Brazilian Nursing Technology Production: An Integrative Review

Aim: Technology is essential for nursing care and is seen as support that puts a transforming action into practice. Methods: Integrative review consulting 97 issues of the Revista Brasileira de Enfermagem published from 2000 to 2015. Results: A total of 2,163 papers were identified, 15 of which were included in the corpus of analysis: 40% of these referred to technologies aimed to aid direct care provided to patients, 33% addressed education in nursing; and 27% addressed the management of services. The largest number (three) of papers was published between 2010 and 2011, followed by two papers published in 2009. The remaining years together totalled 46%. Conclusion: Given the daily practice of nurses, they are able to identify needs that can be met by the production of technology of their own authorship or in partnership with other professionals. Nonetheless, the papers do not present a discussion from this perspective or regarding intellectual property and do not present a taxonomy regarding technology and technological production in the nursing field.


Introduction
The term technology has been frequently used by various fields in Brazilian and international nursing and is "seen as a set of tools, among them work actions, which put into movement a transforming action of nature" [1].
In the historical process of techniques and technologies, these cannot be interpreted as only a description of products that were discovered or created. These also refer to life conditions, arising from circumstances in various situations, which can either favor or harm human performance in the development of artefacts and in the way world is transformed [2].
Technologies in the nursing field overcome a strictly technicalscientific nature because interpersonal relationships are key and a priority in the practice of nurses [3]. In this sense, the definition of technology is not directed to a product only, but also to the broader sense of a process that is based on knowledge and instruments mutually connected, which justifies and define the various forms in which care is provided. Hence, technology plays a mediating role between human subjectivity and rationality, structuring and improving healthcare [4,5].
In this sense, there is no single classification for the different types of technologies. Two segments were addressed in the 20th century based on the understanding of health technologies, namely: technology of products and technology of processes. These approaches guide the definition of technology, though some consider these to be insufficient to encompass the complexity that delineates it [1].
Technologies are important tools for nursing. They are used in teaching as didactic resources, seeking a pedagogical process and also used in research addressing education in nursing. In management, technologies are used in the planning of scales, care actions and in the supervision of services, while technologies also guide proper procedures in the care delivered to patients [6].
Nurses use technologies to acquire or improve skills compatible with their functions as either a member of the health staff, a professor or a manager. Technological advancements have influenced the work of nurses and have led to changes in the various professional settings [7].
Constant change, adaptation and improvement in care delivery highlight the central role of nurses in the development of technologies. The reason is that nurses have scientific knowledge and daily experience with the delivery of care, which enables them to recognize the need for new products and processes.
For this reason, the objective established for this study was to identify papers addressing the topic of technological production published in the Revista Brasileira de Enfermagem from 2000 to 2015.

Methods
This integrative review is based on 97 issues of the Revista Brasileira de Enfermagem (REBEn) and 2,163 papers published from 2000 to 2015. Data were collected between June and August 2016, using the following descriptors found in the BIREME platform: Scientific and An electronic spread sheet was built as a database in the first stage after locating the manuscripts, so three analysts could consult it by the papers' titles that were linked to electronic versions of the papers. In the second stage, three independent analysts read the abstracts and those that referred to technology and met the following criteria were selected: quantitative approach, original paper, addressing patents and intellectual property, authored or co-authored by a nurse. The exclusion criteria were: qualitative approach, essays, theses, dissertations, experience reports, editorials, chronicles, letters, interviews, news reports, papers the authorship or co-authorship of which did not include a nurse or yet, the authors' background was not reported.
The full texts were read in the third stage. Table 1 was developed after excluding those considered being outside the topic after the results from the independent analysts were reconciled.  Finally, Figure 1 presents a flowchart with the synthesis of the review process.

Results
This review and analysis of papers published in REBEn employed criteria defined in the Method section so that 97 issues were analyzed, which resulted in the identification of 2,163 manuscripts.
A total of 2,140 papers were excluded in the process, so that 23 papers remained. A deeper analysis resulted in the exclusion of another eight papers and 15 papers remained for the final analysis. These papers focus on the following areas of knowledge within nursing: six (40%) papers address direct care provided to patients; five (33%) focus on education in nursing; and four (27%) focus on the management of services.
The highest number of papers, that is three (20%) papers, was published between 2010 and 2011 followed by two (14%) papers published in 2009. The remaining years together totalled 46%.
The results refer to the benefits, weaknesses and requirements of technology for nursing, the correct use of the term technology and technological advancements in nurses' professional practice (Table 1).

Discussion
The development of health technologies seeks solutions to problems presented by various authors who work in health services and related facilities. The nurses' daily care practice reveals new needs, which can lead to the development of new products and processes, that is, innovations that can be used in the application of nursing care [23].
Technologies can aid managerial processes, practical actions and teaching/learning. Therefore, the use of technologies to perform nurses' daily tasks and functions ensures new forms of providing care [7].
The Revista Brasileira de Enfermagem (REBEn) is one of the resources that the professional class association created to disseminate knowledge of nursing. Hence, it is committed to promoting discussions on emerging themes in the scientific community. For this reason, this study presents the technological production contained in the papers published by REBEn from 2000 to 2015.
The papers indicate that technological production for education is focused on information technology. Hence, professors or researchers use existing computer technology or develop it to make teaching content available to nursing undergraduate students.
Educational technologies, mainly software, seek to break from traditional teaching paradigms, transforming learning and demanding changes of those involved in the process [9,17]. Rapidly developing information technologies have expanded didactic approaches and teaching strategies, innovating the way knowledge is acquired, promoting interaction among students, professors and content from a more dynamic and accessible perspective.
A diversity of content was found, namely: mental health, child health, Theory of Meaningful Learning, intensive care and intravenous therapy. The adequacy of technologies was highlighted because they enable the inclusion of different topics for teaching, in addition to the different forms through which they can be accessed: CD-Rom, Web-CT (Web Course Tools), Moodle platform (Modular Object-Oriented Dynamic Learning Environment), Microsoft PowerPoint Office 2007 and Wiki tool [9,17,18,20]. experimentation with new procedures in care delivery [11][12][13]16,19,21].
The technologies focused on care delivery do not use computer tools in their development, assessment or experimentation. The studies present technologies to solve problems in the various settings of nurses' practice, from the instrumentalization of professionals to record care delivery to the development of technology to include the vision impaired [11][12][13]16,19,21].
The papers addressing technological production directed to management sought to assess, compare, and implement technologies for managers to use in hospital or PHC settings or even in home care. The studies used computer-based technological resources, presented instruments for use and manual or observational recording, the construction and validation of instruments and assessment of their adequacy for mastering new technologies [10,[14][15]22].
Additionally, it is possible to observe that technologies of this nature have the capacity to encompass on a large scale what one wants to manage, for instance, the use of a cartographic basis for the georeferencing of a community or the use of a management system for material and inventory control applied to the sectors of a hospital [14,15].
The papers did not present information regarding patents or intellectual property or even the responsibility nurses have in protecting nurses' capacity of production.
The papers addressing technological production show the complexity in which the work of nurses is involved, given the diversity of areas, services, target public, and because nurses assume multiple functions, which require a professional to have a proactive attitude when searching for solutions.

Conclusion
Technologies permeate nurses' professional practice in the educational, care delivery, and managerial dimensions. Given the daily practice of nurses, they are able to identify needs that can be met with the production of technologies of their own authorship or in partnership with other professionals.
Technologies represent a business opportunity for nurses when products result from research projects. The papers under study, however, do not present this perspective. Additionally, no discussions were found regarding standards regulating new creations or intellectual property protection.
The papers presented various conceptions regarding the term technologies, showing that nursing is in a development process to some degree. Therefore, no taxonomy concerning technology and technological production in nursing was found.