Sistema de classificação de pacientes psiquiátricos – versão 2: um estudo de confiabilidade e validade de conteúdo
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Data
2020-02-28
Autores
Vieira, Letícia Carvalho [UNESP]
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Universidade Estadual Paulista (Unesp)
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Objetivo: Compreender o significado do uso dos sistemas de classificação de pacientes como ferramenta gerencial para os gestores de enfermagem psiquiátrica e avaliar as características psicométricas do Sistema de Classificação de Pacientes Psiquiátricos – versão 2. Método: Estudo multimétodo sendo o delineamento qualitativo para a compreensão do significado, coleta de dados por meio de entrevistas semiestruturadas áudio gravadas e referencial metodológico da Análise de Conteúdo, já o delineamento de estudo metodológico foi utilizado para avaliar as características psicométricas através da Técnica Delphi com análise estatística. Participaram 10 gerentes de enfermagem de instituições psiquiátricas do Estado de São Paulo e 60 juízes especialistas. Utilizou-se o software NVivo para auxílio na análise das entrevistas e opiniões dos juízes e o software R Core Team para a análise estatística. A coleta de dados foi realizada entre agosto/2016 e maio/2017. Resultados: Quanto aos gerentes, a amostra constituiu-se de nove mulheres e um homem, com 14 anos de experiência em saúde mental e que estavam há quase sete anos no referido cargo na atual instituição. O ambiente do cuidado psiquiátrico emergiu como tema geral cercado por quatro subtemas: modelo atual de tomada de decisão, modelo ideal de tomada de decisão, dimensionamento de enfermagem, legislação profissional e de saúde mental. Apenas metade dos gerentes utilizaram um sistema de classificação de pacientes como ferramenta gerencial e as práticas ainda são baseadas no empirismo. Quanto ao painel de juízes, a amostra constituiu-se de 14 docentes, cinco enfermeiros pesquisadores e 41 enfermeiros assistenciais pertencentes às 10 Instituições participantes. Obteve-se uma concordância geral de 90% na 1ª rodada não sendo necessária rodadas subsequentes. O indicador “comportamento relacionado ao fumo” e “equivalência das horas de enfermagem” obtiveram concordância de 63,3% e 78,3%, respectivamente, sinalizando a exclusão de ambos do instrumento. O instrumento apresentou alpha de Cronbach de 0.85 e Índice de Validade de Conteúdo de 0.9 no geral. Conclusão: Estabeleceu-se um modelo conceitual de como o ambiente psiquiátrico ainda é visto pelos gerentes de enfermagem e identificada a necessidade de remodelamento do processo de trabalho gerencial para estabelecer-se uma prática baseada em evidências. Identificou-se que o subdimensionamento da equipe de enfermagem é um dificultador para o remodelamento embora o órgão regulamentador da enfermagem respalde este processo. A educação permanente é necessária para o remodelamento. No que tange ao instrumento, foi retirado somente o indicador “comportamento relacionado ao fumo”, pois a baixa concordância do outro item foi avaliada como dificuldade dos juízes no entendimento da proposta de equivalência das horas de enfermagem já que os parâmetros atuais ainda são incipientes e pouco utilizados. Apesar disto, o instrumento pôde ser considerado válido e confiável na população estudada devendo ser aplicado em contexto psiquiátrico para realizar outros testes psicométricos.
Objective: To understand the meaning of using patient classification systems as a managerial tool for psychiatric nursing managers and to evaluate the psychometric characteristics of the Psychiatric Patient Classification System - version 2. Method: Multi-method study used or qualitative quality design of the meaning, data collection through recorded semi-structured audio interviews and methodological references of Content Analysis, already outlining methodological studies used to evaluate how psychometric characteristics applied by the Delphi Technique with Statistical Analysis. Participated 10 managers of psychiatric nursing institutions in the State of São Paulo and 60 expert judges. The N-Vivo software was used to aid in the analysis of interviews and judges' opinions and the R Core Team software for statistical analysis. Data collection was carried out between August 2016 and May 2017. Results: As for the managers, a sample composed of nine women and one man, with 14 years of experience in mental health and who were almost seven years without a load at the current institution. The emerging psychiatric care environment as the general theme surrounded by four sub-themes: current decision model, ideal decision model, nursing dimension, professional legislation and mental health. Only half of the managers used a patient classification system as a management tool and as practices are still used without empiricism. As for the panel of judges, a sample composed of 14 documents, five nurse researchers and 41 nurse assistants belonging to 10 participating institutions. Obtained an overall agreement of 90% in the 1st round, with no subsequent rounds required. The indicator "behavior related to smoking" and "equivalence of nursing hours" obtained an agreement of 63.3% and 78.3%, respectively, signaling an exclusion of both instruments. The instrument displayed Cronbach's alpha of 0.85 and content validity index of 0.9 overall. Conclusion: A conceptual model of how the psychiatric environment is still seen by nursing managers was established and the need to remodel the managerial work process to establish an evidence-based practice was identified. It was identified that the under sizing of the nursing team makes reform difficult, although the nursing regulatory body supports this process. Continuing education is necessary for reform. Regarding the instrument, only the indicator “behavior related to smoking” was removed, since the low agreement of the other item was assessed as the difficulty of the judges in understanding the proposal for equivalence of nursing hours, since the current parameters are still incipient and little used. Despite this, the instrument can be considered valid and reliable in the population studied and must be applied in a psychiatric context to perform other psychometric tests.
Objective: To understand the meaning of using patient classification systems as a managerial tool for psychiatric nursing managers and to evaluate the psychometric characteristics of the Psychiatric Patient Classification System - version 2. Method: Multi-method study used or qualitative quality design of the meaning, data collection through recorded semi-structured audio interviews and methodological references of Content Analysis, already outlining methodological studies used to evaluate how psychometric characteristics applied by the Delphi Technique with Statistical Analysis. Participated 10 managers of psychiatric nursing institutions in the State of São Paulo and 60 expert judges. The N-Vivo software was used to aid in the analysis of interviews and judges' opinions and the R Core Team software for statistical analysis. Data collection was carried out between August 2016 and May 2017. Results: As for the managers, a sample composed of nine women and one man, with 14 years of experience in mental health and who were almost seven years without a load at the current institution. The emerging psychiatric care environment as the general theme surrounded by four sub-themes: current decision model, ideal decision model, nursing dimension, professional legislation and mental health. Only half of the managers used a patient classification system as a management tool and as practices are still used without empiricism. As for the panel of judges, a sample composed of 14 documents, five nurse researchers and 41 nurse assistants belonging to 10 participating institutions. Obtained an overall agreement of 90% in the 1st round, with no subsequent rounds required. The indicator "behavior related to smoking" and "equivalence of nursing hours" obtained an agreement of 63.3% and 78.3%, respectively, signaling an exclusion of both instruments. The instrument displayed Cronbach's alpha of 0.85 and content validity index of 0.9 overall. Conclusion: A conceptual model of how the psychiatric environment is still seen by nursing managers was established and the need to remodel the managerial work process to establish an evidence-based practice was identified. It was identified that the under sizing of the nursing team makes reform difficult, although the nursing regulatory body supports this process. Continuing education is necessary for reform. Regarding the instrument, only the indicator “behavior related to smoking” was removed, since the low agreement of the other item was assessed as the difficulty of the judges in understanding the proposal for equivalence of nursing hours, since the current parameters are still incipient and little used. Despite this, the instrument can be considered valid and reliable in the population studied and must be applied in a psychiatric context to perform other psychometric tests.
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Palavras-chave
Enfermagem psiquiátrica, Administração de serviços de saúde, Enfermagem baseada em evidência, Determinação de necessidades de cuidados de saúde, Estudos de validação, Psychiatric nursing, Health services administration, Evidence-based nursing, Needs assessment, Validation studies