Intensity of nursing work in public hospitals / Intensidade do trabalho em enfermagem nos hospitais públicos / La intensidad del trabajo en enfermería en los hospitales públicos

Abstract Objective: to analyze the intensity of nursing work in public hospitals. Method: cross-sectional, quantitative study, carried out in 22 public hospitals. The sample was composed of 265 nurses and 810 nursing technicians and assistants. Data were collected through a questionnaire and analyzed with Exploratory Factor Analysis. The calculation of the distribution of the work intensity by category was done using a score ranging from -1 to +1 standard deviation of the data. Fisher's exact test (0.05 <p≤0.10) was used to observe the significance between groups according to the employment bond. Results: work intensity contributed to the explanation of precarization of work, with a value of 13% for nurses and 51.2% for technicians and assistants. For the technicians and assistants, the variables with the highest factor loadings were 'work requires more than she can do' (0.6696) and 'takes on multiple tasks due to staff shortages' (0.6156). Among nurses, the highest factor loadings were observed in the variables 'time pressure at work (0.6779) and 'Work pace' (0.6651). Conclusion: the variables analyzed indicate that work intensity occurs differently among nursing workers, and is revealed by the versatility, understaffing and flexibility of work.

Resumo Objetivo: analisar a intensidade do trabalho em enfermagem nos hospitais públicos. Método: estudo transversal, quantitativo, realizado em 22 hospitais públicos. A amostra totalizou 265 enfermeiras e 810 técnicas e auxiliares em enfermagem. Os dados foram coletados por meio de questionário e analisados com a Análise Fatorial Exploratória. O cálculo da distribuição da intensidade do trabalho por categoria foi feito por escore que abarca de -1 a +1 desvio padrão dos dados e utilizou-se o teste Exato de Fisher (0,05 <p≤0,10) para observar a significância entre os grupos de acordo com o vínculo de trabalho. Resultados: a intensidade do trabalho contribuiu com 13% da precarização do trabalho para as enfermeiras e 51,2% para as técnicas e auxiliares. Para as técnicas e auxiliares as variáveis com maior carga fatorial foram trabalho exige mais do que pode fazer (0.6696) e assume múltiplas atribuições devido à escassez de pessoal (0.6156). Entre as enfermeiras as maiores cargas fatoriais foram observadas nas variáveis pressão do tempo no trabalho (0.6779) e ritmo de trabalho (0.6651). Conclusão: as variáveis analisadas indicam que a intensidade do trabalho ocorre de forma distinta entre as trabalhadoras em enfermagem, o que se revela pela polivalência, subdimensionamento e flexibilização do trabalho.

Resumo Objetivo: analizar la intensidad del trabajo en enfermería en los hospitales públicos. Método: estudio transversal, cuantitativo, realizado en 22 hospitales públicos. La muestra totalizó 265 enfermeras y 810 técnicas y asistentes de enfermería. Los datos fueron recolectados a través de un cuestionario y analizados con el Análisis Factorial Exploratorio. El cálculo de la distribución de la Intensidad del trabajo, por categoría, se realizó utilizando una puntuación que varía de -1 a +1 desviación estándar de los datos, y se utilizó la prueba Exacta de Fisher (0,05 <p≤0,10) para observar la significancia entre grupos según la relación laboral. Resultados: la Intensidad del trabajo contribuyó con el 13% de la explicación trabajo precario para las enfermeras y el 51,2% para técnicas y asistentes. Para las técnicas y auxiliares, las variables con la carga de factor más alta fueron trabajo requiere más de lo que puede hacer (0,6696) y asume múltiples asignaciones debido a la escasez de personal (0,6156). Entre las enfermeras, las cargas de factor más altas se observaron en las variables presión de tiempo en el trabajo (0,6779) y ritmo de trabajo (0,6651). Conclusión: las variables analizadas indican que la intensidad del trabajo ocurre de manera diferente entre los trabajadores de enfermería, lo que se revela por la versatilidad, por condiciones laborales reducidas y la flexibilización del trabajo.

Uncovering the Disconnect Between Nursing Workforce Policy Intentions, Implementation, and Outcomes: Lessons Learned From the Addition of a Nursing Assistant Role.

The use of nursing assistants has increased across health systems in the past 20 years, to alleviate licensed nurses' workload and to meet rising health care demands at lower costs. Evidence suggests that, when used as a substitute for licensed nurses, assistants are associated with poorer patient and nurse outcomes. Our multimethods study evaluated the impact of a policy to add nursing assistants to existing nurse staffing in Western Australia's public hospitals, on a range of outcomes. In this article, we draw the metainferences from previously published quantitative data and unpublished qualitative interview data. A longitudinal analysis of patient records found significantly higher rates adverse patient outcomes on wards that introduced nursing assistants compared with wards that did not. These findings are explained with ward-level data that show nursing assistants were added to wards with preexisting workload and staffing problems and that those problems persisted despite the additional resources. There were also problems integrating assistants into the nursing team, due to ad hoc role assignments and variability in assistants' knowledge and skills. The disconnect between policy intention and outcomes reflects a top-down approach to role implementation where assistants were presented as a solution to nurses' workload problems, without an understanding of the causes of those problems. We conclude that policy makers and managers must better understand individual care environments to ensure any new roles are properly tailored to patient and staff needs. Further, standardized training and accreditation for nursing assistant roles would reduce the supervisory burden on licensed nurses.

The health care aide position in nursing homes: A comparative survey of nurses' and aides' perceptions.

BACKGROUND: The health care aide position embodies one of the most basic paradoxes of long-term care for older adults: those who have the most contact and most intensive interaction with nursing-home residents are also those having the least training, authority, and status within the system. They therefore hold one of the keys to quality care in many settings, especially nursing homes. In the absence of agreement on the position's roles, responsibilities, and authority, it is important to examine how the position is perceived by the key members in the long-term-care framework. OBJECTIVES: The current study examined and compared health care aides' and nurses' perceptions of the position in nursing-home settings in Israel, using a standardized tool developed for this inquiry. The comparison accounted for potential intervening factors that may help better understand the job requirements and boundaries. DESIGN: A comparative survey design. SETTINGS: 30 nursing homes (of at least 20 beds) in northern Israel. PARTICIPANTS: We used convenience sampling to recruit 369 health care aides and 261 nurses (a total of 630 participants). METHODS: The main instrument of data collection was specially designed and validated for this study. It was based on a qualitative study that defined basic content units representing tasks importance, knowledge, and personal characteristics for the job. RESULTS: Participants found it difficult to prioritize the job components or to differentiate between core tasks and characteristics and the secondary aspects of their job. General care, profession-specific knowledge, and emotional abilities were endorsed the most by participants. Cleaning, communication, and safety were ranked lower (although rankings were still considerably high). However, previous experience as a health care aide undermined incumbents' perceptions of their own responsibilities and professionalism. Incumbent health care aides rated most factors higher than nurses did, with the exception of the importance of communication. CONCLUSION: Our results may help decision makers understand the complexity around the health care aide position, manage and develop it more effectively while setting standards (training and certification, performance appraisal, and more) for professionalization processes and better defining the division of nursing work between health care aides and nurses.

Care staff's self-efficacy regarding end-of-life communication in the long-term care setting: Results of the PACE cross-sectional study in six European countries.

BACKGROUND: An important part of palliative care is discussing preferences at end of life, however such conversations may not often occur. Care staff with greater self-efficacy towards end-of-life communication are probably more likely to have such discussions, however, there is a lack of research on self-efficacy towards end-of-life discussions among long-term care staff in Europe and related factors. OBJECTIVES: Firstly, to describe and compare the self-efficacy level of long-term care staff regarding end-of-life communication across six countries; secondly, to analyse characteristics of staff and facilities which are associated to self-efficacy towards end-of-life communication. DESIGN: Cross-sectional survey. SETTINGS: Long-term care facilities in Belgium, England, Finland, Italy, the Netherlands and Poland (n = 290). PARTICIPANTS: Nurses and care assistants (n = 1680) completed a self-efficacy scale and were included in the analyses. METHODS: Care staff rated their self-efficacy (confidence in their own ability) on a scale of 0 (cannot do at all) to 7 -(certain can do) of the 8-item communication subscale of the Self-efficacy in End-of-Life Care survey. Staff characteristics included age, gender, professional role, education level, training in palliative care and years working in direct care. Facility characteristics included facility type and availability of palliative care guidelines, palliative care team and palliative care advice. Analyses were conducted using Generalized Estimating Equations, to account for clustering of data at facility level. RESULTS: Thde proportion of staff with a mean self-efficacy score >5 was highest in the Netherlands (76.4%), ranged between 55.9% and 60.0% in Belgium, Poland, England and Finland and was lowest in Italy (29.6%). Higher levels of self-efficacy (>5) were associated with: staff over 50 years of age (OR 1.86 95% CI[1.30-2.65]); nurses (compared to care assistants) (1.75 [1.20-2.54]); completion of higher secondary or tertiary education (respectively 2.22 [1.53-3.21] and 3.11 [2.05-4.71]; formal palliative care training (1.71 [1.32-2.21]); working in direct care for over 10 years (1.53 [1.14-2.05]); working in a facility with care provided by onsite nurses and care assistants and offsite physicians (1.86 [1.30-2.65]); and working in a facility where guidelines for palliative care were available (1.39 [1.03-1.88]). CONCLUSION: Self-efficacy towards end-of-life communication was most often low in Italy and most often high in the Netherlands. In all countries, low self-efficacy was found relatively often for discussion of prognosis. Palliative care education and guidelines for palliative care could improve the self-efficacy of care staff.

Mechanisms for reducing low back pain: a mediation analysis of a multifaceted intervention in workers in elderly care.

PURPOSE: A multifaceted workplace intervention consisting of participatory ergonomics, physical training, and cognitive-behavioural training (CBT) has shown effectiveness for reducing low back pain (LBP). However, the mechanisms of action underlying these intervention components are not well understood. METHODS: This was a mediation analysis of a cluster-randomised controlled trial of a multifaceted intervention in 420 workers in elderly care. Mediation analysis was carried out via structural equation modelling. Potential mediators investigated were: fear-avoidance beliefs, perceived muscle strength, use of assistive devices at work and perceived physical exertion at work. LBP outcomes assessed were: days with LBP, LBP intensity and days with bothersome LBP. RESULTS: There were no significant indirect effects of the intervention on LBP outcomes. There were significant effects of the intervention on both fear-avoidance measures [ß = - 0.63, 95% CI (1.23, 0.03); ß = - 1.03, 95% CI (- 1.70, - 0.34)] and the use of assistive devices [ß = - 0.55, 95% CI (- 1.04, - 0.05)], but not on perceived muscle strength [ß = - 0.18, 95% CI (- 0.50, 0.13)] or physical exertion [ß = - 0.05, 95% CI (- 0.40, 0.31)]. The only potential mediator with a significant effect on LBP outcomes was physical exertion, which had a significant effect on LBP intensity [ß = 0.14, 95% CI (0.04, 0.23)]. CONCLUSIONS: A multifaceted intervention consisting of participatory ergonomics, physical training, and CBT was able to decrease fear-avoidance beliefs and increase use of assistive devices in the workplace. However, these changes did not explain the effect of any of the intervention components on days with LBP, LBP intensity and days with bothersome LBP.

The Effects of the Hospice & Palliative Care Education Program for Caregivers / 한국호스피스완화의료학회지

PURPOSE: This study aimed to identify how an education program on palliative care affects nursing home caregivers' perception of hospice care and attitude towards terminally ill patient care. METHODS: This study was conducted using a nonequivalent control group with a pretest-posttest design. The participants were 101 certified care workers: 58 in the experimental group and 43 in the control. The experimental group completed the palliative care education program consisted of 20 hours of classroom training and 20 hours of clinical practicum. An ANCOVA was performed to compare the score changes to outcome variables. RESULTS: Compared with the control group, the experimental group showed significant pretest-posttest differences in both the perception of hospice care (F=21.09, P < 0.001) and attitude towards caring for terminally ill patients (F=13.28, P < 0.001). CONCLUSION: These results indicate that the palliative care education program for caregivers is effective in preparing participants to provide hospice/palliative care service. Further study is warranted to explore the effects of this program on palliative caregivers' performance.

Consumo de sustancias psicoactivas en auxiliares de enfermería / Consumo de sustâncias psicoativas em auxiliares de enfermagem / Consumption of psychoactive substances by nursing aides

INTRODUCCIÓN: El consumo de drogas trae consecuencias adversas en todos los ámbitos y se considera un problema de salud pública. El objetivo fue determinar la prevalencia de consumo de sustancias psicoactivas en auxiliares de enfermería. MATERIALES Y MÉTODOS: Estudio descriptivo, transversal, muestra probabilística constituida por 110 auxiliares de enfermería que trabajaban en una institución de salud. La información se recolectó a través de una encuesta que contenía variables demográficas y de consumo, se aplicaron los test de CAGE y de Fagerström. Se calcularon medidas de tendencia central y de dispersión para variables cuantitativas y frecuencias absolutas y relativas para las cualitativas, se realizó análisis bivariado, que estableció la diferencia de proporciones de consumo en vida de sustancias psicoactivas por algunas variables sociodemográficas. RESULTADOS: La mediana de edad fue de 29 años, el 81.8% eran mujeres, el 60% estaban solteras. La sustancia más consumida fue el alcohol con 62.7%, seguido por bebidas energizantes con 28.2% y tabaco 19.1%. DISCUSIÓN: Igual que en otros estudios las sustancias más consumidas fueron el alcohol y el tabaco, los que más consumieron fueron los hombres. Los motivos para el consumo fueron socializar. Más de la cuarta parte consumieron bebidas energizantes para aumentar el estado de alerta. La prevalencia del consumo de alcohol en vida es menor que la reportada en población general colombiana. CONCLUSIONES: El consumo de sustancias legales e ilegales excepto los sedantes fue menor a las reportadas en población general y semejante a otros estudios en personal de salud.

INTRODUÇÃO: O consumo de drogas traz consequências adversas em todos os âmbitos e é considerado um problema de saúde pública. O objetivo foi determinar a prevalência de consumo de sustâncias psicoativas em auxiliares de enfermagem. MATERIAIS E MÉTODOS: Estudo descritivo transversal, amostra probabilística composta por 110 auxiliares de enfermagem que trabalham em uma instituição de saúde. A informação foi coletada através de um instrumento que continha variáveis demográficas e de consumo, se aplicaram os testes de CAGE e de Fagerström. Calcularam-se medidas de tendência central e de dispersão para as variáveis quantitativas e frequências absolutas e relativas para as qualitativas, se realizou análise bivariada, que estabeleceu a diferença nas proporções de consumo na vida de sustâncias psicoativas por algumas variáveis sócio-demográficas. RESULTADOS: A idade média foi de 29 anos, 81,8% eram mulheres, 60% eram solteiras. A substância mais utilizada foi o álcool com 62,7% de álcool, seguida de bebidas energéticas com 28,2% e tabaco com 19,1%. DISCUSSÃO: Como em outros estudos, as substâncias mais consumidas foram álcool e o tabaco, os mais consumidores eram homens. As razões para o consumo foram socializar. Mais de um quarto consumiram bebidas energéticas para aumentar a vigilância. A prevalência do consumo de álcool na vida é menor do que a relatada na população geral da Colômbia. CONCLUSÕES: O consumo de substâncias lícitas e ilícitas, exceto sedativos foram menores do que os relatados na população em geral e semelhante a outros estudos em pessoal de saúde.

INTRODUCTION: Drug use brings negative consequences in all settings and it is considered a public health problem. The aim was to determine the prevalence of consumption of psychoactive substances by nursing aides. MATERIALS AND METHODS: Cross-sectional descriptive study, with probabilistic sample comprised of 110 nursing aides who work in a health institution. The information was collected through a survey that contained demographic and consumption variables; CAGE and Fagerström tests were applied. Measures of central tendency and dispersion were calculated for quantitative variables and absolute and relative frequencies were calculated for qualitative variables. Bivariate analysis was performed, establishing the difference lifetime consumption proportions of psychoactive substances for some sociodemographic variables. RESULTS: Mean age was 29 years, 81.8% were women, and 60% were single. The most-consumed substance was alcohol with 62.7%, followed by energy drinks with 28.2%, and tobacco at 19.1%. DISCUSSION: As in other studies, the most-consumed substances were alcohol and tobacco; men were the highest consumers. The motives for consuming were to socialize. More than a fourth consumed energy drinks to increase their state of alertness. The prevalence of lifetime consumption of alcohol is lower than that reported in the general Colombian population. CONCLUSIONS: Consumption of legal and illegal substances, except for sedatives was lower than those reported in the general population and similar to other studies in health staff.

A Multidisciplinary Workplace Intervention for Chronic Low Back Pain among Nursing Assistants in Iran.

STUDY DESIGN: Interventional research with a 6-month follow-up period. PURPOSE: We aimed to establish the effectiveness of a multidisciplinary workplace intervention on reduction of work-related low back pain (WRLBP), using ergonomic posture training coupled with an educational program based on social cognitive theory. OVERVIEW OF LITERATURE: WRLBP is a major occupational problem among healthcare workers, who are often required to lift heavy loads. Patient handling is a particular requirement of nurse aides, and has been reported as the main cause of chronic WRLBP. METHODS: We included 125 nursing assistants from two hospitals affiliated to Qom University of Medical Sciences from May to December 2015. There was an intervention hospital with a number of 63 nursing assistants who received four multidisciplinary educational sessions for 2 hours each plus ergonomic posture training over two days and a control hospital with a number of 62 nursing assistants who didn't receive educational intervention about low back pain. The outcomes of interest were reductions in WRLBP intensity and disability from baseline to the follow up at 6 months, which were measured using a visual analog scale and the Quebec Disability Scale. Descriptive and analytical statistics were used to analyze the data. RESULTS: The comparison tests showed significant change from baseline in reduction of WRLBP intensity following the multidisciplinary program, with scores of 5.01±1.97 to 3.42±2.53 after 6 months on the visual analog scale in the intervention group (p<0.001) and no significant change in control groups. There was no significant difference in the disability scores between the two groups (p=0.07). CONCLUSIONS: We showed that our multidisciplinary intervention could reduce the intensity of WRLBP among nurse aides, making them suitable for implementation in programs to improve WRLBP among nursing assistants working in hospitals.

Barriers and facilitators in providing oral care to nursing home residents, from the perspective of care aides: A systematic review and meta-analysis.

BACKGROUND: Oral health of nursing home residents is generally poor, with severe consequences for residents' general health and quality of life and for the health care system. Care aides in nursing homes provide up to 80% of direct care (including oral care) to residents, but providing oral care is often challenging. Interventions to improve oral care must tailor to identified barriers and facilitators to be effective. This review identifies and synthesizes the evidence on barriers and facilitators care aides perceive in providing oral care to nursing home residents. METHODS: We systematically searched the databases MEDLINE, Embase, Evidence Based Reviews-Cochrane Central Register of Controlled Trials, CINAHL, and Web of Science. We also searched by hand the contents of key journals, publications of key authors, and reference lists of all studies included. We included qualitative and quantitative research studies that assess barriers and facilitators, as perceived by care aides, to providing oral care to nursing home residents. We conducted a thematic analysis of barriers and facilitators, extracted prevalence of care aides reporting certain barriers and facilitators from studies reporting quantitative data, and conducted random-effects meta-analyses of prevalence. RESULTS: We included 45 references that represent 41 unique studies: 15 cross-sectional studies, 13 qualitative studies, 7 mixed methods studies, 3 one-group pre-post studies, and 3 randomized controlled trials. Methodological quality was generally weak. We identified barriers and facilitators related to residents, their family members, care providers, organization of care services, and social interactions. Pooled estimates (95% confidence intervals) of barriers were: residents resisting care=45% (15%-77%); care providers' lack of knowledge, education or training in providing oral care=24% (7%-47%); general difficulties in providing oral care=26% (19%-33%); lack of time=31% (17%-47%); general dislike of oral care=19% (8%-33%); and lack of staff=22% (13%-31%). CONCLUSIONS: We found a lack of robust evidence on barriers and facilitators that care aides perceive in providing oral care to nursing home residents, suggesting a need for robust research studies in this area. Effective strategies to overcome barriers and to increase facilitators in providing oral care are one of the most critical research gaps in the area of improving oral care for nursing home residents. Strategies to prevent or manage residents' responsive behaviors and to improve care aides' oral care knowledge are especially needed.

Processes, barriers and facilitators to implementation of a participatory ergonomics program among eldercare workers.

This study aimed to investigate the processes of a participatory ergonomics program among 594 eldercare workers with emphasis on identified risk factors for low back pain and solutions, and reveal barriers and facilitators for implementation. Sixty-nine per cent of the identified risk factors were physical ergonomic, 24% were organisational and 7% were psychosocial risk factors. Most solutions were organisational (55%), followed by physical (43%) and psychosocial solutions (2%). Internal factors (e.g. team or management) constituted 47% of the barriers and 75% of the facilitators. External factors (e.g. time, financial resources, collaboration with resident or relatives) constituted 53% of the barriers and 25% of the facilitators. This study revealed the processes and implementation of a participatory ergonomics program among eldercare workers. The findings can be transferred to workers, workplaces, health and safety professionals, and researchers to improve future participatory ergonomics programs.

Empathy Ability, Communication Ability, and Nursing Performance of Registered Nurses and Nursing Assistants in Long-term Care Hospitals / 간호행정학회지

PURPOSE: The purpose of this study was to investigate empathy ability, communication, and nursing performance among registered nurses (RN) and nursing assistants (NA) in long-term care hospitals. METHODS: Participants were 155 nursing personnel (RN 80 and AN 75) who worked in 8 long-term care hospitals in G city and J Province. Data collection was conducted from July 6 to August 6, 2016. Descriptive statistics, independent t-test, one-way ANOVA, and stepwise multiple regression were used with SPSS/WIN program version 23.0 for data analysis. RESULTS: Nursing performance of RN was significantly influenced by communication ability (β=.88, p<.001) and university graduation (β=.25, p=.025). Nursing performance of NA was influential by communication ability (β=.77, p<.001) and marriage (β=.42, p=.018). CONCLUSION: Findings show that communication ability of RN and NA is important in nursing performance. Therefore, there is a need to develop programs to improve communication ability and validate the effectiveness of the programs in improving nursing performance of nursing personnel working at long-term care hospitals.

A Multidisciplinary Workplace Intervention for Chronic Low Back Pain among Nursing Assistants in Iran

STUDY DESIGN: Interventional research with a 6-month follow-up period. PURPOSE: We aimed to establish the effectiveness of a multidisciplinary workplace intervention on reduction of work-related low back pain (WRLBP), using ergonomic posture training coupled with an educational program based on social cognitive theory. OVERVIEW OF LITERATURE: WRLBP is a major occupational problem among healthcare workers, who are often required to lift heavy loads. Patient handling is a particular requirement of nurse aides, and has been reported as the main cause of chronic WRLBP. METHODS: We included 125 nursing assistants from two hospitals affiliated to Qom University of Medical Sciences from May to December 2015. There was an intervention hospital with a number of 63 nursing assistants who received four multidisciplinary educational sessions for 2 hours each plus ergonomic posture training over two days and a control hospital with a number of 62 nursing assistants who didn't receive educational intervention about low back pain. The outcomes of interest were reductions in WRLBP intensity and disability from baseline to the follow up at 6 months, which were measured using a visual analog scale and the Quebec Disability Scale. Descriptive and analytical statistics were used to analyze the data. RESULTS: The comparison tests showed significant change from baseline in reduction of WRLBP intensity following the multidisciplinary program, with scores of 5.01±1.97 to 3.42±2.53 after 6 months on the visual analog scale in the intervention group (p<0.001) and no significant change in control groups. There was no significant difference in the disability scores between the two groups (p=0.07). CONCLUSIONS: We showed that our multidisciplinary intervention could reduce the intensity of WRLBP among nurse aides, making them suitable for implementation in programs to improve WRLBP among nursing assistants working in hospitals.

Processo de trabalho do profissional de nível médio de enfermagem na estratégia saúde da família / El proceso trabajo del profesional de enfermería de nivel medio en la estrategia de salud de la familia / The work process of the mid-level professional nursing in the family health strategy

Objetivo: analisar a percepção do profissional de nível médio de enfermagem sobre o seu processo de trabalho na Estratégia Saúde da Família. Método: trata-se de um estudo de abordagem qualitativa. Foi desenvolvido em unidades de saúde da família, em um município de médio porte brasileiro. Realizaram-se entrevistas abertas, com oito profissionais de enfermagem. Utilizou-se a Análise de Conteúdo para organização e análise dos dados coletados. Resultado: verificou-se que os profissionais valorizam um processo de trabalho norteado para a realização de procedimentos visando às ações curativas em detrimento de ações de prevenção e promoção. Perceberam-se dificuldades, como a falta de estrutura, grande demanda espontânea para ser atendida e burocratização do processo de trabalho. Também apresentam uma dualidade de sentimentos representados pela satisfação e a frustração com o seu processo de trabalho. Conclusão: é preciso repensar a formação deste profissional, bem como sua inserção na equipe de saúde da família em uma perspectiva de valorização do seu conhecimento.

Abstract: to analyze the perception of the average level of nursing professionals about their work process in the FamilyHealth Strategy. Method: this is a qualitative study. It was developed in Family Health Units in a municipality of Brazilian midfielder size. There were open interviews with eight nurses. We used the Content Analysis for organizing and analyzing the collected data. Results: it was found that professionals value a guided work process for performing procedures tocurative actions to the detriment of prevention and promotion activities. They realized to difficulties such as lack of infrastructure, large spontaneous demand for care and bureaucratization of the labor process. They also have a duality of feelings represented by satisfaction and frustration with your work process. Conclusion: it is necessary to rethink the formation of this professional as well as their integration into family health team with a view to increasing their knowledge.

Objetivo: analizar la percepción del nivel medio de los profesionales de enfermería acerca de su proceso de trabajo en laEstrategia Salud de la Familia. Método: se trata de un estudio cualitativo. Fue desarrollado en las Unidades de Salud de la Familia en un municipio de tamaño centrocampista brasileño. Hubo entrevistas abiertas con ocho enfermeras. Se utilizó el análisis de contenido para organizar y analizar los datos recogidos. Resultados: se encontró que los profesionales valoran un proceso de trabajo guiada para realizar procedimientos de los curativos acciones en detrimento de las actividades de prevención y promoción. Se dieron cuenta de las dificultades como la falta de infraestructura, la gran demanda espontánea de la atención y la burocratización del proceso de trabajo. También tienen una dualidad de sentimientos representados por la satisfacción y la frustración con su proceso de trabajo. Conclusión: es necesario repensar la formación de este profesional, así como su integración en el equipo de salud de la familia con el fin de aumentar sus conocimientos.

Ensinar sistematização da assistência de enfermagem em nível técnico: percepção de docentes / Systematization of teaching nursing care at a technical level: perception of professors

Resumo Objetivo: Descrever a percepção de docentes sobre o ensino da sistematização da assistência de enfermagem em nível técnico. Métodos: Estudo descritivo, de abordagem mista. Participaram do grupo focal sete docentes do Curso Técnico em Enfermagem de uma universidade pública do Nordeste brasileiro. O conteúdo textual foi tratado com auxílio do IRAMUTEQ e a análise dos dados foi realizada a partir do referencial teórico de Alfred Schutz. Resultados: Os docentes do curso técnico de enfermagem tipificam a importância de integrar o técnico de enfermagem na sistematização da assistência e para tanto realçam a necessidade de incluir tal temática na formação em nível técnico. Conclusão: Os docentes denotam dúvidas e receios em não saber como e quando efetivar o ensino da SAE em nível técnico, mas refletem sobre as possibilidades e necessidades de consolidar esta temática.

Abstract Objective: The aim was to describe the perception of professors on approaching systematization of teaching nursing care at the technical level. Methods: Descriptive study of a mixed approach. Seven professors of the Technical Nursing Course of a public university in northeastern Brazil participated in a focus group. The textual content was organized by using the free software “Interface of R for multi-dimensional text and questionnaire analysis”, and data analysis was performed based on the theoretical framework of Alfred Schutz. Results: The technical nursing course professors indicated the importance of integrating the nursing technician into the systematization of care, and emphasized the need to include this theme in technical level training. Conclusion: Professors identify doubts and fears about not knowing how and when to teach the systematization of nursing care at the technical level, but ponder the possibilities and needs to consolidate this theme.

Perceptions of Adequacy and Job Performance of Nurse Assistant Nursing Jobs according to Registered Nurses and Nurse Assistants in Geriatric Hospitals, and Caregivers / 간호행정학회지

PURPOSE: The purpose of this study was to investigate perceptions of adequacy and job performance of the nurse assistants' nursing job as evaluated by registered nurses and nurse assistants in geriatric hospitals, and by caregivers from the same hospitals. METHODS: Participants included 62 registered nurses, 57 nurse assistants, and 64 patient caregivers who completed a measurement scale on the job of nurse assistants. Data collection was conducted from October to December, 2015. Data were analyzed using descriptive statistics and one-way ANOVA by IBM SPSS/WIN program version 21.0. RESULTS: There were significant differences by items in perception of adequacy of nurse assistants' nursing job of among the three groups. There was also a significant difference in perception of the nurse assistants' job performance among the three groups. CONCLUSION: For nurse assistants in geriatric hospitals, the Ministry of Health and Welfare needs to develop an appropriate job practice guideline. In addition, there should be periodic courses of retraining and continuing education for nurse assistants.

Ensino da sistematização da assistência de enfermagem aos técnicos de enfermagem / Teaching the systematization of nursing care to nursing technicians / Enseñanza de la Sistematización de la Atención de Enfermería a los técnicos de enfermería

Objetivo: Compreender o típico ideal de técnicos de enfermagem acerca da sistematização da assistência de enfermagem (SAE), à luz do referencial teórico de Alfred Schutz. Métodos: Trata-se de uma investigação fenomenológica. O estudo foi aprovado pelo Comitê de Ética em Pesquisa da UFRN. A coleta de dados ocorreu por grupo focal, em fevereiro de 2013, de acordo com a pedagogia vivencial humanescente, com trezes técnicos de enfermagem de um hospital universitário norte-riograndense. Resultados: A análise das falas, dos cartazes e das descrições escritas permitiu desvelar o típico ideal a partir de quatro eixos: tipificação do conceito da SAE; benefícios da SAE - os motivos-para acreditar na positividade dessa ferramenta de trabalho; problemas vivenciados, reveladores do mundo vida cotidiano dos profissionais de enfermagem; e possibilidades de melhoria. Conclusão: Concluiu-se que o técnico de enfermagem, apesar de ter tido uma formação acadêmica que não enfatizou os aspectos concernentes à SAE, acredita em sua positividade.

Objective: To understand the typical ideal of nursing staff about the systematization of nursing care (SAE) in the light of the AlfredSchutz's theoretical framework. Methods: This is a phenomenological investigation. The study was approved by the ResearchEthics Committee of UFRN (Federal University of Rio Grande do Norte). The data were collected by focus group in February2013, according to experiential pedagogy humanescent with thirteen nursing staff of a university hospital of Rio Grande do Norte.Results: The analysis of discourse, from posters and written descriptions allowed to reveal the typical ideal of participants fromfour axes: typifying the concept of SAE; benefits of SAE, which resulted in the reasons to believe in the positive-that workingtool; problems experienced, revealing the world of everyday life of nursing professionals, and possibilities of improvement.Conclusion: It was concluded that the nursing technician believes in the benefits of SAE.

Objetivo: Comprender el típico ideal de los técnicos en enfermería acerca de la Sistematización de la Atención de Enfermería(SAE) a la luz del referencial teórico de Alfred Schutz. Métodos: Investigación fenomenológica aprobada por el Comité de Éticaen Investigación de UFRN (Universidad Federal de Rio Grande do Norte). Los datos fueron recolectados en Febrero de 2013a partir de un grupo focal compuesto por trece técnicos de enfermería de un hospital universitario de Rio Grande do Norte yrealizado de acuerdo con la pedagogía experiencial humanescente. Resultados: El análisis del discurso, carteles y descripcionesescritas permitieron revelar el típico ideal de los participantes a partir de cuatro ejes: tipificación conceptual de la SAE;beneficios de la SAE; problemas del cotidiano de los profesionales de enfermería; oportunidades de mejora. Conclusión: Eltécnico de enfermería cree en los beneficios de la SAE, aunque su formación académica no haya enfatizado estos aspectos.

Invisible no more: a scoping review of the health care aide workforce literature.

BACKGROUND: Healthcare aides (HCAs) are the primary caregivers for vulnerable older persons. They have many titles and are largely unregulated, which contributes to their relative invisibility. The objective of this scoping review was to evaluate the breadth and depth of the HCA workforce literature. METHODS: We conducted a search of seven online bibliographic databases. Studies were included if published since 1995 in English, peer-reviewed journals. Results were iteratively synthesized within and across the following five categories: education, supply, use, demand and injury and illness. RESULTS: Of 5,045 citations screened, 82 studies met inclusion criteria. Few examined HCA education; particularly trainee characteristics, program location, length and content. Results in supply indicated that the average HCA was female, 36-45 years and had an education level of high school or less. Home health HCAs were, on average, older and were more likely to be immigrants than those working in other settings. The review of studies exploring HCA use revealed that their role was unclear - variation in duties, level of autonomy and work setting make describing "the" role of an HCA near impossible. Projected increased demand for HCAs and high rates of turnover, both at the profession and facility-level, elicit predictions of future HCA shortages. Home health HCAs experienced comparatively lower job stability, earned less, worked the fewest hours and were less likely to have fringe benefits than HCAs employed in hospitals and nursing homes. The review of studies related to HCA illness and injury revealed that they were at comparatively higher risk of injury than registered nurses and licensed practical nurses. CONCLUSIONS: This is the largest, most comprehensive scoping review of HCA workforce literature to date. Our results indicate that the HCA workforce is both invisible and ubiquitous; as long as this is the case, governments and healthcare organizations will be limited in their ability to develop and implement feasible, effective HCA workforce plans. The continued undervaluation of HCAs adversely impacts care providers, the institutions they work for and those who depend on their care. Future workforce planning and research necessitates national HCA registries, or at minimum, directories.

Ludic representations of nursing technicians about the systematization of nursing care / Representações lúdicas de técnicos de enfermagem acerca da sistematização da assistência de enfermagem

The objective was to describing the ludic representations of nursing technicians about the Systematization of Nursing Care. This is a clipping of a phenomenological investigation results. The data were collected from a focus group with thirteen nursing technicians, using the construction of projective technique, based on the principles of Experiential Humanescent Pedagogy. The data analysis was carried out from guiding principles based on the work of Alfred Schutz. The ludic representation of nursing technical architects perpassed four thematic axes: Systematization of Nursing Care concept; benefits; problems experienced; and needs for improvement. It is concluded that nursing technicians represent positively the Systematization of Nursing Care, and believe in its consolidation. It is stressed that the use of the construction of billboards as projective technique constitutes an element qualifier of the study by stimulating the expression of subjectivities of the subjects surveyed.

Objetiva-se descrever as representações lúdicas de técnicos de enfermagem acerca da Sistematização da Assistência de Enfermagem. Trata-se de um recorte dos resultados de uma investigação fenomenológica. A coleta de dados foi realizada a partir de um grupo focal com treze técnicos de enfermagem, utilizando a construção de cartazes como técnica projetiva, pautando-se nos princípios da Pedagogia Vivencial Humanescente. A análise dos dados foi realizada a partir de princípios orientadores baseados na obra de Alfred Schutz. A representação lúdica dos técnicos de enfermagem perpassou quatro eixos temáticos: conceito da Sistematização da Assistência de Enfermagem; benefícios; problemas vivenciados; e necessidades de melhoria. Conclui-se que os técnicos de enfermagem representam positivamente a Sistematização da Assistência de Enfermagem, e acreditam em sua consolidação. Destaca-se que o uso da construção de cartazes como técnica projetiva constitui um elemento qualificador do estudo, estimulando a expressão das subjetividades dos sujeitos pesquisados.

Association between shift working and musculoskeletal symptoms among nursing personnel.

BACKGROUND: Some health problems are more prevalent in shift workers than day workers. Musculoskeletal disorders are considered as one of the most common health-related problems that can cause disability among health care workers. The aim of this study was to assess the associations between shift working and the prevalence of musculoskeletal symptoms (MSs) among nursing personnel. MATERIALS AND METHODS: This study was conducted among 454 health care workers including nurses and nurses' aides in a general hospital in Iran. A Nordic musculoskeletal questionnaire was used to evaluate the prevalence of MSs. Logistic regression analysis with adjusting for confounding factors was performed to evaluate the associations between shift working and the prevalence of MSs. RESULTS: Lower back, knees, and upper back symptoms with the prevalence of 57.4%, 48.4%, and 47%, respectively, were the most common MSs. The prevalence of MSs in eight regions of the body (lower back, neck, knees, upper back, shoulder, wrist, buttock, and ankle) was higher among shift workers than day workers. The differences were statistically significant only in the lower back and ankle regions (P < 0.05). Odds Ratio for lower back symptoms in shift workers was 1.94 compared to day workers (P = 0.003). CONCLUSION: Findings of this study suggested that shift working could be associated with increased prevalence of lower back disorders among nursing personnel. This study emphasizes on the importance of proper work planning and regulating working hours for nursing personnel.