Moral distress in nursing students: Cultural adaptation and validation study.

BACKGROUND: Moral distress, defined as moral suffering or a psychological imbalance, can affect nursing students. However, many new instruments or adaptations of other scales that are typically used to measure moral distress have not been used for nursing students. AIM: This study aimed to translate, culturally adapt and evaluate the psychometric properties of an Italian version of the Moral Distress Scale for Nursing Students (It-ESMEE) for use with delayed nursing students (students who could not graduate on time or failed the exams necessary to progress to the next level). RESEARCH DESIGN: The study used a cross-sectional research design. PARTICIPANTS AND RESEARCH CONTEXT: Incidental sampling resulted in a sample of 282 delayed nursing students (mean age = 26.73 ± 4.43 years, 73% female) enrolled between May and August 2020 in a University of central Italy. ETHICAL CONSIDERATIONS: The research protocol was approved by the internal review board of the university, and all participants provided their written informed consent. RESULTS: The study confirmed a multidimensional second-order factorial structure for the It-ESMEE with five dimensions: improper institutional conditions to teach user care, authoritarian teaching practices, disrespect for the ethical dimension of vocational training, lack of competence of the teacher and commitment of ethical dimension of user care. The internal consistency was high (0.753-0.990 across the factors), and the standard error of measurement and smallest detectable change were adequate. DISCUSSION: The It-ESMEE is able to assess moral distress in delayed nursing students with good validity and reliability. It can be used in research and to determine moral distress levels, helping teachers to monitor the condition in nursing students. CONCLUSION: This instrument can help in comprehending moral distress, enabling students to develop coping and intervention strategies to maintain their well-being, and to ensure the quality of nurse education.

Validity and reliability of the self-care of hypertension inventory (SC-HI) in a Brazilian population.

BACKGROUND: Poor self-care in patients with hypertension is associated with worse patient outcomes. The Self-Care of Hypertension Inventory (SC-HI) measures self-care in patients with hypertension and includes three scales: self-care maintenance, which measures adherence to prescribed treatments and behaviors; self-care management, which evaluates the responses to signs and symptoms of high blood pressure; and self-care confidence, which measures self-efficacy in dealing with the entire process. OBJECTIVE: To test the psychometric characteristics of the Brazilian version of the SC-HI. METHODS: We enrolled a sample of 360 patients with hypertension and performed confirmatory factor analysis (CFA) and exploratory factor analysis (EFA) to test the factorial structure of the SC-HI and computed the factor score determinacy coefficient to evaluate the SC-HI internal consistency reliability. RESULTS: The sample was predominantly female (65%), mean age of 65 years (SD = 10), white (70%). The self-care maintenance scale resulted in a unidimensional scale, with supportive fit indices (CFI = 0.901, RMSEA = 0.048); the self-care management did not reflect the original factorial structure and had unsupportive fit indices. EFA showed a different factorial solution in reference to the original study. Finally, the self-care confidence scale resulted in a unidimensional scale with supportive fit indices (CFI = 0.940, RMSEA = 0.093). The reliability of the self-care maintenance, management, and confidence scales resulted in factor score determinacy coefficients of 0.83, 0.78, and 0.97 respectively. CONCLUSION: This study shows that the SC-HI is a valid and reliable tool to measure self-care in patients with hypertension among the Brazilian population.

Effect of motivational interviewing in hypertensive patients (MIdNIgHT): study protocol for a randomized controlled trial.

BACKGROUND: Only one-third of hypertensive patients achieve and maintain blood-pressure control. This is attributed to low treatment adherence and has a negative impact on clinical outcomes. Adherence is multidimensional and involves aspects both related to patient characteristics and to the chronic nature of the disease. In this context, motivational interviewing has been proposed as an approach to foster patients' motivations to change their behavior for the benefit of their own health, thus providing more lasting behavioral changes. DESIGN AND METHODS: Single-center, parallel, randomized controlled trial with outcome-assessor blinding. This study will select adult patients (n = 120) diagnosed with hypertension who receive regular follow-up in a specialized outpatient clinic. Patients will be randomly allocated across two groups: the intervention group will have appointments focused on motivational interviewing, while the control group will have traditional appointments. Patients will be monitored face-to-face, once monthly for six months. The primary outcomes will be a reduction of at least 8 mmHg in systolic blood pressure and changes in mean blood pressure measured by 24-h ambulatory blood pressure monitoring. Secondary outcomes include improvement of adherence to a low-sodium diet, adherence to self-care behaviors, regular use of antihypertensive medications, increase or maintenance of physical activity, weight reduction, evaluation of changes in daytime sleepiness, and cessation of smoking. DISCUSSION: This study shows an intervention strategy that will be tested and, if effective, warrant replication in monitoring of other chronic diseases. TRIAL REGISTRATION: ClinicalTrials.gov, NCT02892929 . Registered on 24 August 2016.

Surgical safety in catheterization laboratory. / Segurança cirúrgica em laboratório de cateterismo.

OBJECTIVE: To describe the process of implanting the surgical safety checklist in a catheterization laboratory (CL). METHOD: Descriptive case report study about the safety strategies developed in the last six years in a university hospital in the southern region of Brazil. RESULTS: The six international patient safety goals (IPSG) were incorporated into the care practice in accordance with the hospital's Joint Comission International (JCI) accreditation program, through a continuous process of educational nature. The checklist was adapted considering the characteristics of the unit and the procedures performed. CONCLUSION: The implementation of the checklist provided the promotion of patient safety, greater staff integration, advances in communication among professionals and the recording of in-room care information.

Segurança cirúrgica em laboratório de cateterismo / Seguridad quirúrgica en laboratorio de cateterismo / Surgical safety in catheterization laboratory

Resumo OBJETIVO Descrever o processo de implantação da lista de verificação de segurança cirúrgica em laboratório de cateterismo (LC). MÉTODO Estudo descritivo do tipo relato de experiência das estratégias de segurança desenvolvidas nos últimos seis anos em hospital universitário da região Sul do Brasil. RESULTADOS Foram incorporadas na prática assistencial as seis metas internacionais de segurança do paciente (MISP) em consonância com o programa de acreditação hospitalar pela Joint Comission International (JCI), por meio de um processo contínuo com caráter educativo. A lista de verificação foi adaptada considerando as características da unidade e os procedimentos realizados. CONCLUSÕES A implantação da lista de verificação proporcionou a promoção da segurança do paciente, maior integração da equipe, avanços na comunicação entre os profissionais e no registro das informações da assistência em sala.

Resumen OBJETIVO Describir el proceso de implantación de la lista de verificación de seguridad quirúrgica en un laboratorio de cateterismo (LC). MÉTODO Estudio descriptivo del tipo relato de experiencia sobre las estrategias de seguridad desarrolladas en los últimos seis años en un hospital universitario de la región Sur de Brasil. RESULTADOS Se incorporaron en la práctica asistencial las seis metas internacionales de seguridad del paciente (MISP) en consonancia con el programa de acreditación hospitalaria por la Joint Comission International (JCI), a través de un proceso continuo con carácter educativo. La lista de verificación fue adaptada considerando las características de la unidad y los procedimientos realizados. Conclusión: La implantación de la lista de verificación proporcionó la promoción de la seguridad del paciente, una mayor integración del equipo, avances en la comunicación entre los profesionales y en el registro de las informaciones de la asistencia en sala.

Abstract OBJECTIVE To describe the process of implanting the surgical safety checklist in a catheterization laboratory (CL). METHOD Descriptive case report study about the safety strategies developed in the last six years in a university hospital in the southern region of Brazil. RESULTS The six international patient safety goals (IPSG) were incorporated into the care practice in accordance with the hospital's Joint Comission International (JCI) accreditation program, through a continuous process of educational nature. The checklist was adapted considering the characteristics of the unit and the procedures performed. CONCLUSION The implementation of the checklist provided the promotion of patient safety, greater staff integration, advances in communication among professionals and the recording of in-room care information.

Cross-cultural Adaptation of the Self-care of Hypertension Inventory Into Brazilian Portuguese.

BACKGROUND: Lifestyle changes and treatment adherence still constitute a challenge to healthcare providers involved in the care of persons with hypertension. The lack of validated instruments measuring the ability of hypertensive patients to manage their disease has slowed research progress in this area. The Self-care of Hypertension Inventory, originally developed in the United States, consists of 23 items divided across 3 scales: Self-care Maintenance, Self-care Management, and Self-care Confidence. These scales measure how well patients with hypertension adhere to treatment and manage elevated blood pressure, as well as their confidence in their ability to perform self-care. A rigorous cross-cultural adaptation and validation process is required before this instrument can be used in other countries. OBJECTIVE: The aims of this study were to translate the Self-care of Hypertension Inventory into Brazilian Portuguese with cross-cultural adaptation and to evaluate interobserver reliability and temporal stability. METHODS: This methodological study involved forward translation, synthesis of forward translations, back-translation, synthesis of back-translations, expert committee review, and pretesting. Interobserver agreement and the temporal stability of the scales were assessed. RESULTS: The expert committee proposed semantic and cultural modifications to some items and the addition of guidance statements to facilitate administration of the scale. Interobserver analysis demonstrated substantial agreement. Analysis of temporal stability showed near-perfect agreement. CONCLUSIONS: Cross-cultural adaptation of the Self-care of Hypertension Inventory successfully produced a Portuguese-language version of the instrument for further evaluation of psychometric properties. Once that step is completed, the scale can be used in Brazil.

Cross-cultural adaptation and psychometric testing of the brazilian version of the self-care of heart failure index version 6.2.

Objective. To adapt and evaluate the psychometric properties of the Brazilian version of the SCHFI v 6.2. Methods. With the approval of the original author, we conducted a complete cross-cultural adaptation of the instrument (translation, synthesis, back translation, synthesis of back translation, expert committee review, and pretesting). The adapted version was named Brazilian version of the self-care of heart failure index v 6.2. The psychometric properties assessed were face validity and content validity (by expert committee review), construct validity (convergent validity and confirmatory factor analysis), and reliability. Results. Face validity and content validity were indicative of semantic, idiomatic, experimental, and conceptual equivalence. Convergent validity was demonstrated by a significant though moderate correlation (r = -0.51) on comparison with equivalent question scores of the previously validated Brazilian European heart failure self-care behavior scale. Confirmatory factor analysis supported the original three-factor model as having the best fit, although similar results were obtained for inadequate fit indices. The reliability of the instrument, as expressed by Cronbach's alpha, was 0.40, 0.82, and 0.93 for the self-care maintenance, self-care management, and self-care confidence scales, respectively. Conclusion. The SCHFI v 6.2 was successfully adapted for use in Brazil. Nevertheless, further studies should be carried out to improve its psychometric properties.

Adesão às consultas e ao tratamento medicamentoso de pacientes em ensaios clínicos randomizados da indústria / Adhesión a las consultas y al tratamiento medicamentoso de pacientes en ensayos clínicos randomizados de la industria / Adherence to appointments and medication treatment of patients from randomized clinical trials of the industry

Estudo de coorte histórico que avaliou a taxa adesão dos pacientes de ensaios clínicos randomizados (ECR) da indústria farmacêutica na área de cardiologia às consultas de seguimento e ao tratamento medicamentoso. Estudo conduzido na unidade de pesquisa de cardiologia de um hospital público e universitário em Porto Alegre, Rio Grande do Sul. A adesão foi considerada como ≥ a 80 por cento. Foram revisados os registros de sete ECR (120 prontuários). Verificou-se que 117 (97 por cento) pacientes apresentaram adesão às visitas de seguimento ≥ a 80 por cento; 83,3 por cento dos pacientes apresentaram taxa de adesão ≥ 80 por cento à medicação do estudo; a mediana do número de comprimidos ingeridos entre os pacientes com boa adesão foi de 175 (72-500) e entre os pacientes com menor adesão foi de 500 (500-962). Estes resultados indicam que pacientes em estudos com seguimento mais longo e maior número de comprimidos apresentam prejuízo na adesão.

Estudio de cohorte histórica para evaluar la tasa de adherencia de los pacientes de ensayos clínicos randomizados (ECR) de la industria farmacéutica en la consulta de cardiología y el seguimiento de tratamiento médico. Un estudio realizado en la investigación en cardiología en un hospital público y de la universidad de Porto Alegre, Rio Grande Sul, Brasil. Alta adhesión fue considerada como un ≥ 80 por ciento. Revisado siete ECR (120 prontuarios). Se constató que 117 (97 por ciento) de los pacientes tenían la adhesión a las visitas de seguimiento a ≥ 80 por ciento, 83,3 por ciento de los pacientes tenían tasas de ≥ 80 por ciento la adherencia a la medicación en el estudio; la mediana del número de comprimidos ingeridos, entre pacientes con buena adherencia fue 175 (72-500) y entre los pacientes con menor adhesión fue 500 (500-962). Estos resultados indican que los estudios con seguimiento por más tiempo y mayor número de comprimidos perjudican la adhesión de pacientes.

Historical cohort study to assess the adherence rate of patients randomized clinical trials (RCT) of the pharmaceutical industry in the cardiology appointment and follow-up medical treatment. A study conducted at the cardiology research in a public hospital and university in Porto Alegre, Rio Grande do Sul, Brazil. High adherence was regarded as a ≥ 80 percent. Revised seven- RCT (120 medical records). It was found that 117 (97 percent) of patients had adherence to follow-up visits to ≥ 80 percent, 83.3 percent of patients had rates of ≥ 80 percent adherence to medication in the study; the median number of tablets ingested, among patients with good adherence was 175 (72-500) and among patients with lower adherence was 500 (500-962). These results indicate that patients in studies with longer follow up and greater number of oral medications present loss in adhesion.

[Adherence to appointments and medication treatment of patients from randomized clinical trials of the industry]. / Adesão às consultas e ao tratamento medicamentoso de pacientes em ensaios clínicos randomizados da indústria.

Historical cohort study that assessed the adherence rate of patients of randomized clinical trials (RCT) of pharmaceutical industry in cardiology to appointments and follow-up medical treatment. This study was conducted at the cardiology research unit in a public university hospital in Porto Alegre, Rio Grande do Sul, Brazil. High adherence was regarded as > or = 80%. Seven RCT (120 medical records) were revised. We discovered that 117 (97%) of patients had adherence to follow-up visits to > or = 80%; 83.3% of patients had rates of > or = 80% adherence to medication in the study; the median number of tablets ingested, among patients with good adherence was 175 (72-500), and among patients with lower adherence was 500 (500-962). These results indicate that patients in studies with longer follow up and greater number of oral medication present loss in adherence