Em decorrência do sucesso da cirurgia bariátrica para o tratamento da obesidade grau III e de suas comorbidades associadas, esta cirurgia vem se tornado cada vez mais indicada. A redução do consumo de cuidados com a saúde tem sido relatada após o tratamento cirúrgico, entretanto a utilização de serviços hospitalares não tem sido bem documentada. O conhecimento do consumo destes serviços na cirurgia bariátrica é importante para dimensionar serviços de saúde e custos resultantes desta cirurgia. Objetivos: Analisar o consumo dos serviços hospitalares e de exames bioquímicos em pacientes submetidos à cirurgia bariátrica. Métodos: O estudo foi retrospectivo. A amostra foi constituída por indivíduos do sexo feminino por ser a predominante na população bariátrica. O consumo de serviços hospitalares foi analisado pela quantidade de atendimentos ambulatoriais, hospitalizações, atendimento em pronto-socorro e exames bioquímicos realizados durante quatro anos pós-operatórios e comparados com o período pré-operatório. Os exames bioquímicos analisados foram hemograma completo, colesterol total e frações, triglicérides, albumina, glicemia, insulina, hemoglobina A1c, uréia e creatinina. Estas variáveis foram comparadas com grupos de obesos em tratamento clínico e pacientes cirúrgicos submetidos à cirurgia curativa de câncer colo-retal. Resultados: A quantidade de consultas ambulatoriais não se modificou ao longo do tempo em todos os grupos. O grupo de obesos em tratamento clínico teve maior demanda para esta variável, seguido pelo grupo bariátrico e cirúrgico respectivamente. Hospitalizações aumentaram no grupo bariátrico, entretanto não houve diferenças significativas quando comparadas com os outros grupos. Atendimentos em pronto-socorro não se alteraram durante o estudo e também não houve diferenças para esta variável entre os grupos. O grupo de obesos em tratamento clínico teve maior demanda de exames bioquímicos durante o período, não havendo alteração ao longo do estudo. Já nos grupos bariátrico e cirúrgico esta variável foi reduzida após a cirurgia. O colesterol total e HDL pré-operatório de todos os grupos se apresentaram com valores alterados e houve melhora somente no grupo bariátrico. Triglicérides não estavam elevados no grupo bariátrico e com a cirurgia houve também redução. Valores de glicemia, insulina, hemoglobina A1c e leucócitos (inflamação sistêmica) reduziram-se somente no grupo bariátrico. A creatinina diminuiu nos grupos bariátrico e de obesos em tratamento clínico. Albumina e uréia permaneceram inalteradas em todos os grupos. O Índice de Massa Corporal (IMC) inicial manifestou diferenças entre os grupos, sendo maior no grupo bariátrico, seguido pelos obesos em tratamento clínico e por último o grupo cirúrgico. Somente o grupo bariátrico teve seus valores reduzidos. Conclusão: A cirurgia bariátrica foi capaz de melhorar a maioria das variáveis laboratoriais, juntamente com a perda de peso. Entretanto, há um grande impacto no consumo de visitas ambulatoriais mantendo-se em níveis elevados até o quarto ano após a cirurgia, exceto para a demanda de exames bioquímicos que se reduziu. O consumo de serviços hospitalares destes pacientes é comparável ao de outros pacientes submetidos a cirurgia abdominal de grande porte. A administração hospitalar bem como autoridades de saúde pública devem ficar atentos para as peculiaridades desta demanda face às dimensões do atual problema com a obesidade. / Due to the success of bariatric surgery in the treatment of obesity class III and associated comorbidities, this surgery is becoming more common. Consumption of healthcare has been shown to diminish after surgical treatment but utilization of hospital services has not been well documented. The knowledge of consumption of this service in bariatric surgery is important to project the requirement for health services and the costs resulting from this surgery. Objectives: Analyze the consumption of hospital services and biochemical tests by patients submitted to bariatric surgery. Methods: Retrospective study. Sample was constituted by female individuals because they are predominant in bariatric population. Consumption of hospital services was analyzed by documentation of outpatient visits, hospitalizations, emergency department visits and biochemical tests during four years in the postoperative period, compared to the preoperative year. Variables included hematologic counts, total cholesterol and fractions, triglycerides, albumin, blood glucose, insulin, hemoglobin A1c, urea and creatinine. These variables were compared to conservatively managed obese cases and to surgical patients submitted to curative colorectal cancer operation. Results: Obese nonsurgical participants displayed the highest demand for outpatient visits, followed by bariatric and surgical cases respectively. Hospitalizations increased in bariatric group, however they did reach statistical difference concerning other groups. Emergency visits did not alter along the study and did not have differences between the groups. Obese cases receiving clinical treatment had the highest demand of biochemical tests, without modification along the study. Bariatric and surgical groups demonstrated decrease of this variable after surgery. Preoperatively cholesterol and HDL was abnormal in all groups, subsequent reduction occurring in bariatric group only. Triglycerides were not elevated but again diminished in bariatric group only. Blood glucose, insulin, Hemoglobin A1c and white blood cell count (systemic inflammation) decreased in bariatric subjects only. Creatinine was reduced in bariatric and obese nonsurgical patients. Albumin and urea remained stable in all groups. Initial Body Mass Index was different in all groups, being highest in bariatric group, followed by obese submitted to clinical treatment and colorectal surgical group respectively. Just bariatric subjects had reduction in their values. Conclusion: Bariatric intervention was able to ameliorate most variables, simultaneously to weight loss. However, it has a significant impact on outpatient visits, which maintained high values until four years after surgery. The opposite occurred with biochemical tests which decreased in the follow-up period. Consumption of hospital services by bariatric subjects was comparable to patients requiring major abdominal operations such as colorectal interventions. Hospital administration and public health authorities should consider the characteristics of such demand, since obesity is a significant problem in our days.

<p>Background: Childrens health, particularly in the early years, forms the basis of future health and development and plays a significant role in predicting individual life and opportunities. Thus, studies which enhance the understanding of the determinants of childrens health status are needed. Previous research on childrens health had focused on the familys and infants characteristics and ignored the potential impact of macro-level influences. The objectives of this thesis were (i) to examine the independent effects of neighbourhood factors on childhood health outcomes, (ii) to explore neighbourhood moderating effects on the associations between some individual risk factors and childhood health outcomes, and (iii) to quantify the contribution of neighbourhood factors to childhood health outcomes.</p><p>Method: The study population included 9,888 children born to women residing in Saskatoon during three years, 1992-1994. The data used in this study were extracted from three sources. The information related to birth outcomes and the mothers characteristics was extracted from the birth registration files maintained by Saskatchewans Vital Statistics Branch. The health services utilization information was generated from Saskatchewan Healths computerized administrative databases. The information related to the neighbourhood characteristics was obtained from Statistics Canadas 1991 Census, from local sources such as the Planning Department of the City, and two specialized neighbourhood surveys. Six domains of neighbourhood were examined in this study: socio-economic disadvantage, social interaction, physical condition, population density, local programs and services, and unhealthy lifestyle norm. This study was divided into two focused topics corresponding to two childrens health outcomes: low birth weight (LBW) and childrens hospitalizations (both incidence and length of stay). Multilevel modelling was employed to examine the independent/moderating impacts of neighbourhood characteristics on these childrens health outcomes. GIS mapping was used to visualize the associations between neighbourhood characteristics and childrens health outcomes.</p><p>Findings of focused topic 1: There was a significant variation across Saskatoon neighbourhoods in the distribution of LBW rate. This significant variation was attributed to both the characteristics of individuals living within the neighbourhoods as well as the characteristics of the neighbourhood of residence. Neighbourhood variables were both independent risk factors for LBW and moderators for the association between maternal characteristics and LBW. Specifically, a greater level of socio-economic disadvantage, a lower level of program availability and accessibility within the neighbourhoods were associated with a higher risk of LBW. A significant interaction between neighbourhood social interaction and single parent status was found. The risk of single parent status on LBW was mitigated by a greater level of social interaction within neighbourhoods. With individual level variables held constant, three neighbourhood variables predicted LBW, together contributing to a change in LBW rate of 7.0%.</p><p>Findings of focused topic 2: This focused topic employed a longitudinal/multilevel design to examine the effects of socio-economic status at multiple levels on childrens hospitalization. The key findings of this focused topic are the following: (i) There was a gradient association between the number of adverse birth outcomes and childhood hospitalization; (ii) There was a significant interaction between family income and adverse birth outcomes (i.e., the effect of adverse birth outcomes on childhood hospitalization was heightened among those children living in low income families); (iii) Neighbourhood characteristics, specifically neighbourhood socio-economic disadvantage, neighbourhood physical condition, and neighbourhood population density had independent effects on childhood hospitalization over and above the effect of family income; (iv) With individual level variables held constant, three neighbourhood variables (i.e., neighbourhood socio-economic disadvantage, physical condition and population density) together accounted for a variation of 40% in the incidence rate of hospitalization, and two neighbourhood variables (i.e., neighbourhood socio-economic disadvantage and physical condition) together accounted for a change in the length of stay per hospitalization from 2.88 days to 5.18 days across neighbourhoods.</p><p>Conclusion: Both individual and neighbourhood characteristics determined childhood health outcomes examined. Neighbourhood factors acted as independent risk factors as well as moderators on the association between individual risk factors and health outcomes. The contribution of neighbourhood factors to childrens health outcomes was quite substantial. The findings suggest that future interventions aimed at improving childrens health status in Saskatoon may be enhanced by targeting both high risk individuals and high risk neighbourhoods. The geographical variations in childrens health outcomes reported in this study are modifiable; they can be altered through public policy and urban planning, and through the efforts of families and children.

<p>Background: Childrens health, particularly in the early years, forms the basis of future health and development and plays a significant role in predicting individual life and opportunities. Thus, studies which enhance the understanding of the determinants of childrens health status are needed. Previous research on childrens health had focused on the familys and infants characteristics and ignored the potential impact of macro-level influences. The objectives of this thesis were (i) to examine the independent effects of neighbourhood factors on childhood health outcomes, (ii) to explore neighbourhood moderating effects on the associations between some individual risk factors and childhood health outcomes, and (iii) to quantify the contribution of neighbourhood factors to childhood health outcomes.</p><p>Method: The study population included 9,888 children born to women residing in Saskatoon during three years, 1992-1994. The data used in this study were extracted from three sources. The information related to birth outcomes and the mothers characteristics was extracted from the birth registration files maintained by Saskatchewans Vital Statistics Branch. The health services utilization information was generated from Saskatchewan Healths computerized administrative databases. The information related to the neighbourhood characteristics was obtained from Statistics Canadas 1991 Census, from local sources such as the Planning Department of the City, and two specialized neighbourhood surveys. Six domains of neighbourhood were examined in this study: socio-economic disadvantage, social interaction, physical condition, population density, local programs and services, and unhealthy lifestyle norm. This study was divided into two focused topics corresponding to two childrens health outcomes: low birth weight (LBW) and childrens hospitalizations (both incidence and length of stay). Multilevel modelling was employed to examine the independent/moderating impacts of neighbourhood characteristics on these childrens health outcomes. GIS mapping was used to visualize the associations between neighbourhood characteristics and childrens health outcomes.</p><p>Findings of focused topic 1: There was a significant variation across Saskatoon neighbourhoods in the distribution of LBW rate. This significant variation was attributed to both the characteristics of individuals living within the neighbourhoods as well as the characteristics of the neighbourhood of residence. Neighbourhood variables were both independent risk factors for LBW and moderators for the association between maternal characteristics and LBW. Specifically, a greater level of socio-economic disadvantage, a lower level of program availability and accessibility within the neighbourhoods were associated with a higher risk of LBW. A significant interaction between neighbourhood social interaction and single parent status was found. The risk of single parent status on LBW was mitigated by a greater level of social interaction within neighbourhoods. With individual level variables held constant, three neighbourhood variables predicted LBW, together contributing to a change in LBW rate of 7.0%.</p><p>Findings of focused topic 2: This focused topic employed a longitudinal/multilevel design to examine the effects of socio-economic status at multiple levels on childrens hospitalization. The key findings of this focused topic are the following: (i) There was a gradient association between the number of adverse birth outcomes and childhood hospitalization; (ii) There was a significant interaction between family income and adverse birth outcomes (i.e., the effect of adverse birth outcomes on childhood hospitalization was heightened among those children living in low income families); (iii) Neighbourhood characteristics, specifically neighbourhood socio-economic disadvantage, neighbourhood physical condition, and neighbourhood population density had independent effects on childhood hospitalization over and above the effect of family income; (iv) With individual level variables held constant, three neighbourhood variables (i.e., neighbourhood socio-economic disadvantage, physical condition and population density) together accounted for a variation of 40% in the incidence rate of hospitalization, and two neighbourhood variables (i.e., neighbourhood socio-economic disadvantage and physical condition) together accounted for a change in the length of stay per hospitalization from 2.88 days to 5.18 days across neighbourhoods.</p><p>Conclusion: Both individual and neighbourhood characteristics determined childhood health outcomes examined. Neighbourhood factors acted as independent risk factors as well as moderators on the association between individual risk factors and health outcomes. The contribution of neighbourhood factors to childrens health outcomes was quite substantial. The findings suggest that future interventions aimed at improving childrens health status in Saskatoon may be enhanced by targeting both high risk individuals and high risk neighbourhoods. The geographical variations in childrens health outcomes reported in this study are modifiable; they can be altered through public policy and urban planning, and through the efforts of families and children.

A concept of "total patient care" was developed in Hong Kong to enhance public hospital services. The development of this concept aimed to resolve two major concerns about patient care delivery. First, for historical reasons, there were differences among public hospitals in their emphases on the scientific medicine and social aspects of caring. Secondly, the health care system was under pressure to change due to rising expectations, in particular to an increasing number of patients requiring complex care in the community. The purposes of this study were (1) to investigate the historical influence on the development of patient services and (2) to examine the determinants affecting the development of new initiatives. The path-finding process to shift care practice from a traditional institutional orientation to a person-centred approach was studied through a focal point of study in all 38 public hospitals, serving a population of 6.3 millions. An analysis of the "successful" examples of the implementation of the concept of total patient care was initially conducted. The subsequent development of a variety of hospital patient care models was traced back to the different origins of patient care orientations through collecting views of hospital stakeholders and the support provided for patients outside the hospitals. A pluralistic approach, which involved site visits, interviews, focus group discussion and survey, was chosen to understand the complexity of historical influence and contemporary determinants in the development of the totality of patient care. A "mapping" method was adopted to analyse the data reflected different levels of concerns. The findings in this study indicated that, technological and financial factors often identified as the more important determinants in development of health care system, might have ignored the historical development of the hospitals and health traditions in the community in the development of totality of patient care. This study suggested that influences of these informal factors, as experienced in a Chinese community, would likely to continue and diffuse the goal of a planned policy. Formalisation of the informal and community involvement in formal hospital settings, through a concept of total patient care, had resulted in the consolidation of some diversified experience in the support of a diversified range of patient needs. The strengthening of a hospital-community linkage was highlighted as a possible solution to bring a full transformation of patient care into a model of totality.

Em decorrência do sucesso da cirurgia bariátrica para o tratamento da obesidade grau III e de suas comorbidades associadas, esta cirurgia vem se tornado cada vez mais indicada. A redução do consumo de cuidados com a saúde tem sido relatada após o tratamento cirúrgico, entretanto a utilização de serviços hospitalares não tem sido bem documentada. O conhecimento do consumo destes serviços na cirurgia bariátrica é importante para dimensionar serviços de saúde e custos resultantes desta cirurgia. Objetivos: Analisar o consumo dos serviços hospitalares e de exames bioquímicos em pacientes submetidos à cirurgia bariátrica. Métodos: O estudo foi retrospectivo. A amostra foi constituída por indivíduos do sexo feminino por ser a predominante na população bariátrica. O consumo de serviços hospitalares foi analisado pela quantidade de atendimentos ambulatoriais, hospitalizações, atendimento em pronto-socorro e exames bioquímicos realizados durante quatro anos pós-operatórios e comparados com o período pré-operatório. Os exames bioquímicos analisados foram hemograma completo, colesterol total e frações, triglicérides, albumina, glicemia, insulina, hemoglobina A1c, uréia e creatinina. Estas variáveis foram comparadas com grupos de obesos em tratamento clínico e pacientes cirúrgicos submetidos à cirurgia curativa de câncer colo-retal. Resultados: A quantidade de consultas ambulatoriais não se modificou ao longo do tempo em todos os grupos. O grupo de obesos em tratamento clínico teve maior demanda para esta variável, seguido pelo grupo bariátrico e cirúrgico respectivamente. Hospitalizações aumentaram no grupo bariátrico, entretanto não houve diferenças significativas quando comparadas com os outros grupos. Atendimentos em pronto-socorro não se alteraram durante o estudo e também não houve diferenças para esta variável entre os grupos. O grupo de obesos em tratamento clínico teve maior demanda de exames bioquímicos durante o período, não havendo alteração ao longo do estudo. Já nos grupos bariátrico e cirúrgico esta variável foi reduzida após a cirurgia. O colesterol total e HDL pré-operatório de todos os grupos se apresentaram com valores alterados e houve melhora somente no grupo bariátrico. Triglicérides não estavam elevados no grupo bariátrico e com a cirurgia houve também redução. Valores de glicemia, insulina, hemoglobina A1c e leucócitos (inflamação sistêmica) reduziram-se somente no grupo bariátrico. A creatinina diminuiu nos grupos bariátrico e de obesos em tratamento clínico. Albumina e uréia permaneceram inalteradas em todos os grupos. O Índice de Massa Corporal (IMC) inicial manifestou diferenças entre os grupos, sendo maior no grupo bariátrico, seguido pelos obesos em tratamento clínico e por último o grupo cirúrgico. Somente o grupo bariátrico teve seus valores reduzidos. Conclusão: A cirurgia bariátrica foi capaz de melhorar a maioria das variáveis laboratoriais, juntamente com a perda de peso. Entretanto, há um grande impacto no consumo de visitas ambulatoriais mantendo-se em níveis elevados até o quarto ano após a cirurgia, exceto para a demanda de exames bioquímicos que se reduziu. O consumo de serviços hospitalares destes pacientes é comparável ao de outros pacientes submetidos a cirurgia abdominal de grande porte. A administração hospitalar bem como autoridades de saúde pública devem ficar atentos para as peculiaridades desta demanda face às dimensões do atual problema com a obesidade. / Due to the success of bariatric surgery in the treatment of obesity class III and associated comorbidities, this surgery is becoming more common. Consumption of healthcare has been shown to diminish after surgical treatment but utilization of hospital services has not been well documented. The knowledge of consumption of this service in bariatric surgery is important to project the requirement for health services and the costs resulting from this surgery. Objectives: Analyze the consumption of hospital services and biochemical tests by patients submitted to bariatric surgery. Methods: Retrospective study. Sample was constituted by female individuals because they are predominant in bariatric population. Consumption of hospital services was analyzed by documentation of outpatient visits, hospitalizations, emergency department visits and biochemical tests during four years in the postoperative period, compared to the preoperative year. Variables included hematologic counts, total cholesterol and fractions, triglycerides, albumin, blood glucose, insulin, hemoglobin A1c, urea and creatinine. These variables were compared to conservatively managed obese cases and to surgical patients submitted to curative colorectal cancer operation. Results: Obese nonsurgical participants displayed the highest demand for outpatient visits, followed by bariatric and surgical cases respectively. Hospitalizations increased in bariatric group, however they did reach statistical difference concerning other groups. Emergency visits did not alter along the study and did not have differences between the groups. Obese cases receiving clinical treatment had the highest demand of biochemical tests, without modification along the study. Bariatric and surgical groups demonstrated decrease of this variable after surgery. Preoperatively cholesterol and HDL was abnormal in all groups, subsequent reduction occurring in bariatric group only. Triglycerides were not elevated but again diminished in bariatric group only. Blood glucose, insulin, Hemoglobin A1c and white blood cell count (systemic inflammation) decreased in bariatric subjects only. Creatinine was reduced in bariatric and obese nonsurgical patients. Albumin and urea remained stable in all groups. Initial Body Mass Index was different in all groups, being highest in bariatric group, followed by obese submitted to clinical treatment and colorectal surgical group respectively. Just bariatric subjects had reduction in their values. Conclusion: Bariatric intervention was able to ameliorate most variables, simultaneously to weight loss. However, it has a significant impact on outpatient visits, which maintained high values until four years after surgery. The opposite occurred with biochemical tests which decreased in the follow-up period. Consumption of hospital services by bariatric subjects was comparable to patients requiring major abdominal operations such as colorectal interventions. Hospital administration and public health authorities should consider the characteristics of such demand, since obesity is a significant problem in our days.

Thesis (M.S.)--Boston University / A panel of speakers from several hospital services including; psychiatry, nursing and social service, who speak on the work of the psychiatric hospital has just completed its tenth year of community education in and around Greater Boston, under the auspices of the Massachusetts MentalHealth Center. The purpose of this study is now to seek some index of its effectiveness, to consider how the findings may serve as a gP.ide to practice for the panel itself and for other programs in the mental health education field, and to recommend areas for further study.

O estudo tem como tema central a educação dos trabalhadores de enfermagem e a sua articulação com o cotidiano de trabalho. Foi desenvolvido com os objetivos de analisar as concepções dos enfermeiros sobre as relações existentes entre atividades educativas de trabalhadores e processo de trabalho de enfermagem, e as possibilidades de mudança nessa relação na perspectiva da integralidade da saúde, da educação permanente em saúde e do trabalho em equipe, conceitos que compõem o referencial teórico. Na pesquisa de campo foram realizadas 22 entrevistas semi-estruturadas com enfermeiros de dois hospitais públicos, 14 em hospital de ensino e 8 em hospital municipal. Os sujeitos foram selecionados com a utilização da técnica de bola-de-neve, iniciando com a gerente da área de enfermagem de cada hospital estudado. Os resultados mostraram que nos dois hospitais o processo de trabalho dos enfermeiros se compõe de duas dimensões complementares: gerencial e assistencial. Na primeira predominam atividades de gerenciamento de recursos humanos e, na segunda, a sistematização da assistência de enfermagem. Contudo, no hospital de ensino a atuação dos enfermeiros na sistematização da assistência de enfermagem refere-se à execução do cuidado e ao gerenciamento do cuidado e, no hospital municipal, apenas ao gerenciamento do cuidado. Há, em ambos os serviços, uma estreita relação entre processo de trabalho e atividades educativas de trabalhadores de enfermagem, porém, de caráter instrumental, técnico; e os enfermeiros têm a expectativa que as atividades educativas sejam realizadas pela área de educação continuada. Foram identificadas possibilidades de mudanças nas relações entre o processo de trabalho e a atividade educativa, em experiências voltadas a gestão participativa e ao trabalho em equipe, porém uma frágil presença de tematização da integralidade e da educação permanente em saúde. Conclui-se pela necessidade de construção de mudanças do modelo assistencial e das atividades educativas de trabalhadores nos hospitais, na perspectiva da atenção integral à saúde contemplando para além do biológico, também as dimensões da vida social, cultural e emocional. / The study is focused on nursing workers education and the relationship with the daily work. It was developed with the purpose of analyzing the nursess views on the relationship between educational activities for workers and work processes of nurses, and the possibilities for change in this relationship in perspective for integration of health, of continuing health education and teamwork concepts which constitute the theoretical framework. In the field research were carried out as follows: 22 semi-structured interviews with nurses from two hospitals, 14 in educational hospital and 8 in the public hospital. The subjects were selected using the snowball technic, starting with the nurse area manager at each hospital. The results showed that both hospitals nurses work processes is composed by two complementary dimensions: management and care. The first activities are mostly of human resource management and, second, the nursing care systematization. However, in educational hospital the nurses work in nursing care systematization refers to the care implementation and care management and in public hospital, just care management. In both services, we found a close relationship between work processes and educational activities nursing workers, however of instrumental character, technical; though nurses have the expectation that the educational activities be done by the educational area. We identified opportunities for change in relations between the work processes and educational activities, in experiments aimed at participatory management and teamwork, but a weak presence of thematizing completeness and continuing health education. It is needed to change the assistencial model and educational activities for workers in hospitals, in view of the comprehensive health care in addition to addressing the biological, also the dimensions of social, cultural and emotional.

O estudo tem como tema central a educação dos trabalhadores de enfermagem e a sua articulação com o cotidiano de trabalho. Foi desenvolvido com os objetivos de analisar as concepções dos enfermeiros sobre as relações existentes entre atividades educativas de trabalhadores e processo de trabalho de enfermagem, e as possibilidades de mudança nessa relação na perspectiva da integralidade da saúde, da educação permanente em saúde e do trabalho em equipe, conceitos que compõem o referencial teórico. Na pesquisa de campo foram realizadas 22 entrevistas semi-estruturadas com enfermeiros de dois hospitais públicos, 14 em hospital de ensino e 8 em hospital municipal. Os sujeitos foram selecionados com a utilização da técnica de bola-de-neve, iniciando com a gerente da área de enfermagem de cada hospital estudado. Os resultados mostraram que nos dois hospitais o processo de trabalho dos enfermeiros se compõe de duas dimensões complementares: gerencial e assistencial. Na primeira predominam atividades de gerenciamento de recursos humanos e, na segunda, a sistematização da assistência de enfermagem. Contudo, no hospital de ensino a atuação dos enfermeiros na sistematização da assistência de enfermagem refere-se à execução do cuidado e ao gerenciamento do cuidado e, no hospital municipal, apenas ao gerenciamento do cuidado. Há, em ambos os serviços, uma estreita relação entre processo de trabalho e atividades educativas de trabalhadores de enfermagem, porém, de caráter instrumental, técnico; e os enfermeiros têm a expectativa que as atividades educativas sejam realizadas pela área de educação continuada. Foram identificadas possibilidades de mudanças nas relações entre o processo de trabalho e a atividade educativa, em experiências voltadas a gestão participativa e ao trabalho em equipe, porém uma frágil presença de tematização da integralidade e da educação permanente em saúde. Conclui-se pela necessidade de construção de mudanças do modelo assistencial e das atividades educativas de trabalhadores nos hospitais, na perspectiva da atenção integral à saúde contemplando para além do biológico, também as dimensões da vida social, cultural e emocional. / The study is focused on nursing workers education and the relationship with the daily work. It was developed with the purpose of analyzing the nursess views on the relationship between educational activities for workers and work processes of nurses, and the possibilities for change in this relationship in perspective for integration of health, of continuing health education and teamwork concepts which constitute the theoretical framework. In the field research were carried out as follows: 22 semi-structured interviews with nurses from two hospitals, 14 in educational hospital and 8 in the public hospital. The subjects were selected using the snowball technic, starting with the nurse area manager at each hospital. The results showed that both hospitals nurses work processes is composed by two complementary dimensions: management and care. The first activities are mostly of human resource management and, second, the nursing care systematization. However, in educational hospital the nurses work in nursing care systematization refers to the care implementation and care management and in public hospital, just care management. In both services, we found a close relationship between work processes and educational activities nursing workers, however of instrumental character, technical; though nurses have the expectation that the educational activities be done by the educational area. We identified opportunities for change in relations between the work processes and educational activities, in experiments aimed at participatory management and teamwork, but a weak presence of thematizing completeness and continuing health education. It is needed to change the assistencial model and educational activities for workers in hospitals, in view of the comprehensive health care in addition to addressing the biological, also the dimensions of social, cultural and emotional.

Yes / To assess developments over time in the capture, curation and use of quality and safety information in managing hospital services. Setting: Four acute National Health Service hospitals in England. Participants: 111.5 hours of observation of hospital board and directorate meetings, and 72 hours of ward observations. 86 interviews with board level and middle managers and with ward managers and staff. Results: There were substantial improvements in the quantity and quality of data produced for boards and middle managers between 2013 and 2016, starting from a low base. All four hospitals deployed data warehouses, repositories where datasets from otherwise disparate departmental systems could be managed. Three of them deployed real-time ward management systems, which were used extensively by nurses and other staff. Conclusions: The findings, particularly relating to the deployment of real-time ward management systems, are a corrective to the many negative accounts of information technology implementations. The hospital information infrastructures were elements in a wider move, away from a reliance on individual professionals exercising judgements and towards team-based and data-driven approaches to the active management of risks. They were not, though, using their fine-grained data to develop ultrasafe working practices. / NIHR Health Service and Delivery Research (HS&DR) programme, project 13/07/68.

Yes / There have been concerns about the quality and safety of NHS hospital services since the turn of the millennium. This study investigated the progress that acute NHS hospital trusts have made in developing and using technology infrastructures to enable them to monitor quality and safety following the publication in 2013 of the second Francis report on the scandal at Mid Staffordshire NHS Foundation Trust (The Mid Staffordshire NHS Foundation Trust Public Inquiry. Chaired by Sir Robert Francis QC. Report of the Mid Staffordshire NHS Foundation Trust Public Inquiry. HC 898. London: The Stationery Office; 2013). Methods: A telephone survey of 15 acute NHS trusts in the Yorkshire and the Humber region, and a review of board papers of all acute NHS trusts in England for January 2015, were undertaken. The telephone survey was used to identify trusts for a larger field study, which was undertaken in four acute NHS trusts between April 2015 and September 2016. The methods included the direct observation of the use of whiteboards and other technologies on two wards in each trust, an observation of board quality committees, semistructured interviews and an analysis of the quality and safety data in board papers. Published sources about national and local agencies were reviewed to identify the trust quality and safety data that these agencies accessed and used. An interview programme was also undertaken with those organisations. The Biography of Artefacts approach was used to analyse the data. Findings: The data and technology infrastructures within trusts had developed over many years. The overall design had been substantially determined by national agencies, and was geared to data processing: capturing and validating data for submission to national agencies. Trust boards had taken advantage of these data and used them to provide assurance about quality and safety. Less positively, the infrastructures were fragmented, with different technologies used to handle different quality and safety data. Real-time management systems on wards, including electronic whiteboards and mobile devices, were used and valued by nurses and other staff. The systems support the proactive management of clinical risks. These developments have occurred within a broad context, with trusts focusing on improving the quality and safety of services and publishing far more data on their performance than they did just 3 years earlier. Trust-level data suggest that quality and safety improved at all four trusts between 2013 and 2016. Our findings indicate that the technology infrastructures contributed to these improvements. There remains considerable scope to rationalise those infrastructures. / National Institute for Health Research Health Services and Delivery Research programme.