A experiência das enfermeiras de turno num hospital espanhol: estudo qualitativo-fenomenológico.

O propósito deste estudo é descrever a experiência das enfermeiras de turno nas diferentes unidades hospitalares. Seguiu-se um enfoque fenomenológico e qualitativo. Realizamos uma amostragem teórica com o pessoal de enfermagem de turno do Hospital Santa Bárbara de Soria (Espanha), com a finalidade de obter uma compreensão mais profunda do fenômeno. Os dados foram coletados a través de entrevistas e de diário de campo. Os dados foram analisados usando a proposta de Giorgi. 21 enfermeiros de turno com uma média de idade de 46 anos foram incluídos. Três temas principais, que descrevem a experiência das enfermeiras, emergiram dos dados: construindo o primeiro contato, buscando um espaço e estabelecendo relações interprofissionais/interpressoais. Concluimos que a experiência de acolher as enfermeiras de turno em ambientes clínicos mutáveis está condicionada por diferentes fatores. É preciso estabelecer objetivos claros a respeito do papel das enfermeiras de turno nas unidades por parte de enfermeiras e gestores.El propósito de este estudio es describir la experiencia de las enfermeras “de apoyo” en las diferentes unidades de hospitalización. Seguimos un enfoque fenomenológico cualitativo. Realizamos un muestreo por propósito y teórico de dicho personal del Hospital Santa Bárbara de Soria (España), con el fin de obtener una comprensión más profunda del fenómeno. Los datos fueron recolectados a través de entrevistas en profundidad y diario de campo. Los datos fueron analizados usando la propuesta de Giorgi. Veintiuna enfermeras “de apoyo” con una media de edad de 46 años fueron incluidos. Tres temas principales que describen la experiencia de los enfermeros emergieron de los datos: construyendo el primer contacto, buscando un hueco y estableciendo relaciones interprofesionales/interpersonales. Concluimos que la experiencia de acoger dichas enfermeras en entornos clínicos cambiantes esta condicionada por diferentes factores. Es preciso establecer objetivos claros respecto al rol de las mismas en las unidades por enfermeras y gestores.The objective of this study was to describe the Supplemental Nursing Staff´s experiences at different hospital units. A qualitative phenomenological approach was conducted; a purposeful and theoretical sampling was implemented with supplemental nursing staff at Santa Barbara Hospital of Soria (Spain), to gain a more in-depth understanding of the Supplemental Nursing Staff ´s experience. Data were collected by in-depth interviews and through a field notebook. Data were analyzed using the Giorgi proposal. Twenty-one nurses with a mean age of 46 years were included. Three main topics emerged from the data analysis: building the first contact, carving out a niche and establishing interprofessional/interpersonal relationships. We conclude that the experience of hosting the supplemental nursing staff in changing clinical environments is conditioned by various factors. It is necessary for nurses and hospital managers to establish clear objectives with regard to the supplemental nursing staff´s role in the units

IDENTIFICACIÓN DE FACTORES DE ESTRÉS LABORAL EN PROFESIONALES DE ENFERMERÍA

Durante las últimas décadas, ha crecido el interés por el estudio del estrés y los factores psicosociales relacionados con el trabajo. Se suele estudiar el estrés en unidades específicas, pero es frecuente encontrar situaciones de estrés en Unidades Médicas. Fue objetivo de ese estudio identificar y clasificar factores laborales estresantes que afectan a los profesionales de enfermería en Unidades Hospitalarias. Estudio cualitativo, descriptivo-analítico, prospectivo siguiendo la metodología Delphi, en España – Hospital Geral. Universitario de Alicante y Hospital Geral. de Elda. Participaron profesionales de enfermería (n=30) de las unidades. Se identifican en las cuatro etapas del proceso diferente factores de estrés en los profesionales, elevándose progresivamente los niveles de consenso. Se concluye que los factores con mayor consenso y mayor puntuación en el grupo, pueden usarse como herramienta en la gestión clínica de unidad hospitalaria, a fin de mejorar la calidad de vida laboral de los trabajadores, y buscar la excelencia en la línea gestora.Interest in the study of stress and the psycho-social factors related with work has grown over recent decades. Stress may be studied in specific units, but situations of stress are frequently to be found in medical units. The objective of this study was to identify and classify work-related stress factors which affect nursing professionals in hospital units. The study was qualitative with a descripto-analytical approach, following the Delphi methodology, and was carried out in Spain at the University of Alicante General Hospital and Elda General Hospital. Thirty nursing professionals from these units participated. Different stress factors acting on the health professionals were identified in the four stages of the process, in progressively raising levels of consensus. It is concluded that the factors referred to most frequently and with the greatest consensus may be used as a tool in the clinical management of hospital units, to improve the work life of the staff and to seek excellence in management.Durante as últimas décadas, o interesse pelo estudo do estresse vem crescendo, bem como os fatores psicossociais relacionados com o trabalho. É comum estudar o tema estresse em unidades específicas, porém frequentemente se encontram situações de estresse em Unidades Médicas. O objetivo desse estudo foi identificar e classificar fatores laborais estressantes que afetam os profissionais de enfermagem em Unidades Hospitalares. Estudo qualitativo, descritivo-analítico, prospectivo segundo a metodologia Delphi, na Espanha – Hospital Geral. Universitário de Alicante e Hospital Geral. de Elda. Participaram 30 profissionais de enfermagem das unidades. Foram identificados, nas quatro etapas do processo, diferentes fatores de estresse nos profissionais, elevando-se progressivamente os níveis de consenso. A conclusão a que se chegou foi a de que os fatores com maior consenso e maior pontuação no grupo podem ser usados como feramenta na gestão clínica de unidade hospitalar, a fim de melhorar a qualidade de vida laboral dos trabalhadores e buscar a excelência na linha gestora

Nurses' experiences working with nursing students in a hospital: a phenomenological enquiry

Objective: this paper explores the experiences of registered nurses working with Spanish nursing students within the hospital. Methods: a qualitative phenomenological approach was followed. Purposeful sampling was employed. Twenty-one registered nurses, from a public hospital located in Spain, were included in the study. Data were collected by means of unstructured and semi-structured interviews and were analysed using Giorgi's proposal. The Consolidated Criteria for Reporting Qualitative Research were followed. Results: three main themes described the experience of registered nurses: "The nurse's relationship with nursing students"; most nurses emphasized the importance of the first contact with students and they considered students' attitude to be key. "Defining the role of the student in clinical practice"; it is necessary to unify the nurse's role and interventions to avoid misleading students and establish priorities in clinical practice. "Building bridges between clinical settings and the University"; the need to establish a common ground and connection between the university and hospital clinical settings was emphasized. Nurses felt that the training program should also be designed by the clinical settings themselves. Conclusions: understanding the meaning of nursing students with registered nurses might gain a deeper insight into their expectations.Objetivo: este artículo explora las experiencias de las enfermeras que trabajan con estudiantes de enfermería españolas en un hospital. Métodos: se utilizó un abordaje fenomenológico cualitativo y una muestra de conveniencia. Se incluyeron en el estudio veintidós enfermeras pertenecientes a un hospital público de España. Los datos fueron recogidos a través de entrevistas no estructuradas y semi-estructuradas, y analizadas usando la propuesta de Giorgi. Se siguieron los Criterios Consolidados para Relatos de Investigación Cualitativa. Resultados: tres temas principales describen la experiencia de las enfermeras: "La relación de la enfermera con las estudiantes de enfermería" la mayoría de las enfermeras dan énfasis a la importancia del primer contacto con las estudiantes y consideran que la actitud de las estudiantes es esencial. "La definición del rol de la estudiante en la práctica clínica"; es necesaria para unificar el rol y las intervenciones de la enfermera para evitar guiar en forma errónea a las estudiantes y establecer prioridades en la práctica clínica. "Construir puentes entre los ambientes clínicos y la Universidad"; se enfatizó la necesidad de establecer un terreno común y conexiones entre la universidad y los servicios clínicos del hospital. Las enfermeras piensan que el programa educativo debe ser también diseñado por los servicios clínicos. Conclusiones: comprender los significados de las estudiantes de enfermería con las enfermeras puede proveer una introspección más profunda de sus expectativas.Objetivo: este artigo explora as vivencias das enfermeiras que trabalham com estudantes de enfermagem espanholas em um hospital. Método: foi utilizada uma abordagem fenomenológica qualitativa e uma amostra por conveniência. Vinte e uma enfermeiras pertencentes a um hospital público na Espanha foram incluídos no estudo. Os dados foram coletados através de entrevistas não-estruturadas e semiestruturadas e analisadas usando a proposta de Giorgi. Foram observados os Critérios Consolidados para Relatos de Pesquisa Qualitativa. Resultados: três temas principais descrevem a experiência das enfermeiras: "A relação da enfermeira com as estudantes de enfermagem"; a maioria das enfermeiras enfatizam a importância do primeiro contato com estudantes e consideram central a atitude dos estudantes. "A definição do papel da estudante na prática clínica"; é necessária para unificar o papel e as intervenções da enfermeira para evitar guiar erroneamente ao estudante e estabelecer prioridades na prática clínica. "Construir pontes entre os serviços clínicos e a Universidade"; enfatizou-se a necessidade de estabelecer um terreno comum e conexões entre a universidade e os serviços clínicos do hospital. As enfermeiras pensam que o programa educacional deve também ser desenhado pelos serviços clínicos. Conclusões: compreender os significados das estudantes de enfermagem com as enfermeiras graduadas pode permitir uma introspecção mais aprofundada nas suas expectativas

Identificaçao de fatores de estresse laboral em profissionais de enfermagem

Durante las últimas décadas, ha crecido el interés por el estudio del estrés y los factores psicosociales relacionados con el trabajo. Se suele estudiar el estrés en unidades específicas, pero es frecuente encontrar situaciones de estrés en Unidades Médicas. Fue objetivo de ese estudio identificar y clasificar factores laborales estresantes que afectan a los profesionales de enfermería en Unidades Hospitalarias. Estudio cualitativo, descriptivo-analítico, prospectivo siguiendo la metodología Delphi, en España – Hospital Geral. Universitario de Alicante y Hospital Geral. de Elda. Participaron profesionales de enfermería (n=30) de las unidades. Se identifican en las cuatro etapas del proceso diferente factores de estrés en los profesionales, elevándose progresivamente los niveles de consenso. Se concluye que los factores con mayor consenso y mayor puntuación en el grupo, pueden usarse como herramienta en la gestión clínica de unidad hospitalaria, a fin de mejorar la calidad de vida laboral de los trabajadores, y buscar la excelencia en la línea gestora.Interest in the study of stress and the psycho-social factors related with work has grown over recent decades. Stress may be studied in specific units, but situations of stress are frequently to be found in medical units. The objective of this study was to identify and classify work-related stress factors which affect nursing professionals in hospital units. The study was qualitative with a descripto-analytical approach, following the Delphi methodology, and was carried out in Spain at the University of Alicante General Hospital and Elda General Hospital. Thirty nursing professionals from these units participated. Different stress factors acting on the health professionals were identified in the four stages of the process, in progressively raising levels of consensus. It is concluded that the factors referred to most frequently and with the greatest consensus may be used as a tool in the clinical management of hospital units, to improve the work life of the staff and to seek excellence in management

Nurses' experiences working with nursing students in a hospital: a phenomenological enquiry

Abstract Objective: this paper explores the experiences of registered nurses working with Spanish nursing students within the hospital. Methods: a qualitative phenomenological approach was followed. Purposeful sampling was employed. Twenty-one registered nurses, from a public hospital located in Spain, were included in the study. Data were collected by means of unstructured and semi-structured interviews and were analysed using Giorgi's proposal. The Consolidated Criteria for Reporting Qualitative Research were followed. Results: three main themes described the experience of registered nurses: "The nurse's relationship with nursing students"; most nurses emphasized the importance of the first contact with students and they considered students' attitude to be key. "Defining the role of the student in clinical practice"; it is necessary to unify the nurse's role and interventions to avoid misleading students and establish priorities in clinical practice. "Building bridges between clinical settings and the University"; the need to establish a common ground and connection between the university and hospital clinical settings was emphasized. Nurses felt that the training program should also be designed by the clinical settings themselves. Conclusions: understanding the meaning of nursing students with registered nurses might gain a deeper insight into their expectations

Hospitalization model and the readmission frequency in patients with copd exacerbation

Objetivo. Evaluar la efectividad de (UCE) en pacientes con (EPOC) agudizada frente a (HC) en términos de reingreso y mortalidad. Método. Estudio de cohortes retrospectivo no aleatorizado de pacientes hospitalizados por exacerbación de EPOC durante 2004 en un hospital general. El seguimiento se prolongó hasta el 31 de diciembre de 2006. La censura de datos se produce en la fecha final de seguimiento o aparición de muerte o reingreso. El análisis estadístico se basó en Kaplan-Meier, test del log-rank y regresión de Cox. Resultados. De los 543 pacientes incluidos, 252 ingresaron en UCE y 291 en HC. Los pacientes de UCE eran mayores (75,4 frente a 71,7 años; p < 0,001), y tendencia a un menor I. Charlson (0,46 frente a 0,58; p <0,07) que los pacientes de HC. La estancia media fue de 3,2 días en UCE frente a 8,9 días en HC (p <0,001). En el análisis univariante, los pacientes ingresados en UCE mostraron una mayor incidencia de muerte o reingreso (Riesgo Relativo [RR] 1,31; p<0,001), a expensas de los reingresos (RR 1,53; p= 0,013), no hubo diferencias de mortalidad (RR 0,82; p=0,34). Al ajustar para las covariables del modelo de hospitalización mediante regresión de Cox, estas estimaciones no cambiaron El análisis de las curvas de supervivencia demostró que las diferencias no se debieron a un aumento de los reingresos precoces. Conclusiones. En el estudio, los pacientes con exacerbación de EPOC ingresados en UCE tuvieron peores resultados en términos de reingreso que los de HCABSTRACT Objective: To evaluate the effectiveness of the Short Stay Unit (USS) in patients who suffer from a chronic obstructive pulmonary disease (COPD) that worsens versus conventional hospitalization (CH) in terms of readmission and mortality. Patient and Method. Non randomized retrospective study of cohorts of patients hospitalized due to exacerbation of EPOC during 2004 in a general hospital. The monitoring was prolonged until December 31st 2006 or the occurrence of an event (death or readmission). The statistical analysis was based on the Kaplan-Meier method, the log-rank test and Cox regression. Results. Of the 543 subjects, 252 were admitted in USS and 291 in CH. Those admitted in USS were more advanced in years (75.4 versus 71.7 years; p < 0,001), and with a tendency to a smaller Charlson index (0.46 versus 0.58; p < 0,07) than the patients in HC. The average stay was 3.2 days in UCE versus 8.9 days in CH (p < 0,001). In the univariant analysis, the patients admitted in USS showed a major incidence of death or readmission (Relative Risk [RR] 1.31; p < 0,001), at the expense of the readmission (RR 1.53; p = 0,013), while there were no differences in mortality (RR 0,82; p=0 ,34). After applying the Cox regression for the hospitalization covariables fit, there was no substantial change in the estimates. The analysis of the survival curves demonstrated that the differences were not due to an increase in precocious readmissions. Conclusions. In the field of the study, the patients with exacerbation of COPD admitted in USS had worse results in readmission terms than the patients admitted in CH

Quality of life and self-care in patients with Parkinson in a regional hospital: descriptive study

Objetivos:Determinar el grado de autocuidadoy la calidad de vida en una muestra de pacientes con Enfermedad de Parkinson en estadios inicialesy conocer las dimensiones de autocuidado y calidad de vida más afectadas. Estudiar la relación entre los síntomas no motores con estas medidas de resultado.Metodología:Estudio observacional transversal realizado en una muestra de 21 enfermos de Parkinson grado I, II de la escala Hoenh Yarh. Se estudió el nivel de autocuidados, calidad de vida, síntomas no motores y nivel de salud percibido. Se realizó análisis descriptivo, inferencial y de correlación con el paquete estadístico SPSS v.20.Resultados:La edad media de la muestra fue de 71,86 (dt8,93) años, el 52,4% eran hombres. El nivel medio de autocuidados fue de 1,14 (dt0,35) siendo la dimensión más afectada el uso de medicamentos con una autonomía completa del 61,9% y 17,28 (dt7,75) para la calidad de vida siendo la dimensión más afectada el disconfort corporal (m=35,03; dt19,61). Se observó correlación baja entrelos síntomas no motores y la calidad de vida (r=0,246;p=0,022), pero no entre los síntomas no motores y el autocuidado (r=0,010;p=0,662).Conclusiones:El nivel de autocuidados y calidad de vida de la muestra estudiada es adecuado. Las dimensiones de calidad de vida más afectadas son el disconfort corporal seguida por el deterioro cognitivo y los síntomas no motores están relacionados con el nivel de calidad de vida. Es relevante considerar estos aspectos en el desarrollo de intervenciones de educación terapéutica dirigidas a pacientes con Parkinson.ABSTRACT: Objectives:To determine the level of self-care and quality of life in a sample of patients in the early stages of Parkinson’s disease and identify the most highly affected dimensions of self-care and quality of life. To study the relationship between non-motor symptoms and these outcome measures.Method:A cross-sectional study was conducted in a sample of 21 patients with stage I or II Parkinson’s disease as defined by the Hoenh Yarh Scale. We studied the level of self-care, quality of life, non-motor symptoms and perceived health status. Descriptive, inferential and correlation analyses were performed using SPSS v.20.Results:Mean sample age was 71.86 (SD8.93) years old, and 52.4% were males. The mean score for self-care was 1.14 (SD0.35), and the most highly affected dimension was medication use, with 61.9% of the sample presenting complete autonomy, while for quality of life it was 17.28 (SD7.75), and the most highly affected dimension was bodily discomfort (m=35.03; SD19.61). We observed a correlation betweennon-motor symptoms and quality of life (r=0.246; p=0.022), but not between non-motor symptoms and self-care (r=0.010; p=0.662).Conclusions:Our sample presented an acceptable level of self-care and quality of life. The most highly affected quality of life dimensions were bodily discomfort followed by cognitive impairment, and non-motor symptoms were related to the level of quality of life. It is important to consider these aspects when designing therapeutic education interventions targeting patients with Parkinson’s disease