The diploma thesis deals with a problematic of management of the nursing care by a patient with intracranial hemorrhage. Most of the patients who survive intracranial hemorrhage stay permanently reliant on the care from others. That is why it is so important for this care to be as qualitative as possible and to have a fluent continuity. The aim of the thesis was to find out what is the role of a nurse by the patient with intracranial hemorrhage, then also find out, if the nurses know the warning signs of a worsening state of such patient, how do they cooperate with his/her family and what are the possibilities of the following care. In the empirical part of the diploma thesis, qualitative-quantitative research was used. For a complex view on a management of nursing care, the chosen technique of research was semi-structured questionnaire with patients with intracranial hemorrhage and non-standardized questionnaire with nurses who take care of these patients. For the quantitative part of the research, two hypotheses to two aims of the diploma thesis were set. Both hypotheses weren't proven by statistical methods. For qualitative research, four research questions were set. The respondents described the role of a nurse, especially in helping the patient, in rehabilitation and in also her role in educating the patient. Addressed respondents agreed on appropriate and swift reactions of the nurses in case the state of the patient starts to worsen. The cooperation of nurses and families is according to the patients without problems. It showed in the interviews with respondents, that there is a problem with insufficient awareness of the patients about the existing possibilities of following care. The outcome of the diploma thesis is a coherent educational material about nursing care by a patient with intracranial hemorrhage, which can serve to either the students or the nurses taking care of these patients.

Requirements for changes in nursing care on the part of top management Abstract At present, nursing care has been experiencing a great progress. Implementation of the nursing process as a working method has been striven for. The educational system for non-medical workers has been changing. Nurses holding top managerial posts should have competence to lead and manage people effectively in the ever changing nursing environment. To acquire information necessary for achievement of the set goals, a quantitative research was employed. Within the framework of the quantitative research, the questioning method using a questionnaire was selected. The questionnaires concerned were sent to top managers among nurses and doctors working in medical centres all over the Czech Republic. The thesis had three objectives defined. First, to discover what prerequisites top managers miss to be able to implement the changes concerned in the area of nursing care. Second, to discover top managers´ opinions on the system of nursing care provision. Third, to identify differences between requirements for the nursing process method on the part of top managers {--} nurses and top managers {--} doctors. Based on these objectives, four hypotheses were formulated. The hypothesis no. I: The current situation does not allow top managers operating in health service to implement changes in nursing care in practice. This hypothesis has been confirmed. The hypothesis no. 2: Top managers do not require group nursing care as a prerequisite for the implementation of nursing care changes. This hypothesis has not been confirmed. The hypothesis no. III: Representatives of nurses in managerial posts promote the nursing process application as a prerequisite for changes concerning nursing care. This hypothesis has been confirmed. The hypothesis no. IV: Representatives of medicine doctors in managerial posts do not promote the nursing process application as a method of nurses´ work. This hypothesis has not been confirmed. As far as the results of this diploma thesis are concerned, we were trying to outline possible solutions of the issues concerning changes in nursing care. Top managers are recommended to stimulate critical thinking in their employees in the course of work in the nursing process. It is beneficial to improve communication on the managerial level in hospitals, and in addition, to obtain feedback from subordinates with respect to continuing education, to identify effectiveness and needs relating to education on the part of employees and to enable them to participate in the process of the respective changes implementation. To train function nurses in such changes management. To implement a programme aiming at continual quality improvement.

Submitted by Cássia Santos (cassia.bcufg@gmail.com) on 2015-01-30T14:21:05Z No. of bitstreams: 2 license_rdf: 23148 bytes, checksum: 9da0b6dfac957114c6a7714714b86306 (MD5) Dissertação - Alexandrina Maria Nogueira Guerra Adorno - 2014.pdf: 1569833 bytes, checksum: 80174f660391d5adb56ad382b123abde (MD5) / Approved for entry into archive by Luciana Ferreira (lucgeral@gmail.com) on 2015-01-30T14:26:32Z (GMT) No. of bitstreams: 2 license_rdf: 23148 bytes, checksum: 9da0b6dfac957114c6a7714714b86306 (MD5) Dissertação - Alexandrina Maria Nogueira Guerra Adorno - 2014.pdf: 1569833 bytes, checksum: 80174f660391d5adb56ad382b123abde (MD5) / Made available in DSpace on 2015-01-30T14:26:32Z (GMT). No. of bitstreams: 2 license_rdf: 23148 bytes, checksum: 9da0b6dfac957114c6a7714714b86306 (MD5) Dissertação - Alexandrina Maria Nogueira Guerra Adorno - 2014.pdf: 1569833 bytes, checksum: 80174f660391d5adb56ad382b123abde (MD5) Previous issue date: 2014-02-28 / Coordenação de Aperfeiçoamento de Pessoal de Nível Superior - CAPES / The humanization policy in the context of health constitutes a relevant actions sedimentary health care of the population direction and determines the reflection on the formative processes in human resources for health. Qualitative study, aimed at analyzing the humanization management of human resources, the perception of nursing staff in a public maternity hospital. Collecting data through semi-structured interviews with 29 respondents recorded, with 06 nurses and 23 nursing technique, the period February to May 2013 collection The material was literally transcribed and subjected to content analysis technique developed by five thematic categories: Humanization Policy of the SUS; Assistance and Processes promoters humanization of nursing services; Skills and managerial skills of the nurse; Quality of nursing care. It is understood that, in the view of the interviewed nurses to fit the humanization of nursing services, the development of managerial skills of staff. Humanizing nursing service in maternity is a complex process that requires professional expertise in health management, the institution must carry continuing education discussing actions based practices and clinical evidence hinged to technological advances, promote host environments for nursing staff, enable workers to suitable conditions for quality care to women during pregnancy and puerperal period. / A política de humanização no contexto da saúde se constitui em um direcionamento relevante para sedimentar ações de assistência à saúde da população brasileira, bem como determina a reflexão nos processos formativos em recursos humanos na saúde. Estudo com abordagem qualitativa, tem por objetivo analisar a humanização no gerenciamento dos recursos humanos, segundo a percepção de equipe de enfermagem de uma maternidade de hospital público. Coleta de dados por meio de entrevista semi-estruturada gravadas com 29 depoentes, sendo 06 enfermeiras e 23 técnicas de enfermagem, período da coleta fevereiro a maio de 2013. O material foi transcrito literalmente e submetido a técnica de Análise de Conteúdo elaborou-se cinco categorias temáticas: Política de Humanização do SUS; Assistência e Processos promotores de humanização nos serviços de enfermagem; Habilidades e Competências gerenciais do enfermeiro; Qualidade da assistência de enfermagem. Compreende-se que, na visão das entrevistadas cabe ao enfermeiro a humanização no serviço de enfermagem, o desenvolvimento das competências gerenciais da equipe. Humanizar o serviço de enfermagem na maternidade é um processo complexo que exige competência profissional de gestão em saúde, a instituição deve efetivar ações de educação continuada discutindo as práticas baseadas em evidências clínicas e articulada aos avanços tecnológicos, promover ambientes de acolhimento para equipe de enfermagem, possibilitar aos trabalhadores condições adequadas para assistência de qualidade às mulheres no período gravídico-puerperal.

Introdução: A demonstração da associação entre tempo de assistência de enfermagem dispensado aos pacientes e indicadores de qualidade assistencial pode constituir-se em importante ferramenta de gestão, subsidiando o processo de tomada de decisão acerca das questões relacionadas à adequação quantitativa e qualitativa de profissionais de enfermagem frente aos padrões de qualidade e segurança assistenciais almejados pelos serviços de saúde. Objetivo: Verificar a correlação entre tempo médio de assistência de enfermagem dispensado aos pacientes adultos, internados em unidades de terapia intensiva (UTI) do Município de São Paulo, e indicadores de qualidade assistencial: Incidência de Saída Não Planejada de Sonda Oro/Nasogastroenteral (SONGE) para Aporte Nutricional; Incidência de Extubação não Planejada (ENP) de Cânula Endotraqueal; Incidência de Perda de Cateter Venoso Central (CVC). Método: Estudo de abordagem quantitativa, observacional e correlacional, desenvolvido em 11 UTI de pacientes adultos de dois hospitais públicos e um privado, localizadas na cidade de São Paulo. A população compreendeu os registros do quantitativo e qualitativo de profissionais de enfermagem, do número de pacientes portadores de, ao menos, um dos dispositivos terapêuticos (SONGE, COT, CVC) e das ocorrências relativas às perdas dos dispositivos. Os hospitais foram nominados pelas siglas HA, HB e HC. A coleta de dados, nos HA e HB, ocorreu no período de 17 de julho a 17 de novembro de 2015. No HC os dados foram coletados de 12 de agosto a 12 de dezembro do ano de 2015. A análise foi baseada na estatística descritiva e inferencial, com significância de 5%. Resultados: Nos quatro meses do estudo foram assistidos 2.569 pacientes. O tempo médio de assistência de enfermagem dispensado aos pacientes correspondeu a 18,86 horas no HA, 21,00 horas no HB e 19,50 horas no HC. A porcentagem média do tempo ministrado por enfermeiras foi de 37,75% no HA, 35,00% no HB e 41,36% no HC. O indicador Incidência de Saída Não Planejada de SONGE para Aporte Nutricional apresentou média de 2,19/100 pacientes-dia (dp=10,93). A média do indicador Incidência de ENP de Cânula Endotraqueal correspondeu à 0,42/100 pacientes-dia (dp=4,51) e a do indicador Incidência média de Perda CVC foi de 0,22/100 pacientes-dia (dp=2,04). Não houve correlação estatisticamente significante entre o tempo médio de assistência de enfermagem dispensado pela equipe, tempo médio dispensado por categoria profissional e os indicadores de qualidade elencados. Conclusões: Apesar da hipótese do estudo ter sido refutada, esta pesquisa avança no sentido de elucidar outras variáveis que podem interferir na correlação entre eventos adversos referentes aos artefatos terapêuticos estudados e o quadro de profissionais de enfermagem. Os resultados do presente estudo podem apoiar decisões metodológicas para a verticalização do conhecimento técnico/científico em enfermagem e a condução de futuras investigações que procurem demonstrar o impacto dos recursos humanos de enfermagem na qualidade e segurança dos pacientes, profissionais e instituições de saúde. / Introduction: The evidence of association between nursing care time spent with patients and healthcare quality indicators may be an important management tool, supporting the decision-making process on issues related to quantitative and qualitative adequacy of nursing professionals when handling the care quality and safety standards needed by health services. Objective: To investigate the correlation between average times of nursing care spent with adult patients in intensive care units (ICU) in São Paulo and care quality indicators: Non Planned Incidence of Loss of Oro / Nasogastric tube (NGT) for Nutritional Intake; Non Planned Extubating (NPE) incidence of Endotracheal Cannula; Incidence of Loss of Central Venous Catheter (CVC). Method: this is a quantitative observational, correlational study carried out in 11 adult ICU patients in two public and one private hospital, located in the city of São Paulo. The population understood quantity and quality records of nursing professionals, the number of patients with at least one of therapeutic devices (NGT, NPE, CVC) and occurrences relating to device losses. Hospitals were nominated by HA, HB and HC initials. Data collection in HA and HB, occurred in the period from 17 July to 17 November 2015. In HC data were collected from August 12 to December 12, 2015. The analysis was based on descriptive and inferential statistics, with 5% significance. Results: 2,569 patients were assisted in the four months of the study. The average time of nursing care spent with patients accounted for 18, 86 hours at HA, HB and 21 hours at HB and 19, 50 at the HC. The average percentage of time dedicated by the nurses was 37.75% in HA, 35.00% in HB and 41.36% in HC. The indicator Non Planned Loss of NGT for Nutritional Intake averaged 2.19 / 100 patient-days (SD = 10.93). The average indicator incidence of NPE of Endotracheal Cannula corresponded to 0.42 / 100 patient-days (SD = 4.51) and the average indicator Incidence loss of CVC was 0.22 / 100 patient-days (SD = 2, 04). There was no statistically significant correlation between the average time of nursing care spent by the team, average time spent by professional category and the mentioned quality indicators. Conclusions: Though the study hypothesis was disproved, this research moves towards elucidating other variables that may affect the correlation between adverse events related to the analyzed therapeutic artifacts and the nursing professionals. The results of this study may support methodological decisions for the verticalization of the technical / scientific knowledge in nursing and the management of future researches aiming to demonstrate the impact of nursing human resources in the quality and safety of patients, health professionals and institutions.

The thesis is based on the needs of non-medical staff members in acute psychiatric care. The main aim of the thesis is to identify the needs of staff members and the relationship to their work. The theme is focussed on theoretical part and formed by information about the needs, motives and motivation in general within a working context. It further focuses on the branch of mental health care, describing the history of psychiatric nursing and current trends in psychiatric care. It then provides an analysis of specifics of psychiatric nursing and goes on to present the possibilities of professional support of the nursing staff. The practical part describes a qualitative study that aims on identification of needs of non-medical staff members working on acute psychiatric unit. The result of the study is formed by 23 identified domains of the needs implanted into the theoretical framework of Maslow's hierarchy of needs. In making recommendations for practise the author uses two attitudes for practical implementation of the results: 1. the results are rearranged into Herzberg's two factor model of motivation, 2. the mind map is used to capture the most dominant groups of needs and their mutual interferences. The thesis concludes by proposing an implementation of supervision into the organization where the...

Eva Bendová: Introducing managerial supervision at the Department of Anesthesiology ABSTRACT In the form of a case study, this diploma thesis describes the process of introducing managerial supervision at the Department of Anesthesiology of Masaryk Hospital in the town of Ústí nad Labem. The theoretical part of the thesis describes theoretical prerequisites of change. It deals with managerial supervision, its basic aspects and principles. Furthermore, it focuses on issues closely related to successful introduction of managerial supervision - management, staff evaluation and development, organizational context and the process of change management. The practical part of the thesis draws a comparison between the situation as it was before introducing the managerial supervision process in the anesthetics ward and the situation a year after I took up my post there. It describes the process of introducing managerial supervision as a tool of change management, the individual stages of change and its evaluation. The thesis is concluded with a reflexion on personal change occurred within a managerial position as a result of analyzing the individual managerial supervision records. Keywords: Managerial supervision, organizational diagnosing, management in nursing, change management, case study

Made available in DSpace on 2016-06-02T20:45:41Z (GMT). No. of bitstreams: 1 5323.pdf: 1239824 bytes, checksum: e10265e2651b624739cc1f4f8d63986e (MD5) Previous issue date: 2013-04-09 / This is a qualitative study aimed to evaluate the limits and possibilities for implementation of user embracement and risk assessment. In particular, from the perspective of local health managers of San Carlos, a town in the state of São Paulo. To collect the data, some semi-structured interviews were conducted with managers of the municipal health system: 61.53% graduated in nursing, 15.38% in medicine, 7.69% in dentistry; 7.69% in management and production engineering. The data were analyzed through thematic analysis. For this research, after collecting and analyzing data, six categories emerged from the analysis: (1) user embracement by organizing the service, (2) undesirable reality or constructed intentionally, (3) something intended but not accomplished, (4) A dream under construction, (5) learning to learn in daily service, (6) speaking the same language. From this definition, the study pointed out that there are different conceptions of user embracement , due to the approach assumed by each manager as suitable. There are also disparities in taking user embracement and under risk assessment as a procedure, possibly as a result of intricate political actions on health. To implement user embracement and risk assessment, it was possible to perceive the existence of limits and possibilities, with regards to organization of the service, local reality, care approaches, quality of assistance, permanent and continuing education as well as networking. / Trata-se de um estudo qualitativo cujo objetivo foi avaliar por onde perpassam os limites e possibilidades para implantação do acolhimento com avaliação de risco. Em específico, na perspectiva dos gestores municipais de saúde de São Carlos, uma cidade do interior do estado de São Paulo. Para coleta de dados, foram realizadas entrevistas semi-estruturadas com gestores do sistema municipal de saúde: 61,53% graduados em enfermagem; 15,38% medicina; 7,69% odontologia; 7,69% administração e 7,69% engenharia de produção. Os dados foram tratados através da análise temática. Para esta pesquisa, após coleta e análise dos dados, emergiram seis categorias de análise; (1) O acolhimento organizando o serviço; (2) Realidade não desejada ou construída intencionalmente; (3) Desejo algo e pratico outro; (4) Um sonho em construção; (5) Aprendendo a aprender no cotidiano do serviço; (6) Falar a mesma língua. A partir dessa delimitação, o estudo apontou que existem diferentes concepções sobre o acolhimento, em decorrência do modelo de atenção que cada gestor assume como sendo resolutivo. Também há disparidades em assumir o acolhimento com avaliação de risco como prática, possivelmente por questões políticas intrincadas nas ações em saúde. Para implementação do acolhimento com avaliação de risco, foi possível perceber a existência de limites e possibilidades, no que diz respeito à organização do serviço, realidade local, modelos de atenção, qualidade da assistência, educação permanente e continuada, trabalho em rede.

We have dealt in this thesis with problems of nursing care of the newborn from the perspective of standardized classification systems NANDA, NIC and NOC which offer many opportunities for streamlining, simplifying and improving of the quality of care. The theoretical part of this thesis focuses on nursing care of physiological newborn during the first moments after the birth until leaving hospital. Furthermore, the common nursing language which is included in standardized classification systems NANDA, NIC and NOC.The empirical part of the thesis was prepared with the help of qualitative - quantitative strategy. We chose to collect valid data a research method of content analysis of documents, modelling, thought experiment and a structured interview. The first aim of the research was to identify the use file from various classification systems related to nursing care of physiological newborn. We selected 9 nursing diagnoses from the publication NANDA International Taxonomy II through content analysis, 9 nursing interventions from Nursing Interventions Classification (NIC), 5 expected results related to the care of physiological newborn from the publication Nursing Outcomes Classification (NOC). We worked out a research form and submitted it in the way of a specific questionnaire to the validation of respondents ? who were experts in the field of nursing care of the newborn, it was made from the selected NANDA nursing diagnoses, NIC interventions and expected results of NOC. The second aim was to verify the usability of the selected files from the classification systems NANDA, NIC and NOC in clinical practice. The results of validation of NANDA nursing diagnoses were done by Diagnostic Content Validity Model ? DCV by Fehring. We determined the absolute and relative frequency of their designation within classification systems NIC and NOC. Nurses working at neonatal wards were our basic research populations; we created a targeted selection of two research samples divided by educational attainment. The first research sample consisted of 20 nurses with university education. The second research group was represented by 18 nurses with secondary education. The survey was realised in the time from January to March 2013 in the neonatal wards of the Hospital České Budějovice, a.s. Hospital Strakonice, a.s., Hospital Písek, a.s. Our third aim was to determine the attitudes of neonatal nurses to usage of classification systems in daily practice. We focused questions directed to the respondents on the knowledge and source of acquired knowledge, their attitude and possible reasons preventing the implementation of classification systems into clinical practice. The results showed nurses are reluctant to the usage and implementation of new standardized classification systems into clinical practice. The output of this thesis is the basic concept of nursing diagnosis according to NANDA-I, NIC and NOC focused on nursing care of physiological new-born in the area of the Czech Republic. 12 NANDA nursing diagnoses taxonomies was verified with 128 characteristics, 9 NIC nursing intervention taxonomies with 183 activities and 5 results of NOC nursing care with 72 areas of evaluation. There was selected in this survey 100 characteristics of NANDA taxonomy (62 %). It was chosen as being applicable in practice 130 from 9 selected files of NIC (71 %). It was selected 39 indicators (54 %) within 5 files of expected NOC results. The survey brought a lot of interesting information and also revealed even the lacks in the area of nursing care of physiological new-born; research also showed the lack in the area of nursing care of physiological newborn.