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BACKGROUND: Patients with cancer are referred late to palliative care services (PCS). AIM: To analyse the time of referral to PCSs and the characteristics of patients that are referred. METHODS: A retrospective cohort. All patients admitted in a single tertiary care institution were evaluated by the PCSs from February 1, 2018 to January 31, 2019. FINDINGS: Among the 642 patients (557 patients with cancer) referred to PCSs: 7.47% died before evaluation, 13.08% died before transfer, and 15.6% died within 8 days after transfer. Out of all the patients with cancer included in the study, 85.28% had less than 2 months of PCS follow-up during their disease. In the last 30 days of life, 96.26% had were readmitted to hospital. A total of 94.09% of patients with cancer died in a hospital. CONCLUSION: These findings suggest that patients with cancer in Brazil are not referred early enough to PCSs. Early integration with PCS must be sought to improve the accuracy of referral.

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OBJECTIVE: To characterize nursing care management strategies for addressing the COVID-19 pandemic. METHOD: A descriptive, qualitative study conducted with 22 nurse professionals at a University Hospital in Southern Brazil. Data collection through interviews in June and August 2021, analyzed according to Bardin's Content Analysis and the theoretical framework of complex thinking. RESULTS: The identified strategies were organized into four categories: Reorganization of health services; People management and emergency admission; Multiprofessional articulation; and Bedside nursing care. FINAL CONSIDERATIONS: Professional performance revealed a complex interplay between leadership and care management practices, even in the face of working condition restrictions, and were understood as crucial in the pandemic scenario.

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OBJECTIVE: To understand the clinical and epidemiological characteristics, outcomes, and nursing care of adult patients affected by COVID-19 in the Intensive Care Unit. METHODS: This is a quantitative, retrospective, and descriptive study. The study participants were clinical and epidemiological statistical reports. Variables analyzed included age, gender, race, comorbidities, signs and symptoms, length of hospital stay, use of mechanical ventilation, medications, infections, monitoring, invasive devices, positioning, diet, comfort, and clinical outcomes. RESULTS: The majority of individuals were men, of white race, with a mean age of 63 years, hypertensive, diabetic, and obese. The average length of hospital stay was 16 days. Most required invasive mechanical ventilation, vasopressor drugs, sedoanalgesia, and neuromuscular blockers. CONCLUSION: Nursing care is related to monitoring, ventilation, medication administration, installation of devices, prone positioning, diet administration, and providing comfort.

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OBJECTIVE: To develop a nursing intervention model for adolescents and parents experiencing parental cancer. METHOD: Multimethod research, which integrated five studies: a scoping review and four qualitative studies. Considering the results of these studies, a nursing intervention model was constructed based on two theoretical frameworks, such as the A Model of Children's Adjustment to Parental Cancer, for adolescents, and Neuman Systems Model, for parents, and on a semantic framework, such as Nursing Ontology. RESULTS: The model is aimed at three target audiences: individual - parental figure with cancer; individual - adolescent; and family - parental figure with cancer, second parental figure and adolescent. The model is based on health literacy and includes four topics that address central topics in the experience of parental cancer: "The elephant in the room"; "Everything changes in us"; "Life goes on"; and "With the present, we plan the future". CONCLUSION: The proposed model is assumed as a health promotion strategy that empowers nurses for a family-centered intervention, in order to minimize the impact of parental cancer.

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OBJECTIVE: To compare the effectiveness of flipped classroom (FC) model with traditional lecture-based learning (LBL) model in the education of hemodialysis nurses. METHOD: Enrolled were 46 nurses who had received training from the hemodialysis center. These nurses were randomly assigned to FC or LBL groups, with 23 nurses in each group. FC group received the FC method, while LBL group was trained via the traditional LBL. After training, all nurses were examined for their theoretical knowledge, clinical practice skills and self-learning abilities. Furthermore, their satisfaction with the teaching mode was evaluated. RESULTS: FC group outperformed LBL group in the mastery of theoretical knowledge. In FC group, the scores in objective, subjective and overall questions were significantly higher than those in LBL group. FC group demonstrated a superior capability in clinical practices. FC group exhibited a superior performance over the LBL group in self-learning ability. Additionally, FC group showed a higher degree of satisfaction with the training method. CONCLUSION: FC method benefits nurses in mastering knowledge about hemodialysis. It enhances their clinical practice skills and self-learning capabilities, and brings them with a higher degree of satisfaction.

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OBJECTIVE: to explore the nurses' perceptions among the quality of care to stroke patients in a public hospital in Northern Honduras. METHOD: a descriptive phenomenological study was carried out. The data collection was conducted by means of depth- interviews to 20 general nurses from the emergency and clinical medicine departments from the Atlántida General Hospital. Data analysis was by thematic technique. RESULTS: the research found three key themes, and 10 subthemes, which illustrated the quality of stroke patients care in a general hospital from Honduras. The finding points up the theme "negative outcomes regarding the structure dimension of the patient care units", which means the failure to improve or maintain the quality of healthcare. Likewise, "positive outcomes regarding the nursing process", defined as pleasant and helpful among the care of stroke patients, such as ethical and humanized caring, and activities on promoting patient self-care with involvement of the relatives. CONCLUSION: the results indicate that Honduran nurses do not have qualified graduate training in critical care, which is a limitation that compromises the quality of care. Therefore, it is recommended to have clear organization structures and better resources managing, consequently, it may increase user satisfaction, as well as reducing hospital stays.

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PURPOSE: To identify the prevalence of the nursing diagnosis of compromised end-of-life syndrome in patients in end-of-life care. METHODS: This is a clinical validation based on a cross-sectional epidemiological clinical study conducted at the National Cancer Institute in Rio de Janeiro, Brazil. The defining characteristics of a syndrome diagnosis were identified, defined as a "subset of nursing diagnoses," using sensitivity and specificity measures through the application of latent class statistical methods. FINDINGS: The statistical results revealed seven nursing diagnoses characterizing the syndrome: imbalanced nutrition: less than body requirements, nausea, anxiety, ineffective breathing pattern, disturbed sleep pattern, ineffective thermoregulation, and fatigue. Compromised end-of-life syndrome was present in 76% of the sample. CONCLUSION: The study demonstrated the presence of compromised end-of-life syndrome in most end-of-life patients from the sample. IMPLICATIONS FOR NURSING PRACTICE: Recognizing the presence of the syndrome diagnosis enables nurses to have efficient and effective clinical reasoning for implementing the nursing process in palliative care. CAAE Number: 85415618.0.3001.5274.

OBJETIVO: Identificar a prevalência do diagnóstico de enfermagem Síndrome de fim de vida comprometido em pacientes em cuidados de fim de vida. MÉTODO: Trata­se de uma validação clínica baseada em um estudo clínico epidemiológico transversal, desenvolvido no Instituto Nacional do Câncer no Rio de Janeiro, Brasil. Foram identificadas as características definidoras de um diagnóstico de síndrome, definido como um "subconjunto de diagnósticos de enfermagem" utilizando­se medidas de sensibilidade e especificidade a partir da aplicação do método estatístico de classe latente. RESULTADOS: Os resultados estatísticos identificaram sete diagnósticos de enfermagem caracterizadores da síndrome: nutrição desequilibrada: menor que as necessidades corporais, náusea, ansiedade, padrão respiratório ineficaz, padrão de sono perturbado, termorregulação ineficaz e fadiga. O diagnóstico Síndrome de fim de vida comprometido esteve presente em 76% da amostra. CONCLUSÃO: O estudo demonstrou a presença da Síndrome de fim de vida comprometido na maioria dos pacientes em cuidados de fim de vida da amostra. IMPLICAÇÕES PARA A PRÁTICA DE ENFERMAGEM: O reconhecimento da presença do diagnóstico de síndrome permite ao enfermeiro um raciocínio clínico eficaz e eficiente para a implantação do processo de enfermagem em cuidados paliativos. Número CAAE: 85415618.0.3001.5274.

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AIM: To validate the defining characteristics (CDs) of the nursing diagnosis 'Activity intolerance [00092]' in patients with acute coronary syndrome (ACS). DESIGN: Cross-sectional study. Patients over 18 years of age with a confirmed medical diagnosis of hospitalised ACS were included and those who were haemodynamically unstable, with alterations in the mental sphere or with communication limitations were excluded. The CDs were previously operationalised for standardised measurement and independently assessed by nurses. RESULTS: A total of 111 patients with ACS were studied. The CDs with prevalence > 50% were: generalised weakness (80.56 vs. 78.70%), discomfort on exertion (72.07% vs. 75.68%) and ECG changes (71.17% vs. 68.47%). Inter-rater agreement for determining the CDs ranged from 0.69 to 1.00. CONCLUSIONS: This study established the clinical validation of the CDs of the nursing diagnosis 'Activity Intolerance [00092]' in patients with ACS identifying three major CDs: EKG changes, generalised weakness and exertional discomfort. PATIENT OR PUBLIC CONTRIBUTION: No patient or public contribution the research was developed in its entirety by the authors. IMPLICATIONS FOR THE PROFESSION AND/OR PATIENT CARE: The clinical validation of the defining characteristics of the activity intolerance diagnosis was conducted. This validation was based on operationalising each characteristic using commonly employed nursing scales and instruments. This process contributes significantly to the establishment of evidence-based nursing practices. The customisation of nursing diagnoses gains further ground through the validation studies of NANDA-I diagnoses. This process solidifies standardised nursing language as a valuable strategy in nursing care, providing substantial support for practical decision-making. Among the evaluators, EKG changes, generalised weakness and discomfort on exertion emerged as the most frequently encountered defining characteristics with substantial agreement. This discovery offers crucial insights for devising individualised and collective care plans within coronary units.

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OBJECTIVES: to develop a digital technological solution (prototype) for assessing patients with chronic pain. METHODS: this is a methodological and technological development study based on the Human-Centered Design framework and the principles of Patient-Centered Care. The prototype guides patients through a body diagram and directs them to an evaluation using specific instruments that address the multidimensional aspects of chronic pain. RESULTS: the GerenciaDOR* project enables navigation through the Web App screens, providing access to pain assessment features up to the presentation of results. FINAL CONSIDERATIONS: the study describes a systematic approach to pain assessment and expands nurses' knowledge in pain management. Additionally, it can promote the development of other digital technologies for chronic pain assessment and contribute to a multidisciplinary, patient centered treatment.

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OBJECTIVES: to understand nurses' experiences in caring for people with mental health problems hospitalized due to clinical comorbidities in non-psychiatric Inpatient Units. METHODS: qualitative study, guided by Alfred Schutz's social phenomenology. Sixteen phenomenological interviews were conducted. The content was analyzed and discussed based on the literature, through the composition of three categories of analysis. RESULTS: three categories emerged in the study: Challenges in care faced by nurses; Fragmented care action; and Ideal care. The disarticulation of the clinic was revealed, as described by nurses, showing care as an action far removed from the comprehensiveness of a person. Nurses' performance is guided predominantly by biomedical reference, disregarding appreciation of subjectivity. FINAL CONSIDERATIONS: it was observed that nurses attribute the responsibility for patient care to factors external to their life-world, when, in fact, these aspects should be components that help them in comprehensive care construction.

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OBJECTIVES: to analyze stress from the perspective of nursing workers caring for people with COVID-19 in a public hospital in the Recôncavo region of Bahia. METHODS: this is an exploratory qualitative study, conducted through semi-structured interviews. The data were analyzed using word clouds, similarity trees, and content analysis. RESULTS: nursing workers were exposed to stress while attending to patients with COVID-19. The reported stressors in the workplace included: work overload, lack of planning, speed in performing tasks, fatigue, lack of participation in decision-making, lack of support from management, technological changes, excessive responsibility without preparation, interpersonal conflicts, and professional undervaluation. CONCLUSIONS: exposure to these stressors leads to emotional exhaustion and demotivation, which were intensified during the COVID-19 pandemic.

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OBJECTIVE: To analyze the knowledge and perceptions of the nursing team about arrest and cardiopulmonary resuscitation in adults before and after in situ simulation in emergency care. METHOD: A sequential explanatory mixed methods study conducted in an Emergency Care Unit. Quantitative data were obtained through pre- and post-simulation questionnaire answered by 21 professionals and analyzed using descriptive and inferential statistics. The qualitative data was obtained through individual structured interviews with 19 professionals, analyzed according to thematic content analysis. The data was combined through connection. RESULTS: In situ simulation did not significantly change pre- and post-simulation knowledge. Hand positioning for cardiac compressions and handling the automatic external defibrillator had the lowest number of correct answers. The qualitative data indicated difficulties related to knowledge, such as lack of training and insufficient experience with cardiopulmonary resuscitation. CONCLUSION: No statistically significant differences were identified in the proportions of answers obtained through the pre- and post-simulation in situ questionnaire regarding correct answers and wrong answers. Furthermore, the qualitative data reinforced the professionals' lack of experience in critical situations, the lack of training and ongoing studies on the subject.

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OBJECTIVE: To describe an implementation study protocol for an intervention based on educational guidelines focused on seven self-care behaviors, through phone calls to individuals with type 2 diabetes. METHOD: We will conduct a hybrid type 1 effectiveness-implementation pragmatic randomized clinical trial, with 198 individuals with type 2 diabetes on insulin therapy, from the Glycemic Self-Monitoring Program of two Primary Health Care in the city of São Paulo and three in Campinas, located in the state of Sao Paulo. Patients will be allocated in a 1:1 ratio to either the intervention or control group. Both groups will receive standard care, with the intervention group also receiving a phone call. During the call, nurses will provide guidance based on seven self-care behaviors, known as The ADCES7 Self-Care Behaviors™. Evaluations will happen at the baseline, and after 3- and 6-months post initiation of the trial. Glycemic levels and adherence to self-care behaviors will be compared before and after the intervention using multiple linear regression models. Through interviews with participants from the intervention group, implementation determinants based on the Capability, Opportunity, Motivation-Behavior (COM-B) model, and implementation outcomes feasibility, acceptability, and appropriateness will be evaluated. EXPECTED OUTCOMES: We will evaluate the effectiveness of an intervention while exploring contextual conditions for its implementation in clinical practice of Primary Health Care. This study will provide preliminary evidence on the effectiveness of educational guidance through nurse-led telephone calls, as well as implementation determinants and outcomes in the clinical practice of Primary Health Care. Its results are important for expanding this assistance in locations where nursing consultation for people with diabetes is absent, hindered, or restricted. Study is registered on the ReBEC platform.

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OBJECTIVE: To structure a proposal for implementing and monitoring the nursing care protocol for the safety of adult patients with external ventricular drains. METHOD: Descriptive exploratory research based on Implementation Science, with intentional sampling. Carried out in a hospital complex in southern Brazil, between May and December 2022, in four stages: online questionnaire on knowledge of care for patients with external ventricular shunt for nurses; matrix of proposed indicators with key actors; self-instructional online course for nurses; synthesis of the existing protocol. Contextualized instructional design was used to develop the course. RESULTS: Six nurses from the operating room and intensive care unit participated, identifying knowledge gaps, pointing out the need for specific training; four key actors in the neurosurgery service defined six indicators. An online course was created and made available on the platform of the institution with two modules, including eight videos. Protocol synthesis was adapted to the standards of the institution's quality sector. CONCLUSION: A report regarding the implementation of the nursing care protocol for patients with external ventricular drains was delivered for the nurse who was the technical responsible. Future studies should evaluate the implementation and impacts it will generate. This model can be adapted by other institutions.

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OBJECTIVES: to understand the nursing team's perception in relation to the care provided to pregnant women with mental disorders admitted to a psychiatric hospital unit. METHODS: Convergent Care Research carried out between August and December 2021, through semi-structured interviews with 25 nursing professionals from a Psychiatric Unit from a reference Hospital in Southern Brazil. RESULTS: the organized and analyzed data resulted in two thematic categories: Technical, generic and impersonal care; and From impersonality to the singularity of nursing care. Ensuring unique care for pregnant women with mental disorders means giving them a meaning of existence and providing care from a multidimensional and continuous perspective. FINAL CONSIDERATIONS: nursing care for pregnant women in psychiatric hospitalization requires continuous professional qualification, interactive technologies and support for the nursing process, in addition to promoting singular and multidimensional care.

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OBJECTIVES: to analyze the relationship between religion and professional experience with spiritual intelligence in nurses. METHODS: cross-sectional and analytical study carried out in 2021, with the participation of 544 nursing professionals working in health facilities in Peru during the COVID-19 pandemic. Multiple regression analysis and Pearson's correlation were used to analyze the data. RESULTS: in nurses, a healthy level of spiritual intelligence predominated (42.8%). Those who did not profess a religion were more likely to have a lower spiritual intelligence score (global scale and dimensions); however, experienced nurses were more likely to have higher spiritual intelligence (global scale and dimensions) than novice nurses (p<0.05). CONCLUSIONS: spiritual intelligence in nurses was predicted by religion and professional experience. This finding suggests that spiritual intelligence in nursing is consolidated through religious practices and during professional practice.

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OBJECTIVE: To map the evidence on quality nursing care practices in pain management in orthopedic surgical patients. METHOD: Scoping review, as per the JBI Manual recommendations. Searches were performed in the MEDLINE (PubMed), LILACS (Regional VHL), Scopus, Embase, Web of Science, Cochrane, Cinahl databases, and gray literature, regardless of language and period. Selection and extraction were performed by two independent reviewers, using inclusion/exclusion criteria, and the extracted data were organized to reflect key themes or recurring patterns related to the purpose of the review. RESULTS: A total of 94 studies were included, most from the United States, corresponding to 34% of the sample, and published between 1997 and 2022. The findings were categorized into: nursing quality practices in pain management related to the organization and monitoring of units, and pre- and post-operative period. CONCLUSION: The research revealed that quality nursing care practices in pain management in orthopedic surgical patients encompass a variety of approaches, from the use of nonpharmacological practices and patient education to the use of pain assessment scales, staff training, to innovative pharmacological procedures.

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OBJECTIVE: to analyze the leadership practices among nurses in face of COVID-19 pandemic in university hospitals in Brazil. METHOD: this is a multicenter, qualitative and exploratory-descriptive research. Semi-structured interviews were conducted with 139 nurses who worked in the care for patients with COVID-19 in Brazilian university hospitals. Thematic content analysis was carried out with support of Iramuteq® software. RESULTS: Three categories were obtained: 1) Leadership practices with individual emphasis, highlighting decision-making agility and technical-scientific knowledge as relevant elements for professional performance; 2) Leadership practices with emphasis on the team and direct care for critical patients, presents the challenges faced in managing human resources amidst a high number of infections and professional absences; and 3) Leadership practices with emphasis on Safety and material management, presenting strategies to enhance patient and professional safety despite difficulties related to the supply of materials. CONCLUSION: leadership practices such as adaptive capacity, transmission of trust in the leader, collaborative decision-making, encouraging team development, management of human and material resources, and effective communication allowed nurses to cope with the critical moments of the pandemic.

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OBJECTIVE: to analyze the preparation of nurses from the Brazilian Expeditionary Force to work in the air transport of wounded people during World War II. METHOD: historical-social study, of a qualitative nature, based on the work entitled "Nurses with the FAB on the Italian front: 1944-1945", written by nurse Izaura Barbosa Lima. The data results from a bibliographic survey, the use of documentary sources and database consultations, with the material being treated using Thematic Content Analysis. RESULTS: the following categories emerged: Professional trajectory of Nurse Izaura; Commuting between the United States and Italy; and the Nursing Air Evacuation Course. CONCLUSION: the study highlights the pioneering role of nurses in the Brazilian troops sent to Italy, the necessary preparation and completion of the course to join the air transport service for the wounded. Its achievement assumes relevance for contributing new elements to the History of Brazilian Nursing, particularly regarding the establishment of the foundations of Brazilian female military nursing.

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OBJECTIVE: To estimate the prevalence and factors associated with the performance of specific admission nursing consultations for SARS-CoV-2 in individuals deprived of liberty with COVID-19 in prison units in Central Brazil. METHOD: Analytical cross-sectional study conducted between May and September 2020 through individual interviews and lateral flow immunochromatography tests to detect IgM/IgG antibodies for SARS-CoV-2. The analysis was performed using the Chi-square or Fischer's exact tests, with the outcome being the specific admission nursing consultation for SARS-CoV-2. RESULTS: Among the 1,272 individuals investigated, 21.3% (95% CI: 19.1-23.6) tested positive for antibodies against SARS-CoV-2. Of these, 10.3% (95% CI: 7.0-14.6) underwent a specific nursing consultation for SARS-CoV-2. The most prevalent signs and symptoms were loss of taste (33.2%) and smell (32.8%), body aches (28.8%), and fever (28.4%). The analysis indicated associations between contact with symptomatic COVID-19 case (p=0.039), contact in the yard with a prisoner with COVID-19 (p=0.012), and sore throat (p=0.010), with the outcome. CONCLUSIONS: The low prevalence of specific nursing consultations for SARS-CoV-2 and the high prevalence of COVID-19 reinforce the need for mandatory implementation of this strategy in groups living in closed environments. Furthermore, nursing consultations based on the nursing process must be adopted as a public health measure.