Primary Healthcare of black immigrants during the COVID-19 pandemic

OBJECTIVE

To analyze how the healthcare of black immigrants was conducted during the COVID-19 pandemic in Primary Healthcare.

METHOD

An exploratory-descriptive study with a qualitative approach, carried out through semi-structured interviews with professionals who worked in 10 Health Units in the city of Curitiba, Brazil, from October 2020 to January 2021. Structural racism was the conceptual framework. The statements were submitted to content analysis after using the MAXQDA program as support.

RESULTS

A total of 21 professionals from the multidisciplinary team participated and three categories emerged from the analyzes: Healthcare for black immigrants in PHC during the Covid-19 pandemic; Limits and potentialities of PHC for healthcare for black immigrants; Structural racism in PHC practices aimed at black immigrants.

CONCLUSION

Action in the pandemic was guided by protocols that did not expand healthcare to vulnerable populations, including black immigrants. The main barrier was communication, as most black immigrants in the surveyed locations were Haitians. Structural racism was identified in professional practice.

[Organization of healthcare systems to confront COVID-19: a scoping reviewOrganización de los sistemas de salud para hacer frente a la COVID-19: revisión del alcance]

Objective

To identify evidence in the literature on the response of managers regarding the organization of global healthcare systems to face the COVID-19 pandemic.

Method

For this scoping review, searches were performed in 11 databases accessible through the Virtual Health Library. Eleven studies, published in 2019 and 2020, were selected based on the following guiding question: "How did managers act to organize healthcare systems to face the coronavirus pandemic?". The results were organized in terms of the categories outlined in the Pan-American Health Organization's Framework for the response of Integrated Health Service Delivery Networks to COVID-19: governance; model of care; organizational and management; financial allocations.

Results

Managers in countries that invested and articulated actions in the categories of the Reference Framework, with coordination of care at the primary healthcare level, achieved better outcomes in coping with the COVID-19 pandemic.

Conclusions

Situating the coordination of healthcare systems at the primary care level, preparing managers and ensuring the continued allocation of financial resources to healthcare are important factors to secure a satisfactory response to crises such as the covid-19 pandemic.

Approaches of the systematization of nursing care, complexity and ontology in the professional practice of nurses

OBJECTIVE

To reflect on the approaches of the Systematization of Nursing Care, ontology and complex thinking in professional nursing practice.

METHOD

A reflective theoretical study grounded on the Complexity Theory of Edgar Morin and on the ontological principles of computational application which enables representing nursing concepts.

RESULTS

The paradigm of complexity breaks the linearity and expands the meaning of Systematization of Nursing Care, supporting a conceptualization of new entities and objectives, moving away from reductionism in work practice. Ontology is considered as a potential technology for creating a standardized language capable of representing the Systematization of Nursing Care from the perspective of complex thinking.

CONCLUSION

Ontology furthers the formal representation of Systematization of Nursing Care knowledge, creating strength in its identity, organization, and sharing its knowledge and information. Supporting the dissemination of common nursing vocabulary contributes to nurses' daily experience and decisions.

Case Management for People with Stroke: Quasi experimental study

Objective: to compare the effect of intervention by nurse-case manager on risk factors and blood pressure in post-stroke people. Method: quasi-experimental study conducted over six months with 14 post-stroke patients in southern Brazil. The intervention with case management consisted of nursing consultations, individualized educational actions and referrals to other professionals, operationalized in three home visits and six telephone contacts. For data analysis, descriptive statistics and Fisher’s test were used, with a significance level of p≤0.05. Results: Reduction of smoking (p=0.0414), alcohol intake (p=0), sodium consumption (p=0.0024), fat (p=0.0027), carbohydrate (p=0.0203) and sugar (p=0.0111), increased physical activity (p=0.0382) and non-significant reduction of blood pressure levels were observed. Conclusion: Nurse-led case management is a valid strategy to follow people recovering from stroke.

Gestión de casos para personas con accidente cerebrovascular: estudio cuasi experimental

Objetivo: comparar el efecto de la intervención de la enfermera gestora de casos sobre los factores de riesgo y la presión arterial en personas que han sufrido un accidente cerebrovascular. Método: estudio cuasi experimental realizado a lo largo de seis meses con 14 pacientes post ictus en el sur de Brasil. La intervención con gestión de casos consistió en consultas de enfermería, acciones educativas individualizadas y derivaciones a otros profesionales, operativas en tres visitas domiciliarias y seis contactos telefónicos. Para el análisis de los datos se utilizó la estadística descriptiva y la prueba de Fisher, con un nivel de significación de p≤0,05. Resultados: se observó una reducción del consumo de tabaco (p=0,0414), de la ingesta de bebidas alcohólicas (p=0), del consumo de sodio (p=0,0024), de la gordura (p=0,0027), de los carbohidratos (p=0,0203) y del azúcar (p=0,0111), un aumento de la práctica de la actividad física (p=0,0382) y una reducción no significativa de los niveles de presión. Conclusión: El manejo de casos, conducido por el enfermero, es una estrategia válida para acompañar a las personas en la recuperación de la acidez vascular cerebral.

GERENCIAMENTO DE CASO PARA PESSOAS COM ACIDENTE VASCULAR CEREBRAL: ESTUDO QUASE EXPERIMENTAL

Objetivo: comparar o efeito da intervenção por enfermeira gerente de caso nos fatores de risco e na pressão arterial de pessoas pós Acidente Vascular Cerebral. Método: estudo quase experimental realizado durante seis meses com 14 pacientes pós Acidente Vascular Cerebral no sul do Brasil. A intervenção com gerenciamento de caso foi constituída por consultas de enfermagem, ações educativas individualizadas e encaminhamentos a outros profissionais, operacionalizadas em três visitas domiciliares e seis contatos telefônicos. Para a análise dos dados, utilizou-se a estatística descritiva e teste de Fisher, com nível de significância de p≤0,05. Resultados: observou-se redução do tabagismo (p=0,0414), ingestão de bebida alcoólica (p=0), do consumo de sódio (p=0,0024), gordura (p=0,0027), carboidrato (p=0,0203) e açúcar (p=0,0111), aumento da prática de atividade física (p=0,0382) e redução não significativa dos níveis pressóricos. Conclusão: O gerenciamento de caso conduzido por enfermeiro é uma estratégia válida para acompanhar pessoas em recuperação de acidente vascular cerebral.

Aproximações entre sistematização da assistência de enfermagem, complexidade e ontologia na prática profissional do enfermeiro

RESUMO Objetivo: Refletir sobre as aproximações entre Sistematização da Assistência de Enfermagem, ontologia e pensamento complexo na prática profissional do enfermeiro. Método: Estudo teórico reflexivo fundamentado na Teoria da Complexidade de Edgar Morin e nos princípios ontológicos com aplicação computacional possíveis de representações conceituais na enfermagem. Resultados: O paradigma da complexidade rompe com a linearidade e amplia o significado da Sistematização da Assistência de Enfermagem, favorecendo a conceituação de novas entidades e objetivos, distanciando-se do reducionismo na prática laboral. Considera-se a ontologia como potencial tecnologia para criação de linguagem padronizada capaz de representar a Sistematização da Assistência de Enfermagem na perspectiva do pensamento complexo. Conclusão: A ontologia facilita a representação formal do conhecimento da Sistematização da Assistência de Enfermagem, gerando fortalecimento da sua identidade, organização, compartilhamento do conhecimento e informação. Aliada ao pensamento complexo, favorece a difusão de vocabulário comum à enfermagem, contribuindo na experiência e decisões dos enfermeiros.

Atenção às mulheres em situação de violência: construção de modelo de educação permanente em saúde

RESUMO Objetivo: Propor um Modelo de Educação Permanente em Saúde com estratégias vinculadas ao referencial das Cinco Disciplinas para o desenvolvimento de competências dos profissionais que atuam na atenção direta às mulheres em situação de violência. Método: Pesquisa qualitativa realizada pela técnica de grupo focal, com 16 profissionais que integram uma rede intersetorial em Curitiba-PR, de agosto a outubro de 2019. Dados analisados por análise de conteúdo na modalidade temática, à luz do referencial teórico das Cinco Disciplinas: domínio pessoal; modelo mental; visão compartilhada; aprendizagem em equipe; e, pensamento sistêmico. Resultados: As Cinco Disciplinas foram evidenciadas nas categorias, bem como estratégias a serem utilizadas para desenvolvimento de competências. Utilizou-se uma representação diagramática a ser percorrida durante processo de aprendizagem. Conclusão: As estratégias sugeridas pelos profissionais que atuam na atenção às mulheres em situação de violência apoiaram a proposição de um Modelo de Educação Permanente em Saúde baseado no referencial teórico adotado.

Care for women in situations of violence: construction of a model of permanent health education

ABSTRACT Objective: To propose a Permanent Health Education Model with strategies linked to the Five Disciplines framework for the development of competencies of professionals who work in direct care for women in situations of violence. Method: A qualitative research carried out by the focus group technique, with professionals who are part of an intersectoral network in Curitiba-PR, from August to October 2019. Data analyzed by content analysis in the thematic modality, in the light of the theoretical framework of the Five Disciplines: personal mastery; mental model; shared vision; team learning and systems thinking. Results: The Five Disciplines were evidenced in the categories, as well as strategies to be used for competence development. A diagrammatic representation was used to be covered during the learning process. Conclusion: The strategies suggested by professionals who work in the care for women in situations of violence supported the proposition of a Permanent Health Education Model based on the adopted theoretical framework.

MESTRADO PROFISSIONAL EM ENFERMAGEM: DEZ ANOS FORMANDO ENFERMEIROS PARA A INOVAÇÃO EM SAÚDE

Editorial

Liaison nurse competences at hospital discharge

OBJECTIVE

To identify the liaison nurse competences at hospital discharge in the light of Strengths-Based Nursing Care theoretical reference.

METHOD

Descriptive and qualitative study, developed at the province of Quebéc-Canada, with 23 liaison nurses. The data were collected from March to July 2016, by a semi-structured questionnaire via Survey Monkey® electronic platform and analyzed through the content analysis, supported by software Qualitativa Data Analysis Miner.

RESULTS

The categories that has emerged were: competences related to patient care, competences related to personal characteristics of the liaison nurse and managerial competences.

FINAL CONSIDERATIONS

Liaison nurses hold a set of competences from different dimensions, which provide the care centered in the person, in its potentialities, and assure the continuity of patient care with hospital discharge.

The role of nurses in the integration of care for people with chronic noncommunicable diseases

OBJECTIVE

To describe the role of nurses in the integration of care for people with chronic noncommunicable diseases.

METHOD

This was an integrated single-case study conducted with care coordinators and nurses, purposefully selected, with interviews, documentary analysis and computerized files as sources of evidence. Categorical analysis was used based on data organization using MAXQDA® software, version 2018.

RESULTS

Thirty-four professionals participated. Most of the professionals who held coordination positions were nurses. The categories clinical team integration and care integration and their subcategories increased understanding of the roles of nurses.

CONCLUSION

The role of nurses in integrating care for people with chronic noncommunicable diseases was mainly focused on coordination of care, which occurred because of the different roles that they play and that give them autonomy to make decisions and place them in the front line to contribute to situations that required assertive attitudes, such as directing users within the care network.

Innovative actions developed by nurses in primary health care

OBJECTIVES

to understand the work process dimensions related to innovative actions developed by nurses in Primary Health Care.

METHODS

qualitative, descriptive study, developed in Primary Health Care in a city in the Southern Region of Brazil. Seventy-six nurses, who worked in management and assistance, participated in this study through semi-structured interviews. After data processing by IRAMUTEQ software, the textual analysis occurred by descending hierarchical classification.

RESULTS

forty-two innovative actions, considered by the participants as new ways of working, were identified. There was a predominance of innovative actions related to the Management and Assist dimensions; we noticed the fragility of the actions to contemplate all the nurse's work process dimensions.

FINAL CONSIDERATIONS

the predominance of innovative actions was related to users' assistance and better conditions in the teamwork process, besides highlighting the role of nurses in the perspective of a new way of working in health services.

Managerial competences of researchers from Nursing research groups

Objective:

to analyze the managerial competences of researchers from research groups linked to a Graduate Program in Nursing.

Method:

a cross-sectional study with researchers from Nursing research groups, which analyzed the managerial competences by means of a Scale of Managerial Competences in Research Groups containing 50 items related to people management and research results (Factor 1) and resource provisioning and people management (Factor 2), with answers 4 and 5 considered as sufficient dexterity for each competence analyzed. For data analysis, logistic regression was used.

Results:

of the 219 participants evaluated, the prevalence was 48.86% of sufficient dexterity for factor 1 and 32.88% of sufficient dexterity for factor 2; with 41.21% of sufficient dexterity for Managerial Competences in research groups. A significant difference was identified in the proportions of the managerial competences for schooling, age group and performance in the group (p≤0.001). There were differences in mean age, time of experience with research and participation in the research group (p≤0.001), between the participants with sufficient and insufficient dexterity for the managerial competences.

Conclusion:

the results obtained in this study emphasize the potential of the research groups for the development of managerial competences of Nursing researchers, especially for people management.

Contributions of the Simplified Competency Management Model to a Municipal Health Secretariat

Objective:

to present the contributions of the Simplified Competency Management Model in a municipal health secretariat.

Method:

research of integrated mixed methods of exploratory-descriptive type. The model was applied in a southern Brazilian city, in the following stages: documentary, questionnaire, mapping of gaps and educational proposal.

Results:

in the first stage, after documentary research, a total of 14 general core competences were described and a questionnaire with specific core competences was chosen, with confirmation of correlation among them; in the second stage, the importance and expression competence at work degrees were obtained, after the questionnaires were filled out by 74 municipal public health managers; in the third one, a formula was adopted for the training priority degree and its classification; the fourth stage presented an educational proposal for the development of one of the competences with the highest priority degree.

Conclusion:

the model brings contributions by describing general core competences, after documentary research; carrying out the correlation between a questionnaire, containing specific core competences with the general ones; by mapping gaps; and by the proposal of learning trails for the development of competences.

Professional Nursing Communication Competence: Theoretical procedures for instrument development and pilot test

AIMS

To describe the theoretical procedures for the development of the Professional Nursing Communication Competence instrument, determine the content validity and describe the pilot test application.

BACKGROUND

Measuring instruments must be developed in accordance with the context and communication process by adopting theoretical procedures based on competence structures to support quality patient-centred care and nursing management.

METHODS

A methodological study was employed. The instrument was developed by using content-validated theoretical construct in accordance with 33 communication theories followed by semantic analysis and content validity by experts. The instrument was tested over three phases: before the lecture on professional nursing communication competence, after the simulation scenario experience and after debriefing.

RESULTS

The instrument showed an extremely high agreement (CVI = 0.99). Linear regression suggested three domains of the 46-item content-validated instrument comprising knowledge (18 items), skills (12 items) and attitudes (16 items).

CONCLUSION

The instrument was found to measure professional communication competence with a high theoretical reliability of the contexts and processes through a simulation strategy.

IMPLICATIONS FOR NURSING MANAGEMENT

Nursing educators, managers and staff can adopt the Professional Nursing Communication Competence (IMC-CPE) instrument to improve the effectiveness level of knowledge, skills and attitudes to reduce misunderstanding among team members and health care errors.

Percepção das mulheres em situação de violência sobre o apoio formal: Scoping review

RESUMO Objetivo Examinar e mapear as evidências científicas acerca das percepções das mulheres em situação de violência quanto aos serviços de apoio social formal. Método Scoping Review, conforme Joanna Briggs Institute e a questão norteadora: “Qual a percepção das mulheres em situação de violência ao buscar atendimento profissional nos serviços de apoio?”. Inclusos estudos nacionais, internacionais, primários, abordagens qualitativas, quantitativas, métodos mistos, idiomas inglês, português e espanhol, no espaço temporal de 2014 a 2019. Realizadas buscas em sete bases de dados, encontrados 1557 artigos e selecionados 16 como amostra final. Resultados Os atendimentos evidenciaram a escuta ativa, criação de vínculo e articulação dos serviços. Como também a falta de acolhimento; sentimento de insegurança, medo e humilhação. O processo de capacitação foi estabelecido pelos artigos como ferramenta aos profissionais, na promoção de abordagem direcionada e individualizada. Conclusões e considerações para a prática O acolhimento e vínculo propiciado por alguns serviços de apoio resultou em propostas de mudanças e suscitou nas mulheres reflexão, confiança e busca para saída do ciclo da violência. O contrário gerou afastamento dos serviços e consequente permanência junto ao agressor.

Primary Healthcare management strategies in socially vulnerable territories exposed to violence

OBJECTIVE

To identify management strategies used by the Family Health Strategy teams of a Basic Health Unit in organizing work in socially vulnerable territories exposed to violence.

METHOD

A single case study with a qualitative approach in a family health unit located in the southern region of Brazil. Data collection was conducted through individual interviews with 27 health professionals from August to September 2017 and a focus group with 18 participants in April 2018. Data organization and processing was performed with the support of the IRAMUTEQ software program and subsequently the content analysis technique.

RESULTS

The five classes characterized strategies used by professionals to provide care to the population considering their experience in facing violent situations. A guideline was developed and validated in the focus group to guide the management and organization of work in these services.

CONCLUSION

It was evidenced that professionals develop strategies which include strengthening the team as a form of collective protection, welcoming focused on comprehensive care and bonding, even without the support of specific public policies for these situations. The population is allied to facilitate access to care for vulnerable people and alerts professionals to critical situations in the territory.

Essential management competencies of nurses: actions and interactions in the context of the Family Health Strategy

OBJECTIVE

to understand the meanings attributed by the Family Health Strategy (FHS) nurses to the management competencies essential to the performance of their actions.

METHOD

explanatory, qualitative study, whose methodological framework was based on Grounded Theory. A total of 12 Family Health Strategy nurses from a municipality in southern Brazil participated through semi-structured interviews, between December 2018 and February 2019.

RESULTS

the experience was understood by the phenomenon "Lapidating management competencies daily to play the role of a nurse in the context of the Family Health Strategy". As action/interaction strategies, the following categories emerged: "Evidencing the management skills of Family Health Strategy nurses" and "Recognizing the need for strategies to work on specificities in the context of the Family Health Strategy".

FINAL CONSIDERATIONS

according to the meanings attributed by nurses, there are several essential management skills for the work in the Family Health Strategy, but they are still little worked and developed in this context, mainly because it is a complex health care scenario.

Regional support in the health regions of Rio de Janeiro state: a strategy for strengthening SUS

Brazil is one of the few countries in the world with more than 200 million inhabitants that has a universal public health system. In its 30 years of existence, the Unified Health System (SUS) has brought many advances to the Brazilian society. However, it still faces challenges to ensure health services in quantity and quality to the entire population. Federal, state and municipal government levels share the responsibility for its management and financing. In this governance scheme, it is the Municipal Health Secretariats (MHS) of the 5,596 Brazilian municipalities that are primarily responsible for providing and managing health services. Given the importance of this responsibility, Councils of Municipal Health Departments (COSEMS) and the National Council of Municipal Health Departments (CONASEMS) were created in 1986. Their role is to promote the articulation and negotiation of their interests with the federal and state levels. In Rio de Janeiro, a team of specialized professionals has been providing support for COSEMS-RJ since 2012. The team carries out activities in the nine regions of the state, which has 92 municipalities and more than 16 million inhabitants, the 3rd largest population in Brazil. Its activities are maintained by CONASEMS, the Ministry of Health and the State University of Rio de Janeiro (UERJ). The objetive of this report is to present the experience of the expert team of COSEMS RJ as a strategy for strengthening regional governance and intergovernmental relations. Providing specialized technical support for MHS has improved local management of SUS and has allowed for the establishment of regionalized health care networks in Rio de Janeiro.

Key messages

The project improves the participation of municipal managers and teams in regional spaces. It strengthens their capacity for intergovernamental decision-making and regionalization of the health system. The project qualifies the municipal management for fundraising, knowledge building, policy implementing and monitoring, as well as participatory planning.

ACCESS VERSUS CARE CONTINUITY IN HEALTH NETWORK SERVICES: EXPERIENCING POSSIBILITIES AND CONTRADICTIONS

ABSTRACT Objective: to understand the meaning of access to health services with a view to care continuity in the care network for users and professionals. Method: qualitative research, which used the methodological steps of Grounded Theory, carried out from November 2015 to April 2017. The theoretical sampling was obtained with 33 participants from a hospital institution and a Family Health Strategy unit. The participants were organized into three sample groups according to circular and continuous orientation of data collection and Grounded Theory analysis. The analysis was conducted according to the guidelines of the methodological framework which was composed of the open, axial and integrative coding phases. Results: four central concepts emerged from the data that demonstrate how participants experience access with a view to care continuity. These range from the first contact with the health network, through limitations and alternatives found to achieve perspectives to the care continuity in health actions and services. Conclusion: possibilities and contradictions were identified in the experience of care, with regard to access to health services and actions for the continuity of care, understanding them as feasible in health services, but divergent from the ideal advocated by the literature on the theme, as well as by the norms and prerogatives in force in the Unified Health System.

Relationship between the implementation of primary nursing model and the reduction of missed nursing care

AIMS

To evaluate and predict the relationship between the implementation of the primary nursing model and the reduction of missed nursing care.

BACKGROUND

Primary nursing can provide hospital leaders and nursing staff with guidance in implementing safe, patient-centred care, with responsibility and accountability during the nursing process. The implementation can be measured in terms of missed nursing care.

METHODS

A predictive correlational study was used. The study was conducted in four inpatient units at the University Hospital, Northeast, Brazil. Data were collected from 96 nursing professionals, using the MISSCARE instrument at four and seven months after the implementation of the primary nursing model.

RESULTS

Missed nursing care was reduced by 78.5%. Job title and staff satisfaction showed significant associations with decreased missed care (p < .05).

CONCLUSION

The predictive effect between efficacy in reducing missed nursing care and reasons and efficiency in the management of nursing care, using the primary nursing model, was verified.

IMPLICATIONS FOR NURSING MANAGEMENT

Nursing staff and managers should consider adopting a Primary Nursing Model of care to reduce missed nursing care.

Organizational climate and teamwork at the Family Health Strategy

ABSTRACT Objective: to measure the organizational climate in the work of professionals from Family Health Strategy (FHS) teams. Method: a cross-sectional study carried out with 458 professionals belonging to 72 FHS teams in a municipality in Southern Brazil. Data collection occurred between March and July of 2016 with self-application of the Team Climate Inventory (TCI). Data were analyzed by means of a non-parametric ANOVA. Results: “Team Participation” was the best-rated domain (8.11), while “Task orientation” was the worst (7.51). Nurses obtained the highest mean in TCI (8.05), and dentists, the lowest (7.45). Conclusion: TCI is an appropriate and innovative tool for assessing the teamwork climate at the FHS. Identifying fragilities such as “task orientation” and relationships among professional categories of the team supports the planning of actions for organizational climate improvements and teamwork at the FHS.

Improving social skills in care management provided by nurses: intervention research

OBJECTIVE

to analyze the process of introducing an educational intervention for the improvement of social skills in care management provided by nurses.

METHOD

intervention research, according to its complexity, carried out in a South-Brazilian public university hospital. To identify learning needs, 11 nurses were interviewed and educational meetings were held with 20 participants, who evaluated with open-ended questions: what they would stop doing; what they would continue doing; and what they would start doing on the issues addressed. The data was analyzed comprehensively.

RESULTS

we developed 30 educational hours on social skills of communication, work, assertiveness, and other themes inherent in care management mentioned by the participants as deficient. The evaluation revealed intentions of advances in: self-monitoring, communication, empathy, assertiveness, leadership and search for knowledge. Monthly meetings on care management were formally requested by the institution.

FINAL CONSIDERATIONS

social skills are intertwined in care management relationships and their improvement has proved to be dialogical, recursive and hologrammatic.

Papel do gestor de saúde pública em região de fronteira: scoping review

Resumo Objetivo: Examinar e mapear as evidências científicas sobre o papel do gestor de saúde pública em região de fronteira. Métodos: Scoping Review, baseado nos procedimentos recomendados pelo Instituto Joanna Briggs. Este método visa mapear os principais conceitos, clarificar e identificar lacunas do conhecimento, e obter a significância e a adequação da prática dos cuidados de saúde. Com base nestas perspectivas, estabeleceu-se a pergunta norteadora: “Quais são as evidências científicas sobre o papel do gestor na gestão em saúde pública nas regiões de fronteira?”. Foram realizadas buscas em oito bases de dados nacionais e internacionais, sobre trabalhos publicados até agosto de 2017. Dos 188 estudos encontrados, 13 foram selecionados para leitura na íntegra, resultando em uma amostra final de sete estudos analisados. Resultados: As sete publicações analisadas foram publicadas de 2005 a 2017. Os estudos selecionados sobre a temática são de âmbito nacional e internacional e de abordagens quantitativa, qualitativa ou qualiquantitativa. Os objetos dos estudos foram semelhantes, uma vez que a maioria retratava sobre o atendimento ao paciente transfronteiriço e o aumento dos gastos públicos em saúde nestas regiões. Conclusão: Os resultados desta revisão mostraram uma escassez de estudos nacionais e internacionais sobre o papel do gestor em saúde na fronteira. A relevância do tema e sua complexidade evidenciam a necessidade de pesquisas sobre o gestor nestas regiões.

DEMANDAS DE EDUCAÇÃO PERMANENTE DE ENFERMAGEM EM HOSPITAL DE ENSINO

Objetivo: analisar demandas de educação permanente da equipe de enfermagem de um hospital público de ensino do sul do Brasil.Método: pesquisa documental, descritiva e quanti-qualitativa, realizada a partir de documentos preenchidos por profissionais de enfermagem em 2016, para avaliação do programa de educação permanente desse hospital. Na análise dos dados, utilizou-se funções estatísticas do Biostat5.3® e IRAMUTEQ®.Resultados: 72 (48%) documentos preenchidos por profissionais de urgência/emergência; 140 (54,93%) marcações de não participação em ações educativas por desconhecimento; 108 (38,3%) solicitações de ações educativas para atualização técnico-científica. Sobre as expectativas acerca do programa, definiram-se seis classes: apresentação do programa; divulgação das ações; ações educativas relacionadas às unidades assistenciais; ações educativas a distância e nos setores; disponibilidade de horários para a mesma ação educativa; escala para participação dos profissionais nessas ações.Conclusão: a análise documental de tais demandas subsidia o planejamento e aperfeiçoamento de propostas de educação permanente em enfermagem.

Violence against women: historical trajectory of a care program (Curitiba - 1997-2014)

OBJECTIVE

To analyze the historical trajectory and the contributions of the Programa de Atenção às Mulheres em Situação de Violência (Program of Care to Women Victims of Violence) of Curitiba.

METHOD

Research with documentary and local approach, inspired by the Dimension of Political History, to unveil power relations, political representations, symbols and discourses. Eighty-eight sources were used for the period 1997-2014. The data collection was performed in May 2016 and presented in the timeline modality.

RESULTS

The historical trajectory of the program indicates intersectoral and interinstitutional experience that has been increasing and originating important innovations in care to women based on humanization and from the perspective of comprehensiveness.

FINAL CONSIDERATIONS

Historicizing the Program contributed to the reflection on the construction of practices aimed at confronting violence, the need for intersectoral actions and looks that involve its complexity.

ESTRATÉGIAS DE ENSINO NA GRADUAÇÃO EM ENFERMAGEM: ESTUDO DESCRITIVO

Objetivo: identificar estratégias de ensino facilitadoras para a formação do Enfermeiro na visão de discentes de enfermagem. Método: estudo quantitativo, descritivo e transversal, realizado em três universidades do sul do Brasil, por questionário semiestruturado, com 258 discentes de Enfermagem, entre março e abril de 2014. Os dados foram analisados por estatística descritiva com frequências absolutas e relativas. Resultados: sobre estratégias de ensino, verificou-se que as facilitadoras da aprendizagem durante aulas teóricas relacionavam-se aos recursos audiovisuais 67 (33,16%), aulas dinâmicas 67 (33,16%), discussão de artigos 60 (29,70%), trabalhos em grupo 47 (23,26%). As estratégias de ensino menos citadas foram: seminários, resumos de aulas anteriores e artigos, estudo de caso. Sobre estratégias facilitadoras, 48 (20%) discentes buscaram outras oportunidades de aprendizado além daquelas oferecidas no currículo da graduação. Conclusões: conclui-se que os discentes consideram múltiplas formas facilitadoras utilizadas como estratégias de ensino, sendo as mais citadas aulas dinâmicas, trabalhos em grupo e problematização.

The use of IRAMUTEQ software for data analysis in qualitative research

OBJECTIVE

To describe the use of IRAMUTEQ software in qualitative data analysis.

METHOD

A description for using a software program as a tool to support data processing in qualitative research, carried out in 2015. Data collection was done through interviews using a semi-structured script.

RESULTS

Twenty-one (21) companions participated in the study. The five classes resulting from data processing by the software allowed for analysis and interpretation of the nursing performance with the parturient as an active participant in the process of labor and delivery, and in the role of companion in this period.

CONCLUSION

The use of IRAMUTEQ software as a tool for processing qualitative data through the Descending Hierarchical Classification emerged classes and a connection between them, which further allowed for secure and credible data analysis. It is necessary to explore the other possibilities of using this tool in greater depth.

The challenges of teamwork in the family health strategy

Abstract Objective: To grasp the perceptions and experiences of professionals in the primary health care as teamwork in the Family Health Strategy (FHS) in a medium-sized municipality in the southern of Brazil. Method: Qualitative research carried out, between April and July 2016, with 13 health professionals (nurses, doctors, dentists, community health agents, nursing technicians and oral health aide) workers in FHS. Data were collected through semi-structured interviews, transcribed and submitted to content analysis. Results: From the analysis emerged three thematic categories: Teamwork from the perspective of the FHS health professionals; Strategies for maintaining teamwork out of daily routine; and Challenges of the insertion of Oral Health in the FHS. Conclusions and implications for a practice: Participants demonstrated that they understood the importance of teamwork and interpersonal relationships, and recognize the inherent challenges of this process. They revealed weaknesses in the relationships among dentistry and other members of the FHS, marked by a sense of exclusion and disinterest in participating.

Innovation in nursing health care practice: expansion of access in primary health care

Objective:

analyze the reorganization of the health care practice of nurses as an innovative strategy for expansion of access in primary care.

Method:

qualitative and quantitative study, which interviewed 32 management and care nurses and collected documentary data from public reports of production of nursing consultations from 2010 to 2014, in a municipality in southern Brazil. Data processing for textual analysis was performed by IRAMUTEQ software; for simple descriptive statistical analysis, the program Excel 2013 was used.

Results:

in the innovative care practice  class, associated with awareness of change, related to implementation of the FHS, its challenges and advantages, the following subclasses were identified: reorganization of schedules, nursing consultation, physical restructuring of BHUs, and shared consultation.

Final considerations:

the need to expand access to and valorization of care practice encourages the development of innovative strategies. The protagonism of care needs to be discussed in the various spaces so that each professional carry out the respective role with competence and efficacy.

Objetivo:

analisar a reorganização da prática assistencial do enfermeiro como estratégia inovadora para ampliação do acesso na atenção primária.

Método:

estudo qualiquantitativo, tendo sido entrevistados 32 enfermeiros gerenciais e assistenciais e coletados dados documentais de relatórios públicos de produção de consultas dos enfermeiros de 2010 a 2014, num município sul-brasileiro. O processamento dos dados para análise textual foi realizado pelo software IRAMUTEQ; para análise estatística descritiva simples, o programa Excel 2013.

Resultados:

na classe prática assistencial inovadora, associada à sensibilização para a mudança, relacionada à implantação da ESF, seus desafios e fortalezas, foram identificadas as subclasses: reorganização das agendas, consulta do enfermeiro, reestruturação física das UBS e consulta compartilhada.

Considerações finais:

a necessidade de ampliar o acesso e valorização da prática assistencial incentiva o desenvolvimento de estratégias inovadoras. O protagonismo do cuidado precisa ser discutido nos diversos espaços a fim de que cada profissional desempenhe seu papel com competência e resolutividade.

Teaching-learning tendencies and strategies used in the leadership development of nurses

ABSTRACT Objective: To identify the tendencies and teaching-learning strategies used for leadership development in the discipline Nursing Administration in higher education institutions in Brazil. Method: Non-experimental, type survey, descriptive and exploratory, cross-sectional, with quantitative approach. Results: The dialogued lecture strategy was cited as used by 241 (91%) professors, followed by research, by 237 (89%), and discussion or group work, by 221 (83%). Strategies not used were: spiral learning, 166 (63%), and online programs, 151 (57%) professors. The strategy that presents higher tendency of use is that of online courses, 104 (39%). Conclusion: among the strategies mentioned, all are aligned with the directions given in the literature for nursing education, but these strategies and methodologies influence the formation of leader nurses differently.

Cultura organizacional na área da saúde: um estudo bibliométrico

RESUMO O artigo objetivou identificar as características das pesquisas na área de saúde sobre o tema cultura organizacional publicadas em revistas brasileiras. A busca foi efetuada na Biblioteca Virtual em Saúde a partir do termo ‘cultura organizacional’, no período de 2007 a 2016. Foram encontrados 30 artigos em revistas nacionais de Qualis A1, A2, B1 nas áreas de avaliação Capes (Coordenação de Aperfeiçoamento de Pessoal de Nível Superior): enfermagem, saúde coletiva e psicologia. Os resultados evidenciaram o predomínio de artigos quantitativos e a aplicação de grande variedade de instrumentos para analisar a cultura organizacional na saúde, o que amplia as possibilidades de investigação e análise de diferentes aspectos do tema.

Clinical competences of nursing assistants: a strategy for people management

OBJECTIVE

to identify the clinical competences of nursing assistants in a hospital organization and to understand how professional acquired these competences.

METHOD

an exploratory study of a qualitative approach, performed at a private hospital in southern Brazil, through a semi-structured interview, in May and June 2013 with 20 nursing assistants.

RESULTS

the nursing assistantswho worked longer in the same work unit had a higher list of clinical competences. The acquisition of clinical competences occurred through interaction with other professionals; in daily nursing practice; in previous experiences and in formal learning.

FINAL CONSIDERATIONS

the identification of clinical competences and the way nursing assistants acquire these competences can be important resources for managing people, which can be used by nurse managers to better allocate these professionals and provide th e opportunity for their professional development.

Translation and cross-cultural adaptation of the Clinical Competence Questionnaire for use in Brazil

Objective:

translating and transculturally adapting the Clinical Competence Questionnaire to Brazilian senior undergraduate Nursing students, as well as measuring psychometric properties of the questionnaire.

Method:

a methodological study carried out in six steps: translation of the Clinical Competence Questionnaire instrument, consensus of the translations, back-translation, analysis by an expert committee, pre-testing and then presentation of the cross-cultural adaptation process to the developers. Psychometric properties were measured using Cronbach's alpha, intraclass correlation coefficient and content validity index.

Results:

the instrument was translated, transculturally adapted and its final version consisted of 48 items. Cronbach's alpha coefficient was 0.90, and the agreement index of the items was 99% for students and 98% for evaluators.

Conclusion:

the Clinical Competence Questionnaire was translated and adapted to Brazilian students, and the psychometric properties of the Portuguese version of the questionnaire presented satisfactory internal consistency regarding the studied sample.

Translation and adaptation of the Competencias Esenciales en Salud Pública para los recursos humanos en salud

Objective:

to perform the translation and cultural adaptation of the document named Marco Regional de Competencias Esenciales en Salud Pública para los Recursos Humanos en Salud de la Región de las Américas (Regional Framework of Core Competencies in Public Health for Health Human Resources in the Region of Americas) from Spanish to Brazilian Portuguese.

Method:

a methodological study comprising the following phases: authorization for translation; initial translation; synthesis of translations and consensus; back-translation and formation of an expert committee.

Result:

in the translation of domain names, there was no difference in 66.7% (N = 4); in the translation of domain description and competencies there were divergences in 100% of them (N = 6, N = 56). A consensus of more than 80% was obtained in the translation and improvement in the expert committee by the change of words and expressions for approximation of meanings to the Brazilian context.

Conclusion:

the translated and adapted document has the potential of application in research, and use in the practice of collective/public health care in Brazil.

Objetivo:

realizar a tradução e adaptação cultural do Marco Regional de Competencias Esenciales en Salud Pública para los Recursos Humanos en Salud de la Región de las Américas, do espanhol para a língua portuguesa do Brasil.

Método:

pesquisa metodológica, que seguiu as fases: autorização para tradução; tradução inicial; síntese das traduções e consenso; retrotradução e composição de um comitê de especialistas.

Resultado:

na tradução dos nomes dos domínios, não houve diferença em 66,7 % (N=4); na tradução da descrição dos domínios e das competências ocorreram divergências em 100 % destes (N=6, N=56), obteve-se consenso acima de 80% ainda na tradução, e aprimoramento no comitê de especialistas pela alteração de palavras e expressões para aproximar os significados ao contexto brasileiro.

Conclusão:

o documento traduzido e adaptado possui potencial de aplicação em pesquisas e utilização na prática da atenção à saúde pública/coletiva no Brasil.

Objetivo:

realizar la traducción y adaptación cultural del Marco Regional de Competencias Esenciales en Salud Pública para los Recursos Humanos en Salud de la Región de las Américas, del español para el idioma portugués de Brasil.

Método:

investigación metodológica, que siguió las fases: autorización para traducción; traducción inicial; síntesis de las traducciones y consenso; y, retrotraducción y composición de un comité de especialistas.

Resultado:

en la traducción de los nombres de los dominios, no hubo diferencia en 66,7 % (N=4); en la traducción de la descripción de los dominios y de las competencias ocurrieron divergencias en 100 % de estos (N=6, N=56), se obtuvo consenso arriba de 80%, durante la traducción y perfeccionamiento, en el comité de especialistas, en la alteración de palabras y expresiones para aproximar los significados al contexto brasileño.

Conclusión:

el documento traducido y adaptado posee potencial de aplicación en investigaciones y de utilización en la práctica de la atención a la salud pública/colectiva en Brasil.

Integrality of care: challenges for the nurse practice

ABSTRACT Objective: to understand the role of the nurse in the collegiate management model of a teaching hospital, in the integrality of care perspective. Method: a single case study with multiple units of analysis, with the theoretical proposition "integrality of care is a result of the care offered to the user by multiple professionals, including the nurse". Data were obtained in a functional unit of a teaching hospital through interviews with 13 nurses in a non-participant observation and document analysis. Results: from the analytical categories emerged subcategories that allowed understanding that the nurse promotes integrality of care through nursing management, team work and integration of services. Final considerations: the theoretical proposition was confirmed and it was verified that the nursing management focus on attending to health care needs and is a strategy to provide integrality of care.

Systematization of Nursing Care in undergraduate training: the perspective of Complex Thinking

AIM:

to evaluate the clinical applicability of outcomes, according to the Nursing Outcomes Classification (NOC) in the evolution of orthopedic patients with Impaired Physical Mobility

METHOD:

longitudinal study conducted in 2012 in a university hospital, with 21 patients undergoing Total Hip Arthroplasty, evaluated daily by pairs of trained data collectors. Data were collected using an instrument containing five Nursing Outcomes, 16 clinical indicators and a five point Likert scale, and statistically analyzed.

RESULTS:

The outcomes Body Positioning: self-initiated, Mobility, Knowledge: prescribed activity, and Fall Prevention Behavior presented significant increases in mean scores when comparing the first and final evaluations (p<0.001) and (p=0.035).

CONCLUSION:

the use of the NOC outcomes makes it possible to demonstrate the clinical progression of orthopedic patients with Impaired Physical Mobility, as well as its applicability in this context.

MAPPING COMPETENCIES: IDENTIFYING GAPS IN MANAGERIAL NURSING TRAINING

ABSTRACT Objective: mapping necessary competencies in managerial nursing training. Method: a cross-sectional study conducted between March and June 2013 with 258 students from three Higher Education Institutions of a municipality in the South of Brazil. Results: mapping made it possible to identify necessary competencies for managerial nursing training, including those acquired and gaps. The relative majority of the students considered having the right attitude to act as a nurse in the managerial dimension; however, significant gaps during their training were identified in managerial competencies of supervision, auditing and change processes. Conclusion: this mapping provides subsidies for pedagogical planning, seeking to promote the acquisition of managerial competencies during undergraduate course training.

[Managerial nursing competencies in the expansion of the Family Health Strategy]

OBJECTIVE

To relate the managerial competencies required of nurses with the process of change experienced in the expansion of the Family Health Strategy (FHS).

METHOD

A qualitative research conducted in primary health care in a southern Brazilian city, through interviews with 32 managerial and clinical nurses. The interviews were processed by IRAMUTEQ software. The resulting classes were examined under five managerial competencies to promote change.

RESULTS

The four classes obtained from data were: the Family Health Strategy expansion process; confrontations and potentialities; mobilization for the change; innovations in medical and nursing consultations. The classes were related to one or more competencies.

CONCLUSION

The expansion of the Family Health Strategy requires managerial competencies of implementing and sustaining change, negotiating agreements and commitments, using power and influence ethically and effectively, sponsoring and selling new ideas, and encouraging and promoting innovation.

NÚCLEO DE ENFERMEIROS DE EDUCAÇÃO PERMANENTE DO PARANÁ: TRAJETÓRIA E CONTRIBUIÇÕES

O objetivo deste estudo foi descrever a trajetória e contribuição na institucionalização da educação permanente nas organizações hospitalares desde sua fundação até os dias atuais. Pesquisa histórico-social, fundamentada na análise das fontes do acervo de um núcleo de enfermeiros do estado do Paraná, realizada entre o período de março de 2013 e janeiro de 2014. As transformações ocorridas nesse núcleo, ao longo de quase cinco anos, consolidaram-no como espaço efetivo para discussão e reflexão na construção de conhecimentos relacionados aos processos de educação nessas organizações hospitalares. Conclui-se que espaços como este possibilitam uma visão crítica dos movimentos históricos até os tempos atuais, que envolvem a Proposta da Educação Permanente em Saúde; auxiliam na compreensão do presente, de forma reflexiva; e, fornecem perspectivas futuras para a área de Enfermagem.

PRÁTICAS DE ATENÇÃO PERINATAL EM MATERNIDADES DE RISCO HABITUAL: AVALIAÇÃO NA PERSPECTIVA DE MULHERES

O objetivo da pesquisa foi avaliar práticas de atenção perinatal em maternidades de risco habitual, na perspectiva de mulheres. Pesquisa avaliativa, transversal, de abordagem quantitativa, realizada em três maternidades públicas de uma capital do Sul do Brasil. A amostra probabilística constituiu-se de 95 mulheres que vivenciaram o parto normal e nascimento sem intercorrências, internadas no Alojamento Conjunto. Dados coletados entre maio e julho de 2014, mediante entrevista estruturada, foram submetidos à análise descritiva e de frequência. Há evidências de incorporação de práticas recomendadas pela Organização Mundial de Saúde na rotina das maternidades, entretanto outras necessitam ser aprimoradas. Os resultados fornecem informações úteis aos gestores, visando a garantia dos direitos reprodutivos das mulheres.

Collective Health Nursing: the construction of critical thinking about the reality of health

This article presents an analysis of the Collective Health Nursing teaching-learning processes and research in view of the consolidation of the Brazilian National Health System (Sistema Único de Saúde - SUS), performed with the objective to acknowledge the potentiality of the health reality of the population as a strategy to approximate the field of nursing practice and training as a way to revert undesired health situations. Thus, the authors reflect about the work of Collective Health Nursing, as they understand it is a mediator to promoting teaching, learning and knowledge development in this field. The authors believe that those processes, founded on critical thinking, permit to reflect about the contradictions between the current public policy and the actions promoted by the sector, and, this way, contribute to overcome the current health care mode, which has historically been founded on curative actions towards individuals, to assuming a model that acknowledges the health needs and intervenes in the social determination of the health-disease process.

THE NEGOTIATOR THAT WE HAVE AND THE NEGOTIATOR THAT WE WANT IN NURSING

ABSTRACT This study aimed to identify the negotiator profile of nurse managers of a public hospital. Data collection occurred between April and June of 2012, using a semi-structured questionnaire and a logical framework as a resource for planning the development of the action plan prepared by the nine nurses who participated in the study. In the data analysis, the following categories were identified: the negotiating process; the negotiator that we have in nursing; and the negotiator that we want, according to Bardin's content analysis technique. It was evident that the nurse negotiator profile was marked by the lack of autonomy and legitimacy. The conclusion shows that nurses are essential in the negotiating process when they understand the principles of conflict management, the establishment of rules and acceptable behavior, and the instrumentalization of the teamwork to develop healthy spaces in redefining the conflict as a situation that can contribute to organizational growth.

Development of nursing management competencies: guidelines for continuous education services

Abstract OBJECTIVE Developing continuing education guidelines for the development of nursing management competencies along with the members of the Center of Nursing Continuing Education of Parana. METHOD A qualitative research outlined by the action research method, with a sample consisting of 16 nurses. Data collection was carried out in three stages and data were analyzed according to the thematic analysis technique. RESULTS It was possible to discuss the demands and difficulties in developing nursing management competencies in hospital organizations and to collectively design a guideline. CONCLUSION The action research contributed to the production of knowledge, confirming the need and the importance of changing the educational processes and evaluations, based on methodologies and instruments for professional development in accordance with human resource policies and contemporary organizational policies.

Análise de modelo de tomada de decisão de enfermeiros gerentes: uma reflexão coletiva

RESUMO Objetivo: analisar o modelo de tomada de decisão construído por enfermeiros na perspectiva das teorias da administração sobre processo decisório. Método: pesquisa qualitativa na modalidade pesquisa-ação, realizada de abril a junho de 2012 que, por meio de questionário semiestruturado e seminários, buscou explorar a compreensão de nove enfermeiros gerentes de um hospital público do sul do Brasil sobre processo decisório e a natureza da tomada de decisão. Os dados foram submetidos à análise de conteúdo. Resultados: emergiram duas categorias: Situação atual de tomada de decisão, que apresentou falta de sistematização; e Construção coletiva do processo decisório, que enfatiza a necessidade da construção de um modelo de tomada de decisão. Conclusão: o modelo de tomada de decisão elaborado é limitado, pois não considera importantes aspectos do processo decisório: os limites da racionalidade humana e o ambiente externo e interno das organizações que interferem e determinam as decisões.

O PROCESSO DE TRABALHO DE ENFERMEIROS EM NÚCLEOS HOSPITALARES DE EPIDEMIOLOGIA

Estudo exploratório e qualitativo, com o objetivo de caracterizar o processo de trabalho de enfermeiros de Núcleos Hospitalares de Epidemiologia quanto aos agentes, finalidade, meios e instrumentos, objeto e produtos. Os dados foram coletados, entre março e maio de 2012, por meio de entrevista aberta com nove enfermeiros de cinco Núcleos Hospitalares de Epidemiologia existentes em Curitiba-PR, em conformidade com a Resolução 196/96. O estudo permitiu identificar os elementos constituintes do trabalho do enfermeiro em Vigilância Epidemiológica Hospitalar e evidenciou práticas ainda incipientes em algumas instituições. Depreendeu-se que a prática profissional, nos referidos núcleos, deve romper com o modelo de atuação centrado em tarefas, para um modelo articulado com serviços de referência e que contribua com a construção de Políticas Públicas alinhadas às necessidades em saúde da população.