A dissertation submitted in partial fulfillment of the requirements for the degree of Master of Arts in the Department of Psychology, University of Zululand, South Africa, 2006. / The University of Zululand Community Psychology Centre (CPC) is a joint project of the Department of Psychology, Educational Psychology and Industrial Psychology. It was established in response firstly to the University's need to provide relevant training for its post-graduate psychology students and secondly to meet the need within the Zululand community for affordable psychosocial and psycho-educational services. The Centre works in partnership with other local Zululand Mental Health centres. The Centre is accredited with the Professional Board for Psychologists of the Health Professions Council of South Africa (HPCSA). This board ensures that institutions providing psychological services observe ethical codes of conduct and good practice (HPCSA, 2002). The present research was motivated by the fact that the CPC functioning has never been evaluated in terms of service delivery and relevance. The desire to know whether the CPC serves the purposes for which it was established, and to identify areas that need improvement, is a strong motivation. This helps to identify its viability, effectiveness, and value for the University of Zululand and the community served by the University. The aims of the study were to evaluate the CPC in terms of clients' perceptions with regard to effectiveness of the centre in meeting their needs and improving their psychological well-being. An accidental or convenient sample was used. An invitation to volunteer was extended to clients who happened to come for the CPC services. Volunteers completed a questionnaire^ which included a biographical inventory needs analysis questionnaire and RyfTs Scale (1995) of psychological well-being. Participants were pre and post-tested on the variable of psychological well being. The study concluded that the CPC still serves the purpose for which it was established. It is still relevant to the demand of the community. The results revealed that pre and post testing was associated with a significant improvement in total psychological well-being as with special reference to personal growth and positive relations with others. / NRF

Job titles and responsibilities of community health workers (CHWs) have evolved along with the different organizations that have elected to employ them. In a 2020 speech, Democratic presidential candidate Joe Biden discussed the health disparities individuals face in economically distressed communities. He specifically discussed the roles of CHWs and the hiring of 150,000 CHWs to be placed in communities across the country. Unfortunately, information on the experiences, competencies, and factors that contribute to the success of CHWs is limited. The purpose of this cross-sectional study was to explore CHWs’ perceptions of what their role entails and what internal and external factors impact their success on healthcare teams and at the current organization for which they work. Forty CHWs from four different states completed 60-minute semi-structured Zoom interviews. The findings of this study described the role of CHWs as locating and engaging members, connecting members of the health plan to both medical and social resources, assisting in navigating the healthcare system, and educating members on their benefits. The COVID-19 pandemic that began in 2021 introduced changes in the way CHWs completed outreach and connected with members; it also introduced the use of personal protective equipment (PPE) and connections to testing and vaccine programs. Important competencies highlighted by CHWs included empathy, communication skills, networking skills, and cultural competency. CHWs preferred hands-on learning methods when acquiring necessary skills for success. Lastly, organizations can assist and motivate CHWs in their organizations by providing incentives, ongoing training, and management support.

Abstract This study proposes a model for meeting increasingly mandated outcome research objectives in a university counseling center setting. It is proposed that counseling centers utilize their existing intake forms, along with an annual satisfaction survey to determine the effectiveness of counseling services. Effectiveness is defined as improvement and measured by the reduction of the symptoms or presenting concerns with which the client initially presented. It also introduces the Relative-Change Index (R-Chi) as an objective way to quantify intra-individual change occurring as a result of therapy. This new mathematical procedure allows for a more meaningful assessment of the client's degree of improvement, relative to their potential for improvement. By re-administering the problem checklist, routinely included as part of the initial paperwork for each client at intake, again post-therapy, it is possible to quantify improvement by measuring the difference in distressing concerns. Additionally, including a subjective, retrospective survey question asking the client to indicate their perceived rate if improvement at follow-up provides construct validity and allows for correlational comparisons with R-Chi. Results suggest that student/client ratings of the degree to which the services they received satisfactorily addressed their presenting concerns were significantly rated to their R-Chi score. This model suggests that the framework guiding client outcome research should include measures of the client's level of distress, improvement in reducing the distress, and satisfaction with services.

There are four main components in this thesis: a literature review of program evaluation, a description and discussion of the current status of program evaluation in the crisis intervention literature, results and discussion of the formative evaluation which is the primary element of the thesis, and a report on the use of the Goal Attainment Follow-up Guide (GAFG) (Kiresuk & Sherman, 1968) and the Brief Derogatis Psychiatric Rating Scale (B-DPRS) (Derogatis, 1978) for community-based mobile crisis intervention programs. The data for the evaluation were gathered using both quantative and qualitative methods. There were 150 participants in the study: 89 females and 61 males. The mean age was 35. The GAFG was completed by 81 of the participants; 33 of the participants were administred the B-DPRS. There were three major findings in this evaluation. the participants contacted significantly more community agencies and spent less time in hospital after using the crisis program and the GAFG and B-DPRS were found to be unsuitable as outcome instruments for a community-based mobile crisis program. / xv, 208 leaves : ill. ; 28 cm.

Globally, nearly 40% of under-five deaths occur in the first 28 days after birth. Neonatal mortality is concentrated in sub-Saharan Africa and South Asia with an estimated 80% of all neonatal deaths occurring in the two regions. Low quality of care has been associated with poor health outcomes in low-and middle-income countries (LMICs). Low quality of intrapartum care has been shown to be strongly associated with poor newborn outcomes. Improving access to high-quality neonatal care for small and sick newborns is crucial to reducing preventable deaths in the immediate newborn period. Over the last two decades, significant advances have been made in measuring the coverage, quality and equity of maternal health services. However, few studies to-date have explored the quality of care for small and sick newborns in resource-constrained settings. Those studies conducted in low-and middle-income settings demonstrate that in-patient service readiness for small and sick newborns is low. While there have been increasing efforts to develop and standardize metrics for measuring facility readiness for this population, few studies to-date have explored the effective coverage – a term used to denote utilization adjusted for quality – of services for emergency newborn care in such settings. Recommendations for intervention packages for small and sick newborns have largely focused on secondary and tertiary levels of care, leaving the role of community and peripheral facilities under-explored. Central to the agenda of improving the coverage of high-quality services for small and sick newborns is also strengthening the capacity of health workforce that participate in their care. A plethora of training packages and supervision strategies have been tried and tested in LMICs for improving emergency obstetric care with the focus on emergency newborn limited to a few complications. These human resources initiatives have been criticized for being fragmented in implementation. Little is known about the quality of training and supervision for emergency newborn care competencies for the rural health workforce in under-resourced settings. This dissertation is presented in three papers to help evaluate specific components of quality and coverage for the small and sick newborn population in LMICs. Paper one identifies and describes the breadth of strategies used to successfully translate evidence-based community interventions for the management of newborns with possible serious bacterial infections (PSBI), enabling the generation of a common and consistent taxonomy for practitioners and researchers in this domain. Paper two uses quantitative methods to examine the service readiness and effective coverage of services for small and sick newborns at the sub-district and district levels in rural Ghana. Paper three, using a mixed-methods design, assesses health worker perceptions of the quality and gaps in training, supervision and tele-mentoring activities for emergency obstetric and newborn care in rural Ghana.

Introdução: As instituições de saúde trabalham, incansavelmente, em prol da melhoria da qualidade dos serviços prestados e a enfermagem, como integrante desses serviços, busca, constantemente, programas que acarretem melhores resultados assistenciais e com isso a segurança do paciente. Dentre esses programas destaca-se o Magnet Recognition Program, desenvolvido pela American Nurses Credentialing Center- ANCC, o qual visa acreditar os estabelecimentos de saúde com excelência na prática de enfermagem. Objetivo: Analisar a produção científica acerca do processo de implementação do Magnet Recognition Program, publicada no período de junho de 2004 a junho de 2014. Metodologia: Trata-se de uma revisão integrativa de literatura, cuja coleta de dados foi realizada de julho a agosto de 2014, no portal de dados BVS que contempla as bases de dados BDENF, LILACS e MEDLINE e na base de dados CINHAL. A amostra constituiu-se de 16 artigos. Resultados: Os resultados evidenciaram que grande parte dos estudos eram oriundos de revistas de enfermagem, no idioma inglês. Quanto ao delineamento do estudo, verificamos que 11 deles eram constituídos por relatos de experiência e cinco compreendiam pesquisas de abordagem qualitativa, com nível de evidência VI. A análise dos estudos possibilitou compreender com maior clareza o processo de implementação do Magnet Recognition Program constituído por seis etapas, a saber: aplicação, avaliação, visita local, premiação, manutenção e redesignação. Os estudos demonstraram que a etapa de aplicação consistia no processo de submissão da instituição à candidatura frente a ANCC. A etapa de avaliação constituiu-se na análise, pelos avaliadores da ANCC, da documentação escrita apresentada pela organização candidata. Após a aprovação, uma visita ao local era agendada. Na ocasião da visita à instituição a ser acreditada eram identificadas a presença das 14 Forças do Magnetismo na organização. Uma vez aprovado, a certificação Magnet era concedida, constituindo a fase de premiação. Decorrido esse processo, havia o início da fase de manutenção da cultura Magnet, para que a redesignação acontecesse após quatro anos. Como facilitador de todo o processo, os estudos evidenciaram a utilização de consultores, a visita a uma organização anteriormente credenciada, a utilização de um profissional experiente para a elaboração do relatório, o envolvimento de todos os profissionais entendendo o Magnet como uma meta organizacional e o apoio do corpo diretivo, a fim de que os recursos financeiros e estruturais fossem providenciados. Os estudos evidenciaram, ainda, aspectos importantes relacionados aos componentes do Magnet Recognition Program os quais versavam principalmente sobre a governança compartilhada, prática profissional exemplar e estrutura de empowerment fundamentais para as organizações. Conclusão: Este estudo propiciou o conhecimento das etapas para a implementação do Magnet e, desse modo, acreditamos que esse resultado possa contribuir com outras organizações que estão pleiteando essa certificação, fornecendo subsídios para o alcance de seus credenciamentos. No entanto, frente aos níveis de evidência dos artigos, torna-se imperativo a realização de estudos com rigor metodológico mais elevados. / Introduction: Health care organizations vigorously work for the improvement of service quality and nursing, as part of these services, always seeking for assistance programs that involve better results and consequently the patient safety. Among these programs, the Magnet Recognition Program, developed by the American Nurses Credentialing Center-ANCC, aims to accredit health facilities with excellence in nursing practice. Objective: To analyze the scientific production on the implementation process of the Magnet Recognition Program, published from June 2004 to June 2014. Methodology: This is an integrative literature review. Data collection was carried out from July to August 2014, through BVS data portal that includes the BDENF, MEDLINE, LILACS and CINHAL databases. The sample consisted of 16 articles. Results: The results showed that most of the studies were from nursing journals in the English language. Regarding design of the study, we found that 11 of them were based on case reports and five researches comprised a qualitative approach, with evidence level VI. The analysis of the studies allowed us to clearly understand the implementation process of the Magnet Recognition Program consisting of six stages, as follows: implementation, evaluation, site visit, awards, maintenance and reassignment. Studies have shown that the application stage consisted of submitting to the institution the process to be elected by the ANCC. The evaluation stage consisted of analysis by the evaluators of the ANCC related to writing documentation presented by the applicant organization. After approval, a visit to the place was scheduled. On the occasion of the visit to the institution to be accredited, it was identified the presence of 14 Magnetism Forces in the organization. Once approved, the Magnet certification was granted, constituting the awards stage. After this process, the culture Magnet maintenance stage was started so that the reassignment could be performed after four years. As a facilitator item of the whole process, the studies showed the use of consultants, the visit to a previously accredited organization, the employment of an experienced professional to prepare the report, the involvement of all professionals understanding the Magnet program as an organizational goal and the support of the governing staff, in order that the financial and structural resources can be provided. The studies also showed important aspects related to the components of the Magnet Recognition Program which were mainly about the shared governance, professional exemplary practice and fundamental empowerment structure for the organizations. Conclusion: This study allowed to identify the steps to implement the Magnet program and the results can contribute to other organizations that are seeking for this certification, providing subsidies to reach their accreditation. However, when comparing the levels of evidence of the analyzed studies, it was observed the need to use a higher methodological rigor for further studies.

A mensuração da satisfação do usuário quanto ao serviço recebido, passou a ser considerada um elemento de avaliação da qualidade dos serviços de saúde. Diante disso buscou-se avaliar o grau de satisfação dos usuários internados no Hospital Universitário (HU) de Sergipe quanto à qualidade do serviço hospitalar. Trata-se de estudo exploratório, descritivo, com abordagem quantitativa e de corte transversal; desenvolvido em três unidades de internação com pacientes de 18 a 80 anos, alfabetizados ou não e que permaneceram internados por um período mínimo de 48 a 72 horas. Foi aplicado um instrumento para caracterização sócio demográfica da população e a escala SERVQUAL, para determinação do grau de satisfação quanto à qualidade do serviço recebido. A coleta de dados ocorreu em dois momentos distintos, denominados período letivo e período não letivo. Foram entrevistados 305 usuários do serviço de ambos os sexos, com média de idade de 46,2 anos, 177 (58,0%) declararam ter de cinco a dez anos de estudo, 165 (54,1%) participantes não desenvolviam qualquer tipo de atividade econômica, 178 (58,4%) mantinham uma união estável e 157 (51,5%) residiam na capital do Estado. Em relação à experiência prévia de internação hospitalar, 174 (57,0%) afirmaram ter vivido essa experiência, destas, 66 (21,7%) ocorreram no HU. As expectativas dos usuários nos dois períodos analisados concentraram-se no escore cinco, portanto, uma alta expectativa em relação ao serviço. Verificou-se que no período letivo e não letivo, para as cinco dimensões e seus 22 atributos houve resultados negativos próximos de 0 (zero) e a média geral do gap foi de - 0,82 e - 0,86, respectivamente, caracterizando qualidade de serviço aceitável. No período letivo, o maior grau de insatisfação foi referente à dimensão empatia; e no período não letivo a tangibilidade. Na relação dos gaps das cinco dimensões pelos períodos de coleta de dados, confirmou-se a diferença entre o grau de satisfação dos usuários apenas para as dimensões atendimento e empatia. Quanto as variáveis de influência no grau de satisfação, para a dimensão confiabilidade os homens mostraram-se mais insatisfeitos quanto ao serviço em relação às mulheres, assim como na dimensão atendimento. Para a variável escolaridade, os usuários com até quatro anos de estudos apresentaram maior insatisfação em relação aos aspectos da dimensão segurança. Quanto ao grau de importância das características relacionadas à qualidade do serviço de saúde, à dimensão empatia foi considerada prioritária nos dois períodos, assim como a dimensão tangibilidade, foi apontada como de menor importância para a qualidade do serviço. Diante disso, verificou-se que, embora o grau de satisfação dos usuários do HU tenha sido caracterizado como aceitável, pelo presente estudo constatou-se lacunas na qualidade do serviço, as quais até então estavam ocultas às vistas dos gestores desse serviço. Esses resultados constituem importante ferramenta, à medida que, fornecem dados específicos de como os clientes percebem o serviço prestado, e deste modo, facilitam a tomada de decisões, a fim de melhorar a qualidade do serviço. Recomenda-se a implantação de um processo de avaliação contínuo sob a óptica do usuário no HU / The measurement of user satisfaction as the service received, came to be considered an element of assessing the quality of health services. Given that, it was sought to assess the level of satisfaction of the users hospitalized in the Hospital University (HU) of Sergipe on the quality of hospital service. It is an exploratory, descriptive study, with quantitative and transversal approach; developed in three inpatient units with patients from 18 to 80 years old, literate or not and who remained hospitalized for a minimum period of 48 to 72 hours. An instrument was applied to characterize the socio-demographic population and SERVQUAL scale, to determine the level of satisfaction regarding the quality of service received. Data collection occurred at two different times, denominated as term and academic period. 305 service users were interviewed in both sexes, with an average age of 46.2 years old, 177 (58.0%) reported from five to ten years of study, 165 (54.1%) participants do not develop any kind of economic activity, 178 (58.4%) maintained a stable union and 157 (51.5%) resided in the capital of the State. In relation to the previous experience of hospitalization, 174 (57.0%) claimed to have lived that experience, of these, 66 (21.7%) occurred at the HU. The expectations of the users in both analyzed periods were focused on a score of five, so a high expectation in relation to the service. It was found that the academic and no academic period for the five dimensions and its 22 attributes, negative results close to 0 (zero) and the overall average of the gap was - 0.82 and - 0.86 , respectively, featuring acceptable quality of service. In the academic period the highest level of dissatisfaction was referring to dimension empathy; and during the no academic period was the tangibility. In respect of gaps of five dimensions by periods of data collection, it was confirmed the difference between the degree of satisfaction of users only for the dimensions care and empathy. As the influence on the level of satisfaction, for the dimension reliability men were more unhappy about the service towards women, as well as in the care dimension. For the variable education, users with up to four years of study showed greater dissatisfaction in relation to aspects of the security dimension. In the level of importance of the characteristics related to quality of health service, empathy was considered a priority dimension in both periods, as well as the tangibility dimension that was chosen as of lesser importance to the quality of service. Given this, it was found that, although the level of satisfaction of users of HU has been characterized as acceptable by the present study found gaps in service quality, which until then the views of managers of that service were hidden. These results are important tool providing specific data on how customers perceive the service provided, and in this way, facilitate decision-making, in order to improve the quality of service. It is recommended the implementation of a continuous evaluation process under the user\'s optical in HU

As temáticas da qualidade, avaliação e gestão hospitalar, na atualidade, têm pautado as transições demográficas e epidemiológicas como elementos fundamentais de análise organizacional tendo em vista reorientar a gestão da qualidade hospitalar. Tal perspectiva é importante para os gestores que devem buscar desenvolver uma visão que inclua em suas análises administrativas as características da clientela atendida, uma vez que trazem implicações para a gestão do espaço físico, dos recursos materiais, equipamentos médicos, dos recursos humanos, entre outros. Desse modo, nosso estudo tem como objetivo caracterizar o perfil demográfico e epidemiológico das internações e identificar os eventos adversos relativos a infecção hospitalar segundo as topografias do trato urinário, do aparelho respiratório e da corrente sangüínea, na especialidade de clínica médica de um hospital de urgência e emergência de alta complexidade. Trata-se de estudo exploratório, retrospectivo com foco em análise de dados secundários, do tipo individual, o que possibilitou realizar associações das características das internações estudadas. A população de estudo constituiu-se de todas as internações de pacientes adultos, na especialidade de clínica médica no período de 1999 a 2005. As variáveis de interesse para o estudo foram as variáveis demográficas, as epidemiológicas e as relativas a eventos adversos de infecção hospitalar. Os dados foram coletados do Sistema de Informação Gerencial Hospitalar - SIGH e dos arquivos da Comissão de Controle de Infecção Hospitalar - CCIH. Os resultados revelaram que com a implantação da Central Única de Regulação Médica houve uma reorganização do atendimento no hospital de estudo, priorizando-se o acesso a pacientes que demandam atenção de nível terciário, assim ocorreu diminuição de 32,6% das internações do ano de 1999 para 2000. Os dados demográficos revelaram que as internações de 60 anos ou mais, nos anos de 1999-2003, obtiveram percentual superior a 40%. Em relação ao estado civil o maior percentual por ano foi da categoria casados com variação no período de 33,2% a 46,8%, houve predomínio da raça branca com média de 76,5% e o grau de instrução preponderante foi o 1º grau com média de 76,4%. Quanto aos dados epidemiológicos, as doenças do aparelho circulatório participaram do quantitativo de internações com o maior percentual, com uma média de 26,1%, seguida das doenças do aparelho respiratório com média de 12,2% e doenças infecciosas e parasitárias com 11,9%. Nota-se no decorrer dos anos aumento no percentual de pacientes com diagnósticos de neoplasias, doenças do sangue, dos órgãos hematopoéticos e transtornos imunitários e, dos casos de lesões, envenenamento e outras causas externas. Cabe destacar que a maioria, média de 77,6% das internações no período retratam co-morbidades com associação de 2 a 7 diagnósticos médicos. Em relação ao evento adverso infecção hospitalar a pneumonia mantêm padrão em elevação atingindo 57,1% em 2002, sendo a ocorrência mais freqüente das infecções ao longo do período. As infecções da corrente sangüínea nos dois últimos anos apresentam elevação significativa de 8,3% em 2003 para 36,4 em 2005 e as infecções urinárias demonstram uma trajetória de alternância de ocorrências, atingindo o patamar máximo de 41,6% em 2003 declinando para 18,2% em 2005. Acreditamos que o estudo do perfil demográfico de uma clientela internada, também contribui para o delineamento de planos de ações de saúde e de enfermagem, cabendo destacar que as co-morbidades, a faixa etária de 60 anos ou mais, o rebaixamento do grau de instrução implicam em um maior número de fatores de risco à saúde exigindo direcionalidade na atuação dos gestores e profissionais de saúde. A análise dos resultados conforma o contexto de atuação do enfermeiro no que refere a gerência de cuidados à pacientes de alta complexidade, cabendo destacar o foco prioritário da gerência clínica, inicialmente no que concerne à dimensão biológica uma vez que as situações de urgência colocam em risco a vida do paciente, para então, ir ampliando a fim de acolher as necessidades integrais da pessoa hospitalizada. / Hospital quality, assessment, and management are themes that have currently affirmed demographic and epidemiologic transitions as fundamental elements for organizational analyses, with a view to redirect hospital quality management. This perspective is important for administrators who should search to develop a view that includes clients\' characteristics in the administrative analyses, since they bring implications when administrating the physical area, material resources, medical equipment, human resources, and others. Hence, the purpose of this study is to characterize demographic and epidemiological profiles of hospitalizations and identify the adverse events regarding hospital infection according to topographies of the urinary tract, respiratory system, and bloodstream, in the internal medicine ward of a highcomplexity emergency hospital. This is an exploratory, retrospective study, focused on individual secondary data analysis, which permitted to make associations between the studied hospitalization characteristics. The study population consisted of all adult patient hospitalizations in the internal medicine ward, from 1999 to 2005. The variables of interest in this study were the demographic variables, as well as epidemiological variables and those regarding adverse hospital infection events. Data were collected from the Hospital Management Information System (HMIS) and from the Commission for Hospital Infection Control (CCIH) files. Results showed that, by implementing the Single Medical Regulation Central, a reorganization of the studied hospital care took place, giving priority to patients who required tertiary care. Hence, there was a 32.6% reduction in hospitalizations from 1999 to 2000. Demographic data revealed that hospitalizations of patients aged 60 years or more from 1999 to 2003 was above 40%. Regarding marital status, the highest percentage was for married patients, with a rate ranging from 33.2% to 46.8% in the studied period. As to ethnicity, most patients were white, with an average of 76.5%. Regarding education, primary level prevailed, with an average of 76.4%. As to epidemiological data, circulatory system diseases were the most frequent among hospitalizations, with an average of 26.1%, followed by respiratory system diseases with an average of 12.2%, and infectious and parasitic diseases with 11.9%. It is observed that, over the years, there was an increase in the percentage of patients with diagnosis for neoplasms, blood diseases, hematopoietic organ diseases, and immunity disorders, as well as cases of injuries, poisoning, and other external causes. It is worth highlighting that most hospitalizations (77.6% in average) in the studied period represent co-morbidities with associations between 2 to 7 medical diagnoses. Regarding the adverse hospital infection event, pneumonia maintains a growing standard, reaching 57.1% in 2002. Moreover, pneumonia is the most frequent infection occurrence throughout the period. Bloodstream infections presented a significant increase over the two last years, from 8.3% in 2003 to 36.4 in 2005. Urinary infections demonstrated a path of occurrence exchange, reaching a maximum level of 41.6% in 2003 and dropping to 18.2% in 2005. The authors believe that studies about the demographic profile of a hospitalized population also contribute to outlining health and nursing action plans. It is worth emphasizing that co-morbidities, the age group of 60 years or more, and low education levels imply a greater amount of health risk factors, and, thus, demand directionality from administrators and health professionals. The result analysis confirms the context in which nurses work regarding managing highcomplexity patient care, and it is worth emphasizing the primary focus of clinical management, initially concerning the biological dimension since emergency situations put patients\' lives at risk, to then broaden the focus with a view to approach the hospitalized individual\'s integral needs.

A Secretaria Municipal de Saúde (SMS) do município de Ribeirão Preto (SP), desde 2011, vem centralizando de forma gradual o serviço de esterilização dos artigos provenientes das Unidades Básicas de Saúde. O objetivo deste estudo foi analisar o serviço de esterilização, em relação à prática centralizada e descentralizada nas unidades de saúde da atenção básica do município de Ribeirão Preto (SP) e aproximar das legislações vigentes, com fluxos e serviços adequados. O referencial teórico utilizado foi o de Avaliação da Qualidade segundo Donabediam, através dos indicadores de estrutura, processo e resultado. Para a coleta utilizamos a técnica do grupo focal. Encontramos 64% das enfermeiras que trabalham em Unidade com esterilização centralizada em outra Instituição, 36% possuem esterilização no próprio local de trabalho, a maioria com formação entre 10 e 15 anos e inserção na Atenção Básica entre 5 e 11 anos. A esterilização centralizada apresentou vantagens em relação à prática realizada localmente nas Unidades de Saúde no sentido de adequação estrutural, favorecendo a ambiência nos serviços de saúde, a sistematização de fluxo para transporte, aumento e padronização de arsenal cirúrgico e diminuição da carga de trabalho na enfermagem. Os enfermeiros se colocaram como gerenciadores desta atividade. A prática de esterilização realizada localmente apresentou riscos ocupacionais. O estudo apontou necessidade de treinamento adequado para esta atividade. Nas Centrais de Material e Esterilização da rede de atenção primária à saúde, as demandas de manutenção e reparos, bem como o uso de salas de consultório para guarda e utilização dos equipamentos são constantes. Uma vantagem importante do serviço de esterilização centralizada decorre da possibilidade de realização de indicadores de validação do processo de forma mais rigorosa. Alguns problemas levantados no serviço centralizado foram, extravio de instrumental cirúrgico, caixas de transporte e acondicionamento instrumentais fora do padrão bem como a necessidade de melhoria em relação ao transporte e cumprimento de rotina estabelecida, favorecendo assim a resistência de mudança para algumas enfermeiras. A implantação da Central de Material e Esterilização centralizada na Atenção Primária é uma alternativa para adequação do serviço de esterilização visando otimizar e qualificar este serviço / The Municipal Health Bureau (SMS) of Ribeirão Preto (SP), since 2011, has gradually centralized sterilization service of articles from the Basic Health Units. The aim of this study was to analyze the sterilization service in centralized and decentralized practices in health units of basic care of Ribeirão Preto (SP) and approach the current legislation, with adequate flows and services. The theoretical framework used was the Quality Assessment using Donabediam Model through the structure, process and outcome indicators. To collect data, we used the technique of focus group. The survey showed 64% of nurses working in unit with sterilization centralized in another institution, 36% with sterilization in the workplace, most of them with training between 10 and 15 years and insertion in Primary Care between 5 to 11 years. Centralized sterilization presented advantages over the practice carried out locally in the health units towards structural adjustment, favoring the ambience in the health services, systematization of flow to transport, increase and standardization of surgical material and decreased workload in nursing. Nurses put themselves as managers of this activity. Sterilizing practice performed locally presented occupational hazards. The study pointed out the need for proper training for this activity. In the Material and Sterilization Center of the primary health care network, the demands for maintenance and repairs, as well as the use of office rooms for equipment storage and use are constant. An important advantage of centralized sterilization service arises from the possibility of conducting process validation indicators more accurately. Some issues raised in centralized service were: loss of surgical instruments, nonstandard instrumental shipping boxes and packaging and the need for improvement in relation to transport and established routine compliance, thus favoring the resistance for change among some nurses. The implementation of a Material and Sterilization Center centralized in Primary Care is an alternative to the adequacy of the sterilization service to optimize and qualify this service

O estudo teve como objetivo avaliar os serviços da Atenção Básica para o tratamento da tuberculose (TB) em São José do Rio Preto-SP. Trata-se de um estudo avaliativo, quantitativo, que adotou como referencial metodológico os componentes da avaliação da qualidade dos serviços de saúde estrutura, processo e resultado. Constituíram-se como unidades de observação os 25 serviços da Atenção Básica (Unidades Básicas de Saúde-UBS e Unidades de Saúde da Família-USF) da rede municipal de saúde de São José do Rio Preto-SP. A coleta de dados foi realizada entre julho a dezembro de 2011 por meio de entrevistas com 239 profissionais de saúde (médico, enfermeiro, auxiliar/técnico de enfermagem e Agentes Comunitários de Saúde) utilizando instrumento específico e levantamento de dados secundários para avaliar o tratamento da TB na Atenção Básica. A análise dos dados foi realizada por meio de distribuição de frequência e medidas de tendência central. Para a análise do desempenho dos serviços de saúde da Atenção Básica segundo os componentes avaliativos de Estrutura e Processo foi realizada validação das variáveis do instrumento de coleta de dados, tendo como referência para tal os dados produzidos pelos cinco municípios participantes do projeto multicêntrico do qual integra o presente estudo, a partir da qual se criou nove indicadores avaliativos (5 Estrutura e 4 Processo). Dessa forma, para analisar o desempenho dos serviços de saúde calculou-se e considerou-se como unidade de comparação um indicador padronizado Z, adotando-se como parâmetro o valor de Z =1. Assim, os indicadores foram classificados como: insatisfatório (Z<1), bom (-1<Z<1) e Muito bom (Z>1). Para o componente avaliativo resultado, calculou-se proporção. Verificou-se baixo tempo de atuação profissional principalmente entre médicos e enfermeiros na Atenção Básica. Foram classificados como insatisfatórios os indicadores de Estrutura \"capacitação de profissionais\" e \"acesso a instrumentos de registro\" e os de Processo \"realização de tratamento diretamente observado\" e \"ações externas para o controle da TB\". Os indicadores de estrutura \"disponibilidade de insumos\" e \"articulação com outros serviços\" e o de Processo \"Informações sobre a TB\" foram considerados bons. O município obteve melhor desempenho para os indicadores \"Profissionais envolvidos no atendimento\" e \"referência e contra- referência\". Houve baixa proporção de TDO efetivado e de realização de baciloscopia de controle de tratamento entre os doentes acompanhados pelos serviços da Atenção Básica, sendo observado em 2011 um aumento abrupto dos casos de abandono tanto nas UBS quanto nas USF. A análise dos indicadores de resultado de tratamento dos doentes de TB manteve coerência com os indicadores de estrutura e processo e dificuldades para a condução operacional do tratamento da TB nos serviços da Atenção Básica foram identificadas. Apesar do esforço de horizontalização das ações de controle da TB, a dinâmica de organização do serviço da Atenção Básica reproduz a centralização e fragmentação da assistência, com enfoque na atuação do enfermeiro enquanto coordenador do cuidado em um contexto complexo e contraditório no qual a atuação dos demais membros da equipe ocorre de modo pontual e reativo, contrapondo-se às premissas ideológicas e operacionais da Atenção Básica. / The study aimed to assess Primary Health Care (PHC) in regard of tuberculosis (TB) treatment at São José do Rio Preto-SP. An evaluative and quantitative study was conducted, adopting the components of health services assessment: structure, process and outcomes, as the methodological framework. The observational units of the study were composed by 25 PHC services from the municipal health network (Basic Health Units-BHU and Family Health Units-FHU). To assess PHC in regard of TB treatment, data collection was performed between July to December 2011 through interviews with 239 health staff members (physician, nurses, nursing assistants and community health workers) using a specific questionnaire and secondary data survey. Data analysis was performed using descriptive statistics techniques. Performance analysis of PHC to TB treatment, according to the evaluative components of Structure and Process, was performed through validation of the data collection questionnaire variables, from which nine evaluative indicators (5 related to structure and 4 related to TB care process) were created, using as a reference to this validation data produced by five municipalities of a multicenter study in which the present study is included. Considering the differences between the health services, a standardized variable Z was calculated. Using as parameter of comparison the value of Z = 1, indicators were rated as unsatisfactory (Z <1), good (-1 <Z <1) and very good (Z> 1). Proportions were calculated for the evaluative component \"result\". Time of practice in PHC was low especially among doctors and nurses. Structure indicators \"training of staff\" and \"access to medical records\" and process indicators \"DOT (directly observed therapy)\" and \"TB activities in the community\" were classified as unsatisfactory (Z<1). Structure indicators \"material resources\" and \"integration among other services\" were classified as good. The best evaluated indicators in the municipality were \"staff involved with TB treatment\" and \"reference and counter reference\". There was a low proportion of DOT and sputum smear control exams among TB patients followed by PHC services. In 2011 there was an abruptly increase of TB cases in BHU and FHU. TB outcomes indicators were consistent with structure and process indicators. Operational difficulties for TB case management in PHC services were identified. Despite the effort for horizontalization of TB control, organizational aspects of PHC reproduces centralization and fragmentation of care, focusing on the role of nurses as coordinators of TB care in a complex and contradictory context, in which the actions of other team members occurs occasionally, opposing the ideological and operational assumptions of PHC.