The practice environment of primary care nurses: A cross-sectional study of five health care districts in San Paulo, Brazil.

Background: Primary care is a fundamental component of healthcare in Brazil. Often provided by nurses, little is known about the practice environment of nurses in primary care and if nurses are satisfied with their role in the primary care setting. Objective: The purpose of this study was to determine if aspects of the primary care practice environment in Brazil are associated nurse reported outcomes of job satisfaction, intention to stay on the job, and the quality of care. Design: A cross-sectional survey that included a randomized cluster stratified sample of nurses who provided primary care services. Settings: 55 health centers within five health districts located in Campinas, São Paulo, Brazil. Participants: 148 primary care nurses who completed and returned a survey. Methods: The paper-based survey was made available to nurse participants. Nurses were queried on demographic and practice characteristics. Specific measures included the Practice Environment Scale-Brazilian, the job satisfaction subscale of the Safety Attitudes Questionnaire, and single items that assessed intention to stay on the job and the perceived quality of care. Generalized linear and Poisson regression models were used to estimates outcomes of interest. Results: Slightly more than half (56.5%) of the nurses reported a favorable practice environment and they provided on average a high score of 75.29 (SD = 21.03) on job satisfaction. High scores were also reported on intention to stay on the job (mean = 8.08; SD = 2.91) and the quality of patient care (mean = 7.68; SD = 1.38). In a fully adjusted regression model, a favorable practice environment was significantly associated with a 2.15 (p <0.0001) increase in job satisfaction, a 1.72 (p = 0.0003) increase in the intention to stay on the job and a 1.16 (p < 0.001) increase in the nurse reported quality of patient care. Conclusion: Overall, our sample of Brazilian nurses that work in primary care reported a favorable perception of their practice environment. This likely contributed to their high scores on intention to stay on the job and the overall quality of patient care. Nurse managers and administrators should focus their attention on aspects of the practice environment as a low cost means to attract and retain nurses in primary care and to improve the overall quality of care.

Carga de trabalho de enfermagem em uma unidade de terapia intensiva de trauma / Nursing workload in a trauma intensive care unit / Carga de trabajo de enfermería en una unidad de terapia intensiva de trauma

Pacientes gravemente feridos, com lesões múltiplas e conflitantes, apresentam-se aos enfermeiros de unidades de cuidados críticos como desafios na gestão da assistência. O objetivo deste estudo foi avaliar a carga de trabalho de enfermagem e verificar a correlação entre a carga e o índice de gravidade APACHE II. Estudo descritivo, realizado em uma Unidade de Terapia Intensiva de Trauma de um hospital de ensino. Foram utilizados os instrumentos Nursing Activities Score e APACHE II. A amostra foi composta por 32 pacientes, sendo a maioria do sexo masculino, adultos jovens, com politraumatismo, procedentes da Unidade de Emergência Referenciada, em tratamento cirúrgico, com alta da UTI. A média do Nursing Activities Score no período de internação foi de 72%, e os dados mostraram uma correlação moderada entre a carga de trabalho e a gravidade do paciente, ou seja, quanto maior o escore, maior o risco de mortalidade apresentado pelos pacientes.

Severely injured patients with multiple and conflicting injuries present themselves to nursing professionals at critical care units faced with care management challenges. The goal of the present study is to evaluate nursing workload and verify the correlation between workload and the APACHE II severity index. It is a descriptive study, conducted in the Trauma Intensive Care Unit of a teaching hospital. We used the Nursing Activities Score and APACHE II as instruments. The sample comprised 32 patients, of which most were male, young adults, presenting polytrauma, coming from the Reference Emergency Unit, in surgical treatment, and discharged from the ICU. The average obtained on the Nursing Activities Score instrument was 72% during hospitalization periods. The data displayed moderate correlation between workload and patient severity. In other words, the higher the score, the higher the patient's mortality risk.

Los pacientes gravemente heridos, con lesiones múltiples y conflictivas se presentan ante los enfermeros de unidades de cuidados críticos como desafíos en gestión de atención. El estudio objetivó evaluar la carga de trabajo de enfermería y verificar la correlación entre la carga y el índice de gravedad APACHE II. Estudio descriptivo realizado en una Unidad de Terapia Intensiva de Trauma de un hospital de enseñanza. Fueron utilizados los instrumentos: Nursing Activities Score y APACHE II. Muestra compuesta por 32 pacientes, mayoría de sexo masculino, adultos jóvenes con politraumatismo, procedentes de la Unidad de Emergencia Referenciada, en tratamiento quirúrgico, con alta de la UTI. La media del Nursing Activities Score durante el período de internación fue de 72%, y los datos mostraron una correlación moderada entre la carga de trabajo y la gravedad del paciente; es decir, ante mayor puntaje, mayor fue el riesgo de mortalidad presentado por los pacientes.

[Translation and cross-cultural adaptation of the newcastle satisfaction with nursing scales into the Brazilian culture]. / Tradução e adaptação cultural do Newcastle satisfaction with nursing scales para a cultura brasileira.

This study aimed to translate and culturally adapt the Newcastle Satisfaction with Nursing Scales for use in Brazil, and to assess its usability. The instrument contains two scales and aims to assess the patient's experiences and level of satisfaction with nursing care. The methodological procedure of cultural adaptation followed the steps: translation, synthesis, back-translation, assessment by an expert committee, and pre-test. The process of translation and cultural adaptation was considered adequate. The committee assessment resulted in simple grammatical modifications for most of the items, and 40 subjects were considered for the pre-test. The Brazilian version of the Newcastle Satisfaction with Nursing Scales demonstrated adequate content validity and was easily understood by the group of subjects. However, this is a study that precedes the evaluation of the psychometric properties of the instrument, whose results will be presented in a later publication.

[Demands for attention experienced by a patient in a bone marrow transplants unit]. / Demandas de atenção de um paciente na unidade de transplante de medula ossea.

The capacity to focus attention is essential for the effective handling of everyday life for it allows one to perceive, think clearly and keep the intended activity in course despite environmental distractions. This qualitative approached study was aimed at identifying the attention demands experienced by a patient diagnosed with sharp myeloid leukemia submitted to a bone marrow transplants (BMT) following the theoretical reference of attention and attention demands. The data was collected through a semi-structured interview and a-systematic observation, with later content thematic analysis. The results pointed out that the patient in BMT lives multiple attention demands, such as: absence of family, fear of death, uncertainty about the future, restricted physical space, removal from work and too much handling by the Nursing staff, among others.