Prioritization criteria in policies and management of human resources for health: a proposal for a validated methodology.

Objective: To create and validate criteria for prioritizing problems related to policies and management of the health workforce. Methods: This methodological study was divided into three stages. First, the criteria were elaborated by means of a systematized literature review. Second, the criteria were evaluated online by a committee of judges comprised of eight specialists. In the third stage, an evaluation was carried out by the target audience in a hybrid workshop. The participants evaluated the material using the Suitability Assessment of Materials instrument, adapted for the research. Results: Three prioritization criteria (relevance, window of opportunity and acceptability) and a scoring scale were developed based on the literature review. In the evaluation by the committee of judges, the approval percentage of the criteria and prioritization method was 84%. Modifications were made based on suggestions in relation to the material presented to the specialists. In the pre-test stage, the approval percentage varied by item, with six of them reaching a maximum approval of 100% (corresponding to approximately 46% of the items), four reaching 92% and three achieving 83% each, indicating positive results. Conclusions: The developed criteria were considered valid for use in the context of policies and management in the area of human resources for health.

Community Health Workers and Stigma Associated with Mental Illness: An Integrative Literature Review.

Community health workers (CHWs) are facilitators between health services and service users, providing essential and effective support to those seeking health care. However, stigmatizing attitudes towards people with mental illness also exist among CHWs and are based on prejudicial and biasedopinions. This integrative review critically assessed evidence regarding CHWs approaches for addressing mental health issues. In total, 19 studies were included in this review. The results revealed that CHWs have limited knowledge about mental illness and also stigmatizing attitudes towards people with mental illness or substance use problems. Despite feeling unprepared, CHWs are favorable resources for mental health care and can contribute to reducing stigma due to the similarities they share with the communities that they serve. Task-sharing between health professionals and CHWs is an important strategy to improve access to health services and reducing stigma towards people with mental illness, provided that receive adequate training to perform the duties.

Factors associated with internalized stigma in people with common mental disorders using services of Family Health Strategy.

PURPOSE: To identify factors associated with the presence of internalized stigma in people with Common Mental Disorders (CMD) using Family Health Strategy. METHOD: Quantitative study carried out with 529 users with CMD answered the sociodemographic questionnaire and the scales Self-Reporting Questionnaire and scale on Internalized Stigma of Mental Illness. RESULTS: Internalized stigma was associated with education level, medication use, treatment for mental disorders, suicidal ideation, attendance at a psychosocial care center and psychiatric hospital. CONCLUSION: The adequate identification and treatment of psychological distress constitute effective prevention strategies to safeguard life and ensure the stigma reduction and better quality of life.

General Beliefs About Illicit Drug Use and Stigma: Perspective of People Who Use Illicit Drugs.

People who use illicit drugs are continuously subjected to harsh stigmatization from society. This study explores the perspectives of people who use illicit drugs, specifically their general beliefs about illicit drug use and related stigma. A convergent parallel mixed methods design was used, combining quantitative and qualitative methods. The participants were recruited in a Psychosocial Care Centre (CAPSad) of a municipality in the state of Sao Paulo in Brazil. Findings revealed that illicit drug use can cause individual, family, professional and social difficulties, including problems with the law. The participants indicated they felt victimized by illicit drugs and their use, but also shared prejudicial and discriminatory views, highlighting self-stigmatizing perspectives. There is a need to develop intervention studies with a psychosocial approach on the use of illicit drugs, valuing the person's participation in the treatment, covering biomedical approaches, having in mind the social impact of illicit drugs and their use.

Living conditions of persons with mental and behavioral disorders in a psychiatric hospital, São Paulo, Brazil.

The objective of this study was to identify the conditions of life of patients with mental and behavioral disorders admitted to a specialized hospital in an inner city in the state of São Paulo, Brazil, and their possible relationship with inequities and social exclusion. The information about the conditions of life was gathered through medical records and structured interviews with the patients. The data collected were compared with the recent literature on the subject. We conclude that the conditions of health, life and social vulnerability are associated with changes in family and social relationships, stigma, discrimination and prejudice, and barriers to the exercise of citizenship for these patients. Findings confirm the need for equity in this group's access to the exercise of human rights.

Nursing care in mental health: Human rights and ethical issues.

People with mental illness are subjected to stigma and discrimination and constantly face restrictions in the exercise of their political, civil and social rights. Considering this scenario, mental health, ethics and human rights are key approaches to advance the well-being of persons with mental illnesses. The study was conducted to review the scope of the empirical literature available to answer the research question: What evidence is available regarding human rights and ethical issues regarding nursing care to persons with mental illnesses? A scoping review methodology guided by Arksey and O'Malley was used. Studies were identified by conducting electronic searches on CINAHL, PubMed, SCOPUS and Hein databases. Of 312 citations, 26 articles matched the inclusion criteria. The central theme which emerged from the literature was "Ethics and Human Rights Boundaries to Mental Health Nursing practice". Mental health nurses play a key and valuable role in ensuring that their interventions are based on ethical and human rights principles. Mental health nurses seem to have difficulty engaging with the ethical issues in mental health, and generally are dealing with acts of paternalism and with the common justification for those acts. It is important to open a debate regarding possible solutions for this ethical dilemma, with the purpose to enable nurses to function in a way that is morally acceptable to the profession, patients and members of the public. This review may serve as an instrument for healthcare professionals, especially nurses, to reflect about how to fulfil their ethical responsibilities towards persons with mental illnesses, protecting them from discrimination and safeguarding their human rights, respecting their autonomy, and as a value, keeping the individual at the centre of ethical discourse.

Cultivating ethical leadership in the recovery of COVID-19.

AIM: To propose the necessity of fostering ethical leadership in the recovery of COVID-19. BACKGROUND: Supporting physically and emotionally exhausted nurses, whilst ensuring quality standards of care delivery in the recovery phase of COVID-19, requires careful, considerate and proactive planning. EVALUATION: Drawing on literature and utilizing Lawton and Paez Gabriunas' (2015) integrated ethical leadership framework (purpose, practices, virtues), possible practical suggestions for the operationalization of ethical leadership are proposed. DISCUSSION: Nurse managers must maintain ethical vigilance in order to nurture value-driven behaviour, demonstrating empathy and compassion for nurses experiencing physical and emotional exhaustion because of COVID-19. It is important that open dialogue, active listening and self-care interventions exist. Nurse managers have an essential role in inspiring and empowering nurses, and building morale and a collective commitment to safe and quality care. CONCLUSION: Nurse managers need to consider ways of empowering, supporting and enabling nurses to apply ethical standards in everyday practice. IMPLICATIONS FOR NURSING MANAGEMENT: Fostering ethical nurse leadership requires careful and sensitive planning, as well as charismatic, compassionate and inspirational leaders. Supporting staff through respect, empathy, role modelling and genuine conscientiousness is essential for increasing job performance and sustaining an ethical work environment.

Alignment and contribution of nursing doctoral programs to achieve the sustainable development goals.

BACKGROUND: Different social segments from several regions of the world face challenges in order to achieve the sustainable development goals (SDGs). Nursing represents the greatest number of health workforce in the globe, dealing with these challenges in different paths, among them the training of human resources. In this context, the goal of this study was to compare the relationship between the objectives and research areas underlying nursing doctoral programs in Latin America and the SDGs. METHOD: Documental research comparing data of all Latin American nursing doctoral programs and the SDGs, conducted between January and March 2020. RESULTS: From the total of 56 existing programs in Latin America, this study analyzed 52 of them, representing 92.8% of the total. Most nursing doctoral programs have contributed to SDG 3, in addition to goals 1, 2, 4, 5, 6, 8, 9, 10, 12 and 16. The SDGs 11, 13, 14, 15 and 17 were not related to any of the analyzed programs. Data reveal that the training of nursing PhDs is essential to fulfilling these goals. Results also indicate a need of programs to remain committed to relationships that enhance nursing skills to cope with the current challenges in terms of global health, such as investments for the reduction of social and gender inequities. CONCLUSION: The doctoral training of nurses in Latin America needs to be better aligned with the sustainable development goals (SDGs), since there is a high concentration in SDG 3. We believe that nursing will bring a greater contribution to the movement to protect planetary health as the principles governing nursing practices are better aligned with international health demands and agendas.

Empathizing and systemizing profiles of Brazilian and Portuguese nursing undergraduates.

AIM: To analyze the empathizing and systemizing profiles of Brazilian and Portuguese nursing undergraduates. BACKGROUND: Empathy is a fundamental skill for nursing practice and should be analyzed during the student's education. METHODS: Descriptive study with cross-sectional design. Participants were 968 undergraduate students, including 215 (22.2%) Brazilians from a university in the state of São Paulo and 753 (77.8%) Portuguese students from a higher education institution in central Portugal. The Portuguese and Brazilian versions of the Empathizing/Systemizing Quotient have good internal consistency and reliability. ETHICAL CONSIDERATIONS: In Brazil, approval for the study was obtained from the Research Ethics Committee of the University of São Paulo at Ribeirão Preto College of Nursing (protocol 191/2016) and in Portugal, from the Ethics Committee of the Health Sciences Research Unit: Nursing, Coimbra Higher School of Nursing (protocol P362-09/2016). RESULTS: Most (86%) participants were female and aged between 20 and 24 years. In the general profile analysis between both groups, the domains "Social Skills," "Contents," and "Processes" scored higher. Gender differences exist for the feeling of empathy and systemizing, as women scored better on the short version of the Empathy Quotient and men on the Systemizing Quotient. CONCLUSION: As demonstrated in the domain scores for "Social Skills," "Contents," and "Processes," the undergraduate nursing students analyzed have the ability to deal intuitively and spontaneously with social situations; they are also characterized as methodical people, who like to follow rules, and experience practice better than theory, and the women have a higher empathetic level than men, who in turn are more systemizing.

Perspectives About Treatment Services From People Who Use Illicit Drugs.

The objective of the current study was to describe the perspectives of people who use illicit drugs regarding the availability and effectiveness of drug treatment services. A total of 111 participants with illicit drug use experience were recruited from an inner city community in São Paulo, Brazil. Treatment services were considered to be essential and necessary by the majority of participants, whereas general hospitals and mental health services were considered to be the most highly available treatment options for illicit drug use. Participants also indicated that treatment led to positive changes in their lives, highlighting the importance of drug treatment services for promoting the rights and responsibilities of people who use illicit drugs. Results support the need for services that value and respect the fundamental rights of people who use illicit drugs. [Journal of Psychosocial Nursing and Mental Health Services, 58(4), 28-37.].

Perceptions of brazilian nursing faculty members regarding literacy of human rights related to health in nursing undergraduate programs.

BACKGROUND: In the context of global health, the work of nurses is of key importance, given their role as diplomats in global health and as fundamental forces in the construction of global partnerships. This study seeks to identify the understanding and perceptions of Brazilian nursing faculty members regarding literacy of human rights related to health in nursing undergraduate programs. METHODS: Methodological, quantitative and cross-sectional study carried out with nursing faculty members from 20 Brazilian higher education institutions. For the data collection, the Brazilian version of the Basic Core Competencies in Global Health questionnaire was used, available on the website Survey Monkey. In this article, the answers related to the domain "Health as a human right and development resource" were assessed. Descriptive statistics were applied, as well as Cronbach's alpha coefficient. RESULTS: In total, 222 questionnaires were completed. As for the domain "Health as a human right and development resource", Cronbach's alpha coefficient corresponded to 0.839 for the three domain items. Most of the participants fully agreed on the relevance of the contents related to the theme for nurses' education. CONCLUSIONS: It is essential that nurses have contact with human rights international instruments that influence implementation of health and health research policies, though this content's treatment is still incipient in Brazilian nursing programs.

Perspectives toward brain death diagnosis and management of the potential organ donor.

BACKGROUND: Organ donation and transplantation represent one of the most important scientific advances over the last decades. Due to the complexity of these procedures and related ethical-legal aspects, however, there are a lot of doubts and uncertainty about the brain death diagnosis and the maintenance of potential organ donor. AIM: To identify and discuss the different meanings and experiences of registered nurses and physicians from an adult intensive care unit in relation to the diagnosis of brain death and the maintenance of potential organ donors for transplantation purposes. STUDY DESIGN: Participants were registered nurses and physicians from an adult intensive care unit at a University Hospital from Brazil. Data were collected through semi-structured interviews and analyzed using content analysis. ETHICAL CONSIDERATIONS: This study was approved by the University of São Paulo at Ribeirão Preto College of Nursing Research Ethics Committee. RESULTS: Two main categories emerged from the analysis: (1) brain death diagnosis and its implications and (2) maintenance of the potential organ donor and its repercussion in the donation-transplantation process. Six subcategories were also identified: (1.1) understanding the brain death diagnosis as a tool to aid decision-making; (1.2) diagnosis as guarantee of rights; (1.3) difficulties encountered to establish the diagnosis; (1.4) clinical criteria adopted in Brazil and related ethical-legal aspects; (2.1) specificities of care to the brain dead person and outcomes; and (2.2) nurse's duties toward the brain dead person. CONCLUSION: Although the brain death diagnosis is scientifically and legally defined in Brazil and the maintenance of the potential organ donor for transplantation purposes has been addressed during the last years, there are still some doubts about the subject, as its understanding varies according to the personal beliefs, culture, and educational background of individuals, including those who work in this scenario.

Empathic profile of nursing freshmen.

OBJECTIVE: To analyze the empathic profile and the empathy scores of freshmen of the nursing course. DESIGN AND PARTICIPANTS: Descriptive study involving 399 freshmen students of two modalities of nursing courses: Bachelor and Bachelor and Teaching Diploma, in the period from 2012 to 2015. A sociodemographic questionnaire and the Empathy Inventory were applied. ETHICAL CONSIDERATIONS: The research received approval from the Research Ethics Committee of the University of São Paulo at Ribeirão Preto College of Nursing. The students registered their acceptance to participate in the research by signing the Free and Informed Consent Form and anonymity was guaranteed. FINDINGS: The mean age of the participants was 19 years, being 85.5% female. The students were grouped by course modality and all groups presented high empathy scores. A significant difference (p < 0.001) was found, which indicates that students of the Bachelor and Teaching Diploma program presented a higher degree of empathy for the General Score, Domain 2 (Interpersonal Flexibility), and Domain 3 (Altruism) in relation to students in the Bachelor program. CONCLUSION: Results show that nursing undergraduate freshmen are emphatic, with minimum differences between the two courses. This profile is relevant for the development of future professionals capable to demonstrate a balance between instrumental and expressive competences.

Expectations and perceptions of clients concerning the quality of care provided at a Brazilian hospital facility.

PURPOSE: To identify the expectations and perceptions of clients concerning the quality of hospital care provided to them and their respective companions at a private Brazilian hospital using SERVQUAL. The SERVQUAL questionnaire can provide information concerning expectations and perceptions of clients. In addition, it is able to identify the participation of frontline employees and how they contribute to the organization's end product (service delivery). METHODS: In total, 172 inpatients for surgical reasons answered the SERVQUAL questionnaire. It consists of 23 pairs of statements, 22 of which are distributed into the dimensions of tangibles, reliability, responsiveness, assurance and empathy. Statement 23 refers to the overall quality of care. Exploratory analysis, internal consistency (Cronbach's alpha) and the kappa Coefficient were calculated using the Statistical Package for Social Sciences and SAS 9.2. Ethical approval was obtained from the Institutional Review Board at the Hospital das Clínicas at the University of São Paulo at Ribeirao Preto Medical School. RESULTS: Most participants had a bachelor's degree and were over than 60years old. Cronbach's alpha coefficients indicated good internal consistency (α=0.93) and high levels of agreement were observed (91.10%). CONCLUSION: The SERVQUAL questionnaire was sensitive to items in each dimension for which clients' perceptions surpassed their expectations. IMPLICATIONS FOR NURSING MANAGEMENT: The continuous quality assessment of health services is mandatory for nursing leadership. The nursing leadership can further explore the SERVQUAL with a view to better attending to the clients' expectations.

Self-stigma, mentally ill persons and health services: An integrative review of literature.

Integrative review about self-stigma among people with mental illness and its relationship with health services. A total of 149 articles were found in four databases. After screening, 9 articles were selected for complete reading and data extraction. The studies identified that higher levels of self-stigma result in lower levels of adherence to treatment and that lower levels of self-stigma result in greater adherence to treatment. Active participation and engagement in the aspects of care facilitate the empowerment of people with mental illness for better adherence to treatment, reduction of self-stigma and increase of recovery possibilities.

Physical and mechanical restraint in psychiatric units: Perceptions and experiences of nursing staff.

BACKGROUND: Physical restraint in psychiatric units is a common practice but extremely controversial and poorly evaluated by methodologically appropriate investigations. The cultural issues and professionals' perceptions and attitudes are substantial contributors to the frequency of restraint that tend to be elevated. Aim In this qualitative study, we aimed to understand the experiences and perceptions of nursing staff regarding physical restraint in psychiatric units. METHOD: Through theoretical sampling, 29 nurses from two Brazilian psychiatric units participated in the study. Data were collected from 2014 to 2016 from individual interviews and analyzed through thematic analysis, employing theoretical presuppositions of symbolic interactionism. RESULTS: Physical restraint was considered unpleasant, challenging, risky, and associated with dilemmas and conflicts. The nursing staff was often exposed to the risks and injuries related to restraint. Professionals sought strategies to reduce restraint-related damages, but still considered it necessary due to the lack of effective options to control aggressive behavior. CONCLUSIONS: This study provides additional perspectives about physical restraint and reveals the need for safer, humanized and appropriate methods for the care of aggressive patients that consider the real needs and rights of these patients.

Psychiatric Nursing Care in a General Hospital: Perceptions and Expectations of the Family/Caregiver.

The current study aimed to investigate the perceptions and expectations of family members/caregivers regarding nursing care provided to psychiatric inpatients in a general hospital. The study was a descriptive-exploratory study with a qualitative approach. Data were collected through open interviews with 10 relatives of patients hospitalized in the psychiatric unit and analyzed using content analysis. Participants reported that nursing care was good and emphasized a good relationship between the patient and nursing staff marked by professionalism, care, and dedication. Participants' expectations highlighted staff's need for relational skills, represented by patience, attention, and interaction, and for meeting the basic human needs of patients. Most participants did not have higher expectations regarding the care provided. Future studies should address the family/caregiver's point of view, as psychiatric hospitalizations in general hospitals are a recent practice that should be the subject of further reflection and discussion to improve the quality of care. [Journal of Psychosocial Nursing and Mental Health Services, 56(8), 31-36.].

General Beliefs and Stigma Regarding Illicit Drug Use: Perspectives of Family Members and Significant Others of Drug Users in an Inner City in Brazil.

People who use drugs are continuously subjected to harsh stigmatization through a process of relational and social degradation, which limits their possibility for recovery. This quantitative study explores the perspectives of family members or significant others of illicit drug users, regarding general beliefs about illicit drug use and their stigma. Respondents agree that most people do not trust people who use drugs, disregard individuals who have been hospitalized due to drug problems and do not think people who use drugs are as intelligent as the general population. These findings reveal a high level of public stigma regarding illicit drug use.

Meanings attributed by nurses to ensure the care of critical patients in the light of simulations' premises.

AIM: The aim of this study was to identify the feelings experienced by nurses in caring the first visit to a critical patient. BACKGROUND: Understand the ethical aspects from the first experiences in the nursing profession lead us to reflect on the teaching-learning methodologies and also their improvements. METHODS: A study with a mixed and exploratory approach was realized with the nurses. RESULTS: From 72 (100.0%) nurses who participated in the study, 56 (77.8%) did their first visit to critical patients in the clinical practice and did not feel prepared. The feelings mentioned were as follows: insecurity due to lack of skill, risk both to the patient and also the professional, feelings of fear, anxiety, discomfort and related aspects to ethical competence. CONCLUSION: The feelings experienced by professionals led us to reflect about the function of institutions, which must have the commitment and the responsibility of providing to the society able professionals who are acting safely and with technical and scientific expertise in valuing human integrity.