Competências do enfermeiro para atuação na atenção domiciliar e situações que mobilizam as competências: estudo de caso / Nurse skills to work in home care and situations that mobilize skills: case study

Introdução: A assistência à saúde no domicílio configura-se como uma modalidade de cuidado em expansão no cenário mundial e a enfermagem integra a equipe multiprofissional, sendo a maior provedora de assistência domiciliar. No contexto de especificidades da atenção domiciliar, o enfermeiro é constantemente desafiado a mobilizar conhecimentos, habilidades e atitudes de forma inter-relacionada e espera-se que seja competente na prática profissional. O objetivo deste estudo foi analisar as competências mobilizadas por enfermeiros na atenção domiciliar no dia a dia do seu trabalho. Método: estudo de abordagem qualitativa com delineamento metodológico de estudo de caso único. A produção dos dados teve como cenário o serviço de atenção domiciliar do Sistema Único de Saúde do município de Belo Horizonte. Participaram da pesquisa 12 enfermeiros que compõem equipes multiprofissionais de atendimento domiciliar. As fontes de evidência foram a análise documental, entrevistas guiadas por um roteiro semiestruturado com foco em competências e grupo focal. Os dados foram submetidos à Análise de Discurso Crítica, na perspectiva de Fairclough, possibilitando a discussão de duas categorias empíricas: competências do enfermeiro para atuação na atenção domiciliar; e situações que promovem a mobilização das competências. Resultados: identificou-se um conjunto de dezessete competências mobilizadas pelos enfermeiros do serviço de atenção domiciliar, quais sejam: liderança, comunicação, tomada de decisão, avaliação holística do paciente e ambiente domiciliar, gestão do trabalho, gestão do cuidado, educação em saúde, sensibilidade cultural, assistência de enfermagem, trabalho em equipe, colaboração interdisciplinar, trabalho em rede, gestão de recursos materiais, gestão do tempo, desenvolvimento profissional, adaptação à tecnologia e segurança para o trabalho. Para cada uma das competências foram apontados e discutidos os atributos relacionados a conhecimentos, habilidades e atitudes. Os discursos revelaram que as competências são mobilizadas por situações relacionadas as particularidades da atenção domiciliar, singularidade do contexto domiciliar e demandas profissionais. Conclusão: a prática dos enfermeiros na atenção domiciliar mobiliza diversas competências compreendidas como uma necessidade no dia a dia do trabalho.

Introduction: Home health care is an expanding modality of care on the world stage and the nurse is part of the multidisciplinary team, being the largest provider of home care. In the context of specificities of home care, nurses are constantly challenged to mobilize knowledge, skills and attitudes in an interrelated way and are expected to be competent in professional practice. The objective of this study was to analyze the skills mobilized by nurses in home care in their day-to-day work. Method: qualitative approach study with a single case study methodological design. Data production took place in home care service of the Unified Health System in the city of Belo Horizonte. 12 nurses who make up multidisciplinary home care teams participated in the research. The sources of evidence were documents analysis, interviews guided by a semi-structured script focusing on skills and focus groups. The data were submitted to Critical Discourse Analysis, from Fairclough 's perspective, enabling the discussion of two empirical categories: nurse skills to work in home care; and situations that promotes the mobilization of skills. Results: a set of seventeen skills mobilized by nurses in home care service were identified, namely: leadership, communication, decision making, holistic assessment of the patient and home environment, work management, care management, health education, cultural sensitivity, nursing care, teamwork, interdisciplinary collaboration, networking, material resource management, time management, professional development, adaptation to technology and work safety. For each of the competencies, attributes related to knowledge, skills and attitudes were highlighted and discussed. The speeches revealed that skills are mobilized by situations related to the particularities of home care, the uniqueness of the home context and professional demands. Conclusion: the practice of nurses in home care mobilizes several skills understood as a necessity in day-to-day work.

Competências e formação em psicologia: diretrizes para o Sistema Único de Saúde / Skills and training in psychology: guidelines for the Unified Health System

Este trabalho tem como objetivo a compreensão das possíveis relações existentes entre as competências apontadas pelas Diretrizes Curriculares Nacionais de Psicologia com as Referências Técnicas publicadas pelo Centro de Referência Técnica em Psicologia e Políticas Públicas (CREPOP). Trata-se de uma pesquisa documental, tendo como metodologia a análise do discurso. Após a leitura flutuante das referências técnicas produzidas pelo CREPOP entre janeiro de 2007 a setembro de 2019, foram selecionados quatro documentos para a pesquisa. Estes foram lidos na íntegra, realizando-se um fichamento e a construção de mapas dialógicos dos capítulos relacionados às práticas profissionais. Observou-se a existência de uma maior relação com as competências de atenção à saúde e educação permanente. As demais competências liderança, tomada de decisão e administração e gerenciamento sendo ampliadas para formas de atuação compartilhadas. Além disso, foi possível observar discursos que faziam menção a outras competências que acabavam ampliando a atuação da psicologia, mas que não são apontadas pelas diretrizes curriculares, como o trabalho com clínica ampliada, diálogo, trabalho colaborativo e ética dialógica.

This work aims to understand the possible relationships between the competences pointed out by the National Curriculum Guidelines for Psychology with the Technical References published by the Technical Reference Center in Psychology and Public Policies (CREPOP). It is a documentary research, using the discourse analysis methodology. After the floating reading of the technical references produced by CREPOP between January 2007 and September 2019, four documents were selected for the research. These were read in their entirety, a file was created and the construction of dialogical maps of the chapters related to professional practices. It was observed that there is a greater relationship with the competence of health care and permanent education. The other competencies of leadership, decision making and administration and management are being extended to shared forms of action. In addition, it was possible to observe speeches that mentioned other competencies that ended up expanding the performance of psychology, but that are not pointed out by the curriculum guidelines, such as working with an expanded clinic, dialogue, collaborative work and dialogic ethics.

Construction of an evaluation index system for the core competence of chemotherapy specialist nurses / 中华护理杂志

Objective To construct an evaluation index system for the core competence of tumor chemotherapy specialist nurses in China and to provide standards for training of tumor chemotherapy specialist nurses.Methods Through literature research and expert meeting,the first draft of index system was established,and consultation questionnaire was compiled.Two rounds of consultation were conducted with 23 experts in China using Delphi method.AHP method was used to determine the weights of indicators at all levels.Results The effective rates of 2 rounds of expert consultation were 100％ and 73.91％,respectively.In the 2 rounds of consultation,the expert authority coefficients were 0.855 and 0.867,respectively.The coordination coefficient of first and second level indexes and expert opinions were 0.693 and 0.371 (P＜0.001),respectively.The final evaluation index system for the core competence of tumor chemotherapy specialist nurses included 5 first-level indexes (positive professional attitude,sufficient clinical practice ability,strong educational counseling ability,basic clinical research and evidencebased practice ability,and basic management ability),16 second-level indexes,and 59 third-level indexes.Conclusion The evaluation index system for chemotherapy specialist nurses based on core competence determined by expert consultation is scientific and reasonable,and can provide a powerful basis for training qualified chemotherapy specialist nurses.

Percepción del liderazgo en las(os) enfermeras(os) de un hospital del sur de Chile / Leadership perception in nurses belonging to a southern hospital in Chile

Objetivo: Conocer la percepción del Liderazgo en las(os) Enfermeras(os) de un Hospital del Sur de Chile. Método: Se realizó una investigación cualitativa, descriptiva, exploratoria e interpretativa a través de un estudio de caso único. Los informantes claves fueron seis Enfermeras(os) que se desempeñan en puestos de responsabilidad. La recolección de datos fue mediante grupo focal. El análisis siguió un esquema a través de la reducción progresiva (separación de unidades, agrupamiento, identificación y clasificación de elementos), disposición, transformación y obtención de conclusiones verificables, validándose a través de la triangulación por investigadores. Resultados: Del discurso surgieron 118 unidades de significado, emergiendo 4 categorías. Las de mayor frecuencia fueron "Significado del Liderazgo" (40), "Liderazgo en las funciones" (33), y "Factores que facilitan el desarrollo del Liderazgo" (28). En tanto la de menor frecuencia fue "Factores que obstaculizan el desarrollo del Liderazgo" (17). Al final del proceso se levantan dos dominios cualitativos "Conceptualización del Liderazgo que tienen las(os) Enfermeras(os) de un Hospital del sur de Chile" y "Correspondencia entre las funciones de Enfermería y el ejercicio del Liderazgo". Conclusión: El Liderazgo es percibido por la mayoría como un conjunto de características y no como un proceso de influencia; no existe un concepto claro del mismo, sin embargo se reconoce como un elemento fundamental para las distintas funciones en el ámbito de la práctica profesional, primando en el asistencial, donde se identifican en general más factores facilitadores que obstaculizadores y asociados a la "Calidad de atención del paciente".

Objective: To know the perception of Nurses Leadership (os) at San Carlos Hospital, from Ancud city in Chiloe island, Chile. Method: A qualitative, descriptive, exploratory and interpretative through a single case study, was conducted. Key informants were six nurses working in responsibility positions. The data were collected through focus group. The analysis followed a pattern through the progressive reduction (separation units, grouping, identification and classification of elements), disposal, processing and obtaining verifiable conclusions, validating it through triangulation by researchers. Results: From the discourse emerged 118 units of meaning, emerging four categories. The most frequent ones were "Meaning of Leadership" (40), "Leadership in the functions" (33), and "Factors facilitating leadership development" (28). While the lowest frequency one was "Factors that hinder leadership development" (17). At the end of the two qualitative domains rise "Conceptualizing Leadership with nurses (I) at San Carlos Hospital (Ancud)" and "Correspondence between functions and Nursing Leadership exercise". Conclusion: Leadership is perceived by most as a set of features and not as a process of influence; there is no clear concept of it, but it is recognized as a fundamental element for the different functions within the scope of professional practice, focusing on care, which identifies more generally hindering and facilitating factors associated with the "Quality of patient care".

Simulación clínica en la mediación pedagógica y su relación con la práctica clínica / Clinical simulation on the pedagogical mediation and its relationship to clinical practice

El presente artículo de reflexión está concebido en la investigación "Simulación clínica en la mediación pedagógica para la configuración del razonamiento clínico en estudiantes de medicina de la Universidad Pedagógica y Tecnológica de Colombia". En él se abordó la simu-lación clínica, como una de las herramientas más utilizadas actualmente en los ambientes educativos de formación de profesionales de la salud, y se resaltó cómo la apropiación de aprendizajes mediados por esta herramienta, puede influir en el desarrollo de competencias, para el fortalecimiento y mejoramiento continuo de la práctica clínica. El objetivo de este escrito fue reflexionar sobre la simulación clínica en el contexto de la educación médica y en salud, introducida como una innovación pedagógica para garantizar la calidad de la atención en salud, calidad que puede materializarse en aspectos como: bien-estar del paciente, actualización de técnicas de diagnóstico, adopción de nuevos protocolos de actuación y tratamiento, y humanización del ejercicio profesional. El elemento axial de la práctica clínica es el paciente como sujeto de intervención. Por esta razón, la introducción de la simulación clínica en los procesos educativos y formativos para el desempeño de competencias profesionales en salud, en los que el docente asume el papel de mediador, resulta muy importante a la hora de promover aprendizajes significativos fun-damentados en pedagogías invisibles, a partir de los cuales se pueden instaurar cambios paradigmáticos que conduzcan a la construcción e interiorización de conocimientos, no solo para desarrollar habilidades técnicas (saber hacer), sino para desarrollar habilidades de pen-samiento en lo social, en lo científico y en lo humano (saber ser).

This paper addresses the clinical simulation as one of the tools most presently used in the educational main rooms of formation of healthcare professionals and how learning involve appropriation of this tool, may influence the development of competences, for strengthen-ing and continuous improvement of clinical practice. The objective of this product is to install a reflexive discourse about clinical simulation in the context of medical education and health introduced as a pedagogical innovation for the quality of assurance in healthcare, care quality that can be seen materialized in aspects such as patient welfare, updating of diagnostic techniques, adopting new action protocols and treatment and humanization of professional practice. The axial element of clinical practice is the patient as a subject of intervention, for this reason, the introduction of clinical simulation in educational and training processes for health per-formance professional competences, where the teacher alone assuming the role of mediator, find it very important when it comes to promoting significant learning founded on invisible pedagogies, from which to place paradigm shifts that lead to construction and internaliza-tion of knowledge, not only for the development of technical skills -know how to do, but also for the development of thinking skills in the social, scientific and human -knowing how to be