<p>The aim of this thesis was to identify important aspects of surgical nursing care, designing strategic and clinical quality indicators in postoperative pain management, investigate content validity, develop and evaluate psychometric properties of an instrument to measure the indicators, test the applicability of the instrument and investigate patient and nurse assessment.</p><p>To identify the important aspects of nursing care which might impact on quality of care in surgical wards, it was conducted 4 focus group interviews with clinical nurses (n=20). A tentative model with 15 categories in 2 dimensions, elements of performance and prerequisites, emerged from the data analysis. The categories were, e.g. detecting and acting on signs and symptoms, informing and educating, promoting relationships, responsibility and attitudes. The model was used as a foundation for developing indicators in postoperative pain management, one in each category, each supported by a literature review. To assess the content validity of the indicators, a questionnaire was compiled and sent to registered nurses with a special interest in pain (n=210) and to a random sample of clinical nurses working in surgical wards (n=321). The groups assessed the indicators as essential for achieving high quality, realistic to carry out and possible for nurses to influence management. The first group validated 14 of the 15 indicators and the second group validated 12 as “major” factors in terms of being essential to achieve high quality of care. The remaining factors were classified as “supportive”. No indicator was discarded.</p><p>To measure the indicators, an instrument was developed and psychometric properties were evaluated. The indicators were converted to statements suitable for a patient questionnaire and were scored on a 5-point scale with higher values indicating higher quality of care. Patients (n=198) answered the questionnaire on their second postoperative day. The inter-item and item-total correlation coefficients were in a satisfactory range, and Cronbach’s coefficient alpha (0.84) supported internal consistency reliability. Four sub-scales, entitled communication, action, trust and environment emerged from the factor analysis with a total variance of 61.4%. The total scale correlated (rs=0.53) with the single item pain-relief-satisfaction question. The patients who reported more pain than expected scored lower on the total scale and the patients who received epidural analgesia reported higher scores on the total scale. A nurse questionnaire, similar to the patient questionnaire, was compiled. The responsible nurse at the time (n=63) answered 196 questionnaires paired with the individual patient. The new instrument appeared to be useful in identifying important areas for improvement both from the patients’ and nurses’ perspectives, based on the number of disagreements (1 and 2). Differences were found among departments. The patients’ assessments on the environment sub-scale and the overall satisfaction question were higher than the nurses’ assessments. The findings suggest initial support for the instrument as a means to measure the quality of nursing care in postoperative pain management. Key words: quality indicators; health care, pain; postoperative, focus groups, psychometrics, questionnaires, nursing care.</p> / On the day of the public defence of the doctoral thesis the status of the articles III was: Accepted; article IV and V was: Accepted for publishing.

The aim of this thesis was to identify important aspects of surgical nursing care, designing strategic and clinical quality indicators in postoperative pain management, investigate content validity, develop and evaluate psychometric properties of an instrument to measure the indicators, test the applicability of the instrument and investigate patient and nurse assessment. To identify the important aspects of nursing care which might impact on quality of care in surgical wards, it was conducted 4 focus group interviews with clinical nurses (n=20). A tentative model with 15 categories in 2 dimensions, elements of performance and prerequisites, emerged from the data analysis. The categories were, e.g. detecting and acting on signs and symptoms, informing and educating, promoting relationships, responsibility and attitudes. The model was used as a foundation for developing indicators in postoperative pain management, one in each category, each supported by a literature review. To assess the content validity of the indicators, a questionnaire was compiled and sent to registered nurses with a special interest in pain (n=210) and to a random sample of clinical nurses working in surgical wards (n=321). The groups assessed the indicators as essential for achieving high quality, realistic to carry out and possible for nurses to influence management. The first group validated 14 of the 15 indicators and the second group validated 12 as “major” factors in terms of being essential to achieve high quality of care. The remaining factors were classified as “supportive”. No indicator was discarded. To measure the indicators, an instrument was developed and psychometric properties were evaluated. The indicators were converted to statements suitable for a patient questionnaire and were scored on a 5-point scale with higher values indicating higher quality of care. Patients (n=198) answered the questionnaire on their second postoperative day. The inter-item and item-total correlation coefficients were in a satisfactory range, and Cronbach’s coefficient alpha (0.84) supported internal consistency reliability. Four sub-scales, entitled communication, action, trust and environment emerged from the factor analysis with a total variance of 61.4%. The total scale correlated (rs=0.53) with the single item pain-relief-satisfaction question. The patients who reported more pain than expected scored lower on the total scale and the patients who received epidural analgesia reported higher scores on the total scale. A nurse questionnaire, similar to the patient questionnaire, was compiled. The responsible nurse at the time (n=63) answered 196 questionnaires paired with the individual patient. The new instrument appeared to be useful in identifying important areas for improvement both from the patients’ and nurses’ perspectives, based on the number of disagreements (1 and 2). Differences were found among departments. The patients’ assessments on the environment sub-scale and the overall satisfaction question were higher than the nurses’ assessments. The findings suggest initial support for the instrument as a means to measure the quality of nursing care in postoperative pain management. Key words: quality indicators; health care, pain; postoperative, focus groups, psychometrics, questionnaires, nursing care. / On the day of the public defence of the doctoral thesis the status of the articles III was: Accepted; article IV and V was: Accepted for publishing.

Thesis (Ph. D.)--University of Missouri--Columbia, 2002. / "May 2002." Typescript. Vita. Includes bibliographical references (leaves 90-96).

Thesis (Ph. D.)--University of Missouri--Columbia, 2002. / Typescript. Vita. Includes bibliographical references (leaves 90-96). Also available on the Internet.

Source: Dissertation Abstracts International, Volume: 70-07, Section: B, page: 4122. Adviser: Osama I. Mikhail. Includes bibliographical references.

Thesis (Ph.D. in Nursing) -- University of Colorado, 2005. / Typescript. Includes bibliographical references (leaves 198-212). Free to UCDHSC affiliates. Online version available via ProQuest Digital Dissertations;

Thesis (Ph. D.)--Virginia Commonwealth University, 2005. / Prepared for: Dept. of Health Administration. Bibliography: leaves 202-251. Also available online.

Made available in DSpace on 2016-01-13T13:28:07Z (GMT). No. of bitstreams: 0 Previous issue date: 2015-08-21. Added 1 bitstream(s) on 2016-01-13T13:33:39Z : No. of bitstreams: 1 000855273.pdf: 1212244 bytes, checksum: add90137d414db0496ffe767161126de (MD5) / Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES) / A Organização Mundial da Saúde formalizou seu compromisso com a Atenção Primária à Saúde (APS), no final da década de 70 na Conferência de Alma Ata, quando à destacou como ferramenta chave para o cumprimento da meta Saúde para Todos. No Brasil, o Sistema Único de Saúde (SUS) é uma política de Estado e a APS articula ações clínicas de promoção, prevenção, tratamento e reabilitação. Essas ações são pautadas nos princípios da universalidade, integralidade e equidade, e possuem como princípios organizativos a Descentralização, Regionalização, Hierarquização e a Participação Social. Frente ao crescente esforço para melhoraria da qualidade da APS no país, mecanismos avaliativos vêm sendo amplamente utilizados para a melhoria dos serviços, das ações em saúde e de programas, instituídos em diferentes níveis de atenção. A avaliação das Internações por Condições Sensíveis à Atenção Primária (ICSAP) tem por objetivo identificar falhas no acesso e na qualidade dos serviços primários ofertados a população. O objetivo deste estudo é o de analisar as ICSAP em um hospital de referência regional, no período de 2008-2012. A tese é composta por três estudos, sendo eles: um de natureza qualitativa, de revisão integrativa de literatura; dois de natureza quantitativa, transversais e de base hospitalar. As principais características da APS associadas às menores taxas de ICSAP foram: elevada cobertura da Saúde da Família; localização de clinicas de saúde em áreas urbanas; médicos na área urbana; clínicas rurais em áreas com escassez profissional; maior tempo de permanência do médico em equipe de Saúde da Família realização de consultas na atenção primária no ano anterior; consultas em atenção primária com qualidade e maior densidade médico/habitante; implantação de programa de distribuição de medicamentos para maiores de 65 anos; incentivo financeiro à atenção... / The World Health Organization has formalized its commitment to primary health care (PHC) in the late 70s in the Alma Ata Conference, when the stressed as a key tool for meeting the goal Health for All. In Brazil, the Unified Health System (SUS) is a state policy and articulates the APS clinical actions of promotion, prevention, treatment and rehabilitation. These actions are based on the principles of universality, comprehensiveness and equity, and have as organizational principles Decentralisation, Regionalisation, Hierarchy and Social Participation. To the growing effort to improve the quality of PHC in the country, evaluative mechanisms have been widely used to improve services, the health actions and programs established at different levels of care. The evaluation of Admissions by Primary Care Sensitive Conditions (ICSAP) aims to identify gaps in access and quality of primary services offered to the population. The aim of this study is to analyze the ICSAP in a regional referral hospital in the period 2008-2012. The thesis consists of three studies, namely: a qualitative nature, literature integrative review; two quantitative, transversal and hospital-based. The main characteristics of APS associated with lower ICSAP rates were high coverage of the Family Health; health clinics located in urban areas; doctors in urban areas; rural clinics in areas with professional shortages; most doctor's length of stay in the Family Health team consultations in primary care in the previous year; consultations in primary care with quality and greater physician / inhabitant density; implementation of drug distribution program for over 65 years; financial incentives for primary care and funding for Indian Health Service. The hospital performed 49,476 hospitalizations in the 2008-2012 period, and of these only 7.43% were due Sensitive Conditions Primary. The three main causes of hospitalization were: Cerebrovascular diseases (27.3), Bacterial ...

Orientador: Elen Rose Lodeiro Castanheira / Coorientador: Paula Araújo Opromolla / Banca: Fúlvio Borges Nedel / Banca: Maria do Carmo Guimarães Caccia Bava / Banca: Carlos Alberto Macharelli / Banca: Wilza Carla Spiri / Resumo: A Organização Mundial da Saúde formalizou seu compromisso com a Atenção Primária à Saúde (APS), no final da década de 70 na Conferência de Alma Ata, quando à destacou como ferramenta chave para o cumprimento da meta "Saúde para Todos". No Brasil, o Sistema Único de Saúde (SUS) é uma política de Estado e a APS articula ações clínicas de promoção, prevenção, tratamento e reabilitação. Essas ações são pautadas nos princípios da universalidade, integralidade e equidade, e possuem como princípios organizativos a Descentralização, Regionalização, Hierarquização e a Participação Social. Frente ao crescente esforço para melhoraria da qualidade da APS no país, mecanismos avaliativos vêm sendo amplamente utilizados para a melhoria dos serviços, das ações em saúde e de programas, instituídos em diferentes níveis de atenção. A avaliação das Internações por Condições Sensíveis à Atenção Primária (ICSAP) tem por objetivo identificar falhas no acesso e na qualidade dos serviços primários ofertados a população. O objetivo deste estudo é o de analisar as ICSAP em um hospital de referência regional, no período de 2008-2012. A tese é composta por três estudos, sendo eles: um de natureza qualitativa, de revisão integrativa de literatura; dois de natureza quantitativa, transversais e de base hospitalar. As principais características da APS associadas às menores taxas de ICSAP foram: elevada cobertura da Saúde da Família; localização de clinicas de saúde em áreas urbanas; médicos na área urbana; clínicas rurais em áreas com escassez profissional; maior tempo de permanência do médico em equipe de Saúde da Família realização de consultas na atenção primária no ano anterior; consultas em atenção primária com qualidade e maior densidade médico/habitante; implantação de programa de distribuição de medicamentos para maiores de 65 anos; incentivo financeiro à atenção... / Abstract: The World Health Organization has formalized its commitment to primary health care (PHC) in the late 70s in the Alma Ata Conference, when the stressed as a key tool for meeting the goal "Health for All". In Brazil, the Unified Health System (SUS) is a state policy and articulates the APS clinical actions of promotion, prevention, treatment and rehabilitation. These actions are based on the principles of universality, comprehensiveness and equity, and have as organizational principles Decentralisation, Regionalisation, Hierarchy and Social Participation. To the growing effort to improve the quality of PHC in the country, evaluative mechanisms have been widely used to improve services, the health actions and programs established at different levels of care. The evaluation of Admissions by Primary Care Sensitive Conditions (ICSAP) aims to identify gaps in access and quality of primary services offered to the population. The aim of this study is to analyze the ICSAP in a regional referral hospital in the period 2008-2012. The thesis consists of three studies, namely: a qualitative nature, literature integrative review; two quantitative, transversal and hospital-based. The main characteristics of APS associated with lower ICSAP rates were high coverage of the Family Health; health clinics located in urban areas; doctors in urban areas; rural clinics in areas with professional shortages; most doctor's length of stay in the Family Health team consultations in primary care in the previous year; consultations in primary care with quality and greater physician / inhabitant density; implementation of drug distribution program for over 65 years; financial incentives for primary care and funding for Indian Health Service. The hospital performed 49,476 hospitalizations in the 2008-2012 period, and of these only 7.43% were due Sensitive Conditions Primary. The three main causes of hospitalization were: Cerebrovascular diseases (27.3), Bacterial ... / Doutor

nÃo hà / Os serviÃos de saÃde vÃm desenvolvendo aÃÃes e programas visando à qualificaÃÃo de seus processos de trabalho, com intuito de reduzir, prevenir e eliminar deficiÃncias da qualidade e que tambÃm atendam Ãs necessidades e expectativas dos usuÃrios. Diferentes estratÃgias de avaliaÃÃes das prÃticas em saÃde tÃm sido adotadas, permitindo a identificaÃÃo das condiÃÃes em que as prÃticas assistenciais sÃo executadas. As infecÃÃes hospitalares constituem risco significativo à saÃde dos usuÃrios, e dentre estas, a infecÃÃo de corrente sanguÃnea relacionada ao cateter venoso central, dada a mortalidade a ela associada, especialmente quando acomete pacientes graves, internados em Unidade de Terapia Intensiva (UTI). Assim, este estudo objetivou avaliar a conformidade e nÃo conformidade das prÃticas de prevenÃÃo de infecÃÃo de corrente sanguÃnea relacionada ao cateter venoso central de curta permanÃncia (ICS-ACVC), por meio de indicadores clÃnicos em uma Unidade de Terapia Intensiva. Trata-se de um estudo observacional, seccional, com abordagem quantitativa, estruturado a partir do âmanual de avaliaÃÃo das prÃticas de controle e prevenÃÃo de infecÃÃo hospitalarâ, realizado em um hospital da rede privada da cidade de Fortaleza/CearÃ. O universo do estudo foi composto pelas oportunidades de avaliaÃÃo das prÃticas selecionadas, realizadas pelos profissionais de saÃde (mÃdicos e profissionais de enfermagem) em pacientes internados na Unidade de Terapia Intensiva da instituiÃÃo e que passaram pelo procedimento de inserÃÃo do cateter venoso central de curta permanÃncia. A amostra baseou-se na conformidade esperada de 80%, com 2064 avaliaÃÃes distribuÃdas entre as prÃticas selecionadas, realizadas por meio da observaÃÃo direta ou registro em prontuÃrios. De acordo com os resultados encontrados, o indicador CSPI apresenta maior Ãndice de conformidade geral (62,5%), em seguida o indicador CSCM apresenta conformidade geral inferior à ideal, com apenas 45%, entretanto, quando analisado cada item que compÃe este indicador, pode-se observar que essa inferioridade deve-se principalmente à nÃo realizaÃÃo da prÃticas de desinfecÃÃo de hubs e conectores com clorexidine 0,5% (17,5%) e troca de equipos e transdutores conforme recomendaÃÃo (13,5%). O indicador CSQI apresentou conformidade geral baixa (12,5%), devido à nÃo conformidade de algumas prÃticas como: uso de campo estÃril ampliado no momento de instalaÃÃo do cateter (30%) e o uso de antissÃptico de veÃculo alcoÃlico para preparo da pele antes da punÃÃo (37,5%). Jà o indicador HMSEL apresentou Ãndice de conformidade geral nulo. Conclui-se que, embora a avaliaÃÃo das prÃticas de registro de indicaÃÃo, tempo de permanÃncia, inserÃÃo percutÃnea, presenÃa de curativo oclusivo apÃs inserÃÃo do cateter, registro e periodicidade da troca do curativo do cateter tenham atingido conformidade similar ou superior à esperada de 80%, as demais prÃticas precisam de uma nova elaboraÃÃo de estratÃgias que assegurem a adesÃo duradoura das prÃticas de controle e prevenÃÃo de ICS-ACVC, associada à anÃlise contÃnua de condiÃÃes de trabalho e disponibilidade de material. / Health services has developed actions and programmes targeting the qualification of its work processes, in order to reduce, prevent and elimiinar quality deficiencies and which also meet the needs and expectations of users. Different evaluations of strategies in health practices has been adopted, allowing the identification of the conditions under which assists practices are performed. Hospital-acquired infections pose significant risk to the health of users, and among these, bloodstream infection central venous catheter-related, given the associated mortality, especially when it involves serious patients admitted to intensive care unit (ICU). Thus, this study aimed to evaluate compliance and non-compliance of practices for the prevention of infection of the bloodstream of central venous catheter related sojourn (ICS-ACVC), through clinical indicators in a therapy unit Intensive. This is an observational study, sectional, with quantitative approach, structured from the "Handbook of practical assessment of hospital infection control and prevention", held in a private network hospital of Fortaleza/CearÃ. The universe of study was composed of selected practices assessment opportunities, conducted by health professionals (doctors and nursing professionals) in patients hospitalized in the intensive care unit of the institution and who went through the procedure of central venous catheter insertion of sojourn. The sample was based on expected 80% compliance with 2064 evaluations distributed among selected practices, carried out by means of direct observation or record in charts. According to the results, the CSPI, indicator presents greater overall compliance index (62.5%), then the CSCM indicator, presents general compliance less than ideal, with only 45%, however when analysed each item that makes up this indicator it can be observed that this inferiority is mainly the non-realization of the practice of disinfection of hubs and connectors with 0.5% (17.5%) also and exchange of equipment and transducers as recommendation (13.5%). The CSQI indicator, presented general compliance low (12.5%), due to non-compliance of some practices such as: use of sterile field expanded at the time of installation of the catheter (30%) and the use of antiseptic of vehicle alcohol for skin preparation before the LP (37.5%). Already the HMSEL indicator presented general compliance index null. It is concluded that, although the evaluation of registration practices, on-call time, percutaneous insertion, presence of Occlusive dressing after catheter insertion, registry and periodicity curative catheter Exchange have reached compliance similar to or greater than 80% expected, other practices need a new elaboration of strategies that ensure lasting adhesion control practices and prevention of ICS-ACVC, associated with the analysis continues working conditions and availability of material.