| Name: | Description: | Size: | Format: | |
|---|---|---|---|---|
| 7.01 MB | Adobe PDF |
Advisor(s)
Abstract(s)
O desenvolvimento das competências comuns e específicas do
enfermeiro especialista em enfermagem médico-cirúrgica, bem como das competências
específicas na área de enfermagem à pessoa em situação crítica, serviram como guia
condutor na realização destes estágios, tendo por base os regulamentos n.º 140/2019 e n.º
429/2018 da Ordem dos Enfermeiros (OE, 2018, 2019b). Além disso as competências
referentes ao grau de mestre também foram comtempladas. Este grau exige a capacidade
de integrar e aplicar conhecimentos de forma autónoma, bem como iniciar, contribuir,
desenvolver e disseminar investigação que promova a prática de enfermagem baseada na
evidência reforçando assim a componente de investigação inserida nestas competências
(Ministério da Ciência, 2006). Esta prática baseada na evidência é importante para
melhorar a qualidade dos cuidados de enfermagem e neste sentido, foi desenvolvido um
estudo sobre os conhecimentos, perceções, práticas e barreiras que os enfermeiros têm
sobre a gestão antimicrobiana. Este tema foi escolhido por a resistência antimicrobiana
ser um problema mundial, com impacto significativo na saúde da população, afetando
diretamente a qualidade e segurança dos cuidados prestados aos utentes, ao mesmo tempo
que representa um desafio tanto para os prestadores de cuidados como para a sociedade
em geral.
Objetivos: Realizar uma descrição e reflexão crítica das atividades e competências
desenvolvidas no cuidado à pessoa em situação critica; explorar os conhecimentos,
perceções, práticas e barreiras que os enfermeiros têm sobre a gestão dos antimicrobianos.
Métodos: O desenvolvimento de competências foi realizado através de três estágios
clínicos centrados no cuidado ao doente crítico (serviço de controlo de infeção, serviço
de medicina intensiva e urgência médico-cirúrgica). Para o desenvolvimento da
competência de investigação, foi realizado um estudo analítico e transversal, com uma
amostra de 182 enfermeiros a exercerem funções numa unidade de saúde da região Norte.
O instrumento de recolha de dados foi um questionário adaptado da literatura,
nomeadamente de Padigos, et al. (2022), aplicado nos meses de setembro e outubro de
2023. Todos os princípios éticos foram respeitados durante o estudo. As análises
estatísticas foram realizadas utilizando o software IBM SPSS Statistics 24.0
Resultados: Os estágios permitiram o desenvolvimento e a consolidação das
competências comuns e específicas do enfermeiro especialista. As competências
comuns incluem a responsabilidade profissional, ética e legal; a melhoria contínua da qualidade; a gestão dos cuidados e o desenvolvimento das aprendizagens profissionais.
No que concerne às competências especificas do enfermeiro especialista em
enfermagem à pessoa em situação critica são o cuidar da pessoa, família/cuidador a
vivenciar processos complexos de doença crítica e/ou falência orgânica, dinamizar a
resposta em situações de emergência, exceção e catástrofe, da conceção à ação e
Maximizar a prevenção, intervenção e controlo da infeção e de resistência a
antimicrobianos perante a pessoa em situação crítica e/ou falência orgânica, face à
complexidade da situação e à necessidade de respostas em tempo útil e adequadas (OE,
2018, 2019b). O estudo de investigação revelou diferenças significativas entre os
géneros e os serviços onde os enfermeiros exercem. Enfermeiros do género masculino
relataram uma maior frequência de práticas com antimicrobianos (p <0,05), enquanto as
enfermeiras mulheres relataram maiores dificuldades no seu envolvimento na gestão
antimicrobiana (p <0,05). Foi também observado que os enfermeiros do serviço de
medicina intensiva tinham uma menor frequência de práticas com antimicrobianos (p
<0,05). Apesar de não haver significância estatística (p = 0,067), os enfermeiros do
serviço de ortopedia mostraram menos dificuldades no envolvimento com a gestão
antimicrobiana, em contraste com os do serviço de medicina intensiva, que tiveram uma
perceção menos positiva sobre o seu papel (p = 0,075). O tempo de exercício profissional
dos enfermeiros não demonstrou ter um impacto direto nas perceções, práticas e
barreiras relacionadas com o Stewardship antimicrobiano.
Conclusão: Os estágios foram fundamentais para desenvolver as competências previstas
para o enfermeiro especialista e mestre em Enfermagem Médico-Cirúrgica na Área de
Enfermagem à Pessoa em Situação Critica. Os principais contributos do estudo para a
prática baseada na evidência incluem a demonstração da importância de envolver mais
ativamente os enfermeiros na gestão antimicrobiana, o alerta para lacunas no
reconhecimento e valorização da sua opinião pelas equipas, bem como a necessidade de
formação específica em Stewardship antimicrobiano e prevenção de infeções, apontando
para estratégias que potenciem a participação efetiva dos enfermeiros na promoção da
segurança e qualidade dos cuidados. A capacitação dos enfermeiros nesta área deveria
começar na formação académica e serem emanadas diretrizes de organismos
competentes que contemplem o papel dos enfermeiros no Stewardship antimicrobiano.
The development of common and specific competencies for nurse specialists in medical-surgical nursing, as well as specific competencies in critical care nursing, were a guiding framework for these clinical internships, based on regulations No. 140/2019 and No. 429/2018 from the Portuguese Nursing Council (OE, 2018, 2019b). Additionally, competencies related to the master’s degree were also included. This degree requires the ability to integrate and apply knowledge autonomously, as well as initiate, contribute, develop, and disseminate research that promotes evidence-based nursing practices, reinforcing the research component embedded in these competencies (Ministry of Science, 2006). In this context, a study was developed with the focus on nurses' knowledge, perceptions, experiences, and barriers regarding antimicrobial management. This topic was chosen because antimicrobial resistance is a global issue, with a significant impact on public health, directly affecting the quality and safety of patient care. Also, this represents a challenges for both healthcare providers and society. Objectives: To describe and analyze the activities andcompetencies acquired in caring critically ill patients; to explore knowledge, perceptions, experiences, and barriers regarding antimicrobial management in nurses. Methods: The skills were acquired through three clinical internships focused on critical patient care. The first internship took place in an infection control department, the second in an intensive care unit (ICU), and the third in a medical-surgical emergency department. For the research skill development, an analytical and cross-sectional study was conducted with a sample of 182 nurses working in a healthcare unit in the northern region. The data collection instrument was a questionnaire adapted from the literature, specifically from Padigos et al. (2022), and administered in September and October 2023. All ethical principles were applied during the study. Statistical analyses were performed using IBM SPSS Statistics 24.0. Results: The internships facilitated the development and consolidation of both common and specific skills of the nurse specialist. Common skills include professional, ethical, and legal responsibility; continuous quality improvement; care management; and professional learning development. The specific skills of the critical care nurse specialist included caring for the person, for the family, or caregiver that experiences complex critical illness and/or organ failure. Leading the response to emergencies, exceptional situations, and disasters from planning to action, and maximizing infection prevention, intervention, and control are other skills. As well as antimicrobial resistance management in critically ill patients and/or those experiencing organ failure, considering the complexity of the situation and the need for timely and appropriate responses (OE, 2018, 2019b). This research study revealed significant differences between genders and services in relation to nurses' practices, experiences, and barriers in antimicrobial management. Male nurses reported a higher frequency of practices and experiences with antimicrobials (p <0.05), while female nurses reported greater difficulties in their involvement in antimicrobial management (p <0.05). It was also observed that ICU nurses had a lower frequency of antimicrobial practices (p <0.05). Although statistical significance was not reached (p = 0.067), orthopedic nurses showed fewer difficulties with antimicrobial management compared to ICU nurses, who had a less positive perception of their role (p = 0.075). The duration of professional experience did not have a direct impact on perceptions, practices, and barriers related to antimicrobial stewardship. Conclusion: The internships were essential for acquiring the competencies outlined for the nurse specialist and master’s degree in medical-Surgical Nursing, with a focus on Critical Care. The main contributions of the study to evidence-based practice include demonstrating the importance of more actively involving nurses in antimicrobial management, highlighting gaps in the recognition and appreciation of their input by teams, as well as the need for specific training in antimicrobial stewardship and infection prevention, pointing to strategies that enhance nurses’ effective participation in promoting care safety and quality. Empowering nurses in this field should begin during academic training, and guidelines should
The development of common and specific competencies for nurse specialists in medical-surgical nursing, as well as specific competencies in critical care nursing, were a guiding framework for these clinical internships, based on regulations No. 140/2019 and No. 429/2018 from the Portuguese Nursing Council (OE, 2018, 2019b). Additionally, competencies related to the master’s degree were also included. This degree requires the ability to integrate and apply knowledge autonomously, as well as initiate, contribute, develop, and disseminate research that promotes evidence-based nursing practices, reinforcing the research component embedded in these competencies (Ministry of Science, 2006). In this context, a study was developed with the focus on nurses' knowledge, perceptions, experiences, and barriers regarding antimicrobial management. This topic was chosen because antimicrobial resistance is a global issue, with a significant impact on public health, directly affecting the quality and safety of patient care. Also, this represents a challenges for both healthcare providers and society. Objectives: To describe and analyze the activities andcompetencies acquired in caring critically ill patients; to explore knowledge, perceptions, experiences, and barriers regarding antimicrobial management in nurses. Methods: The skills were acquired through three clinical internships focused on critical patient care. The first internship took place in an infection control department, the second in an intensive care unit (ICU), and the third in a medical-surgical emergency department. For the research skill development, an analytical and cross-sectional study was conducted with a sample of 182 nurses working in a healthcare unit in the northern region. The data collection instrument was a questionnaire adapted from the literature, specifically from Padigos et al. (2022), and administered in September and October 2023. All ethical principles were applied during the study. Statistical analyses were performed using IBM SPSS Statistics 24.0. Results: The internships facilitated the development and consolidation of both common and specific skills of the nurse specialist. Common skills include professional, ethical, and legal responsibility; continuous quality improvement; care management; and professional learning development. The specific skills of the critical care nurse specialist included caring for the person, for the family, or caregiver that experiences complex critical illness and/or organ failure. Leading the response to emergencies, exceptional situations, and disasters from planning to action, and maximizing infection prevention, intervention, and control are other skills. As well as antimicrobial resistance management in critically ill patients and/or those experiencing organ failure, considering the complexity of the situation and the need for timely and appropriate responses (OE, 2018, 2019b). This research study revealed significant differences between genders and services in relation to nurses' practices, experiences, and barriers in antimicrobial management. Male nurses reported a higher frequency of practices and experiences with antimicrobials (p <0.05), while female nurses reported greater difficulties in their involvement in antimicrobial management (p <0.05). It was also observed that ICU nurses had a lower frequency of antimicrobial practices (p <0.05). Although statistical significance was not reached (p = 0.067), orthopedic nurses showed fewer difficulties with antimicrobial management compared to ICU nurses, who had a less positive perception of their role (p = 0.075). The duration of professional experience did not have a direct impact on perceptions, practices, and barriers related to antimicrobial stewardship. Conclusion: The internships were essential for acquiring the competencies outlined for the nurse specialist and master’s degree in medical-Surgical Nursing, with a focus on Critical Care. The main contributions of the study to evidence-based practice include demonstrating the importance of more actively involving nurses in antimicrobial management, highlighting gaps in the recognition and appreciation of their input by teams, as well as the need for specific training in antimicrobial stewardship and infection prevention, pointing to strategies that enhance nurses’ effective participation in promoting care safety and quality. Empowering nurses in this field should begin during academic training, and guidelines should
Description
Keywords
Enfermeiros Stewardship antimicrobiano Perceções Barreiras Conhecimentos