Estudo de natureza quantitativa, descritiva, transversal, elaborado com o objetivo de identificar e analisar o absenteísmo por doença, dos profissionais de enfermagem do Hospital Universitário da USP, no período de janeiro a dezembro de 2007. A metodologia foi desenvolvida em duas etapas: caracterização demográfica dos profissionais e análise e caracterização das ausências quanto aos tipos de afastamento, aos diagnósticos médicos, à taxa de absenteísmo por doença, à relação com a taxa de ocupação do Hospital e ao custo médio estimado. O quadro de profissionais foi constituído, em média, de 647 profissionais, destes 362 apresentaram absenteísmo por doença: 69 (19,1%) enfermeiros, 212 (58,6%) técnicos de enfermagem, 78 (21,5%) auxiliares de enfermagem e três (0,8%) atendentes. Os afastamentos por doença foram classificados em: licença por falta abonada (FA); licença por falta compensada por folga (FO), licença-médica com até 15 dias (LM), licença- médica acima de 15 dias (INS) e licença-médica acima de 15 dias, porém iniciadas antes de 2007 (IN). A idade média dos profissionais ausentes por doença, o sexo e o tempo de experiência não condicionaram o absenteísmo por doença. Possuem em média 1,5 filhos, 83% reportaram trabalhar em um emprego e despenderem cerca de 50min no trajeto para o trabalho. O salário bruto, dos enfermeiros foi de R$ 4.958,32, dos técnicos/auxiliares de enfermagem R$ 2.650.07 e de R$ 1.360,94 para os atendentes de enfermagem. A quantidade de licenças concedidas, em 2007, aos 362 profissionais foram 762 licenças que representaram 6.245 dias de absenteísmo por doença ao trabalho, correspondendo a LM 67,6%, FA 10,8%, FO 12,1%, INS 5,0% e IN 4,5%. Os técnicos de enfermagem apresentaram a maior quantidade de licenças por doença, e os auxiliares de enfermagem a maior de dias de ausências. Quanto à unidade de origem, os maiores percentuais de licenças ocorreram na Clínica Cirúrgica, no Pronto-Socorro Adulto e na Clínica Médica. Na unidade de Pronto-Socorro Adulto, proporcionalmente ao quadro da unidade, ocorreu a maior quantidade de profissionais ausentes por doença. Na Clinica Médica, 73 licenças geraram a quantidade mais elevada de dias de ausências (1.216). O total do tempo em dias de ausência por doença foi de 11.948 dias, no ano, sendo: 5.757 dias (48,2%) IN; 3.552 dias (29,7%) INS e 2.470 dias (20,75%) LM; 101 dias (0,8%) FO; 68 dias (0,6%) FA. A menor ocorrência de licenças por doença foi no turno da noite e a maior no turno da manhã. As doenças sistema osteomuscular e do tecido conjuntivo representaram 4.957 dias (41,5%) de ausências e os transtornos mentais e comportamentais 3.393 dias (28,4%). As LM representaram 83,5% do custo estimado. O percentual mensal de licenças por doença foi inversamente proporcional à taxa de ocupação. A taxa de absenteísmo por doença da equipe de enfermagem, em 2007, foi 5,3%, as licenças INSS representaram 4,2% e as LM 1,1%. A política de cobertura, por contratação temporária, do absenteísmo por doença poderá contribuir para diminuir a sobrecarga de trabalho, possibilitando condições mais seguras de trabalho aos profissionais de enfermagem / The aim of this quantitative, descriptive and transversal study was to identify and analyze sickness absenteeism in the nursing staff of the University Hospital-USP, from January to December 2007. Methodology was carried-out in two phases: professionals demographic characterization and analyze and characterization of absences regarding type of leave, medical diagnosis, rate of sickness absenteeism, relationship with rate of Hospital occupation and with the mean estimated cost. The professional chart consisted of, on average, 647 professionals, of which 362 presented sickness absenteeism: 69 (19.1%) nurses, 212 (58.6%) nursing technicians, 78 (21.5%) nursing assistants and three (0.8%) hospital attendants. Sick leaves were classified into: leave due to excused absence (EA); leave of absence, performing overtime work in non-work days (NW), medical leave up to 15 days (ML), and medical leave for more than 15 days (EML) and medical leave more than 15 days but started before 2007 (BML). The professionals mean age for sickness absenteeism, sex and expertise time did not correlated absenteeism to disease. The professionals had an average of 1.5 children, 83% reported to have a job and they expended about 50 minutes in the way to the workplace. The gross income of the nurses was R$ 4,958.32 and R$ 2,650.07 for technicians/nursing assistants and R$ 1,360.94 for nursing attendants. The total of leaves granted in 2007, for the 362 professionals was 762 leaves representing 6.245 days related to sickness absenteeism, corresponding to ML 67.6%, EA10.8%, NW 12.1%, EML 5.0% and BML 4.5%. The nursing technicians presented the greater rates of sick leaves and nursing assistants presented the greatest rate of absences. Regarding unit of origin of the greatest leave rates occurred in Surgical Clinic, Adult First-Aid Clinic and Medical Clinic. In the Adult First-Aid, proportionally in relation to the unit size, occurred the greatest number of sick leaves. In the Medical Clinic 73 leaves triggered a greater rate of absent days (1,216). The total amount of days on sick leave was 11,948 days, per year, of which: 5,757 days (48.2%) BML; 3,552 days (29.7%) EML and 2,470 days (20.765%) ML; 101 days (0.8%) NW; 68 days (0.6%) EA. The lower occurrence due to disease was observed at the night shifts and the greater in the morning shifts. Diseases of the osteomuscular system and connective tissue represented 4.957 days (41.5%) of absences and psychological and behavioral disorders 3,393 days (28.4%). The ML represented 83.5% of the estimated cost. Monthly percentage of leaves per disease was inversely proportional to the occupation rate. Sick absenteeism rate in the nursing staff, in 2007, was 5.3%, INSS* leaves represented 4.2% and MD 1.1%. Coverage Policies for temporary contract, sickness absenteeism may contribute to decrease work overload, allowing more safe conditions of working for the nursing professionals

M.Cur. / The nursing service manager is accountable for the managerial outputs of the nursing service, being quality nursing care, cost effectiveness and quality nursing staff management. These managerial responsibilities will influence the overall management efficiency of the health delivery system. There is a need for a more scientific basis of staffing in South African critical care units. Various methods are used to determine staffing needs, but the most accurate and acceptable method being used is the patient classification system. The success of a critical care patient classification system is based upon the accurate determination of the ideal nurse-patient ratio. Ideal nursepatient ratio depends on matching the competency of the critical care nurse to the severity of the critical care patient's illness. Internationally and nationally very few guidelines describe the competency requirements that the critical care nurse should have to function effectively in the critical care unit. To maintain a high standard of quality nursing care, the critical care nurse should be assigned to a critical care patient according to her competency level. The aim of this study was to describe a scientific patient classification system for critical care patients according to which workload and nursing requirements can be ascertained. Secondly, to describe guidelines for the competency requirements of a registered critical care nurse assigned to nurse the different categories of critical care patients categorised by the patient classification system as prescribed. The aim of the study is justified by means of an exploratory, descriptive, contextual research design. A critical care patient classification system has been developed and validated by a group of critical care nursing experts using a structured two phase research method. The statistical validity of each item of the critical care patient classification system was determined by means of a content validity index. All the items of the critical care patient classification system were rated as valid and therefore the critical care patient classification system as a whole has been accepted as valid. The reliability of the critical care patient classification system was tested by means of a pilot study in two selected research units. It was determined that the inter-rater reliability was within the 95 per cent confidence interval, that the system could discriminate between different critical care patients and nurse-patient ratios were effectively determined by the system. Critical care nurse competency requirements were identified by critical care nursing experts by means of a focus group interview. The results obtained from the focus group interview were verified by a literature control and peer group review. Guidelines for the competency requirements of the critical care nurse were compiled. The critical care patient classification system developed will equip the critical care manager with a scientific instrument to assign personnel to critical care units. The critical care patient classification system will furthermore assist the critical care unit manager in the daily utilisation of valuable human resources, in that critical care nurses with the appropriate level of expertise can be assigned to each patient, thus facilitating quality critical care nursing.

Submitted by Nadir Basilio (nadirsb@uninove.br) on 2015-07-17T14:28:35Z No. of bitstreams: 1 Flavia Regina Cocuzza das Eiras.pdf: 1667187 bytes, checksum: b039c92b8913ea5abb2e449b63917ea6 (MD5) / Made available in DSpace on 2015-07-17T14:28:35Z (GMT). No. of bitstreams: 1 Flavia Regina Cocuzza das Eiras.pdf: 1667187 bytes, checksum: b039c92b8913ea5abb2e449b63917ea6 (MD5) Previous issue date: 2015-12-05 / With the evolution of healthcare expertise and the incorporation of new medical technologies, Terminal Hepatic Insufficiency nowadays has the possibility of liver transplantation as a therapeutic means of great effectiveness. For the establishment of fully qualified service units implementation several of the following a resources needs to be available. Manage these resources is one basic concern of health managers. The main objective of the study was the evaluation of usefulness of MELD severity indicator for end-stage liver disease as a predictive element for the use of support resources to patients undergoing liver transplantation in a Teaching Hospital. The study was characterized as quantitative, retrospective, and prospected variables were classified by 6 main dimensions; the identification and classification of patient risk, the use of advanced life support structures, imaging diagnostic, clinical tests, the appointment of special procedures and haemotherapeutics procedures. It were analyzed their frequencies by linear regression with analysis of variance (ANOVA), with the application of software STATATM 12.1 to detect which variables had relevance in view of the dependent variable and were analyzed 76 cases occurred in the period in terms of 6 dimensions. As a result, what it were found that some variables and dimensions included in the model explain the dependent variable, which implies the assumption of the deterministic character of the same. Among the dimensions in which the indicator was featured as a predictive factor were identified laboratory test results variables, same imaging tests and blood products. Given the results obtained and considering the main purpose of the study is concluded that the indicator "MELD" has projected potential capacity in terms of utilization of resources necessary for the postoperative management of patients undergoing liver transplantation. / Com a evolução da competência assistencial e a incorporação de novas tecnologias, a Insuficiência Hepática Terminal passou a contar com a possibilidade de transplante hepático como uma via terapêutica de grande efetividade. Para a constituição de unidades de atendimento plenamente habilitadas na execução destes procedimentos várias são as necessidades de recursos que deverão estar disponíveis. Gerenciar estes recursos é preocupação básica dos gestores de saúde. O objetivo principal deste estudo foi avaliar a utilidade do indicador de gravidade MELD para doenças hepáticas terminais como elemento preditivo do uso de recursos de apoio aos pacientes submetidos ao transplante hepático em um Hospital de Ensino de São Paulo. O estudo caracterizou-se como quantitativo e retrospectivo, foram classificadas variáveis objeto da prospecção segundo seis dimensões principais: a identificação e classificação do risco do paciente; a utilização de estruturas de suporte avançado à vida, de exames de apoio diagnóstico por imagem, de exames de análises clínicas; a indicação de procedimentos especiais; e de uso de hemoderivados. Foram analisadas suas frequências por regressão linear com análise de variância (ANOVA), com a aplicação do software STATATM 12.1 para detecção de quais variáveis apresentaram relevância face à variável dependente, sendo analisados 76 casos ocorridos no período frente às dimensões. Como resultado, o que se verificou foi que algumas variáveis e dimensões incluídas no modelo explicam a variável dependente, o que implica na assunção do caráter determinístico do mesmo. Dentre as dimensões em que o indicador se apresentava como fator preditivo foram identificadas variáveis de exames laboratoriais, de imagens e no uso de hemoderivados. Dados os resultados obtidos e considerando-se o propósito principal do estudo, conclui-se que o indicador "MELD" apresenta potencial capacidade previsão de utilização de recursos necessários ao tratamento pós-operatório dos pacientes submetidos a transplantes hepáticos.

Le travail administratif est bien souvent vécu comme un fardeau par les infirmières hospitalières qui ont le sentiment qu’une accumulation de paperasse les empêchent de passer plus de temps auprès du patient. Pourtant, il existe peu de description de cette part oubliée du travail infirmier, de ces tâches peu valorisées. Cette thèse s’est donc attachée à ouvrir la boite noire du travail administratif infirmier à travers divers contextes de soins dans deux pays : la France et les Etats-Unis. Une étude ethnographique a été réalisée, impliquant plus de 50 infirmières et près de 700 heures d’observation. Les résultats ont permis l’identification de 6 grandes activités administratives et organisationnelles appelées DOA (Documentation and organizational activities) : Ces DOA sont symptomatiques d’une adaptation aux nouvelles complexités des parcours de soin et prennent trois formes : le reporting d’indicateurs et de suivis de l’activité, les activités organisationnelles et l’implication dans la vie institutionnelle de l’établissement. Le sentiment de fardeau administratif serait plutôt lié à la manière dont ces tâches sont intégrées ou non à la pratique, des facteurs d’intégration du travail administratif sont révélés par le terrain. Enfin, les ambiguïtés et contradictions révélées dans cette thèse nous apprennent qu’il existe plusieurs registres de perception du travail. Cette thèse invite les institutions hospitalières et les leaders infirmiers à mieux prendre en considération considèrent ces différents registres dans leur vision de l’idéal du métier. / Administrative work is often perceived as a burden by hospital nurses, who have the impression that the accumulation of paperwork prevents them from spending more time with patients. And yet, precious few descriptions exist of this forsaken aspect of nursing work, of these under-valued responsibilities. Existing research about the nursing profession focuses on the evolution of clinical care, which often contributes to obfuscating an important part of the nurse’s workday. Thus, this thesis seeks to open the black box of nurses’ administrative activities throughout various care contexts in two countries: France and the United States. An ethnographic study provided the basis for this research, involving nearly 50 nurses and 700 hours of observation. The results allowed for the identification of 6 categories of administrative and organizational activities, called DOA (Documentation and Organizational Activities). These DOA are symptomatic of an adaptation to new complexities of care, and manifest themselves in three ways: the reporting of indicators and the monitoring of caregiving, organizational activities, and the involvement in the establishment’s institutional life. The ambiguities and contradictions revealed by this thesis demonstrate that perceptions of administrative work are indeed quite varied. If the valorization of nursing work through patient care is legitimate, so is complaining about what distances caregivers from it. This kind of complaint, echoed by the profession, is not always experienced as such in practice. This thesis invites hospital managers and nursing leaders to take into account these different perceptions in their ideal vision of the profession.

Text in Afrikaans / In hierdie studie is die noodsaaklike bestuursrol van die rampverpleegster tydens rampoptrede en direk daarna verken, nagevors en beskryf. Haar bevoegdheid om die verskillende rampbestuurstake effektief te kan verrig voor, tydens en na rampe wat buite 'n hospitaal plaasvind, is oak nagegaan. Bestuurstake is geidentifiseer waarmee verpleegsters tydens rampsituasies buite hospitale vertroud behoort te wees. Die navorsingsprojek het deur middel van vraelyste biografiese data ingesamel met betrekking tot die persone wat as rampverpleegsters by Burgerlike Beskerming in Pretoria geregistreer is, met die doel om 'n kursus aan te beveel wat pertinent op hul behoeftes gerig is. Die rampverpleegster se behoefte aan toepaslike verdere opleiding, inoefening of leiding betreffende die ge1dentifiseerde bestuurstake, is bepaal. Dit het geblyk dat opleiding in die meeste take nodig is, en 'n kursus in rampbestuur vir verpleegkundiges is ontwerp / In this study the essential management role of the disaster nurse during disaster action was outlined, researched and described. Her competency to effectively execute disaster relief tasks before, during and after a disaster occurring outside a hospital, was studied. Management tasks were identified which nurses should have mastered regarding disaster situations occurring outside hospital boundaries. Research data were gathered by means of a questiorinaire on the biographic detail of disaster nurses registered with · Civil Defence in Pretoria, in order to recommend a course specifically aimed at fulfilling their requirements. The research project identified requirements of the disaster nurse for appropriate further training, practise and guidance regarding the identified-management tasks. It became evident that training is required in most of the tasks, and a training course for nurses in disaster management was designed / Health Studies / M.A. (Verpleegkunde)

Text in Afrikaans / In hierdie studie is die noodsaaklike bestuursrol van die rampverpleegster tydens rampoptrede en direk daarna verken, nagevors en beskryf. Haar bevoegdheid om die verskillende rampbestuurstake effektief te kan verrig voor, tydens en na rampe wat buite 'n hospitaal plaasvind, is oak nagegaan. Bestuurstake is geidentifiseer waarmee verpleegsters tydens rampsituasies buite hospitale vertroud behoort te wees. Die navorsingsprojek het deur middel van vraelyste biografiese data ingesamel met betrekking tot die persone wat as rampverpleegsters by Burgerlike Beskerming in Pretoria geregistreer is, met die doel om 'n kursus aan te beveel wat pertinent op hul behoeftes gerig is. Die rampverpleegster se behoefte aan toepaslike verdere opleiding, inoefening of leiding betreffende die ge1dentifiseerde bestuurstake, is bepaal. Dit het geblyk dat opleiding in die meeste take nodig is, en 'n kursus in rampbestuur vir verpleegkundiges is ontwerp / In this study the essential management role of the disaster nurse during disaster action was outlined, researched and described. Her competency to effectively execute disaster relief tasks before, during and after a disaster occurring outside a hospital, was studied. Management tasks were identified which nurses should have mastered regarding disaster situations occurring outside hospital boundaries. Research data were gathered by means of a questiorinaire on the biographic detail of disaster nurses registered with · Civil Defence in Pretoria, in order to recommend a course specifically aimed at fulfilling their requirements. The research project identified requirements of the disaster nurse for appropriate further training, practise and guidance regarding the identified-management tasks. It became evident that training is required in most of the tasks, and a training course for nurses in disaster management was designed / Health Studies / M.A. (Verpleegkunde)

Partout dans le monde, la formation en gestion des cadres infirmiers est devenue une nécessité. Afin de doter la profession infirmière de chefs de file capables de faire face aux changements, plusieurs pays ont conçu des programmes de formation de deuxième cycle en administration des services de soins infirmiers. Plusieurs programmes sont développés en ce sens dont peu ou prou sont évalués. Plusieurs auteurs croient que l’évaluation de ces programmes permettrait de mieux apprécier l’atteinte des objectifs pédagogiques et ultérieurement, d’améliorer la formation et les pratiques de gestion. Afin de contribuer à ce projet, la présente étude vise à évaluer le programme de formation Administration et enseignement de l'École nationale de développement sanitaire et social (ENDSS) du Sénégal. Cette évaluation prend en compte les points de vue des diplômés, des enseignants, des concepteurs du programme et des directions d’hôpitaux. Il s’agit d’une recherche évaluative de type rétrospectif. Une enquête par questionnaire et par entrevue a été réalisée auprès des diplômés, des enseignants, des concepteurs de programme et des directions d'hôpitaux. Également, des bases de données sur les étudiants finissants entre les années 2003 et 2009 ont été consultées pour recueillir les notes obtenues à l’examen de certification, les effectifs d’admission et d’inscrits et les renseignements sociodémographiques. Cette évaluation porte sur les principales composantes du programme de formation Administration et enseignement de l’ENDSS qui sont examinées à l’aide du modèle systémique d’évaluation de programme éducatif de Stufflebeam (1981) communément appelé modèle CIPP. Les résultats de l’analyse s’appuient sur 70 questionnaires et 37 entrevues. En vue de répondre aux questions de recherche, les données recueillies sont analysées et interprétées à partir d’indicateurs et selon des critères définis. La démarche d’analyse des résultats s’est effectuée en deux étapes. D'abord, les données des questionnaires et des entrevues fournies par les diplômés, les enseignants et les concepteurs ont été analysées ainsi que celles du dossier scolaire des étudiants inscrits au programme. Ensuite, l’examen a porté sur les données des questionnaires recueillies auprès des directions d’hôpitaux. Les avis de tous les répondants sur les améliorations à apporter au programme sont analysés pour rendre compte de leurs recommandations à ce sujet. Tout au long de l’analyse des résultats, les données des questionnaires et des entrevues sont présentées à la fois. Le jugement sur l’efficacité du programme de formation Administration et enseignement de l’ENDSS est établi par l’analyse d’indicateurs reliés aux quatre types d'évaluation proposés par Stufflebeam (1981). Les diplômés et les concepteurs jugent que la formation est adéquate pour l’exercice de la fonction de chef de services des soins infirmiers. Par contre, les enseignants sont très partagés sur cette question, puisque près de la moitié d'entre eux expriment un avis favorable tandis que les autres ont une opinion contraire. Les diplômés apparaissent très partagés par rapport à la cohérence apparente entre les objectifs de stage d’administration hospitalière et les compétences à développer, alors que les enseignants et les concepteurs expriment plus largement une opinion négative. La cohérence entre les notions du module de Management des services de santé et l’exercice de la fonction de chef de services des soins infirmiers est jugée plus forte en ce qui concerne plusieurs notions, par les diplômés, les enseignants et les concepteurs. La majorité des diplômés et des enseignants jugent que la supervision offerte aux étudiants est insatisfaisante. Les diplômés et les enseignants croient que la disponibilité des ressources didactiques à la bibliothèque ne facilite pas les apprentissages. Tandis que les concepteurs, en proportion plus élevée, expriment le même jugement. Les diplômés et les enseignants sont divisés sur la question de l’équilibre entre le nombre d’heures alloué à la théorie et à la formation pratique. Tandis que la majorité des concepteurs croient qu’il n’y a pas d'équilibre entre le nombre d'heures consacré aux cours et à la formation pratique. Les diplômés et les enseignants expriment une opinion très positive sur la qualité des rapports sociaux des étudiants entre eux, avec les enseignants et le personnel administratif. Tandis que les concepteurs ont une opinion plutôt négative à ce sujet. Les diplômés, de même que les enseignants jugent en majorité, que la supervision des stages offerte aux étudiants est insatisfaisante. Ces opinions convergent avec celles de la grande majorité des concepteurs. Selon les diplômés, le travail de groupe, de même que les études de cas sont les méthodes les plus pertinentes dans la formation de chef de service des soins infirmiers. Pour les enseignants et les concepteurs c'est le travail de groupe qui est la méthode la plus pertinente pour faire acquérir des connaissances. Parmi l’ensemble des inscrits, incluant les étudiants sénégalais et étrangers, 104 d’entre eux ont obtenu un diplôme. Subséquemment, seuls 2 étudiants sur les 106 inscrits au programme ont échoué. Les enseignants, les diplômés et les concepteurs sont tous satisfaits du programme de formation Administration et enseignement de l’ENDSS. Les directions d'hôpitaux sont partagées quant à elles, à l’idée selon laquelle les étudiants sont préparés aux fonctions de chef de service des soins infirmiers. En plus, selon la grande majorité des directions le programme de formation ne répond pas à la stratégie de la réforme hospitalière. Elles affirment à l’unanimité qu’elles n’ont pas été associées au processus d’élaboration du programme et sont d’accord que, de manière générale, la formation reçue par le chef de services des soins infirmiers est de qualité. Unanimement, les directions d’hôpitaux jugent que des notions devraient être ajoutées ou améliorées au programme de formation Administration et enseignement de l’ENDSS. L’interprétation des données révèle la complexité qui entoure l’importance de l’équilibre du volume horaire à consacrer à la théorie et à la pratique dans un programme de formation. En plus, les résultats sur les connaissances à acquérir par les diplômés durant la formation montrent un besoin élevé de perfectionnement voire d’enseignement plus poussé du contenu des notions Système d’information sanitaire et Introduction à l’informatique, Introduction au management; Élaboration de programme et Administration hospitalière. Un choix approprié de terrain où l’étudiant pourrait réaliser les objectifs d’apprentissage, une sélection de la période adéquate pour le stage, de même qu’un encadrement signifiant, seraient le gage d’un stage profitable pour l’étudiant. Nous estimons que cette recherche a ouvert des pistes à des perspectives de recherches reliées au développement professionnel des futurs chefs de service des soins infirmiers. Mots clés : évaluation de programme, acquisition de connaissances, développement des compétences, administration des soins infirmiers, programme de deuxième cycle. / All over the world providing a solid education to nurses is a necessity. In order to face the changes, a lot of countries are conceiving postgraduate programs. Around the world, training in management of nursing managers has become a necessity. To provide nursing leaders abilities to cope with change, many countries have developed training graduate programs in educational administration for the nursing services. Several programs that are being developed in this direction are more or less valued. Several authors believe that evaluation of these programs would better appreciate the achievement of educational goals and ultimately, improve training and management practices. To contribute to the development of new skills that will surely meet the training needs and assist in real change, we propose to make this study which aims to evaluate the training program administration and teaching of the National School of Health and Social Development (ENDSS) of Senegal. This assessment takes into account the views of graduates, teachers, program designers and directions of hospitals. This is a retrospective evaluation research type. A questionnaire survey and interview was conducted with graduates, teachers, program designers and management head of the hospitals. Also, databases of students graduating between 2003 and 2009 were consulted to collect the scores on the certification exam, the number of admission and enrollment and demographic information. This assessment focuses on the major components of the training program Administration and teaching of ENDSS are evaluated through the systemic model of evaluation of educational program of Stufflebeam commonly known as CIPP model, which is retained as the reference of this study. The results of the analysis based on 70 questionnaires and 37 interviews. In order to answer the research questions, the data are analyzed and interpreted using indicators and according to defined criteria. The process of analyzing the results was carried out in three stages. First, data from questionnaires and interviews provided by graduates, teachers and program designers are analyzed as well as the academic record of students enrolled in the program. Second, the review focused on questionnaire data collected from directions of hospitals. Finally, the opinions of all respondents on improvements to the program are analyzed to account for their recommendations thereon. Throughout the analysis of results, data from questionnaires and interviews are presented at a time. The verdict on the effectiveness of the training program Administration and teaching of ENDSS is determined by analysis of indicators related to four types of evaluation proposed by Stufflebeam (1981). Graduates and program designers believe that training is adequate for the exercise of the functions of head of nursing services. Consistency between the concepts of the module Management of health services and the exercise of the function of chief of nursing services is considered stronger in respect to several notions, by graduates, teachers and program designers. Graduates, as well as teachers believe in the majority, provided that supervision is inadequate. More than half of graduates and a majority of program designers believe that the material and didactic resources in the library do not facilitate learning the matter. However, students do well in their school leaving examination, particularly in the last four years reviewed. Teachers, graduates and program designers are satisfied with the training program Administration and teaching of ENDSS. Directions of hospitals are shared on the idea that students are prepared for function of chief of nursing services. In addition, as most of the directions of hospitals is not responding to the strategy of the hospital reform. They unanimously say that they were not involved in the process of developing the program and agree that, in general, the training received by the head of nursing services is quality. Unanimously, the directions of hospitals felt that the concepts should be added or improved in the training program administration and teaching-ENDSS. Interpretation of the data reveals the complexity surrounding the importance of balancing the number of hours to devote to the theory and practice in a training program. In addition, results on knowledge gain express a high need for development of further education or the content of notions Health Information System and Introduction to Computers, Introduction to Management, Program elaboration and Hospital administration. An appropriate choice of land where the student could achieve the learning objectives, a selection of the appropriate period for the course, and a signifier coaching, would be a profitable course for the student. We believe that this research has opened avenues for research perspectives related to professional development of future leaders of the nursing department. Keywords: Program evaluation, acquisition of knowledge, development of the competence-nursing management-master degree formation program.

A sistematização da avaliação de desempenho, levando-se em consideração a história da organização do trabalho, apresenta uma trajetória relativamente recente. Entretanto, o ato de avaliar sempre esteve presente no processo evolutivo da humanidade e o ser humano, desde o seu nascimento, é constantemente avaliado no âmbito de seus pares. O objetivo geral do estudo consistiu em analisar o processo de avaliação de desempenho de profissionais da saúde em uma instituição hospitalar pública. Desse eixo, desdobraram-se os objetivos específicos: caracterizar aspectos do ato de avaliar e do espaço/momento de ser avaliado na percepção dos sujeitos envolvidos nesse processo; identificar os aspectos que dinamizam e/ou obstaculizam o processo de avaliação de desempenho e discutir com a equipe multiprofissional estratégias facilitadoras do processo de avaliação de desempenho. Em Paulo Freire encontrou-se o marco teórico conceitual para ancorar a questão de estudo. A pesquisa tramitou na Plataforma Brasil, obtendo aprovação sob o CAAE número 47689015.0.0000.5347 e foi desenvolvida com profissionais da saúde de um hospital público, localizado em Porto Alegre, RS. Propôs-se uma investigação qualitativa, descritiva-exploratória, numa perspectiva dialética-emancipatória, em duas etapas, tendo coletado os dados entre novembro de 2015 e abril de 2016. Na primeira etapa participaram 65 trabalhadores em dupla condição de avaliador-avaliado, mediante preenchimento de um Questionário Semiestruturado Autoaplicado. Os resultados parciais desta etapa constituíram-se nos disparadores dos debates na segunda etapa da pesquisa. Houve três encontros de Grupo Focal com a participação de seis profissionais provenientes da primeira etapa. Para análise dos resultados das questões fechadas do questionário empregou-se a análise descritiva, enquanto que as informações das questões abertas e aquelas oriundas do grupo focal foram submetidas à análise de conteúdo temática e colocadas em diálogo com os conceitos do marco conceitual que norteia o estudo. O perfil dos participantes caracteriza predomínio do sexo feminino (89%), idade média de 42,68 anos, mediana de 18 anos de tempo de serviço na área da saúde e 10 anos na instituição. Na condição de avaliados (35%) e de avaliadores (44%), os respondentes consideram satisfatória a condução da entrevista avaliativa. Já a privacidade e confidencialidade no processo avaliativo é assegurada em ambas condições, alcançando índice de 65% das respostas. Para 51% dos participantes, o instrumento é adequado e supre demandas, mas, embora não explicitados, houve menção a entraves que derivam da cultura organizacional. Nos debates do grupo focal, os trabalhadores sinalizaram que a finalidade da avaliação de desempenho está vinculada à oportunidade para o desenvolvimento profissional, enfatizando a necessidade de alicerçá-la em um contexto dialógico capaz de potencializar a autorreflexão, a troca de saberes e a construção coletiva do conhecimento. Também, foi pontuado a respeito da cultura sobre avaliação de desempenho enquanto dinamizador/obstaculizador do processo avaliativo. Ainda, estratégias foram discutidas pelo grupo, reforçando a consolidação e fomento de espaços para diálogo e o impulso à noção de co-responsabilidade entre avaliador e avaliado para o exercício de um processo avaliativo crítico e propositivo. / Considering the history of work organization, the systematization of performance appraisal is somewhat recent. However, evaluation has always been part of the evolutionary process of mankind, once man is constantly assessed by his peers. This study aims to analyze the process of performance appraisal of professionals in a public hospital. More specifically, it focuses on three objectives: to characterize the evaluation process and the location/moment of one’s state of being assessed under the perspective of the subjects; to identify points that enhance and/or hinder such process; and to discuss with the multi-professional team strategies to facilitate the performance appraisal process. This study was based on Paulo Freire’s conceptual framework. It was submitted to Plataforma Brasil, and approved under the CAAE code 47689015.0.0000.5347. It was carried out with health professionals in a public hospital in Porto Alegre, Brazil. This research employed a qualitative, descriptive-exploratory approach under a dialetical-emancipatory perspective. The data were collected between November 2015 and April 2016. The study comprised two phases. In the first phase, 65 professionals took part in the study both as evaluator and the person being assessed, filling out a Semi-Structured Questionnaire. The partial results from this phase triggered the debates in the second phase of the research. There were three focus group sessions with six professionals from the first phase. Descriptive analysis was employed for the results of the closed-ended questions, while the information gathered from the open-ended questions and focus groups was examined through thematic- content analysis and later discussed based on Freire’s conceptual framework. The subjects were mostly female (89%) and their average age was between 42 and 68 years old. They had been working for approximately 18 years in health care and 10 years at the hospital. The subjects being assessed (35%) as well as the evaluators (44%) considered the conduct of the appraisal interview satisfactory. Privacy and confidentiality of the evaluation process were also ensured in both conditions, reaching 65% of the answers. According to 51% of the participants, the tool is appropriate and meets the demands, but obstacles derived from organizational culture were mentioned, although not explicitly. In the focus group sessions, the employees linked the aim of the performance appraisal to professional development, which reinforces the need to base it on a dialogical context that promotes self-reflection, knowledge exchange, and collective construction of knowledge. Moreover, the subjects also highlighted that the culture of performance appraisal both enhanced and hindered the evaluation process. The group also discussed strategies, which shows the need for fostering opportunities for dialogue as well as for the encouragement of accountability between the evaluator and the one being assessed, in order to promote a critical and constructive evaluation process. / La sistematización de la evaluación de desempeño, llevándose en consideración la historia de la organización del trabajo, presenta una trayectoria relativamente reciente. Sin embargo, el acto de evaluar siempre estuvo presente en el proceso evolutivo de la humanidad y el ser humano, desde su nacimiento, es constantemente evaluado en el ámbito de sus pares. El objetivo general del estudio consistió en analizar el proceso de evaluación de desempeño de profesionales de la salud en una institución hospitalaria pública. De ese eje, se desdoblan los objetivos específicos: caracterizar aspectos del acto de evaluar y del espacio/momento de ser evaluado en la percepción de los sujetos involucrados en ese proceso; identificar los aspectos que dinamizan y/u obstaculizan el proceso de evaluación de desempeño y discutir con el equipo multiprofesional estrategias facilitadoras del proceso de evaluación de desempeño. En Paulo Freire se encontró el marco teórico conceptual para anclar la cuestión de estudio. La investigación tramitó en la Plataforma Brasil, obteniendo aprobación bajo el CAAE número 47689015.0.0000.5347 y fue desarrollada con profesionales de la salud de un hospital público, ubicado en Porto Alegre, RS. Se propuso una investigación cualitativa, descriptiva-exploratoria, en una perspectiva dialéctica-emancipatoria, en dos etapas, habiendo recolectado los datos entre noviembre de 2015 y abril de 2016. En la primera etapa participaron 65 trabajadores en doble condición de evaluador-evaluado, mediante llenado de un Cuestionario Semiestructurado Autoaplicado. Los resultados parciales de esta etapa se constituyeron en los disparadores de los debates en la segunda etapa de la investigación. Hubo tres encuentros de Grupo Focal con la participación de seis profesionales provenientes de la primera etapa. Para análisis de los resultados de las preguntas cerradas del cuestionario se empleó el análisis descriptivo, mientras que las informaciones de los temas abiertos y aquellos oriundos del grupo focal se sometieron al análisis de contenido temático y colocados en diálogo con los conceptos del marco conceptual que guía el estudio. El perfil de los participantes caracteriza predominio del sexo femenino (89%), edad promedio de 42,68 años, mediana de 18 años de tiempo de servicio en el área de la salud y 10 años en la institución. En la condición de evaluados (35%) y de evaluadores (44%), los que respondieron consideran satisfactoria la conducción de la entrevista evaluativa. Ya la privacidad y confidencialidad en el proceso evaluativo es asegurada en ambas condiciones, alcanzando índice del 65% de las respuestas. Para el 51% de los participantes, el instrumento es adecuado y suple demandas, pero, aunque no se explicite, hubo mención a trabas que derivan de la cultura organizacional. En los debates del grupo focal, los trabajadores señalaron que la finalidad de la evaluación de desempeño está vinculada a la oportunidad para el desarrollo profesional, enfatizando la necesidad de cimentarla en un contexto dialógico capaz de potenciar la autorreflexión, el intercambio de saberes y la construcción colectiva del conocimiento. También, se puntuó sobre la cultura sobre evaluación de desempeño como dinamizador/obstaculizador del proceso evaluativo. También, el grupo discutió estrategias, reforzando la consolidación y fomento de espacios para diálogo y el impulso a la noción de corresponsabilidad entre evaluador y evaluado para el ejercicio de un proceso evaluativo crítico y propositivo.

Partout dans le monde, la formation en gestion des cadres infirmiers est devenue une nécessité. Afin de doter la profession infirmière de chefs de file capables de faire face aux changements, plusieurs pays ont conçu des programmes de formation de deuxième cycle en administration des services de soins infirmiers. Plusieurs programmes sont développés en ce sens dont peu ou prou sont évalués. Plusieurs auteurs croient que l’évaluation de ces programmes permettrait de mieux apprécier l’atteinte des objectifs pédagogiques et ultérieurement, d’améliorer la formation et les pratiques de gestion. Afin de contribuer à ce projet, la présente étude vise à évaluer le programme de formation Administration et enseignement de l'École nationale de développement sanitaire et social (ENDSS) du Sénégal. Cette évaluation prend en compte les points de vue des diplômés, des enseignants, des concepteurs du programme et des directions d’hôpitaux. Il s’agit d’une recherche évaluative de type rétrospectif. Une enquête par questionnaire et par entrevue a été réalisée auprès des diplômés, des enseignants, des concepteurs de programme et des directions d'hôpitaux. Également, des bases de données sur les étudiants finissants entre les années 2003 et 2009 ont été consultées pour recueillir les notes obtenues à l’examen de certification, les effectifs d’admission et d’inscrits et les renseignements sociodémographiques. Cette évaluation porte sur les principales composantes du programme de formation Administration et enseignement de l’ENDSS qui sont examinées à l’aide du modèle systémique d’évaluation de programme éducatif de Stufflebeam (1981) communément appelé modèle CIPP. Les résultats de l’analyse s’appuient sur 70 questionnaires et 37 entrevues. En vue de répondre aux questions de recherche, les données recueillies sont analysées et interprétées à partir d’indicateurs et selon des critères définis. La démarche d’analyse des résultats s’est effectuée en deux étapes. D'abord, les données des questionnaires et des entrevues fournies par les diplômés, les enseignants et les concepteurs ont été analysées ainsi que celles du dossier scolaire des étudiants inscrits au programme. Ensuite, l’examen a porté sur les données des questionnaires recueillies auprès des directions d’hôpitaux. Les avis de tous les répondants sur les améliorations à apporter au programme sont analysés pour rendre compte de leurs recommandations à ce sujet. Tout au long de l’analyse des résultats, les données des questionnaires et des entrevues sont présentées à la fois. Le jugement sur l’efficacité du programme de formation Administration et enseignement de l’ENDSS est établi par l’analyse d’indicateurs reliés aux quatre types d'évaluation proposés par Stufflebeam (1981). Les diplômés et les concepteurs jugent que la formation est adéquate pour l’exercice de la fonction de chef de services des soins infirmiers. Par contre, les enseignants sont très partagés sur cette question, puisque près de la moitié d'entre eux expriment un avis favorable tandis que les autres ont une opinion contraire. Les diplômés apparaissent très partagés par rapport à la cohérence apparente entre les objectifs de stage d’administration hospitalière et les compétences à développer, alors que les enseignants et les concepteurs expriment plus largement une opinion négative. La cohérence entre les notions du module de Management des services de santé et l’exercice de la fonction de chef de services des soins infirmiers est jugée plus forte en ce qui concerne plusieurs notions, par les diplômés, les enseignants et les concepteurs. La majorité des diplômés et des enseignants jugent que la supervision offerte aux étudiants est insatisfaisante. Les diplômés et les enseignants croient que la disponibilité des ressources didactiques à la bibliothèque ne facilite pas les apprentissages. Tandis que les concepteurs, en proportion plus élevée, expriment le même jugement. Les diplômés et les enseignants sont divisés sur la question de l’équilibre entre le nombre d’heures alloué à la théorie et à la formation pratique. Tandis que la majorité des concepteurs croient qu’il n’y a pas d'équilibre entre le nombre d'heures consacré aux cours et à la formation pratique. Les diplômés et les enseignants expriment une opinion très positive sur la qualité des rapports sociaux des étudiants entre eux, avec les enseignants et le personnel administratif. Tandis que les concepteurs ont une opinion plutôt négative à ce sujet. Les diplômés, de même que les enseignants jugent en majorité, que la supervision des stages offerte aux étudiants est insatisfaisante. Ces opinions convergent avec celles de la grande majorité des concepteurs. Selon les diplômés, le travail de groupe, de même que les études de cas sont les méthodes les plus pertinentes dans la formation de chef de service des soins infirmiers. Pour les enseignants et les concepteurs c'est le travail de groupe qui est la méthode la plus pertinente pour faire acquérir des connaissances. Parmi l’ensemble des inscrits, incluant les étudiants sénégalais et étrangers, 104 d’entre eux ont obtenu un diplôme. Subséquemment, seuls 2 étudiants sur les 106 inscrits au programme ont échoué. Les enseignants, les diplômés et les concepteurs sont tous satisfaits du programme de formation Administration et enseignement de l’ENDSS. Les directions d'hôpitaux sont partagées quant à elles, à l’idée selon laquelle les étudiants sont préparés aux fonctions de chef de service des soins infirmiers. En plus, selon la grande majorité des directions le programme de formation ne répond pas à la stratégie de la réforme hospitalière. Elles affirment à l’unanimité qu’elles n’ont pas été associées au processus d’élaboration du programme et sont d’accord que, de manière générale, la formation reçue par le chef de services des soins infirmiers est de qualité. Unanimement, les directions d’hôpitaux jugent que des notions devraient être ajoutées ou améliorées au programme de formation Administration et enseignement de l’ENDSS. L’interprétation des données révèle la complexité qui entoure l’importance de l’équilibre du volume horaire à consacrer à la théorie et à la pratique dans un programme de formation. En plus, les résultats sur les connaissances à acquérir par les diplômés durant la formation montrent un besoin élevé de perfectionnement voire d’enseignement plus poussé du contenu des notions Système d’information sanitaire et Introduction à l’informatique, Introduction au management; Élaboration de programme et Administration hospitalière. Un choix approprié de terrain où l’étudiant pourrait réaliser les objectifs d’apprentissage, une sélection de la période adéquate pour le stage, de même qu’un encadrement signifiant, seraient le gage d’un stage profitable pour l’étudiant. Nous estimons que cette recherche a ouvert des pistes à des perspectives de recherches reliées au développement professionnel des futurs chefs de service des soins infirmiers. Mots clés : évaluation de programme, acquisition de connaissances, développement des compétences, administration des soins infirmiers, programme de deuxième cycle. / All over the world providing a solid education to nurses is a necessity. In order to face the changes, a lot of countries are conceiving postgraduate programs. Around the world, training in management of nursing managers has become a necessity. To provide nursing leaders abilities to cope with change, many countries have developed training graduate programs in educational administration for the nursing services. Several programs that are being developed in this direction are more or less valued. Several authors believe that evaluation of these programs would better appreciate the achievement of educational goals and ultimately, improve training and management practices. To contribute to the development of new skills that will surely meet the training needs and assist in real change, we propose to make this study which aims to evaluate the training program administration and teaching of the National School of Health and Social Development (ENDSS) of Senegal. This assessment takes into account the views of graduates, teachers, program designers and directions of hospitals. This is a retrospective evaluation research type. A questionnaire survey and interview was conducted with graduates, teachers, program designers and management head of the hospitals. Also, databases of students graduating between 2003 and 2009 were consulted to collect the scores on the certification exam, the number of admission and enrollment and demographic information. This assessment focuses on the major components of the training program Administration and teaching of ENDSS are evaluated through the systemic model of evaluation of educational program of Stufflebeam commonly known as CIPP model, which is retained as the reference of this study. The results of the analysis based on 70 questionnaires and 37 interviews. In order to answer the research questions, the data are analyzed and interpreted using indicators and according to defined criteria. The process of analyzing the results was carried out in three stages. First, data from questionnaires and interviews provided by graduates, teachers and program designers are analyzed as well as the academic record of students enrolled in the program. Second, the review focused on questionnaire data collected from directions of hospitals. Finally, the opinions of all respondents on improvements to the program are analyzed to account for their recommendations thereon. Throughout the analysis of results, data from questionnaires and interviews are presented at a time. The verdict on the effectiveness of the training program Administration and teaching of ENDSS is determined by analysis of indicators related to four types of evaluation proposed by Stufflebeam (1981). Graduates and program designers believe that training is adequate for the exercise of the functions of head of nursing services. Consistency between the concepts of the module Management of health services and the exercise of the function of chief of nursing services is considered stronger in respect to several notions, by graduates, teachers and program designers. Graduates, as well as teachers believe in the majority, provided that supervision is inadequate. More than half of graduates and a majority of program designers believe that the material and didactic resources in the library do not facilitate learning the matter. However, students do well in their school leaving examination, particularly in the last four years reviewed. Teachers, graduates and program designers are satisfied with the training program Administration and teaching of ENDSS. Directions of hospitals are shared on the idea that students are prepared for function of chief of nursing services. In addition, as most of the directions of hospitals is not responding to the strategy of the hospital reform. They unanimously say that they were not involved in the process of developing the program and agree that, in general, the training received by the head of nursing services is quality. Unanimously, the directions of hospitals felt that the concepts should be added or improved in the training program administration and teaching-ENDSS. Interpretation of the data reveals the complexity surrounding the importance of balancing the number of hours to devote to the theory and practice in a training program. In addition, results on knowledge gain express a high need for development of further education or the content of notions Health Information System and Introduction to Computers, Introduction to Management, Program elaboration and Hospital administration. An appropriate choice of land where the student could achieve the learning objectives, a selection of the appropriate period for the course, and a signifier coaching, would be a profitable course for the student. We believe that this research has opened avenues for research perspectives related to professional development of future leaders of the nursing department. Keywords: Program evaluation, acquisition of knowledge, development of the competence-nursing management-master degree formation program.

The thesis attempts to outline the extent to which the decision-making role of nurses is utilized, and the main factors that affect decision-making of nurses within the scope of provision of nursing care. The research has found out that nurses utilize their decision-making role to an insufficient extent hence the sense and purpose of decision-making must be emphasised again. This task may be assumed by managing nurses. Managing nurses may also contribute by more effective defending of competences of nurses. From the factors needed by nurses for effective decision-making, attention should be paid particularly to education. It is necessary to make possible for nurses to extend their knowledge and thus to obtain theoretical insight (e.g. in respect of decision-making) to be used by them while providing care to a patient/client.