Pressure injury prevention in older people: construction and validation of an instrument for caregivers.

OBJECTIVES: to construct and validate an instrument to assess the knowledge, attitudes, and practices related to pressure injury prevention among caregivers of institutionalized older people. METHODS: this is a three-stage methodological study that consisted of instrument construction, analysis by experts, and semantic and appearance analysis, with 78 participants, observing the validation process steps for psychometric instruments in the criteria of clarity and relevance. RESULTS: in the Delphi I round, the validity index of the general content in the clarity criterion was 0.66, in relevance 0.85, and the Kappa value was >0.76. In Delphi II, clarity was 0.95, relevance 1.00, and the Kappa value was >0.97. CONCLUSIONS: this is a valid instrument in terms of content and appearance, which allows further analysis of its reliability for the measurement of the constructs for which it is intended. Therefore, it can be considered a tool for care management in pressure injury prevention.

Pressure injury prevention in older people: construction and validation of an instrument for caregivers / Prevención de lesiones por presión en ancianos: construcción y validación de instrumento orientado al cuidador / Prevenção de lesão por pressão em idosos: construção e validação de instrumento voltado ao cuidador

ABSTRACT Objectives: to construct and validate an instrument to assess the knowledge, attitudes, and practices related to pressure injury prevention among caregivers of institutionalized older people. Methods: this is a three-stage methodological study that consisted of instrument construction, analysis by experts, and semantic and appearance analysis, with 78 participants, observing the validation process steps for psychometric instruments in the criteria of clarity and relevance. Results: in the Delphi I round, the validity index of the general content in the clarity criterion was 0.66, in relevance 0.85, and the Kappa value was >0.76. In Delphi II, clarity was 0.95, relevance 1.00, and the Kappa value was >0.97. Conclusions: this is a valid instrument in terms of content and appearance, which allows further analysis of its reliability for the measurement of the constructs for which it is intended. Therefore, it can be considered a tool for care management in pressure injury prevention.

RESUMEN Objetivos: construir y validar un instrumento pera evaluación del conocimiento, actitud y práctica relacionado a la prevención de lesiones por presión entre cuidadores de ancianos institucionalizados. Métodos: estudio metodológico realizado en tres fases: construcción del instrumento, análisis de los evaluadores y análisis semántico y de apariencia, con 78 participantes siguiendo las etapas del proceso de validación de instrumentos psicométricos para los criterios claridad y pertinencia. Resultados: en la ronda Delphi I el índice de validez de contenido general del criterio "claridad" fue de 0,66, "pertinencia" 0,85, y valor de Kappa > 0,76. En Delphi II, el criterio de "claridad" fue 0,95, "pertinencia" 1,00 y valor de Kappa > 0,97. Conclusiones: se tiene un instrumento válido respecto de contenidos y apariencia, para continuar analizando su confiabilidad para medir los constructos a los cuales se propone, para que sirva como herramienta de gestión del cuidado en la prevención de lesiones por presión.

RESUMO Objetivos: construir e validar instrumento relacionado à prevenção de lesão por pressão para avaliação do conhecimento, da atitude e da prática de cuidadores de idosos institucionalizados. Métodos: estudo metodológico realizado em três fases: construção do instrumento, análise dos juízes e análise semântica e aparente, com 78 participantes, seguindo as etapas do processo de validação de instrumentos psicométricos para os critérios clareza e pertinência. Resultados: na rodada Delphi I, o índice de validade de conteúdo global do critério "clareza" foi de 0,66, "pertinência" 0,85 e valor de Kappa > 0,76. Em Delphi II, o critério de "clareza" foi de 0,95, "pertinência" 1,00 e valor de Kappa > 0,97. Conclusões: dispõe-se de instrumento válido quanto a conteúdo e aparência para dar seguimento à análise da sua confiabilidade em medir os construtos aos quais se propõe, para que possa servir de ferramenta para gestão do cuidado na prevenção de lesão por pressão.

Burnout among nurses: a multicentric comparative study.

OBJETIVO: to identify and compare burnout levels between Portuguese, Spanish and Brazilian nurses. METHOD: quantitative, descriptive, correlational, comparative and cross-sectional study conducted using a sample of 1,052 nurses working in hospitals and primary care centers. A sociodemographic questionnaire and the Maslach Burnout Inventory were applied to nurses in Porto, Portugal (n=306), Oviedo, Spain (n=269) and S. Paulo, Brazil (n=477). Data analysis was performed using descriptive, inferential and multivariate analysis. RESULTS: approximately 42% of the nurses showed moderate/high levels of burnout, with no differences found between countries (Portugal and Brazil 42%, Spain 43%). Only depersonalization showed differences between countries, presenting Spain the highest level and Portugal the lowest one. Comparative analysis showed higher burnout levels in young nurses and those working by shifts. Considering job schedules, burnout was associated to shift work in Portugal, while in Spain and Brazil it was associated with fixed schedules. CONCLUSION: these results suggest that this syndrome among nurses is a global phenomenon. The daily stressors and higher demands of the nursing profession are crucial in the preparation of nurses to deal with complex situations, to avoid burnout, and to reduce the negative impact on nurses' health and on the quality of care they provide.

Burnout among nurses: a multicentric comparative study / Burnout entre enfermeiros: um estudo multicêntrico comparativo / Burnout entre enfermeros: un estudio multicéntrico comparativo

Objetivo: to identify and compare burnout levels between Portuguese, Spanish and Brazilian nurses. Method: quantitative, descriptive, correlational, comparative and cross-sectional study conducted using a sample of 1,052 nurses working in hospitals and primary care centers. A sociodemographic questionnaire and the Maslach Burnout Inventory were applied to nurses in Porto, Portugal (n=306), Oviedo, Spain (n=269) and S. Paulo, Brazil (n=477). Data analysis was performed using descriptive, inferential and multivariate analysis. Results: approximately 42% of the nurses showed moderate/high levels of burnout, with no differences found between countries (Portugal and Brazil 42%, Spain 43%). Only depersonalization showed differences between countries, presenting Spain the highest level and Portugal the lowest one. Comparative analysis showed higher burnout levels in young nurses and those working by shifts. Considering job schedules, burnout was associated to shift work in Portugal, while in Spain and Brazil it was associated with fixed schedules. Conclusion: these results suggest that this syndrome among nurses is a global phenomenon. The daily stressors and higher demands of the nursing profession are crucial in the preparation of nurses to deal with complex situations, to avoid burnout, and to reduce the negative impact on nurses' health and on the quality of care they provide.

Objetivo: identificar e comparar os níveis de burnout entre enfermeiros portugueses, espanhóis e brasileiros. Método: estudo quantitativo, descritivo, correlacional, comparativo e transversal, realizado com 1.052 enfermeiros em hospitais e unidades básicas de saúde. Um questionário sociodemográfico e o Maslach Burnout Inventory foram aplicados com enfermeiros de Porto-Portugal (n=306), Oviedo-Espanha (n=269) e São Paulo-Brasil (n=477). Os dados foram analisados por meio de estatística descritiva, inferencial e multivariada. Resultados: aproximadamente 42% dos enfermeiros apresentaram níveis moderados/altos de burnout, não sendo encontradas diferenças entre os países (Portugal e Brasil com 42%, Espanha com 43%). Apenas a dimensão despersonalização apresentou diferenças entre os países, com um nível mais elevado na Espanha e mais baixo em Portugal. A análise comparativa mostrou níveis mais elevados de burnout em enfermeiros jovens e naqueles que trabalhavam em turnos. Em relação às escalas de trabalho, burnout foi associada ao trabalho por turnos em Portugal e aos horários fixos na Espanha e no Brasil. Conclusão: esses resultados sugerem que essa síndrome em enfermeiros é um fenômeno global. Estressores diários e maiores demandas da profissão de enfermagem são elementos cruciais para preparar os enfermeiros para lidar com situações complexas, evitar burnout e reduzir o impacto negativo na sua saúde e na qualidade dos cuidados que prestam.

Objetivo: identificar y comparar los niveles de burnout entre enfermeros portugueses, españoles y brasileños. Método: estudio cuantitativo, descriptivo, correlacional, comparativo y transversal, realizado con 1.052 enfermeros de hospitales y unidades básicas de salud. Se aplicó un cuestionario sociodemográfico y el Maslach Burnout Inventory a enfermeras de Porto, Portugal (n=306), Oviedo, España (n=269) y São Paulo, Brasil (n=477). Los datos se analizaron mediante estadística descriptiva, inferencial y multivariada. Resultados: aproximadamente el 42% de los enfermeros presentaban niveles moderados/altos de burnout y no se encontraron diferencias entre países (Portugal y Brasil 42%, España 43%). Solo la dimensión de despersonalización mostró diferencias entre países, con un nivel mayor en España y menor en Portugal. El análisis comparativo mostró mayores niveles de burnout en enfermeros jóvenes y en los que trabajaban por turnos. En cuanto a los horarios de trabajo, el burnout se asoció con el trabajo por turnos en Portugal y con horario fijo en España y Brasil. Conclusión: estos resultados sugieren que el síndrome de burnout en enfermeros es un fenómeno global. Los estresores cotidianos y las mayores exigencias de la profesión de Enfermería son elementos cruciales para preparar a los enfermeros para enfrentar situaciones complejas, evitar el burnout y reducir el impacto negativo en la salud de los enfermeros y la calidad de la atención que brindan.

Presenteeism in nurses: comparative study of Spanish, Portuguese and Brazilian nurses.

AIM: To compare presenteeism levels among three samples of nurses and to identify the relationship between presenteeism and sociodemographic and professional characteristics. BACKGROUND: Presenteeism (going to work ill) is a phenomenon studied from different perspectives, and it has become especially important during the current COVID-19 outbreak; its connection to high healthcare costs, patient safety breaches and negative nurse well-being has been proved. INTRODUCTION: The nursing profession is particularly associated with caring for the culture of teamwork, loyalty to colleagues and professional identity. This condition enhances the 'super nurse phenomenon', even though nurses do not feel physically and psychologically able to work. METHODS: A multicentre, cross-sectional study was conducted in three different country contexts: Oviedo (Spain), Porto (Portugal) and São Paulo (Brazil). Nurses performing functions in hospitals and primary health care were enrolled. Informed consent and data collection questionnaires were hand delivered. The Stanford Presenteeism Scale-6 was applied. RESULTS: A total of 659 nurses participated. Portuguese nurses showed greater prevalence of presenteeism, followed by Brazilian and Spanish nurses. Younger nurses with less professional experience presented lower levels of presenteeism but greater psychological commitment. Male participants showed lower capacity to complete work when ill than female participants. CONCLUSIONS: Age and length of professional experience proved to be significant predictors of total presenteeism, although only professional experience revealed statistical significance in the adjusted model. IMPLICATIONS FOR NURSING AND HEALTH POLICY: The knowledge of this phenomenon among nurses highlights the need for the development of strategies in the curriculum of nursing students and organizations. Resilience and ergonomic training should be applied in the training programmes of the students and reinforced by the health centre managers. It is essential that healthcare systems design worksite wellness programmes that pursue greater physical and mental well-being for healthcare professionals.

Persona mayor con limitaciones funcionales diarias / Elderly person with daily functional limitations

Introducción: el creciente proceso de envejecimiento de la población tiende a provocar cambios sociales, económicos y de salud y la creación de nuevas demandas en el sector público, debido a las limitaciones funcionales impuestas por el envejecimiento. Sin embargo, aunque la mayoría de las personas mayores es un portador de al menos una enfermedad crónica, no todos están limitados por ella, llevando una vida normal con sus enfermedades cuando se controla. Objetivo: comprender la vida cotidiana de las personas mayores con limitaciones funcionales. Métodos: cualitativo, descriptivo y exploratorio, guiado por el método de la historia oral, realizado con 15 personas de edad matriculados en una Unidad Familiar Estrategia de Salud en Bahía (Brasil noreste). Como la recolección de datos técnica se utilizó una entrevista semi-estructurada. Las entrevistas fueron grabadas, transcritas y sometidas a análisis de contenido de Bardin. Resultados: las personas mayores con limitaciones funcionales desarrollaban sus actividades diarias, relacionadas con el cuidado de la casa, esposo, hijos y nietos, sociales y de ocio. Las actividades realizadas por los hombres se relacionan con el espacio exterior de la casa y las tareas que requieren fuerza física, mientras que las mujeres desarrollan el papel de los cuidadores de la casa y la familia. Conclusión: las limitaciones funcionales hacen que sea difícil llevar a cabo las actividades cotidianas, así como mantener una vida social activa, pero no excluye el anciano realizarlas(AU)

Introduction: The growing process of population aging tends to cause social, economic and health changes, creating new demands on the public sector, because of the functional limitations imposed by aging. However, although most of the elderly is a carrier of at least one chronic disease, not all are limited by it, leading a normal life with their infirmities, when controlled. Objective: To understand the daily life of the elderly with functional limitations. Method: qualitative, descriptive and exploratory, guided by the method of oral history, conducted with 15 elderly people enrolled in a Health Strategy Unit Family in Bahia (northeastern Brazil). As data collection technique was used a semi-structured interview. Interviews were recorded, transcribed and subjected to content analysis of Bardin. Results: Unveiled that older people with functional limitations develop in their daily activities of daily living and instrumental activities of daily living, which are related to the care of the home, social and leisure activities, and the activities performed by men bind If the external space of the house and the tasks that require physical strength, while women develop the role of caretakers of the home and family, caring for husband, children and grandchildren. Conclusion: The functional limitations make it difficult to carry out everyday activities as well as maintaining an active social life, but does not preclude the elder perform them(AU)

Relação familiar da pessoa idosa com comprometimento da capacidade funcional / Relación familiar del adulto mayor con comprometimiento de la capacidad funcional / Family Relationships of Elderly Adults with Compromised Functional Capacity

Objetivo: compreender a relação familiar da pessoa idosa com comprometimento da capacidade funcional. Materiais e métodos: estudo exploratório e descritivo de abordagem qualitativa, fundamentado no método da história oral, realizado com 15 pessoas idosas assistidas por uma unidade de saúde da família, residentes com familiares e que apresentavam comprometimento da capacidade funcional. Os dados foram coletados no período de março a abril de 2012, por meio de entrevistas em profundidade. As categorias temáticas foram: bom relacionamento familiar, mudanças na relação familiar, sentindo-se um incômodo para a família, sentindo-se abandonado pela família. Resultado: o estudo revelou que as pessoas idosas com comprometimento da capacidade funcional vivenciam sentimentos variados, que vão desde a alegria, por serem respeitadas e terem suas necessidades atendidas, à tristeza e revolta, pela adaptação negativa da família e o abandono dos filhos. Conclusão: a relação familiar da pessoa idosa passa por reajustes após o comprometimento da capacidade funcional, o que repercute significativamente na dinâmica das relações. A partir dessa compreensão, os profissionais de saúde, sobretudo de enfermagem, devem reconhecer os desafios enfrentados pela família, orientá-la e capacitá-la para o atendimento às demandas de cuidado apresentadas pela pessoa idosa com comprometimento da capacidade funcional, e favorecer a realização do cuidado sem que haja desgaste das relações.

Objetivo: comprender la relación familiar de la persona adulta con comprometimiento de la capacidad funcional. Materiales y métodos: estudio exploratorio y descriptivo de abordaje cualitativo, fundamentado en el método de la historia oral, realizado con 15 adultos mayores asistidos por una unidad de salud de la familia, residentes con familiares y que presentaban comprometimiento de la capacidad funcional. Se recolectaron los datos en el período de marzo y abril del 2012, por medio de entrevistas en profundidad. Las categorías temáticas fueron: buena relación familiar, cambios en la relación familiar, sintiéndose un estorbo para la familia, sintiéndose abandonado por la familia. Resultado: el estudio ha revelado que las personas mayores con comprometimiento de la capacidad funcional vivencian sentimientos diversos que van desde la alegría porque son respetadas y tienen sus necesidades atendidas, hasta la tristeza y revuelta, por la adaptación negativa de la familia y el abandono de los hijos. Conclusión: la relación familiar de la persona mayor pasa por reajustes luego del comprometimiento de la capacidad funcional, lo que repercute significativamente en la dinámica de las relaciones. Desde esta comprensión, los profesionales de salud, sobre todo de enfermería, deben reconocer los retos a los que la familia afronta, orientarla y capacitarla para la atención a las demandas de cuidado presentadas por la persona mayor con comprometimiento de la capacidad funcional, y favorecer la realización del cuidado sin que esto desgaste las relaciones.

Objective: This research was intended to understand the family relationships of adults with compromised functional capacity. Materials and Methods: It is an exploratory, descriptive study with a qualitative approach, based on the oral history method. The sample included 15 elderly adults who were being assisted by a family health unit, were living with family members, and had compromised functional capacity. The data were collected between March and April 2012, through in-depth interviews. The subject categories were: good family relationships, changes in family relationships, feeling of being a nuisance to the family, and feeling abandoned or neglected by the family. Result: The study found that elderly adults with compromised functional capacity experience a variety of feelings that range from joy, because they are respected and their needs are met, to sadness and shock over their family's negative adjustment to the situation and by being abandoned or neglected by their children. Conclusion: The dynamics of the family relationships of elderly adults change significantly when the person's functional capacity is compromised. With this in mind, health professionals, especially nurses, must recognize the challenges the family faces and be prepared to guide and train family members to satisfy the demands of caring for an elderly relative with compromised functional capacity and to favor rendering the care that is needed without jeopardizing family relationships.

Crenças de adolescentes portugueses sobre o uso do preservativo / Portuguese adolescent's beliefs in relation to the use of the condom / Creencias de adolescentes portugueses con respecto al uso del condón

Esta pesquisa revela os resultados obtidos durante Doutorado Sandwich, que incluiu trabalho de campo realizado em Portugal e que teve a CAPES como agência financiadora. Seus objetivos foram: identificar as crenças comportamentais e normativas de adolescentes em relação ao uso do preservativo durante as relações sexuais e apresentar sugestões práticas que possam contribuir à definição de estratégias sólidas relacionadas ao Programa de Educação da Sexualidade na Escola. Estudo quantitativo, com base na Theory of Reasoned Action ? TRA, realizado em escolas públicas do Porto, de janeiro a março de 2008. A amostra constou de 252 adolescentes, de 13 a 19 anos, que responderam a um questionário estruturado. A idade média dos participantes foi de 14,7 anos. As vantagens para o uso do preservativo foram: prevenção de DSTs, da gravidez e da SIDA. As desvantagens foram: risco de romper, diminuição do prazer e incômodo. Entre os referentes positivos se destacaram amigos, pais e família. Os resultados obtidos revelaram crenças positivas e negativas, podendo àquelas serem reforçadas e estas minimizadas ou transformadas em positivas, durante as estratégias do programa que vem sendo desenvolvido nas escolas, servindo de contribuição para que os jovens exerçam uma vida sexual saudável.

This research shows the results obtained during PhD Sandwich that includes work carried in Portugal and had the funding agency CAPES. The goals were: to identify adolescents' behavior and normative beliefs toward condom use during the sexual relationships and to develop practical suggestions that can contribute to the definition of solid strategies related to the Sexuality Education Program in the School. Quantitative study, based on the Theory of Reasoned Action - TRA, accomplished at public schools of Porto, from January to March of 2008. The sample consisted in 252 teenagers from 13 to 19 years old that answered a structured questionnaire. The medium age was of 14, 7 years old. The advantages for the use of the condom were: prevention of DSTs, of the pregnancy and of SIDA. The disadvantages were: risk of breaking, decrease of the pleasure and discomfort. Among positives persons were highlighted friends, parents and family. The results showed beliefs positive and negative, the positive can be strengthened and the negative minimized or turned into positive during the strategies of the program, that it has been developed at the schools, serving as a contribution to young people carry on a healthy sexual life.

Esta investigación muestra los resultados obtenidos durante el Doctorado Sandwich que incluye el trabajo del campo llevado a cabo en Portugal y tenía como organismo de financiación la CAPES. Las metas fueran: identificar las creencias de comportamiento y normativas de adolescentes con respecto al uso de condón durante las relaciones sexuales y proponer sugerencias prácticas que pueden contribuir a la definición de estrategias sólidas relacionadas al Programa de Educación de Sexualidad en la Escuela. Investigación cuantitativa, basado en la Theory of Reasoned Action-TRA, realizado en escuelas públicas de Porto, de enero a marzo de 2008. La muestra consistió en 252 adolescentes de 13 a 19 años que contestaron un cuestionario estructurado. La edad media de los participantes fue de 14,7 años. Las ventajas para el uso del condón fueran: la prevención de DSTs, del embarazo y de SIDA. Las desventajas fueran: el riesgo de romper, disminución del placer y incómodo. Entre los referentes positivos se destacaran amigos, padres y familia. Fue pequeño el número de referentes negativos mencionados. Los resultados mostraron las creencias positivas y negativas, el positivo puede fortalecerse y el negativo minimizarse o se convirtir en el positivo durante las estrategias del programa que se ha desarrollado en las escuelas, sirviendo de contribución a que los jóvenes desempeñen una vida sexual saludable.