A Research Report submitted to the Faculty of Health Sciences of the University of the Witwatersrand in partial fulfillment of the requirements for the degree of Master of Public Health (Hospital Management) Johannesburg 2011 / With the exception of emergency cases most patients should first be seen at the Primary Health Care(PHC) level where a decision is made by a doctor or nurse as to whether they should be referred to a higher level of care or not. Such referral would be referring to a district hospital, from there to a regional hospital then eventually to a central hospital. Over the last five years the argument from Pelonomi Regional Hospital (PRH) casualty department doctors has been growing louder and louder about patients they see which should be seen at PHC level. It was for this reason that this study was found to be necessary in order to put the arguments to a scientific test and be certain that the complaints are valid i.e. Are the majority of patients seen inappropriate for this level of care?

A dissertation submitted to the University of Witwatersrand in partial fulfillment of the requirements for the Master of Medicine Speciality Obstetrics and Gynaecology. Johannesburg, 2013 / Wireless communicating networks are becoming more and more utilized. By using Short Message Service (SMS) via mobile phones, patients can be contacted regarding blood results, follow-up appointments and reminders for chronic medication.In this study the use of SMS was put to the test in South Africa, a middle income country. Objectives: 1. To evaluate whether there is better compliance in patients who received a SMS, reminding them of the date of elective surgery, as opposed to patients who did not receive a reminder SMS. 2. To describe demographic and clinical information of women who are booked forelective gynaecological surgery at Chris Hani Baragwanath Academic Hospital Methods: This study was undertaken at Chris Hani Baragwanath Academic Hospital, which offers a gynaecological elective surgery list on every working day.As with any busy hospital, it is not uncommon for women to wait lengthy periods of time for their surgery Participants were recruited and followed-up between 30th May 2011 and 14th of December 2011. Eligible criteria included all women scheduled to undergo surgery with a waiting list of at least one month. Women who did not have mobile phones and women who objected to receiving SMS communications from the researcher on their mobile phones were excluded. Participants less than 18yrs, inability to read English SMS and refusal to participate in the trail were excluded. This was a double-blinded randomized controlled trial, which assessed the impact of a reminder SMS, in addition to the traditional methods of ensuring return for gynaecological surgery on patients remembering to avail themselves for surgery on their specific date. These numbers were randomized by block randomization into intervention group and control group. The Research Randomiser Form v4.0 program was used. Twenty nine patients were randomized to the intervention group who received a reminder SMS and 29 patients to the control group who did not receive the reminder SMS. Only patients with personal cell phones were included in the study. The participants as well as the researcher were blinded and only the supervisor knew who of the participants were randomised in either group. Results: A total of 58 patients were enrolled in this study. Participants included in the study were allocated numbers. The study showed that even though the shortest waiting period was < 2 months and the longest >5 months there was no significant difference in the number of patients that returned for surgery (53% versus 47%). Most of the patients in this study were African, unemployed and agesranged from 17 – 78 years. The primary reasons for their return in order of frequency were the presence of a mass (60%), pain (59%) and bleeding (36%). One of the major findings of this study was that older patients tended not to return for surgery. Surprisingly, patients who waited longer from the time of booking of surgery to the date of surgery, tended to return more frequently. The main reasons for not returning were that patients did not have money for transport and four patients were unreachable and hence lost to follow-up. Conclusion: This study failed to show that reminders by SMS for elective gynaecological surgery are effective. It also demonstrated that older women were more likely not to return for surgery. Perhaps their ability to read or respond to SMS is more limited than younger women. The other significant finding of this study contrary to expectation is that longer waiting periods seemed to encourage a better return rate.

Research Doctorate - Doctor of Philosophy (PhD) / Despite the emergence of smoking care guidelines and best practice recommendations over the past 13 years, it has been suggested that smoking care is not routinely provided in hospitals. Although there is a relatively large body of evidence regarding the prevalence of patient smoking cessation after hospitalisation and the effectiveness of interventions to increase cessation levels, much less is known regarding the prevalence of best practice smoking care routinely provided in hospitals or the effectiveness of interventions to increase such care provision. This thesis seeks to address these deficiencies in the evidence base. In particular this thesis aimed to: 1. Examine the prevalence of hospital smoking care in the international and Australian contexts. This is addressed via a literature review of studies that have reported the level of smoking care delivered routinely in hospitals and a survey of hospital managers in New South Wales, Australia. 2. Examine the effectiveness of interventions to increase the routine delivery of smoking care in hospitals. This is addressed via a literature review of studies that have reported the effect of an intervention on smoking care levels, and via the implementation of a quasi-experimental study that was designed to increase the hospital-wide delivery of a broad range of smoking care elements. 3. Propose recommendations for future practice and research regarding the routine provision of hospital smoking care. This thesis consists of six chapters that address the above aims. Each of the chapters has been written as a relatively distinct report in the style of a journal article. The approach has been adopted to facilitate the reading of the thesis, and results in some repetition in some chapters. At the time of submission, two papers based on the chapters of this thesis have been published in peer-reviewed journals. A further two papers are under editorial review.

Research Doctorate - Doctor of Philosophy (PhD) / Despite the emergence of smoking care guidelines and best practice recommendations over the past 13 years, it has been suggested that smoking care is not routinely provided in hospitals. Although there is a relatively large body of evidence regarding the prevalence of patient smoking cessation after hospitalisation and the effectiveness of interventions to increase cessation levels, much less is known regarding the prevalence of best practice smoking care routinely provided in hospitals or the effectiveness of interventions to increase such care provision. This thesis seeks to address these deficiencies in the evidence base. In particular this thesis aimed to: 1. Examine the prevalence of hospital smoking care in the international and Australian contexts. This is addressed via a literature review of studies that have reported the level of smoking care delivered routinely in hospitals and a survey of hospital managers in New South Wales, Australia. 2. Examine the effectiveness of interventions to increase the routine delivery of smoking care in hospitals. This is addressed via a literature review of studies that have reported the effect of an intervention on smoking care levels, and via the implementation of a quasi-experimental study that was designed to increase the hospital-wide delivery of a broad range of smoking care elements. 3. Propose recommendations for future practice and research regarding the routine provision of hospital smoking care. This thesis consists of six chapters that address the above aims. Each of the chapters has been written as a relatively distinct report in the style of a journal article. The approach has been adopted to facilitate the reading of the thesis, and results in some repetition in some chapters. At the time of submission, two papers based on the chapters of this thesis have been published in peer-reviewed journals. A further two papers are under editorial review.

O presente estudo objetivou compreender o significado que os graduandos de enfermagem de uma Universidade Estadual Pública atribuem à Gerência da Assistência de Enfermagem. Para essa finalidade optou-se por uma abordagem qualitativa, na vertente da fenomenologia. Esse desenho metodológico contribui para iluminar a ideia de Gerência da Assistência para estudantes de graduação e procura tornar visível o que está oculto. Busca-se a essência dos significados atribuídos pelos sujeitos sobre o fenômeno investigado e procura compreender o homem segundo a realidade vivenciada por ele. Essa metodologia também possibilita desvendar os valores, as percepções e emoções dos sujeitos envolvidos. É uma filosofia que repõe as essências na existência e não compreende o homem e o mundo de outra maneira senão a partir da sua facticidade. A fim de compreender o fenômeno que este trabalho pretendeu desvelar, foi escolhido para o cenário do estudo os cursos de Graduação em Enfermagem de uma Universidade Pública, situada no Estado de São Paulo. A instituição congrega dois cursos de graduação em enfermagem. Foi realizada entrevista fenomenológica com 26 estudantes. Para o desenvolvimento da pesquisa a seguinte questão norteadora foi adotada: Qual a sua compreensão sobre Gerência da Assistência? Após as transcrições, os depoimentos foram primeiramente analisados individualmente e após globalmente, resgatando os temas: Significado da Gerência da Assistência; Exercício da Gerência da Assistência;Gerência da Assistência no campo de estágio; Gerência da Assistência e o papel do enfermeiro; Exercício Burocrático. Avaliou-se nos discursos apresentados que em diversos momentos a definição de gerência da assistência foi trazida como um processo de coordenação da unidade de trabalho, sendo que as articulações com o cuidado direto ao paciente foram poucas vezes manifestadas. Em relação à supervisão, os discursos revelam como atividade de fiscalização e controle do processo de trabalho e pouco como artifício de educação. Os discursos também apontam como uma das principais atividades da gerência da assistência o controle e organização de recursos humanos.Uma ferramenta da gerência da assistência citada pelos graduandos foi a Sistematização da Assistência de Enfermagem (SAE), destacando-a como importante instrumento para um atendimento integral e qualificado. Elucidaram que há enfermeiros que desenvolvem a SAE com a finalidade de atender às normas das instituições. Foi mencionada a dicotomia entre a teoria e a prática durante a formação; salientaram a importância do estágio e da contribuição da disciplina de gerenciamento (bloco teórico) para o entendimento da gerência da assistência. Ainda com relação ao processo formativo, referiram que durante toda a graduação o foco na abordagem gerencial acontece principalmente no último semestre de graduação. Os estudantes de enfermagem também trouxeram o conceito de atividades burocráticas. Muitos enfermeiros estão apenas cumprindo tarefas estabelecidas pela instituição e exercem atividades burocráticas; outros são tecnicistas e não desenvolvem a gerência de enfermagem. A ideia de compreender o significado da gerência da assistência para o graduando de enfermagem é um ato de repensar a prática de ensino e aprendizado. Faz-se importante expandir a população de estudo, incluindo outras instituições de ensino, sejam públicas ou privadas / The present study aimed to understand the meaning that the nursing students from a State Public University assign to the Management of Nursing Care. For this purpose, it was chosen a qualitative approach, based on phenomenology. This methodological design has helped to brighten the idea of Management Assistance for graduation students and seeks to make visible what is hidden. It is searched the essence of the meanings attributed by the subjects about the investigated phenomena and it is sought to understand the man according to the reality experienced by him. This methodology enables to unveil values, perceptions and feelings of the subject involved. It\'s a philosophy which replaces essence in existence and does not understand the man and the world in other way but from their facticity. In order to comprehend the phenomena that this work intended to unveil, nursing graduate courses from a public university located in the state of São Paulo were chosen for the study setting. The institution gathers two nursing graduate courses. A phenomenological interview was carried out with 26 students. The following guiding question was adopted for the research development: What is your comprehension about the management assistance? After transcriptions, the testimonials were analyzed individually and then globally, rescuing the theme: Meaning of Management Assistance; Exercise of Management Assistance; Management Assistance in the internship field; Management Assistance and the rule of nurses; Bureaucratic Exercise. It was evaluated that at several moments in the presented speeches, the definition of Management Assistance was translated as coordination process in the work unit, whereas the articulations with the patient direct care were only a few times expressed. Regarding the supervision, the speeches reveal as inspection and control of the work process and a little as artifice of education. The speeches also points out the human resources control and organization as one of the main activities of the Management Assistance. A tool of the Management Assistance mentioned by undergraduates was the Nursing Care Systematization (SAE), standing out itself as an important instrument for a whole and qualified care. They have elucidated that there are nurses who develop the SAE in order to suit the rules of the institution. The dichotomy between the theory and the practice on learning was mentioned; they pointed out the importance of the internship and the contribution of the administration subject (theoretical block) for the understanding of Management Assistance. Still concerning the formative process, they referred that in the whole graduation the focus on management approach happens in the last semester of graduation. The nursing students have also brought the concept of the bureaucratic activities. Many nurses are just complying with tasks established by the institution and exert bureaucratic activities; others are technicists and do not develop the nursing management. The idea of understanding the management assistance for the nursing student is an act to rethink the practice of teaching and learning. It is important to expand the study population, including educational institutions, whether public or private

O presente estudo objetivou compreender o significado que os graduandos de enfermagem de uma Universidade Estadual Pública atribuem à Gerência da Assistência de Enfermagem. Para essa finalidade optou-se por uma abordagem qualitativa, na vertente da fenomenologia. Esse desenho metodológico contribui para iluminar a ideia de Gerência da Assistência para estudantes de graduação e procura tornar visível o que está oculto. Busca-se a essência dos significados atribuídos pelos sujeitos sobre o fenômeno investigado e procura compreender o homem segundo a realidade vivenciada por ele. Essa metodologia também possibilita desvendar os valores, as percepções e emoções dos sujeitos envolvidos. É uma filosofia que repõe as essências na existência e não compreende o homem e o mundo de outra maneira senão a partir da sua facticidade. A fim de compreender o fenômeno que este trabalho pretendeu desvelar, foi escolhido para o cenário do estudo os cursos de Graduação em Enfermagem de uma Universidade Pública, situada no Estado de São Paulo. A instituição congrega dois cursos de graduação em enfermagem. Foi realizada entrevista fenomenológica com 26 estudantes. Para o desenvolvimento da pesquisa a seguinte questão norteadora foi adotada: Qual a sua compreensão sobre Gerência da Assistência? Após as transcrições, os depoimentos foram primeiramente analisados individualmente e após globalmente, resgatando os temas: Significado da Gerência da Assistência; Exercício da Gerência da Assistência;Gerência da Assistência no campo de estágio; Gerência da Assistência e o papel do enfermeiro; Exercício Burocrático. Avaliou-se nos discursos apresentados que em diversos momentos a definição de gerência da assistência foi trazida como um processo de coordenação da unidade de trabalho, sendo que as articulações com o cuidado direto ao paciente foram poucas vezes manifestadas. Em relação à supervisão, os discursos revelam como atividade de fiscalização e controle do processo de trabalho e pouco como artifício de educação. Os discursos também apontam como uma das principais atividades da gerência da assistência o controle e organização de recursos humanos.Uma ferramenta da gerência da assistência citada pelos graduandos foi a Sistematização da Assistência de Enfermagem (SAE), destacando-a como importante instrumento para um atendimento integral e qualificado. Elucidaram que há enfermeiros que desenvolvem a SAE com a finalidade de atender às normas das instituições. Foi mencionada a dicotomia entre a teoria e a prática durante a formação; salientaram a importância do estágio e da contribuição da disciplina de gerenciamento (bloco teórico) para o entendimento da gerência da assistência. Ainda com relação ao processo formativo, referiram que durante toda a graduação o foco na abordagem gerencial acontece principalmente no último semestre de graduação. Os estudantes de enfermagem também trouxeram o conceito de atividades burocráticas. Muitos enfermeiros estão apenas cumprindo tarefas estabelecidas pela instituição e exercem atividades burocráticas; outros são tecnicistas e não desenvolvem a gerência de enfermagem. A ideia de compreender o significado da gerência da assistência para o graduando de enfermagem é um ato de repensar a prática de ensino e aprendizado. Faz-se importante expandir a população de estudo, incluindo outras instituições de ensino, sejam públicas ou privadas / The present study aimed to understand the meaning that the nursing students from a State Public University assign to the Management of Nursing Care. For this purpose, it was chosen a qualitative approach, based on phenomenology. This methodological design has helped to brighten the idea of Management Assistance for graduation students and seeks to make visible what is hidden. It is searched the essence of the meanings attributed by the subjects about the investigated phenomena and it is sought to understand the man according to the reality experienced by him. This methodology enables to unveil values, perceptions and feelings of the subject involved. It\'s a philosophy which replaces essence in existence and does not understand the man and the world in other way but from their facticity. In order to comprehend the phenomena that this work intended to unveil, nursing graduate courses from a public university located in the state of São Paulo were chosen for the study setting. The institution gathers two nursing graduate courses. A phenomenological interview was carried out with 26 students. The following guiding question was adopted for the research development: What is your comprehension about the management assistance? After transcriptions, the testimonials were analyzed individually and then globally, rescuing the theme: Meaning of Management Assistance; Exercise of Management Assistance; Management Assistance in the internship field; Management Assistance and the rule of nurses; Bureaucratic Exercise. It was evaluated that at several moments in the presented speeches, the definition of Management Assistance was translated as coordination process in the work unit, whereas the articulations with the patient direct care were only a few times expressed. Regarding the supervision, the speeches reveal as inspection and control of the work process and a little as artifice of education. The speeches also points out the human resources control and organization as one of the main activities of the Management Assistance. A tool of the Management Assistance mentioned by undergraduates was the Nursing Care Systematization (SAE), standing out itself as an important instrument for a whole and qualified care. They have elucidated that there are nurses who develop the SAE in order to suit the rules of the institution. The dichotomy between the theory and the practice on learning was mentioned; they pointed out the importance of the internship and the contribution of the administration subject (theoretical block) for the understanding of Management Assistance. Still concerning the formative process, they referred that in the whole graduation the focus on management approach happens in the last semester of graduation. The nursing students have also brought the concept of the bureaucratic activities. Many nurses are just complying with tasks established by the institution and exert bureaucratic activities; others are technicists and do not develop the nursing management. The idea of understanding the management assistance for the nursing student is an act to rethink the practice of teaching and learning. It is important to expand the study population, including educational institutions, whether public or private

Syftet med studien var att undersöka hur sjuksköterskor på en allmänpediatrisk avdelning disponerar sin tid gällande administrativa arbetsuppgifter jämfört mot direkt och indirekt patientkontakt. För att granska detta fenomen utfördes en aktivitetsstudie. Metod designen var icke experimentell deskriptiv observationsstudie. Där sju olika sjuksköterskor följdes under femton dagar där tidmätning skedde av på förhand kategoriserade aktiviteter. Kategoriseringsschema innehöll nio olika kategorier. Resultatet visade att 19,53 procent av arbetspasset vilket motsvarar 97 minuter spenderades med direkt patientkontakt respektive de 24,3 procent vilket motsvarar 120 minuter per dag till administrativa göromål. Dessutom uppmättes det att sjuksköterskorna blev avbrutna i snitt 26 gånger under ett åtta timmars arbetspass vilket resulterar till 3,25 avbrott per timme. Forskarnas slutsats är att det finns flera fördelar med ökad tid för patientkontakt och att detta är synnerhet gällande på en allmänpediatrisk avdelning. / The aim of the study was to examine how nurses at a general pediatric unit dispose of their time regarding administrative duties compared to direct interaction with the patient. To appropriately survey this phenomenon an activity study was conducted. The method for data collection was a nonexperimental descriptive observational study where seven nurses were followed for a total of fifteen days where the amount of time of their activities where noted according to an activity schedule that was formed beforehand. The schedule contained nine categories including the amount of interruptions nurses where subject to. The result of the study showed that roughly 19,53 percent of the nurses’ time, which is the equivalent to 97 minutes, were spent directly with the patients compared to the 24,3 percent, which amounts to 120 minutes a day, she spent with administrative tasks. Furthermore it was found that a nurse is in average interrupted 26 times during an eight hour shift which gives an average of 3,25 interruptions every hour. In conclusion the authors found ground that there are many benefits with increased nurse-patient time and believe this is especially true in a general pediatric unit.

Objetivos: Determinar la proporción de pacientes que cumplen los criterios internacionales de gastrectomía en manga así como estimar la asociación entre el porcentaje de pérdida de peso en el primer, tercer y sexto mes del tratamiento nutricional con la tasa de abandono del mismo. Materiales y métodos: Estudio de tipo cohorte retrospectivo realizado con historias clínicas de pacientes con gastrectomía en manga laparoscópica operados desde el 2008 hasta marzo 2014 en una clínica privada. Dos fueron las variables resultado de interés: la elegibilidad para cirugía bariátrica según criterios internacionales (IMC ≥40 kg/m2o ≥ 35 kg/m2 con comorbilidades) y el abandono antes o durante (inasistencia por más de 60 días desde la consulta previa sin haber sido dado de alta (IMC < 25)) el tratamiento nutricional. La exposición fue el porcentaje de peso perdido en las primeras cincos semanas después de la cirugía (< 10% vs. ≥ 10%). Se utilizaron modelos de regresión de Poisson y se calcularon riesgos relativos y sus respectivos intervalos de confianza al 95% (IC95%). Resultados: La muestra estuvo compuesta por datos de 423 historias clínicas de pacientes bariátricos, 294 (69.5%) fueron mujeres, edad media 39.2 (DE: 12.3) años. Solo 117 (27.7%) pacientes cumplieron con los requisitos establecidos para la cirugía, y 48 de esos 117 (41%) abandonaron el tratamiento nutricional antes de iniciarlo. Controlando por sexo y edad y tomando como referencia aquellos que perdieron <10% de peso, los que perdieron ≥10% del peso inicial redujeron el riesgo de abandonar el tratamiento nutricional (RR = 0.10; IC95% 0.01–0.68) en el primer mes. Conclusión: A pesar de las recomendaciones internacionales, una gran proporción de los pacientes de cirugía bariátrica no cumple los requisitos. La incidencia de abandono antes y durante el tratamiento nutricional es alta. Los resultados resaltan la necesidad de tener guías para el manejo de cirugía bariátrica en nuestro contexto. / bjectives: To determine the proportion of patients who meet international recommendations for bariatric surgery and to assess the impact of weight loss in the first, third and sixth month of nutritional treatment on it’s abandonment. Methods: A retrospective cohort study was performed using data from clinical records of patients who underwent sleeve gastrectomy in a private clinic of Lima, Peru. Two outcomes were evaluated, eligibility for bariatric surgery according to international recommendations (BMI ≥40 kg/m2 or ≥35 kg/m2 with comorbidities) and abandonment before and after starting nutritional management (no nutritional assessment after 60 days from the previous visit without achieving ideal BMI). The exposure was the percentage of weight lost in the first five weeks after surgery split into <10% and ≥10%. Poisson regression was used and relative risks and 95% confidence intervals (95%CI) were calculated. Results: Data from 423 medical records of bariatric patients, mean age 39.2 years (SD 12.3), 294 (69.5%) women, were analyzed. Only 117 (27.7%) patients met international recommendations for bariatric surgery. Before starting nutritional management, 48/117 (41%) abandoned treatment, whereas an additional 29/69 (42.0%) abandoned before six months of nutritional management. In multivariable model, a weight loss ≥10% in the first five weeks reduced the risk of abandoning nutritional management (RR = 0.10, 95% CI 0.01-0.68) in the first month. Conclusions: Despite of international recommendations, a great proportion of patients undergoing bariatric surgery did not meet the criteria. Rates of abandonment before and after starting nutritional management are high. Results highlight the urgency of having appropriate guidelines for managing bariatric surgery in our context. / Tesis

This thesis describes patients in acute postoperative pain as well as patients with acute cancer-related pain in palliative care, and their experiences and perceptions of pain management in relation to HRQOL and the multidimensionality of pain. A combination of qualitative and quantitative methods was chosen. Data were collected using interviews and questionnaires; APS, SF:36 and a new developed questionnaire PC-PPQ measuring care related to pain management in palliative care. For assessing pain VAS and Pain-o-Meter were used. The study group consisted of 100 patients on their second postoperative day, and of 75 patients with cancer-related pain from two palliative care teams. The result showed that at the time of the interview 29 of the patients with postoperative pain reported a pain &gt; 3 on VAS and 79 reported VAS &gt; 3 as worst pain past 24 hours. The higher the intensity of pain the less satisfied the postoperative patients were with the nurses´ way of treating their pain. Thirty-three patients stated that they had received information regarding the importance of pain relief. Patients with postoperative pain as well as patients with cancer-related pain had been prescribed analgesics mostly a combination of Paracetamol, NSAID and opioid. Of the 75 patients with cancer-related pain and in palliative care 22 patients reported pain &gt;3 on POM-VAS and 47 patients reported &gt;3 on POM-VAS as worst pain past 24 hours. Twenty-eight patients reported an average pain &gt; 3 on POM-VAS past 24 hours. Twenty-four patients used the words troublesome or tiring when describing their affective pain. Sensory pain was described as prickling or sore by 15 patients. The patients perceived their pain as “aching all over” and expressed a wish for pain relief as well as a fear for increased pain. HRQOL especially physical functioning decreased for patients with average pain &gt; 3. Being cared for by a nurseled or a physician-led palliative care team indicated no statistically significant differences for patients´ HRQOL or pain intensities. The patients had experienced a statistically significant better care after being referred to a palliative care team, despite that pain control had not been optimized. Patients expressed a need for communication, planning and trust in order to improve pain management. Continuity of care and the opportunity to talk increase the patients feeling of security, as well as improved their perceived pain control. Structured ongoing discussion concerning pain management from an early stage of the disease or already preoperatively can provide an important intervention to meet the results of this thesis. Pain assessment covering the multidimensionality of pain, and pain treatment plans including both pharmacological and non-pharmacological treatment are further important interventions.

Submitted by Geandra Rodrigues (geandrar@gmail.com) on 2018-09-12T19:18:45Z No. of bitstreams: 1 ramonpachecodesouza.pdf: 3118492 bytes, checksum: 204ec4b24db83d64f5b5e1a036f16aa7 (MD5) / Approved for entry into archive by Adriana Oliveira (adriana.oliveira@ufjf.edu.br) on 2018-10-01T19:22:58Z (GMT) No. of bitstreams: 1 ramonpachecodesouza.pdf: 3118492 bytes, checksum: 204ec4b24db83d64f5b5e1a036f16aa7 (MD5) / Made available in DSpace on 2018-10-01T19:22:59Z (GMT). No. of bitstreams: 1 ramonpachecodesouza.pdf: 3118492 bytes, checksum: 204ec4b24db83d64f5b5e1a036f16aa7 (MD5) Previous issue date: 2018-07-12 / O estudo caracterizou-se pelo tipo descritivo, de caráter compreensivo e com abordagem qualitativa. Objetivou-se compreender como os registros de enfermagem eram utilizados pelos enfermeiros para a gerência do cuidado; caracterizar os tipos de registros de enfermagem utilizados pelos enfermeiros para a gerência do cuidado; apreender como os enfermeiros utilizavam dos registros de enfermagem para a gerência do cuidado; conhecer os fatores que facilitavam e dificultavam a utilização dos registros de enfermagem para a gerência do cuidado e; discutir os aspectos intervenientes para a utilização dos registros de enfermagem para a gerência do cuidado. Os dados foram coletados no setor de Clínica Médica de um hospital público de ensino, após aprovação pelo Comitê de Ética em Pesquisa da referida instituição, sob o Parecer de número 2213143. Participaram desse estudo 13 enfermeiras que estavam na gerência do cuidado. Para a coleta de dados foram utilizadas as seguintes técnicas: a entrevista do tipo semiestruturada, a observação participante e a pesquisa documental. Inicialmente foram realizadas as entrevistas semiestruturadas, no período compreendido entre outubro e novembro de 2017, que combinaram perguntas fechadas e abertas. Para operacionalização das entrevistas foi utilizado o software IRaMuTeQ 0.7 alpha 2. Concluída a etapa da coleta das entrevistas foi realizada a etapa da observação participante, após a análise dos discursos das participantes. Essa técnica foi desenvolvida em 21 ocasiões durante o serviço diurno, com 150 horas de observação, cujos conteúdos foram registrados em notas de campo/observação. Concomitante à observação participante houve a etapa da pesquisa documental, que se apoiou em um roteiro de análise de prontuários e bases de dados, livros, formulários e requerimentos de enfermagem. Como resultados, emergiram três categorias: registros de enfermagem como meio de comunicação; instrumentos adotados na elaboração dos registros de enfermagem e; o contexto de utilização dos registros de enfermagem e o desenvolvimento da gerência do cuidado. Percebeu-se que muitas enfermeiras enxergavam os registros de enfermagem como sendo parte, tão somente, do gerenciar em enfermagem, desvinculando-o do cuidado de enfermagem propriamente dito. Concluiu-se que os registros de enfermagem contribuem para o gerenciar e para o cuidar, sendo que essas duas dimensões estão articuladas, conjugadas e intimamente imbricadas. Embora, na prática, o registro de enfermagem não se configura, ainda, como ferramenta básica de comunicação entre os profissionais de saúde e de parâmetro para comprovar a qualidade da assistência prestada ao paciente. / The study was characterized by the descriptive type, of a comprehensive nature and with a qualitative approach. The objective was to understand how nursing records were used by nurses for care management; characterize the types of nursing records used by nurses for care management; to learn how nurses used nursing records for care management; to know the factors that facilitated and made difficult the use of the nursing records for the management of the care; discuss the intervening aspects for the use of nursing records for the management of care. Data were collected in the Medical Clinic of a public teaching hospital, after approval by the Research Ethics Committee of the referred institution, under the number 2213143. Participated in this study 13 nurses who were in the care management. For data collection, the following techniques were used: semi-structured interview, participant observation and documentary research. Initially, semi-structured interviews were carried out between October and November 2017, which combined closed and open questions. The IRaMuTeQ 0.7 alpha 2 software was used to make the interviews operational. After the interviews were completed, the participant observation stage was performed, after the participants' discourse analysis. This technique was developed on 21 occasions during the daytime service, with 150 hours of observation, whose contents were recorded in field / observation notes. Concomitant to the participant observation was the documental research stage, which was based on a script of analysis of medical records and databases, books, forms and nursing requirements. As results, three categories emerged: nursing records as a means of communication; instruments adopted in the elaboration of nursing records and; the context of utilization of nursing records and the development of care management. It was noticed that many nurses saw the nursing records as being only part of the nursing management, dissociating it from the nursing care itself. It was concluded that nursing records contribute to the management and care, and these two dimensions are articulated, conjugated and closely intertwined. Although, in practice, the nursing record does not also configure as a basic tool of communication between the health and parameter practitioners to prove the quality of the patient care.