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Bedridden patients risk presenting several problems caused by prolonged immobility, leading to a long recovery process. There is thus a need to develop solutions that ensure the implementation of physical rehabilitation programs in a controlled and interactive way. In this context, the ABLEFIT project aims to develop a medical device to physically rehabilitate bedridden patients with prolonged immobility. A partnership was established between the school of nursing, business enterprises and an engineering institute to develop a prototype. After creating the prototype, a pre-clinical experimental usability study was created using the user-centred multi-method approach (User and Human-Centered Design) to assess the device’s functionality, ergonomics and safety. The pre-clinical stage was initiated with a sample of 12 health professionals (that manipulated the device’s functionalities) and 10 end-users (who used the device). During the pre-clinical stage, the need to incorporate in the final version joint stabilizers was observed. Another important finding was the importance of the continuous monitorization of vital signs on Ablefit, namely, heart rate and SPO2. Therefore, the development of the Ablefit system allows the monitoring of a set of variables and conditions inherent to immobility. At the same time, this device will be a dynamic solution (using gamification and simulation technologies) by generating personalized rehabilitation plans.

Objetivos: Adaptar a Escala Portuguesa de Flebite para a cultura brasileira e verificar as propriedades psicométricas da versão adaptada. Métodos: Estudo metodológico envolvendo análise da equivalência semântica, cultural e idiomática para adaptação transcultural, cognitive debriefing, verificação da consistência interna e validade de construto. Equivalência foi analisada utilizando percentual de acordos. Validade de construto foi testada utilizando análise fatorial exploratória. A confiabilidade foi avaliada pela consistência interna (α de Cronbach e Ω de McDonald). Resultados: No processo de adaptação transcultural, envolvendo dez especialistas, dois itens não alcançaram concordância ≥ 80% e sofreram ajustes conforme as sugestões recebidas. Doze participantes do cognitive debriefing aprovaram a versão adaptada. Participaram da análise de confiabilidade e de validação do construto 244 adultos em uso de cateter venoso periférico. Análise fatorial exploratória identificou um único fator incluindo todos os itens testados (dor, eritema, edema, rubor no trajeto da veia e cordão venoso palpável) e carga fatorial > 0,743. Consistência interna do conjunto de itens foi alta (α de Cronbach = 0,771 e Ω de McDonald = 0,853). Conclusão: A Escala Portuguesa de Flebite – Versão adaptada para o Brasil mostrou-se válida e confiável. Alcançou propriedades que permitem sua utilização na prática clínica, no ensino e pesquisas no país.

Introdução: Com o aumento do uso de dispositivos tecnológicos e auxiliares na reabilitação, tem-se observado um crescente interesse na exergaming e gamificação para melhorar a motivação e o envolvimento dos indivíduos em processo de reabilitação (Willwacher & Korn, 2021). No entanto, embora o exergaming e a gamificação tenham já sido amplamente estudados em vários contextos, há uma falta de compreensão sobre o que a literatura indica relativamente à experiência, perceção e expectativas dos indivíduos acerca do recurso ao exergaming e à gamificação para reabilitação. Objetivo: Sintetizar a literatura qualitativa disponível para fornecer uma compreensão abrangente das experiências, perceções, e expectativas utilização de exergaming e/ou gamificação por parte dos indivíduos em processo de reabilitação. Material e métodos: Foi desenvolvida uma revisão sistemática da literatura de evidência qualitativa com recurso às recomendações do JBI e a extensão PRISMA (JBI, 2020). Foi utilizada uma estratégia de pesquisa em três fases. Os critérios de inclusão incluíram estudos com indivíduos com idade superior a 18 anos em processo de reabilitação com recurso a exergaming e/ou gamificação, que visassem a compreensão das suas experiências, perceções e expectativas no uso destas tecnologias. Foram considerados todos os contextos de reabilitação. Estudos qualitativos e mixed-methods publicados em inglês ou português de natureza qualitativa foram incluídos, sem limite temporal. A estratégia de busca incluiu as seguintes bases de dados: MEDLINE (PubMed), CINAHL (EBSCOhost), SportDiscus(EBSCOHost), PEDro, Scopus, Dart-Europe e RCAAP. Para efeitos deste trabalho, foi realizada uma análise preliminar dos resultados obtidos na MEDLINE (PubMed). Resultados: Num total de 310 artigos, foram analisados 63 artigos após aplicação dos critérios de inclusão. Pela análise dos artigos, verificou-se que as categorias consideradas facilitadoras mais mencionadas se relacionavam aspetos de motivação associada ao divertimento, benefícios percecionados, e o impacto psicossocial. As categorias consideradas como dificultadoras mais mencionadas relacionavam-se com a monotonia/tédio a médio longo-prazo, frustração pela dificuldade no jogo, e perceção de não existir recuperação. Conclusões: Os resultados sugerem que a gamificação/exergaming podem ser ferramentas percecionadas como eficazes no processo de reabilitação. No entanto, desafios como a monotonia/tédio e a frustração devem ser abordados para garantir um engajamento sustentado.

Introdução: Pessoas acamadas correm o risco de múltiplos problemas causados pela imobilidade prolongada. Assim, existe a necessidade de desenvolver soluções que garantam a implementação de programas de reabilitação física de forma interativa, evitando o desenvolvimento da síndrome da imobilidade. Neste contexto, surgiu o projeto ABLEFIT – visa desenvolver um sistema avançado de reabilitação física para pessoas acamadas com imobilidade prolongada. Objetivos: Criar um dispositivo médico (Ablefit) para a reabilitação física de pessoas acamadas com imobilidade prolongada, considerando aspetos de funcionalidade, ergonomia e segurança. Material e Métodos: Um consórcio foi criado entre a Escola Superior de Enfermagem de Coimbra, o sector industrial e a faculdade de engenharia para criar o protótipo. Etapa1 – Scoping review para mapear programas de reabilitação física para pessoas acamadas com imobilidade prolongada. Etapa2 – Criação do protótipo de acordo com a evidência obtida na scoping review. Etapa3 – Estudo pré-clínico, abordagem multi-método centrado no utilizador (User and Human-Centered Design) avaliou a funcionalidade, ergonomia e segurança do dispositivo. Etapa4 – O protótipo foi aprimorado considerando os aspetos identificados no estudo pré-clínico. Etapa5 – Novo estudo pré-clínico realizado para garantir a viabilidade das melhorias realizadas e garantir a segurança do novo modelo. Resultados: Os resultados da scoping review (Cardoso et al., 2022) sustentaram o desenvolvimento e versatilidade do protótipo, oferecendo resposta ao nível dos domínios motor e cardiorrespiratório, contemplando movimentos lineares e circulares, passivos e ativos. A primeira etapa pré-clínica foi desenvolvida com uma amostra de 11 enfermeiros e 1 fisioterapeuta (manipularam o aparelho) e 8 end-users idosos (usaram o aparelho). Observou-se a necessidade de incorporar estabilizadores articulares e integrar gamificação para promover a motivação e conscientização do processo de recuperação. Com esta informação, desenvolveu-se uma nova versão do Ablefit para dar resposta ao objetivo proposto, tendo sido desenvolvido um segundo estudo pré-clínico para garantir a sua funcionalidade, ergonomia e segurança. Conclusões: O desenvolvimento do sistema Ablefit permite monitorizar um conjunto de variáveis e condições inerentes à imobilidade. Ao mesmo tempo permite ser uma solução dinâmica, utilizando tecnologias de gamificação, através da criação de planos de reabilitação personalizados.

Introdução: Doentes acamados com imobilidade prolongada desenvolvem frequentemente complicações como pneumonia, úlceras de pressão, atrofia muscular e trombose venosa profunda (TVP), aumentando as taxas de mortalidade durante o internamento e após alta, e com um impacto relevante em termos económicos. Atualmente, o desenvolvimento de dispositivos médicos inovadores, principalmente na tecnologia de reabilitação, é uma tendência da área da saúde que visa aumentar e manter a independência e a autonomia de pessoas com deficiência física. Para responder a esta realidade e, assim, contribuir para a resolução dos problemas mencionados, o projeto “Ablefit” propõe o desenvolvimento de um sistema avançado de reabilitação. Objetivos: Avaliar a funcionalidade, ergonomia e segurança do protótipo Ablefit desenvolvido. Material e Métodos: Um estudo pré-clínico foi realizado através de um design centrado no usuário e uma abordagem de método misto com usuários finais. Recrutou-se uma amostra não randomizada de oito idosos (65 anos ou mais) em condição física saudável. Os participantes realizaram exercícios passivos e ativos nos membros superiores e inferiores utilizando o Ablefit. Vários parâmetros foram avaliados e registados antes, durante e após os exercícios. Entrevistas semiestruturadas foram realizadas ao final dos testes. Os dados quantitativos foram analisados através do SPSS, nomeadamente estatística descritiva e os dados qualitativos, através da análise de conteúdo. Resultados: Os participantes tinham entre 69 e 89 anos (M= 78,60; DP=6,98), e sete (70,0%) eram do sexo feminino. As diferenças não foram significativas na pressão arterial, frequência cardíaca e saturação de oxigênio. A análise de conteúdo revelou cinco categorias: segurança, facilidade de uso/aprendizagem, conforto, movimentos e benefícios. Conclusão: Este estudo contribuiu para desenvolver um novo protótipo atualizado e otimizado, com inclusão de mudanças nas categorias identificadas, com reforço de um sistema de feedback ao usuário final, demonstrando a necessidade de desenvolver soluções centradas na pessoa.

Contrary to many international settings, there are no clinical guidelines for peripheral intravenous catheter (PIVC) insertion and maintenance in Portugal. We sought to derive an international consensus on a PIVC bundle that could guide Portuguese nurses’ clinical decision-making in this scope. Methods: Two international vascular access specialist groups participated in an online Delphi panel. During the first round, specialists (n = 7) were sent a summary report from a previous observational study conducted in a surgical ward in Portugal. Based on the report findings, specialists were asked to provide five to eight PIVC insertion and maintenance interventions. Then, another set of specialists (n = 7) scored and revised the recommendations until a consensus was reached (≥70% agreement). The PIVC bundle was made available and discussed with the surgical ward’s nurses. Results: After three rounds, a consensus was achieved for five evidence-informed interventions: (i) involve the person and assess the peripheral venous network; (ii) maintain an aseptic no-touch technique; (iii) ensure proper catheter dressing and fixation; (iv) perform catheter flush & lock; (v) test the peripheral venous catheter’s functionality and performance at each shift. Conclusion: The final version of the PIVC bundle achieved consensus among international experts. Despite the positive feedback provided by the ward nurses, future studies are warranted to assess its effectiveness in standardizing PIVC care delivery and its potential implications for care outcomes in Portuguese clinical settings.

Aim: This study aims to describe rehabilitation nurses' perspectives on the complexity of and intention to use an innovative device for post-infarction patients. Design: The research employed a qualitative method, with a video demonstration, and analysis provided by the participants. To guide the study, the Technology Acceptance Model was used in order to measure perceived usefulness and perceived ease of use. Methods: Focus Groups were used to collect nurses' perspectives on the developed device. Recruitment followed a snowball sampling method. Eligible participants received an email with an informed consent form. Privacy and confidentiality were maintained throughout. Content analysis was performed using ATLAS.ti v7, with Bardin's technique, i.e., an a posteriori categorical organization. Results: Three categories were identified as relevant to the study objectives: "Therapeutic adherence and motivation"; "Home and autonomy of the patient and caregiver"; and "Factors that facilitate the practice of the rehabilitation nurse". Participants felt that the innovation and technological complexity of the device might help to increase patient motivation and adherence, which would be of great use to rehabilitation nurses, allowing better intervention development. Conclusion: Participants perceived the device as useful to practice, and beneficial to post-infarction patients. Interestingly, the complexity inherent to the device is regarded as a factor that may increase motivation and adherence.

BackgroundThe incidence of diabetic foot ulceration (DFU) is increasing worldwide. Therapeutic footwear is usually recommended in clinical practice for preventing foot ulcers in persons with diabetes. The project Science DiabetICC Footwear aims to develop innovative footwear to prevent DFU, specifically a shoe and sensor-based insole, which will allow for monitoring pressure, temperature, and humidity parameters.MethodThis study presents a three-step protocol for the development and evaluation of this therapeutic footwear, specifically: (i) a first observational study will specify the user requirements and contexts of use; (ii) after the design solutions were developed for shoe and insole, the semi-functional prototypes will be evaluated against the initial requirements; (iii) and a pre-clinical study protocol will enable the evaluation of the final functional prototype. The eligible diabetic participants will be involved in each stage of product development. The data will be collected using interviews, clinical evaluation of the foot, 3D foot parameters and plantar pressure evaluation. This three-step protocol was defined according to the national and international legal requirements, ISO norms for medical devices development, and was also reviewed and approved by the Ethics Committee of the Health Sciences Research Unit: Nursing (UICISA: E) of the Nursing School of Coimbra (ESEnfC).ResultsThe involvement of end-users (diabetic patients) will enable the definition of user requirements and contexts of use to develop design solutions for the footwear. Those design solutions will be prototyped and evaluated by end-users to achieve the final design for therapeutic footwear. The final functional prototype will be evaluated in pre-clinical studies to ensure that the footwear meets all the requirements to move forward to clinical studies.DiscussionThe three-step study outlined in this protocol will provide the necessary insights during the product development, ensuring this new therapeutic footwear's main functional and ergonomic features for DFU prevention.

Objetivo: evaluar la eficacia de una intervención educativa basada en la evidencia para prevenir las complicaciones del catéter venoso periférico. Método: estudio observacional con intervención educativa para los profesionales de enfermería de un hospital de Minas Gerais, Brasil, sobre las técnicas de lavado, empuje-pausa y bloqueo. Muestreo de conveniencia: 181 catéteres en el grupo pre-intervención y 157 en el grupo post-intervención. La incidencia de complicaciones y la comparación se evaluaron mediante los tests de Chi-cuadrado y exacto de Fisher. Resultados: la incidencia de complicaciones en el grupo posterior a la intervención fue del 4,5% para la obstrucción (p=0,000), del 10,8% para la extracción accidental (p=0,265) y del 1,9% para la flebitis (p=0,847). El uso de las técnicas de enjuague, empuje-pausa y bloqueo dio lugar a una reducción significativa de la incidencia de la obstrucción. Conclusión: la intervención educativa permitió la actualización de los conocimientos y la implementación del flushing, push-pause y locking en las prácticas de enfermería. El estudio es una contribución a la planificación de la intervención de enfermería para reducir la aparición de la obstrucción.

Objective: To evaluate the effectiveness of an evidence-based practice educational intervention in preventing peripheral venous catheter complications. Method: observational study with educational intervention for nursing professionals of a hospital in Minas Gerais, Brazil, about flushing, push-pause and locking techniques. Convenience sampling: 181 catheters in the pre-intervention group and 157 in the post-intervention group. The incidence of complications was evaluated and compared by the Chi-square and Fisher's exact tests. Results: the incidence of complications in the post-intervention group was: 4.5% for obstruction (p=0.000), 10.8% for accidental removal (p=0.265) and 1.9% for phlebitis (p=0.847). The use of the flushing, push-pause and locking techniques resulted in a significant reduction in the incidence of obstruction. Conclusion: the educational intervention enabled updated knowledge and the implementation of flushing, push-pause and locking in nursing practices. The study is a contribution to nursing intervention planning to reduce the occurrence of obstruction.

Objetivo: avaliar a eficácia de uma intervenção educativa de prática baseada em evidências na prevenção de complicações no cateter venoso periférico. Método: estudo observacional com intervenção educativa para profissionais de enfermagem de um hospital de Minas Gerais, Brasil, sobre as técnicas de flushing, push-pause e locking. Amostragem por conveniência: 181 cateteres no grupo pré-intervenção e 157 no pós-intervenção. Avaliaram-se a incidência de complicações e comparação pelos testes do Qui-quadrado e exato de Fisher. Resultados: a incidência de complicações no grupo pós-intervenção foi: 4,5% para obstrução (p=0,000), 10,8% para remoção acidental (p=0,265) e 1,9% para flebite (p=0,847). A utilização das técnicas de flushing, push-pause e locking resultaram em significativa redução na incidência de obstrução. Conclusão: a intervenção educativa possibilitou conhecimento atualizado e a implementação do flushing, push-pause e locking nas práticas de enfermagem. O estudo é uma contribuição para o planejamento de intervenção de enfermagem para reduzir a ocorrência de obstrução.

This study aimed to compare the extent to which a sample of Portuguese teachers in Higher Education Institutions, divided into two groups (young adults, ages 20-39 years; and advance adults, ages 40-70 years), differed in the management of their work-life balance and organizational commitment. Data collection was conducted using the Work-Family Scale, the Organizational Commitment Scale and a sociodemographic questionnaire. Between 2012 and 2019, 652 participants were enrolled in the study. Through a multivariate analysis of variance (MANOVA, General Linear Model procedure), results suggest that young adult teachers display higher scores of family to work facilitation, while advance adult teachers evidence higher scores of normative commitment. Given the results found, recommendations for Higher Education Institutions were outlined.

This study focuses on the impact of demographic, socioeconomic, geographic and health determinants on Portuguese seniors’ life satisfaction. The aim of this research is, therefore, to map the determinants of satisfaction with the life of the Portuguese seniors at a national and regional level. This knowledge brings insights to improve quality of life, starting with prevention in their active life (organizational level). We used data collected by the National Health Survey of 2014 and estimated a linear OLS regression both for Portugal and its regions. The main results show that determinants that contribute positively to the level of satisfaction with life are: marital status of being “married”; higher levels of education; higher levels of income; being men and people living in rural areas. The determinant that contributed negatively to the level of satisfaction with life is the existence of chronic diseases. The results at the regional level maintain the trends observed at the country level, showing income and chronic diseases as determinants that have an impact on life satisfaction in all regions. A general profile of the Portuguese seniors is provided for the country and by region, as well as proposals, generic and transversal, at the organizational level are outlined.

Musculoskeletal disorders can be significantly disabling, particularly those related to work, when the underlying mechanisms and clinical variables are not well known and understood. Nurses usually remain in standing positions or walk for long periods, thus increasing the risk for the development of musculoskeletal disorders, particularly on the foot, such as plantar fasciitis or edema. This type of disorders is a major cause of sickness, absence from work, and also dropout ratios among nursing students, which contributes to the shortage of nursing professionals. This review will address foot disorders that arise from prolonged standing in nursing professionals and describe the main clinical parameters characterizing them, with exclusions for other health professions or disorders with other identified causes. English, French, Portuguese, and Spanish published studies from 1970 to the current year will be considered. The review will follow the JBI methodology, mainly though the PCC mnemonic, and the reporting guidelines for Scoping Reviews. The search will include main databases and relevant scientific repositories. Two independent reviewers will analyze the titles, abstracts, and full texts. A tool developed by the research team will aid in the data collection.

Enquadramento: Os programas de reabilitação cardíaca são fundamentais para a recuperação e manutenção da capacidade funcional em pessoas vítimas de enfarte agudo do miocárdio. Os programas atuais evidenciam taxas de abandono elevadas e requerem mais elementos geradores de motivação nos utilizadores. Objetivos: Avaliar e comparar a usabilidade de dois protótipos de um dispositivo de reabilitação inovador para doentes pós enfarte agudo do miocárdio. Metodologia: Estudo observacional quantitativo, utilizando uma escala do tipo Likert de 5 pontos numa amostra de 16 enfermeiros especialistas em reabilitação, selecionados através da técnica de amostragem “bola de neve”. Resultados: A análise quantitativa revelou uma avaliação tridimensional dos protótipos com uma pontuação média de 4 valores, indicando usabilidade e intenção de uso. Ambos os protótipos foram considerados úteis, funcionais e fáceis de aprender e utilizar, observando-se poucas diferenças nas três dimensões. A facilidade de aprendizagem revelou-se mais consensual no protótipo Alfa. Conclusão: Os dois protótipos desenvolvidos alcançaram pontuações de usabilidade elevadas e são muito semelhantes, apresentando um forte potencial de eficácia no contexto desejado.

Peripheral venous catheters (PVCs) are the most used vascular access devices in the world. However, failure rates remain considerably high, with complications such as PVC-related infections posing significant threats to patients’ well-being. In Portugal, studies evaluating the contamination of these vascular medical devices and characterizing the associated microorganisms are scarce and lack insight into potential virulence factors. To address this gap, we analyzed 110 PVC tips collected in a large tertiary hospital in Portugal. Experiments followed Maki et al.’s semi-quantitative method for microbiological diagnosis. Staphylococcus spp. were subsequently studied for the antimicrobial susceptibility profile by disc diffusion method and based on the cefoxitin phenotype, were further classified into strains resistant to methicillin. Screening for the mecA gene was also done by a polymerase chain reaction and minimum inhibitory concentration (MIC)-vancomycin as determined by E-test, proteolytic and hemolytic activity on skimmed milk 1% plate and blood agar, respectively. The biofilm formation was evaluated on microplate reading through iodonitrotetrazolium chloride 95% (INT). Overall, 30% of PVCs were contaminated, and the most prevalent genus was Staphylococcus spp., 48.8%. This genus presented resistance to penicillin (91%), erythromycin (82%), ciprofloxacin (64%), and cefoxitin (59%). Thus, 59% of strains were considered resistant to methicillin; however, we detected the mecA gene in 82% of the isolates tested. Regarding the virulence factors, 36.4% presented α-hemolysis and 22.7% β-hemolysis, 63.6% presented a positive result for the production of proteases, and 63.6% presented a biofilm formation capacity. Nearly 36.4% were simultaneously resistant to methicillin and showed expression of proteases and/or hemolysins, biofilm formation, and the MIC to vancomycin were greater than 2 µg/mL. Conclusion: PVCs were mainly contaminated with Staphylococcus spp., with high pathogenicity and resistance to antibiotics. The production of virulence factors strengthens the attachment and the permanence to the catheter’s lumen. Quality improvement initiatives are needed to mitigate such results and enhance the quality and safety of the care provided in this field.

Enquadramento: A patologia cardiovascular constitui uma das principais causas de morte e incapacidade em Portugal. Para a promoção da recuperação funcional da pessoa, o desenvolvimento de dispositivos de reabilitação é uma prioridade importante. Objetivos: Descrever dois protótipos do Ablefit a nível da funcionalidade e aprendizagem para doentes pós-enfarte. Metodologia: Investigação qualitativa com recurso a grupos focais. Foram recrutados enfermeiros especialistas em reabilitação por amostragem de conveniência. Resultados: Foram incluídos 16 participantes no estudo. Os protótipos são funcionalmente distintos, possibilitando o beta maior variação de resistência e introdução de progressão a nível do programa de exercícios. A função de biofeedback introduzida posteriormente permite adaptação do programa e facilita o regresso a casa. A cicloergometria para membros inferiores incluída no alfa é uma vantagem significativa e deverá ser melhorada. Conclusão: O protótipo alfa apresenta menos características funcionais e facilidade de aprendizagem que o beta, sendo limitativo na modulação da resistência dos exercícios, bem como na incapacidade de monitorizar os parâmetros fisiológicos. Recomenda-se explorar a funcionalidade de biofeedback em futuros protótipos.

IntroductionNursing students are exposed to increased risks of developing foot and ankle disorders due to prolonged standing and walking positions during clinical settings. This can lead to high dropout rates from nursing degree, thus contributing to a future shortage in nursing professionals. This protocol aims to develop a study to understand the influence of prolonged standing and walking positions on nursing students' foot health, and specifically to study the relationship between the podiatric profile (regional force and pressure exerted on the foot) and related signs and symptoms.Methods and AnalysisA prospective observational cohort study will be conducted with 194 nursing students. Participants will be asked to walk through a baropodometric platform before and after a 5-month clinical training session. Assessment will focus on the change in podiatric profile, namely foot posture and foot function, at 5 months, and changes in foot health at 5 months. The study will start in January 2022 and it's expected to end by June 2022.DiscussionThe study aims to perform an innovative assessment of nursing students' podiatric profile, which will allow for a comprehensive description of foot/ankle changes and their relationship with prolonged standing and walking contexts.Ethics and DisseminationThe study was approved by The Ethical Committee of the Health Sciences Research Unit: Nursing (UICISA: E), of the Nursing School of Coimbra (ESEnfC), with the approval code nr. P799_07_2021. The study was also recorded in ClinicalTrials.gov on the number NCT05197166. Findings will be used to publish articles in peer-review scientific journals and oral communications and posters at scientific meetings.

Abstract Background The prevention of catheter-related complications is nowadays an important topic of research. Flushing catheters is considered an important clinical procedure in preventing malfunction and several complications such as phlebitis or infection. Considering the latest guidelines of the Infusion Nurses Society, the flushing should be carried out both pre- and post-drug administration, requiring different syringes (with associated overall increased times of preparation/administration of intravenous medication by nurses, and also increasing the need for manipulation of the venous catheter). Methods/design A multi-centre, two-arm randomised controlled trial with partially blinded outcome assessment of 146 adult patients. After eligibility analysis and informed consent, participants will receive usual intravenous administration drugs with flushing procedures, with a double-chamber syringe (arm A) or with classic syringes (arm B). The outcomes assessment will be performed on a daily basis by an unblinded ward team, with the same procedures in both groups. Some main outcomes, such as phlebitis and infiltration, will also be evaluated by nurses from a blinded research team and registered once a day. Discussion The study outlined in this protocol will provide valuable insight regarding the effectiveness and safety of this new medical device. The development of this medical device (dual-chamber syringe, for drug and flush solution) seems to be an important step to facilitate nurses’ adoption of good clinical practices in intravenous procedures, reducing catheter manipulations. Trial registration ClinicalTrials.gov, NCT04046770. Registered 13 August 2019.

Healthcare-associated infections are one of the major concerns worldwide. This study presents the development and the validation process of the InovSafeCare scale and aimed at identifying and measuring the ecosystem variables related to healthcare-associated infection (HCAI) prevention and control practices in European nurse students. Qualitative and quantitative approaches were used to (1) elaborate an item pool related to the educational environment, the healthcare setting environment, and the attitudes, beliefs, and performance of the nursing students regarding HCAI prevention and control and (2) analyze psychometric properties of the scale using factor analysis. The validated InovSafeCare scale was applied to undergraduate nursing students of five European Higher Education Institutions. The partial least square structural equation modeling (PLS-SEM) method with SMART-PLS3 software was used. The study sample consists of 657 nursing students, who responded a self-report inventory. From the analyzed data were identified 14 factors. The InovSafeCare scale reveals good validity and reliability of the dimensions in different European countries.

The present study has as main objective to evaluate the students’ perception of the entrepreneurial education level of higher education institutions (HEIs) and its impact on their entrepreneurial motivations to become an entrepreneur and their entrepreneurial intention. Finally, we intend to measure to what extent the effect of entrepreneurial education is direct or indirect in their entrepreneurial intention, evaluating the role of entrepreneurial motivation of students in this relationship. A sample of 966 students from different HEIs in Portugal was surveyed using the HEInnovate Self-Assessment, student entrepreneurial motivations scale (based on the Society for Associated Researchers on International Entrepreneurship — SARIE), and an adapted version of the Carland entrepreneurship index. Our results point indirect effects of the entrepreneurial universities on entrepreneurial intention by the entrepreneurial motivations of the students to become an entrepreneur. This study showed the importance of analyzing, fostering, and investing in entrepreneurial education in the HEIs to achieve a more entrepreneurial level, due to the interesting positive direct and indirect impact on the entrepreneurial motivations and entrepreneurial intention of the students.

Enquadramento: Um número significativo de pessoas adultas tem um acesso venoso periférico difícil, o que leva a múltiplas tentativas de punção e ao esgotamento da rede venosa. A escala Venous International Assessment (VIA) é considerada a nível internacional como um instrumento fiável que classifica as vias de acesso venoso periférico das pessoas e determina o risco de complicações associadas. Objetivos: Traduzir, adaptar culturalmente e validar a Escala VIA para português europeu. Metodologia: Estudo da tradução, adaptação cultural, e avaliação das propriedades psicométricas da escala VIA em amostra não probabilística de 100 pessoas doentes a precisar de cateterização venosa periférica. Resultados: A versão em português europeu da escala VIA (EARV) revelou valores moderados de fiabilidade inter-observadores (k = 0,490; p < 0,0005). As validades do critério e do constructo da EARV foram avaliadas através de análise preditiva, convergente e correlacional, com magnitudes moderadas a grandes e significância estatística. Conclusão: A EARV é um instrumento fiável e válido que pode ajudar os profissionais de saúde portugueses na determinação e categorização de acessos venosos periféricos difíceis. Contudo, recomenda-se a realização de mais estudos para testar a aplicabilidade transversal desta escala.

Background: during the hospital admission, nurses play a fundamental role in the adherence to hand hygiene (HH) measures by patients and their families, enhancing the quality and safety of care. Objective: synthesize the latest scientific evidence regarding nurse-led interventions focused on hospitalized patients’ adherence to HH and its impact on preventing Healthcare-Associated Infections (HAIs). Methodology: following the PICOD mnemonic, a narrative review was conducted in MEDLINE (via PubMed), CINAHL (via EBSCO), and Cochrane Library. Two independent reviewers analyzed the relevance of the studies, extracted and synthesized data. Results: seven studies were included for review, published between 2016 and 2018. Three central themes emerged: i) nurse-led interventions that promote patients’ adherence to HH; ii) patients’ HH adherence and HAIs prevention; iii) the importance of person-centered nursing care in this scope. Conclusion: isolated interventions do not lead to adequate behavioural changes. Although educational interventions are the most common actions used by nurses, visual cues, distribution of informational material, provision of HH material, and creation of specific moments for HH are complementary strategies that enhance the efficiency and quality of the intervention.

Background: Current international policies converge to the need of empowering patients and families in becoming more autonomous in the self-caring and management of their noncommunicable diseases (NCDs). Given their professional scope, nurses are the most well-positioned health professionals to answer this societal challenge. In the literature, health coaching and the use of information and communication technologies (ICTs) emerge as two still under-used contributions to nursing practice in this regard. Given the lack of instruments and research developed so far in the use of health coaching and ICTs during nurses training, we aim to develop a scale that explores nursing students’ perceptions regarding their coaching skills of people with NCDs and the potential role of ICTs in this domain. Methods: After a comprehensive literature review, an initial items list (n = 39) was delineated and discussed by a panel of international experts. After conceptual and structural consensus, the pre-validated version of the Personal and Technological Skills to coach people with noncommunicable diseases scale (PTSC-NCD scale) was created. Then, the pre-validated PTSC-NCD scale was translated to Portuguese, Finnish, Flemish and Slovenian following Beaton and colleagues’ recommendations, and applied to undergraduate nursing students in five European universities. Principal component analysis and reliability analysis were performed in each country through the statistical program Statistical Package for the Social Sciences (version 22.0). All ethical assumptions were complied with throughout this study. Results: 874 nursing students enrolled in the study, predominantly female (71.1%) and with a mean age of 22.4 years (SD = 5.49). After data analysis across international settings, three dimensions emerged: Coaching Centred Personal Skills (F1); Digital Technology Improving Patient-Centred Care (F2); and Digital Technology Improving Relational Skills (F3). All the dimensions showed good reliability (Cronbach's alpha >.80). Conclusion: The PTSC-NCD scale evidence good validity and reliability indicators across different international settings.

Background: In patients with peripheral intravenous catheters (PIVCs), performing flushing is an essential procedure to maintain catheter patency and prevent complications. These PIVC related complications can lead to premature removal and therapeutics interruption, which implies the need of a new catheterization thus increasing patient discomfort and pain. Aims: To identify nursing practices related to the flushing procedure, namely: moment(s) of the flushing; the syringe size used; the flush solution, volume and technique; the knowledge and accomplishment of the recommended standards on flushing by nurses. Methods: A cross-sectional study was conducted between July and December 2017, with Brazilian and Portuguese nurses. An online questionnaire was developed based on the international recommendations on flushing procedure. Descriptive analysis was performed. Results: A total of 76 nurses answered the questionnaire. The majority of nurses (84.2%) performed flushing: the most common technique used was continuous syringe pressure (31.2%), with the push-pause technique being performed by 23.4% of the nurses. Despite the majority performs flushing at four distinct moments (after the PIVC insertion, before, between and after drug delivery), there are inconsistencies in flush solution, volume, and syringe size. The most used volume to perform flushing was 5 mL, filled using normal saline. Despite this, they also recognized the omission of this procedure due to time constrains, no familiarity with the procedure and unavailable material. Conclusions: This study identified that flushing procedure isn't always performed by nurses in their clinical practice. Also, several inconsistencies were observed between nurses that performed flushing, reflecting the lack of empirical evidence in this area of research.

Contexto: O flushing dos cateteres venosos periféricos (CVPs), aquando da administração intravenosa, encontra-se descrito como um procedimento preventivo das complicações associadas aos CVPs. Contudo, esta prática não se escontra convenientemente operacionalizada nas diretrizes internacionais em termos do volume da solução de flushing, frequência e técnica. Objetivos: Mapear as evidências no âmbito do flushing dos CVPs. Método de revisão: Foi definido o protocolo de scoping review, baseado na metodologia proposta pelo Joanna Briggs Institute, considerando os critérios definidos e a adequação às bases/repositórios propostos. Apresentação e interpretação dos resultados: O mapeamento das evidências permitirá identificar os volumes, frequências e técnicas utilizadas na prática de flushing. Conclusão: Prevê-se que esta revisão constitua um ponto de partida para a análise e sistematização dos estudos relativos às práticas de flushing dos CVPs, contribuindo não apenas para a otimização desta prática clínica, mas também para a investigação científica nesta temática.

BackgroundIn nursing practice, flushing the catheters pre and post-drug administration is considered an important clinical procedure to prevent complications, and requires the use of several syringes to comply with international standards of care. We envisioned an innovative double-chamber syringe that enables the filling and administration of both solutions. Following current international recommendations, the development of new medical devices should integrate Health Technology Assessment. The Human-centred design is usually used for that assessment purposes, as a method that actively include end-users in the devices development process.MethodApplication of the Human-Centred Design through the involvement of nurses in the initial stages of the device development in order to accomplish the initial stages of Technology Readiness Level. A multi-method approach was used, including literature/guidelines review, focus groups with end-users and expert panels.ResultsThe involvement of nurses enabled the definition of user requirements and contexts of use, as well as the evaluation of design solutions and prototypes in order to accomplish with usability and ergonomic features of the medical device.ConclusionsSignificant contributions were made regarding the final design solution of this innovative double-chamber syringe.

ABSTRACT Contemporaneously, and with the successive paradigmatic revolutions inherent to management since the XVII century, we are witnessing a new era marked by the structural rupture in the way organizations are perceived. Market globalization, cemented by quick technological evolutions, associated with economic, cultural, political and social transformations characterize a reality where uncertainty is the only certainty for organizations and managers. Knowledge management has been interpreted by managers and academics as a viable alternative in a logic of creation and conversation of sustainable competitive advantages. However, there are several barriers to the implementation and development of knowledge management programs in organizations, with organizational culture being one of the most preponderant. In this sense, and in this article, we will analyze and compare The Knowledge Creation and Conversion Model proposed by Nonaka and Takeuchi (1995) and Quinn and Rohrbaugh's Competing Values Framework (1983), since both have convergent conceptual lines that can assist managers in different sectors to guide their organization in a perspective of productivity, quality and market competitiveness.

Enquadramento: Ao envelhecimento associam-se problemas agudos e crónicos que interferem com a mobilidade da pessoa idosa e a sua independência. Atualmente, existem no mercado diversas tipologias de andarilho com diferentes perfis de desempenho funcional do idoso, que visam compensar limitações físicas e prevenir quedas. Objetivo: Comparar o perfil de desempenho funcional de pessoas idosas institucionalizadas tendo em conta o tempo percorrido, velocidade de marcha, variância frequência cardíaca e custo energético despendido aquando da realização do teste Expanded Timed Get-up-and-Go no uso de três tipologias de um andarilho: fixo, duas rodas e quatro rodas. Metodologia: Estudo quasi-experimental antes e após de grupo único, numa amostra de conveniência de 40 pessoas idosas institucionalizadas. Resultados: Foram identificadas diferenças significativas no tempo percorrido (X2 = 15,65; p < 0,001) e na velocidade de marcha (X2 = 15,80; p < 0,001). Conclusão: Não existe uma solução ideal única entre as tipologias do andarilho analisadas, sendo, portanto, desejável uma solução personalizada às características e necessidades da pessoa idosa institucionalizada.

O presente artigo tem como finalidade apresentar e avaliar os efeitos de um projeto de escola a tempo integral, com uma jornada diária de 8 tempos. Participaram no estudo 20 alunos do 6º ano de escolaridade (11.7±1.1 anos de idade), 20 encarregados de educação dos referidos alunos (42.6±4.54 anos) e 5 professores (51.8±4.66 anos). O método adotado combinou metodologias quantitativas e qualitativas. Para além do desempenho académico no início e fim do ano letivo, utilizou-se a técnica de associação livre de palavras (210 evocações) e realizaram-se 13 entrevistas. Os resultados indicaram que os vários atores no processo educativo valorizaram a aprendizagem, a afetividade, o convívio, a diversidade de ofertas educativas, a organização temporal da jornada escolar, o trabalho colaborativo, a intergeracionalidade, o diário de bordo e os métodos de estudo. Os inquiridos também consideram que houve cansaço, sobrecarga no tempo de permanência na escola e falta de tempo livre.

The aim of this study was to evaluate the psychometric qualities of the WHOQOL-BREF(PT) (the questionnaire developed by the World Health Organization Quality of Life Grpup for quality of life assessment), when applied to Portuguese elderly people residing in a community setting. The psychometric qualities were assessed by confirmatory factor analysis. A hierarchical second-order model and a third model were performed, and all three models presented similar and reasonable adjustment indexes. The data analysis showed that the construct failed only regarding discriminant validity because the correlations between the first-order factors were higher, associated with lower values of average variance extracted. The psychometric qualities found in the original translation/validation of the WHOQOL-BREF(PT) were compared with those found in this study; this study found higher correlations between domains but a similar level of factor reliability. The findings of this study lead to three recommendations: (i) to compute each factor score for each participant using the factor score weights obtained from confirmatory analysis models instead of adopting a unitary weight for each item, as proposed by the authors of the original translation/validation of the WHOQOL-BREF(PT); (ii) to compute a QOL score, which is not included in the original translation/validation; and (iii) to analyze differences between individual scores for each participants, which should be done by a group of health experts.

Objective to contribute to the validation study of the Scale of Adverse Events associated with Nursing Practices in the hospital context. Method cross-sectional study, in public hospital units, in the central and northern regions of Portugal. The exploratory factor analysis of the Scale of Adverse Events associated to Nursing Practices was conducted with a sample of 165 nurses and the confirmatory factorial analysis was made with a sample of 685 nurses. Reliability, internal consistency and construct validity were estimated. The invariance of the model was evaluated in two subsamples to confirm the stability of the factorial solution. Results the global sample consisted of 850 nurses aged between 22 and 59, mostly licensed professionals. The model had a good overall fit in the subscales (Nursing Practices: χ2/df = 2.88, CFI = 0.90, GFI = 0.86, RMSEA = 0.05, MECVI = 3.30; Adverse Events: χ2/df = 4.62, CFI = 0.93, GFI = 0.95, RMSEA = 0.07, MECVI = 0.39). There was a stable factor structure, indicating strong invariance in the subscale Nursing Practices and structural invariance in the subscale Adverse Events. Conclusion the refined model of the Scale of Adverse Events associated with Nursing Practices revealed good fit and stability of the factorial solution. The instrument was adjusted to evaluate the perception of nurses about adverse events associated with health care, precisely nursing care, in the hospital setting.

ABSTRACT Objective: to evaluate the psychometric qualities of the Portuguese version of the Organizational Commitment Questionnaire for the nursing context, through confirmatory analysis and invariance, aiming to evaluate the reliability, internal consistency, construct validity and external validity of the instrument. Method: confirmatory factor analysis of the Portuguese version of the questionnaire was carried out with a sample of 850 nurses, in hospital context. The analysis was complemented using specification search. Goodness of fit was evaluated through different indices. Reliability, internal consistency and construct validity were estimated. The invariance of the model was evaluated in two subsamples of the same sample, in order to confirm the external validity of the factorial solution. Results: the refined model demonstrated good overall fit (χ2/df=6.37; CFI=0.91; GFI=0.92; RMSEA=0.08; MECVI=0.62). The factorial structure was stable (λ:Δχ2(14)=18.31; p=0;193; Intercepts: Δχ2(14)=22.29; p=0.073; Covariance: Δχ2(3)=6.01; p=0.111; Residuals: Δχ2(15)=22.44; p=0.097). Conclusion: the simplified model of the questionnaire demonstrated adequate goodness of fit, representing a stable factorial solution. The instrument was fit to monitor and evaluate the organizational commitment of Portuguese nurses.

Resumo do projeto de investigação apresentado no Encontro Internacional de Doutorandos de Enfermagem da Universidade de Lisboa, Maio de 2016.

Objective: to understand the referral to the National Network of Integrated Continuous Care, from the perspective of nurses who work in this care context. Method: an exploratory and descriptive study with a qualitative approach, with data collection between July and September 2019 through interviews with 12 nurses who work in Integrated Continuous Care Teams, in Northern Portugal. The content analysis technique was used to analyze the statements. Results: the professionals revealed that there are difficulties and constraints in the process of referring users to the National Network of Integrated Continuous Care. The process is bureaucratic, complex, and time-consuming, conditioning user accessibility to timely care. Conclusion: the referral process is a very bureaucratic and time-consuming procedure, which not only conditions and delays users’ access to the National Network of Integrated Continuous Care network, contributing to the worsening of the clinical status of some patients. The number of professionals is insufficient, inducing the demand for services through urgency. The focus on primary care should seek to improve inequalities in access, compete for more equitable and accessible care, generating more quality in health care.