Double nursing degree: potentialities and challenges of an international student academic experience. / Dupla titulação em enfermagem: potencialidades e desafios de uma experiência de internacionalização acadêmica discente.

Objective To share the experience of a Double Nursing degree promoted between the Nursing School of the Universidade de São Paulo and the Health Sciences Institute of the Universidade Católica Portuguesa, reflecting on the potentialities and challenges of this opportunity for graduate students. Method This is an experience report presented in chronological order and of a descriptive nature. The double degree in Nursing was accomplished over a period of 6 months in a different institution from the institution of origin. Results Among the activities developed during the Double Degree are: participating in examining boards, congresses, seminars, courses, meetings, lectures, colloquium, classes, research groups and technical visits to health services. A table presents and describes the main benefits of the experience experienced by the authors. Conclusion When well-planned and well-developed, a double degree can promote personal, cultural and professional development of the students, favoring internationalization and contributing to the qualification of graduate programs.

Psychic and moral exhaustion in primary care workers.

OBJECTIVE To report the experience of developing a workshop proposal to assist local managers with the identification, management and prevention of primary care workers' psychic and moral exhaustion. METHOD The workshop was developed through a literature review performed between November 2014 and June 2015. The temporal cut considered studies of the ten previous years. The selection included studies describing collective interventions for situations generating psychic and moral exhaustion, preferably in primary care services. RESULTS Thirty-five articles were analyzed. The workshop provides five meetings with an average duration of one hour. The themes are: awareness; recognizing personal stress; dealing with personal stress; recognizing team stress; and dealing with team stress. The workshop is based on five key principles: detection and coping; attention to interpersonal relationships; communication; self-knowledge and mindfulness. CONCLUSION Psychic and moral exhaustion may reflect negatively on workers' health, the care, and the organization. The proposal of measures to recognize, deal with and prevent psychic and moral exhaustion is relevant and strategic in the constant search for improvement of satisfaction and quality.

Interface between social support, quality of life and depression in users eligible for palliative care.

OBJECTIVE: Analyzing the relationship between social support, quality of life and depression in patients eligible for palliative care at Primary Health Care of a municipality in the interior of Minas Gerais, Brazil. METHOD: A correlational cross-sectional study carried out with patients treated in six primary health care units. Data were submitted to descriptive statistical analysis, tests for differences between averages and medians, and correlation tests. The significance level was 0.05. RESULTS: The sample consisted of 115 participants, and it was identified that the higher the social support, the better the global quality of life (p<0.001) and functional quality of life (p=0.035); the greater the presence of physical symptoms, the lower the level of social support (p=0.012) and the higher the level of depression (p<0.001); the higher the symptoms of depression, the worse the global quality of life (p<0.001), functional quality of life (p<0.001) and the lower the levels of social support (p<0.001). CONCLUSION: Levels of quality of life, social support and depression of patients eligible for palliative care are influenced by socioeconomic factors such as marital status, gender, age, income, education and presence of a caregiver. OBJETIVO: Analisar a relação entre apoio social, qualidade de vida e depressão em pacientes elegíveis para cuidados paliativos atendidos na Atenção Primária à Saúde de um município no interior de Minas Gerais, Brasil. MÉTODO: Estudo transversal correlacional, realizado com pacientes atendidos em seis unidades da atenção primária à saúde. Os dados foram submetidos à análise estatística descritiva, testes de diferenças entre médias e medianas e testes de correlação. O nível de significância adotado foi 0,05. RESULTADOS: A amostra foi composta por 115 participantes, e identificou-se que quanto maior o apoio social, melhor é a qualidade de vida global (p<0,001) e funcional (p=0,035); quanto maior a presença de sintomas físicos, menor o nível de apoio social (p=0,012) e maior o nível de depressão (p<0,001); quanto maiores os sintomas de depressão, pior é a qualidade de vida global (p<0,001), funcional (p<0,001) e menores os níveis de apoio social (p<0,001). CONCLUSÃO: Os níveis de qualidade de vida, apoio social e depressão de pacientes elegíveis para cuidados paliativos são influenciados por fatores socioeconômicos, tais como estado conjugal, sexo, idade, renda, escolaridade e presença de cuidador. OBJETIVO: Analizar la relación entre apoyo social, calidad de vida y depresión en pacientes elegibles para cuidados paliativos atendidos en la Atención Primaria a la Salud de un municipio en el interior de Minas Gerais, Brasil. MÉTODO: Estudio transversal correlacional, realizado con pacientes atendidos en seis unidades de atención primaria a la salud. Los datos fueron sometidos al análisis estadístico descriptivo, pruebas de diferencias entre medias y medianas y pruebas de correlación. El nivel de significancia adoptado fue 0,05. RESULTADOS: La muestra fue compuesta por 115 participantes, y se identificó que cuanto mayor el apoyo social, mejor es la calidad de vida global (p <0,001) y funcional (p = 0,035); cuanto mayor sea la presencia de síntomas físicos, menor el nivel de apoyo social (p = 0,012) y mayor el nivel de depresión (p <0,001); cuanto mayores los síntomas de depresión, peor es la calidad de vida global (p <0,001), funcional (p <0,001) y menores los niveles de apoyo social (p <0,001). CONCLUSIÓN: Los niveles de calidad de vida, apoyo social y depresión de pacientes elegibles para cuidados paliativos son influenciados por factores socioeconómicos, tales como estado conyugal, sexo, edad, renta, escolaridad y presencia de cuidador.

Identification of risk factors for moral distress in nurses: basis for the development of a new assessment tool.

This article proposes to identify risk factors for moral distress from the literature, validate them through expert analysis and provide the basis for a new tool to assess the risk of moral distress among nurses. Moral distress is related to the psychological, emotional and physiological aspects of nursing. It arises from constraints caused by various circumstances and can lead to significant negative consequences. A scoping review and validation through expert analysis were used. The research question guiding this study was as follows: What is known about risk factors for moral distress in nursing? The research was conducted using multiple sources including electronic databases and lists of references from relevant literature. The final sample consisted of 38 studies. A validation analysis was conducted by experts during December 2014 and June 2015. To exclude a risk factor item, at least 80% of the experts had to agree with the exclusion. In total, 53 risk factors for moral distress were identified, reviewed by the experts and grouped to form a new instrument that may help to identify risk for moral distress and to address its consequences.

[Ethical problems experienced by nurses in primary health care: integrative literature review]. / Problemas éticos vivenciados por enfermeiros na atenção primária à saúde: revisão integrativa da literatura.

The aim of this study is to identify ethical problems experienced by nurses in primary health care and resources for coping based on publications on the subject. An integrative literature review was performed between the months of October and November 2013, using the databases: BDTD, CINAHL, LILACS, MEDLINE, Biblioteca Cochrane, PubMed, RCAAP and SciELO. Articles, dissertations and theses published in Portuguese, English and Spanish were included, totalling 31 studies published from 1992 to 2013. This analysis resulted in four categories: ethical problems in the relationship between team members, ethical problems in the relationship with the user, ethical problems in health services management and resources for coping with ethical problems. Results showed that nurses need to be prepared to face ethical problems, emphasizing the importance of ethics education during the education process before and during professional practice to enhance the development of ethical sensitivity and competence for problem resolution.

Role of complementary therapies in the understanding of primary healthcare professionals: a systematic review.

Objective To identify the understanding of the healthcare professionals in relation to the role of complementary therapies in primary health care. Method Systematic review by way of the following information sources: PubMed, CINAHL, PeriEnf, AMED, EMBASE, Web of Science, Psicoinfo and Psicodoc, using the keyword Primary Health Care alone, and associated with the following keywords: Medicinal Plants, Herbal Medicine, Homeopathy, Traditional Chinese Medicine, Acupuncture, Anthroposophical Medicine. Results Twenty-two studies from 1986 to 2011 were included. We identified three styles of practice: conventional medicine, complementary therapies and integrative medicine. Positioning professional practices within these three styles may facilitate discussion of concepts of health care, enhancing the health care provided as a result. Conclusion The work process in primary care presents difficulties for conducting integrative and holistic health care, but this practice has been introduced over time by professionals who integrate conventional medicine and complementary therapies, concerned with the care and well-being of patients.

[Validation of the comprehensiveness of an instrument on ethical problems in primary care]. / Validação da compreensibilidade de um instrumento sobre problemas éticos na atençao primária.

The study aimed to validate the comprehensiveness of an instrument on the occurrence of ethical problems in primary health care and discuss their results. This is a methodological research. The technique used was Delphi, which seeks to obtain a consensus on a subject by experts, using structured questionnaires that are modified to obtain consensus on the comprehensibility of content. The sample was composed by nine professionals with expertise in primary health care in São Leopoldo. Data collection was in March and April 2011. In the first round, the professional was asked to respond whether the described situation has represented an ethical problem, whether the statement was clear and whether there was any suggestion to rewriting the problem. Were presented thirty-six statements, and to twenty was suggested new rewrite. After the review and systematization the proposed amendments, has begun the second round to seek consensus among all the statements that its writing had changed. In the second round, the consensus required by the method was obtained. Using the method supported significantly to build the instrument in its initial stage, what makes it appropriated and comprehensive for the subsequent steps of the validation.

[Family practices related to breast-feeding maintenance: literature review and meta-synthesis]. / Práticas familiares relacionadas à manutenção da amamentação: revisão da literatura e metassíntese.

OBJECTIVE: To identify and summarize family practices related to the maintenance of breast-feeding. METHODS: We conducted a literature review and meta-synthesis of the findings of selected articles. Fourteen articles published in English, Portuguese, and Spanish between 1989 and 2009 were selected. RESULTS: The synthesis revealed five categories concerning family practices related to the maintenance of breast-feeding: 1) emotional support, which involves welcoming the mother and the baby, valuing and encouraging breast-feeding, and emphasizing the value of breast-feeding; 2) instrumental support, which covers attending prenatal consultations and home visits, participating in baby care, and providing help in everyday tasks beyond the first few weeks postpartum; 3) informational support, which involves stating the wish to be involved in breast-feeding and encouraging the mother, but not forcing her to share experiences; 4) presence support, which involves being close to the mother and taking the time to listen to her; and 5) self-support, which involves maintaining positive expectations about breast-feeding. CONCLUSIONS: The results show that practices defined as support contribute to the maintenance of breast-feeding for longer periods. These findings underscore the need for expansion of the care provided to women, children, and families to include issues related to interpersonal interactions.

Dignity in care: where next for nursing ethics scholarship and research?

Dignity is recognised as both a central and also a contested value in bioethics discourse. The aim of this manuscript is to examine some of the key strands of the extensive body of dignity scholarship and research literature as it relates to nursing ethics and practice. The method is a critical appraisal of selected articles published in Nursing Ethics and other key manuscripts and texts identified by researchers in the UK and Brazil as influential. The results suggest a wide and rather confusing range of perspectives and findings albeit with some overall themes relating to objective and subjective features of dignity. In conclusion, the authors point to the need for more sustained philosophical engagement contextualising human dignity within a plurality of professional values. Future empirical work should explore what matters to patients, families, professionals and citizens in different cultural contexts rather than foregrounding qualitative research with such a contested concept.

[A training course on bioethics for Family Health Strategy professionals in Santo André, SP]. / Capacitação em bioética para profissionais da Saúde da Família do município de Santo André, SP.

This case report presents the experience of a training course on bioethics for nurses and physicians of the Family Health Strategy in Santo André, SP. This study is based on problem-based learning and deliberative bioethics, and aimed at presenting the deliberation procedure as a means of handling ethical issues. Contents were addressed in a cross-section manner through five sequential activity sessions at two different moments of concentration with one dispersion interval. In the first moment of concentration, key concepts and deliberative bioethics contents were developed. The second involved deliberation sessions on moral conflicts, which were selected and prepared during the dispersion interval. Participants evaluated the deliberation as an appropriate instrument to deal with the ethical issues they are faced with. Problem-based learning was an effective educational strategy for continuing education in deliberative bioethics.

[Health education in the care to clients of the blood glucose self-monitoring program]. / A educação em saúde no cuidado de usuários do Programa Automonitoramento Glicêmico.

This article reports, in a systemized and analytical way, the experience of an Outreach Program in the period between 2010 and 2011. The study focused on health education interventions as strategies to improve the adherence of individuals with insulin- dependent diabetes mellitus (IDDM), clients of a blood glucose self-Monitoring program. In addition, we intended to contribute to the reorganization of the program's working processes in the unit. Health education strategies were used in both educational groups and home visits, thus permitting the provision of care that was more individualized. Data regarding the clients were organized on a spreadsheet and in files for the Family Health teams, which made it easier to identify the patients, including those who were absent, helping to decentralize the care. By using health education strategies, we intended to contribute to a more comprehensive and emancipatory care of the clients, aimed at a continuous reflection of the workers regarding their practices.

[How to make consent forms easier to read?]. / Como tornar os termos de consentimento mais fáceis de ler?

OBJECTIVE: Define the literacy level of Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (HCMFUSP) outpatients, for the purpose of identifying recommendations to adapt writing of the informed consent form to the outpatients literacy level, since these can become the subject of research. METHODS: Quantitative cross sectional study with 399 subjects. The sample was intentional, selected from different outpatient care units of HCFMUSP. Data collection used an instrument that contained a text with prose compatible for assessment of reading skills needed for comprehension of the consent form. RESULTS: More than 46.6% of the interviewees were classified as functionally illiterate, of these, 12.7% were even unable to understand the proposed task in the text they read. Nevertheless, nearly 50% of the interviewees reported having at least started high school. CONCLUSION: The results and the orientations for the text writing centered on the reader allowed us to make recommendations to render the consent form easier to read. We recommend that the researcher modifies the text to a structural narrative, addressed to the reader, using terms that are familiar. In other words, with terms common to the subjects' and to the medical language. In addition to improving the relationship between the subject and researcher, it is believed that these recommendations may reduce the time taken for the proceeding of research projects, since problems in the wording of consent forms contribute significantly to project delays.

Counseling regarding sexual and reproductive behavior: principles and practices of catholic priests.

Considering and respecting religious beliefs and values is vital for delivering integral health care. This study describes the religious principles and guidance provided by Catholic priests on sexuality and reproduction. The oral history method was used. Interviews were carried out between August 2007 and May 2008 and were analyzed in an inductive and interpretive manner to acquire a deep focus on the theme. Thirteen Catholic priests from the city of São Paulo, SP, Brazil were interviewed. Counseling provided by the priests has a traditional and conservative character and is based on principles of Catholic doctrine. Health education and promotion activities involving aspects related to sexuality and reproduction should be relevant and permeated with ethical considerations from the perspective of health care services' users, including religious perspectives.

Nurses' moral deliberation in the child care process.

OBJECTIVE: To understand the nurses' moral deliberation in the face of an ethical problem involving breastfeeding. METHOD: Qualitative study based on the methodological theoretical framework of deliberative bioethics. Data collection was through a vignette-based interview and results were organized by thematic analysis. RESULTS: Nurses tend to take over intermediate courses of action, although extreme courses of action are found as well. FINAL CONSIDERATIONS: When they tend to take extreme courses of action, nurses approach decisions focused on the child welfare to the detriment of the mother's need as a working woman.

[Health surveillance based on social and health indicators (corrected)]. / Indicadores sociais e de saúde para a operacionalização da Vigilância à Saúde.

The proposal of Health Surveillance is a techno-assistance model that is still in construction in Brazil. To implement the Health Surveillance proposition, the healthcare professionals have to be prepared to capture and understand the epidemiologic and social profiles of the population. The goal of this study was to identify and classify information about social and health indicators available on the Internet to be used by healthcare professionals. One is about a literature review, performed in several databases. The results show that there is a wide range of information related of health indicators on the Internet, although all this information is a limited instrument for healthcare professionals. The level of aggregation and the focus in morbimortality make the utilization of these databases difficult within the proposal of Health Surveillance. The conclusion of this study notes that research findings based on social and health indicators must be made available in Internet.

Poverty, bioethics and research.

The article presents a reflection on conception of poverty as a condition or circumstance that restricts personal autonomy and increases vulnerability. Focusing on bioethical arguments, the authors discuss two perspectives: (i) economic, that relates poverty to incapacity to work and (ii) ethical-philosophical, which relates poverty to inequality and injustice. The first perspective corresponds to the World Bank's view according to its recommendations to the political and economic adjustment in Latin America. The second one is based on concepts of fairness and equality as components of social justice. The subjects' autonomy and vulnerability have been under question in an international movement that requests revision of ethical guidelines for the biomedical research. The bioethical arguments presented in this article enhance a discussion on unfair treatment to subjects enlisted in protocols sponsored by rich countries and hosted by poor nations.

Moral sensitivity in Primary Health Care nurses.

OBJECTIVE: to characterize the profile and describe the moral sensitivity of primary health care nurses. METHOD: this is a quantitative, transversal, exploratory, descriptive study. The data were collected through the Moral Sensitivity Questionnaire translated and adapted to Brazil. 100 primary health care nurses participated, from Rio Grande do Sul, Brazil. The data collection took place during the months of March and July 2016, in an online form. The analysis of the data occurred through descriptive statistical analysis. RESULTS: the nurses had an average moral sensitivity of 4.5 (out of 7). The dimensions with the greatest moral sensitivity were: interpersonal orientation, professional knowledge, moral conflict and moral meaning. CONCLUSION: the nurses of Rio Grande do Sul have a moderate moral sensitivity, which may contribute to a lower quality in Primary Health Care.

Experiences and shared meaning of teamwork and interprofessional collaboration among health care professionals in primary health care settings: a systematic review.

BACKGROUND: During the last decade, teamwork has been addressed under the rationale of interprofessional practice or collaboration, highlighted by the attributes of this practice such as: interdependence of professional actions, focus on user needs, negotiation between professionals, shared decision making, mutual respect and trust among professionals, and acknowledgment of the role and work of the different professional groups. Teamwork and interprofessional collaboration have been pointed out as astrategy for effective organization of health care services as the complexity of healthcare requires integration of knowledge and practices from differente professional groups. This integration has a qualitative dimension that can be identified through the experiences of health professionals and to the meaning they give to teamwork. OBJECTIVE: The objective of this systematic review was to synthesize the best available evidence on the experiences of health professionals regarding teamwork and interprofessional collaboration in primary health care settings. INCLUSION CRITERIA TYPES OF PARTICIPANTS: The populations included were all officially regulated health professionals that work in primary health settings: dentistry, medicine, midwifery, nursing, nutrition, occupational therapy, pharmacy, physical education, physiotherapy, psychology, social work and speech therapy. In addition to these professionals, community health workers, nursing assistants, licensed practical nurses and other allied health workers were also included. PHENOMENA OF INTEREST: The phenomena of interest were experiences of health professionals regarding teamwork and interprofessional collaboration in primary health care settings. CONTEXT: The context was primary health care settings that included health care centers, health maintenance organizations, integrative medicine practices, integrative health care, family practices, primary care organizations and family medical clinics. National health surgery as a setting was excluded. TYPES OF STUDIES: The qualitative component of the review considered studies that focused on qualitative data including designs such as phenomenology, grounded theory, ethnography, action research and feminist research. SEARCH STRATEGY: A three-step search strategy was utilized. Ten databases were searched for papers published from 1980 to June 2015. Studies published in English, Portuguese and Spanish were considered. METHODOLOGICAL QUALITY: Methodological quality was assessed using the Qualitative Assessment and Review Instrument developed by the Joanna Briggs Institute. All included studies received a score of at least 70% the questions in the instrument, 11 studies did not address the influence of the researcher on the research or vice-versa, and six studies did not present a statement locating the researcher culturally or theoretically. DATA EXTRACTION: Qualitative findings were extracted using the Joanna Briggs Institute Qualitative Assessment and Review Instrument. DATA SYNTHESIS: Qualitative research findings were pooled using a pragmatic meta-aggregative approach and the Joanna Briggs Institute Qualitative Assessment and Review Instrument software. RESULTS: This review included 21 research studies, representing various countries and healthcare settings. There were 223 findings, which were aggregated into 15 categories, and three synthesized findings: CONCLUSIONS: This review shows that health professionals experience teamwork and interprofessional collaboration as a process in primary health care settings; its conditions, consequences (benefits and barriers), and finally shows its determinants. Health providers face enormous ideological, organizational, structural and relational challenges while promoting teamwork and interprofessional collaboration in primary health care settings. This review has identified possible actions that could improve implementation of teamwork and interprofessional collaboration in primary health care.

Nursing challenges for universal health coverage: a systematic review.

OBJECTIVES: to identify nursing challenges for universal health coverage, based on the findings of a systematic review focused on the health workforce' understanding of the role of humanization practices in Primary Health Care. METHOD: systematic review and meta-synthesis, from the following information sources: PubMed, CINAHL, Scielo, Web of Science, PsycInfo, SCOPUS, DEDALUS and Proquest, using the keyword Primary Health Care associated, separately, with the following keywords: humanization of assistance, holistic care/health, patient centred care, user embracement, personal autonomy, holism, attitude of health personnel. RESULTS: thirty studies between 1999-2011. Primary Health Care work processes are complex and present difficulties for conducting integrative care, especially for nursing, but humanizing practices have showed an important role towards the development of positive work environments, quality of care and people-centered care by promoting access and universal health coverage. CONCLUSIONS: nursing challenges for universal health coverage are related to education and training, to better working conditions and clear definition of nursing role in primary health care. It is necessary to overcome difficulties such as fragmented concepts of health and care and invest in multidisciplinary teamwork, community empowerment, professional-patient bond, user embracement, soft technologies, to promote quality of life, holistic care and universal health coverage.

Construção de um inventário de problemas éticos na Atenção Primária para a saúde bucal / Constructing an inventory of ethical problems in primary health for oral health / Construcción de un inventario de problemas éticos en la atención primaria para la salud bucal

Considerando-se as especificidades dos problemas éticos em saúde bucal, esta pesquisa objetivou construir uma proposta de Inventário de Problemas Éticos na Atenção Primária à Saúde (IPE-APS) para a saúde bucal (SB), estudo metodológico desenvolvido por um comitê de juízes. Após levantamento prévio de 32 problemas éticos específicos, fez-se sua equivalência com quarenta itens do IPE-APS: de itens; de semântica e conteúdo; de avaliação dos itens não equivalentes; de avaliação dos problemas específicos não equivalentes. Apontaram-se 18 itens do IPE-APS equivalentes a 17 problemas específicos, confluindo para 16 itens finais. Dos 22 itens não equivalentes, 5 foram mantidos. Incluíram-se os 15 problemas éticos específicos não equivalentes. Evidenciou-se a complexidade do trabalho de equivalência de inventários de natureza ética. Chegou-se à proposta de um IPE-APS-SB de 36 itens. (AU)

Considering the specificities of ethical problems in oral health, the aim of this study was to develop a proposal for an Inventory of Ethical Problems in Primary Health Care (IPE-APS) for oral health (SB). A methodological study was developed by a committee of judges. Thirty-two previously identified specific ethical problems were matched to the 40 items of the IPE-APS: items; semantics and content; evaluation of unmatched items; evaluation of unmatched specific problems. Eighteen of the items of the IPE-APS were matched to 17 specific problems, converging into 16 final items. Five of the 22 unmatched items were maintained and 15 unmatched specific ethical problems were included. The findings reveal the complexity of matching ethical Inventories. We achieved the aim of proposing a 46-item IPE-APS for oral health. (AU)

Llevando en consideración las especificidades de los problemas éticos en salud bucal, esta investigación tuvo el objetivo de construir una propuesta de Inventario de Problemas Éticos en la Atención Primaria de la Salud (IPE-APS) para la salud bucal (SB). Estudio metodológico desarrollado por un comité de jueces. Después de un levantamiento de 32 problemas éticos específicos, se realizó su equivalencia con cuarenta ítems del IPE-APS: de ítems; semántica y de contenido; evaluación de los ítems no equivalentes; evaluación de los problemas específicos no equivalentes. Se señalaron 18 ítems del IPE-APS equivalentes a 17 problemas específicos, confluyendo para 16 ítems finales. De los 22 ítems no equivalentes, 5 se mantuvieron. Se incluyeron los 15 problemas éticos específicos no equivalentes. Se dejó en evidencia la complejidad del trabajo de equivalencia de inventarios de naturaleza ética. Se llegó a la propuesta de un IPE-APS-SB de 36 ítems. (AU)