Educação permanente em saúde para elaboração de um fluxograma de atendimento a pacientes cirúrgicos eletivos / Permanent education in health to elaborate a flowchart of care for elective surgical patients

A assistência ao paciente cirúrgico é considerada complexa pelas características inerentes ao próprio ambiente, o que demanda dos profissionais um perfil altamente especializado considerado um determinante para a garantia de uma assistência contínua e individualizada. Nesse sentido, é inegável a importância do papel do enfermeiro na realização do planejamento e gerenciamento do cuidado aos pacientes cirúrgicos, uma vez que é esse profissional que participa de todas as etapas do cuidado prestado. O objetivo foi desenvolver um fluxograma de atendimento aos pacientes cirúrgicos eletivos utilizando como estratégia a educação permanente em saúde. Estudo qualitativo, do tipo pesquisa-ação, contemplando as etapas exploratória, de planejamento e de ação. A coleta de dados ocorreu nos meses de outubro a novembro de 2022, por meio de entrevista semiestruturada e encontros coletivos. Os dados coletados, transcritos e validados pelos participantes, foram analisados pelo método de análise de conteúdo de Bardin (2004), com apoio do software Nvivo®. Foram identificadas quatro categorias que, articuladas entre si, originaram a metacategoria: Mapeamento do processo cirúrgico eletivo: desafios e perspectivas para o gerenciamento do cuidado de enfermagem. Constatou-se que: o mapeamento das etapas de assistência cirúrgica é o ponto de partida para compreender os desafios vivenciados por enfermeiros no gerenciamento do cuidado e seu impacto na assistência cirúrgica eletiva, e que a dificuldade de acesso às consultas especializadas, a terceirização dos serviços a falta de gerenciamento da demanda espontânea e programada, representam pontos críticos na gestão da fila. O perfil profissional somado à sobrecarga foram considerados importantes e decisivos na otimização e resolutividade do processo. Notou-se também que, os enfermeiros reconhecem as ações que envolvem o gerenciamento do cuidado e entendem sua importância para efetivação da assistência qualificada. Conclui-se que, a ressignificação do contexto investigado, por meio da educação permanente em saúde, possibilitou a construção e desconstrução saberes e práticas voltados a linha de cuidado cirúrgico, valorizou o protagonismo dos participantes, e possibilitou o desenvolvimento de ações de melhorias na construção do fluxograma de atendimento

Surgical patient care is considered complex due to the inherent characteristics of the environment itself, and this complexity demands a highly specialized profile from professionals, which is considered a determinant for ensuring continuous and individualized care. In this sense, the importance of the nurse's role in carrying out the planning and management of care for surgical patients is undeniable, since it is this professional who participates in all stages of the care provided. The objective was to develop a flowchart of care for elective surgical patients using permanent health education as a strategy. Qualitative study, of the action-research type, contemplating the exploratory, planning and action stages. Data collection took place from October to November 2022, through semi-structured interviews and collective meetings. The collected data, transcribed and validated by the participants, were entered into the Nvivo® software and analyzed using Bardin's (2004) content analysis method. Four categories were identified that articulated with each other, originating the metacategory: Mapping of the elective surgical process: challenges and perspectives for the management of nursing care. It was found that: mapping the stages of surgical care is the starting point for understanding the challenges experienced by nurses in care management and their impact on elective surgical care, and that the difficulty in accessing specialized consultations, the outsourcing of services the lack of management of spontaneous and scheduled demand represent critical points in queue management. The professional profile added to the overload were considered important and decisive in the optimization and resolution of the process. It was also noted that the nurses recognize the actions that involve the management of care and understand its importance for the effectiveness of qualified assistance. It is concluded that the re-signification of the investigated context, through permanent health education, enabled the construction and deconstruction of knowledge and practices aimed at the line of surgical care, valued the protagonism of the participants, and enabled the development of improvement actions in the construction of the service flowchart

Technological innovation for workload allocation in nursing care management: an integrative review.

Background: Technology reduces the nursing workload, improve the quality care processes, patient's safety, and avoid staff burnout. Innovative technologies are disrupting healthcare systems by improving the efficiency of processes and management. There is a discussion on the benefits, challenges, and barriers of these technologies and considering human factors of nursing management. The aim was to analyze the influence of technologies on the distribution of workload for nursing care management. Methods: An integrative literature review was performed. Four databases were searched: Scopus, Scielo, PUBMED, and CINALH following PRISMA guidelines. Articles published from January 2016 to December 2020, published in English, Spanish and Portuguese were included. Studies were excluded when they were not original research, did not met the quality criteria or they did not answer the research questions. Quality appraisal was performed using the Crowe Critical Appraisal Tool version 1.4 (CCAT). Two reviewers independently examined the title and abstract for eligibility according to the inclusion and exclusion criteria. Results: 2818 potentially relevant articles were found, but once the inclusion and exclusion criteria in the abstracts were analyzed, 177 remained for evaluation. After following the PRISMA Guidelines, 35 studies were included in the review. Three categories were identified: Nursing workload; Information technologies and technological means for management; Technology acceptance. Conclusions: Technology has the potential to improve care management by estimating nurse workload in ICUs and non-critical units, but scientific evidence is more detailed in the former type of services. The literature provides insights about the factors that factors and the barriers that promote the technology acceptance and usability. We did not find studies comparing technologies and no scientific evidence proving improvements in care.

Validation of a Nursing Workload Measurement Scale, Based on the Classification of Nursing Interventions, for Adult Hospitalization Units.

We conducted validation of a scale to measure nursing workloads, previously designed using NIC interventions within the four nursing functions (patient care, teaching, management, and research). METHODS: This is an analytical, descriptive, prospective, and observational study using qualitative methodology (focus groups and in-depth interviews) with a quantitative and qualitative section (committee of experts and real application of the scale through a validation pilot and with multicentric application, including hospitalization units of internal medicine and surgery of four hospitals). Qualitative analysis was performed with Atlas.ti8 and quantitative analysis with R. RESULTS: Qualitatively, all the participants agreed on the need to measure workloads in all nursing functions with standardized terminology. The expert committee found greater relevance (91.67%) in "prevention" and "health education" as well as consistency with the construct and adequate wording in 99% of the selected items. In the pilot test and multicenter application, the nurses spent more time on the caring dimension, in the morning shift, and on the items "self-care", "medication", "health education", "care of invasive procedures", "wounds care", "comfort", and "fluid therapy". Cronbach's alpha 0.727, composite reliability 0.685, AVE 0.099, and omega coefficient 0.704 were all acceptable. Construct validity: KMO 0.5 and Bartlett's test were significant. CONCLUSIONS: The scale can be considered valid to measure nursing workloads, both qualitatively in obtaining the consensus of experts and health personnel and quantitatively, with acceptable reliability and validity superior to other similar scales.

Application of 6S and PDCA cycle lean management in nursing management of orthopedic trauma surgery / 中华创伤杂志

Objective:To explore the application effect of 6S and PDCA cycle lean management in nursing management of orthopaedic trauma surgery.Methods:A retrospective cohort study was conducted to analyze the clinical data of 80 patients with orthopedic trauma admitted to University-Town Hospital of Chongqing Medical University from January 2020 to November 2021, including 51 males and 29 females; aged 23-68 years [(44.5±9.2)years]. According to the order of operation date, 40 patients from January 2021 to November 2021 received routine management plus 6S and PDCA cycle lean management (lean management group), and 40 patients from January 2020 to December 2020 received routine surgical nursing management (routine management group). The nursing quality score in operating room (instrument and equipment management, surgical instrument preparation, surgical coordination, disinfection and isolation), qualified rate of infection monitoring in operating room (air in operating room, hand hygiene of medical staffs and sterile articles in operating room), surgeons′ satisfaction with operating nurses (circulating nurses and scrub nurses), self- rating anxiety scale (SAS) of patients before operation, incidence of complications at postoperative 12 days and patients′ satisfaction with nurses in operating room at postoperative 2-3 days.Results:The four dimensions of the nursing quality score in operating room in lean management group were (27.8±1.5)points, (18.1±1.1)points, (26.6±1.5)points and (18.1±0.8)points, significantly higher than (23.7±2.3)points, (14.6±1.1)points, (22.4±1.8)points and (13.7±1.1)points in routine management group (all P<0.01). The three dimensions of qualified rate of infection monitoring in operating room in lean management group were all 100%, showing no significant differences in routine management group (75%, 100%, 100%) (all P>0.05). Surgeons′ satisfaction with circulating nurses and scrub nurses in lean management group was 90% and 85%, higher than 73% and 65% in routine management group (all P<0.05). Preoperative SAS in lean management group was (32.5±8.2)points, significantly lower than (54.6±10.7)points in routine management group ( P<0.01). The incidence of postoperative complications in lean management group was 0, significantly lower than 15%(6/40) in routine management group ( P<0.05). Patients′ satisfaction with nurses in operating room in lean management group was 95% (38/40), significantly higher than 78%(31/40) in routine management group ( P<0.05). Conclusion:6S and PDCA cycle lean management can effectively improve the nursing quality of orthopedic trauma surgery, reduce patients′ anxiety and postoperative complications, and improve surgeons′ and patients′ satisfaction, which is worthy of further clinical application.

Evaluation of health care quality among insured patients in Indonesian mother & child hospital: A secondary data analysis.

OBJECTIVE: This study aimed to evaluate the health care quality among insured patients hospitalized in the Indonesian mother and child hospital. METHOD: A secondary data analysis was performed to evaluate the health care services received by the insured patients hospitalized in the Indonesian mother and child hospital. Data were extracted from the BPJS health insurance e-claim database from January 1 to December 31, 2019 and from January 1 to June 30, 2020. A descriptive and bivariate analysis were used to examine total patients and hospital admissions; INACBGs diagnoses, procedures by severity; types of inpatient wards; length of stay; discharge status; hospital costs; and 30-day readmissions. RESULTS: Total inpatient unit admissions were 2870 in 2019 and 1533 in 2020. From total hospital admissions in 2019 and 2020, over 50% were admitted to the 3rd class of inpatient units, less than 10% had length of stays more than 5 days, and over 98% were discharged based on physician approval. However, hospital readmissions were also found for about 20.1% in 2019 and 2.9% in 2020 and about 42.9% in 2019 and 61.3% in 2020 were found causing hospital financial losses. Older patients, longer hospital stays, inpatient ward class 1 & 2, high hospital tariff, inadequate clinical pathway implementation, lack of interprofessional collaboration, and ineffective nurse manager supervision were identified as contributing factors to the hospital financial losses. CONCLUSION: Integrated clinical pathways with interprofessional collaboration that are implemented through professional nursing practice model are suggested for health care quality improvement.

The experiences and needs of re-entering nurses during the COVID-19 pandemic: A qualitative study.

Background: During the COVID-19 outbreak in the Netherlands, thousands of former nurses have returned to nursing to support healthcare staff. After a period of absence and with little time to prepare, these former nurses re-entered  during a challenging, uncertain and rapidly evolving pandemic. Little is known about the experiences and needs of these re-entering nurses. Objectives: Assessing the needs and experiences of re-entering nurses during the COVID-19 pandemic. Design: Qualitative study using a pragmatist approach within the interpretative paradigm. Settings: This study took place in the following settings within the Dutch healthcare system: Intensive care units, COVID and regular departments within hospitals, nursing home settings, a rehabilitation centre and newly established COVID-19 departments within nursing home settings. Participants: We purposively selected 20 nurses who had re-entered nursing during the first wave of the COVID-19 pandemic between March 2020 and June 2020 in the Netherlands. The first interview was conducted on the eighth of May 2020. Methods: We conducted 20 semi-structured interviews in Dutch. Interviews were transcribed verbatim and analysed via thematic content analysis in the coding program of MAXQDA2020. This study followed the SRQR and COREQ  guidelines. Results: Seven main themes were identified. Clear job description: Participants mentioned that a lack of a clear job description led to lack of clarity  about the kind of tasks that re-entering nurses were expected and allowed to perform. Training: the majority of the participants had received none or little training prior to their return. Training content:  Re-entering nurses mentioned to wish for an easily accessible mentorship structure and an individualised and practical training program. Positive team dynamic: Re-entering nurses felt supported by a positive team dynamic, which was shaped by the sense of urgency and relevance of their work and helped them deal with stressful experiences. Mental health: Nearly all participants mentioned that re-entering during a pandemic did not lead to impairment of their mental health. mental health support:  Most participants mentioned being able to cope with their mental health independently, sharing experiences with family and colleagues Conclusion:  The results indicate that a rapid and safe return to nursing during a pandemic could be facilitated by: a clear description of roles and responsibilities; an individualised assessment determining the competences and knowledge disparities of re-entering nurses; practical training focussing on competencies needed during a pandemic; and a collaborative mentorship structure to guide re-entering nurses. Tweetable abstract: In-depth interviews with former nurses who returned to #nursing during the first wave of the #COVID19 #pandemic in the Netherlands.

Work Methods for Nursing Care Delivery.

This article analyzes the work methods based on care design, identification of needs, care organization, planning, delivery, evaluation, continuity, safety, and complexity of care, and discharge preparation. It describes the diagnosis of the situation, goal setting, strategy selection, implementation, and outcome evaluation that contribute to adopting a given work conception and/or method for nursing care delivery. Later, the concepts underlying the several methods-management theories and theoretical nursing concepts-are presented, with reference to relevant authors. The process of analysis and selection of the method is explained, highlighting the importance of diagnosis of the situation, goal setting, strategy selection, implementation, and outcome evaluation. The importance of various elements is highlighted, such as structural aspects, nature of care, target population, resources, and philosophy of the institution, which may condition the adoption of a method. The importance of care conceptualization is also underlined. The work methods are presented with a description of the key characteristics, advantages, and disadvantages of the task-oriented method (functional nursing) and patient-centered methods: individual, team nursing, and primary nursing. A critical and comparative analysis of the methods is then performed, alluding to the combination of person-centered methods.

Strategies to prevent missed nursing care: An international qualitative study based upon a positive deviance approach.

AIM: To identify the strategies to prevent missed nursing care (MNC) that can be implemented by nurse managers/directors on a daily basis. BACKGROUND: Only few recommendations have been established to date aiming at supporting nurse managers/ directors in preventing MNC. However, several strategies are implemented on a daily basis, suggesting that a body of tacit, practical and wise knowledge is already in place. METHOD(S): An international qualitative descriptive study based on the positive deviance approach conducted in 2019-2020 and reported according to the Consolidated Criteria for Reporting Qualitative Research. A purposeful sample of 35 nurse managers/directors working in hospitals in Cyprus, Italy, Germany and Switzerland was involved. Codes were extracted from each country, and a thematic analysis was performed at the transnational level to identify strategies and interventions preformed to prevent MNC. RESULTS: Eight strategies and 22 interventions, mainly with preventive intent and designed at the hospital level, affecting both the processes and the structural dimensions, have been reported as effective in preventing MNC. CONCLUSION: Nurse leaders are involved daily in implementing strategies to minimise MNC at the nursing and at the hospital system levels, integrated with each other. IMPLICATIONS FOR NURSING MANAGEMENT: Preventing MNC should be a core value of the entire hospital, and not merely a nursing issue. Therefore, complex interventions at the system level are required.

Evaluation of health care quality among insured patients in Indonesian mother & child hospital: A secondary data analysis

Objective: This study aimed to evaluate the health care quality among insured patients hospitalized in the Indonesian mother and child hospital. Method: A secondary data analysis was performed to evaluate the health care services received by the insured patients hospitalized in the Indonesian mother and child hospital. Data were extracted from the BPJS health insurance e-claim database from January 1 to December 31, 2019 and from January 1 to June 30, 2020. A descriptive and bivariate analysis were used to examine total patients and hospital admissions; INACBGs diagnoses, procedures by severity; types of inpatient wards; length of stay; discharge status; hospital costs; and 30-day readmissions. Results: Total inpatient unit admissions were 2870 in 2019 and 1533 in 2020. From total hospital admissions in 2019 and 2020, over 50% were admitted to the 3rd class of inpatient units, less than 10% had length of stays more than 5 days, and over 98% were discharged based on physician approval. However, hospital readmissions were also found for about 20.1% in 2019 and 2.9% in 2020 and about 42.9% in 2019 and 61.3% in 2020 were found causing hospital financial losses. Older patients, longer hospital stays, inpatient ward class 1 & 2, high hospital tariff, inadequate clinical pathway implementation, lack of interprofessional collaboration, and ineffective nurse manager supervision were identified as contributing factors to the hospital financial losses. Conclusion: Integrated clinical pathways with interprofessional collaboration that are implemented through professional nursing practice model are suggested for health care quality improvement. (AU)

Nurses' perceptions of patient safety culture: a mixed-methods study.

BACKGROUND: There are relatively few qualitative studies concerning patient safety culture. METHODS: We aimed to explore patient safety culture as perceived by the nursing staff in two public hospitals in Catalonia, Spain. A mixed-methods design was employed using a questionnaire, in-depth interviews, and non-participant observations. RESULTS: Sixty-two percent of the nursing staff rated patient safety as "Acceptable" but was not higher because of work pressure and lack of resources as perceived by staff. "Teamwork within units" had the highest rate of positive responses, and "Staffing" had the lowest rate. Emergency units showed more negative results than the other two units. CONCLUSIONS: Safety incidents are not always reported due to fear of punishment, reflecting a lack of positive safety culture. It is necessary to design and implement strategies that promote a positive culture to avoid punitive responses and apply and evaluate these changes.

Frontline nurse managers' visions for their units: A qualitative study.

AIMS: To elucidate frontline nurse managers' visions of their units. BACKGROUND: Managers have the opportunity to imagine and share their visions for effective unit management. METHODS: Semi-structured interviews were conducted with 12 frontline nurse managers working at inpatient units in two hospitals between 2016 and 2017. Data were qualitatively analysed using an inductive approach, focusing on participants' intents. RESULTS: Although participants showed four types of difficulties in verbalizing visions, five categories and 18 subcategories were extracted through analysis of their descriptions about actual cases reflecting their visions. The categories were (a) provide excellent care to ensure patient recovery based on reliable knowledge and skills, (b) make efforts to broaden patients' futures, (c) create a climate for pursuing better practice, (d) all staff continuously pursue professional development and (e) provide nursing care that responds to external changes. All categories were common to all participants' images of the future and linked together to form each manager's vision. CONCLUSION: Frontline managers experienced difficulty in articulating their visions. However, through episodes, they represented images of visions. The managers' visions comprised five categories reflecting various perspectives. IMPLICATIONS FOR NURSING MANAGEMENT: Using a conceptualized vision framework, and identifying difficulties in verbalizing their images, can help managers articulate their visions.

Nursing Interventions for Patients with Intracranial Hypertension: Integrative Literature Review / Intervenciones de Enfermería para pacientes con hipertensión intracraneal: revisión integradora de la literatura / Intervenções de Enfermagem para pacientes com hipertensão intracraniana: revisão integrativa da literatura

ABSTRACT Objective: the study sought to identify, in national and international publications, the principal Nursing interventions aimed at patients with intracranial hypertension. Materials and Method: integrative literature review with search in LILACS, PubMed, Scopus, Web of Science, Cinahal, and Google Scholar databases, from 2013 to 2018. Results: the sample was comprised of seven articles fulfilling the inclusion criteria. Two thematic categories were established for the Nursing interventions aimed at patients with intracranial hypertension: cognitive skills and clinical reasoning, necessary to control neuro-physiological parameters and prevent intracranial hypertension, and evidence-based practices to improve care for neuro-critical patients. Conclusions: intracranial hypertension is an event of great clinical impact, whose complications can be minimized and control through specific Nursing interventions that encompass control of neuro-physiological and hemodynamic parameters and prevention of increased intracranial pressure related with the performance of procedures by the Nursing staff.

RESUMEN Objetivo: el estudio tiene como objetivo identificar, en publicaciones nacionales e internacionales, las principales intervenciones de Enfermería dirigidas a pacientes con hipertensión intracraneal. Materiales y método: revisión integradora de la literatura con búsqueda en las bases de datos LILACS, PubMed, Scopus, Web of Science, Cinahal y Google Académico, del 2013 al 2018. Resultados: la muestra se conformó de siete artículos que cumplieron con los criterios de inclusión. Se establecieron dos categorías temáticas para las intervenciones de Enfermería dirigidas a pacientes con hipertensión intracraneal: habilidades cognitivas y razonamiento clínico, necesarias para el control de parámetros neurofisiológicos y la prevención de hipertensión intracraneal, y prácticas basadas en evidencias para la mejora de la asistencia al paciente neurocrítico. Conclusiones: la hipertensión intracraneal es un evento de gran repercusión clínica, cuyas complicaciones se pueden minimizar y controlar mediante intervenciones de Enfermería específicas que abarcan controles de parámetros neurofisiológicos, hemodinámicos y prevención de aumento de la presión intracraneal relacionado a la realización de procedimientos por el equipo de Enfermería.

RESUMO Objetivo: este estudo objetiva identificar, nas publicações nacionais e internacionais, as principais intervenções de Enfermagem direcionadas a pacientes com hipertensão intracraniana. Materiais e método: revisão integrativa da literatura com busca nas bases de dados LILACS, PubMed, Scopus, Web of Science, Cinahal e Google Acadêmico, de 2013 a 2018. Resultados: a amostra foi constituída por sete artigos que atenderam aos critérios de inclusão. Elencaram-se duas categorias temáticas para as intervenções de Enfermagem direcionadas ao paciente com hipertensão intracraniana: habilidades cognitivas e raciocínio clínico, necessárias para o controle de parâmetros neurofisiológicos e para a prevenção de hipertensão intracraniana, e práticas baseadas em evidências para a melhoria da assistência ao paciente neurocrítico. Conclusões: a hipertensão intracraniana é um evento de grande repercussão clínica, cujas complicações podem ser minimizadas e controladas mediante intervenções de Enfermagem específicas que abrangem controles de parâmetros neurofisiológicos, hemodinâmicos, bem como prevenção de aumento da pressão intracraniana atrelado à realização de procedimentos pela equipe de Enfermagem.

Examining practical nursing experiences to discover ways in which to retain and invigorate the remaining functions of the elderly with a demented and complex disability in nursing homes.

AIM: The bedridden elderly with moderate-to-severe dementia account for a large proportion of the residents in nursing homes and form a specialized group requiring customized care in order to encourage their remaining functions, which determine the quality of their residual life. The purpose of this study was to search for ways to invigorate and foster the remaining functions of this complex-disability group, based on practical nursing strategies in nursing homes. METHODS: The qualitative thematic analysis was done by conducting in-depth interviews with 29 nurses working at 11 different nursing homes in South Korea. RESULTS: This study proposed four main themes and 19 sub themes as keys for providing specialized nursing care to the elderly with physical and cognitive disabilities. The main themes encourage the residents' remaining functions: (i) accurate identification of an elderly resident's physical, cognitive, and behavioral baseline is necessary in order to determine their functional levels; (ii) nurses provide meticulous management to support the remaining functions in order to prevent further deterioration; (iii) optimized know-how, based on accumulated experience and knowledge, is reflected in nursing strategies that maximize the effects of nursing interventions; and (iv) steady compliance with nursing guidelines and standards in nursing homes creates the best therapeutic environment and brings unexpected positive changes in the elderly's status. CONCLUSION: A practical nursing strategy to target the group with a demented and complex disability in nursing homes was developed through thematic analysis of the empirical knowledge of nurses. The findings provide new insights for developing specialized nursing interventions and practical nursing models in long-term care facilities.

Mediating Role of Psychological Capital in Relationship between Occupational Stress and Turnover Intention among Nurses at Veterans Administration Hospitals in Korea.

PURPOSE: The aim of this study was to evaluate the mediating role of psychological capital (PCP) in the relationship between occupational stress and turnover intention in nurses. METHODS: Data were collected from a sample of 447 nurses working at four Veterans Administration Hospitals throughout South Korea from July 1 to July 31, 2014. We collected data from the nurses using the following surveys: the Short Form Korean-Occupational Stress Scale, the Korean version of the Turnover Intention Scale, and the Korean version of the Psychological Capital Questionnaire. Multiple linear regression analysis was performed to examine the mediating role of PCP. RESULTS: The level of occupational stress was 1.81 ± 0.23, the level of turnover intention was 3.29 ± 0.86, and the PCP level was 3.95 ± 0.52. There were significant correlations among the three variables (occupational stress, turnover intention, and PCP). PCP played a partial mediating role (ß=-0.22, p=.008) in the relationship between occupational stress and turnover intention (p<.001) among nurses working at the Veterans Administration Hospitals. CONCLUSION: Based on the findings of this study, we recommend that South Korean hospitals offer occupational stress management programs that incorporate relevant programs in efforts to strengthen the overall components of PCP among nurses to reduce turnover intentions. Further studies are required to determine the most effective intervention programs for hospital settings.

Development and Implementation of the Clinical Decision Support System for Patients With Cancer and Nurses' Experiences Regarding the System.

PURPOSE: The purpose of this study was to develop and implement the clinical decision support system (CDSS) for oncology nurses in the care of patients with cancer and to explore the nurses' experiences about the system. METHODS: The study was conducted using a mixed-methods research design with 14 nurses working at a gynecological oncology clinic at a university hospital in Turkey. FINDINGS: The nurses stated that they did not experience any problems during the implementation of the CDSS, and its usage facilitated the assessment of patients' needs and care management. CONCLUSIONS: The results indicated that the CDSS supported the nurses' decision-making process about patients' needs and preparation of individual care plans. PRACTICE IMPLICATIONS: The CDSS should be developed and implemented by the nurses working with patients with cancer. AMAÇ: Amaç kanser hastalarinin bakimina yönelik klinik karar destek sistemi olusturmak, uygulamak (KKDS) ve sistemi kullanan hemsirelerin deneyimlerini incelemektir. YÖNTEM: Çalisma kalitatif ve kantitatif arastirma yöntemleri kullanilarak Türkiyede'ki bir üniversite hastanesinin jinekolojik onkoloji servisinde çalisan 14 hemsire ile yürütülmüstür. BULGULAR: Hemsireler KKDS'ni kullanirken herhangi bir sorun yasamadiklarini ve sistemin hasta gereksinimlerini degerlendirmeyi ve bakim yönetimini kolaylastirdigini belirtmislerdir. SONUÇ: Bulgular hastanin gereksinimlerine karar verme sürecinde ve bireysel bakim planlari hazirlamada KKDS'nin hemsireleri destekledigini göstermektedir. HEMSIRELIK UYGULAMALARI IÇIN ÖNERILER: Kanserli hastalarin bakimina yönelik KKDS gelistirilebilir ve hemsireler tarafindan klinikte kullanilabilir.

Quality of life and anxiety in women with breast cancer before and after treatment / Qualidade de vida e ansiedade em mulheres com câncer de mama antes e depois do tratamento / Calidad de vida, ansiedad antes y después del tratamiento en mujeres con cáncer de mama

ABSTRACT Objectives: to determine the quality of life and anxiety in patients with breast cancer and the changes they experience after treatments. Method: prospective study. Breast cancer statistics (n=339, confidence=95%, accuracy= ± 5.32%). The quality of life questionnaires (QLQ) used were QLQ C-30 and QLQ Br23, and the State-Trait Anxiety Inventory (STAI) was used for anxiety. A multivariate analysis was performed to identify variables associated with baseline quality of life and anxiety as well as pre- and post-treatment differences. Authorization was obtained from the Ethics Committee, and informed consent was provided by all patients. Results: the baseline quality of life dimensions with the lowest score were future prospects (46.0/100) and sexual enjoyment (55.7/100). The dimensions with the highest score were body image (94.2/100) and role (93.3/100). The most disturbing symptoms were insomnia, fatigue and concern about hair loss. After treatment, the dimensions of physical function, role, body image, financial concerns and symptomatology worsened, whereas emotional function and future prospects improved. Severe anxiety presented as a state (48.6%) and as a trait (18.2%). The highest baseline state anxiety was associated with married-widowed status and anxiolytic medication. The greatest trait anxiety was associated with an inactive work situation, anxiolytic medication, breast swelling and advanced stage at diagnosis. After treatment, anxiety significantly decreased. Conclusions: After treatment, the quality of life score was positively modified, while state and trait anxiety decreased.

RESUMO Objetivos: determinar a qualidade de vida e a ansiedade de pacientes com câncer de mama e as mudanças sofridas após os tratamentos. Método: estudo prospectivo. Incidentes de câncer de mama (n = 339, nível de confiança = 95%, precisão = ± 5,32%). Os questionários de qualidade de vida foram o QLQC-30 e o QLQBr23 e o de ansiedade, o Inventário de Ansiedade Traço Estado (IDATE; em inglês: State-Trait Anxiety Inventory - STAI). Foi feita uma análise multivariada para identificar as variáveis associadas à qualidade de vida e à ansiedade iniciais e as diferenças entre os períodos pré e pós tratamento. Foi obtido consentimento informado e uma autorização do Comitê de Ética. Resultados: as dimensões iniciais da qualidade de vida com as menores pontuações foram: perspectivas futuras (46,0/100) e prazer sexual (55,7/100). Dimensões com as pontuações mais altas: imagem corporal (94,2/100) e funcional (93,3/100). Os sintomas mais perturbadores foram: insônia, fadiga e preocupação com a queda de cabelo. Após os tratamentos, pioraram: função física, funcional, imagem corporal, preocupações financeiras e sintomatologia. A função emocional e as perspectivas futuras melhoraram. A ansiedade grave foi apresentada como estado (48,6%) e como traço (18,2%). A maior ansiedade inicial como estado estava associada ao estado civil de casada ou viúva e ao uso de medicamentos ansiolíticos. A maior ansiedade como traço estava associada a: situação inativa no trabalho, medicamentos ansiolíticos, inchaço nas mamas e estágios avançados no momento do diagnóstico. Após os tratamentos, a ansiedade diminui significativamente. Conclusões: após os tratamentos, a pontuação da qualidade de vida é modificada positivamente e a ansiedade como estado e traço diminui.

RESUMEN Objetivos: determinar calidad de vida y ansiedad en pacientes con cáncer de mama y cambios experimentados tras tratamientos. Método: estudio prospectivo. Casos incidentes de cáncer de mama(n=339;seguridad=95%;precisión=±5,32%). Los cuestionarios de calidad de vida fueron: QLQC-30, QLQBr23, y ansiedad: STAI. Se realizó análisis multivariado para identificar variables asociadas a calidad de vida y ansiedad basales y las diferencias pre y post tratamiento. Se obtuvo autorización del comité de ética y consentimiento informado. Resultados: las dimensiones de calidad de vida basales con menor puntuación son: perspectivas de futuro(46,0/100), disfrute sexual(55,7/100). Dimensiones con mayor puntuación: imagen corporal(94,2/100), funcionalidad del rol(93,3/100). Los síntomas más perturbadores fueron: insomnio, fatiga, preocupación por pérdida del cabello. Tras tratamientos, empeoraron: función física, del rol, imagen corporal, dificultades financieras y sintomatología. Mejoraron la función emocional y perspectivas de futuro. Presentaron ansiedad severa como estado 48,6% y como rasgo 18,2%. La mayor ansiedad estado basal se asoció con estado civil casadas-viudas y medicación ansiolítica. La mayor ansiedad rasgo con: situación laboral inactiva, medicación ansiolítica, hinchazón mamaria y estadios avanzados al diagnóstico. Tras los tratamientos, disminuye significativamente la ansiedad. Conclusiones: tras los tratamientos, la puntuación de calidad de vida se modifica positivamente y la ansiedad como estado y como rasgo disminuye.

Mediating Role of Psychological Capital in Relationship between Occupational Stress and Turnover Intention among Nurses at Veterans Administration Hospitals in Korea

PURPOSE: The aim of this study was to evaluate the mediating role of psychological capital (PCP) in the relationship between occupational stress and turnover intention in nurses. METHODS: Data were collected from a sample of 447 nurses working at four Veterans Administration Hospitals throughout South Korea from July 1 to July 31, 2014. We collected data from the nurses using the following surveys: the Short Form Korean-Occupational Stress Scale, the Korean version of the Turnover Intention Scale, and the Korean version of the Psychological Capital Questionnaire. Multiple linear regression analysis was performed to examine the mediating role of PCP. RESULTS: The level of occupational stress was 1.81 ± 0.23, the level of turnover intention was 3.29 ± 0.86, and the PCP level was 3.95 ± 0.52. There were significant correlations among the three variables (occupational stress, turnover intention, and PCP). PCP played a partial mediating role (β=−0.22, p = .008) in the relationship between occupational stress and turnover intention (p < .001) among nurses working at the Veterans Administration Hospitals. CONCLUSION: Based on the findings of this study, we recommend that South Korean hospitals offer occupational stress management programs that incorporate relevant programs in efforts to strengthen the overall components of PCP among nurses to reduce turnover intentions. Further studies are required to determine the most effective intervention programs for hospital settings.

Evaluating the capabilities model of dementia care: a non-randomized controlled trial exploring resident quality of life and care staff attitudes and experiences.

BACKGROUND: This 12 month, Australian study sought to compare the Capabilities Model of Dementia Care (CMDC) with usual long-term care (LTC), in terms of (1) the effectiveness of the CMDC in assisting care staff to improve Quality Of Life (QOL) for older people with dementia; and (2) whether implementation of the CMDC improved staff attitudes towards, and experiences of working and caring for the person with dementia. METHODS: A single blind, non-randomized controlled trial design, involving CMDC intervention group (three facilities) and a comparison usual LTC practice control group (one facility), was conducted from August 2010 to September 2011. Eighty-one staff members and 48 family members of a person with dementia were recruited from these four LTC facilities. At baseline, 6 and 12 months, staff completed a modified Staff Experiences of Working with Demented Residents questionnaire (SEWDR), and families completed the Quality of Life - Alzheimer's Disease questionnaire (QOL-AD). RESULTS: LTC staff in the usual care group reported significantly lower SEWDR scores (i.e. less work satisfaction) than those in the CMDC intervention group at 12 months (p = 0.005). Similarly, family members in the comparison group reported significantly lower levels of perceived QOL for their relative with dementia (QOL-AD scores) than their counterparts in the CMDC intervention group at 12 months (p = 0.012). CONCLUSIONS: Although the study has a number of limitations the CMDC appears to be an effective model of dementia care - more so than usual LTC practice. The CMDC requires further evaluation with participants from a diverse range of LTC facilities and stages of cognitive impairment.

Qualifications for nurses for the care of patients with dementia and support to their caregivers: A pilot evaluation of the dementia care management curriculum.

BACKGROUND: A substantial increase of people with dementia (PwD) is predicted for the future. Nurses are taking over important tasks to support PwD, which requires a specialized qualification. OBJECTIVES: The aim was to identify points for revision and to further improve the Dementia Care Manager (DCM) curriculum as a basis for probable qualification of nurses caring for PwD. DESIGN: We conducted a summative evaluation study to revise the first version of the DCM curriculum. SETTING: The study was conducted in the primary health care setting. PARTICIPANTS: Nurses and lecturers of the first theoretical and practical implementation were involved. METHODS: Questionnaire-based interviews with nurses and lecturers after every module during the theoretical qualification. Besides, nurses rated the curriculum after the end of the theoretical part and evaluated the DCM tasks and the usefulness of the curriculum contents after the practical phase in questionnaire-based interviews. Descriptive statistics were used for analysis. RESULTS: A total of five nurses and 33 lecturers participated in the first theoretical and practical implementation of the DCM qualification. Generally, nurses and lecturers assessed the curriculum contents as "very important" or "important." In particular, the job-related issues, the variety of course topics and the close combination of theory and practice were highly valued. The practical implementation of the DCM was rated predominantly as "important" by nurses for the delivery of care for PwD. To optimize the theoretical DCM curriculum, participants suggested increasing the number of lessons for two of the modules (gerontopsychiatry, interdisciplinary case reviews). Furthermore, nurses preferred a longer practical phase, whereas some lecturers called for larger group sizes of participants. CONCLUSIONS: The DCM qualification enhances nurses' competencies to care for PwD. The curriculum regards an interprofessional, cooperative team approach as the potential to improve health care supply for demented people and to better support their caregivers.

[Delphi study to identify the management skills of nursing executives]. / Estudio Delphi para identificar las competencias en gestión del directivo de enfermería.

OBJECTIVE: To determine and update the skills map for the position of Nurse Administrator in hospitals and Primary Care. METHOD: An observational, descriptive, cross-sectional study based on a Delphi technique was conducted in hospital and Primary Care settings. Two nominal groups with 15 nurses each were used to define the contents of the questionnaire 0 in the Delphi technique. All nurses registered in the professional associations of Alicante, Castellón and Valencia were invited to participate. The results of the Delphi study was submitted to factor analysis to identify the set of skills and, subsequently, compare them with the offer of post-graduate course in colleges and universities during the 2014-15 academic year. RESULTS: Forty-five competences were extracted during the Nominal groups. In total, 705 nurses replied to the first wave in the Delphi Technique, and 394 in the second (response rate of 56%). Factorial analysis grouped the skills chosen into 10 factors: managing people, conflict management, independent learning, ethics, emotional balance, commitment, self-discipline, continuous improvement, critical-thinking, and innovation. Four skills groups identified in this study (emotional balancing, commitment, self-discipline and courage) were not usually included in the post-graduate courses CONCLUSIONS: The nurse administrator skills should be related to relational and ethical behaviour. The training offer of the post-graduate courses must be reoriented.