Orientador: Vera Lúcia Pamplona Tonete / Banca: Eliana Mara Braga / Banca: Elza de Fátima Ribeiro Higa / Resumo: O presente estudo aborda a promoção da segurança no cuidado de crianças hospitalizadas, elegendo como objeto o ensino desse tema em cursos técnicos de enfermagem. Objetivou-se elaborar proposta sistematizada para subsidiar o planejamento de ensino técnico de enfermagem sobre promoção da segurança no cuidado de crianças hospitalizadas, com base na literatura especializada e a partir da perspectiva de docentes atuantes em escolas técnicas de enfermagem públicas do estado de São Paulo - Brasil. Inicialmente, foi realizada revisão integrativa de literatura sobre erros, eventos adversos e medidas para promoção da segurança pediátrica hospitalar e sua abordagem no ensino técnico de enfermagem. Na revisão foram incluídos 17 artigos completos, publicados de janeiro de 2001 a dezembro de 2012, em nove periódicos nacionais e oito internacionais, sendo que a maior parte dos primeiros autores era de enfermeiros e 15 deles utilizaram abordagem quantitativa de pesquisa. Realizou-se análise descritiva dos dados que foram categorizados: "Tipos de erros e eventos adversos relacionados à internação hospitalar pediátrica", "Medidas para promoção da segurança do paciente pediátrico", "Estratégias para a inserção do tema da promoção da segurança do paciente na educação formal de enfermagem". Posteriormente, sob a abordagem qualitativa de pesquisa, aplicou-se entrevistas semiestruturadas a 10 docentes de seis escolas técnicas de enfermagem públicas do Estado de São Paulo, vinculadas ao Centro Paula Souza. Os depoimentos colhidos foram sistematizados conforme a vertente temática do Método de Análise de Conteúdo, sendo os mesmos analisados segundo os postulados de Paulo Freire. Os temas e seus respectivos núcleos de sentido foram: Tema 1 - Segurança de crianças internadas em hospitais: Crianças em internação hospitalar estão expostas a diferentes tipos de erros e eventos adversos; A equipe de saúde ... / Abstract: The present study addresses the promotion of safety in the care of hospitalized children, electing as object teaching of this topic in nursing technical courses. The objective of elaborating systematic proposals to subsidize the planning of nursing technical teaching about promoting safety in the care of hospitalized children, based on specialized literature and from the perspective of active teachers in technical schools public nursing in the State of São Paulo - Brazil. Initially, integrative literature review was performed on errors, adverse events and safety promotion measures for hospital and its approach in pediatric nursing technical teaching. In the review were included 17 full papers, published January 2001 to December 2012, on nine national and eight international journals, and most of the early authors was of nurses and 15 of them have used quantitative research approach. Descriptive analysis was conducted of the data were categorised: "types of errors and adverse events related to pediatric hospitalization", "measures to promote patient safety in children", "strategies for the inclusion of the theme of promoting patient safety in nursing formal education". Subsequently, under the qualitative research approach, semi-structured interviews was applied to 10 teachers from six schools public nursing techniques do Estado de São Paulo, linked to the Paula Souza Centre. The evidence collected were organized according to the thematic aspects of the method of content analysis, being the same analyzed according to the postulates of Paulo Freire. The themes and their respective nuclei of meaning were: Theme 1-safety of children admitted to hospitals: Children in hospitalization are exposed to different types of errors and adverse events; The team must have health profile and be able to prevent errors and adverse events with children; There must be the institutionalization of measures to promote ... / Mestre

Orientador: Wilza Carla Spiri / Banca: Inahiá Pinhel / Banca: Silvana Andrea Molina Lima / Resumo: O contexto de trabalho dos profissionais de enfermagem é bastante complexo e permeado por práticas que se fundamentam na história da profissão e pela constante necessidade de atualização em função dos avanços científicos e tecnológicos do mundo globalizado e do contexto social em que as práticas de saúde emergem. O objetivo deste estudo é: Compreender o significado do subprocesso educar/ensinar em enfermagem para a equipe de enfermagem de uma instituição hospitalar privada no interior do Estado de São Paulo. O estudo foi realizado no município de Bauru, Estado de São Paulo no ano de 2011. A abordagem utilizada foi qualitativa, na vertente da fenomenologia, buscando a essência da realidade vivenciada por treze profissionais da equipe de enfermagem, sendo sete enfermeiros, quatro técnicos de enfermagem e dois auxiliares de enfermagem de uma instituição hospitalar privada que por meio de entrevistas áudio gravadas revelaram o significado do processo educativo no cotidiano de seu trabalho. Os temas desvelados foram: O Significado de Educação no trabalho, A Atualização Profissional, A Educação no trabalho e os Custos, A Educação no Cotidiano de Trabalho, O Papel do Enfermeiro na Educação no trabalho e A Educação no trabalho e Trabalho em Equipe. Os trabalhadores de enfermagem participantes deste estudo referem à necessidade e a importância de se manterem atualizados na profissão garantindo assim uma assistência de qualidade e livre de iatrogenias. Ressaltam a importância do investimento na educação da equipe, sendo ela dentro ou fora da instituição hospitalar. Acreditamos que a educação no contexto do trabalho é um caminho fundamental para, além do conhecimento técnico e científico necessário para a realização de protocolos e procedimentos, a percepção de forma crítica, competente... (Resumo completo, clicar acesso eletrônico abaixo) / Abstract: The work context of nursing is quite complex and influenced by practices that are grounded in the history of the profession and the constant need of updating in the light of scientific and technological advances of the globalized world and the social context in which health practices emerge. The objective of this study is to: Understand the subprocess to educate / teach nursing for the nursing staff of a private hospital within the State of Sao Paulo. The study was conducted in the city of Bauru, São Paulo State in 2011. The approach used was qualitative, on phenomenology, seeking the essence of the reality experienced by thirteen professional nursing staff, seven nurses, four nursing technicians and two nursing assistants in a private hospital that through audio taped interviews revealed the significance of the educational process in their daily work. The themes were unveiled: The Meaning of Work in Education, Training Update, at work and Education Costs, Education in the Everyday Work, The Role of the Nurse Education Education at work and at work and teamwork. The nursing staff participating in this study relate to the need and importance of keeping up to date in the profession ensuring quality care and iatrogenic free. They emphasized the importance of investment in education of the team, she is inside or outside the hospital. We believe that education in the context of the work is a fundamental way, beyond the technical and scientific knowledge necessary for the performance of protocols and procedures, awareness of a critical, competent and autonomous in discussions with those involved. We note that the concepts of continuing education are increasingly present in our everyday hospital, even though the team still does not differentiate between the terms presented and refer the same similarity is important to understand... (Complete abstract click electronic access below) / Mestre

A manager is the one who sets everything on movement in an organization. He/she is also the one who gives order to the movement and who conditions success of all the processes running in an organization. His/her aim is to lead the team to efficient and good quality work performance. A nurse-manager performs the tasks of nursing care of individuals or groups by managing the nursing process. People and their work activities are her goals. She leads them to work, influences them and coordinates their performance, checks, assesses, guides and manages their professional careers. She affects the everyday workplace operation towards high performance and cooperation. She indirectly influences patient satisfaction, the nursing care and moreover also the organization prosperity in her everyday effort. She does all that with regard to satisfaction of the team members and their professional development. If she is to be a really efficient source she must be perceived basically as a capable and motivated person. This also means to do everything for her to become like this. The first goal of the work was to find out the determinants of success of an operative manager and his/her position in general. The second goal was to map the attributes of manager{\crq}s managerial position. The third goal was to map manager{\crq}s work with an operative group. Quantitative research was applied on the issue processing. Questioning, the technique of a questionnaire, was chosen as a data collection method. The questionnaire was designed for head nurses working in hospitals and social care facilities within the region. It consisted of 48 closed and one semi-closed questions. Hypothesis No. 1 states that managerial position is affected by horizontal and vertical relations within an organization. According to the research results the vertical relations may affect a position of a manager in both, positive and negative senses. The position may also be affected by relations between the manager and the staff reporting to him/her. If a manager lacks managerial skills his/her team might be unstable. Such a team might not perform good work and might provide medical care of poor quality. In the sense of vertical relation the position of a manager may thus be uncertain. Hypothesis No. 1 was confirmed. Hypothesis No. 2 says that quality relations between an operative line manager and the staff managed by him affect positively the nursing care. According to the research results the good quality relations may affect the nursing care positively under particular conditions. If the manager creates condition for successful team work and nurses in the team are satisfied. Hypothesis No. 2 was confirmed. Hypothesis No. 3 on a stable team that forms upon forming a functional network of informal social and work relations was also confirmed. In some managers{\crq} opinion a stable team forms upon a functional network of informal social and work relations. The thesis might be utilized for providing the found out information to the basic line managers at professional training sessions. It may contribute to better understanding in relation to the managed staff. Actually if managers are able to understand the issues of leadership and management of people they will have sufficient information in this field and will be able to understand it and lead their teams much better.

A dor pós-operatória é um fenômeno complexo, multidimensional e subjetivo, tanto para a criança quanto para os profissionais de saúde que lidam com ela. Seu manejo constitui-se em desafio, principalmente quando está ligado à dor em crianças, com suas particularidades do desenvolvimento infantil. Buscando contribuir com a discussão a respeito do manejo da dor pela equipe de enfermagem, o objetivo do presente estudo é compreender como os profissionais de enfermagem lidam com o manejo da dor em criança, no pós-operatório tardio de cirurgia cardíaca. O estudo é de natureza descritivo-exploratória, com abordagem metodológica qualitativa. Participaram do estudo vinte e três profissionais de enfermagem, sendo seis enfermeiros, três técnicos de enfermagem e quatorze auxiliares de enfermagem. A principal técnica de coleta de dados foi a entrevista semi-estruturada. A observação das atividades desses profissionais na enfermaria, relacionadas ao manejo da dor da criança, e a coleta de dados no prontuário da criança foram as técnicas usadas para complementar os dados provenientes das entrevistas. Na análise de conteúdo, os dados permitiram a compreensão de como os profissionais de enfermagem manejam a dor da criança, no pós-operatório tardio de cirurgia cardíaca. No contexto em que o manejo da dor da criança ocorre, a presença da mãe e a comunicação entre os membros da equipe de enfermagem e entre esses e a mãe mostraram-se como elementos essenciais para um adequado manejo da dor da criança. O estudo mostrou que os profissionais de enfermagem avaliam a dor por meio de parâmetros comportamentais e fisiológicos, atentando-se para as fases do desenvolvimento da criança, da mesma forma em que buscam superar as dificuldades impostas na avaliação da dor de crianças menores. Utilizaram a intervenção farmacológica para o alívio da dor como primeira escolha; a não-farmacológica também se constituiu em estratégia para o alívio da dor, porém em menor proporção. Dando continuidade ao processo, os participantes mencionaram reavaliar a dor da criança, após a utilização da intervenção de alívio escolhido, e registrar os procedimentos realizados. Os dados provenientes das observações demonstraram a utilização de intervenções não-farmacológicas para o alívio da dor, os quais não são rotineiramente registrados nos prontuários das crianças. Alguns desafios foram apontados pelos profissionais de enfermagem para o manejo da dor da clientela pesquisada. Os resultados do estudo possibilitaram identificar, no contexto pesquisado, aspectos do processo do manejo da dor em crianças, no pós-operatório tardio de cirurgia cardíaca, que necessitam ser aprimorados, objetivando a melhoria do cuidado prestado a essa clientela. / Postoperative pain is a complex, multidimensional and subjective phenomenon, for children as well as for health professionals. Its management is a challenge, mainly when related to pain in children, whose development has particular characteristics. In an attempt to contribute to the discussion about pain management by the nursing team, this study aims to understand how nursing professionals deal with pain management in children during the late postoperative period of heart surgery. This is a descriptive-exploratory study with a qualitative methodological approach. Study participants were twenty-three nursing professionals, including six nurses, three nursing technicians and fourteen nursing auxiliaries. The main data collection technique was through semistructured interviews. To complement data from the interviews, these professionals? activities related to pain management in children were observed at the ward and data were collected from the children?s files. In content analysis, data permitted an understanding of how nursing professionals manage the child?s pain in the late postoperative period after heart surgery. The context in which the pain occurs, the mother?s presence and communication among nursing team members and between professionals and the mother revealed to be essential elements for the adequate management of the child?s pain. The study showed that nursing professionals assess pain through behavioral and physiological parameters, paying attention to the child?s development phases and attempting to overcome the difficulties imposed by pain assessment in younger children. The pharmacological intervention is their first choice for pain relief; the non-pharmacological intervention is another strategy for pain relief, although to a lesser extent. To continue the process, the participants mentioned that they reassess the child?s pain after using the chosen relief method and register the procedures they performed. Observation data demonstrate the use of non-pharmacological intervention for pain relief, which are not routinely registered in the children?s files. The nursing professionals indicate a number of challenges for pain management in the clientele under study. The study results made it possible to identify, in the study context, aspects of the pain management process in children during the late postoperative period after heart surgery that need to be improved, with a view to a better care delivery to these clients.

D.Cur. / A qualitative approach was followed to conduct a case study. Data was collected through participative observation, document analysis and interviewing of team members representing seven different disciplines. The practice model of Dickoff, James and Wiedenbach (1986:415-435) was utilized as theoretical framework to explore and describe the role players involved in team functioning within the context of primary health care. Team objectives and processes relevant to team functioning as well as the dynamics of team work were described and compared to a guide for team functioning, the elements which were derived from a literature study. The credibility of the research was enhanced through long term involvement in the activities of the study case as participative observer, through triangulation of methods to collect and verify data and through peer evaluation and auditing. It was determined that within the context of a home care service at primary health care level, it was mainly the nurse, being the team member with whom the patient and family have continued personal contact, who acts as team leader and initiates involvement of members from other disciplines. The decisions regarding whom to involve and how and when to involve them, are based on the knowledge and skills of the nurse in relation to the situation he/she has to manage, the acceptability of the team approach and compliance by the patient and family, the attitude, commitment and perception of other team members as well as the availability of facilities and infrastructure to enable team functioning. The organizational and philosophical framework within which service is delivered have a direct impact on team functioning. Community involvement and its acceptance of responsibility for health, enhances quality team functioning, but is dependant on effective empowerment strategies, a sound trust relationship and a reliable support system. Clear and agreed upon goals and objectives for team functioning are essential for effective team work. Innovative and creative strategies are necessary to enable team members representing different disciplines, who function in the context of primary health care, to have sufficient contact with each other to discuss objectives, give feedback and communicate effectively. Processes for and dynamics in team functioning are complex in nature and need to be identified, evaluated and, if necessary, adapted on a regular basis to promote effective team functioning. The objectives of the research, namely to explore and describe team functioning at primary health care level and to formulate guidelines for effective team functioning, were realized. A structure for working from the basis of a core team was proposed, as well as interdisciplinary training of team members, commencing at undergraduate level and continuing throughout professional life. The researcher recommends that the guidelines formulated with regard to the role players, context, objectives, processes and dynamics of team functioning at primary health care level be implemented. Aspects related to team functioning to be further researched have been identified, namely: assessing the quality of team functioning at primary health care level; the effect of interdisciplinary training on team functioning; the relationship between team functioning and the health status of communities; cost-efficiency of team functioning; utilizing latest technological developments for communication between and support for team members at primary health care level; the relationship between community empowerment, community involvement and interdisciplinary team functioning and the design of a model for team functioning at primary health care level. The research report is written in Afrikaans, but the conclusions reached in each of the nine chapters have also been translated into English to enhance the accessibility of research findings.

In response to the needs of patients, coupled with nursing workforce predictions and the pressure of cost containment, a shift to a new team nursing model of care has been seen in Canada and Australia. Today's patients require multiple resources, nurses with additional skillsets and vast amounts of experience during their hospital stays, and a team of nurses can meet these needs. This project explored the experiences and perspectives of nurses during the implementation of a team nursing model of care on a 32-bed, inpatient, cardiology floor in southern Ontario. The purposes of this project were to conduct a formative evaluation of the pilot unit implementation and make recommendations for future units who will implement this change in model. The project tracked all nurses on the pilot unit, from frontline nurses to those of influence and authority. Guided by an action research framework and a qualitative approach, nurses' experiences were explored through observations and analysis of organizational reports. These data were triangulated and further validated with evidence from the current literature. Major themes included the need for clear definitions of roles and responsibilities, a strong organizational support system, and the recognition that team nursing was more than a division of tasks but was a shift in culture to that of shared responsibility and accountability for all patients. These findings have implications for positive social change by informing the work of those in the health care setting, illuminating the benefits of team-based nursing.

Att vara sjuksköterskestudent innebär mycket klinisk praktik. Möjlighet erbjuds att känna på hur det dagliga arbetet organiseras på klinikerna. Erfarenheter av detta gav inspiration till denna studie. Hur upplever människor att vara del av en organisation? Syftet med studien var att sammanställa beskrivningar av upplevelser från beprövade sätt att organisera omvårdnadsarbetet inom sjuksköterskans område. En litteraturstudie grundad på kvalitativa artiklar genomfördes. Resultaten kopplades till fyra klassiska metoder för organiserat omvårdnadsarbete och mynnade ut i tre teman. Ledarskap, arbetsmiljö och gruppdynamik återfanns som huvudteman som speglade upplevelser av respektive organisationsmodell hos personal, patienter och anhöriga. / How do persons experience being part of an organisation? To be a nursing student includes much time spent in clinical practice. Opportunity to get a sense of how the daily work is organised is provided. Experiences of this kind gave inspiration to this study. The aim of the study was to put together descriptions of experiences from classic modes of care in nursing. A literature review founded on qualitative studies was performed. The results were linked to four classic modes of organised care and led to three themes. Leadership, work environment and group dynamics were found as main themes that reflected experiences of each organisational model from staff, patients and relatives.

Submitted by Cláudia Carolina Costa (clah.costa@gmail.com) on 2016-04-11T18:45:40Z No. of bitstreams: 1 dissertaçãoCláudiaCCosta.pdf: 3674971 bytes, checksum: 7a709df2da80e41ba1b68863b360c1c1 (MD5) / Approved for entry into archive by Juliano Benedito Ferreira (julianoferreira@reitoria.unesp.br) on 2016-04-12T18:31:26Z (GMT) No. of bitstreams: 1 costa_cc_me_bot.pdf: 3674971 bytes, checksum: 7a709df2da80e41ba1b68863b360c1c1 (MD5) / Made available in DSpace on 2016-04-12T18:31:26Z (GMT). No. of bitstreams: 1 costa_cc_me_bot.pdf: 3674971 bytes, checksum: 7a709df2da80e41ba1b68863b360c1c1 (MD5) Previous issue date: 2016-02-22 / Introdução: A hipotermia está associada ao aumento da mortalidade e morbidade neonatais. O uso da incubadora neonatal previne esta intercorrência, devendo estar em condições físicas adequadas e ser manuseada por profissionais capacitados. Objetivos: Avaliar incubadoras e comparar conhecimentos e práticas de manuseio entre enfermeiros e técnicos/auxiliares de enfermagem. Método: Estudo transversal, quantitativo, realizado em unidade neonatal de um hospital de referência. A avaliação da estrutura física das incubadoras foi realizada por check-list e analisada por estatística descritiva. Aplicou-se questionário e foi realizada observação direta envolvendo o manuseio das incubadoras pelos profissionais, considerando-se p<0,05 para o nível de significância estatística ao compará-los. Resultados: Detectaram-se inúmeros defeitos nas incubadoras. Técnicos/auxiliares de enfermagem mais frequentemente receberam treinamento ao ingressarem na unidade e sentiam-se aptos para manusearem incubadoras. Práticas adequadas de manuseio tiveram proporções semelhantes entre os profissionais. Conclusões: Identificaram-se problemas físicos nas incubadoras, dúvidas e práticas inadequadas pelos profissionais. Como produto do estudo, foi elaborado manual para orientação da equipe de enfermagem, visando práticas uniformes, seguras e qualificadas. / Introduction: It have been shown that hypothermia increases the mortality and morbidity on neonates. Infant incubators prevent these complications, but only if they are operated by trained professionals and if they are physically preserved. Objectives: Reviewing infant incubators and analyzing nurses and nursing assistants and technicians handling expertise. Method: It was a cross-sectional and quantitative study in the neonatal unit of a reference hospital. The evaluation of the structure of incubators was performed by a checklist. We observe the handling of the equipment by the staff and we analyzed the survey by descriptive statistics and we set results with p<0.05 as statistically significant. Results: The incubators have showed numerous physical flaws. Nursing assistants and technicians have received training to join the unit and they found themselves as better incubator operators than nurses very often. Nevertheless, the handling practices had similar results among the professionals. Conclusions: We identified physical problems in incubators and some questionable and inappropriate practices among the nursing staff. We elaborated a manual to orientate the nursing staff based on the findings, which purpose uniform, safe and qualified nursing practices on the field.

Orientador: Cristina Maria Garcia de Lima Parada / Resumo: Introdução: A hipotermia está associada ao aumento da mortalidade e morbidade neonatais. O uso da incubadora neonatal previne esta intercorrência, devendo estar em condições físicas adequadas e ser manuseada por profissionais capacitados. Objetivos: Avaliar incubadoras e comparar conhecimentos e práticas de manuseio entre enfermeiros e técnicos/auxiliares de enfermagem. Método: Estudo transversal, quantitativo, realizado em unidade neonatal de um hospital de referência. A avaliação da estrutura física das incubadoras foi realizada por check-list e analisada por estatística descritiva. Aplicou-se questionário e foi realizada observação direta envolvendo o manuseio das incubadoras pelos profissionais, considerando-se p<0,05 para o nível de significância estatística ao compará-los. Resultados: Detectaram-se inúmeros defeitos nas incubadoras. Técnicos/auxiliares de enfermagem mais frequentemente receberam treinamento ao ingressarem na unidade e sentiam-se aptos para manusearem incubadoras. Práticas adequadas de manuseio tiveram proporções semelhantes entre os profissionais. Conclusões: Identificaram-se problemas físicos nas incubadoras, dúvidas e práticas inadequadas pelos profissionais. Como produto do estudo, foi elaborado manual para orientação da equipe de enfermagem, visando práticas uniformes, seguras e qualificadas. / Mestre

A critical care unit is a dynamic and highly technological environment. Professional nurses who have been working in the critical care unit for a period of time are passionate about the environment in which they work. They find their on duty time challenging and stimulating. The critical care environment is slowly changing. Due to the fact that there are fewer professional nurses with an additional qualification in critical care available to work in the critical care units. The utilisation of an increasing number of agency nurses leads to an increase in sub-standard nursing care as well as dissatisfied doctors and patients. The shortage of critical care staff has resulted in the need to find an alternative human resources framework and still provide cost effective, safe quality patient care. This leads to the design and implementation of a team nursing care framework for critical care. The research objectives for this study were: - To explore and describe the experiences of professional nurses with regard to a team nursing care framework in private critical care units. - Develop guidelines to optimize the team nursing care framework in critical care units in a private hospital group. The research is based on a qualitative, explorative, descriptive and contextual research design. The study is based on a phenomenological approach to inquiry. Eleven in-depth semi structured face-to-face phenomenological interviews were utilized as the main means of collecting data. A purposive, criterion based, sampling method was used. Specific inclusion criteria were met and consent was obtained from the participants and from the management of the private clinic where the research was conducted. Two central themes were identified:- Theme One: The professional nurses experienced the team nursing care framework in the critical care unit as a burden. Six sub-themes were identified. - Theme Two: Professional nurses made recommendations for improvement of the team nursing care framework in the critical care unit. By describing the lived experiences of the professional nurses in the critical care units, based on research interviews, the researcher painted a clear picture of the team nursing care framework in the critical care unit. Guidelines were developed based on the identified themes. The broad guidelines are aimed at ensuring that the nurses are competent to care for critical care patients prior to them commencing work in the critical care unit. The researcher concludes this study by making recommendations for Nursing practice, education and research.