A supervisão de enfermagem é um instrumento gerencial, capaz de influenciar na dinâmica dos serviços de saúde, em particular, no Centro de Terapia Intensiva, cenário de alta complexidade e dependência assistencial, que conta com especificidades na interação e organização do trabalho com foco no cuidado. Nesse sentido, apropriar-se de instrumentos gerenciais pode favorecer o trabalho do enfermeiro. Destaca-se a potencialidade da supervisão de enfermagem, particularmente sob uma perspectiva colaborativa, participativa e educativa, para alcançar os melhores resultados assistenciais. Nesse sentido, este estudo teve como objetivo analisar as limitações e as potencialidades do exercício da supervisão de enfermagem, segundo a perspectiva de enfermeiros do Centro de Terapia Intensiva. Trata-se de estudo descritivo, de abordagem qualitativa, utilizando a Técnica do Incidente Crítico. A amostra foi composta por 17 enfermeiros de dois Centros de Terapia Intensiva de um hospital público do interior paulista. As entrevistas semiestruturadas ocorreram do período de maio a junho de 2017, foram gravadas com o auxílio de dois gravadores digitais e transcritas pela própria pesquisadora. Em seguida, realizou-se a sistematização dos dados, utilizando-se planilhas eletrônicas no Microsoft Excel, para identificação de situações, comportamentos e consequências dos incidentes críticos, bem como síntese acerca de instrumentos e desafios para supervisão. A pesquisa cumpriu os preceitos da Resolução 466/12. Das entrevistas emergiram 32 situações das quais 13 (40,6%) receberam referências positivas e 19 (59,4%) negativas, que foram agrupadas nas categorias: Cuidado, Relacionamento Interpessoal e Gerenciamento do Cuidado. Foram levantados 177 comportamentos sendo 114 (64,4%) positivos e 63 (35,6%) negativos, reunidos nas categorias: Cuidar, Gerenciar o Cuidado, Relacionar-se, Comunicar. Foram identificadas 67 consequências, destas 46 (68,6%) positivas e 21 (31,4%) negativas compiladas nas categorias Cuidado, Relacionamento Interpessoal e Gerenciamento do Cuidado. Foi possível identificar os instrumentos utilizados pelos enfermeiros para o exercício da supervisão, com destaque para a observação direta, a análise de registro e a checagem de prescrição. Destacam-se os desafios relatados: multiplicidade de tarefas realizadas pelo enfermeiro, relacionamento interpessoal e pouco tempo de experiência na profissão, além do embate entre os profissionais. Os dados evidenciaram elementos presentes no cotidiano dos enfermeiros que limitam e potencializam a prática da supervisão de enfermagem. Dentre as potencialidades identificadas, destacam-se: a colaboração entre os membros da equipe de enfermagem; o engajamento e a sinergia da equipe, o relacionamento interpessoal, o fornecimento de feedback oportuno. Como limitações para a supervisão foram identificadas: a fragilidade no vínculo entre os profissionais; a relação conflituosa entre os membros da equipe; os conflitos e o despreparo dos enfermeiros para desenvolver a supervisão de enfermagem. Ressalta-se a relevância dos aspectos relacionais entre os membros da equipe de enfermagem permeando a supervisão de enfermagem, bem como o incipiente enfoque educativo dado a esse instrumento gerencial no cenário de estudo. A partir das limitações identificadas no exercício da supervisão de enfermagem entende-se pertinente investir em estratégias de intervenção para superação desse quadro, bem como incrementar ações que reforcem os aspectos favoráveis apresentados / Nursing supervision is a management tool capable of influencing the dynamics of health services, particularly in the Intensive Care Center, a scenario of high complexity and care dependence, which has specific interactions and work organization focused on care. In this sense, it is understood that the appropriation of management tools can favor the work of the nurse. It highlights the potential of nursing supervision, particularly from a collaborative, participatory and educational perspective, to achieve better care outcomes. In this way, this study aimed to analyze the limitations and potentialities of the nursing supervision exercise, according to the perspective of nurses of the Intensive Care Center. This is a descriptive study, of a qualitative approach, using the Critical Incident Technique. The sample consisted of 17 nurses from two ICCs of a public hospital in the interior of São Paulo. The semistructured interviews took place from May to June 2017, were recorded with the help of two digital recorders and transcribed by the researcher herself. Then, the data was systematized using spreadsheets in Microsoft Excel to identify situations, behaviors and consequences of critical incidents, as well as a synthesis of instruments and challenges for supervision. The research complied with the precepts of Resolution 466/12. From the interviews emerged 32 situations, of which 13 (40.6%) received positive referral and 19 (59.4%) negative, which were grouped into the categories: Care, Interpersonal Relationships and Care Management. A total of 177 behaviors were identified, 114 (64.4%) positive and 63 (35.6%) negative, in the following categories: Caring, Managing Care, Relating, Communicating. Have been identified 67 consequences, of these 46 (68.6%) positive and 21 (31.4%) negative compiled in the categories Care, Interpersonal Relationship and Care Management. It was possible to identify the instruments used by nurses for the exercise of supervision, with emphasis on direct observation, registry analysis and prescription checking. Stand out the challenges reported: multiplicity of tasks performed by the nurse, interpersonal relationship and little experience in the profession and conflict between professionals. The data showed elements present in the nurses\' daily routine that limit and enhance the practice of nursing supervision. Among the potentialities identified, the following stand out: collaboration among members of the nursing team; engagement and synergy of the team, interpersonal relationship, provide opportune feedback. As limitations for supervision were identified: the fragility in the link between professionals; conflict relationship among team members; conflicts; unprepared nurses to develop nursing supervision. It is important to emphasize the relevance of the relational aspects among the members of the nursing team permeating the nursing supervision, as well as the incipient educational approach given to this management tool in the study scenario. From the limitations identified in the nursing supervision exercise, it is pertinent to invest in intervention strategies to overcome this situation, as well as to increase actions that reinforce the favorable aspects presented

This research is a qualitative approach investigation that has the aim of studying the conflict in nurse s management practice in hospital context. Its objective is to analyze the conception nurses have of conflict, to infer the strategies used to solve it and to interpret the phenomenon from the variables it assumes in management ambit. The theoretical references are based on the concepts of habitus and Bourdieu s field and on the disciplines of Nursing and Management. For the data collection, a semistructured interview was used, according to Resolution 196/96. Thirteen nurses, hospital managers of hospitals with more then fifty beds, were the informants of this research. In order to interpret the results, one made use of the technique of content analysis (Minayo, 2007), from which emerged five categories: 1) the manager nurses and their practice; 2) the manager nurses perception and the conflict; 3) manager nurses and their sentences; 4) in presence of conflict, to combat it strictly is needed; 5) the conflict in every day fighting camp. Among the evidences, one highlight: 11 from the 13 nurses are in management function most of 80% of their time as graduated and express they have no Idea about the role of a manager before assuming this function. The whole of them understands that conflicts are inherent to organization and the nurse has to acquaint and interact with it. They reveal that inside conflicts are the most impacting to the managers. One concludes that: it is necessary to understand the origin of conflicts; factors which favor their installation and to recognize the importance to approach them in an interdisciplinary way. / Trata-se de uma dissertação com abordagem qualitativa tendo como objeto de estudo o conflito no exercício gerencial do enfermeiro no contexto hospitalar. Objetiva analisar a concepção que os enfermeiros têm do conflito, inferir estratégias utilizadas na resolução dos mesmos e interpretar o fenômeno a partir das nuances que ele assume no âmbito da gerência. O referencial teórico tem como base os conceitos de habitus e campo de Bourdieu e das disciplinas de Administração e Enfermagem. Para a coleta dos dados foi utilizada a entrevista semi-estruturada, os procedimentos de pesquisa seguiram a Resolução 196/96. Participaram do estudo 13 enfermeiras gerentes de hospitais com mais de cinqüenta leitos. Para a interpretação dos resultados utilizou-se a técnica de análise de conteúdo (Minayo, 2007) emergindo cinco categorias: 1) as enfermeiras gerentes e sua prática; 2) percepção das enfermeiras gerentes e o conflito; 3) enfermeiras gerentes e suas sentenças; 4) na presença do conflito combater com altivez é preciso; 5) o conflito no campo de luta de todos os dias. Entre as evidências destaca-se: 11 das 13 enfermeiras estão na função de gerente mais de 80% do período de graduadas e expressam que não tinham idéia sobre o papel do gerente antes de assumir a função. A totalidade compreende que os conflitos são imanentes à organização tendo o enfermeiro que conviver e interagir diante dele. Revelam que conflitos internos são os mais marcantes para as gerentes. É preciso compreender a origem dos conflitos; fatores que favorecem sua instalação e reconhecer a importância de abordá-lo interdisciplinarmente.

In this thesis, I explore the impact and effectiveness of clinical supervision provided by external clinical supervisors, on workers from a variety of practice backgrounds in a residential rehabilitation centre, in the AOD sector. This thesis uses the framework of social work supervision, as defined by Kadushin (1985; 2002), with the administrative, educative and supportive elements. The research focuses closely on the latter two elements. For this purpose, I employ qualitative research methods, via a triangulation of methods, being guided by Participatory Action Research (PAR) and then conducting semi-structured interviews and focus groups as well as acting as a participant observer, to gather the data. The data was analysed using grounded theory. This research was based upon a clinical supervision project that was fully funded and provided free clinical supervision by external supervisors, providing both individual and group supervision, for a period of 10 months. There were a total of 16 respondents with varied roles and training backgrounds as well as an additional six supervisors, interviewed throughout different stages of the project. The various roles undertaken by me throughout the research process provided essential viewpoints on supervision, as well as the place of boundaries and need for support. The power of such a large scale intervention is discussed and ultimately highlights and identifies the particular benefits of supervision in this research arena. This thesis places clinical supervision in the context of workforce development in the Alcohol and Other Drug (AOD) sector. Thus, while this research elucidates a number of benefits and the factors involved with this experience, the clear separation of other modalities such as training, mentoring and Critical Incident debriefing are seen as integral additional avenues of support and professional development. This research concludes also with what the difficulties and hindrances were for people to continue with regular ongoing clinical supervision, and warrants the argument for interminable supervision in this setting. This research points to an overall paucity of literature on efficacy studies, especially in the AOD context in Australia. This research significantly adds to this dearth and examines the factors unique to the AOD sector in Australia, as well as what factors make for effective supervision. The particular impact of external supervisors and group supervision are explored, which underwrites the forwarded concept of a customised supervision for this setting. By making explicit in this research what the efficacy is on those new to supervision, it provides greater clarity for future studies. A number of recommendations are proposed as result of this research. New definitions of the supportive function of supervision and of clinical supervision are forwarded, as is a new look at the evolving history of social work supervision. This thesis highlights the impact of external supervisors and the unique contribution they offer.