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Prática de Enfermagem Avançada: Tradução, Adaptação e Evidências de Validação Transcultural do Instrumento Advanced Practice Nursing Competency Assessment Instrument (APNCAI) Para o Contexto Português
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O presente relatório final integra o Mestrado em Enfermagem Médico-Cirúrgica, na vertente da Pessoa em Situação Crítica, constitui a síntese de um percurso académico que articulou a prática clínica especializada em contextos de elevada complexidade com a investigação científica aplicada. A sua estrutura organiza-se em duas partes: (i) o relatório de estágios clínicos e (ii) o estudo metodológico de tradução, adaptação transcultural e validação de um instrumento de avaliação de competências em prática de enfermagem avançada.
Na primeira parte, descreve-se e analisa-se o desenvolvimento de competências comuns e específicas do enfermeiro especialista em diferentes contextos clínicos. Os estágios decorreram em emergência pré-hospitalar, serviço de urgência e unidade de cuidados intensivos, proporciona uma visão integrada do percurso do doente crítico e permite a consolidação de competências especializadas. A prática clínica possibilitou desenvolver competências no cuidado à pessoa e família em situação de doença crítica e/ou falência orgânica, na dinamização da resposta a situações de emergência, exceção e catástrofe, bem como na prevenção, intervenção e controlo da infeção e da resistência a antimicrobianos, em conformidade com os referenciais regulamentares da Ordem dos Enfermeiros.
Na segunda parte, apresenta-se o estudo metodológico de adaptação transcultural e validação do Advanced Practice Nursing Competency Assessment Instrument (APNCAI) para o contexto português. O processo seguiu recomendações internacionais, o que inclui a tradução, síntese, retrotradução, análise por comité de especialistas, pré-teste e estudo psicométrico com 264 enfermeiros, com o recurso à análise fatorial e ao estudo da consistência interna. Os resultados demonstraram validade de conteúdo adequada, estrutura fatorial consistente e excelente fiabilidade, o que confirma a robustez da versão portuguesa do instrumento.
Este relatório evidencia a integração entre prática clínica especializada e investigação científica como pilares indissociáveis da formação avançada em enfermagem. A experiência de estágio contribuiu para a consolidação das competências do enfermeiro especialista e o estudo metodológico disponibilizou, em Portugal, um instrumento validado para avaliar competências em prática de enfermagem avançada. Em conjunto, estes resultados reforçam a relevância da prática baseada na evidência e o contributo da enfermagem para a qualidade e sustentabilidade dos cuidados de saúde.
This final report is part of the Master’s Degree in Medical-Surgical Nursing, specialization in the Care of the Critically Ill Person, and constitutes the synthesis of an academic journey that articulated specialized clinical practice in highly complex contexts with applied scientific research. The structure of the work is divided into two parts: the first corresponds to the clinical internship report, and the second to the methodological study of translation, cross-cultural adaptation, and validation of an instrument for assessing competencies in advanced nursing practice. Objective: To describe and analyse the development of common and specific competencies of specialist nursing in different clinical contexts and to perform the cross-cultural adaptation and validation of the Advanced Practice Nursing Competency Assessment Instrument (APNCAI) for Portuguese context. Background: The internships took place in pre-hospital emergency care, emergency department, and intensive care unit, providing a comprehensive view of the critically ill patient’s trajectory and enabling the consolidation of specialized competencies. At the same time, advanced practice nursing, which is expanding in Portugal, lacks specific assessment tools to support its consolidation and the recognition of the specialist nurse’s role. Methodology: The report was based on an expository-reflective methodology, supported by critical analysis of the internship experiences. The research study followed international guidelines for the cross-cultural adaptation of instruments, including translation, synthesis, back-translation, expert committee review, pre-test, and psychometric study with 264 nurses, using factor analysis and internal consistency testing. Results: Clinical practice enabled the development of specific competencies of the specialist nurse in the Care of the Critically Ill Person, particularly in providing care to patients and families experiencing complex critical illness and/or organ failure, in response leading in emergency exceptional contexts, catastrophe situations, and in preventing, intervening, and controlling infection and antimicrobial resistance, in accordance with the regulatory standards of the Portuguese Ordem dos Enfermeiros. The adaptation process of the APNCAI was carried out without significant difficulties, ensuring adequate content validity, a consistent factor structure, and excellent reliability, confirming the robustness of the Portuguese version of the instrument. Conclusion: This report highlights the integration between specialized clinical practice and scientific research as inseparable pillars of advanced nursing education. The internship experience contributed to the consolidation of the specialist nurse’s competencies, and the methodological study provided, in Portugal, a validated instrument to assess competencies in advanced nursing practice. Together, these results reinforce the relevance of evidence-based practice and nursing’s contribution to the quality and sustainability of healthcare.
This final report is part of the Master’s Degree in Medical-Surgical Nursing, specialization in the Care of the Critically Ill Person, and constitutes the synthesis of an academic journey that articulated specialized clinical practice in highly complex contexts with applied scientific research. The structure of the work is divided into two parts: the first corresponds to the clinical internship report, and the second to the methodological study of translation, cross-cultural adaptation, and validation of an instrument for assessing competencies in advanced nursing practice. Objective: To describe and analyse the development of common and specific competencies of specialist nursing in different clinical contexts and to perform the cross-cultural adaptation and validation of the Advanced Practice Nursing Competency Assessment Instrument (APNCAI) for Portuguese context. Background: The internships took place in pre-hospital emergency care, emergency department, and intensive care unit, providing a comprehensive view of the critically ill patient’s trajectory and enabling the consolidation of specialized competencies. At the same time, advanced practice nursing, which is expanding in Portugal, lacks specific assessment tools to support its consolidation and the recognition of the specialist nurse’s role. Methodology: The report was based on an expository-reflective methodology, supported by critical analysis of the internship experiences. The research study followed international guidelines for the cross-cultural adaptation of instruments, including translation, synthesis, back-translation, expert committee review, pre-test, and psychometric study with 264 nurses, using factor analysis and internal consistency testing. Results: Clinical practice enabled the development of specific competencies of the specialist nurse in the Care of the Critically Ill Person, particularly in providing care to patients and families experiencing complex critical illness and/or organ failure, in response leading in emergency exceptional contexts, catastrophe situations, and in preventing, intervening, and controlling infection and antimicrobial resistance, in accordance with the regulatory standards of the Portuguese Ordem dos Enfermeiros. The adaptation process of the APNCAI was carried out without significant difficulties, ensuring adequate content validity, a consistent factor structure, and excellent reliability, confirming the robustness of the Portuguese version of the instrument. Conclusion: This report highlights the integration between specialized clinical practice and scientific research as inseparable pillars of advanced nursing education. The internship experience contributed to the consolidation of the specialist nurse’s competencies, and the methodological study provided, in Portugal, a validated instrument to assess competencies in advanced nursing practice. Together, these results reinforce the relevance of evidence-based practice and nursing’s contribution to the quality and sustainability of healthcare.
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Pessoa em situação crítica Engermagem médico-cirúrgica