Competencias y habilidades de la y el profesional de enfermería, para aplicar el proceso enfermero durante el cuidado: Revisión sistemática / Competencies and skills of the nursing professional to apply the nursing process during care: A systematic review

INTRODUCCIÓN: las competencias y habilidades de la y el enfermero para aplicar el proceso de atención de enfermería corresponden a un aprendizaje evolutivo que requiere rigurosidad, conocimiento científico y creatividad. Este proceso potencializa el pensamiento crítico para brindar cuidados con calidad adaptados a las necesidades del paciente. OBJETIVO: analizar la evidencia científica disponible sobre las competencias y habilidades del profesional de enfermería para aplicar el proceso enfermero durante el cuidado. METODOLOGÍA: revisión integrativa de la literatura según PRISMA, en diez bases de datos, con sintaxis de palabras clave, publicados en la última década. Se seleccionaron catorce artículos. RESULTADOS: la literatura reconoce tanto competencias generales como específicas para el desarrollo del proceso enfermero, entre ellas: la toma de decisiones y el emitir juicios clínicos, la capacidad de brindar cuidados particulares y prioritarios, la autoevaluación y autorregulación de su accionar, la ética, la autonomía, y la competencia cultural y tecnológica. De igual forma, se resaltó la importancia de habilidades como: la capacidad de recolectar información y llevar a cabo actividades procedimentales clínicas, la capacidad afectiva (demostrar comprensión-emoción por la otra persona), el empoderamiento y el trabajo en equipo. CONCLUSIONES: las competencias y las habilidades para la ejecución del proceso de atención de enfermería durante el cuidado son múltiples y se interrelacionan; así mismo, estas deben seguir siendo individualizadas, reconocidas y socializadas para corroborar su grado de aplicabilidad en la práctica profesional.

INTRODUCTION: The competencies and skills of the nurse to apply the nursing care process correspond to an evolutionary learning that requires rigor, scientific knowledge, and creativity. This process potentiates critical thinking to provide quality care adapted to the needs of the patient. OBJECTIVE: The following is an analysis of the available scientific evidence on the competencies and skills of the nursing professional to apply the nursing process during care. METHODOLOGY: An integrative review of the literature according to PRISMA, in ten databases with keyword syntax published in the last decade. Fourteen articles were selected. RESULTS: The literature recognizes both general and specific competences for the development of the nursing process, including decision-making and clinical judgments, the ability to provide particular and priority care, self-assessment and self-regulation of their actions, ethics, autonomy, and cultural and technological competence. Similarly, the importance of skills such as: the ability to collect information and carry out clinical procedural activities, affective capacity (show understanding-emotion for the other person), empowerment and teamwork were highlighted. CONCLUSIONS: The competencies and skills for the execution of the nursing care process during care are multiple and interrelated; Likewise, these must continue to be individualized, recognized, and socialized to corroborate their degree of applicability in professional practice.

Bringing Joy-Sorrow to Light: Informing Practice Utilizing Theoretical and Research Perspectives.

This article focuses on the substance of centering on a nursing disciplinary theoretical approach accomplished through a brief review of the phenomena of joy-sorrow from a research and practice perspective. When practice is designed from a theoretical conceptual system, it takes form and provides tangible benefits through the creative conceptualizations and connectedness that arise to influence persons who seek healthcare. Although the article espouses a humanbecoming framework, the take-away is that a nursing disciplinary approach promotes congruence among theory, research, practice, and education, thereby advancing the discipline's meaning and contributions.

Factors affecting conscience-based nursing practices: A qualitative study.

BACKGROUND: Conscience is a guiding factor in nursing practice for delivering the ultimate care. In order to expand the concept of conscience-based care, factors affecting conscience in nursing practice need to be identified. OBJECTIVES: The current study assessed nurses' experiences to explore factors affecting conscience in nursing practice. RESEARCH DESIGN: This qualitative content analysis study employed purposive sampling to reach 14 nurses working at educational hospitals in Tabriz and Urmia, Iran. Data were analyzed using inductive and conventional analysis. ETHICAL CONSIDERATIONS: This research was approved by the Ethics Committee of Urmia University of Medical Science. Voluntary participation, anonymity, and confidentiality were considered. FINDING: Two themes emerged from our analysis for enhancing conscience in nursing practices, including environment of professional performance and personal factors. DISCUSSION: The two important factors for enhancing conscience in nursing practice are environment and personal factors. CONCLUSION: It is necessary to emphasize on religious beliefs, professional commitment, and communication skills in educational training structure. Also, establishing appropriate management systems will help nurses to provide moral care.

Truth-telling, decision-making, and ethics among cancer patients in nursing practice in China.

BACKGROUND: Truth-telling toward terminally ill patients is a challenging ethical issue in healthcare practice. However, there are no existing ethical guidelines or frameworks provided for Chinese nurses in relation to decision-making on truth-telling of terminal illness and the role of nurses thus is not explicit when encountering this issue. OBJECTIVES: The intention of this paper is to provide ethical guidelines or strategies with regards to decision-making on truth-telling of terminal illness for Chinese nurses. METHODS: This paper initially present a case scenario and then critically discuss the ethical issue in association with ethical principles and philosophical theories. Instead of focusing on attitudes toward truth disclosure, it aims to provide strategies regarding this issue for nurses. It highlights and discusses some of the relevant ethical assumptions around the perceived role of nurses in healthcare settings by focusing on nursing ethical virtues, nursing codes of ethics, and philosophical perspectives. And Confucian culture is discussed to explicate that deontology does not consider family-oriented care in China. CONCLUSION: Treating each family individually to explore the family's beliefs and values on this issue is essential in healthcare practice and nurses should tailor their own approach to individual needs regarding truth-telling in different situations. Moreover, the Chinese Code of Ethics should be modified to be more specific and applicable. Finally, a narrative ethics approach should be applied and teamwork between nurses, physicians and families should be established to support cancer patients and to ensure their autonomy and hope. ETHICAL CONSIDERATIONS: This paper was approved by the Ethics Committee of The Second Affiliated Hospital of Guangzhou Medical University. The authors have obtained consent to use the case study and it has been anonymised to preserve the patient's confidentiality.

Perinatal Nurses' Experiences With and Knowledge of the Care of Incarcerated Women During Pregnancy and the Postpartum Period.

OBJECTIVE: To describe perinatal nurses' experiences of caring for incarcerated women during pregnancy and the postpartum period; to assess their knowledge of the 2011 position statement Shackling Incarcerated Pregnant Women published by the Association of Women's Health, Obstetric and Neonatal Nurses (AWHONN); and to assess their knowledge of their states' laws regulating nonmedical restraint use, or shackling, of incarcerated women. DESIGN: Cross-sectional survey. SETTING: Online across the United States. PARTICIPANTS: AWHONN members who self-identified as antepartum, intrapartum, postpartum, or mother-baby nurses (N = 923, 8.2% response rate). METHODS: A link to an investigator-developed survey was e-mailed to eligible AWHONN members (N = 11,274) between July and September 2017. RESULTS: A total of 74% (n = 690) of participants reported that they cared for incarcerated women during pregnancy or the postpartum period in hospital perinatal units. Of these, most (82.9%, n = 566) reported that their incarcerated patients were shackled sometimes to all of the time; only 9.7% reported ever feeling unsafe with incarcerated women who were pregnant. "Rule or protocol" was the most commonly endorsed reason for shackling. Only 17.0% (n = 157) of all participants knew about the AWHONN position statement, and 3% (n = 28) correctly identified the conditions under which shackling may ethically take place (risk of flight, harm to self, or harm to others). Only 7.4% (n = 68) of participants correctly identified whether their states had shackling laws. CONCLUSION: Our results suggest critical gaps in nurses' knowledge of professional standards and protective laws regarding the care of incarcerated women during pregnancy. Our findings underscore an urgent need for primary and continuing nursing education in this area.

Do governing body and CSU nurses on clinical commissioning groups really lead a nursing agenda? Findings from a 2015 Survey of the Commissioning Nurse Leaders' Network Membership.

AIMS: This paper reports the findings from a 2015 survey of the Commissioning Nurse Leaders' Network. Our aim was to understand how governing body nurses perceive their influence and leadership on clinical commissioning groups. METHODS: An online survey method was used with a census sample of 238 governing body nurses and nurses working in Commissioning Support Units, who were members of the Commissioning Nurse Leaders' Network. The response rate was 40.7% (n = 97). RESULTS: While most governing body nurses felt confident in their leadership role, this was less so for non-executive governing body nurses. Nurses in Commissioning Support Units were much less positive than governing body nurses about their influence on clinical commissioning groups. CONCLUSION: Governing body nurses were satisfied with their impact on clinical commissioning groups and so could be said to be leading a nursing agenda but this evidence is limited to their own perceptions and more objective or diverse measures of impact are needed. The purpose of such roles to 'represent nursing, and ensure the patient voice is heard' may be a flawed aspiration, conflating nursing leadership and patient voice. IMPLICATIONS FOR NURSING MANAGEMENT: This is the first study to explore explicitly the differences between executive and non-executive governing body nurses and nurses working in commissioning support units. Achieving clinical commissioning groups' goals, including developing and embedding nursing leadership roles in clinical commissioning groups, may be threatened if the contributions of governing body nurses, and other nurses supporting clinical commissioning groups, go unrecognised within the profession, or if general practitioners or other clinical commissioning group executive members dominate decision-making on clinical commissioning groups.

Profits and prophets: Derrida on linguistic bereavement and (Im)possibility in nursing.

The work of Jacques Derrida has received relatively little attention within nursing philosophy. Perhaps this is because Derrida is known best for deconstructing philosophy itself, a task he performed by making language unintelligible to make a point. This in itself makes his work daunting for nurses who do applied philosophy. Despite these difficulties, Derrida's focus on holding open a space for ideas, particularly those ideas that are invisible or unpopular, holds potential for enhancing the diversity of ideas within nursing. His work, liberally scattered with religious references, and focused on deconstructing language that served the profits of a few, earned him the characterization of a prophet without religion. This idea was further supported in the way his deconstruction attempted to keep spaces open for the un-representable and its generativity in opening new possibilities in life. A deconstruction for generative purposes is particularly helpful within palliative care where language quickly takes on dogma in the face of mystery and where new possibilities support life amidst the irrevocable nature of death. In this article, I discuss Derrida's deconstructive approach of differance and then apply that approach to language common in palliative care.

¿Es necesaria una estrategia integrada de biosocioética? / Is a strategy of bio-socio-ethic necessary?

OBJETIVO: El presente artículo reflexiona sobre la necesidad de apostar por la articulación de una estrategia de ética que incluya 2 de los pilares básicos que afectan al bienestar de las personas, la atención de los servicios sanitarios y de los servicios sociales. El objetivo es realizar un acercamiento a la percepción de profesionales de los servicios sociales y sanitarios en Andalucía acerca de la necesidad de desarrollar un espacio de encuentro entre la bioética y la ética de la intervención social. MÉTODO: Estudio observacional, transversal y descriptivo, mediante encuesta a profesionales de los servicios sociales y sanitarios. Se utilizó una técnica de muestreo intencional. El cuestionario constaba de 10 preguntas sobre conflictos éticos en la práctica profesional social y sanitaria, y la percepción de desarrollo de un espacio compartido para la bioética y la ética de la intervención social. RESULTADOS: La muestra constó de 124 profesionales, un 56% del sector sanitario y un 44% del sector de servicios sociales. Alrededor del 90% de las personas encuestadas se habían enfrentado a decisiones éticas difíciles de abordar en su práctica profesional y valoraron positivamente un abordaje común social y sanitario. El 75% afirmaron que los conflictos se presentan en los 2 ámbitos simultáneamente más que por separado. La gestión de los asuntos éticos se realizaba preferentemente de manera individual y de forma independiente. CONCLUSIONES: El social y el sanitario son sistemas que poseen identidad y características diferenciadas, pero tienen una afinidad especial pues comparten saberes, espacios y valores comunes, que requieren de una profunda y comprometida reflexión, en aras a crear metodologías conjuntas de actuación, gestión y deliberación ética

AIM: The aim of this paper is to assess the need for a common ethics strategy shared by 2 of the cornerstones of human welfare: the healthcare and social services sectors. Method: An observational cross-sectional descriptive study was performed by surveying social services and healthcare professionals. A purposive sampling technique was used. The questionnaire consisted of 10 questions about ethical conflicts in professional practice and respondents' views on a proposed shared approach to bioethics and ethics in social intervention. RESULTS: 124 professionals completed the questionnaire, 56% of the health sector and 44% of the social services sector. About 90% professionals surveyed had had to make difficult ethical decisions in their work and would welcome a common approach to ethics in the social services and healthcare sectors.75% said that conflicts are occurring more frequently in both sectors simultaneously and that they were resolved preferably individually and independently. CONCLUSIONS: The survey respondents believe that a common approach to tackling ethical conflicts in professional practice is required. Nevertheless, it is still rare for ethics committees to intervene in the conflict resolution process and for decision-making support and evaluation tools to be used

La responsabilidad como eje integrador de la Farmacología con el proceso de atención de enfermería / Responsibility as integrative axis of Pharmacology with the process of nursing care

Está bastante difundida la idea de que los valores y las actitudes forman parte de los contenidos de enseñanza-aprendizaje. A tales efectos se exponen algunos aspectos relacionados con el proceso de formación de valores, donde se revela la importancia del valor responsabilidad en la integración de la Farmacología con el proceso de atención de enfermería en la formación curricular, en beneficio de la calidad y la excelencia en los servicios de salud(AU)

The idea that values and attitudes are part of the teaching-learning contents is greatly diffused. To such effects some aspects related to the training process of values are exposed, where the importance of the value responsibility is revealed in the integration of Pharmacology with the nursing care process in the curricular training, for the benefit of quality and excellence in the health services(AU)

The nursing discipline and self-realization.

BACKGROUND: It is obvious from literature within the nursing discipline that nursing is related to moral or moral-philosophical related ideas which are other-oriented. The socio-cultural process of change in modern society implies that more self-oriented ideas have been found to be significant. AIM: The overall aim of this article is to highlight self-oriented moral or moral-philosophical related ideas as an important part of the nursing discipline. This is achieved by (a) exploring self-realization as a significant self-oriented moral or moral-philosophical related idea based on a philosophical anthropological perspective, (b) demonstrating how moral or moral-philosophical related ideas are expressed by nurses, (c) discussing the relevance of self-realization for the nursing discipline, and (d) pointing out possible consequences for the future development of the discipline of nursing. RESEARCH DESIGN: This theoretical study draws empirical examples from interviews. PARTICIPANTS AND RESEARCH CONTEXT: Data consisted of interviews with 13 nurses with varying work experience within the primary and secondary somatic and psychiatric health service, from inside as well as outside institutions. ETHICAL CONSIDERATIONS: The empirical study was approved by the Norwegian Social Science Data Services. Information was given and consent was obtained from the study participants. FINDINGS: Findings are presented in two themes: (a) other-oriented ideas and (b) self-oriented ideas. More concretely, the findings show that nurses hope to make life as good as possible for the patient and they have a wish to improve themselves as human beings, to become better persons. DISCUSSION: The relevance of self-realization for the nursing discipline is discussed along two lines, first, by connecting nurses' self-understanding to a horizon of identity and second, by considering what self-realization could offer. CONCLUSION: It is of ultimate concern for the nursing discipline to highlight self-realization connected to the positive view of freedom understood as an exercise-concept. Further identifying and articulating the contribution of self-realization to nurses and nursing practice is of particular importance.

Ethical challenges in everyday work with adults with learning disabilities.

BACKGROUND: Healthcare providers caring for learning-disabled individuals in institutions face challenges of what is right or wrong in their daily work. Serving this group, it is of utmost importance for the healthcare staff to raise awareness and to understand how ethical values are at stake. RESEARCH QUESTION: What ethical challenges are discussed among healthcare providers working with adults with learning disabilities? RESEARCH DESIGN: The study had a qualitative and investigative design. PARTICIPANTS AND RESEARCH CONTEXT: The study was conducted in a community institution for adults with learning disabilities. Participants were healthcare providers joining regular focused group discussions. Two groups participated and each group consisted of six participants. The conversations were taped and transcribed. ETHICAL CONSIDERATIONS: The study was reported to Norwegian Social Science Data Services and was approved by the regional ethics committee. FINDINGS: Findings are presented in four themes: (a) feeling squeezed between conflicting actions, (b) being the client's spokesman, (c) searching shared responsibility, and (d) expecting immediate and fixed solutions. The healthcare providers wanted to be the clients' advocates. They felt obliged to speak up for the clients, however, seeking for someone with whom to share the heavily experienced responsibility. Data likewise revealed that the group discussions created expectations among the healthcare providers; they expected smart and final solutions to the problems they discussed. DISCUSSION: The discussion focuses on everyday ethical challenges, the meaning of being in-between and share responsibility, and the meaning of ethical sensitivity. CONCLUSION: Ethical challenges can be demanding for the staff; they might feel squeezed in-between contradictory attitudes or feel alone in decision-making. Frequent conversations about ethical challenges do not solve the ethical problems here-and-now, but they do visualize them. This also visualizes the staff's need for support.

Doing the right thing by incorporating evidence and professional goals in the ethics consult.

Classic ethical decision-making models are discussed, and two recommendations are provided. The author proposes applying evidence-based position statements to ethical deliberation and suggests acknowledging the differing philosophical underpinnings and goals of various stakeholders, including nurses, physicians, families, institutions, and the nation. Examples are provided throughout. When combined with evidence-based information and consideration of group goals, traditional ethical analysis may help nurses "do the right thing."

Nursing ethical processes in the State of Santa Catarina: characterization of factual elements.

OBJECTIVE: The present study aimed to characterize the processes of ethical and professional nursing transacted at the Regional Nursing Council of Santa Catarina (Coren/SC), considering their factual elements (events/offenses, causes and outcomes). METHOD: This descriptive, exploratory and documentary research with a quantitative approach was developed at Coren/SC. Data was collected from 128 professional ethical processes in nursing, between 1999 and 2007, analyzed descriptively with regard to the origin of the complaints and ethical processes, the denouncers, the accused, the subject of the complaint and the outcome of the process. RESULTS: Considering the topics, out of the eight categories described, iatrogenesis was highlighted, as well as illegal professional practice, conflicting inter-professional relationships and professional responsibility of the nurse. CONCLUSION: The results show the need for discussion and intervention in concrete practical and arouse reflections about the process of professional training and continuous education in the institutional spaces of health, in order to reduce ethical occurrences in professional practice.

Experiencias de los alumnos sobre la aplicación del proceso enfermero en el / área hospitalaria. Estudio cualitativo / Nursing students’ experiences about the application of the nursing process in the hospital area. Qualitative study

Objetivo: Conocer las experiencias de los estudiantes de quinto semestre de la carrera de Licenciatura en Enfermería en la aplicación del proceso enfermero en el área hospitalaria. Material y métodos: Estudio cualitativo realizado en un hospital público de segundo nivel, con una población de 31 estudiantes con la que se alcanzó la saturación de datos. Se recolectó la información a través de técnicas como: Observación participante, entrevista semiestructurada y a través de un registro anecdótico de los cuidados proporcionados al paciente. Los datos obtenidos se analizaron a través de contenido temático utilizando el programa Atlas-Ti. Resultados: Las experiencias sobre la aplicación del proceso enfermero en el área hospitalaria en estudiantes de quinto semestre estuvieron limitadas porque hicieron falta conocimientos, organización del tiempo y experiencia en la aplicación de las diferentes etapas del proceso enfermero; además hubo exceso de actividades. Conclusiones: Las experiencias de los alumnos sobre la aplicación del proceso enfermero fueron regulares. Este resultado reduce la posibilidad de que el alumno, durante su formación y en su futura vida profesional, utilice esta herramienta científica como método de trabajo para brindar cuidado de enfermería, debido a la falta de conocimientos y de tiempo para realizar el proceso enfermero, y también debido al exceso de trabajo en los servicios.

Objective of this article was to determinate students’ experiences of the bachelor of nursing about the application of nursing process in the hospital. Methodology: Qualitative design through 31 semi structured interviews, using observational techniques and anecdotic documentation, Identifying meaning units. The data analysis was performed using Atlas-Ti. Results: the subjects were application of nursing process and the spaces of professional practice, and the result was that students’ experience about the application of nursing process was regular, because they said that there are several factors that limit the application of nursing process in hospital setting; among this factors were: an excess in the number of patients, the lack of level of knowledge in students and the lack of time. Conclusion: Students’ experiences were regular about the application of the nursing process, and this one reduces the possibility that the student use this scientific method in the future.

Proceso de atención enfermero a persona con insuficiencia renal crónica / Nursing process person with chronic renal failure

El proceso de atención en enfermería (PAE) tiene como finalidad brindar atención integral y especializada a cada agente de cuidado, impulsando y conservando la salud del usuario cuando lo requiera. Este PAE se realizó en el Hospital “Lic. Adolfo Ló- pez Mateos” y se utilizó la teoría del déficit de autocuidado de Dorothea Orem. Se trata de Jesús (nombre ficticio), masculino de 66 años con un padecimiento de insuficiencia renal crónica y peritonitis bacteriana; HAS (hipertensión arterial sistémica), DM T2 (diabetes mellitus tipo 2) descontroladas debido a una falta de adhesión al plan terapéutico.

The completion of the Nursing Care Process is designed to provide comprehensive care to each agent specialized care by developing and maintaining the health of the user when required. The Nursing Care Process (SAP) at the Hospital “Lic. Adolfo López Mateos”, was applied using Dorothea Orem’s theory in conjunction with his theory of self-care deficit. This is Jesus, 66 years old male with chronic renal disease, bacterial peritonitis, HAS (hypertension), T2 DM (diabetes mellitus type 2) uncontrolled due to a lack of adherence to therapeutic plan.