Dissertations / Theses on the topic 'Nursing theories'

Aim: The research study sought to examine qualified registered nurses' attitudes towards and understanding of nursing theories, models and care planning in Scotland. Problems have been identified with the attitudes towards and understanding of nursing theories and models as well as the implementation of care planning. This is perceived as affecting the way care is carried out. Method: Qualified registered nurses' attitudes towards, understanding and knowledge of nursing theories, models and care planning in two regions of Scotland were explored. Data were collected through a questionnaire. Findings: The data suggest that there are five factor analysis themes (Enabling Theory; Caring Practice; Negative Doing; the Encompassing Nature of Nursing and Apprenticeship) concerning with nursing theories, models and care planning. These had some similarities and some differences with Benner and Wrubel's (1987) and Glen's (1998) ideas about these areas of nursing. There was a significant level of dissatisfaction with the education around care planning with more than half the respondents indicating that they had received no such training. The qualitative findings provided a more detailed picture of the quantitative results and showed that there are five groups of nurses where caring practice is involved. There was also uncertainty and confusion about whether or not nursing is an art or a science and a lack of knowledge about the issues surrounding models, theories and care planning. There is a negative attitude to care planning that specifically relates to the doing of care planning. Conclusions: There is a need to encourage the development of education about nursing theories, models and care planning for all nurses in all clinical areas because, despite the lack of credible evidence for them, there is an expectation by senior nurses that they should be used in practice.

Western nursing has been deeply influenced by Christianity and more latterly by the Nightingale ideal of the good nurse. Both views have, as their foundation, the belief that there is an objectively knowable good way to live. This belief presents problems to the modern nurse and has, in large part, been rejected. However, the rejection of this objective moral foundation for nursing has resulted in a crisis of confidence about the best way to articulate what it is to be a good nurse. Two new ways have emerged in recent times. A scientific approach to nursing has elevated the work of nursing to increasingly complex levels and resulted in significantly improved health outcomes for patients. This scientific approach to nursing has manifested itself in two ways. It has resulted in the development of theories of nursing based on psychological concepts. Parallel to this approach has been the tendency for nursing itself to become increasingly scientific and nurses in turn to be technologists. It was thought that nursing that was increasingly shaped in scientific terms would achieve professional status because it presented a scientifically verifiable knowledge base. At the same time, however, it has resulted in an understanding of what counts as being a good nurse being reduced to the nurse’s ability to perform tasks to a high level of clinical precision. Alternatively, nursing as a care-based activity has made a caring attitude the moral centre point of nursing. On this view objective standards of practice are regarded as secondary to the emotional care that the nurse brings to the patient. This belief arose in part because notions of the objectivity of science were challenged as ideological rather than the dispassionate form of knowledge that scientists claimed. It was fostered by the emergence and dominance of phenomenology and the influence of the feminist care ethic. There was also some anxiety about what had been lost in nursing by the embrace of science. In addition, the care ethic seemed to promise the possibility of defining nursing in its own terms in order to make nursing a distinct professional body. However, the demands of an ethic of care have proven elusive and, in the minds of some, unattainable. Given these criticisms of both these ways of thinking about nursing it is proposed that nursing think of itself as a virtues-based activity. Virtues theory incorporates within it the strengths of the two formerly mentioned ways of describing nursing without being subject to the limitations of each. Virtues such as love friendliness, compassion , courage and conscientiousness and the intellectual virtue of prudence or practical wisdom enable nurses to realise that goal in their practice. In this thesis virtue theory will be analysed and applied to nursing in the following way. Some Aristotelian concepts will be identified and their application t professional ethics by contemporary virtue theorists will be discussed. This involves and explication of some virtues that enhance shared conceptions of the practice of nursing. The significance of the good nurse in the shaping of good nursing practice will be considered alongside a reflection on the place of moral luck in nursing practice. It is argued that when nurses think of themselves as participating in a tradition of health care they find meaning in their work, Finally an understanding of nursing as a virtue-based activity clarifies good practice in such a way that nurses are able to elicit from it the qualities needed for its good practice.

Psychological investigation of occupational choice has traditionally followed one of two dominant approaches. The structural (or 'personality-matching') approach (e.g., Holland, 1985) has used pysychometric testing to predict occupational choice on the basis of personality assessments whilst the process (or 'developmental') approach (e.g., Ginzberg et al., 1951) has mainly used interview responses to identify stages in the maturation of vocational thinking culminating 'realistic' decision-~aking. The aim of this study was to test the utility of these approaches in undertaking a detailed analysis of interview data. Garfinkel's (1967) proposal that decisions can be viewed as the retrospective construction of 'sense-able' accounts provided a useful perspective on collected interview responses. A discourse analysis approach was adopted in which the functional nature of language, as achieving interactive purposes, was stressed (Potter and Wetherell, 1987). Finally, use was made of the conversation analytic focus on turn-taking in order to examine the interdependent nature of the question-and-answer turns of the interviews (e.g., Sacks, 1972). Forty undergraduate students following the BSc courses in mechanical engineering and nursing at Dundee Institute of Technology were interviewed. The sample consisted of twenty students from each course, ten from the first year and ten from the final year. Comparisons were made between the two vocational groups and between first and final year students. A preliminary examination of course selection interviews was also undertaken. The data could not be categorized in accordance with Holland's 'personality patterns' for mechanical engineering and nursing, nor in terms of Ginzberg's 'realistic stage' of vocational thinking, due to categorization conflicts and within-interview response variability. The apparent contradictions and complexities generated by categorizing responses in these terms were clarified when accounts were analyzed as ongoing constructions of 'sense-able' choices within which 'personality-expressive' and 'developmental-stage' talk served specific conversational functions. The findings call into question methods of careers guidance based on these theories and it is argued that attention should be directed at career-selection preparation. However, it should be noted that a focus on the conversational skills required to succeed in selection interviews could challenge faith in a meritocratic selection system.

Relatório de Estágio apresentado para cumprimento dos requisitos necessários à obtenção do grau de Mestre em Enfermagem Perioperatória
Este relatório de estágio foi realizado em contexto perioperatório, no âmbito do Curso de Mestrado em Enfermagem Perioperatória, da Escola Superior de Saúde do Instituto Politécnico de Setúbal. O estágio, o relatório e o mestrado, tiveram como finalidade geral e concomitante: proporcionar conhecimentos e espaços de reflexão, análise e prática clínica, promotores do desenvolvimento e suporte de um conjunto de competências conduzindo à prestação de cuidados de enfermagem perioperatórios, centrados na pessoa e, baseados na evidência científica. Este relatório pretende apresentar os critérios que determinaram os objetivos de estágio, descrever as reflexões e a análise critica realizadas sobre a prática dos cuidados de enfermagem inerentes às especificidades das especialidades cirúrgicas e o desenvolvimento profissional de competências conducentes ao grau de Mestre em Enfermagem Perioperatória. Pretende ainda, apresentar o projeto individual desenvolvido através da Metodologia de Projeto, e concretizado, seguindo as etapas da Prática Baseada na Evidência. Através deste projeto, intitulado “Teorização na área de Enfermagem Perioperatória”, em que se realizou uma Revisão Integrativa de forma a responder à pergunta “Que teorização tem sido desenvolvida na área de Enfermagem Perioperatória?”; pudemos concluir que a teorização na área da Enfermagem Perioperatória não tem sido muito desenvolvida. Existe alguma evidência da aplicação de diversos tipos de Teorias de Enfermagem ao contexto perioperatório, nos quais se destaca o Modelo Perioperatório focado no Utente enquanto a única específica à área.
Abstract: This curricular internship report was accomplished in a perioperative context, as part of the Nursing Masters program of the Escola Superior de Saúde of Instituto Politécnico de Setúbal. The internship, the report and the Masters program have as a converging main goal the following: to provide the student with the know-how, reflection, analysis and clinical practice, which promote the development of competences that allow perioperative nursing health care. These should be based on scientific evidence but still be focused on the person undergoing surgery. The report aims to present the criteria which determined the internship objectives, describe the reflection and critical analysis conducted on nursing practice and the specificities inherent to the surgical specialties; and further professional development leading to the degree of Master of Perioperative Nursing. The report also aims to present the individual project developed through Project Methodology, in which Evidence Based Practice was applied. Through this project, entitled "Theorizing in the Perioperative Nursing area", in which an Integrative Review was conducted in order to answer the question "What theory has been developed in the area of Perioperative Nursing?”, it was concluded that theory in the Perioperative Nursing area hasn’t been greatly developed. There is some evidence of the application of various types of Nursing Theories to the perioperative period. It’s noteworthy to refer the Perioperative Patient Focused Model as the only theory specific to this area of nursing.

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In modern world, many people live the Spiritual Suffering and have a damaged ability to reflect upon their subjectivity and to recognize themselves, finding more difficulties to face life adversities. The Transpersonal Caring Theory by Jean Watson understands the human being as a spiritual being, that transcends the physical and mental dimensions, and values love and respecting what is sacred as a way to reach harmony between spirit-mind-body. This study aimed to purpose nursing interventions for the Spiritual Suffering nursing diagnosis, in the light of the foregoing Theory, and to submit them to the analysis of specialists, considering its relevance for the nursing care. It is a methodological and exploratory-descriptive study with a quali-quantitative approach that resulted in the construction of three nursing interventions: guiding the patient to perform the Gratitude Prayer; guide the patient to practice Altruist Love; guide the patient to practice Nature Appreciation. Twenty-one propositions substantiated these three proposes and composed an instrument that counted with a Likert like scale with scores ranging from one to five, besides a free field for comments. Six judges performed the propositions analysis using the Delphi technique. The quantitative analysis contemplated the median, the interquartile range and the consensus percentage; for reviewing the propositions between the first and second cycle of the technical application and elaborating an interpretative synthesis of judges’ comments, the content analysis, thematic modality, was used. Two cycles to reach consensus, pre-established in 80% of agreements for each propositions, were necessary. The Gratitude Prayer intervention was the one that generated more discussion due to its rather non-material character. The Altruist Love intervention was the one that most evolved in the agreements between cycles because of its relations with the existential meaning of life. Nature Appreciation had an agreement consensus already in the first cycle once it makes possible to elevate the human feeling, awakening spirituality. The results point that the proposed nursing interventions are relevant for caring in the spiritual perspective of the human being
No mundo moderno, muitas pessoas vivem o Sofrimento Espiritual e trazem uma capacidade prejudicada de refletir sobre a sua subjetividade e de se reconhecer, encontrando mais dificuldades para enfrentarem as adversidades da vida. A Teoria do Cuidado Transpessoal, de Jean Watson, compreende o ser humano como um ser espiritual, que transcende as dimensões física e mental, e valoriza o amor e o respeito ao sagrado como formas de alcançar a harmonia entre espírito-mentecorpo. O objetivo deste estudo foi propor intervenções de enfermagem para o diagnóstico de enfermagem Sofrimento Espiritual, à luz da Teoria supracitada, e submetê-las à análise por especialistas, considerando sua relevância para o cuidado de enfermagem. Trata-se de um estudo metodológico e exploratório-descritivo, de abordagem quali-quantitativa, que resultou na construção de três intervenções de enfermagem – orientar o paciente a realizar Oração de Gratidão; orientar o paciente a praticar o Amor Altruísta; orientar o paciente a exercitar a Apreciação da Natureza. Vinte e uma proposições fundamentaram estas três propostas e compuseram um instrumento que contou com uma escala tipo Likert com pontuação de 1 a 5, além de um campo livre para comentários. Seis juízes realizaram a análise das proposições utilizando-se a técnica Delphi. A análise quantitativa contemplou a mediana, a amplitude interquartílica e o percentual de consenso; para a revisão das proposições entre o primeiro e segundo ciclo de aplicação da técnica e elaboração de uma síntese interpretativa dos comentários dos juízes, foi utilizada a análise de conteúdo, modalidade temática. Foram necessários dois ciclos para alcançar o consenso, préestabelecido em 80%, de concordância para cada proposição. A intervenção da Oração de Gratidão foi a que gerou mais discussão devido ao seu caráter bastante imaterial. A intervenção do Amor Altruísta foi a que mais evoluiu na concordância entre ciclos por conta da sua relação com o sentido existencial da vida. A da apreciação da natureza já no primeiro ciclo obteve consenso de concordância, uma vez que ela possibilita a elevação do sentimento humano, despertando a espiritualidade. Os resultados indicam que as intervenções de enfermagem propostas são relevantes para o cuidado na perspectiva espiritual do ser humano

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Coordenação de Aperfeiçoamento de Pessoal de Nível Superior
Introduction: This work arises from the need for recognition of the care process in Long-Term Care Institution (LTCI) seeking improvements to the standard of care support network for institutionalized elderly. Purpose: To analyze the process of care in a LTCI, aiming to (co)structuring of care based on practical knowledge of the socialization of elderly caregivers and Cáritas Clinical Process. Method: Converged Care Research (CCR).performed in a LTCI in Campina Grande/PB in the period of June to November 2013, with the participation of 18 caregivers. Data collection took place following the phases of the PCA, and the instruments were used for data collection: two semi-structured questionnaires and ten scripts used in meeting titled as workshops for caregivers of the elderly. Through content analysis was possible to list the themes related to the care process based Cáritas Clinical Process. The project followed the ethical recommendations and was approved under protocol n. 18413413.3.0000.5187. Results: The results allowed us to describe and analyze the process of care in the LTCI, as well as the profile of caregivers of elderly motivations that forwarded the letter to the institution, description of activities and difficulties experienced in the service routine. There was possible (co) design a care process based Cáritas Clinical Process (CCP), which were listed the factors of care exercised by caregivers: 1) Caregivers practice love, kindness and fairness; 2) Caregivers describe its authenticity with their tools ; 3) Caregivers try to cultivate self care practices to yourself and to each other; 4) Caregivers help develop confidence in transpersonal caring; 5) Perception of caregivers of elderly in relation to positive and negative feelings; 6) Caregivers using creativity and knowledge to know is, how to do, learn to understand and know how to live; 7) Engaging caregivers on experiences of genuine teaching and learning; 8) Caregivers attempt to provide an environment for the care of institutionalized elderly; 9) Caregivers help in satiation of basic needs with the intention of caring; 10) Perceptions of elderly caregivers about the mysteries of life and death. Conclusions: It is concluded that the process of care in the LTCI has attributes that drive a humanistic system of action oriented transpersonal relationship between caregivers and elderly. It was possible to measure the effectiveness of the CCP through the proposal of care exercised daily by workers who work at the institution weaving rethinking the role of these workers that use of empiricism and creativity among their care practices. Also showed the importance of the use of Science in Nursing preparation of the whole study. It is assumed that this study is useful for the social recognition of the care in LTCI process of rethinking the role of caregivers for the elderly in institutions, to foster future research related to LTCI and the elderly, and especially for public institutions, seeking assistance for improvements to its residents.
Introdução: Este trabalho surge da necessidade de reconhecimento de como é programado o processo de cuidar nas instituições de longa permanência para idosos (ILPIs) buscando melhorias ao padrão de assistência a rede de apoio à pessoa idosa institucionalizada. Objetivo: Analisar o processo de cuidar em uma ILPI, visando a (co)estruturação do cuidado baseado na socialização do conhecimento prático de cuidadores de idosos e o Processo Clinical Cáritas. Método: Pesquisa Convergente Assistencial (PCA), realizada em uma ILPI no município de Campina Grande/PB, no período de Junho a Novembro de 2013, com a participação de 18 cuidadores. A coleta de dados aconteceu seguindo as fases da PCA, utilizando-se instrumentos para coleta de dados como: dois questionários semiestruturados e dez roteiros utilizados em encontros intitulados como oficinas para cuidadores de idosos. Através da análise do conteúdo foi possível elencar categorias temáticas relacionadas ao processo de cuidar baseado no Processo Clinical Cáritas (PCC). O projeto seguiu as recomendações éticas e foi aprovado sob protocolo de nº. 18413413.3.0000.5187. Resultados: Os resultados permitiram descrever e analisar o processo de cuidar na ILPI, assim como traçar o perfil dos cuidadores de idosos, motivações que o encaminharam ao ofício na instituição, descrição das atividades e dificuldades vivenciadas na rotina de serviço. Foi possível (co)estruturar um processo de cuidar baseado no Processo Clinical Cáritas, onde foram elencados os fatores de cuidado exercidos por cuidadores: 1) Cuidadores praticam amor, bondade e equidade; 2) Cuidadores descrevem sua autenticidade com seus instrumentos de trabalho; 3) Cuidadores tentam cultivar práticas de cuidado com autoconsciência para si mesmo e para com o outro; 4) Cuidadores desenvolvem a ajuda-confiança no cuidar transpessoal; 5) Percepção de cuidadores de idosos em relação a sentimentos positivos e negativos; 6) Cuidadores usam criatividade e conhecimento para saber ser, saber fazer, saber compreender e saber conviver; 7) Engajamento de cuidadores em experiências de ensino-aprendizagem genuínas; 8) Cuidadores tentam providenciarum ambiente de cuidado a pessoa idosa institucionalizada; 9) Cuidadores ajudam na saciedade das necessidades básicas com a intenção de cuidar; 10) Percepções de cuidadores de idosos sobre os mistérios da vida e da morte. Conclusões: Conclui-se que o processo de cuidar na ILPI possui atributos que direcionam a um sistema humanístico de ação voltado a relação transpessoal entre cuidadores e idosos. Foi possível mensurar através do PCC a efetivação da proposta de cuidado exercida diariamente pelos trabalhadores que atuam junto à instituição tecendo o repensar da atuação desses trabalhadores que se utilizam do empirismo e criatividade dentre suas práticas de cuidado. Evidenciou-se também a importância da utilização da Ciência da Enfermagem na elaboração de todo o estudo. Pressupõe-se que esse estudo seja útil para o reconhecimento social do processo de cuidar em ILPI, do repensar a função de cuidadores de idosos em instituições, para fomentar futuras pesquisas relacionadas às ILPIs e a pessoa idosa, e principalmente para as instituições, buscando por melhorias assistenciais aos seus residentes.

Trata-se de uma de pesquisa de caráter qualitativo, descritivo e exploratório, com abordagem fenomenológica, proposta por Paterson e Zderad. Esta pesquisa tem como objetivo geral: compreender a dimensão existencial do idoso em situação de hospitalização. E como objetivos específicos: descrever a percepção do idoso acerca do ambiente que o cerca. Entender a partir da ótica do idoso, quais são as melhores ferramentas para o estabelecimento de inter-relações com a equipe de enfermagem. E analisar o processo de cuidar a partir da perspectiva de Paterson e Zderad. Os sujeitos da pesquisa foram quinze idosos hospitalizados nos setores de clínica médica e cirúrgica e a unidade intermediária. O cenário foi um hospital público do interior do Estado do Rio de Janeiro. A coleta de dados aconteceu durante o ano de 2011, em um município que integra a Região dos Lagos. A técnica utilizada para a coleta de dados foi a entrevista não dirigida. Emergiram deste estudo oito categorias: ambiente hospitalar; enfermagem; acompanhantes; o que incomoda; agradecimentos; aprendizado e troca; religiosidade/espiritualidade; conselhos dos idosos para a equipe de enfermagem e imagem corporal. Espera-se que o presente estudo seja uma ferramenta para a melhoria da assistência de enfermagem aos idosos que vivenciam o processo de internação hospitalar, já que esta população possui características, especificidades e necessidades próprias, sendo seres singulares, com potencial de vir-a-ser, e necessitando do outro para a sua auto-realização.
It is a qualitative study descriptive and exploratory approach to phenomenological, proposed by Paterson e Zderad. Having as general objective: understand the existencial dimension from elderly in hospitalization. And specific objectives: Describe the perception of the elderly about the environment it is inserted. Understand from the perception of the elderly, what are the best tools to establish interrelationships with the nursing staff. And analyze the care process from the perspective of Paterson and Zderad. The subjects of study were fifteen elderly hospitalized in sectors of medical clinic and or surgical and the intermediate unit. The scenario was a public hospital in the state of Rio de Janeiro. The data collection happened during 2011, in a city that integrates the Região dos Lagos. The techiques use were interview an not directed. Emerged this study eight categories: ambient hospital; nursing; companions; what bothers; thanks; learning and exchange; religiosity and spirituality; advice the elderly for nursing staff and body image. It is expected that this study represents a tool to improve nursing care to elderly that experience the process of hospitalization since this population has characteristics, specificities, and needs, being unique people with potencial coming to be and requiring the other to self realization.

Background: To date, little attention has focused on what the factors are and how Best Practice Guidelines (BPGs) are sustained in acute care over time. Problem: For ten years, a multi-site acute care center supported the use of a Pain Assessment and Management Policy and Protocol (Pain P/P), placing the decision to use it with point of care nurses. Despite early implementation success, the nursing department identified an evidence-based gap on Medicine care units. Purpose: To (i) identify factors influencing nurses’ use (or not) of the Pain P/P over time, and ten years post-implementation; (ii) examine related knowledge translation interventions (KTIs) used over time, and ten years post-implementation; (iii) validate unit nurses’ use of the Pain P/P ten years post-implementation; and (iv) identify relevant sustainability frameworks/models/theories (F/M/Ts), constructs and factors for sustained use of BPGs in acute care. Methodology: A case study of an organization-wide nursing BPG was conducted ten years following initial implementation using mixed methods guided by the Dynamic Sustainability Framework (Chambers, 2013). The case study setting was a 1122 bed acute care center in Canada. I examined BPG sustainability at the (corporate) department and unit levels (two embedded subcases). Data sources included 19 informant interviews (3-corporate, 16-unit level), 200 chart audits (100/subcase), and 29 documents. I concurrently conducted a systematic review to identify sustainability concepts and factors for use in acute care to compare case study results. Results: I identified 7 constructs, 49 factors, and 29 KTIs influencing sustained use of evidence-base practices (EBPs) in acute care. Three factors and eight KTIs had a continuous influence during implementation and sustained use phases. Findings confirm the concept of sustainability is a dynamic ‘process’ or ‘ongoing phase’. Conclusions: This thesis provides a novel resource to support future practice and research aimed at sustaining EBPs to improve nursing practice and related patient outcomes. Attention to the level of application and changing conditions over time impacting factors that influence EBP use is required for sustainment. Use of a participatory approach to engage users in designing remedial plans and link KTIs to target behaviors that incrementally address low adherence rates promotes sustainability.

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This study one has a starting point a thougest aboput the way covered for the Nursing as profession. We searched to understand the knowledge professional practice, as well as the interferences that esapenad in the trajectory of the nursing since its origin. With this purpose the knawledage concepts, knowledge in nursing, as well as the analysis of history, nursing, origin and nursing in Brazil are loarded. The aurim of this study was: to contribute for the professional education of the nurse, to understand the constitution of one specific knowledge of the Nursing in the modern society and to know the contribution of theniursing education in Brazil, aiming the constitution of the Brazilian Nursing knowledge. Being a theoretical research, we searched a revision of the literature produced in Brazil, through the quantities of the libraries and electronic publications about this thematic. Thus, we expect that this study can also contribute to new elements, which are important to rethink the education of the nurse.
Este estudo tem como ponto de partida repensar o caminho percorrido pela Enfermagem como profissão. Buscou aqui compreender a prática profissional do saber, bem como as interferências que se deram na trajetória da enfermagem desde sua origem. Com essa finalidade são abordados os conceitos de saber, saber em enfermagem, bem como a análise da história, da origem da enfermagem e a enfermagem no Brasil. O presente estudo objetivou: contribuir para a educação profissional do enfermeiro, compreender a constituição de um saber específico da Enfermagem na sociedade moderna e conhecer a contribuição do ensino de enfermagem no Brasil, visando a constituição do saber da Enfermagem brasileira. Sendo uma pesquisa teórica, buscou-se a revisão da literatura produzida no Brasil, através dos acervos das bibliotecas e publicações eletrônicas existentes sobre essa temática. Assim, espera-se que este estudo possa também contribuir com novos elementos os quais sejam importantes para repensar a educação do enfermeiro.

Nos modelos de gestão clássicos o conflito era tido como algo prejudicial à organização sendo, na maioria das vezes ignorado, no entanto, tendências contemporâneas visualizam-no como um fenômeno inevitável e que está presente nas organizações. Porém, acredita-se que o mesmo deva ser gerenciado adequadamente para promover mudanças no ambiente de trabalho. Nossa vivência como enfermeira demonstra que na equipe de enfermagem os conflitos acontecem com freqüência, todavia são escassos os estudos realizados no Brasil sobre essa temática. Esta pesquisa objetivou analisar a natureza dos conflitos frente às relações pessoais, grupais, ambiente físico e organização do trabalho na equipe de enfermagem e, descrever como os conflitos são abordados e processados por essa equipe no âmbito da estrutura organizacional hospitalar. Para tal, foi realizada uma pesquisa qualitativa, descritiva e exploratória através da utilização de entrevista semi-estruturada aplicada a dezenove profissionais da equipe de enfermagem de um hospital público geral de médio porte da cidade de Londrina, PR, Brasil. Realizou-se análise de conteúdo, com identificação de unidades de significação extraídas dos textos das entrevistas, sendo posteriormente analisadas segundo referencial das teorias administrativas e da gestão contemporânea. As falas dos sujeitos evidenciam que os conflitos ocorrem devido à falta de clareza da missão e objetivos organizacionais; ao modelo de organização adotado pelo serviço de enfermagem; à estrutura do ambiente físico inadequada; as políticas de contratações de pessoal diferenciadas; as relações pessoais e grupais na equipe de enfermagem, à comunicação ineficaz e dimensões da liderança. Em relação ao gerenciamento dos conflitos, por parte da enfermagem, pode-se destacar que existe uma tentativa para que os conflitos sejam gerenciados através de diálogo com os envolvidos, entretanto, ainda prevalecem os valores individuais. Percebe-se, também, que as várias causas dos conflitos são decorrentes de problemas funcionais que dependem de instâncias superiores, de políticas articuladas de recursos humanos e de saúde. Os resultados indicam a necessidade dos enfermeiros adquirirem posições mais articuladas institucionalmente e, neste sentido faz-se imperativo a reavaliação dos projetos político-pedagógicos das escolas de enfermagem a fim de implementarem estratégias de participação e mediação grupal visando o desenvolvimento gerencial do futuro enfermeiro.
In classical management models, conflict was seen as something harmful to the organization and was mostly ignored. Contemporary tendencies, on the other hand, tend to consider it as an unavoidable phenomenon present in organizations, which should be adequately managed in order to promote changes in the work environment. Our experience as a nurse demonstrates that, in spite of the lack of studies about this subject in Brazil, conflicts are frequent in the nursing team. This research aimed to analyze the nature of conflicts in view of personal and group relations, physical environment and work organization in the nursing team, as well as to describe how these conflicts are approached and processed by the nursing team and in the sphere of the organizational hospital structure. A qualitative, descriptive and exploratory research was carried out by means of semi-structured interviews with nineteen professionals who are part of the nursing team at a general medium size public hospital in Londrina, PR, Brazil. Content analysis was used, identifying the units of meaning that were extracted from the interview texts, which were then analyzed in the reference framework of administrative theories and contemporary management. The subject’s discourse evidenced that conflicts are due to the lack of clearness about the organization’s mission and objectives, the organization model adopted by the nursing service, the physical environment inadequacy, distinct policies as far as human resources are concerned, personal and group relations in the nursing team, inefficient communication and leadership dimension. Concerning the conflict management by nursing, attempts are made to manage conflicts through dialogue with the persons involved, although individual values still prevail. It was also perceived that various causes of conflict result from functional problems depending on higher instances, and on the association of human resources and health policies. The results pointed towards the need for nurses to assume institutionally articulated positions. In this sense, it is essential to the nursing schools to review their pedagogical and political projects so as to introduce participatory strategies and group mediation aiming at the future nurse’s development of management.

Seasonal influenza, or the flu, impacts over 3 million people each year. Within the health sector, nosocomial infection and absenteeism are frequently associated with the flu. The Centers for Disease Control and Prevention (CDC) recommend flu vaccination for all eligible individuals, especially health care workers (HCWs). Interventions associated with increased HCW vaccination include educational programs and occupational health campaigns to address misconceptions regarding vaccine safety and efficacy. This project evaluated the impact of a voluntary, web-based education module to encourage registered nurse (RN) vaccination. The logic and health belief models served as the theoretical frameworks. In a nonequivalent group design, an educational program addressing evidence-based barriers to vaccination was delivered at 1 acute-care hospital and was not delivered at a comparison hospital within the health system. A total of 192 surveys (116 at intervention facility) were returned over 3 weeks. Statistically significant differences (x2 = 7.210, p = 0.007) were found for RNs who accepted influenza vaccination after education when compared to the RNs not receiving education. The 15% higher vaccination rate for RNs receiving education (91.1% vs. 76.1%) translates into more than 100 additional vaccinated RNs if applied across both hospitals. This project found that a simple but tailored web-based educational program is effective in converting RNs to vaccination acceptance. Increased vaccination produces societal change by reducing nosocomial and community influenza transmission. Reduced influenza infection improves community health as well as patient safety. Future work should address community-wide HCW education initiatives and evaluate their impact on quality and financial indicators at the hospital and community levels.

Por intermédio deste procurou-se identificar nexos que evidenciassem adesão ao tratamento da hipertensão arterial nos modos de vida dos usuários portadores de hipertensão arterial; compreender as relações dialéticas da assistência prestada pela Unidade de Saúde da Família expressa por contradições e congruências no modo de vida destes e elaborar um programa educativo segundo pedagogia emancipatória fundada nos pressupostos teóricos de Paulo Freire, com temas referentes às necessidades evidenciadas pelos usuários portadores de hipertensão arterial. O fenômeno modo de vida foi apreendido sob o referencial teórico-metodológico do materialismo histórico e dialético. As entrevistas realizadas com 11 usuários portadores de hipertensão arterial foram submetidas ao procedimento de análise de discurso, que revelou o modo de vida destes usuários representado pelos temas: crenças, sentimentos, para além do individual, controle pressórico, descontrole pressórico e causa da hipertensão arterial. Estes temas foram analisados frente às categorias dialéticas o subjetivo e o objetivo e processo saúde-doença-cuidado. Para estes usuários portadores de hipertensão arterial a vida cotidiana se apresenta com inúmeras contradições referentes ao tratamento necessário e a doença que não é assumida como doença; necessidade de modificações em hábitos e valores humanos que se contrapõem às essas modificações; impossibilidade concreta de controle dos níveis pressóricos decorrente de situações do modo de vida como o nervosismo, problemas familiares e financeiros. Ao identificar contradições do modo de vida destes usuários, este estudo apresenta uma proposta de melhoria da adesão ao tratamento da hipertensão arterial por meio da educação emancipatória nos pressupostos de Paulo Freire. É necessário que a enfermagem reconheça e se aproxime desta realidade e de modo ético transforme sua prática profissional no sentido de propiciar caminhos de maior autonomia aos usuários portadores de hipertensão arterial assistidos pelas enfermeiras.
This study intended to identify, in the way of life of hypertensive patients, connections which could clarify their compliance of hypertension treatment, to understand dialectical relationship of the assistance offered by a Family Healthcare Program expressed through contradictions and coincidences in the patients\' way of life, and to create an educative program according to the emancipatory pedagogy based on Paulo Freire\'s conception of emancipatory education, with themes related to hypertensive patients\' required needs. The phenomenon \"way of life\" was grasped on the grounds of the theoretical and methodological aspects of the historical and dialectical materialism. The interviews, held with 11 hypertensive patients, were submitted to the analysis of the speech procedures, which showed the way of life of these patients. It can be represented by the following: beliefs, feelings, beyond-individual, under-control pressure, out-of-control pressure and hypertension causes These categories were analyzed according to dialectical categories - the subjective and the objective - and the health-illness-care process. Hypertensive patients\' daily life shows many contradictions related to the treatment needed and the illness not assumed as it is; the need of changing habits and human values which oppose to these changes; the real impossibility of controlling pressure levels due to daily life conditions such as nervousness and financial and familiar problems. Once many contradictions in these patients\' way of life have been identified, this study sugests the improvement of the acceptance of hypertension treatment by means of emancipatory education, according to Paulo Freire\'s theory. Nursing has to accept this reality, approach to it, and ethically change its own practice in order to show hypertensive patients under the care of nurses a better way towards their autonomy.

Dissertação de Mestrado em Gestão e Economia da Saúde apresentada à Faculdade de Economia
ENQUADRAMENTO: A informação clínica é um elemento indiscutível no âmbito da prestação de cuidados, sendo a qualidade da mesma influenciadora de uma prestação de cuidados de enfermagem segura e com continuidade. Os enfermeiros pesquisam e consomem dados clínicos por forma a que o planeamento da sua assistência acrescente valor para a pessoa, indo ao encontro das suas necessidades. A informação partilhada (oralmente nas transições de cuidados e documentada no processo clínico) deve aproximar-se do Modelo Exposto para a prestação de cuidados. Sabendo que a qualidade dos cuidados de enfermagem dependerá da qualidade da informação partilhada, a análise da mesma num contexto específico poderá contribuir para a obtenção de orientações para a construção de caminhos de desenvolvimento.OBJECTIVO: Analisar a informação partilhada (oral e escrita) no âmbito da tomada de decisão clínica em enfermagem no serviço de urgência pediátrica, identificando o paradigma emergente da conceção de cuidados.MÉTODO: Optou-se por uma abordagem de ênfase qualitativa, através do estudo de caso, baseado em Yin (2010). Realizado num serviço de urgência pediátrico, envolvendo 31 crianças. Os dados foram colhidos através de três métodos: transcrição da passagem de turno, processo documentado e processo realizado pelo perito, procedendo-se a análise documental e de conteúdo segundo Bardin.RESULTADOS: Os resultados mostram uma maior valorização de dados respeitantes a processos corporais não intencionais, sobretudo no âmbito da transmissão oral de informação aquando das transições de cuidados. A informação documentada nos processos clínicos evidencia maior detalhe no âmbito dos processos adaptativos (sobretudo dos pais), mas ainda incipiente para uma conceção estruturada e intencional da assistência de enfermagem. No âmbito da informação documentada, há alguma evidência de dados quanto ao Papel Parental, aspeto central no domínio de autonomia dos Enfermeiros, quase inexistente durante a transmissão oral.CONCLUSÃO: O estudo evidencia um desfasamento entre a informação oral e escrita, traduzindo ainda uma prestação de cuidados com maior ênfase nos processos corporais, e, portanto, numa lógica mais executiva e menos conceptual. Constatou-se que a ausência de referenciais teóricos estruturados é um fator dificultador á elaboração de um plano de cuidados centrado nas respostas humanas, que vá para além da gestão de sinais e sintomas.
BACKGROUND: Clinical information is an indisputable element in the scope of care provision, the quality of which influences the provision of safe and continuous nursing care. Nurses’ research and analyse clinical data so that care approach planning adds value to the individual, meeting their needs. The information shared (verbally in care transitions and documented in the clinical process) should be close to the Exposed Model for care delivery. Knowing that the quality of nursing care will depend on the quality of the information shared, its analysis in a specific context may contribute to obtaining guidelines for the construction of development paths.OBJECTIVE: To analyse the shared information (verbal and written) in the context of nursing clinical decision-making within the paediatric emergency department by identifying the emerging paradigm of care design.METHOD: A qualitative approach through case study analysis based on Yin (2010). Study performed in the paediatric emergency service involving 31 children. The data were collected using three methods: transcription of the change of shift, documented process and process performed by the expert; utilizing documentary and content analysis according to Bardin.RESULTS: The results show a greater appreciation for data regarding involuntary bodily processes, particularly in the context of verbal transmission of information during care transitions. The information documented in clinical processes shows detail in the context of adaptive processes (especially from parents), but still incipient for a structured and intentional conception of nursing care. In the context of documented information there is some evidence regarding the Parental Role, a central aspect in the domain of nurses' autonomy, almost non-existent during verbal transmission.CONCLUSION: The study shows a gap between verbal and written information, with a provision of care with greater emphasis on bodily processes, and therefore an executive and less conceptual logic. It was found that the absence of structured theoretical references is a complicating factor in the development of a care plan centred on human responses which goes beyond the management of signs and symptoms.

Significant changes have taken place in higher education over the past ten years. Learners are more liberated and want to be acknowledged as individuals with differences, and not expected to adapt their individual characteristics to fit in with the specific environment of the learning situation. A new emphasis is placed upon creating and sustaining learning environments that accommodate learner needs and the process of effective learning. Learners' individual needs include their need to learn how to learn and an acceptance of their individual differences as expressed in learning styles. Active learner participation in the learning process is necessary for effective learning to take place. Only then can the desired outcome be reached. For a learner to actively participate in the learning process, the learner must know how to learn, and how to function as an independent learner. To reach these goals, sound knowledge of individual differences in learning styles is necessary. The impact of individual differences on education and the way they affect educational practice, future learning and academic achievement places the emphasis even more strongly on constant awareness, updating or change, improvement and development of the educational environment. The educator, as one of the role players in the educational environment, is the facilitator of learning, and should be empowered with a strong knowledge base regarding individual differences among both learners and educators, thus becoming more innovative and creative. Qualitative non-empirical research was undertaken. The aim of this research was to analyse and explore the concept learning style as well as to promote learning style awareness through assessment of learning styles, and to provide an organised frame of reference to guide the learning process and provide for systematic education. Based on insight and knowledge gained through inductive and deductive reasoning, the Learning Style Assessment Tool and a model for learning style promotion in higher education were constructed. The instrument enables learners and educators to assess their own learning styles and identify their learning characteristics and preferences. The model can serve as a basis for acknowledging and accommodating learning styles in higher education. The desired outcome of this research is effective learning and quality education.