Orientador: Solange L'Abbate / Tese (doutorado) - Universidade Estadual de Campinas, Faculdade de Ciencias Medicas / Made available in DSpace on 2018-08-09T01:40:40Z (GMT). No. of bitstreams: 1 Spagnol_CarlaAparecida_D.pdf: 6634502 bytes, checksum: 47034f29257b951227f80406fc8f54c2 (MD5) Previous issue date: 2006 / Resumo: Nessa pesquisa, investiguei os conflitos vivenciados pela equipe de enfermagem do Hospital das Clínicas-UFMG, motivada pelo fato de o enfermeiro desempenhar atividade de gerência nos serviços de saúde e freqüentemente lidar com relações conflituosas. Os objetivos delineados foram: conhecer as diferentes percepções de conflito dos enfermeiros; identificar aqueles mais comuns e os principais fatores que geram esses conflitos; compreender como o enfermeiro lida com os conflitos no trabalho; levantar facilidades e dificuldades para lidar com os conflitos e propor aos enfermeiros a construção coletiva de um dispositivo socioanalítico, a ser utilizado como espaço de análise e reflexão da prática profissional, focalizando o objeto de estudo. Por se tratar de um fenômeno processual, optei pela abordagem qualitativa, desenvolvendo uma pesquisa-intervenção em duas fases. Na primeira, realizei uma pesquisa exploratória, com o objetivo de me aproximar dos sujeitos e do objeto de estudo, utilizando um questionário, que foi aplicado, em setembro de 2003, a cento e cinco enfermeiros (105), sendo que desses, trinta e sete (37), o devolveram. Na segunda, utilizei a perspectiva da socioanálise, para construir um dispositivo, visando a criação de um espaço que permitisse à pesquisadora e às pesquisadas realizarem, conjuntamente, análises e reflexões acerca da prática profissional, focalizando situações de conflito vivenciadas no trabalho. Foram realizados cinco encontros nos meses de setembro e outubro de 2005, com duração de duas horas cada, onde participaram seis enfermeiras que, no questionário, responderam afirmativamente quanto à sua continuidade no estudo. Nessa fase, as integrantes ao elaborarem a demanda de análise do grupo, expressaram vários motivos para participarem dessa investigação, dentre eles destaco suas implicações com a pesquisadora. Para as enfermeiras conflito é: diferença de pensamentos e de posições, coisa que incomoda e algo estressante. Apresentam uma visão bipolar desse fenômeno, pois, a princípio, são percebidos como negativos, mas dependendo do ângulo que se olha também o consideram como positivo, isso se forem discutidos com todos os envolvidos e conduzidos adequadamente. Identifiquei os seguintes tipos de conflitos: intrapessoal, interpessoal, intergrupal, de poder e de interesse. As principais causas que geram esses conflitos são: duplicidade de vínculo empregatício; deficiências na estrutura organizacional e no modelo de gerência implantado; escassez de recursos; centralização do trabalho; hierarquia; autoritarismo; imaturidade; escalas de serviço; falta de respeito e compromisso profissional, trazendo conseqüências para as relações interpessoais e para a assistência prestada. As enfermeiras lidam com situações de conflito, de forma racional, apresentando desejo de fuga, ao realizarem ações imediatistas, a fim de contornarem ou amenizarem a situação, assumindo que não são preparadas para conduzirem questões problemáticas ligadas ao comportamento e relacionamento interpessoal. Sendo assim, em determinadas situações, solicitam ajuda aos psicólogos da Diretoria de Recursos Humanos do hospital. O próprio dispostivo socioanalítico se constituiu em um analisador, permitindo explicitar instituídos e instituintes, implicações e transversalidades, presentes na organização hospital que é atravessada pelas 'instituições enfermagem e medicina¿. Diante das avaliações positivas relacionadas aos encontros grupais, sugiro desenvolvermos outros trabalhos tendo o dispositivo socioanalítico como um espaço coletivo de análise e reflexão das relações e práticas profissionais / Abstract: In this research, I investigated the conflicts experienced by a nursing team at the Federal University of Minas Gerais Hospital, motivated by the fact that nurses manage health care and frequently face conflict situations. The aims of this research were: to learn about nurses different perceptions regarding conflict; to identify the most common conflicts and the main factors that generate these conflicts; to understand how nurses manage conflicts at work; to find out motivations and difficulties to manage conflicts and propose to nurses a collective construction of a socio-analytical instrument to be used as a space for analysis and reflection of professional practice, focusing on the study object. As it is a process phenomenon, I used a qualitative approach, developing an intervention research in two phases. In the first phase, I developed an exploratory research with the purpose to get closer to the subjects and study object, using a questionnaire that was applied in September 2003 to 105 nurses. Among them, 37 responded and sent it back. In the second phase, I used the socio-analysis perspective to build an instrument, aiming at creating a space that would allow the researcher and research to be developed as well as analyses and reflections regarding professional practice, focusing on conflict situations experienced at work. Five meetings happened in September and October 2005, of two hours each, with the participation of six nurses that manifested in the questionnaire their intention to continue the study. In this phase, the members of the group expressed their motivations to participate in the study, emphasized its implications regarding the researcher. According to these nurses, conflict is a difference of thoughts and positions, something that may impair the relationship. They present a bipolar view of this phenomenon as at first they are perceived as negative, but depending on the way they are seen they can be considered positive, if they are discussed with all the persons involved and managed adequately. The following types of conflict were identified: intrapersonal, interpersonal, intergroup, of power and of interest. The main causes that generate these conflicts are: work in more than one place, problems regarding the organizational structure and management, lack of resources, work centralization, hierarchy, authoritarianism, immaturity, work shifts, lack of respect and professional commitment that influence interpersonal relations and the care provided. Nurses manage conflict situations in a rational way, presenting their desire to run away when they implement immediate actions, in order to minimize the situation, assuming that they are not prepared to conduct problems related to behaviors and interpersonal relationships. Therefore, in some situations they ask for help to psychologists from the Hospital Human Resources Division. The socio-analytical instrument was a means to analyze it, enabling them to expose the situations, implications and transversal intersections that are present at the hospital organization that is crossed by other institutions such as ¿nursing and medicine¿. Considering the positive evaluation of the group meetings, I suggest the development of other works based on socio-analytical instruments as a collective space for the analysis and reflection of relationships and professional practices / Doutorado / Saude Coletiva / Doutor em Saude Coletiva

Total quality management--Performance expectations and review--manager as a teacher/facilitator.

Thesis (MCur (Interdisciplinary Health Sciences. Nursing Science))--University of Stellenbosch, 2008. / The South African Nursing Council believes that “quality nursing practice is based on adequate knowledge, skills or competencies, ethically and scientifically based comprehensive and holistic patient care, timely, accurate and complete or comprehensive recording” (SANC, n.d.). The aim of professional regulation is to protect the public from unsafe practices and to ensure quality services (SANC, n.d.). A shortage of nursing staff resulted in the implementation of a staffing strategy of increasing the work hours of nurses by ten hours a week. Patient complaints and unacceptable patient incidences resulted in it becoming essential to evaluate the effect of this strategy on patient care. As a goal of this study, the researcher decided to investigate the quality of patient care before the implementation of the strategy and the effect of the strategy on patient care after the implementation. The objectives of the study were set to determine whether • The patients were assessed according to activities of daily living and psychosocial data; • The nursing diagnosis was done • Nursing interventions are prescribed for each problem identified • The patients’ records were utilised to enhance individualised patient care and to ensure responsibility and accountability for patient care • The evaluation of patient progress was done according to the different prescriptions and interventions at least twice in 24 hours • A written final report for discharge criteria and health education was provided • A comparison of the quality of nursing care delivered before and after the implementation of the staffing strategy exist Research question What is the effect of an implemented staffing strategy in a selected hospital in KwaZulu-Natal on the quality of care delivered? Research methodology A non-experimental, descriptive design with a quantitative approach was applied. Population and sampling The target population for the study was patient care records of patients who were hospitalised during 2003. A non-probability convenience sample for a retrospective audit of a total of 372 patient care records over a period of 12 months was audited. An evaluation of the records was done and a comparison was drawn between the results obtained before and after the implementation of the staffing strategy. For both periods, 186 patient records were audited. The pilot study included the audit of 40 files. Reliability and validity were assured with a pilot study and the use of experts in nursing management, quality assurance, research methodology and statistics. The researcher audited the patient files personally. Ethical approval was obtained from Stellenbosch University and the ethics committee of the hospital. All principles related to ethics, such as confidentiality and anonymity, were maintained. Neither patient names were used nor the name of the hospital or wards from which the records were used. Codes were used to identify the hospital wards. The hospital was informed in the letter requesting consent to conduct the research, that the researcher intends publishing the findings of the research. Data analysis and interpretation Statistical associations using Chi-square tests were carried out to determine the significance between the various variables. The results of this study were presented in percentages, tables and histograms. Findings obtained showed that the quality of nursing declined after the strategy. Documentation of patient records was incomplete and did not meet legal requirements. Recommendations The implementation and maintenance of a quality assurance programme, human resource management, the on-going use of the nursing process and record keeping should be emphasised in the clinical practice environment and in the formal education environment.

The purpose of this study was to explore and to describe experiences of learner nurses regarding clinical supervision at private hospitals in East London in the Eastern Cape. These were Life Healthcare hospitals. A qualitative, contextual approach was used and the exploratory, descriptive design was seen as most appropriate in this study. The subjects were the learner nurses in the Bridging Course Programme leading to registration as a General Nurse. The research questions were: How did you as a learner nurse, doing the Bridging Course, experience clinical supervision at Life Healthcare hospitals? A pilot study was conducted in a clinical setting involving respondents with similar characteristics to the study population. Fourteen participants were selected for this study by using a purposive, non-probability sampling method. Data were collected by means of individual interviews during which participants were able to describe their experiences during clinical supervision; data were collected until data saturation was reached.During data analysis, the researcher used the process of bracketing and remained neutral, setting aside previous knowledge and beliefs about the phenomenon under investigation. The researcher listened to the audiotapes used for data collection several times until she was completely satisfied with the interpretation of the verbatim data. Transcriptions were made within three days of the interview. The research was done in an ethically reflective manner and the researcher ensured the trustworthiness of the study at all times. The researcher allowed the participants freedom to conduct their lives as autonomous agents, without external The purpose of this study was to explore and to describe experiences of learner nurses regarding clinical supervision at private hospitals in East London in the Eastern Cape. These were Life Healthcare hospitals. A qualitative, contextual approach was used and the exploratory, descriptive design was seen as most appropriate in this study. The subjects were the learner nurses in the Bridging Course Programme leading to registration as a General Nurse. The research questions were: How did you as a learner nurse, doing the Bridging Course, experience clinical supervision at Life Healthcare hospitals? A pilot study was conducted in a clinical setting involving respondents with similar characteristics to the study population. Fourteen participants were selected for this study by using a purposive, non-probability sampling method. Data were collected by means of individual interviews during which participants were able to describe their experiences during clinical supervision; data were collected until data saturation was reached.During data analysis, the researcher used the process of bracketing and remained neutral, setting aside previous knowledge and beliefs about the phenomenon under investigation. The researcher listened to the audiotapes used for data collection several times until she was completely satisfied with the interpretation of the verbatim data. Transcriptions were made within three days of the interview. The research was done in an ethically reflective manner and the researcher ensured the trustworthiness of the study at all times. The researcher allowed the participants freedom to conduct their lives as autonomous agents, without external control, coercion or exploitation. The following findings were evident: Three main themes emerged from data analyses. These comprised inadequate clinical supervision, satisfactory clinical supervision and suggestions and inputs regarding clinical supervision. Detailed discussions about the findings in relation to earlier studies were conducted. Recommendations to improve clinical supervision were made in order to improve the experiences of learner nurses during training. The findings of the research will be made available through the University of Fort Hare library and the Life College of Learning. Furthermore the information of this study will be shared with colleagues and will be published in an accredited nursing journal such as Curationis as well as other journals.control, coercion or exploitation. The following findings were evident: Three main themes emerged from data analyses. These comprised inadequate clinical supervision, satisfactory clinical supervision and suggestions and inputs regarding clinical supervision. Detailed discussions about the findings in relation to earlier studies were conducted. Recommendations to improve clinical supervision were made in order to improve the experiences of learner nurses during training. The findings of the research will be made available through the University of Fort Hare library and the Life College of Learning. Furthermore the information of this study will be shared with colleagues and will be published in an accredited nursing journal such as Curationis as well as other journals.