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10-21-2022
Cancer symptom clusters: from the lab bench to clinical practice
Revista Brasileira de Enfermagem. 2022;75(5):e2022v75n5inov
Abstract
Cancer symptom clusters: from the lab bench to clinical practice
Revista Brasileira de Enfermagem. 2022;75(5):e2022v75n5inov
DOI 10.1590/0034-7167-2022v75n5inov
Views0See moreABSTRACT
Objective:
to present and discuss the advancement of science in symptom management through research involving oncological symptom clusters (OSC).
Method:
a reflective study, supported by the scientific literature on OSC.
Results:
five key points are crucial to advancing the science of symptom management through research involving OSC: definition of OSC characteristics; underlying mechanisms and priority symptom clusters; OSC measurement; targeted and personalized interventions; new analytical strategies.
Final considerations:
a better understanding of the complex connections between different systems and biobehavioral aspects in patients, especially in the field of oncology nursing, is urgent. The study of these interactions has become increasingly promising and emerging for oncology nursing, since therapeutic interventions, whose target is the neuroimmunoendocrine axis, are relevant for personalized care, translating into greater scientific and nurse autonomy to care for patients.
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ORIGINAL ARTICLE10-21-2022
Technology for nursing consultation with transsexual women in the light of Leininger’s transcultural theory
- Josueida de Carvalho Sousa
, - Ednaldo Cavalcante de Araújo ,
- Eliane Maria Ribeiro de Vasconcelos ,
- Nelson Miguel Galindo-Neto ,
- Marclineide Nóbrega de Andrade Ramalho , [ … ],
- Paula Daniella de Abreu
Abstract
ORIGINAL ARTICLETechnology for nursing consultation with transsexual women in the light of Leininger’s transcultural theory
Revista Brasileira de Enfermagem. 2022;75(5):e20210769
DOI 10.1590/0034-7167-2021-0769
- Josueida de Carvalho Sousa ,
- Ednaldo Cavalcante de Araújo ,
- Eliane Maria Ribeiro de Vasconcelos ,
- Nelson Miguel Galindo-Neto ,
- Marclineide Nóbrega de Andrade Ramalho ,
- Paula Daniella de Abreu
Views0See moreABSTRACT
Objective:
to describe the construction and validation of a nursing consultation technology for transgender women.
Methods:
a methodological study developed in three stages with construction based on the Leininger’s Cross-Cultural Theory, content validation performed by experts in transgender sexual health and evaluation by nurses of care for transgender women. Items with a minimum agreement of 80% were considered validated, according to the Content Validity Index and binomial test.
Results:
the technology contains 59 items in three blocks: the first, for identification of the transsexual woman; the second, with the Clinical Data; and the third, regarding the Propaedeutics of Care. All items reached agreement higher than 0.8 and an overall Validity Index of 80%.
Conclusions:
the technology was content-validated and evaluated by nurses and can be applicable in clinical and outpatient practice as well as in academia to promote quality care for transgender women.
- Josueida de Carvalho Sousa
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ORIGINAL ARTICLE10-21-2022
“EMPODEREENF”: construction of an application for nurses’ continuing education on psychological violence against women
- Beatriz de Castro Magalhães ,
- Mauro Mccarthy de Oliveira Silva ,
- Caik Ferreira Silva ,
- Patrícia Pereira Tavares de Alcântara ,
- Camila Almeida Neves de Oliveira , [ … ],
- Grayce Alencar Albuquerque
Abstract
ORIGINAL ARTICLE“EMPODEREENF”: construction of an application for nurses’ continuing education on psychological violence against women
Revista Brasileira de Enfermagem. 2022;75(5):e20200391
DOI 10.1590/0034-7167-2020-0391
- Beatriz de Castro Magalhães ,
- Mauro Mccarthy de Oliveira Silva ,
- Caik Ferreira Silva ,
- Patrícia Pereira Tavares de Alcântara ,
- Camila Almeida Neves de Oliveira ,
- Moziane Mendonça de Araújo ,
- Grayce Alencar Albuquerque
Views0See moreABSTRACT
Objective:
to construct a prototype of a mobile application on psychological violence against women to facilitate nurses’ continuing education.
Method:
an applied methodological research of technological development, based on the Contextualized Instructional Design method.
Results:
the prototype content was based on the learning objectives developed through a narrative review, which guided an integrative review to compile the information. The prototype is called “EmpodereEnf”, and is composed of an initial screen, bringing nurses as a target audience, and, soon after, offering nine general moblets for access to information such as: concepts, causes, manifestations and consequences of psychological violence; means for identification and approach in nursing consultation and health education; compulsory notification and referral; examples of cases of psychological violence and references.
Final considerations:
the prototype is a possibility for future coping interventions and a work tool for nurses in the face of psychological violence against women.
- Beatriz de Castro Magalhães
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ORIGINAL ARTICLE10-21-2022
Management in the Family Health Strategy: workloads and structured institutional violence
- Rosani Ramos Machado ,
- Denise Elvira Pires de Pires ,
- Letícia de Lima Trindade ,
- Felipa Rafaela Amadigi ,
- Thayse Aparecida Palhano de Melo , [ … ],
- Mariana Mendes
Abstract
ORIGINAL ARTICLEManagement in the Family Health Strategy: workloads and structured institutional violence
Revista Brasileira de Enfermagem. 2022;75(3):e20220071
DOI 10.1590/0034-7167-2022-0071
- Rosani Ramos Machado ,
- Denise Elvira Pires de Pires ,
- Letícia de Lima Trindade ,
- Felipa Rafaela Amadigi ,
- Thayse Aparecida Palhano de Melo ,
- Mariana Mendes
Views0See moreABSTRACT
Objectives:
to understand the relationship between workloads and institutional violence in Family Health Strategy managers’ practice.
Methods:
qualitative research using theoretical triangulation and data from semi-structured interviews. Participants were 35 managers of Basic Health Units in the five Regions of Brazil, who worked in the Family Health Strategy. We used thematic analysis and ATLAS.ti for data analysis.
Results:
workloads were analyzed, showing relationships with institutional violence. Thematic categories emerged: “related to the management work itself”; “related to other instances of health system management”; “related to users and community”. There was an interrelationship between increased managers’ workloads and institutional violence.
Final Considerations:
the Family Health Strategy is relevant for universal access to health and requires favorable institutional conditions for its effectiveness. Adverse scenarios lead to increased workloads, approaching institutional violence.
- Rosani Ramos Machado
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ORIGINAL ARTICLE10-17-2022
Cross-cultural adaptation of the University Student Depression Inventory for Brazil
Revista Brasileira de Enfermagem. 2022;75:e20220004
Abstract
ORIGINAL ARTICLECross-cultural adaptation of the University Student Depression Inventory for Brazil
Revista Brasileira de Enfermagem. 2022;75:e20220004
DOI 10.1590/0034-7167-2022-0004
Views0See moreABSTRACT
Objectives:
to adapt the University Student Depression Inventory for Brazil.
Methods:
we used 6 methodological stages: initial translation, translation synthesis, back-translation, expert committee, pre-final version testing and document submission to the scale authors for assessing the adaptation process. The judges were 2 methodologists, 1 health professional and 2 translators. For the pre-test, 30 undergraduate and graduate students participated.
Results:
the data were analyzed by Excel®, resulting in satisfactory content validity, a scale composed of 30 items, 3 domains and a total CVC of 0.91. Language clarity and practical relevance had a CVC of 0.91 and theoretical relevance of 0.90.
Conclusions:
the USDI-BR was cross-culturally adapted for Brazil, showing evidence of satisfactory content validity. After an analysis of reliability and convergent validity to be tested in future studies, multidisciplinary teams will be able to apply this scale to Brazilian students.
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ORIGINAL ARTICLE10-17-2022
Factors associated with psychoactive substance use among professional truck drivers
- Ângela Maria Mendes Abreu ,
- Rafaela Maria Figueiredo da Costa ,
- Rafael Tavares Jomar ,
- Luciana Fernandes Portela
Abstract
ORIGINAL ARTICLEFactors associated with psychoactive substance use among professional truck drivers
Revista Brasileira de Enfermagem. 2022;75:e20210187
DOI 10.1590/0034-7167-2021-0187
- Ângela Maria Mendes Abreu ,
- Rafaela Maria Figueiredo da Costa ,
- Rafael Tavares Jomar ,
- Luciana Fernandes Portela
Views0See moreABSTRACT
Objectives:
to identify factors associated with the use of psychoactive substances among professional truck drivers.
Methods:
cross-sectional study that investigated the use of at least one psychoactive substance and its association with sociodemographic, occupational, and health characteristics in 354 professional truck drivers. Researchers collected data through face-to-face interviews using forms. Multiple regression analyzes estimated prevalence ratios (PR) and respective 95% confidence intervals (95%CI).
Results:
lower family income (PR: 2.03; 95%CI: 1.08-3.83), symptoms of insomnia (PR: 2.18, 95%CI: 1.46-3.26), and long working hours (PR: 1.95, 95%CI: 1.30-2.92) independently associated with the use of at least one psychoactive substance.
Conclusions:
a set of sociodemographic, occupational, and health variables acts at distinct levels and is independently associated with the use of psychoactive substances among professional truck drivers.
- Ângela Maria Mendes Abreu
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ORIGINAL ARTICLE10-17-2022
Ethics, COVID-19 and nursing vulnerability: analysis of photographs released by the media
- Gabriele Pereira de Sena ,
- Alessandra Lima Fontenele ,
- André Di Carlo Araújo Duarte ,
- Graziani Izidoro Ferreira ,
- Dirce Bellezi Guilhem
Abstract
ORIGINAL ARTICLEEthics, COVID-19 and nursing vulnerability: analysis of photographs released by the media
Revista Brasileira de Enfermagem. 2022;75:e20210960
DOI 10.1590/0034-7167-2021-0960
- Gabriele Pereira de Sena ,
- Alessandra Lima Fontenele ,
- André Di Carlo Araújo Duarte ,
- Graziani Izidoro Ferreira ,
- Dirce Bellezi Guilhem
Views1See moreABSTRACT
Objectives:
to analyze nursing vulnerability through photos released by the media amidst the COVID-19 pandemic.
Methods:
a documentary study, with a qualitative approach. The object of analysis were photographic images selected between January 2020 and March 2021, published by the main news portals in countries such as Brazil, the United States, France, Spain, England and Germany. Thematic categorical analysis was the method of analysis used.
Results:
we found 74 photographs that portrayed nursing professionals in different work situations. It was possible to identify stigma and social devaluation about this class’s representation and professional attribution. Moreover, we found an underrepresentation of black professionals in Brazilian portals and the man as the prominent figure in the spaces of claims.
Final Considerations:
the photographs represented an important tool for the social analysis of nursing vulnerability, favoring the unveiling of situations that may go unnoticed by nursing and society.
- Gabriele Pereira de Sena
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ORIGINAL ARTICLE10-17-2022
Coping with the health condition from the perspective of people with HIV who abandoned treatment
- Juliete Bispo dos Santos Mandu ,
- Elen Ferraz Teston ,
- Gleice Kelli Santana de Andrade ,
- Sonia Silva Marcon
Abstract
ORIGINAL ARTICLECoping with the health condition from the perspective of people with HIV who abandoned treatment
Revista Brasileira de Enfermagem. 2022;75:e20210958
DOI 10.1590/0034-7167-2021-0958
- Juliete Bispo dos Santos Mandu ,
- Elen Ferraz Teston ,
- Gleice Kelli Santana de Andrade ,
- Sonia Silva Marcon
Views0See moreABSTRACT
Objectives:
to understand how people living with HIV who have abandoned treatment face their health condition.
Methods:
a qualitative study, based on the Chronic Care Model theoretical precepts. Data were collected between April and August 2021, through interviews with 24 people registered in a specialized service in the Brazilian Midwest.
Results:
coping with the health condition included good and bad moments and is influenced by individual behaviors and the way in which the network was organized. Treatment abandonment was motivated by the absence of signs and symptoms, the way care is provided and medication side effects.
Final Considerations:
care actions focusing on behavior change and maintenance become necessary in order to favor continuity of treatment. Furthermore, the gaps identified in the way health services are organized are subject to intervention.
- Juliete Bispo dos Santos Mandu
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01-01-2015
Quality of life and physical activity in intensive care professionals from middle São Francisco
Revista Brasileira de Enfermagem. 2015;68(1):26-31
Abstract
Quality of life and physical activity in intensive care professionals from middle São Francisco
Revista Brasileira de Enfermagem. 2015;68(1):26-31
DOI 10.1590/0034-7167.2015680104i
Views0See moreObjective:
the objective was to assess the level of physical activity (LPA) and the quality of life QL of the professionals who work in ICU.
Method:
this was a cross-sectional study carried out in Adult ICUs. LPA was assessed by the International Questionnarie of Physical Activity – short form (IQPA-SF) and the QL by the Medical Outcomes Study 36 (SF-36) questionnaire.
Results:
it was classified active 50.89% out of a total of 59 professionals. Nursing technicians were considered the most active with 60.6%. The QL of the professionals who were considered active were better when compared to inactives, with statistical differences to the category of physical aspects limitation, social aspects and mental health. The working hours were higher than recommend, the physicians were higher than the physical therapist, nurses and technicians nurses (p = 0.046).
Conclusion:
physically active professionals who work in ICU had higher quality of life probably why have lower hours of work and consequently more free time to engage in physical activity.
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01-01-2015
Learning needs of Nursing students in technical vocational education
Revista Brasileira de Enfermagem. 2015;68(1):20-25
Abstract
Learning needs of Nursing students in technical vocational education
Revista Brasileira de Enfermagem. 2015;68(1):20-25
DOI 10.1590/0034-7167.2015680103i
Views0See moreObjective:
identify learning needs of students of Technical Vocational Education (TVE) in Nursing. Qualitative study conducted in a city of São Paulo state.
Method:
the subjects were students, teachers and coordinators of TVE and students of the bachelor degree who have had contact with TVE. Data collection was performed by questionnaire socioeconomic and cultural circles about the learning needs. For data analysis we used the content analysis.
Results:
it was found that students have difficulties contents not related to nursing as portuguese and mathematics, as well as introductory courses in the course of TVE which possibly may interfere negatively in learning specific content of nursing and the quality of health care.
Conclusion:
it is necessary to rethink the content taught and ways to teach from basic education, as well as the training of teachers who now works in the TVE.
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01-01-2015
Serious game e-Baby: nursing students’ perception on learning about preterm newborn clinical assessment
Revista Brasileira de Enfermagem. 2015;68(1):13-19
Abstract
Serious game e-Baby: nursing students’ perception on learning about preterm newborn clinical assessment
Revista Brasileira de Enfermagem. 2015;68(1):13-19
DOI 10.1590/0034-7167.2015680102i
Views0See moreObjective:
to evaluate students opinion regarding e-Baby educational technology.
Methodology:
exploratory descriptive study in which participated a sample composed of 14 nursing Portuguese students that used e-Baby digital educational technology in an extracurricular course. To achieve the aim of the study, the data collection was realized through an opinion instrument in Likert scale including the possibility of commentaries by students. Is was also collected data of participants’ characterization.
Results:
students made very satisfactory evaluations regarding the game e-Baby, varying since usability acceptation through suggestions of expansion of the game to other nursing themes.
Conclusion:
serious game e-Baby can be considered a didactic innovation and motivator tool of learning. Besides, it demonstrates have adequate interface in design and educative function aspects, evocating intense interaction between user and computational tool.
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01-01-2015
Challenges beyond the scientific knowledge production
Revista Brasileira de Enfermagem. 2015;68(1):7-8
Abstract
Challenges beyond the scientific knowledge production
Revista Brasileira de Enfermagem. 2015;68(1):7-8
DOI 10.1590/0034-7167.2015680101p
Views0For several decades, innumerous appeals and reflections on how to build the nursing science and achieve visibility in the scientific world led researchers to make efforts to produce knowledge that contributed to the well-being of people, improving their quality of life, relieving their suffering and transforming the reality in which we live. In addition to […]See more
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01-01-2015
Risk classification in pediatrics: development and validation of a guide for nurses
Revista Brasileira de Enfermagem. 2015;68(5):913-922
Abstract
Risk classification in pediatrics: development and validation of a guide for nurses
Revista Brasileira de Enfermagem. 2015;68(5):913-922
DOI 10.1590/0034-7167.2015680521i
Views0See moreABSTRACT
Objective:
to develop and validate a short guide for the protocol to user embracement with risk classification in pediatrics.
Method:
methodological study developed in two stages: development of the guide, and face and content validation. The development involved the stratification of the protocol contents into five risk indicators according to the level of complexity; subsequently it was submitted to validation by nine experts divided in two groups: professors who were also researchers, and nurses.
Results:
in the face validation the experts considered the 25 items of the guide clear and understandable, with agreement levels above 70%. In the content validation, 17 (68%) items were considered relevant by 88.9% of the experts. The eight items considered irrelevant were changed according to suggestions of the experts, yielding an overall content validity index of 0.98.
Conclusion:
the study resulted in a guide for the classification of risks in pediatrics that is valid to assess children in emergency services.
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01-01-2015
Components of social learning theory in a tool for teaching Nursing
Revista Brasileira de Enfermagem. 2015;68(5):906-912
Abstract
Components of social learning theory in a tool for teaching Nursing
Revista Brasileira de Enfermagem. 2015;68(5):906-912
DOI 10.1590/0034-7167.2015680520i
Views0See moreABSTRACT
Objective:
to identify key components of the social learning theory in a computational tool to aid in teaching the reasoning process for the preparation of a nursing diagnosis.
Method:
qualitative study that analyzed the statements collected through a focus group of 18 teachers and students from two Brazilian nursing schools.
Results:
the themes were grouped into four categories related to the components of the theory and into 13 subcategories.
Conclusion:
the meaning of learning can be extended by the teacher’s didactics and corroborated by the relationship between systematization and reasoning. To learn by doing, some prerequisites are required as is a process of motivation and qualification, which are also inherent to learning by forming an identity in the group. In the feeling of belonging to a particular group, aspects related to the profession become visible as opposed to the aspects of belonging to a community of practice of learning.
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01-01-2015
Telephone call for post-discharge surveillance: validation and application of tool for video-assisted surgery
Revista Brasileira de Enfermagem. 2015;68(5):899-905
Abstract
Telephone call for post-discharge surveillance: validation and application of tool for video-assisted surgery
Revista Brasileira de Enfermagem. 2015;68(5):899-905
DOI 10.1590/0034-7167.2015680519i
Views0See moreABSTRACT
Objective:
to validate an instrument for post-discharge surveillance by telephone for video assisted surgeries.
Method:
a multi-method study with development, validation and application of the instrument. The validation was performed by experts considering the relevance, clarity and completeness of the contents in the calculation of the content validity index and valid questions that demonstrated 80% agreement. For the application of the instrument, the sample consisted of 68 women undergoing video-assisted surgery, and we conducted a descriptive analysis.
Results:
there was disagreement among experts in the first evaluation, and the instrument was redesigned obtaining agreement in the second evaluation. The response rate to the telephone contact was 88.2% (60/68). Complaints of abdominal pain, bleeding and incisional edema were more frequent. No patients presented with infection.
Conclusion:
the questionnaire was validated and applied and is available for use.
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01-01-2015
Managerial competences of coordinators of undergraduate nursing courses
Revista Brasileira de Enfermagem. 2015;68(5):890-898
Abstract
Managerial competences of coordinators of undergraduate nursing courses
Revista Brasileira de Enfermagem. 2015;68(5):890-898
DOI 10.1590/0034-7167.2015680518i
Views0See moreABSTRACT
Objective:
to analyze the experiences of how the managerial competences of coordinators, ideal and real, of undergraduate nursing course coordinators from the city of Belo Horizonte, Minais Gerais.
Method:
the theoretical framework presented a conceptual model of eight managerial roles (director, producer, monitor, coordinator, mentor, facilitator, broker and innovator) and three specific competences to the exercise of each one of them. Descriptive and qualitative research with 14 interviews conducted using semi-structured scripts, whose data were subjected to content analysis.
Results:
we highlighted the roles: mentor, director and facilitator as the most prominent, whose competences can be continually improved as a result of differentiated and permanent demands which the subject face, in addition to the natural ambiguities and contradictions of management function.
Conclusion:
the higher education institution can adjust their selection and evaluation processes for this position, including the difficulties of professional competences training required in the exercise of managerial function.
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01-01-2015
Participação familiar para a reabilitação de idosos com fratura de fêmur
Revista Brasileira de Enfermagem. 2015;68(5):883-889
Abstract
Participação familiar para a reabilitação de idosos com fratura de fêmur
Revista Brasileira de Enfermagem. 2015;68(5):883-889
DOI 10.1590/0034-7167.2015680517i
Views1See moreRESUMEN
Objetivo:
verificar si el modo de cuidar adoptado por los cuidadores favoreció la recuperación de la independencia funcional de los ancianos con y sin la presencia de enfermedad en el sistema nervioso y trastornos mentales y comportamentales y si enfermedades interfirieron en la independencia funcional.
Método:
estudio trasversal, con seguimiento por 12 meses de 89 ancianos brasileños (≥ 60 años), sometidos a cirugía de fémur proximal y sus cuidadores familiares.
Resultados:
los scores de la Medida de Independencia Funcional disminuyeron 0,7 puntos por año vivido y, en el caso de enfermedad en el sistema nervioso y trastorno mental y comportamental, esa pérdida aumentó para 20,5 puntos. El incentivo a la deambulación aumentó 18,9, al autocuidado 12,8 y al ocio 11,5 puntos de la Medida de Independencia Funcional.
Conclusión:
se recomienda el incentivo al movimiento y a la deambulación, al autocuidado y a las actividades de ocio, principalmente en aquellos ancianos con enfermedades en el sistema nervioso y trastorno mental y comportamental.
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01-01-2015
Family participation to elderly rehabilitation with femoral fracture
Revista Brasileira de Enfermagem. 2015;68(5):883-889
Abstract
Family participation to elderly rehabilitation with femoral fracture
Revista Brasileira de Enfermagem. 2015;68(5):883-889
DOI 10.1590/0034-7167.2015680517i
Views0See moreABSTRACT
Objective:
verify if the mode of care adopted by caregivers favored functional independence recovery by elderly with and without the presence of nervous system disease and mental and behavioral disorders; and, if disease interfered with their functional independence.
Method:
transversal study, with 12-month follow-up of 89 Brazilian elders (≥ 60 years) after proximal femoral surgery, and their family caregiver.
Results:
the Functional Independence Measure scores decreased by 0.7 points per year of life, and in the case of presenting nervous system disease and mental and behavioral disorders, this loss amounted to 20.5 points.
Conclusion:
The incentive to ambulate increased by 18.8 for self-care, 12.8 for self-care, and 11.5 for leisure activities on the Functional Independence Measure. Encouraging movement and ambulation, self-care and leisure activities, especially with those elderly with nervous system diseases and mental and behavioral disorders, is recommended.
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01-01-2015
Absenteeism – illness of the nursing staff of a university hospital
Revista Brasileira de Enfermagem. 2015;68(5):876-882
Abstract
Absenteeism – illness of the nursing staff of a university hospital
Revista Brasileira de Enfermagem. 2015;68(5):876-882
DOI 10.1590/0034-7167.2015680516i
Views0See moreABSTRACT
Objective:
to analyze absenteeism – illness of the nursing staff.
Method:
this was a retrospective study of a university hospital in the city of Goiânia, Goiás, Brazil, using a quantitative approach. Data were collected from functional records of the staff during the period from 2008 to 2012.
Results:
of 602 workers, 435 had 1574 medical certifi cates. Diseases of the musculoskeletal system and connective tissue, followed by mental and behavioral disorders were the major diseases for sick leave. The occupation with the highest number of medical certifi cates was the nursing technician. Females and the age group between 41-50 years prevailed in the sample. Ambulatory was the area with most frequent events, followed by the medical clinic and emergency room.
Conclusion:
absenteeism-illness affects the functioning of the service, the nursing staff and users, promoting work overload, and interfering in the quality of nursing care.
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01-01-2015
The nurse faced with early weaning in child nursing consultations
Revista Brasileira de Enfermagem. 2015;68(5):869-875
Abstract
The nurse faced with early weaning in child nursing consultations
Revista Brasileira de Enfermagem. 2015;68(5):869-875
DOI 10.1590/0034-7167.2015680515i
Views0See moreABSTRACT
Objective:
analyze the role of the nurse regarding early weaning in children younger than 6 months old.
Method:
qualitative and descriptive study. The nurses who performed the study did nursing consultation to children programmatically in family health units in Cuiabá – Mato Grosso. Data were collected in January and February 2012, through participant observation of nursing consultations. For data analysis, content analysis was used.
Results:
that nurses, in most cases, used appropriate strategies for the management of common problems in breastfeeding, although some behaviors have not yet proven scientifi c evidence about the benefi ts and/or damage to its practice.
Conclusion:
nurses addressed important aspects of breastfeeding during consultations and worked for the promotion and resumption of exclusive breastfeeding.
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