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

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

Construção de uma escala de avaliação do ambiente de trabalho na atenção primária à saúde / Construcción de una escala de evaluación del ambiente laboral en la atención primaria de salud / Construction of an assessment scale for the work environment in primary health care

Resumo Objetivo Descrever as etapas da construção de uma escala para avaliar o ambiente de trabalho na Atenção Primária à Saúde (APS). Método Estudo metodológico com cinco etapas: estabelecimento da estrutura conceitual; construção das questões e da escala de respostas; estruturação; validade do conteúdo com especialistas; e análise semântica com profissionais de saúde. Resultados A construção da estrutura conceitual com revisão de literatura e a análise dos pesquisadores, especialistas e profissionais de saúde, finalizou a escala com 36 questões. O ambiente de trabalho é influenciado por condições de trabalho, questões de administração e gestão, saúde do trabalhador, cargas de trabalho, valorização e motivação, violência e estratégias para um ambiente de trabalho saudável. Foi realizado o Índice de Validade de Conteúdo (IVC) e Porcentagem de Concordância, com valores de 0,96 (IVC) e 96% de concordância, respectivamente. Conclusões e implicações para prática A escala foi elaborada e apresentou concordância, de acordo com o teste de validade de conteúdo, por especialistas e profissionais de saúde. Assim, a escala está apta a seguir para outros processos de validação e pode contribuir para a prática de pesquisadores das áreas de saúde na avaliação do ambiente de trabalho.

Resumen Objetivo Describir las etapas de la construcción de una escala para evaluar el clima laboral en la Atención Primaria de Salud (APS). Método Estudio metodológico con cinco etapas: establecimiento de la estructura conceptual; construcción de preguntas y escala de respuestas; estructuración; validez de contenido con expertos; y análisis semántico con profesionales de la salud. Resultados La construcción de la estructura conceptual con revisión de la literatura, el análisis de investigadores, expertos y profesionales de la salud finalizó la escala con 36 preguntas. El ambiente de trabajo está influenciado por las condiciones de trabajo, cuestiones de administración y gestión, salud de los trabajadores, cargas de trabajo, aprecio y motivación, violencia y estrategias para un ambiente de trabajo saludable. Se realizó el Índice de Validez de Contenido (IVC) y Porcentaje de Concordancia, con valores de 0,96 (IVC) y 96% de Concordancia, respectivamente. Conclusiones e implicaciones para la práctica La escala fue desarrollada y mostró concordancia, según la prueba de validez de contenido realizada por expertos y profesionales de la salud. Así, la escala está lista para pasar por otros procesos de validación y puede contribuir a la práctica de los investigadores de salud en la evaluación del clima laboral.

Abstract Objective To describe the stages of constructing a scale to evaluate the work environment in Primary Health Care. Method methodological study with five stages: establishment of the conceptual structure; construction of questions and response scale; structuring; content validity with experts and semantic analysis with health professionals. Results construction of the conceptual structure with literature review, the analysis of researchers, experts and health professionals finalized the scale with 36 questions. The work environment is influenced by working conditions, administration and management issues, worker health, workloads, appreciation and motivation, violence and strategies for a healthy work environment. The Content Validity Index (CVI) and Percentage of agreement were performed, with values of 0.96 (CVI) and 96% agreement, respectively. Conclusions and implications for practice the scale was developed and showed agreement, according to the content validity test by experts and health professionals. Thus, the scale is capable of being used for other validation process and can contribute to the practice of health researchers in assessing the work environment.

Assistance to victims of violence in Emergency services from the Forensic Nursing perspective / Atención a víctimas de violencia en el servicio de urgencias desde la perspectiva de la enfermería forense / Atendimento às vítimas de violência no serviço de emergência na perspectiva da enfermagem forense

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

Objetivo: analizar el papel del enfermero en la recolección, identificación y preservación de rastros en la atención de emergencia a las víctimas de violencia, desde la perspectiva de estos profesionales. Método: estudio cualitativo, con enfoque descriptivo exploratorio. Desarrollado a través de entrevistas semiestructuradas a 21 enfermeros de hospitales que forman parte del flujo intersectorial de atención a víctimas de violencia en dos hospitales de referencia de este servicio, en una capital del sur de Brasil. Se incluyeron enfermeros que forman parte del equipo multidisciplinario que trabaja en el servicio de urgencias de sus respectivos hospitales, y el criterio de exclusión fue profesionales reasignados al servicio de urgencias durante la pandemia. El análisis de los datos se realizó según análisis de contenido temático. Resultados: de los datos surgieron cinco categorías: 1) Calificación Profesional; 2) Protocolo Institucional y Materiales; 3) Percepción de los profesionales; 4) Acciones de los profesionales y 5) Estructura del equipo. Conclusión: es necesario organizar, estructurar y estandarizar mejora las competencias de los profesionales de enfermería para recolectar, identificar y preservar rastros en la atención de emergencia a las víctimas de violencia. La presencia de los enfermeros en la atención a las víctimas de violencia en los servicios de emergencia es innegable, pero aún se subestima su importancia y se subutiliza su contribución potencial en el abordaje pericial.

Objetivo: analisar a atuação dos enfermeiros no recolhimento, identificação e preservação de vestígios no atendimento de emergência à vítima de violência, na perspectiva desses profissionais. Método: estudo qualitativo, com abordagem descritiva exploratória. Desenvolvido por meio de entrevista semiestruturada com 21 enfermeiros de hospitais que integram o fluxo intersetorial para atendimentos às vítimas de violência de dois hospitais de referência neste atendimento, em uma capital do sul do Brasil. Foram incluídos enfermeiros membros da equipe multiprofissional que atuam na emergência nos respectivos hospitais, e o critério de exclusão foi profissionais realocados na emergência durante a pandemia. A análise de dados foi realizada conforme análise de conteúdo temático. Resultados: os dados foram discutidos em cinco categorias: 1) Qualificação Profissional; 2) Protocolo Institucional e Materiais; 3) Percepções dos profissionais; 4) Ações dos profissionais e 5) Estrutura da equipe. Conclusão: as competências dos profissionais de enfermagem no recolhimento, identificação e preservação de vestígios no atendimento de emergência à vítima de violência precisam ser melhor organizadas, estruturadas e padronizadas. É incontestável a presença de profissionais enfermeiros nos atendimentos às vítimas de violência nos serviços de emergência, mas sua importância ainda é subestimada e sua potencial contribuição para a abordagem pericial é subutilizada.

Estratégias para promoção do clima ético positivo sob a perspectiva de enfermeiros hospitalares / Strategies to promote a positive ethical climate from the perspective of hospital nurses / Estrategias para promover un clima ético positivo desde la perspectiva de los enfermeros hospitalarios

Objetivo: analisar as estratégias de promoção do clima ético positivo sob a perspectiva de enfermeiros hospitalares. Método: estudo qualitativo e descritivo exploratório, realizado com 182 enfermeiros de um hospital universitário do sul do Brasil. A coleta dos dados ocorreu por meio de um questionário sociodemográfico, laboral e uma pergunta aberta sobre estratégias de promoção do clima ético positivo. A organização dos dados ocorreu no software Atlas TI 8.0, versão 2019, e aplicou-se análise temática dos dados. Recebeu aprovação do Comitê de Ética em Pesquisa da instituição envolvida. Resultados: a macro categoria "Organização do trabalho" elencou itens sobre as relações na equipe, gestão, educação permanente e condições de trabalho. A macro categoria "Dimensão ética do trabalho" se referiu a exigências, valores pessoais e profissionais, expressão e sensibilidade moral. Conclusão: as estratégias de melhores condições de trabalho e organização, bem como o tratamento das questões éticas e relações interpessoais promovem o clima ético positivo(AU)

Objective: to analyze strategies for promoting a positive ethical climate from the perspective of hospital nurses. Method: qualitative and descriptive exploratory study, carried out with 182 nurses from a university hospital in southern Brazil. Data collection occurred through a sociodemographic and employment questionnaire and an open question about strategies for promoting a positive ethical climate. The data was organized using the Atlas TI 8.0 software, version 2019, and thematic analysis of the data was applied. It received approval from the Research Ethics Committee of the institution involved. Results: the macro category "Work organization" listed items on team relationships, management, continuing education and working conditions. The macro category "Ethical dimension of work" referred to demands, personal and professional values, expression and moral sensitivity. Conclusion: strategies for better working conditions and organization, as well as the treatment of ethical issues and interpersonal relationships promote a positive ethical climate(AU)

Objetivo: analizar las estrategias para promover un clima ético positivo desde la perspectiva de los enfermeros hospitalarios. Método: estudio cualitativo y descriptivo exploratorio, realizado junto a 182 enfermeros de un hospital universitario del sur de Brasil. La recolección de datos tuvo lugar mediante un cuestionario sociodemográfico y laboral y una pregunta abierta sobre estrategias para promover un clima ético positivo. Los datos se organizaron por medio del software Atlas TI 8.0, versión 2019, y se aplicó análisis temático de los datos. Recibió la aprobación del Comité de Ética en Investigación de la institución involucrada. Resultados: la macro categoría "Organización del trabajo" enumeró ítems sobre las relaciones en el equipo, la gestión, la educación continua y las condiciones de trabajo. La macro categoría "Dimensión ética del trabajo" hacía referencia a exigencias, valores personales y profesionales, expresión y sensibilidad moral. Conclusión: las estrategias para mejores condiciones de trabajo y organización, así como el tratamiento de las cuestiones éticas y las relaciones interpersonales promueven un clima ético positivo(AU)

Existing workloads among managers and healthcare workers during the COVID-19 pandemic: Meanings in the Amazon context.

INTRODUCTION: The global COVID-19 pandemic has increased the concern and risks of health professionals exposed by acting on the front lines in combating and controlling the spread of the virus. This study aims at analyzing the workloads and their implications for the activities carried out by managers and health workers in the face of the COVID-19 pandemic in Manaus, Amazonas, Brazil. METHOD: This is a qualitative study, of the case study type, that integrates a macro research that deals with the experiences built during the confrontation of the pandemic of COVID-19 in the capital of the state of Amazonas, Brazil, the epicenter of the pandemic in the country. Data production resorted to documentary analysis and semi-structured interviews with 56 managers or professionals from the Manaus Health Care Network. The analytical process was supported by the resources of the Atlas.ti 8.0 software and the precepts of Thematic Networks analysis. RESULTS: The thematic network "workloads" brought together three topics related to the experience of psychological, physiological and biological loads. Psychological workloads were strongly present in the work routine, being referred to in a more significant way. The sources that increase them are strongly related to work stress, dealing with suffering and death and excess demand on the service. Physiological loads were related to excessive working hours, staff shortages and activity overload. "Biological burdens" include exposure to the SARS-CoV-2 virus, constant contact with infected individuals, and individual protection as key elements of this set. CONCLUSION: The study showed that both managers and workers have work processes and environments with conditions that tend to generate workloads that harm their health and safety, as well as institutions and patient care. Therefore, there is a need for more effective organizational actions in workers' health surveillance, disease prevention, adequate working conditions, reducing workloads and promoting more resolute and less stressful work environments.

Intensity and frequency of moral distress in mental health nurses in Brazil.

OBJECTIVE: To assess the intensity and frequency of moral distress in mental health nurses in Brazil. METHOD: Cross-sectional study with 173 nurses from the Psychosocial Care Network in Brazil. The Brazilian Scale of Moral Distress in Nurses, adapted for the context of mental health, was used. For data processing, descriptive and inferential statistical analysis was used. RESULTS: Mostly moderate levels of intensity and frequency of moral distress (medians between 2.25 - 3.73 and 2.00 - 3.22, respectively) were observed, with emphasis on the factors working conditions and social conflicts. CONCLUSION: The level of moral distress evidenced in mental health nurses in Brazil reflects the dimension and amplitude of the phenomenon in different points of the Psychosocial Care Network. The relevance of discussions on coping strategies for moral distress is highlighted, articulating elements such as sensitivity, resilience, and moral courage, so that ethical deliberation is applied in care and management settings.

CROSS-CULTURAL ADAPTATION OF THE HOSPITAL ETHICAL CLIMATE SURVEY TO BRAZIL.

Background and Purpose: Adapting cross-culturally the Hospital Ethical Climate Survey to Brazilian nurses. Methods: A methodological study comprising translation, back translation, multidisciplinary committee, expert panel, pilot test and validation of the instrument. The validation was carried out with 269 nurses of a university hospital in the South of Brazil. Results: In the validation step, the quadratic weighted Kappa test-retest and the correlation coefficient ranged from 0.15 to 0.74. All factor loadings were higher than 0.4, ranging from 0.445 to 0.859. The Portuguese version of the instrument had a 0.93 Cronbach's alpha and the confirmatory analysis demonstrated the model's suitability with five factors and 26 items validated. Conclusions: The version of the instrument adapted to Brazilian Portuguese was considered valid and reliable in this sample.

Repercussions and Legacy of the COVID-19 Pandemic in Manaus, Brazil: The Health Managers' Perspective.

The present study aimed to know and analyze the repercussions and legacy of the COVID-19 pandemic for the Unified Health System from the perspective of health managers working in Manaus, a city considered the epicenter of the pandemic in Brazil. This qualitative research was designed as the study of a single incorporated case and conducted with 23 Health Care Network managers. The analysis was applied in two thematic coding cycles (values and focused coding methods), with the aid of the ATLAS.ti software. The categories we analyzed covered the lessons learned within the scope of the work process, change in stance, and human values, as well as the coping strategies adopted by individual or team initiatives or by the incorporation of innovations in practices. This study highlighted the importance of strengthening primary health care; of promoting team spirit in the service and establishing partnerships with public and private institutions, of being integrated with the training in complex situations, and of reflecting on human values and appreciation of life. Coping with the pandemic promoted an in-depth reflection about the functioning of the Unified Health System and the individual ways of being.

The organization of healthcare work in the light of ergology: experiences in the COVID-19 pandemic.

OBJECTIVE: To understand the work organization of health professionals when coping with the COVID-19 pandemic in Manaus. METHOD: This is a qualitative case study which adopted ergology as theoretical framework. Data production used document analysis and semi-structured interviews with 33 health workers from the Health Care Network. The resources of the software Atlas.ti 8.0 were used for data analysis. RESULTS: The precepts of Thematic Networks analysis revealed the following categories: "Reordering services and functions"; "Incorporation and management of instruments application"; "Professional experiences and tactics: changing roles, attitudes and relationships". CONCLUSION: It was found that they express a dynamic view of the organizational process, in which the worker, when discussing past standards and comparing his/her knowledge, experiences and values, modifies the environment, flows and conducts as needed, facing the lack of safety, conditions and solidity of the technical bases of work.

Validação de tecnologia educativa para prevenção da doença do pé relacionada ao diabetes / Validación de tecnología educativa para la prevención de enfermedades del pie relacionadas con la diabetes / Educational technology validity to prevent diabetes-related foot disease

Resumo Objetivo validar o conteúdo da Tecnologia Educativa (OUVIR, VER, FAZER) para prevenção de alterações nos pés de pessoas com Diabetes Mellitus. Método pesquisa metodológica para a validação de conteúdo. Juízes selecionados na Plataforma Lattes/Conselho Nacional de Desenvolvimento Científico e Tecnológico com a expressão pé diabético e incluindo filtros de busca avançada, resultando em 51 potenciais juízes, dos quais obteve-se o retorno de 32 juízes. Os resultados foram analisados quanto a Taxa de Concordância do Comitê (TCC) e Índice de Validade de Conteúdo (IVC) dos seus subitens. Resultados todos os itens da tecnologia educativa atingiram os índices previamente estabelecidos com a concordância dos experts sobre o conteúdo avaliado (TCC) que foi superior a 96% em cada um dos itens e o IVC foi superior a 0,90 em cada um dos subitens. Conclusão e implicações para a prática a Tecnologia Educativa OUVIR, VER, FAZER atendeu aos critérios previamente estabelecidos de validação de conteúdo e foi considerada pelos juízes como tendo a composição adequada dos itens, além de seus subitens terem clareza e serem relevantes. a Tecnologia validada disponibiliza um material para prevenção do pé diabético usando estratégias inovadoras que estimulam as pessoas de forma auditiva, visual e cinestésica.

Resumen Objetivo validar el contenido de la Tecnología Educativa (ESCUCHAR, VER, HACER) para prevenir alteraciones en los pies de personas con Diabetes Mellitus. Método investigación metodológica para la validación de contenido. Jueces seleccionados en la Plataforma Lattes/Conselho Nacional de Desenvolvimento Científico e Tecnológico con la expresión pie diabético e incluyendo filtros de búsqueda avanzada, resultando en 51 jueces potenciales, de los cuales se obtuvo la retroalimentación de 32 jueces. Los resultados fueron analizados en relación con el Tasa de cumplimiento del comité (TCC) y al Índice de Validez de Contenido (CVI) de sus subelementos. Resultados todos los elementos de tecnología educativa alcanzaron los índices previamente establecidos con la concordancia de los expertos sobre el contenido evaluado (TCC), el cual fue superior al 96% en cada uno de los elementos y el CVI fue superior a 0,90 en cada uno de los subelementos Conclusión e implicaciones para la práctica la Tecnología Educativa ESCUCHA, VE, HACE cumplió con los criterios de validación de contenido previamente establecidos y fue considerada por los jueces con la composición adecuada de elementos, además de que sus subelementos son claros y pertinentes. La tecnología validada proporciona material para la prevención del pie diabético utilizando estrategias innovadoras que estimulan a las personas de forma auditiva, visual y cinestésica.

Abstract Objective to validate the content of the Educational Technology (LISTEN, SEE, DO) for the prevention of foot alterations in people with Diabetes Mellitus. Method methodological research for content validation. Judges were selected from the Lattes/Conselho Nacional de Desenvolvimento Científico e Tecnológico Platform using the expression "diabetic foot" and including advanced search filters, resulting in 51 potential judges, of which 32 judges responded. The results were analyzed in relation to the Committee's Concordance Rate (CCR) and the Content Validity Index (CVI) of its sub-items. Results all items of the educational technology reached the previously established indices with experts' agreement on the evaluated content (CCR) being higher than 96% in each item, and the CVI being higher than 0.90 in each sub-item. Conclusion and implications for practice the Educational Technology LISTEN, SEE, DO met the previously established criteria for content validation and was considered by judges to have appropriate item composition, with clear and relevant sub-items. The validated technology provides material for preventing diabetic foot using innovative strategies that stimulate people in an auditory, visual, and kinesthetic way.

Intensity and frequency of moral distress in mental health nurses in Brazil / Intensidad y frecuencia del sufrimiento moral en enfermeros de salud mental en Brasil / Intensidade e frequência de distresse moral em enfermeiros de saúde mental no Brasil

ABSTRACT Objective: To assess the intensity and frequency of moral distress in mental health nurses in Brazil. Method: Cross-sectional study with 173 nurses from the Psychosocial Care Network in Brazil. The Brazilian Scale of Moral Distress in Nurses, adapted for the context of mental health, was used. For data processing, descriptive and inferential statistical analysis was used. Results: Mostly moderate levels of intensity and frequency of moral distress (medians between 2.25 - 3.73 and 2.00 - 3.22, respectively) were observed, with emphasis on the factors working conditions and social conflicts. Conclusion: The level of moral distress evidenced in mental health nurses in Brazil reflects the dimension and amplitude of the phenomenon in different points of the Psychosocial Care Network. The relevance of discussions on coping strategies for moral distress is highlighted, articulating elements such as sensitivity, resilience, and moral courage, so that ethical deliberation is applied in care and management settings.

RESUMEN Objetivo: Evaluar la intensidad y frecuencia del sufrimiento moral en enfermeros de salud mental en Brasil. Método: Estudio transversal con 173 enfermeros de la Red de Atención Psicosocial del territorio brasileño. Se utilizó la Escala Brasileña de Sufrimiento Moral en Enfermeros adaptada para el contexto de la salud mental. Se utilizó análisis estadístico descriptivo e inferencial para el procesamiento de datos. Resultados: Se observó, en su mayoría, niveles moderados de intensidad y frecuencia de sufrimiento moral (medianas entre 2,25 - 3,73 y 2,00 - 3,22, respectivamente), con énfasis en los factores condiciones de trabajo y conflictos sociales. Conclusión: El nivel de sufrimiento moral evidenciado en enfermeros de salud mental en Brasil refleja la dimensión y amplitud del fenómeno en los diferentes puntos de la Red de Atención Psicosocial. Se destaca la relevancia de las discusiones sobre estrategias de enfrentamiento del sufrimiento moral, articulando elementos como la sensibilidad, la resiliencia y el coraje moral, para que la deliberación ética sea aplicada en contextos de cuidado y gestión.

RESUMO Objective: To assess the intensity and frequency of moral distress in mental health nurses in Brazil. Method: Cross-sectional study with 173 nurses from the Psychosocial Care Network in Brazil. The Brazilian Scale of Moral Distress in Nurses, adapted for the context of mental health, was used. For data processing, descriptive and inferential statistical analysis was used. Results: Mostly moderate levels of intensity and frequency of moral distress (medians between 2.25 - 3.73 and 2.00 - 3.22, respectively) were observed, with emphasis on the factors working conditions and social conflicts. Conclusion: The level of moral distress evidenced in mental health nurses in Brazil reflects the dimension and amplitude of the phenomenon in different points of the Psychosocial Care Network. The relevance of discussions on coping strategies for moral distress is highlighted, articulating elements such as sensitivity, resilience, and moral courage, so that ethical deliberation is applied in care and management settings.

Concepções e contribuições de trabalhadores de saúde sobre ambiente de trabalho saudável / Concepciones y contribuciones de trabajadores de la salud sobre ambientes de trabajo saludables / Health workers' conceptions and contributions regarding healthy work environments

Objetivo: discutir concepções e contribuições de trabalhadores de uma instituição hospitalar, acerca de ambientes de trabalho saudáveis. Método: estudo exploratório descritivo, de abordagem qualitativa, que entrevistou 21 trabalhadores do Serviço de Saúde Ocupacional e Segurança do Trabalho e da Comissão Interna de Prevenção de Acidentes de um hospital público de grande porte da região Norte do país. Os dados foram analisados pela Análise de Conteúdo Focal apoiada por recursos do software ATLAS.ti, 9.0. Resultados: quatro categorias foram geradas: condições necessárias: materiais e pessoal; desafios a superar: gestão, reconhecimento, desgaste e acolhimento; sugestões e ferramentas; concepções para um ambiente de trabalho saudável. As contribuições apreendidas na análise indicam componentes que se referem ao bem-estar ao trabalhar, efetiva proteção e controle de riscos, e relações interpessoais positivas. Considerações finais: os trabalhadores de saúde expressam fragilidades e necessidades que podem contribuir para a compreensão, intervenções e melhorias dos ambientes do trabalho.

Objetivo: debatir concepciones y contribuciones de trabajadores de una institución hospitalaria sobre ambientes de trabajo saludables. Método: estudio cualitativo en el que se entrevistó a 21 trabajadores del Servicio de Seguridad y Salud en el Trabajo y de la Comisión Interna de Prevención de Accidentes de un hospital público de gran porte de la región norte del país. Los datos se analizaron mediante análisis de contenido focal compatible con características del software ATLAS.ti, 9.0. Resultados: se generaron cuatro categorías: Condiciones necesarias: materiales y personal; Retos a superar: gestión, reconocimiento, desgaste y aceptación; Sugerencias y herramientas; y (Concepciones) para ambientes de trabajo saludables. Los aportes derivados del análisis señalan componentes que se refieren al bienestar en el trabajo, protección y control de riesgos efectivos, y relaciones interpersonales positivas. Consideraciones finales: los trabajadores de la salud expresan debilidades y necesidades que pueden contribuir a la comprensión, intervenciones y mejoras en los ambientes de trabajo.

Objective to discuss conceptions and contributions of hospital workers about healthy work environments. Method: a qualitative study that interviewed 21 workers from the Occupational Health and Safety Service and the Internal Accident Prevention Commission from a large-sized public hospital in the northern region of the country. The data were analyzed by means of Focal Content Analysis supported by ATLAS.ti, 9.0 software features. Results: four categories were generated: Necessary conditions: materials and personnel; Challenges to overcome: management, recognition, attrition and acceptance; Suggestions and tools; and (Conceptions) for healthy working environments. The contributions seized in the analysis indicate components that refer to well-being at work, effective protection and risk control, and positive interpersonal relationships. Final considerations: health workers express weaknesses and needs that can contribute to understanding, interventions and improvements in work environments.

The organization of healthcare work in the light of ergology: experiences in the COVID-19 pandemic / La organización del trabajo en salud a la luz de la ergología: experiencias en la pandemia de COVID-19 / A organização do trabalho em saúde à luz da ergologia: experiências na pandemia da COVID-19

ABSTRACT Objective: To understand the work organization of health professionals when coping with the COVID-19 pandemic in Manaus. Method: This is a qualitative case study which adopted ergology as theoretical framework. Data production used document analysis and semi-structured interviews with 33 health workers from the Health Care Network. The resources of the software Atlas.ti 8.0 were used for data analysis. Results: The precepts of Thematic Networks analysis revealed the following categories: "Reordering services and functions"; "Incorporation and management of instruments application"; "Professional experiences and tactics: changing roles, attitudes and relationships". Conclusion: It was found that they express a dynamic view of the organizational process, in which the worker, when discussing past standards and comparing his/her knowledge, experiences and values, modifies the environment, flows and conducts as needed, facing the lack of safety, conditions and solidity of the technical bases of work.

RESUMEN Objetivo: El estudio buscó comprender la organización del trabajo de profesionales de salud en el enfrentamiento de la pandemia de COVID-19 en la ciudad de Manaus, Brasil. Método: Se trata de una investigación cualitativa, del tipo estudio de caso, que adoptó el referencial teórico la ergología. La producción de los datos empleó análisis documental y entrevista semiestructurada con 33 trabajadores de salud de la Red de Atención a la Salud. Fueron utilizados los recursos del software Atlas.ti 8.0 para analizar los datos. Resultados: Los preceptos del análisis de Redes Temáticas revelaron las siguientes categorías: "Reordenamiento de servicios y funciones"; "Incorporación y gestión de la aplicación de instrumentos"; "Experiencias y tácticas profesionales: cambios de roles, actitudes y relaciones". Conclusión: Se constató que ellos expresan una visión dinámica del proceso organizacional, en la que el trabajador, al debatir normas del pasado y comparar sus conocimientos, experiencias y valores, cambia el ambiente, los flujos y las conductas de acuerdo a la necesidad, enfrentando la falta de seguridad, de condiciones y de solidez de las bases técnicas del trabajo.

RESUMO Objetivo: O estudo buscou compreender a organização do trabalho de profissionais de saúde no enfrentamento da pandemia de COVID-19 em Manaus. Método: Trata-se de uma pesquisa qualitativa, do tipo estudo de caso, que adotou como referencial teórico a ergologia. A produção dos dados empregou análise documental e entrevista semiestruturada com 33 trabalhadores da saúde da Rede de Atenção à Saúde. Utilizaram-se os recursos do software Atlas.ti 8.0 para análise de dados. Resultados: Os preceitos da análise de Redes Temáticas revelaram as seguintes categorias: "Reordenamento de serviços e funções"; "Incorporação e gestão da aplicação de instrumentos"; "Experiências e táticas profissionais: mudanças de papeis, atitudes e relações". Conclusão: Constatou-se que eles expressam uma visão dinâmica do processo organizacional, em que o trabalhador, ao discutir normas do passado e comparar seus conhecimentos, experiências e valores, modifica o ambiente, os fluxos e as condutas conforme a necessidade, enfrentando a falta de segurança, de condições e de solidez das bases técnicas do trabalho.

Problemas éticos na experiência clínica hospitalar de estudantes e profissionais de enfermagem / Ethical problems in hospital clinical experiences of nursing students and professionals / Problemas éticos en la experiencia clínica hospitalaria de estudiantes y profesionales de enfermeira

Resumo Enquadramento: Os problemas éticos são frequentes na prática da enfermagem. Saber identificá-los, buscando soluções prudentes, é fundamental para promover um cuidado ético e seguro. Objetivo: Conhecer experiências e compreensão de estudantes e profissionais de enfermagem sobre problemas éticos e tomada de decisão nos contextos da prática da enfermagem hospitalar. Metodologia: Pesquisa qualitativa, exploratório-descritiva realizada com 30 estudantes de graduação em enfermagem e 20 profissionais de enfermagem de um hospital universitário do sul do Brasil. Os dados foram recolhidos através de dois questionários contendo questões abertas e submetidos a análise textual discursiva. Resultados: Os estudantes compreendem o problema ético a partir de vivências concretas de desrespeito e afronta a princípios e regras, enquanto os profissionais o conceptualizam como um desafio ao julgamento nas complexas fronteiras entre certo e errado. Há similaridades e especificidades das vivências e tomada de decisão. Conclusão: Estudantes e profissionais demonstram sensibilidade moral para compreender os problemas éticos da prática; senso crítico e reflexivo é decisivo na identificação e nas condutas face aos conflitos éticos no ambiente laboral.

Abstract Background: Ethical problems often emerge in nursing practice. Knowing how to identify them and seeking prudent solutions is essential to promoting ethical and safe care. Objective: To know the experiences and understanding of nursing students and professionals regarding ethical issues and decision-making in hospital nursing practice. Methodology: Qualitative, exploratory-descriptive research was carried out with thirty undergraduate nursing students and twenty nursing professionals from a University Hospital in Southern Brazil. Data were collected through two questionnaires containing open questions and submitted to Discursive Textual Analysis. Results: Students perceive the ethical problem based on concrete experiences of disrespect and insult to principles and rules. Professionals conceptualize it as a challenge to judgment in the complex boundaries between right and wrong. The experiences and decision-making share similarities and have their specificities. Conclusion: Students and professionals display moral sensitivity to understand the ethical problems of practice; critical awareness and reflection are crucial to identifying and responding to workplace ethical conflicts.

Resumen Marco contextual: Los problemas éticos son frecuentes en la práctica de la enfermería. Saber identificarlos, buscando soluciones prudentes, es esencial para promover una atención ética y segura. Objetivo: Conocer las experiencias y la comprensión de los estudiantes y profesionales de enfermería sobre los problemas éticos y la toma de decisiones en los contextos de la práctica enfermera hospitalaria. Metodología: Investigación cualitativa, exploratoria-descriptiva, realizada con 30 estudiantes del grado de Enfermería y 20 profesionales de enfermería de un hospital universitario del sur de Brasil. Los datos se recogieron mediante dos cuestionarios con preguntas abiertas y se sometieron a un análisis textual discursivo. Resultados: Los estudiantes entienden el problema ético a partir de experiencias concretas de falta de respeto y afrenta a los principios y normas, mientras que los profesionales lo conceptualizan como un desafío al juicio en los complejos límites entre lo correcto y lo incorrecto. Hay similitudes y especificidades en las experiencias y la toma de decisiones. Conclusión: Los estudiantes y profesionales demuestran sensibilidad moral para comprender los problemas éticos de la práctica; el sentido crítico y reflexivo es decisivo en la identificación y las conductas ante los conflictos éticos en el entorno laboral.

Technical-assistance arrangements in coping with the COVID-19 pandemic from the managers' perspective. / Arranjos tecnoassistenciais no enfrentamento da pandemia da COVID-19 na perspectiva de gestores.

OBJECTIVE: to describe the technical-assistance arrangements developed within the scope of work management in the COVID-19 pandemic care network, from the managers' perspective. METHOD: a qualitative research study, of the incorporated single case type, conducted with 23 managers of a Health Care Network. The analysis was applied in two thematic coding cycles, with the aid of the ATLAS.ti software. RESULTS: the arrangements were analyzed in categories related to health care; management; incorporation of technologies; implementation of a field hospital; and retrospective analysis of the experiences as a whole. There was emphasis on the implementation of care flows, virtual health bulletins, Telemonitoring, chatbots, use of applications, and implementation of field hospitals and of basic urgency services within the scope of the Basic Health Units. Hyperjudicialization in the system was identified; as well as weaknesses in information management, intersectoriality and technical-political leadership at the national level; the role of nurses in management positions and for coping with the pandemic. CONCLUSION: despite the health services' unpreparedness to face the pandemic, the actors' resilience promoted dynamism and technical-assistance arrangements in the context of management and humanized care. The study has a potential to contribute to the qualification of the public policy management and development practices.

Moral distress and moral resilience of nurse managers.

BACKGROUND: Moral distress is a phenomenon that can lead to an imbalance of the mind and body. There are many coping strategies to overcome the obstacles that lead the subject to this condition. Some coping strategies are capable of being achieved through the cultivation of moral resilience. AIM: The aim is to identify the strategies of moral resilience in the nursing management of University Hospitals in Brazil. RESEARCH DESIGN: The research design is the qualitative study with discursive textual analysis. PARTICIPANTS AND RESEARCH CONTEXT: : 44 nurse managers and nurses in leadership positions participated in a total of 30 University Hospitals in Brazil. Data were collected online, using a questionnaire with open questions. ETHICAL CONSIDERATIONS: The Ethics Committee approved the study. Participants received information about the research, agreed to respond to the questionnaire, and were guaranteed anonymity. FINDINGS: Personal adaptive strategies (intrapersonal and interpersonal) and organizational collaborative strategies (intrinsic and transformational management) emerged from this process. The intrapersonal strategies involved elements of rationality, flexibility, rebalancing practices, moral courage, and detachment. The interpersonal strategies addressed support networks, team involvement, and dialog. Organizational strategies dealt with actions which reorient ethical infrastructure, ethical education, and psychological protection, as well as fostering dialogical relationships, empowerment, and cooperation. CONCLUSION: From the perspective of social historical construction, it is understood that developing personal and organizational strategies is essential to cultivating moral resilience.

Moral distress-associated sociodemographic and occupational aspects in nursing managers at federal university hospitals.

OBJECTIVE: To analyze the association between sociodemographic and occupational characteristics and the predictors of Moral Distress in nursing managers of Federal University Hospitals. METHOD: Cross-sectional study carried out with 126 nurses. Data were collected online between September 2019 and May 2020 applying the Brazilian Scale of Moral Distress in Nurses. The variables were analyzed using descriptive and bivariate statistics to compare the instrument mean responses in relation to sociodemographic and occupational characteristics (hospital size, region, age, gender, training and experience variables, employment relationships, and workload). RESULTS: The highest levels of Moral Distress were experienced by nurses in large hospitals, with statistical significance among civil servants with job stability who have no management training, with less time of professional experience and with the highest weekly workload, with emphasis on predictive factors of "safe and qualified care", "work conditions" and "work team". CONCLUSION: Based on the above, it is understood that studies of this nature allow the generation of adaptive strategies to reduce the impacts of Moral Distress.

Conceptual framework for the ethical climate in health professionals.

The ethical climate is the perception of health professionals about the work environment, meaning the reflection on care practices and ethical-related decisions. There are extensive studies in the international literature about the ethical climate, but there are still theoretical gaps about it in health services. In this reflection article, the objective was to explore conceptual components about the ethical climate, proposing new elements of analysis of the construct. The starting point was the accumulated knowledge itself, the possibilities for expansion, and the conceptual progress emerging from contributions from studies on nursing ethics. It was understandable that the ethical climate is considered in its procedural model and cyclically, being articulated with organizational elements, as established in the literature, and, expanding the concept, with the worker's health and the ethical expressiveness at work. Regarding this last contribution, the suggestion is to think about the potential for work to allow, limit, or favor professionals to express their ethical and esthetic values in the most daily decisions and relationships, in care, management, and education. The conceptual framework of this study progressed by addressing the ethical climate as a process articulating several concepts and elements regarding the organizational aspect, ethics, and the workers' well-being.

Gestão e ambientes de trabalho na atenção primária à saúde: revisão de escopo / Gestión y entornos de trabajo en la atención primaria de salud: revisión del alcance / Management and work environments in primary health care: scope review

RESUMO Objetivo: identificar subsídios teóricos e empíricos sobre ambientes de trabalho na atenção primária à saúde (APS) em sua relação à saúde do trabalhador (questão preliminar) que indiquem elementos relativos à gestão (questão específica). Métodos: Scoping Review de seis etapas com consulta aos sujeitos, busca na literatura do período de 2010 a 2019 em seis bases de dados e bibliotecas virtuais com seleção de 21 artigos. A etapa complementar, de consulta, operacionalizou grupo focal com 14 trabalhadores da APS em um município do Sul do Brasil. Resultados: foram organizados em três categorias temáticas: i) Aspectos administrativos no ambiente de trabalho: dificuldades relacionadas à gestão; ii) Percepções sobre as relações de trabalho: barreiras entre equipe e gestão; e iii) Conflitos no ambiente de trabalho: estratégias de enfrentamento. Considerações finais: questões de ordem burocrática e de rotina da APS influenciam as relações interpessoais e os resultados alcançados, sendo fundamentais para o alcance de ambientes saudáveis de trabalho dos atores em cena. O suporte institucional, o diálogo e a possibilidade de exercer um trabalho pleno de sentido e valor é direito do trabalhador, reafirmando a promoção de ambientes de trabalho saudáveis na APS como prioridade ético-política.

RESUMEN Objetivo: identificar subsidios teóricos y empíricos sobre ambientes de trabajo en APS en su relación con la salud de los trabajadores (cuestión preliminar) que indiquen elementos relacionados con la gestión (cuestión específica). Métodos: Scoping Review de seis etapas con consulta a los sujetos, búsqueda bibliográfica en el período de 2010 a 2019 en seis bases de datos y bibliotecas virtuales con selección de 21 artículos. La fase complementaria, de consulta, consistió en un grupo de reflexión con 14 trabajadores de Atención Primaria de Salud en un municipio del Sur de Brasil. Resultados: organizados en tres categorías temáticas: Aspectos administrativos en el entorno laboral: dificultades relacionadas con la gestión; Percepciones sobre las relaciones laborales: barreras entre el equipo y la dirección; Conflictos en el entorno laboral: estrategias de afrontamiento. Consideraciones finales: las cuestiones burocráticas y rutinarias de la APS influyen en las relaciones interpersonales y en los resultados alcanzados, siendo fundamentales para el logro de ambientes de trabajo saludables de los actores en escena. El apoyo institucional, el diálogo y la posibilidad de ejercer un trabajo lleno de sentido y valor es un derecho del trabajador, reafirmando la promoción de ambientes de trabajo saludables en la APS como una prioridad ético-política.

ABSTRACT Objective: to identify theoretical and empirical subsidies on work environments in primary health care (PHC) in relation to workers' health (preliminary question) that indicate elements related to management (specific question). Methods: six-step Scoping Review with consultation with the subjects, literature search from 2010 to 2019 in six databases and virtual libraries with selection of 21 articles. The complementary stage, consultation, operated a focus group with 14 PHC workers in a municipality in southern Brazil. Results: they were organized into three thematic categories: i) Administrative aspects in the work environment: difficulties related to management; ii) Perceptions about labor relations: barriers between staff and management; and iii) Conflicts in the workplace: coping strategies. Final considerations: bureaucratic and routine PHC issues influence interpersonal relationships and the results achieved, being fundamental for achieving healthy work environments for the actors on the scene. Institutional support, dialogue and the possibility of carrying out work full of meaning and value are workers' rights, reaffirming the promotion of healthy work environments in PHC as an ethical-political priority.

Discourse and manipulation: Nursing in question.

The history of Brazilian nurses is marked by several challenges, in part resulting from discontinuous and fragile activity boundaries among the health professions that share the same work objective in care services. A field of constant disputes, the Brazilian health system, was the target of a lawsuit filed by the Federal Council of Medicine that temporarily suspended nurses' activities in primary care. This study aimed to demonstrate the manipulative discourse present in the text of the injunction request by medical doctors against legislation by the Brazilian Federal Government in 2017. This is a qualitative and documental study that used the theoretical-methodological framework of critical discourse studies based on Teun Van Dijk's analytical categories. The results pointed to manipulative discourse through a polarization between manipulators' good qualities and intentions and the bad qualities of nurses and Brazilian primary care policies; episodic manipulation by the presentation of documental and historical evidence of the submission of nursing roles; and social manipulation marked by strong emotional appeal. The study demonstrated that manipulative discourse extrapolated linguistic categories in the form of ideology and history.