusion: The historical event that legitimized the social function of the nurse meant a vindicating process to the social mission of the nurse's work and became a sociopolitical milestone, however, more than twenty years later new challenges arise in the area of people's health care, giving new value to self-regulation to strengthen autonomy and professional identity.

RESUMO A profissão de enfermagem no Chile foi afetada pelos acontecimentos na sociedade chilena desde a Constituição de 1980 e a modificação do Código Sanitário em 1981, através do DL 3621. A construção da definição de Enfermagem inserida no Código Sanitário chileno o ano de 1997 forneceu o suporte legal à função social da enfermeira, reconhecendo a Enfermagem como uma profissão autônoma. Objetivo: Analisar como foi construída a definição de enfermagem que foi inserida no Código Sanitário chileno, no artigo n° 113. Método: Estudo de abordagem sócio-histórica, através do depoimento de duas enfermeiras que foram atores relevantes na construção da definição de enfermagem. As entrevistas foram analisadas por meio da análise do discurso. Resultados: Apresenta-se uma reflexão crítica feita por enfermeiras visionárias para obter uma definição de Enfermagem, que legalmente reconhece a profissão em sua função social, principalmente no cuidado da saúde das pessoas. Conclusão: Este fato histórico que legitimou a função social da enfermaria significou um processo reivindicatório á missão social do trabalho do enfermeiro e significou um marco sócio-político, porém, mais de vinte anos depois existem novos desafios na saúde e no cuidado das pessoas, ganhando valor continuar com a auto-regulação para consolidar sua autonomia e identidade profissional.

Competências para enfermeiros generalistas e especialistas atuarem na prevenção e controle de infecções no Brasil / Skills for generalist and specialist nurses working in the prevention and control of infections in Brazil / Competencias para enfermeros generalistas y especialistas actúan en la prevención y control de infecciones en Brasil

Objetivo definir as competências para a prevenção e o controle de infecções relacionadas à assistência à saúde que devem ser desenvolvidas pelo enfermeiro generalista e pelo enfermeiro especialista em controle de infecções no Brasil. Método empregou-se a técnica Delphi, desenvolvida em quatro rodadas. Participaram do estudo 31 enfermeiros e oito médicos com expertise em prevenção e controle de infecções. Para a coleta de dados, utilizaram-se instrumentos com perguntas abertas cujas respostas foram tratadas por meio da técnica de análise de conteúdo e instrumentos estruturados para avaliar a importância de cada competência por meio de escala Likert, sendo os dados analisados e apresentados de forma descritiva, uso de mediana e de coeficiente de variação. Resultados as competências foram organizadas em 04 centrais, 14 genéricas e 17 específicas, com nome e a descrição de cada competência. Conclusão a definição das competências para a prevenção e o controle de Infecções Relacionadas à Assistência à Saúde é o primeiro passo para se iniciar o repensar acerca do processo de ensino e aprendizagem na formação inicial dos enfermeiros. Os dados encontrados auxiliam na reestruturação do ensino, além de fundamentar programas de educação permanente em saúde.

Objective to define the competencies for the prevention and control of healthcare-related infections that should be developed by the generalist nurse and the specialist nurse in infection control in Brazil. Method the Delphi technique, developed in four rounds, was used. Thirty-one nurses and eight physicians participated in the study, with expertise in infection prevention and control. Data were collected using open-ended questionnaires, whose answers were treated using the content analysis technique. Structured instruments were used to evaluate the importance of each competency using a Likert scale. Data were analyzed and presented in a descriptive way, use of median and coefficient of variation. Results the competences were organized in 4 core, 14 generic and 17 specific, with name and description of each competency. Conclusion the definition of competencies for the prevention and control of healthcare-related infections is the first step to begin the rethinking of the teaching and learning process in the initial training of nurses. The data found in the present study may help to restructure education and support permanent education programs in health.

Objetivo definir las competencias para la prevención y el control de infecciones relacionadas a la asistencia a la salud que deben ser desarrolladas por el enfermero generalista y por el enfermero especialista en controle de infecciones en Brasil. Método se empleó la técnica Delphi, desarrollada en cuatro rodadas. Participaron del estudio 31 enfermeros y ocho médicos, con experiencia en prevención y control de infecciones. Para la recolección de datos se utilizaron instrumentos con preguntas abiertas, cuyas respuestas fueron tratadas por medio de la técnica de análisis de contenido, e instrumentos estructurados para evaluar la importancia de cada competencia por medio de escala Likert, siendo los dados analizados y presentados de forma descriptiva, uso de mediana y de coeficiente de variación. Resultados las competencias fueron organizadas en 04 centrales, 14 genéricas y 17 específicas, con nombre y la descripción de cada competencia. Conclusión la definición de las competencias para la prevención y el control de Infecciones Relacionadas a la Asistencia a la Salud es el primer paso para iniciarse el repensar acerca del proceso de enseñanza y aprendizaje en la formación inicial de los enfermeros. Los datos encontrados auxilian en la reestructuración de la enseñanza además de fundamentar programas de educación permanente en salud.

Fissura labiopalatina: avaliação do impacto psicológico utilizando a Escala de Autoestima de Rosenberg / Cleft lip and palate: evaluation of the psychological impact using the Rosenberg self-esteem scale

Introdução: A fissura labiopalatina é a malformação mais frequente da região da cabeça e afeta mais de 10 milhões de pessoas no mundo. O objetivo do estudo foi avaliar a autoestima em pacientes portadores de fissura labiopalatina em acompanhamento no Serviço de Cirurgia Plástica Craniomaxilofacial do Hospital de Clínicas de Porto Alegre, comparando-os com indivíduos não fissurados. Métodos: Estudo transversal contemporâneo, com 160 participantes, sendo 80 pacientes com fissura labiopalatina já submetidos a procedimentos cirúrgicos relacionados à afecção e, como grupo controle, 80 alunos e funcionários da rede pública de ensino. Um questionário para caracterizar o grupo e a escala de autoestima de Rosenberg foram utilizados para a coleta de dados. Resultados: Houve diferença significativa entre os grupos quanto ao estado civil, escolaridade e repetência escolar. Os pacientes com fissura labiopalatina apresentam níveis de autoestima menores em relação a indivíduos não afetados. Dentre eles, os subgrupos dos indivíduos com fissura bilateral, fissura completa, do gênero feminino, classe econômica D/E, baixa escolaridade, situação familiar reconstituída na infância e com resultados não satisfatórios em relação à comunicação, dentição e cicatriz de lábio também mostraram níveis de autoestima menores. Conclusão: Houve relação significativa entre fissura labiopalatina e baixa autoestima.

Introduction: Cleft lip and palate is the most frequent malformation of the head region and affects more than 10 million people worldwide. This study aims at evaluating the selfesteem in patients with cleft lip and palate and comparing that with the self-esteem of non-affected individuals during followup at the Department of Craniomaxillofacial Plastic Surgery of the Hospital de Clínicas of Porto Alegre. Methods: This is a cross-sectional, contemporary study with 160 participants, comprising 80 patients with cleft lip and palate who have already undergone surgical procedures for correcting the condition and 80 non-affected students and employees of the publicschool system as a control group. We used a questionnaire to characterize the group and the Rosenberg self-esteem scale for data collection. Results: There was a significant difference between groups in terms of marital status, schooling, and school retention. Patients with a cleft lip and palate had lower levels of self-esteem than non-affected individuals. Among them, the individuals with bilateral clefts or complete clefts; female gender; economic strata of D/E; low level of schooling; families reconstituted during childhood; and with unsatisfactory results concerning communication, dentition, and lip scar also showed lower levels of self-esteem. Conclusion: There was a significant relationship between cleft lip and palate and low self-esteem.

Cumplimiento de los registros clínicos, esquemas terapéuticos e intervenciones de enfermería en un hospital de segundo nivel de atención / Compliance with clinical records, therapeutic schemes and nursing interventions in a second-level care hospital

Resumen

Introducción: los registros clínicos de enfermería constituyen un documento legal en donde se evalúa la calidad científica, humana y ética de la atención al paciente.

Objetivo: determinar el cumplimiento de los registros clínicos de enfermería con base en la "Herramienta única de evaluación de los registros clínicos, esquemas terapéuticos e intervenciones de enfermería".

Metodología: estudio descriptivo transversal. En una muestra de 156 expedientes clínicos, se evaluó la hoja de enfermería mediante un instrumento diseñado como "Herramienta única de evaluación de los registros clínicos, esquemas terapéuticos e intervenciones de enfermería".

Resultados: en general el cumplimiento de los registros clínicos fue del 61%. La omisión en el registro se presentó en la valoración continua del dolor. El registro de intervenciones fue del 70% y de estudios 48%. Solo el 41% registró las acciones para reducir el riesgo de úlceras por presión. La mayoría (75%) no firma sus notas o lo hace de forma incompleta.

Conclusiones: la utilidad práctica de este estudio se traduce en un diagnóstico situacional sobre los registros de enfermería como información esencial sobre la cual tomar futuras decisiones con respecto a la temática abordada.

Abstract

Introduction: Nursing clinical records are a legal document in which the scientific, human and ethical quality of patient care is evaluated.

Objective: To determine compliance with nursing clinical records based on the "Single tool for the evaluation of clinical records, therapeutic schemes and nursing interventions".

Methods: Cross-sectional descriptive study. In a sample of 156 clinical files, the nursing sheet was evaluated by means of an instrument designed as "Single tool for evaluation of clinical records, therapeutic schemes and nursing interventions".

Results: In general, compliance with clinical records was 61%. The omission in the registry was presented in the continuous pain assessment. The registry of interventions was 70% and studies 48%. Only 41% registered the actions to reduce the risk of pressure ulcers. The majority (75%) do not sign their notes or do so in an incomplete way.

Conclusions: The practical utility of this study is translated into a situational diagnosis of nursing records as essential information on which to make future decisions regarding the subject matter addressed.

Developmental Care: assistance of nurses from Neonatal Intensive Care Units / Cuidado de desarrollo: asistencia de los enfermeros de Unidad de Terapia Intensiva Neonatal / Cuidado Desenvolvimental: assistência de enfermeiros de Unidade de Terapia Intensiva Neonatal

ABSTRACT Objective: to analyze the Developmental Care in nursing care for Newborns in critical Neonatal Intensive Care Units. Method: a qualitative study with 11 nurses from Neonatal Intensive Care Units of a city in the State of São Paulo countryside, based on the Developmental Care. Data collection was based on non-participant observation, documentary research in medical records and semi-structured interviews. The Symbolic Interactionism was adopted as theoretical framework, and the Bardin Content Analysis, as method of analysis. Results: nurses have knowledge about Developmental Care; however, there are dissonances with doing them. The analysis is presented from two thematic categories: "Nurses' performance in the Developmental Care" and "Nurse, Family and Developmental Care". Final considerations: it is necessary to encourage reflections on the care of nurses regarding Developmental Care, and to foster sensitivity and perception in relation to the executed and registered.

RESUMEN Objetivo: analizar el cuidado de desarrollo en la asistencia de los enfermeros al Recién Nacido crítico, en Unidad de Terapia Intensiva Neonatal. Método: estudio cualitativo con 11 enfermeros de Unidades de Terapia Intensiva Neonatal de un municipio del interior paulista que tuvo como base conceptual el cuidado de desarrollo. La recolección de datos ocurrió a partir de la observación no participante, investigación documental en prontuarios y entrevista semiestructurada. El Interaccionismo Simbólico fue adoptado como referencial teórico, y el Análisis de Contenido de Bardin, como método de análisis. Resultados: los enfermeros poseen conocimiento acerca del Cuidado de Desarrollo; sin embargo, hay disonancias con el hacer de los mismos. El análisis se presenta a partir de dos categorías temáticas: "Cuidado de Desarrollo en la actuación del enfermero" y "Enfermero, familia y Cuidado de Desarrollo". Consideraciones finales: es necesario avivar reflexiones sobre la asistencia del enfermero en cuanto al Cuidado de Desarrollo y fomentar sensibilidad y percepción en relación al ejecutado y registrado.

RESUMO Objetivo: analisar o Cuidado Desenvolvimental na assistência de enfermeiros ao Recém-Nascido crítico, em Unidade de Terapia Intensiva Neonatal. Método: estudo qualitativo com 11 enfermeiros de Unidades de Terapia Intensiva Neonatal de um município do interior paulista que teve como base conceitual o Cuidado Desenvolvimental. A coleta de dados ocorreu a partir da observação não participante, pesquisa documental em prontuários e entrevista semiestruturada. O Interacionismo Simbólico foi adotado como referencial teórico, e a Análise de Conteúdo de Bardin, como método de análise. Resultados: os enfermeiros detêm conhecimento acerca do Cuidado Desenvolvimental, contudo, há dissonâncias com o fazer dos mesmos. A análise está apresentada a partir de duas categorias temáticas: "Cuidado Desenvolvimental na atuação do enfermeiro" e "Enfermeiro, família e Cuidado Desenvolvimental". Considerações finais: é necessário avivar reflexões sobre a assistência do enfermeiro quanto ao Cuidado Desenvolvimental, e fomentar sensibilidade e percepção em relação ao executado e registrado.