O processo de cuidar do enfermeiro em unidade de terapia intensiva: uma análise dos conhecimentos utilizados

Care has always been present in the history of humanity and in contemporary nursing it is considered to be a fundamental characteristic. In the Intensive Care Unit (ICU), care occurs within an environment that is known for its stressful factors, technological equipment, social isolation and discomfort. Whilst the reality of nursing practice in ICU demonstrates the lack of planned and systematized care, there is an indication that the professionals working in this setting utilize some type of knowledge. Based on that premise, in this study we aim to identify the knowledge that the nurses use in providing care in the ICU. We believe that the identification and characterization of this knowledge, and how it presents itself in practice, requires a reflective analysis process. Therefore, we utilized a qualitative perspective and Kim´s (1999) investigative methodology of reflective inquiry that is based on the precepts of Action Science proposed by Argyris et al. (1985). The study was conducted with 8 intensive care nurses of a public hospital. Data were collected by means of non-participative observation of the nursing care actions and a semi-structured interview conducted within the reflective mode that focused on the nurses practice in the ICU. The results enabled us no only to detect that the nurses utilized knowledge and patterns of knowledge acquired or constructed, but to identify them as: scientific, philosophic, religious, empirical, personal, ethical, and esthetic knowledge. The predominance of the scientific knowledge in the care process suggests that these nurses hold an acquired scientific substance that they utilize to provide specialized care directed toward critical treatment. The conception of this reality surpasses the theoretical limits, the techniques, and the known facts, and denotes the need for a reflective process in action to aide in the comprehension of the knowledge involved in the construction of excellent care

Violência ocupacional contra profissionais de saúde em um hospital de urgência. natal/rn, 2009

Descriptive exploratory study, with quantitative approach, with data collected from April to May 2009, aiming to identify the types of occupational violence affecting professionals on the nursing and medical staff in an emergency hospital service in Natal/RN, over the last 12 months; to identify emergency sectors where occupational violence episodes took place; to characterize aggressors on each type of occupational violence; to know the procedures adopted after each violent act targeting nursing and medical staff professionals; and to know the consequences of violence suffered by the nursing and medical staff professionals. The sample consisted of 26 nurses, 95 nursing assistants/technicians and 124 physicians, for a total of 245 professionals. The results showed that 50.61% of the professionals were women, aged 41 to 45 (22.45%), with post-graduate studies (51.43%), married (60.82%); 21.22% had 16 to 20 years of experience in the profession and in emergency practice; working 40 weekly hours (86.12%); and working both the day shift and the night shift (70.21%); 27.35% consider violence to be a part of their profession and the patient s companions as an important risk factor (86.53%); couldn t inform whether there was a specific established procedure for reporting occupational violence (45.71%); 73.06% suffered occupational violence in the 12 months; 70.20% verbal assault, 24.08% moral harassment, 6.12% physical assault, and 3.67% sexual harassment; 66.67% of the patients took part in the physical assault; the companions, in verbal assault (58.14%); and the health staff in moral harassment (69.49%); facing episodes violence, 37.65% of the professionals reported the fact to their co-workers; 57.25% uffered from stress as a consequence; on 4.71% of the episodes the professionals had to be bsent from work, resulting in 75 days of occupational violence-related absence. We conclude here was a high rate of occupational violence in the researched population, with verbal ssault and moral harassment as the most frequent violence types. Because factors related to ccupational violence were very diverse, actions seeking to confront this problem shouldn t be limited to the work environment itself. Education ought to be one of the most effective ctions for avoiding or minimizing these events occurrence

A intenção e o gesto :ações gerenciais de enfermeiros em espaços hospitalares

The present study analyses the supervisory practice of the nurse in the hospital environment. It has, as its main objective identify the use of planning, supervision and evaluation, as managerial instruments in the daily nursing practice. It tries also to identify the importance given to these instruments in their supervisory actions and the difficulties encountered in their use. It deals with an exploratory and analytical investigation with a qualitative approach having as its main point of analysis the principles of strategic planning. In order for it to be done 10 nurses were interviewed, distributed in three public hospitals in the city of Natal/RN. The results show that, although the nurses recognize the importance of the managerial instruments, they do not put them into practice in an effective and systematic way. They justify it because of the existence of personal, professional and institutional difficulties. On the other hand we could conclude from what they say that there is the desire to overcome the eminently burocratic vision of the management. Thus, they express a feeling for change and point in the direction of looking for ways that will contribute to innovate this practice

A ciência-ação: fundamentos filosóficos e relevância para a enfermagem

ENDERS,Bertha Cruz, FERREIRA,Priscila Brigolini Porfírio, MONTEIRO, Akemi Iwata.A ciencia-açao: fundamentos filosoficos e relevancia para a enfermagem. Revista Texto Contexto em Enfermagem, Florianópolis, v.19, n.1,p.161-7.Jan/Mar.2010.

A ciência-ação: fundamentos filosóficos e relevância para a enfermagem

A prática de enfermagem envolve o enfermeiro da clínica como agente de deliberação e ação, confrontando situações do cotidiano e assumindo, através de conhecimento científico, experiências anteriores ou por conceitos próprios e intuitivos, formas específicas de ver e agir na prática. O agir constitui fonte de conhecimento passível de acesso por métodos de investigação interpretativos. O objetivo deste trabalho é apresentar, analiticamente, a filosofia da Ciência-Ação em sua relação com a construção do conhecimento na enfermagem. Explica-se a Ciência-Ação como método inovador de inquérito e a sua tradição filosófica na abordagem nas ciências sociais, e se discute a sua articulação com a proposta epistemológica da enfermagem. Sugere-se a adoção dessa vertente em estudos de enfermagem, pelo seu enfoque na reflexão sobre as ações do enfermeiro e na prática como fonte de conhecimento. Conclui-se que a Ciência-Ação possui potencial para o avanço da teoria específica da prática da enfermagem, do conhecimento próprio da enfermagem

Teoria do déficit de autocuidado análise da sua importância e aplicabilidade na prática de enfermagem

submeter a teoria do déficit de autocuidado de Orem a uma reflexão crítica. Metodologia: estudo teórico sobre os aspectos Importância e Aplicabilidade contidos no Modelo de Análise Crítica de Chinn e Kramer para análise crítica da teoria do déficit de autocuidado. Desenvolvido no período de outubro a dezembro de 2008. Resultados: o posicionamento da teoria do déficit de autocuidado está essencialmente relacionado à filosofia da enfermagem e demonstra potencial para influenciar ações de enfermagem, em especial relativas à educação para o autocuidado em pacientes portadores de cardiopatia isquêmica. Conclusões: a enfermagem, mediante a teoria do déficit de autocuidado, pode oferecer condições mais saudáveis e de maior autonomia ao indivíduo portador de cardiopatia isquêmica

Interação entre a equipe de enfermagem e a gestante com diagnóstico de pré-eclâmpsia

The objective of this exploratory descriptive study with a qualitative approach was to analyze the perception of the nursing team and the pregnant women hospitalized with pre-eclampsia regarding the interactive process occurring in the care relationship. Data were collected by semi-structured interview with twenty nursing professionals that work in the high-risk ward and ten pregnant women with the diagnosis of pre-eclampsia. The discourses were analyzed using the content analysis method, in the modality of thematic identification. Three categories were identified that describe the perception of the interaction by the nursing professionals: recognizing the needs of the hospitalized pregnant woman, understanding the woman with pre-eclampsia, and presenting difficulties in the interactive process. With regards to the pregnant women, four categories emerged: recognizing the clinical care, feeling the lack of information, experiencing feelings during the hospitalization, and envisioning the interaction process. The meaning of the discourses was analyzed according to the principles of symbolic interactionism. The results indicate that both, the nursing professionals and the pregnant women, have a limited perception of their interaction, suggesting a need for further reflection about this reality in the health service units and in the nursing education environment

Representações sociais sobre a prática do cuidado para enfermeiros da saúde indígena: um estudo transcultural

The desire to research on this subject arisen from the experience as nursing in the indigenous health, where I observed that many professionals from all regions of Brazil chose to work within this zone. It was notorious the nurse s difficult to settle in only one place for a long length of time. Probably due to health care in indigenous zones happens from a cultural confront. This confront materialize because both sides are imbued with their own culture: in one hand the nurse professional with its scientific knownledgment on the other the indigenous with their rituals and peculiars habits. In this context nurses should delineate and negotiate the reality through symbolic representations of life, and then make questions on the new reality. In this way, this study set out with the aim of apprehends the nurse s social representations of transcultural care in indigenous health. This knownledgment is important to avoid possible conflicts, shocks, difficulties and health care incongruence within this context. The data collect was carried out on a range of non structured interview guided by a pre-elaborated questionnaire with four questions and a hand drawing related to nurse s health care in the indigenous health. This research had a sample of 17 nurses from the Indigenous Sanitary District of Manaus in the Amazon State. To interpret data we used the Discourse of the Collective Subject, which findings were presented in three chapters: characterization of participants, discussion on themes prevalent in discourse; social representation of nursing care through infographics. The analysis revealed that the care in the indigenous health is challenging because the native people imbued in its world are perceived and processed according to the nurse s cultural lens, leading to materialize of some strangeness and adaptation difficulties, especially in the first contacts. The Social Representation on nursing practice, in many cases, is projected and contrived on the basis of scattered believes and on perception derived from common sense. The findings shows that representions are essential to mitigating the initial strangeness and help nurses to better situate themselves in the new universe. The nurse s practice in the indigenous health care should merge into each other. From the Social Representations is possible to perceive that assimilation, also comprehension on indigenous health system and its traditional knowledge are important to developing strategies to improve access and quality of care for indigenous peoples. After analysis the nurse s discourses and drawings, it is possible to represent the nurse s practice in the indigenous health as anthropophagism, since nurses should literally consuming its patients culture, digesting it and seize it as means to provide culturally congruent care. We highlight the urgent need for preparation and training of professionals to work more effectively with indigenous peoples

Viabilidade do processo de enfermagem no contexto hospitalar

The Nursing Process (NP) is considered as the dynamics of the systemized and inter-related actions of human care. We believe that the nursing manager, as the representative of all the nursing care provided in the hospital setting, is an important agent for the implementation of institutional policies, such as the NP, in the service. However, there is little information in the literature about the NP in the perspective of the nurse manager. The objective of this study was to analyze the viability of the Nursing Process in the hospital context based on the attitudes of the nurse managers toward the Process. We conducted a descriptive-exploratory research study, of quantitative approach, with a population of 45 nurse managers that worked in the state hospitals located in Natal, RN and in the university hospitals of the UFRN. Two instruments were used for the collection of data: a nursing process questionnaire, constructed for use in this study, and the scale for the measurement of the attitudes titled Positions on the Nursing Process. The population is predominantly feminine (91,0%) and have relative nursing practice experience (Mean=17,6 years). However, they have little experience in management (Mean=8,6 years). They express little knowledge of the PE nursing terms and little experience with the Process. They have a positive atitude toward the NP (Mean = 110,9); are favorable to its developement in the service (86,7%); 48,9% indicated little possibility of institutionalization in the service and 37,8% indicated large possibility. The Spearman test for association between the variables of attitude about the NP and the possibility of its institutionalization demonstrated a weak negative association in the total individual scores of the attitudes (-,316) as in the 20 itens of the instrument, with coefficients varying from 0,014 to 0,464. Factorial analysis of the instrument identified three underlying factors to the attitudes of the managers in this study: relevance, operationalization and collaboration, with Cronbach Alpha coeficients of 0,955, 0,844 and 0,807, respectively, and 0,956 for the whole instrument, indicating that the scale and its factorial subscales have internal consistency. We conclude that there is a weak tendency for the managers with a favorable attitude to have a negative perception about the possibility of institutionalization of the NP in the service. The favorable position does not appear to be sufficient for the viability of this methodology in the hospital sector, results that is worrisome for nursing. This situation suggests that the difficulties with the institution of the NP in the hospitals may be related to other factors, including the organizational conditions. We believe that the institucionalization of the NP in a servisse where it is not known and not practiced, constitutes the introduction of an innovative work technology that involves many demands, among them the adherence of the persons to the proposed innovation. This demands time and the institutional adjustments and the human resources necessary. In this process, the involvement of the health professional of the institution is necessary. This situation brings to light the discussions of professional autonomy, the action limits and perspectives, the redefinition of roles, delimiation (or consensus) of the objects of study and of the work processes, among others.

Ensino do processo de enfermagem: visão dos discentes de graduação de Natal/RN

The nursing process (NP) it s the systematized way of offering humanized care with the objective of reaching the expected results. The concern of the health and education institutions of elaborating implementation strategies of it is growing. The objective of this research was to know the vision of the senior students of the nursing graduation courses from Natal/RN, about the teaching of the NP. It s about a descriptive and exploratory study of the qualitative and quantitative type, done in five teaching institutions of the undergraduate nursing course of the municipality of Natal- RN in 2011. The research was composed by 48 students of the last 2 years of the nursing course. The gathering of the data was done through an online survey with open and closed questions via SurveyMonkey. For the quantitative data it was used the descriptive statistics from Microsoft Office Excel and for the qualitative data the Content Analysis of Bardin. The results pointed a predominance of female students (81,25%) with an age between 21- 39 years old (75,00%) and in the last year of the course (62,50%). As the opinion of the students about the NP two categories emerged: 1) Nursing Process as grounded method in scientific knowledge and established in two stages; 2) Nursing Assistance Quality, with two subcategories: Nursing Process as Nursing Practice and Nursing Process as instrument of improvement of the aid quality and promotion of well-being. In relation to the tuition of the NP the students (45,83%) said that the knowledge on the subject of the instructor was good; 81,25% reported that the professors use a traditional teaching methodology with the problem solving components and 45,83% answered that is addressed in specific disciplines in an isolated way starting from the professional line. The phase of NP that the nursing students have more difficulties of learning and implementing, being mentioned 22 times (29,70%). In relation to the student s difficulties, in the fields of supervised internships, in applying the NP it was stated for 83,50% that the barriers were related to the non implementation of the practice, overwork and the lack of trust of the nurse in the NP. The teaching-care strategies described as the internship fields were: the training of nurses to be able to contribute with the University in the implementation of the service and teaching; and the need of the universities to focus, continuously throughout the course, the NP with the involvement and incentive of the instructors in this process. These results show that the NP for the nursing students is a work methodology of the profession that needs to be implemented effectively in the practical reality for its teaching to turn effective and for the future professionals to be able to bring real contributions in the achievement of systematized actions trying to improve the assistance quality and the nursing actions. It is expected that this study could help bringing some strategies to facilitate the merging between theory and practice in teaching the NP and stimulate a discussion about the topic at the Nursing Schools where the research was held together with the coordinators, instructors and students

A ciência-ação: fundamentos filosóficos e relevância para a enfermagem

ENDERS,Bertha Cruz, FERREIRA,Priscila Brigolini Porfírio, MONTEIRO, Akemi Iwata.A ciencia-açao: fundamentos filosoficos e relevancia para a enfermagem. Revista Texto Contexto em Enfermagem, Florianópolis, v.19, n.1,p.161-7.Jan/Mar.2010.

A ciência-ação: fundamentos filosóficos e relevância para a enfermagem

A prática de enfermagem envolve o enfermeiro da clínica como agente de deliberação e ação, confrontando situações do cotidiano e assumindo, através de conhecimento científico, experiências anteriores ou por conceitos próprios e intuitivos, formas específicas de ver e agir na prática. O agir constitui fonte de conhecimento passível de acesso por métodos de investigação interpretativos. O objetivo deste trabalho é apresentar, analiticamente, a filosofia da Ciência-Ação em sua relação com a construção do conhecimento na enfermagem. Explica-se a Ciência-Ação como método inovador de inquérito e a sua tradição filosófica na abordagem nas ciências sociais, e se discute a sua articulação com a proposta epistemológica da enfermagem. Sugere-se a adoção dessa vertente em estudos de enfermagem, pelo seu enfoque na reflexão sobre as ações do enfermeiro e na prática como fonte de conhecimento. Conclui-se que a Ciência-Ação possui potencial para o avanço da teoria específica da prática da enfermagem, do conhecimento próprio da enfermagem

Teoria do déficit de autocuidado análise da sua importância e aplicabilidade na prática de enfermagem

submeter a teoria do déficit de autocuidado de Orem a uma reflexão crítica. Metodologia: estudo teórico sobre os aspectos Importância e Aplicabilidade contidos no Modelo de Análise Crítica de Chinn e Kramer para análise crítica da teoria do déficit de autocuidado. Desenvolvido no período de outubro a dezembro de 2008. Resultados: o posicionamento da teoria do déficit de autocuidado está essencialmente relacionado à filosofia da enfermagem e demonstra potencial para influenciar ações de enfermagem, em especial relativas à educação para o autocuidado em pacientes portadores de cardiopatia isquêmica. Conclusões: a enfermagem, mediante a teoria do déficit de autocuidado, pode oferecer condições mais saudáveis e de maior autonomia ao indivíduo portador de cardiopatia isquêmica