Submitted by Cláudia Bueno (claudiamoura18@gmail.com) on 2016-01-08T14:25:37Z No. of bitstreams: 2 Dissertação - Giane Cristina Alvarenga - 2015.pdf: 653540 bytes, checksum: 5587d9fd4fd0d44bcd30dbbf710240af (MD5) license_rdf: 23148 bytes, checksum: 9da0b6dfac957114c6a7714714b86306 (MD5) / Approved for entry into archive by Luciana Ferreira (lucgeral@gmail.com) on 2016-01-11T06:41:39Z (GMT) No. of bitstreams: 2 Dissertação - Giane Cristina Alvarenga - 2015.pdf: 653540 bytes, checksum: 5587d9fd4fd0d44bcd30dbbf710240af (MD5) license_rdf: 23148 bytes, checksum: 9da0b6dfac957114c6a7714714b86306 (MD5) / Made available in DSpace on 2016-01-11T06:41:39Z (GMT). No. of bitstreams: 2 Dissertação - Giane Cristina Alvarenga - 2015.pdf: 653540 bytes, checksum: 5587d9fd4fd0d44bcd30dbbf710240af (MD5) license_rdf: 23148 bytes, checksum: 9da0b6dfac957114c6a7714714b86306 (MD5) Previous issue date: 2015-03-11 / Transversal, descriptive, exploratory study with a quantitative approach, performed in a university hospital in the Midwest region of Brazil, involving 91 nurses gazetted by the institution. We sought to evaluate job satisfaction of these and to describe the demographic profile and professional partner thereof and to identify factors that influence job satisfaction. Two instruments for data collection were used: being a questionnaire for sociodemographic data and other professionals and to assess job satisfaction, the S20 / 23. The collection occurred during the months of November and December 2013. The study nurses are in most cases, female (90.1%); mean age, 47 years; 60.4% were married or in a stable relationship; have an average of two children; have a family income of 10 minimum wages and more (71.4%); are experts (59.3%), teachers (30.8%) and doctors (4.4%). Just over half have other employment; working on average 60 hours a week. As for job satisfaction, there is a mixture of satisfaction and professional dissatisfaction among nurses in the research institution. We conclude that nurses are fully satisfied with the opportunities to perform activities that stand out and also about the objectives and goals to achieve. A partial job satisfaction related to the act of doing things they enjoy, as well as the possibilities of decision and autonomy. Though fully satisfied with relations with positions of power, nurses are partially satisfied with the possibilities of decision and autonomy. More than half of the professionals are dissatisfied with the work environment. The variables: time of graduation, family income and other employment relations do not appear to interfere with the satisfaction of nurses in this study. With this research, there were simple interventions measures that can enhance job satisfaction, aiming to better quality of care delivered to customers, reflecting the characteristics of the institution, which is part of the Unified Health System (SUS), and strengthening the Legitimizing humanization of service to the community, extended to individuals that do so. / Estudo transversal, descritivo, exploratório, com abordagem quantitativa, realizado em um hospital universitário localizado na região Centro Oeste do Brasil, envolvendo 91 enfermeiros concursados pela instituição. Buscou-se avaliar a satisfação profissional desses, bem como descrever o perfil sócio demográfico e profissional dos mesmos e identificar fatores que influenciam na satisfação no trabalho. Foram utilizados dois instrumentos para coleta de dados: sendo um questionário para levantamento de dados sociodemográficos e profissionais e outro para avaliação da satisfação no trabalho, o S20/23. A coleta ocorreu nos meses de novembro e dezembro de 2013. Os enfermeiros do estudo são na grande maioria, do sexo feminino (90,1%); com idade média, de 47 anos; 60,4% casados ou em união estável; possuem, em média, dois filhos; apresentam renda familiar de 10 salários mínimos e mais (71,4%); são especialistas (59,3%), mestres (30,8%) e doutores (4,4%). Pouco mais da metade possuem outro vínculo empregatício; trabalham, em média, 60h semanais. Quanto à satisfação no trabalho, há um misto de satisfação e insatisfação profissional entre os enfermeiros da instituição pesquisada. Conclui-se que os enfermeiros estão totalmente satisfeitos com as oportunidades de executarem atividades nas quais se destacam e também quanto aos objetivos e metas que devem alcançar. Há satisfação parcial no trabalho relacionado com o ato de fazer coisas que gostam, assim como com as possibilidades de decisão e autonomia. Apesar de totalmente satisfeitos com as relações com instâncias de poder, os enfermeiros encontram-se parcialmente satisfeitos com as possibilidades de decisão e autonomia. Mais da metade dos profissionais estão insatisfeitos com o ambiente de trabalho. As variáveis: tempo de graduação, renda familiar e outro vínculo de trabalho parecem não interferir na satisfação dos enfermeiros deste estudo. Com a presente investigação, surgiram medidas de intervenções simples, que podem reforçar a satisfação profissional, almejando melhor qualidade da assistência prestada aos clientes, com reflexo nas características da instituição, que está inserida no Sistema Único de Saúde (SUS), reforçando e Legitimando a humanização dos serviços prestados à comunidade, extensiva aos indivíduos que os prestam.

Magister Public Health - MPH / In response to the increasing burden with regard to treatment of HIV/AIDS in Mozambique, the Ministry of Health has developed a national strategic plan for HIV and AIDS. This provided for broader access to Antiretroviral Therapy (ART) by decentralizing and integrating ART services into the essential services provided at the primary care level. In keeping with this initiative,medical technicians are now responsible for first-line ART prescription and management at primary-level care health centres in the country. The ART programme was introduced in Mozambique in 2003 alongside other health services offered in hospitals; it was decentralized to PHC health centres in 2006.This study aimed to explore the experiences and perceptions of medical technicians regarding the decentralization and integration of ART services into PHC health centres in Beira. An exploratory qualitative study was conducted using in-depth interviews, key informant interviews and focus group discussions. A sample of 15 medical technicians was distributed across two focus groups for the purpose of discussion. In addition there were four in-depth individual follow-up interviews with four medical technicians, drawn from the two focus groups. Three key informant interviews were also held to collect data. The data was analysed using content analysis.The study revealed that the decentralization process was viewed by many of the medical technicians as a very positive initiative for the country. However a number of operational and managerial issues need to be addressed to ensure the effectiveness of the comprehensive approach that was institutionalized and adopted by all PHC health centres. Key amongst the issues that needed to be addressed were the workloads of the health care personnel, and of medical technicians in particular. Their workloads have increased without any corresponding increase in the health workforce needed to manage the patient load. The medical technicians felt that this adversely affected the quality of care they were able to provide to patients, and specifically to those requiring ART medication. The recommendations that emerge from the study are intended to promote the development of policy that will improve of working conditions and assist medical technicians to provide a better service to their patients.

Although Skilled Birth Attendance has been universally acknowledged as essential to progress in the field of maternal health (WHO, 2004), Human Resources for Health (HRH) deficits are currently impeding the sustainability of essential maternal health interventions on a global scale. Over the past 30 years, the Shoklo Malaria Research Unit (SMRU), along with other agencies such as non-governmental organizations and community-based organizations, have developed a self-contained health system, which provides health services, including maternity care, to migrants and refugees at the Thailand-Myanmar Border. The staff necessary to the provision of care in SMRU’s clinics are mostly recruited from within the migrant and refugee populations, and trained internally by SMRU. In the last decade, SMRU has experienced high-turnover rates and shortages of Skilled Birth Attendants (SBA). Consequently, their current maternity workforce is characterized by an acute shortage of SBAs who have attained senior status, and a higher concentration of SBAs at the assistant and junior levels. As a response to these HRH challenges, this case study aimed to conduct a multi-level analysis of obstacles and enablers to professional development amongst Skilled Birth Attendants working for SMRU. This single descriptive case study with embedded units of analysis, which incorporated non-participant observation, a template-based personnel file review, individual interviews, and focus groups at two of SMRU’s Birthing Units, represented a unique opportunity to observe and analyze the multiple influences that interact at various levels of a relatively self-contained health system. By highlighting the obstacles and enablers present within the system, this study purposed to identify means by which to empower lower level SBAs, support their professional development, and create a more sustainable maternity workforce. The study found that SMRU has been successful in providing its SBAs with the appropriate midwifery skills to fulfill a limited scope of practice, and in fostering strong intra-professional relationships that allow the SBAs to motivate and mentor each other. Achieving workforce sustainability with a model of care that implements task-shifting requires a balance of appropriate and constructive consultation structures without enabling the stagnation of SBAs’ skills and confidence. This study also reveals the importance of context and culture to a health system’s capacity to optimally plan and implement its HRH functions. Finally, in the case of SMRU, persistent recruitment and retention concerns underscore that workforce sustainability cannot be achieved through professional development alone. Therefore, this study reveals a need for further inquiry into the complexities of maternal health workforce planning in contexts of protracted displacement, and the challenges associated with developing appropriate supervisory structures for lower level health professionals.

This diploma thesis focuses on development of managerial competencies of manager‘s personality in the business environment. This work is divided into two main parts. The first, theoretical, includes theory and introduces basic terms. The second, practical, consists of two sub-parts: analytical, in which I analyse the situation and explore the problems, in the second sub-part I present a concept of my own solution.

Introdução: Conhecer e medir a carga de trabalho dos profissionais de saúde pode contribuir para a gestão eficiente e eficaz das organizações de saúde, a carga de trabalho excessiva é a principal causa de estresse e insatisfação. Objetivo: Levantar e analisar as dissertações e teses referentes à distribuição da carga de trabalho dos profissionais de saúde, fundamentadas na Classificação das Intervenções de Enfermagem, desenvolvidas por participantes do grupo de pesquisa Gerenciamento de recursos humanos: conceitos, instrumentos e indicadores do processo de dimensionamento de pessoal, cadastrado no diretório do Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq). Método: Estudo secundário tipo documental para identificar os instrumentos produzidos para medir a carga de trabalho, as intervenções/atividades realizadas, bem como a probabilidade de ocorrência e o percentual do tempo produtivo na jornada de trabalhadores profissionais de saúde. As fontes de dados foram dissertações e teses desenvolvidas pelos participantes do grupo de pesquisa disponíveis no banco de TESES-USP e DEDALUS. Resultados: Foram selecionados dezessete estudos nos quais foram construídos dezessete instrumentos de medida da carga de trabalho para profissionais de saúde sendo: 11,7% enfermeiros, 76,5% enfermeiros e técnicos/auxiliares de enfermagem, 5,9% assistente técnico administrativo e 5,9% nutricionista clínico. Os instrumentos foram aplicados nas unidades de alojamento conjunto, ambulatório de especialidades de oncologia e hematologia, centro cirúrgico de oncologia, centro de diagnóstico por imagem, clínica cirúrgica, clínica médica, emergência, serviço de nutrição, sala de recuperação pós-anestésica, unidade de internação pediátrica, unidades de terapias intensivas: adulto, pediátrica e neonatal; unidade de saúde da família. Os instrumentos apresentaram 192 intervenções de cuidado direto, 75 com frequência 1% e 80 intervenções de cuidado indireto, 39 com frequência 1%. As intervenções com maior frequência, no conjunto das unidades, foram Documentação, Administração de medicamentos, Passagem de plantão. O tempo produtivo dos profissionais na jornada ficou distribuído entre intervenções de cuidado direto e indireto e atividades associadas ao trabalho. Conclusões: Os instrumentos elaborados e aplicados evidenciaram as intervenções/atividades essenciais em cada unidade estudada e por categoria profissional que mais contribuem na medida da carga de trabalho e no tempo produtivo, mostrando ser importante estratégia gerencial para reorganizar os processos de trabalho. / Introduction: Knowing and measuring the workload of health professionals can contribute to the efficient and effective management of health organizations; excessive workload is the main cause of stress and dissatisfaction. Objectives: Analyze the dissertations and theses related to the distribution of the workload of health professionals, based on the Classification of Nursing Interventions, developed by participants of the research group \"Human resources management: concepts, instruments and indicators of the nursing staff process registered in the directory of the National Council of Scientific and Technological Development (CNPq). Methods: Documentary study secondary type to identify the instruments produced to measure the workload, was performed, the interventions / activities performed, the interventions / activities performed, as well as the probability of occurrence and the percentage of productive time in the workday of health professionals. The data sources were dissertations and theses, developed by the research group participants available at the thesis base USP and DEDALUS. Results: Were selected seventeen studies were carried out in which 17 workload measurement instruments were constructed for health professionals: 11.7% nurses, 76.5% nurses and technicians/Nursing assistants, 5.9% administrative assistant and 5, 9% clinical nutritionist. They were applied in pediatric areas, medical clinic, surgical clinic, emergency, rooming-in, surgical center, units of intensive therapies: adult, pediatric and neonatal, oncology and hematology outpatient clinic, diagnostic imaging center; family health unit and nutrition service. The instruments presented 192 direct care interventions, 75 with 1% frequency and 80 indirect care interventions, 39 with frequency 1%. The most frequent interventions, in the units as a whole, were Documentation, Medication Administration, Shift work. The productive time of the professionals on the journey was distributed between direct and indirect care interventions and work-related activities. Conclusions: The instruments elaborated and applied showed the essential interventions / activities in each unit studied and by professional category that contribute the most to the work load and productive time, showing that it is an important managerial strategy to reorganize work processes.

O Sistema Único de Saúde (SUS) avançou muito desde o seu surgimento, entretanto, ainda existem muitos desafios que precisam ser superados. Entre eles, encontram-se a qualificação e a formação dos profissionais de saúde. Os cursos de graduação em saúde têm privilegiado uma formação tecnicista e fragmentada, incapaz de formar a força de trabalho necessária à resolução dos problemas de saúde da população brasileira. Neste sentido, há necessidade de desenvolver instrumentos direcionados ao incentivo de mudanças curriculares no ensino superior em saúde, tendo como um dos eixos a interação com os serviços de saúde. Cita-se, nesse contexto, o Programa de Educação pelo Trabalho para a Saúde (PET-Saúde). A presente investigação se propôs a avaliar o PET-Saúde instituído na Universidade de São Paulo (USP), campus Capital. Os sujeitos do estudo foram tutores, preceptores e alunos de odontologia que integraram o Programa em algum momento da sua existência. Foi utilizada uma abordagem qualitativa, sendo a coleta de dados realizada com o auxílio das técnicas Delphi e de Grupo Focal. O tratamento do material coletado foi orientado pela análise de conteúdo. Os dados levantados evidenciaram que, apesar das mudanças já implementadas, o modelo formador em odontologia apresenta fragilidades no sentido de atender completamente as Diretrizes Curriculares Nacionais (DCN), visto que é persistente a tendência tecnicista, biologicista e fragmentada. Os sujeitos reforçaram que a aproximação dos estudantes com os cenários de prática é capaz de auxiliar no processo formativo de alunos e na qualificação de profissionais inseridos nos serviços e professores dos cursos de graduação em saúde. Além disso, o PET-Saúde proporciona a ampliação do olhar do estudante em direção ao processo saúde/doença e o despertar para atuação futura no âmbito do SUS. A imersão no Programa foi responsabilizada pela quebra de pré-conceitos e pela consequente compreensão da organização da Atenção Primária e do trabalho desenvolvido no setor. Uma das vantagens apontadas pelos moldes de interação ensino-serviço do PET-Saúde consiste no estabelecimento da interdisciplinaridade no processo formador o que, dentre outras características, o conforma como um modelo de interação ensino-serviço mais próximo do ideal almejado. Como principais limites foram apontados a incompatibilidade de horários entre os protagonistas do programa, a distância dos cenários de prática em relação às unidades de ensino, além da ausência de diretrizes operacionais claras e da heterogeneidade de organização das atividades pelas unidades de saúde. Os resultados do estudo traduzem o PET-Saúde como um poderoso instrumento de indução de mudanças na concepção dos profissionais de saúde, contribuindo para uma formação condizente com as necessidades do SUS. / The Unified Health System of Brazil has advanced greatly since itsestablishment, but there are many challenges that need be overcome. Among them are the qualification and the education of health workers. Health courses have privileged a technicist and fragmented education, that is unable to create the workforce needed to solve the health problems of the Brazilian population. So there is a need to create instruments directed to the encouragement of curriculum changes in the higher health education , based on the interaction with health services. In this context, the Education Program of Work for Health is pointed out. The research evaluated the Education Program of Work for Health established at the University of São Paulo, Brazil. The study subjects were dental students, preceptors and tutors in the program. A qualitative approach was used and data collected using the Delphi technique and focus group. The material obtained was treated by Bardin analysis of content . Data collected evidenced that despite changes already implemented, dentistry education model presents fragilities onfully meeting the National Curriculum Guidelines since much students keep the technicist, fragmented and biologicist tendency. The subjects reinforcedthat students approximation with practice scenarios is able to assist in the formation process of students and qualification of professionals inserted in services and of health courses professors. Moreover, the Education Program of Work for Health provides a wider view from students toward the health/disease process and also an awakening for later operating in the Unified Health System. The immersion in the program was responsible for breaking preconceptions and for the consequent understanding of the organization of Primary Care and of work in the sector. One of the advantages pointed by the model of interaction between teaching and service by the Education Program of Work for Health is the establishment of interdisciplinarity in the formation process that, among others characteristics, conforms it as a model of interaction between teaching and service closest to the desired ideal. The incompatibility of schedules between the protagonists of the program, the distance of the practice scenarios in relation to teaching units besides the absence of clear operational guidelines and diverse organization of activities by health units were pointed as the main limitations. The study results reflect the Education Program of Work for Health as a powerful tool to induce changes in the conception of health professionals, contributing to an education consistent with the needs of the Unified Health System.

O estudo teve como objetivo analisar o desempenho do primeiro serviço de saúde procurado para o diagnóstico da tuberculose (TB), em São José do Rio Preto (2009), na percepção do doente. Trata-se de estudo epidemiológico descritivo, tipo inquérito, que adotou como eixo metodológico os componentes de avaliação de serviços de saúde estrutura e processo. Participaram do estudo 99 doentes de TB, maiores de 18 anos e em tratamento, entrevistados por meio de um instrumento elaborado com base no Primary Care Assessment Tool (PCAT), adaptado para avaliar a atenção aos doentes de TB, e que contemplou questões das dimensões de porta de entrada e acesso ao diagnóstico. A análise dos dados foi realizada por meio de distribuição de frequência absoluta/relativa e da construção de indicadores, utilizando proporções e intervalos de confiança, de acordo com o tipo de serviço de saúde procurado pela primeira vez, quando da percepção dos sinais/sintomas, sendo esses agrupados em: Atenção Básica (AB), Pronto Atendimento (PA) e Serviços Especializados (SE). O perfil epidemiológico dos doentes entrevistados evidencia o predomínio dos casos novos de TB pulmonar entre indivíduos do sexo masculino, em idade produtiva e reprodutiva, com baixa renda e escolaridade. A principal porta de entrada no município foi o PA. Em relação ao componente estrutura, encontrou-se que o PA e, principalmente, a AB se constituíram como os serviços mais próximos ao domicílio dos doentes, entretanto, a AB não foi a mais acessível, uma vez que a maioria daqueles que a procuraram não conseguiu consulta no prazo de 24 horas. Quanto ao componente processo, houve baixa suspeição de TB nos três tipos de serviços analisados. A maior proporção de exames solicitados para o diagnóstico ocorreu no SE, seguido pelas unidades de AB. Houve baixa proporção de encaminhamento para a realização de baciloscopia de escarro, nos três tipos de serviços. O PA e a AB encaminharam a maioria dos doentes para realização de raio-x e para consulta médica em outro serviço, principalmente os casos extrapulmonares. Doentes com TB, que buscaram primeiramente a AB, necessitaram procurar mais vezes os serviços de saúde e mais de 50% desses tiveram atraso no diagnóstico. O PA foi o serviço que menos diagnosticou os usuários suspeitos, sendo o SE (especialmente os hospitais) os que apresentaram melhor desempenho, principalmente para o diagnóstico dos casos extrapulmonares. Para o controle efetivo da doença, os serviços de saúde, que se configuram como porta de entrada do sistema, devem estar preparados para a suspeição e diagnóstico e que sejam criadas estratégias de fluxo de referência e contrarreferência entre o primeiro serviço de saúde procurado e os outros serviços que compõem a rede de atenção, de modo que seja assegurada a continuidade da assistência. / The study aimed to analyze the performance of the first health care sought for the diagnosis of TB, in Sao Jose do Rio Preto (2009), according to the patients perception. A descriptive inquiry epidemiological study was conducted, which adopted as methodological framework the components of health services assessment: structure and process. The study included 99 TB patients, aged 18 years and in treatment, interviewed using a questionnaire based on the Primary Care Assessment Tool (PCAT), adapted to assess TB care and that included dimensions of first contact care and access to diagnosis. Data analysis was performed using absolute and relative frequency and indicators development, by ratios and confidence intervals, according to the type of health service sought by the first time when the perception of signs / symptoms, grouped as follows: Primary Health Care (PHC), Emergency Services (ES) and Specialized Services (SS). The epidemiological profile of patients interviewed shows the prevalence of new cases of TB among males, in productive and reproductive age with low income and low education. The main first contact care in the city was the ES. Regarding the structure component, we found that the ES and, especially, the PHC are identified as services closest to the patients home, however, PHC was not accessible, since most of those failed to get a medical appointment within 24 hours. Regarding the process component, there was a low suspicion of TB in the three types of services examined. The greatest proportion of diagnosis exams requirement occurred in SS, followed by PHC. There was a low proportion of referrals to performing sputum smear test, in the three types of services. ES and PHC refer the majority of patients to perform x-ray and medical examinations to another service, especially extrapulmonary cases. TB patients, who sought first the PHC, needed to look for more health services and over 50% of these had a delay in diagnosis. The ES was the one who less diagnosed TB suspect case, and the SS (especially hospitals) showed the best performance, particularly for the diagnosis of extrapulmonary cases. For effective control of this disease, first contact care should be prepared for suspicion and diagnosis, and strategies of reference between the first health care sought and other services need to be developed, building a network of care so that it ensured the continuity of it.

Submitted by Filipe dos Santos (fsantos@pucsp.br) on 2016-08-08T12:08:23Z No. of bitstreams: 1 Gisele Aparecida Mendes Rolim.pdf: 1253325 bytes, checksum: dbcd440c81b9f2d9ac442a95ecad1c9a (MD5) / Made available in DSpace on 2016-08-08T12:08:23Z (GMT). No. of bitstreams: 1 Gisele Aparecida Mendes Rolim.pdf: 1253325 bytes, checksum: dbcd440c81b9f2d9ac442a95ecad1c9a (MD5) Previous issue date: 2016-03-09 / The technical inability of health employees is reason of concern for the professionals in charge of selection process, training and health teams development. This inability has been noted since the early stage of the process, which is a time for vocational training. Given these facts, it is up to health institutions to qualify their professionals according to the necessary technical skills for health assistance with quality and excellence, focused on the patient. Goals: The study has used the tool Evaluation on Reproducibility of Nursing Procedures (IARPE), to evaluate the professionals concerning their skills and practical performance in order to highlight the effectiveness of the updating course on peripheral venipuncture; evaluate the reproducibility of procedures in distinct simulation scenarios; evaluate the adopted skills to perform the peripheral venipuncture procedure; and analyze the tool psychometric properties. Material and method: The theoretical and practical course has been carried out by professionals of the Teaching and Research Institute – IEP, where the data collection has been made: firstly, during the course, in specific during the practical skills, second and third in practical field, which is the workplace of the samples professionals. Results: the final sample of the study was composed by 45 professionals: 31 (68,9%) nursing assistants and nursing technicians and 14 (31,1%) nurses. The average obtained by participants in the after-test was: 8,49; skill-wise the average obtained was 9,58; in practice 1 an average of 9,53 with a p=0,652; regarding practice 2, they have obtained an average of 9,94, with a p=<0,001, given the fact that the average obtained in practical evaluations was higher than the one obtained in skills. The resulting data points out that there is more reliability and value of the IARPE / A deficiência de habilidade técnica dos profissionais da saúde é motivo de preocupação para os profissionais responsáveis por processo de seleção, treinamento e desenvolvimento das equipes de saúde. Essa deficiência tem sido notada desde a etapa inicial do processo, período de formação profissional. Diante desse cenário, cabe às instituições de saúde qualificar os seus profissionais de acordo com as habilidades técnicas necessárias para uma prestação de assistência em saúde com qualidade e excelência, com foco no cliente. Objetivos: O estudo utilizou o instrumento de Avaliação de Reprodutibilidade de Procedimento de Enfermagem (IARPE), para avaliar o profissional em seu cenário de habilidade e de atuação prática com a finalidade de evidenciar a eficácia do curso de atualização em punção venosa periférica; avaliar a reprodutibilidade de procedimentos em diferentes cenários de simulação; avaliar as habilidades estabelecidas para a execução do procedimento de punção venosa periférica; e analisar as propriedades psicométricas do instrumento. Material e método: O curso teórico e prático foi realizado por profissionais do Instituto de Ensino e Pesquisa – IEP, onde foi feita a coleta dos dados: no primeiro momento durante o curso, no momento da habilidade prática, no segundo e terceiro momentos no campo prático, local de trabalho dos profissionais da amostra. Resultados: A amostra final do estudo foi composta por 45 profissionais sendo: 31 (68,9%) auxiliares e técnicos de enfermagem e 14 (31,1%) enfermeiros. A média obtida pelos participantes no pós teste: 8,49; na habilidade apresentaram uma média de 9,58; na prática 1 apresentou uma média de 9,53 com um p=0,652; já na prática, 2 apresentaram uma média de 9,94, com um p= <0,001, sendo as médias obtidas nas avaliações práticas maiores do que a média obtida na habilidade. Os dados obtidos apontaram que há confiabilidade e validade do IARPE.

Submitted by Cássia Santos (cassia.bcufg@gmail.com) on 2016-08-09T14:07:27Z No. of bitstreams: 2 Tese - Valquiria Coelho Pina Paulino - 2016.pdf: 860942 bytes, checksum: 6d5cacf017c6629cb84860a5d389a67e (MD5) license_rdf: 0 bytes, checksum: d41d8cd98f00b204e9800998ecf8427e (MD5) / Approved for entry into archive by Luciana Ferreira (lucgeral@gmail.com) on 2016-08-09T15:03:34Z (GMT) No. of bitstreams: 2 Tese - Valquiria Coelho Pina Paulino - 2016.pdf: 860942 bytes, checksum: 6d5cacf017c6629cb84860a5d389a67e (MD5) license_rdf: 0 bytes, checksum: d41d8cd98f00b204e9800998ecf8427e (MD5) / Made available in DSpace on 2016-08-09T15:03:34Z (GMT). No. of bitstreams: 2 Tese - Valquiria Coelho Pina Paulino - 2016.pdf: 860942 bytes, checksum: 6d5cacf017c6629cb84860a5d389a67e (MD5) license_rdf: 0 bytes, checksum: d41d8cd98f00b204e9800998ecf8427e (MD5) Previous issue date: 2016-03-23 / Fundação de Amparo à Pesquisa do Estado de Goiás - FAPEG / The overall objective of the study was to analyze the teaching identity, practice and training of teachers of undergraduate courses in public and private nursing in the state of Goiás. Methodology: Field research, descriptive cross-sectional. The sample consisted of 213 teachers which corresponds to 74.2% of professionals in undergraduate courses in Nursing, 60 linked to public and private courses to 153. For collection, we used a questionnaire addressing the teacher identity in personal, professional and administrative dimensions. Data were tabulated in Microsoft ® Excel 2010 program and the statistical analysis by SPSS program for Windows, version 16.0. Results: In the personal dimension the predominant age group was 30-51 years, and the oldest are in public institutions. In the professional dimension, the prevailing academic courses in Pubic was the doctorate and private in the Masters. As for specific training for teaching 85% of teachers were public courses and 73.8% in private. In the administrative dimension, public courses, the working time average in higher education was 11.13 years, 81.7% statutory, 81.7% worked exclusively at the university, with average weekly working hours of 38.53 hours, and 11.3 hours for education, 7.97 hours for planning and 19.3 hours for research and extension activities, 55% earned more than 8 times the minimum wage. Among the participants, 86.7% have published at least one article in a scientific journal and 70% in conference proceedings in the last three years. The greatest difficulty pointed to the teaching exercise was the workload and demand for production and qualification (31.6%). In private courses, the working time average in higher education is 8.95 years, 79.1% were hourly, with weekly working hours of 42.46 hours, and the average in education 23.7 hours and 6.76 hours of planning, having no specific time for research. As for workplaces, 39.2% worked in two or more institutions and 28.1% earned over 8 minimum wages, 22.9% have published at least one work in conference proceedings and 37.3% in the journal three years. The greatest difficulty pointed to the teaching exercise was the lack of interest and intellectual training of students (37.2%). Conclusions: There are differences in the teaching identity, practice and training of teachers of public and private institutions in this respect confirming the first hypothesis established for the study. The second hypothesis was refuted because, teachers in both types of courses studied, most have specific training for teaching and there is a search movement of teachers for qualifying. / O objetivo geral do estudo foi analisar a identidade docente, prática e formação dos professores dos cursos de graduação em Enfermagem públicos e privados do Estado de Goiás. Metodologia: Pesquisa de campo, descritiva do tipo transversal. A amostra constitui-se de 213 professores o que corresponde a 74,2% destes profissionais nos cursos de graduação em Enfermagem, sendo que 60 vinculados aos cursos públicos e 153 aos privados. Para a coleta, utilizou-se um questionário que abordou a identidade docente nas dimensões pessoal, profissional e administrativa. Os dados foram tabulados no programa Microsoft ® Excel 2010 e a análise estatística realizada pelo programa SPSS® for Windows®, versão 16.0. Resultados: Na dimensão pessoal a faixa etária predominante foi de 30 a 51 anos, sendo que os mais velhos estão nas instituições públicas. Na dimensão profissional, a formação acadêmica predominante nos cursos púbicos foi o doutorado e nos privados o mestrado. Quanto à formação específica para a docência 85% dos professores eram dos cursos públicos e 73,8% nos privados. Na dimensão administrativa, nos cursos públicos, a média de tempo de trabalho no ensino superior era de 11,13 anos, sendo 81,7% estatutários, 81,7% trabalhavam exclusivamente na universidade, com média de carga horária semanal de 38,53 horas, sendo 11,3 horas para o ensino, 7,97 horas para o planejamento e 19,3 horas para atividades de pesquisa e extensão, 55% ganhavam acima de 8 salários mínimos. Entre os participantes, 86,7% publicaram no mínimo um artigo em revista científica e 70% em anais de congressos nos últimos 3 anos. A maior dificuldade apontada para o exercício docente foi a sobrecarga de trabalho e exigência por produção e qualificação (31,6%). Nos cursos privados, a média de tempo de trabalho no ensino superior é de 8,95 anos, 79,1% eram horistas, com carga horária semanal de 42,46 horas, sendo a média no ensino 23,7 horas e 6,76 horas de planejamento, não tendo tempo específico para a pesquisa. Quanto aos locais de trabalho, 39,2% atuavam em duas ou mais instituições e 28,1% ganhavam acima de 8 salários mínimos, 22,9% publicaram no mínimo um trabalho em anais de congressos e 37,3% em revista científica nos últimos três anos. A maior dificuldade apontada para o exercício docente foi a falta de interesse e de preparo intelectual dos alunos (37,2%). Conclusões: Existem diferenças quanto à identidade docente, prática e formação dos professores das instituições públicas e privadas confirmando neste aspecto a primeira hipótese estabelecida para o estudo. A segunda hipótese foi refutada, pois, os professores nos dois tipos de cursos estudados, a maioria tem formação específica para a docência e existe um movimento de busca dos docentes para a qualificação.

The strength of health systems predict access to medicines that prevent death from pregnancy related complications (essential maternal health medicines). But little is known about the relative impact of each health system building block on access. This quantitative cross-sectional study applied Ishikawa model to examine the relative effect of health systems governance, facilities, service delivery, financing and medicine procurement and distribution (independent variables), on availability, affordability and accessibility (dependent variables) of maternal health medicines in resource poor settings. Data analyzed was pulled from 37 WHO pharmaceutical country profiles and USAID MCHIP survey that assessed national programs for the prevention and management of Postpartum hemorrhage and Pre-Eclampsia/Eclampsia. Data analysis included bivariate and multivariate logistic regressions. All independent variables, except for quality of health services showed statistically significant association with access to maternal health medicines and achieved a p-value < .05 in bivariate analysis. Only three predictors however explained 27% of the variance (R2 =.266, F(5,162)=13.12, p<.01). The strength of medicine procurement and distribution systems significantly predicted access to essential maternal health medicines (β= -.41, p<.001), as did robustness of health system financing (β= -.51, p<.001), and quality of health facilities (β= -.34, p<.05). Authorities may prioritize investments in quality improvement, supply chain strengthening programs, and incentives for private sector financing and public-private partnerships for health system strengthening. This study contributes to positive social change by identifying key health system considerations that can inform future efforts to close geographical gaps in MCH outcomes.