Le processus de production de savoirs dans la pratique infirmière au moyen de la réflexivité

Un nouveau cadre théorique pour concevoir le processus de production du savoir dans la pratique infirmière s’avère nécessaire pour tenir compte du processus sur les plans individuel et collectif et de l’influence du contexte dans cette production. Pour cette démarche, c’est la théorie de la réflexivité de Giddens qui nous a semblé être la plus pertinente pour guider la présente étude qui visait à décrire et à comprendre le processus de production du savoir dans la pratique infirmière au moyen de la réflexivité. Plus concrètement, l’étude s’est intéressée à découvrir les conditions et dynamiques des contextes institutionnel, pratique et professionnel qui peuvent influencer le processus de production du savoir dans la pratique infirmière ainsi qu’identifier les étapes de ce processus. Le constructivisme projectif fut le paradigme qui a guidé l’étude. Le devis de recherche ce fut l’analyse secondaire de données qualitatives. Le contexte de l’étude était une unité de soins intensifs d’un hôpital général et universitaire à Barcelone. La collecte de données avait été réalisée à l’aide de l’observation systématique, de six entrevues structurées, de sept réunions de groupe et d’une analyse documentaire. L’analyse des données a été effectuée selon des critères provenant de l’approche mixte de Miles et Huberman, du processus d’analyse des données qualitatives de Morse ainsi que des recommandations faites par des auteurs clés par rapport à l’analyse secondaire. Les critères de rigueur ont été utilisés et les aspects éthiques ont été assurés. Les résultats de cette étude démontrent que les conditions et dynamiques des contextes institutionnel, pratique et professionnel influencent profondément l’action infirmière et le développement du savoir. Ces conditions et dynamiques sont intériorisées dans la vie professionnelle des infirmières et constituent des façons «normales» d’aborder la pratique. Toutefois, bien qu’il existe une acceptation du statu quo, les sentiments contradictoires et la souffrance ressortent facilement. Ces conditions et dynamiques provoquent chez les infirmières une incapacité à agir de façon juste, éthique et responsable ainsi qu’une limitation face à l’exploration de nouvelles possibilités, formulations et manifestations de pratique. Les résultats mettent également en évidence les étapes du processus de production du savoir au moyen de quatre grands thèmes: la reconnaissance de la réflexivité quotidienne, l’examen systématique des pratiques, la construction d’un nouveau savoir et la reconstruction émancipatrice du savoir. Finalement, cette thèse met en relief l’importance de la théorie de Giddens pour l’étude de la production du savoir et de la relation entre l’infirmière et le contexte ainsi que l’utilisation du devis d’analyse secondaire des données qualitatives pour la discipline infirmière.A new theoretical framework for designing the process of knowledge production within nursing practice is necessary to take into account the individual and the collective process of knowledge production as well as the influence of the context on this production. The theory of reflexivity of Giddens seems to be most relevant. This study aimed to describe and understand the process of knowledge production within nursing practice through reflexivity. More specifically, it was important to uncover the conditions and dynamics of the institutional, professional and practice context which influence the process of knowledge production within nursing practice and to identify the steps of this process. Projective constructivism was the paradigm that has guided the study. The research design was a secondary analysis of qualitative data. The study context was a critical care unit of a general and university hospital in Barcelona. Data were collected through systematic observation, six structured interviews, seven focus groups, and documents analysis. Data were analysed according to the mixed approach of Miles and Huberman, the qualitative analysis of Morse, and recommendations from various authors on secondary analysis. The rigor criteria were used and the ethical aspects were covered. The study results suggest that the conditions and dynamics of institutional, practical and professional contexts impact profoundly the nursing action and knowledge production. These conditions and dynamics are internalized in the working lives of nurses and provide “normal” ways of nursing practice. However, although there is an acceptance of the status quo, the conflicting feelings and suffering emerge easily. These conditions and dynamics cause incapacity among nurses to act fairly, ethically and responsibly and limit their exploration of new possibilities, formulations and demonstrations of practice. The results propose also the stages of knowledge production through four major themes: the recognition of daily reflexivity, systematic review of practices, the construction of new knowledge and the re-construction of emancipatory knowledge. Finally, this thesis suggests the importance of Giddens' theory for the study of knowledge production and the relationship between the nurse and the context, as well as the use of secondary analysis of qualitative data for the nursing discipline

Coping strategies in health care providers as second victims: A systematic review

Aim: To analyze personal and organizational strategies described in the literature for dealing with the second victim phenomenon among healthcare providers. Background: The second victim phenomenon involves many associated signs and symptoms, which can be physical, psychological, emotional, or behavioral. Personal and organizational strategies have been developed to deal with this phenomenon. Materials and methods: A systematic review was carried out in PubMed, Cochrane Library, Web of Science, Scopus, PsycINFO, Science Direct, and Cumulative Index to Nursing and Allied Health Literature databases, searching for evidence published between 2010 and 2019 in Spanish, English, German, and Portuguese. Results: Seven hundred and eighty-three articles were identified. After eliminating duplicates, applying inclusion and exclusion criteria and critical analysis tools of the Joanna Briggs Institute, 16 research articles were included: 10 quantitative studies (design: descriptive, correlational, systematic, or integrative review) and six qualitative studies (descriptive, systematic review). There are several different personal and organizational strategies for dealing with the second victim phenomenon. Among these, peer support and learning from adverse events are highly valued. In personal strategies stands out the internal analysis of the adverse event that the professional performs to deal with the generated negative feelings. In organizational strategies, the most valued are second victim support programs with rapid response teams and made up of peers. Conclusions: The main organizational coping strategies for tackling this phenomenon are online programs in countries such as the United States, Spain, and other European countries. Formal evaluation of these programs and research is required in Latin America

Do conceito de empoderamento do paciente aos instrumentos de medição: uma revisão integrativa

OBJETIVO Analizar definiciones y dimensiones de empoderamiento. Identificar fortalezas y debilidades de los instrumentos de medida de empoderamiento respecto al modelo conceptual. MÉTODO Revisión integrativa de la literatura en las bases de datos MEDLINE y Cumulative Index to Nursing and Allied Health Literature (CINAHL). RESULTADOS Fueram seleccionados 29 artículos . Se identificaron 17 definiciones, 7 propuestas de dimensiones y 10 instrumentos de medida. Empoderamiento puede ser un proceso de capacitación o habilitación en el que se transfiere el poder de un individuo a otro, o bien un resultado producto de ese proceso. Las dimensiones reflejan indicadores de resultados como son la participación en la toma de decisiones y tomar el control, e indicadores relativos al proceso como son la adquisición de conocimientos y las habilidades de afrontamiento. De los instrumentos analizados seis son los instrumentos que presentan mayor robustez. CONCLUSIÓN Se propone una definición de empoderamiento que puede ayudar a mejorar la comprensión del término y por lo tanto a operacionalizarlo.OBJETIVO Analisar as definições e as dimensões do conceito de empoderamento. Identificar os pontos fortes e fracos dos instrumentos de medição de empoderamento a partir do seu modelo conceitual. MÉTODO Revisão integrativa da literatura nas bases de dados MEDLINE e Cumulative Index to Nursing and Allied Health Literature (CINAHL). RESULTADOS Foram selecionados 29 artigos, 17 definições de empoderamento, sete propostas de dimensões e 10 instrumentos de medição. Empoderamento pode ser concebido como um processo de formação e habilitação em que se transfere o poder de um indivíduo a outro, ou como resultado/produto desse processo; as dimensões refletem indicadores de resultados, tais como a participação na tomada de decisões e assumir o controle; e os indicadores relativos ao processo referem-se à aquisição de conhecimentos e às habilidades de enfrentamento. Dos instrumentos analisados, seis têm maior robustez. CONCLUSÃO Propor uma definição de empoderamento que possa ajudar a melhorar a compreensão do termo e, assim, operacionalizá-lo.OBJECTIVE Analyze the definitions and dimensions of empowerment. Identify the strengths and weaknesses of empowerment measures based on the conceptual model. METHOD This was a comprehensive literature review of publications on the MEDLINE and Cumulative Index to Nursing and Allied Health Literature (CINAHL) databases. RESULTS Twenty-nine articles were selected. Seventeen definitions and seven dimensions of empowerment, and 10 empowerment measures were selected. Empowerment can be seen as an enabling process involving a shift in the balance of power, or as an outcome of this process. The dimensions reflect outcome indicators, such as participation in decision-making and control, and process indicators, such as knowledge acquisition and coping skills. Six of the tools analyzed by this study could be said to provide a robust measure of patient empowerment. CONCLUSION we propose a definition of empowerment that helps to deepen understanding of the term and, therefore, its operationalization

Individualization process of the standardized care plan in acute care hospitalization units: study protocol

Aim: to understand the individualization process of the standardized care plan (SCP) that nurses design for hospitalized patients. Background: to apply the nursing process, it is advisable to use SCP to standardize the diagnosis, planning and evaluation stages. However, the fundamental element of this methodology is the individualization of the care plan. Design: a qualitative study, framed within the constructivist paradigm and applying the Grounded Theory method, in accordance with Strauss and Corbin's approach. Methods: multicentre study. Theoretical sampling with maximum variation will be used. The data collection will consist of: in‐depth individual interviews, participant observation, document analysis, focus group, and the questionnaires for Critical Thinking Assessment in relation to clinical practice and Nursing Competency Assessment for hospital nurses. The qualitative data will be analysed according to the constant comparative method of Strauss and Corbin's Grounded Theory, which involves performing open, axial and selective coding. The questionnaire results will be used to make a qualitative analysis that will consist of a triangulation between the level of critical thinking, level of expertise and record of the individualization process performed by the nurses. This protocol was approved in July 2015. Discussion: by knowing the possible stages used in the individualization of a SCP, together with the elements that facilitate or hinder said individualization and nurses' attitudes and experiences regarding this phenomenon, it could help direct improvement strategies in the standardization and individualization process. In addition to recommendations for teaching and research

Revisión de conocimientos sobre el fracaso renal agudo en el contexto del paciente crítico

El fracaso renal agudo afecta entre un 1 y un 25% de los pacientes ingresados en unidades de cuidados intensivos, cifras que varían según la población y los criterios estudiados. Las complicaciones derivadas del fracaso renal agudo (hipervolemia, acidosis metabólica, hiperpotasemia, hemorragias) se tratan pero la mortalidad sigue siendo elevada a pesar de los avances tecnológicos de los últimos años ya que, habitualmente, el fracaso renal agudo está asociado a sepsis, insuficiencia respiratoria, heridas graves, complicaciones quirúrgicas o coagulopatías de consumo. El rango de mortalidad va desde un 30 a un 90%. Aunque no disponemos de una definición universalmente aceptada, la clasificación RIFLE aporta una herramienta operativa tanto para definir el grado de fracaso renal agudo como para homogeneizar el inicio de las técnicas de depuración extrarrenal y evaluar los resultados obtenidos. En consecuencia, las enfermeras que trabajan en una unidad de cuidados intensivos deben estar familiarizadas con esta afección, con su tratamiento (farmacológico o sustitutivo) y con la prevención de las posibles complicaciones. De igual manera han de ser capaces de detectar las manifestaciones de dependencia de cada una de las necesidades básicas e identificar los problemas de colaboración para conseguir un plan de cuidados individualizado

Guia de valoración de las 14 necesidades básicas en un adulto sano

Se presenta una guía de valoración de las 14 necesidades básicas según el Modelo Conceptual de Virginia Henderson en un adulto sano que muestra la definición de la necesidad, así como la valoración inicial y los comportamientos adecuados para la satisfacción de cada necesidad

Prevalence of the second victim phenomenon among intensive care unit nurses and the support provided by their organizations

Background Health professionals can be 'second victims' of adverse patient events. Second victimhood involves a series of physical and psychological signs and symptoms of varying severity and is most prevalent among nurses and women and in intensive care units (ICUs). Previous research has described personal and organizational coping strategies. Aim The objective of this research is to determine the prevalence of second victimhood, focusing on psychological distress, among Chilean adult intensive care nurses and its relationship with the support provided by their organizations. Study Design A descriptive, correlational and cross-sectional study was conducted in seven intensive care units of Chilean hospitals. Results Of a sample of 326 nurses, 90.18% reported having been involved in an adverse event and 67% reported psychological distress resulting from the adverse event. Embarrassment was the most prevalent psychological symptom (69%). Only 2.8% reported that their organization had an action plan for professionals in the event of a serious adverse event. Participants who had spent longer working in an ICU reported more support from their organization around adverse events. Conclusion Two-thirds of Chilean adult intensive care unit nurses report psychological stress following an adverse event. These results should be assessed internationally because second victims have major implications for the well-being of health professionals and, therefore, for retention and the quality of care. Relevance to Clinical Practice Critical care leaders must actively promote a safe environment for learning from adverse events, and hospitals must establish a culture of quality that includes support programmes for second victims

Implementing evidence-based practices on the therapeutic relationship in inpatient psychiatric care: a participatory action research

Aims and objectives: to produce changes in the therapeutic relationship between clinical practice nurses and patients in psychiatric units by implementing evidence-based practices through participatory action research. Background: the therapeutic relationship is the cornerstone of nursing care in psychiatric units. The literature suggests that theoretical knowledge alone is insufficient to establish the therapeutic relationship in practice. Therefore, strategies are needed to adequately establish the therapeutic relationship in psychiatric units. Design: participatory action research. Methods: participants consisted of nurses from two psychiatric units of a university hospital. Data were collected through focus groups and reflective diaries, which were analysed using the content analysis method. The COREQ guidelines were followed to ensure rigour. Results: nurses conceptualised the therapeutic relationship in their practice, identifying facilitating elements and limitations. They were able to compare their clinical practice with the recommendations of scientific evidence and constructed three evidence-based proposals to improve the therapeutic relationship: (a) a customised nurse intervention space, (b) knowledge updating and (c) reflective groups, which they subsequently implemented and evaluated. Conclusions: this study shows that nurses in psychiatric units can generate changes and improvements in the therapeutic relationship. The process of implementing evidence-based practice enhanced participants' awareness of their clinical practice and allowed them to make changes and improvements. Relevance to clinical practice: the process confirmed that the implementation of evidence-based practice through participatory methods, such as participatory action research, is valid and produces lasting changes. This study also reveals the need to rethink nurses' functions and competencies in current psychiatric units

La relación terapéutica como eje de los cuidados enfermeros en las unidades de agudos de salud mental: análisis del contexto en Cataluña

Múltiples factores de tipo individual y contextual condicionan la calidad de la relación terapéutica en unidades de salud mental. El objetivo fue describir las características de estructura, de equipo, de normativa y de dinámica de cuidados que intervienen en el establecimiento de la relación terapéutica en las unidades de salud mental de Cataluña. El estudio forma parte un proyecto multicéntrico que incluye 18 unidades de salud mental de Cataluña y que pretende mejorar la relación terapéutica a través de una Investigación-Acción Participativa. Este trabajo es la primera etapa en la cual se realizó un análisis del contexto de estudio. Los datos se recogieron a través de guías observacionales cumplimentadas por las enfermeras coordinadoras de cada centro. Los resultados se agruparon en 3 temas: i) estructura de las unidades y dimensión de las plantillas, ii) normativa y dinámica de las unidades y iii) indicadores de calidad de los cuidados. La principal conclusión del estudio es la gran variabilidad observada en las unidades en relación con su estructura, ratios y normativas. Debido a estos factores del entorno, los cuidados que se brindan y, en consecuencia, la relación terapéutica; es considerablemente distinta en función del área en la que reside cada paciente