Bakgrund: Obesitas är en sjukdom som ökar runt om i världen. Personer med obesitas lider många gånger av både fysiska och psykiska besvär. Behandlingen för obesitas kan vara både kirurgisk och icke – kirurgisk. Bariatrisk kirurgi kan utföras på olika sätt; gastric bypass, gastric sleeve och duodenal switch. I samband med bariatrisk kirurgi har operationssjuksköterskan ett stort ansvar när det kommer till bland annat positionering och steriltvätt. Syfte: Syftet med studien var att sammanställa tidigare obesa personers erfarenheter av bariatrisk kirurgi. Metod: En litteraturöversikt där resultaten baseras på 15 vetenskapliga artiklar med kvalitativ design. Studien bygger på artiklar där deltagarna är vuxna personer som tidigare varit obesa. De vetenskapliga artiklarna är framtagna genom en strukturerad sökning på databaserna Cinahl och Pubmed. Resultat: Resultatet beskriver tidigare obesa personers erfarenhet av bariatrisk kirurgi. Resultaten redovisas i tre kategorier med tillhörande subkategorier. De tre kategorierna är: Vägen till operation, positiva effekter av bariatrisk kirurgi och negativa effekter av bariatrisk kirurgi. Slutsats: Att genomgå överviktskirurgi är en kontinuerlig process som innefattar utmaningar i att förändra livsstil samt fysiska och psykologiska förändringar. I resultatet framgår det att personer som genomgått bariatrisk kirurgi upplever både positiva och negativa effekter av sin operation. Resultatet visar också att de negativa effekterna av operationen som patienten upplever är större än de fördelarna som operationen leder till. / Background: Obesity is a disease that is increasing around the world. People with obesity often suffer from both physical and psychological problems. The treatment for obesity can be both surgical and non-surgical. Bariatric surgery can be performed in different ways; gastric bypass, gastric sleeve and duodenal switch. In connection with bariatric surgery, the operating room nurse has a great responsibility when it comes to positioning and sterile washing, among other things. Purpose: The purpose of the study was to compile previously obese people's experiences of bariatric surgery. Method: A literature review where the results are based on 15 scientific articles with a qualitative design. The study is based on articles where the participants are adults who were previously obese. The scientific articles are produced through a structured search of the databases Cinahl and Pubmed. Results: The results describe previously obese people's experience of bariatric surgery. The results are reported in three categories with associated subcategories. The three categories are: Path to surgery, positive effects of bariatric surgery and negative effects of bariatric surgery. Conclusion: Undergoing bariatric surgery is a continuous process that includes challenges in changing lifestyle as well as physical and psychological changes. The results show that people who have undergone bariatric surgery experience both positive and negative effects of their operation. The result also shows that the negative effects of the operation that the patient experiences are greater than the benefits that the operation leads to.

Bakgrund: En operationsavdelning är högteknologisk och arbetet i en operationssal är komplext. Nära samarbete i interprofessionella team är avgörande för att genomföra en operation. Operationssjuksköterskor har en central roll i den perioperativa omvårdnaden. I teamarbete är kommunikation avgörande för att upprätthålla patientsäkerheten och arbetsmiljön. Syfte: Syftet med studien var att beskriva operationssjuksköterskors erfarenheter av kommunikation inom teamet i operationssalen. Metod: En systematisk litteraturstudie med kvalitativ och induktiv ansats användes för att besvara syftet. Resultat: Resultatet visade att ledarskap och teamarbete var avgörande för kommunikationens effektivitet. Det kräver respekt och hänsyn till olika yrkesroller. Utmanande faktorer som framkom inom teamarbetet var hierarki och brist på respekt. Stöd från kollegor och kommunikationsutbildningar ansågs viktiga. Checklista för säker kirurgi ansågs vara ett värdefullt verktyg för att underlätta kommunikationen och främja patientsäkerhet. Slutsats: Kommunikation och teamarbete är nyckelfaktorer för patientsäkerheten inom operationssjukvården. Ett positivt arbetsklimat och öppen kommunikation främjar ett effektivt teamarbete och minskar risken för misstag. Respektfullt ledarskap, konstruktiv feedback och tydlig kommunikation inom teamet är avgörande för en god arbetsmiljö. Genom utbildningar kan kommunikationen och teamarbetet förbättras. En trygg atmosfär och starkt ledarskap är avgörande för att säkerställa patientsäkerheten, medan goda relationer och kontinuitet inom teamet främjar tillit och effektivt samarbete. / Background: An operating department is highly technological, and work in the operating room is complex. Close collaboration in interprofessional teams is crucial for conducting an operation. Operating room nurses play a central role in perioperative care. Communication is crucial for maintaining patient safety and a good working environment. Aim: The purpose of this study was to investigate operating room nurses' experiences of communication within the operating room team. Methods: A systematic literature review with a qualitative and inductive approach was used to address the purpose.Results: The results indicated that leadership and teamwork were crucial for the effectiveness of communication, requiring respect and consideration for different professional roles. Challenging factors within teamwork included hierarchy and lack of respect. Support from colleagues and communication training were seen as important. The surgical safety checklist was considered a valuable tool for facilitating communication and promoting patient safety. Conclusions: Communication and teamwork are key factors for patient safety in the operating room. A positive work environment and open communication cultivate efficient teamwork and reduce the risk of errors. Respectful leadership, constructive feedback, and clear communication within the team are crucial for a good working environment. Teamwork and communication can be enhanced through team-building exercises. A safe atmosphere and strong leadership are essential for ensuring patient safety, while good relationships and continuity within the team promote trust and effective collaboration.

No description available.

Thesis (MCur)--Stellenbosch University, 2015. / ENGLISH ABSTRACT: Disruptive behaviour among health care providers in high stress areas such as the perioperative setting has been linked to negative patient safety. Conflicts of power, role and personality lead to communication failure, which are identified as the leading root cause of medication errors and wrong site surgery. The aim of the study was to explore and describe the factors underlying registered nurse (RN) interactions in a tertiary healthcare perioperative area. A non-experimental, descriptive, exploratory study with self-administered survey using a quantitative approach was used. The total population of N=52 participants working in the perioperative area of a Middle Eastern tertiary healthcare centre were invited to participate in the study and the response rate was n=44, 85%. A structured self-administered questionnaire was used to collect the data. Reliability and validity was assured by means of a pilot study and consultation with nursing experts and a statistician. The Health Research Ethics Committee of the University of Stellenbosch approved the study. Permission for the study to be done in the tertiary care centre was obtained from the Internal Ethical Review Board and the Nursing Executive. Informed written consent was obtained from the participants. Anonymity and confidentiality was respected. The data was analysed with the assistance of a statistician and presented in frequencies, tables and histograms. The responses were compared using Mann-Whitney U test, Kruskal- Wallis ANOVA and Spearman’s Rank correlation, on a 95% confidence level. Only one factor showed a significant result, following Spearman’s Rank correlation that an association exists between work experience and lateral violence (p≤0.045239). The open-ended questions were categorized into themes and respect and communication emerged as factors necessary in teamwork and task management The level of respect and open communication between RNs were seen as important factors for interacting with colleagues in the workplace and if poor, affects team work. An area of concern was the high number of neutral responses to the statements on morale and conflict. Underpinned by the literature and the outcomes of this study, it is recommended that strong leadership is required to implement regular team building activities. Furthermore, perioperative staff should be monitored for emotional fatigue which results from conflict situations in order to avert adverse patient care events. / AFRIKAANSE OPSOMMING: Steurende gedrag onder gesondheidsorgwerkers in hoë gespanne areas soos in die perioperatiewe omgewing, word gekoppel aan negatiewe pasiënt veiligheid. Konflikte van mag, rol en persoonlikheid lei tot mislukking van kommunikasie wat geïdentifiseer word as die hoofoorsaak van foute by die toediening van medikasie en verkeerde plek vir chirurgie. Die doel van die studie was om die faktore te ondersoek en te beskryf wat onderliggend is aan geregistreerde verpleeg (GV) interaksies in ’n tersiêre gesondheidsorg perioperatiewe area. ’n Nie-eksperimentele, beskrywende, ondersoekende studie met ’n self-administrerende opname deur ’n kwantitatiewe benadering, was gebruik. Die totale populasie van N=52 deelnemers wat in die perioperatiewe area van ’n Midde-Oosterse tersiêre gesondheidsorgsentrum werk, was uitgenooi om deel te neem aan hierdie studie en die responskoers was n=44, 85%. ’n Gestruktureerde self-administrerende vraelys was gebruik om die data te kollekteer. Betroubaarheid en geldigheid was verseker deur die gebruik van ’n loodsprojek en konsultasie met verpleegdeskundiges, asook ’n statistikus. Die Gesondheidsnavorsingsetiekkomitee aan die Universiteit van Stellenbosch het die studie goedgekeur. Toestemming vir die uitvoer van die studie by die tersiêre gesondheidssentrum was verkry van die Interne Etiese Oorsigraad en die Uitvoerende Verplegingsbestuur. Ingeligte geskrewe toestemming was verkry van die deelnemers. Anonimiteit en vertroulikheid was gerespekteer. Die data was geanaliseer met die hulp van ’n statistikus en aangebied in frekwensies, tafels en histogramme. Die response was vergelyk deur van Mann-Whitney U-toets, Kruskal-Wallis ANOVA of Spearman se Rangkorrelasie op ’n 95% vertroulikheidsvlak gebruik te maak. Slegs een faktor het ’n beduidende resultaat getoon, dat daar ’n assosiasie bestaan tussen werkservaring en laterale geweld (p≤0.045239), deur Spearman se Rangkorrelasie te volg. Die ope-vrae was gekategoriseer in temas. Respek en kommunikasie het as noodsaaklike faktore vir spanwerk en taakbestuur na vore gekom. Die vlak van respek en ope kommunikasie tussen geregistreerde verpleegsters was gesien as belangrike faktore vir interaksie met kollegas in die werkplek en indien dit swak is, affekteer dit spanwerk. ’n Area van besorgdheid was die hoë aantal neutrale response op die stellings oor moraal en konflik. Ondersteun deur die literatuur en die uitkomste van die studie, word dit aanbeveel dat sterk leierskap vereis word om gereelde spanbou aktiwiteite te implementeer. Verder behoort perioperatiewe personeel gemonitor te word vir emosionele moegheid wat spruit uit konfliksituasies, ten einde nadelige pasiëntsorg af te weer.

O emprego de práticas Lean pode apoiar melhorias no que se refere a aumentar a eficiência e a qualidade de processos em sistemas de produção. Sistemas como hospitais vêm empregando o chamado Lean Healthcare para criar mais valor aos serviços entregues aos pacientes, reduzir os desperdícios dos processos e aumentar a qualidade nos tratamentos e atendimentos. Nesses ambientes, destacam-se as oportunidades de melhoria em centros cirúrgicos e salas cirúrgicas, responsáveis pelo relevante volume de atendimentos hospitalares e grande parte da receita e estrutura de custos de hospitais. Nesse contexto, a medição de desempenho, assim como a gestão dos indicadores, tem se mostrado uma árdua tarefa, e estudos destacam a relevância dessas práticas para iniciativas Lean Healthcare, as quais podem apoiar a melhoria dos processos e prover tomadas de decisão baseadas em informações confiáveis e precisas. A partir disso, a presente pesquisa propõe a estruturação de um Sistema de Medição de Desempenho (SMD) para apoiar a introdução de práticas Lean em centros cirúrgicos. Esse SMD foi construído a partir de um modelo conceitual baseado em oito requisitos sobre aspectos teóricos advindos de revisões da literatura acerca da relação da gestão de centros cirúrgicos com práticas Lean e de medição de desempenho. O modelo conceitual possibilitou exemplificar os requisitos em um estudo de caso no centro cirúrgico de um hospital brasileiro. Por meio do caso, aspectos práticos foram observados e utilizados para formalizar o SMD, a exemplo do desenvolvimento de cinco classes de indicadores de desempenho (volume de cirurgias, processos cirúrgicos, sustentabilidade financeira, gestão de recursos e stakeholders) e o teste de ferramentas <i\\>Lean (como o mapeamento do fluxo de valor e quadros de gestão visual). Assim, um framework para SMD pode ser estruturado, unindo aspectos teóricos e práticos da pesquisa, de modo a alinhar e promover a medição, melhoria e gestão das operações e estratégias de um centro cirúrgico. Além do framework, um roteiro de seis fases para sua implementação foi desenvolvido, de modo a apoiar futuras replicações do SMD. Espera-se que a presente pesquisa apoie novos estudos teóricos e práticos sobre a gestão de operações na área da saúde, em especial no centro cirúrgico, de forma a aprimorar as práticas atuais e promover benefícios para pesquisas futuras. / The use of Lean can improve production in order to increase process efficiency and quality. Systems, such as hospitals, have been using an approach named Lean Healthcare to create more value to their services delivered to patients, to reduce process wastes and to increase quality of care. In this setting, improvement opportunities in surgical centers and operating rooms, which are responsible for a relevant volume of hospital procedures and a significant share of revenue and costs structure, can be identified. In this context, performance measurement, as well as performance indicators management, have been shown as a tough task, and studies highlighted its relevance in Lean healthcare initiatives, which could support process improvement and provide relevant decision making based on precise and reliable information. From this premise, this research proposes the structuring of a Performance Measurement System (PMS) to support Lean practices introduction in surgical centers. This PMS was supported by a conceptual model based on eight requirements coming from theoretical aspects, such as literature reviews about the relationship of surgical centers management with Lean and performance measurement practices. The conceptual model made it possible to exemplify the requirements through a case study in a surgical center of a Brazilian hospital. Based on this case, practical aspects were observed and used to ground the proposed PMS, such as the development of five performance indicators categories (surgical volume, surgical processes, financial sustainability, resource management and stakeholders) and Lean practices tests (such as value stream mapping and visual management boards). Then, a PMS framework was structured, joining theoretical and practical aspects of the research, in order to align and to promote measurement, improvement and management of a surgical center\'s operations and strategies. Besides the framework, a six-phase implementation guide was developed, in order to support future replications of this PMS. It is expected that this research supports theoretical and practical studies in healthcare operations management, in order to improve the current practices and promote benefits for future research.

A hipótese principal testada nesse estudo foi que a qualidade de vida do indivíduo está diretamente correlacionada com a qualidade de vida no trabalho, ou seja, quanto maior a qualidade de vida no trabalho, maior a qualidade de vida. O objetivo geral foi avaliar e correlacionar as variáveis qualidade de vida e qualidade de vida no trabalho de profissionais de enfermagem atuantes em unidades do Bloco Cirúrgico de quatro hospitais da cidade de Londrina – PR. Trata-se de um estudo descritivo e correlacional, do tipo corte transversal do qual participaram 105 trabalhadores. A coleta de dados foi realizada com a utilização de três questionários: caracterização sociodemográfica, Escala Adaptada de Qualidade de Vida de Flanagan e o Índice de Satisfação Profissional de Stamps. Ambos os instrumentos foram usados nas versões adaptadas para o português e mostraram valores do alfa de Cronbach de 0,81 para as duas escalas, o que indica a confiabilidade das mesmas na população estudada. Dos participantes, a maioria era do sexo feminino (82,9%) e casado (62,9%). Quanto à caracterização profissional, 12 eram enfermeiros, um técnico, 73 auxiliares e 18 atendentes que atuavam em Centro Cirúrgico (55,2%), Central de Material e Esterilização (33,3%) ou em ambos locais (11,5%). O tempo médio de atuação nas instituições foi de 9,82 anos (intervalo de seis meses a 29 anos). Os resultados relacionados à qualidade de vida nos quais, em um intervalo possível de 16 a 112, quanto maior o valor, maior a satisfação com a vida, obtivemos uma mediana de 77 e média de 77,2+10,5. A média de todos os 16 itens foi de 4,83+0,65 (resultado avaliado entre nem insatisfeito/nem satisfeito e satisfeito). O item de menor satisfação foi atividades recreacionais e esportivas e o de maior satisfação relacionamento com amigos. No que se refere à qualidade de vida no trabalho, os valores obtidos variaram entre 114 a 227 (intervalo possível de 44 a 308), sendo que quanto maior o valor, maior a satisfação com o trabalho. A média obtida foi de 169,7+25,9 e a mediana de 170. O valor médio obtido para os 44 itens foi de 3,85, mostrando que os trabalhadores estavam entre insatisfeitos e nem satisfeitos/ nem insatisfeitos com os aspectos abordados pelo instrumento de qualidade de vida no trabalho. Entre os seis domínios avaliados pelo instrumento, obtivemos que a Remuneração foi considerada como fonte de menor satisfação entre os trabalhadores, enquanto o domínio Status profissional, o de maior satisfação. Para testar a correlação entre as variáveis QV e QVT usamos o teste não paramétrico de Spearman e obtivemos um valor de 0,17 (p=0,07). Assim, constatamos que não houve correlação entre as variáveis, o que não comprovou a nossa hipótese inicial. / The hypothesis tested in this study was that the quality of life of a person is directly correlated to the quality of life at work. Therefore, the better the quality of life at work, better will be the quality of life. The general aim was to evaluate and correlate the variables quality of life at work among nursing professionals working at the surgical unit of four hospitals located in the city of Londrina, state of Paraná. This is a descriptive and correlational study, of the cross sectional type, with a sample of 105 professionals. Data were collected through a questionnaire containing Flanagan’s Adapted Quality of Life Scale and Stamps’ Index of Work Satisfaction. Both instruments were used in their versions adapted to Portuguese and showed values of Cronback alpha of 0.81 for both scales, indicating their reliability in the population studied. Among the participants, the majority were women (82.9%) and married (62.9%). With respect to professional characterization, 12 were nurses, 1 technician, 73 auxiliaries and 18 aids who worked at the Surgical Unit (55.2%), Sterilization and Material Unit (33.3%) or both (11.5%). The average time of work at the institutions was of 9.82 years (interval between six months and 29 years). Considering the results related to the quality of life in which, in a possible interval of 16 to 112 years, greater the value, greater will be life satisfaction, the author found a median of 77 and average of 77.2+10.5. The average of all the 16 items was of 4.83+0.65 (results evaluated between neither satisfied nor dissatisfied and satisfied). The item with lower satisfaction level was related to recreational and sports activities and the one with higher satisfaction rate was relationship with friends. Regarding quality of life at work, values varied between 114 and 227 (possible range of 44 to 308), considering that greater the value, greater will be the work satisfaction. The average was of 169.7+25.9 and the median of 170. The average value obtained for the 44 items was of 3.85, showing that workers were dissatisfied and neither satisfied nor dissatisfied with the aspects mentioned in the instrument on quality of life at work. Among the six domain evaluated by the instrument, the author found that remuneration was considered the source of lower satisfaction among workers, while the domain professional status was the one with higher satisfaction level. In order to test the correlation between the two variables, the Spearman non parametric test was applied and the author found a value of 0.17 (p=0.07). Thus, there were no correlation among the variables and the initial hypothesis was not confirmed.

O presente estudo teve como objetivo geral sintetizar a contribuição das pesquisas produzidas pela enfermagem brasileira em centro cirúrgico. Trata-se de revisão integrativa da literatura nacional, dos artigos no período de 1978 a 2006 e indexados nas bases de dados: LILACS, DEDALUS e SCIELO. Para a coleta de dados foi elaborado um formulário. Foram localizados 56 artigos sendo que a maioria dos autores 58 (40.85%) atuando na área do ensino. Os artigos foram classificados pelo título em seis temas sendo 06 (10,71%) artigos enfocam a visita pré-operatória (VP); 29 (51,78%) dos artigos referem-se à assistência de enfermagem no período transoperatório (PTI); 12 (21,43%) à assistência em sala de recuperação anestésica (SRPA); 01 (1,79%) à visita pós operatória(VPO); 05(8,93%) à construção ou validação de instrumento (CVI); 03 (5,36%) à percepção do paciente (PP). A VP é vista como uma estratégia importante na obtenção de dados para a realização do procedimento anestésico cirúrgico sem expor o paciente a riscos e danos. O PTI aborda diversos aspectos que envolve o paciente como: a ansiedade, medo, participação da família no processo assistencial e os diagnósticos de enfermagem. Com relação SRPA fica caracterizado que é indispensável a presença do enfermeiro na prevenção das complicações. A VPO aparece como uma fase muito incipiente o enfermeiro de CC. A necessidade de se registrar a assistência de enfermagem perioperatória prestada ao paciente por meio de um instrumento estruturado objetiva dar seqüências a esta, documentá-la, facilitar a pesquisa e servir como meio de comunicação entre os setores. Quanto à PP, os pacientes se sentem seguros quando compreendem as orientações recebidas. O tratamento cordial e atencioso é percebido pelo paciente cirúrgico durante todas as fases do SAEP, mesmo estando em uma situação de desconforto, seja emocional ou fisiológica. Isso vem a confirmar a importância da assistência humanizada e individualizada. Os conteúdos dos artigos abordaram as fases do SAEP, as dificuldades e facilidades encontradas na prestação da assistência ao paciente cirúrgico. Fica evidente que a maior dificuldade está relacionada ao número insuficiente de enfermeiros que trabalham no CC e na SRPA em relação ao número de cirurgias programadas. Os objetivos foram alcançados e os 30 anos de pesquisa no Brasil, vêm contribuindo num ritmo crescente para a construção do conhecimento e influenciando positivamente o enfermeiro para o bom desempenho da assistência ao paciente cirúrgico e família / The present study had as a general objective to synthesize the contribution of the researches produced by Brazilian nursing for surgical centers. It\'s a matter of the integrative review of national literature, articles from 1978 to 2006 and indexed at the LILACS, DEDALUS and SCIELO databases. A form was elaborated to extract the data. There were found 56 articles in which most of the authors - 58 (40.85%) - act on education. Articles were classified on titles, divided on six themes in which 06 (10.71%) are focused the pre-operation visit (VP); 29 (51.78%) refer to nursing assistance at transoperating period (PTI); 12 (21.43%) to assistance at anesthesia recovering room (SRPA); 01 (1.79%) to pos operating visit (VPO); 05 (8.93%) to instruments construction or validation (CVI); 03 (5.36%) to patient\'s perception (PP). The VP is seemed as an important strategy to fulfill surgical anesthesia procedures without exposing the patient to risks and damages. The PTI approaches several aspects that involve the patient, such as: anxiety, fear, family participation during the assistance process and the nursing diagnosis. Regarding SRPA it is characterized that the presence of the nurse is indispensable to prevent complications. The VPO appears as a very incipient phase to the surgical center nurse. The necessity of registering the perioperating nursing assistance given to the patient through a structured instrument means to give sequence to this, document it, facilitate the research and serve as media between the sectors. As for the PP patient feel safe when they comprehend the given orientations. Cordial and thoughtful treatment is perceived by the surgical patient during all phases of SAEP, even in an uncomfortable situation, emotional or physiological. It confirms the importance of humanized and individualized assistance. The articles contents approach the phases of SAEP, the difficulties and facilities during the assistance to the surgical patient. It is evident that the major difficult is related to the insufficient number of nurses that work at a surgical center and at the SRPA comparing to the number of surgeries programmed. The objectives were reached and the 30 years of researches in Brazil have been contributing in a crescent rhythm to the knowledge building and positively influencing the nurse to a better assistance performance to the surgical patient and the family

O presente estudo tem como finalidade o conhecimento dos estressores, na atuação dos enfermeiros de centro cirúrgico e recuperação anestésica (CC/RA), assim como as estratégias de coping usadas. A população foi composta por todos os enfermeiros de CC/RA da cidade de Santa Maria, no Rio Grande do Sul. Foram dezessete entrevistados, sendo cinco atuando em hospital privado (29,41%) e doze em hospital público (70,59). Na coleta de dados foram utilizados dois instrumentos: formulário para levantamento de atividades diárias, e inventário de estratégias de coping. Os resultados foram tabulados e analisados usando-se testes não paramétricos. Obteve-se pela avaliação subjetiva e individual dos enfermeiros que 70,59% dos entrevistados percebem-se estressados ao atuar em CC/RA. Pela identificação dos estressores no desempenho das atividades diárias dos enfermeiros, concluiu-se que as condições de trabalho em CC correspondem à área de maior stress para 41,18% dos enfermeiros independentemente do cargo ocupado. Quanto às estratégias de coping mais utilizadas pelos enfermeiros, destaca-se a resolução de problemas. Detectou-se uma diferença significativa entre: stress total e stress percebido por meio da avaliação individual e subjetiva; stress total e o stress decorrente de possuir curso de pós-graduação; stress total e o stress referente ao relacionamento com equipe médica e de enfermagem; ao relacionamento com serviços diretamente ligados à assistência do paciente durante o ato anestésico cirúrgico; atividades relacionadas à administração de pessoal; e condições de trabalho para o desempenho das atividades do enfermeiro de CC. O enfermeiro de CC/RA é estressado, mas tem algumas estratégias que oferecem apoio à realização de sua atividade profissional. / This study intents to verify stress and coping among operating room (OR) nurses and recovery room nurses. The population was composed for all nurses in Santa Maria,RS, Brazil. The total of 17 nurses were intervened, that 29,4% was from private hospitals and 70,6% form governmental hospitals. The date was collected by “ Diary activities inventory" and “ways of coping questionnaire". The results demonstrated that 70,6% of nurses perceived as stressed. The “ conditions of work" was the stressful item cried (41,18%) and was not dependent of function in OR. They answered that “solving problems" was the most useful coping strategy. Differences statistical significant were detected among; total of stress and perceived stress; total of stress and post-graduate curse; total of stress and relation ship with doctors, nurses, other departments, staff administration and work conditions. In conclusion, the OR nurses were stressed but the used coping strategies in order to work and live.

Esta pesquisa é um estudo de caso, com natureza exploratória, descritiva e comparativa de campo, transversal e com abordagem quantitativa. Tem como objetivo classificar as cirurgias em categorias, segundo a necessidade de horas de enfermagem em salas de operações, subsidiando o dimensionamento de pessoal de enfermagem em centro cirúrgico. Foi realizada em um Hospital geral, de grande porte, da rede privada da cidade de São Paulo. A amostra foi constituída de 140 pacientes, divididos em 14 grupos, sendo 10 pacientes em cada grupo. Para a formação dos grupos foi considerado a condição física do paciente, segundo Americam Society of Anestesiologists (ASA), o porte anestésico segundo a Associação Médica Brasileira (AMB), o tipo de procedimento anestésico-cirúrgico, invasivo ou minimamente invasivo (MI) e cirurgias eletivas. Quanto à condição física do paciente, os grupos foram formados com ASA1, ASA2 e ASA3; a ASA4 foi excluída por não apresentar casos, ASA 5 e 6 foram excluídos por serem cirurgias de urgência ou emergência. Quanto ao porte anestésico, as cirurgias foram classificadas em pequeno porte, médio porte, grande porte e porte especial. Desta forma os grupos ficaram simbolizados como: 1P, 1M, 1G, 1E, 2P, 2M, 2G, 2E, 3M, 3G, 3E, 1PMI, 1MMI e 2MMI. A coleta de dados foi realizada dentro das salas de operações, por meio de observação estruturada, a qual foi utilizado um roteiro com itens referentes à caracterização da cirurgia, recursos humanos, condição física do paciente e procedimentos anestésicos-cirúrgicos. O tratamento dos dados foi feito segundo a caracterização do paciente cirúrgico, horas utilizadas pelos recursos humanos e pelo paciente, procedimentos realizados e recursos materiais utilizados. Na comparação entre os grupos, a caracterização do paciente cirúrgico permitiu os seguintes resultados: quanto ao sexo, 83 (59,29%) do sexo feminino e 57 (40,71%) masculino, a maior frequência de idade foi entre 30 e 40 anos, em 34 (24,29%) dos pacientes. As especialidades cirúrgicas de maior frequência foram otorrinolaringologia em 23 (16,43%), ginecologia e obstetrícia 21 (15%) e ortopedia e traumatologia 21 (15%). A anestesia geral prevaleceu com 75 (53,58%) dos pacientes. Quanto aos distúrbios sistêmicos que caracterizaram a ASA, as doenças cardiovasculares prevaleceram em 52 (65%) dos pacientes, sendo 40 (50%) com hipertensão arterial sistêmica e 16 (20%) com diabetes Mellitus. Quanto às horas utilizadas, as média das horas utilizadas por paciente foram: 3,40 horas de enfermagem (HE); 0,10 horas de enfermeira (HEn); 3,28 horas de técnico/auxiliar de enfermagem (HT/A); 6,14 horas da equipe médica (HEM); 1,12 horas de cirurgia (HC); 1,95 horas de salas de operações (HSO); 0,21 horas de preparo para anestesia (HPA) e 0,16 horas de preparo para cirurgia (HPC). Para uma hora de cirurgia (HC), as médias de horas utilizadas em cada paciente foram: 3,54 HE; 0,14 HEn; 3,40 HT/A; 5,77 HEM e 1,90 HSO. Para uma hora de sala de operações (HSO), as médias de horas utilizadas em cada paciente foram: 1,81 HE; 0,06 HEn; 1,75 HT/A; 3,08 HEM e 0,54 HC. Quanto aos procedimentos realizados, as médias dos invasivos foi de 2,04 procedimentos e não invasivos de 5,70 procedimentos; com total de 7,74 procedimentos. A média de recursos materiais utilizados para anestesia foi de 4,19 equipamentos e para a cirurgia de 2,76 equipamentos; com total de 6,95 equipamentos. Na análise estatística dos grupos, referentes às ASA, segundo os portes anestésicos; os resultados demonstraram que os portes anestésicos pequeno e médio não diferiram significativamente entre si, sendo inferiores aos portes grande e especial, nas variáveis HE, HT/A, HEM; quanto aos portes anestésicos, segundo às ASA; os resultados demonstraram que quase não houve diferenças entres as ASA. Os grupos de cirurgias minimamente invasivas, houve diferença apenas nos recursos materiais, sendo superiores conforme o porte anestésico e a análise entre os grupos de cirurgias invasivas e minimamente invasivas, com portes anestésicos e ASA semelhantes, os resultados demonstraram que os grupos de cirurgias invasivas apresentaram - se significativamente inferiores nas variáveis estudadas em relação aos grupos de cirurgias minimamente invasivas. Desta forma, conclui-se com este estudo, que as HE estão relacionadas aos portes anestésicos, onde quanto mais complexo o procedimento anestésico-cirúrgico, mais horas de enfermagem são utilizadas, não foi observado relação das HE utilizadas com a condição física do paciente. Assim, foi elaborado uma classificação das cirurgias em categorias, segundo a necessidade de horas de enfermagem, para uma hora de sala de operações, sendo: cuidados padrão de enfermagem, com 1,41 horas; cuidados complexos de enfermagem, com 1,99 horas e cuidados diferenciados de enfermagem, com 1,78 horas / This is a case study with exploratory character, descriptive and comparative, and a fieldwork with a quantitative approach. It aims to classify the surgeries in categories according to the number of nursing hours in operating rooms, subsidizing the dimensioning of the nursing staff in operating rooms. It was performed in a large general private Hospital in São Paulo. The sample was constituted of 140 patients, divided into 14 groups, 10 patients on each group. To organize the groups it was taken on account the patient\'s physical condition, according to the American Society of Anesthesiologists (ASA), the anesthetic complexity, according to the Brazilian Medical Association (BMA), the sort of surgical anesthetic procedure: invasive, or minimally invasive (MI) and elective surgeries. According to the patient\'s physical condition, groups were constituted with ASA1, ASA2 and ASA3. ASA 4 was put away because there were no cases, and ASA 5 and ASA 6 were put away because they were urgency or emergency surgeries. As to the anesthetic complexity, surgeries were classified as presenting small complexity, mean complexity, large complexity and special complexity. Therefore groups were symbolized as: 1S, 1M, 1L, 1S, 2S, 2M, 2L, 2S, 3M, 3L, 3S, 1SMI, 1MMI AND 2AMI. Data were collect inside the operating rooms, by means of organized observation, according to a guide presenting items referring to the surgery characteristics, human resources, patient\'s physical condition and surgical anesthetic procedures. Data analysis was performed according to the surgical patient\'s characteristics, hours taken by human resources and by the patient, procedures and material resources employed. In the comparison among groups, the characterization of the surgical patient led to the following results: as to gender, 83 (59,29%) female and 57 (40,71%) male, the higher age frequency was between 30 and 40 years in 34 (24,29%) of the patients. The most frequent surgical specialties were otorhinolaryngology and traumatology in 23 (16,43%), gynecology and obstetrics in 21 (15%) and orthopedics and traumatology in 21 patients (15%). General anesthesia prevailed in 75 (53,58%) of the patients. Concerning the systemic disorders that characterize the ASA, cardiovascular disorders prevailed in 52 (65%) of the patients, 40 (50%) presenting systemic arterial hypertension and 16 (20%) presenting diabetes Mellitus. As to the hours taken, the average hours taken by patients was: 3,40 hours of nursing (NH); 0,10 hours of nurse (NeH); 3,28 hours of nursing assistant (NaH); 6,14 hours of medical staff (MSH); 1,12 hours of surgery (SH), 1,95 hours of operating room (ORH); 0,21 hours of anesthetic preparation (APH) and 0,16 hours of surgery preparation (SPH). For one SH, the average hours taken for each patient was: 3,54 NH; 0,14 NeH; 3,40 NaH; 3,08 MSH and 0,54 SH. Concerning to the procedures taken, the average of invasive procedures was 2,04 and non-invasive procedures 5,70; total procedures 7,74. The average material resources used for anesthesia was 4,19 equipment and for surgery 2,76 equipment; total 6,95 equipment. In the statistical analysis of groups referring to the ASA, according to the anesthetic complexity, results evidenced that small and mean anesthetic complexity presented no significant difference, and were inferior to large and special complexity in variables NH, NaH and MSH; as to the anesthetic complexity according to the ASA the results evidenced that there were almost none difference among the ASA. In the group of minimally invasive surgeries, there was difference only in the material resources, that were superior according to the anesthetic complexity and in the analysis comparing groups of invasive and minimally invasive surgeries with similar anesthetic complexity and ASA the results evidenced that groups of invasive surgeries were significantly inferior in the studied variables in relation to groups of minimally invasive surgeries. Therefore, this study concludes that the NH are related to the anesthetic complexity, and the more complex the anesthetic surgical procedure, the more nursing hours are taken. The relation of NH taken with the patient\'s physical condition was not observed. Thus a classification of surgeries in categories was done, according to the necessary nursing hours for one hour of operating room, that is: standard nursing cares, 1,41 hours; complex nursing cares, 1,99 hours and differentiate nursing cares, 1,78 hours

L’objectif de cette thèse de doctorat est d’étudier les mécanismes en jeu dans les comportements informationnels lors de la prise de conscience de la situation afin d’en dégager des leviers permettant d’orienter ces comportements. Ces travaux s’inscrivent dans le cadre du développement du Serious Game 3DVOR, dispositif dédié à la gestion des risques au bloc opératoire. Dans un premier temps, nous avons filmé puis analysé 6 situations d’opération chirurgicale sans complication et avons observé les comportements informationnels des opérateurs du bloc lors d’une simulation numérique d’un cas complexe de chirurgie. Enfin nous avons élaboré un scénario permettant d’interagir avec des partenaires virtuels afin d’observer l’impact de leurs actions sur les stratégies informationnelles d’un apprenant. Nous avons analysé les données recueillies au regard de la littérature sur la conscience de la situation, particulièrement le modèle d’Endsley (1995). Nos résultats montrent que les comportements informationnels varient selon l’expertise des opérateurs et l’ambiguïté de la situation. Les experts adaptent leurs stratégies lorsque la situation ne leur est pas familière et varient leurs sources d’informations pour mettre à jour leur représentation de la situation. Enfin, nous avons montré que l’engagement de partenaires, même virtuels, modifient les stratégies de traitement de l’information des apprenants face à un dispositif de formation numérique. / This doctoral thesis aims at investigating the mechanisms playing a role in both human information behavior and situation awareness in order to develop pedagogical levers that could guide those behaviors. The work we present is part of an industrial project for the development of a serious game named 3DVOR, this game is targeting the risk management education within the operating room. First, we filmed 6 surgical operations that did not present any complications, then we created a simulation of a complex case of surgery to observe the informational behaviors of each member of the surgical team. Last, we elaborated a scenario allowing a learner to interact with virtual partners in order to observe the impact of their actions on the learners’ informational strategies. We analyzed the data in view of the literature on situation awareness and the Endsley’s model. Our results show that the information behaviors vary according to the expertise of the operators and the ambiguity of the situation. Experts adapt their strategies when the situation does not seem familiar and vary their sources of information to update their mental representation of the current situation. Finally, we showed that the engagement, even of virtual partners, modify the learners’ strategies of information processing while using a digital learning software.