Promoting knowledge translation: An ecosystem approach to evidence in health

The dissemination and implementation of evidence in health contexts have been a concern of several international organizations responsible for recommending actions to health policymakers. World Health Organization has been advocating for an ecosystem of evidence to improve clinical practice and health professional education. Thus, in this article, we address the challenges to developing the evidence ecosystem from the point of view of health professional education, considering the contexts of practice and teaching, focused on knowledge translation. There are three pivotal challenges: producing qualified knowledge; adequate communication of the synthesized evidence; and institutional policy to sustain the implemented evidence in continuous and updated flow. The evidence ecosystem helps to understand these flows between the production and implementation of knowledge, based on the capacity and resources of different health systems. It needs to be developed in the field of health professional education, feedback in the contexts of practice and teaching, to contribute to third-generation knowledge being used by different users of health services.

Peripheral Intravenous Catheter Insertion: Professionals' Performance and Implications for Patient Safety: A Cross-Sectional Study

This study evaluated peripheral intravenous catheter insertion by licensed practical nurses in a simulated scenario. This cross-sectional and descriptive study was performed in a general hospital's simulation center located in Brazil, from January to October 2020. The authors developed a tool from the leading guidelines to measure peripheral intravenous catheter insertion performance in 60 licensed practical nurses. Data were analyzed using descriptive statistics, with proportions for categorical variables and analytical statistics to denote significance, using SPSS version 22.0. Ethical aspects were respected. Despite the sample comprising professionals who declared an average experience with peripheral intravenous catheter insertion of 6.4 years, at least 50% failed in some tool element. This low score on peripheral intravenous catheter insertion performance is because automation is possible without efforts to improve it. Adding years of practice does not generate better performance. The licensed practical nurses' performance was lower than expected, considering their reported experience, which poses a risk to patient safety. The training of these professionals needs to be discussed in countries where the practice is legal. Skills training should include simulation to approximate clinical practice; nurses must exercise their role in supervising the team.

Patient Safety in Palliative Care at the End of Life from the Perspective of Complex Thinking

Actions for patient safety at the end of life must be aligned with the principles of palliative care, such as promoting comfort and quality of life. Faced with this complex process, health professionals need to seek the central relationships of the concepts of safety and palliative care to the end of life, in line with the wishes and expectations of the person and family members/caregivers, as well as with available resources and the capacity of services but, above all, reinforcing the importance of a non-reductionist care approach, which encompasses the various aspects inherent to humans. Hence, we present a new vision of patient safety in palliative care at the end of life based on the complex thinking of Edgar Morin, scientific evidence, and health policies in the global context. We discuss the deficiencies and disjunctions in thought and practice of palliative care at the end of life and patient safety, as well as the challenges for the conjunction of these complex themes, to finally present potential ways to apply complex thinking in the safe care of the patient at the end of life. The problematization of different aspects for the interposition of knowledge about patient safety in palliative care at the end of life portrays the existence of intersubjective connections and the multidimensionality that permeate the guidelines, actions and relationships that sustain the disciplines.

The Organization of Home Palliative Cancer Care by Primary Health Care: A Systematic Review Protocol

Greater longevity and chronic diseases, such as cancer, require (re)organization of care for the sustainability of health systems and better quality of life. Palliative care organized by primary health care has positive outcomes, changing standards of care at the end of life, reducing hospitalizations and health costs and contributing to people's autonomy to stay at home with controlled symptoms. However, in many countries, this is not possible because the provision of palliative cancer care is isolated or generalized, concentrated in the hospital, and without the strategic participation of primary care. In many developed countries, where palliative care is offered in an integrated way, home care has increased the people's chances of receiving dignified care at the end of life. The aim of this review is to evaluate the organization of home palliative cancer care by primary care to improve the use of health resources and the quality of life of such patients. This systematic review protocol follows the Cochrane methodology to provide a narrative synthesis, with the resulting report guided by the Preferred Reporting Items for Systematic Reviews (PRISMA).

A Qualitative Study of the Limits and Possibilities of Integrating Palliative Care in Heart Failure

Heart failure is a progressive condition with a high burden of symptoms and clinical decompensations that causes psychological and social suffering, poor quality of life, and limited life expectancy. Therefore, it requires palliative care to control symptoms and signs, but integrating it with clinical care is complicated. We aimed to discuss the limits and possibilities of integrating palliative care in heart failure. This was a qualitative descriptive study. Semi-structured qualitative interviews were carried out between July 2020 and July 2021. We applied the thematic content analysis and the SWOT matrix. Ethical principles were respected. Ten professionals from an Institute specializing in cardiovascular diseases in Rio de Janeiro, Brazil, participated in the study, including physicians, nurses, psychologist, and occupational therapist. We identified 4 categories related to intervening factors: the patient's profile, the emotional aspects of professionals facing these patients, the challenges to integrating and sustaining palliative care in practice, and the ways for assistance planning in this context. The existence of a specialized team, the palliative care commission, and the institutional palliative care protocol, aligned with the realistic perception of the assistance, organizational, political, and social problems, may promote the advancement of palliative care in heart failure.

Meanings and significance attributed by people with HIV/aids to their lives with this virus/disease

OBJECTIVES

to understand the meanings and significance attributed by people with HIV/aids to the process of living with this virus/disease.

METHODS

qualitative and exploratory study, carried out in Rio de Janeiro, Brazil. The Grounded Theory and the Symbolic Interactionism were used. Data were collected in a semistructured interview and through non-participant observation, from August 2017 to May 2018. 29 patients participated.

RESULTS

living with HIV/AIDS is a social phenomenon in which it is not possible to disconnect the process of adapting to the disease from the social relations one (re)constructs during life. It also involves stigmatization, rejection, and isolation.

FINAL CONSIDERATIONS

understanding the meanings of this process is a positive influence for proactive behavior and resilience, not only in regard to the care concerning the presence of the virus and the uninterrupted need to adhere to medication, but also in the way to deal with the social values that reproduce previous models, which, in turn, can help improve self-knowledge.

Information and communication technologies: interfaces the nursing work process

OBJECTIVES

to unveil the meanings that nurses attribute Information and Communication Technologies for the nursing work process.

METHODS

qualitative research, theoretically and methodologically based on the Complexity Theory and on the Grounded Theory, respectively. Research with 19 participants, being 12 clinical nurses, and 7 resident nurses. Semi-structured interviews were used for data collection.

RESULTS

the results revealed the meanings that clinical nurses attribute to Information and Communication Technologies and, thus, the motivations and limitations for the use of these technologies, pointing out possibilities and strategies that impact the nursing work process, based on the interactions promoted by the official and non-official use of these resources.

FINAL CONSIDERATIONS

the meanings that nurses attribute to Information and Communication Technologies are dependent on their ability to successfully employ those technologies and their importance to the work process developed by the professionals.

Methodological path to reach the degree of saturation in qualitative research: grounded theory

OBJECTIVES

to achieve the degree of saturation in study that applied the grounded theory.

METHODS

qualitative research, carried out in four Family Health Units, between June 2018 and May 2019. The data from the interviews with 30 health professionals and non-participant observation were coded in the stages: open, axial and integration.

RESULTS

the degree of saturation was achieved by two conceptual models - theoretical saturation and inductive thematic. Theoretical saturation was considered: the development of conceptual codes and observation, in the collection and analysis of data, when they generated new categories/subcategories or only indicated increasing instances. For thematic inductive saturation, the use of new codes based on each interview stood out.

FINAL CONSIDERATIONS

the visual layout for the number of codes, the theoretical scope of the concepts and the delimitation of the sample groups guided the identification of the degree of saturation for the development of the conceptual body that supported the substantive theory.

Do-not-resuscitate order in COVID-19 times: bioethics and professional ethics

OBJECTIVE

To reflect about the do-not-resuscitation order at COVID-19 in Brazil, under bioethical focus and medical and nursing professional ethics.

METHOD

Reflection study based on the principlist bioethics of Beauchamps and Childress and in professional ethics, problematizing actions, and decisions of non-resuscitation in the pandemic.

RESULTS

It is important to consider the patient's clinic, appropriation of treatment goals for people with comorbidities, elderly people, with less chance of surviving to resuscitation, or less quality of life, with the palliative care team, to avoid dysthanasia, use of scarce resources and greater exposure of professionals to contamination.

CONCLUSION

COVID-19 increased the vulnerabilities of professionals and patients, impacting professional decisions and conduct more widely than important values ​​such as the restriction of freedom. It propelled the population in general to rethink ethical and bioethical values ​​regarding life and death, interfering in decisions about them, supported by human dignity.

Knowledge management: connections for teaching research in undergraduate nursing

OBJECTIVES

to understand the meanings that nursing students and professors attribute to research and research teaching in the context of undergraduate studies.

METHODS

this is a qualitative research, whose theoretical and methodological frameworks were Complexity Theory and Grounded Theory. Sixteen students and 14 undergraduate nursing professors from a public university in Rio de Janeiro were interviewed. Semi-structured interviews were used for data collection.

RESULTS

causes, actions, and interactions related to research and teaching research in undergraduate nursing are connected with learning science for nursing praxis, which ranges from students' ability to question to their and their professors' understanding of social demands guided by science.

FINAL CONSIDERATIONS

nursing professors and students signify research and teaching of this as a structure for the training of nurses for the critical professional capacity needed to meet social demands.

Transition to exclusive palliative care for women with breast cancer

OBJECTIVE

to analyze the perspectives that affect the transition to exclusive palliative care for women with breast cancer.

METHODS

qualitative, descriptive study, carried out in a public health institution in Rio de Janeiro, Brazil, between December 2018 and May 2019. 28 health professionals were interviewed. Content analysis was used in the thematic modality.

RESULTS

the operational difficulties were linked to the fragmented physical structure, the late and unplanned nature of the referral, the ineffective communication, and the deficit of human resources. In general, women and family members resist referral because they do not know palliative care. There is no consensus among oncologists on the most appropriate time to stop systemic therapy for disease control.

FINAL CONSIDERATIONS

the perceived difficulties configure an abrupt referral, accompanied by false hopes and, often, limited to end-of-life care.

Occlusions in peripherally inserted central venous catheters in pediatric patients in antineoplastic chemotherapy

OBJECTIVE

To analyze the occurrence of occlusions in peripherally inserted central venous catheters in pediatric patients in antineoplastic chemotherapy.

METHOD

Retrospective cohort, with 156 medical records of patients aged 0-19 years who underwent outpatient chemotherapy between 2013 and 2017 by this catheter, in a hospital in the city of Rio de Janeiro. Descriptive and inferential statistics were applied.

RESULTS

219 catheters were registered. Occlusion occurred in 141 (64.4%) catheters; 63 (44.7%) were removed because of occlusion, either alone or associated with another factor. Total occlusion alone led to the removal of 27 (12.3%) catheters. Occlusion was associated with: catheter dwell time, cyclophosphamide, neuroblastoma, bone metastasis and number of chemotherapy sessions.

CONCLUSION

Occlusion is an important complication because it occurred in more than half of the catheters and was one of the main reasons for withdrawal. The identified risk factors may guide the care to prevent this complication.

Sinais e sintomas manifestados por pacientes em cuidados paliativos oncológicos na assistência domiciliar: uma revisão integrativa

Resumo Objetivo identificar os principais sinais e sintomas manifestados por pacientes em cuidados paliativos oncológicos na assistência domiciliar. Método revisão integrativa nas bases LILACS, MEDLINE e CINAHL em janeiro de 2020. Perguntou-se: “Quais os principais sinais e sintomas manifestados por pacientes em cuidados paliativos oncológicos destacados nos estudos abrangendo o contexto do domicílio?”. Foram descritores/termos: Sinais e Sintomas/Signs and Symptoms; Assistência Domiciliar/Home Care Services; Cuidados Paliativos/Palliative Care e Neoplasias/Neoplasms. Elencaram-se como critérios de elegibilidade: texto completo; entre 2015 e 2019; em inglês, português ou espanhol e idade adulta. Para o mapeamento dos dados, consideraram-se: título; país; ano; objetivo; método; sinais e sintomas. Os resultados foram categorizados em subgrupos, considerando a classificação conceitual predeterminada (sinal e sintoma). O elemento contagem facilitou a análise e a comparação de dados. Resultados foram selecionados 35 artigos, sendo identificados 25 sinais e 23 sintomas. Os mais frequentes foram: dor, náusea/vômito, dispneia, fadiga, depressão, ansiedade, constipação, perda de apetite, sonolência, bem-estar e insônia. A maioria (39) relacionou-se ao domínio físico. Conclusão a identificação dos principais sinais e sintomas, neste contexto, direciona a prática dos profissionais de saúde para as intervenções mais adequadas e o mais precocemente possível, contribuindo para viabilizar a assistência domiciliar, e alerta para a necessidade de educação permanente sobre este tema.

Conditioning factors for nurses to defend the autonomy of the elderly on the terminality of life

OBJECTIVE

to understand the meanings attributed by nurses about conditions that interfere in defending of the elderly's autonomy on the terminality of life in the context of hospitalization.

METHOD

qualitative and exploratory study, which applied the Grounded Theory. Data were collected between November 2016 and May 2017, in the internal medicine wards of a hospital in Rio de Janeiro, Brazil, through non-participant observation and semi-structured interviews. Three sample groups composed of ten nurses, eight doctors, and 15 nursing technicians were investigated.

RESULTS

the conditions are related to the medical power, subordination of nurses, family influences; the functional decline of the elderly; and biomedical model. Final considerations: the elderly's autonomy is veiled and violated since their abilities are subjugated, and the family's will and professional paternalism may prevail. However, this right must guide contemporary care models and integrate palliative care.

Quality of life of women with locally advanced or metastatic breast cancer

OBJECTIVES

To identify the main affected domains of quality of life of hospitalized women with locally advanced or metastatic breast cancer; and to analyze the association between the level of quality of life and stage of cancer.

METHOD

This was a cross-sectional quantitative, study conducted in Rio de Janeiro, Brazil, between March and July 2017. Interviews were performed with 199 women. The researchers administered the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire Core 30, with analysis using the Statistical Package for the Social Sciences software and the Kruskal-Wallis test.

RESULTS

Mean global health status was 32.04. On the functional scales, cognitive functioning scored the highest (60.47), while role functioning scored the lowest (12.48). Fatigue presented the highest mean (69.57). The scores for global health status and the functional scales (with the exception of the social functioning) decreased as staging progressed.

CONCLUSION

The stage of cancer affects the quality of life of the studied sample of women.

Nurses defending the autonomy of the elderly at the end of life

ABSTRACT Objective: to understand how nurses deal with the elderly’s autonomy at the end of life. Method: qualitative, exploratory study, guided by the Grounded Theory. Ten nurses, eight doctors and 15 nursing technicians were interviewed between November 2016 and May 2017 at a university hospital in Rio de Janeiro/Brazil. Results: nurses deal with the elderly’s autonomy in compliance with the code of ethics and exercise leadership in actions and interactions to defend this right, evaluating, guiding and listening to the preferences of the elderly; interacting with the family; and sharing information with the health team. Final considerations: the elderly’s autonomy must be ensured in care planning, based on patient-centered communication and developed in the interaction among agents involved in care. The discussion on “Living Wills” Health Care Directives and principles of palliative care must be encouraged.

Management of nursing care in HIV/AIDS from a palliative and hospital perspective

OBJECTIVES

To understand the meaning attributed by the nurse to the management of nursing care to the person hospitalized due to clinical complications caused by AIDS; to analyze actions related to palliative care; and to construct a theoretical matrix regarding the management of nursing care.

METHOD

Qualitative, exploratory research, guided by the Grounded Theory. Seven nurses and ten nursing technicians were interviewed between May and September 2015, in a university hospital, located in Rio de Janeiro State, Brazil.

RESULTS

Five categories that covered the profile of the hospitalized person, palliative care, intervening conditions for care management, the need for professional qualification, and other aspects to better organize and manage care, including conflict management arose.

FINAL CONSIDERATIONS

The theoretical matrix values the quality of life, the need to understand the flow of care to avoid readmissions and not adherence to medications, requiring new research in the area, such as implementation.

Fundamentals of Implementation Science: an intensive course on an emerging field of research

Abstract Objective: Report the participation in the Intensive Course on Fundamentals of Implementation Science (IS) in Global Health and present the theoretical scope of IS methods and the potential applicability perspectives for improving global health. Method: Experience report on participation in the course, promoted by the University of Washington, USA, September, 2017. Results: The course introduced IS methodologies and selected case studies, focusing on opportunities and challenges in applying IS in practice. Conclusion: The IS offers tools for the selection of published scientific material and its use through plans, programs, intervention projects, models and protocols that assume diminishing inconsistencies and leverage results on a large scale in health science. Implications for practice: Multidisciplinary teams can benefit from IS training to address in a related way the gaps consistent with progress in the health sciences.

Planejamento da assistência ao paciente em cuidados paliativos na terapia intensiva oncológica

Resumo Objetivo Analisar o entendimento dos profissionais de saúde acerca da assistência ao paciente em cuidados ao fim da vida na unidade de terapia intensiva (UTI) oncológica, e discutir os objetivos que buscam alcançar ao planejar a assistência na perspectiva dos cuidados paliativos. Métodos Estudo descritivo, com abordagem qualitativa, realizado na UTI adulto de um Hospital do Câncer. Participaram do estudo 25 profissionais: 12 enfermeiros, oito médicos, dois nutricionistas e três fisioterapeutas. Respeitou-se o critério de inclusão: estar atuando no setor por tempo maior ou igual a um ano. Foram excluídos profissionais de férias e de licença médica durante o período de coleta de dados, que transcorreu entre dezembro de 2015 a maio de 2016. A técnica de coleta de dados foi a entrevista semiestruturada. Para análise dos dados utilizou-se a análise de conteúdo temática, seguindo as etapas: pré-análise; exploração do material ou codificação; tratamento dos resultados, inferência e interpretação. Resultados As três categorias abrangem particularidades contextuais pela gravidade dos casos, fases da doença e tratamentos, terminalidade da vida, medicalização e dificuldades gerenciais. Entretanto, evidenciou-se a necessidade de promover conforto, atender a família, e investir na integração dos cuidados paliativos e críticos. Conclusão O planejamento assistencial na perspectiva dos cuidados paliativos no contexto é incipiente; elencam-se desafios para a prática e preocupa-se em humanizar a assistência. Sugere-se o modelo interconsultivo para integração das especialidades, mediante características institucionais.

NURSING CARE MANAGEMENT FOR WOMEN WITH BREAST CANCER IN PALLIATIVE CHEMOTHERAPY

ABSTRACT The objective was to understand and to analyze the management of nursing care for women with breast cancer in palliative chemotherapy. This was an exploratory and qualitative study, which used the Grounded Theory. Eight nurses and ten patients of one of the units of the National Cancer Institute, Rio de Janeiro, Brazil, were interviewed. Data analysis showed five conceptual categories. The categories that represent the object of this study were: managing care during nursing consultation; pointing out the difficulties in carrying out nursing care management; listing administrative strategies to better manage care. Faced with the decision to administer palliative chemotherapy, nurses should pay attention to the need for care that women may present. Nurses play an important role in managing care, and contribute to a closer look at the recognition of such needs, prioritizing the quality of life.

COMPLEX THINKING suPPOrTING CArE sTrATEGIEs FOr THE PrEVENTION OF sTDs/AIDs IN ADOLEsCENCE

ABsTrACTThis was qualitative research performed with 15 nursing professionals of a study cohort on adolescent health, in the capital of Rio de Janeiro/Brazil. The objective of the study was to discuss nursing care strategies for the prevention of STDs/AIDS in adolescence, from the perspective of complexity. A semi-structured interview was used for data collection from January to August of 2012. Grounded Theory was used as the methodological framework. The category "Starting points for the nursing care of adolescents in the context of STDs/AIDS" is presented, which discusses aspects related to interdisciplinarity; multidimensionality and specificities of the adolescence-related process, in the midst of vulnerabilities to STDs/AIDS, thereby revealing the importance of contemplating the phenomenon as delimited by its complexity.

Gerenciamento do cuidado de enfermagem à criança em condição crônica hospitalizada

RESUMO Objetivo: compreender as interações do enfermeiro na prática do gerenciamento do cuidado de enfermagem à criança em condição crônica hospitalizada. Método: foram utilizados como referenciais teórico e metodológico, respectivamente, o Pensamento Complexo e a Grounded Theory. Participaram do estudo 18 sujeitos organizados em três grupos: enfermeiros, técnicos de enfermagem e familiares. A técnica empregada para a coleta de dados foi a entrevista semiestruturada. A análise dos dados seguiu as três etapas de codificação: aberta, axial e seletiva. Resultados: a categoria "Necessitando gerenciar o cuidado de enfermagem à criança em condição crônica na Unidade de Internação Pediátrica" e suas respectivas subcategorias apresentam as complexas vinculações intersubjetivas estabelecidas pelo enfermeiro que sustentam a prática do gerenciamento do cuidado de enfermagem. Conclusão: nota-se dificuldade dos profissionais de enfermagem em interagir com o familiar da criança e na implementação do processo gerencial de cuidado, a dialógica ordem/desordem/interação/organização.

[Participation of the family in hospital-based palliative cancer care: perspective of nurses]

The objective was to understand the perspective of nurses about the participation of the family in palliative cancer care and to analyze the nursing care strategies to meet their needs. Descriptive and qualitative research, conducted at the National Cancer Institute between January and March 2013, with 17 nurses. Elements of the Roy Adaptation Model were used for the interpretation of the data. Two categoriesemergedfrom the thematic analysis: perspective of nurses about the presence and valuation of family in the hospital; and appointing strategies to encourage family participation in care and meet their needs. This participation is essentialand represents a training opportunity for the purpose of homecare. Nurses create strategies to encourage it and seek to meet the needs. The results contribute to promote the family adaptation and integrity, in order to balance the dependent and independent behaviors, aimingfor quality of life and comfort. Further studies are neededdue to the challenges of the specialty.

Eventos adversos e segurança na assistência de enfermagem

Objetivo: identificar as publicações científicas sobre os eventos adversos na assistência de enfermagem em pacientes adultos hospitalizados e discutir os principais eventos adversos na assistência de enfermagem. Método: Revisão integrativa com abordagem qualitativa. Os dados foram coletados nas bases LILACS, MEDLINE, BDENF e na biblioteca SCIELO, e submetidos à análise temática. Resultados: emergiram três categorias: eventos adversos na assistência de enfermagem; principais causas dos eventos adversos na assistência de enfermagem; o posicionamento da equipe de enfermagem frente ao evento adverso. Identificou-se os principais eventos na assistência de enfermagem, destacando-se os erros na administração de medicação, não realização de curativos e as quedas. Salienta-se a importância dos instrumentos de notificação de eventos adversos nas instituições, porém o medo dos profissionais acerca da punição poderá estimular a subnotificação. Conclusão: é importante discutir estratégias de prevenção de eventos realmente eficazes, que assegurem a segurança do paciente nas instituições de saúde.

Nursing work at night in palliative oncology care

OBJECTIVE: to understand the meaning baccalaureate nurses and nursing technicians attribute to night work in the context of clinical palliative oncology nursing care services, as well as how nursing works to attend to clients and caregivers' needs in this period. METHOD: in this exploratory and qualitative study, grounded theory was used. Seven nurses and four nursing technicians were interviewed, who composed two sample groups. Nine categories were produced and, in their comparative content analysis, a knowledge emphasis was evidenced with implications for nighttime nursing work. In this study, these aspects were discussed in two of the categories, which are: to describe care practice in order to understand nursing care management and to point out the difficulties in care practice and nursing care management. RESULTS: The results evidence the complexity in the nighttime care context, considering the clients' clinical conditions and clients and caregivers' psychological demands, mainly because of the threat of death. CONCLUSION: The team attempts to respond to these needs through communication, but reveals a lack of assistential services and an overload. Interdisciplinarity is a palliative care premise, favoring holistic care delivery, and cannot be neglected at, which requires attention and investment to develop better practices.

O cuidado de enfermagem no pós-operatório de cirurgia cardíaca: um estudo de caso

Os objetivos deste estudo foram descrever as necessidades do paciente no pós-operatório de cirurgia cardíaca identificadas pelos enfermeiros e discutir o cuidado de enfermagem com base em tais necessidades. Trata-se de uma pesquisa descritivo-exploratória, de natureza qualitativa, desenvolvida na Unidade Cardiointensiva do Hospital Federal dos Servidores do Estado no Rio de Janeiro. Os dados foram coletados em 2008, por meio de entrevista e observação participante, e analisados mediante a análise de conteúdo. Os dados mostraram uma enfermagem preocupada com o cuidado técnico à beira do leito, porém, desprovida de maior interação com o paciente e sua família. Conclui-se que a adoção plena do processo de enfermagem como metodologia de trabalho contribuirá para uma assistência de melhor qualidade, pautada nas orientações necessárias para cada caso, e para uma melhor informação sobre cuidado envolvendo pacientes, familiares e equipe de enfermagem.

Análise do cuidado de enfermagem e da participação dos familiares na atenção paliativa oncológica

O estudo objetivou analisar, por meio da visão dos familiares, o cuidado de enfermagem prestado ao cliente acometido por câncer avançado, no período da internação hospitalar, bem como a sua participação neste cuidado. Estudo exploratório, qualitativo, que utilizou a Teoria Fundamentada nos Dados. Os dados foram coletados por entrevista semiestruturada, no Hospital do Câncer IV - Brasil. Participaram oito familiares. Da análise emergiram três categorias: Analisando o cuidado de enfermagem prestado ao cliente com câncer avançado no dia a dia da internação hospitalar; Ressaltando a importância da sua presença no contexto; e Manifestando o ser familiar que cuida e precisa ser cuidado. Os familiares valorizam que o cuidado de enfermagem seja empático, com bom humor, competente, pautado na comunicação; participam do cuidado e podem apresentar necessidades de ordem física e psicossocial. A enfermagem deve contribuir para o estreitamento das relações com os familiares, e buscar atender suas necessidades, visando a qualidade do cuidado.

A Teoria Fundamentada nos Dados nos estudos de Pós-Graduação Stricto Sensu da Enfermagem brasileira

Estudo documental e quantitativo, que objetivou identificar as teses e dissertações defendidas nos Programas de Pós-Graduação em Enfermagem do Brasil que utilizaram o referencial metodológico da Teoria Fundamentada nos Dados (TFD) e analisar os aspectos epistemológicos destacados. Os dados foram coletados no Banco de Teses da CAPES, no recorte temporal entre 1996 a 2010. Foram levantados 99 resumos. Realizou-se a leitura analítica dos mesmos para constituição do tema ou problema da pesquisa e do enquadramento teórico. O maior número de produção foi em 2005, na soma dos dois níveis acadêmicos, e 54% das defesas foram sediadas na USP. As áreas temáticas mais expressivas foram: Saúde da Criança/Adolescente; Gestão em Saúde/Enfermagem; Saúde Coletiva e Saúde da Mulher. O principal referencial teórico utilizado foi o Interacionismo Simbólico. A TFD compreende uma metodologia que pode ser empregada na enfermagem, capaz de contribuir no desenvolvimento de novas investigações para o seu aprimoramento contínuo.Descritores: Enfermagem; Pesquisa Metodológica em Enfermagem; Educação de Pós-Graduação em Enfermagem.

Sistematização da assistência de enfermagem em cuidados paliativos na oncologia: visão dos enfermeiros

OBJETIVOS: Descrever a visão dos enfermeiros a respeito da sistematização da assistência de enfermagem (SAE) a clientes com câncer avançado em cuidados paliativos; analisar os fatores intervenientes na implantação da SAE na visão dos enfermeiros e discutir possíveis estratégias propostas pelos enfermeiros que favoreçam sua implantação nesse cenário. MÉTODOS: Pesquisa qualitativa, descritiva. Participaram oito enfermeiras do Hospital do Câncer IV, unidade do Instituto Nacional do Câncer especializada na área, localizada no Município do Rio de Janeiro, Brasil. Foram usadas a técnica do grupo focal e a análise de conteúdo. RESULTADOS: Os discursos dos sujeitos indicaram que a unidade encontrava-se na fase de planejamento de implantação da SAE, bem como o reconhecimento dos desafios do processo relacionados com sua complexidade e o contexto de atuação. CONCLUSÕES: Como principal estratégia para implantação da SAE evidenciou-se a necessidade de capacitação da equipe em relação à fundamentação teórica e preparo para a tomada de decisão frente à complexidade da área.

Desafios à sistematização da assistência de enfermagem em cuidados paliativos oncológicos: uma perspectiva da complexidade

doi: 10.5216/ree.v12i3.7274Trata-se de um estudo qualitativo, que objetivou analisar os fatores intervenientes no processo de implantação da sistematização da assistência de enfermagem (SAE) referidos por enfermeiros que atuam na unidade de internação de um hospital especializado em cuidados paliativos na oncologia, localizado no município do Rio de Janeiro - Brasil. O estudo foi realizado no ano de 2008 e participaram oito enfermeiras. A técnica de coleta de dados utilizada foi o grupo focal, e os dados foram submetidos à análise de conteúdo, sob a perspectiva da complexidade. A SAE pode ser entendida como uma das grandes buscas dos enfermeiros em prol da qualificação e humanização do cuidado. Para as enfermeiras, além do déficit de recursos humanos e de conhecimento relacionado à temática, no contexto de atuação, as múltiplas e complexas dimensões de cuidado do cliente e da família conferem maior complexidade ao processo de implantação da SAE, indicando que a mesma precisa ser estruturada a partir de referenciais dinâmicos e flexíveis, capazes de integrar os saberes disciplinares no reconhecimento do ser humano como ser complexo. Dessa forma, a SAE apresenta-se como um desafio, o que indica a necessidade de novas investigações para o aprimoramento contínuo da prática de enfermagem. Descritores: Enfermagem Oncológica; Planejamento de Assistência ao Paciente; Cuidados Paliativos.

Produção de conhecimento na enfermagem em oncologia: contribuição da escola de enfermagem Anna Nery

O estudo teve como objetivos mapear as teses e dissertações produzidas no Programa de Pós-Graduação da Escola de Enfermagem Anna Nery com enfoque na enfermagem em oncologia e analisar as repercussões diante dos aspectos epistemológicos destacados. Estudo exploratório, descritivo, retrospectivo e bibliográfico de 59 estudos (45 dissertações e 14 teses) produzidos de 1980 a 2009. O referencial teórico-metodológico foi a Metodologia de Categorização Epistemológica para a Pesquisa na Enfermagem. Os resultados indicam que a produção analisada é mais setorizada na área da oncologia clínica, com ênfase nos aspectos Gestão Saúde/Enfermagem, Saúde da Mulher e Fundamentos do Cuidado de Enfermagem. Houve predomínio de estudos na perspectiva sociológica com abordagem qualitativa. As repercussões demonstradas nos aspectos epistemológicos destacados possibilitam afirmar que o conhecimento produzido é consistente com a complexidade e as tentativas de explicação sobre a arte de cuidar dos clientes com câncer e com esforços de definir/ampliar critérios e padrões assistenciais. Enfermagem Oncológica. Pesquisa em Enfermagem. Educação de Pós-graduação em Enfermagem

Nursing Support Strategies in the Care of Cancer Patients: Expectations Found among the Residents of a Brazilian Community

Objetivos: describir las prioridades establecidas por los moradores de una comunidad de Río de Janeiro (Brasil), acerca de las estrategias de apoyo a las personas con cáncer, y analizar los indicativos para la planificación de las acciones de enfermería a partir de las expectativas referidas. Método: el marco de referencia se basa en el Modelo de Cuidados Innovadores en Situaciones Crónicas de Salud (Organización Mundial de la Salud) y en las directrices sistémicas de la salud. Investigación cualitativa y descriptiva que utiliza como técnica de recolección de datos la entrevista semiestructurada. Resultados: la mayoría de los encuestados declaró como expectativa para apoyar a las personas con cáncer la información sobre el cambio de estilo de vida; por ejemplo, el autocuidado y reducir el estigma de la enfermedad. Además, los encuestados que declaran conocer a alguien con cáncer declararon la necesidad de apoyo emocional, ayuda para no dejar el tratamiento y creación de un espacio para los pacientes y sus familias para compartir experiencias. Conclusiones: los resultados indican la importancia de establecer un plan de acción de enfermería en la comunidad que alienta su participación en la formulación de estrategias y contribuir a la sensibilización y la motivación de los pacientes con cáncer a manejar el autocuidado y la promoción de la calidad de vida.