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OBJECTIVE: to analyze nurses' role in collecting, identifying and preserving traces in Emergency care for victims of violence, from the perspective of these professionals. METHOD: a qualitative study with an exploratory and descriptive approach. It was developed through semi-structured interviews with 21 nurses from hospitals that are part of the intersectoral flow to assist victims of violence from two reference hospitals in this type of care, in a capital city from southern Brazil. Nurses that are members of the multiprofessional team working in the Emergency areas at the respective hospitals were included; in turn, the exclusion criteria corresponded to professionals relocated in Emergency areas during the pandemic. Data analysis was performed according to Thematic Content Analysis. RESULTS: the data were discussed in five categories: 1) Professional qualification; 2) Institutional protocol and materials; 3) The professionals' perceptions; 4) The professionals' actions; and 5) Team structure. CONCLUSION: Nursing professionals' skills in collecting, identifying and preserving traces in Emergency assistance provided to victims of violence need to be better organized, structured and standardized. The presence of Nursing professionals in the care of victims of violence in Emergency services is undeniable, but their importance is still underestimated and their potential contribution to the forensic approach is underused.

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BACKGROUND: Currently, antivenoms are the only specific treatment available for snakebite envenoming. In Brazil, over 30% of patients cannot access antivenom within its critical care window. Researchers have therefore proposed decentralizing to community health centers to decrease time-to-care and improve morbidity and mortality. Currently, there is no evidence-based method to evaluate the capacity of health units for antivenom treatment, nor what the absolute minimum supplies and staff are necessary for safe and effective antivenom administration and clinical management. METHODS: This study utilized a modified-Delphi approach to develop and validate a checklist to evaluate the minimum requirements for health units to adequately treat snakebite envenoming in the Amazon region of Brazil. The modified-Delphi approach consisted of four rounds: 1) iterative development of preliminary checklist by expert steering committee; 2) controlled feedback on preliminary checklist via expert judge survey; 3) two-phase nominal group technique with new expert judges to resolve pending items; and 4) checklist finalization and closing criteria by expert steering committee. The measure of agreement selected for this study was percent agreement defined a priori as ≥75%. RESULTS: A valid, reliable, and feasible checklist was developed. The development process highlighted three key findings: (1) the definition of community health centers and its list of essential items by expert judges is consistent with the Brazilian Ministry of Health, WHO snakebite strategic plan, and a general snakebite capacity guideline in India (internal validity), (2) the list of essential items for antivenom administration and clinical management is feasible and aligns with the literature regarding clinical care (reliability), and (3) engagement of local experts is critical to developing and implementing an antivenom decentralization strategy (feasibility). CONCLUSION: This study joins an international set of evidence advocating for decentralization, adding value in its definition of essential care items; identification of training needs across the care continuum; and demonstration of the validity, reliability, and feasibility provided by engaging local experts. Specific to Brazil, further added value comes in the potential use of the checklist for health unit accreditation as well as its applications to logistics and resource distribution. Future research priorities should apply this checklist to health units in the Amazon region of Brazil to determine which community health centers are or could be capable of receiving antivenom and translate this expert-driven checklist and approach to snakebite care in other settings or other diseases in low-resource settings.

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Resumo Objetivo Descrever as etapas da construção de uma escala para avaliar o ambiente de trabalho na Atenção Primária à Saúde (APS). Método Estudo metodológico com cinco etapas: estabelecimento da estrutura conceitual; construção das questões e da escala de respostas; estruturação; validade do conteúdo com especialistas; e análise semântica com profissionais de saúde. Resultados A construção da estrutura conceitual com revisão de literatura e a análise dos pesquisadores, especialistas e profissionais de saúde, finalizou a escala com 36 questões. O ambiente de trabalho é influenciado por condições de trabalho, questões de administração e gestão, saúde do trabalhador, cargas de trabalho, valorização e motivação, violência e estratégias para um ambiente de trabalho saudável. Foi realizado o Índice de Validade de Conteúdo (IVC) e Porcentagem de Concordância, com valores de 0,96 (IVC) e 96% de concordância, respectivamente. Conclusões e implicações para prática A escala foi elaborada e apresentou concordância, de acordo com o teste de validade de conteúdo, por especialistas e profissionais de saúde. Assim, a escala está apta a seguir para outros processos de validação e pode contribuir para a prática de pesquisadores das áreas de saúde na avaliação do ambiente de trabalho.

Resumen Objetivo Describir las etapas de la construcción de una escala para evaluar el clima laboral en la Atención Primaria de Salud (APS). Método Estudio metodológico con cinco etapas: establecimiento de la estructura conceptual; construcción de preguntas y escala de respuestas; estructuración; validez de contenido con expertos; y análisis semántico con profesionales de la salud. Resultados La construcción de la estructura conceptual con revisión de la literatura, el análisis de investigadores, expertos y profesionales de la salud finalizó la escala con 36 preguntas. El ambiente de trabajo está influenciado por las condiciones de trabajo, cuestiones de administración y gestión, salud de los trabajadores, cargas de trabajo, aprecio y motivación, violencia y estrategias para un ambiente de trabajo saludable. Se realizó el Índice de Validez de Contenido (IVC) y Porcentaje de Concordancia, con valores de 0,96 (IVC) y 96% de Concordancia, respectivamente. Conclusiones e implicaciones para la práctica La escala fue desarrollada y mostró concordancia, según la prueba de validez de contenido realizada por expertos y profesionales de la salud. Así, la escala está lista para pasar por otros procesos de validación y puede contribuir a la práctica de los investigadores de salud en la evaluación del clima laboral.

Abstract Objective To describe the stages of constructing a scale to evaluate the work environment in Primary Health Care. Method methodological study with five stages: establishment of the conceptual structure; construction of questions and response scale; structuring; content validity with experts and semantic analysis with health professionals. Results construction of the conceptual structure with literature review, the analysis of researchers, experts and health professionals finalized the scale with 36 questions. The work environment is influenced by working conditions, administration and management issues, worker health, workloads, appreciation and motivation, violence and strategies for a healthy work environment. The Content Validity Index (CVI) and Percentage of agreement were performed, with values of 0.96 (CVI) and 96% agreement, respectively. Conclusions and implications for practice the scale was developed and showed agreement, according to the content validity test by experts and health professionals. Thus, the scale is capable of being used for other validation process and can contribute to the practice of health researchers in assessing the work environment.

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Objective: to analyze nurses' role in collecting, identifying and preserving traces in Emergency care for victims of violence, from the perspective of these professionals. Method: a qualitative study with an exploratory and descriptive approach. It was developed through semi-structured interviews with 21 nurses from hospitals that are part of the intersectoral flow to assist victims of violence from two reference hospitals in this type of care, in a capital city from southern Brazil. Nurses that are members of the multiprofessional team working in the Emergency areas at the respective hospitals were included; in turn, the exclusion criteria corresponded to professionals relocated in Emergency areas during the pandemic. Data analysis was performed according to Thematic Content Analysis. Results: the data were discussed in five categories: 1) Professional qualification; 2) Institutional protocol and materials; 3) The professionals' perceptions; 4) The professionals' actions; and 5) Team structure. Conclusion: Nursing professionals' skills in collecting, identifying and preserving traces in Emergency assistance provided to victims of violence need to be better organized, structured and standardized. The presence of Nursing professionals in the care of victims of violence in Emergency services is undeniable, but their importance is still underestimated and their potential contribution to the forensic approach is underused.

Objetivo: analizar el papel del enfermero en la recolección, identificación y preservación de rastros en la atención de emergencia a las víctimas de violencia, desde la perspectiva de estos profesionales. Método: estudio cualitativo, con enfoque descriptivo exploratorio. Desarrollado a través de entrevistas semiestructuradas a 21 enfermeros de hospitales que forman parte del flujo intersectorial de atención a víctimas de violencia en dos hospitales de referencia de este servicio, en una capital del sur de Brasil. Se incluyeron enfermeros que forman parte del equipo multidisciplinario que trabaja en el servicio de urgencias de sus respectivos hospitales, y el criterio de exclusión fue profesionales reasignados al servicio de urgencias durante la pandemia. El análisis de los datos se realizó según análisis de contenido temático. Resultados: de los datos surgieron cinco categorías: 1) Calificación Profesional; 2) Protocolo Institucional y Materiales; 3) Percepción de los profesionales; 4) Acciones de los profesionales y 5) Estructura del equipo. Conclusión: es necesario organizar, estructurar y estandarizar mejora las competencias de los profesionales de enfermería para recolectar, identificar y preservar rastros en la atención de emergencia a las víctimas de violencia. La presencia de los enfermeros en la atención a las víctimas de violencia en los servicios de emergencia es innegable, pero aún se subestima su importancia y se subutiliza su contribución potencial en el abordaje pericial.

Objetivo: analisar a atuação dos enfermeiros no recolhimento, identificação e preservação de vestígios no atendimento de emergência à vítima de violência, na perspectiva desses profissionais. Método: estudo qualitativo, com abordagem descritiva exploratória. Desenvolvido por meio de entrevista semiestruturada com 21 enfermeiros de hospitais que integram o fluxo intersetorial para atendimentos às vítimas de violência de dois hospitais de referência neste atendimento, em uma capital do sul do Brasil. Foram incluídos enfermeiros membros da equipe multiprofissional que atuam na emergência nos respectivos hospitais, e o critério de exclusão foi profissionais realocados na emergência durante a pandemia. A análise de dados foi realizada conforme análise de conteúdo temático. Resultados: os dados foram discutidos em cinco categorias: 1) Qualificação Profissional; 2) Protocolo Institucional e Materiais; 3) Percepções dos profissionais; 4) Ações dos profissionais e 5) Estrutura da equipe. Conclusão: as competências dos profissionais de enfermagem no recolhimento, identificação e preservação de vestígios no atendimento de emergência à vítima de violência precisam ser melhor organizadas, estruturadas e padronizadas. É incontestável a presença de profissionais enfermeiros nos atendimentos às vítimas de violência nos serviços de emergência, mas sua importância ainda é subestimada e sua potencial contribuição para a abordagem pericial é subutilizada.

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RESUMO: Objetivo: Desenvolver protocolo de cuidados de enfermagem para monitorização glicêmica de pessoas com Diabetes Mellitus tipo 2, hospitalizadas. Método: Pesquisa metodológica desenvolvida em 2021 e 2022 em Manaus/AM, Brasil, em três fases: 1) Fase teórica: revisão da literatura, busca em consensos, construção de quadros analíticos, seleção dos conteúdos; 2) Fase de construção do protocolo; 3) Fase de Avaliação do protocolo realizada por enfermeiros em relação à clareza, relevância e aplicabilidade. Resultados: Revisão da literatura obteve 15 artigos e cinco consensos de sociedades científicas. O protocolo está composto por 11 itens, ressaltando a identificação de fatores de risco; manifestações de hiperglicemia e hipoglicemia; cuidados de enfermagem; processo de enfermagem e fluxograma. A avaliação dos enfermeiros foi favorável obtendo IVC de 1,0 em relação à clareza e relevância e considerado aplicável. Conclusão: O protocolo subsidiará a assistência de enfermagem na monitorização glicêmica, possibilitando melhor controle da glicemia de pessoas com diabetes hospitalizadas.

ABSTRACT Objective: Developing a nursing care protocol for glycemic monitoring of hospitalized individuals with Type 2 Diabetes Mellitus. Method: Methodological research conducted in 2021 and 2022 in Manaus, state of Amazonas, Brazil, in three phases: 1) Theoretical phase: literature review, consensus search, development of analytical frameworks, content selection. 2) Protocol development phase. 3) Protocol evaluation phase conducted by nurses regarding clarity, relevance, and applicability. Results: The literature review yielded 15 articles and five consensus statements from scientific societies. The protocol consists of 11 items, with an emphasis on the identification of risk factors, manifestations of hyperglycemia and hypoglycemia, nursing care, the nursing process, and a flowchart. The nurses' evaluation was favorable, achieving an CVI of 1.0 regarding clarity and relevance, and it was considered applicable. Conclusion: The protocol will support nursing care in glycemic monitoring, enabling better glycemic control for hospitalized individuals with diabetes.

RESUMEN: Objetivo: Desarrollar un protocolo de atención de enfermería para el monitoreo glucémico de personas hospitalizadas con Diabetes Mellitus tipo 2. Método: Investigación metodológica desarrollada en 2021 y 2022 en Manaos/AM, Brasil, en tres fases: 1) Fase teórica: revisión de la literatura, búsqueda de consenso, elaboración de cuadros analíticos, selección de contenidos; 2) Fase de elaboración del protocolo; 3) Fase de evaluación del protocolo realizada por enfermeros sobre la claridad, relevancia y aplicabilidad. Resultados: La revisión de la literatura obtuvo 15 artículos y cinco consensos de sociedades científicas. El protocolo consta de 11 ítems, que destacan la identificación de factores de riesgo; manifestaciones de hiperglucemia e hipoglucemia; cuidados de enfermería; proceso de enfermería y diagrama de flujo. La evaluación de los enfermeros fue favorable, se obtuvo un IVC de 1,0 para la claridad y relevancia y se consideró aplicable. Conclusión: El protocolo ayudará en los cuidados de enfermería para el monitoreo glucémico, permitiendo un mejor control de la glucemia en personas hospitalizadas con diabetes.

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Objetivo: analisar as estratégias de promoção do clima ético positivo sob a perspectiva de enfermeiros hospitalares. Método: estudo qualitativo e descritivo exploratório, realizado com 182 enfermeiros de um hospital universitário do sul do Brasil. A coleta dos dados ocorreu por meio de um questionário sociodemográfico, laboral e uma pergunta aberta sobre estratégias de promoção do clima ético positivo. A organização dos dados ocorreu no software Atlas TI 8.0, versão 2019, e aplicou-se análise temática dos dados. Recebeu aprovação do Comitê de Ética em Pesquisa da instituição envolvida. Resultados: a macro categoria "Organização do trabalho" elencou itens sobre as relações na equipe, gestão, educação permanente e condições de trabalho. A macro categoria "Dimensão ética do trabalho" se referiu a exigências, valores pessoais e profissionais, expressão e sensibilidade moral. Conclusão: as estratégias de melhores condições de trabalho e organização, bem como o tratamento das questões éticas e relações interpessoais promovem o clima ético positivo(AU)

Objective: to analyze strategies for promoting a positive ethical climate from the perspective of hospital nurses. Method: qualitative and descriptive exploratory study, carried out with 182 nurses from a university hospital in southern Brazil. Data collection occurred through a sociodemographic and employment questionnaire and an open question about strategies for promoting a positive ethical climate. The data was organized using the Atlas TI 8.0 software, version 2019, and thematic analysis of the data was applied. It received approval from the Research Ethics Committee of the institution involved. Results: the macro category "Work organization" listed items on team relationships, management, continuing education and working conditions. The macro category "Ethical dimension of work" referred to demands, personal and professional values, expression and moral sensitivity. Conclusion: strategies for better working conditions and organization, as well as the treatment of ethical issues and interpersonal relationships promote a positive ethical climate(AU)

Objetivo: analizar las estrategias para promover un clima ético positivo desde la perspectiva de los enfermeros hospitalarios. Método: estudio cualitativo y descriptivo exploratorio, realizado junto a 182 enfermeros de un hospital universitario del sur de Brasil. La recolección de datos tuvo lugar mediante un cuestionario sociodemográfico y laboral y una pregunta abierta sobre estrategias para promover un clima ético positivo. Los datos se organizaron por medio del software Atlas TI 8.0, versión 2019, y se aplicó análisis temático de los datos. Recibió la aprobación del Comité de Ética en Investigación de la institución involucrada. Resultados: la macro categoría "Organización del trabajo" enumeró ítems sobre las relaciones en el equipo, la gestión, la educación continua y las condiciones de trabajo. La macro categoría "Dimensión ética del trabajo" hacía referencia a exigencias, valores personales y profesionales, expresión y sensibilidad moral. Conclusión: las estrategias para mejores condiciones de trabajo y organización, así como el tratamiento de las cuestiones éticas y las relaciones interpersonales promueven un clima ético positivo(AU)

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INTRODUCTION: The global COVID-19 pandemic has increased the concern and risks of health professionals exposed by acting on the front lines in combating and controlling the spread of the virus. This study aims at analyzing the workloads and their implications for the activities carried out by managers and health workers in the face of the COVID-19 pandemic in Manaus, Amazonas, Brazil. METHOD: This is a qualitative study, of the case study type, that integrates a macro research that deals with the experiences built during the confrontation of the pandemic of COVID-19 in the capital of the state of Amazonas, Brazil, the epicenter of the pandemic in the country. Data production resorted to documentary analysis and semi-structured interviews with 56 managers or professionals from the Manaus Health Care Network. The analytical process was supported by the resources of the Atlas.ti 8.0 software and the precepts of Thematic Networks analysis. RESULTS: The thematic network "workloads" brought together three topics related to the experience of psychological, physiological and biological loads. Psychological workloads were strongly present in the work routine, being referred to in a more significant way. The sources that increase them are strongly related to work stress, dealing with suffering and death and excess demand on the service. Physiological loads were related to excessive working hours, staff shortages and activity overload. "Biological burdens" include exposure to the SARS-CoV-2 virus, constant contact with infected individuals, and individual protection as key elements of this set. CONCLUSION: The study showed that both managers and workers have work processes and environments with conditions that tend to generate workloads that harm their health and safety, as well as institutions and patient care. Therefore, there is a need for more effective organizational actions in workers' health surveillance, disease prevention, adequate working conditions, reducing workloads and promoting more resolute and less stressful work environments.

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Background and Purpose: To describe the process of developing and validating the content of the Patient Advocacy Scale for Nurses in Intensive Care (EAPEnf-UTI). Methods: Methodological research. To achieve the elaboration objective, five stages were developed: (a) definition of the theme, (b) generation of the number of items, (c) determination of the measurement format, (d) validation of face and content, and (e) content adjustment. Results: The instrument elaborated from a survey and integrative literature review, and the measurement format chosen was the 5-point Likert scale. The validation of face and content was performed by expert judges and by pretest. The final instrument had 57 items. Conclusion: EAPEnf-UTI is a pioneering instrument built in the Brazilian context, whose future validation will allow the capturing of situations specific to intensive care units and the professional practice of intensive care nurses.

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OBJECTIVE: To assess the intensity and frequency of moral distress in mental health nurses in Brazil. METHOD: Cross-sectional study with 173 nurses from the Psychosocial Care Network in Brazil. The Brazilian Scale of Moral Distress in Nurses, adapted for the context of mental health, was used. For data processing, descriptive and inferential statistical analysis was used. RESULTS: Mostly moderate levels of intensity and frequency of moral distress (medians between 2.25 - 3.73 and 2.00 - 3.22, respectively) were observed, with emphasis on the factors working conditions and social conflicts. CONCLUSION: The level of moral distress evidenced in mental health nurses in Brazil reflects the dimension and amplitude of the phenomenon in different points of the Psychosocial Care Network. The relevance of discussions on coping strategies for moral distress is highlighted, articulating elements such as sensitivity, resilience, and moral courage, so that ethical deliberation is applied in care and management settings.

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This study aimed to understand the expressions of fear in the journeys of health professionals who worked in the confrontation of coronavirus disease 2019 (COVID-19), in the city of Manaus, in the Brazilian Western Amazon. This is an exploratory qualitative study that adopts interpretive description as a method to generate informed knowledge responsive to the needs of the practice. We included 56 participants, comprising 23 health managers and 33 health workers (middle and higher level) of different professional categories. The results revealed three circles of experience: (1) knowledge and professional experience in dealing with the disease (unknown-known-experienced); (2) the growing proximity to death and loss (predicted-witnessed-suffered); and (3) the involvement and proximity to whatever affects the individual, their emotions, and personal transformations in the face of the threat (the collective, the neighbor, and oneself). Our results suggest that health professionals who worked during the COVID-19 pandemic in Manaus experienced insecurity, dread, and fear, illustrating the complexity of developing their activities in the front line of care and management during the different phases of the pandemic. A contribution of the study is precisely that of capturing this complexity, which suggests the impossibility of analyzing fear only in its simple manifestation, or in each circle of experience.