Competências dos enfermeiros da área hospitalar: construção e validação de instrumento
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Data
2019-02-22
Autores
Bernardina, Lucienne Dalla
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Editor
Universidade Estadual Paulista (Unesp)
Resumo
Diante da evolução tecnológica na área da saúde, as competências do enfermeiro, estão diretamente relacionadas a assistência, educação e gestão dos serviços de saúde prestados à população. Atualmente as Instituições Hospitalares possuem uma parcela significativa de alocações de enfermeiros, cujos administradores estão com o foco da atenção voltada às competências profissionais, visando diretamente a qualidade e custo da assistência prestada à população. O objetivo foi construir e validar um instrumento de avaliação de competências dos enfermeiros atuantes em um hospital. Trata-se de um estudo transversal, descritivo e metodológico, com abordagem quantitativa, para a validação do conteúdo de um instrumento de avaliação de competências do enfermeiro. Instrumento inicial de 69 itens e 6 dimensões, validado pela técnica Delphi, e análise da concordância e a consistência interna verificadas pelos Índice de Validade de Conteúdo (IVC), Coeficiente de Kappa (k) e coeficiente Alpha de Cronbach. Após aplicação e análise fatorial exploratória e confirmatória, teste de regressão logística multinomial o instrumento final ficou com 37 itens e 6 dimensões. Os juízes predominaram em 88,90% sexo feminino, média de tempo de atuação em gestão institucional e educacional de 23,2 anos. Em relação ao instrumento foi obtido IVC 0,95 e Alfa de Cronbach 0,92. Os juízes julgaram: 95,30% manter e 4,70% excluir as proposições, houve concordância quanto a representatividade do conjunto de afirmações frente ao universo teórico. Dos 180 enfermeiros, 150 (83,33%) participaram do estudo, 95,95% do sexo feminino, idade média 36,99 anos, tempo médio de trabalho na Instituição 8,76 anos, funções atribuídas, assistencial 64,67%, supervisor 22,67% e gestor 12,66%. A comparação entre dados sociodemográficos e função atribuída aos enfermeiros, mostrou-se estatisticamente significativa em relação a idade, tempo de graduação e tempo de instituição. A autoavaliação dos enfermeiros quanto a experiência profissional foi, proficiente 40,00%, competente 34,00%, especialista 18,00%, iniciado avançado 6,00% e iniciado 2,00%, houve significância na comparação entre dados sociodemográficos, Idade, tempo de graduação, mostrando o proficiente em evidência. Para a análise do instrumento utilizamos a análise fatorial exploratória e confirmatória, cujos índices de qualidade de ajuste, mostraram significância estatística e favorável à continuação do estudo. Originou-se o modelo de 6 fatores e 37 questões, indicado pela análise fatorial exploratória, que foi testado em uma análise fatorial confirmatória. Todos os fatores apresentaram alfa de Cronbach geral demonstrando confiabilidade acima de 0,7. A análise de regressão logística multinomial, evidenciou maior acurácia na predição das atribuições funcionais dos enfermeiros. A nomeação das novas dimensões do instrumento, após as análises e alocações das proposições deste estudo são corroborados pela literatura. O instrumento mostrou-se confiável e válido para avaliar as competências do enfermeiro atuante na área hospitalar, sua aplicação possibilitará auxilio no planejamento e implementações de programas de desenvolvimento profissional, além de identificar melhorias no processo decisório de alocações de enfermeiros competentes para o desempenho de funções especificas e direcionadas de acordo com as necessidades dos departamentos das instituições hospitalares.
Faced with technological developments in the health area, nurses' competences are directly related to the assistance, education and management of health services provided to the population. Currently, the Hospital Institutions have a significant portion of nurses' allocations, whose administrators are focused on professional competencies, directly targeting the quality and cost of care provided to the population. The objective was to construct and validate an instrument to evaluate the competences of nurses working in a hospital.This is a cross-sectional, descriptive and methodological study, with a quantitative approach, for the validation of the content of a nurse competency assessment tool. Initial validity of 69 items and 6 dimensions, validated by the Delphi technique, and concordance analysis and internal consistency verified by Content Validity Index (CVI), Kappa Coefficient (k) and Cronbach's Alpha coefficient. After application and exploratory and confirmatory factorial analysis, multinomial logistic regression test the final instrument was with 37 items and 6 dimensions.The judges predominated in 88.90% female, average time of performance in institutional and educational management of 23.2 years. In relation to the instrument was obtained CVI 0.95 and Cronbach's Alpha 0.92. The judges judged: 95.30% maintain and 4.70% exclude the propositions, there was concordance as to the representativeness of the set of affirmations against the theoretical universe. Of the 180 nurses, 150 (83.33%) participated in the study, 95.95% female, mean age 36.99 years, mean working time in the institution 8.76 years, attributed functions, care 64.67% supervisor 22.67% and manager 12.66%. The comparison between sociodemographic data and the role attributed to nurses was statistically significant in relation to age, graduation time and institution time. Nurses' self-assessment of professional experience was proficient, 40.00%, competent 34.00%, specialist 18.00%, advanced 6.00% and started 2.00%, there was a significant difference between sociodemographic data, age, graduation time, showing the proficient in evidence. For the analysis of the instrument we used the exploratory and confirmatory factor analysis, whose indices of adjustment quality, showed statistical significance and favorable to the continuation of the study. The model of 6 factors and 37 questions was originated, indicated by the exploratory factorial analysis, which was tested in a confirmatory factorial analysis. All factors showed overall Cronbach's alpha demonstrating reliability above 0.7. The analysis of multinomial logistic regression showed a greater accuracy in the prediction of the functional assignments of nurses. The naming of the new dimensions of the instrument, after the analyzes and allocations of the propositions of this study are corroborated in the literature. The instrument proved to be reliable and valid to evaluate the competencies of nurses working in the hospital, its application will enable assistance in the planning and implementation of professional development programs, as well as to identify improvements in the decision-making process of nurses' of specific functions and directed according to the needs of the departments of the hospital institutions.
Faced with technological developments in the health area, nurses' competences are directly related to the assistance, education and management of health services provided to the population. Currently, the Hospital Institutions have a significant portion of nurses' allocations, whose administrators are focused on professional competencies, directly targeting the quality and cost of care provided to the population. The objective was to construct and validate an instrument to evaluate the competences of nurses working in a hospital.This is a cross-sectional, descriptive and methodological study, with a quantitative approach, for the validation of the content of a nurse competency assessment tool. Initial validity of 69 items and 6 dimensions, validated by the Delphi technique, and concordance analysis and internal consistency verified by Content Validity Index (CVI), Kappa Coefficient (k) and Cronbach's Alpha coefficient. After application and exploratory and confirmatory factorial analysis, multinomial logistic regression test the final instrument was with 37 items and 6 dimensions.The judges predominated in 88.90% female, average time of performance in institutional and educational management of 23.2 years. In relation to the instrument was obtained CVI 0.95 and Cronbach's Alpha 0.92. The judges judged: 95.30% maintain and 4.70% exclude the propositions, there was concordance as to the representativeness of the set of affirmations against the theoretical universe. Of the 180 nurses, 150 (83.33%) participated in the study, 95.95% female, mean age 36.99 years, mean working time in the institution 8.76 years, attributed functions, care 64.67% supervisor 22.67% and manager 12.66%. The comparison between sociodemographic data and the role attributed to nurses was statistically significant in relation to age, graduation time and institution time. Nurses' self-assessment of professional experience was proficient, 40.00%, competent 34.00%, specialist 18.00%, advanced 6.00% and started 2.00%, there was a significant difference between sociodemographic data, age, graduation time, showing the proficient in evidence. For the analysis of the instrument we used the exploratory and confirmatory factor analysis, whose indices of adjustment quality, showed statistical significance and favorable to the continuation of the study. The model of 6 factors and 37 questions was originated, indicated by the exploratory factorial analysis, which was tested in a confirmatory factorial analysis. All factors showed overall Cronbach's alpha demonstrating reliability above 0.7. The analysis of multinomial logistic regression showed a greater accuracy in the prediction of the functional assignments of nurses. The naming of the new dimensions of the instrument, after the analyzes and allocations of the propositions of this study are corroborated in the literature. The instrument proved to be reliable and valid to evaluate the competencies of nurses working in the hospital, its application will enable assistance in the planning and implementation of professional development programs, as well as to identify improvements in the decision-making process of nurses' of specific functions and directed according to the needs of the departments of the hospital institutions.
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Palavras-chave
Competência, Enfermagem, Estudos de Validação, Gestão em Saúde, Pesquisa Metodológica em Enfermagem, Psicometria, Administração de Recursos Humanos, Competence, Nursing, Validation Studies, Health Management, Methodological Research in Nursing, Psychometry, Human resource Management