La situación de la enfermería en la Región de las Américas. Informe final del Foro Regional para el Avance de la Enfermería en América Latina (8 y 9 de septiembre del 2022) / The situation of nursing in the Region of the Americas. Final report of the Regional Forum for the Advancement of Nursing in Latin America (September 8 and 9, 2022)

Los días 8 y 9 de septiembre del 2022, La Organización Panamericana de la Salud, la Federación Panamericana de Profesionales de Enfermería y la Facultad de Enfermería de la Universidad Nacional de Colombia celebraron el Foro Regional para el Avance de la Enfermería en América Latina. El objetivo del encuentro fue fomentar acciones con las asociaciones nacionales, las federaciones de profesionales y los colegios de enfermería dirigidas a avanzar el debate sobre la inversión nacional en los y las profesionales de enfermería y sobre la implantación de la enfermería de práctica avanzada para la atención primaria de salud. En este informe final se recogen los debates e intervenciones de ambas jornadas, así como las conclusiones y los próximos pasos acordados en el foro.(AU)

La presencia de las enfermeras en las residencias de mayores en Cantabria / The presence of nurses in Cantabria old people's home

Objetivos: Caracterizar la situación de la asistencia sociosanitaria y de dependencia en la comunidad autónoma de Cantabria y analizar la aplicación de cuidados por parte del personal de enfermería tanto del centro de salud como de los propios de los centros sociosanitarios y de dependencia. Metodología:Estudio descriptivo transversal y multicéntrico en el cual se diseñó una encuesta ad-hoc anónima enviada a todos los centros sociosanitarios de la comunidad autónoma de Cantabria para su cumplimentación. Resultados: Se obtuvieron 54 de las 60 encuestas enviadas, el total de residentes en centros sociosanitarios de Cantabria es de 5.335 personas con una media del 86,4% de pacientes dependientes y un total de 169 profesionales de enfermería que trabajan en estos centros. La ratio enfermera/paciente es de 32 pacientes por enfermera y la media de estos profesionales es de 4,12. La enfermera del centro de salud acude a los centros sociosanitarios 51,66 min/semana. Conclusiones: La situación actual es deficitaria en enfermeras por centro y en ratio por residente, cifras que no posibilitan la atención de enfermería adecuada. La ausencia de profesionales de enfermería no garantiza la continuidad de cuidados, la prevención ni el seguimiento de patologías crónicas. La presencia de enfermeras propias supone una mayor implicación, mejoras en la calidad de vida, calidad asistencial, mayor satisfacción general, minimización de errores y un descenso del intrusismo profesional (AU)

Objectives: Characterize the situation of the socio-sanitary assistance and dependency situation in the autonomous community (region) of Cantabria and to analyze the application of care by the nurses of the health center and the nurses of the sociosanitary and dependency centers. Methodology: Cross-sectional and multicenter descriptive study in which an anonymous ad-hoc survey was designed and sent to all the socio-sanitary centers of the autonomous community of Cantabria to be filled out. Results: A total of 54 of the 60 surveys sent were returned; the total number of residents in socio-sanitary centers in Cantabria is 5,335 people, with an average of 86.4% of dependent patients and a total of 169 nursing professionals who work in these centers. The nurse/patient ratio is 32 patients per nurse and the average of these professionals is 4.12. The health center nurse goes to the socio-sanitary centers 51.66 min/week. Conclusions: The current situation is deficient in nurses per center and in ratio per resident, figures that do not allow for adequate nursing care. The absence of nursing professionals does not guarantee the continuous care, prevention or monitoring of chronic pathologies. The presence of own nurses implies greater involvement, improvements in quality of life, quality of care, greater general satisfaction, minimization of errors and a decrease in professional intrusion (AU)

Black nurse scientists and the undeniable role of historically Black colleges and universities.

The pandemics of COVID-19 and systemic racism highlighted health inequities that have existed for decades among Black communities. Nurses are positioned to address these health inequities through innovative ideas and research. More specifically, Black nurses, because of their shared lived experience, understand sociostructural factors underpinning health inequities and how to best engage with Black communities. However, only 8% of Black nurses make up the overall nursing workforce and far fewer are nurse scientists. Historically Black Colleges and Universities (HBCUs) can offer critically important options for success in addressing the dearth of Black nurse scientists working across sectors and contributing to rich academic milieu, informing innovative national policy, and creating impactful practice. We discuss challenges and strategies to promoting research careers at HBCUs to attract Black nurse scientists as the next leaders in health inequities research.

Avaliação e processos de subjetivação na atenção básica à saúde: avaliação e subjetivação / La evaluación y los procesos de subjetivación en la atención primaria de salud: evaluación y subjetivación / Evaluation and processes of subjectivation at the primary health care: evaluation and subjectivation

RESUMO Desde a redemocratização no Brasil, o tema da subjetividade tem sido um componente importante na discussão e na formulação das políticas públicas no país. Existe um grande embate na literatura em torno dos méritos e dos prejuízos decorrentes dos processos de avaliação. O objetivo desta pesquisa é investigar os efeitos das práticas avaliativas nos processos de subjetivação vividos por profissionais das equipes de Saúde da Família na Atenção Básica, em um distrito sanitário do município de Belo Horizonte. Buscamos também compreender os efeitos da avaliação na subjetividade dos profissionais envolvidos. Realizamos 16 entrevistas semiestruturadas com os profissionais e gestores de duas Unidades Básicas de Saúde. Fizemos uma análise temática das entrevistas em três eixos: os ganhos desencadeados pelas práticas de avaliação, os seus aspectos problemáticos e os processos de subjetivação decorrentes das avaliações. Os ganhos que as avaliações permitiram foram: detectar as falhas no trabalho e redirecionar as atividades; melhorar o atendimento à população e modificar o comportamento com os colegas e em relação ao trabalho. As críticas se direcionaram aos indicadores dos instrumentos, aos processos de avaliação, à dificuldade de colocar em prática os resultados obtidos e ao não cumprimento dos acordos por parte dos gestores municipais. Os processos de subjetivação promovidos pelas avaliações foram por um lado a reflexão em relação ao trabalho e aos colegas, produzindo mudanças de atitudes, e por outro os sentimentos de medo, culpa e frustração em relação ao processo de avaliação, seus resultados e consequências.

RESUMEN Hay un embate en la literatura en torno a los méritos y los perjuicios derivados de los procesos de evaluación. Esta pesquisa investiga los efectos de las prácticas evaluativas en los procesos de subjetivación vividos por los profesionales de los Equipos de Salud de la Familia en la Atención Básica, en un distrito sanitario del municipio de Belo Horizonte. También buscamos comprender los efectos de la evaluación sobre la subjetividad de los profesionales involucrados. Realizamos 16 entrevistas semiestructuradas con los profesionales y gestores de dos Unidades Básicas de Salud. Hicimos un análisis temático de las entrevistas en tres ejes: las ganancias desencadenadas por las prácticas de evaluación, sus aspectos problemáticos y los procesos de subjetivación derivados de las evaluaciones. Las ganancias fueron: detectar los fallos en el trabajo y reorientar las actividades; mejorar la atención a la población y modificar el comportamiento con los colegas y con relación al trabajo. Las críticas se dirigieron a los indicadores de los instrumentos, a los procesos de evaluación, a la dificultad de poner en práctica los resultados obtenidos y al incumplimiento de los acuerdos por parte de los gestores municipales. Los procesos de subjetivación promovidos por las evaluaciones fueron, por un lado, la reflexión con relación al trabajo y a los colegas, lo que produjo cambios de actitudes, y, por otro lado, los sentimientos de miedo, culpa y frustración con relación al proceso de evaluación, sus resultados y consecuencias.

ABSTRACT This study aimed to investigate the effects of evaluation practices in the processes of subjectivation experienced by professionals from Family Health Teams in Primary Health Care, in a health district in the municipality of Belo Horizonte, state of Minas Gerais. We also sought to understand the effects of evaluation on the subjectivity of the professionals involved. We conducted 16 semi-structured interviews with professionals and managers of two Basic Health Units. A thematic analysis of the interviews was carried out in three axes: the gains triggered by the evaluation practices, their problematic aspects and the subjectivation processes resulting from the assessments. The gains that the evaluations allowed were: detecting work failures and redirecting activities; improve service to the population and change behavior with coworkers and in relation to work. Criticism was directed towards the instruments' indicators, the evaluation processes, the difficulty of putting into practice the results obtained and the non-compliance with the agreements by the municipal managers. The subjectivation processes promoted by the evaluations were, on the one hand, the self-reflection in relation to work and coworkers, producing changes in attitudes, and, on the other, the feelings of fear, guilt and frustration regarding evaluation process, its results and consequences.

Enfermeiros no atendimento de urgência em presídios: explorando razões do chamado e local da assistência / Enfermeras en atención de urgencia en cárceles: explorando razones de la llamada y local de la asistencia / Nurses in urgent care in prisons: exploring reasons for the call and place of assistance

RESUMO Objetivo: analisar as percepções dos enfermeiros do Serviço de Atendimento Móvel de Urgência (SAMU) em atendimentos realizados em penitenciárias perante as razões das demandas e o local da assistência. Método: trata-se de um estudo exploratório e descritivo de abordagem qualitativa. Realizaram-se entrevistas nos meses de agosto a dezembro de 2017, individuais e audiogravadas, seguindo roteiro semiestruturado com 91 enfermeiros que atuavam no SAMU de cidades do estado da Paraíba, Brasil. Aplicou-se o referencial metodológico da Análise de Conteúdo proposta por Bardin para categorização dos dados obtidos. Resultados: das análises das falas dos participantes emergiu a presença de dificuldades como demandas não pertinentes ao serviço, local inadequado para assistência, falta de privacidade durante os atendimentos e de escolta para transporte quando necessário. Considerações finais: os problemas relatados evidenciam a necessidade do estabelecimento de estratégias para melhorar as condições da assistência potencializando a capacidade de resolutividade do serviço e para problemas que não podem ser resolvidos em uma única visita de profissionais do SAMU no ambiente prisional, que seja garantido a continuidade da assistência em outros serviços articulados a ele e para isso são necessários fortes laços intersetoriais.

RESUMEN Objetivo: analizar las percepciones de los enfermeros del Servicio de Atención Móvil de Urgencia (SAMU) en atenciones realizadas en prisiones ante las razones de las demandas y el lugar de la asistencia. Método: se trata de un estudio exploratorio y descriptivo de enfoque cualitativo. Se realizaron entrevistas en los meses de agosto a diciembre de 2017, individuales y audiograbadas, siguiendo guion semiestructurado con 91 enfermeros que actuaban en el SAMU de ciudades del estado de Paraíba, Brasil. Se aplicó el referencial metodológico del Análisis de Contenido propuesto por Bardin para categorización de los datos obtenidos. Resultados: de los análisis de los relatos de los participantes surgió la presencia de dificultades como demandas no pertinentes al servicio, local inadecuado para asistencia, falta de privacidad durante las atenciones y de escolta para transporte cuando necesario. Consideraciones finales: los problemas relatados evidencian la necesidad de que se establezcan estrategias para mejorar las condiciones de la asistencia, perfeccionando la capacidad de resolución del servicio y para problemas que no pueden ser resueltos en una sola visita de profesionales del SAMU en el ambiente carcelario, que se garantice la continuidad de la asistencia en otros servicios articulados a él y para ello son necesarios fuertes lazos intersectoriales.

ABSTRACT Objective: to analyze the perceptions of nurses from the Mobile Emergency Care Service (SAMU) in care provided in penitentiaries regarding the reasons for the calls and the place where care is provided. Method: this is an exploratory and descriptive study with a qualitative approach. Individual and audio-recorded interviews were carried out from August to December 2017 following a semi-structured script with 91 nurses who worked in the SAMU in cities in the state of Paraíba, Brazil. The methodological framework of Content Analysis proposed by Bardin was applied to categorize the data obtained. Results: the presence of difficulties emerged from the analysis of the speeches of the participants. They included calls for reasons not relevant to the service, inadequate place for assistance, lack of privacy during consultations, and lack of escort for transport when necessary. Final considerations: the reported problems highlight the need to establish strategies to improve the conditions of care provision so as to enhance the service's ability to solve problems that cannot be solved in a single visit by SAMU professionals in the prison environment, which guarantees the continuity of assistance in other services articulated to it, making strong intersectoral links necessary.

Gerenciamento do tempo no processo de trabalho dos enfermeiros em Unidade de Terapia Intensiva / Gestión del tiempo en el proceso de trabajo de enfermeros de la unidad de cuidados intensivos / Time management in the work process of nurses in the intensive care unit

RESUMO Objetivo analisar o gerenciamento do tempo dispensado por enfermeiros em intervenções de cuidados diretos e indiretos, em atividades associadas ao trabalho e atividades pessoais. Método estudo quantitativo, transversal, realizado em Unidade de Terapia Intensiva de um hospital universitário no Rio de Janeiro em janeiro de 2017. Foram realizadas observações diretas das atividades realizadas pelos enfermeiros em 18 plantões, totalizando 216 horas. O "Instrumento para mensuração da carga de trabalho" foi utilizado para estruturar a observação. Resultados os resultados mostraram que 21,5% do tempo dos enfermeiros foram dedicados às intervenções de cuidados diretos 44,7% aos cuidados indiretos, 6,1% às atividades associadas e 27,7% às atividades pessoais. Conclusão os enfermeiros utilizam maior parte do tempo em atividades não relacionadas ao cuidado direto ao paciente. Os achados podem ser utilizados pelos gestores para revisão e adequação do dimensionamento de profissionais na assistência direta e indireta e do processo de trabalho na Unidade.

RESUMEN Objetivo analizar la gestión del tiempo que brindan los enfermeros en las intervenciones asistenciales directas e indirectas, en actividades asociadas al trabajo y actividades personales. Método estudio cuantitativo, transversal, realizado en la Unidad de Cuidados Intensivos de un hospital universitario de Rio de Janeiro en enero de 2017. Se realizaron observaciones directas de las actividades realizadas por enfermeras en 18 turnos, totalizando 216 horas. Se utilizó la "Herramienta de medición de la carga de trabajo" para estructurar la observación. Resultados los resultados mostraron que el 21,5% del tiempo de los enfermeros se dedicó a intervenciones de cuidados directos, el 44,7% a cuidados indirectos, el 6,1% a actividades asociadas y el 27,7% a actividades personales. Conclusión los enfermeros dedican la mayor parte de su tiempo a actividades no relacionadas con la atención directa al paciente. Los hallazgos pueden ser utilizados por los gestores para revisar y adecuar el dimensionamiento de profesionales en la atención directa e indirecta y el proceso de trabajo en la Unidad.

ABSTRACT Objective to analyze time management by nurses in direct and indirect care interventions, in work-related and personal activities. Method this quantitative, cross-sectional study was conducted in the Intensive Care Unit of a university hospital in Rio de Janeiro in January 2017. Direct observations were made of nurses' activities in 18 shifts, totaling 216 hours. Mello's "Workload Measuring Tool" was used to structure the observations. Results 21.5% of nurses' time was devoted to direct care, 44.7% to indirect care, 6.1% to work-related activities and 27.7% to personal activities. Conclusion nurses spend most of their time on activities unrelated to direct patient care. These findings can be useful to managers in reviewing and adjusting both staffing in direct and indirect care and the unit's work process.

Alternative Approaches to Ensuring Adequate Nurse Staffing: The Effect of State Legislation on Hospital Nurse Staffing.

OBJECTIVE: The objective of this study was to addresses the basic question of whether alternative legislative approaches are effective in encouraging hospitals to increase nurse staffing. METHODS: Using 16 years of nationally representative hospital-level data from the American Hospital Association (AHA) annual survey, we employed a difference-in-difference design to compare changes in productive hours per patient day for registered nurses (RNs), licensed practical/vocational nurses (LPNs), and nursing assistive personnel (NAP) in the state that mandated staffing ratios, states that legislated staffing committees, and states that legislated public reporting, to changes in states that did not implement any nurse staffing legislation before and after the legislation was implemented. We constructed multivariate linear regression models to assess the effects with hospital and year fixed effects, controlling for hospital-level characteristics and state-level factors. RESULTS: Compared with states with no legislation, the state that legislated minimum staffing ratios had an 0.996 (P<0.01) increase in RN hours per patient day and 0.224 (P<0.01) increase in NAP hours after the legislation was implemented, but no statistically significant changes in RN or NAP hours were found in states that legislated a staffing committee or public reporting. The staffing committee approach had a negative effect on LPN hours (difference-in-difference=-0.076, P<0.01), while the public reporting approach had a positive effect on LPN hours (difference-in-difference=0.115, P<0.01). There was no statistically significant effect of staffing mandate on LPN hours. CONCLUSIONS: When we included California in the comparison, our model suggests that neither the staffing committee nor the public reporting approach alone are effective in increasing hospital RN staffing, although the public reporting approach appeared to have a positive effect on LPN staffing. When we excluded California form the model, public reporting also had a positive effect on RN staffing. Future research should examine patient outcomes associated with these policies, as well as potential cost savings for hospitals from reduced nurse turnover rates.

Beyond the Outbreak of COVID-19: Factors Affecting Burnout in Nurses in Iran.

Background: Nurses working in treating patients with COVID-19 are exposed to various stressors, such as fear of COVID-19, stress, and high workload, leading to burnout. Objectives: This study aimed to identify the level of burnout and its predictors in nurses working in hospitals for COVID-19 patients. Methods: Participants in this study were nurses working in 11 hospitals for COVID-19 patients in the Fars province of Iran. The Maslach burnout and the UK Health and Safety stress questionnaires were used to assess burnout and stress, respectively. Analysis, using multiple regression in the SPSS21 software, aimed to identify the factors affecting burnout. Findings: The mean level of burnout in the nurses at the COVID-19 hospitals was 57 out of 120, and burnout was affected by workload (ß = 0.69, p < 0.001), job stress (ß = 0.25, p < 0.001) and inadequate hospital resources for the prevention of COVID-19 (ß = -0.16, p < 0.001). These three variables explained 87% of the variance in burnout. Conclusions: The burnout of nurses directly exposed to COVID-19 patients is more than nurses in other wards, and workload is the most significant cause of burnout in them. Therefore, necessary measures such as hiring more nurses, reducing working hours and increasing rest periods are necessary to reduce workload. In addition, the job stress of these nurses should be managed and controlled, and the hospital resources needed to prevent this disease should be provided.

Factors Influencing Nurses' Work Interruption in Wuhan Isolation Wards During the COVID-19 Pandemic.

BACKGROUND Through January 2021, the novel coronavirus (COVID-19) continued to create significant pressure on medical staff who have worked to treat patients with the disease and control its spread. This study aimed to increase understanding of the situation and influencing factors of nurses' work interruption in Wuhan's isolation ward during the COVID-19 pandemic. MATERIAL AND METHODS A self-designed general situation questionnaire and work interruption questionnaire were used to survey 160 nurses from Beijing, Chongqing, and Jilin who worked during the COVID-19 pandemic in Wuhan in March 2020. The questionnaire could only be answered once by each nurse via a WeChat account. The submitted answers were verified by 2 researchers. RESULTS The results showed that the rate of interruption of work among nurses in the isolation ward was 25%, and the rate of nurses experiencing a negative experience was 96.9%. The results of univariate analysis showed that the following factors were related to the work interruption of the nurses in the isolation ward (all P<0.05): emergency public incident training; emergency public incident treatment experience; knowledge of COVID-19 pneumonia; hours worked per shift in the quarantine area; and negative physiologic experience. Logistic regression analysis showed that negative experience, hours worked per shift, and emergency public incident training were the independent factors influencing work interruption among nurses in the isolation wards. CONCLUSIONS The incidence of interruption of work among nurses in the isolation ward was 25%. Negative experiences, long working hours per shift, and lack of emergency public incident training made the nurses more prone to work interruption.

National Estimates of the Reserve Capacity of Registered Nurses Not Currently Employed in Nursing and Emergency Nursing Job Mobility in the United States.

STUDY OBJECTIVE: In a large-scale disaster, recruiting from all retired and nonworking registered nurses is one strategy to address surge demands in the emergency nursing workforce. The purpose of this research was to estimate the workforce capacity of all registered nurses who are not currently working in the nursing field in the United States by state of residence and to describe the job mobility of emergency nurses. METHODS: Weighted population estimates were calculated using the 2018 National Sample Survey of Registered Nurses. Estimates of all registered nurses, including nurse practitioners who were not actively working in nursing as well as only those who were retired, based on demographics, place of residence, and per 1,000 state population, were visualized on choropleth maps. Workforce mobility into and out of the emergency nursing specialty between 2016 and 2017 was quantified. RESULTS: Of the survey participants, 61% (weighted n=2,413,382) worked full time as registered nurses at the end of both 2016 and 2017. At the end of 2017, 17.3% (weighted n=684,675) were not working in nursing. The Great Lakes states and Maine demonstrated the highest per capita rate of those not working in nursing, including those who had retired. The largest proportion of those entering the emergency nursing specialty were newly licensed nurses (15%; weighted n=33,979). CONCLUSION: There is an additional and reserve capacity available for recruitment that may help to meet the workforce needs for nursing, specifically emergency nurses and nurse practitioners, across the United States under conditions of a large-scale disaster. The results from this study may be used by the emergency care sector leaders to inform policies, workforce recruitment, workforce geographic mobility, new graduate nurse training, and job accommodation strategies to fully leverage the potential productive human capacity in emergency department care for registered nurses who are not currently working.

The Influence of the COVID-19 Pandemic on ICU Organization, Care Processes, and Frontline Clinician Experiences: A Qualitative Study.

BACKGROUND: The COVID-19 pandemic resulted in unprecedented adjustments to ICU organization and care processes globally. RESEARCH QUESTIONS: Did hospital emergency responses to the COVID-19 pandemic differ depending on hospital setting? Which strategies worked well to mitigate strain as perceived by intensivists? STUDY DESIGN AND METHODS: Between August and November 2020, we carried out semistructured interviews of intensivists from tertiary and community hospitals across six regions in the United States that experienced early or large surges of COVID-19 patients, or both. We identified themes of hospital emergency responses using the four S framework of acute surge planning: space, staff, stuff, system. RESULTS: Thirty-three intensivists from seven tertiary and six community hospitals participated. Clinicians across both settings believed that canceling elective surgeries was helpful to increase ICU capabilities and that hospitals should establish clearly defined thresholds at which surgeries are limited during future surge events. ICU staff was the most limited resource; staff shortages were improved by the use of tiered staffing models, just-in-time training for non-ICU clinicians, designated treatment teams, and deployment of trainees. Personal protective equipment (PPE) shortages and reuse were widespread, causing substantial distress among clinicians; hands-on PPE training was helpful to reduce clinicians' anxiety. Transparency and involvement of frontline clinicians as stakeholders were important components of effective emergency responses and helped to maintain trust among staff. INTERPRETATION: We identified several strategies potentially to mitigate strain as perceived by intensivists working in both tertiary and community hospital settings. Our study also demonstrated the importance of trust and transparency between frontline staff and hospital leadership as key components of effective emergency responses during public health crises.

From Cruddiness to Catastrophe: COVID-19 and Long-term Care in Ontario.

Over 80% of Canadian COVID-19 first wave deaths occurred in long-term care homes. Focussing on Ontario, I trace the antecedents of the COVID-19 crisis in long-term care and document experiences of frontline staff and family members of residents during the pandemic. Following Povinelli, I argue that the marginalization of both residents and workers in Ontario's long-term care system over two decades has eroded possibilities for recognition of their personhood. I also question broader societal attitudes toward aging, disability and death that make possible the abandonment of the frail elderly.