Consideram que mesmo para os enfermeiros assistenciais, o PE seria uma tarefa a mais, aumentando a sobrecarga de trabalho. Perception of primary healthcare management nurses on the nursing process. Rev Bras Enferm. Development of an obesity management ontology based on the nursing process for the mobile-device domain. J Med Internet Res [Internet].
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Systematization of nursing care: difficulties highlighted by the grounded theory. I Nurse Midwife. E-mail: aninhapits gmail. PhD in Sociology.
E-mail: srsantos gmail. Master in Public Health. E-mail: romulopits gmail. Many problems are encountered in the implementation of the Systematization of Nursing SAE , reflecting on the quality of care provided. The study aims to investigate the factors that hinder the operation of SAE in the obstetrics service. Data analysis showed that factors hinder the operation of SAE and ways to better adherence and success through the application of the nursing process.
Nurses expressed the knowledge dimension of SAE experienced in practice and their expectations of the socio-organizational context in which they exist. We conclude that the difficulties faced by nurses in the operation of SAE are diverse, highlighting: the small number of professionals, work overload and lack of operation of the process by the nurse.
Keywords: Nurse, nursing process; nursing care, working conditions. In the health scenario, the nurse practice is based nursing care supported on a theoretical and scientific sustained Care System in Nursing ASN and implemented through the nursing process. This is considered a method of decision making that promotes humane care, results oriented, encourages nurses to continually examine their actions, seeking to maximize service and minimize errors.
It also helps to ensure that interventions are developed for the individual and not the disease 1. The application of SAE promotes improved quality of care, allowing the use of a scientific method that supports it.
As part of customer service, directs and organizes the work, enables auditing, favors visibility and effective participation in professional care and in decision making, providing an individualized work on the needs of each client 2.
However, since the beginning of its implementation in health services, some difficulties were noted. Among these are: those related to factors inherent in its structure, as its complexity and lack of uniformity in establishing each of its steps, related to the teaching-learning process, in that the undergraduate teaching and post-graduation courses has favored the acquisition of skills necessary for the development of this process, the difficulties within the healthcare practice, for example, the insecurity of professionals to carry out the activities inherent to the process and the number of nurses in most health services are inadequate for their proper development 3.
Faced with these difficulties, many nurses have left to systematize their assistance and identify the nursing diagnoses. With that, they start to fragment care and customer problems, failing to see it as a whole and often, taking care that bear no relation to the problems encountered.
Therefore, it is assumed that the non-application of the nursing process, an integral form, causes a nursing care inadequate, not individualized and not systematized customer. In this context, the difficulties in operationalizing the SAE are described by nursing students, nurses and teachers in several researches, hence the relevance of this study so that we can think of overcoming them in everyday practice of nursing care.
Beginning with this issue, the following question arose: what factors hinder the implementation of the NCS by nurses in the obstetrics service?
Therefore, this study aimed to investigate the factors that hinder the operation of SAE at obstetrical service of a public hospital. Nursing as a discipline, focuses on the science and art of caring human being. In recent years it has progressively consolidated its known and do care to humans as an integral being, seeking to give meaning to their existence.
In this context, means that care is essential in different situations of human life, be it in health promotion, disease prevention, in the course of diseases and their complications, disabilities or in the process of dying. Considering this scenario, the SAE is an essential tool in planning and executing such care, with a method used by nurses to collect data, plan, implement and evaluate care, ie, identifies the situations of health and illness and care needs nursing and subsidizes the promotion interventions, prevention, recovery and rehabilitation of the individual, family and community 5.
Soon, reveals the importance of this methodology in the care of humans, where there is a meeting of real health problems be careful intervention caregiver, requiring judgment, skill and expertise in decision making of nurses, ensuring that way, the quality and safety of care provided. Its implementation as a process of practical work appropriate to community needs and how to care model to be applied in all areas of health care by nurses is effectively improves the quality of nursing care.
Therefore, the SAE is a form of work organization that aims, through its structuring, ensuring the best quality of care to the client and ensure that nursing interventions are developed for each client. Looking emphasize the individual's assessment focused not only on the disease, providing agility in finding the diagnosis or treatment of health problems and real potential 8. This is a descriptive study with a qualitative approach in the perspective of Grounded Theory.
The subjects of the research collaborators were thirteen nurses who work at the site where the research was conducted. As for the ethical position, norteamo us by the criteria established in the Guidelines and Standards of Research Involving Human Subjects 9. For data collection techniques were used participant observation and semi-structured interview, with guiding questions inherent in the proposed objective research.
The subject of this quantitative benchmark was determined by theoretical saturation. Thus, not restricted the number of participants, so that this number was set according to the content and consistency of data from the depositions.
Thus, as these data were being collected, were analyzed concurrently aiming at theoretical saturation, enabling the emergence of possible sample groups. In this theoretical and methodological framework, to verify the data saturation, ie when no other information adds or modifies existing ones, begins the systematic and deeper analysis of all data from different samples.
Therefore, the saturation of the sample was achieved after completion of the 13 th interview. So that one could understand the meaning of the data obtained through interviews and observations, we proceeded to his analysis, coding them, categorizing them and identifying the phenomenon. Data analysis was done in three steps interdependent, namely: open coding, axial, and selective coding. The open coding was done manually by reading the interviews.
For each fragment of the interview were assigned words or expressions, forming the preliminary code. In the next phase, set itself a conceptual or abstract name for each grouping of data, code by code, which had some resemblance to each other or even distinct characteristics. Continuing with the analysis of the data passed to the stage of axial coding, in which the data were grouped into new forms, establishing connections between categories, seeking to expand and densify the emerging phenomenon.
Continuing the analytical process, it moved to the stage of selective coding where categories were worked in depth and density consistency. This refinement is a process of integration between the categories and subcategories defined, unveiling the results of the studied phenomenon. When this stage of the work has been achieved, we sought to inter-relate the representative categories to translate concretely the theoretical sensitivity to understand the meaning of the experience of nurses as a whole.
From there, we tried to develop a theoretical model of this experience. The phenomenon was examined in the light of the paradigm of analysis of Strauss and Corbin, as a way of grouping the categories and facilitate data analysis.
Therefore, we tried to understand what were the causal conditions that developed in the phenomenon, the context and the strategies that were being conducted. It also sought to identify the consequences that determine the occurrence.
Data analysis of the phenomenon resulted in the factors that hinder the operation of SAE and the paths to greater compliance and success through the application of the nursing process. This phenomenon provides an understanding of the transformation of tacit knowledge into explicit knowledge of the practice of everyday work experienced by nurses, within a context that has its peculiarities.
Therefore, the presentation of results in this study was to enable an understanding of the experiences of these professionals, from the identification of the phenomenon analyzed using the standard paradigm of Strauss and Corbin, as shown in Figure 1, which plots the phenomenon analyzed.
Category: Identifying factors that hinder the operation of SAE. In this category the nurses pointed out the main factors that affect the operation of SAE, impairing its performance. And so, expect to arise proposed solutions that contribute to their development in order to improve the methodology of nursing work. The workload of nurses, coupled with the reduced number of nursing professionals in health institutions, has interfered directly in the application of the nursing process.
These professionals perform many tasks not always linked to their professional area, away from the fact that assistance, leading to excessive workload. Consequently, the execution of the nursing process is no longer priority. Regarding the credibility of SAE, one realizes the devaluation of the practice by some nurses, specifically by some technicians.
These, in most cases, perform the care of mechanically, limiting its assistance to a routine procedure, failing to observe what was prescribed by the nurse, giving priority to medical prescription. Thus, the devaluation of nursing prescription undermines the credibility of the practice of integrative action as SAE care.
These difficulties are similar to those found in some research on the subject, where the overhead of nurses related to bureaucratic activities has hindered their professional as well as the disbelief and rejection of the nursing technicians front of SAE 12, The main problem is compromising the quality of care provided, reflecting the lack of customer needs.
According demonstrates that category, nurses understand that the absence of SAE compromises assistance both in the obstetrics service as in other workplaces, as stated in his speech:. This adversely affects the quality of care provided. The consequences of not using the SAE are: disorganization of the service generated by different forms of professional conduct in care; experienced the conflict between the desire to provide a direct client care and administrative activities; devaluation of nurses in a hospital setting; wear human resources evidenced by the lack of planning, resulting in decreased productivity and quality of care, the loss of time caused by the lack of planning and priority setting.
Although SAE is not implemented in many health services in Brazil is operationalized or partially, nurses recognize their importance and the need to structure the services for their proper functioning.
In this context, the deployment of SAE, care shall be executed individually and needs of each client are met in the best way possible, contributing to its recovery and continuity of care. Thus, by putting into practice the models of the nursing process, nurses promote skilled care to patients in a minimum time and maximum efficiency Category: Having difficulty to relate theory to practice.
A discourse analysis of nurses provides insight into how they see the relationship between theory and practice. In the perception of some nurses, it is difficult to relate theory to practice, when it comes to SAE.
Many of them have difficulty to operationalize it by considering theoretical activity, which is just on paper, far from reality. In this respect, the nurses show that there is a weakness in the way of implementation of the NAS, due to the emergence of many problems. These difficulties need to be understood in order to create strategies that can help in overcoming it, so that nurses are able to develop a planned and organized assistance.
The reports express that situation well:. When we got to the service, not put into practice because in many services, there is no SAE. The lack of relationship between theory and practice in nursing exists as a result of the formation process of these professionals is usually done within a theoretical framework poorly suited for nursing practice.
Consequently, the academic model that prevails in the preparation of nurses is still the technical-rational that describes a scientific perspective of nursing as a hierarchical knowledge, theoretical and academic status Therefore, teachers must commit to promote situations that create a meaningful learning that stimulates critical thinking and reflective of the students, making them understand that they are active subjects in the process of teaching and learning.
The vision of nurses to their lived experience in practice is focused on the SAE as a way to build an integrated knowledge explicit or tacit. Facing the possibility of improving the operation of SAE, the study presents the following category that represents the action strategies used by nurses:. Category: Pointing paths to greater compliance and success of SAE.
To achieve effective implementation of SAE or to overcome difficulties, some studies indicate paths that possibly will lead to success. Therefore, for the success of SAE, there must be a partnership with continuing education in order to overcome the difficulties of real professionals. The maternity nurses studied showed some ways that facilitate the effectiveness of SAE, ensuring adherence and success in nursing practice, among them are: in-service training for nursing staff, political administrators of services, use of instruments that address the phases of the nursing process and wider dissemination of SAE to improve the credibility and value of nursing prescriptions.
This proposal can be seen in the following statements:. But it must appear to most SAE events in nursing and are stimulated research on this topic. For an effective implementation of the NCS, there must be a commitment of the nursing leadership with the proposal. He shall hold meetings and prepare an action plan, including staff awareness of the importance of this methodology. It should also promote further research on the topic with the involvement of the whole team, and collectively build the means to enable the execution of the process.
The lack of tools that can facilitate the registration process by nurses has been identified as a factor that hinders the deployment of SAE.
Online Brazilian Journal of Nursing
Oliveira DPR. Pressman RS. Engenharia de software: uma abordagem profissional. Systematization of nursing care: viewing care as interactive, complementary and multi-professional. Conselho Federal de Enfermagem [homepage on the internet]. Acta Paul Enferm [serial in the internet]. Strauss A, Corbin J.
Resolução COFEN 358/2009
The article points out that it is essential for the government to develop and improve job management and regulation policies, in order to contribute to overcome the problems faced by nursing professionals. The modern society has increasingly become a professionalized society, making a large part of human activities developed in it seek recognition and professional status, gaining social privileges and almost always legal labor market monopoly. Most of our actions and activities are based on or referenced by acts, criteria and professional standards. Contemporary society is characterized by the division of labor into different activities and specialized areas. Andrew Abbott's statement 1 1 Abbott A. The system of professions.