The meaning of evidence-based management to Brazilian senior nurse leaders.

PURPOSE: The study objective was to understand the meaning of evidence-based management for senior nurse leaders in accredited, public hospitals in the State of Sao Paulo, Brazil. DESIGN AND METHOD: A phenomenological approach was used to analyze interviews conducted with 10 senior nurse leaders between August 2011 and March 2012. The analytic method was developed by the Brazilian phenomenologist, Martins. FINDINGS: Senior nurse leaders described how they critically appraise many sources of evidence when making managerial decisions. They emphasized the importance of working with their teams to locally adapt and evaluate best evidence associated with managerial decision making and organizational innovations. Their statements also demonstrated how they use evidence-based management to support the adoption of evidence-based practices. They did not, however, provide specific strategies for seeking out and obtaining evidence. Notable challenges were traditional cultures and rigid bureaucracies, while major facilitators included accreditation, teamwork, and shared decision making. CONCLUSIONS: Evidence-based management necessitates a continuous process of locating, implementing, and evaluating evidence. In this study leaders provided multiple, concrete examples of all these processes except seeking out and locating evidence. They also gave examples of other leadership skills associated with successful adoption of evidence-based practice and management, particularly interdisciplinary teamwork and shared decision making. CLINICAL RELEVANCE: This study demonstrates senior nurse leaders' awareness and utilization of evidence-based management. The study also suggests what aspects of evidence-based management need further development, such as more active identification of potential, new organizational innovations.

Teaching entrepreneurship in undergraduate Nursing course: evaluation of an educational proposal.

OBJECTIVE: To evaluate a proposal for teaching entrepreneurship in an undergraduate Nursing course that uses active methodologies and activities based on the theory of meaningful learning. METHODS: Interventional, prospective study, with a quantitative perspective, with a total of 102 participating students, carried out from July 2017 to December 2019 at a public university in the state of Sao Paulo. Statistical analysis were performed by non-parametric Chi-square or Fisher's exact tests, with differences considered statistically significant if p < 0.05. RESULTS: Improvements were observed in almost all items evaluated, revealing that meaningful learning became more effective with the use of active teaching methodologies. Most students need adaptation and effort to be put into these methods. CONCLUSIONS: The proposal offers pedagogical content adaptation, specifically for nursing students. New research should expand teaching-learning techniques for the development of future nurses, preparing them adequately for the job market.

Absenteeism of nurses and nursing technicians in the urgency and emergency unit.

OBJECTIVE: Associate the absenteeism of nurses and nursing technicians with the work environment in the urgency and emergency care unit. METHOD: Cohort study, urgency and emergency care unit of a public hospital, 57 nursing technicians and 14 nurses, from October 2017 to October 2018. Application of an instrument with sociodemographic and labor data, reported absenteeism and validated Brazilian version of the Nursing Work Index Revised. Multiple logistic regression analysis, significant associations if p<0.05. RESULTS: Work environment showed an average score of 3.10 for nurses and nursing technicians. The more unfavorable the environment, the greater the likelihood employees will no show up for work. Factors that increase the probability of absenteeism: being single or divorced and working night shifts. Factors that reduce this probability: being a nurse and having another job. CONCLUSION: A work environment unfavorable to professional practice increases the probability of absenteeism for nurses and nursing technicians.

Nursing staff's instrument for change-of-shift reporting - SBAR (Situation-Background-Assessment-Recommendation): validation and application.

OBJECTIVES: to validate and apply a change-of-shift instrument using the SBAR (Situation-Background-Assessment-Recommendation) tool. METHODS: methodological study for the validation of an instrument. It was validated by ten judges from the area of nursing teaching and care and applied in a surgical gastroenterology ward by 11 nursing technicians in February 2019. The analyses considered descriptive statistics. RESULTS: the judges analyzed the instrument with a content validity index of 91.7% and made suggestions, which led to the second version of the instrument. The participants reported that the predominant modality of shift handover is oral, in the nursing room, lasting six to ten minutes. Most pay attention during shift change, mention that delays and early departures interfere in the activity and believe that the instrument provides the necessary information and is viable. CONCLUSIONS: the instrument built was validated, and its application proved relevant, as it was considered necessary and feasible.

Vulnerabilities of nurses in an intensive care unit: an integrative review.

OBJECTIVES: to identify vulnerabilities of nurses who work in an intensive care unit. METHODS: an integrative review was held from 2006 to 2019, with searches on the platforms/databases LILACS, BDENF, SciELO, MEDLINE, Scopus, CINAHL, and Web of Science. The theoretical framework of ergology, by Schwartz, was used and the guiding question "What are the main vulnerabilities of nurses who work in an intensive care unit"? RESULTS: eleven articles were included. Five topics of vulnerabilities emerged: physical, emotional, communication process, care process, and organizational. We observed that the organizational vulnerability was kept as a common and intersection factor in developing the other four. CONCLUSIONS: vulnerabilities found have a relationship to the physical, emotional, communication, care process, and institution organization elements. The organization aspect intersected with the others, configuring itself as the core in this context.

Efficacy of Flower Therapy for Anxiety in Overweight or Obese Adults: A Randomized Placebo-Controlled Clinical Trial.

Objective: The aim of this study was to compare the efficacy of flower therapy for the treatment of anxiety in overweight or obese adults with that of a placebo. The authors examined improvement in sleep patterns, reduction in binge eating, and change in resting heart rate (RHR). Design: This was a randomized, double-blind, placebo-controlled clinical trial with a parallel-group design and two arms. Setting/Location: Clinical Research Unit, Medical School, São Paulo State University, Botucatu, SP, Brazil. Subjects: The study included 40 participants in the placebo group and 41 in the intervention group. Participants were of both genders, from 20 to 59 years of age, overweight or obese, with moderate to high anxiety. Interventions: The participants were divided into two random groups: one group was treated with Bach flower remedies (BFR) (bottles containing 30 mL of 30% hydro-brandy solution with two drops each of Impatiens, White Chestnut, Cherry Plum, Chicory, Crab Apple, and Pine), and the other group was given a placebo (same solution without BFR). The patients were instructed to orally ingest the solution by placing four drops directly in the mouth four times a day for 4 weeks. Outcome measures: The primary outcome was anxiety (State-Trait Anxiety Inventory [STAI]). Secondary outcomes were sleep (Pittsburgh Sleep Quality Index [PSQI]), binge eating (Binge Eating Scale [BES]), and RHR (electrocardiogram). Results: Multivariate analysis showed significant reductions in scores for the following variables in the intervention group when compared with the placebo group: STAI (ß = -0.190; p < 0.001), PSQI (ß = -0.160; p = 0.027), BES (ß = -0.226; p = 0.001), and RHR (ß = -0.07; p = 0.003). Conclusions: The anxiety symptoms, binge eating, and RHRs of the individuals treated with flower therapy decreased, and their sleep patterns improved when compared with those treated with the placebo. Registered at the Brazilian Registry of Clinical Trials (no. RBR-47-kfxh).

Transformational leadership: journal club for emergency and intensive care nurse managers.

OBJECTIVES: to understand the meaning of transformational leadership and develop an educational intervention addressing this theme. METHODS: content analysis and action research for the collective construction of an educational intervention addressing management practices and their association with transformational leadership. The setting was the emergency and intensive care network, and nine nurse managers participated in the research. Data was collected from recorded and individualized interviews, and by using the journal club strategy. RESULTS: the unveiled themes were: factors related to the team, to the leadership processes and to the leader. Difficulties in decision-making and planning processes were revealed; the leader needs to work in teams, which in turn should be appropriately sized. The journal club and planning model used provided the praxis of this work. FINAL CONSIDERATIONS: reflection and training for the development of transformational leadership were fundamental to solidify the decision-making processes involved in the managers' practice.

Mental health in primary care: experience of matrix strategy in the rural area.

OBJECTIVE: to report the development of Mental Health actions shared between the Family Health Strategy located in a rural area and the Matrix Support Team by showing the communication resulting from this singular configuration. METHOD: report of experience about the implementation of actions of the Family Health Support Center (Portuguese acronym: NASF) in mental health care for a rural population. RESULTS: the following health needs were identified: psychoactive drugs consumption, lack of activities for collective care and difficulty with access to service. The expansion of actions and intersectoral involvement of actors were demonstrated as the educational attitudes were implemented. FINAL CONSIDERATIONS: the articulation between family health workers, matrix support and community was key for the implementation of mental health care aligned with the psychosocial approach.

Leadership in the perspective of Family Health Strategy nurses.

OBJECTIVE: To understand the perception of leadership in the work process and to promote its discussion within the Family Health Strategy scope. METHOD: A qualitative approach research, guided by the action-research referential, conducted with 15 Familiy Health Strategy nurses in the inland of the state of São Paulo. Data was collected in 2015 in two interdependent phases, interviews and intervention-action, and processed according to the methodological framework of content analysis and the theoretical framework on nursing management. RESULTS: The nurses showed their conceptions of leadership and the inherent challenges of practice: leadership training, overlapping care and management, and management charges. In the discussion of common problems and peer learning, a conception of transformational leadership was constructed. CONCLUSIONS: The common and behavioral styles of leadership influenced on the conception of leadership and mobilized the attitudes of the nurses in the work process; however, there is a need for more engagement in the training/qualification of the professionals and the services about leadership.

Positive aspects of authentic leadership in nursing work: integrative review.

OBJECTIVE: To identify and analyze the existing scientific production on the positive aspects of authentic leadership in the nurse's work process. METHOD: This is an integrative literature review. The databases used were Scientific Electronic Library Online; Latin American and Caribbean Literature on Health Sciences; and National Library of Medicine - National Institutes of Health. RESULTS: In this study, 17 articles were selected for analysis; 1 study (6%) was published in a national journal, and 16 (94%) were international studies. Of the 17 (100%) articles studied, 11 (65%) were developed in Canada. The hospital environment was present in the 17 (100%) articles. Final considerations: Authentic leadership has several positive aspects that significantly influence the nurse's work process, such as engagement and job satisfaction, retention of new nurses, organizational commitment, among others.

Anxiety, sleep quality, and binge eating in overweight or obese adults. / Ansiedade, qualidade do sono e compulsão alimentar em adultos com sobrepeso ou obesidade.

OBJECTIVE: To analyze the relationship of anxiety to binge eating and sleep quality in overweight or obese adults. METHOD: Transversal study, conducted between May 2015 and January 2017, with an intentional sample composed of literate individuals of both sexes, aged 20 to 59 years, who presented body mass index higher or equal to 25 kg/m2. State-Trait Anxiety Inventory, Binge Eating Scale, and Pittsburgh Sleep Quality Index were employed. Pearson or Spearman correlation coefficient was adopted for data analysis, according to its distribution. RESULTS: The sample comprised 130 individuals. The overall and young adults' samples presented a positive correlation between anxiety and binge eating scores (p=0.0011) and sleep quality score (p=0.0081). Adults who were 45 or older presented an inverse relation between age and anxiety (p=0.0003). CONCLUSION: The overall sample and young adults who presented higher anxiety state had higher indexes of binge eating and a worse sleep quality, whereas for middle-aged adults, higher age was related to a lower anxiety score. Brazilian Registry of Clinical Trials (Registro Brasileiro de Ensaios Clínicos): n° RBR-47kfxh.

Absenteeism and the Technical Safety Index of a tertiary hospital nursing team.

OBJECTIVE: To identify the nursing team absenteeism rate, calculate the Technical Safety Index and compare them to the percentage established by the Federal Nursing Council. METHOD: A descriptive, analytical, and retrospective study which included nursing professionals working in a public and tertiary hospital. The Human Resources Department database of the Institution was used for data collection. Absenteeism was considered as any unplanned absence. RESULTS: Ninety-nine (99) professionals participated, of which 21 were nurses and 78 were nursing technicians. Weekly days off prevailed among the expected absences, with 17% for both categories. Maternity leave prevailed among nurses and medical leave among nursing technicians regarding absenteeism, with averages of 12% and 9%, respectively. The Technical Safety Index was 42% for nurses and 38% for nursing technicians. CONCLUSION: The nursing teams absenteeism rate was 21.5%, while the Technical Safety Index was 40%, thus constituting higher values than those established by the Federal Nursing Council.

Adaptation and validation of the Brazilian Portuguese version of the Leader Empowering Behavior scale.

OBJECTIVES: to adapt and validate the Leader Empowering Behavior scale for Brazilian Portuguese in a sample of Brazilian nurses. METHODS: cross-sectional study through translation, back-translation, expert evaluation, application and analysis of content, criteria and construct of the scale. RESULTS: the title of the final version was Comportamento Empoderador do Líder. The equivalence evaluation presented Content Validity Index of 89% among the 27 items of the original scale and was applied to 272 nurses. For the construct validation, psychometric analyzes were performed; through calculations of the measure of sampling adequacy, were excluded six items from the translated instrument; and in the factor analysis, four factors were retained. The Cronbach's alpha was calculated for the four domains and ranged from 0.82 to 0.87, demonstrating the scale reliability. CONCLUSIONS: the adapted version presented validity and reliability criteria for use in Brazil. Its use will make it possible to know the behavior of leaders to empower their team.

Development of a journal club on the Nursing management process.

OBJECTIVE: To develop a journal club on management topics in Nursing. METHOD: Action research, adopting content analysis as methodological reference and the journal club strategy. 12 nursing managers of a public hospital in the state of São Paulo participated from August to November 2016. RESULTS: data showed the participation of nurses in the journal club in five meetings planned collectively with the following topics: "aspects regarding organization", with the subtopics "planning", "work process", "structure" and "people management"; and the topic "aspects regarding the team", with the subtopics "autonomy", "behavior/attitude", "awareness" and "social problems". CONCLUSION: The study showed the comprehensiveness of topics the journal club can address regarding management, and how scientific basis is important in the daily life of nursing managers to improve quality of care and the ability to manage.

Comportamento empoderador do enfermeiro-líder na perspectiva de técnicos e auxiliares de enfermagem / Comportamiento empoderador de enfermeros líderes bajo la perspectiva de técnicos y auxiliares de enfermería / Empowering behavior of the nurse-leader from the perspective of nursing technicians and assistants

Resumo Objetivo Associar dados demográficos e laborais e o comportamento empoderador do enfermeiro-líder na perspectiva de técnicos e auxiliares de enfermagem. Métodos Pesquisa transversal e correlacional realizada em hospital universitário terciário do estado de São Paulo. Participaram 260 profissionais de enfermagem de nível médio (técnicos e auxiliares de enfermagem), por meio de instrumentos autoaplicáveis no período de maio a agosto de 2021. Para verificar a associação entre as classes da escala e as variáveis explanatórias, foi realizado teste qui-quadrado ou exato de Fisher no programa SAS. As relações foram estatisticamente significativas se p<0,05. Resultados O perfil dos participantes predominou o sexo feminino, média de idade de 41,9 anos, trabalhadores do período diurno, carga horária de 36,7 horas e satisfeitos com o trabalho. A aplicação do instrumento Comportamento Empoderador do Líder evidenciou que o domínio com maior média de comportamento empoderador foi "trabalho significativo" e o com menor média foi "autonomia em relação à burocracia". Os auxiliares e técnicos de enfermagem que trabalhavam no período diurno não possuíam outros vínculos de trabalho e estavam satisfeitos com o mesmo, além de terem observado mais o comportamento empoderador do líder. Conclusão O comportamento do enfermeiro para empoderar sua equipe, na perspectiva de técnicos e auxiliares de enfermagem no hospital estudado, foi bom na maioria dos domínios, exceto no domínio "autonomia em relação à burocracia", em que foi razoável. Trabalhar no turno diurno, não ter outros vínculos e estar satisfeito com o trabalho foram aspectos de maior empoderamento.

Resumen Objetivo Asociar datos demográficos y laborales con el comportamiento empoderador de enfermeros líderes bajo la perspectiva de técnicos y auxiliares de enfermería. Métodos Estudio transversal y correlacional realizado en un hospital universitario terciario del estado de São Paulo. Participaron 260 profesionales de enfermería de nivel medio (técnicos y auxiliares de enfermería), mediante instrumentos autoaplicados durante el período de mayo a agosto de 2021. Para verificar la asociación entre las clases de la escala y las variables explicativas, se realizó la prueba ji cuadrado o exacta de Fisher en el programa SAS. Las relaciones fueron estadísticamente significativas si p<0,05. Resultados En el perfil de los participantes predominó el sexo femenino, promedio de edad de 41,9 años, trabajadores del período diurno, carga horaria de 36,7 horas y satisfechos con el trabajo. La aplicación del instrumento Comportamiento Empoderador del Líder evidenció que el dominio con mayor promedio de comportamiento empoderador fue "trabajo significativo" y con menor promedio fue "autonomía con relación a la burocracia". Los auxiliares y técnicos de enfermería que trabajaban en el período diurno no tenían otros vínculos de trabajo y estaban satisfechos con este, además de haber observado más el comportamiento empoderador del líder. Conclusión El comportamiento de los enfermeros para empoderar a su equipo, bajo la perspectiva de técnicos y auxiliares de enfermería en el hospital estudiado, fue bueno en la mayoría de los dominios, excepto en el dominio "autonomía con relación a la burocracia", que fue razonable. Trabajar en el turno diurno, no tener otros vínculos y estar satisfecho con el trabajo fueron aspectos de mayor empoderamiento.

Abstract Objective Associate demographic and work data and the empowering behavior of the nurse-leader from the perspective of nursing technicians and assistants. Methods Cross-sectional and correlational research carried out in a tertiary university hospital in the state of São Paulo. A total of 260 mid-level nursing professionals (nursing technicians and assistants) participated, using self-administered instruments from May to August 2021. To verify the association between the scale classes and the explanatory variables, a chi-square or Fisher's exact test was performed in the SAS program. Relationships were statistically significant if p<0.05. Results The profile of the participants was predominantly female, mean age 41.9 years, daytime workers, workload of 36.7 hours and satisfied with their work. The application of the Leader's Empowering Behavior instrument showed that the domain with the highest average of empowering behavior was "meaningful work" and the one with the lowest average was "autonomy in relation to bureaucracy". Nursing assistants and technicians who worked during the day did not have other work relationships and were satisfied with it, in addition to observing the leader's empowering behavior more. Conclusion Nurses' behavior to empower their team, from the perspective of technicians and nursing assistants in the studied hospital, was good in most domains, except in the domain "autonomy from bureaucracy", where it was reasonable. Working the day shift, not having other jobs and being satisfied with the job were aspects of greater empowerment.

Prenatal care satisfaction: perception of caregivers with diabetes mellitus.

OBJECTIVE: to understand the satisfaction of pregnant women with diabetes who took insulin during pregnancy and prenatal care performed through outpatient and inpatient follow-up. METHOD: a qualitative approach with analysis of 30 pregnant women who underwent prenatal care and participated in a clinical trial study carried out by the research group of the Perinatal Diabetes Research Center of the Hospital das Clínicas, of the Faculdade de Medicina de Botucatu. The data were collected through interviews and analyzed from content analysis. RESULTS: from the category Satisfaction, the following subcategories emerged: facilities and difficulties faced in prenatal care performed through outpatient or inpatient follow-up, demonstrating that the pregnant women were satisfied with the prenatal care offered regardless of the type of follow-up. CONCLUSION: there was satisfaction in both care, but in outpatient care some structural, technical and administrative difficulties were identified, requiring reassessment, in order to guarantee service agility.

Nurses' perception concerning the care for patients with physical disabilities that interfere with self-image: a phenomenological approach.

This study aimed at understanding the perception and the meaning of caring for patients with self-image problems resulting from physical alterations to nurses working at a university hospital. Phenomenology was the methodology used, and the subjects of study were eight nurses. In order to analyze the statements given, transcription and readings were performed, seeking for the essence of the units, the expression of meanings by thematizing and interpreting the discourse and looking for convergence, divergence, idiosyncrasies and synthesis of the phenomenon. The unveiled themes were: (non) Acceptance of the disease; Team work; Limitations resulting from the disease; The nurse's and team's feelings and behavior; Ties between the team, patient and family; The family; Patient's self-image; Patients' age; Prejudice; Acknowledgement or knowledge of the disease; Care level and more intense care; Religion and Capacitation. Due to the amplitude of the phenomenon, other angles can be unveiled and other perspectives can be inhabited.

Development of an eye protector for phototherapy on newborns: a technology.

Hyperbilirubinemia results from the predisposition of newborns to produce bilirubin and their ability to excrete it. The treatment applied is phototherapy; however, one of its complications is degeneration of the retina by exposure to light, making it essential to provide proper eye protection. The objective of this study is to describe the development of an invention (utility model patented) for eye protection in newborn phototherapy. This invention aims to replace the current widespread practice of using improvised means that are uncomfortable for the baby and disrupt the mother/child relationship. A study was made of the radiances emitted by light sources used in phototherapy. The invention consists of an eye protector model for use during the newborn's phototherapy, allowing greater closeness between mother and baby. The device is easy to use, economical, removable and appropriate for newborns, causing no discomfort, and its effectiveness has been proved through radiance tests.

Movement undertaken by newly graduated nurses towards the strengthening of their professional autonomy and towards patient autonomy.

This study involved newly graduated nurses performing in a public hospital and aimed at apprehending how they interpret the reality of their practice as well as their knowledge and experiences; at identifying and problematizing aspects related to the caregiving practice in terms of compliance with the autonomy bioethical framework and at pointing out ways to overcome the problems identified. The strategy adopted for data collection was the focal group and the theoretical framework was based on the Grounded Theory. Two phenomena emerged from the results: 1) Perceiving the fragility of nurse and patient autonomy and 2) Moving towards the strengthening of nurse and patient autonomy. This allowed for the identification of the core category: movement undertaken by newly graduated nurses towards the strengthening of their professional autonomy and towards patient autonomy. Understanding the experience enabled us to expand the knowledge concerning newly graduate nurses' coping, thus favoring our action as nursing professors.

Perception of nursing workers humanization under intensive therapy.

OBJECTIVE: understand the perception of nursing workers working in the Intensive Care Unit (ICU) regarding humanization in the work environment. METHOD: we used the reference of phenomenology, structure of the phenomenon. Participated 25 nursing professionals working in an adult ICU of a university hospital, through focused interviews, answering the guiding question: What do you understand by humanization of the working conditions of the nursing team working in the ICU? RESULTS: the analysis revealed the themes: humanization in the ICU; working condition in the ICU; management of people in the ICU and management process in the ICU. FINAL CONSIDERATIONS: humanization is necessary through the change of the work environment and the managerial process, privileging the participatory management model as a way to transform theory into practice and value the worker.