Generation of Indicators to Assess Quality of Health Care in Hospital at Home Through e-Delphi.

BACKGROUND AND OBJECTIVES: The quality of health care in hospital at home (HaH) has been measured in different countries using simple indicators and clinical results that only contribute to some dimensions of the quality of health care. We sought to generate indicators to comprehensively evaluate the quality of health care provided to HaH users through the e-Delphi technique. METHODS: The e-Delphi technique was performed with the participation of 17 HaH experts. The methodological strategy applied in this study was divided into the following 3 phases: a preparatory phase; consultation phase; and consensus phase. Three rounds of consultations were conducted with experts. In round 1, they were asked to identify which aspects of HaH they believed should be evaluated using an indicator for each of the following 6 dimensions of health care quality: effectiveness; efficiency; timeliness; patient-centered care; equity; and safety. In round 2, they were asked to rate each indicator using a 5-point Likert-type scale with the following values: (1) Totally disagree; (2) Disagree; (3) Moderately agree; (4) Agree; and (5) Totally agree. The criteria for evaluating each indicator were as follows: (1) The indicator is a useful measure for assessing the quality of health care provided to HaH users. (2) The indicator is clearly and specifically written and does not require modification. (3) The indicator is essential and incorporates information that can be extracted from HaH program records. An indicator was considered approved if it received at least 65% approval from the expert panel for each evaluation criterion. In round 3, experts were asked to reassess their ratings, taking into account the opinions of the other experts. The reliability of this technique was ensured through credibility, reliability, and confirmability. We obtained ethical approval of the corresponding institutions and informed consent from the participating experts. RESULTS: Nine unpublished and reliable indicators were generated. In addition, 13 indicators were incorporated that evaluate aspects previously analyzed by other authors and/or national and international institutions, which were adapted to be used in HaH. The total indicators generated (n = 22) represented all dimensions of the quality of health care: safety; opportunity; effectiveness; efficiency; equity; and patient-centered care. CONCLUSIONS: The 22 indicators generated through the e-Delphi technique permit a comprehensive evaluation of the quality of health care provided to HaH users.

Validation of the Chilean version of the "Workplace Violence in the Health Sector" questionnaire in the prehospital care setting / Validación de la versión chilena del cuestionario "Workplace Violence in the Health Sector" en la atención prehospitalaria

Abstract Introduction: Workplace violence is becoming increasingly frequent in the health sector. Therefore, valid and reliable instruments are required to measure this phenomenon. Objective: To validate the factor structure of the Spanish version of the "Workplace Violence in the Health Sector" questionnaire in Chilean prehospital care workers. Material and methods: Quantitative, multivariate study in which the main components of the Spanish version of the questionnaire were analyzed. After being reviewed by experts and conducting a pilot test, 6 questions were eliminated. The adapted version was administered to 74 health professionals (nurses-kinesiologists) and 148 paramedics working in prehospital care. Data were analyzed using descriptive statistics and inferential statistics (chi-square test). The SPSS v15 software was used to perform data analysis and the principal component analysis (PCA). Results: The questionnaire had a high overall reliability (α=0.912). According to the PCA, three factors were identified, namely, physical violence (eigenvalue: 8.3), verbal abuse (eigenvalue: 3.7) and mobbing or workplace harassment (eigenvalue: 3.6), which explain 86% of the variance. Conclusions: The proposed instrument is valid for measuring workplace violence among health professionals working in prehospital care. Having a validated tool to quantify this phenomenon in the country is a significant contribution since it allows carrying out similar studies in other health areas and, based on the results, work on its prevention and the promotion of healthier work environments.

Resumen Introducción. La violencia laboral es cada día más frecuente en el sector de la salud. Por ello, se requieren instrumentos válidos y confiables para poder medir este fenómeno. Objetivo. Validar la estructura factorial de la versión traducida al español del cuestionario "Workplace Violence in the Health Sector" en trabajadores de la atención prehospitalaria de Chile. Material y métodos. Estudio cuantitativo-multivariado. Se realizó un análisis de componentes principales (ACP) de la versión traducida al español del cuestionario. Luego de ser revisada por expertos y de realizar una prueba piloto, se eliminaron 6 preguntas y la versión adaptada fue aplicada a 74 profesionales sanitarios (enfermeros-kinesiólogos) y 148 técnicos paramédicos que trabajaban en atención prehospitalaria. Para el análisis de los datos se aplicó estadística descriptiva y estadística inferencial (prueba x2). El programa SPSS v15 se utilizó para realizar el análisis de los datos y el ACP. Resultados. El cuestionario tuvo una alta contabilidad total (α=0.912). De acuerdo con el ACP se evidenciaron tres factores -violencia física (valor propio: 8.3), abuso verbal (valor propio 3.7) y mobbing o acoso laboral (valor propio: de 3.6)- que explican el 86% de la varianza. Conclusiones. El instrumento propuesto es válido para medir la violencia laboral en personal de la salud que se desempeña en atención prehospitalaria. Además, contar con una herramienta validada que permita cuantificar este fenómeno en el país es un aporte significativo, pues es posible realizar estudios similares en otras áreas de la salud y, a partir de sus resultados, trabajar en su prevención y en la promoción de ambientes laborales más saludables.

Trabajo en equipo y calidad de la atención en salud

RESUMEN Todas las organizaciones aspiran a alcanzar resultados funcionales e integrales para dar respuesta a las necesidades del medio interno y externo en el que se encuentran inmersas. La organización sanitaria no ha sido la excepción, por lo que proveer una atención con altos estándares de calidad se ha transformado en una prioridad a nivel mundial. En este sentido, se precisa poner en práctica una serie de elementos que confluyan funcionalmente para avanzar hacia la calidad de la atención en salud, en donde el trabajo en equipo, sus integrantes, el compromiso y la confianza entre las personas son claves para el logro de esta meta, especialmente para enfermería. El objetivo de este trabajo es describir la importancia del trabajo en equipo para la calidad de la atención en salud.

ABSTRACT All organizations aspire to achieve functional and comprehensive results in order to meet the needs of the internal and external environment in which they are immersed. The healthcare organization has been no exception, and providing high quality care has become a worldwide priority. In this sense, it is necessary to put into practice a series of elements that functionally converge to move towards the quality of health care, where teamwork, team members, commitment and trust between people are keys to achieving this goal, especially for nursing. The objective of this work is to describe the importance of teamwork for the quality of health care.

RESUMO Todas as organizações aspiram a resultados funcionais e abrangentes para responder às necessidades do ambiente interno e externo em que estão inseridas. A organização de saúde não tem sido exceção, portanto, prestar cuidados com elevados padrões de qualidade tornou-se uma prioridade em todo o mundo. Nesse sentido, é necessário colocar em prática uma série de elementos que convergem funcionalmente para caminhar rumo à qualidade da assistência à saúde, onde o trabalho em equipe, seus integrantes, o compromisso e a confiança entre as pessoas são fundamentais para o alcance desse objetivo, especialmente para enfermagem. O objetivo deste documento é descrever a importância do trabalho de equipa para a qualidade dos cuidados de saúde.

[Verbal and physical abuse towards health care workers in emergency services]. / Prevalencia de violencia física, abuso verbal y factores asociados en trabajadores/as de servicios de emergencia en establecimientos de salud públicos y privados.

BACKGROUND: One of the peculiarities of our society is the increase in violence and its repercussions in various areas. Health care is not an exemption. AIM: To determine the prevalence of physical violence, verbal abuse towards emergency service health care workers at two public and two private health centers in the province of Concepción, Chile. MATERIAL AND METHODS: A questionnaire for Work Violence in Health Centers, with dimensions about physical violence and verbal abuse was applied to 366 health care workers, stratified according to center and occupational categories. RESULTS: Thirteen percent of workers perceived physical violence. Paramedical technicians had the higher risk of perceiving this type of violence. Fifty nine percent of workers perceived verbal abuse. Nurses and administrative staff had the higher risk of perceiving this type of violence. The most common offenders were patients and family. The most common form of coping with abuse was avoiding a reaction. Most of the physical and verbal aggressions were not reported or denounced. CONCLUSIONS: There is a high prevalence of verbal abuse and physical violence in emergency services, which requires measures to achieve a zero tolerance to violence in these spaces.

The Comfort Theory as a Theoretical Framework Applied to a Clinical Case of Hospital at Home.

The comfort theory was applied in the development of a nursing process for the clinical case of an older adult with pneumonia treated under hospital at home. It was observed that the theory is easy to apply in the domiciliary context and that it allows the implementation of a holistic care plan.

Indicadores de calidad de la atención en salud en hospitalización domiciliaria: revisión integradora / Indicators of the Quality of Health Care in Home Hospitalization: An Integrative Review / Indicadores de qualidade da atenção em saúde na hospitalização domiciliar: revisão integrativa

RESUMEN Objetivo: describir la producción empírica sobre indicadores para evaluar la calidad de la atención en salud otorgada a usuarios de unidades de hospitalización domiciliaria (HD). Materiales y métodos: se realizó una revisión integradora en las bases Pubmed, Web of Science, IBECS, SciELO y Biblioteca Cochrane. El periodo de búsqueda se extendió del año 1990 hasta el 2017. Resultados: se hallaron 10 documentos, de los cuales 6 correspondieron a artículos originales y 4 a revisiones sistemáticas. Solo en 3 de los 6 artículos originales hallados se mencionaron indicadores relacionados con reingresos hospitalarios no planificados, llamadas telefónicas no planificadas realizadas por los pacientes y/o el equipo de salud de HD, negativa de los pacientes a ser ingresados a HD y errores en la administración de medicamentos. Conclusión: la investigación de la evaluación de la calidad de la atención en salud en HD mediante indicadores ha tenido un escaso desarrollo, especialmente en enfermería. Los indicadores pesquisados han sido desarrollados solo en algunos países europeos, pero sin reportar bases conceptuales claras y sin asegurar la solidez científica y factibilidad de las medidas.

ABSTRACT Objective: Describe the empirical production of indicators to evaluate the quality of health care provided to users of home hospitalization units (HH). Materials and methods: An integrative review was conducted using the Pubmed, Web of Science, IBECS, SciELO and the Cochrane Library databases. The search period went from 1990 to 2017. Results: Ten (10) documents were found: six original articles and four systematic reviews. Only three of the six original articles in question mention indicators related to unplanned hospital readmissions, unplanned telephone calls made by patients and / or the HH health team, refusal of patients to be admitted to HH, and errors in the administration of medication. Conclusion: Research on evaluation of the quality of health care in HH using indicators is very limited, especially in the field of nursing. The researched indicators were developed only in several European countries, but with no clear conceptual basis and without ensuring the scientific soundness and feasibility of the measurements.

RESUMO Objetivo: descrever a produção empírica sobre indicadores para avaliar a qualidade da atenção em saúde outorgada a usuários de unidades de hospitalização domiciliar (HD). Materiais e método: realizou-se uma revisão integrativa nas bases PubMed, Web of Science, IBECS, SciELO e Biblioteca Cochrane. O período de busca foi de 1990 a 2017. Resultados: foram encontrados 10 documentos, dos quais 6 corresponderam a artigos originais e 4 a revisões sistemáticas. Somente em 3 dos 6 artigos originais, mencionaram-se indicadores relacionados com reinternação hospitalar não planejada, ligações não esperadas pelos pacientes e/ou pela equipe de saúde de HD, negativa dos pacientes a serem inseridos na HD e erros na administração de medicamentos. Conclusão: a pesquisa da avaliação da qualidade da atenção em saúde em HD, mediante indicadores, tem tido pouco desenvolvimento, especialmente em enfermagem. Os indicadores pesquisados foram desenvolvidos somente em alguns países europeus, mas sem relatar bases conceituais claras e sem garantir a solidez científica e factibilidade das medidas.

Prevalencia de violencia física, abuso verbal y factores asociados en trabajadores/as de servicios de emergencia en establecimientos de salud públicos y privados / Verbal and physical abuse towards health care workers in emergency services

Background: One of the peculiarities of our society is the increase in violence and its repercussions in various areas. Health care is not an exemption. Aim: To determine the prevalence of physical violence, verbal abuse towards emergency service health care workers at two public and two private health centers in the province of Concepción, Chile. Material and Methods: A questionnaire for Work Violence in Health Centers, with dimensions about physical violence and verbal abuse was applied to 366 health care workers, stratified according to center and occupational categories. Results: Thirteen percent of workers perceived physical violence. Paramedical technicians had the higher risk of perceiving this type of violence. Fifty nine percent of workers perceived verbal abuse. Nurses and administrative staff had the higher risk of perceiving this type of violence. The most common offenders were patients and family. The most common form of coping with abuse was avoiding a reaction. Most of the physical and verbal aggressions were not reported or denounced. Conclusions: There is a high prevalence of verbal abuse and physical violence in emergency services, which requires measures to achieve a zero tolerance to violence in these spaces.

La transculturalidad, elemento esencial para mejorar la atención en salud y de enfermería

l fenómeno migratorio en distintos países es una realidad muy compleja, supone un reto para el sistema de salud, las políticas que se diseñan y los profesionales que prestan sus servicios en él. El profesional en enfermería es el responsable de la prestación de cuidados en un ámbito complejo y de adaptarse a la realidad multicultural que se vive actualmente. Este artículo tiene la finalidad de reflexionar sobre la importancia de la enfermería transcultural para fundamentar la práctica profesional basada en un cuerpo de conocimiento científico y humanizado que permita mejorar la calidad de los cuidados de enfermería culturalmente competentes con base en las necesidades del paciente/familia/comunidad y sistema de salud. A partir del enfoque transcultural se comprende las diferencias culturales existentes, y la importancia de brindar cuidados culturales integrales y de calidad considerando las creencias y valores de las personas a las que se brinda el cuidado. Al adquirir la perspectiva cultural se desarrolla la competencia cultural. Es necesario establecer propuestas de mejoras, redes de apoyo interdisciplinar y multidisciplinar nacionales e internacionales para lograr una salud integral, humanizada y culturalmente congruente tomando en cuenta las necesidades reales de la población.

he migratory phenomenon in various countries is a very complex reality. It poses as a challenge to the healthcare system, policies that are to be designed and the professionals providing services there. Nurses are responsible for providing care in such a complex environment and adapting to the multicultural reality that exists today. This article aims to reflect on the importance of transcultural nursing in order support the professional practice based on a body of scientific and humanized knowledge to improve the quality of culturally competent care based on the needs of the patient / family / community and health system. The transcultural approach allows us to understand cultural differences and provide comprehensive care considering the beliefs and values of the people to whom care is provided. By acquiring cultural perspective, cultural competence is developed. It is necessary to establish different approaches in order for there to be improvements, support networks of interdisciplinary and multidisciplinary national and international efforts to achieve a comprehensive, humane and culturally congruent health taking into account the real needs of the population.

fenômeno migratório em distintos países é uma realidade muito complexa, supõe um reto para o sistema de saúde, as políticas que se desenham e os profissionais que prestam seus serviços. O profissional em enfermagem é responsável da prestação de cuidados em um âmbito complexo e de adaptar-se a realidade multicultural que se vive atualmente. Este artigo tem a finalidade de refletir sobre a importância da enfermagem transcultural para fundamentar a prática profissional baseada em um corpo de conhecimento científico e humanizado que permita melhorar a qualidade dos cuidados de enfermagem culturalmente competentes com base nas necessidades do paciente/família/comunidade e sistema de saúde. A partir do enfoque transcultural se compreende as diferenças culturais existentes, e a importância de brindar cuidados culturais integrais e de qualidade considerando as crenças e valores das pessoas, as quais se brinda o cuidado. Ao adquirir a perspectiva cultural se desenvolve a competência cultural. É necessário estabelecer propostas de melhoras, redes de apoio interdisciplinar e multidisciplinar nacionais e internacionais para alcançar uma saúde integral, humanizada e culturalmente congruente tomando em consideração as necessidades reais da população.

Validación de la Escala Subjetiva de Carga mental de trabajo (ESCAM) en profesionales de la salud de Chile / Validation of the Subjective Mental Workload Scale (SCAM) in health professionals from Chile

El objetivo de este estudio es confirmar las características psicométricas de la Escala Subjetiva de Carga Mental de Trabajo (ESCAM) en trabajadores sanitarios de hospitales chilenos. Participaron en este estudio 379 trabajadores de tres hospitales. Los instrumentos utilizados fueron: (a) ESCAM y (b) el cuestionario SUSESO-ISTAS 21. Los resultados indican que ESCAM se estructura en cinco dimensiones: Demandas cognitivas y complejidad de la tarea, Características de la tarea, Organización temporal, Ritmo de trabajo y Consecuencias para la salud. Asimismo, se observan correlaciones significativas entre la puntuación total de ESCAM y sus dimensiones con los factores de SUSESO-ISTAS 21. Además, se comprobó la validez de la escala mediante el análisis de perfiles de carga mental con diferentes grupos profesionales.

The aim of this study is to confirm the psychometric characteristics of the Subjective Mental Workload Scale (SCAM) in health workers of Chilean Hospitals. The instruments used were: (1) SCAM; (2) questionnaire SUSESO-ISTAS 21. The sample was composed of 379 workers from three hospitals. The findings showed that SCAM is structured in five dimensions: Cognitive demands and task complexity, Task characteristics, Temporal organization, Work rate, and Health consequences. Likewise, significant correlations between overall score of SCAM and its dimensions with the SUSESO-ISTAS 21 factors were found. Also, scale validity was verified through mental workload profiles with different professional groups.

Calidad de vida en el trabajo percibida según niveles de atención y categorías de enfermeras / Perceived quality of life at work according to level of care and nurse category

Objetivo: Determinar la calidad de vida en el trabajo percibida, según niveles de atención y categorías, de enfermeras de instituciones públicas en una ciudad del noroeste de México. Material y método: Diseño cuantitativo, correlacional, transversal y comparativo. Muestra: Incluyó 345 personas, recabada entre 2012-2013. Instrumento para evaluar calidad de vida en el trabajo, validado en población mexicana, Alpha de Cronbach 0.952. Análisis estadístico con SPPS versión 15, Chi-cuadrada y comparación de medias con ANOVA y Kruskal-Wallis, nivel de significancia 0.05. Autorización de Comités de Ética de instituciones involucradas y consentimiento informado de participantes. Resultados: Según nivel de atención la media más elevada corresponde al primer nivel (218.07 DE=42.73), seguido del tercero (208.99 DE= 39.33) y por último el segundo (196.06 DE=42.27) (F=6.854, p=0.001). Según categoría de enfermeras, la media más elevada se encontró en las enfermeras profesionales de primer nivel de atención (218.26 DE=45.44) y la media más baja en enfermeras profesionales de segundo nivel de atención (189.15 DE=44.82) (X2=16.387, p=0.006). Las dimensiones de: satisfacción por el trabajo, bienestar logrado a través del trabajo, desarrollo personal del trabajador y administración del tiempo libre, mostraron diferencias significativas según nivel de atención (p<0.05). Administración del tiempo libre, mostró diferencias significativas según categoría de enfermeras (p<0.05). Conclusión: El personal de enfermería, independientemente del nivel de atención y categoría, se encuentra medianamente satisfecho con su calidad de vida en el trabajo (207.32 DE=41.74), excepto las enfermeras profesionales del segundo nivel de atención que tienen una baja percepción de su calidad de vida en el trabajo.

Aim: To determine the perceived Quality of Life at Work, in relation to level of care and nurse categories at public institutions in a north-eastern Mexican city. Subjects and methods: Quantitative, correlational, cross-sectional and comparative design. Sample: 345 subjects; information was collected between 2012 and 2013. The instrument to measure the Quality of Life at work, validated in Mexican population, was Cronbach's Alpha 0.952. Statistical analysis done with SPSS (v.15), chi-square and mean comparison test performed with ANOVA and Kruskal-Wallis, with a significance level of 0.05. The involved institutions authorized procedures and validated the participants' informed consent forms through corresponding Ethics Committee. Results: According to care levels, the greatest mean corresponds to the first level (218.07 DE=42.73), followed by the third (208.99 DE= 39.33) and lastly by the second level (196.06 DE=42.27) (F=6.854, p=0.001). According to nurse categories, the greatest mean was found among the professional nurses of the first level of care (218.26 DE=45.44), while the lowest mean was found among professional nurses of the second level of care (189.15 DE=44.82) (X2=16.387, p=0.006). The following dimensions showed significant differences in relation to level of care (p<0.05): satisfaction from work, wellness achieved through work, worker's personal development and management of free time. Free time management showed significant differences in relation to nurse categories (p<0.05). Conclusions: The nursing staff is fairly satisfied with their quality of life at work, regardless of level of care and nurse category (207.32 DE=41.74), with the exception of professional nurses of the second level of care, who perceive their quality of life at work as low.

Fuerza laboral que envejece, ¿qué hacer ante esta tendencia? / Ageing workforce: What do to this trend?

OBJETIVO: Conocer las diversas implicancias del envejecimiento en la fuerza laboral activa, sus consecuencias y las posibles estrategias ante esta tendencia desde el punto de vista de la salud y la enfermería del trabajo. MÉTODO: Se realizó una revisión narrativa consultando diversas bases de datos y textos relacionadas con la temática. DESARROLLO: Se exponen diferentes enfoques del envejecimiento de las personas trabajadoras, considerando su desarrollo humano como un fenómeno multidimensional, que involucra una serie de consecuencias que afectan directamente al desempeño laboral actual. De este modo, se analizan los desafíos enmarcados en las necesidades de salud convocadas por los muchos problemas del adulto trabajador envejecido y se proyecta una serie de estrategias ante esta tendencia. CONCLUSIONES: El envejecimiento de la fuerza laboral y los años de vida socialmente productivos se ven influenciados por varios factores, en donde la condición de salud delimita la calidad y prolongación del período de trabajo activo, por lo cual, el rol de enfermería es preponderante en la protección de la salud y la prevención de accidentes y enfermedades profesionales, guiando por medio de su rol promotor a diversas entidades, fomentando la intersectorialidad con involucramiento de la familia, la comunidad, las empresas y entes afines al trabajador, con el objetivo de propiciar lineamientos y oportunidades para un envejecimiento activo y saludable.

OBJECTIVE: To know the various implications of aging on the active labor force, its consequences and possible strategies to this trend from the point of view of health and nursing work. METHOD: Narrative review made by consulting various databases and texts related to the topic. DEVELOPMENT: In the study are exposed different approaches the aging of working people, given its human development as a multidimensional phenomenon that involves a series of consequences that directly affect the actual job performance. Thus, are analyzed the challenges framed in health needs convened by the many problems of the aged adult worker and a number of strategies projected with this trend. CONCLUSIONS: The aging of the workforce and socially productive years of life are influenced by several factors, where the health condition defines the quality and extension of the period of active work, so the nursing role is predominant in the health protection and prevention of occupational accidents and diseases, through its leading role in promoting in various entities, promoting intersectoral involvement with the family, the community, companies and entities related to the worker, with the aim of promoting guidelines and opportunities for an active and healthy aging.

Generación, difusión y transferencia del conocimiento de enfermería a la práctica del cuidado / Generation, diffusion and transfer of nursing care knowledge into practice

El objetivo de este artículo es analizar y reflexionar sobre los aspectos relacionados con la generación, difusión y transferencia del conocimiento de enfermería a la práctica del cuidado. La generación del conocimiento de enfermería ha evolucionado gracias al desarrollo de la investigación científica, la cual ha producido conocimiento para dar respuestas a las necesidades de la profesión y de la sociedad, la difusión del mismo es imprescindible para que se produzca la transferencia de este conocimiento a la práctica de enfermería; sin embargo existen limitaciones y problemas en estas etapas del proceso que deben ser superados para lograr que este conocimiento permita ser contrastado con los cuidados proporcionados a las personas, familias y comunidades de la sociedad humana.

The aim of this paper is to analyze and meditate about the aspects related to the generation, dissemination and knowledge transfer to nursing care practice. The nursing knowledge generation has evolved thanks to the scientific research development, which has produced knowledge to respond to the profession and society requirements. Knowledge dissemination is essential to produce the transfer of this knowledge to nursing practice; however there are limitations and problems in these stages of the process that must be overcome to make this knowledge allowed to be contrasted with the care provided to individuals, families and communities of human society.

Psychosocial factors and mental work load: a reality perceived by nurses in intensive care units.

OBJECTIVE: To analyse the perception of psychosocial factors and mental workload of nurses who work in intensive care units. It is hypothesised that nurses in these units could perceive psychosocial risks, manifesting in a high mental work load. The psychosocial dimension related to the position's cognitive demands is hypothesised to mostly explain mental work load. METHOD: Quantitative study, with a descriptive, cross-sectional, and comparative design. A total of 91% of the intensive care unit populations of three Chilean hospitals was surveyed, corresponding to 111 nurses. The instruments utilised included (A) a biosociodemographic history questionnaire; (b) the SUSESO-ISTAS 21 questionnaire; and (c) the Mental Work Load Subjective Scale (ESCAM, in Spanish). RESULTS: In total, 64% and 57% of participants perceived high levels of exposure to the psychosocial risks Psychosocial demands and Double shift, respectively. In addition, a medium-high level of overall mental load was observed. Positive and significant correlations between some of the SUSESO-ISTAS 21 and ESCAM dimensions were obtained. Using a regression analysis, it was determined that three dimensions of the psychosocial risk questionnaire helped to explain 38% of the overall mental load. CONCLUSION: Intensive care unit nurses felt that inadequate psychosocial factors and mental work overload existed in several of the tested dimensions.

Psychosocial factors and mental work load: a reality perceived by nurses in intensive care units / Fatores psicossociais e carga mental de trabalho: uma realidade percebida pelos enfermeiros em Unidades de Terapia Intensiva / Factores psicosociales y Carga mental de trabajo: una realidad percibida por enfermeras/os en Unidades Críticas

OBJECTIVE: To analyse the perception of psychosocial factors and mental workload of nurses who work in intensive care units. It is hypothesised that nurses in these units could perceive psychosocial risks, manifesting in a high mental work load. The psychosocial dimension related to the position's cognitive demands is hypothesised to mostly explain mental work load. METHOD: Quantitative study, with a descriptive, cross-sectional, and comparative design. A total of 91% of the intensive care unit populations of three Chilean hospitals was surveyed, corresponding to 111 nurses. The instruments utilised included (A) a biosociodemographic history questionnaire; (b) the SUSESO-ISTAS 21 questionnaire; and (c) the Mental Work Load Subjective Scale (ESCAM, in Spanish). RESULTS: In total, 64% and 57% of participants perceived high levels of exposure to the psychosocial risks Psychosocial demands and Double shift, respectively. In addition, a medium-high level of overall mental load was observed. Positive and significant correlations between some of the SUSESO-ISTAS 21 and ESCAM dimensions were obtained. Using a regression analysis, it was determined that three dimensions of the psychosocial risk questionnaire helped to explain 38% of the overall mental load. CONCLUSION: Intensive care unit nurses felt that inadequate psychosocial factors and mental work overload existed in several of the tested dimensions. .

OBJETIVO: analisar a percepção de fatores psicossociais e a carga mental de trabalho de enfermeiros que trabalham em unidades de terapia intensiva. A hipótese é que os enfermeiros dessas unidades podem perceber os riscos psicossociais e manifestar uma alta carga mental de trabalho. Além disso, a dimensão psicossocial relacionada às demandas cognitivas do cargo explicaria a maior parte da carga mental de trabalho. MÉTODO: estudo quantitativo, com delineamento descritivo, transversal e comparativo. Foi examinada 91% da população das Unidades de Terapia Intensiva de três hospitais chilenos, correspondente a 111 enfermeiros. Os instrumentos utilizados incluíram (a) um questionário do histórico biossociodemográfico; (b) o questionário SUSESO-ISTAS 21; e (c) a Escala Subjetiva de Carga Mental de Trabalho (ESCAM). RESULTADOS: no total, 64% e 57% dos participantes perceberam um alto nível de exposição aos riscos psicossociais Demanda psicológica e Jornada dupla, respectivamente. Além disso, foi observado um nível de médio para alto de carga mental global. Foram obtidas correlações positivas e significativas entre algumas das dimensões do SUSESO-ISTAS 21 e do ESCAM. Utilizando uma análise de regressão, determinou-se que três dimensões do questionário de risco psicossocial ajudaram a explicar 38% da carga mental total. CONCLUSÃO: os enfermeiros das unidades de terapia intensiva percebem os fatores psicossociais e a sobrecarga mental de trabalho em várias de suas dimensões. .

OBJETIVO: analizar la percepción de Factores psicosociales y Carga mental de trabajo de enfermeras/os que laboran en Unidades Críticas. Se hipotetiza que los/as enfermeros/as de estas unidades pudieran percibir riesgos psicosociales; Mostrarán una Carga mental de trabajo alta; y la dimensión psicosocial relacionada con exigencias cognitivas del puesto explicará en mayor medida la Carga Mental. MÉTODO: estudio cuantitativo, de diseño descriptivo, transversal y comparativo. Se censó el 91% de la población de Unidades Críticas de tres hospitales chilenos, correspondiente a 111 enfermeras/os. Los instrumentos utilizados fueron: (a) Cuestionario de antecedentes biosociodemográficos; (b) Cuestionario SUSESO-ISTAS 21; y (c) Escala Subjetiva de Carga Mental de Trabajo (ESCAM). RESULTADOS: el 64% y el 57% de los/as participantes perciben un alto nivel de exposición a los riesgos psicosociales Demandas psicológicas y Doble presencia, respectivamente. Además, se obtiene un nivel de Carga mental global media-alta. Se obtuvo correlaciones positivas y significativas entre algunas dimensiones de SUSESO-ISTAS 21 y ESCAM, y mediante un análisis de regresión se obtuvo que tres dimensiones del cuestionario de riesgos psicosociales contribuyen a explicar un 38% de la Carga mental global. CONCLUSIÓN: las/os enfermeras/os de unidades críticas, perciben factores psicosociales inadecuados y sobrecarga mental de trabajo, en varias de sus dimensiones. .

Validación de escala subjetiva de carga mental de trabajo en funcionarios/as universitarios / Validation of subjective mental workload scale in academics staff

Objetivo: Evaluar las características psicométricas de la Escala Subjetiva de Carga Mental de Trabajo (ESCAM). Material y método: La población de este estudio estuvo constituida por 56 personas de ambos sexos, obtenidos a través de un censo a los y las funcionarios/as de dos facultades de una universidad chilena, quienes respondieron la Escala Subjetiva de Carga Mental de Trabajo y cuestionario de Evaluación de Riesgos Psicosociales. La fiabilidad fue comprobada con el coeficiente de alfa de Cronbach; para la validez de contenido, la escala fue revisada por expertos ad hoc; la validez de constructo fue evaluada por análisis factorial con rotación Varimax, y la validez de criterio se midió al correlacionar los resultados de la escala con el instrumento validado SUSESO-ISTAS 21. Resultados: Se obtuvo una adecuada confiabilidad (a=0.79), además una validez de contenido por análisis de expertos y prueba piloto; validez de criterio por análisis factorial; y validez de constructo por correlación de Pearson, las que confirmaron la estructura multidimensional de escala. Conclusiones: ESCAM es un instrumento fiable y válido para evaluar la percepción de Carga Mental de Trabajo.

Objective: Evaluate the psychometric characteristics of the Subjective Mental Workload Scale (SMWS). Materials and methods: the sample of this study consisted of 56 persons of both genders, obtained through a census of the staff of two faculties of a Chilean university, who answered the Subjective Mental Workload Scale and the psychosocial risks evaluation questionnaire. The reliability was verified by Cronbach alpha coefficient, for the validity of content, the scale was checked by ad hoc experts. Constructo validity was evaluated by factorial analysis with Varimax rotation, and the criterion validity was measured when the results of the scale were correlated with the validated instrument SUSESO-ISTAS 21. Results: the multidimensional structure of the scale was confirmed, with a suitable reliability (a=0.79), the criterion validity by factorial analysis, and the constructo validity by Pearson correlation. Conclusion: SMWS is indicated as a reliable and valid instrument to evaluate the Mental Workload Perception.

Factores de riesgos psicosociales en el trabajo: género y enfermería / Psychosocial risk factors at work: gender and nursing

Este trabajo tiene como objetivo reflexionar sobre los aspectos teóricos relacionados con los riesgos psicosociales a nivel laboral, analizar con enfoque de género las desigualdades en relación con los riesgos y vincular la enfermería con los riesgos psicosociales. Se presentan los aspectos teóricos, asociados con los factores de riesgos psicosociales y se visibilizan algunas desigualdades presentes en los lugares de trabajo entre hombres y mujeres; además, el personal sanitario es uno de los que más está expuesto a riesgos psicosociales, por lo que estas temáticas deben incorporarse a los modelos formativos de pregrado de las escuelas de enfermería y en los programas de postgrado con la finalidad de profundizar sobre los riesgos.

These work's objectives are to reflect over the theoretical aspects related to the psychosocial risks at working level, to analyze the inequalities in terms of gender, with respect to the mentioned risks and link the nursing practices with the psycho-social risks. To make some current inequalities between men and women in the working places visible, and to propose the health-care personnel is one of the groups most exposed to psychosocial risks, as a matter of fact these aspects should be incorporated in the training models of undergraduate programs and nursing schools and to deepen the study about these risks.

Este trabalho tem como objetivo refletir acerca dos aspectos teóricos relacionados com os riscos psicossociais no trabalho, analisar com enfoque de gênero as desigualdades relacionadas com os riscos e vincular a enfermagem com os riscos psicossociais. Apresentam-se os aspectos teóricos, associados com os fatores de risco psicossociais e visibilizam-se algumas desigualdades presentes nos locais de trabalho entre homens e mulheres; além o pessoal sanitário é um dos que mais se encontra exposto a riscos psicossociais, pelo qual estas temáticas devem incorporar-se aos modelos formativos de graduação e nos programas de pós-graduação das faculdades de enfermagem, com a finalidade de aprofundar sobre os riscos.

Trabajos atípicos en Chile: un desafío para la salud laboral y la enfermería del trabajo / Atypical jobs in Chile: a challenge for occupational health and work nursing

Objetivo: El presente artículo se propone analizar las diversas formas de trabajo atípico, tales como el subcontrato o tercerización, el trabajo a domicilio y el teletrabajo, los cuales se caracterizan principalmente por tener una fuerza laboral femenina y representan un tipo de empleo emergente en Chile. Método: Se realizó un método de revisión narrativa consultando a diversas bases de datos, páginas web de organizaciones gubernamentales y no gubernamentales, y textos relacionados con la temática. Desarrollo: Se enuncian los diversos factores asociados al desarrollo de este tipo de trabajo. Se analizan algunas formas de trabajos atípicos. Finalmente se presentan implicancias para enfermería y algunas estrategias abordadas con enfoque interdisciplinar para favorecer el bienestar de los trabajadores que se desempeñan en tareas atípicas. Conclusiones: Este tipo de trabajo expone a los trabajadores a un alto grado de vulnerabilidad y que lamentablemente tienen un escaso abordaje en salud. Se observa la necesidad de desarrollar investigaciones interdisciplinarias que aporten en la implementación de políticas públicas y diversas estrategias que permitan favorecer la salud y el bienestar de los trabajadores atípicos.

Objective: This article aims to analyze the diverse form of atypical work, such as subcontract or outsourcing, homeworking and teleworking, which is mainly characterized by having a female workforce and represent a type of emergent employment in Chile. Method: It was used a narrative review method by consulting various databases , web pages from governmental and non-governmental organizations, and texts related to the topic. Development: Various factors associated with the development of this work were stated. Some forms of atypical work are analyzed. Finally, implications for nursing and some strategies addressed with interdisciplinary approach to favor the welfare of workers in atypical tasks are presented. Conclusions: This type of work exposes workers to a high degree of vulnerability and unfortunately they have limited health approach. It is observed the need to develop interdiscipllinary research that contributes to the implementation of public policies and different strategies to favor the health and welfare of atypical workers.

Coaching educativo como estrategia para fortalecer el liderazgo en enfermería / Coaching education as a strategy to enhance nursing leadership

El propósito del artículo es presentar el coaching educativo como una estrategia pedagógica para desarrollar y fortalecer el liderazgo en enfermería. Enuncia los elementos que pueden facilitar o dificultar el liderazgo en enfermería y se destaca a la educación como el factor clave para la adquisición de competencias necesarias para su ejercicio. Finalmente, se proponen algunos lineamientos operacionales para fortalecer y potenciar el liderazgo en la formación de enfermeras/os a través del coaching educativo.

The purpose of this article is to present the coaching education as a pedagogical strategy to develop and strengthen leadership in nursing. It states elements that may facilitate or hinder nursing leadership and education stands out as the key factor for the acquisition of necessary skills for their exercise. Finally, we propose some ways to strengthen and enhance leadership in the education of nurses through educative coaching.

Aplicación del modelo de violencia laboral de Chappell y Di Martino adaptado al usuario hospitalizado / Application of the Chappell and Di Martino Model of Violence at Work to Hospitalized Users / Aplicação do modelo de violência no trabalho de Chappell e Di Martino adaptado para o usuário hospitalizado

La violencia es un fenómeno que involucra a seres humanos en diversas circunstancias y entornos, afectando la salud, el desarrollo social y económico de sectores de la población y a instituciones sanitarias. Investigación cuantitativa descriptiva correlacional transversal, cuyos objetivos fueron: validar los factores del modelo de Chappell y Di Martino en los usuarios hospitalizados, medir la violencia que estos perciben hacia ellos y construir una escala para medir violencia en el contexto hospitalario. La muestra no probabilística estuvo conformada por 510 usuarios hospitalizados durante el 2008, a quienes previo consentimiento informado se les aplicó el instrumento, que fue confeccionado y validado por las autoras. Entre los resultados se encontró que al aplicar la escala de percepción de violencia, el 100 % de los usuarios manifestaron percibir violencia en las diversas dimensiones. Las variables significativas en la percepción de violencia fueron: edad, sexo, previsión, situación laboral, ingreso familiar, calidad de atención, antecedentes de violencia en la adultez, consumo de alcohol, agente agresor, recursos humanos y físicos. Se concluye que el modelo interactivo de violencia laboral de Chappell y Di Martino tiene aplicación en los usuarios en ambientes hospitalarios, ya que las variables que componen los factores también se presentan en estos contextos de salud.

Violence is a phenomenon that affects human beings in different circumstances and surroundings, influencing health, the social and economic development of population groups, and health-care institutions. Method: A descriptive, correlational, cross-sectional, quantitative study was done to validate the factors of the Chappell and Di Martino model in hospitalized users, to measure the violence they perceive as being directed towards them, and to construct a scale for measuring violence in the hospital context. It featured a non-probability sample comprised of 510 hospital users in 2008, who gave prior informed consent to application of the instrument, which was designed and validated by the authors. In terms of the results, application of the violence perception scale showed 100% of the users indicated having perceived violence in various dimensions. The significant variables in violence perception were age, gender, sensation, job situation, family income, quality of care, history of violence in adulthood, alcohol consumption, aggressor agent, and human and fiscal resources. It was concluded Chappell and Di Martino's interactive model of violence at work is applicable to users in hospital environments, since the variables that comprise the factors also are found in these health-care contexts.

A violência, um fenômeno que envolve seres humanos em várias circunstâncias e ambientes, afeta a saúde, o desenvolvimento social e econômico de setores da população, e as instituições de saúde. Método: pesquisa quantitativa descritiva, transversal, correlacional, cujos objetivos foram: validar os fatores do modelo de Carvalho e Di Martino nos pacientes hospitalizados, medir a violência percebida contra eles e construir uma escala para medir a violência no hospital. A amostra não aleatória constou de 510 pacientes internados em 2008. Depois assinar o consentimento informado, se lhes aplicou o instrumento elaborado e validado pelas autoras. Os resultados mostraram que ao aplicar a escala de percepção da violência, 100% dos usuários percebem a violência expressa em várias dimensões. As variáveis significativas na percepção da violência foram: idade, sexo, segurança social, situação de emprego, renda familiar, qualidade de atendimento, história de violência na fase adulta, consumo de álcool, agente agressor, recursos humanos e físicos. Concluímos que o modelo interativo de violência no trabalho de Chappell e Di Martino pode aplicar-se aos usuários em ambientes hospitalares, porque as variáveis que compõem os fatores também se acham nestes contextos de saúde.