Collaborative medication management for older adults after hospital discharge: a qualitative descriptive study.

BACKGROUND: Safe medication management for older adults after hospital discharge requires a well-coordinated, interprofessional, patient-centered approach. This study aimed to describe the perceived needs for collaborative medication management for older adults taking several different medications at home after hospital discharge. METHODS: A qualitative descriptive study was conducted using semi-structured interviews with older adults (n = 28), informal (n = 17), and professional caregivers (n = 13). RESULTS: Findings revealed four main needs: older adults and informal caregivers' perceived needs for greater involvement in discharge planning; older adults' perceived needs to be informed, listened to, and to be actively involved in decision-making; informal caregivers' perceived needs for help in supporting and coordinating medication management; and older adults' and informal and professional caregivers' perceived needs for better communication and coordination between professional caregivers. CONCLUSION: This study revealed two underutilized pathways towards improving collaborative medication management: medication follow-up involving a community healthcare professional taking an overarching responsibility and empowering older adults and their informal caregivers in medication management after hospital discharge.

Scale for the Environment Evaluation of Professional Nursing Practice: Construct validation.

AIM: Testing the validity and reliability of the Scale for the Environments Evaluation of Professional Nursing Practice (SEE-Nursing Practice). BACKGROUND: The environment of professional nursing practice is key to achieve better results for clients, nurses and institutions. Therefore, instruments enabling the assessment of all its attributes are required. METHOD: Cross-sectional methodological study. The SEE-Nursing Practice, based on a previous qualitative study and literature review, was applied as a questionnaire. Exploratory and confirmatory factor analyses were used to assess construct validity. RESULTS: A total of 752 nurses participated in the study. Exploratory factor analysis of the SEE-Nursing Practice led to a factor solution with 93 items and three subscales. The Structure, Process and Outcome subscales, respectively, have 43, 37 and 13 items, loaded in 6 factors, 6 factors and 2 factors and explaining 62.6%, 59.2% and 67.4% of the total variance. Cronbach's alpha of the overall scale and of the 3 subscales was greater than 0.90. Confirmatory factor analysis showed a good fit. CONCLUSION: SEE-Nursing Practice is a good valid and reliable instrument. IMPLICATIONS FOR NURSING MANAGEMENT: The SEE-Nursing Practice enables assessing practice environments and is a tool for nursing managers in the definition of strategies ensuring favourable environments for nursing care quality.

Death and dying: contributions to a practice based on nursing theoretical frameworks. / A morte e o morrer: contributos para uma prática sustentada em referenciais teóricos de enfermagem.

OBJECTIVE: To identify nurses' agreement on nursing conceptions with the potential to support their practice in the death and dying process context. METHOD: An exploratory and descriptive study with a quantitative approach was carried out with 3,451 nurses from 36 hospitals in Portugal, from July 2015 to March 2016. Data collection was carried out with the use of questionnaires and data analysis was carried out by means of descriptive and inferential statistics. RESULTS: Among conceptions with the potential to support practice, nurses highlighted those from Virginia Henderson, Afaf Meleis, and Madeleine Leininger. The following variables influenced the degree of agreement: region, service, gender, professional training, and length of professional practice. CONCLUSION: Considering current challenges of a practice that is mostly based on meeting needs, the relevance of nursing practices' purposes emerges in order to facilitate experiencing death and the dying process in culturally significant ways.

Prevalence and factors associated with polypharmacy in the older people: 2006-2014.

AIMS AND OBJECTIVES: To analyse the prevalence, risk factors and evolution over time of polypharmacy and self-medication in the older people in Spain from 2006-2014. BACKGROUND: Polypharmacy is a public health problem for older people worldwide which causes different negative effects on their health, increasing health costs and pharmaceutical spending. However, previous studies do not include nationally representative samples and none of them provide updated data. DESIGN: Cross-sectional study with community-dwelling older adults (N = 26,277) who participated in the National Health Survey in Spain in 2006 and 2011/2012 and the European Health Survey in Spain in 2009 and 2014. METHODS: Polypharmacy (defined as use of five or more medications in the last 2 weeks), excessive polypharmacy (defined as use of ten or more medications in the last 2 weeks) and self-medication (defined as use of medications without a prescription) were evaluated. A logistic regression was used for to know the association between polypharmacy and self-medication with the sociodemographic characteristic. RESULTS: The participants were 62% female and 38% male. The mean medication consumption was 2.96 (SD ± 2.11). Prevalence of polypharmacy was present in 21.9%, prevalence of excessive polypharmacy was 0.6%, and prevalence of self-medication was 10.7%. The most commonly used medications were for blood pressure (51.6%), pain (42.8%) and cholesterol (28.2%). Polypharmacy is associated with sex (females), age, being separated/divorced/widowed, lack of education, higher body mass index, being bedridden during the last 2 weeks and self-medication. CONCLUSIONS: The prevalence of polypharmacy and prevalence of self-medication are considerable, and they increased significantly from 2006-2014. RELEVANCE TO CLINICAL PRACTICE: To deal with polypharmacy is a big challenge for nurses. These data suggest to establish innovative clinical strategies in which the health professionals and the patients are involved to improve the personal behaviour with medicines and to reduce the risks and costs of polypharmacy and self-medication.

Giving Voice to Caregivers: a game for family caregivers of dependent individuals. / Dar Voz aos Cuidadores: um jogo para o cuidador familiar de um doente dependente.

OBJECTIVE: To construct and assess a board game created to promote the effective transition of family members into caregivers of dependent individuals. METHOD: This was a qualitative exploratory and descriptive case study conducted with family caregivers of dependent individuals. RESULTS: The study resulted in the conceptualization, construction, and assessment of the board game. The game proved to be an important family evaluation tool, enabling open communication and interventions in family dynamics. CONCLUSION: The results showed that the game can help build new family narratives, providing an opportunity for open communication, expression of problems and sharing, representing an important family evaluation and intervention strategy.

Behavior of nursing managers and leaders when errors are disclosed in the media. / Posicionamento de gestores e lideranças de enfermagem diante dos erros divulgados na mídia.

OBJECTIVE: To analyze the behavior of nursing managers and leaders when nursing errors are disclosed in the media. METHODOLOGY: A qualitative, retrospective, documental study of the collection carried out in newspapers in Brazil and Portugal, between 2012 and 2016. Analysis performed at Atlas.ti, using a Ricoeur technique based on Habermas Theory of Communicative Action. RESULTS: Managers and caretakers focused on the workforce, continuing with the opening of internal syndication, removal of position and dismissal. How to lead the discipline process, carrying out inspections, requesting documents and questioning about the facts, as well as repudiating some disclosed notes. CONCLUSION: Leaderships in nursing played a crucial role in developing a complex problem strategy. However, this was not done efficiently.

The influence of capitalism on the production of knowledge in nursing. / Influências capitalistas na produção do conhecimento em enfermagem.

OBJECTIVE: To understand the capitalist influence over the production of nursing knowledge according to Brazilian and Portuguese researchers. METHOD: Descriptive, exploratory, and qualitative research, with 17 research nurses selected using the snowball technique. Data were collected from October 2011 to November 2012 in Brazil and Portugal, by means of semi-structured interviews. We analysed the content of the interviews and produced inferences based in the theoretical assumptions of Gaston Bachelard and the notion of an epistemological obstacle. RESULTS: The results were organised into three categories: Blocks to creativity/innovation and the practice of repetition; Overestimation of the quantitative; and Resistance to rupture. CONCLUSION: It is necessary to create new ways of assessing scientific literature from a qualitative perspective that allows room for creativity, professional development, and critical and reflective thinking. Solidarity is perceived as an alternative to overcoming the problems caused by the capitalist way of producing knowledge.

Educational technology in care management: technological profile of nurses in Portuguese hospitals. / Tecnologia educacional na gestão de cuidados: perfil tecnológico de enfermeiros de hospitais portugueses.

Objective To identify the technological profile of nurses in Portuguese hospitals. Method A quantitative exploratory study conducted in two hospitals in the northern region and one in the central region of Portugal. The sample was randomly selected and included 960 nurses. Results Of the participants, 420 (46.1%) used computers, 196 (23.4%) reported having knowledge about using computers for teaching, 174 (21.1%) used computers to teach, 112 (15.1%) recognized that using computers can be a technological means to supplement classroom training, 477 (61.6%) would like to receive training on using computers, and 382 (40.9%) reported self-learning of information technology. In relation to distance education, 706 (74.9%) reported they were familiar with it and 752 (76.4%) indicated an interest in participating in training using this modality. Conclusion Organizations should be mindful of the technological profile shown by this group of nurses and look for ways to introduce educational technologies in the management of care.

Evaluation of the online management course from the perspective of former students. / Avaliação do curso de gerenciamento online na perspectiva dos egressos.

Objective To evaluate the online course from the perspective of e-learners as well as the relation between variables. Method A quantitative, descriptive and exploratory study. Results After three years, the satisfaction rates in the three listed categories presented an average rate higher than 75%. The coefficients indicated a high consistency of the questionnaire. Considering the overall rates in the three years period, the Instructor Performance category presented the highest rate. Strong associations between Self-Assessment and Instructor Performance, Self-Evaluation and Program of the Course and Instructor performance and Program of the course were identified. There was no association between the three categories mentioned with any other variables existing in the study. Conclusion E-learners expressed satisfaction with the course that means favored the interaction and the promotion of collective knowledge in nursing management. Also aspects need to be improved, especially the training of the instructor to mediate discussions and encourage student involvement throughout the course.

Interventions to promote self-care of people with arteriovenous fistula.

AIMS AND OBJECTIVES: The literature shows many self-care behaviours related to people with end-stage renal disease (ESRD). Our aim is to identify interventions within the 'teaching' that promote self-care (behaviour) with arteriovenous fistula (AVF). BACKGROUND: The development of self-care behaviours with the AVF allows the access to maintain the best possible conditions, because its state influences the efficacy of the dialysis treatment. However, few studies assess self-care behaviours that people with ESRD have with the AVF, as well as interventions that promote this self-care. DESIGN: Discursive paper. METHODS: Our research was conducted in MEDLINE, Health Nursing and Allied Literature (CINAHL), Web of Science and SCOPUS using three search expressions, between the period of 2000-2010. We selected studies that identified interventions that promote self-care with AVF. RESULTS: No study has shown in detail the interventions that aimed at promoting self-care behaviours with the AVF for patients with ESRD. We verify that the interventions that promote self-care are directed mostly to the moments after AVF construction. CONCLUSIONS: This paper reinforces the need to develop guidelines that provide guidance for self-care with the AVF to be developed by people with ESRD. We also found that self-care behaviours directed to the AVF are mostly associated with postconstruction of the access. RELEVANCE TO CLINICAL PRACTICE: Based on these results, it is necessary to delineate clear intervention programmes and objectives, in order to assess self-care with the AVF by people with ESRD, as well as to develop guidelines that provide guidance for self-care for the person with an AVF.

Nurses' attitudes regarding the importance of families in pediatric nursing care.

Affective, cognitive and behavioral components affect nurses´ attitudes to include families in the care processes. The purpose of this study was to investigate the attitudes of nurses about the importance of including families in nursing care. Data collection was performed in pediatric and maternal-child unit of a Brazilian university hospital. A sample of 50 nurses completed the Portuguese version of the instrument Families'Importance in Nursing Care-Nurses' Attitudes (FINC-NA). The results indicated that nurses have supportive attitudes regarding families participation in nursing care. Attitudes of lower support for involving families in nursing care were found among nurses with older age, more time in the profession and who had no previous contact with contents related to Family Nursing. The application of the instrument in other contexts of assistance may help to illuminate important aspects of the challenges to implementing a family-centered approach in clinical practice.

Cardiac Rehabilitation to Inpatient Heart Transplant-HRN4HTx Intervention Protocol.

Heart transplantation is the gold-standard treatment for terminal heart failure. Despite being successful, pre- and post-transplant limitations interfere with patients' functional capacity, self-care, and quality of life post-surgery. Rehabilitation is necessary to address these limitations, prevent complications, and promote a safe return home. This study analyzes the safety of a phase 1 cardiac rehabilitation protocol (RN4HTx) in heart transplant patients and its effects on self-care capacity. A quantitative, descriptive study was conducted with 19 heart transplant recipients. The protocol was implemented in collaboration with a rehabilitation professional, who monitored adverse events, hemodynamic variables, self-care capacity (Barthel) pre- and post-transplant, and functional capacity at discharge (6 min walk test). The results showed that 68.42% of recipients were men, with an average age of 50.21 years and 15 days of hospitalization post-transplant. Approximately 73.68% of recipients were transferred from other wards with changes in functional capacity. All patients progressed to the final stage of the program without adverse events. There was a notable improvement in self-care capacity before and after transplantation, with a measure of functional status of 310.035 m (6MWT). The study found that RN4HTx is a feasible cardiac rehabilitation program without adverse events in the immediate postoperative period following heart transplantation, positively impacting functional recovery and therapeutic self-care capacity, thus increasing the safety of returning home. This study was retrospectively registered on Clinical Trials-NCT06552390.

Development and Validation of the Serious Educational Game in Nursing Appraisal Scale.

OBJECTIVES: This study aims to develop and validate the Serious Educational Game in Nursing Appraisal Scale (SEGiNAS), a tool designed to evaluate the implementation of serious games within nurse education contexts of quantity of process, quality of process, and learning outcomes. METHODS AND MATERIALS: This methodological and psychometric study aimed to develop and validate a scale. The item generation phase was based on the cognitive theory of multimedia learning, resulting in a 20-item scale. The validation phase involved evaluating the psychometric scale by surveying 160 Portuguese nurses. RESULTS: A factor analysis revealed a three-factor structure corresponding to the scale's designed dimensions, explaining a total variance of 64.5%. The scale demonstrated high internal consistency for all factors, including engagement and teaching effectiveness (0.925), learning impact and practical application (0.883), and content relevance and clarity (0.848). The dimensions were engagement and teaching effectiveness, learning impact and practical application, and content relevance and clarity. CONCLUSIONS: The SEGiNAS scale represents a valid and reliable tool for evaluating serious games in nursing education. Its development fills an existing gap in assessing the teaching-learning process with serious games. This study was not registered.

Development and Validation of a Game for Older Adults on Lifestyles and Frailty.

BACKGROUND: Games are a promising strategy for rehabilitating older adults. The effect of games on promoting healthy lifestyles and preventing frailty remains uncertain. This article aims to describe the process of development and validation of the game "Bem-me-quer para a saúde"® to promote the acquisition of healthy lifestyles and prevent frailty in over 65-year-olds. METHODS: This study comprised three distinct phases, spanning from December 2023 to June 2024. The first phase comprised a thorough review of the scientific literature on the frailty and lifestyles of older adults, a second phase of game design, and a third phase of content and semantic validation conducted by specialized nurses and older adults. RESULTS: After revising literature, this study utilized an e-Delphi with a panel of 14 specialist nurses who underwent two rounds of evaluation. The "Bem-me-quer para a saúde"® game includes a puzzle board with 54 pieces and 30 educational cards. In the final phase, we evaluated the game on a cohort of 50 older adults, highlighting its reflective, interactive, and educational aspects. CONCLUSIONS: The game presented sufficient evidence of content validity and relevance to clinical practice. We should conduct additional research to evaluate its impact on lifestyle modification and frailty prevention.

Patients with cervical spondylotic myelopathy and dependency in activities of daily living during hospitalization-descriptive and correlational study.

Background and Aim: Cervical spondylotic myelopathy (CSM) causes progressive spinal cord compression and consequent functional decline. Surgical decompression is considered effective in halting disease progression, producing improvements in neurological prognosis. During hospitalization, several conditions may alter these patients' dependency levels. This study aimed to describe patients with CSM and their evolution regarding dependence in activities of daily living (ADL), from hospital admission to discharge. Methods and Materials: Descriptive and correlational study based on document analysis. Results: Included 96 files of patients with CSM who were admitted to Neurosurgery Department. The sample was 58.3% men, with a mean age of 64.4 years. Of the participants, 96.9% had surgery, mainly an anterior cervical approach. Hygiene was the ADL involving most dependence, both at admission (39.6%) and at discharge (71.9%). Worsening of dependence levels in ADLs was found at the midterm evaluation (mean 13.34; SD 5.59) and at discharge (mean 11.59; SD 5.28) in relation to the functional condition at admission (mean 9.77; SD 6.06). Gender was not associated with any differences, but age and days of hospitalization were associated with variations in participants' dependency levels (P<.05). Conclusion: The level of dependence on ADLs increased during the hospitalization of patients with CSM.

Moral sensitivity as a personal and work attribute of emergency care nurses: a cross-sectional study.

OBJECTIVE: to analyze the moral sensitivity of Brazilian emergency care nurses according to their personal and work characteristics. METHOD: this is a quantitative, descriptive, cross-sectional study with a convenience sample. A total of 422 nurses from emergency care services in the five regions of Brazil took part. Sociodemographic and work-related information was collected, as well as the Brazilian version of the Moral Sensitivity Questionnaire. After approval by the Research Ethics Committee, the data was collected using a self-administered form on the Google Forms Platform, organized using Excel software and analyzed using the R language. RESULTS: nurses with longer experience in emergency care services showed higher levels in the interpersonal orientation, moral conflict and moral significance dimensions, while in the professional knowledge dimension, men showed higher levels, as evidenced by items that include confidence in nursing knowledge, intuition, experience and opinion. CONCLUSION: the differences in the nurses' moral sensitivity were due to their professional experience. It should be emphasized that valuing the sharing of intergenerational experiences in service could be a possible strategy for fostering moral competencies in the field of practice.

Physical Activity during Pregnancy and Risk of Gestational Diabetes Mellitus: A Meta-Review.

BACKGROUND: Nowadays, pregnant women require more individualized attention in their assistance process during pregnancy. One of the aspects that requires the most focus is the suitability of carrying out physical activity. The objective of this meta-review is to find out the effects of physical activity during pregnancy on the incidence of GDM compared to women who do not perform physical activity. METHODS: A search was conducted in Cochrane, CSIC, Ebscohost, Proquest, Pubmed, Scielo, and Scopus. The search focused on systematic reviews and meta-analyses published in the last five years. The AMSTAR-2 scale was used as a quality assessment tool for the final sample. RESULTS: A total of 18 systematic reviews and meta-analyses were included. Sixteen of them found out that physical activity during pregnancy has preventive effects for GDM compared with women who lacked physical activity. Among the studies, we found a reduction in the risk of GDM of between 24% and 38% and odds ratios ranging between 0.39 and 0.83 calculated for a 95% CI. Only two studies did not find statistically significant effects. Other variables such as type and duration of physical activity, overweight and obesity, gestational age, etc., were also considered. CONCLUSIONS: Physical activity prevents the incidence of GDM. The main characteristics that enhance this preventive effect are starting at the initial stages of pregnancy and maintaining during the whole pregnancy as well as combining strength and aerobic exercise at a low to moderate intensity.

Nurses' perspectives on nurses' work methods.

OBJECTIVES: To analyze nurses' perspectives on nurses' work methods in the hospital context. METHODS: A descriptive study with a qualitative approach was conducted in a hospital in northern Portugal, involving 17 nurses. Semi-structured interviews were used for data collection. Data collected between May and June 2023 underwent content analysis, supported by Atlas.ti software. RESULTS: Three thematic areas emerged: "Nurses' work methods in a hospital context," highlighting the conception and components of work methods and the methods in use; "Implementation of nurses' work methods," emphasizing influencing factors and challenges to implementation; and "Impact of nurses' work methods on patients, nurses, and institutions." FINAL CONSIDERATIONS: Nurses' work methods constitute the structure of nursing care. Some factors influence and some challenges arise in the implementation of these methods, producing impacts on patients, nurses, and institutions.

[Scale of conflict in health care decision-making: an instrument adapted and validated for the Portuguese language]. / Escala de conflito em tomadas de decisão em saúde: instrumento adaptado e validado para língua portuguesa.

The different options available to patients in the health environment now are implicated in increasingly difficult processes of decision-making, and may trigger conflict about them. This study had as its purpose, to develop an instrument that enabled us to know about this variable. Therefore, we decided to effect a transcultural adaptation and evaluation of psychometric properties of the Portuguese version of the Decisional Conflict Scale, which seeks information about decision-making and the factors that influence the choices made. The sample consisted of 521 nursing students, with a focus on decision-making regarding the flu syndrome. The results obtained on the reliability tests showed good internal consistency for all items (Cronbach a=0.94). The psychometric study allowed us to affirm that the Portuguese version of the Decisional Conflict Scale, which we call Scale of Conflicts in Decision-Making in Health (ECTDS), was a reliable and valid instrument.

Cardiac Rehabilitation in a Transplanted Person with Emery-Dreifuss Muscular Dystrophy. / Reabilitação Cardíaca na Pessoa Transplantada com Distrofia Muscular de Emery-Dreifuss.

Emery-Dreifuss muscular dystrophy is a rare hereditary neuromuscular disease. Its manifestations begin primarily in childhood. The most frequent manifestations are progressive muscle weakness, atrophy that usually begins in the scapula-vertebral region, extending later to the pelvic girdle, and spinal stiffness. Patients can also manifest cardiac involvement as palpitations, syncope, exercise intolerance, congestive heart failure, and variable heart rhythm disturbances. 1 - 3 The presence and severity of these manifestations can vary according to the individual and the disease's subtypes. 2 Cardiac involvement is the most worrisome feature of this disease, and there are some reports of the need for heart transplantation in this dystrophy. 4.

A distrofia muscular de Emery-Dreifuss é uma doença neuromuscular hereditária rara. Suas manifestações começam principalmente na infância. As manifestações mais frequentes são fraqueza muscular progressiva, atrofia que geralmente se inicia na região escápulo-vertebral, estendendo-se posteriormente para a cintura pélvica e rigidez da coluna vertebral. Os pacientes também podem manifestar envolvimento cardíaco como palpitações, síncope, intolerância ao exercício, insuficiência cardíaca congestiva e distúrbios variáveis do ritmo cardíaco. 1 - 3 A presença e a gravidade dessas manifestações podem variar de acordo com o indivíduo e os subtipos da doença. 2 O envolvimento cardíaco é a característica mais preocupante desta doença, havendo alguns relatos da necessidade de transplante cardíaco nesta distrofia. 4.