Child development surveillance: intervention study with nurses of the Family Health Strategy

Objective:

to evaluate the effectiveness of an educational action in child development surveillance performed by nurses working in primary health care.

Methods:

interventional study with a before-and-after type of design, carried out with 45 nurses and 450 mothers of children under 2 years of age. Initially, it was evaluated the practices and knowledge of nurses on child development surveillance and the mothers were interviewed about these practices. Subsequently, workshops were carried out with nurses and four months later, the knowledge of nurses and the maternal information were reevaluated.

Results:

after intervention there was significant increase in the frequency of the following aspects: from 73% to 100%, in relation to the practice of nurses of asking the opinion of mothers about their children''s development; from 42% to 91%, regarding the use of the systematized instrument of evaluation; from 91% to 100% with respect to guidance to mothers on how to stimulate child development.

Conclusions:

the intervention contributed to the increase of knowledge of nurses and implementation of child development surveillance, showing the importance of this initiative to improve the quality of child health care.     

Napping during the night shift and recovery after work among hospital nurses

OBJECTIVE:

To analyze the association between the length of napping during the night shift and the recovery after work among nurses.

METHOD:

Cross-sectional epidemiological study involving 1940 nurses from 18 public hospitals in the City of Rio de Janeiro. A multidimensional and self-applied questionnaire was used with information about health, sociodemographic and occupational characteristics, health-related behaviors and housework. Multiple logistic regression was applied to identify the association, adjusted for confounding variables.

RESULTS:

The gross analyses showed 44%, 127% and 66% higher chances of a high level of recovery after work for nurses who sleep up to two hours, between 2.1 and 3 hours and 3.1 hours or more, respectively, when compared to the nurses who do not sleep. After adjusting for confounding variables, the association only continues significant for the group that sleeps 2.1 to 3 hours during the night shift (OR=1.79; 95%CI=1.33-2.41).

CONCLUSION:

The association between the length of napping and the high level of recovery after work, confirmed in the present results, can be included in the studies that aim to support more appropriate policies aimed at improving the workers'' work, life and health conditions, not only in nursing, but night-shift workers in general.     

The treatment of childhood cancer: unveiling the experience of parents

Objective

to understand the experiences of parents of children and adolescents with cancer undergoing treatment.

Method

qualitative research, based on Heidegger''s existential phenomenology, in which 13 parents of eight patients under 19 years of age, assisted by a charity association, were interviewed.

Results

three topics resulted from the analysis: "Experiencing the unpleasantness of the treatment"; "Fearing the possibility of a frightening situation" and "Experiencing the carelessness of another person". It was showed that during and after the treatment, the parents experience the fear of the unknown and the uncertainty of the future of their children, especially as they witness the death of other children; they also experience the indifference of professionals working in the local healthcare units and feel helpless and insecure.

Conclusion

It is essential that the healthcare professionals, particularly the nurses, reflect about their care actions focused on the parents of children with cancer, recognizing their existential needs with the purpose of assisting them in their situation.     

Barriers for the inclusion of sexuality in nursing care for women with gynecological and breast cancer: perspective of professionals

AIM:

qualitative study, which aimed to identify the barriers that influence nursing care practices related to the sexuality of women with gynecological and breast cancer.

METHODS:

the study was conducted with 16 professionals of the nursing area (nurses, nursing technicians and nursing assistants) from two sectors of a university hospital situated in the state of São Paulo, Brazil. The data was collected using semi-structured, in-depth individual interviews. All the interviews were recorded and the participants'' responses were identified and categorized using Content Analysis.

RESULTS:

three major themes were identified. These are as follows: 1) barriers related to the biomedical model; 2) barriers related to institutional dynamics and 3) barriers related to the social interpretations of sexuality.

CONCLUSIONS:

the results of this study showed that the systematized inclusion of this issue in nursing care routines requires changes in the health paradigm and in the work dynamic, as well as reflection on the personal values and social interpretations related to the topic. A major challenge is to divest sexuality of the taboos and prejudices which accompany it, as well as to contribute to the nursing team being more aware of the difficulties faced by women with gynaecological and breast cancer.     

Factors associated to persistence with hormonal therapy in women with breast cancer

OBJECTIVE

To analyze factors associated with persistence to breast cancer hormone therapy in order to contribute to the quality of care improvement.

METHODS

Retrospective longitudinal study, based on secondary data. A cohort of 5,861 women with breast cancer registered in different datasets of the Brazilian National Cancer Institute and the Brazilian Unified Health System were analyzed. All women were treated at this hospital, which provides free medication, and the follow-up period was from January 2004 to October 2010. Sociodemographic, behavioral, and clinical variables, as well as aspects of lifestyle and health care, were considered in the explanation of variations in the persistence to hormone therapy, applying the Kaplan-Meier method and the Cox proportional hazard model.

RESULTS

Overall persistence to hormone therapy was 79.0% at the end of the first year, and 31.0% in five years of treatment. The risk of discontinuing hormone therapy was higher among women under 35 years old, with more advanced disease (stages III and IV), alcohol drinkers, those undergoing chemotherapy, and for each additional hospitalization, exam performed, and month between diagnosis and beginning of treatment. In the opposite direction, the risk of discontinuity was lower among women who had at least finished high school, those with partner, with a family history of cancer, those who had undergone breast surgery, and who had outpatient visits to a Mastologist, and a Clinical Oncologist.

CONCLUSIONS

The majority of the women with breast cancer (69.0%) do not persist with hormone treatment for the five years recommended, increasing the risk of inadequate clinical results. The results show aspects of care that can provide better results.     

Between spiritual wellbeing and spiritual distress: possible related factors in elderly patients with cancer

Objective

this article describes the assessment of the spiritual wellbeing of elderly patients with cancer submitted to chemotherapy and possible predictive factors of the spiritual distress diagnosis.

Methodology

this is a methodological study for clinical validation of a nursing diagnosis, using interviews to assist in completing the form.

Results

45 elderly patients participated in this study, Catholics, mostly female, diagnosed with breast cancer, average age of 70.3 years. The prevalence of spiritual distress was of 42%; 24.4% of the elderly patients were under anti-depressant medication. A significant association was noted between spiritual distress, anti-depressant medication and level of education; an increase (not significant) was acknowledged at the start of the treatment.

Conclusion

these results emphasize the relevance of clarifying this diagnosis and the responsibility of nurses to provide spiritual care to patients. Interventions should be planned appropriately every time a nursing diagnosis is identified as a complex answer and for which pharmacological treatment is not sufficient.     

The contribution of distance learning to the knowledge of nursing lecturers regarding assessment of chronic wounds

OBJECTIVE:

to identify the contribution made by a refresher course on the assessment of chronic wounds, offered through the Moodle virtual learning environment (VLE), to the knowledge relating to this issue of nursing lecturers and nurses linked to higher education.

METHOD:

a prospective, quasi-experimental study, with data collection before and after the educational intervention. The study was undertaken in three stages using the Moodle VLE. The sample was made up of 28 participants who answered the pre-test on the knowledge, devised in accordance with international guidelines on chronic wounds. Afterwards, the refresher course was offered (intervention) and was accessed in accordance with individuals'' schedules, during the established time period. At the end of the course, 26 participants answered the post-test. Those who did not participate in the post-tests were excluded from the study, as it is pairwise analysis of the sample.

RESULT:

the participants obtained, on average, 55.5% of correct answers in the pre-test on their knowledge, and 73.4% in the post-test, this difference being statistically significant. There was a negative correlation between the time of experience in lecturing and the performance in the test on their knowledge.

CONCLUSION:

the participation in the online refresher course contributed to improving the lecturers'' performance in the test on their knowledge, in relation to the recommendations for assessing chronic wounds, based in scientific evidence.     

Nurses' daily life: gender relations from the time spent in hospital

Objective:

to analyze the everyday life of nurses through the sexual work division as well as through interdependence relations and the time in hospital.

Method:

quanti-qualitative study, based on the Time Use Survey and in Norbert Elias''s Configuration Theory of Interdependencies. Daily shifts distribution record, directed by 42 participants - with self-confrontation - by interviews which drew dialogues on subjective aspects of the everyday experiences related to use of time, based on a job at a university hospital. The theoretical intake that founded data analysis was based on concepts of conflicts of interest, power struggles, sexual work division and polychronic-monochronic concepts - whether the work environment demands multitasking nurses or not.

Results:

time records allowed to observe differences between the groups studied, useful to identify conflicts, tensions, power struggles and gender inequalities in interviewees'' everyday affairs that do not only affect physical and mental health, but also their way of life.

Conclusion:

the analytical path pointed out the need for public policies that promote equity in gender relations, keeping at sight the exercise of plural discourses and tolerant stances capable to respect differences between individual and collective time.     

Development and assessment of learning objects about intramuscular medication administration

OBJECTIVES:

to develop and assess a learning object about intramuscular medication administration for nursing undergraduates and nurses.

METHOD:

a random, intentional and non-probabilistic sample was selected of nurses from a Brazilian social network of nursing and students from the Undergraduate Program at the University of São Paulo School of Nursing to serve as research subjects and assess the object.

RESULTS:

the participants, 8 nurses and 8 students, studied the object and answered an assessment instrument that included the following criteria: educational aspects (relevance of the theme, objectives and texts/hypertexts), interface of the environment (navigation, accessibility and screen design) and didactic resources (interactivity and presentation of resources). In total, 128 significant answers were obtained, 124 (97%) of which were positive, assessed as excellent and satisfactory, considered as a flexible, dynamic, objective resources that is appropriate to the nursing learning process.

CONCLUSION:

the educational technology shows a clear and easily understandable language and the teaching method could be applied in other themes, contributing to the education and training of nursing professionals, positively affecting nursing teaching, stimulating the knowledge, autonomous and independent learning, aligned with the new professional education requirements.     

Validation of the Adherence Determinants Questionnaire scale among women with breast and cervical cancer

Objectives:

the aim was to translate and culturally adapt the Adherence Determinants Questionnaire scale for the Portuguese language in the Brazilian context, and to check its reliability and validity to analyze the elements of the adherence of patients to the clinical treatment for breast and cervical cancer.

Method:

this was a methodological study, carried out in two oncology reference centers. The sample consisted of 198 participants, with 152 being treated for breast cancer and 46 being treated for cervical cancer. The content validation was performed by a committee of experts. The construct validation was demonstrated through factor analysis and the reliability was analyzed using Cronbach''s alpha.

Results:

the committee of experts made the necessary adjustments so that the scale was adapted to the Brazilian context. The factor analysis suggested a reduction from seven to five factors and the maintenance of 38 items similar to those of the original scale. The reliability, investigated through Cronbach''s alpha, was .829, showing high internal consistency.

Conclusion:

it was concluded that the Brazilian version of the Adherence Determinants Questionnaire scale is a valid and reliable instrument that is able to measure the elements of adherence to the treatment for breast and cervical cancer.     

Cultural experiences of immigrant nurses at two hospitals in Chile

Objective

to explore the cultural experiences of nurses who immigrated to Chile. The study''s theoretical framework was the Purnell Model for Cultural Competence.

Method

Leininger''s Observation-Participation-Reflection method was developed at two hospitals in the city of Santiago, and ethnographic interviews were held with 15 immigrant nurses.

Results

among Purnell''s 12 domains, the following were identified: Overview/heritage, Communication, Workforce issues, Family roles and organization, Biocultural ecology and Health-care practices. The difficulties were related to the language and its semantic meaning, the new responsibilities and the difficult relationship with colleagues. "In search of better horizons - the decision to immigrate", "Gaining confidence and establishing a support network - employability and professional performance" and "Seeking for people''s acceptance - professional adaptation in a new cultural scenario" are cultural themes that represent their experiences.

Conclusions

the competence to offer cultural care demands the development of public policies and continuing education programs at health institutions, specifically focused on immigrant nurses.     

Experience of nurses in the process of donation of organs and tissues for transplant

Objective

to investigate the meaning of the action of nurses in the donation process to maintain the viability of organs and tissues for transplantation.

Method

this qualitative study with a social phenomenological approach was conducted through individual interviews with ten nurses of three Organ and Tissue Procurement Services of the city of São Paulo.

Results

the experience of the nurses in the donation process was represented by the categories: obstacles experienced in the donation process, and interventions performed. The meaning of the action to maintain the viability of organs and tissues for transplantation was described by the categories: to change paradigms, to humanize the donation process, to expand the donation, and to save lives.

Final considerations

knowledge of the experience of the nurses in this process is important for healthcare professionals who work in different realities, indicating strategies to optimize the procurement of organs and tissues for transplantation.     

Risk for leukaemia and brain and breast cancer among Danish utility workers: a second follow-up

Objective

To update a study of risks for leukaemia, brain cancer and breast cancer in a Danish nationwide, population‐based cohort of utility employees.

Methods

A multivariate statistical model including information on age, duration of employment, date of first employment and level of occupational exposure to electromagnetic fields was applied.

Results

No increased risk for these cancers was seen among 28 224 subjects with more than 3 months of employment in whom cancer had not been diagnosed before first employment.

Conclusion

The results do not support the hypothesis of an association between occupational exposure to magnetic fields in the electric utility industry and risks for leukaemia, brain cancer and breast cancer.