Validación de la Versión Brasileña de la Escala Modificada de Delimitación de la Función del Enfermero de Prácticas Avanzadas

Minosso, Kamila Caroline; Santos, Mauricio Bedim dos; Toso, Beatriz Rosana Gonçalves de Oliveira

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Revista Brasileira de Enfermagem

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ORIGINAL ARTICLE • Rev. Bras. Enferm. 77 (2) • 2024 • https://doi.org/10.1590/0034-7167-2023-0211 copiar

Validación de la Versión Brasileña de la Escala Modificada de Delimitación de la Función del Enfermero de Prácticas Avanzadas

Autoría SCIMAGO INSTITUTIONS RANKINGS

RESUMEN

Objetivos:

validar la Escala Modificada de Delimitación de la Función del Enfermero de Prácticas Avanzadas, versión brasileña.

Métodos:

estudio metodológico de validación clínica de un instrumento, realizado con 207 enfermeros activos en la atención primaria. Se utilizaron análisis factorial exploratorio y confirmatorio, prueba alfa de Cronbach y prueba z para la comparación de proporciones.

Resultados:

la fiabilidad interna de la escala fue de 0,944, y el alfa fue mayor que 0,80 en la mayoría de los dominios, excepto en Educación (0,786). En el análisis factorial exploratorio, considerando el criterio de autovalor mayor que uno, se identificaron ocho factores, explicando el 79,38% de la varianza. En la comparación de proporciones, las respuestas suficientes (≥ 2) en el dominio de Cuidados Integrales Directos, en ambos grupos analizados, fueron estadísticamente iguales. Este dominio tuvo la mayor puntuación de respuestas suficientes, seguido por Educación y Apoyo de Sistemas. Se observó una puntuación insuficiente en los dominios de Publicación y Liderazgo Profesional.

Conclusiones:

el instrumento demostró estabilidad y fiabilidad para ser utilizado en la evaluación de la práctica avanzada de enfermería.

Descriptores:
Enfermería; Enfermería de Práctica Avanzada; Atención Primaria de Salud; Estudio de Validación; Enfermería en Salud Pública

Component	Eigenvalue	Explained Variance	Cumulative Explained Variance
1	14.63	35.68%	35.68%
2	6.41	15.64%	51.32%
3	2.65	17.01%	68.33%
4	1.56	2.52%	70.85%
5	1.47	2.44%	73.29%
6	1.30	2.28%	75.57%
7	1.03	2.04%	77.61%
8	1.00	1.77%	79.38%

Question (Dimension)	Components
Question (Dimension)	1	2	3	4	5	6	7	8	h^{2^* * h2 - Shared Variance;}
4.3(4) Contributes to the identification of potential funding sources for the development and implementation of clinical projects/programs.	0.33								0.49
5.1(5) Disseminates nursing knowledge through presentations or publications at local, regional, national, and international levels.	0.47								0.59
5.2(5) Acts as a resource or member of committees in professional organizations.	0.70								0.66
5.3(5) Serves as a consultant for individuals and professional or lay groups and other hospitals/institutions.	0.52								0.53
5.4(5) Represents nursing in institutional or community forums focused on the educational needs of various population groups.	0.96								0.88
5.5(5) Represents the image of the nursing professional in institutional and/or community forums.	0.89								0.82
5.6(5) Collaborates with other healthcare professionals to provide leadership in formulating public health policies.	0.64								0.68
1.3(1) Identifies and requests diagnostic tests and procedures.		0.43							0.43
1.4(1) Gathers and interprets assessment data to formulate a care plan.		0.59							0.61
1.6(1) Assesses patient/family response to the proposed treatment and modifies the care plan based on the response.		0.96							0.88
1.7(1) Communicates the care plan and responses to the patient/family.		0.70							0.66
1.10(1) Acts as a consultant (expert guidance) in improving patient care and nursing practice based on area of expertise.		0.32							0.28
1.11(1) Facilitates the ethical decision-making process in patient care.		0.45							0.55
2.7(2) Acts as a mentor/tutor/preceptor/guide.			0.84						0.75
3.2(3) Serves as an educator and clinical preceptor for nursing and/or medical students, staff, and/or others.			0.95						0.92
2.2(2) Contributes to, consults on, or collaborates with other healthcare professionals in recruitment and retention activities (monitoring the professional’s clinical practice over a certain period for definitive hiring and/or approval in a public service probationary stage).				0.51					0.49
2.3(2) Participates in the strategic planning of the service, department, management, hospital directorate, or health system.				0.77					0.64
2.4(2) Directs and participates in quality improvement programs for the unit/service.				0.90					0.78
2.5(2) Actively participates in the development, implementation, and evaluation of quality improvement programs in collaboration with nursing leadership.				0.83					0.74
2.6(2) Demonstrates leadership in developing, implementing, and evaluating practice protocols, policies, and procedures.				0.64					0.58
4.1(4) Conducts clinical research.					0.76				0.61
4.2(4) Participates in research to monitor and improve the quality of care practices.					0.91				0.87
1.12(1) Coordinates interdisciplinary/interprofessional care plans for patients.		0.31				0.34			0.52
1.13(1) Collaborates with other services to optimize the patient’s health status.						0.49			0.58
1.14(1) Facilitates patient flow among various healthcare system services.		0.32				0.44			0.56
2.1^ Factor Loading < 0.3. (2) Consults with other professionals regarding the conduct of projects and presentations.		0.20	0.23	0.24	0.21	0.26			0.46
3.1^ Factor Loading < 0.3. (3) Evaluates ongoing education programs and recommends revisions when necessary.	0.20	0.20				0.25			0.53
3.3(3) Identifies learning needs of various population groups and contributes to the development of educational programs and resources.	0.32		0.30			0.44			0.69
3.5(3) Facilitates the professional development of the nursing team through continuing/permanent education.						0.37		0.35	0.68
3.6(3) Provides appropriate education to patients and families.						0.36			0.48
1.1(1) Performs and documents patient history and physical examination.							0.62		0.59
1.2(1) Assesses psychosocial, cultural, and religious factors that interfere with patient needs.		0.39					0.40		0.47
1.5(1) Performs specific care and procedures.							0.46		0.43
1.8(1) Promotes health education (counseling) to patients/families.							0.46		0.57
1.9(1) Adequately documents in the patient’s medical record.							0.73		0.66
2.8(2) Advocates for the role of nursing.								0.36	0.34
2.9(2) Acts as a spokesperson for nursing and the service when interacting with other professionals, patients, and the general public.								0.44	0.41
3.4(3) Serves as an educator for the team during direct care activities.								0.39	0.46
4.4(4) Uses research and integrates theory into practice, recommending changes in strategies/policies based on research.						0.31		0.43	0.58
4.5(4) Identifies clinical data that need to be collected and which are available in information systems/medical records for nursing and obstetrics research, as well as for quality assurance projects.								0.53	0.63
4.6(4) Collaborates with Information Specialists in designing information systems for research projects and quality assurance in nursing and obstetrics.								0.36	0.56

Dimension	Florianopolis (Santa Catarina) (n= 79)			Other States (n= 128)			p value
Dimension	Suficiente	Total	Proporção	Suficiente	Total	Proporção	p value
Comprehensive Direct Care	659	1106	0.596	1038	1792	0.579	0.377
Systems Support	248	711	0.349	602	1152	0.523	<0.001
Education	175	474	0.369	347	768	0.452	0.004
Research	72	474	0.152	240	768	0.313	<0.001
Publication and Professional Leadership	45	474	0.095	176	768	0.229	<0.001
General	1199	3239	0.370	2403	5248	0.458	<0.000

Dimension	All States		Santa Catarina		Rio de Janeiro		Paraná		Rio Grande do Sul
Dimension	Average	% ≥ a 2	Average	% ≥ a 2	Average	% ≥ a 2	Average	% ≥ a 2	Average	% ≥ a 2
General	2.1	60.4%	2.0	55.7%	2.4	78.3%	2.2	56.1%	2.2	57.1%
Comprehensive Direct Care	2.7	82.6%	2.7	87.3%	2.7	82.6%	2.6	80.5%	2.5	81.0%
Systems Support	2.2	59.4%	2.0	50.6%	2.4	69.6%	2.3	61.0%	2.3	66.7%
Education	2.2	60.9%	2.0	57.0%	2.6	87.0%	2.2	51.2%	2.2	61.9%
Research	1.7	39.1%	1.4	24.1%	2.3	78.3%	1.7	36.6%	1.8	42.9%
Publication and Professional Leadership	1.2	25.6%	0.9	16.5%	1.8	47.8%	1.3	29.3%	1.4	28.6%

Associação Brasileira de Enfermagem SGA Norte Quadra 603 Conj. "B" - Av. L2 Norte 70830-102 Brasília, DF, Brasil, Tel.: (55 61) 3226-0653, Fax: (55 61) 3225-4473 - Brasília - DF - Brazil
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[1] Corresponding author: Kamila Caroline Minosso, E-mail: kamiminosso@outlook.com