Tradução e adaptação para a cultura brasileira do "Nursing Work Index - Revised"

Relationship between mental workload and hospital infection in the ICU

BACKGROUND: Nursing is among the most stressful professions. Studies that examine possible factors that influence the mental workload (MWL) of nurses are of fundamental importance, because through these results, efforts can be concentrated on improving their working conditions more efficiently. OBJECTIVE: To investigate the influence of hospital infection on the MWL of nurses in an intensive care unit (ICU). METHOD: Cross-sectional and descriptive study, with a quantitative approach. Three research instruments were used: a sociodemographic questionnaire, the NASA Task Load Index (NASA-TLX) and the Nursing Work Index-Revised Brazilian version (B-NWI-R). The sample consisted of 30 nurses from the ICU of a public hospital in João Pessoa city, Brazil, during the daytime period, and the Spearman correlation test (α= 0,05) was applied to verify associations. RESULTS: There was a high MWL among nurses, with a NASA-TLX weighted average of 66.38 (SD±15.0). Correlations were found between the levels of hospital infection in the ICU and the MWL of the nurses (r = 0.654, p <  0.01); in the nurses’ care of patients with urinary tract infection, the correlation is 0.546, p <  0.01; if care is provided to patients with lung problems, the correlation is 0.563, p <  0.01 The ICU presented a favorable environment to nursing practices, with means lower than 2.5, according to the B-NWI-R. CONCLUSION: The MWL of the nurses was associated with the hospital infection levels of the intensive care sector studied. It was found that the MWL of nurses in relation to hospital infection in the ICU increased by 42.8% . This MWL is impacted by 29.8% when nurses’ care is linked to patients with urinary infection. But if care is provided to patients with lung problems, this percentage rises to 31.7%

Development and psychometric evaluation of a quality nursing care scale from nurses' perspective

Aim

To develop and evaluate psychometric property of quality nursing care scale (QNCS) from nurses’ perspective in the Chinese context.

Design

A cross‐sectional survey design.

Methods

This study was conducted in two phases. In Phase I, literature review and interviews were conducted to develop the items. In Phase II, content validity was evaluated by five experts. Construct validity was tested through exploratory factor analysis (EFA) among 302 nurses and confirmatory factor analysis (CFA) among 510 nurses from October 2014 to January 2015. Additionally, internal consistency reliability was tested.

Results

The EFA extracted six factors including staff characteristics, task‐oriented activities, human‐oriented activities, physical environment, patient outcomes and precondition. All six factors accounted for 74.78% of the total variance to explain quality nursing care. The modified measurement model of the final version of QNCS was supported by the CFA with 48 items in six dimensions. The internal consistency reliability of final QNCS was acceptable.

Designing and validating the empowerment scale for the older individuals with chronic obstructive pulmonary disease (ESOCOPD)

Introduction

A standard scale to examine the empowerment status of older individuals with chronic obstructive pulmonary disease (COPD) can be used to assess their ability for self-care and disease management. This study aimed to design and validate the empowerment scale for the older individuals with COPD (ESOCOPD).

Materials & methods

This study was conducted in two phases with a deductive-inductive approach: a qualitative phase for designing the tool (the grounded theory study re-analysis, a review of texts and interviews) and a quantitative phase for validation of the questionnaire (face and content validity and reliability). Reliability was determined by test-retest and Spearman's correlation coefficient.

Results

Based on the results of the grounded theory study re-analysis and a review of texts and interviews, 47 items were designed, 14 of which were removed in the face and content validity assessment. The total Content validity index and content validity ratio of the questionnaire were found as 0.82 and 0.95, respectively.The final number of items in the scale was 33, and its dimensions included “information seeking, achieving independence, learning to live with COPD, participation in care, having critical thinking, psychosocial capacities management, and achieving goals”. Intra-class correlation of questionnaire dimensions was 0.86–0.99.

Conclusions

The ESOCOPD can be used by health care and treatment providers to determine the patient's ability for self-care and disease management because of its small number of items, it's validation, and reliability.

Nurse work environment: comparison between private and public hospitals

Objective

To compare the characteristics of the work environment that enable the professional practice of nurses in private and public organizations.

Methods

A quantitative, exploratory, cross-section study, carried out in four health organizations - one public and three private, with 188 registered nurses. Participants answered the Brazilian version of the Nursing Work Index − Revised, which aims to evaluate the presence of characteristics that favor the development of nursing activities through 15 items distributed into three subscales: autonomy, control over the practice setting and relationships with physicians. The measurement scale used is Likert, and lower scores represent better evaluation of the environment, i.e. , more favorable characteristics are present to assist the development of nursing activities.

Results

The means of the responses of participants of private hospitals were smaller in all subscales of the instrument, as compared to those from public hospitals.

Conclusion

The environment of private hospitals showed more favorable characteristics to the professional practice of registered nurses than the public hospital environment.

Liderança do enfermeiro e sua relação com o ambiente de trabalho hospitalar

Resumo Objetivo Analisar o ambiente de trabalho do enfermeiro considerando: autonomia, controle, relações entre médicos e enfermeiros e suporte organizacional; verificar o estilo de liderança ideal, na percepção do enfermeiro, e o real de acordo com a avaliação de um dos seus liderados; correlacionar as variáveis ambiente de trabalho e liderança real. Métodos Estudo correlacional realizado nas unidades assistenciais dum hospital geral de São Paulo, SP, Brasil. A amostra de conveniência constituiu-se de 62 duplas (enfermeiros e técnicos/auxiliares de enfermagem). Os enfermeiros responderam três instrumentos: 1-) caracterização; 2-) Brasilian Nursing Work Index Revised (B-NWI-R) que mensura: autonomia, controle, relações entre médicos e enfermeiros e suporte organizacional; e 3-) Grid & Liderança em Enfermagem: comportamento ideal que mensura cinco estilos: 1.1, 1.9, 5.5, 9.1 e 9.9. Os técnicos/auxiliares em enfermagem responderam: 1-) caracterização e 2-) Grid & Liderança em Enfermagem: comportamento real considerando o enfermeiro como líder imediato. Os dados foram analisados com análise de variância (ANOVA- p ≤0,05). Resultados A média do B-NWI-R foi de 2,2. O estilo 1.1 foi o considerado ideal pelos enfermeiros (58,1%), seguido de 35,5% do 9.1. Esses foram os mais apontados pelos técnicos, porém, nesta sequência 9.1 e 1.1. Não houve relação do ambiente de trabalho com liderança real do enfermeiro (p=0,39). Conclusão O ambiente de trabalho mostrou-se favorável à prática de enfermagem. O estilo de liderança ideal dos enfermeiros não apresentou correspondência com o real avaliado pelos técnicos ou auxiliares de enfermagem e o ambiente de trabalho não se relacionou com a liderança dos enfermeiros.

Impact of critical care environment on burnout, perceived quality of care and safety attitude of the nursing team

Objective:

assess the perception of the nursing team about the environment of practice in critical care services and its relation with the safety attitude, perceived quality of care and burnout level.

Method:

cross-sectional study involving 114 nursing professionals from the intensive care unit of a teaching hospital. The following instruments were used: Nursing Work Index-Revised, Maslach Burnout Inventory and the Safety Attitude Questionnaire.

Results:

the professionals who perceived greater autonomy, good relationships with the medical team and better control over the work environment presented lower levels of burnout, assessed the quality of care as good and reported a positive perception on the safety attitude for the domain job satisfaction.

Conclusion:

the findings evidenced that environments favorable to these professionals' practice result in lower levels of burnout, a better perceived quality of care and attitudes favorable to patient safety.

Professional nursing practice in critical units: assessment of work environment characteristics

Objective

assess the autonomy, control over environment, and organizational support of nurses' work process and the relationships between physicians and nurses in critical care units.

Method

cross-sectional study conducted with 162 nurses working in the intensive care units and emergency service of a university hospital. The workers' satisfaction with their work environment was assessed using Brazilian Nursing Work Index - Revised, translated and adapted for the Brazilian culture.

Results

average age was 31.6 ± 3.9 years; 80.2% were women; 68.5% Caucasians and 71.6% worked in intensive care units. The nurses considered autonomy (2.38 ± 0.64) and their relationship with physicians (2.24 ± 0.62) to be characteristics of the work environment that favored professional practice. Control over environment (2.78 ± 0.62) and organizational support (2.51 ± 0.54), however, were considered to be unfavorable. No statistically significant differences were found between the units based on the scores obtained by the professionals on the Brazilian Nursing Work Index - Revised.

Conclusion

autonomy, relationship between physicians and nurses, and organizational support were considered by the units to be characteristics that favored nurses' professional practices. On the other hand, control over environment and organizational support were considered unfavorable.

Nursing leadership in intensive care units and its relationship to the work environment

AIM

To establish whether there is any relationship between the work environment and nursing leadership at intensive care units (ICUs).

METHOD

Correlational study conducted at four ICUs in southern São Paulo (SP), Brazil. The study population was comprised of 66 pairs (nurses and nursing technicians) established by lottery. The nurses responded to three instruments: 1) characterization; 2) a validated Portuguese version of the Nursing Work Index Revised (B-NWI-R); and 3) Grid & Leadership in Nursing: ideal behavior. The nursing technicians responded to 1) characterization and to 2) Grid and Leadership in Nursing: actual behavior, relative to the corresponding randomly-assigned nurse. The data were analyzed by means of analysis of variance (ANOVA) at p ≤ 0.05.

RESULTS

The work environment was not associated with actual nursing leadership (p = 0.852). The public or private nature of the institutions where the investigated ICUs were located had no significant effect on leadership (p = 0.437). Only the nurse-physician relationship domain stood out (p = 0.001).

CONCLUSION

The choice of leadership styles by nurses should match the ICU characteristics. Leadership skills could be developed, and the work environment did not exert any influence on the investigated population.

Governance of professional nursing practice in a hospital setting: a mixed methods study

Objective:

to elaborate an interpretative model for the governance of professional nursing practice in a hospital setting.

Method:

a mixed methods study with concurrent triangulation strategy, using data from a cross-sectional study with 106 nurses and a Grounded Theory study with 63 participants. The quantitative data were collected through the Brazilian Nursing Work Index - Revised and underwent descriptive statistical analysis. Qualitative data were obtained from interviews and analyzed through initial, selective and focused coding.

Results:

based on the results obtained with the Brazilian Nursing Work Index - Revised, it is possible to state that nurses perceived that they had autonomy, control over the environment, good relationships with physicians and organizational support for nursing governance. The governance of the professional nursing practice is based on the management of nursing care and services carried out by the nurses. To perform these tasks, nurses aim to get around the constraints of the organizational support and develop management knowledge and skills.

Conclusion:

it is important to reorganize the structures and processes of nursing governance, especially the support provided by the organization for the management practices of nurses.

The environment of professional practice and Burnout in nurses in primary healthcare

OBJECTIVES

to assess how nurses perceive autonomy, control over the environment, the professional relationship between nurses and physicians and the organizational support and correlate them with burnout, satisfaction at work, quality of work and the intention to quit work in primary healthcare.

METHOD

cross-sectional and correlation study, using a sample of 198 nurses. The tools used were the Nursing Work Index Revised, Maslach Burnout Inventory and a form to characterize the nurses. To analyze the data, descriptive statistics were applied and Spearman's correlation coefficient was used.

RESULTS

the nurses assessed that the environment is partially favorable for: autonomy, professional relationship and organizational support and that the control over this environment is limited. Significant correlations were evidenced between the Nursing Work Index Revised, Maslach Burnout Inventory and the variables: satisfaction at work, quality of care and the intent to quit the job.

CONCLUSION

the nurses' perceptions regarding the environment of practice are correlated with burnout, satisfaction at work, quality of care and the intent to quit the job. This study provides support for the restructuring of work processes in the primary health care environment and for communication among the health service management, human resources and occupational health areas.

Professional nursing practice: environment and emotional exhaustion among intensive care nurses

OBJECTIVE

to evaluate the characteristics of the professional nursing practice environment and its relationship with burnout, perception of quality of care, job satisfaction and the intention to leave the job in the next 12 months.

METHOD

cross-sectional study with a quantitative approach to data. The sample was composed of 129 nurses working in adult Intensive Care Units from a region in the interior of São Paulo, Brazil.

RESULTS

The structural equation modeling, using path analysis, revealed that characteristics of the environment influence job satisfaction, perception of quality of care, and having an intention to leave their job, when mediated by emotional exhaustion. Nurses with limited autonomy, poor control over their practice, and poor relationships with physicians, experience a greater level of emotional exhaustion, which can negatively influence their perception of quality of care, job satisfaction and an intention to abandon their jobs.

CONCLUSION

the mediating role of emotional exhaustion may negatively influence care delivery. Therefore, there is a need to adopt strategies to minimize this condition among nurses.

Cross-cultural translation of quality instruments in the organ donation process

OBJECTIVE: To carry out the cross-cultural translation of quality instruments in the organ donation process from the National Transplantation Organization of Spain.METHODS: Methodological research with quantitative approach conducted in three Neurology reference hospitals in the South of the country. The instruments validation was carried out by mean of the steps of translation, backtranslation, synthesis and expert committee. The reliability was conducted by means of inter-observer equivalence and test and retest stability.RESULTS: There was a 100% match among all the judges in 89% of the items in the cross-cultural translation (11% of the items were not equivalent). In the reliability analysis, the Kappa coefficients corresponded to 0.86 and 0.95.CONCLUSION: The versions of the instruments were considered valid and reliable for use by institutions that carry out the organ donation process in Brazil.

O ambiente de trabalho em unidades de terapia intensiva privadas e públicas

OBJETIVO: Analisar o ambiente de trabalho em Unidades de Terapia Intensiva em hospitais privados e públicos. MÉTODOS: Estudo transversal realizado em quatro unidades de terapia intensiva do qual participaram 66 enfermeiros. Utilizou-se dois instrumentos de pesquisa, um para caracterização socioeconômica e as subescalas do Nursing Work Index Revised versão brasileira validadas (B-NWI-R). RESULTADOS: Os enfermeiros consideraram que as unidades de terapia intensivapossuem ambientes de trabalho favoráveis ao exercício da prática profissional em enfermagem (média geral= 1,95 e dp=0,40).Ao comparar as UTI dos hospitais privados e públicos observa-se que o escore geral do B-NWI-R alcançou os valores de 1,91 (dp=0,39) e 1,99 (dp=0,42) respectivamente com p=0,459. CONCLUSÃO: As quatro UTI analisadas apresentaram ambientes favoráveis à prática profissional em enfermagem. O fato de pertencer a hospitais privados e públicos não foi significativo na análise.

Adaptaçâo de um instrumento que avalia alfabetização em saúde das pessoas idosas

OBJETIVO: Descrever o processo de adaptação transcultural de instrumento que analisa a alfabetização em saúde das pessoas idosas. MÉTODOS: A adaptação compreendeu as etapas de equivalência conceitual e de itens, semântica e operacional. RESULTADOS: As etapas de equivalências conceituais e de itens mostraram que os itens e conceitos do instrumento canadense são adequados para uso no Brasil. As etapas de tradução inicial, retrotradução, avaliação por comitê de especialistas e pré-teste realizadas durante avaliação da equivalência semântica resultaram em alterações de alguns itens e reformulação de algumas questões. Na equivalência operacional, a entrevista mostrou-se adequada à realidade local. CONCLUSÃO: Apesar das etapas de adaptação transcultural, geralmente, serem adotadas para validação de instrumentos de aferição, elas foram utilizadas e permitiram aos pesquisadores adequá-las ao tipo de estudo.