In hierdie beskrywende studie is die belang van sorg in verpleegbestuur ondersoek. Die Nyberg Caring Assessment Scale (Nyberg 1989) is benut om die data in te samel. Die doel van die studie was om die sienings van verpleegbestuurders en die ervarings van verpleegkundiges betreffende sorgkonsepte te bepaal. Die data is deur middel van vraelyste by private hospitale in Pretoria ingesamel. Die data-analise het getoon dat verpleegbestuurders en verpleegkundiges sorg as belangrik in verpleegbestuur beskou. Daar is verskille betreffende die sienings van verpleegbestuurders en die ervarings van verpleegkundiges aangaande sorg in verpleegbestuur waargeneem. Dit blyk dat verpleegbestuurders en verpleegkundiges 'n behoefte aan opleiding betreffende sorg in verpleegbestuur benodig en 'n kort kursus is ontwerp om hierdie behoeftes aan te spreek / In this study the importance of caring in nursing management was researched. The Nyberg Caring Assessment Scale (Nyberg 1989) was used to collect data. The purpose of the study was to investigate viewpoints of nurse managers and experiences of nurses regarding caring concepts. The data was collected by means of questionnaires at private hospitals in Pretoria. It was clear from the data analysis that nurse managers and nurses regard caring important in nursing management. Perceptions of nurse managers and the experiences of nurses on caring in nursing management, differ. It was clear that nurse managers and nurses experience a need for training with regard to caring in nursing management and a short coarse was design to address the need / Health Studies / M.A. (Verpleegkunde)

Text in Afrikaans / 'n Opname is onder verpleegkundiges in diens van geselekteerde hospitale onderneem ten einde te bepaal watter ondersteuningstelsels tans in die hospitale vir verpleegkundiges beskikbaar is. Daar is ook bepaal hoe effektief hierdie ondersteuningstelsels benut word, en indien nie waarom nie en ten laaste of ondersteuningstelsels as 'n vereiste fasiliteit gesien word. Die leemtes betreffende ondersteuningstelsels in hierdie hospitale is ge·identifiseer, soos die gebrek van verpleegbestuur om outokratiese en burokratiese bestuurstyle met deelnemende bestuurstyle te vervang. Daar bestaan ook leemtes in ondersteuning by die beplanning van verpleegsorg, wat moontlik toegeskryf kan word aan verpleegbestuur se swak deelname en betrokkenheid by verpleegsorgbeplanning. Aanbevelings is geformuleer om hierdie leemtes aan te spreek. Tydens orientering behoort alle nuwe personeel ingelig te word oor die hospitaalbeleid, sodat doelstellings gesamentlik beplan kan word. Die funksie van bestuur en hulle bydrae tot personeelondersteuning behoort deel van die orienteringsprogram te vorm / A survey to establish which support systems are at present available to nurses, was undertaken in selected hospitals. It was determined how effective these support systems have been utilised, and if not, why not and whether the support systems were seen as an essential facility. The failure of nursing management to replace autocratic and burocratic management styles with participative management styles is a deficiency in the support systems of these hospitals. There is also a need for support in the planning of nursing care. This can possibly be due to the nurse manager's poor participation and involvement in the planning of nursing care. Recommendations were formulated to address these needs. During orientation all new personnel should be informed of hospital policy to enable them to plan collectively, to accomplish objectives. The functions of management and their contribution towards personnel ought to form part of the orientation programme / Agriculture & Environmental Sciences / M.A. (Verpleegkunde)

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

A maioria dos casos de Lesões por Pressão são evitáveis desde que os pacientes em risco sejam identificados precocemente e haja uma correta definição de estratégias de prevenção. Quando as medidas preventivas não são suficientes e surge uma lesão é imprescindível uma correta avaliação e monitoramento da sua evolução. No entanto, a avaliação e monitoramento baseados apenas no olhar e documentação manual do profissional de saúde são subjetivos e muitas vezes imprecisos. As Tecnologias da Informação e Comunicação podem auxiliar nesse sentido, pois essas ferramentas possibilitam a divulgação e atualização de conhecimentos, além de possuírem ferramentas que apoiam a tomada de decisão na prática clínica. Neste espoco, esta pesquisa teve por objetivo desenvolver e avaliar um sistema computacional para gerenciar o cuidado e os indicadores relacionados às lesões por pressão. Trata-se de um estudo aplicado, metodológico e descritivo do tipo coorte prospectivo. A pesquisa foi realizada em etapas que envolveram o desenvolvimento de um sistema computacional, composto por um aplicativo e um sistema web, e testar na prática clínica essa ferramenta. O aplicativo auxilia na avaliação beira-leito do risco do paciente para desenvolver lesão por pressão, sugere cuidados preventivos personalizados e, se o paciente possuir lesão, auxilia na avaliação e registro do estado da lesão por meio de um algoritmo de processamento de imagens. O sistema web, realiza o armazenamento e processamento dos dados baseado nas avaliações beira-leito, nesse sistema é possível consultar estatísticas, tais como incidência, área de tecidos lesado, tempo médio de permanência na unidade, entre outras. Para testar na prática clínica, utilizou-se o sistema em duas Unidades de Terapia Intensiva durante o período de 60 dias, nesse período 126 pacientes foram acompanhados desde sua internação até alta, transferência ou óbito. A pesquisa demonstrou que, apesar das unidades estudadas apresentarem taxas de incidências semelhantes, quando considerado o tempo de internação dos pacientes e área da lesão, observou-se uma significativa diferença entre as unidades. Ainda, nos testes realizados com os usuários finais, o sistema computacional se mostrou altamente preciso e confiável, comprovando sua qualidade técnica e funcional. Neste sentido, o sistema computacional desta pesquisa pode ser uma ferramenta potencial para auxiliar na assistência aos pacientes institucionalizados e no monitoramento de indicadores relacionados as lesões por pressão. Ainda, espera-se que este trabalho contribua para a ampliação de pesquisas cujos objetos de estudo sejam o desenvolvimento de softwares para a saúde / Most cases of Pressure Injury are preventable as long as patients at risk are early identified and strategies for prevention are correctly defined. When preventive measures are not enough and an injury arises, a correct assessment and monitoring of its evolution is essential. However, evaluation and monitoring based only on the healthcare professional\'s observation and manual record is subjective and often inaccurate. The Information and Communication Technologies can help this issue, since these tools allow the dissemination and updating of knowledge, besides having tools that support decision making in clinical practice. In this context, this research aimed to develop and evaluate a computational system to manage care and indicators related to pressure injuries. It is an applied, methodological and descriptive study of the prospective cohort type. The research was carried out in stages that involved the development of a computational system, composed of an application and a web system, and the test in the clinical practice of this tool. The application assists in assessing the patient\'s risk of developing pressure injury, suggests personalized preventive care and, if the patient has an injury, assists in assessing and recording the lesion\'s condition through a digital image processing algorithm. The web system performs data storage and processing based on bedside assessments, which makes it possible to consult statistics such as incidence, area of damaged tissue, average time of permanence in the unit, among others. In the clinical practice test, the system was used in two Intensive Care Units during a 60-day period. During this period, 126 patients were followed from their hospitalization until discharge, transference or death. The research showed that, although the units studied presented similar incidence rates, when considering the length of hospital stay and the area of the lesion, a significant difference was observed between the units. Furthermore, in the tests performed with the application users, the computational system proved to be highly accurate and reliable, proving its technical and functional quality. In this sense, the computational system of this research can be a potential tool to assist healthcare professionals to care of patients and to monitor indicators related to pressure injuries. Still, it is expected that this work contributes to the expansion of research whose objectives are the development of healthcare softwares

Immersed in a context of constrained health resources, nurse managers are at great risk of the experience and negative consequences of values clashes and ethical conflict, such as burnout and attrition. Replicating a qualitative descriptive study previously conducted in Canada (Gaudine & Beaton, 2002) this research is aimed at increasing knowledge of the experience of nurse managers’ ethical conflict with their health care organizations in New Zealand. Semi-structured interviews were used to gather data from eight nurse managers in New Zealand, which was analyzed using a general inductive approach to qualitative research. The experience of advocating for values that may be shared by both nursing and the health care organization, such as safety, teamwork and quality patient care, were revealed in the conceptual category of Nursing Management Advocacy. As with their Canadian study counterparts, Isolation was revealed as a key factor that made the experience of ethical conflict worse and involves the social experiences of silencing, employment barriers and invisibility. Support describes the factors that mitigated the experience of ethical conflict and involves personal, professional and organizational support, and are likewise similar to the experiences of Canadian nurse managers. The Bottom Line describes a focal point of the experience of ethical conflict where the health care organizations predominantly fiscal bottom line was confronted and challenged by nurse managers, and where the nurse manager might reach their own bottom line and choose to leave the organization. Being and Becoming Nursing Leaders describes the outcomes of ethical conflict for nurse managers who were not only transformed into nursing leaders, through learning, reflection, and growth but also counted the costs of nursing leadership. This study concludes that supportive colleagues, organizational structures and culture are essential to mitigating the experience of ethical conflict and isolation which nurse managers encounter. The study also concludes that reducing isolation and supporting nurse managers will ensure that nursing values are appropriately represented and articulated in the health care organization’s decision making systems and processes.

Made available in DSpace on 2014-12-17T14:47:00Z (GMT). No. of bitstreams: 1 MildredNBM.pdf: 247016 bytes, checksum: 9a2eb57ad477ab7964bc571f15fc4a30 (MD5) Previous issue date: 2003-12-11 / Coordena??o de Aperfei?oamento de Pessoal de N?vel Superior / The present study analyses the supervisory practice of the nurse in the hospital environment. It has, as its main objective identify the use of planning, supervision and evaluation, as managerial instruments in the daily nursing practice. It tries also to identify the importance given to these instruments in their supervisory actions and the difficulties encountered in their use. It deals with an exploratory and analytical investigation with a qualitative approach having as its main point of analysis the principles of strategic planning. In order for it to be done 10 nurses were interviewed, distributed in three public hospitals in the city of Natal/RN. The results show that, although the nurses recognize the importance of the managerial instruments, they do not put them into practice in an effective and systematic way. They justify it because of the existence of personal, professional and institutional difficulties. On the other hand we could conclude from what they say that there is the desire to overcome the eminently burocratic vision of the management. Thus, they express a feeling for change and point in the direction of looking for ways that will contribute to innovate this practice / O presente estudo analisa a pr?tica gerencial do enfermeiro no campo hospitalar. Tem como principal objetivo identificar a utiliza??o do planejamento, da supervis?o e da avalia??o, como instrumentos gerenciais, na pr?tica cotidiana do enfermeiro. Busca, igualmente, identificar a import?ncia concedida a esses instrumentos em suas a??es gerenciais e as dificuldades enfrentadas em rela??o ? sua utiliza??o. Trata-se de uma investiga??o de car?ter explorat?rio e anal?tico, com abordagem qualitativa, tendo como fio condutor da an?lise os princ?pios do planejamento estrat?gico. Para sua realiza??o foram entrevistadas 10 enfermeiras, distribu?das em tr?s hospitais p?blicos da cidade de Natal/RN.Os resultados indicam que, embora as enfermeiras reconhe?am a import?ncia dos instrumentos gerenciais, n?o os utilizam na pr?tica, de forma efetiva e sistem?tica. Justificam a exist?ncia de dificuldades de cunho pessoal, profissional e institucional. Por outro lado, pudemos depreender de suas falas o desejo de superar a vis?o eminentemente burocr?tica da ger?ncia. Assim sendo, expressam um sentimento na dire??o de mudan?as e apontam no sentido de buscar sa?das que possam contribuir para inovar a sua pr?tica

Text in Afrikaans / 'n Opname is onder verpleegkundiges in diens van geselekteerde hospitale onderneem ten einde te bepaal watter ondersteuningstelsels tans in die hospitale vir verpleegkundiges beskikbaar is. Daar is ook bepaal hoe effektief hierdie ondersteuningstelsels benut word, en indien nie waarom nie en ten laaste of ondersteuningstelsels as 'n vereiste fasiliteit gesien word. Die leemtes betreffende ondersteuningstelsels in hierdie hospitale is ge·identifiseer, soos die gebrek van verpleegbestuur om outokratiese en burokratiese bestuurstyle met deelnemende bestuurstyle te vervang. Daar bestaan ook leemtes in ondersteuning by die beplanning van verpleegsorg, wat moontlik toegeskryf kan word aan verpleegbestuur se swak deelname en betrokkenheid by verpleegsorgbeplanning. Aanbevelings is geformuleer om hierdie leemtes aan te spreek. Tydens orientering behoort alle nuwe personeel ingelig te word oor die hospitaalbeleid, sodat doelstellings gesamentlik beplan kan word. Die funksie van bestuur en hulle bydrae tot personeelondersteuning behoort deel van die orienteringsprogram te vorm / A survey to establish which support systems are at present available to nurses, was undertaken in selected hospitals. It was determined how effective these support systems have been utilised, and if not, why not and whether the support systems were seen as an essential facility. The failure of nursing management to replace autocratic and burocratic management styles with participative management styles is a deficiency in the support systems of these hospitals. There is also a need for support in the planning of nursing care. This can possibly be due to the nurse manager's poor participation and involvement in the planning of nursing care. Recommendations were formulated to address these needs. During orientation all new personnel should be informed of hospital policy to enable them to plan collectively, to accomplish objectives. The functions of management and their contribution towards personnel ought to form part of the orientation programme / Agriculture and Environmental Sciences / M.A. (Verpleegkunde)

Coordenação de Aperfeiçoamento de Pessoal de Nível Superior / O estudo do fenômeno das adaptações e improvisações de materiais e equipamentos elaboradas no ambiente hospitalar é relativamente recente nas ciências da saúde. Pode-se inferir que esses artefatos decorrem predominantemente devido à adoção de políticas de recorte neoliberal, que gera carência qualitativa e quantitativa de recursos, material e humano, refletindo no gerenciamento administrativo e assistencial do cuidado. Objeto de estudo: as repercussões da prática de improvisar e de adaptar recursos materiais no processo de trabalho da enfermagem em ambiente hospitalar. Os objetivos foram: I) descrever as adaptações e improvisações de materiais e equipamentos no ambiente hospitalar; II) analisar as consequências das adaptações e improvisações de materiais e equipamentos para o processo de trabalho em enfermagem; III) discutir as concepções da prática das adaptações e improvisações para a qualidade do trabalho da enfermagem e para a saúde do cliente, na visão dos trabalhadores de enfermagem. Pesquisa qualitativa e descritiva, desenvolvida em um hospital geral situado no Rio de Janeiro. Os sujeitos foram vinte trabalhadores de enfermagem. A coleta de dados se deu por meio de entrevista semiestruturada e observação sistemática. O método de análise utilizado foi a análise de conteúdo. A partir da apropriação da técnica, emergiram três categorias empíricas: categoria 1: o contexto de criação das adaptações/improvisações no ambiente hospitalar; categoria 2: as adaptações e improvisações de recursos materiais presentes na organização e no processo de trabalho da enfermagem; categoria 3: A dialética da prática das adaptações e improvisações para a qualidade do trabalho da enfermagem e saúde do paciente. Os resultados consolidaram o entendimento de que as adaptações e improvisações surgem predominantemente devido a um contexto de precarização, que impelem os trabalhadores a elaborarem estas criações, a fim de assegurar que o processo de trabalho da enfermagem aconteça. Constatou-se que as adaptações e improvisações interferem no processo de trabalho, no sentido de aumentar o volume de trabalho, o modo operatório da enfermagem, o tempo gasto no processo de criação, os deslocamentos do profissional, a dificuldade do seguimento aos princípios científicos em situações emergenciais. No entanto, depreendeu-se que a enfermagem faz uma multiplicidade de adaptações e improvisações em prol da assistência, porém há concepções dialéticas, as quais simbolizam aspectos positivos e negativos para o trabalho de enfermagem e para a saúde do paciente. Conclui-se que o processo de trabalho na instituição não está em consonância com as necessidades práticas do trabalho da enfermagem, acarretando em sobrecargas, adaptações e improvisações, e em última instância, em transgressões do trabalho prescrito. / Investigation of the phenomenon of adaptation and improvisation practices in the use of materials and equipment in hospital environment is relatively recent in the heath sciences. It can be inferred that those artifacts result predominantly from neoliberal-natured policies, which generate qualitative and quantitative shortage of material and human resources, with effects on care management and assistance. Object: impact of improvisation and adaptation practices in the use of material resources in the nursing work process in hospital environment. Objectives: I) to describe adaptation and improvisation of material and equipment in hospital environment; II) to analyze the consequences of adaptation and improvisation in the nursing work process; III) to discuss adaptation and improvisation practice-related conceptions to the quality of nursing and to clients health in the view of nursing workers. Qualitative and descriptive research, developed in a general hospital in Rio de Janeiro, RJ, Brazil. Subjects comprised twenty nursing workers. Data collection was based on semi-structured interviews and systematic observation. Analysis methodology was content analysis. Three empirical categories emerged out of content analysis technique: category 1: context of adaptation/improvisation in hospital environment; category 2: adaptation and improvisation of material resources found in the organization as well as in the nursing work process; category 3: dialectics of adaptation and improvisation practice to the quality of nursing and clients health. Results have consolidated the understanding that adaptation and improvisation derive primarily from a context of growing precarization of working conditions, which urge workers to make up ways to ensure nursing care. Adaptation and improvisation were found to interfere in the work process, in the sense of increasing the workload, the nursing modus operandi, the time spent on the creative process, nursing professionals commuting, and difficulties abiding by scientific principles in emergencies. However, it was found that nursing relies on a wide spectrum of adaptation and improvisation in favor of assistance. However, dialectic conceptions can be identified, which symbolize both positive and negative aspects to nursing care as well as to clients health. Conclusions show that the work process at the hospital is not in accordance with the practical needs of nursing care delivery. It generates work overload, adaptation and improvisation, and ultimately, transgressions to the work prescribed.

Coordenação de Aperfeiçoamento de Pessoal de Nível Superior / O estudo do fenômeno das adaptações e improvisações de materiais e equipamentos elaboradas no ambiente hospitalar é relativamente recente nas ciências da saúde. Pode-se inferir que esses artefatos decorrem predominantemente devido à adoção de políticas de recorte neoliberal, que gera carência qualitativa e quantitativa de recursos, material e humano, refletindo no gerenciamento administrativo e assistencial do cuidado. Objeto de estudo: as repercussões da prática de improvisar e de adaptar recursos materiais no processo de trabalho da enfermagem em ambiente hospitalar. Os objetivos foram: I) descrever as adaptações e improvisações de materiais e equipamentos no ambiente hospitalar; II) analisar as consequências das adaptações e improvisações de materiais e equipamentos para o processo de trabalho em enfermagem; III) discutir as concepções da prática das adaptações e improvisações para a qualidade do trabalho da enfermagem e para a saúde do cliente, na visão dos trabalhadores de enfermagem. Pesquisa qualitativa e descritiva, desenvolvida em um hospital geral situado no Rio de Janeiro. Os sujeitos foram vinte trabalhadores de enfermagem. A coleta de dados se deu por meio de entrevista semiestruturada e observação sistemática. O método de análise utilizado foi a análise de conteúdo. A partir da apropriação da técnica, emergiram três categorias empíricas: categoria 1: o contexto de criação das adaptações/improvisações no ambiente hospitalar; categoria 2: as adaptações e improvisações de recursos materiais presentes na organização e no processo de trabalho da enfermagem; categoria 3: A dialética da prática das adaptações e improvisações para a qualidade do trabalho da enfermagem e saúde do paciente. Os resultados consolidaram o entendimento de que as adaptações e improvisações surgem predominantemente devido a um contexto de precarização, que impelem os trabalhadores a elaborarem estas criações, a fim de assegurar que o processo de trabalho da enfermagem aconteça. Constatou-se que as adaptações e improvisações interferem no processo de trabalho, no sentido de aumentar o volume de trabalho, o modo operatório da enfermagem, o tempo gasto no processo de criação, os deslocamentos do profissional, a dificuldade do seguimento aos princípios científicos em situações emergenciais. No entanto, depreendeu-se que a enfermagem faz uma multiplicidade de adaptações e improvisações em prol da assistência, porém há concepções dialéticas, as quais simbolizam aspectos positivos e negativos para o trabalho de enfermagem e para a saúde do paciente. Conclui-se que o processo de trabalho na instituição não está em consonância com as necessidades práticas do trabalho da enfermagem, acarretando em sobrecargas, adaptações e improvisações, e em última instância, em transgressões do trabalho prescrito. / Investigation of the phenomenon of adaptation and improvisation practices in the use of materials and equipment in hospital environment is relatively recent in the heath sciences. It can be inferred that those artifacts result predominantly from neoliberal-natured policies, which generate qualitative and quantitative shortage of material and human resources, with effects on care management and assistance. Object: impact of improvisation and adaptation practices in the use of material resources in the nursing work process in hospital environment. Objectives: I) to describe adaptation and improvisation of material and equipment in hospital environment; II) to analyze the consequences of adaptation and improvisation in the nursing work process; III) to discuss adaptation and improvisation practice-related conceptions to the quality of nursing and to clients health in the view of nursing workers. Qualitative and descriptive research, developed in a general hospital in Rio de Janeiro, RJ, Brazil. Subjects comprised twenty nursing workers. Data collection was based on semi-structured interviews and systematic observation. Analysis methodology was content analysis. Three empirical categories emerged out of content analysis technique: category 1: context of adaptation/improvisation in hospital environment; category 2: adaptation and improvisation of material resources found in the organization as well as in the nursing work process; category 3: dialectics of adaptation and improvisation practice to the quality of nursing and clients health. Results have consolidated the understanding that adaptation and improvisation derive primarily from a context of growing precarization of working conditions, which urge workers to make up ways to ensure nursing care. Adaptation and improvisation were found to interfere in the work process, in the sense of increasing the workload, the nursing modus operandi, the time spent on the creative process, nursing professionals commuting, and difficulties abiding by scientific principles in emergencies. However, it was found that nursing relies on a wide spectrum of adaptation and improvisation in favor of assistance. However, dialectic conceptions can be identified, which symbolize both positive and negative aspects to nursing care as well as to clients health. Conclusions show that the work process at the hospital is not in accordance with the practical needs of nursing care delivery. It generates work overload, adaptation and improvisation, and ultimately, transgressions to the work prescribed.

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.