Knowledge of nursing professionals about the risk management process

Objective: To analyze the knowledge of nursing professionals about the Risk Management Process. Method: qualitative study conducted in a public maternity hospital. Data collection took place in June 2018 and was conducted through a semi-structured interview with the participation of 12 nursing professionals. Data were analyzed with the support of IRAMUTEQ Software. Results: the participants knew about risk management, but it was observed difficulties to conceptualize this process and when the actions taken in relation to the identification of a risk situation, they reported that they would trigger the patient's Safety Center, provide immediate assistance, would communicate the doctor/nurse and inform the institution's management through the ombudsman. Final Considerations: Knowledge about risk management is a theme that is far from the reality of some professionals, so it is necessary to improve the disclosure about what is risk management. Descriptors: Risk Management; Patient Safety; Nursing Care. RESUMO Objetivo: analisar o conhecimento dos profissionais de enfermagem sobre o Processo de Gestão de Riscos. Método: estudo qualitativo realizado em uma maternidade pública. A coleta de dados ocorreu em junho de 2018 e procedeu-se por meio de uma entrevista semiestruturada com a participação de 12 profissionais de enfermagem. Os dados foram analisados com o suporte do Software IRAMUTEQ. Resultados: os participantes conheciam sobre gerenciamento de risco, porém foi observado dificuldades para a conceituação deste processo e quanto as ações tomadas diante da identificação de uma situação de risco, os mesmos relataram que acionariam o Núcleo de Segurança do paciente, prestariam assistência imediata, comunicariam o médico/enfermeiro e informariam a gerência da instituição por meio da ouvidoria. Considerações Finais: O conhecimento sobre gerenciamento de risco é uma temática que se encontra distante da realidade de alguns profissionais, por isso é necessário melhorar a divulgação sobre o que se trata a gestão de riscos. Descritores: Gestão de Risco; Segurança do Paciente; Cuidados de Enfermagem. RESUMÉN Objetivo: analizar el conocimiento de los profesionales de enfermería sobre el proceso de gestión de riesgos. Método: estudio cualitativo realizado en una maternidad pública. La recopilación de datos tuvo lugar en junio de 2018 y se realizó a través de una entrevista semiestructurada con la participación de 12 profesionales de enfermería. Los datos fueron analizados con el apoyo del software IRAMUTEQ. Resultados: los participantes sabían sobre la gestión de riesgos, pero se observaron dificultades para conceptualizar este proceso y cuando las acciones tomadas en relación con la identificación de una situación de riesgo, informaron que activarían el Centro de Seguridad del paciente, proporcionarían asistencia inmediata, se comunicarían médico/enfermera e informar a la gerencia de la institución a través del defensor del pueblo. Consideraciones finales: El conocimiento sobre la gestión de riesgos es un tema que está lejos de la realidad de algunos profesionales, por lo que es necesario mejorar la divulgación sobre lo que es la gestión de riesgos. Descritores: Gestión de Riesgos; Seguridad del Paciente; Atención de Enfermería. How to cite: Silva LS, Resende NL, Damasceno CKCS, Sousa CMM. Knowledge of nursing professionals about the risk management process. Rev Pre Infec e Saúde[Internet]. 2019;5:8871. Available from: http://www.ojs.ufpi.br/index.php/nupcis/article/view/8871 DOI: https://doi.org/10.26694/repis.v5i0.8871.8274 Original Silva LS, et al Risk management process by nursing Rev Pre Infec e Saúde.2019;5:8274 2 INTRODUCTION Patient safety is an extremely important topic, as through many issues involving this theme, initiatives have been taken to raise awareness among healthcare professionals about providing safe and quality care.1 Thus, in 2013 was published Resolution of Collegiate Board No. 36, which provides for patient safety actions in health facilities, and among the various terms contained in it stands out Risk Management.2 This risk management is directly associated with health care, as it is an important tool in the early detection of situations that pose risks to the patient's health, as well as helping to resolve these issues and prevent further occurrences.3 In order to prevent incidents, it is necessary to identify risks, which is the first step of the Risk Assessment Process, which is characterized as a way of recognizing risks and seeking ways in the institution to solve them. Therefore, risk identification encompasses the identification of causes and sources of risk.4 It is important to highlight the existence of the Patient Safety Plan, which is a document prepared and updated by the Patient Safety Center, based on integrated risk management and prevention action strategies, which seeks to control and reduce risks to patients, caregivers and service workers. Thus, it is necessary that professionals are able to recognize the situations that contribute to the emergence of risks and the risks already present, so that they participate in the construction of patient safety resolution tools.1 Given this context, the question is: What do professionals know about risk management and what actions would they take if they identified a risk situation? Thus, the study aims to identify the risk management process in patient safety. The objective of this study was to analyze the knowledge of nursing professionals about the Risk Management Process and the specific objectives were to characterize the profile of the study participants regarding the variables: age, length of service, education, training and work shift and to know the use of the risk management process identification step by nursing professionals. METHODS This is a study with a qualitative approach, this type of approach is chosen in order to understand the opinion of an individual or collective being, about a certain theme that is part of their reality.5 The present study was conducted in a public maternity hospital of reference for high complexity in the municipality of Teresina-PI. In addition to all the services offered to the community, this maternity ward is an internship field of the Higher Education Institutions of the municipality, for both undergraduate and graduate students. Data collection was designed with 20 participants, but there was readjustment of the amount due to saturation of responses, so the final total was 12 participants, and their statements were identified as the collaborative name followed by cardinal numbering. Inclusion criteria were: being a nursing professional who has worked for more than 1 year in the institution and were excluded from the research Silva LS, et al Risk management process by nursing Rev Pre Infec e Saúde.2019;5:8274 3 professionals on legal leave (vacation, sick leave or maternity) or time off during data collection. The data collection took place in June 2018, through the use of the data collection instrument, the semi-structured interview, with structural and knowledge questions. Thus, the audio recorder and personal notebooks were used for annotation were transcribed and analyzed. These data were analyzed with the support of the IRAMUTEQ Software (Interface de R pour les Analyses Multidimensionnelles de Textes et de Questionnaires), which among the five different types of analysis were adopted, which were: descending hierarchical classification, similarity analysis and word cloud.6 Descending Hierarchical Classification (CHD) qualifies text segments according to their use in their vocabularies, and lexicographically analyzes the text and provides categorization into word classes, and each word class has a different color.7-8 Concerning the similarity analysis, it is based on the theory of graphs that allows to identify the cooccurrences between words and outcome, indicating the connection between words, which facilitates the identification of the textual corpus structure, due to this type of analysis, it constitutes a mathematical example in the study of the relations between discrete objects.9 In lexical analysis (word cloud), the vocabulary is characterized and quantified according to the frequency of the words, that is, it is possible to perform statistical calculations on qualitative data, which allows the researcher to interpret later. Therefore, this kind of analysis support differs from content analysis, in which there is first interpretation and only then systematization.6 This study complied with Resolution 466/2012 of the National Health Council, which deals with research with human beings. Thus, the Informed Consent Form was delivered and explained to each participant, and only after the signature and the indication by the professional of the most viable day for collection, that it was started. The research risks were minimal, such as embarrassment during the interview or insecurity regarding the confidentiality of the answers provided and to minimize them the researchers committed to maintain ethics at all times of the study development. This research was approved by the Research Ethics Committee of the UNINOVAFAPI University Center, under CAAE 80095617.2.0000.5210 and Opinion Number 2,409,549. RESULTS AND DISCUSSION As for the sociodemographic characteristics of the 12 participants interviewed, 90.9% were female, the age group was between 25-56 years, regarding professional category, 50% of the participants were nurses and the other half were nursing technicians and Operating time in the area ranged from 1-30 years. Regarding education, one participant had only high school, most participants had beyond the undergraduate, a lato sensu postgraduate, Silva LS, et al Risk management process by nursing Rev Pre Infec e Saúde.2019;5:8274 4 and all participated in training in the last 6 months. Dendrogram of Reinert Method Classification The Reinert Method Classification Dendrogram looks for classes from words that are significantly associated. The reading is performed from top to bottom, thus it is observed that the Corpus was presented in two subgroups, the upper subgroup was presented in one group (resulting class 3) and the lower subgroup was divided in two (resulting class 1 and 2). It appears that class 3 has little relationship with classes 1 and 2, but it is clear that class 1 has more proximity to class 2. Figure 01: Reinert Method Classification Dendrogram Note: The words of the dendogram and word clouds were kept in the original language to meet the specifics of the software and the adopted method. Word cloud Word Cloud processing exposes a group of grouped words, with a larger font display to those that had a high importance in the textual corpus, thus we verified that the word risk was the one that had the most frequency in the corpus 34 times, followed by the word patient 27 times (Figure 02). Silva LS, et al Risk management process by nursing Rev Pre Infec e Saúde.2019;5:8274 5 Figure 02: Word cloud Note: The words of the dendogram and word clouds were kept in the original language to meet the specifics of the software and the adopted method. When we questioned the professionals if they knew about Risk Management, four participants stated that they had never heard about this subject, but all gave their opinion about what they thought it was. The other participants knew about risk management and knew how to define, despite difficulties to conceptualize, but all brought a correct direction, as noted below: “It is to manage the various risks in the environment, and various methods can be devised to avoid them and not put the integrity of the patient at risk.” (Collaborator 04) “Risk management is to identify patientrelated adverse damage.” (Collaborator 07) “I believe it is anticipating future harmful occurrences to patients.”


INTRODUCTION
Patient safety is an extremely important topic, as through many issues involving this theme, initiatives have been taken to raise awareness among healthcare professionals about providing safe and quality care. 1 Thus, in 2013 was published Resolution of Collegiate Board No. 36, which provides for patient safety actions in health facilities, and among the various terms contained in it stands out Risk Management. 2 This risk management is directly associated with health care, as it is an important tool in the early detection of situations that pose risks to the patient's health, as well as helping to resolve these issues and prevent further occurrences. 3 In order to prevent incidents, it is necessary to identify risks, which is the first step of the Risk Assessment Process, which is characterized as a way of recognizing risks and seeking ways in the institution to solve them. Therefore, risk identification encompasses the identification of causes and sources of risk. 4 It is important to highlight the existence of the Patient Safety Plan, which is a document prepared and updated by the Patient Safety Center, based on integrated risk management and prevention action strategies, which seeks to control and reduce risks to patients, caregivers and service workers. Thus, it is necessary that professionals are able to recognize the situations that contribute to the emergence of risks and the risks already present, so that they participate in the construction of patient safety resolution tools. 1 Given this context, the question is: What do professionals know about risk management and what actions would they take if they identified a risk situation? Thus, the study aims to identify the risk management process in patient safety.
The objective of this study was to analyze the knowledge of nursing professionals about the Risk Management Process and the specific objectives were to characterize the profile of the study participants regarding the variables: age, length of service, education, training and work shift and to know the use of the risk management process identification step by nursing professionals.

METHODS
This is a study with a qualitative approach, this type of approach is chosen in order to understand the opinion of an individual or collective being, about a certain theme that is part of their reality. 5 The present study was conducted in a public maternity hospital of reference for high complexity in the municipality of Teresina-PI. In addition to all the services offered to the community, this maternity ward is an internship field of the Higher Education Institutions of the municipality, for both undergraduate and graduate students.
Data collection was designed with 20 participants, but there was readjustment of the amount due to saturation of responses, so the final total was 12 participants, and their statements were identified as the collaborative name followed by cardinal numbering. Inclusion criteria were: being a nursing professional who has worked for more than 1 year in the institution and were excluded from the research Silva LS, et al  analyzes the text and provides categorization into word classes, and each word class has a different color. [7][8] Concerning the similarity analysis, it is based on the theory of graphs that allows to identify the cooccurrences between words and outcome, indicating the connection between words, which facilitates the identification of the textual corpus structure, due to this type of analysis, it constitutes a mathematical example in the study of the relations between discrete objects. 9 In lexical analysis (word cloud), the vocabulary is characterized and quantified according to the frequency of the words, that is, it is possible to perform statistical calculations on qualitative data, which allows the researcher to interpret later. and all participated in training in the last 6 months.

Dendrogram of Reinert Method Classification
The Reinert Method Classification Dendrogram looks for classes from words that are significantly associated. The reading is performed from top to bottom, thus it is observed that the Corpus was presented in two subgroups, the upper subgroup was presented in one group (resulting class 3) and the lower subgroup was divided in two (resulting class 1 and 2). It appears that class 3 has little relationship with classes 1 and 2, but it is clear that class 1 has more proximity to class 2.

Figure 01: Reinert Method Classification Dendrogram
Note: The words of the dendogram and word clouds were kept in the original language to meet the specifics of the software and the adopted method.

Word cloud
Word Cloud processing exposes a group of grouped words, with a larger font display to those that had a high importance in the textual corpus, thus we verified that the word risk was the one that had the most frequency in the corpus -34 times, followed by the word patient -

Similarity Analysis
This analysis is based on the theory of From the graphical representation of Figure 03, it is possible to identify the link between the most frequent words, hich were: risk, patient and responsibility.

Figure 03: Similarity analysis
Note: The words of the dendogram, word clouds and similarity analysis were kept in the original language to meet the specifics of the software and the adopted method. Estratégias para promover segurança do