O presente trabalho trata do Hospital de Clínicas de Porto Alegre, um patrimônio moderno reconhecido no âmbito local, apesar do afastamento de sua concepção original de Jorge Moreira, autor das três versões preliminares realizadas entre 1942 e 1952. A conclusão do projeto se deu em 1958 por Oscar Valdetaro e Roberto Nadalutti, o projeto executado seguiu em grande parte a última versão de Moreira. O valor do grande bloco foi reconhecido com a salvaguarda municipal em 2011, quando a defasagem crescente entre estrutura física e serviços demandavam sua ampliação. O novo projeto proposto afetava “parcialmente a percepção do conjunto inventariado”, como apontou o parecer da Equipe do Patrimônio Histórico Artístico e Cultural. Indeferido pela via normal, foi aprovado através de Lei Complementar. A dissertação examina a intervenção acrítica realizada, com ampliação de 84.000m² e rearranjos no interior da preexistência. Analisa a complexa requalificação da “peça urbana” moderna cuja condição de bem protegido somado ao programa hospitalar são agravantes. E, de modo propositivo, busca através de investigação volumétrica relações espaciais consistentes entre as expansões necessárias, a preexistência e o entorno, simulando solução funcional que minimize danos à percepção do conjunto. / The present work addresses the Hospital de Clínicas (Clinic Hospital) in Porto Alegre, a modern heritage recognized in the local sphere, despite the distancing of its original conception by Jorge Moreira, author of the three previous versions conceived between 1942 and 1952. The completion of the project occurred in 1958 by Oscar Valdetaro and Roberto Nadalutti, the executed project followed mostly the last version by Moreira. The worth of the big block was recognized by the municipal safeguard in 2011, when the increasing gap between physical structure and services required its extension. The new proposal affected “partially the perception of the inventoried assemblage”, as pointed by the report from the Historic Artistic and Cultural Heritage Staff. Dismissed by standard measures, it was approved by Supplementary Law. The dissertation examines the uncritical intervention implemented, the 84.000m² extension and rearrangements in the preexistent interior. Analyses the complex requalification of the modern “urban element” whose condition as protected asset combined with the hospital program are aggravators. Furthermore, as a proposed method, pursues through volumetric investigation consistent spatial relations between the required expansions, the preexistence and surroundings, simulating a functional solution, which minimizes damages regarding the perception of the assemblage.

A morte està presente no contexto hospitalar desde os primÃrdios de sua criaÃÃo com os profissionais da saÃde operacionalizando no seu cotidiano de trabalho a presenÃa da finitude como contingÃncia inerente da prÃtica em saÃde. A investigaÃÃo teve como objetivo compreender a relaÃÃo do psicÃlogo com o ambiente hospitalar pela construÃÃo de sentidos deste quanto ao processo da morte, tendo como referÃncia a categoria da afetividade (emoÃÃes e sentimentos). Adotou-se o referencial teÃrico da Psicologia Social e Ambiental com base na abordagem histÃrico-cultural e na afetividade como um caminho possÃvel de atingir a complexidade dos fenÃmenos humanos. A pesquisa de campo foi realizada em quatro hospitais da rede pÃblica estadual de Fortaleza com a participaÃÃo de seis psicÃlogas. Os instrumentos aplicados foram os mapas afetivos e a entrevista. Os dados coletados foram submetidos a anÃlise de conteÃdo e agrupados em trÃs categorias temÃticas, a saber: morte, cuidados terapÃuticos e hospital. Foram formados, por meio dos mapas afetivos, as seguintes imagens no ambiente hospitalar: contraste, sofrimento, destruiÃÃo, agradabilidade e pertencimento. Procurou-se ao longo da produÃÃo textual relacionar a morte aos sentimentos e emoÃÃes das psicÃlogas na inter-relaÃÃo com o ambiente do hospital. Os resultados apontaram para uma tendÃncia a uma estima mais positiva do hospital pelas imagens da agradabilidade e pertencimento, muito embora a estima negativa do hospital tenha estado presente nas imagens de contraste, destruiÃÃo e sofrimento com os processos de morte, demandando dor psÃquica nos profissionais participantes da pesquisa, especialmente a morte da crianÃa e do adolestente. / The death is present in the hospitals since the beginning of its creation. Health professionals deal with its presence in their daily routine as a contingency inherent in the health practice. The presented research aimed at understanding the relationship between the psychologist and the hospital environment by building this way about the process of death, taking as reference the affectivity category (emotions and feelings). We adopted the theoretical framework of social and environmental psychology based on cultural-historical approach and affection as possible ways to achieve the complexity of human phenomena. The field of the research was conducted in four public hospitals in the city of Fortaleza with the participation of six psychologists. The instruments used were the affective maps and the interview. The collected data was subjected to content analysis and grouped into three themes: death, therapeutic care and hospital. Four images in the hospital environment were formed through affective maps: contrast, suffering, destruction, pleasantness and inhering. The textual production relates death to the feelings and emotions of the psychologists in the inter-relationship with the hospital environment. The results showed a trend to a more positive estimate of the hospital by the images of pleasantness and belonging, even though the negative estimates of the hospital attended to the contrasting images of destruction and suffering dealing with the death processes. These processes required psychic pain in professional researchers participants. The death, especially in the early stages of development, was the key point to this suffering

O estudo analisa relações sociais e de poder em uma micro-unidade penitenciária de hospital geral, no Rio Grande do Sul, no período compreendido entre julho a outubro de 2004. Para tanto, examina o processo de atendimento à saúde do preso doente que necessita internação hospitalar, destacando o modo como ele chega ao hospital, como é atendido e recebe alta. Focaliza o caso do Hospital Vila Nova, embora também examine o modo como esse atendimento era feito anteriormente, quando ainda funcionava o Hospital Penitenciário do estado. Os dados coletados e analisados referem-se, principalmente, às dinâmicas sociais estabelecidas através das práticas de atendimento médico hospitalar, das práticas de vigilância e das estratégias dos presos doentes na busca de ampliar sua capacidade de negociação e aumentar seu grau de liberdade. Desse modo, verificou-se como a disciplina funcionou como técnica de controle sobre o preso, revelando a supremacia do poder médico no processo de atendimento ao preso doente hospitalizado na micro-unidade penitenciária em foco. O estudo também permite uma apreciação crítica das condições de saúde, a qual a população encarcerada está submetida. / This paper analyzes the social and power relations in a micro-unit of prisoners of a general hospital in Rio Grande do Sul State during the period from July to October 2004.Thus, it examines the hospital attendance process of sick prisoners who need hospitalization, focusing on how they arrive at the hospital, how they are cared and discharged. It focuses on Vila Nova hospital, although it also examines the way how these patients attendance used to happen previously, when the State Prison Hospital was open. The collected and analyzed data is mainly concerned with the social dynamics established through medical hospitalar care practices, surveillance practices and strategies of the sick prisoners who aim at expanding their capacity of negotiation and having a higher degree of freedom.Thus, the discipline worked as a control technique on prisoners, demonstrating the supremacy of the medical power in the attendance process of the prisoners hospitalized in the micro-unit in focus.This study also allows a critical appreciation of the health conditions faced by prison population.

The quality of service from a hospital is the number one factor that will either turn a customer/patient away or make one for life. More and more hospitals are competing for greater shares in the market and customer-driven quality management is becoming the preferred method for improving their performance. Awali hospital is a private hospital in the Kingdom of Bahrain. It is a small 35-bed hospital that offers private medical services to the public. The hospital was originally built to serve the Bahrain Petroleum Company (Bapco) refinery workers but later opened its doors to the public. With the introduction of private patients came higher expectations of quality and higher demands on the overall services. A number of service quality shortfalls were identified over the years but never identified quantitatively by a patient evaluation survey. An English and Arabic version of the questionnaire based on SERVQUAL (Zeithaml, Parasuraman and Berry, 1988) was developed and placed in Awali hospital to test these service quality shortfalls. This study intends to evaluate these areas by answering questions about the relevant areas of service provided by the hospital. It measured patient satisfaction by looking at human aspects of service (responsiveness, reliability, empathy and assurance) with only one factor of the instrument being devoted to the non-human aspect of care rendered (tangibles). The SERVQUAL instrument has five dimensions that were measured by 21 pairs of item statements. One statement from each pair reflects perceptions, the other expectations. Measurement was accomplished by subtracting expectation from perceptions resulting in a service quality score. Positive or zero scores would reflect ideal or adequate service quality offered by the hospital. A negative score would be indicative of a service experience that did not meet customer expectations. Using the SERVQUAL questionnaire provided, quantifiable reasoning to the research questions in each dimension could be obtained so that precision, objectivity and rigour replaced hunches, experience and intuition as a means of investigating problem areas. Customers were first asked to supply some additional demographic information, for example gender, number of hospital visits, nationality, patient type (Bapco worker, general practitioner referred or private) and type of visit (inpatient, outpatient or both). They werethen asked to rate the hospital service on a 7-point Likert scale ranging from Strongly Agree (7) to Strongly Disagree (1). At the end of the questionnaire was space to write open comments. In total 600 paper questionnaires were distributed in the hospital, 300 English and 300 Arabic. Another 150 electronic questionnaires via emails were sent to refinery workers. Of the total 750 questionnaires distributed 162 were returned of which 156 (or 21.6%) could be statistically analysed. The empirical data results showed that the perception scores were significantly different at the p < 0.05 level from expectation scores. All the service quality differences (SQ=P-E) were negatively scored. This indicated that patients were not satisfied in all five dimensions of services offered by the hospital. Of the five dimensions responsiveness had the largest difference with assurance and reliability following with no significant differences between them. The demographic information revealed some interesting differences between the groups. Of all the demographic groups the most significant differences were between groups, “patient types” and “types of visit”, which showed differences between private patients and refinery workers and patients who used the hospital only as an outpatient and patients who used both services, outpatient and inpatient. In terms of the managerial implications, it was recommended that Awali hospital look to closing Gaps 1-4 of the SERVQUAL gap model which would result in closing the consumer gap, Gap 5. A process model for continuous measurement and improvement of service quality was recommended that looks at asking questions about how the hospital is performing. By adopting some of the recommendations identified in the research questions, Awali hospital could improve their quality of service, and as a consequence, their customer satisfaction and loyalty.

De longue date, l’hôpital public a voulu faire fonctionner un service public autonome avec ses propres moyens et ses personnels.Cependant, il s’est trouvé dans l’obligation d’ouvrir ses portes à des opérateurs privés (l’intervention des médecins libéraux l’illustre) pour répondre à ses besoins de fonctionnement et d’organisation, dont les voies ont été ouvertes par la dernière loi hospitalière. Ainsi, la loi HPST a créé des dispositifs contractuels via notamment le « contrat d’exercice libéral » et le contrat de « clinicien hospitalier » pour que l’hôpital public propose des conditions statutaires plus attractives à l’attention de ces nouveaux opérateurs.Ce besoin nouveau qui s’impose, sans être véritablement souhaité, entraîne le recours à des solutions juridiques trop diversifiées.De ce fait, une cohabitation et un foisonnement de statuts s’est créé au sein de l’hôpital public. Cette situation apporte une vraie contradiction de règles statutaires, un véritable fatras qui met à mal sa cohérence.Un rapprochement des statuts des praticiens hospitaliers et des praticiens libéraux paraît inévitable pour clarifier et donner une lisibilité à l’hôpital public avec le souci unique d’apporter des soins de qualité aux usagers du service public. / The public hospital has long been willing to operate an independent public service with its own means and own staff.However, it was forced to open its doors to some private operators (the intervention of private doctors illustrates it) to satisfy its needs for operating and organization, the path of which has been opened by the last Hopsital Act. Thus, the HPST Law has created some contractual arrangements mainly with the “private practice contract”and the contract of “hospital clinical practitioner” in order that the public hospital offers more attractive statutory conditions to these new operators.This new major need, not being really desired, requires legal solutions which are too diverse.Consecuently, a coexistence and a lot of statuses have emerged within the public hospital. This situation causes a real contradiction of the statutory rules, a real hackneyed nonsense which undermines its consistency.An harmonization of the hospital and private practitioners statuses seems to be inevitable in order to clarify and make the public hospital more transparent with the sole concern to improve the quality of the health care provided to the public service users.

Orientador: Carmen Maria Bueno Neme / Resumo: A Psicologia está cada vez mais presente no contexto da saúde e a inserção do psicólogo em instituições hospitalares vêm crescendo nos últimos anos, em diferentes clínicas e especialidades médicas, demandando aperfeiçoamento e solidificação da prática deste profissional junto às equipes de saúde. Neste estudo, de caráter qualitativo, entrevistou-se 10 profissionais de saúde, sendo dois médicos; duas enfermeiras; duas fisioterapeutas; uma fonoaudióloga; uma nutricionista; uma assistente social e uma terapeuta ocupacional, pertencentes a equipes interdisciplinares de um hospital geral público, referência em urgências e emergências em trauma, neurologia e neurocirurgia, localizado na região centro-oeste do estado de São Paulo. Visou compreender como os profissionais identificam e concebem as diferentes possibilidades de atuação do psicólogo no hospital. As entrevistas semiestruturadas individuais foram gravadas em áudio e analisadas por meio da técnica da análise de conteúdo. Identificou-se 10 categorias que indicam a visão que os profissionais da equipe interdisciplinar possuem acerca do trabalho do psicólogo hospitalar e 2 categorias referentes à formação dos profissionais de saúde, revelando que os entrevistados reconhecem e valorizam o trabalho do psicólogo no hospital junto a pacientes, familiares e à própria equipe. Cada profissional identifica a necessidade de interconsultas e da intervenção psicológica, com base em sua própria prática profissional e experiências pessoais... (Resumo completo, clicar acesso eletrônico abaixo) / Abstract: Psychology is increasingly present in the health context and the insertion of the psychologist in hospital institutions has been growing in recent years, in different clinics and medical specialties, demanding improvement and solidification of the practice of this professional with the health teams. In this qualitative study, 10 health professionals were interviewed: two physicians, two nurses, two physiotherapists, a speech therapist, a nutritionist, a social worker and an occupational therapist, belonging to interdisciplinary teams of a public general hospital, reference in emergencies and emergencies in trauma, neurology and neurosurgery, located in the Midwest region of the state of São Paulo. It aimed to understand how the professionals identify and conceive the different acting possibilities of the psychologist in the hospital. Individual semi-structured interviews were audio recorded and analyzed using the content analysis technique. We identified 10 categories that indicate the view that professionals of the interdisciplinary team have about the work of the hospital psychologist and two categories referring to the training of health professionals, revealing that respondents recognize and value the work of the psychologist in the hospital with patients, family members and the team itself. Each professional identifies the need for interconsultation and psychological intervention, based on his or her own professional practice and personal experiences, resulting in genera... (Complete abstract click electronic access below) / Mestre

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Thesis (M.A. (Nursing Science)) -- University of Limpopo, 2016 / The purpose of the study was to develop a protocol to enhance patient satisfaction with regard to nursing care at Health Centres and to determine factors leading to patient dissatisfaction. A quantitative, descriptive and cross-sectional research design was used for this study. The population of the study for the two Health Centres was: Agincourt Health Centre= 5697 while Thulamahashe Health Centres= 5696. Systemic random sampling method was used to select 400 respondents from each Health Centre. Data were collected through self-developed questionnaire. The questionnaire was pre-tested at Cunningmoore clinic. Reliability was ensured through conducting of a pre-test. Validity was ensured through undertaking extensive literature review. The questionnaire was also given to the supervisor for content validity. Data analysis was done through descriptive and inferential statistics using SPSS version 22 programme of data analysis. The findings indicated that factors leading to patient dissatisfaction with regard to nursing are: long waiting time, poor communication and information between nurses and patients, shortage of nurses, poor service and environmental condition and shortage of treatment (medication). The study recommends that waiting time should be reduced to less than 3 hours, shortage of nurses should be addressed, workshops and inservice training should be implemented and treatment should be monitored.

La presente investigación es de naturaleza cualitativa, con abordaje de estudio de caso, cuyo objetivo fue identificar y analizar los conflictos éticos que afrontan los internos de enfermería en un hospital del distrito de Chiclayo, 2014. Los sujetos de estudios fueron 8 internas de enfermería, según criterio de inclusión: se consideraron internos hombres o mujeres, que cursen el internado desde el primer mes, después de haber ingresado al hospital, determinados por técnica de saturación y redundancia. Para la recolección de datos se utilizó la entrevista semiestructurada a profundidad. Los datos obtenidos fueron por análisis de contenido. Se tuvo en cuenta los criterios bioéticos según Sgreccia y los criterios de rigor científico planteados por Hernández. Los resultados emergentes fueron categorías y subcategorías:1) Conflictividad ética: Poder vs Autoridad frente a la vulnerabilidad de la Interna de enfermería: Sumisiones de la interna ante carácter autoritarismo de la enfermera, Comunicación ineficaz entre interna y enfermera, Rutina laboral frente a la formación profesional y exigencias de la universidad, Improcedente utilización de materiales y medicamentos. 2) Internas de enfermería con autonomía profesional limitada para enfrentar conflictos éticos. 3) Solicitando prácticas innovadoras durante el internado de Enfermería. Como consideración final los conflictos éticos que afrontan los internos de enfermería, emergen por escasa comunicación, rutina laboral y el carácter de las enfermeras asistenciales.

Published Article / The aim of this research was to identify the design aspects necessary to create an aesthetically appealing playroom environment to aid the well-being of hospitalised oncology children at a public hospital in Bloemfontein, South Africa. The methodology design is overall qualitative within the interpretivist paradigm with a triangulation methodology design with explanatory components. These components consisted of a literature review which was further explored by means of a qualitative questionnaire. The playroom was created as part of a community project according to the literature review and questionnaire after which semi-structured individual interviews were conducted with the children themselves.