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      Ambiente de trabalho do enfermeiro em um serviço hospitalar de emergência Translated title: The nurse’s work environment in a hospital emergency service

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          Abstract

          Objetivo analisar as características do ambiente de trabalho do enfermeiro em um serviço hospitalar de emergência. Métodos estudo de método misto com estratégia triangulação concomitante de dados de um estudo descrito-exploratório com 19 enfermeiros e uma Teoria Fundamentada nos Dados com três grupos amostrais, perfazendo 21 participantes. Os dados quantitativos foram coletados por meio do Brazilian Nursing Work Index Revised e submetidos à análise estatística descritiva. Os dados qualitativos foram obtidos a partir de entrevistas e analisados mediante codificação inicial e focalizada. Resultados os enfermeiros consideraram ter autonomia, boas relações com os médicos e suporte organizacional. No entanto, o controle sobre o ambiente mostrou-se como característica desfavorável. A partir dos resultados, apresenta-se a categoria: “Buscando organizar o ambiente de trabalho para uma demanda maior do que a capacidade de atendimento”. Conclusão as características do ambiente da emergência mostraram-se favoráveis ao trabalho do enfermeiro, exceto o controle sobre o ambiente.

          Translated abstract

          Objective to analyze the characteristics of the nurse’s work environment in a hospital emergency service. Methods a mixed method study with a concurrent triangulation strategy using data from a descriptive-exploratory study, with 19 nurses, and a Grounded Theory study with three sample groups totaling 21 participants. The quantitative data were collected using the Brazilian Nursing Work Index - Revised and were subjected to descriptive statistical analysis. The qualitative data were obtained from interviews and were analyzed through initial and focused coding. Results the nurses considered that they had autonomy, good relationships with the physicians, and organizational support. However, the control over the environment was shown to be an unfavorable characteristic. Based on the results, the category: “Seeking to organize the work environment for demand which exceeds attendance capacity” is presented. Conclusion the characteristics of the emergency environment were shown to be favorable to the nurse’s work, with the exception of control over the environment.

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          Achieving integration in mixed methods designs-principles and practices.

          Mixed methods research offers powerful tools for investigating complex processes and systems in health and health care. This article describes integration principles and practices at three levels in mixed methods research and provides illustrative examples. Integration at the study design level occurs through three basic mixed method designs-exploratory sequential, explanatory sequential, and convergent-and through four advanced frameworks-multistage, intervention, case study, and participatory. Integration at the methods level occurs through four approaches. In connecting, one database links to the other through sampling. With building, one database informs the data collection approach of the other. When merging, the two databases are brought together for analysis. With embedding, data collection and analysis link at multiple points. Integration at the interpretation and reporting level occurs through narrative, data transformation, and joint display. The fit of integration describes the extent the qualitative and quantitative findings cohere. Understanding these principles and practices of integration can help health services researchers leverage the strengths of mixed methods. © Health Research and Educational Trust.
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            Nurse staffing and education and hospital mortality in nine European countries: a retrospective observational study.

            Austerity measures and health-system redesign to minimise hospital expenditures risk adversely affecting patient outcomes. The RN4CAST study was designed to inform decision making about nursing, one of the largest components of hospital operating expenses. We aimed to assess whether differences in patient to nurse ratios and nurses' educational qualifications in nine of the 12 RN4CAST countries with similar patient discharge data were associated with variation in hospital mortality after common surgical procedures. For this observational study, we obtained discharge data for 422,730 patients aged 50 years or older who underwent common surgeries in 300 hospitals in nine European countries. Administrative data were coded with a standard protocol (variants of the ninth or tenth versions of the International Classification of Diseases) to estimate 30 day in-hospital mortality by use of risk adjustment measures including age, sex, admission type, 43 dummy variables suggesting surgery type, and 17 dummy variables suggesting comorbidities present at admission. Surveys of 26,516 nurses practising in study hospitals were used to measure nurse staffing and nurse education. We used generalised estimating equations to assess the effects of nursing factors on the likelihood of surgical patients dying within 30 days of admission, before and after adjusting for other hospital and patient characteristics. An increase in a nurses' workload by one patient increased the likelihood of an inpatient dying within 30 days of admission by 7% (odds ratio 1·068, 95% CI 1·031-1·106), and every 10% increase in bachelor's degree nurses was associated with a decrease in this likelihood by 7% (0·929, 0·886-0·973). These associations imply that patients in hospitals in which 60% of nurses had bachelor's degrees and nurses cared for an average of six patients would have almost 30% lower mortality than patients in hospitals in which only 30% of nurses had bachelor's degrees and nurses cared for an average of eight patients. Nurse staffing cuts to save money might adversely affect patient outcomes. An increased emphasis on bachelor's education for nurses could reduce preventable hospital deaths. European Union's Seventh Framework Programme, National Institute of Nursing Research, National Institutes of Health, the Norwegian Nurses Organisation and the Norwegian Knowledge Centre for the Health Services, Swedish Association of Health Professionals, the regional agreement on medical training and clinical research between Stockholm County Council and Karolinska Institutet, Committee for Health and Caring Sciences and Strategic Research Program in Care Sciences at Karolinska Institutet, Spanish Ministry of Science and Innovation. Copyright © 2014 Elsevier Ltd. All rights reserved.
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              A construção da teoria fundamentada: Guia prática para análise qualitativa

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                Author and article information

                Journal
                rene
                Rev Rene
                Rev. Rene
                Universidade Federal do Ceará (Fortaleza, CE, Brazil )
                1517-3852
                2175-6783
                April 2017
                : 18
                : 2
                : 195-203
                Affiliations
                [1] Florianópolis Santa Catarina orgnameUniversidade Federal de Santa Catarina Brazil
                [2] Florianópolis Santa Catarina orgnameInstituto Federal de Santa Catarina Brazil
                Article
                S1517-38522017000200195 S1517-3852(17)01800295
                10.15253/2175-6783.2017000200008
                f9caf3f6-0ab0-4e3c-ae5e-11321f43b522

                This work is licensed under a Creative Commons Attribution 4.0 International License.

                History
                : 29 December 2016
                : 09 February 2017
                Page count
                Figures: 0, Tables: 0, Equations: 0, References: 20, Pages: 9
                Product

                SciELO Revista de Enfermagem

                Categories
                Artigos Originais

                Ambiente de Trabalho,Cuidados de Enfermagem,Gerência,Enfermagem em Emergência,Working Environment,Nursing Care,Management,Emergency Nursing

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