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- The COVID-19 Pandemic and Professional Nursing Practice in the Context of HospitalsPublication . Ribeiro, Olga; Trindade, Letícia de Lima; Pinto Novo, André Filipe Morais Pinto; da Rocha, Carla Gomes da; Sousa, Clemente Neves; Cabral Teles, Paulo João Figueiredo Cabral; Reis, Ana Catarina Rodrigues da Silva; Perondi, Alessandro Rodrigues; Andrigue, Karen Cristina Kades; Pereira, Soraia Cristina de Abreu; Leite, Paula Cristina da Silva; Ventura-Silva, João Miguel AlmeidaThe COVID-19 pandemic has imposed challenges to health systems and institutions, which had to quickly create conditions to meet the growing health needs of the population. Thus, this study aimed to assess the impact of COVID-19 on professional nursing practice environments and to identify the variables that affected their quality. Quantitative, observational study, conducted in 16 Portuguese hospitals, with 1575 nurses. Data were collected using a questionnaire and participants responded to two different moments in time: the pre-pandemic period and after the fourth critical period of COVID-19. The pandemic had a positive impact on the Structure and Outcome components, and a negative trend in the Process component. The variables associated with the qualification of the components and their dimensions were predominantly: work context, the exercise of functions in areas of assistance to COVID-19 patients, length of professional experience and length of experience in the service. The investment in professional practice environments impacted the improvement of organizational factors, supporting the development of nurses’ work towards the quality of care. However, it is necessary to invest in nurses’ participation, involvement and professional qualifications, which are aspects strongly dependent on the institutions’ management strategies
- Impact of COVID‐19 on professional nursing practice environments and patient safety culturePublication . Ribeiro, Olga; de Lima Trindade, Letícia; Silva Fassarella, Cintia; de Abreu Pereira, Soraia Cristina; Figueiredo Cabral Teles, Paulo João; Gomes da Rocha, Carla; da Silva Leite, Paula Cristina; Almeida Ventura‐Silva, João Miguel; Sousa, Clemente NevesAim: To analyse the impact of COVID-19 on professional nursing practice environments and patient safety culture. Background: The relationship between work environments and patient safety has been internationally recognized. In 2020, the pandemic imposed enormous challenges, yet the impact on these variables remains unknown. Method: This is a quantitative observational study, conducted in a Portuguese hospital, with 403 registered nurses. A self-completion questionnaire was used. Results: The impact on the Structure and Outcome components of nursing professional practice environments was positive. Although the Process component remained favourable to quality of care, a negative trend was confirmed in almost all dimensions. The results regarding safety culture showed weaknesses; ‘teamwork within units’ was the only dimension that maintained a positive culture. Conclusion: Positive responses regarding patient safety were significantly associated with the quality of the nursing professional practice environment. The need to invest in all dimensions of safety culture emerges to promote positive professional environments. Implications for nursing management: Improving professional nursing practice environments can be achieved through managers’ investment in the participation and involvement of nurses in the policies and functioning of institutions, as well as promoting an open, fair and participatory safety culture that encourages reporting events and provides adequate support for professionals.
- Scale of Assessment of Self-Care Behaviors with Arteriovenous Fistula in Hemodialysis: A Psychometric Study in BrazilPublication . Lira, Marta Nunes; Sousa, Clemente Neves; Wanderley, Maria Carolina Medeiros; Pessoa, Natália Ramos Costa; Lemos, Kelly Cristiane Rocha; Manzini, Carlene Souza Silva; Nicole, Andressa Garcia; Morais, Sheila Coelho Ramalho Vasconcelos; Frazão, Cecília Maria Farias de Queiroz; Ramos, Vânia Pinheiro; Teles, Paulo; Ribeiro, Olga; Dias, Vanessa Filipa Ferreira; de Souza, Lara Helk; Ribeiro, Rita Cássia Helú Mendonça; Magalhães, Anna Luiza Pereira; de Sá Basílio Lins, Silvia Maria; Pressi, Maira Maria Trevisan; Dourado, Polyana Bezerra Mendonça; Delgado, Millena Freire; Mendonça, Ana Elza Oliveira; Pinheiro, Jacielly Andes Araújo; Ozen, NurtenThe purpose of this study was to evaluate the psychometric properties of the Brazilian Scale for the Assessment of Self-Care Behaviors with Arteriovenous Fistula in Hemodialysis. Cross-sectional validation study, followed the recommendation provided by Sousa and Rojjanasrirat. Content validity, explanatory and confirmatory factor analyses used to check validity and Cronbach's alpha was the reliability measure. Three hundred hemodialysis patients with arteriovenous fistula were included in the study. The expert committee assessed the content validity. Exploratory factor analysis confirmed the same two-factor structure found for the original scale, explaining 60.10% of the variance. Such solution was checked by confirmatory factor analysis with Cronbach's alpha equal to 0.920, 0.810, and 0.884 for the overall scale, the self-care in management of signs and symptoms and the self-care in prevention of complications subscales respectively. The scale has good psychometric properties to assess self-care behaviors and can be used with Brazilian patients on hemodialysis with arteriovenous fistula.
- Effects of demographic and clinical character on differences in self‐care behavior levels with arteriovenous fistula by hemodialysis patients: An ordinal logistic regression approachPublication . Sousa, Clemente Neves; Teles, Paulo; Paquete, Ana Rita Cabral; Dias, Vanessa Filipa Ferreira; Manzini, Carlene Souza Silva; Nicole, Andressa Garcia; Sousa, Rui André Saldanha Santos; de Souza, Lara Helk; Ribeiro, Olga; Lira, Marta Nunes; de Queiroz Frazão, Cecília Maria Farias; Ramos, Vânia Pinheiro; Leal, Luciana; Ribeiro, Rita Cássia Helú Mendonça; Magalhães, Anna Luiza Pereira; de Sá Basílio Lins, Sílvia Maria; Mendonça, Ana Elza Oliveira; Delgado, Millena Freire; Pressi, Maira Maria Trevisan; Pressi, Nicole Trevisan; Campos, Luís; Campos, Tiago; Gonçalves, Diana; Ribeiro, Edgar; Ozen, NurtenIntroduction: Hemodialysis (HD) patients should be trained to develop selfcare behaviors in order to prevent and preserve their arteriovenous fistula (AVF). The aim of this study was identifying the factors that affect the levels of self-care behavior with AVF by HD patients. Methods: A cross-sectional study was conducted involving 89 patients. Results: Self-care levels were negatively affected by patients' location (Azores) and positively affected by marital status, education, employment, AVF duration, and absence of complications with the AVF. Concerning the management of signs and symptoms, self-care levels were negatively affected by patients' location. Regarding prevention of complications, self-care levels were negatively affected by age and marital status and positively affected by marital status, employment, chronic kidney disease etiology, AVF duration, and previous AVF. Conclusion: Further studies are required in order to confirm whether the considered factors affect levels of self-care behaviors with AVF, or whether other factors are needed as well.
- Escala de avaliação dos ambientes da prática profissional de enfermagem: construção e validação de conteúdoPublication . Ribeiro, Olga; Vicente, Corália Maria Fortuna de Brito; Martins, MM; Trindade, Letícia De Lima; Sousa, Clemente Neves; Cardoso, Maria Filomena Passos TeixeiraObjective: to construct and validate the content of the Assessment Scale of Nursing Professional Practice Environments. Method: methodological study conducted from January to May 2020. The construction of the Scale after a previous qualitative research and literature review. Content validation was performed by 22 experts. Results: initially, the Scale had 128 items grouped in the dimensions structure, process and outcome. Due to the experts’ evaluation, in the structure dimension, the 65 initial items, 20 were excluded, 10 were reformulated and one, added. In the process dimension, of the 49 initial items, 8 were excluded and 2 were reformulated. In the outcome dimension, of the 14 initial items, 2 were excluded, 2 reformulated and added 1. The final version contained 100 items, in which the Content Validity Index of each item fluctuated between 0.86 and 1. Conclusion: the construction and subsequent validation of the items by the experts was a fundamental step, giving security to the continuity of psychometric procedures.
- Investigating the Effect of a Structured Intervention on the Development of Self-Care Behaviors With Arteriovenous Fistula in Hemodialysis PatientsPublication . Sousa, Clemente Neves; Paquete, Ana Rita Cabral; Teles, Paulo; Barroso, Cristina; Dias, Vanessa Filipa Ferreira; Ribeiro, Olga; Manzini, Carlene Souza Silva; Nicole, Andressa Garcia; Souza, Lara Helk; Ozen, NurtenThis study aimed to assess the effectiveness of a structured intervention on the frequency of self-care behaviors with arteriovenous fistula (AVF) by patients on hemodialysis. This is a quasi-experimental study with pre- and post-measurements. Participants were assigned to an intervention group (IG) (n=48) or to a control group (CG) (n=41). IG patients were subject to a structured intervention on self-care with AVF (SISC-AVF) consisting of both a theoretical and a practical part. After SISC-AVF application, patients in the IG showed better overall self-care behaviors with AVF than patients in the CG (79.2% and 91.4%, respectively, p<.001) as well as better self-care concerning both the management of signs and symptoms (90.1% and 94.4% respectively, p=.004) and the prevention of complications (72.7% and 89.5%, respectively, p<.001). The study results suggest that the SISC-AVF had positive effects on patients in the IG.
- Ambientes de trabalho de enfermagem durante a Covid-19: contribuições para desenvolver uma ferramenta tecnológicaPublication . Ribeiro, Olga; de Lima Trindade, Letícia; Sousa, Clemente Neves; de Abreu Pereira, Soraia Cristina; Rodrigues da Silva Reis, Ana Catarina; Almeida Ventura-Silva, João Miguel; Alves Faria, Ana da ConceiçãoObjetivo:avaliar o impacto da COVID-19 nos ambientes de trabalho de enfermagem e desenvolver uma ferramen-ta tecnológica para avaliar sistematicamente a qualificação desses contextos. Método: pesquisa de método misto realizada em seis hospitais portugueses, com participação de 442 enfermeiros. Utilizou-se um questionário com caracterização sociodemográfica e profissional, a Scale for the Environments Evaluation of Professional Nursing Practice e questões abertas. Resultados: a COVID-19 teve impacto negativo nos componentes Estrutura (ƿ<0,001), Processo (ƿ<0,001) e Resultado (ƿ=0,009) dos ambientes de trabalho de enfermagem. A monitorização da qualidade dos ambientes de trabalho foi apontada como uma estratégia de melhoria. A ferramenta tecnológica desenvolvida permite identificar precocemente as dimensões mais fragilizadas e priorizar melhorias. Conclusão: a COVID-19 re-percutiu negativamente nos ambientes de trabalho. A ferramenta tecnológica construída, que tornou mais dinâmica a avaliação dos ambientes de trabalho, além de garantir o envolvimento dos enfermeiros, constitui uma importante ferramenta de gestão.
- Hemodialysis vascular access coordinator: Three‐level model for access managementPublication . Sousa, Clemente Neves; Teles, Paulo; Sousa, Rui; Cabrita, Filipa; Ribeiro, Olga; Delgado, Elisabete; Coutinho, Sara; Moura, Sandra Cristina Mendo; Delgado, Millena Freire; Costa, João Filipe; Sá, Tiago Gomes; Teixeira, Sílvia Mónica Pereira; Mendonça, Ana Elza Oliveira; Ozen, NurtenManagement of vascular access is a challenge for the dialysis team, particularly tokeep the arteriovenous access working. The vascular access coordinator can posi-tively contribute to increase the number of arteriovenous fistulas and reduce centralvenous catheters. In this article, we introduce a new approach to vascular accessmanagement centered on (the results of setting up) the role of vascular access coor-dinator. We described the three-level model (3Level_M) for vascular access manage-ment organized in three levels: vascular access nurse manager, vascular accesscoordinator, and vascular access consultant. We defined the instrumental skills andtraining required to be developed by each element and clarify the articulationbetween the model and all members of the dialysis team related to vascular access.1|INTRODUCTIONThe implementation and effectiveness of renal replacement therapy(RRT) depend directly on appropriate vascular access, such as arterio-venous fistula (AVF) (best choice), or alternatively a graft or a centralvenous catheter (CVC).1Nowadays, chronic kidney disease (CKD) patients are older, sufferfrom a larger number of comorbidities, and have more complex vascu-lar accesses. Therefore, the dialysis team and patients face new chal-lenges. The complications of the arteriovenous accesses are alreadydocumented and require supervision (monitoring and surveillance) inorder to decide the appropriate time to intervene.1,2Literature shows that the vascular access coordinator canhave an important contribution in the identification ofthese situations and in the implementation of a new approachleading to the best results in clinical care.3–8The vascularaccess coordinator's role can be crucial to improve the planning oftimely interventions free of thrombosis,7,6improve vascular accessoutcomes,3,7decrease the number of grafts and CVCs,5and applya quality policy with the vascular access.6The purpose of thisarticle is to analyze the vascular access coordinator's contribution(to) in the vascular access outcomes and introduce a newapproach on vascular access management, the three-level model(3Level_M).Received: 12 February 2023 Revised: 22 March 2023 Accepted: 26 March 2023DOI: 10.1111/sdi.13153Semin Dial.2023;1–6.wileyonlinelibrary.com/journal/sdi© 2023 Wiley Periodicals LLC.1
- From the first to the fourth critical period of COVID-19: what has changed in nursing practice environments in hospital settings?Publication . Ribeiro, Olga; Cardoso, Maria Filomena; de Lima Trindade, Letícia; da Rocha, Carla Gomes; Teles, Paulo João Figueiredo Cabral; Pereira, Soraia; Coimbra, Vânia; Ribeiro, Marlene Patrícia; Reis, Ana; da Conceição Alves Faria, Ana; da Silva, João Miguel Almeida Ventura; Leite, Paula; Barros, Sónia; Sousa, Clemente NevesBackground The COVID-19 pandemic reinforced the need to invest in nursing practice environments and health institutions were led to implement several changes. In this sense, this study aimed to analyze the impact of the changes that occurred in nursing practice environments between the first and fourth critical periods of the pandemic. Methods Quantitative, observational study, conducted in a University Hospital, with the participation of 713 registered nurses. Data were collected through a questionnaire with sociodemographic and professional characterization and the Scale for the Environments Evaluation of Professional Nursing Practice, applied at two different points in time: from 1 to 30 June 2020 and from 15 August to 15 September 2021. Data were processed using descriptive and inferential statistics. Results Overall, the pandemic had a positive impact on nursing practice environments. However, the Process component remained favourable to quality of care, while the Structure and Outcome components only moderately favourable. Nurses working in Medicine Department services showed lower scores in several dimensions of the Structure, Process and Outcome components. On the other hand, nurses working in areas caring for patients with COVID-19 showed higher scores in several dimensions of the Structure, Process and Outcome components. Conclusions The pandemic had a positive impact on various dimensions of nursing practice environments, which denotes that regardless of the adversities and moments of crisis that may arise, investment in work environments will have positive repercussions. However, more investment is needed in Medicine Department services, which have historically been characterised by high workloads and structural conditions that make it difficult to promote positive and sustainable workplaces.
- How to choose the appropriate cannulation technique for vascular access in hemodialysis patientsPublication . Sousa, Clemente Neves; Teles, Paulo; Ribeiro, Olga; Sousa, Rui; Lira, Marta Nunes; Delgado, Elisabete; Oliveira, Debora; Campos, Luís; Fernandes, Filipa; Moura, Sandra Cristina Mendo; Delgado, Millena Freire; Sá, Tiago Gomes; Teixeira, Sílvia Mónica Pereira; Souza, Lara Helk; Ribeiro, Rita Cássia Helú Mendonça; Oliveira, Gabriela Fernanda Neves; Mendonça, Ana Elza Oliveira; Ozen, NurtenThe cannulation technique is important for the survival of the arteriovenous access. Choosing the appropriate technique is a complex decision. Such choice must be customized to patients, considering their characteristics, the type of arteriovenous access and the experience of the hemodialysis team. We describe seven items that can help nurses to identify the appropriate cannulation technique: type of arteriovenous access; drainage vein; hygienic self-care profile; experience of the nursing staff in the cannulation technique and nurse-to-patient ratio; hemodialysis treatment method; patient's condition; and patient's decision. Such items can help nurses in decision-making on the "ideal" cannulation technique for each patient.