Competências profissionais do Enfermeiro em emergência e sua relação com o produto do cuidar em Enfermagem
Data
2022-12-05
Autores
Jesus, Jucinei Araújo de 
Orientadores
Balsanelli, Alexandre Pazetto
Tipo
Tese de doutorado
Título da Revista
ISSN da Revista
Título de Volume
Resumo
Objetivo: Analisar a relação entre a autoavaliação e heteroavaliação das competências profissionais dos enfermeiros com o produto do cuidar em Enfermagem. Método: Estudo transversal analítico, realizado entre os meses de junho a dezembro de 2020, nas unidades de urgência e emergência de dois hospitais públicos, no município de São Paulo, Brasil. Na autoavaliação das competências profissionais, participaram 91 enfermeiros e três residentes em enfermagem; a heteroavaliação foi realizada por quatro coordenadores e um gerente de enfermagem destas unidades. Os mesmos enfermeiros e residentes avaliaram o produto do cuidar em enfermagem considerando 15 plantões. Foram utilizados dois instrumentos específicos e validados na literatura: 1) Escala de Competências das Ações dos Enfermeiros em Emergências (ECAEE); 2) Instrumento de Avaliação do Produto do Cuidar em Enfermagem (APROCENF). Utilizaram-se os testes de Wilcoxon, Mann-Whitney e de correlação de Spearman com p<0,05. Utilizou-se ainda a classificação de Cohen, onde são consideradas correlações pequenas ou fracas (0,10 < r < 0,29), médias (0,3 < r < 0,49) e grandes ou fortes (0,50 < r < 1,0). Resultados: Na comparação dos escores do nível de competência, verificou-se diferença significativa (p<0,001) com maiores valores para autoavaliação nos fatores: 1 (Prática profissional), 4 (Ação direcionada) e 5 (Conduta construtiva) e maiores valores para heteroavaliação no fator 6 (Excelência profissional). Nas 1410 avaliações do produto do cuidar em enfermagem realizadas por meio do APROCENF a graduação mais enfatizada pelos enfermeiros na escala de itens foi a de número 3 (n=1034 - 73,33%), em que o escore médio foi classificado como Bom. Dimensionamento de pessoal de enfermagem (3º domínio do APROCENF) relacionou-se com os seguintes domínios da Escala de Competências das Ações dos Enfermeiros em Emergências (ECAEE): Prática profissional r=0.52719, Relações no trabalho r=0.54319, Desafio positivo r=0.51199, Ação direcionada r=0.43229, Conduta construtiva r=0.25601 e Adaptação à mudança r=0.22095. Também se observou correlação significativa no quinto domínio do APROCENF- Acompanhamento e transferência do cuidado - com os níveis de competência (ECAEE): Prática profissional r=0.47244, Relações no trabalho r=0.46993, Desafio positivo r=0.41660 e Adaptação à mudança r=0.31905. Tal correlação também foi também observada no domínio oito - Atendimento das necessidades assistenciais - em relação à Prática profissional r=0.32933, Relações no trabalho r=0.31168, Desafio positivo r=0.29845 e Adaptação à mudança r=0.28817. Conclusão: Foram identificadas as seguintes competências: Prática profissional, Relações no trabalho, Desafio positivo, Ação direcionada, Conduta construtiva e Adaptação à mudança na auto e heteroavaliação. O produto do cuidar em enfermagem foi considerado, majoritariamente, como “bom” o que demonstra boa avaliação sobre a entrega da assistência de enfermagem nas unidades de emergência investigadas. Existe relação positiva entre as competências profissionais com as dimensões do APROCENF com destaque para dimensionamento de pessoal e transferência do cuidado. Estudos nessa propositura viabilizarão processos na área da enfermagem, conferindo uma maior autonomia aos enfermeiros que desenvolvem o processo de cuidados nas urgências e emergências, pautando suas ações nas competências já existentes e nas que surgirão com o desenvolvimento de novas pesquisas.
Objective: To analyze the relationship between self-assessment and hetero-assessment of nurses' professional skills with the product of nursing care. Method: Analytical cross-sectional study, carried out between June and December 2020, in the urgency and emergency units of two public hospitals, in the city of São Paulo, Brazil. In the self-assessment of professional skills, 91 nurses and three nursing residents participated; the hetero-assessment was carried out by four coordinators and a nursing manager from these units. The same nurses and residents evaluated the nursing care product considering 15 shifts. Two specific instruments validated in the literature were used: 1) Scale of Competencies for Actions of Nurses in Emergencies (ECAEE); 2) Nursing Care Product Assessment Instrument (APROCENF). Wilcoxon, Mann-Whitney and Spearman correlation tests were used with p<0.05. Cohen's classification was also used, in which correlations are considered small or weak (0.10 < r < 0.29), medium (0.3 < r < 0.49) and strong or strong (0.50 < r < 1.0). Results: When comparing the competence level scores, there was a significant difference (p<0.001) with higher values for self-assessment in factors: 1 (Professional practice), 4 (Directed action) and 5 (Constructive conduct) and higher values for hetero-assessment in the factor 6 (Professional excellence). In the 1410 evaluations of the nursing care product carried out through APROCENF, the graduation most emphasized by the nurses in the item scale was number 3 (n=1034 - 73.33%), in which the average score was classified as Good. Dimensioning of nursing staff (3rd domain of APROCENF) was related to the following domains of the Scale of Competencies for Actions of Nurses in Emergencies (ECAEE): Professional practice r=0.52719, Relationships at work r=0.54319, Positive challenge r=0.51199 , Directed action r=0.43229, Constructive conduct r=0.25601 and Adaptation to change r=0.22095. A significant correlation was also observed in the fifth domain of APROCENF - Follow-up and transfer of care - with the levels of competence (ECAEE): Professional practice r=0.47244, Relationships at work r=0.46993, Positive challenge r=0.41660 and Adaptation to change r= 0.31905. Such a correlation was also observed in domain eight - Meeting care needs - in relation to Professional practice r=0.32933, Relationships at work r=0.31168, Positive challenge r=0.29845 and Adaptation to change r=0.28817. Conclusion: The following competences were identified: Professional practice, Relationships at work, Positive challenge, Directed action, Constructive conduct and Adaptation to change in self and hetero-assessment. The product of nursing care was considered, mostly, as “good”, which demonstrates a good assessment of the delivery of nursing care in the investigated emergency units. There is a positive relationship between professional skills and the dimensions of the APROCENF, with emphasis on staff dimensioning and care transfer. Studies based on this proposal will enable processes in the area of nursing, giving greater autonomy to nurses who develop the care process in urgencies and emergencies, basing their actions on existing skills and those that will emerge with the development of new research.
Objective: To analyze the relationship between self-assessment and hetero-assessment of nurses' professional skills with the product of nursing care. Method: Analytical cross-sectional study, carried out between June and December 2020, in the urgency and emergency units of two public hospitals, in the city of São Paulo, Brazil. In the self-assessment of professional skills, 91 nurses and three nursing residents participated; the hetero-assessment was carried out by four coordinators and a nursing manager from these units. The same nurses and residents evaluated the nursing care product considering 15 shifts. Two specific instruments validated in the literature were used: 1) Scale of Competencies for Actions of Nurses in Emergencies (ECAEE); 2) Nursing Care Product Assessment Instrument (APROCENF). Wilcoxon, Mann-Whitney and Spearman correlation tests were used with p<0.05. Cohen's classification was also used, in which correlations are considered small or weak (0.10 < r < 0.29), medium (0.3 < r < 0.49) and strong or strong (0.50 < r < 1.0). Results: When comparing the competence level scores, there was a significant difference (p<0.001) with higher values for self-assessment in factors: 1 (Professional practice), 4 (Directed action) and 5 (Constructive conduct) and higher values for hetero-assessment in the factor 6 (Professional excellence). In the 1410 evaluations of the nursing care product carried out through APROCENF, the graduation most emphasized by the nurses in the item scale was number 3 (n=1034 - 73.33%), in which the average score was classified as Good. Dimensioning of nursing staff (3rd domain of APROCENF) was related to the following domains of the Scale of Competencies for Actions of Nurses in Emergencies (ECAEE): Professional practice r=0.52719, Relationships at work r=0.54319, Positive challenge r=0.51199 , Directed action r=0.43229, Constructive conduct r=0.25601 and Adaptation to change r=0.22095. A significant correlation was also observed in the fifth domain of APROCENF - Follow-up and transfer of care - with the levels of competence (ECAEE): Professional practice r=0.47244, Relationships at work r=0.46993, Positive challenge r=0.41660 and Adaptation to change r= 0.31905. Such a correlation was also observed in domain eight - Meeting care needs - in relation to Professional practice r=0.32933, Relationships at work r=0.31168, Positive challenge r=0.29845 and Adaptation to change r=0.28817. Conclusion: The following competences were identified: Professional practice, Relationships at work, Positive challenge, Directed action, Constructive conduct and Adaptation to change in self and hetero-assessment. The product of nursing care was considered, mostly, as “good”, which demonstrates a good assessment of the delivery of nursing care in the investigated emergency units. There is a positive relationship between professional skills and the dimensions of the APROCENF, with emphasis on staff dimensioning and care transfer. Studies based on this proposal will enable processes in the area of nursing, giving greater autonomy to nurses who develop the care process in urgencies and emergencies, basing their actions on existing skills and those that will emerge with the development of new research.
Descrição
Citação
JESUS, J A. Competências profissionais do enfermeiro em emergência e sua relação com o produto do cuidar em enfermagem. São Paulo, 2022. 150 f. Tese (Doutorado em Enfermagem) - Escola Paulista de Enfermagem (EPE), Universidade Federal de São Paulo (UNIFESP). São Paulo, 2022.