Evaluación de la competencia profesional del enfermero en urgencias: Instrumento creado y validado

Holanda, Flávia Lilalva de; Marra, Celina Castagnari; Cunha, Isabel Cristina Kowal Olm

doi:10.1590/0034-7167-2016-0595

Flávia Lilalva de Holanda CORRESPONDING AUTHOR: Flávia Lilalva de Holanda. E-mail: flholanda@uol.com.br

Universidade Federal de São Paulo, São Paulo School of Nursing. São Paulo, Brazil.

Celina Castagnari Marra

Universidade Federal de São Paulo, São Paulo School of Nursing. São Paulo, Brazil.

Isabel Cristina Kowal Olm Cunha

Universidade Federal de São Paulo, São Paulo School of Nursing. São Paulo, Brazil.

CORRESPONDING AUTHOR: Flávia Lilalva de Holanda. E-mail: flholanda@uol.com.br

Variables	Concept
Degree of professional competence	Numeric value obtained from the competence in the analysis of the quality of the actions of nurses in emergency.
Level of professional competence	Quality obtained by the performance of nurses in emergencies.
Frequency of action	Frequency with which the actions proposed to the competent practice of nurses in emergencies are carried out.
Autonomy	Relation of independence of nurses and the need for supervision in daily practice of actions in emergencies, considering their complexity.
Complexity of the action	It considers the required knowledge associated with the proper techniques for nurses to take actions in their daily practice, from the basic to the advanced ones.
Results of the actions	Result obtained by the range of the objectives recommended for the excellence for the practice in emergencies.

Research instrument of reliability of nurses in emergency actions proposed by Brazilian researchers Part C – Parameters of the level of competence of nurses in emergency services Guidance for using the research instrument
To choose the level of competence to be indicated in each action, please consider the quality of devotion to the provided care as a ref- erence, i.e., the association of the following variables: frequency, autonomy, complexity, and result of the action, in such a way that it corresponds to the level of competence you deem more appropriate for each action described.
The parameters delimiting the levels of competence of nurses in emergencies, such as “Extremely competent” and “Not competent at all”, will serve as a reference for you to reply the three cases exemplified and to the self-evaluation or hetero-evaluation described next:

	Degree/Level of competence	Quality of devotion to the provided care
	5 Extremely competent	Always perform the action described in your daily practice with all required knowledge and use of proper techniques, independently and without any need for supervision when taking managerial and assistance activities at all levels of complexity, achieving the recommended objectives to execute it.
	4 Very competent	Almost always perform the action described in your daily practice with the aimed knowledge and use of proper techniques, independently, although with the need for supervision when taking more complex managerial activities, in such a way to achieve the recommended objectives to execute it.
	3 Competent	Frequently perform the action described in your daily practice with enough knowledge and use of proper techniques, independently and with the need for supervision exclusively when taking more complex managerial activities, achieving the recommended objectives to execute it.
	2 Little competent	Sometimes perform the action described in your daily practice with a certain lack of knowledge, and often without the use of proper techniques, not always independently and therefore with need for supervision in assistance and managerial actions of medium complexity, in order to achieve most of the objectives recommended to execute it.
	1 Not competent at all	Rarely perform the action described in your daily practice, with a lack of knowledge and not using proper techniques, requiring constant supervision in the actions of low complexity in such a way to achieve the objectives recommended in the plan.

Part D – Assessment of level of competence presented by the nurses in the following situations. Mark with an “X” the degree of competence that best depicts the reality of the work of nurses described in each case.
Case 2 – Adult man, mixed-race, aged approximately 30 years was found lying in the street victim of a gunshot wound in the chest. He was attended by rescuers and sent to the Emergency Room (ER). On that late shift on Sunday, as a routine determined by the nurse, only half the nursing staff that should compose the scale in the ER was present. When the rescuers arrived, most of the nursing staff was already attending a young person, ZBN, aged 20 years, victim of a motorcycle fall, and also an older lady, AMS, aged 65 years, with a history of sudden and bounding headache. Immediately, the nurse who was providing care to the old lady, AMS, received the gunshot victim and asked the nursing technician who was taking care of the patient FCD, aged 35 years, who was confused and without a companion, to get the chest drainage material. While the technician was picking up the material, his/her patient fell out of the bed, before the nurse or his/her team could intervene. The husband, who was outside waiting to visit her, heard the screams of his wife and broke into the ER. When he saw her lying on the floor, he started arguing with the nurse, who sought to avoid conflicting behaviors when hearing his complaints.
	Nurses’ actions in emergencies	Competence degree
	Nurses’ actions in emergencies	5	4	3	2	1
	Listen to people with clear interest in meeting their requests.
	Use the freedom of action regarding the law and without harm to others.
	Consider the risks involved when choosing actions.

Part E – Representative items of actions of nurses in emergencies proposed by Brazilian researchers. Consider your actions on a daily basis to indicate the degree of competence that best reflects your work reality.
Actions for nurses’ practices in emergencies		Degree
		5	4	3	2	1
1. Overcome obstacles in the work with clear ideas.
2. Maintain emotional control when solving problems.
3. Constantly update the knowledge in emergencies.
4. Perceive the needs of people in the environment in which they are.
5. Manage agreements on work by dialoguing.
6. Periodically take part in realistic simulations in emergencies .
7. Maintain the right to privacy of each person.
8. Create favorable conditions for people to accept the ideas/attitudes/actions proposed by yourself or others.
Are attentive to the stimuli coming from	9. people;
	10. equipment;
	11. environment.
12. Make nursing diagnosis for the patient according to the theoretical reference adopted by the institution.
13. Clearly perceive the potential of people at work.
14. Work without prejudging people.
15. Make choices compatible with the freedom of action that you have.
16. Transform the existing reality at work.
17. Form bonds with colleagues at work.
18. Transmit messages without distorting their content with the means available to make it.
19. Make people feel members of a group.
20. Produce something new in the work reality.
21. Quickly perform the clinical evaluation of patients.
22. Act within the limits of ethics demanded by the globalized world when communicating with others.
23. Have transparent, honest and responsible behaviors in relationahips with people.
24. Provide adequate responses to the problems reported by people.
25. Identify causative agents of damage in the service provided to the patients.
26. Clearly demonstrate that you understand the needs of others.
27. Assume co-responsibility for the work of the nursing staff in providing care in emergencies.
28. Spontaneously provide help to one or more people at work in a coherent manner.
29. Listen to people without prejudging their ideas and positions.
30. Have energy, perseverance, and moral force in confronting the difficulties present in the everyday life.
31. Consider the risks involved when choosing actions.
32. Direct efforts to anticipate actions before problems arise.
33. Use other opportunities for your professional development.
34. Use the freedom of action regarding the law in force and without harm to others.
35. Share with others what a fact or thought means in the context in which it was exposed.
36. Act with self-confidence in unexpected work situations that can really be resolved by your interference.
37. Spontaneously conceive one or more useful ideas to the work completion.
38. Correctly evaluate the limits of people
39. Correct deviations found in the work environment.
40. Collectively achieve the objectives recommended in care plans aimed at the patients.
41. Expose positions in an impersonal way.
42. Control emotions before adversity and changes in daily work.
43. Maintains a healthy professional relationship with people.
44. Quickly perceive the reality that surrounds you.
45. Grant added value to the work reality.
Quickly adapt to unexpected situations at work without crossing	46. physical and
	47. mental boundaries.
48. Avoid conflicting behaviors with people.
49. Clarify doubts of others according to their needs.
50. Put into practice useful ideas in appropriate moments.
51. Develop a favorable environment to the emergence of new ideas at work.
52. Are responsible for your actions when providing care in emergencies.
53. Come up with ideas based on real events.
54. Separate truth from error as an essential condition to the analysis of situations of everyday life.
55. Accept people as they are.
56. Train people using the most appropriate means at all moments.
57. Use indispensable resources when providing care to the patients.
58. Fully comply with your obligations concerning the performance of the work.
59. Negotiate agreements with balance of the legitimate interests of the parties involved.
60. Use the minimum time required for the performance of the daily work.
61. Propose appropriate solutions for problems of the everyday life at the right time.
62. Determine the actions required to prevent damages in the service provided to patients.
63. Ensure the expression of the will of each person.
64. Establish priorities in the development of actions at work.
65. Seek to establish a harmonious contact with the other.
66. Identify the limit regarding your freedom of action.
67. Get the best performance possible in the work actions with the resources available to carry them out.
68. Clearly guide people.
69. Listen to people with clear interest in meeting their requests.
70. Act with self-confidence and rapidity when providing care to the patients.
71. Intervene at the right time in the face of the harms to the patients’ health.
72. Are open to ask people for help when the complexity of the situation thus requires.
73. Take calculated risks when directing actions of the nursing staff for providing care to the patients.
74. Correct deviations found in the care provided to patients at the right time.
75. Perform all kinds of nursing procedures with safe techniques.
76. Propose adjustments without causing conflicts.
77. Promptly consider the consequences of your actions in emergencies.
78. Maintain a good relationship when managing emotions at work.
79. Use resolutive actions as a strategy for the nursing staff to conclude the work guaranteeing the patients’ satisfaction.
80. Manage emotions to achieve an empathetic and professional relationship.
81. Use arguments consistent with the situation.

[1] CORRESPONDING AUTHOR: Flávia Lilalva de Holanda. E-mail: flholanda@uol.com.br

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Evaluación de la competencia profesional del enfermero en urgencias: Instrumento creado y validado

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