This study investigated the registered nurses' perceptions of the bureaucratic view of power in health care services in the Tshwane metropolitan region. The study further sought to describe how power affects the role of registered nurses in an organisation that is perceived to be predominantly bureaucratic in its' approach to management. A quantitative descriptive exploratory approach was adopted. Data was drawn from 121 respondents by random distribution of questionnaires to three selected health care services in the Tshwane metropolitan region. The findings revealed that registered nurses were largely divided in their perception of the bureaucratic view of power in health care services. Almost half of the respondents indicated that great strides had been taken by organisations in transforming health care services in accordance with the White Paper (1997) on Transformation of the Health System in South Africa and the recommendations of the 2001 Health Summit. The others indicated that registered nurses still needed to break out of the restraints of their dependant role towards taking ownership of health care services by equally bearing the burden of the organisation with management. / Health Studies / M.A.(Health Studies)

The purpose of this study is to explore and describe the challenges experienced by non-governmental organisations with regards to the roll-out of ART, with an aim to facilitate strategy development to overcome the challenges and enhance the success of ART rollout by the NGOs. A qualitative, exploratory and descriptive study was conducted. Data collection was done using in-depth semi-structured interviews. Three groups of respondents participated in the study; programme coordinators who directed and supervised ART programmes; doctors who were responsible for prescribing, monitoring and dealing with ART complications; and registered nurses who were responsible for monitoring, referring and providing nursing care to patients on ART. The findings revealed five broad areas of challenges namely; challenges related to sustainability, challenges related to adherence, challenges related to health systems, challenges related to stigma and challenges related to behavior. Of interest were the surge of whoonga and the infiltration of ART roll-out by crime and violence. / Health Studies / MA (Public Health)

Comment s’adaptent des organisations lorsqu’elles font face à des changements qui les dépassent? De cette question a émergé une recherche voulant comprendre comment et pourquoi des organisations de santé décident d’adapter (ou non) leurs services aux besoins et aux caractéristiques des populations migrantes accueillies sur leur territoire. Pour y répondre, cette thèse s’est intéressée à la gouvernance multiniveaux appliquée aux organisations de santé fournissant des services à des populations migrantes. Dans un contexte de régionalisation de l’immigration, la dynamique du processus migratoire est de mieux en mieux documentée, mais les capacités organisationnelles d’adaptation le sont beaucoup moins. Nous avons réalisé une étude de cas multiples à l’aide d’entrevues semi-directives auprès d’acteurs provenant de deux CSSS montéregiens (région au sud de Montréal, Québec) et des paliers locaux, régionaux et nationaux. Les résultats de cette étude ont permis (1) de mettre en évidence les différents acteurs impliqués dans ce processus d’adaptation, dont des acteurs de connectivité; (2) de cerner huit leviers d’action, divisés en trois catégories de leviers : administratif, émergent et d’habilitation. La possible imbrication de ces trois catégories de leviers facilite l’apparition de structures de connectivité, légitimant ainsi l’adaptation de l’organisation; et (3) de montrer l’ambigüité de l’adaptation à travers des facteurs d’influence qui favorisent ou entravent le processus d’adaptation à plusieurs niveaux de la gouvernance. Cette thèse est construite autour de quatre articles. Le premier, de nature conceptuelle, permet de circonscrire les concepts d’adaptation et de gouvernance multiniveaux à travers la lentille des théories de la complexité. Nous campons ainsi notre sujet dans une problématique liée à la vulnérabilité et la migration tout en appréhendant l’adaptation du système et son opérationnalisation au niveau local. Il en ressort un cadre conceptuel avec six propositions de recherches. Le second article permet quant à lui de comprendre les jeux des acteurs au sein d’une organisation de santé et à travers son Environnement. Le rôle spécifique d’acteurs de connectivité y est révélé. C’est dans un troisième article que nous nous intéressons davantage aux différents leviers d’action, analysés selon trois catégories : administrative, émergente et d’habilitation. Les acteurs peuvent les solliciter afin de d’adapter leurs pratiques au contexte particulier de la prise en charge de patients migrants. Un passage des acteurs aux structures de connectivité est alors rendu possible via un espace : la gouvernance multiniveaux. Enfin, le quatrième et dernier article s’articule autour de l’analyse des différents facteurs pouvant influencer l’adaptation d’une organisation de santé, en lien avec son Environnement. Il en ressort principalement que les facteurs identifiés sont pour beaucoup des leviers d’action (cf. article3) qui à travers le temps, et par récursivité, deviennent des facteurs d’influence. De plus, le type d’interdépendance développé par les acteurs a tendance soit à façonner un Environnement « stable », laissant reposer les besoins d’adaptation sur les acteurs opérationnels; soit à façonner un Environnement plus « accidenté », reposant davantage sur des interactions diversifiées entre les acteurs d’une gouvernance multiniveaux. De cette adéquation avec l’Environnement à façonner découle l’ambigüité de s’adapter ou non pour une organisation. / How do organizations adapt when faced with changes that exceed their current capacities? More specifically how and why do healthcare organizations choose to adapt- or not- their services to the needs and characteristics of new and established migrant populations? In this thesis, we attempt to answer these questions using a conceptual model of multilevel governance, applicable to healthcare organizations that provide primary care to migrant population. In a context of regionalized immigration, the dynamics of the migration process are well documented, however organizations abilities to adapt are less so. We conducted a multiple case study, collecting data from semi-structured interviews with providers from two healthcare organizations from Montéregie region (South shore of Montréal, Québec) as well as stakeholders from local, regional and national scale. The data collected has allowed us, (1) to identify the most significant stakeholders in adaptation process and to highlight the connectivity between them; (2) to reveal eight action levers that we divided in three categories: administrative, emerging and enabling. The possible imbrications of these three categories facilitate the creation of connectivity structures that legitimate the organization’s adaptation; and (3) to show the ambiguity of adaptation through the influence of facilitating or hindering factors at several levels of governance. This thesis is structured on four articles. The first article is conceptual: adaptation and multilevel governance are therein defined through the framework of complexity theory. We anchor our subject in the vulnerability and migration schemata, while apprehending the system’s adaptation at the local scale. The result is a conceptual framework with six research propositions. The second article elaborates on the dynamics among stakeholders within healthcare organizations, its networks and the Environment. The specific role of the connectivity between stakeholders is highlighted. In the third article, we focus on the different action levers, which are analysed in three categories: administrative, emerging and enabling. The stakeholders seek to adapt their practices to the particular context of providing timely and appropriate care to migrant patients. A transition from connectivity between actors and structures is then made possible through multilevel governance. Finally, the fourth article is an analysis of the different factors that influence a healthcare organization’s adaptation with regards to the Environment. The results show that many identified factors are firstly action levers (see article 3), and become through time and recursively of influence factors. In addition, the type of interdependence developed between the stakeholders tends to shape either “stable” Environment which transfers the responsibility of the adaptation to the operational stakeholders or “rugged” Environment based on diverse and decentralized interactions between stakeholders through multilevel of governance. From this constant adjustment with the Environment appears the ambiguity of the adaptation for a healthcare organization.

Introduction The clinical community in Western society has long practised medicine as organized by "two dominant principles: 1) the principle of essentialism which states that there is a fixed "natural" border between disease and health, and 2) the principle of specific treatment which states that having revealed a disease, the doctor can, at least in principle, find the one, correct treatment. These principles have served as the legitimization of the traditional, hierarchical organization of health-care" (Jensen, 1987:19). A main feature of medical practices based on these principles has been to address specific kinds of problems impeding or decaying health. This research is centrally concerned with essentialism and the institutional fixation of problems as two important nodal points of Canada's biomedical value and belief system. More specifically, I hope to show in an organized way how these principles shape staff knowledge of client and culture in a community health centre (CHC) in Lethbridge, Alberta. My analysis is based on four guiding points: 1) that in our polyethnic society health care institutions are massively challenged with actual and perceived cultural diversity and cross cultural barriers to which their staff feel increasingly obliged to respond with their services; 2) while the client cultural diversity is "real", institutional responses depend primarily on how that diversity is imagined by staff -often as a threat to a health institution's sociocultural world; 3) that problem-specific, medicalized thinking is central in this community health centre, even though its mandate is health promotion and this problem orientation often combines with medical essentialism to reduce "culturally different" to a set of client labels, some of which are problematic; and 4) while a "lifestyle model" and other models for health promotion are at present widely advocated and are to be found centrally in this institution's (CHC) charter, they have led to little institutional accomodation to cultural diversity. In this thesis my aim is to present an ethnographic portrait of a community health centre, where emphasis is given to the distinctive formal and informal "formative processess" (Good 1994) of social construction of certain perceived common core challenges facing the Canadian biomedical community today - challenges concerning cultural difference and its incorporation into health care perception and practice. I am particularly interested in institutions subscribing to a "health promotion model" of health care, a term I have borrowed from Ewles and Simnett (1992). Ewles and Simnett descrive the meaning of "health promotion" as earlier defined by WHO (World Health Organization): this perspective is derived from a conception of "health" as the extent to which an individual or group is able, on the on hand, to realise aspirations and satisfy needs; and, on the other hand, to change or cope with the environment. Health is, therefore seen as a resource for everyday life, not the objective of living; it is a positive concept emphasising social and personal resources, as well as physical capacities (Ewles & Simnett, 1992:20) Health is therefore concerned with "a state of complete physical, mental and social wellbeing, and not merely the absence of disease and infirmity" (Ewles and Simnett, 1992:6), I am interested in determing how threats to this defintion prevail in a community health centre's ideology of preventive care, and how that ideology encodes dimensions of diversity. I, however, want to go much further than this by exploring everyday staff discourse and practice, to understand how client cultural diversity is formed and informed by what staff do and say. How, in short, do individuals based in a health promotion organization socially construct their clients as objects of institutional concern? We need, as Young (1982) suggest, "to examine the social condition of knowledge production" in an institutionalized health care service provision subculture. There are, I believe, also practical reasons for conducting this research. Over the past ten years the Canadian health care system increasingly has had to focus on two potentially contradictory goals: reducing costs, and lessening persistent inequalities in health status among key groups and categories of persons in the Canadian population. Many now argue that one of the most central dimensions of the latter - of perisistent health inequalities in Canada - is ethnocultural. Few would seriously argue, for example, that Canadian First Nation health statistics are anything but appalling. Moreover, radical changes in immigration patterns over the past three decades have greatly increased urban Canadian cultural diversity. Caring "at home" now assumes international dimensions (McAdoo, 1993; Butrin, 1992; Buchignani, 1991; Indra, 1991, 1987; Galanti, 1991; Dobson, 1991; Waxler-Morrison, 1990; Quereshi, 1989). A growing voiced desire to provide more pluralistic health care and health care promotion has become persistently heard throughout the clinical community in Canada (Krepps and Kunimoto, 1994; Masi, 1993). Even so, for many health professionals cultural difference evidently remians either irrelevant or a threat to the established order of things. Applied research on health care institutions undertaken to investigate how better to meet these challenges nevrtheless remains very incomplete and highly concentrated in two broad areas. One of these is structural factors within the institution that limit cross-cultural access (Herzfeld, 1992; Hanson, 1980). Some of these studies have shown the prevalence of a strictly conservative institutional culture that frequently makes frontline agency workers gate-keeprs, who actively (if unconsciously) maintain client-institution stratification (Ervin, 1993; Demain, 1989; Ng, 1987; Murphy, 1987; Foster-Carter, 1987; de Voe 1981). In addition, extensive research has been conducted on disempowered minority groups. This research has examined the frequency, effectiveness and manner with which ethnic and Native groups make use of medical services. Some institutional research on cross-cultral issues shows that under appropriate conditions health professional like nurses have responded effectively to client needs by establishing culturally sensitive hiring and training policies and by restructuring their health care organizations (Terman, 1993; Henderson, 1992; Davis, 1992; Henkle, 1990; Burner, 1990). Though promising, this research remains radically insufficient for learning purposes. In particular, little work has been done on how such institutions come to "think" (Douglas, 1986) about cultural difference, form mandates in response to pressure to better address culturally different populations and work them into the institution's extant sub-cultral ideas and practice (Habarad, 1987; Leininger, 1978), or on how helping instiutions categorize key populations such as "Indians" or "Vietnamese" as being culturally different, or assign to each a suite of institutionally meaningful cultural attributes (as what becomes the institution's working sense of what is, say, "Vietnamese culture"). This is so despite the existence of a long and fruitful ethnographic institutional research tradition, grounded initially in theories of status and role (Frankel, 1988; Taylor, 1970; Parson, 1951), symbolic ineractionism (Goffman, 1967, 1963, 1961), ethnomethodology (Garfinkle, 1975), and organizational subcultures (Douglas, 1992, 1986, 1982; Abegglen & Stalk, 1985; Ohnuki-Tierney, 1984; Teski, 1981; Blumers, 1969). More recent work on anthropological social exchange theory (Barth, 1981), on institutional and societal discipline (Herzfeld, 1992; Foucault, 1984, 1977), on the institution-client interface (Shield, 1988; Schwartzman, 1987, Ashworth, 1977, 1976, 1975), and on framing the client (Hazan, 1994; Denzin, 1992; Howard, 1991; Goffman, 1974). I also hope that this study makes a contribution to the study of health care and diversity in southern Alberta. Small city ethnic relations in Canada have been almost systematically ignored by researchers, and similar research has not been conducted in this part of Alberta. Local diversity is significant: three very large Indian reserves are nearby, and the city itself has a diverse ethnic, linguistic and ethno-religious population. Also, significant province wide restructuring of health care delivery was and is ongoing, offering both the pitfalls and potentials of quick institutional change. Perhaps some of the findings can contribute to making the future system more responsive to diversity than the present one. / 202 p. ; 29 cm.

PPSUS / A gestão de custos, em qualquer organização, proporciona uma série de benefícios, como a segurança na boa administração dos recursos, porém é pouco utilizada na área hospitalar pública, o que se configura como um paradoxo, frente à complexidade da organização hospitalar e à situação de subfinanciamento da saúde. Sendo assim, a questão de pesquisa que norteia este estudo é: Qual a contribuição de um modelo de custeio para a governança pública nas unidades hospitalares próprias do Estado do Paraná? Este estudo tem como objetivo propor um modelo de custeio para a gestão de custos em hospitais públicos administrados diretamente pelo Estado, como proposta de aprimoramento para controle, transparência, orçamentação e planejamento das ações estratégicas de saúde. Tal estudo mostra-se relevante, uma vez que a área hospitalar é bastante complexa, tornando-se ferramenta útil para tomada de decisão sobre investimentos, alterações de perfil de atendimento, utilização de capacidade ociosa, ampliações de serviços, entre outros. O sistema de saúde público brasileiro necessita de máxima eficiência, tendo em vista os direitos universais garantidos pela Constituição Federal. Assim, justifica-se pela complexidade hospitalar, um cenário de elevada evolução de custos, seja pela mudança do perfil demográfico e epidemiológico, como o envelhecimento da população brasileira e o crescente número de doenças crônicas, bem como pela crescente evolução tecnológica e seu incremento acelerado. Trata-se de uma pesquisa-ação com base no levantamento de resultados de pesquisas similares para análise da aplicação do modelo de custeio para organizações hospitalares, bem como a análise empírica das informações existentes em dois hospitais selecionados. Com base nos conceitos teóricos e empíricos da aplicação da metodologia de custo por absorção, gera elementos para melhor compreensão do problema para desenvolver o modelo de custeio. A avaliação dos resultados se constitui em importante instrumento de gestão dos hospitais e da Secretaria de Estado da Saúde, pois permite aos dirigentes maior segurança diante das dificuldades e desafios impostos nesse segmento, caso contrário há uma restrição ainda maior na gestão, no financiamento e operacionalização dos hospitais públicos. / Cost management brings about several benefits to any type of organization, such as the certainty that resources are well managed, but it is not much used by the public hospital sector, what is a paradox seeing that hospital management is complex and public health faces an under-financing situation. Based on the aforementioned facts, the present study aims at answering the following question: What is the contribution of costing models to public governance in the State of Paraná public hospitals? So, the study objective is to propose a costing management model addressed to improve health strategy control, transparency, budget and planning actions in public hospitals directly managed by the State of Paraná. Since the hospital sector is complex, our study is highly relevant as a helping tool to: investment decision-making processes, changes of healthcare profile, use of spare capacity and service improvement, among others. Considering the universal rights ensured by the Brazilian Federal Constitution, the country public health system needs to show maximum efficiency. In addition to hospital complexity, the sector increased costs are justified by the change of demographic and epidemiological profiles, Brazilian population aging, chronic disease growth, increased technological evolution and development. The research/action is based on the results of similar researches addressed to analyze the application of costing models addressed to hospital organization, as well as on the empiric analysis of data existing in two hospitals selected by the study. By applying the theoretical and empiric costing absorption methodology, our study provides elements to help understanding the problems involved in the costing model development. Result assessment is an important tool which permits Hospital and the State Health Department managers to deal with the sector challenges and difficulties more easily, since it helps lessen the restrictions imposed to public hospital management, financing and operation.

A demanda por procedimentos médicos gerados pela transformação dos perfis etários e de morbi-mortalidade das populações tem forçado uma escalada contínua dos custos da assistência que atingem limites críticos em relação à disponibilidade de recursos. É neste contexto onde a priorização é a regra e o desperdício inaceitável, que métodos de otimização vem sendo desenvolvidos, dentre eles o “Audit and feedback”. De um total de 176 médicos de uma regional de cooperativa, 130 constituíram a amostra para estudo Quase-experimento com total de dois anos de seguimento (2004- 2005). As informações tratavam do “Índice de Solicitações de Serviços Auxiliares de Diagnose e Terapia” (Is SADT) e eram fornecidas de modo que cada profissional sabia qual era a sua posição dentro do grupo da mesma especialidade, mas não tinha condições de identificar os demais. Apesar do número absoluto de SADT realizados ter sido no mínimo o quádruplo do esperado para a população de beneficiários, o retorno de informações visando à conscientização pelo método “Audit and Feedback” não foi capaz de provocar diferenças significas nas solicitações de procedimentos nos diferentes grupos de médicos, conforme constatado após análise estatística. Não se evidenciou nenhuma relação significativa das variáveis independentes deste estudo (sexo, tempo de formado e tempo de cooperado), com os Índices de Solicitações de SADT dos médicos que estavam acima ou abaixo da mediana nos diferentes estratos. Persiste como desafio, a comprovação do fator ou fatores responsáveis por esta resposta. Propõe-se um conjunto de ações a serem associadas, uma vez que o processo de conscientização isoladamente foi inócuo. / Changing age, morbidity and mortality profiles of populations have caused an increase in the demand for medical procedures and a continuous increase in the cost of health services that is reaching limits in terms of available resources. It is in the context of prioritization as the rule and waste as unacceptable that optimization methods have been developed, among them “audit and feedback”. Of a total of 176 physicians of a regional cooperative, 130 were included in the study sample. The procedure ordering behaviour of each physician in the sample was monitored during all of 2004 and 2005. Audit: each month the an “index of solicitations for auxiliary diagnostic and treatment services”, or SADT, basically the average number of orders per consultation for the month, was calculated for each physician. Feedback: SADT for all participating physicians, organized by speciality and rank, were sent to each participating physician. The results were presented in a way that each physician could locate themselves in the ranking without being able to identify where any other physicians placed in the ranking. Despite absolute number of SADT on average fourfold that expected for the demographic profile of the population being served, statistical analysis of the results showed that the “Audit and Feedback” optimization method did not have a significant effect on the ordering behaviour of physicians or in the sample, un-grouped or grouped by speciality, gender, time in practice or time in the cooperative. Nor did grouping according the whether and individual physician was initially above or below the median SADT reveal any significant effect of the method on ordering behaviour. The results do show that factors other than how a physician's individual SADT compares to that of his or her peers, determines their procedure ordering behaviour. Identifying these factors remains an important challenge in the context of health services optimization.

This study investigated the registered nurses' perceptions of the bureaucratic view of power in health care services in the Tshwane metropolitan region. The study further sought to describe how power affects the role of registered nurses in an organisation that is perceived to be predominantly bureaucratic in its' approach to management. A quantitative descriptive exploratory approach was adopted. Data was drawn from 121 respondents by random distribution of questionnaires to three selected health care services in the Tshwane metropolitan region. The findings revealed that registered nurses were largely divided in their perception of the bureaucratic view of power in health care services. Almost half of the respondents indicated that great strides had been taken by organisations in transforming health care services in accordance with the White Paper (1997) on Transformation of the Health System in South Africa and the recommendations of the 2001 Health Summit. The others indicated that registered nurses still needed to break out of the restraints of their dependant role towards taking ownership of health care services by equally bearing the burden of the organisation with management. / Health Studies / M.A.(Health Studies)

A demanda por procedimentos médicos gerados pela transformação dos perfis etários e de morbi-mortalidade das populações tem forçado uma escalada contínua dos custos da assistência que atingem limites críticos em relação à disponibilidade de recursos. É neste contexto onde a priorização é a regra e o desperdício inaceitável, que métodos de otimização vem sendo desenvolvidos, dentre eles o “Audit and feedback”. De um total de 176 médicos de uma regional de cooperativa, 130 constituíram a amostra para estudo Quase-experimento com total de dois anos de seguimento (2004- 2005). As informações tratavam do “Índice de Solicitações de Serviços Auxiliares de Diagnose e Terapia” (Is SADT) e eram fornecidas de modo que cada profissional sabia qual era a sua posição dentro do grupo da mesma especialidade, mas não tinha condições de identificar os demais. Apesar do número absoluto de SADT realizados ter sido no mínimo o quádruplo do esperado para a população de beneficiários, o retorno de informações visando à conscientização pelo método “Audit and Feedback” não foi capaz de provocar diferenças significas nas solicitações de procedimentos nos diferentes grupos de médicos, conforme constatado após análise estatística. Não se evidenciou nenhuma relação significativa das variáveis independentes deste estudo (sexo, tempo de formado e tempo de cooperado), com os Índices de Solicitações de SADT dos médicos que estavam acima ou abaixo da mediana nos diferentes estratos. Persiste como desafio, a comprovação do fator ou fatores responsáveis por esta resposta. Propõe-se um conjunto de ações a serem associadas, uma vez que o processo de conscientização isoladamente foi inócuo. / Changing age, morbidity and mortality profiles of populations have caused an increase in the demand for medical procedures and a continuous increase in the cost of health services that is reaching limits in terms of available resources. It is in the context of prioritization as the rule and waste as unacceptable that optimization methods have been developed, among them “audit and feedback”. Of a total of 176 physicians of a regional cooperative, 130 were included in the study sample. The procedure ordering behaviour of each physician in the sample was monitored during all of 2004 and 2005. Audit: each month the an “index of solicitations for auxiliary diagnostic and treatment services”, or SADT, basically the average number of orders per consultation for the month, was calculated for each physician. Feedback: SADT for all participating physicians, organized by speciality and rank, were sent to each participating physician. The results were presented in a way that each physician could locate themselves in the ranking without being able to identify where any other physicians placed in the ranking. Despite absolute number of SADT on average fourfold that expected for the demographic profile of the population being served, statistical analysis of the results showed that the “Audit and Feedback” optimization method did not have a significant effect on the ordering behaviour of physicians or in the sample, un-grouped or grouped by speciality, gender, time in practice or time in the cooperative. Nor did grouping according the whether and individual physician was initially above or below the median SADT reveal any significant effect of the method on ordering behaviour. The results do show that factors other than how a physician's individual SADT compares to that of his or her peers, determines their procedure ordering behaviour. Identifying these factors remains an important challenge in the context of health services optimization.

O conceito de segurança nasceu com o homem primitivo ao lutar diariamente para sobreviver contra os ataques de predadores. Com o passar dos anos foram surgindo parâmetros de sobrevivência e segurança em quase todas as atividades de trabalho. Na área de saúde e de enfermagem este tema tem mobilizado esforços das organizações de saúde no sentido de evitar falhas nos processos de cuidado que possam causar eventos adversos aos pacientes. Trata-se de uma pesquisa exploratória, descritiva, com abordagem qualitativa, com o objetivo de analisar a aplicação do checklist da cirurgia segura no centro cirúrgico para a segurança do paciente. O estudo foi conduzido utilizando-se a técnica de grupos focais e métodos fotográficos de pesquisa, na perspectiva do pensamento ecológico restaurativo, entre o período de março e junho de 2014. As informações foram organizadas com o recurso do programa NVivo 10 e submetidas à análise de conteúdo do tipo temática, surgiram três categorias: Checklist para a segurança do paciente: ainda um desafio, Motivos da não adesão ao checklist da Cirurgia Segura, Etapas do Checklist. Os resultados ressaltam que o checklist é de suma importância e contribui como uma barreira para prevenir possíveis erros de lateralidade do procedimento cirúrgico e de troca de paciente na sala operatória, além de assegurar a correta identificação do paciente no momento do preparo para ingressar no centro cirúrgico. Nos debates foi ressaltado que o grupo pesquisado conhece o instrumento para a realização do checklist da cirurgia segura, porém, refere ter dificuldades para o preenchimento do mesmo, principalmente devido à necessidade de agilizar o processo e encaminhar rapidamente o paciente à sala de cirurgia. Foi percebido que existem falhas no preenchimento do protocolo da cirurgia segura, em algumas situações o instrumento é preenchido antes de iniciar a cirurgia ou após o término da mesma. É fundamental envolver e comprometer as equipes médicas para a aplicação do checklist da cirurgia segura, além de (re) orientar e empoderar as equipes de enfermagem, a fim de seguir corretamente o protocolo da lista de verificação instituída, minimizando situações de desvalorização e ridicularização da rotina. A aplicação de maneira correta desse protocolo contribui para o reconhecimento assistencial das equipes na instituição. A natureza participativa do método de pesquisa fotográfico restaurativo oportunizou o engajamento dos profissionais do campo de estudo e possibilitou implementar muitas melhorias, a partir de sugestões e propostas dos mesmos. Outro aspecto que merece ser destacado, diz respeito ao duplo papel de pesquisador e gestor da instituição investigada, que permitiu traduzir os conhecimentos produzidos a partir do estudo em ações no cenário da prática assistencial, transformando-o em um ambiente mais seguro para o paciente. / The security concept was born with primitive man to fight daily to survive against attacks by predators. Over the years arose survival and safety parameters in almost all work activities. In the health and nursing area this theme has mobilized efforts of health organizations to avoid gaps in care processes that may cause adverse events to patients. This is an exploratory, descriptive research with a qualitative approach, in order to analyze the application of the safe surgery checklist in the operating room for patient safety. The study was conducted using the technique of focus groups and photographic research methods from the perspective of restorative ecological thinking, in the period between March and June 2014. The information was organized with the use of NVivo program 10 and subjected to analysis of thematic content, there were three categories: Checklist for patient safety: still a challenge, Reasons for non-adherence to the Safe Surgery Checklist, Steps Checklist. The results emphasize that the checklist is very important and contributes as a barrier to prevent possible errors laterality of the surgical procedure and patient exchange in the operating room, and ensure the correct identification of the patient while preparing to enter the operating room. In the discussions it was stressed that the group researched know the instrument for the achievement of the safe surgery checklist, however, concerns have trouble completing it, mainly because of the need to streamline the process and quickly refer the patient to the operating room. It was noticed that there are errors in the completion of the safe surgery protocol, in some situations the instrument is filled before starting surgery or after the same. It is essential to involve and engage the medical teams to the application of the safe surgery checklist, and (re) direct and empower the nursing staff in order to properly follow the established checklist protocol, minimizing devaluation situations and ridicule of routine. The application correctly this protocol contributes to the recognition of care teams in the institution. The participatory nature of the photographic restorative search method provided an opportunity to engage the professional field of study and made it possible to implement many improvements from suggestions and proposals from them. Another aspect that deserves to be highlighted concerns the dual role of researcher and manager of the investigated institution, which translated the knowledge produced from the study into shares in the care practice setting, turning it into a safer environment for the patient. / El concepto de seguridad nació con el hombre primitivo que luchar a diario para sobrevivir contra los ataques de los depredadores. Con los años surgieron parámetros de supervivencia y seguridad en casi todas las actividades de trabajo. En el área de la salud y de enfermería este tema ha movilizado esfuerzos de las organizaciones de salud para evitar lagunas en los procesos de atención que pueden causar efectos adversos a los pacientes. Se trata de una investigación exploratoria, descriptiva con enfoque cualitativo, con el fin de analizar la aplicación de la lista de verificación de la seguridad quirúrgica en el quirófano para la seguridad del paciente. El estudio se realizó mediante la técnica de grupos focales y los métodos de investigación fotográficos desde la perspectiva del pensamiento ecológico restaurativa, en el período comprendido entre marzo y junio de 2014. La información se organizó con el uso del programa NVivo 10 y se sometió a análisis de contenido temático, había tres categorías: Lista de verificación para la seguridad del paciente: sigue siendo un reto, Razones para la no adhesión a la Lista de verificación de cirugía segura, Pasos Lista de verificación. Los resultados ponen de manifiesto que la lista es muy importante y contribuye como una barrera para evitar posibles errores de lateralidad del procedimiento y paciente intercambio quirúrgica en el quirófano, y garantizar la correcta identificación del paciente mientras se preparan para entrar en la sala de operaciones. En los debates se destacó que el grupo investigado conocen el instrumento para el logro de la lista de verificación cirugía segura, sin embargo, las preocupaciones tienen problemas para completarla, principalmente a causa de la necesidad de racionalizar el proceso y rápidamente derivar al paciente a la sala de operaciones. Se observó que hay errores en la finalización del protocolo de cirugía segura, en algunas situaciones el instrumento se llena antes de comenzar la cirugía o después de la misma. Es esencial involucrar y comprometer a los equipos médicos a la aplicación de la lista de verificación de la seguridad quirúrgica y (re) dirigir y capacitar al personal de enfermería con el fin de seguir correctamente el protocolo de lista de control establecido, minimizando situaciones de devaluación y el ridículo de rutina. La aplicación correcta de este protocolo contribuye al reconocimiento de los equipos de atención en la institución. El carácter participativo del método de búsqueda restaurador fotográfico proporcionado una oportunidad para entablar el campo profesional de estudio e hizo posible la implementación de muchas mejoras de sugerencias y propuestas de ellos. Otro aspecto que merece ser destacado se refiere a la doble función de investigador y director de la institución investigada, que tradujo el conocimiento producido a partir del estudio en acciones en el ámbito de la práctica de atención, convirtiéndola en un entorno más seguro para el paciente.

Made available in DSpace on 2014-06-11T19:27:46Z (GMT). No. of bitstreams: 0 Previous issue date: 2002Bitstream added on 2014-06-13T19:35:55Z : No. of bitstreams: 1 presta_aa_me_araca.pdf: 1876065 bytes, checksum: b6855e36cd133000f28173ee9b0b6dd4 (MD5) / O presente estudo teve como objetivo a análise dos Planos Municipais de Saúde (PMS) dos 27 municípios integrantes da 8ª Regional de Saúde do Estado do Paraná (8ªRS/PR), com ênfase na identificação e descrição dos registros referentes à Odontologia. Após a análise dos registros dos PMS, visando consolidar o estudo, optou-se pelo confronto dos dados obtidos com dados de outras fontes. Para tanto foram coletadas informações junto à 8ª RS/PR e enviados questionários aos secretários municipais de saúde e aos coordenadores dos serviços públicos odontológicos dos municípios participantes.Os resultados evidenciaram a presença de registros tênues referentes à Odontologia na totalidade dos PMS. A análise dos PMS permitiu identificar somente duas categorias de assuntos: a) caracterização da situação gerencial e assistencial da rede pública de serviços odontológicos; b) objetivos para a Odontologia nos PMS. A comparação dos dados obtidos nos PMS com os da 8ªRS/PR demonstrou incoerência entre os mesmos ao que se relaciona aos assuntos analisados, na maioria dos registros. Quando comparados os objetivos descritos nos PMS com a percepção dos secretários e dos coordenadores, percebeu-se que praticamente não houve correspondência entre os mesmos. Com base nos registros de Odontologia, conclui-se que as informações contidas nos PMS apresentam-se insuficientes ao planejamento em saúde bucal. / The present study aimed at analyzing the Municipal Plans of Health (MPH) of the 27 cities constituting the 8th Health Sector of the State of Paraná (8th HS/PR), focusing on the identification and description of the sectors as far as dentistry is concerned. After the analysis of the records of the MPH, we opted for the confrontation between the obtained data and the data from other sources. In order to do that, information was collected in the 8th HS/PR and questionnaires were sent to municipal health secretaries and coordinators of the odontological public services of the participating cities. The results evidenced the presence of tenuous records referring to Dentistry in all the MPH. The analysis of the MPH allowed the identification of only two categories of subjects: a) characterization of the managerial and assistance situation of the public odontological services; b) objectives for Dentistry in the MPH. The comparison between the obtained data and the ones from the 8th HS/PR showed incoherence among them concerning the analyzed issues in the majority of the records. When the described objectives of the MPH were compared with the secretaries’ and coordinators’ perceptions, it was observed that there was practically no correspondence between them. Based on the Dentistry records, it was concluded that the information in the MPH is insufficient for buccal health planning.